infection total joint replacement although small number infections total joint replacements blood borne distant sources , infections appear derived operation strenuous attempts reduce risk cleaning air wound environment , coupled prophylactic antibiotics , reduced infection rates order magnitude decade time potential exchange arthroplasty established infection shown , results encouraging rigorous infection control key containing difficult expensive problem
analysis immune response lipopolysaccharide existence cross reactive idiotype associated anti lipid antibodies lps major surface glycolipid gram negative bacteria work , characterized antibody response lps different species , produced mab lps binding many antibodies lps could inhibited lps lipid , indicating specific lipid , toxic moiety lps molecule one anti lipid antibody , , proved protective gram negative bacteremia endotoxic shock murine protection models generated anti idiotypic antibodies binding several anti id specifically inhibited lipid used anti id characterize anti lps response , results revealed id conserved different species importance cross reactive id response endotoxin relevance vaccine development septic shock discussed
platelet activating factor \( paf \) tumor necrosis factor alpha \( tnf alpha \) interactions shock studies bn 50739 , novel paf antagonist bn 50739 , new paf receptor antagonist , tested vitro vivo capacity block paf , endotoxin recombinant human tumor necrosis factor alpha \( rtnf \) mediated effects vitro , bn 50739 blocked paf induced platelet aggregation 60 100 0 2 1 x 10 \( 7 \) \( p less 002 \) , respectively conscious rat , pretreatment \( 30 min \) bn 50739 \( n 5 13 \) dose dependently attenuated paf induced hypotension \( 5 5 vs 43 2 mm hg , p less 01 \) shortened recovery time mean arterial pressure \( 22 13 vs 325 46 sec , p less 01 \) bn 50739 \( 10 mg kg p , n 5 11 \) prevented endotoxin \( 14 4 mg kg \) induced \( 54 1 vs 46 1 , p less 01 \) reduced 24 hr mortality \( 100 vs 60 , p less 05 \) partial protection bn 50739 hypotensive response endotoxin \( 115 3 vs 91 4 mm hg , p less 03 \) also , bn 50739 attenuated lipopolysaccharide induced elevation plasma thromboxane b2 \( 21 2 0 8 vs 46 7 11 8 pg 100 microliters , p less 01 \) tumor necrosis factor alpha \( vs 26 , 430 u ml , p less 05 \) , whereas leukopenia thrombocytopenia remained unchanged
direct costs universal precautions teaching hospital analysis increase expenditures barrier isolation materials institution universal precautions 900 bed university hospital used generate national estimate cost implementation new centers disease control guidelines following institution universal precautions , use rubber gloves hospital increased 1 64 million pairs 2 81 million pairs annually 5 year review hospital supply records inpatient outpatient areas indicated total annual costs isolation materials increased 350 , 900 represented increase 13 70 22 89 per admission \( 60 \) adjustment inflation cost isolation materials increased 98 215 per 1000 outpatient visits , adjusted increase 92 two thirds increase \( 64 \) due rubber gloves additional 25 due disposable isolation gowns universal precautions estimated cost least 336 million united states year 1989 adjustment inflation expenditures isolation materials medical center representative , previous estimates may significantly underestimated costs nationwide
epidemiologic , clinical , laboratory findings human united states , 1988 1988 , centers disease control state department health identified 40 patients fourfold greater change antibody titer response canis median age patients 42 years , 83 male , 76 became ill may july , 92 reported recent exposures patients resided exposed 14 states , including five reported 1988 thirty four patients \( 85 \) hospitalized , many serious complications , including acute respiratory failure \( seven patients \) , encephalopathy \( six patients \) , acute renal failure \( four patients \) pulmonary infiltrates demonstrated 14 patients , cerebrospinal fluid seen 10 patients , elevated levels serum creatinine demonstrated eight patients two patients , preexisting medical problems , died patients received tetracycline therapy earlier course illness hospitalized patients significant difference interval initiation antibiotic therapy first day patients treated treated chloramphenicol
, life cycle , infectious neoformans neoformans like fungus , epidemiology mainly explained exposure infective inoculum c neoformans postulated principal infectious exposure , host tree , required initiate infection man animals c neoformans may australia infected seeds e containing fungus c neoformans neoformans encapsulated yeast cells postulated act infectious , showing seasonal distribution association yet unidentified host plant , encapsulated yeast cells dispersed bird \( mainly pigeon \) act year round vector
borrelia burgdorferi infection brain characterization organism response antibiotics immune sera mouse model learn neurologic involvement lyme disease , inoculated inbred mice causative agent lyme disease , borrelia burgdorferi cultured brains organs , measured anti b burgdorferi antibody titers studied brain isolate plasmid dna content response vitro immune sera antibiotics one strain b burgdorferi , , consistently infective mice , resulted chronic infection bladder spleen sjl mice developed fewer culture positive organs lower antibody titers balb c c57bl 6 mice organism cultured brain early course infection , isolate , named , studied vitro plasmid content different strain , implying either highly selective process infection dna rearrangement organism vivo sensitive antibiotics , prolonged incubation immune sera mice humans infected b burgdorferi unable completely kill organism complement mediated cytotoxicity data demonstrate b burgdorferi brain experimental animals , resistant immune sera vitro sensitive prolonged treatment antibiotics
cefazolin hysterectomy prophylaxis efficacy data single dose cefazolin prophylaxis hysterectomy , none evaluating impact route administration efficacy reasons , women undergoing elective abdominal vaginal hysterectomy benign diseases given 1 g cefazolin either intramuscularly intravenously randomized clinical trial preoperative diagnoses clinical , surgical , outcome variables similar route administration surgical approach risk factors infection abdominal hysterectomy included younger age , lower postoperative hemoglobin concentration , pelvic hematoma women developed infection vaginal hysterectomy heavier remained uninfected likely pelvic hematoma overall incidence major operative site infection requiring parenteral antimicrobial therapy evaluable women 7 2 7 6 539 women undergoing abdominal hysterectomy 6 3 207 women undergoing vaginal hysterectomy postoperative infection unrelated route cefazolin administration
safety immunogenicity haemophilus influenzae type b oligosaccharide conjugate vaccine infants aged 15 23 months total infants aged 15 23 months received one dose vaccine composed haemophilus influenzae type b oligosaccharides covalently linked nontoxic diphtheria toxin variant \( hboc \) side effects associated vaccination infrequent , transient , mild one month single vaccination , anti h influenzae type b capsular polysaccharide antibody concentration rose geometric mean level 0 20 microgram ml 13 77 micrograms ml infants , 99 level greater equal 1 00 microgram ml , level associated long term protection immune response long lived children monitored 17 27 months vaccination concentrations greater equal 1 00 microgram ml anti h influenzae type b capsular polysaccharide antibody generated predominantly igg igg1 subclass immune sera activity vitro conferred passive protection infant rat meningitis model
poor compliance universal precautions universal phenomenon \? anonymous survey conducted order examine compliance universal precautions department pediatrics university medical center , illinois completed questionnaires returned 23 faculty members , 29 residents , 22 medical students gloves worn consistently venipuncture intravenous catheterization 13 , 7 , 18 attending physicians , residents , students , respectively physicians wear gloves occasionally presence high risk factors selection criterion interference performance procedures common cause noncompliance view poor compliance universal precautions , efforts needed order decrease incidence preventable exposure blood borne infections
study assess efficacy prevention endoscopy related bacteraemia patients aged 60 five hundred fifteen patients aged 60 \( mean age 74 7 278 men 237 women \) underwent routine endoscopic procedures \( , bronchoscopy cystoscopy \) alternate patients given antibiotics procedure , currently recommended , blood taken culture patients within five minutes completion procedure 74 patients underwent bronchoscopy , one culture , one 37 controls positive 262 underwent , cultures negative 130 received antibiotics positive 13 132 controls \( 9 8 per cent p less 0 001 \) cystoscopy performed 179 one culture positive 88 given antibiotics \( 1 1 per cent \) compared 25 91 controls \( 27 5 per cent p less 0 001 \) bacteraemia rates appear low following bronchoscopy \( less 5 per cent \) higher \( 10 per cent \) cystoscopy \( 28 per cent \) effective reducing rates patient group
health issues us mexican border rapidly growing population , increasing manufacturing activity , increased , health issues us mexican border demanding greater attention unlikely border world two variety health status , , utilization initiatives areas environmental health clearly needed cooperation united states mexico provision health services warranted probably require enhanced funding successful
breast milk neonatal necrotising enterocolitis prospective multicentre study preterm infants formally assigned early diet , necrotising enterocolitis developed 51 \( 5 5 \) mortality 26 confirmed cases exclusively formula fed babies confirmed disease 6 10 times common fed breast milk alone 3 times common received formula plus breast milk donor milk seemed protective raw maternal milk among babies born 30 weeks' gestation confirmed necrotising enterocolitis rare whose diet included breast milk 20 times common fed formula risk factors included low gestational age , respiratory disease , umbilical artery catheterisation , polycythaemia formula fed breast milk fed infants , delayed enteral feeding associated lower frequency necrotising enterocolitis fall use breast milk british neonatal units , exclusive formula feeding could account estimated 500 extra cases necrotising enterocolitis year 100 infants would die
lipid infusion increases oxygen consumption similarly septic nonseptic patients investigation compared metabolic effects lipid infusion five septic five nonseptic patients oxygen consumption determined indirect calorimetry 1 h rest 2 h intralipid \( 20 \) infused 166 ml h 23 min \( 5 5 kcal min \) septic patients resting metabolic rate 17 higher nonseptic control subjects significant \( p less 0 05 \) rise \( 13 \) oxygen uptake measured groups subjects 2 h infusion lipid respiratory \( \) 7 higher septic patients \( p less 0 05 \) , infusion period decreased similarly \( approximately 6 p less 0 05 \) groups plasma catecholamines elevated septic patients concentrations remained unaltered infusion norepinephrine rose significantly nonseptic group lipid infusion results show sepsis little influence characteristic rise metabolic rate occurs intravenous lipid
methicillin resistant staphylococcal colonization infection long term care facility objective determine natural history colonization methicillin resistant staphylococcus aureus \( mrsa \) among patients long term care facility specifically sought determine mrsa colonization predictive subsequent infection design cohort study setting long term veterans affairs medical center patients total 197 patients residing two units followed regular surveillance cultures anterior nares main outcome measurement development staphylococcal infection results thirty two patients persistent carriers mrsa 44 persistent carriers methicillin susceptible strains \( \) twenty five percent mrsa carriers episode staphylococcal infection compared 4 carriers 4 5 non carriers \( p less 0 01 relative risk 3 8 95 ci , 2 0 6 4 \) rate development infection among mrsa carriers 15 every 100 days carriage using logistic regression analysis , persistent mrsa carriage significant predictor infection \( p less 0 001 odds ratio , 3 7 \) seventy three percent mrsa infections occurred among mrsa carriers isolates mrsa 7 patients typed strains type 7 patients pattern plasmid restriction endonuclease fragments 5 patients conclusions colonization anterior nares mrsa predicts development staphylococcal infection long term care patients infections arise endogenously carried strains colonization mrsa indicates significantly greater risk infection colonization results offer rationale reduction mrsa infections interventions aimed eliminating carrier state
primary dapsone resistant hansen 's disease california experience 100 mycobacterium leprae isolates found years 1978 1981 one 54 previously untreated patients hansen 's disease found harbor dapsone resistant mycobacterium leprae single strain partially resistant , ie , resistant 0 0001 dapsone mouse diet higher concentrations years 1983 1988 , leprae 47 previously untreated patients presenting clinics san francisco , calif , los angeles , calif , grew mice none strains found dapsone resistant thus , 1978 1988 one 101 leprae isolates obtained skin biopsy specimens patients leprosy found resistant dapsone concluded primary dapsone resistance still appear significant problem california owing fact single resistant case reported international sources , general , partially resistant , potential importance partial dapsone resistance discussed
hepatic abscess changes etiology , diagnosis , management recent reviews hepatic abscess emphasize percutaneous versus open surgical management little time studying etiology clinical condition patient study detailed review performed computerized analysis multiple clinical parameters 73 patients treated hepatic abscess 17 year period mean age patients 55 years 38 \( 52 \) male mortality rate comparable solitary \( 17 \) multiple \( 23 \) abscesses likelihood death higher antibiotic treatment alone \( 45 \) percutaneous treatment \( 25 \) surgical treatment \( 9 5 \) primary determinant outcome , however , underlying disease , e , malignancy immunocompromised patient , rather solitary versus multiple abscesses addition incidence hepatic abscess seen center doubled first half second half review , reflecting population severely ill patients apparent current clinical practice several methods management effective , choice therapy determined individualized selection principle timely diagnosis prompt institution treatment appropriate specific patient remains standard care potentially disease
staphylococcus aureus infection human endothelial cells potentiates fc receptor expression vasculitis , recognized complication staphylococcal endovascular infections , may result part , expression fcr staphylococcus aureus infected endothelial cells fcr measured using 51 cr labeled srbc rabbit anti srbc igg fcr detected uninfected endothelial cells , demonstrated aureus infected cells using igg , igm labeled srbc fcr expression dependent initial bacterial density \( greater equal 8 x 10 \( 7 \) cfu ml \) phagocytosis staphylococci , new protein synthesis igg labeled srbc binding blocked aggregated igg igm srbc coated f \( ab' \) 2 portion igg bind , thus confirming fcr specifically involved interaction fcr expressed aureus invasion human endothelial cells may contribute vasculitis often aureus endovascular infections
immunization mice antibiotic treated escherichia coli results enhanced protection challenge homologous heterologous bacteria murine immune response escherichia coli exposed inhibitory concentrations four antibiotics investigated groups mice injected 8 weeks formalin killed bacteria subsequently challenged 10 x ld50 viable e coli mice receiving saline \( controls \) died within 24 h mortality mice immunized ciprofloxacin treated e coli significantly lower mice immunized e coli untreated treated antibiotics sera mice immunized ciprofloxacin treated bacteria showed better capacity enhanced production antibodies bound homologous heterologous lipopolysaccharide isolated several smooth rough gram negative strains better protection observed mice immunized ciprofloxacin treated e coli probably due enhanced production antibodies epitopes lipopolysaccharide became better exposed accessible treatment ciprofloxacin
instillation vancomycin cerebrospinal fluid reservoir clear infection pharmacokinetic considerations vancomycin instilled reservoir used treat reservoir associated infection vancomycin concentrations cerebrospinal fluid \( csf \) measured , pharmacokinetic parameters allowed dosing first order kinetics observed calculated half life 3 52 h less reported others , apparent volume distribution \( 60 ml \) less anticipated elimination constant 0 197 h 1 empiric dosing based schedules suggested literature would led high peak low mean concentrations vancomycin patients reservoir associated infections variety pathophysiologic conditions result alteration normal csf dynamics pharmacokinetic analysis useful dosing optimize therapy vancomycin
blood cultures resource utilization true consequences false positive results determine whether blood cultures increase resource utilization , studied charge length stay data episodes blood cultures obtained hospitalized adults compared negative episodes , 94 false positive episodes associated increased subsequent length stay \( median , 12 5 vs 8 days \) subsequent total charges \( median , 13 , 116 vs \) , charges \( median , vs 798 \) , laboratory charges \( median , vs \) multivariate analyses , contaminants independently correlated 20 39 increases total subsequent laboratory charges intravenous antibiotic charges , respectively thus , true costs contaminants may greatly exceed test identifying patients low risk bacteremia attention sterile technique may reduce costs decreasing frequency contaminants
fluconazole new triazole antifungal agent fluconazole fluorine substituted , bis triazole antifungal agent mechanism action , like , involves interruption conversion via binding fungal cytochrome p 450 subsequent disruption fungal membranes activity aspergillus , , candida , , neoformans , capsulatum , demonstrated several animal models fluconazole administered orally intravenously mean peak serum concentrations achieved human volunteers 50 100 mg \( oral \) 3 1 7 0 mumols l respectively protein binding low \( 11 percent \) cerebrospinal fluid serum ratio 0 58 0 89 serum half life long \( 22 32 hours \) elimination via renal clearance unchanged drug clinical trials reports support use fluconazole treatment candidiasis , particularly oropharyngeal esophageal infections immunocompromised hosts fluconazole also approved initial suppressive therapy meningitis role management systemic fungal infections defined results comparative trials become available fluconazole well tolerated effects markedly less ketoconazole clearance altered low doses \( 50 mg \) fluconazole however , drug interactions use larger doses anticipated agents cyclosporin , phenytoin , oral , warfarin rifampin appears decrease metabolic clearance fluconazole fluconazole available oral parenteral formulations daily doses 100 400 mg recommended dosage reduction advised patients impaired renal function
transmission syndrome infected child cpr several cases toxic syndrome reported united states past five years association streptococcus pyogenes infection report case exposed attempted cpr secretions pyogenes infected child developed infection hand subsequent febrile illness hypotension , erythematous rash , renal failure , bacterial isolates blood cerebrospinal fluid deceased child identical type production isolates grown hand wound first reported case documented transmission pyogenes , causing toxic syndrome emergency medical
audit major colorectal biliary surgery reduce rates wound infection objective reduce rates wound infection major colorectal biliary surgery design prospective audit antibiotic prophylaxis keeping copies typed notes operations discharge first follow visit annual review prophylactic regimen according yearly rate wound infection modification necessary setting work one consultant surgeon working district general hospital patients patients major colorectal resection 1976 89 \( 400 \) cholecystectomy 1981 9 \( 500 \) main outcome measures wound infection , defined discharge wound detected observation inpatient stay specific first follow visit six weeks later results serial changes prophylaxis colorectal surgery resulted progressive reduction rate wound infection 43 1976 , prophylaxis , 1 1986 9 single intravenous doses metronidazole cefuroxime intraoperatively lavage peritoneal cavity wound 0 1 tetracycline 1981 7 , prophylaxis , rate infection biliary surgery 12 whereas 1988 9 , introduction lavage tetracycline alone , rate reduced 2 implications action simple prospective audit identified need changes antibiotic prophylaxis successive audit resulted improved rates wound infection , lavage 0 1 tetracycline seemed major factor achieving
behavior pulmonary circulation rest exercise tuberculosis studied hemodynamic behavior pulmonary circulation rest exercise six patients group , contrast advanced tuberculosis , patients exhibited normal pulmonary hemodynamics rest exercise minor abnormalities pulmonary vascular resistance exercise \( increased gradient \) noted two patients increase rp exercise appear related acute hypoxic rather functional changes \( compliance recruitment \) pulmonary microvasculature genesis functional changes , chronic alveolar hypoxia inflammatory fibrotic process might interacting
rabbit skeletal muscle po2 sepsis measured skeletal muscle tissue po2 \( \) anesthetized rabbits \( n 7 \) following infusion intravenous bolus e coli endotoxin array surface po2 placed hindlimb biceps femoris muscle sufficient readings obtained construct histogram changes histogram standard deviation used characterize micro circulatory systemic o2 consumption \( vo2 \) measured expired gas method cardiac output \( q \) systemic o2 transport \( \) calculated samples arterial , right atrial \( ra \) , hindlimb venous blood , catheter placed infrarenal portion vena cava , simultaneously obtained measurement blood gases following administration endotoxin , decreases q approximately 50 percent vo2 initially decreased 23 percent , returned baseline levels 30 minutes endotoxin administration systemic o2 extraction ratio \( vo2 \) increased 0 32 03 0 54 07 \( p less 0 01 \) , whereas hindlimb increased 0 42 03 0 60 02 \( p less 0 01 \) arithmetic mean histograms decreased endotoxin infusion \( 43 4 7 2 mm hg p less 0 01 \) , remained baseline levels \( 35 2 vs 33 2 mm hg p ns \) standard deviation histograms remained constant experiment finding supports notion skeletal muscle heterogeneity increase endotoxin induced sepsis
enhancement antibiotic concentrations gastric mucosa h2 receptor antagonist implications treatment helicobacter pylori infections measured effects cimetidine antibiotic concentrations luminal portion gastric mucosa guinea pigs cimetidine 4 mg kg intramuscularly clindamycin , antibiotic previously characterized physiologic ph conditions , administered intramuscularly levels measured serum tissue using high pressure liquid chromatography \( hplc \) technique luminal mucosa concentration clindamycin 1 hr \( ph 5 9 \) fivefold greater compared concentrations seen physiologic \( ph 2 0 \) conditions \( 81 5 micrograms g vs 15 9 micrograms g p less 0 05 \) 10 fold greater 2 hr \( 82 7 micrograms g vs 8 09 micrograms g p less 0 05 \) difference peak serum levels groups finding antibiotic characteristics base thus affected acid inhibitor cimetidine supports presence acidic storage pool proposed investigators h2 receptor antagonists may useful therapeutic adjuncts h pylori infections virtue increasing gastric concentrations antibiotics behave weak bases
computer generated physician patient reminders tools improve population adherence selected preventive services despite emerging consensus appropriate preventive services , minority patients receive study undertaken assess impact computer generated reminders adult patients , physicians , patients physicians adherence five recommended preventive services cholesterol measurements , fecal occult blood testing , mammography , papanicolaou smears , tetanus immunization academic year 1988 1989 , adult patients 49 physicians university family medicine clinical practice randomized practice group one four study groups control , physician reminders , patient reminders , physician patient reminders adherence defined community oriented terms percentage patients within group received preventive service recommended interval study period , adherence four five preventive services increased significantly , largest increases physician patient reminder group cholesterol measurements increased 19 5 38 1 , fecal occult blood testing 9 3 27 0 , mammography 11 4 27 1 , tetanus immunization 23 4 35 4 \( increase , p less 0001 , 's chi square test \) general , increases greater blacks patients form insurance coverage computer based physician patient reminder systems great promise improving adherence preventive services primary care settings
person person transmission brucella human brucellosis primarily occupational hazard usa middle east africa ingestion contaminated products important route infection whether human become infected via person person spread uncertain investigation , laboratory associated outbreak due brucella , 3 , serologically proven brucellosis became infected blood isolate indistinguishable epidemic strain absence risk factors , suggest sexual intercourse possible means transmission
utility collecting blood cultures newly inserted intravenous catheters prospectively examined utility obtaining blood cultures newly inserted intravenous catheters 99 children required blood culture placement intravenous catheter two blood cultures collected patient , one freshly inserted intravenous catheter another needle separate venipuncture site standardized technique skin preparation iodine used rate contamination 1 0 \( 95 confidence intervals , 0 3 0 \) method ten patients blood cultures yielding true pathogens five bacteremic children , one two sets blood cultures positive conclude blood cultures collected freshly placed intravenous catheters without increasing risk contamination results also raise possibility obtaining two blood cultures instead single culture may improve detection bacteremia children
syphilis new visit old syphilis number stages , including latent one , may overlooked misdiagnosed possibility kept mind adequate treatment primary stage results high cure rate latent stage may last years , time woman may still give birth infected child symptomatic occurs often men women penicillin g preferred treat stages disease antibiotics used patients sensitive penicillin
metabolic changes patients severely affected tetanus metabolic changes six severely affected tetanus patients suffering characteristic labile hypertension \( maximum systolic blood pressure greater 200 mmhg , maximum diurnal change systolic pressure greater 100 mmhg \) investigated daily urinary excretion urea nitrogen increased gradually onset , reached peak value \( 10 4 15 4 g m2 \) 8 20 days , decreased subsequently average cumulative excretion 30 days reached 239 6 32 7 g m2 urine catecholamine excretion elevated patient remained elevated period plasma cortisol glucagon concentrations increased markedly except case complicated systemic bacterial infection increased protein catabolism patients could explained metabolic effects alone , neurologic factors must considered
technetium 99m human polyclonal igg radiolabeled via nicotinamide derivative imaging focal sites infection rats biologic behavior human polyclonal immunoglobulin \( igg \) radiolabeled technetium 99m \( 99mtc \) novel method , via derivative , evaluated rats technetium 99m indium 111 igg co administered normal rats determined 2 , 6 , 16 hr inflammation imaging properties two reagents compared rats deep thigh infection due escherichia coli blood clearance antibody preparations well described bi exponential function \( 99mtc igg t1 2 3 82 0 89 57 52 1 70 hr 111in igg 3 93 0 117 40 71 1 26 hr \) solid organs similar , however , small statistically significant differences detected 99mtc igg greater 111in igg lung , liver , spleen 99mtc igg less 111in igg kidney skeletal muscle \( p less 0 01 \) three imaging times , target background ratio percent residual activity two compounds remarkably similar studies establish human polyclonal igg labeled 99mtc via modified intermediate equivalent 111in igg imaging focal sites infection experimental animals
modern chemotherapy brucellosis humans effective , least toxic chemotherapy human brucellosis still vitro , antibiotics active brucella include , aminoglycosides , , cephalosporins , trimethoprim sulfamethoxazole , erythromycin , rifampin , new quinolones brucella species intracellular parasites , penetration drugs within phagocytes problematic best studied experimental animals tissue cultures humans , effectiveness various regimens chemotherapy compared best acute bacteremic infections assessment control symptoms , bacteremia , complications , relapses standard therapy therapies judged combination tetracycline streptomycin , almost universally effective fails prevent relapse 10 cases combination oral doxycycline rifampin convenient currently popular highly effective , average relapse rate 8 4 trimethoprim sulfamethoxazole less effective controlling bacteremia manifestations collected series , 5 7 cases respond 12 relapsed drug resistant brucella strains rarely cause therapy failure localized brucellosis poses special problems , often requiring surgery addition prolonged combined chemotherapy
absence bacteremia nasal septoplasty episodes staphylococcal bacteremia resulting metastatic infection occurred association nasal septoplasty , suggested possible need antimicrobial prophylaxis study designed measure actual frequency transient staphylococcal bacteremia occurs nasal septoplasty , 50 healthy patients blood cultures drawn immediately prior procedure although 46 50 patients studied nasal mucosa staphylococcus aureus , blood cultures obtained 50 patients showed bacterial growth authors conclude staphylococcal bacteremia nasal septoplasty rare occurrence , antimicrobial prophylaxis unnecessary
correlation gross microscopic appearance skin total artificial heart animals pneumatic artificial hearts powered compressed air delivered percutaneous tubes stress relief device , termed skin button , tubes exit recipient 's tissues skin button designed protect tissues damage provide secure material tissue interface prevention superficial invasive infection primary goal skin button eight calves studied prospectively identify gross microscopic infection skin button animals survived sixty days \( 62 136 \) gross microscopic evidence infection animals surviving less 60 days \( 13 43 \) gross evidence infection one subcutaneous microscopic abscess formation animal died secondary skin button infection skin cannot prevent infection contain pathologic process superficial tissues evidence systemic effects
effects three serotypes ureaplasma spermatozoal motility penetration vitro published erratum appears 1991 jun 55 \( 6 \) effects incubation spermatozoa three serotypes ureaplasma spermatozoal motility penetration vitro investigated using computer assisted video microscopy , three parameters motility determined individual path lengths , individual distances , percentage motility polyacrylamide gels used medium assessment spermatozoal penetration ureaplasma infected spermatozoa significantly greater path lengths individual distances uninfected controls , ureaplasma infection significant effect percentage motility overall , significant differences penetration distances ureaplasma infected spermatozoa corresponding uninfected controls conclusion adversely affect motility penetration spermatozoa incubated 45 minutes ureaplasma sperm ratios high 100 1
tumor necrosis factor independent il 6 production murine report tnf , il 6 , ifn alpha beta produced mice either sublethal lethal listeria infections quantities cytokines infected spleens increase decrease concordance bacterial numbers organs cytokines present listeria infected spleens , il 6 ifn alpha beta found peripheral circulation inasmuch tnf reported responsible production il 6 vivo following inoculation lethal dose gram negative , escherichia coli \( et al , 1989 j med 170 \) , experiments undertaken determine whether il 6 production elicited gram positive , l , also tnf dependent found passive immunization mice neutralizing antibodies specific tnf shortly v injection lethal sublethal listeria inoculum resulted complete neutralization endogenously produced tnf , progressive bacteria infected organs also found anti tnf igg treatment resulted progressive increase amounts listeria induced il 6 present spleen blood , death host findings indicate listeria induced il 6 production mice occurs primarily tnf independent pathway , correlates directly severity infection
lymphoproliferative responses borrelia burgdorferi lyme disease objective compare lymphocyte proliferative responses borrelia burgdorferi healthy controls patients lyme disease patients twelve patients case definition criteria lyme disease twelve healthy volunteers two newborns served controls measurements antibodies b burgdorferi measured enzyme linked immunosorbent assay \( elisa \) proliferation peripheral blood lymphocytes cultured 5 days b burgdorferi , recall antigens , pokeweed mitogen measured radioactive thymidine uptake results lymphocytes 11 patients lyme disease , 8 healthy seronegative controls , two newborns showed elevated responses stimulated b burgdorferi patient control studied day , patient 's lymphocyte response b burgdorferi exceeded control 's 5 12 cases lymphocytes patients controls responded b burgdorferi isolates three different sources conclusions heightened lymphocyte responses b burgdorferi found patients lyme disease elevated responses also frequently occur healthy controls present , interpretation positive lymphocyte response b burgdorferi would difficult ambiguous clinical situations
effect steroids cerebrospinal fluid penetration drugs tuberculous meningitis sixteen patients oral isoniazid , , rifampin , intramuscular streptomycin tuberculous meningitis studied concentrations isoniazid , , rifampin , streptomycin cerebrospinal fluid \( csf \) obtained 3 hours administration 2 40 , 34 78 , 0 29 , 3 78 micrograms ml , respectively csf concentrations isoniazid well minimum inhibitory concentration mycobacterium tuberculosis concentrations rifampin streptomycin minimal inhibitory concentration initially declined minimal inhibitory concentration later times csf penetration isoniazid , , rifampin , streptomycin 89 , 91 , 5 , 20 , respectively eight patients received drugs combination steroids , mean csf serum concentrations , well csf serum ratios various intervals treatment , statistically different \( p greater 0 05 \) eight patients receive steroids
endothelin immunoreactivity mice gram negative bacteraemia relationship tumour necrosis factor alpha 1 investigate role endothelin gram negative bacteraemia possible involvement tumour necrosis factor alpha pathophysiology , measured plasma tissue \( lung , kidney spleen \) immunoreactive endothelin levels gram negative mice , without passive immunization anti \( tumour necrosis factor alpha \) antibody 2 plasma immunoreactive endothelin levels greatly increased escherichia coli injection pretreatment anti \( tumour necrosis factor alpha \) antibody suppress elevated plasma immunoreactive endothelin levels \( p greater 0 1 \) 3 lung tissue immunoreactive endothelin levels mice increased 16 h e coli injection affected prior passive immunization anti \( tumour necrosis factor alpha \) antibody immunoreactive endothelin spleen kidney undetectable \( less 34 fmol g wet weight \) 4 injection tumour necrosis factor alpha mice increase plasma immunoreactive endothelin levels 5 antibody endothelin given 30 min 90 lethal dose challenge e coli affect mortality 6 conclude rise plasma tissue endothelin occurs gram negative bacteraemia independent tumour necrosis factor alpha
non invasive assessment cardiovascular eicosanoids , thromboxane a2 prostacyclin , randomly sampled males , special reference influence inheritance environmental factors 1 studied , random sample nonsmoking men born 1968 1969 31 men born , whether inheritance environmental factors influenced platelet activity vessel wall prostacyclin formation , reflected non urinary excretion 2 , 3 dinor metabolites thromboxane a2 \( 2 , 3 dinor thromboxane b2 , tx \) prostacyclin \( 2 , 3 dinor 6 keto prostaglandin f1 alpha , pgi \) , respectively 2 fathers young men high platelet activity tx fathers young men low platelet activity men born displayed higher tx \( 563 versus 128 pg mg creatinine , p less 0 001 \) pgi \( 163 versus 130 pg mg creatinine , p less 0 01 \) excretion born 1968 1969 excretion tx pgi correlated urinary output noradrenaline adrenaline 3 well trained subjects differ excretion tx pgi exercise regularly recent acute infection also unrelated excretion tx pgi pgi excretion , however , significantly correlated tx excretion \( r 0 51 , p less 0 001 \) 4 study provides first non invasive evidence advancing age tone positively correlated platelet activity randomly sampled men , paternal inheritance , physical fitness recent infection lack correlation platelet activity
furfur associated central venous catheter lipid emulsion infusion furfur associated infants prolonged intravenous lipid emulsion cases furfur reported literature involved neonates required catheter removal cure furfur probably problem neonates well adults central venous catheters , receiving lipid , organism requires selective enrichment media growth , example , 's dextrose agar sterile olive oil overlay case report furfur neonates unique neonate recovered discontinuation lipid emulsion , without removal central venous catheter
comparison functional activities igg1 igm class switched human monoclonal antibodies reactive group b streptococci escherichia coli k1 influence heavy chain antibody activity investigated using derived , class switched igg1 igm human monoclonal antibodies \( mabs \) reactive bacterial pathogens escherichia coli k1 group b streptococcus species igg igm pairs compared vitro antigen binding activities vivo protective efficacy neonatal rats anti e coli pair , igm mab 1000 fold potent assay importantly , 50 protection dose \( \) igm mab 10 20 ng rat , 100 micrograms igg mab minimally protective group b streptococcal mabs , igm 100 fold potent binding assays , respectively however , 20 micrograms igm protected neonatal rats , 100 micrograms igg mab partly protective experiments demonstrate utility recombinant dna technology creating panel antibodies may aid selecting potential immunotherapeutic candidates
macrophage oxidant mediated inhibition ability live conidia transform pathogenic yeast phase implications pathogenesis dimorphic fungal infections conidia , produced phase dimorphic fungi , thought represent infectious form organism must complete transition tissue invasive , yeast like phase infection preventing transition effectively eliminate using target , murine bronchoalveolar macrophages preferentially blocked phase transition 4 h incubation conidia , relatively sparing ability conidia produce h2o2 , relatively high concentrations , demonstrated activity effects h2o2 seem irreversible , since h2o2 treated conidia 48 h 25 degrees c still unable produce next 5 days incubated 37 degrees c catalase could reverse macrophage induced inhibition phase transition , suggesting defense mechanisms may operative vivo since conidia form temperatures found mammalian hosts , effects may represent novel host defense mechanism dimorphic fungal pathogens
three new serovars chlamydia trachomatis da , ia , three new chlamydia trachomatis serovars identified several monoclonal antibodies test proposed called da , ia , clearly distinguishable related serovars , , l2 date , 7 , 41 , 4 isolates respective serovars identified appears distributed worldwide findings meet previously established criteria establishment new serovars
molecular epidemiologic techniques analysis epidemic endemic shigella type 1 strains 1988 number shigella type 1 infections reported united states increased fivefold determine recent isolates mexico related caused epidemics worldwide , southern hybridization analysis done toxin ribosomal rna gene probes western hemisphere eastern hemisphere strains differed size single fragment carrying toxin genes three ribosomal dna \( \) patterns observed , correlated strain 's origin 81 83 isolates tested together toxin probe results indicated recent mexican isolates similar earlier central american isolates distinct asian african strains suggests significant exchange organisms recent decades 1988 outbreak mexico caused strains present central america since least 1962
combined use released proteins lipopolysaccharide enzyme linked immunosorbent assay serologic screening yersinia infections elisa screening serum antibodies yersinia species developed using plasmid encoded released proteins yersinia 8 lipopolysaccharide 3 combined antigen 43 sera patients infected one six different yersinia serotypes , 40 \( 93 \) positive assay tested using six serotype specific corresponding yersinia bacteria antigens , 38 \( 88 \) positive screening elisa detects antibodies virulent one assay offers possibility diagnosis infections caused yersinia serotypes seen occasionally usually included serotype specific thus , elisa offers substantial advantage saving time routine laboratory work
indium 111 labeled leukocyte scan detection synthetic vascular graft infection effect antibiotic treatment determine sensitivity specificity indium 111 \( 111in \) labeled leukocyte scan prosthetic vascular graft infection patients treated antibiotic therapy , retrospective study performed 41 consecutive 111in labeled leukocyte scans performed evaluate possible vascular graft infection , 23 scans performed patients treated antibiotics average duration antibiotic therapy 21 days twelve positive 11 negative scans graft infection found surgical autopsy correlation positive cases , clinical correlation \( negative cases \) , 10 true positive , 11 true negative , 2 false positive , false negative scans graft infections , overall sensitivity 100 specificity 85
treatment gram negative bacteremia septic shock ha 1a human monoclonal antibody endotoxin randomized , double blind , placebo controlled trial ha 1a sepsis study group background ha 1a human monoclonal igm antibody binds specifically lipid domain endotoxin prevents death laboratory animals gram negative bacteremia endotoxemia methods evaluate efficacy safety ha 1a , conducted randomized , double blind trial patients sepsis presumed diagnosis gram negative infection patients received either single 100 mg intravenous dose ha 1a \( 3 5 g albumin \) placebo \( 3 5 g albumin \) interventions , including administration antibiotics fluids , affected study protocol results patients sepsis treated , 200 \( 37 percent \) gram negative bacteremia proved blood culture patients gram negative bacteremia followed death day 28 , 45 deaths among 92 recipients placebo \( 49 percent \) 32 deaths among 105 recipients ha 1a \( 30 percent p 0 014 \) patients gram negative bacteremia shock entry , 27 deaths among 47 recipients placebo \( 57 percent \) 18 deaths among 54 recipients ha 1a \( 33 percent p 0 017 \) analyses stratified according severity illness entry showed improved survival ha 1a treatment severely ill less severely ill patients 196 patients gram negative bacteremia followed hospital discharge death , 45 93 given placebo \( 48 percent \) discharged alive , compared 65 103 treated ha 1a \( 63 percent p 0 038 \) benefit treatment ha 1a demonstrated 343 patients sepsis prove gram negative bacteremia patients sepsis treated , mortality rate 43 percent among recipients placebo 39 percent among given ha 1a \( p 0 24 \) patients tolerated ha 1a well , anti ha 1a antibodies detected conclusions ha 1a safe effective treatment patients sepsis gram negative bacteremia
evaluation two rapid group b streptococcal antigen tests labor delivery patients two rapid group b streptococcal antigen tests compared nonselective blood agar culture unselected patients admitted labor delivery vaginal specimens taken patient admission used perform two rapid tests corresponding cultures rapid tests latex agglutination assay b test , uses solid phase immunoassay overall , 105 patients \( 9 9 \) least one positive culture sensitivities rapid tests 15 1 21 5 specificities 99 3 98 7 , respectively sensitivity minimally increased setting ruptured membranes tests likewise , use separate swabs culture plate performing rapid test increased sensitivity , significant either test control experiments , limit sensitivity rapid tests 5 x 10 \( 6 \) colony forming units conclude present , tests sensitive enough routine use type clinical setting
use pediatric risk mortality score predict nosocomial infection pediatric intensive care unit objective define infection rates patients pediatric risk mortality \( prism \) scores greater less 10 admission pediatric icu \( picu \) design descriptive setting 18 bed picu patients ages except nonsurgical neonates within 585 bed tertiary care pediatric hospital patients patients admitted picu july 1987 february 1988 inclusive admitted , 480 followed greater equal 72 hr methods baseline state patients admission determined designated using prism score variables included age , length stay , hospital day onset infection infections identified designated undertook prospective daily bedside observation , chart , radiographic , laboratory review measurements main results equal portions patients prism scores less greater 10 significantly infections occurred high prism population \( 10 8 vs 3 4 , p less 001 \) association held age , service , length stay sensitivity , specificity , positive negative predictive values prism score greater 10 75 , 53 , 11 , 97 , respectively accounted 36 infections , skin eye drain site 22 , respiratory 16 , wound 15 , urine 9 prevalent organisms negative staphylococci \( 32 \) , pseudomonas aeruginosa \( 23 \) , candida sp \( 20 \) , aureus \( 9 \) conclusions prism score greater 10 picu admission characterizes population within picu increased risk infection however , 93 patients develop infection thus , negative predictive value 97 yields little additional information
systemic muscle oxygen uptake delivery dopexamine infusion endotoxic dogs background methods study designed test whether dopexamine , dopaminergic beta 2 adrenergic agonist , would \) increase systemic oxygen delivery \( do2 \) endotoxic dogs , b \) interfere ability resting skeletal muscle extract oxygen three treatment groups \( n 6 group \) control , endotoxin alone \( e \) 4 mg kg iv , endotoxin dopexamine \( e \) 12 micrograms kg min data analyzed within groups split plot analysis variance significance identified differences tested post hoc 's multiple range test donor rbc dextran used endotoxin maintain adequate perfusion pressures , hct kept near 40 blood flow left hindlimb muscles decreased controlled steps 15 min stabilization results e group , cardiac output \( qt \) , mean arterial pressure \( map \) , systemic do2 , oxygen uptake \( vo2 \) decreased despite blood volume expansion e group similar volume expansion , dopexamine maintained qt , systemic do2 , vo2 near control levels , although map systemic vascular resistance reduced comparison control subjects , endotoxin increased critical do2 isolated limb muscles 4 6 7 ml kg min decreased critical oxygen extraction 81 68 pressure flow relationship limb became flattened , indicating loss vascular reactivity e group , change pressure flow curve critical oxygen extraction level conclusions dopexamine provided hemodynamic support endotoxic dogs , thereby increasing total do2 vo2 , altering oxygen extraction muscle
gram negative infection increases noninsulin mediated glucose disposal peripheral glucose uptake occur either insulin noninsulin mediated mechanisms , two pathways appear regulated independently using euglycemic hyperinsulinemic clamp technique , previously demonstrated sepsis induces whole body insulin resistance purpose present study determine whether infection also alters noninsulin mediated glucose uptake \( nimgu \) , , tissues affected studies performed chronically catheterized conscious rats either basal \( 6 mm glucose , 30 microu ml insulin \) insulinopenic conditions determine nimgu hypermetabolic sepsis induced sc injections live escherichia coli , 24 h later tracer amount u 14c deoxy 2 glucose injected determination vivo glucose metabolic rate \( \) selected tissues results indicate nimgu predominant route glucose disposal septic nonseptic rats , accounting 79 83 total rate glucose disposal rate whole body glucose disposal increased sepsis , absolute rate nimgu 46 higher septic rats nonseptic animals increase result elevated liver , spleen , ileum , lung sepsis also increased whole body insulin mediated glucose uptake 88 basal conditions , due enhanced glucose uptake muscle skin insulinopenic animals plasma glucose concentration elevated 17 mm , whole body glucose disposal increased 107 nonseptic animals , 32 septic rats hyperglycemic induced increment organ smaller tissues examined septic animals however , absolute rate whole body tissue glucose utilization different two groups results indicate gram negative infection increases whole body nimgu , results enhanced rate glucose utilization tissues rich mononuclear phagocytes , including liver , spleen , ileum , lung , muscle
terconazole treatment candidiasis double blind , randomized trial conducted evaluate efficacy safety terconazole candidiasis treatment consisted daily application one following regimens 80 mg terconazole 3 days , nitrate 7 days placebo 7 days terconazole nitrate groups significantly higher therapeutic cure rates placebo group evaluation vaginal secretions microscopic examination showed evidence leukocyte proliferation proline activity , present patients bacterial , could detected vaginal secretions patients yeast
challenge prophylaxis cesarean section 1990s physicians evaluated role antibiotics prevention perioperative infections since drugs discovered , determined antibiotics prevented staphylococcal wound infections animal model surgeons consider use prophylaxis 1970s , improved techniques identifying anaerobic microorganisms unacceptably high incidence infection related complications obstetricians study , ultimately accept , use perioperative antibiotic administration prevent infections recent progress included refinement guidelines patient selection drug regimens although single dose antibiotic given patient undergoing primary cesarean section demonstrated effective prophylaxis administered clamping umbilical cord , practice widely accepted discovery role broad spectrum antibiotics obstetric gynecologic surgery investigated one studies compared efficacy cefmetazole preventing post cesarean section infection eighteen patients group received 2 g dose one two drugs umbilical cord clamped predetermined elevations temperature used evaluate presence ensuing infections four subjects group developed type morbidity postoperative complications included wound infection , , bladder infection cellulitis cefmetazole seemed equally effective preventing post cesarean section infections
cefmetazole comparative efficacy safety preventing postoperative infections vaginal abdominal hysterectomy single 1 g dose cefmetazole compared single 1 g dose prophylaxis vaginal abdominal hysterectomy determine efficacy safety antibiotics administered intramuscularly 15 90 minutes incision made cefmetazole similar activity aerobic organisms recovered , cefmetazole significantly active anaerobic gram negative microorganisms patterns vaginal flora similar two treatment groups patient demographic characteristics surgical procedures similar groups difference primary prophylactic failure \( e g , cuff cellulitis \) two study drugs \( 1 53 1 9 cefmetazole 2 28 7 1 \) reach statistical significance , results similar two routes hysterectomy cefmetazole , dose 1 g intramuscularly preoperatively , safe effective agent prophylaxis hysterectomy
changes differential white blood cell count screening group b streptococcal sepsis compared several previously defined scoring systems using white blood cell indices part retrospective evaluation infants early onset group b streptococcal \( gbs \) sepsis nineteen newborns diagnosed gbs sepsis january , 1988 , april , 1990 case controls \( n 33 \) selected patients admitted neonatal intensive care unit suspected sepsis complete blood counts obtained admission 12 24 hours age reviewed significant change ratio immature total neutrophils gbs group time scoring systems neonatal sepsis et al , et al et al poor sensitivity , specificity , positive predictive value negative predictive value initial white blood cell count criteria used , scoring systems 100 sensitive 100 negative predictive value applied repeat white blood cell count conclude single early complete blood count may adequate screening tool early onset gbs sepsis used rule infection optimal screening gbs sepsis requires repeat complete blood count within first 24 hours age
cytokines glucocorticoids regulation skeletal muscle axis sepsis sepsis results muscle catabolism peripheral release amino acids concomitant uptake amino acids liver acute phase protein synthesis addition , appears cytokine induced process blocks muscle amino acid uptake sepsis , amino acids periphery liver article , evidence cytokines glucocorticoids play important role regulation hepatic muscle protein metabolism sepsis presented
outbreak tuberculosis shelter homeless men description evolution control outbreak tuberculosis shelter homeless men studied detail understanding epidemiology tuberculosis setting shelter provides evening men aged 50 yr older capacity approximately 200 clients , pool approximately 1 , 000 men yr 6 wk period december 1986 january 1987 , seven cases tuberculosis diagnosed shelter clients nine cases reported clients preceding 12 months , four cases year previous majority outbreak cases pulmonary tuberculosis , sputum smear positive drug resistance rare typing 15 mycobacterium tuberculosis isolates revealed one predominant type four types goals control plan \( steps taken achieve \) render known infectious cases \( directly observed therapy \) find undiagnosed infectious cases \( repetitive mass \) protect exposed clients \( repetitive tuberculin skin testing isoniazid preventive therapy \) make shelter environment safe \( exclude infectious , noncompliant clients improve shelter 's ventilation system \) implementation plan rapidly terminated outbreak following first mass screening january 1987 , six asymptomatic cases detected , five additional cases occurred shelter clients 2 yr period follow investigation suggested outbreak evolved 1986 result presence shelter increasing number men undiagnosed infectious pulmonary tuberculosis
role prophylactic antibiotics neck dissections use perioperative prophylactic antibiotics head neck surgery remains controversial performed retrospective analysis 192 patients undergoing neck dissections 1976 1989 wound infection developed 10 \( 10 99 \) patients receive antibiotics , three \( 3 3 \) 93 patients received antibiotics developed infections difference statistically significant correlated use flaps , length surgery , prior radiation treatment , postoperative complications rate wound infection difference statistically significant variables beta error , however , greater 0 2 data demonstrate efficacy prophylactic antibiotics neck dissections statistical significance however , trend exists suggesting possible value
helicobacter pylori infection rates relation age social class population men seroprevalence igg antibodies helicobacter pylori determined using standard enzyme linked immunosorbent assay population randomly selected men , aged 30 75 years , caerphilly , south wales overall prevalence h pylori 56 9 , increasing sharply middle age 29 8 aged 30 34 59 aged 45 older \( p less 0 0001 \) age standardised seroprevalence rates lowest combined social class categories ii \( 49 2 \) , intermediate categories \( 57 5 \) , highest categories iv v \( 62 2 \) \( p 0 01 \) aged 30 34 years , prevalence rate combined social class categories iv v 57 9 double rate social class categories n \( 28 3 \) five times prevalence rate social class categories ii \( 11 1 \) differences infection patterns h pylori social class consistent patterns peptic ulcer disease gastric cancer
urinary nitrate excretion relation murine macrophage activation influence dietary l arginine oral ng l arginine murine macrophage oxidation l arginine guanidino nitrogen nitrite nitrate yields intermediate effector , possibly nitric oxide , antimicrobial activity total body nitrogen oxidation metabolism \( \) measured vivo determining urinary nitrate excretion mice ingesting chemically defined nitrite nitrate free diet reported previously , mycobacterial infection bacillus calmette guerin led large increase urinary nitrate excretion increase temporally related macrophage activation vivo substrate macrophage nitrogen oxidation metabolism vitro , l arginine , deleted diet without ameliorating urinary nitrate excretion response induced bcg suggested l arginine synthesized endogenously known natural substrates competitive inhibitor , l arginine analog , ng l arginine fed mice drinking water ng l arginine ingestion blocked basal bacillus calmette guerin induced urinary nitrate excretion 2 4 week time span experimental conditions prove useful investigation role macrophage host defense intracellular microorganisms
nosocomial pseudomonas pickettii traced case selective drug screening health care personnel three patients university hospital developed nosocomial infusion related pseudomonas pickettii bacteremia investigation identified six additional patients received intravenous fluid contaminated p pickettii become ill nine patients surgery , patients nine 19 operated control patients received intravenous fentanyl citrate operating room mean dose given nine case patients far greater given control patients fentanyl 20 \( 40 \) 50 30 ml shown contaminated p pickettii contamination caused fentanyl replacement water contaminated p pickettii health care personnel may cause patients suffer pain also result consequences , nosocomial bacteremia whereas drug testing workplace highly controversial , believe testing health care personnel indicated drug abuse suspected
recombinant fusion protein identified lepromatous sera mimics native mycobacterium leprae cell responses across leprosy spectrum pooled sera lepromatous leprosy patients used screen lambda recombinant dna expression library mycobacterium leprae order identify relevant antigens recognized human immune response 300 , 000 screened , 4 clones identified coded fusion proteins molecular mass fusion protein clone tested immunoreactivity assays using peripheral blood cells sera 11 laboratory personnel 105 patients across leprosy spectrum protein appears predominantly cell antigen similar lymphoproliferative responses native bacillus individual level leprosy spectrum whole though 50 patient sera anti leprae antibodies reacted fusion protein , pattern reactivity antibody responses also similar various clinical types coding regions clones identical show homology sequences stored data banks encode protein 89 amino acids calculated molecular mass approximately 10 kda
clinical spectrum fungal infections orthotopic liver transplantation 50 month period , identified 91 episodes fungal infection 72 liver transplant recipients \( 23 8 \) candida species accounted 83 5 cases clinical patterns fungal infections included disseminated infection \( 19 \) , peritonitis \( 17 \) , pneumonitis \( 15 \) , multiple sites colonization \( 13 \) , \( 11 \) , sites \( 16 \) diagnosis fungal infection usually made first 2 months \( 84 7 cases \) , mean time 16 days transplantation risk factors fungal infections included , risk score , intraoperative transfusion requirement , urgent status , roux limb biliary reconstruction \( adults \) , steroid dose , bacterial infections antibiotic therapy , vascular complications fungal infections successfully treated amphotericin b 63 cases \( 74 1 \) associated diminished patient survival \( 50 vs 83 5 \) fungal infection frequent source early morbidity related well defined risk factors , suggesting need effective prophylaxis
effect dietary fish oil plasma thromboxane b2 6 keto prostaglandin f1 alpha levels septic rats increased mortality sepsis associated high levels thromboxane b2 \( txb2 \) 6 keto prostaglandin f1 alpha \( pgf1 alpha \) linoleic acid , n 6 essential fatty acid , usual precursor txb2 pgf1 alpha , fish oil rich n 3 essential fatty acid , precursor less active moieties rats fed chow , essential fatty acid deficient diet , essential fatty acid deficient diet supplemented linoleic acid fish oil 2 weeks animals underwent sham operation cecal ligation puncture induce sepsis six hours later , blood obtained analysis chow linoleic acid diets produced significant \( twofold fivefold \) increases levels txb2 pgf1 alpha sepsis essential fatty acid deficient diet fish oil diet protected increases levels txb2 pgf1 alpha sepsis dietary restriction linoleic acid fish oil supplementation may play important role altering inflammatory mediator response sepsis
hepatic extraction indocyanine green depressed early sepsis despite increased hepatic blood flow cardiac output although active hepatocellular function depressed sepsis , known whether occurs early stages sepsis whether due depressed cardiac output hepatic blood flow study , rats subjected sepsis cecal ligation puncture hepatocellular function determined various intervals thereafter assessing ability liver clear different doses indocyanine green indocyanine green concentration continuously measured vivo fiberoptic catheter vivo maximal velocity kinetic constant clearance indocyanine green , hepatic blood flow , cardiac output determined experimental sham operated rats results demonstrate hepatic blood flow cardiac output increased 2 10 hours cecal ligation puncture , hepatocellular function \( maximum velocity kinetic constant \) decreased even 2 hours following cecal ligation puncture linear correlation hepatocellular function hepatic blood flow cardiac output found conditions extremely early depression active hepatocellular function , despite increased hepatic blood flow cardiac output , may form basis cellular dysfunctions leading multiple organ failure sepsis
effects high dose igg survival surgical patients sepsis scores 20 greater sixty two consecutive septic surgical patients receiving standard multimodal intensive care unit treatment developed sepsis score 20 greater \( day 0 \) randomized receive 0 4 g kg either intravenous igg \( 29 patients \) human albumin \( controls 33 patients \) , repeated days 1 5 , prospective , double blind , multicenter study two groups similar age , initial sepsis scores , acute physiology chronic health evaluation ii score significantly lower mortality recorded igg treated group \( 38 \) controls \( 67 \) septic shock cause death 7 igg treated patients 33 controls results study indicate high dose igg improves survival decreases death septic shock surgical patients sepsis score 20 greater
clostridium difficile disease department surgery significance prophylactic antibiotics clustering clostridium difficile associated disease department surgery prompted program infection control evaluation contributing factors fifty patients diarrhea positive assays c difficile cytotoxin study period twenty one 36 cases developed among patients admitted surgical services occurred two adjacent general surgery wards shared attending surgeons house staff perioperative prophylactic antibiotics c difficile associated disease 20 patients , 12 short courses \( less 24 hours \) symptoms typically nonspecific early diagnosis may difficult incidence remained high , despite infection control measures , closure two surgical wards clostridium difficile associated disease nosocomial infection associated short courses prophylactic antibiotics recommendations regarding use perioperative prophylaxis recognize c difficile associated disease significant potential complication
clinical immunologic responses haemophilus influenzae type b tetanus toxoid conjugate vaccine infants injected 3 , 5 , 7 , 18 months age safety immunogenicity haemophilus influenzae type b tetanus toxoid conjugate vaccine \( hib tt \) evaluated 77 healthy infants receiving injections 3 , 5 , 7 , 18 months age serious local systemic reactions noted first injection geometric mean hib antibody level rose 0 55 micrograms ml , subsequent injection elicited statistically significant rise geometric mean percentage vaccinees hib antibody levels greater 0 15 micrograms ml serum 75 5 first , 97 4 second , 100 third hib tt injection percentage fell 90 9 18 months age rose 100 fourth injection control infants \( n 10 \) injected diphtheria tetanus toxoid pertussis vaccine levels second injection hib tt elicited increases hib antibody isotypes igg greater igm greater iga among igg subclasses highest increases igg1 vaccinated subjects greater 0 01 u ml tt antibody \( estimated protective level \) throughout study conclude hib tt , injected 3 , 5 , 7 , 18 months , safe induces protective levels antibodies age highest incidence meningitis caused hib
splenectomy influence outcome pneumococcal septicemia porcine model existence overwhelming infection syndrome adults traumatic splenectomy controversial due similarity porcine immune system man pig study subsets peripheral mononuclear cells splenectomy resistance experimental pneumococcal infection splenic surgery specific immunization female pigs assigned four operative groups sham operation , splenectomy , splenic resection , heterotopic splenic autotransplantation hematologic flow cytometric analysis mononuclear cells subsets revealed marked leukocytosis following splenectomy autotransplantation significant shift monocyte b cell numbers response leukocytes septicemia , bacterial elimination peripheral blood , mortality affected splenectomy spleen preserving operations mortality splenectomized animals 18 , compared 42 sham operated controls \( difference significant \) immunization protected animals development leukopenia , led enhanced bacterial elimination , significantly decreased mortality 5 , compared 48 nonimmune animals thus data show significant effects splenectomy subsets porcine mononuclear cells resistance experimental pneumococcal septicemia
epidural spine case report epidural spine reported rarely past decades case surgically treated epidural thoracic spine 76 year old women presented
factors affecting outcome meningococcal infections prognostic score evaluating meningococcal infections patients consists following five features indicate poor prognosis onset within 12 hours presentation shock normal low peripheral leukocyte count normal low erythrocyte sedimentation rate absence meningitis based experience published data , suspected score may longer reliable reviewed charts 73 children meningococcal infection december 19 , 1979 december 19 , 1987 applied prognostic score mentioned previously findings indicate although low score generally associated good outcome , higher score less predictive poor outcome previously suggested rash purpura , presence shock , normal low peripheral leukocyte count continue predictors poor outcome erythrocyte sedimentation rate evaluated owing limited amount data absence meningitis correlate worse outcome patients patients died evidence meningeal involvement time presentation instead , altered mental status presentation , particularly coma , ominous sign conclude absence meningitis good predictor outcome , previously thought altered mental status time presentation may prove stronger indicator poor outcome
antibody responses four haemophilus influenzae type b conjugate vaccines serum antibody responses four haemophilus influenzae type b capsular polysaccharide protein conjugate vaccines \( prp , hboc , , prp \) studied compared 175 infants , 85 adults 140 2 year old children antibodies h influenzae type b polysaccharide vaccines determined type radioimmunoassay infants received two doses vaccine ages 4 6 months first dose vaccine , geometric mean antibody concentration measured age 6 months 0 09 0 10 mg l , marginally higher measured immunization infants received prp , hboc , increased 0 82 mg l received prp one month second dose , geometric mean antibody concentration increased vaccine groups significant differences noted recipients hboc , , prp \( geometric mean antibody concentrations , 4 32 , 3 10 , 6 10 mg l , respectively \) , whereas prp recipients significantly lower geometric mean antibody concentration \( 0 63 mg l \) contrast , prp , hboc , , prp highly immunogenic adults , differences noted among 2 year old children also responded one dose vaccines high antibody concentration
efficacy short courses oral rifampin eradicating carrier state methicillin resistant staphylococcus aureus vitro killing studies clinical isolates methicillin resistant staphylococcus aureus \( mrsa \) important nosocomial infection problem colonization appears common invasive disease eradication colonization carrier state could limit spread mrsa , thus reducing potential mortality morbidity patients detection patients mrsa infection rehabilitation ward led study combination rifampin vivo vitro found 300 mg rifampin plus 500 mg orally twice daily 5 days , 18 courses treatment given 12 patients , resulted clearing mrsa 79 evaluable courses 81 evaluable sites second course cleared mrsa one patients treatment failure side effects noted 18 isolates susceptible either drug vitro , 1 2 isolates rifampin resistant timed kill studies demonstrated rate killing either drug alone drugs together isolates treatment successes failure killed rate drug combination however , rifampin resistant isolate killing ceased 48 h results study suggest previously untreated patients likely isolates susceptible combination drugs combination commonly effective eradicating mrsa carriage since regimen orally administered , thus convenient , conjunction measures promise reducing spread mrsa hospitals
ampicillin resistant species acute care hospital prospective review isolates 13 months showed 9 0 resistant ampicillin \( mic , greater equal 16 micrograms ml zone diameter , less 15 mm \) , determined system , disk diffusion , mic testing , mic testing beta lactamase negative total 19 3 resistant isolates urine intravascular sites , respectively ampicillin resistant appear growing clinical problem
endogenous colonization gentamicin resistant gram negative \( 3 \) 5 acetyltransferase members family 3 5 acetyltransferase \( 3 \) 5 caused nosocomial outbreak university medical center persisted see whether gene \( 3 \) 5 present community , stool cultures newly admitted patients ambulatory persons examined specific gene probe \( 3 \) 5 positive strains present intestinal flora examined
increasing resistance staphylococcus aureus ciprofloxacin demonstrated marked emergence resistance ciprofloxacin among staphylococcus strains isolated ann veterans administration medical center aureus isolates tested 1984 1985 susceptible , whereas 55 1 methicillin resistant 2 5 methicillin susceptible strains 1989 high level resistance ciprofloxacin
prevalence chlamydia trachomatis infection women cervical smear tests objective determine prevalence sexually transmitted diseases patients normal abnormal cervical smears design prospective study asymptomatic women normal cervical smears attending general practitioner newly referred patients abnormal smears attending colposcopy clinic setting hospital based colposcopy clinic urban general practice \( list size \) north west glasgow subjects 197 asymptomatic women attending general practitioner cervical smear tests 101 randomly selected patients attending colposcopy clinic investigation abnormal smears main outcome measures presence various sexually transmitted infections determined culture serological tests results 101 women cytological abnormalities , six current chlamydial infection proved culture none gonococcal infection 197 women normal smears , 24 \( 12 \) chlamydial infection two serological studies chlamydia trachomatis specific antibody also indicated large proportion patients exposed agent groups significant difference groups prevalence sexually transmitted disease studied conclusion high prevalence chlamydial infection present women north west glasgow irrespective cervical cytological state
reversible decrease oxygen consumption hyperoxia hemodynamic metabolic effects 90 minutes normobaric hyperoxia studied 20 critically ill patients \( 11 septic , 9 nonseptic \) requiring mechanical ventilation inspired o2 fraction \( fio2 \) less 0 40 thirty minutes increasing fio2 1 0 , arterial po2 increased 100 400 mm hg , whole body oxygen uptake \( vo2 \) decreased 10 percent \( p less 0 05 \) due 18 percent decrease o2 extraction ratio subsequent 60 minutes hyperoxia , significant change vo2 cardiac index change hyperoxia , increased 10 percent \( p less 0 05 \) recovery systemic vascular resistance decreased vo2 returned baseline 30 minutes recovery original fio2 due increased o2 extraction well increased cardiac output decrease vo2 without decrease o2 delivery may reflect blood flow functional o2 shunting protect tissue high po2 brief oxygenation advisable periods , present data suggest ventilation patients already adequate o2 delivery
serologic diagnosis human using two canis isolates canis closely related organism implicated serologically morphologically causative agent human united states although e canis serially primary canine monocytes , limited quantity antigen obtained method continuous canine macrophage cell line , , supports growth new isolate e canis established whole blood carrier dog serologic comparison isolate continuous canine cell line florida isolate commercial antigen slides revealed 100 specificity 87 5 sensitivity
clinical disease , drug susceptibility , biochemical patterns third complex mycobacterium previous studies mycobacterium identified isolates fit two recognized eighty five clinical isolates group , third complex , evaluated represented 16 410 isolates submitted texas laboratory 22 45 isolates , australia infections \( 76 \) involved skin , soft tissue , bone occurred metal puncture wounds open fractures isolates differed resistance acid use inositol carbon sources two subgroups present , examples deposited american type culture collection isolates resistant doxycycline one third resistant cefoxitin susceptible , ciprofloxacin , sulfamethoxazole , imipenem surgical debridement combined drug therapy based vitro susceptibilities resulted cutaneous disease osteomyelitis dna homology studies needed determine status organisms
urinary glycolipid 1 diagnosis management leprosy simplified assay measure glycolipid 1 \( 1 \) mycobacterium leprae urine applied diagnosis leprosy monitoring chemotherapy one hundred seventy nine previously untreated patients 25 normal controls tested specificity assay 100 false positive results sensitivity assay varied type leprosy 92 lepromatous leprosy 56 borderline lepromatous 18 borderline patients onset chemotherapy lepromatous leprosy patients , often transient increase urinary 1 , followed steady decline within 3 months multiple drug therapy , urinary 1 levels reduced 90 99 often undetectable assay appears considerable potential monitoring chemotherapy detecting treatment failure relapse patients hansen 's disease
promising investigation data available antifungal use four countries 14 different indians countries employ exudate similar purposes three five methods investigation proposed 1976 employed research furthermore , present authors successfully employed antifungal treatment given deep fungal infections skin often considered incurable medications currently use , laboratory analysis resin undertaken soon possible
issues cerebrospinal fluid management csf disease research laboratory testing three policies decreasing unnecessary cerebrospinal fluid \( csf \) management disease research laboratory \( vdrl \) tests compared first policy attempted educate physicians use serologic tests diagnosing allowed csf vdrl performed either screening test retrospective test second policy required csf vdrl performed retrospective test without regard patient 's serologic status third policy required patient seropositive either rapid plasma \( \) fluorescent antibody absorbance \( \) csf vdrl could performed policies instituted , vdrl testing performed 18 2 csf samples required retrospective policies decreased csf vdrl rate 13 0 8 5 , respectively , percentages seropositive patients procedures performed 7 3 12 9 third policy decreased csf vdrl test rate 1 8 \( p less 0 001 \) seropositivity improving 90 assure serologic tests obtained evaluation , requirement seropositivity must implemented use retrospective csf vdrl testing
issues cerebrospinal fluid management acid fast bacillus smear culture meningeal tuberculosis uncommon disease united states annual incidence fewer 200 cases study evaluates three approaches improving use cerebrospinal \( csf \) acid fast bacillus \( afb \) smear culture procedure \( 1 \) education alone \( 2 \) screening physicians select afb analysis stopped initial csf findings unremarkable \( 3 \) mandatory screening performance csf afb analyses education alone , csf afb culture rate decreased 20 6 csf 15 7 \( p less 0 001 \) however , effect may related decrease types afb testing screening impact afb testing rate mandatory screening significantly decreased csf afb rate 6 7 \( p less 0 001 \) , unrelated changes types afb testing laboratories employ mandatory screening report screening results immediately mechanism whereby physicians bypass screen , providing csf afb analysis unremarkable fluid high risk patients
closed suction drainage following knee arthroplasty effectiveness risks prospective investigation performed determine remove suction drain following total knee arthroplasty \( tka \) forty one randomly allocated closed suction drainage either 24 48 hours drain removed tip cut processed method giving quantitative cultures 48 hour group , 85 total volume drained first 24 hours following 24 hour period , mean volume 50 ml drained organism isolated cultures drain tips sampled 24 hours however , 48 hours , 25 drain tips yielded light negative staphylococci \( four drain tips \) staphylococcus aureus \( one drain tip \) clinical evaluations wound healing comparable two groups clearly , nothing gained continuing drainage beyond 24 hours drainage maintained longer periods , increased risk contamination bacteria
office laboratory areas medicine experiencing tremendous growth office based laboratory recent advances technology changes reimbursement practices greatly expanded potential segment patient care 1990s physician opportunity introduce many testing procedures office laboratory available 20 years ago requirements areas quality assurance quality control constantly changing regulations vary state state laboratory know required respective today 's market , physician must choose referral laboratory resources office consider option provides best care cost patient
antibiotics infectious diseases selection antibiotics clinical practice become increasingly complex patients underlying infection , greater variety microorganisms varying antibiotic resistance patterns cause infections , antibiotics available treat pathogens practical approach antibiotic decision making involves comparing advantages disadvantages group antibiotics available patient population treated common pathogens encountered one 's practice helpful study penicillin derivatives approximately chronologic order development cephalosporins terms generations use individual agent perspective familiarity commonly encountered adverse antibiotic reactions , dosage guidelines , special situations \( pregnancy , pediatric patients \) help avoid problems associated antibiotic use finally , one useful references hand aid resolving questions antibiotic use
infectious skin diseases descriptions individual diseases , including impetigo , fever , toxic shock syndrome , presented context specific organisms cause used show diseases testing treatment information diseases included
antibiotics common infections elderly decline host defense mechanisms concurrent diseases combine make elderly patient particularly susceptible common infections bacterial cause antimicrobial sensitivity patterns may also different elderly appropriate selection dosing antibiotics elderly patients common infections pneumonia , bronchitis , urinary tract infections , skin soft tissue infections optimize patient 's response minimizing adverse consequences
activities vancomycin vitro experimental infection efficacies vancomycin experimental staphylococcus aureus infection mice related activities vitro pharmacokinetic profiles vitro higher intrinsic activity vancomycin also favorable pharmacokinetic profile , resulting higher peak concentrations plasma , longer elimination half life , larger area concentration time curve vancomycin predict antibacterial efficacies drugs vivo basis activities vitro pharmacokinetics , mathematical model applied model vitro effect expressed difference growth rate control cultures presence antibiotic \( er \) , vivo effect expressed difference numbers cfu control antibiotic treated animals \( en \) integral er time , , calculated using concentrations found vivo significant linear relationship found en different dosages times \( 4 h \) drug administration well doses consecutive times , although lowest doses observed effect less predicted effect
pharmacokinetics tissue penetration single dose \( 1 , 000 intravenously \) antibiotic prophylaxis colorectal surgery levels serum tissue penetration studied single intravenous injection 1 , 000 mg given 14 patients prophylaxis surgical infection scheduled elective colorectal surgery adequate levels blood \( greater equal mic 90 bacteroides strains tested \) found patients throughout procedure hour 24 mean maximal \( 15 min \) last determined \( 24 h \) levels serum 24 5 2 6 3 1 4 mg liter , respectively beta phase elimination half life 14 1 2 7 h , clearance apparent volume distribution 47 12 ml min 0 9 0 13 liters kg , respectively patient , adequate levels tissue found abdominal wall fat time incision colonic wall time anastomosis time closure , one patient adequate levels tissue abdominal wall fat anaerobic aerobic infection occurred study patients
comparative study effects four cephalosporins escherichia coli vitro vivo thigh muscle infection induced escherichia coli irradiated mice used model compare vivo pharmacodynamics antibacterial effect four cephalosporins \( e , cefepime , ceftriaxone , ceftazidime , \) vitro antibacterial pharmacodynamics drugs following vitro pharmacodynamic parameters determined maximum effect measure efficacy , 50 effective concentration parameter potency , slope concentration effect relationship analysis vivo antibacterial pharmacodynamics , parameters applied dose instead concentration detection relationship concentration antibacterial effect vivo , determined pharmacokinetics four cephalosporins plasma mice results showed , general , direct relationship vivo vitro pharmacodynamics cephalosporins maximum effects cefepime , ceftazidime , approximately similar vivo vitro sequence potency drugs , descending order , cefepime , ceftazidime , ceftriaxone differed three cephalosporins displayed unexpected vivo pharmacodynamics ceftriaxone efficacious three vitro , maximum effect vivo much lower relatively low maximum effect ceftriaxone vivo explained pharmacokinetic characteristics drug present results concluded vitro efficacy cephalosporins necessarily predictive value vivo efficacy
debridement pleural irrigation management empyema paper reporting good results obtained 12 patients empyema treated debridement irrigation department , subsequent experience 18 patients reported drainage irrigation resulted resolution improvement general condition patients overall , complete resolution obtained technique alone 60 \( 18 30 \) 12 patients complete resolution obtained , secondary surgical measures resulted resolution empyema 8 four patients died elderly severely , 3 advanced malignancy deaths related technique , well tolerated cases debridement irrigation used routinely first line measure empyema safe relatively procedure , exclude use subsequent surgical measure , provides valuable time improve condition patients may tolerate aggressive surgical procedures
successful treatment disseminated cutaneous inclusion disease associated hodgkin 's disease case disseminated cutaneous inclusion disease associated hodgkin 's disease described patient diffuse eruption , erosive erythematous nodules histologically , many inclusion bodies observed perivascular areas skin lesions immunohistologically , inclusion bodies positively stained antibody anti factor viii related antibody electron microscopy many virus particles dense bodies found area inclusion bodies observed treatment high dose intravenous acyclovir large amount immunoglobulin resulted prompt healing skin lesions subsequently , patient 's hodgkin 's disease well controlled chemotherapy patient steadily improved without relapse skin lesions 1 year antiviral therapy administered
cortisol response corticotropin survival septic shock corticotropin stimulation tests used assess adrenocortical function 32 patients septic shock 13 patients poor cortisol response \( rise less 250 nmol l \) corticotropin , died however , 6 deaths among 19 patients adequate responses \( p less 0 001 \) results suggest patients septic shock may relative adrenocortical insufficiency
case neonatal tetanus morbidity mortality neonatal tetanus preventable largely disease developing countries single case neonatal tetanus southern florida must serve indicator need health care professionals evaluate degree utilization maternal health services impact immunization programs women risk , case , women migrated developing countries
bacterial translocation gut impairs systemic immunity goal study determine influence bacterial translocation systemic immunity , since bacteria products play major role development maintenance host 's immune system test hypothesis , measured response mononuclear cells harvested blood , spleen , 's patches , mesenteric lymph nodes control escherichia coli mice battery mitogens e coli model used bacterial translocation model associated experimental manipulations likely affect systemic immune system mitogenic response lymphocytes isolated e coli mice significantly depressed compared control groups \( p less 0 01 \) since biologic significance depressed vitro mitogen responsiveness difficult determine , assessed ability mice control bacterial challenge using vivo staphylococcus aureus abscess model appears observed changes mitogen responsiveness may biologic significance , since ability e coli mice control injected aureus impaired \( p less 0 01 \) results suggest association exists bacterial translocation decreased systemic immune responsiveness
cephalosporins rationale clinical use cephalosporins , widely used class antibiotics , resistant inactivation beta based spectrum activity gram negative bacteria , cephalosporins classified three generations generation classification , however , correlate activity gram positive bacteria first generation cephalosporins narrow gram negative spectrum active gram positive bacteria , particularly staphylococcus aureus third generation compounds excellent activity gram negative bacteria , second generation subgroup includes cefoxitin , cefmetazole , best activity
empiric antibiotic selection physicians evaluation reasoning strategies objectives study evaluate appropriateness empiric antibiotic selection treating medical patients bacteremia design prospective , observational study university affiliated hospital seventy eight patients bacteremia evaluated clinical grade acceptable acceptable assigned antibiotic prescription consensus panel consensus panel found 34 6 antibiotic unacceptable \( clinical grade \) least one chain reasoning found 56 4 78 cases evaluated assessment clinical setting correct 94 9 cases portal entry identified 91 adequate knowledge bacterial flora suspected site infection found 69 diagnostic workup appropriate 81 , correct antibiotic susceptibility patterns given 72 correct chain reasoning likely result acceptable clinical grade reasoning \( p less 0 005 \) however , appropriate antibiotic selection made physicians despite reasoning , inappropriate antibiotic selection occurred cases despite reasoning 3 8 cases , unexpected organisms appeared blood culture prescription broad spectrum antibiotics may learned response , educational efforts emphasize narrow , rather broad spectrum prescribing may inadequate change physician prescribing habits
assessment platelet antibody flow cytometric elisa techniques comparison study two different methods evaluating platelet antibody used study 12 normal subjects 24 patients consisting primarily intravenous drug users \( ivdus \) positive human immunodeficiency virus \( hiv \) total platelet associated immunoglobulin g \( igg \) immunoglobulin \( igm \) measured enzyme lined immunosorbent assay platelet lysate , platelet surface associated igg igm measured semiquantitative flow cytometry igg igm values showed significant correlations two measurement methods mean platelet surface igg total igg 3 6 4 3 times greater , respectively , ivdus controls , platelet igm also significantly higher ivdus controls measured techniques although mean platelet immunoglobulin levels higher ivdus thrombocytopenia ivdus normal platelet counts , differences achieve significance data show platelet igg igm levels increased associated hiv infection suggest increases confined patients thrombocytopenia herein described platelet surface antibody total platelet antibody measurements appear equally useful studying patient population specific details generating platelet associated immunofluorescence units discussed
report eight hiv seropositive patients major depression responding fluoxetine pilot study examined effectiveness fluoxetine depressed human immunodeficiency virus \( hiv \) seropositive asymptomatic patients eight patients , participating azt trial met criteria major depression syndrome \( dsm iii r \) , treated fluoxetine \( 20 40 mg day \) 4 weeks initially , mean hamilton depression scores 23 8 \( range 17 31 \) , improved 6 4 \( range 3 10 \) subjects maintained remission 2 month follow fluoxetine treatment may effective treating major depression hiv seropositive asymptomatic patients
antibody persistence children high dose measles vaccine measles antibody concentrations children 4 months age high dose \( \) measles vaccine 9 months conventional vaccine measured 5 months vaccination , 18 36 months age vaccinees produced , average , 2 4 fold higher concentration measles inhibiting \( \) antibody vaccinees , 36 months age 82 93 \( 88 \) vaccinees 83 87 \( 95 \) vaccinees measles plaque antibody concentrations assumed protective level 200 ml \( p greater 0 1 \) antibody concentrations 5 months vaccination inversely related presence maternal antibody vaccination , protective levels 18 36 months age relation antibody concentration vaccination , decay antibody 18 36 months age similar vaccinees
oral pharyngeal herpes simplex virus infection allogeneic bone marrow transplantation analysis factors associated infection study analyzed factors associated acute oropharyngeal herpes simplex virus \( hsv \) infection patients undergone allogeneic bone marrow transplantation leukemia , lymphoma , aplastic anemia hsv infection developed 233 \( 37 \) patients two seropositive hsv transplant sixty two percent seropositive patients least one episode hsv reactivation first 100 days transplant factors placed patients increased risk hsv infection pretransplant diagnosis leukemia , remission time transplant , conditioned transplant chemoradiotherapy recognition factors may predispose patients hsv infection helps determine transplant recipients might benefit antiviral prophylaxis approaches prevention hsv reactivation
evidence susceptibility cell precursors progeny carrying cell antigen receptor phenotypes tcr alpha beta tcr gamma delta human immunodeficiency virus infection mechanism cd4 \( t4 \) lymphocyte depletion individuals infected human immunodeficiency virus type 1 \( hiv 1 \) demonstrate progressive depletion qualitative dysfunction helper t4 \( cd4 \) cell population mechanisms proposed cd4 cells include direct mature cells following infection well infection early lymphocyte progenitors latter mechanism could lead failure mature functioning cd4 cells present study determines susceptibility thymocytes various stages maturity infection hiv 1 various normal thymocyte populations inoculated hiv 1 , including unfractionated \( uf \) , cd3 cd4 cd8 triple negative \( tn \) , cd4 cd8 double positive \( dp \) thymocytes , thymocyte populations obtained limited dilution cloning cultures studied presence hiv 1 dna polymerase chain reaction addition examination reverse transcriptase activity determined transformed cell thymocyte cell lines completely lacking cd4 susceptible infection hiv 1 , whereas following lines uf thymocytes \( 70 90 cd4hi \) dp thymocytes \( 99 cd4hi \) tn thymocytes \( 0 cd4hi \) tcr alpha beta , tcr gamma delta , cd16 cd3 \( natural killer \) thymocyte clones expressing variable levels cd4 representing progeny tn thymocytes tcr alpha beta tcr gamma delta refer chains cell antigen receptor \( tcr \) , cd4hi strong rightward shift \( greater 30 linear channels \) cd4 curve flow cytometric analysis compared control monoclonal antibodies \( mabs \) cd4 \( epitope \) cd3 \( t3 \) capable blocking infection mature immature cd4hi thymocytes moreover , anti cd4 \( \) mabs also inhibited infection cd4hi tn thymocytes , indicating cell precursors despite apparent triple \( cd3 cd4hi cd8 \) expressed sufficient cd4 molecules become infected cell analysis panel cd4 mabs demonstrated mean shift mean fluorescence channel \( \) cd4 mabs tn thymocytes 6 4 units thus , cell precursors progeny representing many stages cell ontogeny susceptible infection hiv 1 , including early tn thymocytes , express low levels cd4 infection multiple stages multiple subsets cell lineage man , mediated via cd4 molecule , may explain inability cell pool setting progressive hiv infection
subacute sclerosing panencephalitis black children review 18 cases despite fact measles severe presents young black children , south africa , case subacute sclerosing panencephalitis reported region prior 1982 retrospective study therefore made six year period 1982 1987 18 patients presented king viii teaching hospital , , clinical laboratory features subacute sclerosing panencephalitis majority patients \( 66 per cent \) 8 12 years age mean age onset 9 3 years , youngest patient four years nine months oldest 14 years male female ratio 1 25 1 previous history primary measles infection obtained 44 4 per cent cases 62 5 per cent occurred second commonest mode presentation personality , intellectual behaviour disorders \( 83 per cent \) followed seizures \( 61 per cent \) movements \( 28 per cent \) measles antibody present csf cases eeg abnormal recorded cases periodic complexes found 56 2 per cent confirmation diagnosis provided brain biopsy two cases necropsy one case findings study suggest subacute sclerosing panencephalitis may uncommon black children hitherto thought
preliminary report protection macaques simian immunodeficiency virus fixed infected cell vaccine macaques vaccinated inactivated simian immunodeficiency virus infected cells a' adjuvant 0 , 4 , 8 , 36 weeks 0 , 4 , 8 , 16 weeks 2 weeks later animals , together similar group , challenged 10 \( 50 monkey infectious doses \) pool previously titrated vivo virus repeatedly isolated animals least five separate occasions proviral dna detected circulating lymphocytes polymerase chain reaction amplification contrast , virus proviral dna found vaccinated animals however , vaccination regimen used live virus challenge eliminate virus previously infected macaques
safety immunogenicity human immunodeficiency virus type 1 \( hiv 1 \) recombinant candidate vaccine humans aids vaccine clinical trials network objective evaluate safety immunogenicity human immunodeficiency virus type 1 \( hiv 1 \) recombinant envelope glycoprotein \( 160 \) candidate vaccine humans subjects healthy adults \( 72 \) seronegative hiv 1 randomly assigned one four groups interventions subjects randomly assigned receive 40 80 micrograms 160 , 10 micrograms hepatitis b vaccine , placebo three doses \( days 0 , 30 , 180 \) , elective , administration fourth dose day 540 measurements main results neither clinical laboratory toxicity encountered follow period exceeding 21 months effect immunization noted lymphocyte counts , mitogenic responses , delayed type hypersensitivity serum antibody responses hiv envelope proteins detected western blot seen 30 33 subjects \( 91 95 ci , 71 97 \) receiving either 40 80 micrograms doses commonly weakly reactive intensity responses first noted western blot second dose markedly increased frequency third dose declined next 12 18 months administration fourth dose resulted homologous neutralizing activity sera 5 24 subjects \( 21 ci , 7 37 \) well complement mediated antibody dependent enhancement sera 6 24 subjects \( 25 ci , 10 42 \) antibody responses detected enzyme linked immunosorbent assay \( elisa \) less frequently western blot , responses persisted shorter time conclusions administration well tolerated safe , resulted high rate antibody response western blot administration third fourth doses , generated serum neutralizing activity complement mediated antibody dependent enhancement subjects fourth dose
abnormal function cd4 helper inducer lymphocytes patient widespread human papillomavirus type 3 related infection human papillomavirus induced infections may associated cellular immunodeficiency however , little known interactions among lymphocytes , b lymphocytes , antigen presenting cells 30 year old heterosexual man 10 year history persistent multiple refractory flat lesions containing human papillomavirus type 3 related dna sequence studied patient severe depletion cd4 lymphocytes compensatory increase number cd8 lymphocytes impaired lymphocyte response various stimuli found depletion increased number cd8 lymphocytes , suppressed immunoglobulin production vitro , restore impaired lymphocyte response immobilized anti cd3 beads stimulate lymphocyte antigen complex absence antigen presenting cells indicated lymphocyte defect , rather decreased antigen presenting cell function thus , pronounced cellular immunodeficiency due abnormal function cd4 helper inducer lymphocytes
antibody dependent cellular cytotoxicity hiv coated target cells peripheral blood monocytes hiv seropositive asymptomatic patients cytotoxic effector cells like cytotoxic cells , nk cells , monocytes macrophages , neutrophils lyse directly hiv infected hiv coated cells absence presence anti hiv antibodies therefore , cytotoxic mechanisms either control hiv infection early stages disease generalized immunosuppression observed later stages disease relationship anti hiv effector mechanisms disease , however , remains present study hiv seropositive asymptomatic patients peripheral blood monocytes \( pbm \) mediated antibody dependent cellular cytotoxicity \( adcc \) hiv coated target cells presence heterologous autologous anti hiv serum test specific adcc hiv ag , t4 cem tr line resistant tnf macrophage mediated cytotoxicity selected vitro adcc performed 18 h 51cr release assay using cem tr cells coated inactivated hiv unlike pbm normal controls , significant adcc observed pbm hiv seropositive patients presence pooled hiv antiserum adcc activity specific hiv dependent e ratio antiserum dilution used upon activation pbm rifn gamma , normal hiv pbm mediated adcc hiv coated cem tr furthermore , adcc activity pbm hiv seropositive patients presence autologous serum examined significant adcc activity observed dependent e ratio serum dilution used findings demonstrating anti hiv adcc activity pbm hiv seropositive individuals autologous sera support notion monocyte mediated adcc may operative vivo
long term combined rifn alpha 2a zidovudine therapy hiv associated kaposi 's sarcoma clinical consequences side effects interferon alpha \( ifn alpha \) shown effective treating hiv associated ks least 30 patients , zidovudine proved beneficial aids patients moreover , drugs demonstrated inhibitory effect hiv replication based , combined ifn alpha zidovudine treatment hiv associated ks order evaluate tolerance clinical efficacy twenty one homosexual men histologically proved hiv associated ks treated open trial rifn alpha 2a 18 x 10 \( 6 \) iu every second day zidovudine 800 1200 mg treatment discontinued within first month six patients three developed subjective intolerance , three others contracted severe opportunistic infections hiv fifteen evaluable patients received combination treatment period 2 20 months \( average 10 months \) dosage reduced required based drug induced cytotoxicity complete remission observed four patients , partial remission three , stable disease two , progression six , resulting overall response rate 46 negative p24 expression prior treatment positive predictor although extracutaneous involvement negative influence tumor remission , even patients mean initial helper cell count 100 mm3 responded positively conclusion , combination therapy rifn alpha 2a azt may effectively control hiv related kaposi 's sarcoma 40 patients contrast monotherapy ifn alpha , patients severely reduced immune systems also benefit combined treatment
biologic effects interferons one review articles ifn published 1967 would become apparent virtually none held still valid today whereas ifn long considered specific antiviral substance without effect normal cellular metabolism , accept today affects normal cell division many specialized cellular functions respect unique ifn prototype family similar substances called cytokines appear function regulatory molecules held production ifn constituted specific response viral infection today believe ifn integral part cytokine network cytokines may produced constitutively low levels substances exert multiple effects virtually cells play important role host defense viral parasitic infections , resistance experimental tumors ifn shown exert effects immune system lymphocyte circulation , biologic effects , may even contribute pathogenesis certain diseases thus , large amounts ifn administered induced newborn mice cause liver , kidney , pulmonary disease field ifn cytokine research continues expand increasing number therapeutic applications twenty years , scientists clinicians may understood little ifn act used treat disease
mucosal immunity induced enhance potency inactivated oral polio vaccines oral polio vaccine \( opv \) recommended routine immunization united states part ability induce intestinal pharyngeal immunity mucosal immunity produced opv enhanced potency inactivated polio vaccine \( e ipv \) compared challenging vaccines type 1 opv fewer opv \( 25 \) e ipv \( 63 \) vaccinees excreted opv virus stool challenge mean stool virus titer higher duration longer among e ipv one e ipv three opv vaccinees shed virus pharynx challenge prechallenge serum neutralizing antibody levels statistically different among e ipv vaccinees shed virus levels much higher opv vaccinees poliovirus specific iga levels stool correlate viral excretion e ipv less effective opv preventing limiting intestinal infection , even though induced higher serum antibody levels
measles among comparative study measles severity primary secondary cases households outbreak measles among predominantly susceptible population county , pennsylvania , offered opportunity test hypothesis secondary cases households severe primary cases former intense exposure receive greater virus inoculum 130 measles cases reported april june 1988 , 119 \( 92 \) constituted study disease severity severity assessed determining frequency duration symptoms , length hospitalization , number days bed univariate analysis , fewer secondary cases \( relative risk rr , 0 67 95 confidence interval ci , 0 48 0 96 \) headache \( rr , 0 37 ci , 0 15 0 86 \) , \( rr , 9 69 ci , 1 8 202 9 \) compared primary cases secondary cases shorter mean duration \( 4 0 vs 5 0 days , student 's test , p 08 \) however , logistic regression model matched family controlled age sex indicated significant differences measles severity among primary secondary cases households
use brain biopsy diagnostic evaluation patients suspected herpes simplex encephalitis statistical model clinical implications collaborative antiviral study group using decision analysis technique multivariate regression methods , statistical model established define utility brain biopsy diagnostic evaluation patients suspected herpes simplex encephalitis \( \) two strategies compared strategy , brain biopsy acyclovir \( \) treatment 10 days biopsy positive patients , strategy ii , therapy without brain biopsy strategy resulted greater 6 month survival rate likelihood patients less 70 based current estimated prevalence \( patients suspected \) 35 , strategy showed slight advantage 3 2 increase 6 month survival rate individual patient 's chance positive brain biopsy predicted using mathematical equation based several important clinical assessments equation conjunction decision analysis useful guide clinical management patients regard brain biopsy
role secretory immunity hepatitis virus infection role intestinal immunity remains uncertain hepatitis , samples feces saliva infected primates humans tested virus neutralizing activity two eight monkeys infected intragastric route developed neutralizing antibody detectable extracts feces collected 88 days viral challenge , although serum neutralizing antibody present monkeys day 33 similarly , neutralizing antibody detected fecal extracts none three experimentally infected human volunteers 1 15 naturally infected humans single positive human specimen contained occult blood 2 19 saliva samples naturally infected humans significant viral neutralizing activity contrast , neutralizing antibody type 2 poliovirus present human fecal saliva specimens tested data suggest intestinal immunity play significant role protection hepatitis
unexplained rabies three immigrants united states investigation background extensive investigation three patients died rabies united states failed reveal source exposure disease three patients united states areas , philippines , mexico rabies endemic methods studied rabies viruses isolated three patients , patients known source exposure , animals united states , \( proxy \) , philippines , mexico viruses characterized indirect immunofluorescence neutralization tests according reactions panels monoclonal antibodies transcribed complementary dna isolates amplified polymerase chain reaction dna product analyzed differential digestion restriction enzymes results viral isolate three patients rabies variant distinctive antigenic genetic characteristics three isolates , identical variants found specimens animals obtained near country patient lived united states none variants found among isolates collected animals united states conclusions rabies infection three patients originate united states resulted exposures , philippines , mexico since three patients lived united states 4 years , 6 years , 11 months , findings suggest onset clinical manifestations rabies occurred long incubation periods
antibodies hiv 1 nef \( p27 \) prevalence , significance , relationship seroconversion sensitive specific enzyme linked immunoassay antibodies human immunodeficiency virus type 1 \( hiv 1 \) nef gene product , p27 , developed using recombinant escherichia coli derived protein 1 sequence 92 hiv 1 infected , 72 \( 78 \) produced anti nef antibodies assay early appearance anti nef prior full seroconversion rare event population , occurring one subject \( approximately 1 \) anti nef antibodies detected 500 sera 98 repeatedly hiv seronegative subjects exposed sexually transmitted modes hiv infection \( 45 subjects \) blood products \( 53 subjects \) significant association titer anti nef antibody protection disease hiv infection \( p 0 1 \) although nef protein relatively immunogenic natural infection , study cannot confirm previously reported high prevalence anti nef antibodies prior seroconversion , finding anti nef antibodies hiv seronegative exposed subjects
rapid diagnosis herpes simplex encephalitis polymerase chain reaction assay cerebrospinal fluid aim improving early diagnosis herpes simplex encephalitis polymerase chain reaction \( pcr \) assay two primer pairs developed amplification herpes simplex virus dna cerebrospinal fluid \( csf \) southern blotting used confirm specificity amplification assay applied 151 csf samples 43 consecutive patients herpes simplex encephalitis verified finding herpes simplex virus viral antigen brain biopsy sample necropsy \( 13 \) intrathecal production igg antibody virus \( 40 \) controls , 87 csf samples 60 patients acute febrile focal encephalopathy \( initially suspected herpes simplex encephalitis excluded absence intrathecal antibody synthesis \) tested pcr detected herpes simplex virus dna 42 43 patients proven herpes simplex encephalitis 1 positive first csf sample taken 1 pcr negative patient treated acyclovir 20 h onset symptoms control subjects pcr negative , 270 internal contamination controls pcr result remained positive samples drawn 27 days onset neurological symptoms method rapid non invasive means diagnose herpes simplex encephalitis highly sensitive specific
antiviral drug therapy major advances molecular led development new antiviral compounds drugs include , used treatment severe respiratory syncytial virus infection children , used prophylaxis treatment influenza infection acyclovir , used variety infections , including primary , genital herpes herpes zoster ganciclovir , used treatment retinitis due cytomegalovirus , zidovudine , used prophylaxis treatment human immunodeficiency virus infection
detection salivary hiv 1 specific igg antibodies high risk populations zaire saliva blood samples tested human immunodeficiency virus 1 \( hiv 1 \) antibodies two high risk populations , zaire seroprevalence study sexually transmitted disease \( std \) clinic , 142 145 seropositive individuals enzyme linked immunosorbent assay \( elisa \) positive saliva samples \( 97 9 sensitivity \) saliva samples seronegative patients elisa negative \( 100 specificity \) 142 elisa positive saliva specimens , 137 also western blot positive \( 94 5 sensitivity \) subsequent study 315 initially seronegative female prostitutes followed 183 woman years observation , 9 14 women seroconverted \( 7 7 \) elisa positive saliva samples time seroconversion detected three saliva specimens could confirmed western blot although salivary testing hiv 1 antibodies using conventional assays sensitive detecting recent , screening salivary samples hiv 1 antibody provides convenient alternative method conducting seroprevalence surveys populations venipuncture possible convenient
clinical manifestations primary herpes simplex virus type 1 infection closed community clinical features molecular epidemiology primary herpes simplex virus type 1 \( hsv 1 \) infection among children younger 3 years age investigated day care serial sera assayed anti hsv 1 glycoprotein b antibody enzyme linked immunosorbent assay serologic examinations revealed 55 cases primary hsv infection observation period fifty one \( 93 \) typical , showing high rate clinically overt infection four outbreaks observed observation period forty one children infected hsv 1 outbreaks rates infection susceptible children 81 , 73 , 78 , 100 , respectively , four outbreaks restriction endonuclease analysis dna isolated hsv revealed one strain hsv 1 transmitted among children long period
vaccination disease recombinant virus vaccines express limited number epitopes currently developed prevent disease changing relative balance viral spread immune response circumstances , however , found infections virus vaccination caused disease sensitive parameters included genetic background host , time dose infection , constituents vaccine thus , immunopathologic damage cells may consequence vaccination new types peptide recombinant vaccines investigated human immunodeficiency viruses pathogens
effect anti neoplastic drugs murine acquired immunodeficiency syndrome murine acquired immunodeficiency syndrome \( \) associated proliferation target cells infected defective retrovirus control growth primary neoplasia , virus inoculated mice treated anti neoplastic drugs paradoxically , cyclophosphamide , also immunosuppressive , effective preventing appearance progression disease , restoring normal cell function , number infected target cells result suggests proliferating infected target cells responsible immunodeficiency
epidemiologic patterns wild type hepatitis virus determined genetic variation hepatitis virus \( hav \) isolates different parts world single serotype however , genetic analysis genome region published hav sequences suggested distinct genotypes hav could defined based upon geographic source original isolates process cell culture adaptation animal passage , 247 bp segment within genome region wild type hav amplified reverse transcription followed polymerase chain reaction amplification presence negative positive sense primers sequences obtained 22 distinct hav isolates , three genetic groups hav could delineated two groups differed 10 , third group differed isolates approximately 20 investigations indicate hav isolates different parts world differentiated genetically , facilitate studies epidemiologic transmission
genome analysis adenovirus type 31 strains immunocompromised immunocompetent patients adenovirus type 31 \( ad31 \) isolated 15 immunocompromised patients 12 seroconversion also recorded ad31 infection substantial clinical relevance since 8 10 lower respiratory tract infection 4 4 hepatitis died therefore , ad31 isolates immunocompetent immunodeficient hosts compared restriction endonuclease analysis nine genome types identified among 79 ad31 isolates pairwise comparison restriction fragments indicated genome types could divided three genomic clusters several ad31 genome types isolated immunocompromised patients , highly virulent genome type could found genome type identified child severe combined immunodeficiency originally infected another genome type observation suggested evolutionary implications
comparison protection influenza taiwan 86 \( \) attenuated inactivated vaccines 83 like viruses children \( n 192 \) aged 3 19 years 98 families completed double blind , placebo controlled study comparing efficacy attenuated \( cr \) vaccine inactivated \( ti \) vaccine vaccines contained 83 \( \) like antigens vaccination geometric mean titer taiwan 86 \( \) 1 36 cr group , 1 92 ti group , 1 5 placebo group influenza taiwan 86 \( \) epidemic , 21 4 cr recipients , 16 7 ti recipients , 43 9 placebo recipients infected influenza taiwan ti vaccine provided better protection cr vaccine children aged 10 18 years \( infection rate , 0 vs 24 , respectively p less 025 \) contrast , younger children \( 3 9 years \) , cr vaccine tended protective \( 19 vs 26 ti \)
antiidiotypic responses immunization anti leu 3a human immunodeficiency virus seropositive individuals anti idiotypic antibodies anti cd4 monoclonal antibodies \( mabs \) reported bind human immunodeficiency virus \( hiv \) envelope glycoprotein gp120 establish whether hiv infected patients anti idiotypic response murine mab , four individuals symptoms aids related complex \( arc \) immunized 10 weeks six intramuscular injections anti leu 3a \( 1 mg \) despite immunocompromised state , patients made anti constant region anti idiotypic antibodies , although amplitude responses varied individuals significant toxic allergic reactions seen , changes clinical status 6 months immunization increase serum hiv neutralization titers seen , purified anti idiotypic antibodies bind gp120
rats myelin basic protein without aid water oil induction experimental allergic encephalomyelitis \( eae \) purified myelin basic protein \( mbp \) , , required incorporation water oil emulsion adsorption particulate present work , absorption saline solution mbp peritoneal cavity mediastinal lymph nodes increased giving repeated rats peritoneal irritant conditions , adjuvant needed production eae aqueous pertussis vaccine injected separately hours one day mbp pertussis vaccine also necessary production eae intradermal injection aqueous mbp injecting aqueous mbp directly pre enlarged popliteal lymph nodes , possible produce eae without pertussis vaccine thus , eae induced rats using mbp without addition 's adjuvant pertussis vaccine
depression , distress , lymphocyte subsets , human immunodeficiency virus symptoms two occasions hiv positive homosexual men evaluated extent depressive disorders , psychiatric distress , psychosocial stressors related three measures human immunodeficiency virus \( hiv \) illness , cross 6 month period , community sample 124 hiv positive homosexual men dependent variables immune status measured cd4 cd8 cell subsets , number signs symptoms commonly associated hiv infection , cumulative index hiv illness stage focus cd4 cell count immune marker closely linked clinical consequences hiv infection found relationships independent variables immune status illness stage hiv positive men depressed reported life stressors greater immunosuppression advanced illness stage others , either concurrently across occasions find suggestive pattern association depressive disorders , distress , stressors number hiv related symptoms , warrants study
multidisciplinary baseline assessment homosexual men without human immunodeficiency virus infection overview study design although much known virus believed experts cause acquired immunodeficiency syndrome pathogenic actions , major areas remain among reasons varying time infection human immunodeficiency virus development acquired immunodeficiency syndrome , relationship neurologic medical aspects disease , time course neuropsychological findings , prevalence psychiatric morbidity assessed 124 homosexual men positive human immunodeficiency virus 84 negative virus article describe study design , method recruitment , medical demographic characteristics cohort , followed 5 years
effectiveness interventions reducing emotional distress human immunodeficiency virus antibody testing examine effectiveness three interventions reducing emotional distress voluntary serologic testing human immunodeficiency virus 1 , physically asymptomatic adults randomly assigned standard counseling , counseling plus three session interactive video program , counseling plus six individual sessions stress prevention training subjects evaluated using five standardized distress measures entry 3 months later among 204 human immunodeficiency virus seronegative subjects , mean distress measures decreased significantly three interventions without differential treatment effects among 103 human immunodeficiency virus seropositive subjects , mean distress measures decreased significantly stress prevention training significantly increase two interventions conclude stress prevention training particularly helpful notification human immunodeficiency virus seropositivity
family physicians test human papillomavirus infection \? view recent advances field molecular biology expanded knowledge hpv manifestations attempted separate circumstances hpv testing may useful patient management may routine screening hpv yet shown useful one must 10 patients potentially oncogenic virus ability repeat papanicolaou smear detect lesion hand , hpv detection setting abnormal papanicolaou smear lesion biopsy lacks histologic features predict high risk hpv typing affect clinical management , recommend hpv detection situ hybridization useful adjunct histological analysis genital tract lesions clinically suggestive hpv lesion histological analysis equivocal ability distinguish true hpv lesions mimics often crucial patient , given implications sexually transmitted disease
voluntary human immunodeficiency virus testing acceptance levels identification seropositive individuals clients clinic sexually transmitted diseases eligible voluntary , , serologic testing human immunodeficiency virus , \( 97 8 \) testing 23 \( 0 5 \) seropositive 94 persons declined voluntary testing tested blinded study , nine \( 9 6 \) seropositive seropositive persons declined voluntary testing association risk group , 61 seropositive individuals accepted voluntary testing admitted inclusion risk group test voluntary testing appears insufficient , 28 seropositive individuals identified seropositive also , significant deficiency associated identification risk pretest counseling among persons voluntary testing
bronchial hyperresponsiveness normal subjects attenuated influenza virus infection fourteen healthy male subjects hemagglutination inhibition antibody titers 1 8 less homologous influenza virus studied six subjects received live , attenuated influenza virus nasal drops aerosol although infection occurred six subjects , development 4 fold greater increases hemagglutination inhibition antibody titers , remained asymptomatic eight subjects received placebo via route , develop symptoms showed increase antibody titer prior administration virus placebo , histamine diphosphate aerosol increased airway resistance slightly , difference virus placebo groups two days inoculation , responses placebo group unchanged \( p greater 0 05 \) , virus infected group , responses significantly greater state \( p less 0 01 \) isoproterenol hydrochloride reversed prevented increase airway resistance histamine , suggesting bronchoconstriction caused smooth muscle contraction findings indicate transient , asymptomatic respiratory virus infection augments airway smooth muscle responses
induction cd4 , human lymphotropic virus type 1 specific cytotoxic lymphocytes patients ham tsp recognition immunogenic region gp46 envelope glycoprotein human lymphotropic virus type 1 although humoral response human lymphotropic virus type 1 \( htlv \) well characterized patients htlv associated neurologic disease \( ham tsp \) , little known functional htlv specific human cell response , ctl , patients define phenotype responding ctl fine specificity response , long term cell lines generated two ham tsp patients two different countries patient 's peripheral blood lymphocytes repeatedly stimulated vitro htlv expressing autologous cell line resultant long term cell culture shown cd4 cytotoxic targets expressing htlv ag using panel synthetic peptides span hydrophilic regions htlv gp46 envelope glycoprotein , ctl lines generated patients shown recognize region htlv envelope amino acids 196 209 defined synthetic peptide interestingly , sequence region htlv envelope also shown elicit strong b cell response ham tsp patients \( amino acids 190 203 \) one ctl line recognized htlv epitope context hla whereas ctl line restricted hla generation two independent ctl lines two ham tsp patients different geographic areas recognize region htlv envelope glycoprotein highlights immunogenic nature envelope region
htlv associated myelopathy associated blood transfusion united states epidemiologic molecular evidence linking donor recipient six months receiving 58 units blood components , 65 year old white man new york city , risk factors human lymphotropic virus type \( htlv \) infection , developed htlv associated myelopathy tropical spastic \( ham tsp \) investigation blood donors identified 25 year old white hispanic woman florida whose platelets given patient seropositive virus serum specimen obtained 2 years donation born 2 sexual relationships men either born resided polymerase chain reaction \( pcr \) studies peripheral blood mononuclear cells indicated donor recipient infected htlv molecular studies nucleotide sequence 5' envelope region htlv indicated viruses donor recipient identical 32 positions published htlv sequences demonstrate molecular heterogeneity donor recipient viruses also identical 2 additional positions differed published sequences transfusion associated ham tsp occurred united states , additional cases prevented screening blood donations htlv molecular studies htlv may prove useful defining genetic heterogeneity htlv isolates united states studying transmission virus
peptide induced antiviral protection cytotoxic cells specific antiviral cytotoxic immune response vivo could induced subcutaneous injection cell epitope lymphocytic virus \( \) unmodified free synthetic peptide \( arg pro gln ala ser gly val tyr met gly leu ala gln \) incomplete 's adjuvant immunization rendered mice specific protective state shown inhibition replication spleens mice protection level mice correlated ability respond peptide challenge cd8 virus specific cytotoxic cells direct demonstration peptide vaccines protective vivo , thus encouraging search appropriate mixtures stable peptides may used cell vaccines
influence inhaled cadmium immune response influenza virus cadmium may exacerbate pulmonary infections previous study , however , cadmium appeared enhance mouse resistance influenza pneumonia report herein influence cadmium intoxication mice different factors anti influenza immunity , e g , antibody response , local production interferon , pulmonary cellular response , interaction pulmonary alveolar macrophages influenza virus cadmium inhalation affect production antibodies interferon protective effect appeared related enhanced supply phagocytic cells lung
early specific diagnosis seropositivity enzyme linked immunosorbent assay using env derived synthetic peptides describe evaluate sensitivity specificity enzyme linked immunosorbent assay \( elisa \) using 22 amino acid peptide corresponding terminal end hiv 1 gp120 two 30 amino acid long cyclic peptides including two present hiv 1 gp41 hiv 2 gp36 test evaluated data obtained western blot \( wb \) peptide based elisa first panel composed sera patients attending specialized outpatient clinic \( high risk population \) perfect agreement moreover , 39 samples falsely found positive viral lysate based elisa detected peptide based elisa second panel composed 309 sera difficult resolve using wb viral lysate based elisa using peptide based elisa , 134 found clearly positive 173 clearly negative two falsely positive finally , sera 16 individuals examined time seroconversion gave high readings even weakly reactive wb \( weak band \) test thus highly sensitive specific , capable detecting early seroconversion also instrumental clearly defining samples found indeterminate wb , consequently avoids unnecessary follow required false positive result obtained using viral lysate based elisa
six epitopes reacting human cytotoxic cd8 cells central region hiv 1 nef protein order identify target epitopes recognized specific ctl nef protein hiv 1 , 33 peptides derived hiv sequence tested nef specific ctl generated hiv seropositive donors six different epitopes identified several points remarkable 1 \) located two regions central part nef protein corresponding residues 73 94 113 147 , respectively 2 \) ctl issued single donor could recognize several peptides nef protein 3 \) peptides could recognized association least two three different hla class molecules 4 \) two different overlapping epitopes present relatively short sequence 15 amino acids results suggest multiple epitopes corresponding different hla restrictions could relatively small region nef protein implications results vaccine strategies using synthetic peptides bearing ctl epitopes discussed
measles outbreak college immunization requirement background early 1988 outbreak 84 measles cases occurred college colorado 98 percent students documentation adequate measles immunity \( physician diagnosed measles , receipt live measles vaccine first , serologic evidence immunity \) due immunization requirement effect since 1986 methods examine potential risk factors measles vaccine failure , conducted retrospective cohort study among students living campus using student health service vaccination records results overall , 70 \( 83 percent \) cases vaccinated greater equal 12 months age students living campus increased risk measles compared students living campus \( rr 3 0 , 95 ci 2 0 , 4 7 \) students vaccinated 12 14 months age increased risk compared vaccinated greater equal 15 months \( rr 3 1 , 95 ci 1 7 , 5 7 \) time since vaccination risk factor vaccine failure measles vaccine effectiveness calculated 94 \( 95 ci 86 , 98 \) vaccination greater equal 15 months conclusions secondary schools , measles outbreaks occur among highly vaccinated college populations implementation recent recommendations require two doses measles vaccine college help reduce measles outbreaks college populations
safety prophylactic efficacy low dose rimantadine adults influenza epidemic placebo controlled , double blind study evaluate safety prophylactic efficacy low dose \( 100 mg \) rimantadine hydrochloride naturally occurring influenza adults conducted two sites onset influenza season , volunteers \( ages , 18 55 years \) assigned randomly receive rimantadine placebo daily subjects monitored adverse effects evidence influenza virus infection weekly six weeks 10 \( 8 7 \) 114 rimantadine recipients 5 \( 4 4 \) 114 placebo control recipients reported one mild moderate adverse symptoms , related gastrointestinal central nervous system compared placebo , low dose rimantadine highly effective prevention influenza virus infection \( 20 110 versus 7 112 participants p less 0 01 \) influenza illness \( 7 110 versus 1 112 participants p 0 04 \) influenza 87 like \( \) virus recovered five placebo recipients findings indicate low dose rimantadine well tolerated highly effective prevention influenza illness healthy adults
alpha interferon \( 2b \) combination zidovudine treatment leukemia virus induced immunodeficiency syndrome therapeutic efficacies human recombinant alpha interferon \( ifn alpha \) , ifn alpha plus zidovudine \( azt \) , azt alone evaluated cats established leukemia virus \( \) acquired immunodeficiency syndrome \( \) infection high levels persistent antigenemia subcutaneous injection 1 6 x 10 \( 6 \) u human recombinant ifn alpha 2b per kg delivered peak concentrations plasma 3 , 600 u ml 2 h half life elimination 2 9 h dosage ifn alpha could delivered cats 12 weeks without significant clinical toxicity oral administration azt \( 20 mg kg three times daily \) resulted peak concentrations plasma 3 micrograms ml 2 h half life elimination approximately 1 60 h treatment infected cats ifn alpha , either alone combination orally administered azt , resulted significant decreases circulating p27 core antigen beginning 2 weeks initiation therapy azt alone effect circulating virus antigen depending upon whether high \( 1 6 x 10 \( 6 \) u kg \) low \( 1 6 x 10 \( 4 \) 1 6 x 10 \( 5 \) u kg \) dosage ifn alpha used , cats became refractory therapy 3 7 weeks beginning treatment times , ifn alpha treated animals developed antibodies ifn alpha neutralizing , specific human recombinant ifn alpha , dose dependent magnitude results study indicate human recombinant ifn alpha effective reducing circulating virus antigenic load cats persistently infected
preparation characterization intravenous solution igg human immunodeficiency virus seropositive donors intravenous solution 99 pure globulin \( igg , hivig \) obtained pooled plasma selected human immunodeficiency virus \( hiv 1 \) seropositive asymptomatic donors greater 400 cd4 microliters cells per microliter high titer antibody hiv 1 p24 protein hivig high titers antibody p24 , glycoprotein 41 \( gp41 \) , gp120 , group specific neutralizing activity , binding gp120 hypervariable loop region inhibited formation low concentration , enhanced viral production hiv 1 infected peripheral blood monocytes inhibitory higher concentration hivig directed group specific antibody dependent cellular cytotoxicity hiv infected targets period 6 28 months , plasma donors kept stable antibody titers 1 0 decrease cd4 cells per month one gram per kilogram hivig injected two juvenile well tolerated transmit hiv , measured negative cell culture , igm immune response hiv proteins , polymerase chain reaction mean half life hiv 1 p24 antibody 15 days preliminary data suggest hivig safe product suitable clinical trial hiv 1 infected individuals
cytomegalovirus infection sexually active adolescents determine whether cytomegalovirus \( cmv \) infection girls related sexual activity , 254 girls 12 18 years old \( mean , 15 8 \) attending contraceptive counseling clinic studied participants screened chlamydia trachomatis , , , serum antibody cmv determined demographic sexual history data collected interview mean number lifetime sex partners 2 2 173 \( 68 \) seropositive race , greater 3 years sexual activity , greater 2 lifetime sex partners significant risk factors cmv infection \( odds ratios , 1 8 4 7 p less 05 \) using logistic regression analysis , composite sexual activity variable important risk factor cmv infection \( , 4 8 p 003 \) , followed race \( , 3 4 p 004 \) sexually transmitted disease composite variable \( , 2 4 p 016 \) sexual activity important risk factor cmv infection adolescent girls
pattern respiratory syncytial virus epidemics finland two year cycles alternating prevalence groups b time resolved monoclonal antibodies distinguishing respiratory syncytial virus \( rsv \) group b strains used analyze prevalence finland 1981 1990 among patients laboratory diagnosis rsv , hospitalized group typing antigens rsv positive nasopharyngeal aspirates showed regular alternation group prevalence , following cyclic occurrence virus group predominated 73 90 specimens 1981 1982 , 1985 1986 , 1989 1990 , whereas group b predominated 70 100 specimens 1983 1984 1987 1988 epidemiologic occurrence verified hospitalized children group typing results indicated children greater 6 months age first infection resistant severe homologous heterologous group virus study shows group antigenic variation rsv significant effect epidemiology virus
hiv prevalence midwestern emergency department study objective determine prevalence human immunodeficiency virus \( hiv \) seropositivity patients 15 years age older emergency department design hiv status determined , seroprevalence rate calculated 95 confidence intervals also calculated twenty demographic predictor categorical variable cross tabulated hiv status determine associations gender male homosexual preference significantly associated fisher 's exact test type participants excess serum samples 454 randomly selected patients 15 years age older required venipuncture ed evaluation included study measurements main results 454 serum specimens , six \( 1 32 \) positive hiv 95 confidence interval 0 27 2 37 six positive patients men statistically significant risk factors associated hiv seropositivity male sex \( p \) male homosexual preference \( p \) conclusion hiv seropositivity occurs 1 32 ed population age 15 years factors correlate hiv seropositivity male homosexual preference male sex
apparent response subacute sclerosing panencephalitis intrathecal interferon alpha 8 year old boy subacute sclerosing panencephalitis \( \) treated 1 0 3 0 x 10 \( 6 \) iu human interferon alpha \( ifn \) intrathecal route weekly pronounced improvement clinical electroencephalographic findings observed dose dependent manner patient raises hope ifn induce sustained remission patients
counseling patients seropositive human immunodeficiency virus approach medical practice persons risk infection human immunodeficiency virus encouraged learn knowledge help patients seek appropriate medical care , also distressing describe approach , based crisis counseling , physicians use working patients infected hiv help physicians patients emotional reactions diagnosis well patients manage practical issues concern methods discussing safer sex injection practices also presented
keratitis two species describe case keratitis related soft contact lens wear patient presented 3 week history severe pain , radial stromal infiltrates subepithelial infiltrates epithelial defect cultured corneal biopsy specimen , contact lens lens case corneal biopsy culture grew well escherichia coli patient treated topical \( \) drops , neomycin b drops gentamicin drops gradual clinical improvement ensued
prenatal diagnosis congenital toxoplasmosis prenatal diagnosis congenital toxoplasmosis attempted 50 pregnant women risk giving birth affected child fifteen patients seroconverted pregnancy 35 high initial antibody level first serum sample prenatal diagnosis consisted combination ultrasound screening , amniocentesis , funipuncture 20 weeks' gestation diagnosis congenital toxoplasmosis based positive toxoplasma culture amniotic fluid fetal blood presence specific immunoglobulin antibodies fetal blood addition , alterations fetal hematology , cellular immunology , fetal liver tests indicative infection fetal infection detected six fetuses two died utero consequence infection four born 37 weeks' gestation despite antibiotic treatment pyrimethamine sulfadiazine , one child internal hydrocephalus another unilateral two children , disease still subclinical 44 children born negative prenatal diagnosis , 35 reached age 1 year toxoplasma antibodies disappeared investigation remaining nine children showed decrease toxoplasma antibodies , suggesting none affected prenatal diagnosis never associated fetal loss , premature delivery occurred two cases conclude prenatal diagnosis congenital toxoplasmosis safe reliable
filarial specific igg4 response correlates active bancrofti infection filarial specific humoral immune response adult residents two areas papua new guinea , differing transmission bancrofti infection compared majority residents village , area transmission filariasis interrupted 20 year spray program control malaria , showed signs active w bancrofti infection negative circulating ag peripheral blood contrast , adult residents village area exposed infection , ag positive antibody response two groups adult excretory secretory \( es \) ag somatic antigen extract examined determine components filarial specific immune response dependent active infection identification immune responses may point immunologic methods evaluate control programs lymphatic filariasis adults found significant immune responses 35s methionine labeled es ag immunoprecipitation adult somatic antigen extracts elisa immunoblotting result consistent fact individuals previously exposed infected w bancrofti similarly , residents endemic village detectable immune responses ag irrespective striking immunologic difference observed two groups residents dramatically reduced filarial specific igg4 antibody response adult somatic ag adult es ag data suggest longitudinal measurement filarial specific igg4 levels may useful indicator changes w bancrofti infection status
serum resistance stage leishmania major promastigotes due release c5b 9 mechanism serum resistance infective promastigotes leishmania major investigated prior results suggested mechanism resistance mediated step c3 deposition equivalent amounts deposited serum susceptible , promastigotes harvested log stage cultures \( log \) c resistant , infective , promastigotes \( mp \) purified stationary stage cultures whereas binding c9 log stable incubation serum , c9 binding mp minimal unstable , molecules bound initially mp released continued incubation failure bind c9 result inability activate c kinetics c3 , c6 , c9 consumption similar log mp deposition c5b 7 mp stable , indicating initial steps terminal complex formation intact instead , majority c5b 9 formed mp spontaneously released serum 9 residual c5b 9 mp released 1 nacl data show developmental modification membrane transition infective stage blocks insertion lytic c5b 9 membrane
analysis permissive association malaria cell epitope dr molecules study examined association malaria cell epitope , cs t3 , different hla dr alleles large series singly substituted truncated variants cs t3 prepared tested ability recognised association , bind , three distinct hla dr alleles \( dr1 , , \( \) \) three natural variants hla found although association different dr molecules mapped identical closely overlapping regions peptide , distinct substitutions could drastically influence capacity peptide interact one another three dr molecules tested based analysis distribution residues recognized cell clones restricted different dr alleles , suggest peptide cs t3 bound , least three dr examined , alpha helix addition tested three subtypes apc cs t3 analogues observed peptide likely bound conformation three natural variants molecule
effectiveness tolerance long term malaria prophylaxis mefloquine need better dosing regimen measure effectiveness tolerance long term malaria prophylaxis mefloquine , incidence plasmodium falciparum malaria adverse reactions compared volunteers west africa took mefloquine every 2 weeks volunteers took chloroquine phosphate weekly mefloquine 63 effective chloroquine monthly incidence p falciparum infections one case per 100 volunteers took mefloquine 2 7 cases per 100 volunteers took chloroquine using daily \( \) hydrochloride addition chloroquine provide additional protection mefloquine prophylaxis failures occurred second week every 2 weeks dosing regimen volunteers used mefloquine 2 months blood concentrations mefloquine lower second week alternate week regimen first week , suggesting blood levels low second week suppress parasitemia serious adverse reactions observed results indicate dosing regimen 250 mg mefloquine weekly considered travelers areas chloroquine resistant p falciparum malaria
plasmodium falciparum malaria american travelers africa implications prevention strategies data us national malaria surveillance system analyzed assess characteristics travelers acquired plasmodium falciparum infections africa evaluate impact chloroquine resistance incidence malaria although number cases acquired east africa stabilized , number p falciparum infections acquired west africa increased threefold 1985 1988 , proportion travelers reported failure chloroquine prophylaxis increased 10 48 fifty eight percent patients acquired malaria west africa used rising incidence p falciparum infections american travelers , centers disease control revised malaria prophylaxis recommendations include use mefloquine areas chloroquine resistance use malaria protection measures travelers west africa must also improved
leishmania new clinical variant cutaneous leishmaniasis surveillance endemic visceral leishmaniasis island coast , unusual form cutaneous leishmaniasis encountered clinical laboratory criteria , 17 cases identified 5 months children aged 4 15 years primarily affected lesions generally number , small , always , non ulcerative , even present several years patients skin lesions seemed otherwise healthy well skin tests leishmania mexicana l major antigens positive 10 17 patients tested , lesions 9 patients positive culture since summer 1988 , cases atypical cutaneous leishmaniasis continue occur island \( 8 \) well mainland southern \( 23 \) total 9 parasite isolates skin lesions , 4 bone marrow patients , 2 identified l indistinguishable one another isoenzyme analysis
rapid diagnosis malaria fluorescence microscopy light microscope interference filter fluorochrome staining detect malaria parasites bloodfilms sensitive , easier , less time consuming giemsa staining however , standard epi , mercury , fluorescence expensive , especially tropical countries malaria endemic fluorescence microscopy standard light microscope new interference filter specially designed fluorochrome stain , acridine orange , used detect malaria parasites thick thin bloodfilms system two fluorescence , green \( nuclei \) red \( cytoplasm \) , emitted stained parasites thick thin bloodfilms patients malaria examined system bloodfilms fixed stored 1 5 years rapid scanning thick thin bloodfilms possible magnification standard lenses , indicating may useful economic system rapid diagnosis
exchange transfusion adjunct treatment severe falciparum malaria case report review malaria associated complications fatal outcome almost always caused plasmodium falciparum mortality due disease parallels degree parasitemia successful use exchange blood transfusion therapeutic adjunct infection first reported 1974 , although efficacy procedure established randomized , controlled trials rationale form therapy based \( 1 \) rapid reduction parasite load direct removal \( 2 \) decreased risk severe intravascular hemolysis consequences \( disseminated intravascular coagulation renal dysfunction \) \( 3 \) improved transfused blood reduced \( 4 \) improved oxygen carrying capacity transfused erythrocytes describe case severe falciparum malaria review literature describing use exchange transfusion treatment infection
leishmania mexicana complex human infections republic parasites leishmania responsible human cutaneous leishmaniasis new world form 2 major leishmania braziliensis l mexicana complexes report isolation characterization l mexicana complex among humans republic characterization based parasite morphology , pathogenesis infected golden hamsters , cellulose acetate isoenzyme electrophoretic , membrane specific monoclonal antibodies using binding assay technique
infectivity leishmania braziliensis complex vivo vitro infectivity leishmania braziliensis relation growth kinetics 's medium determined using human macrophage cell line u937 inbred hamsters systems , infectivity shown distinctive l b promastigotes 6 day old cultures \( early stationary phase \) infective parasites culture day , l b l b braziliensis reached maximum infectivity days 8 10 day 10 \( late stationary phase growth \) , respectively although maximum infectivity occurred stationary growth , strict growth phase dependency observed populations parasites culture days composed mostly small , highly motile promastigotes 2 3 times length cell bodies promastigotes resembled infective forms transmitted vector distinct pathological picture characterized disease caused different reference strains hamsters l b developed severe lesions , moderate lesions observed l b l b braziliensis , respectively , constituted
improved procedure visceral leishmaniasis enzyme linked immunosorbent assay \( elisa \) sensitive specific method leishmaniasis report , describe assay improved use protein protein g conjugates specific detection leishmania antibody sera patients visceral leishmaniasis direct comparisons anti immunoglobulin conjugate , enzyme linked protein gave significantly higher absorbance values positive sera without corresponding increase absorbance values sera normal individuals patients diseases known cross react leishmaniasis effect increase distance positive negative values , aided interpretation results also permitted visual distinction positive sera negative weakly reactive sera assay effective using either blood serum source primary antibody advantage protein anti ig conjugate ability detect specific antibody dog well human sera finally , demonstrated usefulness protein elisa recombinant leishmania antigen ,
effects multiple monthly doses ivermectin adult onchocerca volvulus paper assesses effects adult onchocerca volvulus monthly doses ivermectin \( 150 micrograms kg \) given 4 , 8 , 12 months patients guatemala nodules removed 4 months last dose adult volvulus extracted collagenase digestion , studied histological techniques , compared worms untreated patients twelve monthly doses killed proportion adult worms \( 12 males 22 females \) , leaving remainder relatively unaffected females slowly 8 12 doses , number female worms resumed 1 genital tract , 1 female total degeneration 1 ovary seen ivermectin also led marked drop number male worms nodules serious adverse reactions occurred treatment well accepted
scabies nursing homes eradication program 5 cream 5 cream used treat scabies three large nursing homes protocol chronic , therapy resistant residents , staff , frequent visitors treated whether symptomatic family members groups treated either symptomatic directly exposed scabies nine hundred ninety five persons treated , 202 diagnosed scabies approximately 35 \( 111 \) nursing home residents diagnosed scabies patients multiple treatments unsuccessful completion study , 195 patients examined efficacy treatment , 91 \( 46 7 \) clearing lesions one medication application , 77 \( 39 5 \) two treatments , 23 \( 11 8 \) three treatments overall cure rate 98 adverse experiences occurred 2 4 cases mild \( e , pruritus rash \)
monoclonal , polyclonal , antibodies protect plasmodium yoelii sporozoites one primary strategies malaria vaccine development design subunit vaccines induce protective levels antibodies \( cs \) protein malaria sporozoites plasmodium yoelii mouse model system vaccines uniformly unsuccessful protecting sporozoite induced malaria demonstrate antibodies p yoelii cs protein could provide protection established passive transfer model passive transfer navy yoelii sporozoite 1 \( \) , igg3 mab p yoelii cs protein , protected 100 mice challenge 5000 p yoelii sporozoites binding sporozoites inhibited incubation \( \) 2 , synthetic peptide derived repeat region p yoelii cs protein , indicating epitope sporozoites recognized mab included within peptide levels antibodies \( \) 2 elisa , sporozoites indirect fluorescent antibody test cs precipitation reaction similar sera mice received passive transfer protected challenge 5000 sporozoites , mice immunized subunit vaccines containing \( \) 2 protected challenge 40 200 sporozoites determine antibody , absolute concentration could explain striking differences protection , established elution assay results suggest , protective mab , lower \( \) 2 sporozoites vaccine induced antibodies although results conventional antibody assays correlate protection , sera protected animals inhibited sporozoite development mouse hepatocyte cultures significantly sera unprotected , subunit vaccine immunized animals , correlating protection data clearly demonstrate antibodies cs protein protect intense sporozoite infection improved understanding differences protective mab polyclonal antibodies important development malaria vaccines
comparison 6 , 12 , 24 monthly dosing ivermectin treatment onchocerciasis study designed examine optimal dose interval administration ivermectin , accepted drug choice onchocerciasis two hundred onchocerca volvulus infection received 100 , 150 , 200 micrograms kg ivermectin placebo followed 36 months reaction second dose ivermectin significantly less initial dose , although still significant 200 micrograms kg group skin microfilaria counts group treated 6 monthly 150 micrograms kg significantly less group treated yearly \( 12 24 months initial therapy \) prevalence anterior chamber corneal opacities decreased progressively groups 3 years appears slight advantage , terms effect first 2 years , therapy given 6 monthly compared yearly
community based treatment onchocerciasis ivermectin safety , efficacy , acceptability yearly treatment safety , acceptability , efficacy ivermectin community based mass treatment onchocerciasis assessed ivermectin distributed three times , 1 year apart , population rubber \( 14 , 000 people \) greater 80 adults onchocerca volvulus infection sample adults , density reduced 84 2 years treatment acceptance high 98 third year adverse reactions occurred 6 13 1000 people first treatment 3 4 1000 receiving second third annual dose ivermectin severe adverse reactions seen data show community based treatment ivermectin safe , well accepted , effective reducing loads suggest ivermectin first practical drug suitable mass treatment control human onchocerciasis
effect n modification antimalarial activity 3 4 one oral iron effect iron attributed interaction labile iron pool within erythrocytes , postulated increased affinity iron well increased may improve antimalarial activity present study examined antimalarial effect 3 4 ones , family orally effective iron whose may modified altering length r2 ring nitrogen significant dose related suppression plasmodium falciparum cultures observed drugs tested vitro concentrations 5 mumol l higher contrast , clear segregation vivo effect p rats \( 300 mg kg subcutaneous \) two categories compounds , 38 , 40 failed suppress malaria , whereas , 94 , 96 strong antimalarial effect , similar better deferoxamine close linear correlation suppression peak parasite counts reduction hepatic iron induced various drugs tested \( r \) lipophilic compounds also effective suppressing malaria hepatic iron stores data indicate 3 4 ones able suppress malaria vivo vitro lipid solubility important determinant antimalarial action , study provides useful information regarding selection orally effective iron compounds may suitable clinical application antimalarial agents
changes electrocardiographic patterns different stages heart disease rats 1 resting electrocardiogram obtained 25 infected rats 30 days infection \( phase \) resting electrocardiogram abnormal 12 \( group \) normal 13 \( group ii \) animals nineteen similar non infected animals served controls resting electrocardiogram test performed 120 350 days infection \( phases ii iii , respectively \) 2 regard resting electrocardiogram group animals , left axis deviation found 10 12 \( 83 \) phase , one 12 \( 8 \) phase ii \( p less 0 05 \) none phase iii \( p less 0 05 \) intraventricular conduction delay found four 12 \( 33 \) rats phase , two 12 rats \( 16 \) phase ii \( p greater 0 05 \) six 12 rats \( 50 \) phase iii \( p greater 0 05 \) test abnormal nine 10 \( 90 \) rats group normal resting electrocardiogram phase ii , three six \( 50 \) animals phase iii \( p greater 0 05 \) 3 intraventricular conduction delay found resting electrocardiogram one 13 \( 7 \) rats group ii phase iii test abnormal one 13 \( 7 \) rats phase ii one 12 \( 8 \) rats phase iii 4 control rat showed pathological changes
inability malaria vaccine induce antibodies protective epitope within sequence monkeys immunized recombinant protein containing 20 copies nine amino acid repeat plasmodium vivax \( cs \) protein developed high concentrations antibodies repeat sequence sporozoites , protected challenge intravenous injection immunoglobulin g3 monoclonal antibody \( \) irradiated p vivax sporozoites , four six monkeys protected sporozoite induced malaria , remaining two animals took significantly longer become epitope mapping demonstrated recognizes four \( \) nine amino acids within repeat region p vivax cs protein monkeys immunized \( \) 20 produce antibodies protective epitope thus , determination fine specificity protective immune responses may critical construction successful subunit vaccines
rapid microscopic detection malaria parasites permanently fluorochrome stained blood smears aluminum intra extracellular plasmodium parasites fixed blood smears easily identifiable fluorescence microscopy brief aluminum ammonium sulfate staining \( 3 , 5 , 7 , , 4' \) intensely fluorescent preparations stained parasites strongly resistant remained essentially unimpaired two years
detection plasmodium falciparum infection fluorescent dye , fluorescent dye \( bcp \) intensely stains nucleic acids dye viable white blood cells stain cells following fixation also found dye stains nucleic acid viable plasmodium falciparum subsequently evaluated staining p falciparum within red blood cells found red blood cell membrane permeable dye consequently p falciparum stained within red blood cell finding prompted depth analysis dye laboratory field study alternative giemsa stained blood smears means enhancing microscopic diagnosis infection field study bcp dye allowed detection malaria fresh blood level equivalent giemsa method \( parasitemia ranged 0 01 30 \) bcp staining procedure could also used fixed specimens although differential staining characteristics lost following specimen preparation 111 blinded samples obtained field 22 negative giemsa stained thin smear , 16 negative thick smear 16 negative bcp analysis found bcp dye offers many advantages compared microscopic diagnosis p falciparum infection standard giemsa stains advantages especially evident conditions low parasitemia , speed staining evaluation , relatively low level training required provide consistent results
acridine orange fluorescent microscopy detection malaria populations low density parasitemia detection low density malaria parasites giemsa stained thick smears \( g ts \) requires time experience becomes high sample loads acridine orange fluorescent microscopy \( ao fm \) capillary blood may offer alternative technique compared ao fm readings g ts 290 specimens asymptomatic people villages endemic malaria ao fm specimens prepared modified capillary tubes coated acridine orange \( quantitative buffy coat tubes \) examined fluorescent microscope twenty three \( 85 2 \) 27 specimens found positive g ts 100 parasites microliters blood \( less 35 parasites 200 microscopic fields \) overall ao fm sensitivity 78 9 range 66 7 \( 10 15 \) 86 7 \( 13 15 \) plasmodium falciparum , regardless stages , sensitivities varied 66 7 \( 8 12 \) 91 7 \( 11 12 \) ao fm performed better p falciparum plasmodium vivax asexual sexual stages parasite however , species stage specific results must interpreted caution small sample sizes low parasite densities involved test specificity 96 6 range 95 6 \( 263 275 \) 97 1 \( 263 271 \) levels accuracy plus known advantages ao fm suggest test , supplemented g ts improve species stage differentiation , also useful screening low density
plasmodium vivax sporozoite antibodies individuals exposed single malaria outbreak non endemic area studied plasmodium vivax antigens 62 individuals living small community near , , brazil , area outside endemic malaria zone brazil eight months earlier , transmission p vivax period 50 days , totally controlled chemotherapy anti sporozoite response , measured elisa using recombinant protein expressed yeast , detected 45 \( 14 31 \) individuals eight months infection persisted 20 months 12 eighteen individuals treated prophylactically malaria lived overt infection occurred seven individuals elisa positive , 5 antibodies blood stage parasites among 13 individuals endemic area positive smears , ill , received prophylaxis , five anti positive 40 fold serum dilution develop asexual blood stage antibodies remained parasite free following 20 months
comparison high dose ivermectin diethylcarbamazine activity filariasis three phase study designed compare high dose ivermectin standard diethylcarbamazine \( dec \) regimen patient tolerability , potential kill adult , duration suppression 30 subjects bancrofti first given 1 mg oral dose ivermectin \( phase 1 \) reduce microfilaria densities participants randomized three groups group 1 received dec \( kg per day 12 days \) , group 2 received 200 mcg kg ivermectin , group 3 received 400 mcg kg ivermectin \( 200 mcg kg per day 2 days \) drug regimens well tolerated adverse reactions reactions occurred phase consisted primarily headache , fever , end phase 1 , 27 30 \( 90 \) patients microfilaria negative phase 2 , four six men receiving dec developed scrotal reactions suggesting killing adult worms reactions noted 10 men receiving ivermectin \( p less 0 05 \) one year follow \( phase 3 \) , treatment groups less 10 return pretreatment microfilaria levels mean percent baseline microfilaria counts group 1 , 0 9 \( range 0 5 \) group 2 , 8 2 \( range 0 31 \) group 3 , 3 8 \( range 0 25 \) seven individuals group 1 microfilaria negative , one three individuals microfilaria negative groups 2 3 , respectively results suggest dec causes damage adult worms greater reduction microfilaria densities ivermectin , high doses ivermectin may suppress lymphatic filariasis periods much longer previously reported
immunization monkeys ring infected erythrocyte surface antigen plasmodium falciparum immunized 4 mer , 8 mer , 11 mer repeat peptides ring infected erythrocyte surface antigen molecule plasmodium falciparum conjugated diphtheria toxoid \( mdp \) adjuvant immunization failed induce protective immunity strain p falciparum judged maximum levels parasitemia immunized monkeys relative controls fused polypeptide , combined mdp , also failed induce protective immunity however , maximum level parasitemia serologic response 11 mer peptide inversely correlated safety use mdp evident
spleen necessary resolve infections plasmodium yoelii role spleen resistance infections plasmodium yoelii dependent upon genotype host thus , dba 2 \( d2 \) mice infected p yoelii adversely affected removal spleen , splenectomized c57bl 6 \( b6 \) balb c mice failed resolve infections eventually died levels parasitemia lower splenectomized mice compared intact controls however , splenectomized mice became anemic spleen intact controls splenectomy resulted appearance large aggregates mononuclear cells livers infected mice also altered liver body weight ratios results indicate d2 mice spleen independent mechanism clearing parasites lacking b6 balb c mice
effects \( cgp \) latin america open clinical trial carried onchocerciasis patients guatemala administration food effective fasting effective best tolerated regimen , 3 mg kg twice daily food 3 days \( 312 patients \) , killed 73 female worms 4 months treatment mean skin count greatly reduced within week \( 6 11 day 0 value day 8 \) remained low least 6 months \( 14 18 day 180 \) follow higher dose 3 day regimen taken fasting showed 7 9 day 0 value 2 years treatment
angle lipoma angle rare lesions date , 18 patients reported , 17 adults second child described angle lipoma
role cellular maturation neutrophil heterogeneity previous studies shown many neutrophil \( pmn \) characteristics heterogeneous origin pmn heterogeneity unknown unclear pmn functional heterogeneity secondary differences due distinct subpopulations cells possess different functional capacities pmn 31d8 antigen useful probe evaluation pmn subpopulations majority pmns \( approximately 85 \) exhibit high intensity fluorescence 31d8 monoclonal antibody \( moab \) labeling \( 31d8 enriched pmns \) determined flow cytometric analysis cells functional cells low intensity fluorescence \( 31d8 diminished pmns \) various immunologic , clonogenic functional techniques used study expression 31d8 antigen hl 60 cells myeloid cells order evaluate antigenic functional heterogeneity morphologic maturation results study indicate percentage 31d8 antigen positive \( 31d8 antigen enriched diminished \) bone marrow cells increases 20 11 cells 68 10 promyelocytes , 93 2 99 1 bands pmns 31d8 antigen enriched cells first appear stage \( 32 10 \) increase bands \( 52 13 \) , marrow pmns \( 62 13 \) peripheral blood pmns \( 88 4 \) data indicate heterogeneous expression 31d8 antigen pmns due , least part , differences within pmn population raise possibility expressed pmn characteristics also derived also suggest 31d8 antigenic expression may precise indicator myeloid functional maturation maturation identified cellular morphology
papillary cystic neoplasm pancreas radiological pathological characteristics 11 cases clinical charts , radiological features , macroscopic microscopic findings , clinical follow data retrospectively reviewed 11 patients papillary cystic neoplasm pancreas \( pcnp \) patients nine women two men , aged 13 51 years mean age 25 years greatest diameter ranged 2 5 cm 14 0 cm mean size 7 5 cm six tumours located tail pancreas , two body three head patients complained abdominal pain mass ultrasonographic computed tomography findings showed five solid , four mixed \( solid cystic \) two cystic types tumour angiographically , pcnp either mild mass displacement surrounding vessels vascular seen macroscopically 11 tumours consisted well defined solid mass degenerative change various , including haemorrhage , necrosis dystrophic calcification , represented three radiological types pcnp 11 patients pcnp survived 3 253 months curative resection without signs local recurrence remote metastasis pcnp usually affects distal portion pancreas young women despite huge size , pcnp explored aggressive surgical intent inherently good prognosis
ca72 4 new tumour marker gastric cancer date , tumour markers gastric cancer proved unreliable study value new serum marker , ca72 4 , compared serum activities carcinoembryonic antigen \( cea \) ca19 9 consecutive series patients gastric cancer results show ca72 4 assay significantly better separating stage ii disease normal controls \( p less 0 01 \) cea \( n \) ca19 9 \( n \) ca72 4 also gave better differentiation patients positive negative nodes \( p less 0 01 \) serosa positive negative \( p less 0 01 \) cea differentiated patients positive negative nodes \( p less 0 05 \) ca19 9 could ca19 9 cea could discriminate patients serosa positive negative study , specificity 95 per cent , sensitivities cea , ca19 9 ca72 4 0 25 , 0 41 0 94 respectively preliminary findings indicate ca72 4 reliable tumour marker disease stage activity gastric cancer longitudinal studies required full evaluation clinical utility
treatment adenocarcinoma cardia synchronous chemotherapy radiotherapy twenty nine evaluable patients adenocarcinoma cardia treated administered chemotherapy \( two cycles 5 cisplatin 30 36 gy radiation determine whether tumours responsive treatment complete regression tumour observed endoscopically 19 patients , partial regression four fourteen patients tumours resected six microscopic tumour found specimen nine patients received additional radiotherapy total dose 54 60 gy instead surgery tumour response associated rapid reversal dysphagia one patient required subsequent intervention relief dysphagia due fibrous stricture enhanced survival associated complete endoscopic response initial chemotherapy radiotherapy , tumour less 5 cm length median survival responding patients 15 months synchronous chemotherapy radiotherapy major palliative benefit series merits evaluation
manometric evaluation jejunal limb total gastrectomy roux anastomosis gastric cancer total gastrectomy roux anastomosis frequently performed gastric cancer since intestinal motility roux limb never evaluated operation , pressure activity investigated roux limb ten patients \( aged 51 77 years \) undergone total gastrectomy roux reconstruction investigations carried 6 h fast 3 h kcal mixed meal fasting two patients activity abnormal ten patients displayed non bursts contractions three discrete clustered contractions high amplitude jejunal contractions fed state characterized severely reduced motor activity pattern abnormalities total gastrectomy roux anastomoses relatively severe disturbance intestinal activity
intraoperative ultrasonography detection liver metastases patients colorectal cancer total 213 patients carcinoma colon rectum examined detect liver metastases study compared preoperative ultrasonography inspection palpation liver surgery intraoperative ultrasonography preoperative ultrasonography , inspection palpation identified 238 metastases 42 patients intraoperative ultrasonography detected 116 previously unrecognized metastatic tumours 40 surgical procedures \( p less 0 01 \) high resolution intraoperative ultrasonography safe accurate preoperative imaging surgical exploratory methods examination simple perform success appears related careful attention detail
effect gastrin receptor antagonist proglumide survival gastric carcinoma gastric cancer remains disease poor prognosis , safe effective form therapy advanced disease evidence abundant show gastrin stimulates growth gastric colorectal cancer cells vitro vivo , blockade gastrin receptors prolong survival nude mice thus performed randomized , controlled study gastrin cholecystokinin receptor antagonist proglumide therapy 110 patients gastric carcinoma proglumide overall effect survival \( mantel cox statistic 0 5 , p 0 48 \) 95 confidence interval proglumide treated group 260 days compared 230 days control group significant difference seen proglumide , relatively low affinity gastrin receptor also partial agonist activity drugs far specific potent gastrin receptor antagonists becoming available , may greater effect survival , clinical trials compounds clearly indicated determine efficacy hormonal control gastrointestinal malignancy
autopsy documented cure multiple myeloma 14 years m2 chemotherapy multiple myeloma diagnosed 65 year old woman 1974 thereafter received five drug m2 chemotherapy protein abnormalities subsequently returned normal serial bone marrow studies documented complete bone marrow remission destructive bone lesions persisted radiographically , progress 1987 , localized sigmoid adenocarcinoma resected 1988 , patient presented multiple brain metastases associated primary pulmonary adenocarcinoma proved rapidly fatal autopsy , evidence multiple myeloma found report describes first tissue documented cure multiple myeloma 14 years diagnosis initiation m2 chemotherapy possible association multiple myeloma malignancies also discussed
prospective evaluation radiologically directed fine needle aspiration biopsy nonpalpable breast lesions application fine needle aspiration biopsy \( fnab \) diagnosis nonpalpable breast lesions evaluated new method uses standard needle localization mammographic guidance assure accurate sampling fnab method prospectively applied 100 mammographically detected breast lesions 100 women \( mean age , 53 years \) 100 patients underwent surgical excision nonpalpable lesions cytologic aspiration sufficient aspirated material obtained cytologic diagnosis 91 patients \( 91 \) histologic cytologic interpretations compared twenty malignancies ultimately diagnosed histology \( 12 invasive ductal carcinoma , six ductal carcinoma situ , two lobular carcinoma situ \) , 17 diagnosed false positive diagnoses malignancy fnab false negative readings \( 3 3 \) included two cases lobular carcinoma situ one case ductal carcinoma situ technique thus demonstrated sensitivity 85 , specificity 100 , overall diagnostic accuracy 96 7 nonsurgical detection malignancy nonpalpable breast lesions results suggest established safety , reliability , cost effectiveness fnab maintained clinical setting procedure may obviate need open surgical biopsy patients unequivocal diagnosis malignancy also done using standard techniques equipment available many community hospitals
acute cell leukemia lymphoma mimicking hodgkin 's disease secondary htlv seroconversion authors observed lymphoma mimicking hodgkin 's lymphoma french black woman lacking antibodies human cell lymphoma leukemia virus type \( htlv \) two courses chemotherapy either , vincristine , procarbazine , prednisone \( mopp \) doxorubicin , bleomycin , , \( \) , typical acute cell leukemia lymphoma developed htlv seroconversion specific htlv dna sequences detected using polymerase chain reaction \( pcr \) lymph node biopsy obtained chemotherapy mechanisms seroconversion discussed
immunohistochemical studies main entrance route ca19 9 peripheral venous blood gastric cancer patients correlation ca19 9 levels peripheral portal blood correlation ca19 9 levels portal peripheral venous blood , immunohistochemical variables cancer lesions examined 53 gastric cancer patients eight patients benign diseases immunohistochemically , ca19 9 found 33 \( 62 5 \) 53 primary lesions antigen found cancer cells invasive lymphatics node metastases every ca19 9 localized cancer , although cancer cells veins showed little ca19 9 little antigen cancer cells veins , lymphatics , metastases 20 ca19 9 primary lesions patients ca19 9 cancer benign diseases showed elevation antigen levels peripheral portal blood ca19 9 levels portal blood \( mean , 76 4 u ml positive rate , 33 3 \) different peripheral blood \( mean , 91 5 u ml positive rate , 33 3 \) additionally , antigen levels blood patients lymphatic invasion node metastases significantly higher patients without invasion metastases , every patient without invasion showed elevation antigen results suggest production antigen cancer cells may ca19 9 elevation peripheral blood ca19 9 may drained thoracic duct lymphatic system via node metastases invasive lymphatics , portal system
establishment erythroid cell line \( jk 1 \) spontaneously red cells authors established new hemopoietic cell line \( jk 1 \) patient chronic myelogenous leukemia erythroid crisis jk 1 line predominantly consists immature cells , small number mature erythroblasts red cells consistently seen without specific differentiation inducer jk 1 cells grow suspension culture supplemented human plasma carry double philadelphia chromosomes hemoglobin staining positive 20 cells type hemoglobin part hbf surface marker analysis revealed jk 1 cells positive glycophorin , ep 1 , proportion mature cells elevated addition delta acid erythropoietin \( epo \) enhanced growth jk 1 cells either suspension culture total number epo receptors per cell , 220 sites affinity higher sites first report established human erythroid cell line spontaneously undergoes terminal differentiation
mammographic screening women increased risk breast cancer five hundred one women county , texas participated american cancer society 1987 texas breast screening project selected self reported family history breast cancer \( cases \) matched 501 randomly selected women county family history \( controls \) although statistically significant trend age increasing proportion women report undergone mammography , significant difference comparing mammographic histories cases controls controlling age \( 31 5 versus 35 1 , p 0 33 \) significantly cases \( 79 \) perceived risk breast cancer moderate greater compared controls \( 54 , p less 0 0001 \) , mammographic histories different controlling perceived risk cases controls cited lack physician referral cost reasons undergone mammography women increased risk breast cancer \( family history \) undergoing regular mammographic screening despite self awareness increase risk
murine monoclonal anti idiotype antibody potential network antigen human carcinoembryonic antigen carcinomas gastrointestinal tract curable standard therapies thus , new therapeutic approaches disease needed study proposes use anti id mab ag substitutes induce anti tumor immunity gastrointestinal cancer patients recently , generated characterized one monoclonal anti id antibody , designated 3h1 \( ab2 \) , mimics biologically antigenically distinct specific epitope 180 , 000 w carcinoembryonic antigen \( cea \) primarily expressed high density human pancreatic colonic tumor cells epitope unique cea present cea related lower w members ag family also found normal tissues antigenic determinant defined mab \( ab1 \) ab2 , 3h1 raised , absent normal adult tissues immunoperoxidase staining cells including granulocytes flow cytometry analysis anti id \( ab2 \) 3h1 induced cea specific antibodies mice rabbits immune sera mice rabbits ab1 binding colon carcinoma cell line inhibited binding ab1 ab2 indicates anti anti id \( \) mice rabbits share idiotopes ab1 \( \) furthermore , monoclonal bind cea generated mice immunized 3h1 \( polyclonal well monoclonal \) immunoprecipitated 180 , 000 w cea ab1 \( \) western blotting analysis showed almost identical staining patterns ab1 colonic adenocarcinoma tissue sections several patients collectively data suggest ab2 3h1 could potentially used clinically network ag immunotherapy patients cea positive tumors
regulation hla class ii molecule expressions ifn gamma signal transduction mechanism glioblastoma cell lines examined signal transduction mechanism responsible ifn gamma induced hla class ii molecule expressions glioblastoma cell lines , t98g series experiments demonstrated activation protein kinase c \( pkc \) involved dr dp molecule expressions t98g cells addition activation pkc , calcium influx appeared involved dr dp molecule expressions t98g northern blot analyses actinomycin cycloheximide revealed second induce transcription b dpa b genes without de novo protein synthesis furthermore , examined region dpb gene responsible ifn gamma induced gene transcription gene transfer series 5' 3' deletion mutants upstream region dpb linked reporter gene , chloramphenicol acetyltransferase using deletion mutants , appeared region 152 126 bp contains critical ifn gamma responsive element taken together , results suggest ifn gamma activates pkc stimulates calcium influx , resulting induction transcription b dpa b genes without de novo protein synthesis dpb gene , speculate protein \( \) phosphorylated pkc presence ca2 might directly bind indirectly interact region 152 126 bp upstream sequence , leading induction transcription \( possibly concert nuclear protein \( \) bound promoter sequences \)
low doses il 4 injected tumor bearing mice inhibit growth poorly apparently tumors induce tumor specific immune memory ability ril 4 trigger host reactivity chemically induced fibrosarcoma \( ce 2 \) spontaneous adenocarcinoma \( ts \) balb c mice studied daily local c administration around tumor draining lymph nodes 10 injections progressive amounts \( 0 00001 1000 pg day \) ril 4 induced appreciable inhibition growth tumors dose response survival curve peaking 0 1 pg day inasmuch ril 4 direct antitumor activity , shown vitro tests , host immune reactivity plays fundamental role lymphokine activated tumor inhibition \( lati \) lati , fact , abolished recipient mice irradiated treated cyclosporin , reactivity cd4 lymphocytes suppressed , whereas affected anti gm1 antibody morphologic data show ril 4 lati rests recruitment several cell reaction mechanisms , among nonspecific seem predominate ril 4 lati also leads state long lasting specific immune memory growth second contralateral tumor challenge significantly impaired lati immune memory takes place lati poorly immunogenic ce 2 fibrosarcoma ts adenocarcinoma , previously basis immunization protection tests latter case , adoptive transfer experiments show thy 1 lymphocytes , particular , cd4 cell depleted lymphocyte subpopulation , responsible immune memory finally , ability ril 4 trigger lati greater effective doses ril 2 , ril 1 beta , ifn gamma , whereas association ril 1 beta induces effective immune memory
abnormal processing pro igf ii patients hepatoma hepatitis b virus antibody positive asymptomatic individuals hepatomas common malignancy countries high prevalence hepatitis b virus infections tumors may present severe persistent hypoglycemia studied possible relationship production insulin like growth factor ii \( igf ii \) tumors development hypoglycemia mean igf ii concentration significantly higher 23 patients hypoglycemia nine patients euglycemia \( 61 se micrograms l vs 52 micrograms l \) serum igf suppressed patients hypoglycemia \( 16 3 micrograms l \) patients euglycemia \( 57 18 micrograms l \) increased percentage igf ii serum patients hypoglycemia tumors present partially processed pro igf ii \( big igf ii \) , passed sera patients hypoglycemia patients euglycemia hepatomas acidic gel p 60 columns found 57 4 6 igf ii sera patients hypoglycemia present big igf ii compared 22 3 patients euglycemia hepatomas \( significantly different normal controls \) four 11 apparently healthy control subjects hepatitis b virus positive also increased percentages big igf ii , suggesting abnormal processing pro igf ii may result subtle changes liver function infection remains determined whether subjects increased big igf ii increased risk development hepatomas conclusion , confirmed marked suppression igf sera patients hepatoma hypoglycemia
changes surgical treatments example hysterectomy versus conization cervical carcinoma situ 1969 1985 , women state new mexico diagnosed carcinoma situ cervix women , 65 5 underwent hysterectomy 31 1 conservative therapy \( primarily conization \) 17 year period , steady increase percentage women receiving conservative therapies , 11 8 1969 50 3 1985 younger women , unmarried women american indian women likely receive conservative therapy marked shift therapeutic approach occurred time apparent controversy optimal treatment cervical carcinoma situ , illustrates rapid change surgical practice absence controlled trials comparing two major treatment modalities
response oral leukoplakia beta carotene leukoplakia associated increased risk oral cancer considered premalignant lesion retinoids , particularly 13 cis retinoic acid , frequently reverse leukoplakia however , drugs considerable toxicity suitable large scale use prevention oral cancer beta carotene naturally occurring , nontoxic carotenoid biologic properties suggest might efficacious oral leukoplakia 1986 , began randomized study 13 cis retinoic acid \( 1 mg kg \) versus beta carotene \( 30 mg \) leukoplakia however , owing marked differences toxicity two compounds outlined consent form , 11 initial 16 eligible patients refused participate unless beta carotene therefore , study design changed phase ii trial beta carotene compound given daily 3 months responding patients continued another 3 months treatment lesions examined histologically entry responses monitored measurements photography done entry , monthly treatment study completion twenty four evaluable patients treated , 17 major responses \( two complete , 15 partial \) , response rate 71 \( 95 confidence limits , 53 89 \) significant toxicity requiring drug discontinuation dose reduction results indicate beta carotene substantial activity oral lack toxicity , excellent candidate preventive agent oral cancer
pharmacodynamics cancer therapy understanding pharmacodynamics , relationships pharmacologic measurements clinical effects , grown markedly recent years due advances analytical technology although methotrexate plasma levels empirically used guide leucovorin dosing high dose methotrexate therapy , standard use therapeutic drug monitoring oncology recently , investigators attempted precisely dose antineoplastic agents based previously derived models real time analysis plasma drug tissue concentrations studies completed progress using , etoposide , teniposide , fluorouracil \( fura \) , cytarabine \( ara c \) future studies focus optimal sampling strategies , analysis intermediate biochemical end points , combination chemotherapy , modulation colony stimulating factors , pharmacodynamic models
characteristics biological role steroid hormone receptors neuroepithelial tumors tissue samples 57 patients neuroepithelial tumors \( 25 glioblastomas , 18 anaplastic astrocytomas , 14 astrocytomas \) analyzed order evaluate presence estrogen , progesterone , glucocorticoid , androgen receptors glucocorticoid androgen specific binding proteins present 38 6 21 6 cases , respectively tumors showed estrogen progesterone receptors correlation found grade , patient 's sex age , presence glucocorticoid androgen receptors biological role two receptors investigated 10 primary cell cultures derived neuroepithelial tumors purpose , dexamethasone testosterone added culture medium different concentrations \( 50 0 016 micrograms ml \) significant stimulation cell growth observed four five glucocorticoid receptor positive cultures dexamethasone doses ranging 2 0 016 microgram ml added culture modulation growth observed glucocorticoid receptor negative cultures doses higher dexamethasone doses induced significant decrease growth index independently glucocorticoid receptor status cultures tested testosterone activity negative androgen receptors hormone induced inhibition growth index doses ranging 50 0 4 micrograms ml data suggest neuroepithelial tumors contain specific glucocorticoid androgen binding proteins glucocorticoid receptors modulate growth cultured neuroepithelial tumors presence different concentrations dexamethasone
lymphocele spectrum scintigraphic findings associated renal transplant lymphocele well recognized complication renal transplant surgery performed retrospective review 305 renal transplant patients 2 , 500 scintigraphic describe pattern activity technetium 99m dtpa blood flow dynamic imaging , iodine 131 oih studies diagnostic criteria lymphocele ultrasonic evidence fluid collection analysis fluid demonstrated bun , creatinine , electrolytes similar patient 's plasma scintigraphic findings attributed lymphocele abnormalities area ultrasound fluid collection scintigraphic findings attributable lymphocele resolved patients following surgical drainage peritoneal window placement six 11 documented demonstrated cold defect initial dynamic images filled equal background activity another exceeded background three cases showed rim increased activity surrounding lymphocele \( rim sign \)
scintigraphic evaluation aggressive fibromatosis despite benign microscopic appearance , aggressive fibromatosis potential recur infiltrate tissues therefore , necessary determine exact extent therapy present study , 11 cases aggressive fibromatosis examined using 99mtc \( v \) dimercaptosuccinic acid \( 11 cases \) 67ga citrate \( 7 cases \) technetium 99m \( v \) dimercaptosuccinic acid demonstrated lesions , 67ga citrate detected 57 cases
n 18f potential agent cancer diagnosis positron labeled substrates sugars , amino acids , investigated vivo evaluation biochemical processes cancerous tissue obligatory structural components many biologically important macromolecules , including membrane glycoproteins evaluated new synthesized pharmaceutical , n 18f \( 18f \) , structural analog n acetyl c3h mice bearing spontaneous hepatomas used tissue distribution study 60 min injection , high found tumor \( 5 16 , mean value dose g \) , liver \( 3 71 \) , kidney \( 3 27 \) tumor uptake 18f showed highest value tissue pet study , 2 carcinoma rabbit clearly visualized preliminary results suggest 18f potential new agent tumor imaging
desmoplastic variant ameloblastoma report case review literature case desmoplastic variant ameloblastoma reported lesion , 36 year old japanese woman , successfully treated partial reconstruction carried block hydroxyapatite 7 years 6 months later six cases , including case , reported present summarized reviewed
characterization effect two 4 methyl derivatives 3 , 4 5 , choline transport 4 5 tertiary n methyl 4 analogs 3 \( hc 3 \) previous work laboratory shown 4 5 inhibitors sodium dependent , high affinity choline uptake system \( \) effects choline transport characterized using neuroblastoma cells cells rapidly take choline two separate mechanisms system sodium independent , low affinity uptake system \( \) 4 , 5 hc 3 decreased 5 microm choline transport dose dependent fashion compounds unable decrease choline transport 250 microm choline suggesting inactive respect three compounds significantly increased km vmax system , suggesting competitive mechanism inhibition ki values ranged 18 25 microm 4 , 20 26 microm 5 68 75 microm hc 3 dose response curves inhibition choline transport 5 hc 3 changed 24 hr pre exposure cells inhibitor however , 24 hr pre exposure 4 , significantly different dose response curve obtained compared dose response curve 4 untreated cells 24 hr pre exposure , 4 hr recovery period sufficient remove effect compound data suggest 4 5 , like hc 3 , inhibit , competitively reversibly
increasing annual incidence primary malignant brain tumors elderly 1973 1985 , total age adjusted cancer incidence united states \( , men women \) rose 10 7 , average annual percentage change 0 9 analysis reported age specific incidence primary malignant brain tumors years demonstrates incidence rates increased dramatically 1973 1974 1985 1985 , incidence rates persons aged 75 79 , 80 84 , 85 years age 187 , , 501 , respectively , rates 1973 1974 similar increases found men women , analyzed separately combined average annual percentage changes primary brain tumor incidence 7 0 , 20 4 , 23 4 age ranges , respectively reported incidence younger persons varied little period time common histologic type primary brain tumor elderly glial origin , predominantly glioblastoma multiforme astrocytoma tumors highly malignant invariably fatal two possible causes may explain increased incidence elderly introduction extensive use x ray computed tomography since 1973 true increase incidence occurring independently diagnostic advances
effect prostaglandin e multiple experimental models v effect tumor host interaction prostaglandin e \( \) long cause immunosuppression seen cancer patients increased rates tumor growth due impairment immunologic response tumor investigated effect tumor host interaction utilizing parenterally administered long acting derivative , 16 , 16 dimethyl prostaglandin e \( \) administration found decrease rate tumor growth cost decreasing tumor free body mass alter resting metabolic rates alter parts brain dopamine metabolism significantly decreased serum level multiple amino acids conclusion , elevated levels may significantly alter metabolism tumor patients
malignant melanoma occurring pregnancy report northern israel oncology center \( 1968 1988 \) medical records seven patients treated within 20 year period malignant melanoma pregnancy reviewed significant detrimental prognostic effects could attributed pregnancy current literature melanoma pregnancy discussed based , pregnancy seems contraindicated melanoma patients
renal vein leiomyosarcoma case primary leiomyosarcoma renal vein reported unique features case included concomitant resection isolated hepatic metastasis , intraoperative radiation therapy , use electron microscopy immunohistochemical stains confirming diagnosis review previously reported cases shows tendency toward slow tumor growth infrequent recurrence \( 18 \) metastases common \( 82 \) , primarily lung liver aggressive surgical resection adjuvant radiation therapy , including intraoperative radiation therapy , recommended adjuvant chemotherapy considered , although benefits present unclear
adrenal clinical pathologic features case adrenal reported although synchronous malignancy adrenal gland described , case adrenal tumor combining elements previously documented neoplasm extremely aggressive distant metastasis arising component , rapid progression despite multimodal therapy
utility surgical margins management soft tissue sarcomas seventy four adult patients localized soft tissue sarcomas treated radiation therapy following surgery 1965 1988 fifty three treated first excision tumor 6 \( 11 3 \) local recurrences twenty one received radiation excision recurrent disease 11 \( 52 4 \) local failures \( p less 0005 \) metastatic disease occurred 14 \( 26 4 \) primary tumors 8 \( 38 1 \) multiple previous \( p less 48 \) patients treated primary sarcoma , local failures pathologically wide margins single margin microscopically positive local failure occurred 4 26 \( 15 4 \) tumor merely enucleated 2 11 \( 18 2 \) grossly positive surgical margins \( p significant \) local failure also common locations \( 33 3 \) compared extremity locations \( 8 7 , p \) additional factors analyzed adversely affected prognosis included tumor grade , stage , inadequate radiation dose
acral melanoma review 185 patients identification prognostic variables one hundred eight five patients acral melanoma treated since 1972 reviewed included 53 lesions , 123 lesions , 9 palmar lesions eighty percent presented stage disease mean age 57 years males females 1 1 1 seventeen percent \( 17 \) blacks actuarial 10 year survival 58 stage patients 35 stage ii patients univariate cox regression analyses identified 5 prognostic variables affecting survival stage diagnosis \( p less 0 001 \) , race \( p less 0 001 \) , ulceration \( p 0 012 \) , 's level \( p 0 014 \) , thickness primary lesion \( p 0 013 \) factors unrelated survival included sex patient , site \( vs \) , histology , treatment amputation multivariate analysis patients stage lesions identified race \( p 0 001 \) ulceration \( p 0 018 \) significant variables , thickness approaching significance \( p 0 094 \) additional series 71 patients melanomas arising extremity sites near junction glabrous non glabrous skin , survival significantly poorer arising glabrous skin \( p 0 024 \) , reflects higher incidence metastatic disease diagnosis specific active immunotherapy principal adjuvant used patients , survival comparable reported regional perfusion therapy acral melanoma \) strong racial predilection , b \) carries prognosis , c \) arises glabrous skin clinical entity distinct extremity melanomas surgical management either wide excision amputation appropriate primary lesion
long term experience totally implanted catheter system cancer patients long term experience totally implanted catheter systems \( tics \) limited retrospectively evaluated performance long term complications tics intravenous infusion cancer patients 134 systems implanted 128 patients median duration implantation 144 weeks 49 systems implanted one year complications related surgical factors included reservoir \( 2 \) , skin perforation wound dehiscence \( 1 5 \) pneumothorax \( less 1 \) complications related surgical factors included drug extravasation \( 1 5 \) , mechanical malfunction \( 1 5 \) , vein thrombosis \( less 1 \) , clotting reservoir catheter \( 2 \) , skin infection \( 1 5 \) , sepsis \( less 1 \) total complication rate 13 complications resolved spontaneously medical treatment 6 patients \( 4 6 \) required implantation second system conclude long term usage tics , complication rate remains low , making safe viable alternative patients requiring long term intravenous therapy
cutaneous malignant melanoma rochester , minnesota trends incidence survivorship , 1950 1985 rochester , minnesota , 107 incidence cases cutaneous malignant melanoma \( 46 male 61 female patients \) diagnosed years 1950 1985 overall crude incidence rates 6 0 6 6 per 100 , 000 males females , respectively evaluation trends 9 year periods showed rates increased 3 2 8 9 males \( p 0 015 \) 4 4 11 7 females \( p less 0 001 \) age specific rates suggested highest incidence occurs age groups 50 59 years 70 years older males 40 49 years 70 years older females lesions common head neck area among males \( p 0 044 \) lower extremities among females \( p 0 018 \) frequent histologic type superficial spreading melanoma \( 61 \) five year survival diminished overall patients cutaneous malignant melanoma 0 72 comparison 0 88 expected general population statistically significant risk factors survival depth invasion lesion \( level \) , thickness lesion , histologic type , age patient
diagnosis corticotropin producing bronchial carcinoid tumors causing cushing 's syndrome cushing 's syndrome due ectopic production hormone \( corticotropin \) recognized many years traditionally , clinicians thought cases due lung carcinomas clinical manifestations differed pituitary dependent cushing 's syndrome report two cases corticotropin producing bronchial carcinoid tumors clinically biochemically indistinguishable pituitary dependent cushing 's syndrome review literature revealed bronchial carcinoid tumors common cause cushing 's syndrome due ectopic secretion corticotropin biochemical anatomic studies , frequently indistinguishable pituitary dependent cushing 's syndrome thus may difficult diagnose inferior petrosal sinus sampling corticotropin computerized imaging chest may best aids making diagnosis
adult cell leukaemia lymphoma brazil relation htlv series fourteen patients adult cell lymphoma leukaemia \( atll \) brazil main features lymphadenopathy , hepatosplenomegaly , , high leucocyte counts , abnormal lymphoid cells irregular nuclei series included youngest patient atll far \( 18 months \) analysis monoclonal antibodies showed mature cell phenotype \( cd4 , cd8 \) antibodies htlv integration htlv proviral dna found eleven patients three htlv dna could demonstrated even means polymerase chain reaction therefore htlv negative atll report atll brazil serological reports htlv may endemic parts country follow studies required identify precisely main route transmission htlv south america risk factors development atll carriers
local control , , external canal cutaneous malignancies mohs surgery three hundred ninety seven patients 407 cutaneous malignancies , region , cartilaginous external ear canal reviewed tumors commonly located regions , followed helix , , , ear canal lesions excised mohs microscopic control margins lesions requiring lateral temporal bone resection , adaptation fresh tissue microscopic control used analyze deep anterior margins suspected residual tumor two year minimum follow 229 patients tumors \( n 231 tumors \) 14 patients cartilaginous ear canal tumors \( n 14 tumors \) revealed recurrence rates 6 9 14 3 , respectively recurrences common cases large tumors \( greater 2 5 cm \) , basal cell carcinomas elements , multiply recurrent lesions conclude mohs surgery comparatively effective , though uniformly curative , adapted supplement excision large tumors regions
clinical classification staging primary malignancies maxillary antrum study 51 patients primary malignant maxillary sinus neoplasms conducted none patients neck nodes metastases , 5 year follow tumors staged according 1983 1988 american joint committee cancer staging systems maxillary sinus cancers 13 early stage \( t1 , t2 \) 38 advanced \( t3 , t4 \) tumors systems cox regression analyses survival curves showed increasingly worse prognoses advanced tumors staging systems analyses showed significant difference survival t3 t4 1988 , 1983 system significant differences survival according treatment modality histological type malignancy conclude 1988 system successfully stage \( 1 4 \) demonstrates significant improvement detecting t3 versus t4 differences compared 1983 system 1988 system equally epidermoid cancer malignancies antrum
somatostatin receptor imaging localization endocrine tumors background methods number different tumors receptors somatostatin evaluated efficacy scanning 123i labeled octreotide , somatostatin analogue , tumor localization 42 patients carcinoid tumors , pancreatic endocrine tumors , paragangliomas evaluated response octreotide therapy patients results primary tumors metastases , often previously unrecognized , visualized 12 13 patients carcinoid tumors 7 9 patients pancreatic endocrine tumors endocrine symptoms patients responded well therapy octreotide among 20 patients paragangliomas , 8 one tumor , 10 temporal \( tympanic jugular \) , 9 carotid , 10 vagal tumors could visualized one small tympanic tumor one small carotid tumor seen scan conclusions 123i labeled octreotide scanning technique rapid safe procedure visualization tumors somatostatin receptors positive scan may predict ability octreotide therapy control symptoms hormonal hypersecretion
intraoperative ovarian cancer using monoclonal antibody b72 3 portable gamma detecting probe assess value radioimmunoguided surgery intraoperative detection ovarian cancer , used monoclonal antibody b72 3 , radiolabeled 125i , hand held gamma detecting probe 13 women ovarian cancer undergoing exploratory laparotomy b72 3 , recognizes tumor associated glycoprotein , tag 72 , injected 12 29 days preoperatively \( intraperitoneally four cases , intravenously nine , routes one \) intraoperatively , abdomen surveyed probe probe counts correlated biopsies excised specimens studied routine histologic stains probe counts positive four seven evaluable patients histologically confirmed disease three four patients , probe detected cancer specimens interpreted normal frozen histologic sections probe also identified microscopic cancer one patient gross disease specificity probe 70 preoperative computed tomography normal patients , including tumors large 3 cm pilot study shows ability radioimmunoguided surgery detect occult ovarian cancer
prognostic factors outcome survival second look laparotomy patients advanced ovarian carcinoma ovarian cancer stages iib iv , pre treatment variables variables obtained intraoperatively second look laparotomy investigated prognostic influence outcome 109 patients survival second look laparotomy 131 patients subjects came randomized trial sequential versus alternating combination chemotherapy overall median survival second look laparotomy 62 months logistic regression analysis identified stage hysterectomy plus bilateral oophorectomy significant prognostic covariates second look laparotomy outcome based cox multivariate stepwise analysis , independent prognostic factors survival second look laparotomy secondary residual tumor size , pre treatment histologic differentiation grade , performance status high differentiation grade good performance status start therapy thus still effect survival second look laparotomy prognostic power pre treatment variables increased substantially addition secondary residual tumor size variable 3 year survival rate second look laparotomy high low risk patients 15 87 , respectively second look laparotomy thus provides prognostic information patients advanced ovarian carcinoma , benefit terms survival still unclear
ovarian metastases rare stage adenocarcinoma cervix 32 year period university california , los angeles medical center , cases adenocarcinoma carcinoma uterine cervix reviewed determine incidence ovarian metastases stage disease one 25 patients \( 4 0 \) underwent exploratory laparotomy radical hysterectomy microscopic ovarian metastasis literature review identified nine additional patients ovarian metastases stage adenocarcinoma cervix including series , overall reported rate ovarian metastases 1 8 ten patients least one following additional characteristics postmenopausal , adnexal pathology , positive pelvic lymph nodes thus , ovarian preservation warranted premenopausal patients ovarian pathology evidence metastatic disease surgery bilateral oophorectomy may performed frozen section examination enlarged suspicious nodes documents metastases ovaries left pelvis completion surgical procedure microscopic spread pelvic tissues documented , pelvic irradiation administered
screening interval cervical smears one hundred seventy four women invasive cervical carcinoma interviewed cervical smear histories assess accuracy self reporting relate smear history patient tumor characteristics patients reported significantly frequent , recent , normal smears documented medical records interval onset cancer symptoms previous smear correlated directly advanced stage sixteen women normal smears within 36 months significantly advanced cancers 25 women recent abnormal smears women recent normal abnormal smears similar sociodemographic behavioral characteristics patients' self reported smear histories cancers developing women recent normal smears , conclude specific screening interval relied upon
cold knife laser conization cervical intraepithelial neoplasia 5 year study , 425 women conization performed cervical intraepithelial neoplasia \( cin \) , ii iii conization performed cases positive endocervical curettage colposcopy inconclusive cases , local destruction operation choice early years study , conization done cold knife method \( n 201 \) , whereas co2 laser used latter part study \( n 224 \) success complication rates two methods abnormal cytology conization found total 53 cases \( 12 5 \) , histologic confirmation residual recurrent cin made 27 women \( 6 4 \) corresponds success rate 92 cold knife 95 laser conization cin grading residual recurrent cin similar less cin diagnosis cone success rate comparable series much less strict referral criteria , policy seems adequate
primary invasive carcinoma vagina retrospective review conducted 53 women invasive carcinoma vagina without documented exposure diethylstilbestrol seen university california medical center , long memorial medical center , memorial medical center 1976 1988 forty seven \( 89 \) squamous cell carcinoma six \( 11 \) adenocarcinoma thirty seven \( 70 \) treated whole pelvis irradiation brachytherapy , nine surgery alone , seven combination treatments crude corrected 2 year survival rates entire group 47 69 , respectively previous pelvic surgery likely develop serious treatment related complications statistically significant correlation previous hysterectomy diagnosis primary invasive carcinoma vagina onset symptoms women diagnosed routine examination , symptom onset , tended survival advantage women , including hysterectomy , counseled continue gynecologic cancer surveillance regardless age
carbon dioxide laser diaphragmatic metastases cytoreduction ovarian epithelial cancer three patients international federation gynecology obstetrics state ovarian adenocarcinoma underwent co2 laser large volume \( 5 6 cm \) right metastases conclusion standard debulking surgery effect optimal cytoreduction destruction diaphragmatic metastases accomplished rapidly added morbidity blood loss hand held co2 laser useful modality removal isolated large small volume diaphragmatic disease , particularly peritoneum involved , avoids morbidity may accompany entry pleural space
detection , prevalence , prognosis asymptomatic carcinoma cervix 1979 1986 , 82 407 patients \( 20 \) treated infiltrative carcinoma cervix asymptomatic time diagnosis sixteen \( 20 \) 82 patients stage ia , 60 \( 73 \) stage ib , six \( 7 \) stage iia disease asymptomatic patients represented 16 23 \( 70 \) stage ia , 60 196 \( 31 \) stage ib , six 77 \( 8 \) stage iia netherlands , population screening cervical carcinoma conducted women aged 35 55 years examine prevalence asymptomatic cervical carcinoma way detected different age groups , studied patients referred department among patients younger 35 years cervical carcinoma , 20 70 \( 29 \) asymptomatic disease detected incidental screening , whereas eight 177 \( 5 \) group 55 years older detected incidental screening age category 35 55 years , 54 160 \( 34 \) asymptomatic patients aged 35 55 years undergone population screening incidental screening patients 55 years older , asymptomatic disease significantly less prevalent younger patients one 66 asymptomatic patients stage ib higher suffered tumor recurrence among symptomatic patients , 25 136 \( 18 \) stage ib 17 71 \( 24 \) stage iia tumor recurrence despite favorable prognosis patients asymptomatic carcinoma , asymptomatic presentation could shown significant prognostic factor , tumor diameter lymph node status
new findings treatment colon cancer patients colon cancer involving regional lymph nodes \( stage c disease \) 5 year survival rate 30 40 , majority die recurrent disease recent trials shown increased survival rates postoperative use fluorouracil plus levamisole authors discuss findings implications treatment recommendations stage c colon cancer
cloning cdna human 12 lipoxygenase full length cdna clone encoding 12 lipoxygenase \( oxygen 12 , ec 1 13 11 31 \) isolated human platelet cdna library using cdna human reticulocyte 15 lipoxygenase probe initial screening cdna open reading frame encoding 662 amino acid residues calculated molecular weight 75 , three independent clones revealed minor dna sequences thus , three positions deduced amino acid sequence , choice two different amino acids deduced sequence clone showed 65 identity human reticulocyte 15 lipoxygenase 42 identity human leukocyte 5 lipoxygenase 12 lipoxygenase cdna recognized 3 0 kilobase mrna species platelets human erythroleukemia cells \( cells \) phorbol 12 13 acetate induced megakaryocytic differentiation cells 12 lipoxygenase activity increased mrna 12 lipoxygenase identity cloned 12 lipoxygenase expression mammalian cell line \( cells \) human platelet 12 lipoxygenase difficult homogeneity cloning cdna increase possibilities elucidate structure function enzyme
p53 mutations colorectal cancer staining primary colorectal carcinomas antibodies specific p53 demonstrated gross overexpression protein approximately 50 malignant tumors examined benign adenomas negative p53 overexpression determine molecular basis overexpression examined p53 protein expression 10 colorectal cancer cell lines six cell lines expressed high levels p53 elisa , cell staining , immunoprecipitation studies direct sequencing chemical cleavage analysis p53 cdna using polymerase chain reaction cell lines showed cell lines expressed high levels p53 synthesizing mrnas encoded mutant p53 proteins two four cell lines p53 expression lower , point mutations still detected thus , conclude overexpression p53 mutation , mutations would detected simple immunohistochemical analysis mutation p53 gene one commonest genetic changes development human colorectal cancer
chemical carcinogenesis many rodent carcinogens administration chemicals maximum tolerated dose \( mtd \) standard animal cancer tests postulated increase cell division \( mitogenesis \) , turn increases rates mutagenesis thus carcinogenesis animal data consistent mechanism , high proportion half chemicals tested \( whether natural synthetic \) indeed rodent carcinogens conclude low doses human exposures , cell killing occur , hazards humans rodent carcinogens may much lower commonly assumed
gd hp do3a clinical mr imaging brain part phase ii clinical trial , 14 patients presumed intracranial neoplastic disease underwent magnetic resonance \( mr \) imaging intravenous injection gadolinium 1 , 4 , 7 \( \) 10 \( 2' \) 1 , 4 , 7 , 10 \( hp do3a \) neutral \( nonionic \) gadolinium lower osmolality , formulated equimolar concentrations , superior vitro stability compared gadopentetate dimeglumine safety profile gd hp do3a permitted administration doses 0 3 mmol kg , three times dose gadopentetate dimeglumine approved u food drug administration limited clinical trial , gd hp do3a proved safe efficacious agent mr imaging head change documented patient monitoring slight skin injection site immediately administration two patients statistically significant changes due administration agent noted laboratory evaluations results differ obtained gadopentetate , induces transient rise serum iron bilirubin levels 26 patients administration higher doses gd hp do3a , either 0 2 0 3 mmol kg , appeared provide improved enhancement decrease efficacy high doses noted
primary ewing sarcoma follow ga 67 scintigraphy accumulation gallium 67 citrate technetium 99m methylene \( mdp \) occurs initially cases primary ewing sarcoma , uptake therapy less well defined thirty patients ewing sarcoma underwent ga 67 bone scintigraphy diagnosis , completion therapy , relapse 1978 1988 evaluated 30 patients showed less primary site ga 67 activity following therapy twenty three 28 patients underwent corresponding bone scintigraphy showed less uptake , residual activity usually intense ga 67 ga 67 occurred four five patients primary site relapse , patients underwent bone scintigraphy showed less change concluded greater decrease ga 67 tc 99m mdp uptake often occurs patients successfully treated primary ewing sarcoma information obtained ga 67 scintigraphy likely helpful results bone scintigraphy remain abnormal occult relapse suspected
ultrasonographic staging rectal carcinoma ultrasonography valuable imaging method examination rectum tissues assessed 50 patients known rectal carcinoma prospectively using 7 0 mhz transducer determine depth invasion rectal wall tumor presence lymphadenopathy tumors staged using modification dukes staging system , results compared histologic staging surgical specimen ultrasonography accuracy 80 , sensitivity 92 , specificity 76 detection invasion fat ultrasonography sensitive detection lymphadenopathy specific distinguishing benign malignant nodes
invasive lobular carcinoma mammographic findings 10 year experience january 1 , 1976 december 30 , 1985 , 1 , cases breast carcinoma diagnosed treated general hospital , , sweden cases , 185 \( 9 4 \) involved invasive lobular carcinoma \( \) mammography 137 cases demonstrated following findings opacity \( 53 \) , architectural distortion \( 16 \) , poorly defined opacity \( 7 \) , normal benign findings \( 16 \) , parenchymal asymmetry \( 4 \) radiographic definition lesion varied greatly projection view demonstrated significant findings frequently either oblique lateral views secondary radiographic findings present 31 , rare , physical findings present 89 diffuse growth pattern tendency form lesions opacity equal less parenchyma , extremely difficult detect mammographically therefore , radiologist must alert subtle mammographic signs malignancy highly suspicious abnormal physical findings regardless mammographic appearance
mammographic follow low suspicion lesions compliance rate diagnostic yield recommendations mammographic follow low suspicion lesions seen mammography 6 month period reviewed establish compliance rate eventual outcome one hundred forty four 2 , mammograms \( 5 \) showed minimal abnormalities warranted short term periodic mammographic follow rates compliance 4 months 1 , 2 , 3 years 88 , 71 , 60 , 47 , respectively progressive mammographic change found 10 patients , one carcinoma concluded mammographic follow low suspicion lesions reasonable alternative surgical biopsy , although patient compliance remains significant problem
insulinomas localization selective intraarterial injection calcium facilitate noninvasive preoperative localization islet cell tumors less 15 mm diameter , authors examined use calcium insulin secretagogue arterial stimulation venous sampling \( \) technique four patients episodic hypoglycemia , calcium \( 0 01 0 025 meq ca2 kg \) injected directly branches celiac plexus \( gastroduodenal , splenic , hepatic arteries \) superior mesenteric artery patients , serum levels insulin rose blood samples taken right hepatic vein 30 60 seconds infusion calcium artery supplying tumor injection artery supplying tumor result similar rise accurate localization insulinomas verified surgery three patients fourth patient , undergo surgery , arteriographic results positive insulinoma predicted site basis results , authors believe noninvasive may replace invasive portal venous sampling effective method localization occult insulinomas
selective catheterization inferior petrosal sinuses new catheter design catheters selective catheterization right left inferior petrosal sinuses developed replace complex tip catheter guide wire system currently used new catheters easily formed commonly available straight catheters use successfully tested 22 patients complications minor groin hematomas
petrosal sinus sampling technique rationale bilateral simultaneous sampling inferior petrosal sinuses extremely sensitive , specific , accurate test diagnosing cushing disease distinguishing entity ectopic acth syndrome also valuable small hormone producing adenomas within pituitary gland inferior petrosal sinuses cavernous sinuses ipsilateral internal jugular veins anatomy anastomoses inferior petrosal sinus , internal jugular vein , venous plexuses base skull varies , almost always possible inferior petrosal sinus addition , variations size anatomy often present two inferior petrosal sinuses patient advance preparation required petrosal sinus sampling critical element , member staff know procedure samples must properly labeled , processed , stored specific needles , guide wires , catheters recommended procedure procedure performed specific attention three areas potential technical difficulty catheterization common femoral veins , crossing valve base left internal jugular vein , selective catheterization inferior petrosal sinuses specific methods dealing areas non correct catheter position inferior petrosal sinus demonstration reflux contrast material ipsilateral cavernous sinus images must always obtained document correct catheter position special attention must paid two points prevent potential complications patient must given adequate dose heparin , injection contrast material inferior petrosal sinuses surrounding veins must done carefully procedure performed outlined , inferior petrosal sinuses catheterized 98 patients complication rate low , theoretical risk major morbidity death less 1 \( neither yet occurred , knowledge \) common complication groin hematoma
spindle epithelioid cell nevus \( spitz nevus \) natural history following biopsy clinical follow study 49 cases spindle epithelioid cell nevus presented address question potential local recurrence 19 \( 39 \) 49 lesions initially excised en , remainder \( 30 cases \) positive margins six latter spindle epithelioid cell nevi , evidence residual nevus found five six cases recurrences 49 patients average follow period 5 0 years \( range , 1 10 years \) rarity recurrent spindle epithelioid cell nevus would justify conservative approach management , clinical follow alone recommended subtotal excision , pathologic diagnosis unequivocal
occupational sunlight exposure melanoma u navy melanoma second common cancer , testicular cancer , males u navy wide range occupations varying exposures sunlight possible etiologic agents present navy person years risk cases malignant melanoma ascertained using computerized service history inpatient hospitalization files maintained health research center total 176 confirmed cases melanoma identified active duty white male navy personnel 1974 1984 risk melanoma determined individual occupations occupations grouped review job descriptions three categories sunlight exposure \( 1 \) indoor , \( 2 \) outdoor , \( 3 \) indoor outdoor compared u population , personnel indoor occupations higher age adjusted incidence rate melanoma , e , 10 6 per 100 , 000 \( p 06 \) persons worked occupations required time lowest rate , e , 7 0 per 100 , 000 \( p 06 \) incidence rates melanoma higher trunk commonly sunlight exposed head arms two single occupations found elevated rates melanoma \( 1 \) survival , sir 6 8 \( p less 05 \) \( 2 \) , sir 2 8 \( p less 05 \) however , cases melanoma excess risk occupations similar job descriptions findings anatomical site melanoma study suggest protective role brief , regular exposure sunlight fit recent laboratory studies shown vitamin suppress growth malignant melanoma cells tissue culture mechanism proposed vitamin inhibits previously initiated melanomas becoming clinically apparent
control interleukin 1 beta expression protein kinase c cyclic adenosine monophosphate myeloid leukemia cells examined signal transduction pathways leading expression interleukin 1 beta \( il 1 beta \) gene human myeloid leukemia cells lines two cell lines representing different stages differentiation used \( hl 60 , promyelocytic , 1 , mature monocytic \) accordance previous studies , observed protein kinase c \( pkc \) activator , phorbol myristate acetate \( pma \) , sufficient stimulus induction il 1 beta messenger rna \( mrna \) expression il 1 beta protein production cell lines structural analog cyclic adenosine monophosphate \( \) agents elevating endogenous camp levels \( prostaglandin e2 , forskolin \) alone able induce il 1 beta expression , strongly enhanced pma induced il 1 beta production il 1 beta mrna accumulation nuclear run analysis showed elevation il 1 beta mrna levels due increased rate transcription added 6 hours pma cultures , enhancement il 1 beta production seen , implying enhancing effect signals must present simultaneously pkc inhibitor , , also blocked effectively pma plus induced il 1 beta production , protein kinase \( \) inhibitor , , effect , suggesting activation involved mechanism action camp case collectively , present findings show camp dependent signals positive regulatory effect pkc dependent activation il 1 beta gene cells derived different stages myeloid differentiation
potentiation erythropoietin response dimethyl priming erythroleukemia cells evidence interaction two signaling pathways erythropoietin \( epo \) dimethyl \( dmso \) believed induce differentiation transformed erythroid cells different signal transduction pathways obtained evidence interaction pathways used murine erythroleukemia cell line relatively low \( 8 10 \) response epo alone pretreatment cells 1 day dmso followed removal addition epo resulted marked enhancement epo specific designated effect dmso priming priming effect dmso epo response time dependent dmso concentration dependent dmso priming potentiated epo response three ways , dmso priming increased total number epo responsive cells 8 10 40 60 , dmso priming reduced time required reach optimal epo induced response 4 days 2 days , epo dose response curve left shifted approximately 20 fold dmso priming also associated marked increase epo receptor density characterized apparently new receptor population appearance positive receptors results suggest dmso priming effect due potentiation epo signaling pathway , thus resulting much rapid dramatic epo induced response
vitro drug sensitivity cells children leukemia using mtt assay improved culture conditions knowledge drug resistance childhood leukemias acute lymphoblastic leukemia \( \) general limited lack suitable vitro drug sensitivity assay , part due low vitro cell survival recently adapted highly efficient 3 4 , 5 2 2 , 5 tetrazolium bromide \( mtt \) assay test cells patients showed results comparable disc assay , valid assay study , vitro drug sensitivity assessed cells 82 children leukemia , 79 , mtt assay dose response curves obtained 6 , 6 \( 6 tg \) , prednisolone \( \) , daunorubicin \( dnr \) , vincristine \( vcr \) , cytosine arabinoside \( ara c \) , l \( l asp \) , , cytotoxic effect methotrexate could detected cases large interindividual differences drug sensitivity detected compared leukemia cells newly diagnosed patients , leukemia cells relapsed patients significantly vitro resistant 6 tg , , ara c , dnr , vcr , l asp improvements culture medium methods increase mtt reduction studied 10 components tested , addition insulin bovine serum albumin serum containing medium improved cell survival addition succinate increase amount mtt reduction conclude vitro mtt assay highly facilitates large scale studies drug resistance patients lead rational improvements existing treatment protocols
analysis interferon inducible genes cells chronic myeloid leukemia patients responsive resistant interferon alpha treatment recombinant human interferon alpha \( ifn alpha \) induce hematologic remission patients chronic myeloid leukemia however , patients resistant others develop late resistance ifn alpha treatment understand molecular mechanism resistance , analyzed expression 10 ifn inducible genes cells three resistant patients , two responsive patients , six healthy controls northern blot hybridizations showed genes induced vitro ifn alpha treated peripheral blood cells patients healthy controls genes also inducible peripheral blood bone marrow cells two two resistant patients administered injection ifn alpha conclude resistance ifn alpha treatment chronic myeloid leukemia patients studied due \( 1 \) absence induction 10 ifn inducible genes studied , including low molecular weight 2' synthetase \( 2 \) presence antagonist ifn alpha peripheral blood bone marrow cells \( 3 \) presence neutralizing anti ifn alpha antibodies
serum erythropoietin levels patients receiving intensive chemotherapy radiotherapy investigate potential role recombinant human erythropoietin \( \) patients receiving intensive cytotoxic therapy , measured endogenous levels epo 31 patients undergoing bone marrow transplantation \( bmt \) seventeen patients underwent allogeneic bmt 14 underwent autologous bmt average , 10 4 units red blood cells \( rbcs \) transfused per patient mean rbc transfusion requirement autologous bmt patients significantly greater allogeneic recipients \( 12 3 v 8 4 , p less 01 \) , although groups maintained comparable hematocrits epo levels measured radioimmunoassay \( ria \) patient , baseline serum epo levels determined time admission hospital subsequent samples collected within 24 hours completing chemotherapy radiotherapy , days 7 , 14 , 28 , bmt hematocrits \( \) measured daily patients initial serum creatinine less equal 1 5 mg dl despite considerable differences absolute epo levels among individuals , characteristic pattern observed following admission hospital initiation cytotoxic therapy , average hct decreased average epo level initially increased mean serum epo levels peaked day 7 post bmt \( 284 190 mu ml \) fell steadily thereafter average day 7 day 28 post bmt significantly different \( 28 4 6 v 29 3 3 , respectively \) , average serum epo levels decreased fourfold \( p less 01 \) period moreover , day 28 post bmt mean epo levels inappropriately low \( p less 05 \) compared reference population bone marrow failure normal controls received cytotoxic therapy conclude endogenous epo response appears blunted 3 4 weeks immediately post bmt therefore , clinical trials assessing efficacy administration treatment associated cytotoxic therapy warranted
efficacy interferons lesions preliminary results open randomized trial recombinant interferon gamma patients suffering described recombinant interferon gamma given subcutaneously 12 patients daily dose 4 x 10 \( 6 \) u injection four patients assigned one three treatment groups consisting continuous therapy \( group \) three subcutaneous injections per week 13 weeks intermittent block therapy \( group b \) four six week cycles consisting five injections days 1 , 3 , 5 , 7 , 9 cycle intermittent single dose therapy \( group c \) six four week cycles consisting one subcutaneous injection day one cycle twenty sixth week onset therapy , complete responses seen three four patients treatment group , whereas treatment groups b c one patient , respectively , responded partially results suggest contrast condylomata lesions respond better continuous intermittent interferon gamma injections
non aids associated kaposi 's sarcoma \( classical endemic african types \) treatment low doses recombinant interferon alpha treatment classical endemic african forms kaposi 's sarcoma \( ks \) , radiation therapy chemotherapy widely used varying degrees success morbidity report preliminary experiences low doses recombinant interferon alfa 2b \( rifn alpha 2b \) treatment types ks , non linked acquired immunodeficiency syndrome \( aids \) ten consecutive patients \( eight patients classical two endemic ks \) median age 62 years treated long term 5 x 10 \( 6 \) units rifn alpha 2b \( \) given subcutaneously three times weekly least 6 months 10 patients , six presented cutaneous disease , four additional visceral involvement 6 months treatment , seven 10 patients major response cutaneous lesions , three patients showed stable skin diseases four patients additional visceral disease , one patient showed complete regression tumor involving right atrium ventricle , whereas three patients stabilization visceral lesions marked symptomatic improvement occurred whole , long term results median duration 12 months \( range , 7 30 \) also satisfactory ifn alpha continued control ks patients treatment generally well tolerated serious side effects observed preliminary data suggest low dose rifn alpha 2b regimens effective classical endemic african ks however , studies needed establish exact role ifn alpha alternative radiation chemotherapy
clinical evaluation interferons malignant melanoma evaluation interferons treatment malignant melanoma mainly treatment advanced disease using interferons sole agent combination agents studies value interferons adjuvant therapy high risk primary melanoma patients necessary , results published date human interferon alpha produces low response rates sole agent , combination cimetidine , 30 response rate achieved recombinant alpha interferons give responses 15 20 advanced melanomas , combination cimetidine enhance response rate recombinant alpha interferons used combination interferons , cimetidine , monoclonal antibodies , , either small improvement response rates recombinant interferon alpha 2a shown produce objective response rates 26 , low toxicity maintenance quality life randomized trial sole agent , compared combination treatment , conducted determine significance finding
long term adjuvant therapy high risk malignant melanoma interferon alpha 2b fifty three high risk melanoma patients stage 15 patients stage ii treated standard surgical intervention adjuvant therapy recombinant interferon alpha 2b \( rifn alpha 2b \) therapy total period 20 months concomitant patients \( stage , n 82 stage ii , n 33 \) identical stages prognostic factors without adjuvant therapy used evaluate efficacy rifn alpha 2b therapy difference 5 year relapse incidence overall survival rates could detected however , appears patients stage stage ii benefit long term adjuvant rifn alpha 2b therapy , treatment period \( 20 months \) , incidence relapses lower comparison controls stopping treatment incidence relapse equal treated control groups according results study , suggest using continuous low dose rifn alpha 2b therapy adjuvant treatment malignant melanoma
interferon alpha etretinate combination treatment cutaneous cell lymphoma eleven patients suffering cutaneous cell lymphoma \( mycosis fungoides \) treated recombinant interferon alpha 2a combination \( seven patients \) alone two patients , one combined treatment , went clinical complete remission , five experienced partial remission two patients progressed therapy , two stopped treatment early due side effects dosages interferon 3 36 million units daily 3 months , thereafter 3 times weekly etretinate \( 0 7 mg kg \) given orally study showed recombinant interferon alpha 2a combination etretinate alone induce remission cutaneous cell lymphoma
cytostatic cytotoxic effects recombinant tumor necrosis factor alpha sensitive human melanoma cells vitro may result selection cells enhanced markers malignancy monolayer cultures human melanoma cell lines stml 12 , stml 11 , stml 14 \( third , respectively , twenty fifth \) , 28 derived specimens representing different stages tumor progression treated 10 10 , 000 u ml rtnf alpha applied 72 h effects rtnf alpha cell proliferation , dna synthesis , cell viability , cloning efficiency , cell division , cell morphology , immunophenotype studied experiments cell line stml 14 \( 3 \) revealed significantly dose dependent reduction growth due cytostatic cytotoxic activities rtnf alpha well decrease ce increased numbers cells observed 24 h addition r tnf alpha addition , dislocation chromosomes metaphase , formation , dose dependent increases cells exhibiting dna amount per cell detected end treatment hand , slight sensitivity anti proliferative effect rtnf alpha observed stml 14 \( 25 \) 28 , whereas stml 12 stml 11 significantly resistant last four cell lines serially presented common phenotypic patterns malignant characteristics cell line stml 14 \( 3 \) treatment overall , rtnf alpha enhanced malignant immunophenotype cell lines tested increased expression late melanoma progression markers 10 33 1 43 , , decreased expression early progression marker k 1 2 expression hla , hla dr , icam 1 also enhanced rtnf alpha treatment , whereas contrast cytokines , rtnf alpha induce de novo expression hla dr hla dr negative melanoma cell lines findings indicate rtnf alpha induces decreases cell viability certain rtnf alpha sensitive melanoma cells effects may result selection rtnf alpha non sensitive human melanoma cell populations higher proliferation rates aggressive immunophenotype vitro
high incidence antibodies htlv tax blood relatives adult cell leukemia patients adult cell leukemia \( atl \) caused human cell leukemia virus type \( htlv \) although mechanisms process unknown , tax gene may role process clustering occurs htlv atl , members atl families examined antibodies tax protein compared matched htlv positive blood donors investigate antibody response protein , plasmid , 4 , constructed express recombinant tax protein \( r tax \) atl patients htlv antibody positive blood relatives , rate r tax protein 67 3 \( 35 52 \) , compared 51 6 \( 97 188 \) htlv antibody positive control blood donors \( p less 05 \) difference direct offspring atl patients matched htlv blood donors even greater \( 84 2 16 91 vs 44 2 42 95 p less 005 \) thus , tax antibody positivity direct offspring atl patients may reflect differences time route htlv infection alternatively , might reflect genetic differences host susceptibility virus strain
fastigial pressor response case report distinct vasomotor response first identified experimentally elicited intraoperatively 6 year old girl local mechanical stimulation vicinity fastigial nucleus cerebellum findings discussed light current experimental knowledge anatomy physiology fastigial pressor response
correlates survival grading system astrocytomas order examine correlation prognosis histological features nuclear atypia , , endothelial proliferation , necrosis supratentorial adult astrocytomas , authors reviewed 251 cases treated massachusetts general hospital 1972 1980 one point given presence feature total number features translated grade follows none four features grade 1 \( one patient \) , one feature grade 2 \( 36 patients \) , two features grade 3 \( 33 patients \) , three four features grade 4 \( 181 patients \) period survival significantly associated grade , presence absence four histological features , patient 's age , type operation , radiation therapy , extent tumor \( log rank , p less 0 05 \) variables associated grade age \( p less 0 001 \) radiation therapy \( p less 0 02 \) adjustment variables using cox proportional hazards model , difference overall survival time patients grades 2 3 statistically significant comparable groups patients examined terms age receipt radiation therapy , median survival times differed markedly patients 50 years age less median survival time 68 months \( grade 2 tumors \) , 29 months \( grade 3 tumors \) , 13 months \( grade 4 tumors \) patients 50 years age median survival time 6 months \( grade 2 4 tumors \) 9 months \( grade 3 tumors \) patients received radiation therapy median survival time 68 months \( grade 2 tumors \) , 21 months \( grade 3 tumors \) , 11 months \( grade 4 tumors \) patients receive radiation therapy median survival time 1 month \( grade 2 tumors \) 2 months \( grade 3 4 tumors \) half patients died within 2 months surgery grading system , originally proposed , et al , simple , objective , reproducible , correlates well survival times authors recommend astrocytomas graded scale 1 4 , grade 1 reserved rare adult supratentorial astrocytoma none four histological features
intratumoral oxygen pressure malignant brain tumor oxygen pressure \( po2 \) brain tumors , po2 brain cortex surrounding tumors , pao2 measured simultaneously total resection 16 patients previously untreated brain tumors order detect hypoxic regions within tumors inhaled o2 n2o ratio 1 3 enflurane anesthesia , mean pao2 109 2 5 8 mm hg , rather high value compared obtained air inhaled atmospheric pressure simultaneously measured intratumoral po2 po2 brain cortex surrounding tumor 15 3 2 3 59 8 6 5 mm hg , respectively intratumoral po2 value significantly lower po2 brain cortex surrounding tumor \( mean less 30 mm hg , wilcoxon signed rank test , p less 0 005 \) influenced oxygen effects radiation results appear confirm hypoxic regions within human brain tumors comparison intratumoral po2 either angiographic contrast enhanced computerized tomography scans tumor vasculature disclosed correlation
photodynamic therapy spontaneous cancers , , aluminum first report photodynamic treatment second generation , aluminum \( caspc \) spontaneously arising tumors photodynamic therapy \( pdt \) neoplasms 10 cats , 2 dogs , 3 presenting variety tumor types \( squamous cell carcinoma , mast cell malignant tumor , mixed carcinoma sarcoma \) given intravenous injection 1 mg caspc per kilogram body weight 48 hours prior irradiation nm light larger tumors \( greater 1 5 cm deep \) surgically prior pdt significant systemic toxicity skin observed animal tumor responses comparable seen conventional cryotherapy , hyperthermia , surgery pdt caspc cases led 67 \( 12 18 \) complete response , 22 \( 4 18 \) partial response , 11 \( 2 18 \) response \( less 50 reduction tumor size \) four cases could evaluated since overall tumor response caspc good , problem skin photosensitivity , expected using caspc pdt eradicate human tumors would also yield comparable results studies long term follow necessary optimize use caspc pdt human medicine
increased expression laminin receptor human colon cancer proposed among various cell surface proteins capable interacting laminin , 67 kd high affinity laminin receptor plays crucial role tumor invasion metastasis study , expression laminin receptor precursor messenger rna \( mrna \) 67 kd protein analyzed human colon adenocarcinoma 22 23 patients colon cancer , found 2 23 fold increase levels laminin receptor precursor mrna cancer tissues compared matched normal adjacent colonic mucosa 10 11 cases studied , level 67 kd laminin receptor , detected affinity purified anti laminin receptor synthetic peptide antibodies immunoblots matched tumor normal tissue extracts , higher colon carcinoma tissue laminin receptor tissue sections using anti laminin receptor peptide antibodies confirmed increased expression laminin receptor specifically associated cancer cells series 72 paraffin sections colon lesions , observed correlation expression laminin receptor dukes' classification observations indicate increased expression laminin receptor precursor mrna associated enhanced levels 67 kd laminin receptor well invasive phenotype colon carcinoma detection metastasis associated gene product may valuable adjunct evaluation human colon cancer
effect prior cancer chemotherapy human tumor specific cytotoxicity vitro response biologic response modifiers tumor specific cytotoxicity measured fresh human biopsy specimens modification differential staining cytotoxicity assay , cytokine inducer derived , produces broad spectrum activation macrophages lymphocytes , dramatically effective tested tumors obtained patients previously treated , chemotherapy responsive adenocarcinomas \( breast ovary \) tested tumors obtained either previously untreated patients previously treated patients chemotherapy refractory adenocarcinomas \( colon , lung , pancreas , stomach , kidney , gallbladder , uterus , prostate \) similar findings , relating prior chemotherapy treatment status , obtained tumor necrosis factor interferon gamma , interleukin 2 interferon alpha basis findings evidence literature , speculate response chemotherapy produces massive release processing tumor antigens speculate response leads state human immune system primed \( via situ vaccination \) respond exogenous macrophage activation signals potent , specific antitumor effects
comparisons diet biochemical characteristics stool urine chinese populations low high colorectal cancer rates investigation roles diet stool biochemistry human colorectal carcinogenesis , 24 hour food , urine , stool samples collected randomly selected participants two populations fourfold difference colorectal cancer risk chinese , people 's republic china \( low risk \) , chinese americans similar ages san francisco county , calif , united states \( high risk \) findings supported hypotheses colorectal cancer risk increased consumption high fat , high protein , low carbohydrate diets associated high levels cholesterol stool well increased daily outputs 3 methyl histidine urine however , risk increase low stool bulk low total stool fibers
phase trial capsules using prolonged , low dose oral administration treatment advanced malignancies phase trial conducted use prolonged , low dose oral schedule number different regimens tested , including daily dosing 21 days followed 7 days drug therapy continuous dosing daily dosing 5 7 days 3 consecutive weeks followed week rest dose escalation accomplished increasing dosing frequency day twice day three times day increasing number days administration fifty one patients advanced cancer entered study one hundred twenty four \( 96 \) 129 courses considered assessable myelosuppression proved dose limiting toxic effect toxic effects included stomatitis , nausea vomiting , anorexia , diarrhea , skin rash , fatigue , elevation liver transaminase levels antitumor activity observed patients melanoma bladder cancer , disease stabilization occurred sarcoma pheochromocytoma recommended dosing schedule phase ii clinical trials 25 mg three times day 5 days 3 consecutive weeks followed 1 week drug therapy
photodynamic therapy truly future head neck oncology \? 5 year experience photodynamic therapy , consists selective destruction tumors using combination administered systemically \( ether \) argon dye pumped laser , provoked profound interest amongst oncologists particularly head neck oncologists potential unfortunately , multi institutional trials head neck tumors introduced , literature replete anecdotal reports individual researchers management advanced cancers palliation , superficial early cancers , field mucosa \( mucosa \) personal 5 year experience 41 head neck cancers reviewed , current literature attempt made place perspective true role future direction technology
extended approach lesions communication , extension approach permitted safe , effective access petrous tip presented basic technique involved complete , preservation middle inner ear structures , removal sigmoid middle fossa plates , middle posterior fossa , ligation superior petrosal sinus , division nine cases approach constituted basis paper 2 , 2 basilar artery aneurysms , 2 , 3 meningiomas indications , complications , method discussed
novel metalloproteinase gene specifically expressed stromal cells breast carcinomas gene identified expressed specifically stromal cells surrounding invasive breast carcinomas basis sequence , product gene , named stromelysin 3 , new member family metalloproteinase enzymes degrade extracellular matrix suggestion stromelysin 3 one stroma derived factors long postulated play important part progression epithelial malignancies
germ line transmission mutated p53 gene cancer prone family li fraumeni syndrome tumour suppressor genes , whose usual function seems controlling normal cell proliferation , implicated many inherited sporadic forms malignancies much evidence supports concept tumour formation loss function mutations suppressor genes , predicted two hit model suppressor gene , p53 , affected manner numerous mutations , occur variety human tumours mutations usually represent loss one allele substitution single base analysed p53 gene family affected li fraumeni syndrome , rare autosomal dominant syndrome characterized occurrence diverse mesenchymal epithelial neoplasms multiple sites instances neoplasms seem related exposure carcinogens , including ionizing radiation li fraumeni family studied skin fibroblasts \( \) unusual radiation resistant phenotype dna derived cells four family members , spanning two generations , point mutation codon 245 \( \) p53 gene mutation leads substitution aspartic acid glycine one regions identified frequent target point mutations p53 cell lines mutation also retained normal p53 allele inherited p53 mutation may predispose members family increased susceptibility cancer
intracerebral solitary plasmacytoma report rare occurrence plasmacytoma review literature clonal nature neoplasm demonstrated immunohistochemical molecular techniques importance latter techniques pathological entities stressed
mohs micrographic surgery mohs micrographic surgery technique treatment nonmelanoma skin cancers , especially recurrent , invasive , infiltrating basal cell carcinomas provides cure rates using 100 surgical margin control , achieves maximal preservation normal tissue conclusion tumor , defect immediate reconstruction better understanding mohs micrographic surgery technique , effectively used part coordinated multidisciplinary approach treatment patients difficult cutaneous neoplasms
transhepatic portal vein catheterization localization insulinomas ten year experience one important factors management insulinomas ability localize tumor accurately either surgery prospectively carried transhepatic portal venous sampling \( \) tumor localization 35 40 patients organic 10 year period 32 patients underwent single tumor subsequently identified surgically , maximal insulin gradient located vicinity tumor 100 cases specific tumor basis site maximal insulin gradient one three regions \( tail , body neck region , head uncinate region \) gave sensitivity 81 specificity 91 contrast , use specific cutoff levels insulin gradient guide presence tumor one three regions increase accuracy , leading instead significant loss sensitivity comparable increase specificity major complications procedure patient initial use computed tomographic ultrasound scanning selective angiography localized 46 tumors , whereas subsequent led accurate preoperative localization 100 tumors submitted surgery although surgeon would identified 81 tumors correctly operation , 19 \( n 6 \) would failed four tumors uncinate two head seems patients proved established organic , may continue value , tumor , especially pancreatic head uncinate process preclude operations body tail pancreas
myogenic regulatory protein \( myod1 \) expression childhood solid tumors diagnostic utility rhabdomyosarcoma transcripts muscle regulatory gene myod1 expressed normal skeletal muscle rhabdomyosarcomas tissues soft tissue sarcomas report distribution myod1 protein , determined reactivity anti myod1 polyclonal sera normal tissues , rhabdomyosarcoma cell lines , variety pediatric solid tumors distribution myod1 protein highly restricted normal tissues detected fetal skeletal muscle adult skeletal muscle six human rhabdomyosarcoma cell lines analyzed expressed myod1 mrna transcripts well immunoreactive protein immunohistochemical expression myod1 protein examined 49 surgical specimens variety pediatric solid tumors 16 rhabdomyosarcoma specimens positive myod1 , including four express intermediate filament protein desmin two five specimens originally designated sarcoma type indeterminate \( \) two three specimens originally designated ewing 's sarcoma \( \) positive myod1 , suggesting commitment myogenic differentiation three eight wilms' tumors , also expressed desmin clearly evident myogenic elements , also positive myod1 tumors failed express myod1 protein included neuroblastoma , primitive neuroectodermal tumor , non lymphoma , embryonal sarcoma liver , malignant fibrous histiocytoma , malignant rhabdoid tumor , ewing 's sarcoma bone results indicate expression myod1 protein highly restricted normal human tissues expression gene product malignant tissue may diagnostic rhabdomyosarcoma furthermore myod1 staining may valuable adjunct classification pediatric soft tissue sarcomas
vimentin expression appears associated poor prognosis node negative ductal breast carcinomas vimentin expression tumors 83 node negative 112 node positive patients infiltrative ductal otherwise specified \( \) breast carcinomas compared 5 year survival node negative , node positive patients , significant inverse relation vimentin expression survival five year survival node negative patients vimentin positive tumors significantly worse compared vimentin negative tumors \( p less 0 0001 \) node negative group , 36 patients vimentin positive tumors 82 patients vimentin negative tumors survived 5 years tumors eight node negative patients ductal cancer died first 27 months expressed vimentin multivariate analysis node negative group showed strong correlation vimentin expression overall survival , weak significant correlation histologic grade size overall survival 5 years thus vimentin expression seems strong indicator poor prognosis node negative ductal breast carcinomas
study neu protein expression mammary paget 's disease without underlying breast carcinoma extramammary paget 's disease correlation neu c erbb 2 2 gene amplification overexpression neu gene product reported tumors glandular origin , especially ductal breast carcinomas formalin fixed sections 23 cases mammary \( \) 9 cases extramammary \( \) paget 's disease immunohistochemically stained means monoclonal antibody directed intracellular domain neu gene protein exhibited distinct membrane staining tumor cells independent presence ductal breast carcinomas found 18 cases breast carcinomas also positive neu staining contrast , negative normal epidermis always negative northern blot analysis sustained immunohistologic findings presence neu mrna could demonstrated two three cases one case due dilution effects nontumor cells results suggest paget cells mammary extramammary localization , although similar phenotypically , derive different genetic accidents furthermore neu positivity underlying ductal carcinomas suggests common genetic alterations tumors however finding five neu protein positive without associated ductal breast carcinomas may suggest somewhat different transformation process
detection htlv proviral sequences cd30 positive large cell cutaneous cell lymphomas investigate possibility cutaneous cell lymphomas large cell type may associated human cell leukemia lymphoma virus type infection regions , tissue samples six cases large cell cutaneous cell lymphoma four cases small cell cutaneous cell lymphoma screened presence integrated proviral human cell leukemia lymphoma virus type dna combined use southern blot hybridization enzymatic dna amplification revealed human cell leukemia lymphoma virus type specific sequences cases large cell cutaneous cell lymphoma none cases small cell cutaneous cell lymphoma results suggest areas , significant proportion large cell cutaneous cell lymphoma cases associated human cell leukemia lymphoma virus type
metastasis associated laminin receptor human breast cancer cells obtained fine needle aspiration biopsy fine needle aspiration biopsy breast useful technique evaluation suspect lesion surgical removal increased expression 67 kd laminin receptor associated metastatic phenotype cancer cells , particularly colon breast cancers study , expression laminin receptor evaluated using immunoperoxidase technique 81 breast aspirates \( 26 benign 55 neoplastic lesions \) cells obtained benign samples exhibited low level laminin receptor antigen detected affinity purified antibody raised cdna derived laminin receptor peptide contrast , 71 smears obtained malignant breast lesions contained cells strongly stained antibody heterogeneous expression laminin receptor noted breast aspirates fixed tissue specimens data suggest laminin receptor cells obtained fine needle aspiration breast lesions could valuable adjunct prognostic evaluation breast lesions
proliferation markers ki 67 soft tissue lesions correlation dna flow cytometric characteristics frozen tissue immunoreactivity ki 67 , monoclonal antibody recognizes nuclear antigen proliferating cells , compared dna flow cytometry results \( fresh tissue \) diverse group 60 soft tissue lesions dna index ki 67 score independently reported associated grade prognosis sarcomas , direct comparison two variables made attempted measure proliferative activity fixed paraffin embedded tissues immunohistochemically subset lesions using antibody another nuclear proliferation antigen , lesions given grade according lesion category \( reactive , 1 benign , 2 low grade malignant , 3 high grade malignant , 4 \) ki 67 reactivity correlated relatively well grading system \( r 0 59 \) benign lesions usually exhibited low ki 67 score malignant lesions usually always exhibited high score example , malignant fibrous contained rare positive cells disparity ki 67 score grade within histologic types indicates independence features , fact may important correlation prognosis performed however ki 67 correlate well flow data percentage phase \( r 0 30 \) , percentage phases \( r 0 37 \) , dna index \( r 0 39 \) probably due fact ki 67 also cells g1 phase , whereas excluded flow data analyses anti highlighted almost nuclei cases tested , including fibromatosis , correlate ki 67 score , histologic grade dna flow cytometric data results could favorably affected titration experiments reasonable conclude ki 67 score variable related independent histologic grade , histologic type , dna flow values whether important human sarcomas , suggested , awaits clinicopathologic study
alternative splicing endothelial cell fibronectin mrna iiics region functional significance transforming growth factor beta 1 \( tgf beta 1 \) thought play role modulating vascular cell function vivo vitro , decreases endothelial cell proliferation migration postulated biologic activities could mediated tgf beta 1 modulation specific gene expression therefore differentially screened human umbilical vein endothelial cell cdna library cdnas prepared untreated tgf beta 1 treated bovine aortic endothelial cells using technique , isolated many tgf beta 1 induced cdna clones sequence analysis cdnas showed many corresponded alternatively fibronectin mrnas fibronectin clones contained \( ed \) three different forms type iii connecting segment \( iiics \) different fibronectin cdnas expressed bacteria recombinant proteins used study effects iiics alternative splicing cell attachment , spreading , migration bovine aortic endothelial smooth muscle cells b16f10 melanoma cells results experiments show attachment spreading bovine aortic endothelial smooth muscle cells depend primarily presence arg gly asp ser \( \) sequence recombinant fibronectin proteins however attachment spreading bovine aortic endothelial cells modulated alternative splicing iiics region specifically splicing iiics region decreases spreading increases migration rates endothelial cells contrary , using cell line \( b16f10 melanoma cells \) known require sequence adhesion confirmed previous findings b16f10 melanoma cells require presence sequence attachment spreading indeed b16f10 cells able spread two recombinant proteins contain sequence however attachment spreading b16f10 dramatically inhibited 75 base pair dna fragment removed 5' end iiics region results suggest various regions fibronectin molecule may able interact different cell populations promote cell attachment spreading , alternative splicing may modulate process
three dimensional system long term culture human colorectal adenomas studies adenoma carcinoma sequence colon rectum limited paucity experimental models adenoma growth progression progress recently reported development monolayer culture systems principal objective study develop primary culture system colorectal adenomas would simulate three dimensional vivo growth used calcium alginate encapsulation technique previously described established tumor cell lines briefly , fresh resected specimens washed , small particles called , encapsulated 1 calcium alginate maintained minimum essential medium containing 10 fetal bovine serum 37 degrees c 95 air , 5 co2 ten eleven adenomas , including six tubular , three , one villous successfully cultured 34 162 days cell viability confirmed histologically light electron microscopy cells characterized epithelial morphologic features ultrastructural studies , showed high degree cellular differentiation , including villous brush borders many tubular structures observed vitro , correlating cases histology parent adenoma measurements proliferative activity 3h thymidine autoradiography immunohistochemical staining monoclonal antibody ki 67 demonstrated growth fractions 9 25 simple , highly efficient primary culture system developed long term maintenance adenomas promotes three dimensional growth patterns growth rates analogous seen vivo model provides opportunity develop experimental system longitudinal studies pathologic molecular parameters adenoma progression carcinoma
chromatin structural analysis 5' end contiguous flanking region myeloperoxidase gene myeloperoxidase \( mpo \) synthesis known associated stage myeloid differentiation particular downregulation mpo gene transcription associated myeloid cell maturation examined changes hypersensitive sites within 5' end mpo gene 5' flanking region dimethyl \( dmso \) induced differentiation hl 60 cells determine changes chromatin structure accompany process locations hypersensitive sites surrounding 5' end gene proliferating , cells determined three observed 5' flanking region one within gene progressive changes sites accompanied downregulation mpo transcription treatment dmso evidence hypersensitivity observed chromatin region examined 8 days dmso exposure results provide example changes occur chromatin structure gene inactivated differentiation
six years' audit laboratory workload rates referral colposcopy cervical screening programme three districts objective determine laboratory workload rates referral colposcopy three district cervical screening programme 1983 9 assess feasibility call women risk , recall three year intervals \( five year intervals \) , investigation women degrees abnormality design analysis screening histories back 1977 women screened cervical screening programme setting three district health authorities covering population , comprising 800 , 000 people , 250 , 000 female residents aged 20 64 subjects 196 , women aged 20 64 screened cervical screening programme since 1983 results laboratory workload devoted follow women abnormalities increased sharply 1987 8 1988 9 , increases 54 \( \) number smears follow severe invasive cancer , 40 \( \) mild moderate , 49 \( \) borderline change increases partly explained introduction april 1988 protocols follow investigation based guidance working party report proportion women mild moderate recommended referral colposcopy increased steadily 9 9 1983 4 79 9 1988 9 , borderline change proportions 3 5 13 6 respectively women tested 1988 9 , referral colposcopy recommended 3 conclusions increase laboratory follow work identified , continued , could result half existing laboratory capacity devoted follow work , little maintaining call , recall , quality control investigation women minor cytological abnormalities neither benefits screening increasing rate false positive results financial costs
district health authorities cervical screening published erratum appears 1990 24 301 \( \) objectives examine district health authorities cervical screening respect department health guidelines determine assessment problems encountered design postal questionnaire sent 190 district health authorities england 1989 participants 190 district health authorities england main outcome measures population coverage screening , quality smear testing , follow abdominal test results comparison national guidelines district cervical screening services , problems encountered districts results received 178 \( 94 \) districts , 143 person named responsible cervical screening contributed districts implemented computer managed scheme , 150 target date 31 march 1988 , guidelines time survey half called women target age group 20 64 70 expected meet target date 13 march completing call considerable variation evident among schemes regard issues related population coverage , quality testing , follow abnormal results problems commonly identified districts \( n 174 \) laboratory workload \( 107 , 61 \) , computer \( 104 , 60 \) , availability resources \( 78 , 45 \) , non attendance \( 77 , 44 \) , rate opportunistic screening \( 62 , 36 \) , investigation treatment \( 60 , 34 \) conclusions current practice running cervical screening schemes needs examined determine extent contributes goal reducing mortality cervical cancer
etoposide current future status etoposide \( vp 16 213 \) antineoplastic agent demonstrated efficacy broad spectrum human malignancies , including testicular , germ cell , lung , cancers etoposide synergistic agents part combination chemotherapy , etoposide become called standard therapies testicular cancer small cell lung cancer activity tumors lymphoma leukemia , well solid tumors , identifies etoposide highly important chemotherapeutic agent cellular animal models shown cell kill tumor response depend dose time exposure recent clinical studies show dose schedule etoposide important effects clinical response drug research continue \( 1 \) use etoposide part initial therapy several cancers , \( 2 \) higher doses prolonged schedules optimize agent 's potential
new ovarian cancer systemic intraperitoneal derivatives etoposide teniposide evaluated possible use treatment ovarian cancer conflicting studies suggest variables dose prior treatment major influence outcome response rates ranged 0 40 five series teniposide , less 10 overall response rate greater 10 complete response rate nine studies etoposide one study documented activity oral etoposide however , patients received various prior , firm conclusions regarding activity etoposide could drawn results , expectation synergy etoposide cisplatin , led several studies combined etoposide compounds systemic intraperitoneal \( ip \) routes various studies used intravenous drug combinations agents previously treated untreated patients one study , used carboplatin instead cisplatin , reported seven failures among 26 previously untreated patients conversely , prominent toxicities reported another study , responses exceed might expected cisplatin alone studies analogous combinations administered ip ongoing favorable experience , initially reported university california \( san group \) , confirmed investigators prompted incorporation etoposide first line strategies pharmacologic advantage etoposide ip route \( related high protein binding \) may provide appropriate dose intensity ip disease sparing systemic toxicities finally , systemic dose intensity autologous bone marrow support indicates promise etoposide combination high dose drugs
current strategies management locoregional metastatic gastric carcinoma gastric carcinoma remains significant cause death worldwide patient 's prognosis depends degree gastric wall penetration , presence lymph node metastases , location primary site metastatic gastric carcinoma currently incurable however , chemotherapy continues evolve rapid pace active agents include 5 fluorouracil \( 5 fu \) , doxorubicin , cisplatin , methotrexate , , etoposide combination etoposide , doxorubicin , cisplatin \( eap \) reported result high response rates , including 10 complete response rate patients metastatic gastric carcinoma trials way confirm results similarly , another etoposide based combination , etoposide , leucovorin , 5 fu \( \) , resulted equally good response rate less toxicity eap 5 fu , doxorubicin , methotrexate \( \) regimen , previously reported excellent response rate , also investigated patients locoregional carcinoma , curative resection rate often low however , curative resection consistently associated improved survival \( 23 26 months \) patients potentially resectable carcinoma , two significant problems must recognized \( 1 \) low rate curative resection \( 2 \) development widespread carcinoma despite curative resection despite many attempts , postoperative strategies adjuvant chemotherapy ineffective new strategies must investigated combination etoposide , 5 fu , cisplatin \( \) administered preoperatively postoperatively patients resectable gastric carcinoma , resulting encouraging curative resection rate \( greater 70 \) toxicity based promising results reported eap patients unresectable locoregional carcinoma stomach , trial preoperative postoperative eap potentially resectable carcinoma stomach way
etoposide management metastatic breast cancer etoposide , despite extensive use malignancies , played minor role treatment patients breast cancer single agent trials etoposide administered heavily pretreated patients metastatic breast cancer demonstrated low overall response rate \( 6 6 383 patients \) , convincing evidence either schedule dependence relationship dose intensity response sole single agent trial previously untreated patients suggested drug approximately 15 response rate untreated patients combination therapy trials etoposide combined either cyclophosphamide , doxorubicin , cisplatin yet demonstrated superiority drugs single agents , although cisplatin plus etoposide appears superior either agent alone vitro studies suggest hormone sensitive breast cancer cells estradiol may increase sensitivity etoposide induced dna cleavage may represent future direction use etoposide breast cancer currently , however , use etoposide breast cancer considered investigational
etoposide leukemia etoposide \( vp16 213 , \) induces complete response \( cr \) 15 25 previously treated patients acute leukemia \( anll \) used single agent etoposide used successfully combination cytarabine , daunorubicin , salvage consolidation therapies previously untreated anll patients 15 70 years age randomly assigned cytarabine \( 100 mg m2 \) days 1 7 plus daunorubicin \( 50 mg m2 \) days 1 3 \( 7 3 \) drugs plus etoposide \( 75 mg m2 \) days 1 7 \( 7 3 7 \) patients achieving cr received two consolidation courses \( 5 2 , attenuated 7 3 5 2 5 \) among 264 eligible patients , 56 cr rate 7 3 therapy 59 cr rate 7 3 7 therapy remission duration significantly improved 7 3 7 \( median , 12 months 7 3 18 months 7 3 7 p 0 01 \) , survival subset analysis patients younger 55 years age revealed prolonged remission \( median , 12 months 7 3 27 months 7 3 7 p 0 01 \) survival \( median , 9 months 7 3 17 months 7 3 7 p 0 04 \) 7 3 7 regimen hematologic toxicity similar regimens induction , significantly severe 7 3 7 consolidation therapy etoposide active anll prolongs remission used induction therapy
high dose etoposide marrow transplantation etoposide underwent conventional phase testing 1970s dose limiting toxicity studies mild myelosuppression toxicities infrequent greater degree myelosuppression accepted , higher standard doses could given approach takes advantage steep dose response relationship chemotherapeutic agents , including etoposide , shown early vitro clinical studies thus , etoposide considered ideal agent dose escalation studies , given wide range clinical antitumor activity standard doses , steep dose response curve , mild bone marrow suppression , side effects high dose etoposide studies followed used improved intensive hematologic supportive care , including , trials , autologous marrow transplantation etoposide used single agent high dose trials , mucositis , , lesser degree , hepatic dysfunction dose limiting maximum tolerated dose \( mtd \) setting 2 4 3 0 g m2 multi agent phase trials etoposide cyclophosphamide , total body irradiation , , carboplatin also resulted dose limiting mucosal toxicity , liver lung problems appearing often high dose etoposide alone toxicity mtd influenced markedly schedule administration etoposide continuous intravenous infusion given doses 4 2 g m2 \( 200 mg kg cyclophosphamide \) similar toxicity , without marrow support antitumor results lymphomas set stage treatment solid tumors , treatment patients sensitive relapses best outcome lymphoma patients 80 response rate overall , long term \( greater 2 years \) disease free survival approximately 40 germ cell tumors also responsive , pattern sensitive relapses improvement responding patients seen \( 50 75 patients greater 1 year \) breast cancer small cell lung cancer \( sclc \) , high dose etoposide containing regimens used standard therapy results settings quite good \( breast cancer , 30 disease free survival 2 years sclc , 10 2 years \)
pharmacology intravenous oral etoposide derivative etoposide \( vp 16 \) widespread use alone combination chemotherapy past decade phase specific cytotoxicity acts last g2 phases cell cycle although mode action certain , appears act causing breaks dna interaction dna topoisomerase ii formation free radicals studies show decay intravenous \( iv \) administration etoposide approximately 30 70 administered etoposide excreted , approximately 45 present urine etoposide available oral iv preparations highly schedule dependent , daily doses \( e g , 5 8 days every 21 days \) giving results superior intermittent administration bioavailability oral etoposide approximately 50 , absorption linear increasing dose \( e g , greater 200 mg , bioavailability decreases \) factors influencing bioavailability oral etoposide include patient status , concurrent medications , hepatic renal function , nausea vomiting numerous clinical trials , etoposide demonstrated excellent activity range tumors , including small cell lung cancer \( sclc \) , malignant lymphomas , gestational trophoblastic tumors , ewing 's soft tissue sarcomas , germ cell tumors , modest activity tumors \( e g , non sclc \) although comparative studies carried , available data suggest oral etoposide administered daily 5 8 days similar iv preparation range activity study 53 elderly patients sclc treated etoposide \( 200 mg five times \) , response rate 79 median survival 9 5 months results similar achieved intensive iv regimens several studies chronic oral etoposide \( 50 mg m2 21 times \) reported recently responses observed sclc germ cell tumors among patients relapsed standard etoposide containing regimens data suggest etoposide may new drug given schedule high response rates oral etoposide suggest oral administration may substituted iv administration substitution may allow greater flexibility chemotherapeutic administration , less hospitalization , acceptable toxicity
chronic oral etoposide etoposide important drug recently incorporated agents curative treatment patients advanced neoplasms , including germ cell tumors , non hodgkin 's lymphomas \( nhl \) , small cell lung cancer \( sclc \) etoposide demonstrates remarkable schedule dependency randomized comparison shown impressive survival difference patients extensive sclc receiving 5 day course versus receiving 1 day course previous clinical laboratory data , etoposide given intravenously orally 3 day 5 day schedule generally accepted approximately 50 orally administered drug absorbed authors initiated several etoposide studies using extended administration schedule , prolonged schedule may superior standard 3 day 5 day schedule initially tested phase study results showed etoposide \( 50 mg m2 \) given 21 days feasible associated moderate toxicity several phase ii studies completed completion , including studies patients sclc , nhl , germ cell tumors , soft tissue sarcoma , renal carcinoma , ovarian carcinoma responses seen groups , particularly patients sclc , lymphoma , germ cell tumors groups saw responses patients clearly resistant etoposide plus cisplatin given standard schedule patients resistant high dose etoposide bone marrow transplantation investigators indiana university medical center studied oral etoposide similar fashion patients advanced germ cell tumors sclc achieved results similar reported authors initiated number combination chemotherapy programs using chronic oral form etoposide include patients sclc , non small cell lung cancer , elderly patients high grade intermediate forms nhl addition , chronic intravenous oral etoposide used salvage approaches patients acute leukemia recurrent resistant intermediate grade high grade nhl preliminary pharmacokinetic data suggest 50 mg m2 oral dose highly \( 91 96 \) therefore , prolonged oral course 50 mg m2 , many patients maintain minimum plasma concentration 1 microgram ml studies multiple dose continuous infusion etoposide maintain potentially critical plasma level progress etoposide administered way could represent new drug many features different , activity spectrum may broader
future directions etoposide therapy etoposide important chemotherapeutic agent treatment selected patients germ cell tumors , lymphomas , small cell lung cancer \( sclc \) optimal use continuing evolve clear schedule dependency critical importance recently , preliminary studies suggested prolonged schedule etoposide administration \( 21 days \) may effective standard 3 5 day schedule results several phase ii studies show chronic oral etoposide administration induces occasional responses resistant tumors higher expected response rates patients germ cell tumors sclc preliminary data show nearly 90 etoposide absorption given low dose schedule \( 50 mg m2 \) 21 days observations indicate etoposide may new drug given chronic schedule exploration schedule dependency etoposide indicated etoposide recently proven useful selected patients gastric , ovarian , poorly differentiated carcinoma unknown primary site several drugs either synergistic additive explored combination chemotherapy possibility adding topoisomerase inhibitors modulating etoposide 's activity inhibiting drug resistance within human testing
clinical pharmacology etoposide etoposide , semisynthetic derivative , increasingly used treat cancer etoposide phase specific , cytotoxic drug acting late early g2 phases cell cycle appears cause breaks dna either interaction dna topoisomerase ii formation free radicals studies show decay intravenous \( iv \) administration etoposide peak plasma concentrations drug area concentration versus time curve \( auc \) linearly related iv dose considerable variability pharmacokinetic variables exists iv etoposide various metabolites etoposide identified , detection quantitation approximately 30 70 etoposide dose excreted bioavailability oral etoposide approximately 50 , absorption linear increasing doses within range clinical use considerable variability exists pharmacokinetics oral etoposide evidence etoposide accumulation multiple consecutive doses either iv oral route exact roles liver kidney metabolism excretion etoposide uncertain etoposide shown highly schedule dependent drug clinical studies , together phase specific action etoposide increasingly widespread use treating cancer , makes clinical pharmacology drug great clinical importance
limb salvage surgery treatment osteosarcoma skeletally immature individuals sacrifice major growth plates resection fixed length reconstruction limb skeletally immature child osteosarcoma may result significant limb length growth limb length discrepancy humerus may cause minor cosmetic problems generally result significant functional deficit lower extremity , tumors knee , including distal femur proximal tibia , usually present dilemma whether limb salvage arthrodesis , allograft , endoprosthetic replacement would result significant limb length whether amputation extremity preferable procedure techniques rotationplasty expandable endoprosthesis successfully used treating skeletally immature patients osteosarcoma distal femur regard survival function , results obtained innovative methods favorable compared high knee amputation
cellular biology bone tumors new knowledge cell molecular biology begun expand understanding biology osteosarcoma ewing 's sarcoma studies revealed abnormalities growth inhibiting retinoblastoma gene , may release cells normal growth control abnormalities growth factor production response tend inappropriately activate cell growth tumor cell dna content cytogenetics may affect diagnosis prognostic ewing 's sarcomas , characteristic translocation chromosomes 11 22 identified translocation also found malignant variety studies point neuroectodermal mesenchymal origins ewing 's sarcomas applications new biologic knowledge technology clinical problems lead significant changes diagnosis , perhaps treatment , tumors years community referral center physicians scientists critical continued progress
osteoid scapula case report review literature scapula rare location osteoid , cases involve flat bones en bloc excision uncommon location problematic since surgical exposure difficult , shoulder joint function affected lesion subchondral 18 year old man , osteoid located subchondral area glenoid guided needle biopsy resulted complete healing mode treatment , proper follow examination , acceptable benign lesion problematic location
cryosurgery surgical adjuncts treatment aggressive \( benign \) bone tumors analysis 25 patients age 21 article reviews clinical experience cryosurgery \( use liquid nitrogen \) \( \) treatment aggressive , benign bone sarcomas biologic basis technique results 25 patients age 21 treated cryosurgery , average follow period 60 8 months , reported three approaches surgical reconstruction used group 1 \( four patients \) cryosurgery reconstruction , group 2 \( 13 patients \) bone graft reconstruction alone , group 3 \( eight patients \) composite osteosynthesis internal fixation , bone graft , overall control rate 96 \( one recurrence \) tumor types giant cell tumor , , aneurysmal bone cyst , malignant giant cell tumor nineteen lesions involved lower extremity , six lesions located upper extremity two secondary fractures \( 8 \) , one local flap necrosis , one synovial fistula infections two performed functional results excellent \( 83 \) , good \( 13 \) , fair \( 4 \) technique composite osteosynthesis recommended large tumors lower extremity results compare favorably obtained en bloc resection demonstrate ability cryosurgery eradicate tumors avoiding need extensive resections reconstructive procedures
limb reconstruction vascularized fibular grafts bone tumor resection limb salvage operations used increasing frequency patients malignant bone tumors children , biologic reconstruction desired , choice often conventional vascularized fibular grafts experimental study performed dogs compare two types fibular grafts bridging segmental defects radius twenty six adult dogs divided two groups studied intervals two , three , four , six , 12 months transplantation conventional grafts healed substitution e , first partially resorbed new bone contrast , vascularized maintained normal structure hypertrophied new bone formation conventional eventually hypertrophied much later vascularized grafts vascularized grafts stronger four six months six 12 months , grafts resemble size shape forearm bones replacing experimental results influenced treatment patients vascularized fibular grafts ideal diaphyseal defects greater 10 cm long , especially young children , poorly vascularized bed , bone healing delayed chemotherapeutic agents maximize hypertrophy , external used graft rather plate , acts stress shield
modified van nes rotationplasty treatment malignant neoplasms lower extremities children technique modified van nes rotationplasty used since 1981 limb salvage surgery children adolescents malignant sarcoma lower extremity original procedure lesions distal femur modified adopted selected lesions proximal femur tibia sixteen skeletally immature children form base report tumors located distal femur ten children , proximal tibia five proximal femur one intraoperative complications postoperative complications included one infection requiring debridement three minor healing delays local recurrences , neurovascular compromises , late , psychologic one patient died metastatic disease another died second malignancy \( leukemia \) remaining patients good , functional , knee prosthesis users participate number athletic activities procedure safe , relatively low complication rate , allows functional demands active , growing child , future growth extremities
ewing 's sarcoma prognostic factors , disease control , role surgical treatment advances treatment ewing 's sarcoma dramatic present treatment protocols control local disease radiotherapy , surgery , systemic spread limited aggressive chemotherapy patients localized osseous ewing 's sarcoma , five year survival rates range 54 estimated 74 late relapse uncommon , control primary lesion critical long term survival several studies show improved local control possibly improved survival patients surgical treatment primary osseous ewing 's sarcoma
effect chemotherapy growth skeletally immature individual one hundred twenty two children osteogenic ewing 's sarcoma studied assess effect adjuvant chemotherapy skeletal growth final stature deviations height distributions normal population noted diagnosis marked retardation linear growth year intensive chemotherapy 15 patients grew expected rate year distribution nutritional status scores significantly different end first year baseline distribution ultimate height scores significantly different baseline distribution overall final distribution also significantly different normal population expectation absolute difference height , however , likely small subgroups observed full adult stature showed mean heights 162 cm girls 176 cm boys
growth inhibition human breast cancer cells novel synthetic progestin involves induction transforming growth factor beta recent experimental work identified novel intracellular binding site synthetic progestin , gestodene , appears uniquely expressed human breast cancer cells gestodene shown inhibit growth human breast cancer cells dose dependent fashion , effect endocrine responsive human endometrial cancer cells gestodene induced 90 fold increase secretion transforming growth factor beta \( tgf beta \) human breast cancer cells synthetic effect , indicating induction mediated novel gestodene binding site conventional progesterone receptor furthermore , four breast cancer cell lines , extent induction tgf beta correlated intracellular levels gestodene binding site induction tgf beta observed endometrial cancer line , b , lacks gestodene binding site , expresses high levels progesterone receptor inhibition growth cells gestodene partly reversible polyclonal antiserum tgf beta data indicate growth inhibitory action gestodene may mediated part autocrine induction tgf beta
coexpression two fibronectin receptors , vla 4 vla 5 , immature human precursor cells human precursor cells adhere fibronectin \( fn \) exact nature receptors mediating interaction characterized study , report data showing immature human erythroblasts express integrins vla 4 vla 5 molecules act fibronectin receptors cells recently demonstrated adhesion fn purified human cfu e immediate progeny inhibited antibodies directed human fibronectin receptor \( vla 5 \) extended results characterized immunoprecipitation specific antibodies integrins expressed surface labeled normal human immature erythroblasts polyclonal antibody recognizing common vla beta 1 subunit yielded two polypeptides 120 160 kd data demonstrate polypeptide 160 kd contains alpha subunits corresponding alpha 4 alpha 5 thus , lysates prepared 0 3 immunoprecipitated antibodies specifically recognize alpha 4 subunit showed heterodimer peptides 120 \( beta 1 \) 160 kd \( alpha 4 \) additional peptides 70 80 kd usually alpha 4 chain hand , specific anti alpha 5 antibodies immunoprecipitated alpha 5 beta 1 complex peptides 120 160 kd reducing conditions migrated single band 130 kd similar experiments performed cell line \( \) showed cells also vla 4 vla 5 members integrin family furthermore , monoclonal antibodies recognizing vla alpha 4 chain blocked adhesion immature erythroblasts fn coated surfaces , thus demonstrating , vla 5 , vla 4 also functional fn receptor cells
measurement techniques melanoma statistical comparison inter intra observer variation measuring depth invasion malignant melanomas assessed using three different techniques eye piece , stage , projection image analysis significant variation found methods least pronounced stage recommended preferred technique routine use
cartilage removal prior skin grafting fossa , , ear skin grafting onto large area exposed ear cartilage irregular contours poses increased risk inadequate establishment circulation removal cartilage needed structural support grafting following mohs surgery fossa , , ear decreases risk recurrence carcinoma , increases chances survival graft
fine needle aspiration diagnosis squamous cell carcinoma metastatic skin fine needle aspiration useful way determine presence squamous cell carcinoma enlarged lymph nodes patients high risk metastases advantages include high degree accuracy , outpatient well inpatient availability , negligible potential seeding malignant cells cutaneous oncologists consider using technique patients lymphadenopathy previous history cutaneous squamous cell carcinoma
2 month intensive chemotherapy regimen children stage iii iv burkitt 's lymphoma b cell acute lymphoblastic leukemia designed protocol included 2 months intensive \( cyclophosphamide co , , \) , high dose methotrexate \( mtx \) , high dose cytarabine \( ara c \) , vincristine \( \) improve event free survival \( efs \) patients advanced stage burkitt 's lymphoma b cell acute lymphoblastic leukemia \( \) also wished test feasibility rapidly cycling high dose ara c based signs early marrow recovery twenty patients including 12 stage iii burkitt 's lymphoma eight stage iv burkitt 's lymphoma b cell entered onto pilot study rate complete remission 95 four patients relapsed 2 year actuarial efs 75 \( median follow , 37 months \) two initial five patients developed transverse , believe may secondary concomitant administration intrathecal \( \) high dose systemic ara c conclude short intensive regimen highly effective patients advanced burkitt 's lymphoma b cell efs improved previous less intensive regimens , comparable regimens longer duration
high dose chemoradiotherapy supported marrow infusions advanced neuroblastoma pediatric oncology group study published erratum appears j clin 1991 jun 9 \( 6 \) conducted pilot protocol seven pediatric oncology group \( \) institutions examine feasibility , toxicity , efficacy using common regimen high dose chemoradiotherapy \( hd ct rt \) supported autologous allogeneic marrow infusions children metastatic neuroblastoma \( \) first second remission 57 month period , 101 patients report results 81 completed treatment least 2 years ago hd ct rt regimen consisted melphalan 60 mg m2 three doses , total body irradiation \( tbi \) either 1 5 gy \( n 27 \) 2 0 gy \( n 54 \) twice daily six doses twenty three patients also received irradiation consisting 1 2 gy twice daily 10 doses persisting disease sites seventy four given autologous seven allogeneic marrow , 64 autologous purged fifty four children first complete \( cr \) partial \( pr \) remission 27 second cr pr october 1 , 1990 , follow 32 72 months forty seven 81 children relapsed , 10 died complications , one unknown cause , 23 continue remission , including 21 54 treated first remission , 16 completed treatment 3 years ago 2 year actuarial event free survival \( efs \) probabilities first cr \( cr1 \) 32 \( se 10 \) , first pr \( \) 43 \( se 9 \) , second cr \( \) 33 \( se 27 \) , second pr \( \) 5 \( se 5 \) probability efs correlated remission number \( first better second , p less 001 \) , interval diagnosis hd ct rt \( greater 9 months better less 9 months , p \) , tbi dose \( 12 gy better 9 gy , p 031 \) encouraging results may partly reflect selection treatment patients slower disease pace
relationship tumor cell ploidy histologic subtype treatment outcome children adolescents unresectable rhabdomyosarcoma published erratum appears j clin 1991 may 9 \( 5 \) clinical histopathologic features often inadequate accurate prediction relapse survival individual patients rhabdomyosarcoma \( rms \) therefore studied cellular dna content \( ploidy \) rms cells relation histology response therapy 37 patients unresectable tumors using flow cytometric techniques , found one third patients diploid tumor stem lines , regardless histologic subtype group abnormal ploidy , classification \( 1 10 1 80 times dna content normal diploid cells \) exclusively associated embryonal histology \( p 001 \) contrast , near \( 1 80 2 60 times dna content normal cells \) strongly associated alveolar histology \( p 001 \) thus , histologic subtypes rms , abnormal ploidy appears arise different mechanisms tumor cell ploidy significant impact survival especially apparent patients unresectable , \( group iii \) tumors subgroup , conferred best prognosis worst \( p less 0001 \) none eight patients diploid tumors survived 18 months tumor cell ploidy best predictor treatment outcome patients either embryonal \( p less 001 relative risk , 25 5 \) alveolar \( p relative risk 7 1 \) rms contributed significantly adjustment disease stage anatomic site patients unresectable diploid rms unacceptably high risk treatment failure , new therapeutic approaches distinct subgroup
fludarabine phosphate synthetic significant activity lymphoid malignancies fludarabine phosphate 2 fluoro , 5' monophosphate derivative \( ara \) advantages resistance adenosine deaminase \( \) improved solubility mechanism cytotoxic action compound appears involve metabolic conversion active triphosphate fludarabine phosphate substantial activity lymphoid malignancies , particularly chronic lymphocytic leukemia \( cll \) low grade non hodgkin 's lymphoma \( nhl \) single agent activity cll appears least comparable conventional combination regimens activity hodgkin 's disease , mycosis fungoides , , although suggestive , needs defined clinical trials warranted hairy cell leukemia , leukemia , previously untreated myeloma compound appear active common solid tumors early clinical trials indicated significant myelosuppression potential severe neurotoxicity toxicity currently used low dose schedules includes transient reversible myelosuppression , nausea vomiting , diarrhea , somnolence fatigue , elevations liver enzymes serum creatinine possible pulmonary toxicity suggested several patients currently used low doses fludarabine phosphate , even repeated administration , well tolerated appear safe negligible risk severe neurotoxicity based single agent activity tolerability , food drug administration recently group c designation drug treatment patients refractory cll outside clinical trials setting use fludarabine phosphate combination regimens impact natural history lymphoid malignancies yet determined fludarabine phosphate may well pivotal role management cll low grade nhl
american oncologists treat breast cancer assessment influence clinical trials present study designed assess preferred methods treatment breast cancer american oncologists , impact clinical trials practice mailed questionnaires surgical , radiation , medical oncologists questionnaire described five patients breast cancer , respondents asked select preferred treatment patient primary breast cancer , physicians would offer choice local excision followed radiation therapy modified radical mastectomy 80 physicians would adjuvant chemotherapy premenopausal woman estrogen receptor negative , axillary node negative breast cancer , postmenopausal woman estrogen receptor negative , node positive disease policy favored male female physicians specialty almost respondents would treat young woman inflammatory breast cancer initial chemotherapy followed radiation surgery , 60 would recommend chemotherapy postmenopausal patient estrogen receptor negative disease minimally symptomatic bone metastases clinical trials compared treatment strategies could applied patients described questionnaire preferred treatments primary breast cancer , inflammatory breast cancer supported results clinical trials recommendation adjuvant chemotherapy node negative breast cancer based consistent demonstration improvement survival , although randomized trials short follow shown delay recurrence recommendation adjuvant chemotherapy postmenopausal woman node positive breast cancer contrary results large randomized controlled trials \( meta analysis \) , shown policy lead improved survival report suggests even large randomized clinical trials may minimal impact practice results run counter belief value treatment
4 purging breast cancer mononuclear cell fraction bone marrow patients receiving high dose chemotherapy autologous marrow support phase trial designed ex vivo bone marrow treatment breast cancer patients receiving high dose chemotherapy autologous bone marrow support \( \) , using 4 \( 4 hc \) , active derivative cyclophosphamide known activity breast cancer phase bone marrow purging trial used separated mononuclear cells \( \) \( devoid granulocytes rbcs \) , opposed buffy coat twenty five patients metastatic breast cancer studied patients received three cycles adriamycin \( doxorubicin laboratories , , oh \) , fluorouracil , methotrexate \( duke \) regimen , followed marrow harvest fraction marrow prepared treated 4 hc concentrations 20 micrograms ml \( four patients \) , 40 micrograms ml \( four patients \) , 60 micrograms ml \( nine patients \) , 80 micrograms ml \( eight patients \) cryopreserved patients received high dose systemic cyclophosphamide , cisplatin , , followed infusion purged marrow study end point marrow engraftment , defined wbc count greater 1 , 000 cells per microliter first three dose levels \( 20 , 40 , 60 micrograms ml 4 hc \) , significant delay time engraftment \( 19 , 20 , 23 days , respectively \) compared historical controls \( 17 days \) 80 micrograms ml , engraftment significantly delayed compared lower concentrations \( p 027 \) , escalation 4 hc attempted significant correlation observed time leukocyte engraftment 4 hc concentration \( p 017 \) based tissue culture assay , demonstrated statistically significant correlation colony forming unit granulocyte macrophage \( cfu gm \) content purged marrow days engraftment ninety five percent patients responded clinically entire program , 55 completely longer follow required assess ultimate benefit intensive therapy long term survival
phase clinical trial high dose continuous infusion leucovorin calcium sixty two patients metastatic disease treated continuous infusion folinic acid \( leucovorin calcium lv \) 2 deoxy 5 \( fudr \) lv given constant intravenous \( iv \) infusion 500 mg m2 , days 1 6 , fudr given iv push , days 2 6 , 3 00 pm daily doses ranging 294 1 , 214 mg m2 program well tolerated dose limiting toxicities diarrhea stomatitis , hematologic toxicity minimal eighty two percent assessable patients \( 46 56 \) failed least one chemotherapy regimen one complete remission lasting 9 months 10 partial remissions ranging 5 10 months observed heavily pretreated patient population overall response rate 20 data suggest combination therapy lv fudr may clinical use differing patient sensitivity drug combination , recommended dose fudr initial therapy cycle 500 mg m2 , days 2 6 , subsequent escalation 900 mg m2 patients without extreme sensitivity phase ii studies progress doses
application implants use implants provide support craniofacial prostheses provided clinician another approach treatment complex craniofacial reconstructive problems surgical technique reviewed mayo clinic experience presented
antisecretory effect new histamine h2 receptor antagonist , 066 , rats effects new histamine h2 receptor antagonist , 066 \( 3 amino 4 4 4 \( 1 \) 2 cis 2 3 1 , 2 hydrochloride \) , investigated secretagogue induced acid secretion vivo vitro , experimental gastric duodenal lesion rats 066 \( 10 60 micrograms kg \) given v inhibited histamine stimulated acid secretion dose dependently gastric lumen perfused rats , inhibitory effect observed 12 hr famotidine \( \) \( 10 60 micrograms kg v \) also antisecretory effect , acid secretion recovered control level 4 hr administration cold stress plus indomethacin induced lesion significantly inhibited 066 given v 30 min cold stress plus indomethacin treatment 066 given 7 hr cold stress plus indomethacin treatment also inhibited lesion formation significantly , effect observed rat isolated gastric mucosal sheet , 066 inhibited histamine stimulated acid secretion dose dependently action produced via unique mechanism inhibitory effect 066 remained washing mucosa , became potent time dependently inhibitory effects cimetidine observed washing mucosa data suggest 066 potent long lasting antisecretory effect vivo vitro , properties responsible long lasting action
potent selective inhibition 7 methyl ucn 01 protein kinase c ucn 01 staurosporine related compound isolated culture broth sp shows potent selective inhibitory activity protein kinase c cellular inhibitory activity ucn 01 protein kinase c cytotoxicity ucn 01 compared staurosporine mechanism inhibitory activity investigated vitro , ucn 01 well staurosporine inhibited activity catalytic domain protein kinase c spite direct inhibition catalytic domain protein kinase c , cytotoxicity ucn 01 much lower staurosporine addition , ucn 01 showed selective inhibitory activity protein kinase c staurosporine sole structural difference c 7 therefore , series 7 derivatives ucn 01 synthesized investigated interestingly , one compounds , beta methoxy derivative , showed 3 fold greater potency 17 fold selective inhibitory activity protein kinase c ucn 01
stimulatory effects insulin release insulinoma hit cells role calcium uptake phosphoinositide breakdown hamster insulinoma \( hit \) cells , \( mtx \) induces time dependent concentration dependent release insulin requires presence extracellular calcium response nearly completely blocked cinnarizine cadmium , inhibited l type calcium channel blocker nifedipine manganese mtx induces uptake cells dose dependent mode , uptake blocked cinnarizine , nifedipine cadmium , partially inhibited manganese mtx induces phosphoinositide breakdown hit cells , response partially blocked cadmium , affected nifedipine , cinnarizine manganese high concentrations potassium ions also induce insulin release calcium uptake hit cells effects potassium blocked partially nifedipine , cadmium cinnarizine high concentrations potassium induce phosphoinositide breakdown hit cells results suggest mtx elicited release insulin attained two mechanisms 1 \) nifedipine sensitive action , results mtx induced activation l type calcium channels , mimicked high potassium concentrations 2 \) nifedipine insensitive action , may initiated activation phosphoinositide breakdown mtx activation phospholipase c would result formation 1 , 4 , 5 inositol , release intracellular calcium release insulin extracellular space cinnarizine proposed block mtx elicited mechanisms , first blockade calcium channels second blocking 1 , 4 , 5 inositol induced release internal calcium either mechanism alone appears capable eliciting release insulin
molecular surgery basement membrane argon laser although argon laser used successfully weld number different tissues , underlying chemical cellular mechanisms process precisely defined consequently , biochemical model developed vitro using well defined extracellular matrix murine \( \) sarcoma control experimental samples basement membranes irradiated argon laser 500 3 , 000 joules cm2 0 degrees c samples diluted cold phosphate buffered saline allowed gel 35 degrees c time course gelation reaction followed 360 nm irradiation reduced absorbance 7 5 15 compared controls independent dilution 10 fold range gelation also measured determining amount protein assay could collected centrifugation 10 , 10 minutes argon irradiated samples 30 40 less protein precipitate controls addition 5 mm beta extract blocked effect laser gelation reaction addition , gelation carried absence calcium magnesium , differences laser treated samples controls basement membrane proteins separated electrophoresis polyacrylamide gels denaturing plus reducing denaturing non reducing conditions differences polypeptide composition noted irradiated control samples using either silver staining techniques
cancer mortality workers exposed 2 , 3 , 7 , 8 p dioxin background animal epidemiologic studies , exposure dioxin \( 2 , 3 , 7 , 8 p dioxin , tcdd \) associated increased risk cancer methods conducted retrospective cohort study mortality among workers 12 plants united states produced chemicals contaminated tcdd occupational exposure documented reviewing job descriptions measuring tcdd serum sample 253 workers causes death taken death certificates results mortality several cancers previously associated tcdd \( stomach , liver , nasal cancers , hodgkin 's disease , non hodgkin 's lymphoma \) significantly elevated cohort mortality soft tissue sarcoma increased , significantly \( 4 deaths standardized mortality ratio smr , 338 95 percent confidence interval , 92 \) workers greater equal 1 year exposure greater equal 20 years latency , however , mortality significantly increased soft tissue sarcoma \( 3 deaths smr , 95 percent confidence interval , 190 \) cancers respiratory system \( smr , 142 95 percent confidence interval , 103 192 \) mortality cancers combined slightly significantly elevated overall cohort \( smr , 115 95 percent confidence interval , 102 130 \) higher greater equal 1 year exposure greater equal 20 years latency \( smr , 146 95 percent confidence interval , 121 176 \) conclusions study mortality among workers occupational exposure tcdd confirm high relative risks reported many cancers previous studies conclusions increase risk soft tissue sarcoma limited small numbers misclassification death certificates excess mortality cancers combined , cancers respiratory tract , soft tissue sarcoma may result exposure tcdd , although cannot exclude possible contribution factors smoking occupational exposure chemicals
comparison myelography ct follow versus gadolinium mri subarachnoid metastatic disease children evaluated 17 children primary intracranial neoplasms subarachnoid metastatic disease \( \) using myelography computed tomographic follow \( ct \) cerebrospinal fluid \( csf \) histopathologic examination , well magnetic resonance imaging gadolinium dtpa \( mri gd \) , december 1988 december 1989 12 boys , median age 5 7 years \( range , 0 8 21 8 years \) tumor histology included 8 primitive neuroectodermal tumors \( \) , 3 , 2 low grade astrocytomas , 1 anaplastic astrocytoma , 1 glioblastoma multiforme , 1 atypical rhabdoid tumor , 1 malignant fibrous histiocytoma thirteen tumors originated posterior fossa , 2 supratentorial , 2 spinal cord median interval 2 diagnostic tests 2 days mri gd positive 11 \( 65 \) , ct 8 \( 47 \) , csf 5 \( 29 \) cases mri gd superior spinal cord nodules sugar coating whereas ct readily revealed nerve root sleeve filling defects case ct positive mri gd reveal mri gd safe , noninvasive test used initial imaging modality presence
salivary flow rates patients head neck cancer 0 5 25 years radiotherapy clinical study university texas anderson cancer center , unstimulated stimulated salivary flow rates obtained 47 patients head neck cancer received , unilateral facial , bilateral facial field radiotherapy 0 5 25 years earlier magnitude salivary flow rate reduction compared healthy control group primarily related radiation dosage amount salivary gland tissue included irradiated fields flow rates lower women groups , differences statistically significant
intramuscular oral region report three cases occurrence intramuscular intraoral localization rare , thorough knowledge tumors necessary adequate diagnosis treatment three cases presented discussion , histopathology differential diagnosis discussed adequate primary excision necessary avoid recurrence
analysis interleukin 2 various effector cell populations adoptive immunotherapy 9l rat gliosarcoma allogeneic cytotoxic lymphocytes prevent tumor take recombinant interleukin 2 \( ril 2 \) various effector cell populations used adoptive immunotherapy fischer strain 9l rat gliosarcoma model vivo activated lymphocytes specifically activated cytotoxic lymphocytes \( ctls \) assessed modified vivo neutralization \( \) assay effector cells \( 10 \( 6 \) \) 9l tumor cells \( 10 \( 5 combined 10 \( 4 \) units ril 2 implanted right frontal fischer \( \) rat 7 14 days , additional effector cells \( 10 \( 6 ril 2 \( 10 \( 4 \) units \) administered hole activated splenocytes lymphokine activated killer \( lak \) cells , plastic adherent nonadherent , whereas specifically activated ctls either syngeneic \( genetically identical \) allogeneic \( genetically dissimilar \) syngeneic ctls lymphocytes fischer rats primed vivo 9l cells vitro allogeneic ctls generated exposing da rat lymphocytes either irradiated fischer lymph node cells 9l fisher tumor cells vitro control groups included rats bearing 9l tumor untreated , received peripheral \( p c \) administration ril 2 , received syngeneic unstimulated lymphocytes ril 2 set animals given inoculum 9l tumor , significantly improved survival shown groups treated nonadherent adherent lak cells \( p less equal 0 0003 \) , syngeneic ctls \( p 0 \) , allogeneic ctls \( p 0 0025 \) untreated control animals using mantel equations treatment allogeneic ctls prevented tumor take
activation early events mitogenic response covalently bound 3' \( 4 \) 5' triphosphate 3' \( 4 \) atp \( bzatp \) , analog atp , used ligand \( adenine nucleotide receptor \) present intact 3t3 cells 431 epidermoid carcinoma cells serum cells presence 10 50 microm bzatp , followed extensive washing remove bzatp , induced release arachidonic acid trace \( less 0 01 \) bzatp effective 50 microm bzatp atp contained incubation medium assay bzatp also stimulated production prostaglandin e2 accumulation cyclic amp previous studies , demonstrated three events obligatory early steps pathway leading dna synthesis cell lines evidence indicated activated extracellular atp bzatp linked pertussis toxin sensitive gtp binding protein consistent observations , find pertussis toxin inhibits effect bzatp arachidonic acid release results indicate bzatp effective agonist concerned stimulation dna synthesis 3t3 , , 431 cells furthermore , becomes irreversibly associated intact cells promotes activation early events required dna synthesis
boron neutron capture therapy intracerebral rat efficacy boron neutron capture therapy \( bnct \) treatment implanted rat tested preferential accumulation tumors achieved continuous infusion sulfhydryl dimer , \( 10 \) , rate 45 50 micrograms per g body weight per day day 11 day 14 tumor initiation \( day 0 \) infusion schedule resulted average blood concentrations 35 micrograms ml group 12 gliosarcoma bearing rats 45 micrograms ml group 10 similar gliosarcoma bearing rats treated bnct estimated tumor levels two groups 26 34 micrograms g , respectively day 14 , boron treated non boron treated rats exposed 5 0 7 5 mw min radiation medical research yielded thermal neutron approximately 2 0 x 10 \( 12 \) approximately 3 0 x 10 \( 12 \) n cm2 , respectively , tumors untreated rats median survival time 21 days radiation alone increased median survival time 26 \( 5 0 mw min \) 28 \( 7 5 mw min \) days 12 rats received 5 mw min bnct median survival time 60 days two animals survived greater 15 months 7 5 mw min group , median survival time since 6 10 animals remain alive greater 10 months bnct estimated radiation doses tumors two bnct groups 14 2 25 6 gy equivalents , respectively similar gliosarcoma bearing rats treated 15 0 22 5 gy 250 peak x rays median survival times 26 31 days , respectively , tumor initiation
identification transforming growth factor beta family members present bone inductive protein purified bovine bone characterization polypeptides present bone inductive protein extracts bovine bone led cloning seven regulatory molecules , six related transforming growth factor beta three human bone proteins \( \) describe herein , bmp 5 , bmp 6 , bmp 7 , show extensive sequence similarity bmp 2 , molecule sufficient induce de novo bone formation vivo additive synergistic contribution bmp 2 related molecules osteogenic activity associated demineralized bone strongly implicated presence growth factors active fractions highly purified bone extract
adenovirus e1a gene differentiation f9 cells f9 cell line vitro treatment retinoic acid camp widely used model system study molecular events responsible cellular commitment differentiation early development previous experiments suggested parallels control gene expression f9 cell differentiation regulation gene expression adenovirus e1a transfection e1a expressing plasmid terminally differentiated , f9 cells generates , high frequency , colonies dividing cells , expresses e1a cell lines established colonies presence retinoic acid lost fully differentiated phenotype characterized absence expression series differentiation specific genes conclude expression viral e1a gene product interferes retinoic acid induced f9 cell differentiation moreover , results suggest differentiation process , defined markers terminal differentiation , may permanent event reversed e1a expression
frequent mutation p53 gene human esophageal cancer sequence alterations p53 gene detected human tumors brain , breast , lung , colon , proposed p53 mutations spanning major portion coding region tumor suppressor function gene knowledge , neither transforming mutations oncogenes mutations tumor suppressor genes reported human esophageal tumors examined four human esophageal carcinoma cell lines 14 human esophageal squamous cell carcinomas polymerase chain reaction amplification direct sequencing presence p53 mutations exons 5 , 6 , 7 , 8 , 9 two cell lines five tumor specimens contained mutated allele \( one frameshift six mutations \) mutations detected occurred g c base pairs codons adjacent mutations previously reported cancers identification aberrant p53 gene alleles one third tumors tested suggests mutations locus common genetic events pathogenesis squamous cell carcinomas esophagus
activation erythropoietin receptors friend viral gp55 erythropoietin modulation murine fv 2r resistance gene membrane glycoprotein \( gp55 \) encoded friend spleen focus forming virus appears bind erythropoietin receptors \( epor \) stimulate li , j p , , , , h f baltimore , \( 1990 \) nature \( london \) 343 , directly compare effects gp55 erythropoietin \( epo \) , produced encode either gp55 , epo , epor infection epor virus , interleukin 3 dependent da 3 cells bound 125i labeled epo grew without interleukin 3 presence epo latter cells , parental da 3 cells , became factor independent either epo virus friend spleen focus forming virus addition , epo virus caused disease mice mimicked friend erythroleukemia although fv 2r homozygotes susceptible retroviral diseases , resistant epo viral friend viral results indicate gp55 epo stimulate epor fv 2 gene encodes protein controls response ligands however , fv 2 protein epor corresponding genes map opposite ends mouse chromosome 9 results important implications understanding signal transduction epor role host genetic variation controlling susceptibility oncogenic protein
adenocarcinoma colon rectum patients less 40 years age 1962 1988 , 50 801 patients adenocarcinoma colon rectum treated national medical center less 40 years old symptoms present 47 younger patients presentation mean duration time onset symptoms diagnosis group 4 9 months risk factors carcinoma colon rectum identified 14 50 patients less 40 years old significantly greater proportion patients less 40 years old stage c disease compared older group patients \( 42 versus 22 per cent , p 0 014 \) stage b disease common patients 40 years age \( 44 8 versus 26 0 per cent , p 0 014 \) proportion patients stages disease similar age groups cumulative survival rate group five ten years 43 34 per cent , respectively five year survival rate patients less 40 years old stage b disease 76 per cent stage c disease , 37 per cent young patients stage disease dead 28 months synchronous metachronous carcinomas colon rectum uncommon patients less 40 years old patients less 40 years age carcinoma colon rectum usually symptomatic advanced disease time presentation survival time patients stage disease similar population patients carcinoma colon rectum
oncologic risks skin preservation mastectomy combined immediate reconstruction breast oncologic surgeons agree removal nipple , recent scar site biopsy necessary mastectomy treatment carcinoma breast less agreement done remaining uninvolved mammary skin preservation facilitates performance immediate reconstruction breast lead improved aesthetic results , many oncologists fear practice could lead increased incidence local tumor recurrence determine fear justified , 87 patients undergone unilateral bilateral mastectomy immediate reconstruction treatment early carcinoma breast studied preservation uninvolved skin used instances patients documented follow study 12 months average follow time 23 1 months one peripheral local recurrence observed 1 2 per cent rate early local recurrence lower reported several series using modified radical mastectomy without skin preservation immediate reconstruction , suggests skin preservation confer additional risks local recurrence carcinoma breast properly selected patients
gastric lymphoma 1976 1988 , 35 patients treated stage ie stage primary gastric lymphoma \( non hodgkin 's \) pain weight loss predominant symptoms , physical findings usually absent 20 per cent patients anemic results gastrointestinal contrast studies suggested malignant condition 75 per cent , findings specific lymphoma endoscopic findings suggested malignant process 85 per cent , yield biopsy 60 per cent 28 patients undergoing operative exploration , 75 per cent resectable nine patients received adjuvant therapy five chemotherapy three , radiotherapy , one patient , combination two primary nonsurgical treatment consisted chemotherapy 11 , radiotherapy two combined therapy one instance three five recurrences successfully treated five year survival rate 65 per cent without significant differences surgical nonsurgical regimens tumors smaller 7 centimeters five year survival rate 100 per cent versus 50 per cent larger neoplasms patients 60 years age appeared favorable course surgical therapy compared nonsurgical treatment concluded endoscopy useful , although limited diagnostic study since treatment program obviously superior , choice therapy individualized accordingly
nutritional approach cancer prevention emphasis vitamins , antioxidants , carotenoids main human cancers associated complex life style related causative , enhancing , inhibiting factors tobacco smoking humans carcinogens promoting substances likewise , western dietary involve certain carcinogens , whereas implicate carcinogens importantly , virtually situations regular intake fruits vegetables appreciably lowers risk cancer paper reviews causes main human cancers analyzes mechanisms protective effects fruits vegetables prevention human cancer requires definition optimal levels recommended daily
vegetables , fruits , carotenoids risk cancer low intake vegetables , fruits , carotenoids consistently associated increased risk lung cancer prospective retrospective studies addition , low levels beta carotene serum plasma consistently associated subsequent development lung cancer explanation beta carotene protective since retinol \( preformed vitamin \) related similar manner lung cancer risk , beta carotene appears function mechanism require conversion vitamin however , importance carotenoids constituents vegetables fruit adequately explored prospective retrospective studies suggest vegetable fruit intake may reduce risk cancers mouth , pharynx , larynx , esophagus , stomach , colon , rectum , bladder , cervix fewer studies less consistency among studies , epidemiologic evidence present less lung cancer
serum levels carotenoids vitamin e related subsequent cancer washington county , maryland 1974 1975 , serum specimens collected 25 , volunteers washington county , maryland serum kept frozen 73 degrees c time assay samples 436 cancer cases matched control subjects assayed nine sites studied colon , rectum , pancreas , lung , melanoma , basal cell skin , breast , prostate , bladder serum beta carotene levels showed strong protective association lung cancer , suggestive protective associations melanoma bladder cancer , suggestive association rectal cancer serum vitamin e levels protective association lung cancer none sites showed impressive associations low levels serum strongly associated pancreatic cancer less strongly associated cancer bladder rectum
vitamin c cancer prevention epidemiologic evidence epidemiologic evidence protective effect vitamin c non hormone dependent cancers strong 46 studies dietary vitamin c index calculated , 33 found statistically significant protection , high intake approximately twofold protective effect compared low intake 29 additional studies assessed fruit intake , 21 found significant protection cancers esophagus , larynx , oral cavity , pancreas , evidence protective effect vitamin c component fruit strong consistent cancers stomach , rectum , breast , cervix also strong evidence several recent lung cancer studies found significant protective effects vitamin c foods better sources vitamin c beta carotene likely ascorbic acid , carotenoids , factors fruits vegetables act jointly increased consumption fruits vegetables general encouraged
vitamin e cancer prevention animal experiments human studies suggest vitamin e may protect cancer serum alpha tocopherol concentration studied prediction cancer cohort 36 , 265 adults finland mean follow 8 , cancer diagnosed persons levels serum alpha tocopherol determined stored serum samples \( 20 degrees c \) taken cancer patients matched control subjects individuals low level alpha tocopherol 1 5 fold risk cancer compared higher level strength association serum alpha tocopherol level cancer risk varied different cancer sites strongest gastrointestinal cancers combined group cancers unrelated smoking association strongest among nonsmoking men among women low levels serum selenium findings agree hypothesis dietary vitamin e circumstances protects cancer
gastric juice ascorbic acid effects disease implications gastric carcinogenesis n compounds \( \) strongly implicated causation cancer stomach suggested ascorbic acid might reduce risk gastric cancer preventing formation within gastric juice however , recently measurements gastric juice ascorbic acid concentrations measured gastric juice ascorbic total vitamin c \( ascorbic acid acid \) findings suggest ascorbic acid secreted gastric lumen gastric juice concentrations often greater plasma gastric pathology affects secretion , leading values gastric juice lower plasma levels stimulation gastric secretion raise vitamin c concentrations individuals whose values initially low role ascorbic acid preventing formation protecting gastric cancer discussed light findings
interaction chloramphenicol metabolites colony stimulating factors possible role chloramphenicol induced bone marrow injury recently demonstrated two chloramphenicol \( cap \) metabolites known produced intestinal bacteria , cap \( dh cap \) \( \) , much cytotoxic bone marrow vitro cap since colony stimulating factors \( \) play essential role hematopoietic cell growth , toxicity cap metabolites could also involve interaction csf csf producing cells present study , found increasing concentrations rhgm csf rhg csf completely reversed inhibitory effect cap \( 2 x 10 \( 4 \) \) human cfu gm growth growth kg 1 cells gm csf also reversed inhibitory effect cap hl 60 cells inhibition dh cap \( 50 5 x 10 \( 7 \) \) , cap \( cap \) \( 60 5 x 10 \( 6 \) \) \( 35 10 \( 5 \) \) affected either csf addition inhibitory effect cell growth , dh cap \( 5 x 10 \( 6 \) \) cap \( 5 x 10 \( 6 \) \) inhibited csf production buffy coat cells 50 70 without affecting cell viability neither cap inhibited csf production suggested dual toxic inhibitory effect intestinal metabolites cap dh cap hematopoietic cell growth one hand , csf production , renders potent potential mediators cap induced aplastic anemia
kaposi 's sarcoma involvement bone marrow kaposi 's sarcoma \( ks \) predominantly cutaneous malignancy several clinical variants extracutaneous sites involvement uncommon disease variants except epidemic ks \( human immunodeficiency virus related \) african variant extracutaneous ks usually involves lymph nodes , gastrointestinal tract , respiratory tract authors report first description patient classic ks bone marrow involvement two additional patients ks variants bone marrow involvement described bone marrow tumor invasion considered patients ks hematologic abnormalities
ethanol causes accelerated g1 arrest differentiating hl 60 cells effects clinically relevant ethanol concentrations myeloid differentiation hl 60 cell promyelocytic leukemia line studied exposure stem cells 60 mm ethanol results increase g1 cells , increase superoxide production expression antigen hl 60 cells induced differentiate along myeloid line \( dmso \) retinoic acid \( ra \) , shift smaller cell size , increase g1 cells acquisition ability produce superoxide reported previously several authors ethanol present differentiation , increases g1 cells , increases percentage cells produce superoxide express , decreases mean cell size total growth incubation period experiments periods differentiation indicate increased g1 arrest seen presence ethanol represents terminal commitment inducer present , absence inducer increased g1 percentage readily reversible examination rna content flow cytometry reveals decrease peak mean g1 rna content dmso ra induced differentiation decreases accentuated presence ethanol , resulting higher ratio cells findings indicate ethanol enhances g1 growth arrest hl 60 cells exposed myeloid partial differentiation occurs process , resulting terminally arrested cells , undergone fewer postinduction cell normal may fully competent
magnetic resonance imaging computed tomography pediatric head neck masses fifty three magnetic resonance imaging \( mri \) 25 computed tomography \( ct \) studies 53 head neck masses pediatric patients reviewed retrospectively lesions pathologic proof except 2 metastatic 2 recurrent lesions , prior pathologic confirmation primary sites included 12 malignant tumors , 23 benign tumors , 6 inflammatory masses , 12 congenital lesions mri performance ranged predominantly good excellent detection lesion extent involvement contrast surrounding tissue ct comparison available , mri proved equal better detection factors preoperative diagnosis results suggest mri method choice initial evaluation pediatric head neck region , especially patients requiring multiple examinations however , ct mri used complicated cases , especially possibly involving lesions calcifications bony involvement
temporalis muscle rare case intramuscular temporalis muscle reported clinical examination , carotid arteriogram , computed tomographic scan , aspiration cytology suggested vascular nature tumor , exact diagnosis could made histopathologic examination temporary occlusion ipsilateral external carotid artery dissection permitted complete , wide excision without much bleeding
synthesis type collagen healing wounds humans quantify wound healing surgical patients , samples wound fluid collected silicone rubber tube 7 postoperative days concentrations propeptide type procollagen \( \) propeptide type iii procollagen \( piiinp \) measured specific radioimmunoassays mean concentration would fluid day 1 207 92 \( sd \) micrograms l , day 2 469 micrograms l \( p less 0 001 , signed rank test \) day 7 , mean concentration reached 380 times higher day 1 \( 79 , 330 54 , 151 micrograms l \) one peak antigenicity , corresponding intact propeptide set free synthesis type procollagen , detected 300 gel filtration analysis wound fluid samples mean concentration piiinp 70 61 micrograms l day 1 , 86 88 micrograms l day 2 , 180 129 micrograms l day 3 \( p less 0 001 compared day 1 \) finally day 7 , 250 fold concentration \( 17 , micrograms l \) , compared day 1 , reached methods described present paper allow separate repetitive quantification synthesis type type iii procollagen human wound healing
rectus abdominis muscle flap microvascular anastomoses repair recurrent sarcoma radical resection recurrent leiomyosarcoma , thoracic wall stabilized graft skin soft tissue defect repaired large rectus abdominis flap circulation end end microvascular anastomosis inferior epigastric artery internal mammary artery , cut tumor removal
impact physician compliance screening mammography older women screening mammography , even women older 50 years general consensus regular annual screening appropriate necessary evaluate reasons , studied random sample women los angeles , calif older 50 years women found , especially women older 65 years example , approximately 35 women 50 64 years old 47 women aged 65 years older never even one mammogram analyses revealed important factor predicted whether women ever mammogram whether physician mammography women four 12 times likely , depending age group , mammogram time physicians discussed need lengthy complex results indicate physicians need know discussing screening mammography patients major impact breast cancer screening behaviors
relationship papanicolaou testing contacts medical care system stage diagnosis cervical cancer relationship papanicolaou \( pap \) testing physician visits stage diagnosis cervical cancer assessed interviews 149 women invasive cervical cancer 214 women situ cervical cancer significantly smaller percent study subjects invasive disease situ disease least one pap test 3 years prior diagnosis \( age race adjusted odds ratio 3 38 \) two groups differ visits physician reasons period pap testing decreased increasing age groups , physician visits 65 percent subjects invasive disease aged 65 79 years never pap test diagnosis , 88 seen physician preceding 3 years women regional distant invasive disease least likely pap tests , , within group , aged 35 64 years also least likely seen physician strategies early detection must reflect missed opportunities need bring receiving care system
decreased mortality users estrogen replacement therapy prospective study postmenopausal female residents retirement community southern california , evaluated detail relationship estrogen use overall mortality 7 1 2 years follow , deaths women history estrogen use 20 lower age adjusted , cause mortality lifetime \( 95 confidence interval , 0 70 0 87 \) mortality decreased increasing duration use lower among current users among women used estrogens distant past current users 15 years estrogen use 40 reduction overall mortality among oral estrogen users , relative risks death could distinguished specific dosages oral estrogen taken longest time women used estrogen replacement therapy reduced mortality categories acute chronic arteriosclerotic disease cerebrovascular disease group women reduced mortality cancer , although reduction statistically significant mortality remaining causes combined estrogen users lifetime
combined hepatic vena caval resection autogenous caval graft replacement right sided caudate hepatic lobectomy resection vena cava performed 34 year old woman recurrent adrenal carcinoma vena cava replaced graft constructed autogenous superficial femoral vein included herein review literature three previously reported cases combined hepatic caval resection knowledge , prior reports use autogenous vein graft setting surgical anesthetic techniques , including total vascular exclusion liver bypass , methods developed large part experience liver transplantation , type surgery performed high rate success
photodynamic therapy treat tumors extrahepatic biliary ducts case report poor survival rate patients extrahepatic bile duct tumors well documented course 4 years , treated white woman diabetes diagnosed histologically proven adenocarcinoma common bile duct six injections ether followed seven photodynamic therapy treatments biliary duct july 1989 , patient still alive , , karnofsky performance status 70 changes occurred blood chemistry value time injection time photodynamic therapy transient elevations blood chemistry values white blood cell count , occurred within 24 48 hours photodynamic therapy , alanine aminotransferase , aspartate aminotransferase , amylase significant
pigmented spindle cell naevus report 22 cases pigmented spindle cell naevus \( \) usual appearance naevi heavily pigmented found mostly legs young patients histologically , characterized symmetrical proliferation spindle shaped pigmented melanocytes grouped large junctional spread single cells overlying epidermis frequently found opinion , distinctive benign acquired melanocytic naevus past frequently misdiagnosed atypical spitz naevi malignant melanoma
factor nodular malignant melanoma spitz naevi distribution factor positive dermal dendritic cells studied series nodular malignant melanomas compared seen spitz naevi two patterns distribution recognizable \( \) diffusely spread tumour \( b \) located mainly periphery tumour correlate diagnosis melanoma spitz naevus distribution appeared function growth pattern tumour diffuse pattern common regardless diagnosis distribution factor positive cells malignant melanoma spitz naevi
granulocyte macrophage colony stimulating factor interleukin 6 supporting proliferation human myeloma cells role granulocyte macrophage colony stimulating factor \( gm csf \) growth multiple myeloma \( mm \) investigated 21 patients mm 17 patients proliferating myeloma cells vivo , recombinant gm csf significantly increased endogenous il 6 mediated spontaneous myeloma cell proliferation occurring 5 day cultures tumor cells vitro \( p less 01 \) furthermore , gm csf detected 5 day culture supernatants myeloma bone marrow cells endogenous gm csf produced myeloma bone marrow microenvironment myeloma cells contributed spontaneous myeloma cell proliferation observed 5 day cultures fact , proliferation partially blocked \( 67 \) anti gm csf monoclonal antibodies stimulatory effect rgm csf mediated il 6 abrogated anti il 6 monoclonal antibodies rgm csf reproducibly increase endogenous il 6 production short term cultures bone marrow cells mm patients using il 6 dependent myeloma cell line \( 1 cell line \) , rgm csf shown act directly myeloma cells stimulating twofold il 6 responsiveness rgm csf induce il 6 production 1 cells , able sustain growth alone although detectable gm csf levels found peripheral bone marrow blood mm patients , possible gm csf , produced locally tumoral environment , enhances il 6 responsiveness myeloma cells vivo way similar reported vitro
retroviral transformation cerebral microvascular endothelial cells macrophage like microvascular endothelial cell properties report l cell conditioned medium \( \) porcine cerebral microvascular \( pcmv \) endothelial cells cells macrophage like properties known contain cytokine \( \) l cell virus , murine retrovirus found cell evidence suggests cytokine \( \) l cell virus involved pcmv endothelial cell transformation criteria transformation include focus formation , decreased serum requirements growth , changes morphology including , propagation suspension culture , decreased growth response stimulation known endothelial cell mitogen macrophage like characteristics transformed cell , designated , include low density lipoprotein , fc receptor mediated phagocytosis , phagocytosis bacteria zymosan , expression macrophage enzyme markers , constitutive production colony stimulating factor 1 however , transformed cell retains several properties nontransformed cell including expression vitro self organization capillary like structures cloning cells clearly shows macrophage like cerebral microvascular endothelial cell properties present cell self organization , nontransformed cells express morphologic functional characteristics associated macrophage findings suggest brain capillary could involve macrophage like cerebral microvascular endothelial cells furthermore , phenotypic repertoire expressed transformed cerebral microvascular endothelial cell may show cerebral capillary endothelial cell vivo derived hematopoietic phagocytic precursor
consistent involvement bcr gene 9 22 breakpoints pediatric acute leukemias investigate relationship bcr abl fusion mrnas childhood acute lymphoblastic leukemias \( \) , examined 27 pediatric philadelphia chromosome \( ph1 \) positive acute leukemias using reverse polymerase chain reaction \( pcr \) procedure cells 24 leukemias , single bcr abl pcr products detected corresponded breakpoints minor breakpoint cluster region \( mbcr intron 1 bcr gene \) associated production fusion protein cells three remaining leukemias contained breakpoints major breakpoint cluster region \( mbcr \) shown pcr southern blot analyses three leukemias also contained low levels mbcr pcr product may resulted alternative splicing bcr abl precursor rna screen 35 additional leukemias patients failed therapy day 180 \( induction failures early relapses \) found one case unsuccessful cytogenetics express mbcr abl rna four children mbcr breakpoints white blood cell levels excess 250 , 000 presentation \( compared 2 24 mbcr breakpoints \) two hematologic clinical features suggestive chronic myelogenous leukemias \( cml \) lymphoid blast crisis results indicate ph1 positive pediatric leukemias , 9 22 breakpoints occur one two known breakpoint cluster regions bcr gene chromosome 22 reverse pcr reliably detected patients cytogenetic \( 9 22 \) capable detecting additional ph1 positive leukemias missed standard cytogenetics furthermore , mbcr type breakpoint , associated production , seen childhood leukemias presenting either clinical apparent lymphoid blast crisis cml , suggesting \( 9 22 \) breakpoint locations exclusively determine biologic clinical features pediatric ph1 positive
synergistic inhibition verapamil quinine p glycoprotein mediated multidrug resistance human myeloma cell line model effort develop clinically useful approach p glycoprotein mediated multidrug resistance \( mdr1 \) , evaluated combined verapamil quinine multidrug resistant \( \) human myeloma cell line model clonogenic assay , verapamil used concentrations 0 1 1 0 micrograms ml , plasma levels achieved oral administration high dose intravenous \( iv \) infusion , respectively dose quinine held constant 1 0 micrograms ml , plasma concentration readily achieved oral administration dose level verapamil tested , combination quinine proved effective either drug individually reversing resistance doxorubicin vinblastine synergistic interaction observed verapamil 0 1 microgram ml combined quinine capable restoring sensitivity doxorubicin fully reduced resistance vinblastine effectively verapamil alone 1 0 micrograms ml furthermore , combination 1 0 mumol verapamil 10 mumols quinine increased accumulation retention resistant cells greater extent either drug individually \( p less 001 \) inhibited drug efflux effectively verapamil alone 10 mumols findings suggest combined verapamil quinine may prove useful mdr1 patients drug refractory b cell neoplasms multiple myeloma non hodgkin 's lymphomas
anti cd33 monoclonal antibody etoposide cytosine arabinoside combinations ex vivo purification bone marrow acute leukemia pharmacologic immunologic methods ex vivo bone marrow \( bm \) purging acute leukemia \( anll \) combined augment effect either method alone etoposide \( vp16 20 30 micrograms ml \) without cytosine arabinoside \( ara c 10 mg ml \) used tandem anti cd33 monoclonal antibody \( moab \) , my9 , chosen cd33 found stem cell pool majority patients anll agents tested singly sequentially , 1 hour incubation drugs preceding complement mediated lysis using my9 vp16 combined ara c killed 3 9 0 3 5 11 0 4 logs human anll cell lines k562 drug concentrations killed 1 2 0 1 logs normal committed granulocyte macrophage stem cells \( cfu gm \) adding single exposure my9 complement \( c' \) drug treated cells , greater 5 4 logs killed similar pharmacologic agents , differential kill leukemic cells \( colony forming unit leukemia cfu l \) patients anll seen drug treated blasts versus normal cfu granulocyte macrophage \( cfu gm \) , less 1 log cfu l kill drug concentrations spared 1 log cfu gm similarly , 1 1 0 3 logs anll cfu l eliminated using my9 c' however , sequential vp16 ara c my9 c' treatment , synergy demonstrated 2 6 0 3 logs cfu l eliminated cd33 also found normal cfu gm pool , two stage long term bm cultures performed determine pluripotent stem cell elimination drug moab purging combination difference cfu gm bfu e production 4 6 weeks culture vp16 ara c , my9 c' , vp16 my9 c' treated cells seen compared untreated controls indicating sparing early progenitor cells sequential ex vivo treatment human anll cfu l vp16 ara c followed complement mediated lysis using my9 synergistically kills cfu l sparing early normal hematopoietic progenitor cells , thus may effective way bm either alone
flow cytometry clinical estimation circulating hematopoietic progenitors autologous transplantation cancer patients optimum methods harvesting circulating hematopoietic progenitors autologous transplantation support cancer therapy still uncertain , mostly lack assay marrow stem cells cfu gm assay , commonly used indirect indicator quality graft , poorly standardized provides results evaluable retrospectively based knowledge hematopoietic progenitors express cd34 cd33 differentiation antigens , developed dual color direct immunofluorescence flow cytometry assay aim replacing cfu gm assay purpose , applied assays 157 blood samples obtained daily throughout 20 different recoveries pancytopenia induced high dose cyclophosphamide etoposide cancer therapy without recombinant human gm colony stimulating factor \( rhgm csf \) appearance cd34 cells circulation indicated hematopoietic progenitors increased 500 cfu gm ml , level clinically adequate large scale harvest total cd34 cells correlated well cfu gm \( r 89 \) , data could fitted linear regression line described equation 3 64 , cfu gm ml x cd34 cells per microliter moreover , series six patients treated chemoradiotherapy , early hematopoietic recovery marrow functions predicted accurately number transplanted cd34 cd33 cells either total cells , cfu gm , cd34 cd33 cells , cd34 cd33 cells data presented article favor clinical use cd34 cd33 flow cytometry assay guide harvesting circulating hematopoietic progenitors autologous transplantation contribute better understanding role played circulating hematopoietic progenitor cell subsets marrow recovery cancer therapy
variability dna measurements multiple tumor samples human colonic carcinoma dna ploidy cell cycle distribution three separate fresh tissue samples 60 colorectal adenocarcinomas analyzed flow cytometry dna ploidy concordant among three samples 38 cases \( 63 3 \) remaining 22 cases \( 36 6 \) , dna histograms two three multiple samples similar however , ploidy third sample discordant relationship observed dukes' stage histologic grade concordance discordance among samples thus , one third colonic carcinomas , single sample showing either diploid diploid cycling dna histogram would detect aneuploid dna patterns comparison fine needle aspirates tumors alternative sampling methods tumors dna ploidy analysis indicated strong association tumor ploidy \( 84 96 , respectively \) ploidy multiple samples concordant 25 cases , tumor fine needle aspirates correlate abnormal ploidy observed one three tissue samples data suggest single even double tissue samples may show aneuploid dna patterns substantial proportion colorectal cancers
usefulness serum cancerous diseases oral cavity sera 47 healthy controls , 18 normal individuals habit tobacco , 43 patients oral \( pc \) conditions , 40 patients oral cancer \( oc \) studied levels total sialic acid \( \) , lipid bound sialic acid \( lsa \) , proteins , protein bound \( \) \( mannose \) changes levels insignificant controls normal tobacco four parameters significantly elevated oral pc patients compared controls levels lsa showed significant increase oral pc patients compared normal tobacco significant increase observed levels , lsa , proteins , oc patients compared controls , normal tobacco , patients oral pc increasing levels found progression malignant disease elevations levels lsa statistically significant stage iv patients compared stage iii patients patients metastases higher levels patients primary oc however , elevations lsa levels statistically significant results suggest evaluations serum levels may useful diagnosis patients oral pc oc addition value early detection , also help staging disease
prospective randomized comparison protracted 5 fluorouracil without weekly bolus cisplatin metastatic colorectal carcinoma mid oncology program study one hundred eighty four patients advanced measurable colorectal cancer previously treated chemotherapy entered prospective randomized clinical trial mid oncology program \( \) assess value weekly cisplatin \( 20 mg m2 \) added protracted schedule 5 fluorouracil \( 5 fu \) infusion \( \) 300 mg m2 10 weeks every 12 weeks liver primary indicator lesion approximately 75 study group tumor measurements required radiographic confirmation response rate alone arm 35 \( 29 83 95 confidence interval ci , 25 46 \) compared 33 \( 28 85 95 ci , 23 44 \) arm weekly cisplatin added median survival times 11 8 11 2 months two groups weekly cisplatin appear add effectiveness colorectal carcinoma
prognostic value histopathology ewing 's sarcoma long term follow distal extremity primary tumors pathologic material 56 patients diagnosed initially ewing 's sarcoma distal extremity treated national cancer institute protocols 1968 1984 reviewed correlated clinical outcome histologically , tumors categorized , based recent pathologic criteria , three diagnostic groups \( 1 \) typical ewing 's sarcoma , \( 2 \) atypical ewing 's sarcoma , \( 3 \) \( predominantly peripheral pn \) thirty two patients \( 57 \) typical ewing 's , 13 \( 23 \) atypical , 11 \( 20 \) diagnostic category \( seven 13 pn , two primitive rhabdomyosarcoma , one primitive sarcoma bone , one synovial cell sarcoma \) cases metastatic neuroblastoma , osteosarcoma , lymphoma found forty five patients localized disease diagnosis 11 metastases patients typical ewing 's sarcoma less likely metastatic disease time diagnosis two 32 patients typical ewing 's sarcoma metastases compared nine 24 patients two groups pattern relapse also different groups compared typical ewing 's patients five patients developed lymph node metastases two patients developed brain metastases although presence metastatic disease diagnosis strong negative prognostic factor , histologic independently prognostic clinical outcome patients localized disease patients typical osseous ewing 's sarcoma improved overall survival \( p2 0 03 \) patients tumors \( neither typical atypical ewing 's sarcoma \) poorer disease free survival \( p2 0 02 \) since generally accepted histopathologic prognostic criteria exist ewing 's sarcoma , potential value proposed classification evaluated larger retrospective prospective study
prognostic factors yolk sac tumors ovary clinicopathologic analysis 29 cases twenty nine ovarian cancer patients yolk sac tumors germ cell tumors yolk sac tissue component disease \( 16 endodermal sinus tumor , 11 mixed germ cell tumors , one embryonal carcinoma , one \) treated surgery combination chemotherapy prognostic factors investigated group patients stage disease favorable prognosis \( p less 0 003 \) stages ii iv disease difference prognosis significant cases residual tumor absent \( p less 0 003 \) cases ascites either absent less 100 ml volume \( p less 0 05 \) endodermal sinus tumor either intestinal \( p less 0 05 \) pattern \( p less 0 01 \) common survivors died age , preoperative serum alpha fetoprotein level , maximum tumor size , tumor weight significant correlation prognosis advanced cases , chemotherapy regimens including cisplatin gave better results containing vincristine , dactinomycin , cyclophosphamide \( p less 0 05 \) optimal treatment yolk sac tumors tumors yolk sac tissue component ovary discussed light results
bone sarcomas second malignant neoplasms following childhood cancer study explores relationship histologic variants bone sarcomas previous therapy patients unrelated malignant neoplasm diagnosed childhood sarcomas bone common second malignant neoplasm \( \) reported late effects study group , 13 institution consisting pediatric oncology centers western europe , canada , united states authors attempted relate histologic subtypes 91 bone tumors clinical factors previous therapy genetic predisposition morphologic variants shown biologic significance tumors may etiologic import literature concerning subtypes bone tumors , clinical experimental , also reviewed authors also investigated effect several factors time interval first diagnosis \( e , bone sarcoma \) significantly shortened interval 3 years primary diagnosis also significantly affected interval , leukemia lymphomas shortest interval retinoblastoma longest authors could demonstrate significant relationship morphologic characteristics osteosarcoma predisposing conditions however , lesions diagnosed chondrosarcoma malignant fibrous histiocytoma occurred almost exclusively patients received radiation therapy site developed
southwest oncology group study use human tumor cloning assay predicting response patients ovarian cancer total 211 patients epithelial ovarian cancer \( 168 tumors refractory prior chemotherapy 43 prior chemotherapy \) 33 different southwest oncology group institutions tumors sampled specimens two central laboratories drug sensitivity testing human tumor cloning assay 168 patients prior history chemotherapy failure \( median four prior chemotherapeutic agents \) treated effective agent \( \) found cloning assay \( 23 patients \) , patients whose tumors form colonies vitro manifest sensitivity agent \( \) treated clinician 's choice agent \( \) \( 101 patients \) remaining 44 168 patients treated chemotherapy deteriorating performance status early death complete partial response rate patients treated according assay results 28 versus 11 patients treated according clinician 's choice \( p 0 03 \) statistically significant difference survival two options \( 6 25 versus 7 months , respectively \) 43 patients history prior chemotherapy treated standard combination chemotherapy , clinical response compared vitro sensitivity agents overall 100 true positive rate 100 true negative rate seven evaluable patients data authors conclude use human tumor cloning assay may increase response rate survival selected patients advanced chemotherapy refractory ovarian cancer study , however , many steps patient selection necessitated inadequate tumor colony formation vitro inability treat patients \( early death rapid decline performance status \) assay appear additional study predicting response combination chemotherapy patients without prior history chemotherapy finally use central chemosensitivity testing laboratories feasible testing vitro predictive assays cooperative group setting
achievement life goals adult survivors modern treatment childhood cancer assess impact diagnosis modern treatment childhood cancer achievement adult goals , authors evaluated employment , health life insurance coverage , marriage , , 227 former pediatric cancer patients area evaluated relation common set disease demographic factors included age follow , age diagnosis , gender , marital status , history disease recurrence , diagnosis patients younger 20 years age diagnosis , diagnoses made january 1 , 1960 , december 31 , 1984 median age diagnosis 11 4 years , median age follow 26 6 years percentage male respondents differ population norms percentage female respondents , however , slightly higher united states population approximately 11 survivors reported form employment related discrimination , level significantly lower prior reports company offered health insurance provided 92 4 full time 90 0 part time employed respondents life insurance 60 full time employed men 55 women percentages lower reported united states population twenty four percent life insurance difficulty obtaining fifty eight percent subjects married lived married percentages married men women significantly lower united states norms twenty percent married lived married separated longer live married women aged 20 24 years less likely , women aged 35 44 years significantly higher frequency similarly aged united states women general , history childhood cancer influence decision live married occasionally \( 20 \) important decision marital relationship many former patients indicated diagnosis treatment childhood cancer influenced decision children current study suggests former pediatric cancer patients achieve adult life goals additional research necessary define populations greatest risk failure achieve goals
prolonged response carboplatin infant brain stem glioma adults children brain stem gliomas mean survival time 15 months radiation therapy \( \) infants tumor present additional treatment possible neurotoxicity radiation developing brain report 15 month old child biopsy proven brain stem glioma clinical radiographic evidence disease progression treated 24 monthly courses carboplatin without radiation therapy 39 month response clinical response started 3 months radiographic evidence documented 10 months magnetic resonance imaging toxicity minimal longitudinal neuropsychological assessment demonstrated continued improvement 36 months post diagnosis motor functioning expected age levels medullary astrocytoma young patient may appropriate clinical setting future trials chemotherapy without
postoperative follow patients early breast cancer patterns care among clinical oncologists review literature eighty clinical oncologists southeastern united states surveyed determine strategies follow care primary treatment early stage breast cancer frequency use history physical examination , complete blood count , liver function tests , carcinoembryonic antigen levels , chest x ray , skeletal survey , bone scan , liver scan , mammogram observing hypothetical low high risk patients assessed yearly mammograms recommended 95 respondents history physical examination modalities used often , whereas periodic bone liver scans used minority patients review literature supported strategy respondents survey cost effectiveness history physical examination detecting recurrence follow based survey supporting literature , recommendations reasonable yet cost conscious follow presented
imaging \( spect \) indium 111 labeled anti cea antibody , comparison digital subtraction angiography , computed tomography , immunohistochemistry 27 year old male patient investigated radiologically , computed tomography , digital subtraction angiography operation malignancy suspected , patient imaged gamma camera using radiolabeled monoclonal antigen antibody including single photon emission computed tomography accumulated strongly neoplasm tumor background ratio 2 2 samples excised tumor stained immunohistochemically desmin , vimentin , muscle actin , cytokeratin , cea \( carcinoembryonic antigen \) , factor viii showed antibody uptake nature due cea expression tumor
results treating ductal carcinoma situ breast conservative surgery radiation therapy determine frequency , pattern , time course tumor recurrence breast , outcome 38 women ductal carcinoma situ \( \) treated conservative surgery radiation therapy 1976 1985 studied surgery typically consisted local excision without evaluation microscopic margins resection median radiation dose tumor site cgy median follow time 81 months , eight patients \( 21 \) experienced recurrence breast time course recurrence protracted cases , failures occurring 17 , 27 , 43 , 63 , 71 , 83 , 92 , 104 months 5 year 8 year actuarial rates tumor recurrence breast 8 27 , respectively seven patients recurrence near primary tumor site , four invasive carcinoma , one invasive recurrence site elsewhere breast clinical pathologic factor significantly associated increased risk recurrence , number patients study population small authors reached following conclusions patients treated conservative surgery radiation therapy without careful mammographic pathologic evaluation \( 1 \) recurrence breast may seen least one fifth patients \( 2 \) recurrence typically occurs near primary site \( 3 \) recurrence occur long treatment careful mammographic pathologic assessment may useful reducing local recurrence rate considered essential patients considered conservative surgery radiation therapy
interferon system carcinoma cervix effect radiation chemotherapy thirteen patients advanced carcinoma cervix studied parameters interferon system compared 40 age matched sex matched controls patients measurable serum interferon levels controls patients non antibody type interferon inhibitory activity , controls none interferon synthesizing potential higher controls patients successful radiation chemotherapy , parameters normalized patients change seen one patient respond therapy
immunohistologic detection epidermal growth factor receptor human esophageal squamous cell carcinoma epidermal growth factor receptor \( egf r \) expression studied immunohistologically 38 patients esophageal squamous cell carcinoma egf r expressed basal layers normal esophageal epithelia cancer 20 patients strongly expressed areas dysplastic epithelia cancer 18 patients patients strongly expressed egf r lymph node metastases frequently , prognosis poorer expressed egf r egf r expression showed mosaic pattern 17 patients diffuse pattern 21 patients patients mosaic pattern lymph node metastases frequently worse prognosis diffuse pattern expression egf r metastatic lymph nodes similar strongly expressing areas primary cancers mosaic pattern thus egf r expression may important indicator malignancies esophageal squamous cell carcinomas primary cancer cells strongly expressed egf r lymph nodes frequently
value immunohistochemistry collagen iv expression colorectal carcinomas dukes' classification well established prognostic value colorectal cancer patients yet , dukes' class , survival individual patients may vary considerably recent studies show prognostic significance genetic alterations colorectal carcinoma however , importance tumor stromal components noted surrounding tissue may overlooked methods used therefore , longitudinal study 154 patients colorectal cancer operated 1967 1974 , authors determined influence prognosis lymphocytic infiltration expression collagen type iv tumor stroma also , age , sex , dukes' classification , grade tumor differentiation , , number positive lymph nodes analyzed follow least 15 years lymphocytic infiltration collagen iv expression scored mild , moderate , severe survival analyzed cox proportional hazards model density lymphocytic invasion showed significant influence survival collagen iv expression analyzed single variable significantly \( p 0 038 \) related better prognosis colorectal cancer patients multi analysis collagen iv expression showed trend toward better prognosis statistically significant \( p 0 12 \) dukes' classification \( p less 0 001 \) , presence \( p 0 009 \) , lymph node status \( p 0 04 \) significantly influenced survival conclusion immunohistochemistry collagen iv important additional staining technique prognostic value addition , collagen iv immunostaining facilitates recognition vascular invasion basement membrane vessels
phase ii trial carboplatin vinblastine treatment advanced squamous cell carcinoma esophagus cisplatin containing regimens active treatment esophageal cancer , response rates 25 35 advanced disease carboplatin less toxic cisplatin single agent , several responses seen esophageal tumors better define role carboplatin esophageal cancer , authors treated 19 chemotherapy naive patients advanced squamous cell carcinoma esophagus carboplatin vinblastine carboplatin \( 450 mg m2 intravenously iv days 1 , 29 , 57 , every 6 weeks thereafter \) given vinblastine \( 5 mg m2 iv day 1 every 2 weeks \) major responses seen significant renal toxicity mild gastrointestinal toxicity \( emesis , diarrhea \) observed hematologic toxicity severe patients prior radiation therapy \( rt \) , three six patients prior rt exhibiting grade 4 hematologic toxicity although generally less toxic cisplatin containing regimens , carboplatin vinblastine also less active treatment squamous cell carcinoma esophagus hematologic toxicity regimen severe patients received prior rt
phase ii multi institutional trial low dose n \( \) l aspartate high dose 5 fluorouracil short term infusion treatment adenocarcinoma pancreas southwest oncology group study adenocarcinoma pancreas highly lethal malignancy chemotherapy little impact natural history disease , used potentiate 5 fluorouracil \( 5 fu \) , shown synergy vivo vitro twenty seven patients treated intravenous push dose \( 250 mg m2 \) followed 24 hours later 24 hour infusion 5 fu \( mg m2 \) regimen repeated weekly one partial response 21 eligible patients estimated response rate 5 toxicity severe one toxic death four patients experiencing grade 4 toxicity 5 fluorouracil , given schedule described , appear effective adenocarcinoma pancreas
dose intensive regimen 5 fluorouracil treatment metastatic colorectal carcinoma 5 fluorouracil \( 5 fu \) delivered dose intensive schedule 23 patients metastatic unresectable colorectal carcinoma schedule consisted bolus single dose 5 fu therapy 400 500 mg followed 4 day infusion 5 fu , 600 800 mg m2 day , followed 17 day 24 day infusion 200 250 mg m2 day partial remissions seen 22 eligible patients significant toxicity , including mucositis , diarrhea , hand foot syndrome , necessitated dose reductions patients authors conclude 5 fu given moderately intensive schedule associated moderate level response , easily achieved conventional schedules 5 fu leucovorin combinations tumor responsiveness dose intensive 5 fu regimens may limited
neoadjuvant chemotherapy radical surgery locally advanced cervical cancer prognostic factors response survival january 1986 september 1988 , 75 patients locally advanced cervical carcinoma \( international federation gynecology obstetrics figo stages ib iii \) received three courses neoadjuvant chemotherapy \( \) , including cisplatin , bleomycin , methotrexate \( pbm \) fifteen percent patients achieved complete response \( cr \) 68 partial response \( pr \) pretreatment characteristics analyzed response significantly lower response rates found patients tumor size 5 cm diameter bilateral parametrial involvement pelvic side wall none biological parameters studied related patients achieving cr pr significantly improved 3 year survival rate compared respond , radical surgery possible responding patients median number lymph nodes removed 60 lower expected incidence lymph node metastases detected none clinical pathologic features considered significantly correlated lymph node status twelve 62 operated patients disease recurrence pathologic parametrial involvement cervical infiltration equal deeper 5 mm found significant prognostic factors recurrence 3 year , disease free survival 89 , 73 , 43 stage ib iia , iib , iii , respectively , found among operated patients rates increased 100 , 81 , 66 stage ib iia , iib , iii , respectively prospective randomized trial comparing surgery radiotherapy alone progress
prognostic factors treatment hepatocellular carcinoma transcatheter arterial embolization arterial infusion january 1986 december 1988 , prospective trial transcatheter arterial treatment carried hepatocellular carcinoma \( hcc \) two hundred seventy five patients included 's staging system employed patients stage ii hcc treated transcatheter arterial embolization \( \) gelatin containing anti cancer agent \( protocol 1a \) gelatin oil mixed anti cancer agent \( protocol 1b \) oil mixed anti cancer agent \( protocol 2 \) patients stage iii hcc treated oil anti cancer agent \( protocol 2 \) exception , patients unsuccessful catheterization proper hepatic artery technique obstruction main trunk portal vein treated percutaneous transcatheter arterial infusion common hepatic artery regardless stage \( protocol 3 \) tumor type extension , area tumor involvement , portal vein involvement , method treatment , presence ascites found significant factors initial response therapy treatment method important factor respective survival rates 1 2 years 70 9 55 3 protocol 1a 62 3 43 8 protocol 1b 37 8 18 3 protocol 2 16 5 0 protocol 3 many factors proved significantly influenced prognosis however , tumor type important prognostic significance followed afp value , ascites , treatment protocol , area tumor involvement
second cancer radiation therapy cancer uterine cervix radiation induced cancers radiation therapy cancer uterine cervix investigated 11 , 855 patients including patients treated radiation therapy alone , 1969 postoperative radiation therapy surgery alone observed expected ratios second primary cancer 0 patients radiation therapy alone 1 patients postoperative radiation therapy , respectively significant increase observed risk second primary cancers sites combined however , assessing site site basis , significant excess noted rectum cancer , leukemia , bladder cancer radiation therapy group surgery group significant excess lung cancer observed radiation therapy surgery groups , attributed causative factors radiation induced cancers suggested develop apparently organs involved irradiated field
evaluation simple line width test involving magnetic resonance spectroscopy plasma carcinoma ovary magnetic resonance spectroscopic \( mrs \) measurement human plasma reported generally applicable marker malignancy patients malignancy mrs line width significantly different patients benign diseases healthy controls authors investigated value test 213 women ovarian carcinoma , benign pelvic masses , benign diseases , healthy controls mrs measurements performed plasma samples 21 degrees c 27 degrees c line width parameters obtained averaging width half height methyl methylene peaks resonance spectra 27 degrees c using 33 hz threshold abnormal result , significant correlation result test presence absence malignancy however , study demonstrates specificity \( 0 44 \) positive predictive value \( 0 42 \) low test useful management patients carcinoma ovary 21 degrees c correlation results test clinical status women carcinoma ovary observed 47 patients test predict preoperatively benign malignant nature pelvic mass
ki 67 immunostaining human breast tumors relationship prognosis ki 67 labeling quantified 37 nonmalignant breast tissues 63 breast carcinomas counting ten random high power fields three section planes \( rc \) evaluation area highest labeling density \( \) procedures proved highly correlated \( rs 0 94 \) ki 67 positive fractions nonmalignant tissues \( mean , 2 1 rc 4 1 \) significantly lower compared carcinomas \( mean , 14 5 rc 17 5 \) carcinomas ki 67 labeling significantly associated pt stage , axillary lymph node status , tumor grading inversely related progesterone receptor status using counting methods \( 12 rc 17 \) cutoff points , significantly different curves overall disease free survival \( median follow , 37 months \) obtained however , cox multivariate analysis failed demonstrate independent effect ki 67 labeling contrast , ki 67 reactivity seems independent prognostic value higher cutoff level selected
high prevalence antibody hepatitis c virus patients hepatocellular carcinoma japan japan , hepatocellular carcinoma \( hcc \) one prevalent cancers , reported fatality rate showing consistent significant increase last decade , 25 hcc cases positive hepatitis b surface antigen \( hbsag \) investigate potential role hepatitis c virus \( \) development hcc , sera 105 hbsag negative hcc patients collected five districts japan assayed antibody antigen \( \) large number patients \( 76 2 \) found positive comparison reported prevalence sera blood donors \( 1 1 \) history blood transfusion found 39 6 cases positive , significantly different lower rate \( 4 7 \) observed hcc patients positive hbsag negative \( p less 0 001 \)
non hodgkin 's lymphoma brain hodgkin 's disease immunohistochemical study non hodgkin 's lymphoma \( nhl \) central nervous system \( cns \) rarely reported complication hodgkin 's disease \( hd \) two patients nhl brain hd studied histologic immunohistochemical methods patients second decade , treated radiation chemotherapy , experienced relapse hd development nhl , evidence hd time diagnosis nhl , died within 1 year diagnosis brain neoplasms large cell immunoblastic lymphomas b cell lineage patients hd appear increased risk nhl cns , may poor prognosis
dna rna flow cytometric study multiple myeloma clinical correlations flow cytometric studies cellular dna rna content using acridine orange technique conducted 81 patients multiple myeloma \( mm \) patients treated 2 protocol clinical response evaluated according criteria chronic leukemia myeloma task force aneuploid dna found 38 2 untreated patients median dna index \( dna \) 1 15 marrow aspirates 1 22 biopsy specimens median percentage cells abnormal dna content 31 5 \( aspirates \) 35 \( biopsy specimens \) positive correlation percentage bone marrow plasma cells observed significantly higher proliferation \( phase \) found marrow biopsy specimens compared marrow aspirates significantly higher rna content \( rna index rna \) observed aneuploid versus diploid patients biopsy material difference response memorial hospital 2 protocol diploid aneuploid patients patients dna greater 1 15 remission duration shorter compared dna less equal 1 15 furthermore , difference cellular rna content noted responders nonresponders study demonstrates correlation cellular rna content response , previously described patients treated vincristine , adriamycin , dexamethasone \( vad \) , dna aneuploidy appears adverse prognostic factor mm patients treated 2 protocol also demonstrates prognostic models mm universal depend chemotherapeutic regimen used
immunohistochemical evaluation progesterone receptor frozen sections , paraffin sections , cytologic breast carcinomas two monoclonal antibodies progesterone receptor \( pr \) , , used immunocytochemical visualization pr different kinds breast cancer specimens including \( 1 \) cryostat sections tumors frozen 80 degrees c \( 2 \) paraffin sections tumors fixed formalin 's varying periods time room temperature 4 degrees c \( 3 \) cryostat sections prepared tissue used frozen section diagnosis stored 80 degrees c fixation 's solution sections conventionally frozen specimens well cryostat sections stored varying periods time stained peroxidase technique , whereas avidin biotin technique used paraffin sections types specimens pr immunostaining localized nuclei carcinoma cells displayed considerable heterogeneity intensity distribution positive cells close correspondence found different immunohistochemical techniques well immunostaining steroid binding assays pr staining frequently positive well differentiated moderately poorly differentiated carcinomas , whereas meaningful correlation found pr staining extent disease similar results obtained immunostaining estrogen receptor material using monoclonal antibodies gamma thus , choosing technique best type specimen available , possible obtain valid information receptor status breast carcinoma , regardless size clinical presentation
comparative study histopathology , hormone receptors , peanut lectin binding , ki 67 immunostaining , nucleolar region associated proteins human breast cancer current study performed 71 cases human female breast cancer compares results five morphologic methods developed detection estrogen receptors \( er \) , progesterone receptors \( pgr \) , lectin peanut agglutinin \( \) binding sites , monoclonal antibody ki 67 immunoreactivity , mean number nucleolar regions \( ag \) parameters evaluated serial cryostat sections representative closely related , identical , neoplastic population significant positive correlation found occurrence estrogen , progesterone , peanut receptors ki 67 immunoreactivity , mean number , mitotic index furthermore , er , pgr , receptors showed significant , inverse correlation ki 67 immunoreactivity , mitotic index , mean number ag results provide data support hypothesis \( 1 \) progesterone receptors estrogen induced indicate metabolic response target cells functioning estrogen receptors \( 2 \) mean number reflects cell kinetics tumor \( 3 \) metabolic differentiation neoplastic cells inversely correlated proliferation index
nucleolar regions cancerous lesions bronchus using silver staining technique , nucleolar region associated proteins \( ag \) studied paraffin sections five specimens normal bronchial epithelium , eight atypical squamous metaplasia , five carcinoma situ , seven microinvasive squamous cell carcinoma mean number ag nucleus normal epithelium 1 2 0 1 \( mean sd \) , atypical squamous metaplasia \( borderline lesion \) 2 2 0 5 , carcinoma situ 3 8 0 6 , microinvasive squamous cell carcinoma 4 8 1 1 highly significant difference ag numbers atypical squamous metaplasia carcinoma situ \( p less 0 01 \) ag staining useful technique differential diagnosis difficult borderline lesions bronchial epithelium
insulin secretion action patients pancreatic cancer authors investigated insulin secretory capacity insulin action 11 preoperative patients pancreatic carcinoma 15 age matched weight matched healthy subjects \( c \) five patients classified diabetic \( \) , two impaired glucose tolerant \( igt \) , four nondiabetic \( nd \) postabsorptive serum insulin levels \( mean se , ml \) \( 12 2 \) , igt \( 17 7 \) , nd \( 10 2 \) comparable administration 100 g oral glucose , peak insulin achieved \( 60 11 \) lower igt \( 101 26 \) nd \( 83 20 \) , whereas peak insulin levels igt nd significantly \( p less 0 05 \) higher c \( 45 6 \) comparable insulin response nonglucose stimuli documented subjects using slow arginine infusion test mean serum insulin 27 4 , 28 6 igt , 34 10 nd , 32 5 c six patients \( p \) six controls , insulin action assessed euglycemic hyperinsulinemic clamp technique , glucose turnover rates estimated 3 3h glucose infusion steady state plasma glucose concentrations maintained 92 3 \( p \) 91 1 mg dl \( c \) insulin infusion rate 1 0 mu kg min , comparable high physiologic insulin levels observed p \( 73 104 ml \) c \( 81 103 ml \) postabsorptive rates endogenous glucose appearance \( ra \) higher p \( 2 86 3 02 mg kg min \) c \( 1 50 2 80 mg kg min \) high physiologic insulin concentrations , negative ra values documented subjects , complete suppression ra assumed total body glucose use \( \) consistently lower p \( 3 90 6 40 mg kg min \) c \( 6 98 10 40 mg kg min \) , consistent state insulin resistance patients pancreatic cancer manifest insulin resistance virtue decrease total body glucose use \( \) decreased insulin response glucose due either inherent beta cell dysfunction decreased islet cell mass latter identifiable histologic morphology
pancreatic mucinous mural nodules report case immunohistochemical study case pancreatic mucinous \( \) two mural nodules \( pmn \) described nodules previously described type tumor ovarian mucinous tumors \( \) , similar nodules reported , nature discussed detail similarity tumor described ovarian tumors stressed immunohistochemical study carried disclosed nodules strong positive staining vimentin moderate positivity keratin epithelial membrane antigen findings , along histologic details , favor epithelial nature nodules concluded nodules foci anaplastic carcinoma high proliferative cell rate , could explain coexpression vimentin keratin
prognostic implications tumor diameter carcinoma head pancreas two hundred twenty patients carcinoma head pancreas divided three tumor diameter groups group 1 , 0 5 4 4 cm \( n 72 \) group 2 , 4 5 6 0 cm \( n 77 \) group 3 , 6 1 15 0 cm \( n 71 \) tumor diameter groups six fold analysis performed patients liver metastases group 1 last patient died 10 months groups 2 3 patients alive 18 months start complaints patients extrahepatic metastases survive 12 months group 1 , 16 months group 2 , 25 months group 3 6 actuarial survival rate inoperable patients reached group 1 17 months , group 2 36 months , group 3 27 months start complaints groups 1 3 curable , operated patients , respective 0 actuarial survival rate reached 24 months , 23 months , 14 months 0 actuarial survival rate patients vessel invasion reached group 1 33 months , group 2 23 months , group 3 25 months 0 actuarial survival rate patients tumor reached 33 months , 31 months , 27 months start complaints groups 1 , 2 , 3 , respectively 0 actuarial survival rate operated patients reached group 3 26 months group 2 29 months group 1 25 patients alive 36 months start complaints small tumors associated greatest chance curative operation average longest survival however , small tumors liver metastases carried worse prognosis large tumors liver metastases tumors found resectable time operation , size tumor appear affect survival
response rates relapsed wilms' tumor need new effective agents three hundred eighty one children wilms' tumor treated united kingdom children 's cancer study group study \( 1982 1986 \) seventy one patients relapses treatment surgery chemotherapy , radiation therapy , depending stage histologic characteristics forty nine patients evaluable disease response second line chemotherapy alone evaluation response chemotherapy impossible remaining patients either surgery radiation therapy used time relapse second line combination chemotherapy \( included ifosfamide , etoposide , cisplatin carboplatin , bleomycin , melphalan , laboratories , river , ny \) , five complete responses 12 partial responses patients favorable histologic findings , six nine stage , five ten stage ii , none 11 stage iii , three 16 stage iv , one five stage v disease survived two survivors treated chemotherapy alone others received combined treatment chemotherapy , radiation therapy , surgery unfavorable histologic findings stage , two 20 survived authors conclude , even patients localized disease favorable histologic findings , salvage rate little 50 , stages histologic findings likelihood cure relapse remote clearly need additional effective chemotherapeutic agents patients
primary treatment large massive adult sarcomas aggressive hyperfractionated irradiation decade , authors treatment unresectable adult soft tissue bony sarcomas last 6 years , combined hyperfractionated radiation therapy intravenous , regimens designed minimize toxicity permit delivery aggressive radiation therapy patients solitary lesions metastasis \( 38 \) treated hope potential cure durable palliation others cancers large massive , often requiring five fields extensive treatment planning authors report results 36 patients large unresectable sarcomas \( tumors ranging 5 35 cm average 14 cm \) treated hyperfractionated radiation therapy , minimum follow 1 year , follow 4 years \( 50 \) , follow death overall local control 60 , control 66 lesions 5 9 cm , 63 10 14 cm , 63 15 19 cm , 57 greater 20 40 cm morbidity modest experience compares favorably authors' earlier trials , toxicity reduced considerably
ultrasound ultrasound guided fine needle aspiration biopsy supraclavicular lymph nodes patients esophageal carcinoma use ultrasound combined ultrasound guided fine needle aspiration biopsy \( \) supraclavicular lymph nodes pretreatment staging 37 patients squamous cell carcinoma esophagus described patients underwent computed tomography \( ct \) scans chest abdomen ultrasound abdomen supraclavicular regions supraclavicular lymph node metastases \( stage iv disease according tumor nodes metastasis tnm classification \) diagnosed seven \( 18 9 \) 37 patients two patients , metastases found five patients , replaced invasive diagnostic procedures due superficial location , ultrasound supraclavicular lymph nodes relatively simple perform , contributed improved staging squamous cell carcinoma esophagus
altered protein tyrosine kinase levels human colon carcinoma understand molecular mechanisms biological indicators colonic tumorigenesis , authors examined tyrosine kinase activity cytosol particulate fraction homogenates specimens 20 human colonic carcinomas compared adjacent normal mucosal tissues total protein tyrosine kinase activity could precisely detected using column purification synthetic peptide , glu asparagine \( asp \) alanine \( ala \) glu tyrosine \( tyr \) ala ala arginine \( arg \) arg arg glycine \( gly \) \( e11 g1 \) , artificial substrate tyrosine kinase activity colonic carcinoma normal mucosa reduced cytosol fraction whereas activity particulate fraction elevated respect protein concentration average specific activity ratios 1 95 0 27 \( normal cytosolic carcinoma cytosolic \) 0 57 0 01 \( normal particulate carcinoma particulate \) tyrosine kinase activity cellular distribution \( cytosol \) tyrosine kinase activity normal mucosa carcinoma varied 21 0 91 2 7 0 61 4 , respectively nearly cases percentage cytosolic tyrosine kinase activity carcinoma tissues lower normal tissues difference due histologic type presence adenomatous components significant decrease cytosolic tyrosine kinases correlated dukes' stage advancing dukes' stage , average specific activity ratios \( normal cytosol carcinoma cytosol \) decreased study indicates colonic carcinogenesis might associated alterations cellular levels tyrosine kinase activity average specific activity ratio \( normal cytosol carcinoma cytosol \) possible correlation colonic tumor growth
careful surgical treatment staging well differentiated early ovarian cancer patients well differentiated epithelial ovarian cancer stages ia , ib , ic , iia \( figo 1976 \) observed surgical treatment without adjuvant therapy careful surgical staging required , extent staging procedure assessed individual patient 107 patients entered study nine dutch oncology centers 107 , 21 fulfill inlet criteria study excluded central pathologic review performed remaining 86 cases , revealing borderline tumor seven patients , moderately poorly differentiated tumor nine patients , tumor histologic cell type one patient two cases , material histologic review available exclusion 19 cases , 67 patients analyzed none 67 patients lost follow period ranged 19 99 months \( mean , 50 months \) tumor recurrence found four patients 11 , 25 , 34 , 34 months follow , died shortly diagnosis recurrence without satisfactory response secondary treatment patients underwent extensive staging procedure , disease free 5 year survival 100 patients staged , disease free 5 year survival 88 concluded well differentiated early stage \( ia iia \) ovarian cancer carries excellent prognosis surgical treatment complete surgical staging , possible exception patients stage ic disease malignant peritoneal washings furthermore , considered application objective consistent ways assessing tumor grade encouraged surgical staging regarded golden standard defining subsets low risk patients included clearly defined future trials early ovarian cancer
loss expression blood group antigen h associated cellular invasion spread oral squamous cell carcinomas membrane bound carbohydrates may influence metastatic behavior cancer cells forty two squamous cell carcinomas \( scc \) buccal maxillary alveolar mucosa studied retrospectively using monoclonal antibody \( \) reacts blood group h \( type 2 chain \) structure h antigen staining within entire tumor correlate stage tumor , e , spread tumors however , loss staining within invasive sites tumors correlated significantly stage tumor development histologic grade malignancy findings support view features relating cells deeper parts carcinomas important clinical behavior tumors , loss h antigen expression related stage tumor invasion carcinoma cells
ras gene mutations intraductal papillary neoplasms pancreas analysis five cases five intraductal papillary neoplasms pancreas analyzed presence ras gene mutations three \( 60 \) five neoplasms showed point mutations k ras codon 12 incidence mutations rather low compared found ordinary pancreatic adenocarcinoma presence mutations correlate severity cellular atypia , apparently related size tumor two neoplasms mutations smaller others mutations analysis suggested ras gene mutation first genetic alteration tumor progression , occurs development neoplasms pancreas
osteosarcoma young children clinicopathologic features osteosarcoma 12 children younger 16 years age treated children 's hospital cancer institute , , 70 year time period presented one six children treated 1972 long term survivor four six children \( 67 \) treated 1972 disease free average follow 8 8 years year 1972 marked onset use effective chemotherapy osteosarcoma , namely , high dose methotrexate leucovorin rescue would appear pathologic features behavior osteosarcoma young children similar osteosarcoma older children adolescents combination complete \( wide \) surgical resection amputation aggressive chemotherapy offers best chance long term survival
fine needle aspiration hepatocellular carcinoma combined cytologic histologic approach cytologic features fine needle aspiration \( fna \) hepatocellular carcinoma \( hcc \) well documented previous reports described morphologic features tumor cells without considering sinusoidal stroma correlation tissue aspirate rarely done report describes cytologic patterns 50 cases hcc terms histologic pattern observed cell blocks prepared aspiration specimen classified according world health organization \( \) classification tumors classified according predominant pattern thirty two cases gave trabecular pattern smears could subdivided central sinusoidal pattern \( 23 cases \) peripheral sinusoidal pattern \( nine cases \) one case gave pattern seventeen cases gave pattern sinusoids cases sinusoids easily recognized cell block sections cytologic features intranuclear cytoplasmic inclusions , eosinophilic , bile secretion could seen smears cell blocks mallory 's ground glass inclusions recognized cell blocks attention paid sinusoidal stroma diagnosis hcc fna cell blocks widely utilized effect cytologic patterns could classified according histologic classification
clinical presentation , treatment , outcome trilateral retinoblastoma report , three new cases trilateral retinoblastoma presented clinical presentation , treatment , outcome patients described compared 32 cases previously reported literature positive family history obtained 68 patients mean age diagnosis bilateral retinoblastoma 7 2 months mean age diagnosis trilateral disease 39 7 months , resulting mean latent interval 32 6 months mean time diagnosis trilateral retinoblastoma death 6 6 months , patients died spinal metastases patients received therapy survived average 1 3 months diagnosis trilateral disease patients received form definitive therapy survived 9 7 months five patients complete dramatic response therapy computed tomography scans local intracranial tumor present autopsy therefore , aggressive local therapy may warranted
factors related consequences weight loss patients stomach cancer norwegian multicenter experience norwegian stomach cancer trial patients stomach cancer included national , prospective multicenter study 51 surgical units participating , information weight loss diagnosis available 855 patients \( 73 \) median weight loss 5 kg 259 patients \( 31 \) experienced weight loss logistic regression analysis authors found weight loss increased age advancing stages disease \( tnm stage iv \) , decreasing karnofsky index , 's diffuse versus intestinal tumor type , tumors located cardia esophagus increasing weight loss reduced resectability rate significantly , association weight loss postoperative complication rate found odds ratio postoperative mortality 2 5 1 weight loss group 5 versus 0 kg conclusion , weight loss reflects less favorable tumor status weight loss increase postoperative morbidity lead weight higher death rate surgery
zinc copper breast cancer joint study northern italy southern france relationship breast cancer two trace elements , zinc \( zn \) copper \( cu \) , investigated means hospital based case control study milan \( italy \) \( france \) variables concerning dietary intake zn cu \( milan \) blood levels \( milan \) measured dietary intake , evaluated questionnaire dietary history type , blood levels zn cu measured 261 cases 261 controls cu blood level showed contradictory tendency two samples \( higher controls milan , higher cases \) , tended lessen adjustment related variables odds ratios \( \) different , trend reached statistical significance sharp difference evidenced opposite regard zn blood values cases controls samples zn mean values significantly higher cases controls , difference remains significant two samples even adjustment related variables pooled computed two samples , adjustment known risk factors related variables , fourth quartile value 9 5 \( ci 4 9 18 2 \) dietary intake two \( measured milan sample \) showed difference cases controls , stronger relationship dietary blood zn evidenced cases respect controls authors suggest higher zn level cases might related higher incorporation zn cancer cases mineral might play possible role tumor growth promotion
type ii oestrogen binding sites human colorectal carcinoma seven cases colorectal adenocarcinomas investigated presence oestrogen receptors progesterone receptors tumours specifically bound oestradiol binding almost exclusively resulted presence high numbers type ii oestrogen binding sites oestrogen receptors absent present low concentrations immunohistochemical investigation nuclear oestrogen receptors gave negative results indicates receptor antibodies oestrogen receptors type ii oestrogen binding sites presence specific type ii oestrogen binding sites progesterone binding offers evidence potential role steroids receptors colorectal carcinoma
improved silver staining nucleolar regions paraffin sections using inverted incubation technique published erratum appears j clin 1991 jun 44 \( 6 \) new simple modification silver staining nucleolar regions \( \) devised , performing incubation slide inverted , results minimal undesirable background staining , persistent problem inverted incubation facilitated use commercially available plastic technique several additional advantages published staining protocols particular , method straightforward , fast , maintains high degree contrast background
small bowel present case long small bowel stricture pathological features similar described neuromuscular vascular , showing addition extensive fatty submucosal infiltration fibrous intramural nodules controversy nature disorder , consider separate entity taking account mesenchymal tissues originally described participate , propose alternative term small bowel
pharyngeal adenocarcinoma intestinal features high grade adenocarcinoma arising primarily pharynx 67 year old man presented ct scan revealed tumour mass growing pharynx , largely affecting soft tissues lymph node metastases found clinical presentation morphological immunohistochemical studies displayed similar features intestinal origin knowledge , previous examples neoplasm reported site possible origin discussed
cystic massive recurrence adult life cystic considered disease childhood may appear first time adult life recurrence stage rare may present difficulties diagnosis due previous treatment authors present case early pharmacological intervention may prevented potentially life threatening situation world literature also reviewed
papillary adenocarcinoma middle ear case papillary adenocarcinoma middle ear presented patient unusually short history , discharge facial palsy , , presentation tumour large surgical resection feasible option management rare tumour discussed relevant literature reviewed
trends female breast cancer connecticut united states trends female breast cancer examined age , period cohort years 1950 1984 u mortality connecticut mortality connecticut incidence birth cohort patterns evident three sets data results confirm continuing increase invasive breast cancer providing evidence strong birth cohort pattern , time series 90 years birth cohorts trend appears real part cohort patterns minimal data obtained autopsy blind biopsy , cohort modeling applied breast cancer mortality , indication modest decline recent breast cancer mortality \( face apparent long term increase \) , suggests control breast cancer mortality may developed recent decades , perhaps earlier detection improved treatment finally , contrast prior report , little evidence clinically important difference time trend pre postmenopausal breast cancer
recent life change large bowel cancer data melbourne colorectal cancer study large , population based , epidemiological study colorectal cancer , melbourne colorectal cancer study , several etiological factors investigated recent life changes , well degree experienced result changes , included interviews histologically confirmed new cases colorectal cancer occurring 12 month period melbourne , australia , age sex matched community controls conducted one methods assessing effect recall bias , 179 hospital controls also investigated major illness death family member , major family problems major work problems found significantly common cases 5 years preceding diagnosis compared controls cases also reported significantly recent life changes controls significant differences results found males females , colon cancer rectal cancer patients although possibility recall bias , completely controlled study , probably important factor explaining case control differences recent life changes , perceptions , may significance development large bowel cancer
indium 111 antimyosin scintigraphy doxorubicin therapy patients advanced breast cancer indium 111 antimyosin \( 111in antimyosin \) scans performed 20 women advanced breast cancer 10 cycles chemotherapy consisting cyclophosphamide , 5 fluorouracil doxorubicin \( total cumulative dose doxorubicin 500 mg m2 \) antimyosin uptake myocardium quantified means heart lung ratio \( \) antimyosin uptake myocardium observed 17 20 \( 85 \) patients , chemotherapy 1 86 0 25 left ventricular ejection fraction \( ef \) determined chemotherapy patients decreased ef \( 8 20 , 40 \) presented intense antimyosin uptake \( 2 11 0 10 versus 1 70 0 16 \( p 0 01 values correlated ef values chemotherapy \( r 0 47 , p less 0 05 \) positive antimyosin studies chemotherapy including doxorubicin , indicate presence myocardial damage patients antimyosin studies sensitive method detect myocyte damage patients doxorubicin therapy
indium labeled anti colorectal carcinoma monoclonal antibody accumulation non tissue patients colorectal carcinoma indium 111 \( 111in \) labeled murine monoclonal antibodies 025 \( carcinoembryonic antigen \) 103 mab b72 3 \( tumor associated glycoprotein 72 \) used image patients colorectal cancers encouraging results objectives study assess frequency causes 111in mab localization tumor free , benign tissues thus , scans 75 patients undergone exploratory surgery following 111in 025 \( n 37 \) 111in 103 \( n 38 \) reviewed conjunction operative histopathology reports localization non tissues seen 10 8 13 1 , respectively , patients receiving 025 103 common sites involved degenerative joint disease , abdominal aneurysms , postoperative bowel adhesions , local inflammatory changes secondary surgery external irradiation review patients' medical history results concurrent diagnostic modalities likely lessen false positive rate 111in labeled mab scan interpretation
6 18f fluoro l fucose possible tracer assessing synthesis tumors positron emission tomography potential 6 18f fluoro l fucose \( 6 18f \) assessing synthesis tumors positron emission tomography \( pet \) investigated using tissue sampling method five tumor models , different time radioactivity profiles found nearly constant level lewis lung carcinoma \( \) different clearance patterns others rapid clearance normal tissues resulted preferable uptake ratios tumor imaging brain pancreas metabolic studies l fucose loading effects tissue uptake proved tracer biochemically active l fucose analog imaging intracranial rat glioma lungs hepatomas mice autoradiography \( arg \) intramuscular 2 carcinoma rabbits pet demonstrated using double radionuclide arg , similar distribution images 6 18f 14c l fucose different tumor liver uptake ratios found metastasis model seemed show higher uptake tracers compared primary tumor model
spect imaging pediatric brain tumor hexakis \( \) technetium \( \) technetium 99m hexamibi hexakis \( \) technetium \( \) developed myocardial perfusion agent biologic properties similar thallium 201 \( \) recently observed value diagnosis brain tumors used conjunction single photon emission computed tomography \( spect \) imaging technology , possibility biologic similarity two extended affinity tumors tested 5 yr old female patient brain stem astrocytoma showed marked focal uptake 99mtc hexamibi site tumor recurrence defined biopsy prior spect study tumor normal cortex radioactivity ratios 99mtc hexamibi spect study 132 1 spatial resolution 99mtc hexamibi images high observation suggests 99mtc hexamibi merits study potential agent spect imaging human brain tumors
beta camera static dynamic imaging charged particle radionuclides biologic samples detection system based plates constructed image charged particles emitted radionuclides samples technique significant advantages conventional film autoradiography investigating distribution radiolabeled compounds shorter acquisition times due high sensitivity , easier sample handling , direct quantification ability perform dynamic studies detector performance shows spatial resolution 0 9 mm carbon 14 \( 14c \) \( 0 156 \) , good linearity homogeneity noise level 50 \( cm2 sec \) successful imaging system performed beta 14c , sulfur 35 \( 35s \) , iodine 131 \( 131i \) , yttrium 90 \( \) , positron gallium 68 \( \) , fluorine 18 \( 18f \) dynamic studies axonal transport 35s methionine nerve , static images labeled monoclonal antibodies slices tumors presented system shows promise rapid quantitative imaging charged particle radionuclides small biologic samples
modified anterior compartment resection majority patients soft tissue sarcomas anterior compartment thigh , possible preserve small portion quadriceps intact nerve supply without compromising procedure local control rate distal one third vastus usually spared long , branch providing innervation dissection femoral nerve inguinal ligament branch \( es \) uninvolved area location tumor essential modified anterior compartment resection improves dramatically function extremity
granular cell neoplasm extrahepatic biliary tree morphological , ultrastructural , immunohistochemical study review literature recent case biliary granular cell tumor cystic duct prompted literature review extensive pathological examination tumor question total 44 cases described mostly black females cases present biliary symptoms , simple surgical resection allows complete control benign condition granular cell tumors likely derived neural crest cells
bilateral malignant tumours report rare example bilateral primary malignant tumours diagnosis supported identification benign epithelial element lesion case illustrates typical dimorphic features malignant tumours contralateral tumour regarded metastatic without histological confirmation
migration stimulating activity serum breast cancer patients assay measure ability stimulate migration fibroblasts collagen gel carried serum treated untreated breast cancer patients healthy controls migration stimulating activity found serum 10 \( 83 \) 12 untreated breast cancer patients immediately surgical resection primary tumour 9 \( 75 \) 4 days resection 13 \( 93 \) 14 patients 1 13 years tumour resection received adjuvant treatment 2 \( 10 \) 20 healthy women matched age migration stimulating activity cancer patients' serum indistinguishable migration stimulating factor produced vitro fetal cancer patient skin fibroblasts behaviour various biochemical procedures presence activity serum treated breast cancer patients clearly distinguishes proteins , seem produced tumours
axilla go zone many surgeons , particularly uk , give inadequate primary treatment patients operable breast cancer spurious reasons regard axillary clearance extensive surgery rely instead upon total mastectomy tumour excision node sampling , without postoperative radiotherapy clear relapse free overall survival improved appropriate adjuvant therapy thus inadequate exploration axilla obvious risk failure remove nodes contain metastases patients deprived cure primary treatment extent tumour spread assessed many patients , risk may receive appropriate adjuvant treatment
prothymosin alpha antisense oligomers inhibit myeloma cell division function prothymosin alpha investigated using four different antisense directed selected regions mrna every case , synchronized human myeloma cells released stationary phase incubation fresh medium containing antisense oligomers , cell division prevented inhibited sense oligomers random antisense oligomers effect detailed analysis synchronized cell populations indicated sense treated untreated cells divided approximately 17 hr growth initiation , whereas cells incubated antisense 183 , 16 mer targeted 5 bases downstream initiation codon , entered approximately one cell division late failure divide correlated directly deficit prothymosin alpha continued presence intact intracellular antisense oligomers period least 24 hr antisense oligomers effect either timing induction prothymosin alpha mrna upon growth stimulation mrna levels seen throughout cell cycle , concluded antisense dna caused specific hybrid arrest translation data suggest prothymosin alpha required cell division however , evidence prothymosin alpha directly regulates
sequence functional expression xenopus oocytes human insulinoma islet potassium channel regulation insulin secretion involves coordinated control ion channels beta cell membrane isolated characterized cdna genomic clones encoding voltage dependent k channel isoform expressed human islets human insulinoma k channel isoform , designated hpcn1 , deduced amino acid sequence residues \( mr 67 , \) , related family drosophila k channels hpcn1 homologous two human k channel isoforms isolated , , 55 65 amino acid sequence identity , respectively electrophysiological characteristics hpcn1 determined microinjection synthetic rna xenopus oocytes two voltage clamp recordings oocytes injected hpcn1 rna revealed voltage dependent outward k current inactivated slowly time outward currents inhibited 4 aminopyridine ki less 0 10 mm relatively insensitive ion delayed k channel hpcn1 could restore resting membrane potential beta cells depolarization thereby contribute regulation insulin secretion
dimerization mammalian progesterone receptors occurs absence dna related release 90 kda heat shock protein study demonstrated dimerization mammalian progesterone receptors \( pr \) occurs absence dna specific immune assay performed extracts human breast cancer cells monoclonal antibody specific full length b form progesterone receptor \( pr b \) resulted significant amounts truncated form receptors \( pr \) , indicating presence stable pr pr b dimers solution positive correlation observed ability different receptor forms solution ability bind specific dna sequences ability form stable pr pr b oligomers absence dna also found correlate release 90 kda heat shock protein \( \) pr complex results support hypothesis dimerization absence dna important mechanism controlling receptor dna binding function release may key step regulating dimerization suggests may function dna binding activity indirectly blocking receptor dimerization
pancreatic tumor pathogenesis reflects causative genetic lesion transgenic mice c myc expression targeted pancreatic acinar cells develop mixed acinar ductal pancreatic adenocarcinomas 2 7 months age contrasts effect pancreas simian virus 40 tumor antigen activated ras , adult mice causes lesions composed exclusively acinar like cells furthermore , early stage myc induced pathology , transformed acinar derived cells appear within islets , suggesting islet hormones may influence progression exocrine pancreatic tumors findings demonstrate initial oncogenic alteration influence pattern subsequent tumor pathogenesis , given human exocrine pancreatic tumors predominantly ductal adenocarcinomas , support suggestion transformed acinar cells may contribute genesis serious disease man
total pelvic exenteration seven patients delayed total pelvic exenteration three patients died carcinoma cervix \( 2 , 5 , 15 months \) , first died chance attempt intercourse , two reported intercourse least two occasions reconstruction one patients described experiences neither stated husband seemed satisfied patient described experience satisfactory husband remaining four patients alive evidence recurrent disease 28 , 42 , 56 , 106 months operation two patients reported entirely satisfactory sexual relations pre exenteration frequency , remaining two sexual relations since surgery give main reason lack opportunity appears reasonable alternative vaginal reconstruction patients especially exenteration improve results , methods vaginal reconstruction continue evaluated
roentgenographic evaluation augmented breast performed retrospective study determine sensitivity mammography detecting breast cancer arising women augmented breasts eight women breast implants breast cancer developed , six mammograms biopsy two six cancers identified mammographically \( sensitivity 33 \) , one two seen cases , mammographic findings suggested benign rather malignant process eight women palpable mass early disease , clinically disease free present sensitivity mammography detecting palpable cancers control group women without implants 92 \( 118 128 \) tumors 2 cm less , sensitivity 88 \( 58 66 \) results suggest sensitivity mammography detecting breast cancer decreased implants present investigations needed determine effects prostheses mammographic evaluations
scoring system preoperative evaluation metastatic spine tumor prognosis assessment system prognosis metastatic spine tumors evaluated 64 cases undergone surgery six parameters employed assessment system 1 \) general condition , 2 \) number bone metastases , 3 \) number metastases vertebral body , 4 \) metastases major internal organs \( lungs , liver , kidneys , brain \) , 5 \) primary site cancer , 6 \) severity spinal cord palsy parameter ranged 0 2 points total score obtained patient correlated prognosis , valuable predicting however , prognosis could predicted single parameter conclusion , excisional operation performed cases scored 9 points , palliative operation indicated scored 5 points
total reconstruction huge sacral tumors authors carried successful total three cases , two giant cell tumors one anterior posterior approach feasible huge sacral tumors en bloc , important reconstruct continuity pelvic ring spinal column using spinal instrumentation sacral rods ao plates total large scale , time consuming , collaborative operation , two three teams used pelvic spinal surgical techniques required post operatively patient within 3 6 months well planned rehabilitation allows ambulation spite serious structural neurologic damage caused , total procedure terms improved morbidity mortality
infiltration lower respiratory tract helper inducer lymphocytes htlv 1 associated adult cell leukemia lymphoma human cell lymphotropic virus type 1 \( htlv 1 \) causative agent adult cell leukemia lymphoma \( atll \) , disorder peripheral blood multiple organs infiltrated transformed lymphocytes investigated nature pulmonary disease patient serologic evidence htlv 1 infection case , endobronchial biopsy specimens showed infiltration bronchial mucosa pleomorphic cells exhibiting high degree nuclear irregularity cells morphologically identical appearance malignant cells found peripheral blood infiltrating dermis , expressed phenotype receptor interleukin 2 , , analogy gene rearrangement studies leukemic blood cells , monoclonal origin however , situ hybridization endobronchial biopsy specimens full length htlv 1 probes failed detect retroviral rna proviral dna studies indicate lymphocytic involvement lower respiratory tract htlv 1 associated atll characterized expression malignant phenotype despite inability document actual cellular infection retrovirus molecular hybridization technique
diagnosis ovarian cancer pathologists often diagnoses contributing pathologists agree panel gynecologic pathologists \? cancer steroid hormone study , multicenter , population based , case control study ovarian , breast , endometrial cancer women 20 54 years age , permitted diagnoses contributing pathologists compared panel three gynecologic pathologists diagnosis ovarian cancer made contributing pathologists subjects agreement two groups pathologists 97 primary epithelial ovarian cancer 89 primary ovarian malignancies agreement diagnosis major cellular subtypes ovarian malignancy ranged 73 cancer 100 clear cell carcinomas conclude diagnosis pathologic features primary ovarian cancer highly predictable nonetheless , diagnosis histologic type varies sufficiently review process considered clinical investigative decisions involving specific histologic diagnoses ovarian cancer
dissection cardinal ligament radical hysterectomy cervical cancer emphasis lateral ligament surgical experience carcinomas uterus rectum provided new insights surgical anatomy lamina , space space proved lamina consists cardinal lateral ligaments pelvic splanchnic nerves , descending following order cardinal lateral ligaments , connective , insert lateral walls uterus rectum extending inner aspect pelvic wall clarification structural relationship led development new procedure dissection cardinal ligament radical hysterectomy , still preserving lateral ligament facilitated systematic dissection cardinal ligaments posterior manipulation , leading reduction blood loss prevention brisk bleeding venous plexuses
colonic malignancy need definitive preoperative localization colonoscopy biopsy standard practice diagnosis colonic malignancies unfortunately , inability endoscopy obtain precise distance measurements anal make localization lesions operation difficult reason , preoperative barium enema intraoperative colonoscopy advocated sites lesions thought easily located operation five patients presented malignant lesions colon diagnosed verified histologically , later undetectable operation subsequent colonoscopic examinations four patients underwent laparotomy three received colon resections none patients' tumors identified intraoperative colonoscopy , resected bowel pathologic examination , follow colonoscopy fifth patient presented spontaneously passed polyp containing invasive adenocarcinoma , multiple colonoscopic examinations failed identify site lesion date , none tumors recurred periods follow ranging 6 months 2 years patients demonstrate poorly documented little understood aspect behavior colonic malignancies , e , ability spontaneously regress bowel wall based instances , localization potentially malignant colon lesions recommended submucosal dye injections initial endoscopy colonoscopy operating room immediately prior operation
pathology nonpalpable breast cancer principal goal mammographic screening early detection breast cancer reviewed records 125 women referred nonpalpable , suspicious abnormalities mammogram , subsequently proved cancer , requiring mammographic localization biopsy subsequent surgery therapy found 72 \( 57 6 \) invasive tumors , 15 \( 12 \) showed evidence microinvasion 38 \( 30 4 \) noninvasive total 115 patients lymphadenectomy part definitive surgery nine \( 12 7 \) patients infiltrating tumors one 10 malignant nodes histologic section none patients noninvasive microinvasive tumors found involved nodes mammographic abnormalities led biopsy series calcifications 74 \( 59 2 \) patients , mass lesions 39 \( 31 2 \) , mass lesions calcifications 11 \( 8 8 \) , asymmetry one \( 0 8 \) nine patients nodal metastases , seven \( 77 8 \) mass without calcifications indication biopsy increasing tumor size found correlate invasive tumors histopathologic examination incidence lymph node metastases thirty seven \( 54 4 \) patients infiltrating tumors tumor size greater 1 cm , seven \( 77 8 \) nine lymph node positive patients tumors 1 3 cm size note , however , two \( 22 2 \) patients microscopic tumors involved nodes 4 year actuarial survival patients infiltrating tumors 85 2 per cent , patients noninvasive microinvasive tumors 100 per cent \( median follow 20 months \)
intravenous administration recombinant human granulocyte macrophage colony stimulating factor causes cutaneous eruption intravenous administration recombinant human granulocyte macrophage colony stimulating factor three patients leukemia receiving marrow aplasia inducing chemotherapy resulted development wide spread erythematous papules course eruption paralleled time infusion granulocyte macrophage colony stimulating factor skin biopsy specimens taken two eruptions displayed characteristic changes consisting variable mixture granulocytes lymphocytes , increased number size dermal macrophages , mild moderate epidermal exocytosis , intercellular edema , rare keratinocytes immunophenotypic analysis one specimen notable keratinocyte intercellular adhesion molecule 1 expression administration recombinant human cytokine pharmacologic doses postulated induce changes immunologic status skin , resulting expression cutaneous eruption
intraepithelial anchoring components cultured human keratinocytes cultured human cervical carcinoma cells \( 180 \) contained intracellular pools antigens reacted anchoring antibodies keratinocytes , antigens formed basement membrane like structure near apical portions cells using flow cytometric techniques , pretreatment 180 cells acetone revealed large intracellular pools antigen intracellular epitope calcium sensitive forms recessive dystrophic epidermolysis bullosa retention intracellular portions anchoring suggesting relation intracellular anchoring antigens disease
familial multiple desmoplastic kindred familial multiple desmoplastic described desmoplastic added group lesions indicate inherited pattern occur multiple primary tumors implications status treatment desmoplastic considered
vivo ultraviolet irradiation human skin results profound perturbation immune system relevance ultraviolet induced skin cancer published erratum appears arch 1991 sep 127 \( 9 \) ultraviolet exposure human skin function antigen presenting langerhans cells normally resident within epidermis langerhans cells capable activating lymphocytes presenting antigens \( nickel tumor antigens \) lymphocytes activated lymphocytes may involved development contact dermatitis immune surveillance immunogenic skin cancers deletion function langerhans cells result abrogated epidermal antigen presentation since ultraviolet irradiation simultaneously induces appearance another epidermal antigen presenting cell population distinct langerhans cell population seems induce suppression immune response suppression immune response following ultraviolet irradiation murine models critical growth immunogenic ultraviolet induced skin neoplasm thus , ultraviolet irradiation human skin may facilitate growth human neoplasms , spreading skin associated infections due induction suppressor cells
drug response head neck tumors native state describe chemosensitivity testing head neck tumors , native state , ie , three dimensional culture system maintains important vivo properties , including tissue architecture , used fifteen specimens head neck tumors evaluated sensitivity following drugs cisplatin \( ddp \) concentrations 1 5 , 15 , 37 5 micrograms ml fluorouracil concentrations 4 0 , 40 , 100 micrograms ml combinations cisplatin fluorouracil corresponding doses growth measurement drug responses successfully completed 10 specimens \( five others contaminated , four prior rigorous antibiotic \) results indicated cisplatin sensitivity five 10 patients fluorouracil sensitivity four 10 patients fluorouracil cisplatin sensitivity seven eight patients preliminary results indicate native state technique feasible test chemosensitivity head neck tumors
progress challenges psychosocial behavioral research cancer century research psychosocial behavioral aspects cancer shown steady growth since , course development paralleled history medical techniques treating cancer table 1 outlines parallel evolution roles american cancer society national cancer institute \( nci \) research area documented interest questions traced back centuries search etiologic factors psychologic variables would explain individual vulnerability cancer first psychologic studies cancer patients reported 1951 massachusetts general hospital memorial sloan kettering cancer center , respectively 1970s saw new interest psychosocial behavioral research many issues addressed first time better care terminally ill approaches including better means pain control ethical concerns related patient status subjects experimental protocols measure quality life cancer patients protocols need multidisciplinary collaborative groups make absence formal training area need design valid , accurate measuring scales specific patients cancer table 4 outlines 1980s gave increasing recognition support psychosocial dimensions cancer period produced series key examined broad research education perspective produced recommendations remain regard instrumentation , conceptual models , pitfalls psychosocial research , training , education , organization research efforts new precision added field past 6 years studies measuring concurrent psychologic , endocrine , immune function use statistical modeling incorporate quality life data correction factor survival data \( twist \) definitions medical outcome include functional status , thus allowing advances psychiatric measurements help answer questions cancer challenges 1990s identified summary table 9 especially observation comprehensive research needed today cannot carried one alone new approaches call areas social inactive cancer research \( e g , \) contribute tools expertise required address problems
social environment social support research relevance social support cancer since first american cancer society methodological issues behavioral psychosocial science nonetheless , critical shortcomings continue characterize attempt empirically establish things extent social support predicts adjustment cancer diagnosis treatment prominent among failure adequately address large elements social structure , social class , investigate shape well persons risk cancer recommend psychosocial research link social support cancer conducted within populations poverty without adequate access health care funding needed training maintenance multidisciplinary teams researchers working within community based organizations hospitals serving
social support cancer patient implications future research clinical care review assesses past progress , current practices , future needs research clinical practice involving social support needs cancer patients review given various social support stress paradigm state art measuring social support current work field social support cancer considered argument made use social support measures , relevant experiences cancer patient potential existing instrument \( duke functional social support scale \) demonstrated , stages cancer would require additional types social support measures interventions outlined interventions discussed terms traditional support groups well interventions primary care physician argument made inclusion quality life functional measures outcomes clinical trials care cancer patient finally , need address , , religious issues surrounding cancer treatment discussed
needs recommendations behavior research prevention early detection cancer life style patterns affect many cancer risks , research health risk behavior behavior change critical cancer prevention report priorities next decade psychosocial research cancer prevention detection leading priority future research fill gaps basic knowledge left intervention outcome studies research must theoretically driven aim develop broad principles applicable diverse health behaviors studies include relevant process data various stages behavior change considered desirable simple outcome studies epidemiologic investigations expanded include measures relevant behaviors , impact clinical outcomes might established research needed lay perception health risks individual health system barriers effective cancer prevention detection studies address needs minority populations crucial funding narrow categorical interdisciplinary research multiple risk factors interactions boundaries must relaxed promote approaches funding agencies also consider basic research long term towards development effective interventions
epidemiologic perspectives life style modification health promotion cancer research clinical , patient oriented focus medicine contrasted epidemiologic \( public health \) approach assessing role life style factors health promotion cancer research host agent environment epidemiologic paradigm applied contemporary cancer prevention issues , principally smoking cessation dietary modification , demonstrate differences , prevention strategies , research opportunities integration population based approaches dynamics patient behavior risks cancer especially salient considering role psychosocial stress personal social resources social epidemiologic perspective , study psychosocial determinants physical health status , offers one approach resolving outlined differences perspectives particularly relevant understanding etiology life style behaviors might altered
implications oncology \? accumulating evidence indicates central nervous system \( cns \) may regulate activity immune system although overall significance immune system cancer remains controversial , psychosocial influences immune function could potentially provide mechanism account reports association psychosocial factors cancer prognosis
scientific inquiry childhood cancer psychosocial research theoretical , conceptual , methodologic issues investigation behavioral treatment procedure related distress paper discusses current status scientific inquiry childhood cancer psychosocial research investigation behavioral treatment procedure related distress serves model illustrating theoretical , conceptual , methodologic issues problems exist area childhood cancer psychosocial research specifically , issues related process scientific inquiry , theoretical conceptual modeling , measurement assessment , behavioral treatment strategies discussed examples issues addressed investigations procedure related distress presented recommendations facilitating growth development field childhood cancer psychosocial research offered
quality life research oncology past future priorities status quality life research oncology assessed , priorities future research regard conceptual theoretical developments , focus content research , research designs practical strategies research implementation , transferring information clinical practice medical policy decision making identified general agreement quality life subjective multidimensional construct , yet comprehensive theoretical models developed applied fully recommend future research based conceptual models interrelationships among quality life domains throughout stages cancer care models , longitudinal research follows , attend specifically cross class cross cultural issues avoid theory research based largely views majority culture encourage inclusion theory based quality life assessment standard component clinical trials success require additional standardization quality life measures use across range cancer patient populations , including development age specific norms instruments designed assess entire family system
methodologic issues assessing quality life cancer patients although quality life assessments employed successfully descriptive studies oncology , use cancer clinical trials , date , limited range issues conduct clinical trial based quality life investigations include absence theoretical models guide development quality life measures reliance ad hoc approaches quality life assessment insufficient attention practical constraints operating clinical research settings primary importance need develop multidimensional quality life instruments brief suggested future work instrument development focus currently available cancer specific measures , developing new diagnostic specific questionnaire psychometric work guided appropriate theoretical models relationship among health related quality life domains although widely accepted patient represents appropriate source quality life data , suggested efforts also directed toward improving validity reliability physician generated assessments patients' performance status treatment toxicities , toward determining feasibility employing family members proxy psychologic social health status patients unable provide information additional attention paid many problems arise clinical trial based quality life investigations particular , research designs data collection procedures selected minimize patient , medical staff , institutional burden
quality life adjusted survival comparing cancer treatments commentary twist q twist chronic disease situations treatment comparisons favor particular therapy , definitive outcome requires considerable follow period , useful additional perhaps intermediate endpoints relevant clinical significance compare treatments one endpoint time without symptoms toxicity \( twist \) , together q twist , attempts address quality life patients receiving regimens paper provides commentary techniques emphasis problems inherent implementing q twist , measure attempts incorporate patient value preferences twist argued q twist clinical setting , design psychometric must overcome fully concept
progress psychosocial behavioral cancer research need enabling strategies major component second methodology behavioral psychosocial cancer research discussion enabling strategies , , strategies future goals needs area psychosocial behavioral oncology might accomplished report describes discussion took place special session representatives four funding agencies , american cancer society , national cancer institute , national institute mental health , national science foundation , presented views programs promoting research psychosocial behavioral oncology concluded much progress made field strategies place ensuring continued progress however , suggestions also made new strategies might accelerate progress
behavioral psychosocial cancer research building past , future report identifies five general conclusions emerged second methodology behavioral psychosocial cancer research conclusions address diverse topics , including focus areas methodology emphasis transfer technology knowledge applied settings recognition role basic behavioral research clinical questions need recognize field behavioral psychosocial oncology basic behavioral social science fields emerged importance additional research special populations suggested meeting challenges five areas critical continued progress field
fertility sparing treatment patients ovarian cancer variety malignant neoplasms produced ovary must considered individually young woman early disease preserve childbearing capability risks conservative surgery often low , patient advised careful monitoring group patients essential regardless approach
chromogranin posttranslational modifications secretory granules primary structure chromogranin indicates multiple domains might subject posttranslational modification explored chromogranin 's proteolytic cleavage , glycosylation , possible disulfide links , using biochemical cell biological approaches anti chromogranin region specific immunoblots chromaffin granules suggested bidirectional cleavage chromogranin control experiments ruled cleavage granule isolation lysis isolation chromogranin derived peptides gel filtration chromatography sodium dodecyl sulfate polyacrylamide gel electrophoresis \( sds page \) , followed n terminal amino acid sequencing , established several cleavage sites , including least two sites secretion chromogranin bovine chromaffin cells initiate cleavage , prolonged exposure secreted secretory cells chromogranin cleavage pattern qualitatively similar neuroendocrine tissues , though cleavage complete adrenal medullary anterior pituitary hormone storage vesicles , n terminal fragments 45 55 prominent hypothalamus similar cleavage pattern seen human pheochromocytoma granules , judged chromogranin region specific immunoblots , fragment isolation sds page , presence full length chromogranin core protein chromaffin granule soluble proteoglycan suggested bovine \( human \) chromaffin granules glycoprotein staining , digestion , chemical , region specific immunoblotting human \( bovine \) chromogranin displayed disulfide sds page gels immunoblotting results document diverse structural chromogranin molecule may take endocrine secretory cells translation
comparison frtl 5 cell growth vitro cells thyroid recipient mouse present work designed compare vitro cell growth kinetics vivo growth conditions similar possible using labeling 3h thymidine purpose , frtl 5 cells cultured monolayers three dimensional spheroids embedded collagen gels transplanted simultaneously nude mice treated low iodine diet growth transplants compared thyroids host mice intact thyroid , fraction 3h thymidine labeled follicular cells \( flc 24 h labeling \) increased maximum 10 3 weeks exposure , subsequent autoregulatory decrease 3 7 weeks 4 fold higher flc found six adenomas , indicating focal failure growth mechanisms monolayer cultures flc high 90 , even within large individual clusters cells tight contact solid , highly cellular grafts growing transplanted cells showed average flc 20 , 5 times higher flc stimulated mouse thyroid collagen embedded cells , forming three dimensional spheroids , mean flc decreased 70 1 week vitro \( 40 vivo \) 20 3 weeks vitro vivo , suggesting effective auto regulation excessive growth conditions however , flc much higher 3 flc simultaneously assessed host thyroids difference remained throughout 45 day period studied conclude frtl 5 cells growing monolayers three dimensional spheroids vitro vivo invariably show much higher proliferation rates comparable environmental conditions normal follicular epithelium thyroids host mice one exception confluent monolayer near zero growth , densely packed three dimensional transplants still grow intensively although growth cell cell interactions also clearly operative growing frtl 5 cells , less effective replication rate thyrocytes within monolayer normal follicles local failure mechanisms , allowing growth rates comparable grafted frtl 5 cells results adenoma formation normal thyroids observations call caution transfer vitro growth studies frtl 5 cells vivo conditions prevailing normal thyroid
regulation release human pancreatic carcinoid cell line vitro objective experiments investigate influence activation three second messenger systems \( protein kinase c , adenylate cyclase camp , calcium mobilization \) secretion \( pst \) chromogranin \( cga \) human pancreatic carcinoid cell line \( bon \) tissue culture stimulation protein kinase c phorbol ester \( 0 025 7 5 microm \) caused significant dose related release pst \( 186 22 228 controls \) treatment bon cells graded doses 8 camp \( 0 14 3 0 mm \) \( 0 01 1 0 mm \) also stimulated dose related release pst \( 107 22 284 28 16 12 100 controls , respectively \) incubation bon cells ionomycin \( 0 134 13 4 microm \) increased release pst \( 102 15 554 21 controls \) dose related manner combination ionomycin resulted additive effect , whereas treatment phorbol ester plus resulted synergistic effect pst release pretreatment bon cells , agent prevents processing precursors smaller peptides , significantly decreased pst , cga , secretion response phorbol ester ionomycin findings indicate protein kinase c , camp , ca2 mobilization participate cga pst secretion although observation secretions pst cga response theophylline quantitatively associated , absence quantitative relationship release patterns pst cga response phorbol ester ionomycin support simple precursor product relationship cga pst experiments consistent notion pst derived cga bon cells
regulation truncation luteinizing hormone receptors plasma membrane different rat mouse leydig cells regulation truncation lh receptors investigated two types mouse tumor leydig cells \( 1 \) , rat testis leydig cells \( \) , rat tumor leydig cell \( \) receptor numbers measured binding 125i hcg cells cultured monolayers addition 3 3 nm lh 2 h 34 c detectable effect binding sites cells , 1 cells caused loss binding sites effect 1 cells could mimicked inhibiting receptor internalization 5 mm prevented addition protease inhibitors incubating cells protease inhibitors caused 2 3 fold increase binding sites 2 3 fold increase lh \( 0 0 33 nm \) stimulated camp production cells incubated presence 125i hcg , radioactive protein complex approximate mol wt 80 , 000 90 , 000 released incubation medium conclude lh receptors regulated plasma membrane mouse rat leydig cells furthermore , truncation lh receptor mouse leydig cells involved regulation , whereas rat continuous process
breast cancer screening older women practices barriers reported primary care physicians annual mammography , combination clinical breast examinations , reduce mortality breast cancer however , surveys patients physicians suggest mammography study examined whether physicians' reported breast cancer screening practices barriers mammography varied patients' age data primary care physicians \( internal medicine , family general practice , obstetrics gynecology \) participated mailed statewide survey analyzed physicians reported screening elderly women significantly less often younger women , regardless family history breast cancer exception medical specialty , physicians' demographic practice characteristics associated reported screening practices however , physicians' knowledge beliefs breast cancer older women associated reported screening practices analyzing barriers mammography , cost patient viewed barrier women ages , pain viewed greater barrier younger women otherwise , physicians consistently believed elderly patients considerably barriers compared younger women investigation required examine primary care physicians report age related differences breast screening barriers mammography
role tumor derived cytokines immune system mice bearing mammary adenocarcinoma induction regulatory macrophages normal mice vivo administration rgm csf using induced immunogenic murine mammary adenocarcinoma balb c mice , previous work shown splenocytes tumor reduced responses mitogens ag including tumor associated ag nk cytotoxic cell activities also reduced splenocytes tumor mac 1 2 macrophages induced mammary tumor capable regulating lymphocyte responses mitogens tumor associated ag cell cell contact interaction increased pge2 production found tumor constitutively releases granulocyte macrophage \( gm \) csf like factor vivo vitro , may responsible systemic increase cells macrophage lineage tumor bearing mice tumor cell line established vivo tumor expresses releases gm csf shown northern western blot analyses daily p injections 3 wk 10 , 000 u rgm csf normal mice induces hemopoietic immunologic alterations similar observed tumor mac 1 mac 2 macrophages also detected spleens bone marrow mice treated rgm csf additionally , splenocytes rgm csf treated mice reduced responses mitogens peritoneal exudate cells cause vitro regulation proliferative responses lymphocytes normal mice suppression partially reversed addition indomethacin cultures suggesting pge2 may contribute effect rgm csf enhances vitro release pge2 spleen , bone marrow , peritoneal cells normal mice data indicate high levels gm csf constitutively produced tumor may responsible hemopoietic changes immunologic alterations observed tumor bearing mice
insulin like growth factors mitogenic human keratinocytes squamous cell carcinoma normal adult human keratinocytes monolayer culture scl 1 , skin derived squamous cell carcinoma cell line , investigated expression receptors insulin like growth factors \( igf \) insulin demonstrated affinity crosslinking , radiolabeled igf 1 , igf 2 , insulin bound specifically cell types cell expressed type igf receptors , affinity igf 1 greater igf 2 much greater insulin insulin receptors , highest affinity insulin , also present cells however , keratinocytes scl 1 cells differed 125i igf 2 binding 125i igf 2 bound type type ii igf receptors normal keratinocytes , bound predominantly membrane associated igf binding proteins scl 1 igf 1 slightly potent igf 2 stimulating growth keratinocytes scl 1 cells keratinocytes , concentrations igf 1 ranging 5 100 ng ml , igf 2 50 100 ng ml , resulted significant increase cell number maximum dose 100 ng ml , either igf 1 igf 2 caused 2 3 times increase cell number scl 1 cells , igf 1 potent igf 2 insulin lower concentrations , either igf 1 igf 2 maximal concentration 333 ng ml stimulated 4 7 times increase thymidine incorporation stimulatory effect insulin scl 1 10 50 times less potent igf effect either igf scl 1 completely inhibited type igf receptor antibody alpha ir 3 , suggesting igfs mitogenic type igf receptor insulin action partially blocked alpha ir 3 , suggesting insulin act insulin type igf receptors thus appears igf 1 igf 2 mitogens normal transformed human keratinocytes actions primarily mediated type igf receptor , whereas insulin mitogen igf 1 receptor insulin receptor
inositol phosphate formation human squamous cell carcinoma line scc 12 f studies bradykinin , calcium ionophore a23187 , sodium fluoride phospholipase c \( plc \) mediated hydrolysis membrane important signal transduction pathway coupled cell surface receptors several hormones growth factors addition , plc activity modulated changes intracellular calcium activation gtp binding proteins report , differential activation plc human keratinocyte cell line scc studied judged specific patterns inositol phosphate formation several hormones growth factors previously shown stimulate plc variety cell types screened activity scc cells bradykinin active , stimulating plc dependent generation inositol \( 1 , 4 , 5 \) triphosphate \( ins \( 1 , 4 , 5 \) p3 \) ins \( 1 , 4 , 5 \) p3 rapidly metabolized inositol \( 1 , 4 \) \( ins \( 1 , 4 \) p2 \) inositol \( 1 , 3 , 4 , 5 \) \( ins \( 1 , 3 , 4 , 5 \) \) , subsequently degraded inositol response elicited bradykinin concentration dependent \( ec50 value 50 nm \) , suggesting involvement specific bradykinin receptor treatment cells calcium ionophore a23187 appeared result direct formation ins \( 1 , 4 \) p2 without ins \( 1 , 4 , 5 \) p3 precursor treatment cells , putative activator gtp binding proteins , resulted generation inositol major metabolites absence detectable ins \( 1 , 4 , 5 \) p3 formation taken together , observations suggest plc complex present scc cells differentially activated yield either ins \( 1 , 4 , 5 \) p3 , ins \( 1 , 4 \) p2 , observed effects may due direct plc dependent hydrolysis appropriate membrane phosphoinositide
thyroid cancer important recent advances understanding biologic nature thyroid cancer early diagnosis disease despite advances , still considerable controversy management thyroid cancer , including extent surgery , indications use iodine 131 , effectiveness thyroid stimulating hormone suppression , prediction outcome review , current status diagnosis management various types thyroid cancer carefully reviewed extensively documented
hepatic dynamic sequential ct section enhancement profiles bolus ionic nonionic contrast agents enhancement characteristics different portions liver dynamic sequential bolus computed tomography \( ct \) iodinated contrast material \( \) prospectively evaluated 75 patients using iothalamate meglumine , iopamidol , iohexol \( 25 patients received agent \) baseline ct performed , performed 180 ml intravenous bolus administered 2 ml sec scanning started 25 seconds bolus initiated , using 3 second scan time rapid table , yielding contiguous 8 mm thick sections rate nine sections per minute images , peak enhancement 115 iopamidol 117 iohexol , superior iothalamate meglumine 95 \( p less 05 \) peaking , enhancement decreased three contrast agents , although decline iothalamate meglumine enhancement caudal sections iopamidol iohexol superior iothalamate meglumine \( p less 05 \) data suggest enhancement characteristics two nonionic agents may optimal detection focal hepatic lesions ionic agent
linkage early onset familial breast cancer chromosome human breast cancer usually caused genetic alterations somatic cells breast , occasionally , susceptibility disease inherited mapping genes responsible inherited breast cancer may also allow identification early lesions critical development breast cancer general population chromosome appears gene inherited susceptibility breast cancer families early onset disease genetic analysis yields lod score \( likelihood ratio linkage \) 5 98 linkage breast cancer susceptibility early onset families negative lod scores families late onset disease likelihood ratios favor linkage heterogeneity among families ranged 2000 1 greater 10 \( 6 \) 1 basis analysis four loci region
detection ki 67 proliferation rate breast cancer correlation clinical pathologic features situ determination proliferative activity performed 203 breast cancers use ki 67 monoclonal antibody immunohistochemical methods tumor proliferation rate analyzed correlated tumor size nodal status relationship ki 67 proliferative activity nuclear estrogen receptor content also investigated adjacent tissue sections ki 67 values ranged 1 75 , median value 10 premenopausal patients greater ki 67 values \( median value , 14 1 \) postmenopausal ones \( median value , 9 8 \) authors observed correlation lymph nodal involvement , whereas statistically significant relationship tumor size found \( p less 0 01 \) inverse correlation \( 's coefficient 0 56 p less 0 001 \) seen ki 67 values nuclear estrogen receptor content results , similar reported kinetic measurements , suggest situ detection ki 67 proliferation rate useful method obtaining cell cycle information follow studies needed assess eventual prognostic relevance
fluorescent cytochemical detection estrogen progesterone receptors breast fine needle aspirates estrogen progesterone receptors studied fine needle aspiration biopsy specimens 56 patients primary , recurrent , metastatic breast carcinoma ligands , 17 b estradiol 6 bovine serum albumin fluorescein \( fitc bsa estradiol \) bovine serum albumin \( bsa progesterone \) , used fluorescent cytochemical method findings obtained aspirated cells use fluorescent cytochemical technique compared results obtained cell population tumor removal use fluorescent cytochemical technique biochemical dextran coated charcoal \( dcc \) assay needle aspirates , 89 concordance estrogen receptor 86 concordance progesterone receptor biochemical cytochemical results high degree correlation also demonstrated fine needle aspirates imprint preparations use cytochemical technique study suggests fluorescent cytochemical technique effective tool assessment estrogen progesterone receptor content fine needle aspirates primary metastatic breast cancer fluorescent cytochemical technique performed easily community hospitals well suited specimens insufficient size biochemical assay
evaluation vitro bromodeoxyuridine labeling breast carcinomas use commercial kit prognostic significance phase fraction analyses breast carcinomas reported several investigators cell proliferation kit \( corporation , heights , il \) , uses vitro bromodeoxyuridine \( brdu \) labeling evaluate cell cycle kinetics without flow , simplifies assay clinical based laboratory providing standardized reagents recommended methods study performed determine whether data derived use comparable published phase data use thymidine labeling , brdu , methods breast carcinomas primary infiltrating ductal carcinomas \( n 142 \) primary lobular carcinomas \( n 6 \) showed mean median brdu labeling 4 63 3 , 1 3 1 , respectively , range 0 28 benign lesions always less 3 brdu uptake \( n 21 \) estrogen receptor \( er \) progesterone receptor \( pr \) status correlated brdu labeling \( p less 0 05 \) , highest phase fractions er pr negative tumors correlations brdu uptake histologic tumor type size observed significant correlations brdu uptake lymph node status , patient age , histologic tumor grade observed phase studies breast carcinomas using techniques shown similar data , therefore , cell proliferation kit appears practical useful method vitro phase analysis allows concomitant histologic examination tumor tissue sample
expression blood group antigens h 2 , le \( \) , sialylated le \( \) human colorectal carcinoma immunohistochemical study using double labeling techniques study , double labeling immunohistochemistry used gain insight coexpression blood group antigens \( \) differentiation antigens normal colon , sequential moieties synthetic pathway paired sialylated le \( \) le \( \) h 2 le \( \) studied sialylated le \( \) le \( \) synthesized type 1 type 2 , respectively normal colon , le \( \) sialylated le \( \) expressed cells base surface crypt , respectively , representing undifferentiated differentiated h 2 considered nature , considered immediate precursor synthesis le \( \) individual cancers sialylated le \( \) detected different cancer cells within malignant glands , separately different glands , different subcellular compartments cell h 2 le \( \) coexpressed individual cells 92 cancers expressing 50 cancers , h 2 le \( \) also expressed separately different malignant glands within individual tumors findings indicate , colorectal cancers , differentiation antigens \( sialylated le \( \) le \( \) \) expressed different individual cells within malignant gland somewhat , normal colon crypt antigens different occasionally may expressed cells within different subcellular compartments precursor accumulation common cancers , antigens synthetic pathway coexpressed cell expression h 2 le \( \) different glands \( lack coexpression \) may explained possibly aberrant synthesis le \( \) alternate pathway
tumor secreted vascular permeability factor increases cytosolic ca2 von willebrand factor release human endothelial cells vascular permeability factor \( vpf \) , tumor secreted heparin binding protein \( mr approximately 38 , 000 \) , responsible increased vessel permeability fluid accumulation associated tumor growth vascular permeability factor also promotes growth human umbilical vein endothelial cells \( ec \) bovine pulmonary ecs vitro shown first time guinea pig vpf \( half maximal maximal dose approximately 0 4 22 pmol l \( \) , respectively \) , well human vpf , potent stimuli human ecs resulting ca2 increases \( maximal three fourfold \) inositol triphosphate \( ip3 \) formation unlike maximal responses thrombin histamine , ca2 response maximal vpf dose preceded characteristic 10 15 second delay guinea pig vpf also selectively increased ca2 cultured aortic pulmonary artery ecs , aortic smooth muscle cells , human fibroblasts , neutrophils affinity purified rabbit antibody \( raised synthetic peptide representing vpf n terminal amino acids 1 24 \) vessel permeability increasing activity , ec growth promoting activity , specifically activity responsible increasing ec ca2 similar mediators increase ca2 cultured ecs , vpf also induced 200 increase von willebrand factor release together data indicate vpf acts directly ecs rapid cellular events vivo vitro actions likely involve phospholipase c activation , ca2 increase , von willebrand factor release
immunoreactivity receptor expression insulinlike growth factor insulin human adrenal tumors immunohistochemical study 94 cases using immunoperoxidase methods , 94 human adrenal tumors examined evidence immunoreactivity receptor expression insulinlike growth factor \( igf \) insulin frequency igf adrenocortical carcinomas significantly higher adenomas adrenal glands adrenocortical carcinomas showed strong intensity staining igf , igf receptors , insulin receptors significant correlation immunoreactivity receptor expression igf insulin found adrenocortical carcinomas adrenocortical adenomas cushing 's syndrome pheochromocytomas , adrenocortical adenomas 's syndrome , also stained strongly insulin receptors thus igf insulin probably play role growth adrenocortical carcinoma tissues , possibly autocrine mechanisms expression insulin receptors adrenocortical adenomas presence cushing 's syndrome pheochromocytomas may associated functions
critical analysis largest reported mass fecal occult blood screening program united states fecal occult blood testing detection colon cancer remains controversial performed mass screening program january 24 , 1988 , february 19 , 1988 , intensive media promotion , including 121 minutes air time total 5 , 000 primary practitioners mail hemoccult ii tests distributed 156 , 000 individuals 55 , \( 35 \) returned ninety five percent respondents informed program television total 3 , persons \( 6 \) tested positive fecal occult blood , 2 , 469 \( 73 \) informed center saw physician initiate work information physicians regarding work ups returned 1 , \( 55 \) patients diagnostic tests 2 , 227 \( 1 6 tests per patient \) however , 5 testing , 16 repeat hemoccult , 35 neither barium enema colonoscopy performed thirty six colorectal cancers 212 polyps identified predictive value \( e , number cancers per number patients tested positive \) increased directly decade thirty three 36 patients \( 92 \) cancer underwent either barium enema colonoscopy versus 185 438 \( 42 \) patients negative work cancers found carcinoma situ 10 patients \( 29 \) , dukes 12 \( 35 \) , dukes b 4 \( 12 \) , dukes c 8 \( 24 \) distant metastases found participant thirty six percent tumors located either right transverse colon conclude \( 1 \) screening identified early cancers potentially curable 64 limited bowel wall \( 2 \) massive hemoccult distribution possible short interval , patient physician compliance low \( 3 \) total colonic evaluation mandatory , since least 36 tumors beyond reach flexible \( 4 \) many work ups unnecessary \( repeat \) inadequate , indicating need physician education
factors influencing survival pancreaticoduodenectomy pancreatic cancer eighty nine patients carcinoma head pancreas underwent actuarial 5 year survival 89 patients 19 , median survival 11 9 months 81 hospital survivors analyzed effort determine factors influencing long term survival negative lymph nodes absence blood vessel invasion favored long term survival strongest predictive factor negative lymph node status median survival 55 8 months , compared 11 months lymph nodes involved tumor \( p less 0 05 \) blood transfusions also predictive , patients receiving two fewer units median survival 24 7 months , compared 10 2 months receiving three units \( p less 0 05 \) important determinant long term survival pancreaticoduodenectomy pancreatic cancer biology tumor \( lymph node status , blood vessel invasion \) however , performance resection \( units blood transfused \) also appears important factor influencing survival
implications peritoneal cytology staging early pancreatic cancer cytologic examination peritoneal washings performed 40 patients pancreatic ductal adenocarcinoma \( 35 head , 5 body \) whose tumors selected potentially resectable computed tomographic \( ct \) findings saline \( 100 ml \) instilled aspirated laparoscopy 27 patients laparotomy 13 malignant cells found peritoneal washings 12 40 patients \( 30 \) 29 cancers pancreatic head versus 40 body 33 laparoscopy versus 23 laparotomy 4 8 patients ascites versus 8 32 without ascites cytology positive 6 8 patients \( 75 \) prior percutaneous needle biopsy versus 6 32 \( 19 \) \( p less 0 01 \) liver metastases found six patients , negative cytology one 10 pancreatic head cancers positive cytology resectable versus 13 25 negative cytology \( p less 0 05 \) survival significantly longer patients negative cytology conclude \( 1 \) pancreatic cancer malignant cells peritoneum early commonly \( 2 \) laparoscopic lavage effective means cytologic study \( 3 \) ascites cytologic study , presence necessarily imply \( 4 \) intraperitoneal spread cancer cells may promoted tumor biopsy \( 5 \) cytologic findings provide additional index resectability \( 6 \) cytologic findings appear correlate duration survival study shows even localized pancreatic cancer often contained suggests caution biopsy potentially curable lesions
expression abh blood group antigens , ulex europaeus agglutinin , type iv collagen sinusoids hepatocellular carcinoma expression blood group antigens \( , b , h , lewis \( \) lewis \( b \) \) , ulex europaeus agglutinin \( uea \) , factor viii related antigen , type iv collagen sinusoids examined immunohistochemically 15 cases hepatocellular carcinomas \( hcc \) , 11 cases cirrhosis , 12 cases chronic active hepatitis , control sample 16 normal livers sinusoidal endothelial cells hcc characteristically showed diffuse strong immunoreactivity abh blood group antigens specimen comparable abo blood group sinusoidal endothelial cells also diffusely strongly positive uea receptors contrast , cirrhosis chronic active hepatitis sinusoidal endothelial cells positive abh blood group antigens uea receptors normal livers , sinusoidal endothelial cells positive abh blood group antigens uea 1 receptors tests factor viii related antigen lewis blood group antigens almost negative sinusoidal endothelial cells although type iv collagen distributed diffusely space four groups , expression strongest hcc blood vessels portal tracts fibrous septa positive abh blood group antigens , uea 1 receptors , factor viii related antigen , type iv collagen , negative lewis blood group antigens findings suggest sinusoidal endothelial cells undergo cirrhosis chronic active hepatitis , majority sinusoidal endothelial cells hcc phenotypic characteristics capillaries
pleomorphic \( anaplastic \) neuroblastoma nude mice two pleomorphic \( anaplastic \) neuroblastomas , two children aged 1 6 years , transplanted nude mice two observations made one case , transplanted tumor gave rise soft tissue sarcoma moreover , cases hepatic metastases associated striking modification murine hepatocytes , resulting dysplastic nuclei latter finding particularly evident hepatic areas surrounding metastases pleomorphic \( anaplastic \) neuroblastoma cells
glomus tumor curable cause 30 year old woman presented recurrent severe underwent exploration possible sinus found glomus tumor also involved bony trabeculae knowledge , glomus tumor involving bone previously documented view relief patient 's pain following surgical excision tumor , causal role suggested
malignant mixed tumor \( malignant ameloblastoma fibrosarcoma \) maxilla present rare case \( malignant ameloblastoma fibrosarcoma \) left maxilla developed 63 year old japanese man tumor recurred repeatedly despite multiple surgical , radiotherapy , chemotherapy led progressive patient died 3 8 years hospitalization histopathologic examination revealed recurrent tumor , progressed malignant ameloblastoma autopsy confirmed diagnosis malignant mixed tumor lung metastasis malignant ameloblastoma fibrosarcoma
response women aged 65 79 screening breast cancer mammography pilot study published erratum appears 1991 jul 27 303 \( \) 234 objective determine whether sufficient benefit gained offering screening breast cancer mammography women aged 65 79 , normally invited screening design pilot study women eligible screening personal results study compared results routinely screened younger women \( aged 50 64 \) general practice setting one group general practice south patients women aged 65 79 practice list total 42 \( 7 \) excluded general practitioner , 22 \( 4 \) returned post office main outcome measures response rates screening assessed three indices crude population coverage ratio , crude invited population coverage ratio , corrected invited population coverage ratio results 344 patients aged 65 79 \( 61 invited , excluding could traced \) screened compared 77 women aged 50 64 three response indices higher younger women older crude population coverage ratio 66 5 , crude invited population coverage ratio 69 3 , corrected invited population coverage ratio 76 8 women aged 50 64 , compared 54 5 , 58 4 , 60 7 respectively women aged 65 79 four biopsies done older women gave positive results , giving cancer detection rate 11 6 1000 compared 4 1 1000 among younger women conclusions results show potential high attendance routine screening older women invited way younger women results found elsewhere costs benefits screening older women
recreational sun exposure puerto rico trends cancer risk awareness persons engage activities exposed large amounts uv radiation four hundred seven adults visited puerto rico surveyed determine knowledge risks sun exposure evaluate sunscreen use group consisted 195 year round puerto rican residents 212 ninety five percent believed sun cause skin cancer , although half subset lived year puerto rico believed received enough exposure risk majority group \( 83 \) understood meaning sun protection factor numbers , although 35 used either nothing oil half puerto rican residents rarely never used sunscreen protection sunscreen used , important factor sought given sun protection factor \( 64 \) , followed perceived ability aid \( 26 \)
cutaneous describe eight cases cutaneous , rare tumor previously reported term cutaneous clinically , tumors acquired , solitary , asymptomatic nodules always acral location patients' ages ranged 33 77 years \( median 52 6 years \) male female ratio 7 1 signs tuberous sclerosis renal absent cases histologically , tumors subcutaneous , well circumscribed , composed smooth muscle , vascular spaces , connective tissue , mature fat tumors fat predominant component , others smooth muscle predominated elastic tissue stains revealed blood vessels developed elastic lamina whereas blood vessels lacked additional histologic features occasionally observed included vascular thrombi , glomus bodies , focal mucin deposition
risk developing subsequent nonmelanoma skin cancers data southeast arizona skin cancer registry collected 1985 june 1988 used study patients nonmelanoma skin cancer \( basal cell squamous cell carcinoma \) removed 1985 observed subsequent nonmelanoma skin cancers developed june 30 , 1988 twelve categories nonmelanoma skin cancers developed basis type first nonmelanoma skin cancer type second , third , fourth nonmelanoma skin cancers analyses showed highest risk subsequent nonmelanoma skin cancer developing within 1 year \( 36 39 \) , rate developing another nonmelanoma skin cancer depended type \( squamous cell carcinoma , 100 basal cell carcinoma , 44 23 83 65 \) , total risk decreased days study
histologic pattern analysis basal cell carcinoma study series consecutive neoplasms study attempts define histologic patterns consecutive cases basal cell carcinoma correlate patterns adequacy margins surgical excision five major histologic patterns identified nodular , 218 cases \( 21 \) superficial , 181 cases \( 17 \) micronodular , 151 cases \( 15 \) infiltrative , 77 cases \( 7 \) , 11 cases \( 1 \) mixed pattern \( two major histologic patterns \) present 401 cases \( 38 5 \) study indicates nodular superficial basal cell carcinomas completely removed simple surgical excision high percentage cases \( 93 6 96 4 , respectively \) whereas micronodular , infiltrative , basal cell carcinomas higher incidence positive tumor margins \( 18 6 , 26 5 , 33 3 , respectively \) excision mixed patterns consisted combinations nodular , micronodular , infiltrative types exhibited behavior similar pattern resulted greater chance incomplete surgical removal
treatment port wine stains childhood flashlamp pumped pulsed dye laser seventy three patients ages 3 months 14 years \( average age 6 years 2 months \) port wine stains treated flashlamp pumped pulsed dye laser 75 lightening achieved average 2 5 treatments 33 patients \( 45 \) , 50 74 lightening average 1 7 treatments 31 \( 42 \) , 26 49 lightening 2 treatments 5 \( 7 \) , less 25 lightening 1 treatment 4 \( 5 \) overall average lightening one treatment 53 percentage lightening increased number treatments increased three patients 100 clearance port wine stain patients aged 3 months 6 years \( 44 patients \) better response first treatment \( 55 lightening \) patients aged 7 14 years \( 29 patients 48 lightening p 0 027 \) complications included cutaneous four patients , 16 patients , three patients complications transient disappeared completely
induction dna fragmentation chronic b lymphocytic leukemia cells chronic lymphocytic leukemia b cell type \( b cll \) neoplastic disorder characterized accumulation small resting lymphocytes periphery phenotype cells suggests frozen early stage maturation glucocorticoid hormones commonly used treat patients b cll , resulting reduction peripheral lymphocyte count undefined mechanism report glucocorticoids stimulate dna fragmentation characteristic suicide process known apoptosis programmed cell death \( pcd \) suspensions cells patients b cll effects mimicked ca2 ionophore involve sustained increase cytosolic ca2 concentration specific antibodies binding membrane associated igm leukemic cells also induce pcd similar mechanism phorbol esters block dna fragmentation cell killing response agents , suggesting activation protein kinase c cells pcd targeting b cll cells antibodies induce , sustained ca2 increase may therefore represent rational strategy destruction leukemic cells
transforming growth factor beta induced inhibition cell function susceptibility difference cells various phenotypes functions relevance immunosuppression tumor bearing state present study nature humoral component \( \) generated tumor bearing hosts induce immune dysfunction cells cell free ascitic fluid culture supernatant \( sn \) obtained ascites cultures allowing hepatoma cells grow ascites sn samples tested abilities influence generation ctl responses tnp alloantigens generation anti tnp ctl responses require self h 2 restricted cd4 th cells markedly suppressed addition ascites sn conditions samples inhibit anti ctl responses capable using alternate pathways restricted cd4 cd8 th activation cd8 ctl precursors ctl activity also resistant ascites sn ascites sn induced suppressive effect cd4 th susceptible found mediated transforming growth factor beta \( tgf beta \) activity , 1 \) tgf beta activity detected ascites culture sn 2 \) suppression cd4 th function required anti tnp ctl responses almost completely prevented addition anti tgf beta antibody cultures 3 \) beta also induced similar patterns immunosuppression observed ascites sn results indicate tgf beta produced tumor cells induces deleterious effects cell , especially cd4 th subset , provide explanation molecular mechanism underlying previously observed cd4 th selective suppression tumor bearing state
expression vhiii associated cross reactive idiotype human b lymphocytes association staphylococcal protein binding staphylococcus aureus cowan stimulation demonstrated staphylococcal protein \( spa \) alternative binding site specificity human ig h chain v region vhiii subgroup major mitogenic component staphylococcus aureus cowan \( sac \) spa , possible sac stimulates subpopulation b cells expressing ig vhiii h chain subgroup present study , investigated relationship spa binding expression vhiii associated cross reactive idiotype \( cri \) surface b lymphocytes enriched expression cri , examined ig secreted cell lines established populations b cells ebv transformation vhiii cri \( \) enriched population yielded 21 cell lines , 67 secreting spa reactive ig contrast , 6 \( 1 16 \) cri expressing lines secreted spa reactive ig cri negative b cell population yielded 54 cell lines , 20 secreted spa reactive ig , might anticipated majority vhiii ig b cells cri sac stimulation cri cri populations showed preferential stimulation population data support sac stimulation human b cells mediated binding spa alternative binding site regions vhiii subgroup
intraperitoneal cisplatin cytarabine treatment refractory recurrent ovarian carcinoma preclinical evaluation suggested impressive concentration dependent cytotoxic synergy cisplatin cytarabine ovarian carcinoma evaluate clinical relevance observations , 39 patients refractory recurrent ovarian carcinoma entered onto phase ii trial intraperitoneal \( ip \) cisplatin \( 100 105 mg m2 per course \) plus cytarabine \( 600 900 mg per course \) treatment administered 2 3 days maximum five monthly courses , followed surgical reevaluation patients without clinical evidence disease 3 day regimen discontinued secondary development severe thrombocytopenia \( five 12 courses platelets decreased less 50 , 000 mm3 \) additional toxicities included abdominal pain \( moderate severe time therapy 46 patients \) , fever without evidence infection \( 44 \) , bacterial peritonitis \( 10 \) three patients declined surgical reassessment fourteen 36 \( 39 95 confidence interval ci , 23 55 \) assessable patients demonstrated surgically defined responses , including 12 23 \( 52 95 ci , 32 72 \) patients tumor nodules less 1 cm diameter two 13 \( 15 95 ci , 0 34 \) patients lesion greater 1 cm seven \( 30 95 ci , 11 49 \) surgically defined complete responses \( crs \) patients less 1 cm disease none patients larger tumor nodules ip cisplatin cytarabine results high surgically defined response rate patients minimal residual ovarian carcinoma , activity low patients bulky intraabdominal disease
cisplatin cytarabine management malignant pleural effusions lung cancer study group trial malignant pleural effusions common significant problem patients advanced malignancies tetracycline sclerosing agents usual treatment malignant pleural effusions contrast approach , chemotherapy potential advantage treating underlying malignancy addition controlling effusion intracavitary cisplatin based chemotherapy , cytotoxic rather sclerosing , proven safe effective via intraperitoneal route ovarian cancer malignant little previous experience , however , cisplatin based chemotherapy part planned series trials malignant , lung cancer study group first evaluated cisplatin cytarabine patients malignant pleural effusions variety solid tumors april 1986 november 1987 , 46 patients proven , symptomatic , previously untreated malignant pleural effusions entered study single dose cisplatin 100 mg m2 plus cytarabine 1 , 200 mg instilled pleural space via chest tube , immediately removed patients evaluated toxicity response 24 hours 1 , 2 , 3 weeks monthly recurrence effusion considered complete response \( cr \) partial response \( pr \) defined 75 greater decrease amount effusion serial chest radiographs one patient experienced reversible grade 4 renal toxicity , four patients grade 3 hematologic toxicity , five patients grade 3 cardiopulmonary toxicity overall response rate \( cr plus pr \) 3 weeks 49 \( 18 37 patients \) median length response 9 months cr 5 1 months pr outcome trial sufficiently encouraging regimen incorporated subsequent trials malignant pleural
prognostic factor useful \? guide traditionally , number variables used predict outcome patients early stage breast cancer tests simple perform relatively inexpensive recently , number new factors , eg , tumor proliferative index , nuclear dna content , amplification overexpression growth promoting genes oncogenes identified potential predictors outcome patients breast cancer increasing pressure introduce tests routine clinical practice clinical practitioner identify test , group tests , best predicts adverse outcome whether clinically useful information provided use traditional factors alone \? aim prognostic test breast cancer predict patients develop recurrence cancer prognostic usefulness test expressed terms relative risk \( rr \) , ratio risk breast cancer recurrence patients test positive risk test negative methodologic guidelines satisfied study evaluating predictive ability test include following \( 1 \) cohort assembled \? \( 2 \) referral pattern described \? \( 3 \) laboratory clinical outcomes assessed blinded fashion \? \( 4 \) complete follow achieved \? \( 5 \) adjustment prognostic factors carried \? \( 6 \) appropriate statistical methods used \? approach suggested help clinician choose test , combination tests , likely discriminate high low risk patients practice decision regarding particular threshold value \( risk \) defined prognostic test \( series tests \) warrants adjuvant therapy individual patient complex one based clear presentation risks benefits patient
l methionine uptake human cerebral cortex maturation infancy old age age associated changes amino acid transport blood normal frontal cortex studied using positron emission tomography \( pet \) seventeen patients , 1 8 71 yr , injected intravenously tracer doses 11c l methionine baseline pet scan obtained assess competitive inhibition 11c l methionine uptake , patients received either oral l phenylalanine v infusion amino acids 1 hr second pet study uptake 11c l methionine frontal cortex decreased seven fold 1 8 71 yr \( r 0 71 p less 0 05 \) blood brain transfer 11c l methionine , 4 5 yr , exceeded mean adult values five fold competitive inhibition reduced l methionine uptake patients older 4 6 yr developmental changes parallel findings animals neutral amino acid transport system may modulate human brain amino acid levels meet changing developmental metabolic needs
clinical relevance immunohistochemical detection multidrug resistance p glycoprotein breast carcinoma 20 women breast carcinoma , 17 locally advanced cancer 3 confirmed metastases , expression p glycoprotein evaluated start chemotherapy regimen included multidrug resistance related drugs use monoclonal antibody avidin biotin immunoperoxidase technique , p glycoprotein detected 17 20 tumor samples results expressed semiquantitative manner , taking account number positive tumor cells \( n index \) specific staining intensity \( index \) 17 patients cancer followed first cycle chemotherapy cancer recurrence subsequent six cycles chemotherapy , patients except one rendered clinically disease free surgery radiation end point defined either local regional recurrence metastasis strong p glycoprotein positive staining majority tumor cells \( n phenotype \) significantly correlated initial response chemotherapy \( p less 02 \) shorter progression free survival \( p less 02 \) thus , pretreatment evaluation p glycoprotein expression may prognostic value patients locally advanced breast cancer
phase clinical pharmacokinetic trial acetic acid acetic acid synthetic derivative unknown mechanism action thirty eight patients \( 30 men 8 women \) treated week 4 weeks every 5 weeks doses acetic acid ranging 0 33 12 5 g m2 doses less equal 3 9 g m2 , drug administered intravenously 1 hour doses greater equal 5 28 g m2 , infusion period lengthened 6 hours treatment patients included hydration treatment maintain urine ph greater equal 6 5 dose limiting toxic effect hypotension 10 g m2 pharmacokinetic studies revealed linear behavior eight patients studied , beginning 3 9 g m2 peak plasma levels ranged 125 micrograms ml , mean terminal half life 22 4 hours immunologic monitoring performed three patients 10 g m2 transient increase cd16 leu 19 positive cells noted three patients one patient , increase correlated 10 fold increase k562 cell killing objective tumor responses seen trial recommended phase ii dose schedule 8 g m2 studies elucidate drug 's mechanism action define immunologic properties recommended
tumor suppressor genes new prospects cancer research cancer thought arise accumulation several genetic mutations single cell recently , tumorigenic mutations studied detail activate oncogenes discovery tumor suppressor genes , mutations elicit tumorigenesis , added new dimension understanding neoplasia retinoblastoma susceptibility gene prototype tumor suppressor gene shown suppress transformed phenotype several different cancers additional studies revealed tumor suppressor genes may variety tissues variety mechanisms mechanisms may regulate choice cellular proliferation differentiation appear involve processes initiation dna replication , regulation expression certain genes , intercellular communication adhesion , transduction external signals intracellular elucidation mechanisms enhance understanding fundamental operations cell
stress response protein \( srp 27 \) determination primary human breast carcinomas clinical , histologic , prognostic correlations expression estrogen regulated protein known 27 , 000 heat shock stress response protein \( srp 27 \) evaluated human breast carcinomas established breast cancer cell lines results obtained northern western blot analyses immunohistochemical methods concordant immunohistochemical assessment srp 27 expression 300 breast carcinomas \( median patient follow 8 years \) performed twenty six percent lymph node negative 45 lymph node positive tumors univariate analysis demonstrated significant correlations srp 27 overexpression estrogen receptor \( er \) content , ps2 protein expression , nodal metastases , advanced stage , lymphatic vascular invasion , shorter disease free survival period \( shorter overall survival \) study population whole regression tree analysis showed srp 27 expression independent prognostic indicator disease free survival patients one three positive lymph nodes cox proportional hazards model confirmed independent prognostic significance nodal involvement , stage , er content failed recognize srp 27 overexpression significant independent parameter predictive patient outcome patient population whole observed associations srp 27 overexpression aggressive tumors suggest biologic role srp 27 human breast carcinomas
therapeutic advantage hypoxic cells tumors theoretical study presence hypoxic cells solid tumors long considered problem cancer treatment , particularly radiation therapy also treatment drugs three general strategies actively explored overcome problem tumor , sensitizing hypoxic cells radiation \( chemotherapy \) , killing hypoxic cells \( hypoxic cell cytotoxin \) present study , examined impact three strategies standard radiation therapy regimen \( 30 doses 2 gy \) , using either two major assumptions full reoxygenation reoxygenation tumor cells demonstrate hypoxic cell cytotoxin produce level tumor cell killing higher \( several orders magnitude \) produced full oxygenation tumor use optimum hypoxic cell , provided cytotoxin kills approximately 50 hypoxic cells time given assumption makes difference whether reoxygenation occurs worst case \( ie , reoxygenation \) , hypoxic cell cytotoxin well optimum analysis shows hypoxic cells tumors major therapeutic advantage therefore , recommend research efforts concentrated development superior hypoxic cell rather improved hypoxic cell , parallel , emphasis placed development agents increase hypoxia
diffusion binding monoclonal antibody tnt 1 tumor spheroids tumor spheroids ht 29 human colon adenocarcinoma melanoma established investigate uptake clearance kinetics tnt 1 , monoclonal antibody targets necrotic cells tumors data reveal rapid uptake tnt 1 f \( ab' \) 2 fragment models , whereas antibody irrelevant specificity , 1 , f \( ab' \) 2 fragment bound poorly spheroids unlike previously reported monoclonal antibodies tumor cell surface antigens , tnt 1 showed 1 \) linear uptake increased time without saturation tumor spheroids 2 \) unexpected uptake subpopulation cells viable outer rim spheroids preclinical studies provide important information concerning therapeutic potential tnt monoclonal antibodies treatment cancer micrometastases
longitudinal study women negative cervical smears according endocervical status longitudinal study 20 , 222 women received negative cervical smear reports 1987 showed incidence definite equivocal cervical intraepithelial neoplasia \( cin \) significantly different whose first smear lacked endocervical component whose smear included endocervical component incidence definite cytological evidence cin significantly lower women whose first smear include endocervical component concluded women whose smears reported negative lack endocervical component earlier women negative smears include endocervical component
chromogranin storage secretion sensitivity specificity diagnosis pheochromocytoma chromogranin , co stored co released catecholamines adrenal medullary sympathetic neuronal vesicles , elevated plasma patients pheochromocytoma usefulness hormone differential diagnosis hypertension examined elevated level chromogranin comparable diagnostic sensitivity \( 83 , 24 29 \) , greater diagnostic specificity \( 96 , 86 90 \) level plasma catecholamines subjects pheochromocytoma \( n 29 \) evaluated comparison several reference groups , including normotensive controls \( n 49 \) , subjects essential hypertension \( n 28 \) , subjects renovascular hypertension \( n 5 \) , subjects primary \( n 3 \) subjects signs symptoms suggesting pheochromocytoma , diagnosis ultimately ruled \( n 5 \) normal plasma levels chromogranin modest rise chromogranin essential hypertension , correlation chromogranin diastolic blood pressure normotensive patients patients essential hypertension impair diagnostic usefulness chromogranin pheochromocytoma renal failure associated elevated plasma chromogranin independently blood pressure plasma chromogranin correlated tumor mass , tumor chromogranin content , tumor norepinephrine content , urinary acid excretion correlate plasma urinary catecholamines , blood pressure patients pheochromocytoma plasma chromogranin levels differ subjects pheochromocytoma stratified age , sex , tumor location , tumor pathology several drugs used diagnosis treatment pheochromocytoma \( clonidine , metoprolol , phentolamine , \) little effect plasma chromogranin concentration within pheochromocytoma , chromogranin localized along catecholamines soluble core chromaffin granules , accounted 18 5 vesicle soluble protein conclude 1 \) chromogranin along catecholamines pheochromocytoma chromaffin granules 2 \) plasma chromogranin sensitive specific diagnostic tool evaluation actual suspected pheochromocytoma 3 \) plasma chromogranin predicts pheochromocytoma tumor size overall catecholamine production 4 \) drugs commonly employed diagnosis treatment pheochromocytoma little effect plasma chromogranin level , preserving usefulness chromogranin evaluating pheochromocytoma thus , measurement chromogranin provides useful adjunct diagnosis pheochromocytoma
simplified diagnostic approach pheochromocytoma review literature report one institution 's experience pheochromocytoma unusual potentially devastating tumor although high index suspicion necessary , likelihood pheochromocytoma lower absence typical symptoms findings nonetheless , screening must include patients lower risk disease , resistant labile hypertension minimally symptomatic extensive diagnostic evaluations reserved whose clinical laboratory findings suggestive symptoms group patients pheochromocytoma seriously considered excluded overlap symptoms patients pheochromocytoma certain symptoms useful flushing suggest non pheochromocytoma illness visual symptoms , flank pain , suggest pheochromocytoma likely combinations symptoms value 2 symptoms headache , palpitations , present majority pheochromocytoma patients , smaller number non pheochromocytoma patients presence entire specific , less sensitive new hypertension , hypertension associated unexplained orthostatic hypotension , suggestive underlying pheochromocytoma twenty four hour urine studies consistently abnormal patients pheochromocytoma , also elevated significant proportion non pheochromocytoma patients values greater 1 5 2 fold upper limit normal suggestive pheochromocytoma present , warrant intensive subsequent evaluation imaging studies reliable diagnosis pheochromocytoma , help confirm exclude disease patients higher clinical likelihood elevated urinary testing , lower clinical likelihood persistently significantly elevated urinary testing , imaging studies performed combination clinical screening , 24 hour urinary testing , imaging studies useful reliable approach patients suspected pheochromocytoma
myeloma large jugular tumor case report authors report case cranial plasmacytoma multiple palsy lower cranial nerves lesion adjacent jugular foramen demonstrated angiogram exceedingly , arteriovenous shunting resembling seen paragangliomas forty five cases cranial intracranial plasmacytoma literature reviewed findings indicate cranial plasmacytoma commonly appears tumor , whereas dural tumors tumors poor vascularity
prognostic factors stage ib squamous cervical cancer patients low risk recurrence one half cervical cancer patients whose tumors recur radical surgery negative lymph nodes clear resection margins evaluated 95 patients squamous cell tumors underwent radical hysterectomy pelvic lymphadenectomy january 1975 december 1985 thought low risk recurrence see whether clinical histopathologic factors predictive tumor recurrence detailed retrospective record review complete pathology review accomplished case 5 year actuarial survival rate 89 nine patients developed recurrent disease \( 9 5 \) , eight died several clinical features evaluated possible prognostic factors patient age \( p 26 \) , patient race \( p 60 \) , cervical diameter \( p 24 \) , extent gross cervical involvement \( p 36 \) , presence contact bleeding \( p 82 \) histopathologic features examined depth invasion \( p 31 \) , number mitoses \( p 42 \) , tumor stromal border \( p 15 \) , histologic differentiation \( p 02 \) , lymph vascular space invasion \( p 56 \) , width tumor \( p 23 \) depth invasion correlate increasing tumor width \( p less 001 \) node margin positive patients excluded , differentiation may feature useful identifying patients risk recurrence almost one half patients poorly differentiated tumors , sole use feature criterion adjuvant therapy would resulted low risk patients
familial ovarian cancer israeli jewish women among 310 women ovarian cancer epithelial origin , eight ovarian cancer prone families identified , accounting 24 cases five first degree relatives underwent prophylactic oophorectomy , early ovarian carcinoma diagnosed one familial aggregation ovarian cancer occurs israeli jewish population
cone pregnancy report technique cone results outcome 17 patients required diagnostic cone biopsy pregnancy mean age patients 30 6 years \( range 21 41 \) mean gestational age 18 8 weeks \( range 10 32 \) time procedure major complications hemorrhage significant problem second trimester abortions two patients required beta sympathomimetics suppress uterine activity longer 24 hours procedure six patients invasive carcinoma , nine cervical intraepithelial neoplasia \( cin \) iii , two cin ii 14 cases , endocervical margins negative two patients cin one multifocal microinvasion positive margins cone safe easy method performing diagnostic cervical conization pregnancy
queuine , trna base , maintains proliferative pluripotent potential hl 60 cells presence differentiating agent 6 6 \( 6 tg \) induced differentiation hypoxanthine \( imp pyrophosphate , ec 2 4 2 8 \) deficient hl 60 cells characterized 2 days growth , morphological differentiation addition trna base queuine , presence 6 tg , maintains proliferative capability cells ability 6 tg induce differentiation correlates c myc mrna regulation , queuine effect parameter treatment 6 tg 2 3 days hl 60 cells granulocytic differentiation , , committed , cells respond monocytic inducer phorbol 12 myristate 13 acetate nonetheless , cells treated queuine 6 tg , maintain promyelocytic morphology capable induced monocytic pathway phorbol 12 myristate 13 acetate indicated stabilization c fms mrna cell adherence absence queuine , phorbol 12 myristate 13 acetate inducing monocytic markers 6 tg treated cells data presented indicate 6 tg induced differentiation hl 60 cells trna facilitated event trna base queuine capable maintaining proliferative pluripotent potential cells
metastatic melanoma facial nerve isolated metastatic malignant melanoma facial nerve never reported presentation illustrates primary melanoma helix ear treated excisional biopsy wedge resection 1983 primary melanoma 's level iv 1 3 mm thickness 1985 , facial paresis slowly developed gross evidence recurrent melanoma ear neck , ct scan showed mass region foramen reoperation primary site revealed metastatic melanoma facial nerve , expanding approximately 10 times normal size composite resection done melanoma , paralyzed face immediately masseter muscle transfer patient received area postoperatively remained free disease date , returned profession detailed study specimens indicated represented primary metastasis facial nerve
evaluation distinction ectopic pituitary acth dependent cushing 's syndrome clinical features , biochemical tests radiological findings efficiency various laboratory radiological investigations differentiation ectopic pituitary dependent cushing 's syndrome studied , based findings 23 patients verified cushing 's disease seven patients ectopic acth syndrome clinical features strongly ectopic type male sex history less 18 months basal biochemical features strongly indicating ectopic syndrome included plasma k less 3 0 mmol l hco3 greater 30 mmol l serum cortisol 9 midnight greater 800 nmol l urine free cortisol greater nmol 24 hours plasma acth greater 100 ng l high dose dexamethasone suppression test , suppression less 50 per cent 9 serum cortisol , urine free cortisol 17 steroids usually indicative ectopic source acth mean suppressed value greater 450 nmol l 9 midnight cortisol combined occurred ectopic syndrome , none 23 patients cushing 's disease urine free cortisol , mean suppressed value less 1000 nmol 24 hours found patients cushing 's disease , none ectopic group metyrapone test , increase less equal 3 fold 11 24 hours patients ectopic acth increase greater 3 fold one patients cushing 's disease failure respond either dexamethasone metyrapone found one patients cushing 's disease \( patient 16 \) ectopic group , patients except patient failed respond either test concluded patients presenting clinically obvious cushing 's syndrome along measurable plasma acth reliably divided conventional tests driven pituitary driven ectopic acth
genetic mechanisms tumor suppression human p53 gene mutations gene encoding p53 , 53 kilodalton cellular protein , found frequently human tumor cells , suggesting crucial role gene human model stepwise mutation loss p53 alleles tumorigenesis , human osteosarcoma cell line , 2 , used completely lacked endogenous p53 single copies exogenous p53 genes introduced cells recombinant retroviruses containing either point mutated wild type p53 cdna sequence expression wild type p53 suppressed neoplastic phenotype 2 cells , whereas expression mutated p53 conferred limited growth advantage cells absence wild type p53 wild type p53 phenotypically dominant mutated p53 two allele configuration results suggest , retinoblastoma gene , mutation alleles p53 gene essential role
reoperation colorectal carcinoma management patient intra abdominal recurrence colorectal carcinoma , surgery remains primary mode therapy cure significant palliation anticipated appreciation importance close follow primary resection coupled improved diagnostic modalities allowed surgeon detect earlier recurrence also select patients likely benefit resection recurrent disease improved surgical techniques resultant decreases rates morbidity mortality allowed safe hepatic resection metastatic disease selected patients , procedure produces 5 year survival rates approaching 50 although clear consensus reached , studies agree positive prognostic indicators include absence extrahepatic disease , small number intrahepatic lesions , low cea level , better dukes stage primary likewise , patient recurrent disease locally , surgery provides means cure also plays significant role palliation aggressive resection surgical margins patients contained disease may yield 5 year survival rates approaching 35 patients unresectable disease even , palliation obtained surgical therapy judgment necessary treating patients preoperatively intraoperatively surgical intervention obstruction , perforation , anatomic physiological compromise often indicated improve quality life patient intra abdominal recurrence
merkel cell associated neoplasms eyelids region merkel cells clear oval cells epidermis outer root sheaths hair follicles , probably epithelial origin , share ultrastructural features neuroendocrine cells , found association touch receptors eyelid , occur singly epidermis external root sheaths , specialized touch spots alternating typical electron antigenic features include dense core granules , intranuclear , spinous processes , positive reaction specific cytokeratins , epithelial membrane antigen , neuron specific enolase , chromogranin synaptophysin merkel cell carcinoma probably develops precursor cells give rise keratinocytes merkel cells , nearly one ten merkel cell carcinomas occur eyelid region tend bulging lesions near lid margin elderly patients , reddish color , erythematous telangiectatic vessels diagnosis based frequent presence aggregates intermediate filaments addition features typical normal merkel cells tumor often mimics lymphoma undifferentiated carcinoma frequently lymphatic vessels one third merkel cell carcinomas recur , almost two thirds give rise regional node metastases , one half widely result death initial treatment prompt aggressive , wide resection routine postoperative irradiation although metastatic lesions often respond radiation therapy cytostatic drugs , treatments mainly palliative value
surgical strategy early gastric cancer diagnostic therapeutic options early gastric cancer reviewed japan , rate detection early gastric cancers increased minute gastric cancers identified result advances diagnostic methods results histopathological staging large number resected specimens led three surgical options based size depth primary lesion , namely classical r2 resection , radical resection limited lymphadenectomy endoscopic surgery
adjuvant chemotherapy 5 fluorouracil , vincristine ccnu patients dukes' c colorectal cancer swedish gastrointestinal tumour adjuvant therapy group prospective controlled randomized trial testing adjuvant postoperative combination chemotherapy \( 5 fluorouracil , \( ccnu \) vincristine \) versus adjuvant therapy patients operated dukes' c colorectal cancer reported total patients aged less 70 years recruited 205 patients colonic 99 rectal cancer , three protocol violations cases excluded consideration twenty seven patients limited resection cancer 5 years' follow significant difference tumour free survival rate survival rate treated control groups twenty nine 147 patients started chemotherapy discontinued treatment side effects , mainly gastrointestinal tract 30 patients treatment discontinued recurrent disease conclusion systemic administration combination chemotherapy colorectal cancer operation worthwhile routine clinical practice
value subjects positive hemoccult screening colorectal cancer within prospective randomized screening study early detection colorectal cancer hemoccult ii test , possibility increasing specificity test patients initially positive hemoccult ii test investigated offered test \( 62 6 per cent \) returned positive 210 cases \( 5 9 per cent \) repeat test performed 184 patients positive 68 \( 1 9 per cent \) positive initial test 60 cm double contrast enema carcinoma found one seven patients positive retest one 100 patients negative retest \( p less 0 001 \) specificity test , therefore , increased 95 per cent 98 per cent sensitivity unchanged offered later date increased numbers available patients returned test 369 \( 5 2 per cent \) positive test repeated 360 patients 118 \( 1 7 per cent \) positive colorectal neoplasm found one three positive repeat test , compared one seven negative repeat test conclusion , screening early detection colorectal cancer hemoccult ii test may followed investigation patients positive retest procedure reduce work load 60 per cent without reducing sensitivity
epidermal growth factor receptor expression colorectal cancer epidermal growth factor \( egf \) receptor expression estimated 50 invasive human colorectal cancers using immunohistochemistry degree expression quantified integrated optical density measurements stained sections tumours stained positively , dukes' c tumours exhibited significantly higher levels receptor either dukes' b tumours addition , histologically high grade cancers expressed receptors strongly low grade concluded high egf receptor concentration associated poor prognostic factors colorectal malignancy
levamisole 5 fluorouracil therapy resected colon cancer new indication objective evaluate benefits risks postoperative treatment levamisole plus 5 fluorouracil \( 5 fu \) patients colon cancer design computerized medline performed , reference list retrieved article checked randomized trials therapy levamisole alone combined 5 fu colon cancer without distant metastases included studies evaluated use four criteria results reviewed six randomized trials , three satisfied criteria two studies demonstrated significant improvement survival rate levamisole plus 5 fu among patients colon cancer pathologically confirmed metastases adjacent lymph nodes \( dukes' stage c \) subgroup analysis another study demonstrated similar benefit toxic effects drugs generally mild three studies showed difference survival rates treatment groups however , samples small detect clinically statistically important difference conclusions many patients colon cancer suffer relapse recommend offered opportunity participate clinical trials adjuvant therapy stage c disease entering clinical trial levamisole plus 5 fu appropriate adjuvant therapy
retinoid modulation insulin like growth factor binding proteins inhibition breast carcinoma proliferation retinoids induce cellular differentiation inhibit cellular proliferation proliferation human breast carcinoma cells vitro markedly inhibited compounds hand , insulin like growth factors \( igfs \) receptors seem involved growth certain breast carcinoma cells autocrine paracrine effects since effects igf igf ii may modulated specific binding proteins \( igf bps \) examined possibility one mechanism retinoic acid may inhibit cancer growth alteration bps , thereby blocking igf 's growth effect retinoic acid \( ra 1 microm \) completely blocked effect igf \( 50 ng ml \) enhancing proliferation mcf 7 cells culture effect ra associated significant change specific igf binding sites cells ra induced 3 fold increase igf binding activity conditioned medium , measured using polyethylene glycol immunoglobulin precipitation assay charcoal absorption assay increase associated appearance 42 46 kda igf bps ligand blotting effect ra igf bps time concentration dependent contrast , experiments 27 36 kda bps actually decreased findings support hypothesis ra may inhibit growth certain breast carcinoma cells increasing secretion certain igf bps , could directly modulate growth effect igfs
evaluation serum level immunosuppressive substance oral cancer patients serum level immunosuppressive substance \( \) studied 40 patients primary oral cancer 79 patients without cancer usefulness evaluated parameter monitoring therapy well recurrence tumors mean values serum patients cancer patients without 284 micrograms ml 153 micrograms ml , respectively normal healthy controls mean value 431 105 micrograms ml , cutoff value set micrograms ml \( mean 2 sd \) patients without cancer severe infectious disease showed high serum levels , values closely correlated c reactive protein values positive rate increased patients oral cancer 58 mean level serum cancer patients significantly higher controls \( p less 01 \) , level found elevated stage disease advanced \( stage iii , 48 stage iv , 68 \) histologic analysis tumor cells patients squamous cell carcinoma \( scc \) showed mean serum level poorly differentiated scc much higher \( 181 micrograms ml \) patients well differentiated scc \( 159 micrograms ml \) patients recurrent metastatic cancer , died cancer exhibited marked elevation serum levels , whereas patients remained free cancer follow period showed significantly lower serum levels rise fall serum level closely correlated disease progression remission data strongly suggest serum useful parameter monitoring disease stage well effect therapy patients oral cancer
laryngectomy one treat head neck cancer patients cannot read \? entire population radiation oncologists \( n 192 \) active practice state north carolina surveyed assess level awareness illiteracy among adults united states determine whether physicians consider illiteracy treatment decision process patients head neck cancer excluding respondents treat patients head neck cancer physicians practicing outside state north carolina , response rate 115 182 , 63 26 respondents able estimate correctly prevalence illiteracy us adult population forty one percent respondents , however , stated consider patient 's ability read making treatment recommendations head neck cancer survey accompanying literature review suggest physicians illiteracy problem may significant impact patients head neck cancer , lack data needed enable quantify effect illiteracy treatment outcome study reported first step examining ways illiteracy might negatively affect patient outcomes
myxoma unusual benign neoplasm presented case myxoma described clinical history , findings light microscopy immunohistochemistry , possible pathogenesis although primary myxoma rare lesion , considered differential diagnosis mesenchymal tumors
electron microscopy immunohistochemical findings case report clinical , histological , immunohistochemical , electron microscopic features cerebral reported patient young woman superficial parietal tumor macroscopic findings include well delineated superficial nodule hard central core histological study disclosed predominantly papillary tumor vessels tumor cells positive immunohistochemical stain glial acidic protein , extensive diffusely positive vimentin neuron specific enolase , intensely positive 100 epithelial membrane antigen papillary areas ultrastructural study showed abundant intermediate filaments forming bundles tumoral , membrane junctions , external cells contact collagen fibers based immunohistochemical ultrastructural characteristics , believe filaments seen tumor cells mainly vimentin filaments peculiar immunohistochemical patterns glioma may aid histological diagnosis rare tumor type
intramedullary spinal cord case report case intramedullary spinal cord within , pain lower extremities , presented intramedullary spinal cord determined biopsy specimen local irradiation 50 gy , tumor markedly decreased size clinical symptoms disappeared
spinal cord report describes 2 year old boy intramedullary involving almost entire length spinal cord , pathology , behavior tumor discussed
mammography early breast cancer detection screening mammography shown reduce breast cancer mortality film screen mammography highly sensitive specific mammography programs assure physicians patients facility provides mammography highest quality , using lowest possible radiation dose mammographic signs early cancer include small mass , calcifications , architectural distortion dense tissue may result false negative examination even cancer palpable , adverse effects biopsy delayed
carcinoma ductus retrospective review patients treated carcinoma common bile duct demonstrated improvement diagnostic capabilities , leading earlier management resectional therapy ability resect tumors directly improved long term survival efforts obtain proof malignancy prior resection often inability obtain adequate representative tissue frozen section biopsies incisional biopsies given highest yield positive diagnoses experienced hands , program fewer preoperative tests emphasis early operation , diagnosis , definitive treatment may cost effective management patients common bile duct cancer
effects midazolam cerebral blood flow oxygen consumption interaction nitrous oxide patients undergoing craniotomy supratentorial cerebral tumours cerebral blood flow cerebral metabolic rate oxygen measured 30 patients craniotomy supratentorial cerebral tumours modification technique using 133 intravenously anaesthesia induced midazolam 0 3 mg kg , fentanyl pancuronium , maintained midazolam continuous infusion , fentanyl , pancuronium nitrous oxide oxygen oxygen air concentration midazolam blood 10 patients 300 ng litre two measurements patients' lungs ventilated n2o oxygen concentration midazolam blood another 10 patients doubled 600 ng litre second flow measurement patients' lungs ventilated n2o o2 concentration midazolam blood third group 10 patients doubled 600 ng litre second flow measurement patients' lungs ventilated oxygen air relationship found dose midazolam cerebral blood flow oxygen consumption nitrous oxide combination midazolam also effect variables
capillary hemangiomas treatment flash lamp pumped pulsed dye laser , capillary , hemangiomas common vascular neoplasms , incidence approximately 2 6 neonates usually develop first weeks life , 1 month 1 year incidence rises 8 7 10 1 lesions may grow quite large first year life , may vital organ function great majority spontaneously regress first year life parents often hemangiomas need great majority regress spontaneously treatments cryosurgery , irradiation , instillation , corticosteroid therapy , surgical excision often ineffective cause significant morbidity describe 10 children capillary hemangiomas treated flash lamp pumped pulsed dye laser patients ranged age 7 weeks 5 5 years beginning laser therapy patients underwent 3 1 1 \( mean sd \) laser treatments , mean regression lesions 69 9 4 5 patients demonstrated diminution size color hemangiomas treatments , ill effects , ulceration , hemorrhage , infection , scarring evidence pulsed dye laser therapy considered option treatment capillary hemangiomas , preferably prior full evolution also useful therapeutic approach hemangiomas slow regress older children
effectiveness radiotherapy radical neck dissection cancers head neck retrospective analysis 457 radical neck dissections performed 30 year period cancers oral cavity , pharynx , larynx carried two hundred thirteen patients underwent radiotherapy primary cancer site neck , 164 underwent perioperative adjuvant radiotherapy 24 underwent definitive radiation cure followed salvage surgery thus , 188 patients received radiotherapy disease twenty five additional patients underwent radiation surgical failure following radical neck dissection goal study determine whether radiotherapy altered course end result disease n stage onset disease similar radiotherapy groups preoperative radiotherapy effective staging disease primary site , lesser extent , lymph nodes , limited impact survival failure control disease neck occurred 60 \( 32 \) 188 patients received radiotherapy primary disease recurrence rates lower combined therapy group surgical group patients n2 stages disease 3 year disease free survival 45 better 63 survival rate patients receive radiotherapy , although survival better combined therapy group patients stage disease worst results patients irradiated surgical failure \( 14 survival \) 24 patients required salvage radical neck dissection following failure definitive radiotherapy cure 42 survival
juvenile \( embryonal alveolar \) rhabdomyosarcoma head neck adults clinical , pathologic , immunohistochemical study 12 cases sites head neck region \( orbit , nasopharynx , nasal cavity , etc \) among frequent locations juvenile \( embryonal alveolar \) rhabdomyosarcomas patients younger 15 years however , comparable neoplasms adults uncommon clinicopathologic immunohistochemical study 12 juvenile rhabdomyosarcomas patients ages 18 36 years presented female male ratio 2 1 orbit without contiguous paranasal sinus involvement , nasal cavity , sinus , middle ear , soft tissues neck region primary sites seven tumors involved site eight cases alveolar rhabdomyosarcomas together contributed adverse outcome two patients long term , disease free survivors six patients died tumor two others alive persistent disease immunohistochemical study 11 cases demonstrated reactivity vimentin muscle specific actin \( 35 \) desmin ten cases juvenile rhabdomyosarcoma rarely presents head neck adults considered differential diagnosis small cell neoplasm patients third fourth decades life
comparative analysis three different techniques detection breast cancer cells bone marrow three different methods , morphologic , , fluorescence activated cell \( fc \) analysis , compared respect efficiency detecting breast cancer cells bone marrow first series experiments , three techniques compared using bone marrow cells artificially mixed known amount breast cancer cells , whereas second series bone marrow breast cancer patients bone metastases used following results obtained mixtures first series analyzed , fc analysis detected 1 10 breast cancer cells bone marrow \( 0 2 border line value \) , morphologic method detected 0 05 10 , method , clearly superior , detected breast cancer cells mixtures \( 0 10 \) noted , morphologic methods , percentage breast cancer cells detected 2 360 times higher percentage added cells , enrichment inversely proportional percentage added cells result could result different separation cells centrifugation due different density breast cancer cells superiority method confirmed second series experiments
microinvasive carcinoma uterine cervix \( international federation gynecology obstetrics stage ia \) 1985 international federation gynecology obstetrics \( figo \) subdivided stage ia cervical cancer specified criteria stage ia stage ib early stromal invasion \( stage ia1 \) first invasive carcinoma situ stroma \( stage \) small cancers number orders magnitude larger stage ia1 lesions maximum depth invasion 5 mm maximum horizontal spread 7 mm larger lesions classified stage ib study reviews 486 patients previously classified stage ia disease yielded 344 stage ia1 101 stage lesions 41 cancers stage ib three hundred nine , 89 , 38 patients followed greater equal 5 years one \( 0 3 \) patient stage ia1 disease presented stage iib disease 12 years conization five \( 5 6 \) patients stage lesions developed invasive recurrences three died none 38 patients stage ib lesion , including 16 treated conservatively , developed recurrence figo classification treatment stage ia1 lesions treated conservatively , treatment stage must individualized risk factors vascular space involvement high sensitivity low specificity
leiomyosarcoma bone clinicopathologic , immunohistochemical , ultrastructural study five cases authors identified five \( \) review 13 producing spindle cell sarcomas bone two initially recognized others diagnosed malignant fibrous histiocytoma \( two \) fibrosarcoma \( one \) patients , four women , ranged age 32 70 years sites included proximal humerus \( two \) , distal femur \( two \) , rib \( one \) tumors presented clinical radiographic features consistent diagnosis primary bone neoplasms , although one probably represented solitary metastasis primary uterine radiographs showed lytic bone destruction appearance , three cases soft tissue extension histologically , tumors showed broad , fascicles spindle cells pleomorphic nuclei , frequent mitoses , necrosis two cases focal pattern multinucleated cells , two cases focally prominent osteoclast like giant cells extensive immunoreactivity muscle actin seen cases desmin three case , electron microscopy showed definite smooth muscle differentiation including cytoplasmic filaments densities writing , two patients free disease \( including patient presumed metastasis \) , one alive locally recurrent disease , two dead disease experience suggests bone distinct clinicopathologic entity may common previously recognized application immunohistochemistry electron microscopy producing bone sarcomas facilitate diagnosis additional cases
clinical characteristics treatment outcome children acute lymphocytic leukemia 's syndrome pediatric oncology group study children acute lymphocytic leukemia \( \) , treated three consecutive studies pediatric oncology group \( 1974 1986 \) , 52 \( 1 8 \) 's syndrome \( ds \) comparison clinical laboratory characteristics showed significant differences leukocyte count , racial distribution , sex ratio , platelet count , incidence mediastinal mass , lymphadenopathy hepatosplenomegaly , percentage blood bone marrow blasts children without 's syndrome \( ds , respectively \) however , children ds slightly older time presentation higher hemoglobin values relative frequency major immunophenotype \( early pre b , pre b , , b \) also comparable patients without ds report , treatment regimens categorized either conventional \( consolidation therapy \) intensive cox regression analysis revealed presence ds , higher leukocyte count , black race , age older 10 years independently associated poorer event free survival \( efs \) children treated conventional chemotherapy however , cohort children received intensive chemotherapy , ds longer independent risk factor fact , event free survival \( efs \) markedly improved level comparable observed children diagnosed hand , serious toxicity , requiring interruption treatment , significantly frequent intensively treated children ds compared similarly treated patients , although deaths resulting toxicity occurred infrequently
psychosocial adjustment women breast cancer studies investigating psychosocial adjustment women breast cancer , correlates , clinical course , prognosis studies conducted varying degrees methodologic assessment made quality existing evidence identify best evidence factors predict adjustment status women breast cancer studies reviewed , using methodologic standards critical appraisal studies prognosis , developed colleagues department clinical epidemiology university \( hamilton , ontario , canada \) studies investigating psychosocial adjustment women breast cancer meet criteria reviewing studies clinical course prognosis review focuses direction methodologic required future investigations particular , studies needed employ prospective designs measure control prognostic variables may affect adjustment future investigations need incorporate adequate precision measurement measures psychosocial variables objective , reliable , valid
prognosis pregnancy associated breast cancer survival patients pregnancy associated \( pa \) breast cancer difficult predict two reasons combination rare , natural history breast cancer associated pregnancy varies among individuals valid data collection analysis problematic given studies patients many years charts 56 women stages , ii , iii breast cancer , pregnant within 1 year postpartum time breast cancer diagnosis 1960 1980 , analyzed patients pa breast cancer compared nonpregnant women comparable ages , treated hospital , physicians , period four patients lost 5 year follow , one patient 10 year follow five patients distant metastases time lost follow , considered died within time across stages , patients pa breast cancer survival significantly different patients non pregnancy associated \( non pa \) breast cancer
combination hormonal therapy tamoxifen plus versus tamoxifen alone postmenopausal women metastatic breast cancer analysis randomized trial performed determine therapy tamoxifen \( tam \) plus \( flu \) efficacious tam alone postmenopausal women metastatic breast cancer patients failing tam could subsequently receive flu dose drugs 10 mg orally twice daily objective responses seen 50 119 \( 42 \) tam patients 64 119 \( 54 \) tam plus flu patients \( two sided p 0 07 \) time disease progression better tam plus flu \( 11 6 versus 6 5 months cox model , p 0 03 \) duration response survival similar two treatment arms among 97 patients estrogen receptor \( er \) 10 greater 65 years age older , highly significant advantages treatment tam plus flu response rate time progression particular note patient group tam plus flu showed survival advantage \( cox model , p 0 05 \) although data require confirmation prospective randomized trial , suggest therapeutic advantage tam plus flu tam alone elderly women er 10 fmol greater
sphincter preservation rectal cancer local excision postoperative radiation therapy authors report preliminary results 14 patients localized , mobile , resectable rectal cancer treated local excision postoperative radiation therapy \( rt \) negative surgical resection margins two received 5 fluorouracil \( 5 fu \) median follow 29 months \( 4 43 months \) 3 year actuarial survival 88 incidence local failure 7 \( site failure \) 21 \( component failure \) incidence local failure increased stage \( t1 , 0 3 0 t2 , 1 7 14 t3 , 2 4 50 \) tumor size \( greater 3 cm , 33 , versus less equal 3 cm , 0 \) three patients developed local failure 6 , 15 , 21 months three underwent salvage abdominoperineal resection locally controlled 2 28 months following salvage surgery one patient underwent abdominoperineal resection clinically presumed local failure however , tumor found specimen therefore , 13 patients either initially locally controlled underwent salvage surgery evidence disease pelvis time last follow local excision postoperative rt may alternative standard surgery selected cases however , additional follow experience needed order determine approach ultimately local control survival rates similar low anterior resection abdominoperineal resection
flow cytometric dna analysis hepatocellular carcinoma prognostic value nuclear dna content studied retrospectively using flow cytometry 203 cases resected hepatocellular carcinoma occurrence dna aneuploidy , detected 50 patients , correlated significantly tumor size presence vascular invasion intrahepatic metastasis overall , patients dna aneuploid tumors significantly worse prognosis dna diploid tumors \( p less 0 001 \) , also subdivided groups tumor size \( p less 0 01 \) among dna aneuploid patients , survival times significantly shorter patients low dna index \( less 1 5 \) high dna index \( greater equal 1 5 \) \( p less 0 05 \) cox multivariate analysis , nuclear dna content provided significant prognostic value \( p 0 008 \) , vascular invasion \( p 0 001 \) intrahepatic metastasis \( p 0 005 \) results indicated nuclear dna content important prognostic value hepatocellular carcinoma
predictors physician chemotherapy regimens physician cancer treatment regimens may diminish treatment efficacy compromise clinical research influence clinical , demographic , psychosocial patient characteristics physician adherence breast cancer chemotherapy investigated , role clinician 's attitudes concerning chemotherapy one hundred seven women recently diagnosed breast cancer followed 26 weeks treatment fifty six \( 52 \) patients experienced modification least one chemotherapeutic agent stepwise multiple regression revealed independent contributions increased patient age , treatment setting \( clinic versus academic community private practice \) , stage disease physician regimen complexity , delay seeking treatment , presence psychiatric disorder contribute , general , regimen modifications patient psychological psychiatric factors , however , influence prescribing behavior vincristine physician awareness factors contributing unnecessary treatment modifications may reduce frequency behaviors
complete remission refractory anaplastic adult wilms' tumor treated cisplatin etoposide 61 year old woman underwent left radical nephrectomy stage ii anaplastic 's tumor received adjuvant therapy one year later computerized tomography \( ct \) abdomen revealed mass left renal fossa retroperitoneal adenopathy ct guided needle biopsy nondiagnostic patient progressive disease treatment dactinomycin , doxorubicin , vincristine , achieved complete response treatment cisplatin etoposide therapy wilms' tumor adults discussed
expression class ii human leukocyte antigens thyrocytes lymphocytic infiltration human thyroid tumors immunofluorescence study surgical thyroid sections 30 papillary carcinomas \( pc \) , six medullary carcinomas \( mc \) , three anaplastic carcinomas \( ac \) , two follicular carcinomas \( fc \) , 16 adenomas \( ad \) examined indirect immunofluorescence technique employing different monoclonal antibodies evaluate expression human leukocyte antigen \( hla \) , b , c \( class \) dr , dp , dq \( class ii \) thyrocytes , together phenotype distribution inflammatory cells ten pc four fc also investigated presence intercellular adhesion molecule 1 \( icam 1 \) situ deposits circulating thyroid autoantibodies also evaluated increased expression class antigens found pc fc , 33 mc ac , 31 ad anomalous expression class ii antigens observed 70 pc , 50 fc , 33 ac , 19 ad , none mc expression dp dq revealed portion dr positive glands reduction microsomal autoantigen expression found icam 1 positive thyrocytes detected moderate lymphocytic infiltrate noticed pc , correlated dr dp dq coexpression b cells natural killer cells virtually absent authors speculate weak class ii antigens expression , together partial complete loss microsomal autoantigen absence icam 1 thyrocytes , may account limited immunocompetent cells observed thyroid tumors
advances medical imaging cancer diagnosis treatment last several decades , significant new eyes developed improve diagnosis , treatment , planning , monitoring human cancer computer tomography \( ct \) , magnetic resonance imaging \( mri \) spectroscopy \( mrs \) , single photon emission computed tomography \( spect \) , positron emission tomography \( pet \) innovative advances morphologic functional imaging led dramatic improvement ability diagnose monitor human cancer frequently , anatomic detail demonstrated ways exceed views surgery , functional biochemical imaging used show metabolic activity receptor status normal pathologic states vivo functional biochemical studies differentiate normal neoplastic tissue , make possible measure progression regression disease physiologic changes often precede morphologic findings many disease processes , use vivo biochemical probes demonstrate disease anatomic abnormalities become evident gross changes anatomy longer adequate endpoints therapy protocols today , using physiologic imaging , evaluate response treatment within hours administration therapy adjuvant metabolic tumor imaging studies provide information morphologic evaluation human cancers ultimately lead better patient care
natural history colorectal cancer opportunities intervention better understanding natural history colorectal cancer , provided basis intervention influence outcome possible interventions include earlier detection colorectal cancer , removal premalignant adenomas , demonstration mucosal field defect precedes neoplasia evaluate baseline risk change dietary modification , identification inherited dietary risk factors five controlled trials evaluating early detection colorectal cancer fecal occult blood testing enrolled 309 , 000 patients early stage cancers improved survival observed , data mortality reduction yet reported studies patients adenomas demonstrated high synchronous metachronous rates basis complete colon evaluation initially surveillance follow program hyperproliferation lack normal differentiation observed field defect colon preceding neoplasia inherited factors recently shown important larger proportion individuals develop colorectal adenomas cancer observations natural history colorectal cancer provided new opportunities application radiologic endoscopic techniques diagnosis surveillance examination merit research needed answer many critical questions raised regarding impact interventions
imaging techniques diagnosis carcinoma colon variability published results colonoscopy barium enema examinations , optimum results dependent meticulous preparation , technical , proficiency place colonoscopy barium enema competitive positions two methods complement one another evaluation high risk individuals , including positive hemoccult tests exclusion significant pathology double contrast enema relied less patient detection abnormalities barium enema , necessary , followed colonoscopic biopsy used sequence , procedures provide cost effective approach early detection control cancer estimated guidelines reduce mortality rates 30
imaging bone tumors 1990s progress bone tumor management occurred result cooperation among surgeons , oncologists , pathologists , radiologists 1990s radiologists contribute care patients bone tumors major ways tumor detection preliminary diagnosis accomplished radiography tumor local extent assessed magnetic resonance imaging \( mri \) lesser degree computed tomography \( ct \) distant spread malignancy documented radionuclide scintigraphy \( skeleton \) ct \( lungs \) combined estimate local extent distant spread assure adequate staging definitive management decisions preoperative closed percutaneous biopsy histologic diagnosis accomplished outpatient basis fluoroscopic ct guidance arteriography employed delivery local chemotherapy combination arteriography , mri , mr spectroscopy used evaluate tumor response limb salvage surgery , mri sequentially assess tumor bed bone scintigraphy ct detect skeletal pulmonary metastases radiologist 's role undergo continuous
primary neoplasms hollow organs gastrointestinal tract staging follow number imaging modalities available stage follow patients primary neoplasms gastrointestinal \( gi \) tract continues increase magnetic resonance imaging \( mri \) , computed tomography \( ct \) , ultrasonography useful techniques staging follow staging , ct frequently used detection liver metastases increasingly used substitute chest radiograph detection lung metastases ct still imaging test choice preoperative staging esophageal carcinoma ct less helpful staging patient gastric carcinoma colorectal carcinoma current usefulness mri staging gi tract malignancies limited lack adequate oral intraluminal contrast agent degradation images due motion sonography , especially new technique endoscopic ultrasound , promising detection local invasion gi tract malignancies ct used follow patients tumors gi tract detect liver , adrenal , nodal metastases well local recurrence ability ct detect masses ct pelvis recommended routine follow procedure patients undergone abdominal peroneal resection ct mri used detect local recurrence , suffer inability differentiate scar recurrent tumor initial hope mri would capable differentiating postoperative scar tissue recurrent tumor realized therefore , positive ct mri findings , occasionally percutaneous biopsy required confirm local recurrence
liver tumor imaging liver tumor imaging paradigm dilemma diagnostic decision making current era abundant high technology part , reflection imaging techniques wide use worldwide include ultrasound \( us \) , radionuclide scintigraphy \( rns \) , computed tomography \( ct \) , magnetic resonance imaging \( mri \) , techniques especially designed staging extent known liver cancer , computed tomography arterial \( \) intraoperative ultrasound \( ious \) authorities ct scanning single test closely fitting designation gold standard liver tumor imaging , although mri , less mature technique , already preferred local factors profoundly influence selection sequence imaging studies , including available equipment , radiologic skills , institutional , especially specific clinical circumstances patient thus , diagnostic algorithms decision sequential imaging workup liver tumor tend somewhat institution specific
staging follow breast cancer patients staging systems breast cancer , unlike neoplasms distant sites , allowed early development clinical staging evaluation established clinical assessment breast lesion often compared pathologic examination \( benign vs malignant \) clinical measurement tumor centimeters often larger histologic size clinical assessment axillary nodes \( clear metastatic \) incorrect 30 cases although clinical pathologic staging provide effective prognosis treated patients , prognosis accurately determined pathologic stage single important prognostic indicator axillary nodal status , positive , number positive nodes american joint committee cancer union international cancer agreed tnm staging breast carcinoma , preferable staging system follow treated patients value detecting local recurrence chest wall \( mastectomy \) irradiated breast \( \) , also early detection contralateral breast cancer physical examination periodic mammography useful tendency asymptomatic patients \( bone scans , blood tests , etc \) , correctly recent years
primary neoplasms central nervous system children modern diagnostic imaging techniques able detect primary neoplasms central nervous system \( cns \) children safely accurately less specificity cell type degree malignancy neoplasms , often peculiar cell type size , mediated hydrocephalus clinical presentation , demand careful often extensive imaging techniques best evaluate added basic observations , determination neoplasm surrounding edema , detection possible spread , evaluation residual recurrent neoplasm pediatric toward child , ,
magnetic resonance imaging evaluation spinal tumors magnetic resonance imaging \( mri \) , recently begun replace myelography , computed tomography \( ct \) , extent , bone scans , become procedure choice evaluation spinal tumors applications mri role reviewed extradural space , mri sensitive technique detection tumors vertebral bodies time , provides delineation suspected thecal sac impingement space , mri generally accurate myelography ct noninvasive finally , intramedullary space , mri procedure choice evaluation suspected cord tumors general , mri become best initial procedure evaluation suspected tumors spine , regardless space may lie frequently , required examination
imaging therapy targeting radioactivity tumors using antitumor antibodies evolving laboratory toward practical diagnostic therapeutic technique widespread benefits many common human cancers development hybridoma technique producing monoclonal antibodies probably single important contribution development field large array monoclonal antibodies many human tumors created labeled variety 110 clinical trials identified literature interval 1978 present studies beginning form basis certain conclusions regarding likely benefits certain combinations antitumor antibodies isotopes specific instances clinical management patients malignant neoplasms example , melanoma , lymphoma , neuroblastoma , colorectal malignancies , radiolabeled antibodies demonstrated occult tumors , could disclosed conventional malignant lymphoma achieving durable remissions patients failed conventional forms therapy part , advances achieved application known principles , imaging , tumor immunology progress slow steady instances , term bullet warranted describing targeting particular radiolabeled antibody human tumor 131 , 3 , igg3 antigen neuroblastoma , introduced , 111 101 , cd5 antigen cells , developed , consistency high concentration radioactive targeting human tumors clinical trials certain technical fulfill initial promise , future methods diagnosis therapy genetic engineering permit development antibodies biologic properties favor tumor localization new chemical approaches range isotopes available diagnostic therapeutic application modern imaging , positron emission tomography \( pet \) , detect lesions smaller size permit quantitative imaging considerations greater speed ease use computerized work lead broader application fusion imaging images viewed simultaneously mri better anatomic correlation abnormal sites antigen reactive tumor deposits
single photon emission computed tomography positron emission tomography cancer imaging single photon emission computed tomography \( spect \) positron emission tomography \( pet \) used improve information available imaging patients cancer nuclear medicine techniques offer potential studying regional function biochemistry using radiolabeled substrates chemical changes malignancy precede anatomic changes , pet spect may detect changes anatomic changes occurred superiority spect compared planar imaging demonstrated cardiac brain imaging containing technetium 99 \( 99mtc \) best suited spect imaging large amounts radioactivity administered camera systems 140 99mtc current interest imaging cancer spect relates use gallium 67 citrate monoclonal antibodies labeled iodine 123 indium 111 spect image , advantages compared planar imaging clearly defined furthermore , ability quantitate distribution single photon 99mtc demonstrated new spect systems three rings detectors offer promise improved , quantitative imaging pet capability imaging tracers biologically important elements c 11 , n 13 , 15 , f 18 used positron labeling short half lives require close pet facility prominently used radiopharmaceutical pet f 18 fluorodeoxyglucose \( fdg \) pet studies fdg patients primary brain tumors demonstrated ability determine degree malignancy , differentiate necrosis recurrent tumor radiation therapy chemotherapy , predict prognosis metabolic functions cancer studied , including amino acid accumulation , thymidine uptake , oxygen utilization , metabolism , receptor status pet potential make major impact characterization malignancy effect therapy
new directions medical imaging cancer magnetic resonance methods single photon emission computed tomography magnetic resonance methods single photon emission computed tomography \( spect \) developing technologies provide functional anatomic information role diagnosis monitoring cancer subject current clinical research magnetic resonance imaging \( mri \) organs tissue using differences relaxation parameters water fat nuclei imaged studied magnetic resonance spectroscopy \( mrs \) provide information state naturally occurring infused molecules spect distribution radiolabeled agents tissues organs labeled monoclonal antibodies provide highly specific imaging tumors spatial resolution limiting factor proton mri provides highest current resolution , better 1 mm vivo deep tissues , whereas resolution mrs spect limited several centimeters recent advances technologies significantly increased specificity ability detect small , deep lesions
imaging adult central nervous system primary malignant gliomas staging follow classification staging system primary adult gliomas proposed system uses high signal intensity found proton density t2 weighted magnetic resonance \( mr \) scans site tumor surrounding edema \( including infiltrating tumor \)
proliferation dna ploidy malignant breast tumors relation early oral contraceptive use early abortions 175 premenopausal breast cancer patients , history oral contraceptive \( oc \) use 20 years age significantly associated higher tumor cell proliferative activity , indicated higher phase fraction \( spf \) , higher fraction dna aneuploid tumors , compared later never users \( p 0 05 p 0 01 , respectively \) higher spf among early oc users apparent patients aneuploid tumors patients euploid tumors abortions \( spontaneous induced \) first full term pregnancy also associated higher spf compared young patients breast cancer \( p 0 03 \) adjusting parity abortions oc use , respectively , early oc use associated 43 higher spf early abortions associated 49 higher spf younger patients higher spf higher frequency aneuploid tumors , found users oc lower median age diagnosis among never users , significant age relationship seen spf frequency aneuploidy dna analyses selection patients breast cancer larger tumors , therefore conclusions drawn article may patients smaller primary tumors , e g , cases diagnosed breast cancer screening higher tumor proliferative activity frequency aneuploidy early oc users line previously reported findings worse prognostic indicators worse survival early users oc compared young women breast cancer
treatment patients advanced colorectal cancer cisplatin , 5 fluorouracil , leucovorin based vitro studies demonstrated synergy 5 fluorouracil \( 5 fu \) , leucovorin \( lv \) , cisplatin \( cddp \) human colon cancer cell lines , clinical trial initiated determine effects combination patients advanced unresectable colorectal carcinoma fifty nine patients enrolled study 12 received prior conventional 5 fu chemotherapy treatment consisted 4 weekly courses high dose lv \( 200 mg m2 \) administered intravenous \( iv \) bolus , followed 5 fu \( 550 mg m2 \) cddp \( 20 mg m2 \) administered 2 hour infusion 4 consecutive days median 5 5 treatment cycles , objective tumor response seen 20 59 patients \( 34 \) \( included 3 complete remissions \) response rate 47 previously untreated patients 38 \( 95 confidence limits , 26 53 \) stable disease occurred 16 \( 27 \) patients , whereas tumor progressed 23 \( 39 \) patients median survival time 11 5 months , 15 patients alive 2 years regimen well tolerated primary side effects mild reversible gastrointestinal symptoms myelosuppression episode life threatening toxicity eastern cooperative oncology group \( \) grade iii adverse reactions required 25 dose reductions occurred 14 patients results trial suggest 5 fu , lv , cddp active , safe , well tolerated combination regimen patients advanced colorectal cancer
serum tumor markers patient allocation good risk poor risk clinical trials patients germ cell tumors allocation patients advanced germ cell tumors \( gct \) different treatment programs based clinical characteristics standard design clinical trials today studies shown substantial differences exist entry criteria differences could influence outcome clinical trials factors contributing differences clear due patient selection two hundred five unselected consecutive patients allocated treated good risk poor risk treatment programs memorial sloan kettering cancer center \( \) risk status indiana university \( iu \) classification results compared southeastern cancer study group \( \) results using criteria indicated substantial agreement total end results identification good risk patients results poor risk patients differed substantially , 39 patients \( 19 \) classified poor risk criteria 66 \( 32 \) indiana criteria major discrepancy occurred iu stage 7 , 26 32 patients \( 81 \) achieved complete response major factor contributing difference risk assignment use serum tumor markers serum tumor markers must incorporated risk assignment criteria gct clinical trials minimize number good risk gct patients poor risk trials
salvage chemotherapy patients germ cell tumors memorial sloan kettering cancer center experience \( 1979 1989 \) twenty eight 124 \( 23 \) advanced germ cell tumor \( gct \) patients treated four successive based induction regimens failed achieve durable complete response \( cr \) remain alive \( median follow , 50 months \) analysis prognostic factors response survival conducted 94 patients received salvage chemotherapy survival response salvage therapy significantly enhanced patients prior cr induction chemotherapy , treatment cisplatin based salvage regimen , testis primary site , normal serum human chorionic gonadotropin level , normal serum lactate dehydrogenase level , one site metastasis , indiana class 6 less patients prior incomplete response \( ir \) particularly poor prognosis \( p 0 \) 4 52 \( 9 \) patients alive \( median follow , 37 months \) compared 15 42 \( 36 \) patients prior best response cr \( median follow , 35 months \) poor survival patients fail achieve durable cr induction chemotherapy warrants continued investigation new salvage therapy identification prognostic features may direct salvage therapy aid interpretation clinical trials salvage regimens
prognostic value image analysis ovarian cancer histologic grading important treatment decisions ovarian cancer grading systems contain significant subjective component , could reduced including objective measurements diagnostic decision image analysis used determine nuclear area ploidy distributions 42 patients epithelial ovarian cancer , results related tumor grade clinical outcome mean nuclear area , mean optical density , number cells , standard deviation measurements significantly higher grade 2 3 tumors compared grade 1 tumors , rapidly progressive tumors compared less aggressive malignancies , recurrent tumors compared primary lesions number nuclei high dna content found prognostic importance image analysis thus provides additional prognostic information epithelial ovarian cancer
resection primary liver cancer hepatic primary liver cancer \( plc \) hepatic designated tumor main branch portal vein pedicle hepatic veins contact intrahepatic vena cava , main tumor located segment , iv , v , viii concentrating central part liver called central type plc , differed tumor located segment ii , iii , vi , vii latter called peripheral type plc surgical treatment plc significantly improved past two decades , resection central type plc difficult hazardous institution admitted plc january 1970 april 1988 , 118 cases central type 65 cases resected successfully , resectability 55 1 one patient died sepsis within 1 month operation \( mortality 1 53 \) modes operation different segments described , suggestions improvements presented survival rates compared similar number patients peripheral type tumor period treated surgeons results show noticeable differences one year , three year , five year survival rates resection 70 9 , 43 2 , 39 2 central type plc 98 3 , 85 0 , 76 4 peripheral type plc \( p less 0 001 \) discussion improvements surgical techniques mental awareness suggested
structural functional integrity ovarian tumor tissue obtained ultrasonic aspiration patients ovarian epithelial cancer , survival increases residual disease approaches zero surgical removal tumor previous study using ultrasonic surgical \( cusa \) \( corp , , ct \) showed successful removal ovarian tumors areas often considered unresectable diaphragm , spleen , stomach , small bowel however , cusa yet approved food drug administration gynecologic surgery except experimental basis study designed test whether ultrasonic irradiation produced cusa caused alterations cell structure physiology gynecologic tissue adjacent areas paired tumor samples , unirradiated irradiated , obtained ten patients , portions sent pathologic structural evaluation physiologic tissue culture evaluation histologic sections , stained hematoxylin eosin , showed cusa irradiation produced minor tissue distortion observed light microscope correct diagnosis would made cases tissue fragments obtained cusa specimen trap stained nine ten patients , initial tumor cell viability similar two specimen types flow cytometric dna analysis confirmed surgical methods produced matched samples cells survived high frequency ultrasound appeared functionally intact five eight patients , cells cusa specimen survived divided greater extent knife dissected tumors cells surgical routes attained similar number passages culture seems reasonable vitro observations pelvic tumor tissues normal surrounding tissue left situ thus pelvic tissue believed uninjured cusa ultrasonic irradiation
expression progesterone receptors coincides arrest dna synthesis human breast cancer two main models account heterogeneous expression estrogen receptors \( er \) progesterone receptors \( pr \) human breast cancer proposed clonal model stem cell model authors previously provided evidence supporting stem cell model since found proliferating cells er positive \( er \) human breast cancer lack er er negative \( er \) er subpopulations interrelated authors analyzed eighteen er pr primary breast tumors simultaneous expression er pr \( immunohistochemistry \) dna synthesis \( autoradiography \) 30 minutes 3h thymidine incorporation authors demonstrated \( 1 \) average numbers er pr cells similar \( 36 8 10 7 39 3 17 6 , respectively \) \( 2 \) thymidine labeling indexes er , er , pr , pr subpopulations 0 53 0 69 , 0 74 0 49 , 0 21 0 21 0 94 0 54 , respectively \( 3 \) 75 2 dna synthesizing cells er , 88 8 pr authors conclude cellular subpopulations expressing er pr identical , expression pr associated lower rate cellular proliferation er expression
amplification oncogenes mammary carcinoma shown fine needle biopsy procedure measures amplification oncogenes human cancer cells described cells obtained fine needle biopsy allow repeated sampling individual metastases low number cells obtained , could overcome using slot blot hybridization technique measure gene amplification two patients mammary cancer \( primary tumors metastases \) , analyzed levels amplification oncogene erb b2 , described detail technique suitable analyzing alterations occurring cancer progression identifying subgroups mammary cancer different characteristics
predicting recurrence time esophageal carcinoma assessment histologic factors dna ploidy analysis nuclear dna content done 128 patients squamous cell carcinoma esophagus relationship among histopathologic features , dna distribution pattern , survival time investigated standpoint recurrence 128 patients , 77 \( 60 1 \) died recurrence within 2 years surgery 16 \( 12 5 \) 2 5 years two \( 1 6 \) 5 years rate death recurrence within 2 years higher patients t4 t1 , t2 , t3 n0 \( p less 0 01 \) survivors 5 years frequently possessed type ii dna pattern types iii iv \( p less 0 05 \) rate death recurrence within 2 years 34 4 type ii , lower 59 6 rate type iii \( p less 0 05 \) 76 6 rate type iv \( p less 0 01 \) survivors 2 5 years higher type iii type iv \( p less 0 05 \) , recurrence 5 years found type ii apparent curative resection patients type ii , careful follow may needed 5 years late recurrence however , type iv , recurrence 2 years could regarded healed recurrences occur within 2 years findings suggest growth rate esophageal carcinoma reflect dna aneuploidy , dna analysis esophageal carcinoma valuable parameter postoperative follow planning
serial analysis blood tumor cells two patients neuroblastoma tumor surveillance tests used determine whether malignant cells responsive resistant therapeutic regimens patients neuroblastoma , conventional methods surveillance sensitive enough tumor cells shed circulation , analysis blood may function sensitive monitoring system study , five blood samples obtained two patients disseminated neuroblastoma diagnosis therapy samples analyzed monoclonal antibodies immunoperoxidase staining determine whether circulating present patients , presence absence circulating yielded information sensitive conventional tests authors conclude analysis blood included conventional monitoring methods surveillance patients disseminated neuroblastoma
recurrent pelvic desmoid tumor successfully treated tamoxifen case recurrent retroperitoneal desmoid tumor successfully treated tamoxifen \( tablets , ici , division ici , , de \) reported patient presented late second pregnancy large retroperitoneal pelvic desmoid tumor treated surgical excision megestrol acetate tumor recurred 12 months later , treated surgery , time followed radiation therapy desmoid tumor quickly recurred patient treated tamoxifen , resulting complete tumor regression remained stable 27 months tamoxifen considered first line therapy recurrent desmoid tumors
rural urban differences stage diagnosis possible relationship cancer screening stage diagnosis examined various malignancies identifiable screening determine whether rural urban differences exist georgia data obtained population based cancer registry incident cancers among residents metropolitan atlanta ten rural counties black white patients first primary invasive malignancy newly diagnosed 1978 1985 included study residents rural area twice likely cancers \( 18 3 \) urban residents \( 9 6 \) among patients known stage diagnosis , rural patients tended advanced disease urban patients relative excess malignancies rural georgia 21 whites 37 blacks rural excess prostate cancer among blacks especially pronounced differences access utilization early detection methods may contribute rural urban differential extent disease diagnosis
detection ct arterial colorectal cancer metastases liver prospective evaluation accuracy real time ultrasonography \( us \) , computed tomography \( ct \) , infusion hepatic angiography \( iha \) , computed tomography arterial \( ct ap \) performed 65 resected liver metastases colorectal cancers total detection rate 58 5 percent us , 56 3 percent ct , 55 4 percent iha , 86 2 percent ct ap sensitivity 29 lesions diameters smaller 1 cm 65 5 percent ct ap , ct found two , us iha localized three smallest lesions detectable ct ap small 0 4 cm diameter ct ap proved useful detecting liver metastases , use technique recommended preoperative planning hepatectomy patients liver metastases
intraepithelial bodies colorectal adenomas bodies revisited presence intraepithelial inclusion bodies \( bodies \) recorded rectal colonic specimens 130 patients large moderate number intraepithelial bodies recorded 81 8 percent 55 colorectal adenomas patients familial adenomatous polyposis \( fap \) conversely , none 55 non fap adenomas 20 specimens ulcerative colitis \( 10 dysplasia \) similar amounts intraepithelial granules studies demonstrated granules contain dna probably nuclear fragments destroyed lymphocytes although pathogenesis phenomenon remains obscure , appears presence large moderate number intraepithelial bodies colorectal adenomas strongly raise suspicion fap
subsite distribution incidence colorectal cancer new zealand , 1974 1983 purpose study examine changes subsite distribution incidence colorectal cancer within different age groups registration colorectal cancer national cancer registry new zealand approached 100 percent 1974 present study based 15 , 395 individuals aged 25 years registered colorectal cancer 1974 1983 subsite distribution \( right colon , left colon , rectum \) different age groups \( 25 49 , 50 69 , 70 years \) significantly skewed , excess right colonic cancer individuals aged 25 49 years 70 years right colonic excess accompanied relative reduction left colonic cancer age adjusted incidence rates periods 1974 78 1979 83 compared stratified age group subsite incidence rates increased individuals aged 50 years particularly evident right sided cancer elderly sexes marked reduction incidence left colonic cancer rectal cancer individuals 50 years contrast , incidence right colonic cancer remained relatively stable young individuals time trend studies indicate skewed subsite distribution large bowel cancer different age groups may increase time probably due varying etiological factors acting different cohorts
colorectal cancer differences community geographically distant patients seen urban medical center many studies clinical oncology rely hospital derived patients hospitals vary proportions patients local area vs distant places , larger proportion presumably referrals study differences two types patients , analyzed 1 , 245 colorectal cancer patients seen large urban medical center seven year period three hundred ninety eight patients local community \( 32 percent \) , extended community \( 39 3 percent \) , distant communities \( 28 8 percent \) patients local community tended older minority ethnic groups addition , local community patients likely advanced disease time presentation grade tumor site distribution within large bowel similar three groups adjusting age , sex , race , stage disease , survival somewhat better distant community patients compared local extended communities \( p less 0 02 \) overall , patient population , distant patients tended favorable socioeconomic factors less advanced disease , differences may account , large part , better prognosis patients particularly large cooperative trials , studies may need take account respective proportions local community geographically distant patients analyzing treatment outcomes
intra abdominal desmoid tumors familial polyposis coli case report tumor regression prednisolone therapy case intra abdominal desmoid tumors familial polyposis coli \( \) , regressed disappeared prednisolone treatment , reported 37 year old japanese man abdominal admitted hospital proctocolectomy two years rectal cancer laparotomy , tumors present abdominal wall , mesentery , small part tumors resected diagnosed microscopically desmoid tumors prednisolone administration \( 20 5 mg day \) subjective symptoms desmoid tumors slowly regressed bilateral hydronephrosis continued resulted retroperitoneal fibrosis knowledge , case first well documented case retroperitoneal fibrosis patient characteristics desmoid tumor familial polyposis coli 's syndrome methods management discussed
polycystic ovary syndrome bulimia one hundred fifty three patients classified suffering polycystic ovarian syndrome \( \) 109 patients suffering clear organic disorder received bulimia investigation test \( \) \( bite \) questionnaire abnormal eating behaviors patients showed significant increase mean bite score approximately third abnormal eating patterns , 6 scores suggestive clinical bulimia compared 1 women group organic work suggests women screened abnormal eating behaviors raises possibility treatment psychological means considered abnormal eating behaviors present
endoscopic biopsy limited accuracy diagnosis ampullary tumors endoscopic biopsy specimens surgically resected specimens collective series 78 japanese patients ampullary tumor retrospectively reviewed investigate clinical implications endoscopic biopsy endoscopic biopsy specimens classified five groups based degree epithelial atypia group 1 \( atypia \) , group 2 \( mild atypia \) , group 3 \( moderate atypia adenoma \) , group 4 \( severe atypia carcinoma situ \) , group 5 \( invasive carcinoma \) final diagnosis 78 resected ampullary tumors adenoma five cases , carcinoma 27 cases , adenoma carcinoma 46 cases biopsy accuracy carcinoma \( group 4 5 \) 70 \( 51 73 \) overall 73 carcinoma cases biopsy accuracy 50 \( 7 14 \) intramural type , 64 \( 21 33 \) exposed type , 88 \( 23 26 \) type diagnostic accuracy adenoma \( group 3 \) 80 \( 4 5 \) five cases ampullary adenoma 18 \( 25 \) 73 carcinoma cases , biopsy diagnosis adenoma \( group 3 \) , whereas carcinoma found deeper layers surgically resected specimens biopsy diagnosis adenoma rule possibility deeper carcinoma ampullary tumors
evaluation tn staging oesophageal cancer strategies treatment cancer oesophagus depend tumour stage time diagnosis resection , curative treatment , confined early tumour stages tumours local infiltration usually unresectable require palliative treatment computed tomography widely used preoperative staging often fails define correctly endoscopic ultrasound allows direct parietal wall may useful staging gastrointestinal tumours comparative prospective study , 52 patients tumours oesophagus investigated preoperatively endoscopic ultrasound computed tomography determine stage tumour infiltration local lymph node involvement thirty seven patients underwent operation , resection , dissection entered study intraoperative findings histopathological assessment , , taken reference tn stages oesophageal tumours , correct preoperative staging accomplished endoscopic ultrasound 89 stage 69 n stage compared 51 51 respectively computed tomography \( highly significant using fisher 's exact test \) study shows endoscopic ultrasound useful preoperative tn staging tumours oesophagus
chondrosarcoma soft tissues two different sub groups arising soft tissues rare two different described , myxoid mesenchymal collected nine cases tumour , five myxoid four mesenchymal , review cases chondrosarcoma seen 1988 report principal clinical , histological differences two discuss surgical treatment prognosis
determination plasma calcitonin gene related peptide concentrations new assay normal persons patients medullary thyroid carcinoma neuroendocrine tumors concentrations circulating calcitonin gene related peptide \( cgrp \) value plasma cgrp measurements detection follow medullary thyroid carcinoma \( mtc \) thus , developed assay cgrp using antibodies purified polyclonal antiserum human cgrp assay sensitive \( limit detection , 0 4 pmol l multiply 3 derive per l \) highly specific cross reaction human calcitonin \( ct \) normal plasma cgrp values ranged less 0 4 4 5 pmol l \( median , 0 8 n 31 \) , 61 detectable levels values samples patients mtc elevated unoperated patients \( n 10 \) , 4 7 137 pmol l \( median , 7 1 \) operated patients gross persistent recurrent tumor \( n 14 \) , 4 7 171 pmol l \( median , 23 2 \) contrast , cgrp values normal 78 nine postoperative patients elevated ct , detectable tumor \( range , less 0 4 6 3 pmol l median , 1 6 \) cgrp levels increased pentagastrin injection mtc patients , less ct values cultured mtc cells vitro secreted large amounts cgrp , rat nerve root ganglia , human , endothelial cells secreted lesser amounts conclude cgrp normal plasma , low levels plasma cgrp concentrations frequently high patients mtc , primarily gross tumor metastases plasma ct assay preferable test mtc , cgrp assay deserves prospective study possible role predicting gross metastasis
use 131i treatment malignant pheochromocytoma efficacy safety 131i \( 131i \) assessed 15 patients malignant pheochromocytomas , single arm trial , patients treated 131i \( sa , mg \) every 3 months seven patients bone soft tissue metastases , 4 soft metastases , 4 bone metastases follow period ranged 6 54 months number doses ranged 2 11 , 2 9 \( 78 4 mci \) 9 25 \( \) \( 250 mci \) administration cumulative activity 11 1 85 90 \( 300 mci \) absorbed cumulative dose tumors ranged 12 155 gy beneficial effect treatment observed 9 patients \( 60 \) complete remission disease observed seven patients died study , among 4 never responded treatment seven hormonal responses \( 4 complete 3 partial \) , duration ranging 5 48 months among patients , 4 relapsed , 3 died within 3 months five patients partial tumoral responses mainly located soft tissues duration ranging 29 54 months patients hormonal response objective improvement clinical status blood pressure clear cut relationship cumulative dose responses main side effect observed 1 patient widespread bone metastases three doses \( 12 9 \) pancytopenia , resolved treatment discontinued study suggests repeated 131i treatment could effective patients advanced malignant pheochromocytoma
quantitation g0 g1 phase cells primary carcinomas antibody m1 subunit reductase shows g1 phase restriction point block human cancers apparent low growth fraction , bulk cells presumed cycle g0 quiescent state due inability past distinguish g0 g1 cells m1 subunit reductase \( m1 rr \) constitutively expressed cycling cells \( e , g1 , , g2 \) acquired transition g0 g1 , lost exit g0 thus distinguishes g0 g1 cells estimate proportion g0 g1 cells primary human breast \( n 5 \) colorectal \( n 12 \) adenocarcinomas , used analytical dna flow cytometry \( \) immunoperoxidase staining sections monoclonal antibody m1 rr \( mab m1 rr \) fresh tumors revealed low percentage cells phase \( 4 0 3 4 \) immunoperoxidase staining m1 rr revealed unexpectedly high proportion positive cells \( 52 4 12 7 \) g1 , , g2 phases indicating high g1 content primary human tumors thus , human cancers blocked transition g1 predominantly g0 quiescent differentiated state block interpreted mean human cancers responding putative regulatory events restriction point g1 phase , relative growth factor deficiency , density inhibition , antiproliferative cytokines , gene products using flow cytometry dna m1 rr content found human colon cancer cell lines arrest g1 g0 phase upon serum deprivation density inhibition similarly , human breast cancer cell lines arrested g1 g0 phase medroxyprogesterone acetate \( mpa \) tamoxifen exposure findings match situ observations , support concept restriction point block primary human tumors
insulin like growth factor ii mediated proliferation human neuroblastoma neuroblastoma embryonal tumor typically arises cells developing adrenal medulla igf ii mrna expressed high levels adrenal cortex birth detectable birth adrenal medulla neuroblastoma cell lines corresponding early adrenal medullary precursors express igf ii , although three cell lines tested growth stimulated igf ii cell lines corresponding mature adrenal medullary cells expressed igf ii , one , sk n , igf ii autocrine mechanism \( j clin invest 84 \) el , , , , , israel 1989 examination human neuroblastoma tumor tissues igf ii gene expression using situ hybridization histochemistry revealed igf ii expressed tumor cells 5 21 neuroblastomas , detectable cells nonmalignant tissues including adrenal cortical cells , stromal fibroblasts , eosinophils 21 tumors findings indicate igf ii may function autocrine growth factor neuroblastomas paracrine growth factor others suggest growth regulatory pathways utilized neuroblastoma mimic used precursor cell type individual tumors arise
patterns epidermal growth factor receptors basal squamous cell carcinoma presence immunoreactive epidermal growth factor receptors human skin tumors investigated using indirect immunoperoxidase technique sixteen basal cell carcinomas 11 squamous cell carcinomas evaluated specimens studied receptor positive 70 specimens prominent staining cell membranes 54 nodular basal cell carcinoma specimens increased staining periphery tumor cell masses
basal cell carcinoma recurring radiotherapy unique , difficult treatment subclass recurrent basal cell carcinoma twenty seven basal cell carcinomas \( \) recurring following radiation therapy alone addition treatment modalities treated mohs micrographic surgery \( mms \) 1983 1989 mean tumor size 2 1 cm tumors , 70 4 arose mid face region , 55 6 undergone multiple previous treatment modalities present recurrence rate 7 4 \( mean follow 25 months \) basal cell carcinoma recurring following radiotherapy deserves special among recurrent bcc difficult eradicate , high recurrence rates following standard surgical excision radiotherapy tumors usually large , aggressive , invasive arise crucial mid face region , extension subcutaneous tissue planes common mohs surgery , inherent abilities examine margins , map tumor extension , conserve tissue , uniquely suited treatment difficult tumors
medical necessity evaluation treatment port wine stains new lasers improved laser delivery systems allowed safe effective treatment port wine stains patients ages satisfactory results obtained laser treatment increased number patients seeking consultation regarding physicians recognize various medical syndromes problems associated port wine stains review patients facial port wine stains revealed hypertrophy 65 patients fifth decade life , increases significantly morbidity lesions believed laser treatment minimize medical psychologic complications result natural evolution port wine stains
retroviral transduction protein kinase c gamma cytotoxic lymphocyte clones leads retention specific function molecular pathways responsible delivering proliferative signals cell surface nucleus lymphocytes still unresolved , recent data implicates protein kinase c \( pkc \) involvement tcr signaling pathway address role pkc cell activation , effects high level expression pkc gamma isoenzyme murine ctl clones examined unlike parental cells required periodic ag stimulation cell activation growth , cells expressing pkc gamma gene culture independent need ag stimulation , although maintaining identical functional specificity parental ctl constitutive pkc gamma expression may therefore mimic physiologic pkc activation , thereby requirement tcr ag interaction cell activation
dexamethasone inhibits induction monocyte chemotactic activating factor production il 1 tumor necrosis factor recently purified cloned monocyte chemotactic activating factor \( mcaf \) may play major role activating monocytes inflammatory process examined effects potent anti inflammatory agent , dexamethasone \( dxs \) , production factor wide range concentrations \( 10 \( 5 \) 10 \( 8 \) \) , dxs inhibited production mcaf mrna protein level human fibrosarcoma cell line , stimulated either il 1 tnf alpha examined turn synthesized mcaf mrna showed dxs decreased stability mcaf mrna furthermore , addition actinomycin cycloheximide abolished effect dxs , indicating de novo mrna protein synthesis required process addition , nuclear run analysis revealed dxs also inhibited transcription il 1 tnf activated mcaf genes therefore , mcaf mrna inhibition transcription gene contribute decrease mcaf mrna steady state level dxs
dna sequences 3' ig h chain cluster mouse b cell lines mouse myeloma cell line \( , kappa \) variants derived used study dna rearrangements occur ig h chain locus one variant , 5 , acquired vh gene c epsilon gene rearrangements genomic southern blot analysis initially directed mapping c epsilon gene rearrangement , observed vh region rearrangement linked , inversion event , sequences originate 3' cluster , e , 3' c alpha gene subsequent studies shown dna rearrangements within region 3' c alpha gene detected several mouse myeloma hybridoma cell lines associated expression specific isotypes
examination htlv integration skin lesions various types adult cell leukemia \( atl \) independence cutaneous type atl confirmed southern blot analysis various clinical features adult cell leukemia lymphoma \( atl \) frequently accompanied skin eruptions recently , cutaneous type atl proposed clinical studies analyzed viral integration human cell leukemia virus \( htlv \) monoclonal rearrangement cell receptor \( tcr \) gene blood lymphocytes cutaneous infiltrated cells nine atl patients various clinical features skin eruptions classified results southern blot analysis propose cutaneous type atl accordingly two , could detect monoclonal integration htlv cell skin peripheral lymphocytes also demonstrated time course study one patient clinicians aware htlv positive cutaneous cell lymphoma named cutaneous type atl examination viral integration cell skin lesions required make exact diagnosis cutaneous atl
tnf alpha cachectin human melanoma cells studies co cultivated malignant melanoma investigated ability metastatic cells produce macrophage cytokine , tnf alpha cachectin , cells macrophage like properties infiltration migration looked tnf alpha cachectin three tumor cell lines derived human malignant melanomas six co cultivated malignant melanomas derived , vitro , three cell lines plus fibroblasts immunohistochemistry anti tnf alpha cachectin monoclonal antibody showed tnf alpha cachectin produced two three parent melanoma cell lines tumor cells co cultivated malignant melanomas vitro nodules produced tnf alpha cachectin , even derived melanoma cell line , originally results clearly show tnf alpha cachectin produced non hematopoietic tumor cells co cultivated tumor model prepared types human tumor cell lines provide useful tool relationship tnf alpha cachectin
immunohistochemical alterations basement membrane components squamous cell carcinoma investigate alterations basement membrane \( bm \) squamous cell carcinoma \( scc \) , investigated 20 tumors four cytologic characteristics 's disease \( scc bd \) 16 \( scc nb \) tumors studied immunohistochemically double immunofluorescent staining using mouse monoclonal antibodies core protein heparan sulfate proteoglycan \( hspg \) chondroitin 6 sulfate glycosaminoglycan \( ch6s \) well rabbit antiserum laminin \( ln \) type iv collagen \( c 4 \) well differentiated highly scc nb , ln , c 4 , hspg could detected tumor bm showed loss continuity , largely lost poorly differentiated poorly scc nb suggests poorly differentiated scc nb cause greater enzymatic degradation bm components well differentiated scc nb ch6s detected parts bm scc bd , absent scc nb examined appears scc nb lost ability synthesize ch6s , scc bd degrade ch6s although continue produce thus , appears scc bm qualitatively different normal epidermis , scc bd distinguished scc nb ch6s content bm
identification melanoma progression antigen integrin vla 2 expression integrin receptors vla 1 , 2 , 3 , 6 studied normal cultured melanocytes five melanoma cell lines normal melanocytes synthesized vla 3 , reveal detectable levels vla 1 , 2 , 6 melanoma cell lines , however , expressed vla 2 , 3 , 6 vla 1 synthesized two five melanoma lines parallel , analyzed expression four previously characterized melanoma cell surface antigens one \( antigen 1 43 \) , associated tumor progression human melanoma , revealed striking similarity vla 2 sequential immunoprecipitation experiments , show 1 43 identical integrin vla 2 , cell surface receptor collagen , laminin , fibronectin
reproducibility image interpretation performed indium 111 iodine 131 labeled f \( ab' \) 2 antibody injected patients important criterion clinical use new imaging technique correct reproducibility interpretation forty six paired examinations performed 43 patients suspected ovarian carcinoma recurrence using f \( ab' \) 2 fragments antibody labeled first indium 111 iodine 131 planar scintigraphy \( ps \) emission computed tomography \( \) images interpreted blindly separately three observers , reproducibility evaluated kappa concordance index intra interobserver reproducibility generally satisfactory \( kappa values 0 6 0 7 , respectively \) analysis kappa values showed superiority indium 111 intraobserver \( p 0 \) interobserver \( p 0 \) study however , ps significant difference reproducibility two radionuclides
relationship uptake technetium 99m \( sn \) n 5 hepatocellular carcinoma prognosis relationship technetium 99m \( sn \) n 5 \( 99mtc \) uptake hepatic tumors survival studied 162 cases hepatocellular carcinoma \( hcc \) median survival 82 patients hepatic tumors showed increased uptake delayed 99mtc imaging days , significantly longer survival time 398 5 days 80 patients hepatic tumors show increased uptake radioactivity \( p less 0 002 \) relationship ability hepatic tumors take 99mtc survival also analyzed patients hcc showing filling defects 99mtc colloid liver images , relation therapy , serum values bilirubin alpha fetoprotein results indicated degree 99mtc uptake hepatic tumors closely correlated prognosis patients hcc
comparison mbq 3700 mbq iodine 131 postoperative ablation residual thyroid tissue patients differentiated thyroid cancer randomized prospective study , compared efficacy low dose \( mbq \) high dose \( 3700 mbq \) iodine 131 administration postoperative ablation residual functioning thyroid tissue 63 patients differentiated thyroid cancer unable demonstrate difference low high dose radioactive iodine scintigraphic ablation remnant tissue 81 \( 21 26 \) patients , mbq ablated first dose , 77 \( 21 26 3 5 24 31 \) first plus second dose , 69 \( 24 31 0 4 24 35 \) first , second , third dose radioiodine \( 3700 mbq \) ablated 84 , 73 , 69 patients respectively 1 , 1 plus 2 , 1 plus 2 plus 3 dose forty percent patients ablated low dose 44 ablated high dose elevated thyroglobulin levels time complete scintigraphic ablation conclusion , find difference 3700 mbq mbq iodine 131 regard number doses needed complete scintigraphic ablation residual functioning thyroid tissue
extracranial metastatic glioblastoma appearance thallium 201 chloride technetium 99m hmpao spect images sequential thallium 201 chloride technetium 99m oxime single photon emission computed tomography \( spect \) images obtained patient extracranial metastatic glioblastoma multiforme thallium 201 uptake high \( three times scalp background \) pathologically confirmed extracranial metastases moderate \( 1 6 times scalp background \) , biopsy specimens showed gliosis scattered atypical astrocytes technetium 99m hmpao uptake decreased right frontal parietal lobes irradiated also decreased one well encapsulated scalp lesion high another scalp mass less defined borders possible mechanisms tumor uptake agents reviewed
technetium 99m methylene \( mdp \) uptake sympathetic effusion index malignancy review literature report patient sympathetic pleural effusion secondary cell lymphoma accumulated bone imaging agent , technetium 99m methylene \( 99mtc mdp \) case significant malignant cells present three cytologic examinations pleural fluid multiple pleural biopsies also present review published literature pleural effusions accumulate bone tracers conclude pleural effusions accumulate 99mtc mdp considered malignant secondary malignancy work essential even cytologic exam pleural fluid unremarkable
htlv associated leukemia lymphoma south florida report 10 cases adult cell leukemia lymphoma \( atl \) seen south florida february 1988 july 1989 seropositive human lymphotropic virus type \( htlv \) seronegative human immunodeficiency virus type 1 \( hiv 1 \) dna extracted tumor biopsies peripheral blood lymphocytes nine patients shown polymerase chain reaction \( pcr \) contain htlv proviral dna blot hybridization dna extracted seven patients htlv cdna probe revealed monoclonal pattern proviral integration consistent diagnosis atl eight 10 patients women six patients , three , one patients aggressive non hodgkin 's lymphoma two patients presented sinus retro orbital involvement another gastric lymphoma perforated nine patients developed eight patients died within 1 year diagnosis two lost follow course study , 66 new cases non hodgkin 's lymphoma diagnosed hospital ten cases atl prevalence htlv related lymphoma sample 15 since tissue patients available htlv screening , however , possible cases atl went undetected conclude initial survey retroviral etiology considered patients populations known risk htlv infection present non hodgkin 's lymphoma
comparison characteristics esophageal squamous cell carcinoma associated head neck cancer gastric cancer ongoing reviews 339 patients surgically treated primary squamous cell carcinoma , 19 \( 5 6 \) concurrent gastric cancer 11 \( 3 2 \) head neck cancer incidences intra esophageal multiple occurrence esophageal cancer 27 3 26 3 associated head neck cancer gastric cancer , respectively , higher 7 1 without concurrent cancer difference characteristics concurrent head neck gastric cancers , except higher incidence metachronous occurrence former findings suggest , cases esophageal cancer associated concurrent head neck cancer gastric cancer , esophageal carcinoma frequent preoperative serial evaluations important design treatment estimate prognosis
activation vitro expansion tumor reactive lymphocytes lymph nodes draining human primary breast cancers feasibility vitro activation lymphocytes draining lymph nodes \( dln \) breast cancer patients examined lymphocytes isolated 48 dln 12 patients examined proliferative responses ril 2 , autologous tumor cells , ril 2 plus tumor cells three general patterns cellular responses observed cells dln \( 17 \) unresponsive stimuli lymphocytes 52 dln responded moderately ril 2 alone combination ril 2 tumor antigen synergistic effect proliferation cells 31 dln assayed phorbol ionomycin plus ril 2 stimulated expansion dln lymphocytes fold 35 days expanded cell populations , well stimulated antigen plus ril 2 , predominantly cd3 cd16 cells , varying proportions cd4 cd8 subsets populations cytotoxic autologous tumor , mcf 7 , k562 target cells
neuroendocrine carcinoid tumours breast variant carcinoma neuroendocrine differentiation carcinoid tumours frequently develop gastrointestinal tract described many organs body 1977 first cases reported , followed descriptions carcinoid like , neuroendocrine mammary tumours many investigators performed immunohistochemical ultrastructural examinations existence true still controversial issue eight mammary neoplasms features , five small cell carcinoid like variety three composed larger cells , examined immunohistochemical ultrastructural examination believe kind tumours ductal lobular carcinomas focal extensive neuroendocrine features result dual differentiation neoplastic precursor stem cells along epithelial endocrine lines consequently , consider treatment cases different ordinary type mammary carcinomas
characterization histopathological correlation cytosol proteins benign malignant breast tumors significant differences cytosol protein level exist normal benign cancerous breast tissues positive correlation cytosol protein level histological grade carcinoma well differentiated carcinoma lower value cytosol protein poorly differentiated carcinoma gel , total numbers bands almost identical normal , benign , malignant conditions addition , 37 kd protein band consistently present malignant cases always absent normal benign cases extensive examination band may provide insight protein alterations cancer cells molecular level
lactation following conservation surgery radiotherapy breast cancer 38 year old woman early stage invasive breast cancer treated wide excision tumor , axillary lymph node dissection , breast irradiation three years later , gave birth normal baby attempted breast feeding full lactation untreated breast irradiated breast underwent minor changes pregnancy postpartum produced small amounts colostrum milk 2 weeks postpartum reports lactation breast irradiation cases reviewed , possible factors affecting breast function radiotherapy discussed scant information available regarding safety infant , nursing irradiated breast recommended
capsule assay chemosensitivity test primary esophageal squamous cell carcinoma efficiency capsule assay \( \) studied fresh tissue esophageal squamous cell carcinoma day day changes 10 carcinoma cases evaluated 9 days cancer cells continued 3rd day implantation decreased host reaction recognized histologically 3rd 4th day day however , immune reaction significantly influence evaluation day immunohistochemical staining anti bromodeoxyuridine monoclonal antibody revealed existence cancer cells dna synthesizing stage \( stage \) graft day chemosensitivity test , 21 patients studied , evaluable 5 fu administration produced response 8 21 cases \( 38 1 \) , 8 21 \( 38 1 \) , cddp 3 21 \( 14 3 \) used combination , cddp effective 7 18 cases \( 38 9 \) cddp 6 18 cases \( 33 3 \)
squamous carcinoma distal esophagus survival study survival study squamous carcinomas distal esophagus treated southern california medical group interval 1988 undertaken found radiation therapy surgery equally efficacious terms cure patients without distant disease performance status sufficient tolerate treatment find survival benefit patients treated palliative surgery , plan less invasive endoscopic means along chemotherapy radiation palliation , surgery special circumstances
123i labelled epidermal growth factor used 123i labelled epidermal growth factor \( egf \) scans study 14 patients advanced cervical cancer abnormal lymph node imaging seen clearly 6 8 h injection revealed abnormal uptake pelvic lymph nodes 11 patients 4 11 abnormal tomographic ultrasound scans 7 conventional radiology confirm presence disease
imaging modalities recurrent head neck tumors patients recurrent neoplasms head neck present management problems , accurate preoperative assessment disease crucial thirty eight patients suspected recurrent neoplasms comprise study 30 computed tomography scans , 4 magnetic resonance images , 4 patients underwent computed tomography magnetic resonance imaging assess anatomical extent pathology 34 malignant 4 benign tumors contrast enhancement essential detecting disease computed tomography scan differentiation recurrent tumor difficult patient undergone radiation magnetic resonance imaging demonstrated superior recurrent parotid paranasal sinus neoplasm , less helpful laryngeal pharyngeal recurrences computed tomography demonstration mass infiltration normal fat tissue planes lymphadenopathy correlated highly recurrent disease imaging techniques fine points determining recurrent neoplasms presented
use bromodeoxyuridine studies prognostic indicator cancer head neck traditional measures head neck tumors often fail predict patient outcome clinical course , particularly disease problem unpredictable tumor behavior one focus cell proliferation studies studies , however , limited difficult methodology newer method quantifying tumor cell proliferation using bromodeoxyuridine applicable head neck squamous cell carcinomas , shown present study relative ease cell proliferation evaluated using technique allow large numbers head neck tumors studied , enabling correlations tumor behavior made
introduction limb salvage surgery sarcomas article provides history limb salvage surgery definitions terms used describe aspects procedure staging also discussed
limb salvage pediatric surgery use expandable prosthesis limb sparing growing children proved effective oncologic perspective , good , long term acceptance patients adult , performed experienced surgeons , limb sparing neither compromises survival rate significantly increases local recurrence rate , compared cross bone amputation include patient evaluation , surgical options , materials methods , results
resection reconstruction bone tumors proximal tibia proximal tibia common site benign malignant tumors article reviews pertinent anatomy , clinical presentation , staging methods tumors area discussion given various methods resection reconstruction useful guidelines procedure selection use allografts reconstruction discussed depth
endoprosthetic reconstruction bone tumor resections proximal tibia advent successful adjuvant chemotherapy radiation therapy protocols primary malignant tumors development custom designed metallic endoprostheses made possible successful limb salvage procedure malignancies proximal tibia use medial gastrocnemius flap , proposed dr , critical soft tissue reconstruction routinely permits excellent active passive range motion patients article describes operative techniques technical considerations necessary successful proximal tibial endoprosthesis reconstruction
resection reconstruction soft tissue sarcomas extremity soft tissue sarcomas uncommon malignant tumors , diagnosis made early , patient 80 chance surviving treating soft tissue sarcomas , goal surgeon prolongation patient survival , total eradication local disease , functional deficits addition treatment , article discusses evaluation , histology , staging
allograft reconstructions shoulder bone tumor resections large skeletal defects resulting tumor resections shoulder create reconstructive challenges orthopedic surgeon bone allografts offer several advantages compared reconstructive techniques , functional outcomes generally satisfactory may used either grafts , segments create arthrodesis , combination standard proximal humerus metallic implants patient expectations specific oncologic factors must considered selecting optimal method reconstruction
resections reconstructions tumors distal radius primary objective surgical management patient distal radius tumor control disease accurate staging diagnostic methods applied preoperatively predict amount resection necessary obtain adequate tumor margins , also amount remaining bone soft tissues assist reconstruction information , method reconstruction chosen provides patient optimal long term function stability predictable results fewest potential complications
tumors shoulder girdle technique resection description surgical classification limb sparing surgery safe reliable bone soft tissue tumors shoulder girdle eighty ninety percent patients high grade sarcomas shoulder safely treated various surgical techniques described attention must paid appropriate patient selection , preoperative staging , planning addition , careful skeletal muscular reconstruction surgical defect necessary successful outcome new , universal , classification \( types vi \) shoulder girdle resections developed classification system based bones resected , status mechanism , relationship glenohumeral joint system permits easy description comparison various limb sparing procedures performed
cdna cloning sequencing human fibrillarin , conserved nucleolar protein recognized autoimmune antisera isolated 1 1 kilobase cdna clone encodes human fibrillarin screening hepatoma library parallel dna probes derived fibrillarin genes saccharomyces cerevisiae \( \) xenopus rna blot analysis indicates corresponding mrna approximately nucleotides length human fibrillarin expressed vitro sds gels 36 kda protein specifically immunoprecipitated antisera humans scleroderma autoimmune disease human fibrillarin contains amino terminal repetitive domain approximately 75 80 amino acids length rich glycine arginine residues similar amino terminal domains yeast xenopus occurrence putative rna binding domain consensus sequence within protein consistent association fibrillarin small nucleolar rnas protein sequence show 67 amino acids human fibrillarin identical yeast fibrillarin 81 identical xenopus fibrillarin identity suggests evolutionary conservation important function early pathway biosynthesis
free radical derived quinone methide mediates skin tumor promotion expanded role multistage carcinogenesis free radical derivatives , , thought mediate tumor promotion compounds , promoting activity phorbol esters attributed , part , ability stimulate cellular generation oxygen radicals metabolite , 2 , 6 di tert butyl 4 4 methyl 2 , 5 \( bhtooh \) , previously shown tumor promoter mouse skin bhtooh extensively metabolized murine keratinocytes several radical species primary radical generated bhtooh radical disproportionate form quinone methide , reactive since species previously postulated mediate tumor promotion , present study undertaken examine role promoting activity bhtooh biological activities two chemical analogs bhtooh , 4 bhtooh 4 tert butyl bhtooh , compared parent compound 4 bhtooh 4 tert butyl bhtooh reduced ability inability , respectively , form quinone methide however , like parent compound , generate radical incubated keratinocyte cytosol potency bhtooh , 4 bhtooh , 4 tert butyl bhtooh ornithine decarboxylase , marker tumor promotion , capacity generating quinone methide initial results confirmed two stage tumor promotion protocol female mice together , data indicate quinone methide mediating tumor promotion bhtooh , providing direct evidence intermediate elicit stage carcinogenesis
survival groin dissection malignant melanoma groin dissection performed 158 patients malignant melanoma \( superficial dissection , 76 patients radical dissection , 82 patients \) 63 patients palpable nodes , 57 patients \( 90 \) histologic involvement 93 patients nonpalpable nodes , 31 patients \( 33 \) histologically positive nodes 5 year survival rate patients histologically negative nodes \( n 69 \) 77 5 year survival rate patients histologically positive nodes \( n 89 \) 43 respective 5 year disease free survival rates 72 34 57 patients palpable , positive inguinal nodes , 21 patients \( 37 \) involvement deep nodes 31 patients nonpalpable , histologic involvement inguinal nodes , six patients \( 19 \) developed involvement deep nodes one two patients uncertain clinical status nodes preoperatively positive deep nodes prophylactic node dissection , frozen section inguinal group nodes provide reliable method , sampling errors , determining microscopic involvement nodes deciding whether superficial radical groin dissection done patients positive nodes 5 year survival rate 48 inguinal group involved 28 inguinal deep nodes involved respective 5 year disease free survival rates 39 20 survival therapeutic groin dissection may partly depend procedure patients positive , deep nodes undergoing dissection inguinal , iliac , nodes appreciable 5 year survival rate
role resection management melanoma metastatic adrenal gland melanoma metastatic adrenal gland diagnosed death exceedingly rare development computed tomographic \( ct \) scanning records 28 patients melanoma metastatic adrenal gland seen since 1975 reviewed eighteen patients men 10 women twenty three patients unilateral disease four patients diagnosed autopsy , leaving 24 analysis treatment survival twenty one patients received specific active immunotherapy , four received chemotherapy \( , , bleomycin , vincristine \) , three received diagnosis adrenal disease adrenal metastases diagnosed ct scanning 14 patients symptoms , 10 \( 91 \) pain ten patients diagnosed ct entry chemotherapy protocol eight patients underwent resection known disease , five underwent unilateral adrenalectomy , two underwent unilateral adrenalectomy bowel resection , one underwent bilateral adrenalectomy two patients underwent partial resection large unilateral tumors fourteen patients adrenal metastases disease elsewhere initiated continued chemotherapy treated symptomatically mean survival group underwent resection cure 59 months \( 3 112 months \) , whereas survival group unresectable tumors 15 months \( 1 5 132 months \) four eight patients underwent resection cure lived 5 years detection adrenal metastasis , whereas one 14 patients unresectable tumors true patients metastatic melanoma localized one adrenal glands may benefit early detection surgical intervention
evaluation preoperative computed tomography gastric malignancy ninety patients gastric malignancy underwent computed tomography \( ct \) surgery ct findings regarding neoplastic invasion adjacent organs metastasis enlarged lymph nodes compared findings laparotomy \( 85 cases \) autopsy \( 5 cases \) , thus permitting evaluation diagnostic accuracy ct usefulness predicting resectability present , neoplastic invasion adjacent organs overestimated underestimated ct 21 cases invasion adjacent organs according ct false positive 17 cases false negative 11 cases liver metastasis enlarged regional distant lymph nodes present , ct overestimated underestimated extent 17 cases , diagnosis false positive one case false negative 33 cases positive negative predictive values ct concerning resectability tumor 81 64 , respectively routine preoperative ct gastric malignancy concluded limited value surgical exploration , feasible , remains method choice
hepatoblastoma originating caudate lobe radically resected inferior vena cava complete resection rare hepatoblastoma caudate lobe , involving inferior vena cava \( ivc \) , reported systemic chemotherapy , 5 year old child underwent exploratory laparotomy another hospital , resection attempted tumor caudate lobe extensively ivc however , lack distant metastases also establishment extrahepatic collaterals confirmed imaging , thought possible radically resect tumor successfully performed extended left hepatic lobectomy including total excision caudate lobe involved portion ivc although reconstruct ivc , clinical manifestations arising caval congestion seen serum alpha fetoprotein value declined normal limit experience case introduced radical resectability hepatic malignancy caudate lobe , even extended ivc
partial total cancer squamous carcinoma remains uncommon tumor united states properly selected patient , partial total performed understanding salient surgical anatomy results adequate local control cancers excellent functional cosmetic results
primary hepatic carcinoid tumor electron microscopic immunohistochemical study case primary carcinoid tumor liver striking morphologic electron microscopic features reported conventional histologic examination showed prominent clear zone numerous tumor cells electron microscopic examination , clear zone corresponded mass intermediate filaments admixed granules cytoplasmic organelles
secretin provocation test diagnosis zollinger ellison syndrome secretin stimulation test become preferred provocative test suspected cases zollinger ellison syndrome pure secretin preparation , gastrin specific radioimmunoassay , appropriate sampling sequence important proper interpretation test gastric acid analysis necessary assessment confirm acid hypersecretion exclude properly performed interpreted , secretin provocation test offers safe , expeditious , reliable means evaluating patients
dna flow cytometry colorectal carcinoma correlation dna prognostic indices dna flow cytometry \( fcm \) performed paraffin embedded tissue blocks 38 surgically resected colorectal carcinomas \( \) forty seven percent tumors exhibited aneuploidy 53 diploid seventy two percent patients aneuploid 35 diploid group alive mean follow 30 7 28 8 months \( p 0 01 \) , 5 yr survival 56 7 11 7 , respectively \( p less 0 05 \) site tumor location , dukes' stage , serum cea level predict certain dna however , irrespective ploidy pattern , serum cea level greater 5 0 associated higher mortality poor 5 yr survival \( p less 0 005 \) similarly , advanced dukes' stage associated higher mortality \( p less 0 05 \) forty six percent patients lesions dukes' b2 advanced stage received adjuvant therapy eighty five percent subgroup patients died 18 patients aneuploid tumors role fcm assessment prognosis deserves clinical evaluation randomized control trial
magnetic resonance imaging small hepatocellular carcinoma thirty eight patients small hepatocellular carcinomas \( hccs \) , size less 20 mm , initially detected ultrasound \( us \) histologically confirmed , examined magnetic resonance \( mr \) imaging , computed tomographic \( ct \) scan , angiography mr imaging demonstrated hcc nodules nine \( 75 0 \) 12 patients tumors less 10 mm diameter 22 \( 84 6 \) 26 patients tumors 10 20 mm diameter total , hcc nodules detected 31 38 patients \( 81 6 \) mr imaging hand , hcc lesions found ct scan 14 26 patients \( 53 8 \) 27 35 patients \( 77 1 \) angiography mr imaging , hcc nodules demonstrated 21 31 patients t1 t2 weighted images , 13 21 patients \( 61 9 \) shown low intensity areas intensity areas t1 weighted image , whereas eight patients \( 38 1 \) shown high intensity areas 21 patients shown high intensity areas t2 weighted image among 15 resected cases , four patients high intensity area t1 weighted image , significant fatty change noted hcc nodules histological study resected specimen suggest mr imaging useful diagnostic imaging modality , even small hcc less 20 mm
intrahepatic lymphatics hepatic arteriography patient hepatocellular carcinoma extrahepatic lymph node metastases uncommon advanced cases hepatocellular carcinoma \( hcc \) account hcc case intrahepatic lymphatics running toward hepatic clearly hepatic arteriography patient treated hepatic artery embolization followed selective embolization portal branches , lymph node metastases hepatic later found follow clinical course case suggests communication tumor lymphatics responsible lymph node metastasis
inflammatory pseudotumor liver associated acute myelomonocytic leukemia patient inflammatory pseudotumor liver associated acute myelomonocytic leukemia \( m4 \) reported spiking fever , , elevated levels serum c reactive protein \( crp \) alkaline phosphatase \( alp \) ultrasonography showed hypoechoic mass liver , guided fine needle aspiration biopsy mass revealed composed fibrous connective tissue infiltrated plasma cells , eosinophils , neutrophils accordingly , diagnosis inflammatory pseudotumor liver made marked reduction size lesion decrease levels crp alp occurred without specific treatment emphasize importance guided aspiration biopsy diagnosis inflammatory pseudotumor liver without need surgery
endodermal sinus tumor ovary pregnancy case report serum alpha fetoprotein screening led detection endodermal sinus tumor ovary 24 year old female week 17 pregnancy surgery , chemotherapy week 28 levels serum alpha fetoprotein increased , delivery delayed 33 weeks' gestation delivery , patient received four chemotherapy courses \( cisplatin , etoposide , bleomycin \) mother \( 24 months last chemotherapy \) child well
laparoscopic pelvic lymphadenectomy staging early carcinoma cervix laparoscopic pelvic lymphadenectomy performed 39 patients incision peritoneum round pelvic ligament side gave access retroperitoneal space subsequently , laparoscopic surgery allowed precise dissection external internal iliac vessels , umbilical artery , nerve peritoneum left open , lymph drained peritoneal cavity lymphocele observed three 22 \( mean , 8 7 \) nodes removed , significant morbidity sensitivity specificity 100 preliminary experience thus possible remove first line regional lymph nodes cervix pathologic examination metastases quite rare early cervical carcinoma , risk missing positive node low brachytherapy alone , vaginal surgery , , microinvasive carcinoma , conization alone applied safely without need staging laparotomy cases negative nodes
value squamous cell carcinoma antigen patients locally advanced cervical cancer undergoing neoadjuvant chemotherapy serum levels squamous cell carcinoma antigen measured samples 119 patients cervical cancer ninety seven patients primary tumors 22 recurrent disease serum samples obtained cycle chemotherapy , surgery , least 4 weeks surgery , 2 3 month intervals follow 78 patients locally advanced cervical cancer receiving neoadjuvant chemotherapy squamous cell carcinoma antigen serum levels elevated \( greater 2 5 ng ml \) 71 patients primary tumors 77 patients recurrent carcinomas percentage positivity increased significantly stage \( p 0 03 \) higher squamous cell tumors adenocarcinomas \( p less 0 001 \) pretreatment squamous cell carcinoma antigen levels predictive neoadjuvant chemotherapy response however , serial measurement chemotherapy showed good correlation clinical response patients surgery , squamous cell carcinoma antigen positivity correlate pathologic findings \( lymph node status , cervical parametrial infiltration \) disease free survival significantly longer patients squamous cell carcinoma antigen pretreatment values lower 5 ng ml , compared patients marker higher 5 ng ml \( p less 0 01 \) abnormal squamous cell carcinoma antigen serum levels preceded clinical detection recurrence eight 11 patients median lead time 5 months
epidermal growth factor receptor expression normal ovarian epithelium ovarian cancer correlation receptor expression prognostic factors patients ovarian cancer previous studies breast bladder cancer suggested epidermal growth factor receptor expressed proportion cancers associated poor clinical outcome used monoclonal antibody specifically reactive extracellular domain epidermal growth factor receptor localize receptor immunohistochemically frozen sections normal ovary epithelial ovarian cancer normal ovarian epithelium found express epidermal growth factor receptor cases among 87 ovarian cancers , however , 23 express immunohistochemically detectable receptor epidermal growth factor receptor expression related histologic grade stage , associated poor survival \( p less 0 05 \) median length survival patients tumors express epidermal growth factor receptor 40 months compared 26 months patients tumors express epidermal growth factor receptor breast bladder cancer , expression epidermal growth factor receptor ovarian cancer appears poor prognostic factor
detection loss heterozygosity formalin fixed paraffin embedded tumor specimens polymerase chain reaction polymerase chain reaction based procedure used detection dna length polymorphisms generated naturally occurring genetic deletions insertions known sequence method consists simple one step assay require restriction enzyme analysis southern blot hybridization , allowing identification bromide stained gels procedure described used detect loss heterozygosity various loci , including beta globin gene cluster , chemically induced mouse skin tumors , using variety tissue preparations , including formalin fixed , paraffin embedded specimens , short term cultures , fluorescence activated cell epithelial populations approach may useful detecting tumor specific reduction polymorphic chromosomal loci , allowing mapping putative tumor suppressor loci involved carcinogenesis
characterization neoplastic lesions rat pancreas nodules acinar cells increased proliferative potential develop pancreas carcinogen treated rats untreated aged rats large nodules adenomas phenotypic genotypic characteristics nodule cells compared normal pancreas transplantable acinar cell carcinomas several methods nuclei acinar cells normal pancreas , adenomas , three carcinomas situ normal diploid dna content determined flow cytometry one two primary carcinomas dna content two three transplantable carcinomas aneuploid dna content tetraploid range explants nodules adenomas failed grow soft agar , whereas several carcinomas positive assay primary carcinoma serially transplanted , transplantation nodules adenomas failed transfection dna carcinomas situ yielded higher frequency nih 3t3 dna adenomas dnas contain ras sequences studies indicate cells nodules adenomas low growth potential lack critical phenotypic genotypic characteristics transformed malignant cells present primary transplanted carcinomas
induction different morphologic features malignant melanoma pigmented lesions transformation murine melanocytes bfgf cdna h ras , myc , neu , e1a oncogenes malignant melanomas show remarkable degree heterogeneity different morphologic features , biologic behavior , prognosis communication , authors attempted correlate morphologic heterogeneity melanomas transformation different activated oncogenes studied histologic features melanocytic lesions induced murine melanocytes transformed basic fibroblast growth factor \( b cdna \) h ras , neu , myc , e1a oncogenes , lesions compared observed human pathology tumors formed grafting onto mice subcutaneous injections nude mice studied mice , benign melanocytic lesions intradermal nevus observed melanocytes transformed b cdna , myc e1a oncogenes benign lesions also formed neu transformed melanocytes grafted concomitantly keratinocytes , whereas malignant tumors formed cells grafted alone together fibroblasts contrast , h ras melanocytes always formed malignant tumors nude mice , b transformed melanocytes induced benign lesions , whereas transformed melanocytes oncogenes formed malignant tumors distinctive homogeneous morphologic features depended transforming oncogene melanomas either epithelioid cell , spindle cell , small round cell , anaplastic cell growth patterns could distinguished transformation h ras , neu , e1a , myc oncogenes , respectively various histologic types analogous may observed human melanomas , even within tumor studies suggest possible molecular mechanism tumor heterogeneity distinct oncogenes activities activated different tumors discrete parts tumor
treatment angiomas sclerosing injection authors discuss indications sclerosing treatment angiomas , particular reference cavernous , venous , angiomas \( ie , immature angiomas fail eight ten months \) moreover , sclerosing agent may employed , connection embolization subsequent surgery , arteriovenous angiomas relevant cutaneous subcutaneous development authors successfully used interstitial sclerosing technique , according method technique involves interstitial injections obtain sclerosis thin fibrous tissue stroma blood vessels sclerosing therapy may cause complete regression low flow angiomas , least , partial reduction simplifies ensuing surgical excision case partial regression obtained sclerosing therapy , surgery remaining causes lesser degree bleeding \( especially areas particularly surgical exploration , ie , oral cavity \) increased reliability intervention \( due also reduced size lesion \) better results aesthetic functional point view
intraoperative pancreatic fine needle aspiration biopsy results 166 patients intraoperative fine needle aspiration biopsy \( nab \) undiagnosed pancreatic masses studied 166 patients 17 year period cytologic diagnoses correlated histologic specimens , autopsy results , clinical follow \( benign disease documented patient alive without malignancy least 2 years laparotomy \) aspirates interpreted benign , suspicious , malignant , unsatisfactory malignant disease final diagnosis 109 patients cytology concordant 101 interpreted suspicious four four patients benign cytology later proved malignant disease false negative rate 2 5 per cent total 57 patients benign disease 51 benign cytology remaining patients unsatisfactory cytology reports 93 per cent sensitivity , 100 per cent specificity , 0 per cent complication rate reported false positive cytology reports complications rare represent case reports , thus , additional sampling minimal risk intraoperative pancreatic nab safe , easy , accurate biopsy technique historical wedge core needle biopsies biopsy method choice pancreatic masses found laparotomy
surgical voice restoration prosthesis following anastomosis surgical voice restoration using technique well established procedure patients undergone simple laryngectomy operations carcinoma extensive require reconstruction using regional skin myocutaneous flaps , colon , jejunum , stomach report use prosthesis four patients undergone repair following failed achieve satisfactory voice patients initially developed good speech using prosthesis two patients subsequently prostheses removed one recurrent malignant disease one procedure significantly altered quality voice remaining two patients continued use device 2 5 years insertion good voice production
selenium cancer mortality u counties potential protective effect selenium status risk developing cancer examined animal epidemiologic studies ecological study investigated association u county selenium status site sex specific county cancer mortality rates \( 1950 1969 \) using weighted least regression consistent , significant \( p less 01 \) inverse associations observed cancers lung , rectum , bladder , esophagus , cervix model limited rural counties cancers lung , breast , rectum , bladder , esophagus , corpus uteri model counties consistent significant positive associations observed rural county models remarkable degree consistency inverse associations strengthens likelihood causal relationship low selenium status increased risk cancer mortality
rapid analysis carcinoembryonic antigen levels gallbladder bile identification patients high risk colorectal liver metastasis recently found carcinoembryonic antigen \( cea \) levels gallbladder bile may sensitive method detect colorectal liver metastases humans methods used past detection cea various body fluids time consuming , requiring acid extraction , extensive dialysis , column purification single step , solid phase radioimmunoassays , designed specifically serum cea analysis , developed commercially replace methods parameters methodology necessary adapt parameters methodology necessary adapt use gallbladder bile presented combination pretreatment procedures bile , radioimmunoassay , permit rapid , reproducible , accurate measurement cea levels gallbladder bile
liver transplantation hepatoblastoma american experience current role liver transplantation treating malignant tumors liver uncertain , except select histologic types pooled data results liver transplantation 12 children hepatoblastoma presented one half children alive 24 70 \( 44 19 \) months transplantation evidence recurrence three patients \( 25 \) died tumor recurrence three \( 25 \) died causes intrahepatic tumors associated better prognosis compared multifocal tumors tumors extrahepatic spread \( p 0 04 0 13 \) microscopically vascular invasion predominance embryonal anaplastic epithelium associated poor prognosis compared tumors vascular invasion predominantly fetal epithelium \( p 0 08 0 1 \) concluded continued efforts treat unresectable liver transplantation justified role adjuvant chemotherapy improving results needs better defined
population based study functional status social support networks elderly patients newly diagnosed cancer assessed functional status social support networks men women aged 65 years older newly diagnosed cancer living six new mexico counties functional limitations included depending others transportation \( 33 \) mental incompetence poor recent memory \( 42 \) percentage patients functional limitation increased sharply increasing age substantial number patients also evidence poor social support networks 26 5 subjects lived alone 38 9 children living vicinity multiple logistic regression analysis , predictors poor social support network included non hispanic white ethnicity , advanced age , low income , recent area subjects functional limitations likely poor social support networks subjects without limitations deleterious combination impaired functional status limited social support network may explain elderly cancer patients increased risk receiving appropriate therapy given potential involving evaluation appropriate treatment cancer , care must taken adequately assess functional status support mechanisms older patients , provide adequate support ensure compliance treatment
recurrent pigmented melanocytic nevus benign lesion , mistaken malignant melanoma melanocytic nevi recur incomplete removal pigmented lesions may clinically pathologically simulate malignant melanoma situ five examples recurrent pigmented melanocytic nevus , emphasis light microscopic immunohistochemical findings , reported herein prominent 45 staining nevi may cause confusion differentiating malignant melanoma differential diagnosis recurrent pigmented melanocytic nevi discussed , particular emphasis distinguishing lesions malignant melanoma immunohistochemical observations indicate recurrences likely develop result proliferation melanocytes remaining epidermis following incomplete removal approach management recurrent nevi also discussed
secretory carcinoma breast studies secretory carcinoma breast single case reports separate analyses problem either children adults studied 10 female patients , aged 5 87 years patients presented palpable mass , often near five six tumors estrogen receptor negative three analyzed progesterone receptor positive histologic patterns present varying proportions classic secretory carcinoma , abundant secretion papillary features , prominent solid papillary features tumors strong reactivity alpha , , carcinoembryonic antigen \( polyclonal \) negative gross cystic disease fluid protein anti carcinoembryonic antigen \( monoclonal \) six patients mastectomy four local excision none axillary nodal metastases initially follow 3 72 months \( mean , 47 months median , 48 months \) , two patients treated local excision local recurrences , one patient axillary nodal metastases patients alive comparison patients 30 years age revealed one important difference younger patients longer interval detection biopsy 30 vs 2 months treatment recommendations initial wide excision low axillary dissection cases , patients , strong effort preserve breast without local control
intraluminal immunohistochemical , dna flow cytometric , ultrastructural study recently encountered unique case follicular variant papillary carcinoma arising contained numerous evidence capsular vascular invasion metastases , though dna content papillary carcinoma aneuploid contrast , diploid dna manifested histologically benign thyroid tissue nature significance aneuploid dna content discussed
tall cell variant papillary carcinoma thyroid gland comparison common form papillary carcinoma dna morphometric analysis tall cell variant papillary carcinoma thyroid aggressive behavior usual form papillary carcinoma thyroid morphometric analysis nuclear features dna analysis may yield information predictive aggressive behavior accordingly , dna content morphometric features neoplastic cells tall cell variant measured compared measurements obtained neoplastic cells usual form papillary carcinoma six 11 tall cell neoplasms aneuploid , four eight usual papillary neoplasms although benign cells separated malignant cells case , differences tall usual papillary carcinoma cells observed regarding dna content , chromatin , nuclear size shape differences clinical behavior neoplasms likely need explained basis characteristics
squamous cell carcinoma situ arising ovarian mature cystic teratoma report one case histopathologic , cytogenetic , flow cytometric dna content analysis squamous cell carcinoma situ arose ovarian mature teratoma \( ie , cyst \) 62 year old woman flow cytometric dna content analysis paraffin embedded situ carcinoma showed normal dna content moderate high proliferative activity \( phase fraction estimate , 16 18 \) cytogenetic analysis situ cancer benign cystic portion tumor revealed 46 , karyotype addition , benign cystic portion tumor revealed homozygous chromosomal , compared heterozygous markers found peripheral blood lymphocytes results show squamous cell carcinoma situ euploid suggest mature cystic teratoma derived single germ cell
extramammary paget 's disease bronchial epithelium report first case , knowledge , extramammary paget 's disease bronchial epithelium tumor displayed paget 's cells scattered within bronchial epithelium lesion , infiltrating bronchial submucosa pulmonary parenchyma papillary patterns area addition histologic findings coexistence components , situ involvement bronchial glands ducts paget 's cells observed , suggesting extramammary paget 's disease bronchial epithelium may variant pulmonary adenocarcinoma , associated bronchial glands
adult common acute lymphoblastic leukaemia \( c \) presenting skin infiltration 22 year old man presented multiple raised erythematous skin lesions , epistaxis diagnosis common acute lymphoblastic leukaemia \( c \) made morphological , cytochemical , immunological cytogenetic examination peripheral blood bone marrow biopsy skin revealed infiltration similar cells
monoclonal antibody purged autologous bone marrow transplantation therapy multiple myeloma eleven patients plasma cell underwent high dose chemoradiotherapy anti b cell monoclonal antibody \( moab \) treated autologous bone marrow transplantation \( abmt \) majority patients advanced stage myeloma diagnosis , pretreated chemotherapy , six received prior radiotherapy time abmt , patients demonstrated good performance status karnofsky score 80 greater less 10 marrow tumor cells eight patients residual monoclonal marrow plasma cells 10 patients following high dose melphalan total body irradiation \( tbi \) seven complete responses , three partial responses , one toxic death granulocytes greater 500 mm3 noted median 21 \( range 12 46 \) days posttransplant \( pt \) platelets greater 20 , 000 mm3 noted median 23 \( 12 53 \) days pt 10 11 patients natural killer cells cytotoxic suppressor cells predominated early pt , return b cells 3 months pt normalization t4 ratio 1 year pt less 5 polyclonal marrow plasma cells noted patients transplant three seven complete responders return , two myeloma , subsequently responded alpha 2 interferon therapy eight patients alive 18 9 \( 8 9 43 1 \) months pt four remain disease free 12 3 , 17 5 , 18 9 , 29 months pt preliminary study confirms high dose melphalan tbi achieve high response rates without unexpected toxicity patients sensitive disease , moab based purging techniques inhibit engraftment although follow short long term outcome determined , relapses post abmt heavily pretreated patients suggest abmt alternative treatment strategies evaluated earlier disease course
beta globin 3' enhancer element confers regulated expression human gamma globin gene human embryonic fetal erythroleukemia cell line k562 constructed fusion genes comprised gamma beta globin elements globin sequences linked neomycin resistance \( \) genes define cis acting sequences responsible developmental stage specific expression induction fetal globin genes embryonic fetal erythroleukemia k562 cells results indicate gamma promoter required proper initiation transcription however , accumulation gamma globin transcripts response induction requires additional presence either gamma intervening sequence 2 3' enhancer element beta globin gene thus , gamma promoter may provide elements developmental stage specific gene expression fetal life contrast , beta 3' enhancer erythroid specific developmental stage gene specific
detection residual leukemia bone marrow transplant chronic myeloid leukemia role polymerase chain reaction predicting relapse used polymerase chain reaction \( pcr \) detect residual leukemia specific mrna blood marrow 37 patients complete hematologic cytogenetic remission allogeneic bone marrow transplant \( bmt \) chronic myeloid leukemia \( cml \) two step pcr method involved use primers second step could detect one k562 cell diluted 10 \( 5 \) normal cells measures taken exclude false positive false negative results nine patients whose blood marrow studied simultaneously results concordant \( two positive seven negative \) twenty three patients transplanted chronic phase \( cp \) donor marrow studied blood cells nine patients studied 3 6 months post bmt six pcr positive three negative subsequent studies blood cells 18 patients studied 8 months 8 years post bmt pcr negative nine patients transplanted cp cell depleted marrow cells studied blood five positive 3 24 months post bmt blood five negative 3 6 years post bmt four patients longer first cp studied bmt donor marrow blood four positive 5 19 months post bmt based known clinical results transplant three cohorts conclude pcr may positive within 6 months bmt patients expect long lasting remission , whereas pcr positivity later bmt may indicate probability cure reduced thus , technique may prove useful early assessment new transplant protocols might increase risk relapse
reliability palpation assessment tumours joint classification cervical lymph nodes based mainly size nodes recognized error palpation , detecting presence tumour also size study used animal tumour model system compare ability 6 independent observers varying experience detect stage transplanted preclinical medical student good consultant ent surgeon predicting presence tumour ability stage tumours accurately related experience whilst experienced observers accurately estimated size tumours less 2 cm , less accurate larger \( greater 2 cm \) tumours constantly phenomenon may important clinical implications particularly related current nodal staging criteria
epidemiology primary osteogenic sarcoma san francisco bay area california epidemiologic study represents analysis registered new cases osteogenic sarcoma \( ogs \) 14 year period january 1973 december 1986 five san francisco bay counties inclusion study limited patients diagnosed first three decades life residents within bay area time diagnosis determine epidemiologic characteristics ogs , records 96 patients bay area resources cancer control histologically proven ogs reviewed incidence ogs influenced age , gender , race , none effects statistically significant geographic variation incidence ogs discovered , although statistically significant results presented support continued search environmental variables may reveal etiologic factors ogs
solitary fibromatosis bone rare variant congenital generalized fibromatosis congenital generalized fibromatosis part spectrum infancy childhood lesions usually multiple fibrous nature may appear virtually every organ outside central nervous system congenital generalized fibromatosis limited skeleton rarely solitary bone lesion solitary osseous lesions often behave differently multiple osseous lesions solitary lesions often regress without treatment high incidence recurrence less marginal excision multiple osseous lesions often regress without treatment
assessment squamous cell carcinoma antigen \( scc \) marker epidermoid carcinoma anal canal measured squamous cell carcinoma antigen \( scc \) epidermoid carcinoma anal canal 66 patients samples taken diagnosis , treatment , follow samples analyzed positive threshold taken 2 ng ml diagnosis , sensitivity marker 44 percent specificity 92 percent series , level scc correlate clinical staging system , correlate nodal invasion \( p less 0 05 \) prognostic value time diagnosis follow , relapse level scc 20 3 43 ng ml increase significant \( p less 0 01 \) sensitivity marker 77 percent patients relapsed , development illness correlates level scc , prognostic value \( p less 0 01 \) conclusion , level scc associated clinical follow patients epidermoid carcinoma anal canal
anti tumor x anti lymphocyte heteroconjugates augment colon tumor cell lysis vitro prevent tumor growth vivo cross linking anti tumor antibody , specific tumor cell surface antigens , anti lymphocyte antibody , specific lymphocyte receptor complex \( tcr cd3 \) , produces direct cells lyse tumor cells tested ability anti tumor x anti lymphocyte \( cd3 \) heteroconjugates human peripheral blood lymphocytes \( pbls \) lyse human colon cancer cells cytotoxicity assays murine colon tumor model demonstrated vitro , cultured human pbls alone produced low levels tumor lysis , pbls treated anti tumor x anti cd3 heteroconjugates produced significantly greater tumor cell lysis \( p less 0 0025 \) similarly , nude mice injected human colon cancer cells treated cultured human pbls anti tumor x anti cd3 heteroconjugates survived significantly longer saline control mice \( p less 0 01 \) , mice treated pbls alone \( p less 0 01 \) , heteroconjugates alone \( p less 0 05 \) f \( ab' \) 2 heteroconjugates equally effective animal survival , irrelevant heteroconjugates monoclonal anti tumor antibodies showed therapeutic benefit anti tumor x anti cd3 heteroconjugates may represent effective approach tumor specific cellular immunotherapy
polyamine levels healthy tumor tissues patients colon adenocarcinoma tissue polyamine levels determined patients colon adenocarcinoma try identify biochemical indicators able characterize growth metabolism human solid tumors polyamine content determined tumor healthy mucosa sampled different distances within resection edges patient polyamine content tumor compared mucosa results demonstrated concentration higher tumor healthy mucosa differences statistically significant however , tumor increased lesser degree statistically significant differences observed among different , concentration mucosa tumor showed values close neoplasia
isolation characterization normal neoplastic colonic epithelial cell populations aim present study characterize rat mucosal colonic cells harvested crypt continuum differentiation induced neoplasia collection colonocytes performed using modified nonenzymatic isolation procedure based ca2 mechanical dissociation light electron microscopy examinations , 3h thymidine incorporation studies , activity gradients alkaline phosphatase , thymidine kinase , cytoskeleton associated protein tyrosine kinase indicated distinct cell populations harvested various crypt regions temporal sequence zonal functional distribution situ administration , marked protein tyrosine kinase activity noted colonic cells harvested upper crypt zones sustained kinase activity preceded actual polyp tumor formation observation consistent expansion colonic proliferative compartments beyond boundaries period studies human colonic epithelial specimens findings observed normal transformed murine colonocytes believed characterization manipulation colonocytes using vitro model provide important clues molecular events underlying differentiation program carcinogenic process colonic cell
human cd5 b cell clone idiotype specific high affinity igm monoclonal antibody previously demonstrated occurrence naturally arisen human anti idiotypic b cell clone , transformed ebv \( \) show evidence expresses cd5 surface ag , also contains 2 7 kb mrna transcript encoding protein addition , show presence 3 6 kb mrna precursor ig produced cd5 b cells natural igm antibodies encoded copies vh genes however , study present data demonstrating high affinity anti idiotypic antibody \( \) produced data agreement previous observations , showing vh chain encoded extensive mutated gene way consistent ag driven immune response possible role remarkable anti idiotypic antibody maintenance b cell memory discussed
mhc restricted recognition autologous melanoma tumor specific cytotoxic cells evidence restriction dominant hla allele autologous melanoma specific ctl recognize common tumor associated ag \( taa \) context hla class antigens demonstrated hla a2 restricting ag , cell lines homozygous hla a2 , ctl generated stimulation hla a2 allogeneic melanomas current study , investigated cell lines patients heterozygous hla region locus , determine relative importance region allele mhc restricted recognition tumor shown hla a1 restricting ag , allogeneic melanomas expressing hla a1 substitute autologous tumor generation hla a1 restricted ctl however , cell lines express hla a1 hla a2 , hla a2 allele restriction melanoma taa three autologous stimulated hla a1 , a2 ctl lines demonstrated restriction hla a2 allele , examined cytotoxicity assays , cold competition assays , proliferation assays evidence restriction second hla allele , hla a1 although autologous stimulated ctl use single region allele tumor recognition , autologous hla a1 , a2 tumors lysed hla a1 restricted hla a2 restricted ctl restricting alleles demonstrated hla matched allogeneic melanomas used stimulating tumor generate tumor specific ctl stimulation heterozygous \( hla a1 , a2 \) lymphocytes hla a2 matched allogeneic melanomas resulted ctl specific autologous tumor , restricted hla a2 ag however , stimulation hla a1 matched allogeneic melanoma failed induce tumor specific ctl restricted hla a1 ag data suggest hla region ag level cell , one restricting recognition autologous melanoma level tumor , however , taa expressed context hla region alleles generate specific ctl lymph node cells pbl hla region matched allogeneic melanomas however , patients heterozygous hla region locus , understanding dominant restricting alleles must obtained appropriately matched allogeneic melanoma selected
cytotoxic cell clones isolated ovarian tumor infiltrating lymphocytes recognize multiple antigenic epitopes autologous tumor cells ctl clones developed tumor infiltrating lymphocytes \( \) ascites patient ovarian carcinoma autologous tumor cells subsequent cloning presence autologous tumor cells ctl clones expressed preferential cytolytic activity autologous tumor cells allogeneic ovarian tumor cells nk sensitive cell line k562 cytolytic activity ctl autologous tumors inhibited anti tcr \( mab \) , anti hla class , anti cd3 mab nk function antibody leu cloning autologous tumor cells vitro revealed ctl clones ovarian expressed differential abilities lyse autologous tumor cell clones specificity analysis autologous tumor specific ctl suggested recognize several antigenic determinants present ovarian tumor cells results indicate presence least three antigenic epitopes tumor cells \( designated ova 1a , ova 1b , ova 1c \) , one \( ova 1c \) unstable determinants present either simultaneously separately , six types ovarian clones distinguished basis expression results indicate ctl detect antigenic heterogeneity novel heterogeneity identified within ovarian tumor cells report may significance understanding cellular immunity ovarian cancer developing adoptive specific immunotherapeutic approaches ovarian cancer
evidence functional binding vivo tumor rejection antigens antigen presenting cells tumor bearing hosts spleen cells balb c mice bearing syngeneic csa1m fibrosarcoma treated anti thy 1 2 antibody plus c , yielding cell depleted , apc containing fraction apc containing fraction first tested capacity present exogenous modified self another tumor \( meth \) ag vitro pulsing results showed comparable ag presenting capacities obtained apc containing fraction normal spleen cells , indicating apc function affected tumor bearing mice next examined whether apc csa1m bearing mice bind endogenously generated csa1m tumor ag onto surfaces stimulate tumor specific cells five inoculation apc containing fraction csa1m bearing mice without vitro pulsing resulted induction potent anti csa1m immune resistance involvement anti csa1m cells induction anti csa1m immunity excluded fact vivo immunity excluded fact vivo immunity delivered thy 1 cell depleted , thy 1 cell enriched fractions spleen cells csa1m bearing mice moreover , failure sephadex passed spleen cells deliver anti csa1m resistance demonstrated absolute requirement apc inducing vivo immunity finally , vivo resistance found tumor specific , apc fractions csa1m bearing meth bearing balb c mice induced immune resistance selective corresponding tumor cell challenge results indicate apc tumor bearing hosts exert unaffected apc function exogenous ag , also function present tumor ag generated endogenously tumor bearing state produce tumor specific immunity vivo
multiple spinal epidural metastases unexpectedly frequent finding prospective study , patients known malignant disease suspected spinal epidural metastasis , myelography confined clinically suspected site , included least whole lumbar thoracic spinal canal fifty four 106 myelograms revealed least one epidural metastasis twelve 54 myelograms showed two separate lesions , four myelograms showed three separate lesions 16 cases multiple lesions least one lesions asymptomatic time diagnosis concluded multiple spinal epidural metastases common occurrence occur one third cases finding may important clinical implications examination spinal canal epidural metastases confined clinically suspected site , include extensive area possible spinal canal , whatever technique used
gemistocytic astrocytomas reappraisal although gemistocytic astrocytomas considered slow growing astrocytomas , often behave clarify biological clinical behavior rare tumors , authors retrospectively identified 59 patients gemistocytic astrocytoma whose tumors diagnosed treated june , 1976 , july , 1989 three patients lost follow review excluded , two whose original slides could obtained three whose tumors diagnosed recurrence autopsy pathological material remaining 51 patients reviewed using two sets histological criteria thirteen patients \( group \) pure gemistocytic astrocytoma , defined glial tumor 60 high power field background astrocytes fifteen patients \( group b \) mixed gemistocytic astrocytoma , defined glial tumor 20 60 high power field background anaplastic astrocytes twenty three tumors meet criteria excluded analysis median age patients 48 5 years group 38 3 years group b \( p less 0 05 \) groups , median karnofsky performance scale score greater 90 patients underwent surgical procedures \( four total 19 partial resections , five biopsies \) postoperative radiation therapy majority also interstitial brachytherapy , chemotherapy , ten patients one reoperation tumor recurrence one two reoperations treatments recurrence included brachytherapy , chemotherapy , repeat irradiation four patients originally underwent gross total resection still alive five biopsy died significant difference median survival times groups 136 5 weeks group \( range 10 310 weeks \) 135 6 weeks group b \( range 31 460 weeks \) analysis 28 patients showed better prognosis patients less 50 years age \( 185 vs 36 weeks survival time p less 0 001 \) , patients preoperative symptoms lasting 6 months \( 228 1 vs 110 2 weeks survival time p less 0 05 \) , patients seizures first symptom \( 185 7 vs 80 weeks survival time p less 0 01 \) survival time correlate presence perivascular lymphocytic infiltration authors conclude presence least 20 glial neoplasm poor prognostic sign , irrespective pathological background proposed gemistocytic astrocytomas classified anaplastic astrocytomas treated accordingly
improved survival use adjuvant chemotherapy treatment medulloblastoma 1975 1989 , 108 children newly diagnosed medulloblastoma primitive neuroectodermal tumor \( mb pnet \) posterior fossa treated authors' institution patients managed uniformly , treatment included aggressive surgical resections , postoperative staging evaluations extent disease , radiation therapy local boost beginning 1983 , children mb pnet prospectively assigned risk groups standard risk mb pnet treated radiation therapy alone , poor risk group received similar radiation therapy plus adjuvant chemotherapy 1 \( 2 \) 3 1 nitrosourea \( ccnu \) , vincristine , cisplatin 5 year actuarial disease free survival rate patients treated 1975 1982 68 , 73 patients died within 2 weeks operation excluded survival rate statistically better patients treated 1982 \( 82 \) compared treated 1975 1982 \( 49 \) \( p less 0 004 \) difference disease free survival rates time children standard risk factors however , significant difference 5 year survival rate poor risk patients treated prior 1982 \( 35 \) compared treated later \( 87 \) \( p less 0 001 \) group whole , younger age diagnosis correlated poorer survival rate however , relationship age outcome significant children treated 1983 \( p less 0 001 \) results demonstrated encouraging survival rate children mb pnet , especially treated aggressive surgical resection followed radiation therapy chemotherapy results strongly suggest chemotherapy role , possibly , children mb pnet
interstitial chemotherapy drug polymer implants treatment recurrent gliomas malignant gliomas difficult treat chemotherapy effective agent , bcnu \( \) , considerable systemic toxicity short half life serum obviate problems , method developed local sustained release chemotherapeutic agents incorporation polymers implantation drug polymer tumor site allows prolonged local exposure minimal systemic exposure phase ii study , 21 patients recurrent malignant glioma treated bcnu released means polymer implant eight polymer placed resection cavity intraoperatively , upon completion tumor debulking polymer releases therapeutic drug approximately 3 weeks three increasing concentrations bcnu studied treatment well tolerated three levels adverse reactions bcnu treatment average survival period reoperation 65 weeks first dose group , 64 weeks second dose group , 32 weeks highest dose group overall mean survival time 48 weeks reoperation 94 weeks original operation overall median survival times 46 weeks 87 weeks initial surgery eighteen \( 86 \) 21 patients lived 1 year time initial diagnosis eight \( 38 \) 21 patients lived 1 year intracranial implantation polymer frequent hematology , blood chemistry , urinalysis tests reveal systemic effect interstitial chemotherapy since therapy well tolerated safe , placebo controlled clinical trial started trial measure effect second treatment dose survival patients recurrent malignant glioma
characterization astrocytomas , meningiomas , pituitary adenomas phosphorus magnetic resonance spectroscopy phosphorus magnetic resonance \( mr \) spectroscopy allows noninvasive measurement phosphate containing compounds ph within brain cells authors obtained localized phosphorus mr spectra 10 normal brains , four low grade astrocytomas , six glioblastomas , four meningiomas , three pituitary adenomas found differences spectra tumor type compared normal brain , spectra low grade astrocytomas showed significant reduction \( pde \) peak glioblastomas characterized significant reduction pde peak , elevation phosphomonoester \( pme \) peak , relatively alkaline intracellular ph spectra meningiomas pituitary adenomas markedly different glial tumors meningiomas showed significant reductions phosphocreatine , pde , inorganic phosphate , well relatively alkaline ph pituitary adenomas resembled meningiomas , much higher pme peak although number tumors studied small , appears characteristic spectrum associated different tumor types present findings useful preoperative identification tumors understanding growth metabolism vivo
sciatic nerve case report authors report case arising sciatic nerve found invasive within sparing surrounding tissues adequate resection required sacrifice nerve added short list peripheral nerve tumors
dose dependency time onset radiation induced growth hormone deficiency growth hormone \( gh \) secretion insulin induced hypoglycemia assessed 133 occasions 82 survivors childhood malignant disease received cranial irradiation dose range hypothalamic pituitary axis 27 47 5 gy \( estimated schedule 16 fractions 3 weeks \) tested one occasions 0 2 18 9 years treatment results one third gh tests defined normal \( gh peak response , greater 15 mu l \) within first 5 years , comparison 16 5 years stepwise multiple linear regression analysis showed dose \( p 0 007 \) time irradiation \( p 0 03 \) , age therapy , significant influence peak gh responses late incidence gh deficiency similar whole dose range \( 4 26 gh test results normal less 30 gy 4 25 normal greater equal 30 gy 5 years \) , speed onset first years dependent dose conclude requirement gh replacement therapy timing introduction influenced dose irradiation received hypothalamic pituitary axis
deep femoral lymphadenectomy preservation fascia preliminary report 42 invasive vulvar carcinomas forty two patients primary invasive vulvar carcinoma treated radical deep femoral lymphadenectomy preservation fascia cribriform fascia rationale using technique based anatomic knowledge topographic distribution groin lymph nodes , confirmed study 50 cadavers preliminary data show number superficial deep femoral lymph nodes removed 42 patients \( mean number nodes , 20 range , 8 32 \) similar number reported anatomy addition , five year actuarial survival rate , 70 , comparable literature preliminary results suggest surgical technique used study radical oncologic procedure way 's classic groin lymphadenectomy , consists removing fascia cribriform fascia
breast self examination relation occurrence advanced breast cancer two hundred nine female enrollees group health cooperative sound developed advanced stage breast cancer period 1982 1988 interviewed practice breast self examination \( bse \) , use breast cancer screening modalities , medical reproductive histories subject 's description performed examination scored according 10 recommended bse techniques random sample women without advanced stage breast cancer population interviewed comparison relative women practicing bse , risk advanced stage breast cancer among bse users 1 15 \( 95 confidence interval , 0 73 1 81 \) frequency bse differ women advanced stage breast cancer control subjects , whether subjects subgroups defined age , use mammography , frequency clinical breast examinations self described proficiency bse generally low case control subjects , small percentage women reporting thorough self examinations , regardless frequency , 35 decrease occurrence advanced stage breast cancer compared women perform bse results suggest , carefully performed bse may avoid development advanced stage breast cancers , bse seattle area women little benefit
expression gene nm23 human breast cancer association good prognosis nm23 gene identified murine melanoma cells , expression associated metastatic potential expression nm23 detected human breast tumors means hybridization immunocytochemistry measured nm23 mrna 71 patients primary breast cancer found variable levels nm23 expression nm23 gene expressed higher levels well differentiated tumors \( p less 02 \) significant inverse relationship nm23 expression nodal status \( p less 02 \) expression nm23 positively associated longer disease free survival overall survival , relationships significant \( p less 002 p less 003 , respectively \) study showed nm23 expression human breast cancer associated good prognosis lack lymph node metastasis suggests nm23 gene product may play important role suppressing metastatic phenotype
long term follow patients recurrent malignant gliomas treated adjuvant adoptive immunotherapy august 1986 october 1987 , denver brain tumor research group conducted clinical trial using autologous human recombinant interleukin 2 \( ril 2 \) activated lymphocytes treat 20 patients recurrent high grade gliomas trial involved surgical resection decompression followed intracavitary implantation lymphokine activated killer \( lak \) cells autologous stimulated lymphocytes \( \) along ril 2 plasma clot one month later , stimulated lymphocytes ril 2 infused reservoir attached catheter directed tumor bed lak cells ril 2 activated peripheral blood lymphocytes cultured 4 days lectin ril 2 activated peripheral blood lymphocytes cultured 10 days 20 patients treated , 11 evaluated group \( mean age , 44 years , range , 15 61 years mean karnofsky rating , 69 , range , 50 100 mean dose entry , 14 mg , range , 0 32 \) average number lymphocytes implanted 7 6 x 10 \( 9 \) \( range , 1 9 27 5 x 10 \( 9 , together 1 4 x 10 \( 6 \) u ril 2 date , 10 11 patients died , recurrent tumor growth median overall survival time 63 weeks \( range , 36 201 mean , 86 \) median survival time immunotherapy 18 weeks \( range , 11 151 mean , 39 \) significant difference survival immunotherapy found patients received previous chemotherapy use steroids prior chemotherapy influence vitro generation lak cells
disposition cerebral metastases malignant melanoma implications radiosurgery radiosurgery becoming generally available indications use continue defined cerebral metastases malignant melanoma often treated whole brain irradiation , limited benefit innovative treatments , radiosurgery , make possible delivery doses radiation higher usual determine many patients might candidates radiosurgery , retrospective analysis computed tomographic brain scans performed 41 patients cerebral metastases malignant melanoma undertaken one third patients found cerebral metastases amenable approach , illustrated radiation dose volume histograms patient tumor characteristics suggest series represent cerebral metastases malignant melanoma implications radiosurgery normal tissue radiation tolerance effects melanoma discussed
early diagnosis breast cancer universal screening essential breast cancer 1 10 women united states early diagnosis breast cancer improves chances survival universal screening expert evaluation early clinical signs symptoms breast cancer , mortality rates reduced 30 40 physicians help achieve goal taking active role patient education promoting availability screening mammography
primary ct diagnosis abdominal masses environment whether display medium film versus ray tube \( \) affects observer performance interpretation computed tomographic \( ct \) images important research issue times implementation growth picture systems radiology authors performed receiver operating characteristic \( \) study determine performance radiologists read abdominal ct studies displayed film , well high resolution \( video monitor \) made use three different display modes total 166 examinations evaluated eight radiologists , recorded confidence ratings demonstration presence absence abdominal masses analysis showed small differences confidence ratings assigned individual readers detection interpretation tasks results group whole showed significant reduction improvement observer performance ratings one display modes analyzed results study demonstrate current display technology adequate enabling primary detection abdominal masses ct examinations
zollinger ellison syndrome prospective assessment abdominal us localization gastrinomas ability abdominal ultrasound \( us \) help localize gastrinomas prospectively studied 79 patients zollinger ellison syndrome results assessed means laparotomy , autopsy , percutaneous liver biopsy hepatic gastrinoma , us sensitivity 63 specificity 100 , positive predictive value 100 negative predictive value 89 us slightly less sensitive detecting gastrinoma liver computed tomography \( ct \) \( 66 \) selective angiography \( 78 \) detection extrahepatic gastrinoma , us sensitivity 30 , specificity 94 , positive predictive value 100 , negative predictive value 25 us enabled detection tumor eight cases detected ct four detected angiography specificity extrahepatic gastrinoma similar three modalities \( 89 95 \) ct us equally effective detection extrahepatic gastrinoma , angiography significantly effective us ct \( p less 01 \) authors conclude us , although low sensitivity , remains useful initial imaging modality patients zollinger ellison syndrome
epithelial tumors ovary ct findings correlation us one hundred thirty patients 170 epithelial ovarian tumors prospectively studied computed tomography \( ct \) surgery ultrasound \( us \) performed 108 patients 138 tumors pathologic examination , 78 tumors \( 46 \) benign , 14 \( 8 \) borderline , 78 \( 46 \) malignant ct results compared surgical pathologic findings patients ct enabled detection 148 170 tumors \( 87 \) , us enabled detection 118 138 tumors \( 86 \) benign serous \( n 42 \) correctly characterized sensitivity 69 ct 70 us benign mucinous \( n 21 \) correctly characterized sensitivity 62 ct 50 us malignancy suggested nine 14 patients \( 64 \) borderline tumors ct five 14 \( 36 \) us overall accuracy characterization benign versus malignant tumors \( including borderline tumors \) 94 ct 80 us 108 patients studied ct us , sensitivity ct significantly superior us \( p less 03 \) , whereas significant difference specificity \( p 125 \)
intraoperative 125 seed implantation extensive recurrent head neck carcinomas 1978 1988 , 41 patients extensive recurrent carcinomas head neck treated surgical resection plus intraoperative iodine 125 seed implantation surgery performed resect tumors expose tumor beds implantation 125 seeds implanted intraoperatively , 0 75 1 cm adjacent seeds , either soft tissue tumor bed onto small patches gelatin cover bone , nerve , blood vessel involved disease reconstructive flaps used 18 patients average 125 dose delivered implanted seeds 8 , 263 cgy 5 year actuarial survival rate entire group 40 5 year local disease control rate 44 major complications transient wound infection \( 32 \) , flap necrosis \( 24 \) , fistula formation \( 10 \) , carotid \( 5 \) results indicate surgical resection plus 125 seed implantation provides potentially curative treatment patients extensive recurrent head neck carcinomas would considered traditionally unresectable would treated palliative therapy
value symptom directed evaluation surveillance recurrence carcinoma breast specific postoperative tests used diagnose recurrent carcinoma breast evaluated ability impact course disease sixty four patients recurrent new contralateral primary disease divided two groups based method diagnosis patients new complaint interval scheduled follow visits went tests document recurrence categorized interval follow seen regular follow period received tests recommended attending physician surgeon documented recurrence classified routine follow thirteen patients presented new contralateral primary disease 51 metastatic disease \( 16 , bone 13 , lung 11 , local three , liver , eight , multiple \) median time discovery recurrence primary treatment 29 28 months interval routine groups , respectively ninety per cent failures occurred 53 months survival time recurrence significantly greater patients diagnosed routinely \( p 0 003 \) however , survival time \( primary therapy death \) significantly improved routine group contralateral new primary diseases included \( p 0 009 \) method diagnosis contralateral primary carcinoma physical examination mammogram strong recommendations follow testing limited mammogram physical examination
axillary lymphadenectomy intraductal carcinoma breast ten year period , 175 axillary lymph node dissections done part treatment intraductal carcinoma breast 98 patients treated modified radical mastectomy 77 treated mammary preservation , consisting excision lesion , axillary dissection radiation therapy one 175 axillary node dissections yielded positive nodes axillary dissection intraductal carcinoma breast unlikely yield involved nodes indicated use instances reserved lesions demonstrating microinvasion
expression beta 1 integrins normal human keratinocytes majority cell adhesive events extracellular matrix mediated cell surface receptors , beta 1 integrins keratinocytes express least six different polypeptides beta 1 integrin class , namely beta 1 , alpha 2 , alpha 3 , alpha 5 , alpha 6 \( alpha 6 mainly associated beta 4 polypeptide \) epithelial cells use alpha 2 beta 1 collagen receptor alpha 3 beta 1 fibronectin receptor , alpha 6 beta 4 major basement membrane receptor expression alpha 5 beta 1 complex low processing beta 1 integrins fast keratinocytes half maximal maturation takes 3 hours addition function cell matrix interactions , beta 1 integrins \( alpha 2 beta 1 alpha 3 beta 1 \) also role maintaining keratinocyte cell cell interactions possible resting basal keratinocytes use beta 1 integrins cell cell adhesion receptors , activation , like wound healing , receptors mediate events involving cell matrix interactions
using state cancer registry increase screening behaviors sisters daughters breast cancer patients pennsylvania cancer registry used contact breast cancer patients , , adult sisters daughters sisters daughters counseled concerning higher average risks breast cancer need mammography breast self examination results showed 9 percent increase mammography 10 percent increase breast self examination rates counseled control group costs 49 per counseled sister daughter indicating need increase cost effectiveness implementation practical
young case report scapulothoracic bursitis cause symptomatic masses pitchers processes appear represent reactive soft tissue responses repetitive stress inferior border scapula assumed masses area represent scapulothoracic bursitis rather however , possible masses treated conservatively scapulothoracic bursitis may study currently way evaluate incidence masses college professional pitchers united states follow report anticipated study completed author requests information concerning confirmed cases pitchers
glucose transporter blood brain barrier human brain tumors glucose transporter human brain localized endothelial cells expressing blood brain barrier , little known regarding mechanism induction whether expression exclusively linked restricted vascular permeability investigated glucose transporter expression vessels human astrocytic tumors pulmonary metastases brain using immunohistochemical techniques vessels 9 10 low grade astrocytomas 8 10 anaplastic astrocytomas positive glucose transporter glioblastoma vessels transporter positive 2 10 specimens vessels three metastatic tumors negative glucose transporter decrease transporter expression observed higher grade tumors occurred independently increases vascular permeability low grade astrocytomas glioblastomas transporter expression contrast enhancement inversely related , vessels 6 9 anaplastic astrocytomas transporter positive despite contrast enhancement findings suggest separate mechanisms induce glucose transporter permeability restrictions human blood brain barrier also potential implications therapy prognosis neoplasms
effects treatment long term survivors malignant astrocytomas reviewed records 160 consecutive patients glioblastoma anaplastic astrocytoma evaluate long term consequences radiation therapy chemotherapy defined long term survivors patients glioblastoma anaplastic astrocytoma lived least 100 longer median survival historical controls , example , 2 years patients glioblastoma 4 years patients anaplastic astrocytoma 9 \( 5 6 \) long term survivors three \( 30 \) became demented died without evidence tumor recurrence one , survival 10 years , died tumor recurrence remaining survivors , 2 \( 22 \) significantly impaired short term memory function neurological deficits gait three \( 30 \) function independently likely cannot proved radiotherapy chemotherapy causal factor therapeutic outcome study suggests restraint use radiotherapy patients brain tumors favorable prognoses glioblastomas anaplastic astrocytomas , low grade astrocytomas
chemotherapy medulloblastoma primitive neuroectodermal tumors posterior fossa chemotherapy marginal efficacy adult malignant brain tumors contrast , drug therapy considerably effective medulloblastoma primitive neuroectodermal tumors \( mb pnet \) posterior fossa , common childhood primary central nervous system tumor time disease recurrence , variety different single agents drug combinations result tumor shrinkage increased survival addition chemotherapy standard radiotherapy improves rate length disease free survival children mb pnet extensive tumors diagnosis remains determined drug drug combinations effective mb pnet , patients likely benefit chemotherapy chemotherapy may useful reduce , selected cases , obviate need radiotherapy reduce treatment related sequelae
comparative vitro activities newer quinolones pseudomonas species maltophilia isolated patients cancer vitro susceptibilities three pseudomonas species \( pseudomonas aeruginosa , pseudomonas , pseudomonas \) maltophilia quinolone antimicrobial agents determined several newer agents , particularly , , , \( \) , , , active pseudomonas species x maltophilia isolates generally less susceptible pseudomonas isolates inhibited newer quinolones
therapeutic outcome patients suffering malignant melanomas conjunctiva eighty one cases conjunctival melanoma treated 1960 1988 studied determine factors might affect outcome patients lesions therapeutic procedures performed local excision \( 16 \) , local excision followed brachytherapy sr 90 90 \( 32 \) , local excision followed cryotherapy liquid nitrogen \( 16 \) , brachytherapy sr 90 90 \( 12 \) , local excision followed external beam irradiation \( 3 \) , local excision followed brachytherapy cryotherapy \( 2 \) median follow period 5 5 years \( longest 26 , shortest 1 year \) sixty two patients \( 76 5 \) showed complete regression melanoma , 19 \( 23 5 \) developed recurrences , 15 \( 18 5 \) died metastases melanomas developed almost equal frequency pre existing naevus \( 25 9 \) , primary acquired \( 25 9 \) , \( 30 9 \) small tumours higher chance \( 80 6 \) larger ones \( 68 6 \) cumulative survival rate 76 five years 60 10 years causes death 87 6 five years 76 3 10 years deaths caused metastases deaths metastases occurred within 5 years 88 5 , cumulative survival rate patients small tumours \( less one quadrant bulbar conjunctiva less 2 mm thickness \) significantly higher patients larger tumours \( one quadrant bulbar conjunctiva 2 mm thickness \) 65 eight years local excision followed beta ray irradiation \( sr 90 90 \) cryotherapy recommended treatment choice nevertheless behaviour conjunctival melanomas remains unpredictable individual cases
increased lysis patient cd10 positive leukemic cells cells coated anti cd3 fab' antibody cross linked anti cd10 fab' antibody anti cd3 fab' x anti cd10 fab' bispecific hybrid f \( ab' \) 2 antibody \( ab \) generated bispecific ab molecular mass 100 110 kd , capacity react cd3 cells cd10 acute lymphoblastic leukemia \( \) cells studied whether cytotoxic lymphocytes \( ctls \) could lyse patient cd10 cells addition bispecific ab effector ctls , interleukin 2 \( il 2 \) stimulated peripheral blood mononuclear cells \( pbmcs \) ctl clones used il 2 stimulated pbmcs assayed cytotoxicity labeled cd10 cells , activity shown markedly enhanced addition bispecific ab ctl clones established lacked cytotoxicity cd10 cells , addition bispecific ab induced significant level cytotoxicity ctls derived patients also showed significant cytotoxicity autologous cd10 cells addition bispecific ab however , ab affect cytotoxicity ctls cd10 leukemic cells used targets findings suggest bispecific ab used immunotherapy patients cd10
preliminary studies immunotherapeutic approach treatment human myeloma using chimeric anti cd38 antibody multiple myeloma disease conventional chemotherapy limited value , may ideal treatment passive antibody suitable cell surface antigen neoplastic plasma cell cd38 antigen known present majority neoplastic plasma cells , confirmed detailed examination bone marrow aspirates three patients strong expression cd38 confined cells , criteria light scattering profiles cytoplasmic ig , plasma cells vast majority neoplastic plasma cells appeared involved using cell line model , found cd38 antigen acts target chimeric antibody prepared antibody chimeric antibody consists fab portion mouse monoclonal antibody linked stable bond fc molecule derived human igg1 , thereby forming mouse fab human fc contrast parent antibody , chimeric molecule mediates antibody dependent cellular cytotoxicity \( adcc \) efficiently human blood mononuclear effector cells , effective low concentration also , even though cd38 antigen present natural killer cells , appears little deleterious action antibody effector cell function antibody also failed affect growth progenitor cells granulocyte macrophage erythroid lineages present normal bone , despite suspicion cells express antigen advantages cd38 molecule found serum patients myeloma , appear modulate vitro fourteen patients florid myeloma various chemotherapeutic capacity mediate adcc chimeric antibody , compared normal individuals maintenance adcc activity , coupled known suppression antibody response patients , well treatment chimeric antibody
selective hypersensitivity granulocyte macrophage colony stimulating factor juvenile chronic myeloid leukemia hematopoietic progenitors juvenile chronic myelogenous leukemia \( \) good model study hematopoietic progenitor cells grow vitro low cell densities without addition exogenous stimulus previous studies demonstrated proliferation dependent granulocyte macrophage colony stimulating factor \( gm csf \) , removal monocytes cell population culture eliminates spontaneous , suggesting paracrine role monocyte stimulation however , subsequent studies shown increased gm csf production monocytes consistent finding therefore sole mechanism examining hematopoietic growth factor dose response curves , gm erythroid nonadherent progenitor cell populations displayed marked selective hypersensitivity gm csf responses interleukin 3 g csf identical control dose response curves first demonstration myeloid leukemia hypersensitivity specific growth factor appears involved pathogenesis disease
expression laminin receptor 32 human rat hepatoma cells dramatic cellular changes occur associated major alterations extracellular matrix formation relationships cells microenvironment studied expression laminin , major glycoprotein basement membrane , laminin receptor 32 kd laminin binding protein two rat \( \) two human \( hepg2 \) hepatoma cell lines express variety liver specific functions laminin found rough endoplasmic reticulum cells indirect immunoperoxidase method electron microscopic examination used radiolabeled laminin , immunoprecipitated media cell extracts , resolved electrophoresis sodium dodecyl sulfate gel two major polypeptides b subunits tumor laminin immunoblot analysis showed mr 400 , 000 polypeptide correspond subunit laminin northern blot analyses demonstrated large amounts b1 b2 mrnas chain mrna conclude tumor cells produce laminin b chains contrast , normal adult hepatocytes either man rat lacked laminin mrnas , whereas 1 day primary culture , b chain mrnas became detectable steady state level 32 kd laminin binding protein mrna 10 fold threefold higher rat hepatoma cells freshly isolated 1 day cultured normal rat hepatocytes , respectively human hepatocytes , steady state levels 32 kd laminin binding protein mrnas varied depending donor never reached level human hepatoma cells
cyclosporine enhances growth carcinogen induced enzyme altered foci rat liver cyclosporine , powerful , used successfully organ transplantation efficacy liver transplants patients primary hepatic tumors remains controversial high rate recurrence original tumors transplanted livers study , experimentally tested whether cyclosporine exerts effects growth carcinogen initiated liver cells using short term assays rat liver carcinogenesis dietary cyclosporine , maintained sufficient levels blood cyclosporine suppressed host immune functions , enhanced development glutathione transferase , placental form positive hepatocyte foci liver male f 344 rats treated single weekly dose \( 75 mg kg \) 3 wk dietary cyclosporine also accelerated growth preformed glutathione transferase , placental form positive foci induced single dose \( 250 mg kg \) followed promoting regimen choline deficient diet possible enhancement size hepatocyte foci cyclosporine could due stimulation growth inhibition regression mechanisms cyclosporine growth lesions liver yet fully understood possible involvement immunologically relevant cells liver , kupffer cells pit cells process suggested
hepatitis b virus integration hepatitis b virus related hepatocellular carcinoma childhood taiwan , hepatocellular carcinoma one major malignancies children 5 14 yr age studied status hepatitis b virus dna hepatocellular carcinoma liver tissues eight children positive serum hbsag maternal hbsag hepatocellular carcinoma tissues five eight children showed integration hepatitis b virus dna host cellular dna sequences pattern single site integration four children multiple site integration pattern one child demonstrated remaining three children , hepatitis b virus dna could demonstrated tumor tissues using fragments hepatitis b virus genome probes , found x gene fragment surface antigen gene fragment conserved sequences single site integration hepatitis b virus dna childhood hepatocellular carcinoma may hit critical region , resulting mutagenesis early development hepatocellular carcinoma short incubation period less exposure environmental carcinogens early life , childhood hepatocellular carcinoma may provide good model study carcinogenic potential hepatitis b virus
arising cheek report case review literature following points made oral cavity 1 \) rare slow growing 2 \) often mistaken benign lesion 3 \) direct correlation microscopic appearance biological behavior prognosis 4 \) treatment primarily surgical , radiation used selected cases 5 \) better differentiated tumors seem respond favorably radiation
cohort study fat intake risk breast cancer 1982 1987 , newly incident , histologically confirmed cases breast cancer identified cohort 56 , women enrolled canadian national breast screening study women completed dietary questionnaire occurrence breast cancer , used estimate intake dietary fat several nutrients evidence positive association breast cancer total fat intake , relative risk 1 35 \( 95 confidence interval , 1 00 1 82 \) per 77 g per day , evidence dose response relationship \( p \)
hypothesis nonsteroidal anti inflammatory drugs reduce incidence large bowel cancer nonsteroidal anti inflammatory drugs \( nsaids \) inhibit prostaglandin synthesis tumor growth rodent colon assessed nsaid use relation risk human large bowel cancer hospital based , case control study patients colorectal cancer control patients regular nsaid use continued year interview , multivariate relative risk estimate 0 5 \( 95 confidence interval , 0 4 0 8 \) estimate decreased duration use increased , trend statistically significant similar results obtained whether cancer non cancer controls used , inverse association apparent colon cancer rectal cancer men women subjects younger older 60 years regular nsaid use discontinued least 1 year previously non regular use associated risk almost regular nsaid use aspirin containing drugs present data suggest sustained use nsaids reduces incidence human large bowel cancer
rising incidence adenocarcinoma esophagus gastric cardia analyses cancer incidence data nine areas united states revealed steadily rising rates 1976 1987 adenocarcinomas esophagus gastric cardia increases among men period ranged 4 10 per year , thus exceeded type cancer contrast , relatively stable trends squamous cell carcinoma esophagus slight declines adenocarcinoma distal portions stomach adenocarcinomas esophagus gastric cardia disproportionately affected white men rarely occurred among women mid 1980s , among white men , adenocarcinomas accounted one third esophageal cancers , cardia cancers accounted one half stomach cancers specified rising incidence rates similar demographic patterns point need investigation causes poorly understood cancers
influence chromosomal integration glucocorticoid regulated transcription growth stimulating papillomavirus genes e6 e7 cervical carcinoma cells cervical carcinoma cells e6 e7 genes specific human papillomaviruses transcribed viral sequences integrated host cell chromosomes glucocorticoids activate promoter elements various human papillomaviruses transient expression assays analyzed effect dexamethasone transcription rate human papillomavirus 18 e6 e7 genes integrated different chromosomal sites four cervical cancer cell lines dexamethasone led increase transcription rate integrated e6 e7 sequences c4 1 c4 2 cells led decrease sw cells affect transcription rate hela cells however , viral promoter elements derived hela sw cells , dexamethasone activate transcription integrated e6 e7 sequences , tested transient expression assays within cell lines , dexamethasone consistently activated viral promoter thus appears dominant regulatory mechanisms presumably depending chromosomal integration site able response viral promoter steroid hormones growth rate dexamethasone treated cell lines correlated consistently expression papillomavirus e6 e7 genes , supporting role maintenance proliferative phenotype cervical carcinoma cells since human papillomaviruses integrated host cell genome variable , presumably randomly selected chromosomal loci , regulatory mechanisms influence viral gene expression , hence cell growth , may differ among cancers independent clonal origin
human methyltransferase cloning expression membrane associated form cdna clone human methyltransferase \( hcomt l methionine methyltransferase ec 2 1 1 6 \) isolated human hepatoma cell line \( hep g2 \) cdna library hybridization screening porcine cdna probe cdna clone sequenced found insert nucleotides deduced primary structure hcomt composed 271 amino acid residues predicted molecular mass 30 kda n terminus hydrophobic segment 21 amino acid residues may responsible insertion hcomt endoplasmic reticulum membrane primary structure hcomt exhibits high homology porcine partial cdna sequence \( 93 \) deduced amino acid sequence contains two tryptic peptide sequences \( 22 , 33 \) found porcine liver methyltransferase \( comt \) coding region hcomt cdna placed control cytomegalovirus promoter human kidney 293 cells endogenous comt activity , approximately 9 98 units per mg protein cells , increased 206 units per mg protein upon transfection plasmid containing comt cdna comt activity recombinant protein inhibited competitively \( ic50 700 nm \) selective comt inhibitor 40 anti comt monoclonal antibody recognized , immunoblots , major polypeptide apparent molecular mass 29 kda , reasonable agreement predicted molecular mass recombinant hcomt shown immunoblot analysis mainly associated membrane fraction rna blot analysis revealed one comt mrna transcript 1 4 kilobases hep g2 poly \( \) rna
stimulation camp phosphomonoester production melanoma cells 31p nmr studies major part present understanding molecular basis signal transduction gained vitro studies using classical biochemical methods study , used 31p nmr spectroscopy investigate response live mouse melanoma cells stimulation stimulating hormone \( msh \) presence 3 isobutyl 1 synergistic dose forskolin \( 1 67 microm \) , msh induced transient \( approximately 60 min \) rise cellular concentration 3' , 5' cyclic adenosine monophosphate \( camp \) , coincided time equivalent decrease \( approximately 40 \) atp however , detectable change phosphocreatine concentration observed concomitantly , msh induced striking unexpected increase concentration three phosphomonoester \( pme \) metabolites \( approximately 2 fold increase total pme signal area \) one signal assigned phosphoethanolamine levels remained high 2 4 hr declined slowly \( approximately 10 hr \) basal level , following perfusion fresh culture medium increase pme also observed stimulation msh alone contrast , stimulation high dose forskolin \( 50 microm \) \( 0 2 mm \) , although effective stimulating production camp , induce pme response evaluation indicated enhanced production phosphoethanolamine probably due phosphorylation therefore , likely result hydrolysis specific phospholipase c response appears regulated camp independent process , suggesting existence alternative transduction pathway controlled msh
mononuclear phagocytes major population effector cells responsible rejection tumor cells mice understand situ mechanism immunological response recipient animals tumor cells , types cells infiltrated rejection site examined meth cells \( h 2d \) given p allogeneic c57bl 6 \( h 2b \) strain mouse , tumor cells ceased grow day , accompanied p infiltration leukocytes tumor cells totally eliminated peritoneal cavity around day highest cytotoxic activity meth cells obtained peritoneal exudate cells harvested day 8 day , exudate cells consisted three populations examined flow cytometry , isolated appeared homogeneous , morphologically identified lymphocytes granulocytes medium sized , mononuclear , less granular cells cytotoxic activity confined exclusively last population effector cells \( h 2b \) cytotoxic meth cells \( h 2d \) also concanavalin stimulated allogeneic spleen cells c3h \( h \) , cba n \( h \) , j \( h 2a \) , balb c \( h 2d \) , dba 2 \( h 2d \) strains mouse effector cells totally inert concanavalin activated syngeneic spleen cells c57bl 6 \( h 2b \) c57bl 10 \( h 2b \) strains mouse effector cells phenotypically \( thy 1 2 cd3 1 2 immunoglobulin gm1 \) , morphologically , functionally distinct cytotoxic cells , natural killer cells , lymphokine activated killer cells adherent mononuclear phagocytes
intracranial case report rare tumors derived remnants occurring primarily sacrum , , cervical regions , tumors occur children , though usually sacrum eight cases described report , clival unusual radiologic features described 11 year old boy literature regarding entity reviewed
immunochemical studies differential binding properties two monoclonal antibodies reacting tn red cells two monoclonal antibodies \( moabs \) , bric 66 \( igm \) bric 111 \( igg1 \) , produced mice ovarian cyst blood group a1 glycoprotein tn red cells \( rbcs \) , respectively specificities determined using tn \( \) , mucins \( asg ovine glycoproteins \) , bric 66 tn group rbcs reacted immunohistochemically vascular endothelium tumor cells group adenocarcinoma , bric 66 inhibited n \( galnac \) , tn , mucins hemagglutination inhibition tests radioimmunoassay bric 111 tn rbcs , specifically stained tumor cells group patient 's breast carcinoma group patient 's adenocarcinoma hemagglutination inhibition tests , bric 111 readily inhibited tn , partially inhibited galnac , inhibited mucins sensitive radioimmunoassay , bric 111 galnac tn 2000 fold effective inhibitor mucins \( asg \) , contain high content terminal alpha galnac serine \( threonine \) residues postulated bric 66 specific terminal alpha galnac units carbohydrate chains exclusive reaction bric 111 tn indicates combining site larger galnac alpha 1 , probably includes amino acid residues galnac tn view specific agglutination tn rbcs , bric 111 useful reagent examination rbcs
medullary thyroid cancer immunohistochemical humoral study using six separate antigens authors investigated humoral tissue expression six antigens associated medullary thyroid cancer \( mtc \) calcitonin \( ct \) , calcitonin gene related peptide \( cgrp \) , carcinoembryonic antigen \( cea \) , neuron specific enolase \( nse \) , somatostatin \( srif \) , thyroglobulin \( tg \) antigens studied neoplastic c cells using immunohistochemistry specific antisera plasma using specific radioimmunoassay eighteen patients \( 8 male 10 female patients , aged 12 72 years \) studied mean follow 70 7 months \( range , 2 179 months \) nine patients \( 50 \) died disease mean follow 47 2 months \( range , 2 116 months \) immunostaining , primary tumors expressed ct cea cases nse positive 90 , cgrp 66 , srif 63 , tg 58 metastatic tissues positive cases ct staining , 92 8 cea , 71 4 nse , 73 3 cgrp , 38 5 srif , 13 3 tg staining positive cases percentage positive cells degree staining variable among different antigens expression antigen neoplastic cells associated hypersecretion corresponding antigen circulation case ct cea levels antigens elevated patients metastases could accurately predict appearance new metastases indicate effective treatment previous metastases surgery case nse , cgrp , srif , patients increased plasma concentrations antigens usually occurred advanced phases disease detectable levels serum tg never observed outcome disease compared expression ct , cea , nse , cgrp , tg , correlation could found contrary , srif expression primary tumor could differentiate two groups patients different survival rates srif positive patients survival rates 100 50 five seven years , respectively , whereas srif negative patients survival rates 40 five years 25 seven years
small cell carcinomas large intestine authors studied clinical pathologic features 38 small cell carcinomas large intestine located right colon overlying adenomas present 45 squamous differentiation 21 tumors endocrine differentiation present tumors least one method neuron specific enolase , dense core granules , synaptophysin present cases seventy one percent tumors metastasized liver 64 patients dead five months follow twenty one poorly differentiated adenocarcinomas undifferentiated carcinomas large intestine period showed less endocrine \( 7 21 \) squamous differentiation \( 1 15 \) fewer liver metastases \( 4 15 \) small cell carcinomas among 59 tumors studied , small cell histologic characteristics correlated better liver involvement endocrine markers histologic features small cell carcinomas large intestine aggressive tumors propensity early liver involvement although spectrum squamous , endocrine , glandular features large bowel tumors low degrees differentiation , identification small cell component appears clinically relevant
automated immunohistochemical estrogen receptor fixed embedded breast carcinomas authors immunohistochemically assessed presence estrogen receptor \( er \) formalin fixed , paraffin embedded tissue sections 68 breast carcinomas automated method using \( , la , ca \) alkaline phosphatase detection \( method 1 \) results compared obtained automated peroxidase method dnase pretreatment fixed embedded sections \( method 2 \) , er frozen sections \( method 3 \) , biochemical results \( dextran coated charcoal cytosolic dcc assay \) compared dcc assay , methods 1 , 2 , 3 gave sensitivities 54 , 25 , 89 , respectively sensitivity method 1 increased 74 cases dcc results showing greater 50 fmol mg protein findings indicate er immunohistochemical studies formalin fixed paraffin embedded tissues \( assayed method 1 \) provide useful clinical information results positive negative result , especially surrounding normal elements positive , may indicate receptors , receptor levels less 50 fmol mg protein , tissue preservation absence fresh tissue er assay dcc assay frozen sections immunostaining , understanding limitations , method may useful
ovarian myxoma study two cases long term follow two cases called ovarian myxoma reported one 13 year old girl 31 year follow evidence recurrence second case , 65 year old woman , recurred intraperitoneally , 19 years surgery tumors myxoid , round stellate cells immunohistochemical , electron microscopic \( em \) , dna flow cytometric \( fcm \) studies performed formalin fixed , paraffin embedded tissue second patient primary tumor recurrence tumor cells expressed vimentin focally positive desmin em findings suggested fibroblastic differentiation aneuploid cell population present recurrent tumor dna fcm studies four cases called ovarian myxoma reported date , follow exceed 18 months authors conclude presence aneuploidy late recurrence one cases suggest certain ovarian myxomas might behave like low grade sarcomas tumor remains , similarities found myxomas locations
local reactions radioiodine treatment thyroid cancer purpose compare rate local complications resulting radioiodine ablation thyroid cancer patients residual intact thyroid lobe patients extensive surgical treatment prior radioiodine administration patients methods retrospectively studied 59 patients received 131i 1979 1989 patients divided two groups , depending extent previous surgical thyroid excision group 1 comprised 10 patients lobectomy ablative radioiodine dose , group 2 comprised 49 patients extensive thyroid excision \( near total subtotal thyroidectomy \) radioiodine treatment results sixty percent 10 patients group 1 experienced degree neck pain tenderness following radioiodine ablation residual thyroid one case , local reaction severe accompanied development transient hyperthyroidism 6 local complication rate patients undergone extensive thyroid excision ablative therapy \( p less 0 001 \) , none severe reaction conclusions patients unilateral surgical excision radioiodine therapy higher rate local complications patients treated extensive surgery prior radioiodine ablation radioiodine employed patients , informed possible complication since evidence supports dose effect pathogenesis complications , recommend using dose less 30 mci initial ablation patients even though may necessary repeat dose complete thyroid ablation
suddenly symptomatic brain tumors altitude high altitude cerebral edema present wide variety neurologic manifestations symptoms resolve descent persistence neurologic symptoms descent suggests intracranial lesion brain tumors suddenly becoming symptomatic altitude reported previously report three cases previously unsuspected brain tumors suddenly became symptomatic high
surgical staging cervical cancer noninvasive radiologic methods detect paraaortic lymph node metastases reliable combined fna enlarged lymph nodes however , sensitivity low , undetected microscopic metastases leads treatment failure patients paraaortic lymph node metastasis treated extended field radiation , die within 3 years ct scanning probably best diagnostic method evaluate cervical cancer , assess primary tumor , urinary tract , gastrointestinal tract , liver parenchyma , also permits guidance fna arrangement radiation ports surgical staging provides direct assessment peritoneal cavity retroperitoneal spaces metastatic tumor , including enlarged lymph nodes , resected , benefit operative morbidity acceptable , fewer intestinal complications approach used , long term morbidity minimal appropriate paraaortic radiation doses employed \( less 5 , 000 cgy \) surgical staging provided data frequency paraaortic lymph node metastasis stage cervical cancer , thus , treatment strategies better developed extended field radiation results 5 year survival rates 20 25 patients microscopic paraaortic lymph node metastasis , patients would survive without treatment however , surgical staging produced modest boost survival rates , high rate pelvic systemic failure extended field radiation used prophylactically patients probable lymph node metastasis seen radiographic studies , survival rates similar patients irradiated surgical staging paraaortic lymph node disease ability predict , detect , positive paraaortic node disease improves , extended radiation \( adjuvant therapy \) could used frequently without operation patients high risk metastatic disease study et al , prophylactic paraaortic radiation given patients high risk paraaortic metastasis patients high probability local disease control , paraaortic radiation significantly reduced incidence paraaortic distant metastases patients known paraaortic lymph node metastases frequently occult systemic metastases patients , pelvic failure also common thus , effective systemic therapies emerge , marked improvement survival unlikely patients paraaortic lymph node metastasis \( abstract truncated 400 words \)
management malignant bone tumors children adolescents series 205 pediatric patients affected osteosarcoma , ewing 's sarcoma , fibrosarcoma , malignant fibrous histiocytoma bone treated 1978 1988 ninety eight percent patients received chemotherapy 63 surgical resection sixty five percent patients alive 30 months considered disease free functional results surgery evaluated according musculoskeletal tumor society score diaphyseal resections resections upper extremity pelvis , results excellent good 60 cases resections proximal femur , distal femur , proximal tibia reconstruction prostheses , results excellent good 75 hand , lower extremity used , 14 cases good result correlates resulting lack serious limb shortening seen progression skeletal growth
dexamethasone cortisol two cases aldosterone producing adenoma forty one patients aldosterone producing adenoma \( apa \) subjected dexamethasone suppression test \( dst \) surgery serum cortisol urinary excretion 17 suppressed dexamethasone 39 patients dst \( \) two patients \( cases b \) , suppressed dst \( \) clinical manifestations two dst \( \) patients similar dst \( \) patients hypertension , hypokalemia , high serum aldosterone levels , suppressed pra found patients cut surfaces adenomas patients , including cases b , golden yellow , typical apa however , adjacent normal tissues evident exclusively two dst \( \) patients removal affected , serum cortisol level suppressed dexamethasone one dst \( \) patients \( case b \) findings suggested cortisol production apa evaluate whether cortisol could produced adenoma tissue , presence several enzymes studied immunohistochemistry mrna analysis adenomas adjacent 2 dst \( \) 5 dst \( \) patients immunohistochemical analysis demonstrated enzymes expressed apa tumor tissues dst \( \) dst \( \) patients groups , mrnas coding enzymes present also tumor tissues quantitative analysis mrna levels revealed dst \( \) patients , mrnas abundant tissue tumor tissue however , dst \( \) cases , mrnas much abundant tumor tissues tissues results indicate tumor cells two dst \( \) patients synthesized aldosterone also cortisol diameters tumors two dst \( \) patients exceeded 3 cm , dst \( \) patients smaller patients large apa , adrenal insufficiency anticipated upon removal tumor
endothelial markers malignant vascular tumours liver superiority qb end 10 von willebrand factor ulex europaeus agglutinin 1 new monoclonal antibody , qb end 10 , raised cd34 antigen human endothelial cell membranes haemopoietic progenitor cells , studied usefulness marker neoplastic vascular cells 21 seven malignant liver qb end 10 sensitive specific von willebrand factor \( vwf \) ulex europaeus 1 agglutinin \( uea 1 \) labelling endothelial cells cross react epithelia uea 1 often staining uniformly strong clear histological variants two tumours qb end 10 prove particularly useful differential diagnosis malignant vascular tumours liver
generation soft x rays using free electron laser proposed means diagnosing treating breast cancer diagnosis treatment breast lesions may markedly enhanced use unique new source near x rays concentric near x ray may generated collision free electron laser \( \) electron beam optical beam interaction zone x rays environment absence scatter interaction within tissues improves lesions two six times increased attenuation x rays malignant vs normal tissues makes tumors obvious k edge subtraction allows chemical analysis tumors vivo radiation doses one tenth one delivered lowest dose mammographic x ray technique available allows increased sensitivity specificity permits prediction histology , necessity biopsies selective bond depth tissues well x ray activated photodynamic therapy also explored
effective surgical adjuvant therapy high risk rectal carcinoma background radiation therapy adjunct surgery rectal cancer shown reduce local recurrence improved survival previous study , combined radiation chemotherapy improved survival significantly compared surgery alone , compared adjuvant radiation , many regard standard therapy designed combination regimen optimize contribution chemotherapy , decrease recurrence , improve survival compared adjuvant radiation alone methods two hundred four patients rectal carcinoma either invasive metastatic regional lymph nodes randomly assigned postoperative radiation alone \( cgy \) radiation plus fluorouracil , preceded followed cycle systemic therapy fluorouracil plus \( methyl ccnu \) results median follow seven years , combined therapy reduced recurrence rectal cancer 34 percent \( p 0 95 percent confidence interval , 12 50 percent \) initial local recurrence reduced 46 percent \( p 0 036 95 percent confidence interval , 2 70 percent \) , distant metastasis 37 percent \( p 0 011 95 percent confidence interval , 9 57 percent \) addition , combined therapy reduced rate cancer related deaths 36 percent \( p 0 95 percent confidence interval , 14 53 percent \) overall death rate 29 percent \( p 0 025 95 percent confidence interval , 7 45 percent \) acute toxic effects included nausea , vomiting , diarrhea , leukopenia , thrombocytopenia effects seldom severe severe , delayed treatment related reactions , usually small bowel obstruction requiring surgery , occurred 6 7 percent patients receiving radiation , frequencies complications comparable treatment groups conclusions combination postoperative local therapy radiation plus fluorouracil systemic therapy fluorouracil based regimen significantly improves results therapy rectal carcinoma poor prognosis , compared postoperative radiation alone
clinical importance myeloid antigen expression acute lymphoblastic leukemia childhood background leukemic cells 15 25 percent patients acute lymphoblastic leukemia \( \) express myeloid antigens well lymphoid antigens \( latter reflecting b cell cell lineage \) relations myeloid antigen expression features prognosis controversial methods analyzed clinical laboratory features present diagnosis 236 consecutive cases children immunophenotyping , including single dual fluorescence analyses , used classify leukemic cells b also identify myeloid antigen expression simultaneous expression lymphoid associated antigens least one three myeloid associated antigens \( cd33 , cd13 , cd14 \) cells classified l1 l2 according french american british system results forty five 185 patients b lineage myeloid antigen expression , 8 41 patients lineage 10 patients , lineage could determined myeloid antigen expression associated l2 morphology \( p less 0 05 \) , correlate prognostic features recognized previously multivariate analysis showed myeloid antigen expression important predictor relapse childhood significant prognostic factor statistically \( p less 0 0001 \) white cell count greater equal 50 x 10 \( 9 \) per liter diagnosis also important highly significant prognostic feature \( p less 0 001 \) 40 months , estimated disease free survival patients 84 percent without myeloid antigen expression low white cell count , 57 percent without myeloid antigen expression high white cell count , 47 percent myeloid antigen expression low white cell count , 26 percent myeloid antigen expression high white cell count \( p less 0 00001 \) conclusions myeloid antigen expression important independent predictor poor response chemotherapy childhood
interstitial irradiation hyperthermia treatment recurrent malignant brain tumors june 1987 june 1989 , 29 recurrent malignant gliomas recurrent solitary brain metastases 28 patients treated phase study interstitial irradiation hyperthermia patient age ranged 18 65 years , karnofsky performance status scores ranged 40 90 13 glioblastomas , 10 anaplastic astrocytomas , 3 melanomas , 3 adenocarcinomas catheters implanted computed tomography based hyperthermia administered brachytherapy , using one six mhz helical coil microwave one three fiberoptic probes goal heat much tumor possible 42 5 degrees c 30 minutes within 30 minutes first hyperthermia treatment , implant catheters high activity iodine 125 seeds delivering tumor doses 32 6 61 0 gy patients sensation heating complications included seizures 5 patients , reversible neurological changes 9 patients , scalp burn 1 , infections 3 28 evaluable 2 month follow scans , 11 showed definite improvement radiological appearance tumor , 4 slightly improved , 7 stable , 6 showed tumor progression ten patients underwent reoperation persistent tumor necrosis eleven 28 patients alive 40 97 weeks treatment thirteen patients died brain tumor , 2 died extracranial melanoma metastases , 1 died new brain melanoma metastases , 1 died pulmonary embolus median survival 55 weeks overall median survival yet reached anaplastic astrocytoma subgroup conclude interstitial brain hyperthermia using helical coil microwave technically feasible level toxicity acceptable , computed tomographic response rate encouraging
expression platelet derived growth factors , transforming growth factors , gene variety primary human brain tumors ribonucleic acid isolated wide spectrum central nervous system tumors examine expression platelet derived growth factors \( pdgf \) b , tumor growth factors \( tgf beta \) 1 2 , messenger ribonucleic acid eight glioblastoma cell lines examined well cell cultures 22 tumor explants explants included 6 glioblastomas , 4 anaplastic astrocytomas , 5 astrocytomas , 3 tumors , 2 meningiomas , 1 medulloblastoma 1 comparison , 2 nontumor glial cell cultures included pdgf b chain expressed 5 8 glioblastoma cell lines , 2 6 glioblastomas , 3 4 anaplastic astrocytoma explants pdgf b expression 4 astrocytomas , 3 varying malignancy , remainder tumors , nontumor glial cells pdgf chain expressed tumors , exception malignant nontumor glial cell cultures tgf beta 1 expressed tumors nontumor glial cells expression tgf beta 2 expressed many benign malignant tumors also nontumor glial cell cultures messenger ribonucleic acid expressed 1 5 glioblastoma cell lines 2 6 glioblastoma cell explants , none tumors nontumor glial cells
spinal glioblastomas report seven cases review literature intramedullary glioblastomas uncommon tumors occur segments , slight tendency occur early decades life , short clinical history diagnosis report seven cases discuss salient features tumors , particularly pathological features treatment , light relevant literature
oral cancer survey cases university connecticut oral pathology biopsy service , 1975 1986 survey university connecticut oral pathology biopsy service undertaken analyze cases oral cancer 12 year period , 1975 1986 inclusive 33 , 429 total specimens , malignant oral neoplasms diagnosed reported sixty five \( 11 5 \) originated state invasive intraoral squamous cell carcinoma predominant tumor \( 69 7 total \) , whereas lip cancer constituted 2 8 malignancies minor salivary gland adenocarcinomas accounted 11 total malignancies whereas carcinoma , carcinoma situ , forms oral cancer accounted remainder \( 4 6 , 5 3 , 6 6 , respectively \) cases invasive squamous cell carcinoma analyzed year , sex distribution , location subsite , age diagnosis , histologic grade exception histologic grading , found characterization cases squamous cell carcinoma within biopsy service tended parallel results separate related statewide analysis oral cancer intraoral squamous cell carcinoma connecticut much longer time span concluded picture oral cancer characterized cases within university connecticut oral pathology biopsy service generally disease statewide level
ectatic blood vessels port wine stains lack innervation possible role pathogenesis innervation pattern port wine stains investigated using indirect immunohistochemistry antibodies protein gene product 9 5 \( 9 5 \) , neuron specific enolase \( nse \) , calcitonin gene related peptide \( cgrp \) , \( nf \) pathologically dilated vessels middle deep dermis found defective innervation single nerve fibers vicinity , structures skin showed normal density fibers nse like immunoreactive \( li \) nerve fibers observed vessels normal morphology structures skin , sweat glands hair follicles , free nerve nerve bundles nerve bundles often seen pass ectatic vessels without giving branches cgrp li nerve fibers detected running toward epidermis , whereas fibers found around ectatic vessels nf li fibers seen normal vessels dermis , relation dilated vessels , occasional fibers observed lack innervation may importance development disease result decreased vessels loss neuronal trophic factors
community study delay presenting signs melanoma medical practitioners absence effective treatment advanced tumors , early diagnosis treatment localized tumors effective way reducing burden illness associated melanoma study examined following factors prevalence signs melanoma \( mole changing size , shape , appearance , color , , bleeding , becoming raised \) individuals randomly selected sample households length delay seeking medical advice factors associated either going medical practitioner going delaying actions medical practitioners first presented signs results indicate large proportion sample \( 11 9 , n 156 \) observed signs melanoma previous 12 months sample reporting signs first appeared previous 5 years , 32 sought medical advice signs within recommended period sample either seeking advice delaying , 49 reported thought sign n't serious would clear furthermore , 30 sample either known importance early detection treatment lesions results indicate deficit knowledge general public signs melanoma , severity disease , possible risks associated delay
potential role postoperative hepatic artery chemotherapy patients high risk hepatomas relationship operative findings hepatoma postoperative prognosis studied clarify indications adjuvant hepatic arterial chemotherapy hepatectomy results adjuvant hepatic arterial chemotherapy using 0 4 mg kg doxorubicin 0 12 mg kg c infusion 5 fluorouracil reported one hundred sixty patients undergone hepatectomy hepatoma studied operative findings hepatoma , surgical margin less 10 mm , intrahepatic metastasis , tumor embolus second proximal branch portal vein , lack capsule formation related prognosis risk factors recurrence 132 patients risk factors survival rate 19 patients adjuvant arterial chemotherapy significantly higher 113 patients without adjuvant hepatic arterial chemotherapy thus may effective therapy studied prospectively patients undergoing hepatectomy high risk hepatoma
surgical management carcinomas extrahepatic bile ducts \( gallbladder tumors excluded \) results french surgical association survey five hundred fifty two cases primary carcinoma extrahepatic bile ducts \( gallbladder tumors excluded \) collected 55 surgical centers reviewed retrospectively three hundred seven patients \( 56 \) upper third lesions \( proximal carcinoma \) , whereas 71 \( 13 \) 101 \( 18 \) , respectively , middle third lower third bile duct carcinomas remaining patients diffuse lesions resectability rates 32 upper third localization compared 47 51 middle third lower third localization , respectively operative mortality rate proximal carcinomas significantly lower resection \( 16 \) compared palliative surgery \( 31 \) \( p less 0 05 \) overall 1 year survival \( operative deaths excluded \) 68 tumor resection compared 31 palliative surgery \( p less 0 001 \) long term results surgical resection correlated local regional extension disease results study show resection extrahepatic bile duct carcinomas , particularly upper third localization , often associated worthwhile long term survival
bronchoalveolar carcinoma factors affecting survival one hundred thirty four consecutive patients \( 65 men 69 women \) underwent pulmonary resection bronchoalveolar carcinoma mean age 65 years lobectomy done 100 patients , pneumonectomy 10 , 5 , wedge excision 19 10 patients lymph node metastases \( 7 5 \) neoplasm solitary 111 patients \( 82 8 \) 97 stage , 4 stage ii , 9 stage iiia , 1 stage iiib two operative deaths \( 1 5 \) thirty nine complications occurred 31 patients median follow 5 1 years recurrent bronchoalveolar carcinoma developed 45 patients five 10 year survival patients stage 75 2 62 0 , respectively survival patients t1 n0 neoplasms identical expected survival 90 5 5 years , compared 55 4 patients t2 n0 disease , 35 9 patients multiple bilateral disease , 0 0 patients bilateral disease \( p less 0 0001 \) significant factors adversely affecting survival included presence signs symptoms , diffuse malignant invasion , mucin producing tumors , histological absence scar conclude bronchoalveolar carcinoma unique natural history influenced local neoplastic processes lymph node metastases early aggressive pulmonary resection safe offers potential cure presence bilateral cancer , however , ominous
primary cysts tumors mediastinum retrospective analysis performed 230 patients primary cysts tumors mediastinum seen institution january april 1989 divided patients two groups group 1 seen 1970 group 2 seen january 1970 april 1989 significant increase prevalence malignancy group 2 \( 47 2 versus 17 1 p less 0 0001 \) due increase number lymphomas \( 22 6 versus 3 5 p less 0 001 \) malignant neurogenic tumors \( 6 8 versus 1 1 p 0 \) significant increase number malignant tumors anterior \( 59 5 versus 30 9 p 0 \) paravertebral \( 28 5 versus 2 8 p 0 \) compartments group 2 patients tumors symptomatic group 2 \( 63 6 versus 5 p 0 \) increase ancillary diagnostic studies performed evaluate tumors \( 76 0 versus 34 5 p 0 \) logistic regression analysis identified date presentation \( p less 0 005 \) , symptoms \( p less 0 01 \) , size \( p less 0 005 \) , anterior mediastinal compartment \( p less 0 005 \) preoperative predictors malignancy surgical approach tumors included median sternotomy \( 30 1 versus 10 7 p 0 0008 \) , anterior , cervical group 2 \( 1 1 versus 17 5 p 0 0002 \) long term results support surgical resection benign lesions aggressive multimodality approach malignant lesions
surgical management carcinoid heart disease metastatic carcinoid tumor often seen flushing , diarrhea , cardiac symptoms carcinoid syndrome cardiac failure often associated major morbidity mortality carcinoid disease report , case successful cardiac valvar surgical intervention resulted prolonged alleviation cardiac symptoms survival
inflammatory breast cancer historically , prognosis inflammatory breast cancer poor conducted retrospective review evaluate recent memorial sloan kettering cancer center experience , evaluate role combination chemotherapy , compare effect surgery radiation local regional failure fifty six patients local regional inflammatory breast cancer diagnosed 1975 1984 identified treated combination chemotherapy overall 5 year survival 45 5 year disease free survival rate 37 twenty one patients treated induction chemotherapy followed mastectomy adjuvant chemotherapy survival disease free survival rates similar achieved patients treated mastectomy followed chemotherapy residual cancer found 21 patients treated induction chemotherapy , extensive disease present 18 , including six seven complete responders local regional failure rate 34
prognostic significance carcinoembryonic antigen colorectal carcinoma serum levels resection recurrence use carcinoembryonic antigen evaluated 425 patients mean follow 48 months preoperative postoperative carcinoembryonic antigen levels predictive recurrence survival independent tumor stage multivariate regression analysis age , location , tumor stage , preoperative postoperative carcinoembryonic antigen levels , latter three factors significant prognostic variables respect adjusted survival recurrent disease found 42 patients , excluding patients stage iv disease carcinoembryonic antigen level recurrence greater 5 ng ml 79 patients 89 intra abdominal recurrences carcinoembryonic antigen level recurrence predictive survival except subgroup locoregional disease life span patients liver lung metastases influenced carcinoembryonic antigen level recurrence preoperative postoperative carcinoembryonic antigen levels indicate poorer prognostic group patients colorectal cancer may benefit adjuvant treatment carcinoembryonic antigen recurrence used effectively diagnose intra abdominal recurrences project survival development local regional disease
prognostic factors primary retroperitoneal soft tissue sarcomas analyzed independent treatment variables \( age , sex , signs symptoms , site , size , histopathologic findings , grade , clinical presentation \) treatment dependent variables \( resectability , type operation , surgical margins , surgical boundaries , microscopic margins , adjuvant radiotherapy , adjuvant chemotherapy \) 80 patients primary retroperitoneal soft tissue sarcomas admitted 1982 1988 univariate multivariate analysis survival disease free survival performed major factor survival outcome ability completely resect lesion 62 patients underwent complete resection examined , independent prognostic factor survival disease free survival grade conclude completeness resection grade lesion primary determinants survival tumor macroscopically removed , advantage could demonstrated extensive surgical resection current adjuvant therapy
radioimmunoguided surgery using iodine 125 b72 3 patients colorectal cancer preliminary data using b72 3 murine monoclonal antibody labeled iodine 125 suggested clinically apparent well occult sites colorectal cancer could identified intraoperatively using hand held gamma detecting probe report preliminary data multicenter trial approach patients primary recurrent colorectal cancer one hundred four patients primary , suspected , known recurrent colorectal cancer received intravenous infusion 1 mg b72 3 monoclonal antibody radiolabeled 7 4 x 10 iodine 125 twenty six patients primary colorectal cancer 72 patients recurrent colorectal cancer examined using gamma detecting probe , 78 patients localization antibody tumor included 75 primary tumor sites 63 recurrent tumor sites 9 2 tumor sites identified represented occult sites detected gamma detecting probe overall sensitivity 77 predictive value positive detection 78 total 30 occult sites 26 patients identified patients recurrent cancer , antibody study provided unique data resection 10 patients , another eight patients extended potentially curative procedure
radical resection carcinoma ampulla one hundred four consecutive patients underwent radical resection ampullary cancer 1965 1989 retrospectively reviewed frequent clinical findings included jaundice \( 67 \) , significant \( greater 10 \) weight loss \( 42 \) , anemia \( 27 \) eighty seven patients \( 84 \) underwent subtotal pancreatectomy , 17 patients \( 16 \) underwent total pancreatectomy postoperative mortality 5 7 \( six patients \) , reoperation postoperative complications required six patients 5 10 year survival rates 34 25 , respectively eight patients died tumor recurrence 5 years resection patient survival significantly impaired microscopic lymphatic invasion , regional nodal metastasis , tumor grade , epithelium origin multivariate analysis , microscopic lymphatic invasion significantly reduced patient survival radical resection ampullary cancer performed low morbidity mortality remain procedure choice ampullary carcinoma
5 year results cisplatin fluorouracil infusion head neck cancer part developmental process head neck intergroup trial adjuvant chemotherapy advanced resectable head neck carcinoma , 1981 radiation therapy oncology group , philadelphia , pa , conducted two pilot studies using chemotherapy consisting three courses cisplatin fluorouracil infusion chemotherapy administered prior surgery 42 patients \( induction \) surgery additional 29 patients \( sequential \) populations roughly comparable respect tumor site stage twelve 42 patients induction group seven 29 sequential group alive evidence disease last reported follow median survival 31 months sequential group vs 20 months induction group two 26 patients less complete clinical response following induction chemotherapy still alive twenty seven 42 patients received induction chemotherapy undergo surgery initially planned despite lack surgery , 5 years survival two groups significantly different \( 27 induction group vs 23 sequential group \)
effective destruction cervical intraepithelial neoplasia \( cin \) 3 100 degrees c using cold 14 years experience total women cin 3 treated cold 1975 1989 followed primarily cytology standard suitability criteria ablation adhered except patients treated first visit expected diagnosis would worse cin 3 overall 97 women treated first visit 30 women \( 2 \) histology glandular worse expected , 22 showed persistent cervical disease subsequently follow achieved 87 10 years actuarial terms primary success rate 95 1 year 92 5 years , similar age groups repeat cold coagulation persistent recurrent cin 3 less successful advised outcome pregnancies established treatment known rates miscarriage , preterm operative delivery increased cold coagulation cin 3 100 degrees c performed us effective treatment calls question need expensive practices
vaginal epithelial abnormalities patients cin clinical pathological features management women cin treated laser regional oncology centre , hospital , , 103 \( 2 5 \) co existing vaginal epithelial abnormalities cin 3 histological diagnosis often associated vaginal lesions upper vagina almost always involved 67 lesion cervix appeared confluent vagina even lesions confluent , biopsies form cervical vaginal components always show grade intraepithelial neoplasia biopsies showed different lesions laser treatment appears effective vaginal lesions therefore recommended although , selected patients , careful follow alone may
carcinoma breast measurement management treatment value data first series explore insights biological changes accompany treatment human tumours may obtained estimation volume changes relation treatment adopted working hypothesis regression slopes reflect composition individual tumours , indirectly , intrinsic growth rate rather effectiveness treatment breast proved suitable site measurement interpretation results led development new style management carcinoma breast measurement based sequential therapy \( \) paper method measurement detailed statistical evaluation quality data 262 patients \( 263 tumours \) presented exponential regression lines fitted describe volume changes relation treatment radiation , chemotherapy hormones simple classification slopes introduced
detection colorectal liver metastases using intraoperative ultrasonography intraoperative ultrasonography liver carried 99 patients undergoing surgery colorectal cancer palpation liver , preoperative abdominal ultrasonography computed tomography scanning also performed patients metastases identified 26 99 patients \( 26 per cent \) intraoperative ultrasonography diagnosed metastases palpation , abdominal ultrasonography ct scanning , identifying metastases 24 26 patients , including six patients metastases detected technique identification localization impalpable liver metastases therefore possible using intraoperative ultrasonography
primary papillary carcinoma thyroglossal duct cyst report case literature review thyroglossal duct cysts common anomaly thyroid development twice frequent cleft abnormalities , children , second enlarged cervical lymph nodes cause neck mass generally , duct cysts benign , 1 per cent cases may malignant world literature , 114 cases malignant thyroglossal cysts available review addition case , discuss 115 instances duct cysts different types neoplasia described included thyroid papillary carcinoma 81 7 per cent , mixed papillary follicular carcinoma 6 9 per cent , squamous cell carcinoma 5 2 per cent , follicular adenocarcinoma 1 7 per cent , malignant , epidermoid carcinoma anaplastic carcinoma 0 9 per cent 115 cases surveyed , 35 thyroid glands examined microscopically , four \( 11 4 per cent \) contained malignant foci whether primary malignancies thyroglossal duct cysts metastases discussed
value radioimmunoguided surgery first second look laparotomy colorectal cancer radioimmunoguided surgery \( \) using anti cea \( \) monoclonal antibody assessed 52 patients \( 43 primary nine second look procedures \) undergoing surgery colorectal carcinoma antibody localized 97 8 percent primary tumours 88 8 percent principal tumor second look procedures additional information concerning extent primary tumor obtained 11 43 patients \( 25 5 percent \) undergoing excision primary carcinoma five nine patients \( 55 percent \) second look series incorrect information obtained extent primary tumour six patients \( 11 3 percent \) , whereas incorrect information obtained second look procedures correctly predicted subsequent dukes' staging 77 percent first look cases \( sensitivity 65 percent , specificity 90 percent \) , although accurate identification individual nodes impossible technique influenced surgical procedure performed 2 43 cases \( 4 6 percent \) primary surgery three nine patients undergoing second look laparotomy \( 33 percent \) primary colorectal carcinoma may provide additional information concerning extent locally advanced tumors particular principle subsequent surgery may influenced established technique appears greater role second look procedures may help determine extent recurrent tumour larger follow series required define additional information provided technique may best
nuclear shape prognostic discriminant colorectal carcinoma search reliable prognostic discriminant , retrospective analysis 100 cases colorectal carcinoma undergone curative resection followed least 5 years assessed nuclear morphometry case staged according dukes' classification well graded histologically patients series , perimeter , area , nuclear shape factor 50 nuclei determined carcinoma information obtained use image analysis system tracing nuclear profiles \( magnification \) digitized video screen nuclear shape factor defined degree nucleus , perfect circle recorded 1 0 nuclear shape factor greater 0 84 associated poor outcome multiple regression models showed single nuclear parameter shape factor highly significant predictor survival \( p less 0 0001 \) variable remained highly significant even corrected sex , age , histologic grade , dukes' classification findings indicate nuclear shape factor greater equal 0 84 determined nuclear morphometry independent morphometric nuclear variable great importance prognosis large bowel carcinoma
primary de novo adenocarcinoma colon measuring 8 mm diameter lymph node metastases report case colonic adenocarcinomas measuring less 10 mm rare herein , report carcinoma measuring 8 mm diameter associated extension locus metastases lymph nodes , association previously reported residual adenomatous tissue found , suggesting de novo carcinoma
development characterization new , highly specific antibody human chorionic gonadotropin beta fragment addition high concentrations hcg , pregnancy urine contains even higher concentrations fragment hcg beta subunit biologically inactive material immunological measurement hcg , since cross reacts many polyclonal monoclonal antibodies hcg beta subunit employed assays hcg urine although others developed antibodies fragment , specific measurement fragment presence free hcg beta remained difficult due intrinsic cross reactivity antibodies intact hcg beta rather attempt increase specificity assay optimization , developed new , highly specific monoclonal antibody , designated , cross reacts less 0 1 free hcg beta subunit liquid solid phase immunoassay used new monoclonal antibody immunoradiometric assays measure specifically hcg beta fragment urine throughout pregnancy well sera two individuals cancers producing hcg beta subunit discovered hcg beta fragment bind three monoclonal antibodies simultaneously , indicating although epitope antibody new determinant exposed hcg beta fragment intact hcg free hcg beta subunit , hcg beta fragment retains least two hcg beta related epitopes intact , e bind monoclonal antibodies
calcium transport plasma membranes glucose responsive rat insulinoma inside plasma membrane vesicles glucose responsive rat insulinoma showed atp mg2 \( \) dependent uptake ca2 km \( concentration giving half maximal activity \) ca2 60 nm presence 0 4 microm free ca2 , km atp 15 microm , km mg2 4 microm glucose \( 30 mm \) decreased ca2 uptake 50 , insulin secretagogues effect , except , stimulated ca2 uptake calmodulin increased uptake ca2 , trifluoperazine vanadate inhibited uptake ca2 \( \) mg2 \( \) dependent atpase tumor 10 20 fold higher requirement ca2 , suggests enzyme responsible ca2 transport , rather , ca2 transport activity represents small fraction total ca2 \( \) atpase activity physiological importance ca2 transport insulin secretion evident inhibition ca2 uptake glucose , leads decrease ca2 efflux cell inhibition would lead increase intracellular free ca2 insulin release
transcriptional regulation ferritin messenger ribonucleic acid levels insulin cultured rat glioma cells recent data shown ferritin , ubiquitous protein , role regulator cellular differentiation present study investigated expression ferritin mrnas cultured c6 cells , rat glioma cell line , response insulin , important role cellular growth differentiation insulin stimulated steady state levels ferritin heavy chain ferritin light chain mrnas increase level ferritin heavy light chain mrna detected 2 h incubation insulin , plateau reached 48 h heavy chain mrna 72 h light chain mrna responses dose dependent maximal 100 nm mrnas treatment cells actinomycin showed insulin effect stability mrnas actinomycin inhibited insulin induced accumulation mrnas , suggesting transcriptional stimulation ferritin genes insulin nuclear run assay showed insulin induced increase ferritin heavy chain mrna due increase rate gene transcription also demonstrated insulin like growth factor \( igf \) increased ferritin heavy light chain mrna levels dose dependent fashion , maximum effect obtained concentration 10 nm mrna levels igf 10 fold potent , absolute level maximum stimulation also 2 fold greater insulin combination insulin \( 100 nm \) igf \( 10 nm \) showed additive effect results suggested ferritin heavy light chain genes regulated insulin influenced igf
regulation insulin , epidermal growth factor , transforming growth factor alpha levels growth factor degrading enzymes mechanisms growth factors degraded role process plays regulation cell growth well understood insulin degradation believed mediated specific , insulin degrading enzyme \( \) previously shown also degrade transforming growth factor alpha \( tgf alpha \) , epidermal growth factor \( egf \) , vitro selectivity surprising , since tgf alpha egf structurally similar bind receptor comparable affinities using spectrum protease inhibitors , analyzed degradation tgf alpha , egf , insulin human hepatoma hepg2 cells results suggest sensitive involved degradation tgf alpha egf well insulin , degradation tgf alpha , egf , mediated part inhibiting activity decreased growth factor depletion , suggesting enzymes play important role control extracellular growth factor levels existence separate pathways egf tgf alpha may explain two factors exert differential effects systems , degradation tgf alpha would provide possible mechanism interaction insulin tgf alpha egf systems
effects hepatitis b virus , alcohol drinking , cigarette smoking familial tendency hepatocellular carcinoma independent interactive effects related development hepatocellular carcinoma assessed using community based case control study hepatitis b virus , alcohol drinking , cigarette smoking , peanut consumption history hepatocellular carcinoma among immediate family 200 male newly diagnosed hepatocellular carcinoma patients recruited consecutively period study case group two teaching medical centers northern southern taiwan healthy community residents matched one one cases age , sex , ethnic group residential area selected control group carrier status hbsag hbeag determined blind radioimmunoassays , risk factors obtained standardized interviews according structured questionnaire logistic regression analysis showed significant association hepatocellular carcinoma carrier status hbsag hbeag odds ratio 16 7 56 5 , respectively , carriers hbsag alone carriers hbsag hbeag dose response relationship cigarette smoking hepatocellular carcinoma odds ratio 1 1 , 1 5 2 6 , respectively , smoked 1 10 , 11 20 20 cigarettes day significant association hepatocellular carcinoma also observed alcohol odds ratio 3 4 whose immediate family history hepatocellular carcinoma likely disease develop , odds ratio 4 6 however , frequency peanut consumption significantly associated hepatocellular carcinoma
usefulness pulsed doppler ultrasound detection angiographically evident recurrence hepatocellular carcinoma arterial embolization treatment hepatocellular carcinoma treated transcatheter arterial embolization often size , routine follow necessary usefulness pulsed doppler ultrasound detection type recurrence compared ultrasonography computed tomography 21 hepatocellular carcinomas 15 hepatocellular carcinomas diagnosed angiography showing recurrence , four detected ultrasonography five detected computed tomography doppler signals obtained peripheral portions corresponding tumor vessels stains angiograms 14 15 hepatocellular carcinomas , undetectable six hepatocellular carcinomas recurrence signals disappeared transcatheter arterial embolization one false negative hepatocellular carcinoma pulsed doppler ultrasound showed faint tumor stains angiograms also negative ultrasonography computed tomography pulsed doppler ultrasound may superior ultrasonography computed tomography routine procedure detect recurrence hepatocellular carcinoma treated transcatheter arterial embolization
acquired cisplatin resistance human ovarian cancer cells associated enhanced repair cisplatin dna lesions reduced drug accumulation studies undertaken investigate acquired resistance cisplatin human ovarian cancer cells cell lines studied assess respective characteristics drug accumulation efflux , cytosolic inactivation drug , dna repair experiments performed using 1 h drug exposures cell line 13 fold resistant cisplatin cells studied respective ic50 doses , drug accumulation rates similar two cell lines however , resistant cell line twofold efficient drug , associated reduced total drug accumulation equivalent micromolar drug exposures equivalent levels total cellular drug accumulation , two cell lines formed levels cisplatin dna damage , suggesting cytosolic inactivation drug contribute differential resistance cell lines resistant cells also twofold efficient repairing cisplatin dna lesions cellular dna transfected plasmid dna conclude paired cell lines , alterations drug uptake efflux dna repair major contributing factors acquired resistance cisplatin
biology basal cell carcinoma \( part \) basal cell carcinoma common malignancy humans although rarely metastatic , capable significant local destruction two part article reviews current understanding basal cell carcinoma biology part examines significant clinical , histologic , ultrastructural features relate invasive potential genetic characteristics , including tumor growth rate , chromosomal abnormalities , oncogene presence , discussed , expression important cell matrix proteins , including keratin , fibronectin , hla antigens , reviewed topics explored part ii include host immunologic responses , theories pathogenesis , valuable second line therapeutic regimens treatment multiple cancers
late metastases cutaneous melanoma case report literature review development delayed metastases , although rare , well documented patients invasive cutaneous melanoma 24 cases , including , clearly documented literature describe 56 year old woman acral melanoma right hand \( thickness 1 2 mm \) thirteen years excision postoperative irradiation , subcutaneous metastasis developed right arm one year later patient died disseminated bone metastases case , delayed metastases , typical features female sex location site back , arm , neck , scalp primary tumor thickness 1 2 2 5 mm
multiple granular cell tumors associated giant nevus nevus child describe 11 year old girl multiple cutaneous granular cell tumors associated giant nevus extensive nevus association granular cell tumors pigmented skin lesions reported twice previously supports neural origin tumors abnormality neural crest development proposed explain coexistence three uncommon unusually extensive cutaneous disorders patient case may represent variant
abnormal epidermal changes argon laser treatment 26 year old woman congenital port wine stain forehead treated three times 2 month intervals argon laser six months last treatment , moderate mild scaling confined treated area observed biopsy specimen treated area revealed significant decrease ectatic vessels however , epidermal changes similar keratosis cell layers marked cytologic abnormalities seen analysis peripheral blood lymphocytes defect dna repair negative multiple , argon laser induced effects may responsible changes observed case may lead premalignant epidermal transformation
systematic computer aided search optimal staging system colorectal cancer two hundred ninety eight patients resected colorectal cancer classified 12 categories according depth tumour penetration \( t1 t4 \) , lymph node status \( n0 n2 \) using computer , categories grouped 2 12 stages every possible combination , total 146 , logical classifications generated optimal model selected group classifications equal stage number , thus giving greatest prognostic information 5 year survival according criterion results showed \( 1 \) 13 total classifications , including 85 3 stage classifications , better dukes system predicting patients' outcomes \( 2 \) level stage determinant even important n level \( 3 \) major changes prognosis occurred advanced stages classical points conclude order find optimal staging cancer , systematic computer aided search possible classifications necessary , using appropriate database
usefulness epidurally evoked cortical potential monitoring glioma surgery report describes patient intramedullary region junction abolition somatosensory evoked potentials following median nerve stimulation intraoperative monitoring cortical potentials elicited epidural cervical cord stimulation , tumor removed posterior epidural stimulation appeared ascending fibers stimulation single peripheral nerve recommend , cases operations vital area , epidurally evoked cortical potentials monitored intraoperatively
influence drug interval effect methotrexate fluorouracil treatment advanced colorectal cancer importance interval methotrexate \( mtx \) fluorouracil \( 5 fu \) studied 168 patients previously untreated , measurable , advanced colorectal cancer randomized receive mtx 200 mg m2 , followed 5 fu 600 mg m2 either 24 hours \( arm \) 1 hour \( arm b \) mtx patients received leucovorin \( lv \) 24 hours mtx , 10 mg m2 orally every 6 hours six doses regimen repeated every 2 weeks , 5 fu escalation tolerated arm significantly better arm b respect overall response rate \( 29 v 14 5 , p 026 \) , time progression \( median , 9 9 months v 5 9 months , p 009 \) , survival \( median , 15 3 months v 11 4 months , p 003 \) significant differences arms found response rate , median , median survival subgroup patients rectal comprised 20 patients arm significant factors prognostic survival performance status number metastases , well treatment age influence survival toxicity similar arms primarily gastrointestinal mucositis seen arm four toxic deaths secondary neutropenia infection \( one arm three arm b \) three deaths \( two arm one arm b \) possibly drug related combination mtx lv rescue 5 fu active regimen advanced colorectal cancer efficacy increased colon , rectal cancer , interval mtx 5 fu long \( 24 hours \) rather short \( 1 hour \)
clonogenic growth vitro independent biologic prognostic factor ovarian carcinoma retrospective analysis performed investigate prognostic value growth human tumor clonogenic assay system 84 ovarian cancer patients significant difference survival probability \( determined method kaplan meier \) found univariate analysis patients ovarian carcinoma whose tumors manifested clonogenic growth \( defined growth greater equal five colonies per plate \) patients whose tumors grow clonogenic growth vitro associated worse prognosis \( p 007 , log rank test \) number generally accepted prognostic factors , international federation gynecology obstetrics \( figo \) stage \( p 003 \) , residual tumor mass \( p less 001 \) , grade \( p 011 \) , also prognostic importance patient population multivariate analysis , based cox regression model , identified clonogenic growth significant independent prognostic parameter ovarian carcinoma \( p 031 \) , addition conventional risk factors estimation survival individual patients best accomplished combining factors residual tumor mass \( p less 05 \) , age \( p less 01 \) , clonogenic growth \( p less 05 \) \( sequence decreasing potential risk \)
second line platinum therapy patients ovarian cancer previously treated cisplatin effort critically define incidence clinical characteristics secondary responses cisplatin based therapy patients ovarian cancer previously treated cisplatin based program , retrospective review undertaken patients memorial sloan kettering cancer center received greater equal two cisplatin carboplatin based programs eighty two patients identified met entry criteria cisplatin free interval \( \) 4 months completion first regimen institution second cisplatin carboplatin program 72 assessable patients \( 10 measurable disease , laparotomy performed assess response \) , 31 \( 43 \) responded , including 10 surgically defined complete responses \( crs \) overall response rates \( cr rate \) , based duration , 5 12 months , 27 \( 5 \) 13 24 months , 33 \( 11 \) 24 months , 59 \( 22 \) twenty nine patients \( 35 \) received carboplatin containing treatments cisplatin programs patients without treatment 24 months completion initial therapy experienced 77 \( 17 22 \) response rate 32 \( seven 22 \) cr rate conclusion , secondary responses cisplatin carboplatin based treatment common patients ovarian cancer previously responded agents increase frequency greater distance initial therapy
treatment relapsed non hodgkin 's lymphomas dexamethasone , high dose cytarabine , cisplatin marrow transplantation combination chemotherapy capable many patients newly diagnosed intermediate high grade non hodgkin 's lymphomas \( nhl \) , treatment relapsed nhl remains problematic bone marrow transplantation \( bmt \) offers best chance disease free survival , interim chemotherapy often necessary awaiting bmt , especially patients bulky disease report 39 patients \( median age , 44 years \) failed primary therapy doxorubicin based regimens subsequently treated one six cycles dexamethasone , 40 mg intravenous \( iv \) every day days 1 4 , cisplatin 100 mg m2 continuous infusion day 1 , cytarabine 2 g m2 iv every 12 hours x two doses day 2 \( \) planned bmt included 16 diffuse large cell , six diffuse mixed , five diffuse small cleaved , four lymphoblastic , eight twenty eight patients stage iv disease , 13 b symptoms , 20 elevated lactate dehydrogenase \( ldh \) patients treated median three previous chemotherapy regimens sixty one percent patients high tumor according md anderson criteria objective responses seen 26 patients \( 67 \) including nine complete responses \( crs \) \( 23 \) 17 partial responses \( \) \( 44 \) , responses lasted median 7 5 months myelosuppression major toxicity , treatment related deaths date , 17 patients undergone subsequent bmt projected 3 year disease free survival 15 conclude regimen effective short term salvage therapy relapsed nhl patients , long term prognosis multiply relapsed patients remains poor
second primary cancer following hodgkin 's disease results italian study risk second primary cancer \( spc \) evaluated patients treated hodgkin 's disease \( hd \) period january 1969 december 1979 median follow series 10 5 years \( range , 9 19 \) treatment categories included radiotherapy \( rt \) alone \( 115 patients , 12 \) , chemotherapy \( cht \) alone \( 161 patients , 17 \) , combined rt plus cht \( patients , 40 \) , salvage treatment resistant relapsing hd \( 290 patients , 30 6 \) fifty six observed , occurring 1 17 years initial treatment among , secondary acute leukemia \( anll \) frequent spc \( 23 cases \) secondary non hodgkin 's lymphoma \( nhl \) occurred 5 patients , whereas secondary solid tumor \( st \) observed 28 patients calculated actuarial risk \( se \) developing spc 5 0 \( 0 9 \) 23 1 \( 5 8 \) 10 19 years , respectively concerning treatment modalities anll risk , cases observed radiotherapy group , whereas cht plus rt salvage groups showed highest actuarial risk , fact , 10 19 years , 3 1 \( 0 9 \) 8 1 \( 4 0 \) former group , 1 8 \( 1 0 \) 16 \( 9 0 \) latter statistically significant difference observed cht plus rt group compared cht rt groups \( p 04 \) concerning relationships chemotherapeutic regimens , 12 anll cases occurred , vincristine , procarbazine , prednisone \( mopp \) plus rt group , one case group receiving doxorubicin , bleomycin , vinblastine , \( \) plus rt statistically significant difference anll actuarial risk found comparing patients receiving mopp plus rt treatment groups \( p 04 \) respect st , actuarial risk 10 19 years 2 0 \( 0 6 \) 13 0 \( 3 8 \) , respectively significant differences found among groups treated different modalities data confirmed multivariate analysis , indicated treatment modality age independent variables anll st development , respectively based prolonged follow analysis , actuarial spc risk 10 years reported reflect real spc incidence series
pattern intrathoracic hodgkin 's disease assessed computed tomography computed tomography \( ct \) used define sites intrathoracic abnormality hodgkin 's disease , determine pattern progression disease thorax , establish place pattern spread differential diagnosis thoracic abnormalities one hundred eight patients newly diagnosed hodgkin 's disease studied chest ct seventy seven patients intrathoracic abnormalities pattern seen one contiguous spread anterior mediastinal area mediastinal lymph node groups \( aortopulmonary , , posterior mediastinal , internal mammary \) , , lung extension discrete nodules involvement pleura , pericardium , chest wall occurred anterior mediastinal mass enlarged greater 30 thoracic diameter probability pattern contiguous lymph node spread occurred chance alone small hodgkin 's disease anterior mediastinal area contiguous manner exceptions unusual enough occur , diagnoses hodgkin 's disease likely
multiple myeloma alternating combination chemotherapy superior melphalan prednisone even high risk patients efficacy alternating vincristine , melphalan \( \) , cyclophosphamide , prednisone vincristine , , doxorubicin , prednisone \( \) compared prednisone \( mp \) regimen induction treatment multiple myeloma \( mm \) three hundred four mm patients entered study march 1983 july 1986 analysis performed december 1989 treatment groups show significant differences respect major prognostic factors median overall survival 33 8 months mp arms , 12 induction chemotherapy cycles , 59 0 47 3 \( p less \) patients achieved component reduction greater 50 significant difference observed two treatment arms terms remission duration \( 21 3 v 19 6 months , p less 66 \) survival \( 31 6 v 37 0 months , p less 28 \) patients younger 65 years show advantage alternating diagnosis , plasma cell labeling index \( li \) serum beta 2 microglobulin \( beta 2 \) evaluated 173 183 patients , respectively significantly reduced survival observed patients li greater equal 2 \( 16 4 months \) beta 2 greater equal 6 mg l \( 20 4 months \) even poor risk subgroups , superior mp
phase clinical , plasma , cellular pharmacology study novel analog , \( 2' , 2' dfdc \) , studied phase clinical pharmacology trial doses ranging 10 1 , 000 mg m2 administered 30 minutes weekly times 3 weeks every 4 weeks maximum tolerated dose \( mtd \) mg m2 dose limiting toxicity myelosuppression , thrombocytopenia anemia quantitatively important toxicity minimal two responses patients adenocarcinomas colon lung documented maximum dfdc plasma concentration , reached 15 minutes infusion , proportional total dose administered elimination , due mainly , rapid \( terminal half life t1 2 , 8 0 minutes \) dose independent product 2' , 2' \( \) eliminated biphasic kinetics characterized long terminal phase \( t1 2 , 14 hours \) sole metabolite detected urine concentration dfdc 5' triphosphate circulating mononuclear cells increased proportion dfdc dose infusions 35 250 mg m2 increment dfdc 5' triphosphate \( \) observed higher doses , resulted plasma dfdc concentrations greater 20 mumol l \( 350 1 , 000 mg m2 \) , suggesting saturation dfdc 5' phosphate accumulation recommended dose phase ii clinical trials solid tumors mg m2 wk
interleukin 2 prospects lymphocyte mediated destruction pediatric malignancies immunologic therapy cancer speculated turn century animals , vitro , recently patients , evidence obtained lymphocyte responses reproducible beneficial antitumor effect results indicate biologic response modification may truly become fourth modality cancer treatment , integrated standard approaches radiation , chemotherapy , surgery extent immune approaches may enable eradication microscopic amounts residual diseases children would otherwise recurrence malignancies remains critical issue testing next decade enthusiasm regarding approach abundant , critical evaluation clinical trials essential best focus mechanisms effective therapy
alternating hepatic intra arterial fluorouracil less toxic regimen treatment liver metastases colorectal cancer hepatic intra arterial \( hia \) infusion \( fudr \) via implanted pump shown promise treatment colorectal cancer metastasized liver however , potential benefit therapy may offset high incidence treatment limiting biliary toxicity although weekly hia bolus fluorouracil \( 5 fu \) effective metastatic colorectal cancer liver biliary toxicity , limited systemic side effects december 1986 , began phase ii trial alternating hia fudr 5 fu via implanted pump attempt extend duration treatment limiting biliary \( fudr \) systemic \( 5 fu \) drug toxic effects patients received continuous hia fudr 0 1 mg kg body weight per day days 1 8 followed hia bolus 5 fu 15 mg kg given via pump days 15 , 22 , 29 , cycle repeated every 35 days sixty eight patients enrolled trial , 64 fully evaluable 64 patients , 30 \( 47 \) previously received chemotherapy major response \( complete response plus partial response \) observed 32 \( 50 \) 64 patients , median survival pump implantation patients 22 4 months contrast experience single agent hia fudr regimen , patient treatment terminated drug toxicity alternating hia fudr 5 fu efficacy similar hia fudr given alone , closely monitored adjusted appropriately , associated toxic effects requiring treatment termination
preferential localization human adherent lymphokine activated killer cells tumor microcirculation efficacy adoptive immunotherapy solid tumors lymphokine activated effector cells presumably depends ability cells localize adequately tumor tissues present first quantitative study vivo movement labeled adherent lymphokine activated killer \( lak \) cells cells injected intra along low dose interleukin 2 normal \( mature granulation \) tissue implant carcinoma grown rabbit ear chamber small proportion lak cells accumulated preferentially tumor microcirculation vivo increased frequency long term adhesive interactions tumor vasculature stasis blood flow tumor vasculature observed 1 2 days injection subsequent necrosis tumors observed , along diffuse infiltrates lymphocytes , monocytes , granulocytes interstitial space within tumor development necrosis despite low ratios effector cells target cells suggests addition direct cytotoxicity , response adoptive immunotherapy mediated via tumor vasculature novel mechanism adoptive immunotherapy must taken account development improved strategies cancer treatment
cancer populations living near nuclear facilities survey mortality nationwide incidence two states reports united kingdom described increases leukemia lymphoma among young persons living near certain nuclear concerns raised reports , mortality survey conducted populations living near nuclear facilities united states facilities began service 1982 900 , 000 cancer deaths occurred 1950 1984 107 counties near nuclear study county matched comparison three control counties region 1 8 million cancer deaths 292 control counties 35 years studied deaths due leukemia cancers frequent study counties control counties childhood leukemia mortality , relative risk comparing study counties controls plant start 1 08 , start 1 03 leukemia mortality ages , relative risks 1 02 start 0 98 counties two states , cancer incidence data also available one facility , standardized registration ratio childhood leukemia increased significantly start however , increase also operation facility study limited approach large size geographic areas \( counties \) used prove absence effect , however , excess cancer risk present us counties nuclear facilities , small detected methods employed
esophageal ultrasound preoperative staging carcinoma esophagus esophageal ultrasound allows esophageal wall viewed five discrete layers lymph nodes easily identified , size , shape , margin , internal structure assessed provides alternative method preoperative \( clinical \) evaluation primary tumor regional lymph nodes n patients carcinoma esophagus esophageal ultrasound attempted clinical staging 28 patients carcinoma esophagus six patients \( 21 \) assessed inability pass esophageal ultrasound probe malignant stricture staging system carcinoma esophagus developed international union cancer american joint committee cancer used twenty two patients true determined pathologic review resected esophagus esophageal ultrasound correctly identified 13 patients \( 59 accuracy \) four patients \( 18 \) disease esophageal ultrasound patients early t1 tumors confined submucosa five patients \( 23 \) disease esophageal ultrasound patients advanced tumors \( four t3 one t4 \) beyond esophageal wall seven nine incorrect esophageal ultrasound determinations called t2 \( three t1 , three t3 , one t4 \) , suggests borders propria require careful attention evaluated esophageal ultrasound twenty patients true n determined pathologic review resected specimen esophageal ultrasound correctly identified n 14 patients \( 70 accuracy \) three patients falsely identified disease three falsely identified n0 disease sensitivity , specificity , positive predictive value , negative predictive value n assessment esophageal ultrasound 70 esophageal ultrasound provides alternative method visualization esophageal wall regional lymph nodes early experience shows promise esophageal ultrasound clinical staging carcinoma esophagus
lack effect pregnancy outcome melanoma world health melanoma programme determine effect pregnancy prognosis melanoma investigated women treated stage 1 primary cutaneous disease childbearing years 85 women treated pregnancy , 92 pregnancy , 143 completed pregnancies , 68 pregnancies women received treatment pregnant primary tumours significantly greater thickness three groups \( p 0 002 \) possible confounding factors \( site , age , parity \) differ groups tumour thickness controlled , survival rate women melanoma diagnosed treated pregnant differ three groups cox regression analysis showed differences three groups women pregnant diagnosis women melanoma advised pregnancy basis thickness site tumour evidence vascular spread , hormonal status
activation epstein barr virus latent genes protects human b cells death apoptosis epstein barr virus \( ebv \) , human , establishes persistent asymptomatic infection circulating b lymphocyte pool mechanism virus persistence understood , given limited b cells vivo , seems likely ebv infected cells must gain access long lived memory b cell pool show vitro system ebv , expression full set eight virus coded proteins , protect human b cells programmed cell death \( apoptosis \) , deletion mechanism normally entry memory found ebv positive burkitt 's lymphoma \( \) cell clones retaining original tumour cell phenotype expressing one virus latent proteins , nuclear antigen 1 , extremely sensitive apoptosis respect resemble tumour 's normal cell origin found centres lymphoid tissue contrast , cell clones activated expression eight ebv latent proteins resistant induction apoptosis ebv latent proteins therefore seen b cell proliferation , perhaps importantly , mediators enhanced b cell survival
nursing role limb salvage surgery limb salvage surgery proven valuable option sarcoma patients reconstruction options vast include metallic implants , allografts , combination nursing implications patients patient needs educated assessed closely complications infections , nonunion allograft , limited mobility although nursing care complicated , working patients great
patients delay seeking care cancer symptoms patient delay seeking care cancer symptoms common well documented research studies fear denial , lack information cancer , financial considerations contribute delay patient education may important factor decreasing length delay thereby improving treatment outcome making good use opportunities patient education , primary care physicians may positively influence prognosis several types cancer , particularly breast cancer malignant melanoma skin
characteristics erythroleukemia cells selected vincristine resistance accelerated inducer mediated differentiation induction murine erythroleukemia cells \( melc \) terminal differentiation \( \) characterized latent period 10 12 hr onset commitment terminal cell division increased transcription globin genes melc variants , derived parental cell line , selected resistance vincristine \( vc \) , induced differentiate little latent period study shows accelerated induced commitment characteristic melc low level \( 2 5 fold \) vc resistance four independently derived cell lines resistance vc accelerated differentiation stable phenotypes least 50 passages \( approximately 5 months \) absence vc low level vc resistant melc display increased levels p glycoprotein mdr1 , , mrnas , exhibit cross resistance colchicine doxorubicin cells show \( \) increased level protein kinase c activity , \( ii \) reduced accumulation 3h vc , \( iii \) restoration vc sensitivity presence verapamil melc selected higher levels vc resistance \( approximately 500 fold \) express high levels p glycoprotein gene induced differentiation , decrease 3h vc accumulation , p glycoprotein content change vc transport associated protein , also critical process induced differentiation , may constitutively present vc resistant melc , accounting enhanced sensitivity inducer protein exposure vc sensitive cells , contributing differentiation decreased level vc accumulation
effects site directed mutagenesis residues cysteine 31 cysteine 184 lecithin cholesterol acyltransferase activity native lecithin cholesterol acyltransferase \( lcat phosphatidylcholine sterol acyltransferase phosphatidylcholine sterol acyltransferase , ec 2 3 1 43 \) protein , lcat either enzyme free replaced glycine residues site directed mutagenesis , expressed cultured chinese hamster ovary cells stably transfected human lcat gene mass lcat secreted , determined immunoassay , differ native mutant species lcat specific activity also unchanged mutant species particular , cysteine free double mutant , cys 31 cys 184 replaced , fully active synthesis cholesteryl esters result consistent catalytic role lcat free cysteine residues classical inhibitor lcat activity , 5 , 5' \( 2 acid \) \( \) , strongly \( 89 \) inhibited native enzyme , partial \( 45 \) inhibitory activity mutant enzyme species containing single sh residue , double mutant significantly inhibited data interpreted suggest cys 31 cys 184 binding site residues 177 182 , exerts effect inhibition
transfection c6 glioma cells connexin 43 cdna analysis expression , intercellular coupling , cell proliferation c6 glioma cells express low levels gap junction protein connexin 43 mrna display weak dye coupling implanted rat , cells quickly give rise large glioma investigate role gap junctions tumor characteristics cells , used mediated transfection introduce full length cdna encoding connexin 43 several transfected clones obtained exhibited various amounts connexin 43 mrna transcribed inserted cdna immunocytochemical analysis revealed increase amount connexin 43 immunoreactivity transfected cells , localized areas intercellular contact well cytoplasm level dye coupling also assessed found correlate amount connexin 43 mrna cell proliferation followed several days , cells expressing transfected cdna grew slowly non transfected cells transfected cells useful examining role gap junctions tumorigenesis
differentiation hl 60 leukemia type regulatory subunit antisense camp dependent protein kinase marked decrease type camp dependent protein kinase regulatory subunit \( ri alpha \) increase type ii protein kinase regulatory subunit \( beta \) correlate growth inhibition differentiation induced variety types human cancer cells , vitro vivo , site selective camp analogs directly determine whether ri alpha growth inducing protein essential neoplastic cell growth , human hl 60 promyelocytic leukemia cells exposed 21 mer ri alpha antisense , effects cell replication differentiation examined ri alpha antisense brought growth inhibition monocytic differentiation , effects exogenous camp analog effects ri alpha antisense correlated decrease ri alpha receptor increase beta receptor level growth inhibition differentiation abolished , however , cells exposed simultaneously ri alpha beta antisense beta antisense alone previously shown specifically block differentiation inducible camp analogs results provide direct evidence ri alpha camp receptor plays critical role neoplastic cell growth camp receptor isoforms display specific roles camp regulation cell growth differentiation
titrated intravenous control symptoms patients terminal cancer patients terminal cancer may series severe physical psychologic symptoms improve symptom control final days hours life , intravenous continuously provide heavy sedation continuous somnolence titrated dosage reduced minimum , desired steady state achieved improved symptom control provided , patient 's maintained death
management soft tissue sarcomas extremities management soft tissue sarcomas undergone continues undergo important changes purpose report review presentation , diagnosis , natural history soft tissue sarcomas , importance careful rigorous method evaluation emphasized furthermore , results multidisciplinary treatment , goal towards limb salvage , reviewed appropriate timely intervention , selected patients pulmonary metastases may still experience long term survival throughout review , importance early continuing multidisciplinary treatment evaluation emphasized
giant cell tumor bone giant cell tumor second common benign tumor bone plain radiographs may demonstrate distinctive features also misleading diagnosis may aided use imaging modalities , bone scan , computed tomography angiography recurrence rate high , newer treatments seem associated better outcomes
lack effect chronic administration oral beta carotene serum cholesterol triglyceride concentrations previous studies suggest chronic oral administration retinol retinoids causes elevation plasma triglyceride concentrations effects chronic oral administration beta carotene , carotenoid partially metabolized retinol , plasma lipid concentrations well studied therefore , studied 61 subjects 12 mo enrolled skin cancer prevention study patients randomly assigned receive either placebo \( n 30 \) 50 mg beta carotene orally \( n 31 \) study entry 1 later , fasting blood samples obtained measurement triglycerides , total cholesterol , hdl cholesterol , retinol , beta carotene retinol concentrations changed minimally groups beta carotene concentration increased average 12 1 47 nmol l placebo group 657 nmol l active treatment group groups experienced similar small increases triglyceride total cholesterol concentrations small decreases hdl cholesterol daily oral administration 50 mg beta carotene affect plasma lipid concentrations
beta carotene 's effects serum lipoproteins immunologic indices humans doses beta carotene cancer prevention trials chosen based epidemiologic data mechanisms putative antineoplastic effects beta carotene unknown may involve modulation immune system measured plasma carotenoid concentrations selected immunologic indices baseline 2 4 wk 50 healthy humans \( 5 groups 10 \) ingesting 0 , 15 , 45 , 180 , 300 mg beta carotene 1 mo randomized placebo controlled , open label , parallel study plasma beta carotene concentrations markedly increased 2 wk correlated dose beta carotene concentrations 2 4 wk except 300 mg group thus , developed dose concentration curve optimize beta carotene dose selection achieve target plasma concentrations unable identify effects beta carotene ingestion immunologic indices studied , modest increases high density lipoprotein cholesterol observed beta carotene treated groups
development intrapancreatic transplantable model pancreatic duct adenocarcinoma syrian golden hamsters intrapancreatic subcutaneous \( sc \) inoculation cultured pancreatic cancer cells , derived induced primary pancreatic cancer syrian hamster , resulted tumor take recipient hamsters intrapancreatic allografts grew rapidly , invasive , metastasized lymph nodes liver 2 9 cases comparison , sc tumors grew relatively slower formed large encapsulated mass without invasion metastases histologically , tumors sites showed fairly well differentiated adenocarcinomas ductal ductular type resembling induced primary cancer similar primary induced pancreatic cancers , tumor cells allografts expressed blood group related antigens , including , b , h , le \( b \) , le \( \) , le \( x \) , tumor associated antigen tag 72 tumor cells express le \( \) , ca 19 9 , 17 1a , du pan 2 expression antigens retained metastases presented patterns reactivity allografts thus intrapancreatic transplantation provides rapid model production pancreatic cancer morphologic similarities human pancreatic cancer
epithelial cells immortalized human papillomaviruses premalignant characteristics culture three hpv 16 four hpv 18 immortalized human keratinocyte cell lines analyzed epidermal cultures various passage levels culture system allowed normal cultured keratinocytes stratify differentiate manner similar normal epidermis seven hpv immortalized cell lines displayed epidermal cultures , clearly abnormal resembled premalignant lesions vivo features premalignant lesions shared hpv immortalized cell lines included tissue architecture , mitotic cells present throughout living layers epidermal sheet , abnormal mitoses , enlarged nuclei , variable cell size shape hpv immortalized cell lines stable terms epidermal morphology long term passage culture two hpv 18 immortalized cell lines , however , lost morphologically apparent terminal squamous differentiation potential long term passage monolayer culture results strongly support idea squamous epithelial cells culture hpv transforming genes generates morphologically premalignant cell
expression vla alpha 2 , vla alpha 6 , vla beta 1 chains normal mucosa adenomas colon , colon carcinomas liver metastases late \( vla \) proteins members integrin cell surface receptor function involved cell cell matrix interaction common beta 1 chain different alpha chains counted vla 1 vla 6 vla 2 complex \( alpha 2 beta 1 \) found act collagen receptor platelets vla 6 complex \( alpha 6 beta 1 \) laminin receptor using monoclonal antibodies indirect immunoperoxidase method , investigated expression vla alpha 2 , vla alpha 6 , vla beta 1 chains 20 normal colonic mucosa samples , 20 colonic adenomas , 96 carcinomas together 10 accompanying liver metastases three proteins expressed throughout colonic epithelium , except vla alpha 2 , present gland absent mucosal surface cases general , adenomas strongly positive vla proteins 3 20 cases showed focal vla alpha 2 negative areas carcinomas revealed considerable heterogeneity vla alpha 2 expression ie , 59 tumors completely positive , 35 tumors revealed focal loss antigen , 2 cases negative reduced antigen expression statistically associated dukes' stage c \( p 0 003 \) vla alpha 6 expressed throughout tumors vla beta 1 found extensively expressed 77 carcinomas , partially expressed 17 carcinomas , absent 2 carcinomas compared primary tumors , liver metastases showed roughly corresponding patterns antigen expression regulation loss vla proteins subset epithelial colon tumors might cause disturbed cell cell cell matrix interaction might augment invasive property cells
basal cell specific hyperproliferation related keratins human breast cancer normal breast tissue noninvasive breast carcinomas , various keratin 14 antibodies reactive predominantly basal myoepithelial cell layer , although mainly terminal larger ducts luminal cells sometimes also stained similar reaction pattern found antibody directed keratin 17 , although antibody often found negative keratin 14 pre existing myoepithelial cells intraductal carcinomas furthermore antibodies reactive hyperproliferation related keratins 6 16 used one \( \) completely negative normal breast tissue noninvasive breast carcinomas however 10 invasive carcinomas diffusely focally positive latter antibody , 18 115 cases invasive breast carcinomas studied , basal cell phenotype detected relatively high concordance found carcinomas immunostaining basal cell hyperproliferation related keratins , markers proliferation marker ki 67 supports conclusion basal cells breast cancer may show extensive proliferation , absence ki 67 staining mean \( tumor \) cells proliferating
musculoskeletal infection , microbial adhesion , antibiotic resistance osteomyelitis intra articular infection septic diseases present pathogenic features characteristic molecular mechanisms involving adhesion review , mechanisms microbial adhesion bone cartilage presented related host tissue response antibiotic treatment
diagnostic imaging osteomyelitis many imaging procedures diagnosing osteomyelitis , unique strengths plain radiographs inexpensive accurate may provide delayed diagnosis computed tomography magnetic resonance imaging excellent differentiating soft tissue infection osteomyelitis computed tomography , magnetic resonance imaging , bone scans accurate diagnostic tools use bone surgery , trauma , structural alterations changes present , indium 111 leukocyte indium 111 polyclonal antibody study may necessary accurate diagnosis
antibiotic therapy osteomyelitis antibiotic therapy osteomyelitis dramatically changed within past twenty years diagnostic criteria osteomyelitis remain practicing physicians bone biopsy culture standard determining specific antimicrobial therapy many potent used treat increasingly broad bacterial spectrum etiologies osteomyelitis tremendous economic outpatient oral therapy third generation cephalosporins new replaced older , toxic regimens , especially containing used treat gram negative osteomyelitis due susceptible organisms
surgical approaches osteomyelitis use laser doppler flowmetry determine bone surgical management osteomyelitis includes radical debridement bone laser doppler flowmetry method directly assessing functional microcirculation bone early results use technique surgical adjunct management osteomyelitis promising
infectious arthritis patient presents acute arthritis , especially new asymmetric effusion underlying joint disease , suspected bacterial process synovial fluid findings \( leukocyte counts glucose \) may predictive infection , bacteriologic analysis smear culture necessary evaluation new synovial effusion chronic process highly likely infectious also , mycobacterial fungal etiologies frequently require appropriate culture synovial tissue addition processing fluid acute polyarticular syndromes seen manifestations disseminated gonococcal infections \( \) certain viral infections adults diagnostic clues include historic physical findings \( exposure history type rash \) major pathogen adults remains staphylococcus aureus , initial therapy directed organism unless urinary tract infection present also proper recommended therapy ceftriaxone penicillin resistant strains present many urban centers early recognition treatment bacterial arthritis may prevent poor outcome , particularly elderly patients underlying joint diseases chronic mycobacterial fungal infections , surgery may need combined medical management
vertebral osteomyelitis vertebral osteomyelitis caused variety microorganisms form characteristically disease people age 50 , predominantly male population , frequently caused aureus , however , younger patients heavier predominance males seen , p aeruginosa one commonly seen pathogens disease generally , unless secondary contiguous process pressure , infection participation general rule lumbar , greater thoracic , greater cervical involvement rule general population , cervical spine involvement frequently seen often thoracic involvement diabetic patients represented among patients vertebral osteomyelitis , also tendency higher morbidity mortality simultaneous involvement adjacent vertebral end plates intervening disk general rule vertebrae generally involved , posterior elements spine involved infrequently posterior element involvement seen commonly , , neoplasms newer diagnostic modalities , ct , mri , radionuclide scans , may detect disease earlier conventional radiographs bed rest appropriate antimicrobial therapy generally sufficient therapy , well tuberculous , vertebral osteomyelitis selected circumstances , presence marked instability spine , presence new neurologic deficits , progression previous neurologic deficits , surgical intervention may necessary prompt diagnosis proper management , prognosis generally good
approach skull base lesions modification skull base approach described sectioning downward displacement arch , process mandible dissected sectioned base temporal muscle , insertion , retracted upward approach provides direct access temporal adequate vascularity temporal muscle maintained exposure internal carotid artery neck vascular control extensive reconstruction eliminated described technique used seven patients lesions skull base operative mortality , morbidity consisted temporary restriction mandibular opening two patients
simple technique posterior traumatic instability mid lower cervical spine technical note without bone fusion treatment traumatic cervical instability uncommon procedure authors describe technique stabilizing acute injured movement segment mid lower cervical spine results briefly discussed
management delayed union nonunion maxillary osteotomies delayed union nonunion maxillary osteotomies unusual , seen variety surgical management problems divided early late therapy four cases presented illustrating methods treatment
composite temporalis pedicle flap graft temporomandibular joint arthroplasty preliminary report fifteen temporomandibular joint patients evaluated preoperatively postoperatively evaluate effectiveness composite \( fascia , muscle periosteum \) temporalis pedicle flap disc replacement modified index \( \) symptom severity index \( \) used assess clinical subjective symptoms eighteen months postoperatively significant reduction cm ss indices \( p less 001 \) , significant clinical improvement mandibular range motion \( p less 05 \) however , significant reduction translation \( p less 01 \) evident indicating increased mandibular opening owing compensatory rotational movement study indicates composite temporalis pedicle flap good autogenous tissue reconstruction temporomandibular joint
tissue response composite hydroxyapatite demineralized bone implants study evaluated tissue reactions two materials hydroxyapatite \( cha \) , composite material demineralized bone powder \( dbp \) cha \( ratio 4 1 \) collagen vehicle materials tested subcutaneous pocket , mandibular , calvarial model specimens evaluated histologically 7 , 10 , 14 , 21 days hydroxyapatite , implanted subcutaneously , elicited fibrous response minimal inflammation , induce bone formation specimens subcutaneously implanted composite material , induced bone evident association dbp cha specimens , small amount reactive bone extending host bone implant composite , bone filled entire body implant results study indicate cha particles heterotopic sites ingrowth minimal bone induced dbp even mixed cha particles implanted subcutaneous intraosseous sites concluded composite implants may provide means combining properties dbp bulk structural support cha particles
bone response hydroxyapatite particles different rabbit tibia four rabbit tibia filled different commercial hydroxyapatite products particles caused mild inflammatory reaction , disappeared 2 months line new original bone visible even 6 months differences healing pattern discovered various products bone cavities filled hydroxyapatite particles , shape particles seem affect healing process
protocol management temporomandibular joint management protocol temporomandibular joint \( tmj \) consisting 1 \) aggressive resection , 2 \) ipsilateral , 3 \) contralateral necessary , 4 \) lining tmj temporalis fascia cartilage , 5 \) reconstruction ramus graft , 6 \) rigid fixation , 7 \) early mobilization aggressive physiotherapy presented protocol retrospectively evaluated first 14 patients \( 18 involved \) treated followed postoperatively least 1 year facial present unilateral cases remained corrected mean maximum postoperative opening 1 year 37 5 mm \( 292 36 mean increase \) , lateral present 16 18 joints \( vs 0 18 joints preoperatively \) , pain present 2 18 joints \( vs 13 18 preoperatively \) results study indicate protocol effective treatment tmj
magnetic resonance imaging appearance muscles childhood dermatomyositis documentation muscle involvement child thought dermatomyositis may require performance invasive procedures electromyography muscle biopsy describe four patients dermatomyositis magnetic resonance imaging \( mri \) demonstrated muscle involvement involved muscles increased signal intensity t2 weighted images \( se 2500 80 \) normal appearance t1 weighted images \( se 600 20 \) involvement muscles uniform good correlation distribution muscle involvement mri functional testing follow mri scans patients favorable outcome demonstrated affected muscles returned normal signal intensity although mri findings specific , proper clinical context may helpful establishing diagnosis dermatomyositis mri may also used establishing appropriate muscle biopsy site addition , mri may used monitoring progress disease
modification health assessment questionnaire spondyloarthropathies published erratum appears j 1991 feb 18 \( 2 \) 305 functional status measure developed adding 5 items health assessment questionnaire \( \) , compared anthropometric measures spinal mobility forty four patients spondylitis evaluated measures spine flexibility \( finger floor , test , neck rotation , chest expansion \) modification raised mean difficulty score 29 0 38 \( sd 0 49 \) 0 49 \( sd 0 51 \) , indicating increased ability capture functional limitations neck rotation correlated strongly score \( r 0 57 \) , suggests important role measure clinical management followup spondylitis
vitamin bone recent studies effects vitamin bone include characterization receptors 1 , 25 \( oh \) 2d3 bone bone derived cells receptors show similar affinities different tissues receptor concentration affected stage cell cycle glucocorticoid treatment affects number receptor sites extensively studied effects 1 , 25 \( oh \) 2d3 synthesis bone collagen , anabolic effects found differences response may reflect state differentiation cells significant effects seen osteocalcin synthesis , although role protein vitamin action bone still unclear 1 , 25 \( oh \) 2d3 influences activity alkaline phosphatase 25 oh d3 24 hydroxylase bone receptors growth factors , production cytokines may influenced 1 , 25 \( oh \) 2d3 treatment although findings would consistent direct anabolic effects vitamin metabolites bone , process yet integrated complete picture vitamin action physiological pharmacological levels vivo recent studies consistent earlier results indicate effects 1 , 25 \( oh \) 2d3 mediated direct effect bone studies analogs 1 , 25 \( oh \) 2d3 suggest stimulation bone resorption dissociated effects differentiation cells monocyte lineage
spinal bone loss ovulatory disturbances background osteoporosis develops women estrogen deficiency amenorrhea lose bone accelerated rate known extent bone loss differs ovulatory women regular menstrual cycles training intensely sedentary methods measured density cancellous spinal bone thoracic vertebra 3rd lumbar vertebra quantitative computed tomography two occasions one year apart 66 premenopausal women 21 42 years age women two consecutive ovulatory cycles immediately entering study twenty one women training , 22 regularly less intensively , 23 normal levels activity lengths women 's menstrual cycles luteal phases , diet , exercise levels , hormonal levels also determined defined ovulatory disturbances cycles cycles short luteal phases results mean \( sd \) spinal bone density 66 women decreased 3 0 4 8 mg per centimeter per year \( 2 0 percent per year \) \( p less 0 001 \) amenorrhea develop woman year observation \( 2 7 percent cycles greater 36 days long \) ovulatory disturbances occurred 29 percent cycles , however bone loss strongly associated disturbances \( r 0 54 , 24 percent variance \) 13 women cycles lost bone mineral rate 6 4 3 8 mg per centimeter per year \( 4 2 percent per year \) women training menstrual cycles similar women two groups conclusion decreases spinal bone density among women differing exercise habits correlated asymptomatic disturbances ovulation \( without amenorrhea \) physical activity
effect estrone sulfate postmenopausal bone loss estrogen replacement therapy confers many beneficial effects postmenopausal women , slowing rate bone loss decreasing risk coronary artery disease multicenter , placebo controlled study evaluated lowest effective daily dose estrone sulfate \( 0 3 , 0 625 , 1 25 mg \) combined 1000 mg elemental calcium supplementation preventing bone loss immediate supplementation preventing bone loss immediate postmenopausal period spinal bone mineral density measured using quantitative computed tomography compared baseline , bone mineral density increased significantly \( p less 05 \) 12 months 0 625 mg daily \( 1 9 \) 1 25 mg daily \( 2 5 \) difference 0 625 mg 1 25 mg doses statistically significant estrone sulfate administration \( 0 625 1 25 mg \) produced significant changes various lipid measurements 6 12 month observation points prevalence rates adverse events comparable among estrone sulfate groups placebo group estrone sulfate 0 625 mg daily , combined 1000 mg elemental calcium supplementation , minimum effective dosage prevent loss spinal bone mineral density postmenopausal women 12 month period
bone trabecular pattern analysis syndrome use computed panoramic radiography part ii visual pattern analysis frequency enhancement visual pattern analysis mandibular bone 51 patients syndrome 78 normal persons performed using rotational panoramic radiography laser scan system findings patients syndrome consistent , one somatic characteristics syndrome
silicone rubber fossa implant removal via partial followed arthroscopic examination internal surface fibrous capsule thirteen temporomandibular joints examined evaluation fibrous encapsulation silicone disk replacement implants partial performed removal silicone rubber implants , followed arthroscopic examination internal surfaces fibrous capsule verify continuity fibrous barrier condyle fossa
triple bone labeling canine mandibles fluorescence microscopy used evaluation new bone formation 16 canine mandibles augmented \( ha \) granules three injected different time intervals therapeutic radiation treatment , , given intravenously mark bone level times , respectively , defined baseline bone implantation ha , detectable 42 animals irradiated animal control group marker , levels bone start radiation , demonstrated 92 irradiated animals , 75 animals control group uptake determined level bone found end irradiation marker demonstrated 50 dogs irradiated 75 control dogs bony trabeculae found surface ha granules new generation bone directly ha granule surrounding systems part normal bone turnover demonstrated take place 5 months implantation ha
peripheral giant cell granuloma evidence osteoclastic differentiation nine cases peripheral giant cell granuloma oral cavity immunohistochemically analyzed assess nature giant cells giant cells tested antibodies recognizing myelomonocytic macrophage markers \( lysozyme , mac 387 , ham 56 \) showed strong immunoreactivity , antibody reactive osteoclasts concluded giant cells characterizing giant cell granuloma exhibit phenotype distinct giant cells found sites chronic inflammation may true osteoclasts
le iii advancement osteotomy child 7 years age longitudinal study 12 patients craniofacial synostosis syndromes \( 's , 's , 's \) underwent le iii advancement age 7 years \( average age 5 1 years , range 4 0 6 7 years \) average follow 5 0 years included clinical , dental , examinations according prescribed protocol study demonstrated procedure could safely performed younger child acceptable level morbidity remarkable degree postoperative stability maxillary segment however , although vertical \( inferior \) growth movement midfacial segment demonstrated , minimal , , anterior horizontal growth occlusal developing period follow could attributed anticipated mandibular development could corrected orthognathic surgery roles surgical anterior therapy release fixation also discussed le iii osteotomy indicated early childhood psychological physiologic reasons
polyurethane foam covered implants capsular contracture laboratory investigation experiments conducted rabbits comparing polyurethane foam covered implants otherwise identical smooth silicone gel implants using five objective methods measurement capsular contracture , significant difference could identified foam covered implants consistently developed capsular contracture , although cases mild degree would clinically significant two foam covered implants hard contractures , evidence hematoma separation foam
new dynamic simulating splint hand deformity hand deformity , resulting low ulnar combined low ulnar median nerve palsy , situation splint described herein reverses started early , prevents permanent stiffness fingers position , also effectively restores function without day day work surface splint
natural recombinant human il 1 receptor antagonists block effects il 1 bone resorption prostaglandin production inhibitory factors towards il 1 identified urine supernatants human monocyte cultures shown act receptor antagonists investigated whether natural inhibitor purified human urine \( uil 1ra \) recombinant molecule expressed using gene il 1 antagonist isolated monocytes \( ril 1ra \) alter responses human ril 1 alpha organ cultures fetal rat long bones neonatal mouse two preparations probably contained similar identical molecules , antibody ril 1ra reacted uil 1ra western blot analysis uil 1ra ril 1ra specifically blocked stimulation bone resorption ril 1 culture systems , well increase pge2 production cultured resorptive effects parathyroid hormone tnf alpha blocked uil 1ra preparation intrinsic activity , gel chromatography appeared fractions eluted earlier uil 1ra concentration ratios ril 1ra ril 1 low 10 could block resorptive response fetal rat long bones , whereas concentration ratios 100 1000 required block il 1 action neonatal mouse inhibitory effects appeared competitive , increasing concentrations il 1 block bone resorption systems inhibition pge2 production
operative management basilar impression osteogenesis four patients osteogenesis neurologically significant basilar impression treated past 8 years experience resulted changes therapeutic strategy particularly difficult problem cases discussed respect disease process , neurological involvement , radiological findings , modes surgical therapy errors management well success resulting learning experience described currently , recommend extensive removal anterior bony compression approach followed posterior rigid fixation transfers weight head thoracic spine , effort prevent basilar
microcomputer reconstruction analysis spinal deformity lung volume scoliosis current techniques imaging chest deformity limited two dimensional , clinical testing lung volume measurements based pulmonary function studies effort dependent authors evaluated spine deformity lung volume using new three dimensional microcomputer imaging technique results preoperative postoperative chest computed tomograms underwent boundary detection expert human observers data processed surface create three dimensional color images spine lungs display computer technique allowed 1 \) visualization anatomic relationships angle , 2 \) assessment spinal deformity relation lung volume , 3 \) measurement individual lung volumes three dimensional microcomputer imaging useful technique objectively measuring lung volume assessing postoperative changes
cobb angle versus spinous process angle adolescent idiopathic scoliosis relationship anterior posterior deformities standard clinical measurement adolescent idiopathic scoliosis cobb angle , measured end plates end vertebral bodies standing radiograph measurement anterior column structures describes anterior spinal deformity posterior spinal deformity described spinous process angle , measured curve joining tips spinous processes computer model , radiographic study cobb angle , spinous process angle vertebral rotation show adolescent idiopathic scoliosis results larger anterior elements posterior elements helps explain inherent limitations posterior instrumentation , including cotrel dubousset instrumentation , noninvasive posterior surface measurement systems
digital radiography reduce scoliosis x ray exposure digital radiology new computerized system acquiring x rays digital \( electronic \) possesses greatly expanded dose response curve allows broad range x ray dose produce diagnostic image potential advantages include significantly reduced radiation exposure without loss image quality , acquisition images constant density irrespective exposure , reduced repeat rates unsatisfactory films authors prospectively studied 30 adolescents scoliosis conventional \( full dose \) digital \( full , one half , one third dose \) x rays found digital made ap lateral image anatomic areas clearly depicted full one half dose digital better full dose equal conventional one half dose cobb angles easily measured one third dose ap 8 10 one third dose digital digital clearly depicted sign one half one third dose repeat rate study , indicating digital well exposure errors study indicates digital allow radiation dose reduced least one half scoliosis patients improved image quality good contrast wide range x ray exposure
results treatment idiopathic scoliosis charleston bending orthosis authors present preliminary retrospective review treatment 32 patients idiopathic scoliosis charleston bending orthosis \( \) , new , low profile spinal orthosis onset treatment , patients' mean age 12 5 years mean stage 0 4 females achieved menarche mean 1 8 months starting treatment single structural curves treated patients time , 2 patients failed treatment , curves progressing 12 degrees 8 degrees , respectively additional 11 patients successfully completed treatment , reached skeletal maturity 5 degrees curve progression mean curve change 2 2 degrees decrease 19 patients remain treatment charleston bending worn nighttime hours well tolerated , excellent patient compliance low psychological stress , may successful curve control orthoses experience patients longer follow needed
surface electrical stimulation versus brace treatment idiopathic scoliosis surface electrical stimulation using device applied 40 adolescent patients treatment idiopathic scoliosis adequate follow available 30 patients overall failure rate 15 30 50 due curve progression using , patients either went fusion \( 9 15 \) changed brace \( 6 15 \) remaining 15 patients considered successes curve progression \( 10 30 33 \) successful failures slight curve progression requiring change treatment \( 5 30 17 \) none various parameters analyzed found useful indicators successful treatment using device electrical stimulation found ineffective preventing curve progression idiopathic scoliosis
fusion levels hook patterns thoracic scoliosis cotrel dubousset instrumentation study reports results treatment adolescents king types 2 , 3 , 4 idiopathic curves using cotrel dubousset instrumentation imbalance seen types 2 4 curves distraction direction hook patterns crossing thoracolumbar junction employed imbalance seen modified hook pattern employing forces across thoracolumbar junction employed imbalance observed type 3 curves using basic right thoracic curve hook pattern type 4 curves , second modified hook pattern required obtain improved correction balance mechanism production imbalance explained three dimensional analysis deformity forces generated cotrel dubousset system
sagittal plane analysis idiopathic scoliosis patients treated cotrel dubousset instrumentation one hundred sixty patients idiopathic scoliosis underwent preoperative postoperative sagittal plane analysis thoracic spine , thoracolumbar junction , lumbar spine data suggest mild moderate improvements thoracic possible crossing thoracolumbar junction , reversal rod bend reversal rod appears provide physiologic sagittal contour cotrel dubousset instrumentation mid distal lumbar spine preserve , times , enhance lumbar lordosis
immediate complications cotrel dubousset instrumentation pelvis clinical biomechanical study authors reviewed early complications patients fused pelvis using cotrel dubousset instrumentation texas scottish hospital sixteen patients studied average follow 13 months three methods pelvis fixation evaluated screws , sacral screws , technique whereby ends cotrel dubousset rods inserted posterior iliac crest using galveston technique seven 16 sets sacral screws \( 44 \) failed surgery two 7 sets screws failed postoperatively \( 28 \) failures occurred 8 sets cotrel dubousset rods placed galveston technique seven nine medical complications observed \( 77 \) occurred sacral screw group using calf , biomechanical evaluation system undertaken determine strength fixation system failed flexion 3 times sacral screws , pulling directly sacrum 40 n cotrel dubousset rods inserted galveston technique strongest , experiencing rod deformities flexion failure 70 n screws intermediate strength failing rotation axis screws pulling directly 55 n authors conclude using cotrel dubousset rods inserted galveston techniques strongest method pelvis fixation three tested
surgical treatment scoliosis spinal muscular atrophy population seventy eight patients diagnosed spinal muscular atrophy 1969 1988 scoliosis developed 34 patients , incidence 60 thirty one patients could retrospectively reviewed chart review interview average follow 11 5 years onset scoliosis averaged 8 8 years twenty two patients treated nine surgically patients improved sitting balance endurance surgery complications surgery included loss correction one patient , one pseudarthrosis , one patient required prolonged ventilatory support prolonged survival patients spinal muscular atrophy aggressive orthopaedic management scoliosis prevent progression deformity improve sitting comfort
factors affecting fusion rate adult spondylolisthesis authors examined factors affecting fusion rate surgical treatment 89 consecutive adult patients spondylolisthesis two factors significantly improved fusion rate combined anterior posterior fusion rigid postoperative immobilization cast 65 patients spondylolisthesis , fusion rate raised 70 posterior fusion alone used 88 combined anterior posterior fusion used 20 patients degenerative spondylolisthesis , frequent use combined anterior posterior fusion contributed high overall fusion rate 95 among patients spondylolisthesis , postoperative cast immobilization resulted higher fusion rate 90 compared fusion rate 63 obtained brace immobilization
normal dystrophin mcleod myopathy dystrophin gene studied patient mcleod syndrome x linked recessive myopathy localized , duchenne muscular dystrophy gene locus , codes dystrophin histopathological study patient 's muscle showed mild subclinical myopathy immunological studies dystrophin two separate biopsy specimens analysis dystrophin gene dna blood sample detect abnormality suggests duchenne muscular dystrophy gene , albeit close mcleod locus , involved mcleod myopathy
magnetic resonance imaging sacroiliac joint inflammation consecutive series 27 patients symptoms compatible sacroiliitis underwent magnetic resonance imaging \( mri \) sacroiliac joints diagnostic sensitivity mri similar computed tomography conventional radiography however , mri seems potential providing unique information disease process sacroiliitis demonstrating abnormalities subchondral bone bone marrow results study suggest early inflammatory changes sacroiliitis occur subchondral structures sacroiliac joints
articular cartilage iii morphologic changes cellular microenvironment isolated osteoarthritic cartilage isolated human canine osteoarthritic cartilage using low speed techniques changes morphology evaluated using differential interference contrast microscopy , phase contrast microscopy , histochemical ultrastructural methods viability assessed using fluorescein staining , metabolism investigated using autoradiography results suggest initial changes collagen proteoglycan distribution within followed proliferation form clusters techniques offer potential study cell matrix interactions degenerative osteoarthritis
progression osteoarthritis hand metacarpal bone loss twenty year followup incident cases examined prospective relationship metacarpal bone mass osteoarthritis \( oa \) hand , using incidence data historical cohort tecumseh community health study \( tecumseh , mi \) women examined radiographic evidence oa bone mass twice , 20 23 years apart \( 1962 1965 1985 subjects age range 55 74 1985 \) two measures oa evaluated highest score assigned 32 wrist hand joints , sum scores wrist hand joints adjustment age , women classified oa \( either measure oa \) 1985 likely cortical area baseline , indicates greater bone mass women developed oa 23 year period likely experience significantly greater widening medullary cavity time , indicator increased bone resorption women increasing levels oa involvement also increased likelihood greater cortical area loss conclude women later developed oa likely higher baseline bone mass women develop oa , women also greater likelihood bone loss time
suppression type ii collagen induced arthritis monoclonal antibodies mouse monoclonal antibodies raised chicken type ii collagen suppressed delayed onset chicken type ii collagen induced arthritis dba 1 mice correlated suppression anti mouse type ii collagen antibody responses following immunization chicken type ii collagen epitopes recognized suppressive antibodies found present bromide \( cb \) collagen peptides cb 11 cb 12 also confirmed finding administration cb 11 cb 12 peptide suppressed induction arthritis
paget 's disease fifth lumbar vertebra case report paget 's disease osteitis fifth lumbar vertebra occurred 55 year old woman isolated lytic process involving entire vertebral body posterior elements open biopsy showed extensive remodeling cement lines , , osteoclastic resorption typical paget 's disease
scapular allografts report two cases malignant tumors scapula adequately treated limb sparing , partial , total however , resection glenoid portion scapula total result shoulder attempt minimize functional impairment restore stability cosmesis , scapular glenoid allografts offer reasonably good biologic replacement report describes cases 45 year old woman 32 year old man massive allografts used one patient , good stability , cosmesis , function restored resection glenoid portion patient , shoulder stability , cosmesis , limited function restored total reports scapular allografts seem previously published literature
bilateral femoral associated acetabular dysplasia case report proximal femur associated number acquired conditions unusual congenital form even unusual associated acetabular dysplasia 38 year old woman bilateral hip pain roentgenographic evidence acetabular dysplasia valgus neck shaft angles physical findings consistent femoral , computed tomography demonstrated 28 degrees sides symptomatic relief obtained bilateral varus internal rotation osteotomies proximal femur date , case femora associated acetabular dysplasia seems reported literature
simple bone cysts effects methylprednisolone synovial cells culture ten years ago , protocol using injections developed treatment bone cysts concept , designed tumor surgeons based theory , cautiously approached however , reproducible results gradually increased clinical acceptance understanding healing process restricted lack experimental model attempt elucidate mechanism healing , cell culture model used investigate effects methylprednisolone synovial cells initially , three doses drug tested maximal changes noted concentration 40 mg ml changes quantified morphology , dna assay , cell protein analysis , electron microscopy results suggest methylprednisolone may direct effect cellular component bone cysts
apolipoprotein \( apo \) e inhibits capacity monosodium urate crystals stimulate neutrophils characterization intraarticular apo e demonstration apo e binding urate crystals vivo factors modulate ability monosodium urate crystals stimulate leukocytes could regulate gouty inflammation lipoproteins bear apo b 100 apo e bind urate crystals suppress crystal neutrophil interaction study , observed urate crystals , coated apo e monocyte origin , diminished ability stimulate neutrophils apo e also detected surface urate crystals recovered gout patients thus , analyzed apo e noninflammatory synovial fluid , found associated particles heterogeneous size predominantly alpha pre beta electrophoretic mobility local articular synthesis least portion synovial fluid apo e suggested \( \) synovial fluid plasma concentration ratio apo e significantly higher apo b apo , widely synthesized extrahepatic tissues , \( b \) cultured rheumatoid synovial cells first passage secreted apo e , \( c \) portion synovial fluid apo e heavily sialylated conclude synovial fluids contain apo e appears partly local origin apo e binds urate crystals could modulate gouty inflammation
cartilage expression type ii collagen mutation inherited form osteoarthritis associated mild family expressed severe dominantly inherited osteoarthritis , underlying mutation traced genomic sequencing single base change predicts amino acid substitution cysteine arginine residue triple helical domain type ii collagen molecule \( ala , l , c , r w , j 1990 proc natl acad sci usa 87 \) present study examined whether predicted protein phenotype evident articular cartilage obtained affected family member underwent hip surgery cartilage collagen solubilized digestion cysteine residues labeled reduction 14c collagen peptides fractionated ion exchange reverse phase column chromatography one peptide alpha 1 \( ii \) chain , alpha 1 \( ii \) , found radiolabeled tryptic peptides prepared identified analysis results show approximately one quarter alpha 1 \( ii \) chains present polymeric extracellular collagen patient 's cartilage contained cys substitution protein exhibited abnormal properties including disulfide alpha 1 \( ii \) dimers signs posttranslational premature cartilage failure osteoarthritis presumably result abnormal type ii collagen expressed cartilage matrix
report united states secondary drinking well water 54 year old female resident , , found routine chest roentgenogram subsequent investigation disclosed cause secondary ingestion well water containing 429 mumol l fluoride \( recommended levels , 11 58 mumol l \) water samples also obtained 12 properties adjacent index case three , similar depths well index case , fluoride concentration water greater 212 mumol l urine samples members four households obtain drinking water contained elevated urinary fluoride levels thus , may develop certain areas united states result natural occurrence fluoride consequently , known endemic areas , would appear reasonable measure fluoride concentration well water time
vivo muscle magnetic resonance spectroscopy clinical investigation mitochondrial disease investigated sensitivity specificity rapid phosphorus magnetic resonance spectroscopy \( mrs \) protocol detecting metabolic abnormalities vivo skeletal muscle patients mitochondrial disease examined 17 patients mitochondrial myopathies sixteen mild minimal myopathic signs symptoms phosphorus magnetic resonance spectra resting gastrocnemius muscles showed abnormal intracellular energy state \( marked increased intracellular inorganic phosphate concentration \) 14 17 3 17 , associated decreased phosphocreatine concentration also studied 20 patients diseases muscle \( inflammatory myopathies , metabolic myopathies , muscular dystrophies , myasthenia gravis \) present similar clinical features spectra showed increased intracellular inorganic phosphate concentrations 6 20 muscle diseases associated evidence muscle fiber necrosis abnormalities muscle energy state cases may due secondary mitochondrial dysfunction except cases polymyositis dermatomyositis , 6 myopathies could readily distinguished mitochondrial myopathies basis clinical examination blood tests conclude phosphorus mrs resting muscle practical clinical setting useful sensitivity specificity mitochondrial myopathies used conjunction standard noninvasive tests
myopathy heterogeneity distinction clinical types myosin isoform patterns studied muscles 3 patients myopathy \( cnm \) immunocytochemistry using myosin heavy chain \( mhc \) specific monoclonal antibodies determine whether subtypes cnm express prenatal mhc assess arrest development muscles muscle woman childhood onset cnm express prenatal mhc , yet prenatal mhc strongly expressed muscle fibers 2 brothers x linked cnm finding represents 1st immunocytochemical evidence expression prenatal myosin isoform postnatal human muscle suggests x linked form cnm differs types true arrest maturation muscle
clinical evaluation \( f type \) hollow implant 1976 hollow implant introduced number articles published implant system article , short term results 102 f type implants 40 patients reported results showed one stage implant least comparable well known implant systems
massive maxillofacial bones report two cases two cases massive encountered , one affecting mandible maxilla mandible 13 cases reported far existing literature massive mandible indeed rare disease two cases surgically treated clinically histopathologically assessed
african burkitt 's lymphoma case report light electron microscopic findings african burkitt 's lymphoma occurred 9 year old american boy jaw tumors , , abdominal masses histologically , tumor consisted overgrowth undifferentiated lymphocytes appearance differential diagnosis african versus american form burkitt 's lymphoma versus non burkitt 's lymphoma discussed
inherited diseases bone density children article radiographic manifestations various genetic diseases affecting bone mineralization considered osteogenesis diseases diffuse osteopenia , hereditary rickets conditions , diseases increased bone density emphasized recognition radiographic manifestations allows accurate diagnosis , therapeutic intervention possible , determination recurrence risk genetic counseling
metabolic bone disease morphometry history development radiologic morphometric techniques traced , emphasizing pathophysiologic background relevance possible therapies techniques described longitudinal comparative studies assessed technical limitations various methods presented
pathology metabolic bone disease skeletal manifestations diverse group metabolic bone diseases mediated altered function osteoclasts abnormal rates mineralization appropriate understanding pathologic conditions requires familiarity normal anatomy physiology skeleton accurate identification metabolic bone disease frequently demands histologic confirmation analysis bone specimens labeled tetracycline histomorphometric techniques procedures allow assessment many morphologic features characterize specific disease states common types metabolic bone diseases acquired disorders nonetheless , rare forms frequently genetically based cause intrinsic alterations bone cell populations
radiographic appearance osteopenia radiographic appearance bone result two physiologic processes resorption bone remodeling bone response stresses applied relative rates two processes determine structural , therefore , radiographic appearance affected bone
osteoporosis current techniques recent developments quantitative bone densitometry knowledge proper use interpretation bone densitometry studies understanding appropriate medical interventions universal among physicians , instrumentation technical performance bone density studies uniformly high quality indeed , deficiency medical technical expertise principal widespread implementation recommended clinical applications time nonetheless , given current information osteoporosis , make newer instrumentation readily available , limit cost techniques , anticipate recommendations may soon become standard medical practice
osteoporosis osteoporosis , condition decreased bone tissue increases likelihood fracture , places significant burden society terms health cost morbidity common type osteoporosis , two subtypes recognized type 1 type 2 type 1 , postmenopausal , osteoporosis commonly seen postmenopausal women ages 51 75 estrogen deficiency dominant factor pathogenesis disorder type 2 , aging related , osteoporosis seen elderly women men aged 70 bone loss group related aging , estrogen deficiency , negative calcium balance , variety environmental genetic factors best approach management osteoporosis develop strategy peak bone mass minimizes aging related postmenopausal bone loss estrogen medication approved prevention bone loss general use strategies prevent bone loss \( maximize peak bone mass \) include adequate calcium intake , adequate exercise , avoidance excess alcohol , tobacco , caffeine use
functional stability canine cervical spine injury three month vivo study although clinical instability vivo problem , spinal instability criteria either subjective based vitro experiments authors performed vivo experiment using canine model study natural history spinal instability function healing time 12 weeks three injuries produced surgically sham laminectomy c4 bilateral facetectomy c4 c5 three 1 5 mm steel implanted c3 c6 vertebrae time surgery standardized functional flexion extension cervical spine obtained injury , immediately injury 0 5 , 1 , 1 5 , 2 , 3 , 4 , 5 , 6 , 7 5 , 9 , 12 weeks postinjury immediately killing animals general , authors found decreased ranges motion \( rom \) c4 c5 level , compared pre injury values , injuries , significantly facetectomy maximum decrease occurred 0 0 5 weeks postinjury 2 12 weeks , recovery rom , especially two less severe injuries changes rom spinal level explained simultaneous presence factor , caused three different injuries sham least facetectomy injury , stabilizing mechanism muscle spasm beginning healing adaptive responses late phase injury significant differences canine model human cervical spine , present findings human situation caution
analysis chondroitin sulfate proteoglycan core protein \( cspgcp \) gene achondroplasia pseudoachondroplasia achondroplasia pseudoachondroplasia autosomal dominant skeletal resulting short dwarfism histologic ultrastructural studies cartilage pseudoachondroplasia homozygous achondroplasia suggested structural abnormality chondroitin sulfate proteoglycan \( \) , major structural protein extra cellular matrix gene encoding core protein \( cspgcp \) thus logical candidate gene analysis conditions cdna probes encoding cspgcp used identify restriction fragment length polymorphisms \( rflps \) dna panel control individuals gross alterations cspgcp locus noted dna 37 individuals achondroplasia 5 individuals pseudoachondroplasia addition , allelic frequencies rflps significantly different among controls patients either condition one three generation family achondroplasia , close linkage cspgcp locus skeletal dysplasia excluded using ii polymorphism similarly , three generation family pseudoachondroplasia , cspgcp gene tightly linked disease phenotype results indicate mutations chondroitin sulfate proteoglycan core protein locus cause achondroplasia pseudoachondroplasia families
muscle conditioning late study adaptability muscles , 12 subjects \( mean age 54 years \) participated high intensity resistance exercise program seventy five percent met criteria syndrome isometric strength muscle endurance measured polio affected muscles identified muscle biopsies biopsies also used measurements enzymatic activities histochemical histopathologic analyses strength values less half healthy controls , mean fiber areas twice healthy controls , oxidative enzyme activity low training , significant increase isometric \( mean 29 \) \( mean 24 \) strength observed maintained time demonstrates remaining adaptability muscles already compensated long standing polio
corticosteroid injections adhesive investigation value site forty eight patients frozen shoulder less six months assigned random receive three shoulder injections bursa glenohumeral joint weekly intervals treatment groups \( 1 \) intra articular methylprednisolone lidocaine , \( 2 \) methylprednisolone lidocaine , \( 3 \) intra articular lidocaine , \( 4 \) lidocaine physical therapy program carried patients assessments pain range motion performed physical therapist nature injection therapy significant difference outcome injection intra articular injection injection steroid lidocaine advantage lidocaine alone restoring shoulder motion , partial , transient pain relief occurred two thirds steroid treated patients
bracing patellar instability knee pain secondary problems patellar tracking common initial treatment problems conservative patellar used extensively treat variety extensor mechanism problems health care dollars spent annually use braces many different patellar market today use design devices unclear often lack solid biomechanical foundation practical mechanical function braces reduce lateral displacement abnormal patellofemoral tracking designed tested using practical biomechanical principles applying directed force patella seem role treating patients knee pain secondary patellar malalignment instability well defined controlled clinical studies use patellar braces lacking
magnetic resonance imaging shoulder sensitivity , specificity , predictive value sensitivity , specificity , predictive value magnetic resonance imaging diagnosis lesions rotator cuff , glenohumeral capsule , glenoid evaluated ninety one patients fifteen asymptomatic volunteers magnetic resonance imaging demonstrated 100 per cent sensitivity 95 per cent specificity diagnosis complete tears , consistently predicted size tear rotator cuff definite correlation atrophy muscle size complete , chronic tear rotator cuff sensitivity specificity magnetic resonance imaging differentiation tendinitis degeneration cuff 82 85 per cent , differentiation normal tendon one affected tendinitis signs impingement sensitivity specificity 93 87 per cent formation around joint correlated highly increased age patient chronic disease rotator cuff sensitivity specificity magnetic resonance imaging diagnosis tears associated glenohumeral instability 88 93 per cent study showed high resolution magnetic resonance imaging excellent non invasive tool diagnosis lesions rotator cuff glenohumeral instability
tests posterolateral instability knee normal subjects results examination anesthesia apparently normal knee examined 100 subjects general epidural anesthesia unrelated operation , anterior drawer , posterior drawer , pivot shift tests negative knees knees stable varus valgus stress 0 30 degrees flexion external rotation test also negative knees positive reversed pivot shift sign present 35 per cent knees , suggesting may abnormality , least without negative test contralateral knee results posterolateral drawer test variable , difficult quantify , always firm end point amount maximum external rotation tibia , measured reference line medial border foot , extremely variable 30 90 degrees flexion knee external rotation , determined reference , slightly greater \( averaging 9 degrees \) 90 30 degrees flexion normal range maximum external rotation foot 10 45 degrees 30 degrees flexion knee 15 70 degrees 90 degrees flexion presence large angle external rotation positive reversed pivot shift sign correlated strongly increased ligamentous laxity mild varus alignment knee
effect single infusion calcium bone metabolism healthy volunteers monitored 2 months recently , used prevent postmenopausal bone loss effects normal bone metabolism unknown , 3 amino 1 1 , 1 \( \) studied healthy subjects effects single 20 mg infusion biochemical parameters calcium bone metabolism investigated 2 months 10 healthy male volunteers single moderate dose reduced biochemical parameters bone resorption time follow 2 months , urinary hydroxyproline excretion still basal level decreased serum calcium levels return basal values biochemical parameters bone formation , serum alkaline phosphatase osteocalcin , showed slight increase first month stimulation parathyroids corresponding increase serum 1 , 25 dihydroxyvitamin formation parameters decreased thereafter , probably representing coupling bone resorption bone formation
estrogen progestin therapy prevent osteoporosis attitudes practices general internists gynecologists study objective assess combined hormone therapy \( cht \) prescribing patterns , possible cht prescribing , use endometrial biopsy monitor therapy design mailed questionnaire survey subjects gynecologists general internists two teaching hospitals measurements main results based 71 response rate , 72 internists 100 gynecologists reported ever prescribed cht almost 60 internists , compared 8 gynecologists , reported half female patients older 50 years age logistic regression analysis internists' data , female gender physician \( odds ratio 11 0 \) , belief cht decreases myocardial infarction risk \( odds ratio 3 4 \) , knowledge cht 's benefits risks \( odds ratio 2 8 \) associated prescribing endometrial biopsy performed majority physicians unexpected vaginal bleeding occurred cases unclear menopausal transition physicians concerned litigation seven times likely perform baseline endometrial biopsy conclusions authors' sample , well nationally , internists likely provide care menopausal women among internists , gender knowledge strongly associated cht prescribing findings important educational implications internists routinely provide information counseling women osteoporosis cht
syndrome dominant inheritance syndrome \( \) rare congenital multisystem disorder unknown pathogenesis characterized distinct , skeletal deformities , joint contractures , short stature , muscle hypertrophy , clinical myotonia , continuous muscle fiber activity inheritance pattern assumed autosomal recessive report occurrence classic syndrome father non consanguineous family , suggesting potential dominant pattern inheritance
identification alpha motor nerve fiber potentials lumbar epidural space clinical significance alpha efferent component spinal root potentials \( \) recorded lumbar epidural space stimulating tibial peroneal nerves clinical diagnosis clinical treatment five normal volunteers 15 clinical cases lumbar disc herniation \( ldh \) examined srp tibial nerve stimulation normal control group consisted two kinds potentials different latency simultaneous electromyogram \( emg \) recording stimulated muscles indicated shortest latency potential \( first potential \) ascending , including afferent antidromic alpha efferent long latency potential \( second potential \) descending evoked alpha group ia afferents component alpha efferent fiber potential recorded following two methods changing intensity stimulation 1 \) identifying alpha efferent components first potential 2 \) recording second potential conduction blockage spinal roots 15 clinical cases demonstrated abnormal positivity prolonged duration potentials new methods introduced estimate two parameters quantitatively present study showed either signs patients tested examination helpful determine level \( \) lumbar motor , extent pathologic neuropathy
magnetic resonance imaging lumbar disc herniation comparison myelography fifty three patients surgically confirmed lumbar disc herniation 55 levels studied retrospectively compare diagnostic accuracy high field strength surface coil magnetic resonance imaging \( mri \) myelography disc herniation classified three groups according mri findings , namely , unilateral single disc herniation , central single disc herniation , multilevel disc herniation magnetic resonance imaging diagnosis unilateral single disc herniation extremely reliable , myelography considered unnecessary conversely , mri findings central single disc herniation multilevel disc herniation less definite , myelography necessary disc causing symptoms
ultrasonic level diagnosis lumbar disc herniation although use diagnostic ultrasound measure spinal canal proposed , value ultrasound lumbar disc herniation yet fully assessed purpose investigation evaluate effectiveness ultrasound level diagnosis herniated nucleus prospective ultrasound examinations performed 80 consecutive patients clinically suspected lumbar disc herniation 41 discs 40 patients surgically confirmed lumbar disc herniation , 32 discs \( 78 \) true positive ultrasound diagnoses , 37 discs \( 90 \) true positive diagnoses , 20 patients \( 50 \) true positive neurologic diagnoses conversely , ultrasound diagnoses showed positive 24 \( 60 \) 40 nonoperative patients results suggest ultrasound value aid diagnosing level lumbar disc herniation
system procedures percutaneous laser since 1986 , percutaneous laser \( \) studied authors' laser laboratory purpose report develop alternative percutaneous discectomy , currently applied , establish safe , easy , accurate short time therapy method lumbar disc herniation laser irradiation , pressures \( \) decreased nucleus gradually replaced cartilaginous fibrous tissue evaluation heat distribution done determine safe optimum conditions develop new double lumen needle fiber yttrium aluminum \( nd yag \) laser devices improved easy safe use , new tip type pressure transducer made improved therapeutic results using new method
unstable lumbar spine without hypermobility cases mechanism symptoms effect spinal fusion without spinal instrumentation morbid conditions unstable lumbar spine associated hypermobility cases studied dura nerve roots adhesion could affected minimal movement spine , seemed mechanism symptoms instability without hypermobility effects spinal instrumentation particular instability studied spinal instrumentation provides rigid fixation , maintains fusion obtained , might prevent adhesion , new bone formation , stenosis spinal instrumentation seemed effective treatment particular instability
lumbar plate lumbar spondylolisthesis clinical study preoperative postoperative instability authors studied effects lumbar plate \( spinal plate pedicle \) , performed lumbar spondylolisthesis , observing effect remaining adjacent discs regard preoperative postoperative instability authors examined changes preoperative postoperative lumbar rom \( range motion \) , displacement motor unit levels , occurrence instability remaining discs , horizontal rotational displacement , 26 patients followed mean 29 postoperative months 13 patients spondylolisthesis 13 patients degenerative spondylolisthesis authors studied effects fused vertebral angle reduction spondylolisthesis remaining upper lower adjacent discs preoperative postoperative fused disc heights intervertebral fusion must affect remaining adjacent discs , compensatory function remaining motor unit level influenced fused intervertebral angle spondylolisthesis fusion physiologically position quite necessary purpose , considered important prevent grafted bones posterior lumbar interbody fusion \( \) collapse maintain achieved alignment lumbar spine
natural history degenerative spondylolisthesis pathogenesis natural course slippage clarify natural course degenerative spondylolisthesis , mechanism progression disk slippage studied clinically radiographically 40 patients progressive slippage observed 12 patients \( 30 \) progression slippage noted patients showed narrowing intervertebral disk , formation , sclerosis , ossification ligaments suggest mechanisms spinal prevent progression disease general joint laxity observed many patients \( 65 \) , believed involved pathogenic mechanism disease correlation clinical symptoms progression slippage findings suggest careful consideration natural mechanisms spinal well natural course disease important
long term results anterior interbody fusion treatment degenerative spondylolisthesis thirty nine patients , 34 women five men , underwent anterior decompression interbody fusion degenerative spondylolisthesis february august 1988 average age surgery 51 years \( range , 34 74 years \) , average follow period 12 years 7 months \( range , 6 months 30 years \) clinical evaluation done score rating system japanese orthopaedic association \( score \) patients scores 25 points rated satisfactory survivorship analyzed method kaplan meier determine cumulative percentage patients satisfactory results following results obtained seventy six percent patients satisfactory results 10 years anterior interbody fusion , 60 20 years , 52 30 years irrespective age surgery , patients generally maintained satisfactory results 65 years age
clinical study stability combined distraction compression rod instrumentation posterolateral fusion unstable degenerative spondylolisthesis authors examined stability combined distraction compression rod instrumentation posterolateral fusion 40 consecutive patients unstable degenerative spondylolisthesis operations performed floating fusion l3 4 l4 5 decompression procedures mobility fused level checked every 4 weeks operation disc space angle functional radiographic films without brace average period postoperative follow 26 months 30 patients , mobility found time six patients , mobility disappeared within 24 weeks , three patients , within 1 year found one patient solid fusion rate 97 5 values percent slippage angle slightly improved lumbar lordosis normal range follow
relationship complement mediated histologic features clinical duration disease dermatomyositis accumulating evidence indicates complement mediated may play pathogenic role dermatomyositis previous study , demonstrated c5b 9 complement membrane attack complex muscle microvasculature childhood adult cases dermatomyositis characterize relationship vascular complement deposits histologic changes , quantitative histopathologic analyses performed 39 dermatomyositis biopsy specimens \( 26 adult , 13 children \) significant correlation percentage fascicles fibers focal loss , change seen early evolution ischemic muscle fiber damage , percentage fascicles capillary deposits membrane attack complex conversely , biopsy specimens higher percentage fascicles atrophy , membrane attack complex deposits significantly less common fascicle fascicle analysis supported observations patients whose biopsy specimens negative microvascular membrane attack complex clinical weakness significantly longer time patients vascular complement deposits data support hypothesis complement mediated vasculopathy primary event evolution muscle lesions dermatomyositis
magnetic resonance imaging primary skeletal muscle diseases patterns distribution severity involvement magnetic resonance imaging lower extremities performed low field system 51 patients representing three different categories biopsy proven primary skeletal muscle disease muscular dystrophies , congenital myopathies polymyositis distribution abnormal signal intensity grade involvement individual muscles assessed large differences degree pathological signal intensity individual muscles found categories muscular dystrophy polymyositis patients , overall involvement significantly severe patients congenital myopathy definite patterns selective involvement seen statistical evidence selective muscle sparing found gracilis muscle significantly less affected muscles three disease groups muscles significant sparing include rectus femoris muscles thigh posterior muscle leg common anatomical functional characteristics muscles may related distribution muscular disease
identification osteoclast precursors multilineage hemopoietic colonies osteoclast known derived hemopoietic stem cell , lineage mechanisms differentiation regulated largely unknown evidence osteoclastic differentiation induced contact dependent interaction bone marrow stromal cells hemopoietic precursors analyze osteoclastic lineage , colonies generated semi solid medium mouse spleen cells presence erythropoietin either conditioned medium interleukin 3 \( \) 7 days , individual colonies half colony morphology cells preparations second half incubated 7 days bone marrow derived cell line \( \) induces osteoclastic differentiation hemopoietic cells , bone slices presence 1 , 25 dihydroxyvitamin d3 incubation , bone resorption assessed scanning electron microscopy resorption induced cells derived single lineage colonies , resorptive cells differentiated 17 granulocyte macrophage \( gm \) colonies 38 multilineage colonies since minority gm colonies contained osteoclastic precursors , suggests gm colonies contained osteoclasts typical gm colonies may form multilineage colony multilineage colonies contain granulocytes , macrophages , third cell type resorptive cells formed derived colonies incubated bone slices without cells results suggest osteoclasts derived multilineage precursor , upon acts generate cells capable osteoclastic differentiation , form resorptive cells upon incubation bone marrow stromal cells presence 1 , 25 dihydroxyvitamin d3
high concentrations 17 beta estradiol stimulate trabecular bone formation adult female rats although effects low concentrations 17 beta estradiol \( e2 \) bone formation resorption well described , little known effects e2 bone concentrations pregnancy , therefore , investigated effects administration high dose e2 3 month old female wistar rats biochemical histomorphometric indices bone formation resorption animals receiving exogenous e2 \( 4 mg kg day 17 days n 9 \) showed mean serum e2 concentration 17 5 2 9 nm , compared 0 6 0 2 nm receiving vehicle alone \( n 10 \) bone formation rate , measured proximal tibial administration double fluorochrome labels , greatly increased e2 group \( 13 6 2 0 x 10 \( 2 \) day \) compared controls \( 3 9 0 9 \) , serum alkaline phosphatase \( e2 , 133 6 10 1 iu controls , 87 5 5 5 \) increase rate bone formation associated significant increase trabecular bone volume e2 treatment affect urinary hydroxyproline excretion histomorphometric indices bone resorption findings suggest high concentrations e2 strongly stimulate formation trabecular bone may represent important mechanism calcium stores accumulated pregnancy rats , mineral requirements lactation
differential diagnosis osteitis condensans ilii sacroiliitis published erratum appears j 1991 may 18 \( 5 \) sacroiliitis seronegative may sometimes show pelvis plain films findings indistinguishable osteitis condensans ilii computed tomography \( ct \) differentiate earlier plain radiography 2 conditions furthermore , also possible make differentiation clinically aim study verify whether criteria recently proposed european study group \( \) classification useful ct scans synovial part sacroiliac joints 7 consecutive patients meeting criteria showing typical findings osteitis condensans ilii plain films mixed 15 consecutive patients osteitis condensans ilii meeting criteria scans examined joint space surface abnormalities blindly independently 2 observers six patients group one condensans ilii group showed clear joint space narrowing less 2 mm least one joint difference statistically significant \( p less 0 001 \) results suggest using criteria valid whole group seronegative spondyloarthropathies , possible differentiate clinically seronegative spondyloarthropathies sacroiliitis mimicking osteitis condensans ilii true osteitis condensans ilii
trigger finger secondary anomalous insertion case report review literature trigger finger relatively common clinical entity , frequently caused several conditions related also described cause triggering , reviewed present rare anomaly fourth muscle insertion cause triggering right little finger completely relieved following excision anomalous muscle rare anatomic variant added list potential causes trigger finger
internal derangement temporomandibular joint histochemical study purpose study correlate histologic findings temporomandibular joint \( tmj \) condyles discs macroscopic appearance surgery 24 patients internal derangement joint included 20 women 4 men \( mean age , 37 years range , 18 61 years \) tissue lesions varied degree mild soft tissue bone remodeling extensive resorption new cartilage bone formation high phosphatase enzyme activities , even loss articular soft tissue breakdown cortical bone reactions may arise hard tissues occur articular surface layers
drugs lower uric acid levels avoid misuse gouty arthritis several points regarding use drugs lower uric acid levels deserve emphasis first , agents useful management acute gout second , forms drugs initiated low dose gradual increments achieve serum uric acid level 5 6 mg dl data support widely presumed notion uric acid level low range \( 1 3 mg dl \) resorption improves joint function third , agents \( \) \( \) interact number drugs , patient physician aware finally , important , careful frequent monitoring needed first several months therapy drugs
chronic fatigue syndrome real \? epstein barr virus longer considered important cause chronic fatigue syndrome instead , disease probably related underlying psychiatric disorder , subtle immunologic dysfunction , interaction two factors carefully taken history , physical examination , simple laboratory testing usually sufficient establish diagnosis therapy antidepressants nonsteroidal anti inflammatory drugs may effective selected patients thorough follow conducted important cases
laboratory tests rheumatic diseases carefully taken history thorough physical examination remain crucial aspects diagnosing rheumatic disorders non rheumatologic conditions also need kept mind laboratory tests looked mostly supportive confirmatory , many tests relatively nonspecific may lack sensitivity limitations recognized , however , tests invaluable tools clinician task differentiating array rheumatologic disorders
histopathology metastatic temporal bone tumors temporal bone metastasis reported increasing frequency understand process temporal bone metastasis , complete histologic evaluation temporal bones essential study , 60 temporal bones 33 patients evaluated different patterns temporal bone involvement noted depending mode spread temporal bone involvement temporal bone usually occurs late disease process often asymptomatic
familial due calcium pyrophosphate dihydrate crystal deposition english families familial predisposition \( cc \) due calcium pyrophosphate dihydrate \( cppd \) crystal deposition described five english kindreds two families characterized premature onset polyarticular cc little associated structural arthropathy one families , recurrent childhood strongly associated subsequent development cc affected members three families resembled sporadic disease showing predominantly late onset , cc mild arthritis destructive change one case knee synovial fluid levels inorganic pyrophosphate \( \) nucleoside triphosphate pyrophosphate \( \) differ 59 sporadic cases cc due cppd , although levels groups higher normal knee synovial fluid \( p less 0 0001 \) urinary levels different normal controls screening metabolic abnormality negative cases first report familial cc uk , first associate condition childhood absence overt primary abnormality metabolism suggests factors relating crystal nucleation growth may relevant predisposition cases
treatment 's disease new operative technique method treating 's disease head shortening bone described operation performed 15 patients \( 16 feet \) excellent relief pain obtained , although patients persistent stiffness joint
correction childhood use shaped osteotomy long term results following correction shaped osteotomy evaluated 14 children ten children unilateral hip disease otherwise normal four bilateral hip disease due generalised skeletal case , growth plate vertical , femoral head displaced abnormalities femoral neck results indicate osteotomy provides lasting correction deformity , regardless cause , long growth plate corrected 40 degrees less adequate support provided defect displaced femoral head
joint normal , osteoarthritic replaced knees measured joint position sense knee new method tests contribution joint capsule ligaments leg supported splint , held several positions flexion subjects' perception position recorded visual analogue model compared actual angle flexion eighty one normal 45 osteoarthritic knees examined , 10 knees semi 11 joint replacements assessed without elastic around knee steady decline joint position sense age subjects normal knees osteoarthritic knees impaired joint position sense ages \( p less 0 001 \) knee replacement improved joint position sense slightly \( p less 0 02 \) semi replacement greater effect replacement effect elastic subjects poor position sense dramatic , improving accuracy 40 \( p less 0 001 \) proposed reduced elderly osteoarthritic subjects may responsible initiation advancement degeneration knee
natural history nontraumatic avascular necrosis femoral head studied natural history nontraumatic avascular necrosis femoral head \( \) 115 hips 87 patients , 69 steroid induced , 21 related misuse alcohol 25 idiopathic average length follow five years collapse occurred often focus bone necrosis occupied weight bearing surface femoral head head due subchondral fracture early manifestation collapse classification six types based upon radiographic findings provided accurate prognosis individual cases useful planning treatment assessing outcome
effect menopause hormone replacement therapy urinary excretion cross links \( pyr \) \( pyr \) two cross links collagen molecules present extracellular matrix released degradation contrast wide distribution collagen , pyr present bone cartilage , significant amounts connective tissues , pyr appears specific bone tissue therefore , urinary excretion pyr pyr might sensitive marker bone matrix degradation using specific high pressure liquid chromatography assay measured pyr pyr cross links 24 h fasting urine sample 60 early postmenopausal women 19 premenopausal women matched age menopause induced 62 increase fu pyr \( 49 8 18 7 vs 30 8 8 0 pmol mumol creatinine p less 0 001 \) 82 increase fu pyr \( 8 2 3 4 vs 4 5 1 4 pmol mumol creatinine p less 0 001 \) 20 postmenopausal women hormone replacement therapy , urinary pyr pyr returned premenopausal levels within 6 months , contrasting unchanged levels placebo treatment 24 h excretion pyr pyr significantly lower fasting excretion , similarly decreased hormone replacement therapy pyr pyr excretion measured urinary sample highly correlated \( r 0 85 fasting 0 83 24 h sampling \) , correlations fasting 24 h values weak \( pyr , r 0 30 pyr , r 0 29 p less 0 05 \) correlations urinary cross links markers bone turnover \( fu hydroxyproline creatinine plasma osteocalcin \) significant low \( pyr vs osteocalcin , r 0 29 , p less 0 05 pyr vs hydroxyproline , r 0 34 p less 0 01 pyr vs osteocalcin , r 0 39 p less 0 01 \) , except pyr vs hydroxyproline \( r 0 24 p 0 07 \) , suggesting markers reflect different events bone metabolism finally , single measurement fasting excretion , 24 h excretion , cross links significantly correlated \( pyr , r 0 34 p less 0 05 pyr , r 0 46 p less 0 01 \) , subsequent spontaneous rate bone loss assessed repeated measurements radial bone mineral content 37 postmenopausal women \( abstract truncated 400 words \)
correlation serum osteocalcin 24 , 25 dihydroxyvitamin levels paget 's disease bone studied possible correlation serum 24 , 25 dihydroxyvitamin 24 , 25 \( oh \) 2d osteocalcin levels \( sbgp \) paget 's disease bone measured serum calcium , phosphate , pth , 25 hydroxyvitamin , 1 , 25 \( oh \) 2d , 24 , 25 \( oh \) 2d , alkaline phosphatase \( sap \) , urinary hydroxyproline creatinine ratio \( \) 19 patients paget 's disease bone 16 age sex matched controls expected , sap , , sbgp levels significantly elevated , tendency decrease serum levels 24 , 25 \( oh \) 2d patients respect control group significant difference patients controls serum calcium , phosphate , pth , 25 hydroxyvitamin , 1 , 25 \( oh \) 2d patients subdivided two subgroups subgroup normal sbgp levels \( less 5 ng ml \) , subgroup b increased sbgp levels \( greater 5 ng ml \) serum 24 , 25 \( oh \) 2d levels subgroup b significantly lower controls , subgroup showed levels similar control group also found positive linear correlation sap sbgp sap well negative linear correlation sbgp 24 , 25 \( oh \) 2d 24 , 25 \( oh \) 2d patients results point possible role 24 , 25 \( oh \) 2d disease activity
men post syndrome age onset post syndrome \( pps \) coincides tendency declining activity growth hormone c \( gh smc \) axis normal plasma smc range men age 40 0 50 1 50 units ml age 40 30 men plasma smc level 0 35 units ml , detectable spontaneous gh secretory pulses gh smc axis stimulates dna , rna , protein synthesis muscle cells increases size number , deficiency gh smc axis could theoretically contribute secondary factor occurrence severity pps accordingly , authors measured plasma smc level 10 men pps , ages 35 63 , 94 healthy men similar age pps men , 100 values less equal 0 40 units ml , 90 less equal 0 35 units ml corresponding proportions healthy men 40 27 analysis variance including age factor showed smc significantly lower pps men healthy men additional comparison , totally nursing home men lowered smc values fact smc values slightly higher healthy men similar age data revealed new biochemical feature pps , , might play contributory role pathogenesis syndrome
stimulation dorsal root ganglia degradation rabbit annulus authors sought determine whether narrowing intervertebral neural foramen , association vibration , would stimulate dorsal root ganglia result degradation proteoglycan collagen annulus , proposed working model dorsal root ganglia neuropeptide mediated degeneration spinal motion segment degradation proteoglycan collagen rabbit annulus observed narrowing neural degradation process accelerated vibration vibration alone , absence structural abnormalities spinal motion segment , induce matrix degradation probably less pronounced stimulation dorsal root ganglia biological events similar postulated , combination structural abnormalities environmental factors , could involved human disc degeneration
coexistence cervical lumbar disc disease retrospective analysis 200 patients requiring cervical disc surgery performed determine frequency coexistent lumbar disc spine abnormalities duration follow ranged 5 25 years , averaging 14 years sixty percent women 40 men , ages ranging 25 73 years antecedent motor vehicle injury occurred 49 cases work injury spine 23 sixty four percent history prior back injury found 31 undergone lumbar disc surgery , high number patients demonstrated abnormal lumbar radiographs myelograms , including 78 bulging discs , 100 major root defects , 78 minor root defects , 8 spinal stenosis , 7 spondylolisthesis myelograms normal 22 cases sites lumbar abnormalities included l4 5 \( 110 \) , l5 s1 \( 90 \) , multilevel \( 8 \) higher incidence lumbar disc abnormalities associated multilevel cervical also relationship residual symptoms abnormalities two studies authors' institution suggest autoimmune basis frequent coexistence cervical lumbar disc disease , namely demonstration antigenic properties nucleus high serum immunoglobulins
nighttime bracing adolescent idiopathic scoliosis charleston bending brace preliminary report authors report preliminary experience charleston bending brace treatment adolescent idiopathic scoliosis brace holds patient position maximum side bend correction worn night patients prospective study met following criteria skeletal immaturity \( 0 , 1 , 2 \) , curvature greater 25 degrees bracing , prior treatment , greater 1 year follow since initiation treatment 191 structural curves 139 patients one hundred fifteen patients \( 83 \) showed improvement less 5 degree change curvature twenty four patients \( 17 \) demonstrated increase curvature greater 5 degrees based preliminary results , continued use bending brace treatment nighttime justified adolescent idiopathic scoliosis patients double curves observed closely increase compensatory curves
analysis sagittal plane instability lumbar spine vivo segmental instability secondary degenerative disc disease may result chronic low back pain sagittal plane , segmental instability characterized lumbar motion full extension full flexion authors studied movement using method kinematic analysis , implementing new concept known instability factor angular components motion evaluated incremental motion parameters different stages spinal bending , total amount translation obtained combined ratio termed instability factor factor increases linear instability decreases rotational instability authors reviewed 12 control subjects 36 patients chronic low back pain diagnoses patients categorized three groups idiopathic low back pain , lumbar disc prolapse , degenerative disc disease lateral radiographs subject 's spine l4 5 level obtained using low dose radiography performed serially subjects moved full extension full flexion found group patients degenerative disc disease average age corrected instability factor 37 3 \( mm \) , significantly larger normal subjects 25 5 \( mm \) , \( p 0 \) significant difference seen instability factor patients idiopathic low back pain lumbar disc prolapse
lumbar spondylolisthesis children adolescents radiologic evaluation results operative treatment clinical radiologic follow study group 75 children adolescents , comprised boys girls , underwent spondylolisthesis years 1979 1984 reported sagittal rotation , lumbosacral joint angle , lumbar lordosis , vertebrae , upper sacrum showed considerable statistical correlation amount accordingly noted estimating risk progression spondylolisthesis spondylolisthesis accompanied scoliosis , noted seriousness former closely correlated latter patients operation , solid fusion achieved almost cases posterolateral performed using graft iliac crest , interbody fusion technique , combination turned reliable surgical methods combined technique especially required cases high degree
rod distraction instrumentation lumbosacral arthrodesis review 40 patients undergoing lumbosacral fusions 4 year period done determine value , efficiency , safety rod distraction instrumentation age range 30 80 years mean age 51 years follow 1 4 years twenty patients underwent decompression fusion spinal stenosis , nine underwent spinal arthrodesis instability , six underwent spondylolisthesis , five underwent fusions diagnoses posterior midline approach used hook sites prepared , care taken prevent dural compression balanced distraction done restore soft tissue tension stability attempt made reduce deformity posterior lateral mass fusion augmented allograft bone performed three patients , autogenous bone used majority patients placed custom lumbosacral orthosis 3 6 months operation neurologic complications , dural tears , first sacral instrumented 22 patients nine 40 patients underwent rod removal reasons removal pain due loosening five patients failure fusion two rod removal two patients , abnormality found insertion within sacral lead neurologic complications major problem appeared loosening , necessitated rod removal 12 patients rod distraction instrumentation safe effective method internal fixation lumbosacral fusions
microscopically assisted posterior lumbar interbody fusion microscopically assisted posterior lumbar interbody fusion performed 27 patients either spondylolisthesis chronic lower back pain previous lower back surgery overall improved satisfactory results occurred 22 27 patients roentgenographic , stable , interbody fusion occurred 22 27 patients poorest results highest rate pseudarthrosis occurred patients double level fusions pseudarthrosis occurred four six patients double level fusions unsatisfactory clinical results occurred five six patients double level fusions advantages microscopic technique better examination surgical site , less blood loss , less surgical dissection surgical salvage techniques procedure reserved single level pathology lumbosacral spine
role muscles glenohumeral kinematics anterior instability investigate socket mechanism responsible controlling kinematics positioned glenohumeral joint , suprascapular nerve block performed 13 selected patients , recurrent anterior instability defects kinematics documented roentgenograms four positions within horizontal motion plane combined paralysis muscles resulted abnormal anterior translation two 47 roentgenograms normal ball socket kinematics retained remaining 45 roentgenograms consistent arthroscopic findings glenoid articular surface detached absent injury reduced depth socket one half one half socket provided contour glenoid remained intact balanced muscle envelope required maintain normal kinematics selected , actively positioned , unstable retained glenoid depth sufficient produce observed ball socket kinematics vivo study shoulder kinematics needed clarify interactive roles socket muscle envelope maintaining glenohumeral stability demanding stresses active shoulder motion
histologic immunohistochemical study calcium pyrophosphate dihydrate crystal deposition disease articular cartilage , synovial membrane , meniscus ten patients calcium pyrophosphate dihydrate \( cppd \) crystal deposition disease showed strong immunoreactivity sulfate proteoglycan , type collagen , 100 protein hypertrophic chondrocytes around crystals , matrix , deposits crystals electron microscopy revealed small crystals formed around hypertrophic chondrocytes , especially degenerated matrix containing electron dense granular materials cellular debris chondrocytes kind never observed articular tissue ten patients osteoarthrosis hypertrophic chondrocytes several unique immunohistochemical characteristics may initiate formation cppd crystals
familial cervical dysplasia nine twelve family members three generations affected inherited form cervical vertebral dysplasia affected people abnormality first cervical vertebra also defects axis mode transmission disorder autosomal dominant , apparently complete penetrance variable two patients symptoms one passively tilt head , associated hypoplasia left superior facet second cervical vertebra patient local symptoms , neurological involvement , muscle spasm patient , pain developed radiographs revealed anterior occipital dislocation symptoms resolved reduction arthrodesis apparently complete penetrance disorder , physicians caring patients type congenital malformation cervical spine consider examination closely related members family clinical findings head , torticollis , limitation cervical motion suggest additional evaluation done examination include lateral radiographs cervical spine flexion extension three dimensional computed tomography helpful demonstrating complex cervical anatomy patients patients recognized abnormalities followed examined whenever local neurological symptoms develop magnetic resonance image spine flexion extension valuable identification potentially situation damage cord patients instability evolving symptoms
tibial collateral ligament bursa mr imaging bursa tibial collateral ligament \( tcl \) may visualized magnetic resonance \( mr \) imaging becomes distended fluid authors' experience , finding pathologic condition either medial complex bursa finding may indicate tcl bursitis tcl bursitis suspected setting isolated pain medial joint line absence mechanical symptoms prolonged relief symptoms injection steroid bursa supportive diagnosis seven cases presented fluid filled tcl bursa identified mr imaging five cases , tcl bursitis suspected differential diagnosis mr findings discussed
deposition calcium pyrophosphate dihydrate crystals ligamentum flavum evaluation mr imaging ct four patients spinal canal stenosis associated deposition calcium pyrophosphate dihydrate within ligamentum flavum radiologic evaluation performed magnetic resonance imaging computed tomography , surgery performed four patients pathologic examination surgical specimens demonstrated deposits calcium pyrophosphate crystals within ligamentum flavum focal enlargement ligamentum flavum present cervical spine \( n 1 \) , diffuse , bilateral enlargement identified lumbar spine \( n 3 \) enlargement ligament either caused component spinal stenosis caused neurologic signs symptoms three patients evidence calcium pyrophosphate deposition elsewhere deposition calcium pyrophosphate dihydrate within ligamentum flavum causing either focal diffuse enlargement associated significant spinal stenosis
anterior tibial translation maximum quadriceps contraction clinically significant \? quadriceps exercises used early rehabilitation acl reconstructions concern prematurely stretching acl graft aim study determine maximum isometric quadriceps contraction significantly tibia anteriorly 15 degrees , 30 degrees , 45 degrees , 60 degrees , 75 degrees flexion , role acl knee stability analyzed comparing amount tibial translation normal , acl deficient , reconstructed knees , location motion arc quadriceps contraction produces anterior tibial translation determined anterior tibial translation measured using \( kt 1000 \) 89 n manual maximum translation applied knee rest manual maximum translation test determines magnitude anterior tibial translation produced high anterior force applied directly proximal calf compared tibial translation induced quadriceps contraction testing performed normal \( n 22 \) , acl deficient \( n 10 \) , reconstructed \( n 10 \) knees anterior tibial translation produced maximum quadriceps contraction measured 15 degrees , 30 degrees , 45 degrees , 60 degrees , 75 degrees flexion extension exercise resulted less anterior tibial displacement 89 n drawer half translation produced manual maximum translation \( p less 0 001 \) instrumented laxity testing produced greater anterior translation tibia maximum isometric quadriceps contraction anterior tibial translation maximum isometric knee extension tested knees
contribution glenohumeral ligaments anterior stability shoulder joint purpose study investigate ligamentous stabilizing mechanisms preventing anterior instability glenohumeral joint six freshly thawed , cadaveric dissected , preserving joint capsule glenohumeral ligaments , ligament , tendon hall effect strain transducers placed superior , middle , inferior glenohumeral ligaments humerus scapula fixed specifically designed apparatus allowed glenohumeral joint placed 0 degree , 45 degrees , 90 degrees abduction apparatus placed model ttc universal testing instrument , applied external rotation torque humerus strain produced three glenohumeral ligaments recorded three channel x chart recorder 0 degree abduction , superior middle glenohumeral ligaments developed strain 45 degrees abduction , inferior middle glenohumeral ligaments developed strain , considerable strain also developed superior glenohumeral ligament 90 degrees abduction , inferior glenohumeral ligament developed strain , strain also seen middle glenohumeral ligament
mineral balance infantile cortical effects corticosteroids effects mineral metabolism therapeutic doses corticosteroids investigated infantile cortical four untreated cases calcium , phosphorus , magnesium strongly positive one severe case , treatment prednisolone associated alteration negative calcium magnesium balance , faecal losses calcium particularly high effect persisted least three months steroids discontinued , period pronounced retardation linear growth six months treatment stopped mineral balance positive rapid growth infancy , negative effect corticosteroids calcium , phosphorus , magnesium metabolism may contribute inhibition bone growth steroid
bone resorption , stability , soft tissue changes following large chin large advancement performed 10 patients \( mean advancement , 11 7 mm \) horizontal osteotomy inferior border mandible , preservation pedicle advanced segment preoperative , immediate postoperative , long term follow lateral radiographs retrospectively analyzed evaluate osseous soft tissue changes chin mean follow period 15 months , 76 initial advancement preserved , representing 24 osseous resorption soft tissues chin followed bony movement ratio 1 0 88 horizontal osteotomy inferior border mandible relatively stable procedure used large chin possible pedicle remain attached advanced segment minimize osseous resorption achieve predictable soft tissue changes
application technique cotrel dubousset instrumentation scoliosis deformities used 600 cases , posterior cotrel dubousset spinal instrumentation device become device choice technique allows effective correction kinds spinal deformities requires lengthy preoperative planning technically demanding surgical procedure however , adapted spinal deformities cotrel dubousset technique rigid system immobilization , , require postoperative immobilization , patients able resume normal lives activities quickly
minor anatomic abnormalities hip joint persisting childhood possible relationship idiopathic osteoarthrosis retrospective review made roentgenograms 30 patients idiopathic osteoarthrosis hip roentgenograms taken onset early course disease nine measurements made anteroposterior cross table lateral roentgenograms compared 54 hips normal patients twenty nine 30 patients abnormal measurements , many seven single individual , compared normal patients abnormalities control group availability lateral views allowed additional dimension added previous studies literature study lends support biomechanical theory etiology idiopathic osteoarthrosis hip
management arthropathy children adolescents used treatment arthropathy fifty eight joints 35 patients injected 2 5 mci yttrium 90 local anesthesia performed ensure correct placement needle cast immobilization joint used three days mean follow period seven years \( range , two 12 years \) , 47 joints pain free , 13 joints experienced another hemorrhagic episode mean hemorrhagic frequency decreased four per month two per year radiation risk far benefits procedure forty seven 58 joints rated improved patients roentgenographic appearance joints changed little five complications occurred three needle track extravasation , two severely painful joints immediately injection , one massive hemorrhagic episode form treatment suggested failed respond intensive physical hematologic therapy , patients inhibitors
congenital anomalies cervical spine congenital anomalies cervical spine uncommon majority individuals asymptomatic mild restriction neck motion symptoms develop , usually due cervical instability degenerative osteoarthrosis recent information indicates patients upper cervical anomalies fusion , anomalies , transverse ligament great propensity develop early instability neurologic problems secondary minor traumatic events symptoms occurs lower cervical spine , usually adult life due degenerative arthritis adjacent area synostosis relatively good prognosis cervical lesions hidden unrecognized associated anomalies high incidence significant scoliosis , 's deformity , renal anomalies , deafness , neurologic malformations early recognition treatment problems may substantial benefit , sparing patient deformity serious illness
osteoarthrosis development osteoporosis observation coexistence osteoarthrosis osteoporosis clinical , roentgenographic , biochemical features dorsal lumbar spine reviewed 72 postmenopausal women nineteen women osteoporosis \( vertebral collapse \) osteoarthrosis patients compared 26 patients osteoarthrosis spine 27 vertebral collapse patients spinal osteoporosis osteoarthrosis older , advanced menopause , physically smaller stature body weight groups also higher serum parathyroid hormone level , used diuretics frequently , two groups patients osteoarthrosis hip lesser degree patients affected osteoarthrosis alone , fewer fractures forearm sites patients osteoporosis alone incidence femoral neck fractures groups , however , comparable results suggest osteoarthrosis related factor might protective effect progression osteoporosis results confirm earlier observations postmenopausal osteoporosis osteoarthrosis two distinct diseases result normal aging
analysis 61 cases vertebral osteomyelitis sixty one cases bacterial vertebral osteomyelitis july 1969 july 1979 analyzed ages 49 men 12 women ranged 21 66 years portal entry 58 cases , gunshot wounds two cases , adjacent retroperitoneal abscess one case biopsy performed 60 patients 15 complications related disease gram negative rods predominant bacteria isolated blood culture positive 13 26 \( 50 \) patients tested eleven 13 \( 85 \) organisms isolated blood cultures correlated organisms recovered biopsy specimens eleven patients one disk level involved 61 patients , 29 went spontaneous fusion , 17 lost follow study , 11 failed fuse , three surgical fusion , one patient died recommendations diagnosis included collection blood cultures radionuclide bone scans management recommendations included systemic antibiotics least three weeks immobilization either bed rest spinal orthoses surgery indicated abscess present , neurologic complications occurred , instability became factor , medical treatment failed
fractional lengthening flexor tendons clubfoot surgery massive scarring z lengthened flexor digitorum flexor longus constant finding clubfoot surgery method fractional lengthening tendons described method proven effective preventing complication
histochemical localization calcium potassium articular tissues calcium pyrophosphate dihydrate crystal deposition disease ultrastructural localization calcium articular cartilage , meniscus , synovium patients calcium pyrophosphate dihydrate \( cppd \) crystal deposition disease examined using potassium focal areas deposition cppd crystals tissue showed electron dense precipitates antimony calcium complex \( 1 \) cytoplasm hypertrophic chondrocytes around cppd crystals , especially margins intracellular lipid droplets within electron dense amorphous material \( 2 \) margins lipid droplets within electron dense amorphous material degenerated matrix surrounding hypertrophic chondrocytes structures consisting electron dense precipitates antimony calcium complex , suggestive precursor cppd crystals , also observed degenerated matrix findings suggest hypertrophic chondrocytes may contribute formation cppd crystals intracellular accumulation calcium subsequent release high concentration calcium surrounding matrix
method assessment clubfoot deformity literature inadequate common method language assessing deformity lacking different clubfoot deformity give different results standard procedure less severe deformity corrected limited releases , whereas severe deformity requires radical procedures paper presents language assessment used number years importance developing language assessment able identify various types clubfoot deformity important treatment condition develop within field pediatric
perspective recent trends scoliosis correction basic principles scoliosis surgery learned harrington era still valid today experience confirmed need careful selection vertebrae instrumented , value anterior release rigid curves deformity , importance careful fusion techniques last decade , development occurred increased knowledge biomechanical needs instrumented spine three dimensional appreciation curve biomechanical advances centered understanding load properties afforded multiple spinal sites \( segmental spinal instrumentation \) value two rod systems linked advances provided increased stiffness instrumental spine , reduction correction loss , improved fatigue properties implant , fewer important advance last decade improved awareness three dimensional approach deformity need preserve improve sagittal contours particular , importance loss normal thoracic lumbar lordosis emphasized conceptual gains led development many new instrument systems correct deformity associated advantages , problems , risks must understood make choices treatment
recovery osteopenia adolescent girls anorexia nervosa osteopenia frequent complication anorexia nervosa \( \) determine whether deficit bone mineral changes course illness , studied 15 adolescent patients prospectively 12 16 months using dual photon absorptiometry spine whole body follow , mean weight , height , body mass index \( bmi \) increased significantly , although 6 girls weight loss minimal gain \( less 1 2 kg \) spontaneous menses occurred 2 girls , 3 others given estrogen replacement bone mineral density lumbar spine change significantly \( mean sd , 0 0 137 vs 0 855 0 g cm2 \) , whole body bone mineral density increased \( 0 0 118 vs 0 0 105 p less 0 05 \) despite gains bone mineral , 8 patients osteopenia spine whole body changes weight , height , bmi significant predictors change bone mineral density increased bone mass occurred weight gain return menses conversely , weight loss associated decreases bone density 1 patient failed gain weight , estrogen therapy resulted increased spinal , whole body , bone mineral also studied second group 9 women recovered adolescence 9 normal whole body bone mineral age , 3 osteopenia lumbar spine conclude osteopenia adolescents reflects bone loss , perhaps combined decreased bone weight rehabilitation results increased bone mineral return menses estrogen may independent effect bone mass persistence osteopenia recovery indicates deficits bone mineral acquired adolescence may completely reversible
prospective double blind placebo controlled study comparing injection oral diclofenac 50 mg patients rotator cuff tendinitis prospective double blind placebo controlled study carried compare effects injection oral diclofenac patients rotator cuff tendinitis 4 week period forms treatment superior placebo reducing pain , improving active abduction reducing functional limitation showed greatest effect respects , significantly superior diclofenac patients showing improvements 3 variables together \( responders \) considered
growth promoting peptides osteoarthritis insulin , insulin like growth factor 1 , growth hormone alterations cartilage bone , seen radiographically , fundamental features osteoarthritis \( oa \) endogenous compounds regulate bone cartilage metabolism quantified radioimmunoassay patients oa suitable normotensive controls matched age , sex , race , height , weight levels 3 growth promoting compounds abnormal oa demonstrated low levels insulin like growth factor 1 \( igf 1 \) elevated levels insulin growth hormone \( gh \) compared controls findings support role peptides pathophysiology oa
asymptomatic versus symptomatic herniated thoracic discs frequency characteristics detected computed tomography myelography retrospectively reviewed myelograms patients identified symptoms signs thoracic cord , roots , nerves post myelography computed tomographic scan criteria , frequency asymptomatic thoracic herniated discs \( \) calculated post myelography computed tomographic scans 68 analyzed imaging characteristics compared series 5 symptomatic thoracic herniated discs symptomatic thoracic herniated discs literature unable identify imaging features could reliably classify disc symptomatic thoracic herniated disc results call question prophylactic surgery , even lesions radiographically impressive
spinal charcot arthropathy charcot joints spine well documented clinical entities commonly associated spinal neuropathic joints , however , may produced disease processes including review , authors discuss cause treatment spinal charcot arthropathy emphasis surgical therapy results
radiographic manifestations congenital anomalies skull congenital anomalies pediatric skull caused diverse group disorders purposes discussion , entities classified according radiographic appearance skull , may similar variety different diseases enlarged parietal , sinus , aplasia cutis congenita , anterior , , examples , examples calvarial defects although numerous causes bones \( table 1 \) , , dysplasia , congenital hypothyroidism , disorders commonly associated defective ossification appearance bones important example rare bony cause sclerosis skull partial list disorders causing similar radiographic findings found table 2 results abnormality skull shape suture \( \) involved may predicted deformed calvarial configuration knowledge growth development skull understanding varied causes congenital skull anomalies enable radiologist provide diagnosis informed differential diagnosis specific radiographic finding
mild spondyloepiphyseal dysplasia \( type \) genetic linkage type ii collagen gene spondyloepiphyseal dysplasia \( \) mild autosomal dominant form spondyloepiphyseal dysplasia changes maximal femoral capital vertebral bodies condition present large south african family , clinically important virtue severe progressive degenerative hip joint , frequently prosthetic joint replacement adulthood linkage studies using molecular markers shown loci type ii collagen genes linked \( lod score 7 98 recombination fraction 00 \)
quantitative gait analysis unilateral bilateral total hip replacements qualitative quantitative analysis gait evaluated outcomes 41 patients total hip arthroplasty degenerative arthritis patients unilateral bilateral degenerative hip disease evaluated effort characterize preoperative postoperative gait characteristics patients evaluated using subjective hip rating scale gait evaluation data compared obtained control group 91 patients patients showed marked improvement subjective ratings measured quantitative gait parameters patients unilateral hip disease improved greater extent bilateral disease arthroplasty concluded total hip arthroplasty greatly improve gait characteristics patients degenerative arthritis , improvement quantified , documented , followed using system gait evaluation
indomethacin inhibition middle ear bone resorption localized osteoclastic bone resorption responsible pathological changes within middle inner ear , result hearing loss vertigo chronic otitis media otosclerosis local control osteoclastic bone resorption incompletely understood various small , locally active molecules , cytokines , shown affect resorptive processes additionally , prostaglandins inhibitors shown modulate resorptive process number vitro studies study , indomethacin , cyclooxygenase inhibitor , tested model localized bone resorption , experimental period , indomethacin found inhibit number osteoclasts resorptive area inner surface therefore , likely endogenous cyclooxygenase metabolites intermediates sequence cellular events , results localized bone resorption systemic models
muscle performance , voluntary activation , twitch properties perceived effort normal subjects patients chronic fatigue syndrome decrease maximal force generating capacity , degree central activation muscle , subjective perception effort measured prolonged submaximal isometric exercise 12 male patients suffering fatigue 13 naive , healthy male subjects maximal voluntary isometric torque generated elbow measured , 5 min intervals endurance sequence 45 min repetitive isometric contractions \( 6 duration , 4 rest interval \) producing 30 initial maximal voluntary torque electrical stimuli also delivered elbow measure contractile force intervals voluntary contractions degree central motor activation maximal voluntary contractions assessed using sensitive method twitch addition , perceived effort required achieve target submaximal contractions recorded using standardized self report scale high degree central activation achieved maximal contractions endurance sequence patients \( mean maximal force 93 6 sd 7 8 \) , control subjects \( mean 90 9 sd 9 5 \) relative torque produced either voluntary electrically stimulated contractions significantly different patients control subjects throughout test significant difference perceived exertion patients control subjects findings support concept neither poor motivation , muscle contractile failure important pathogenesis patients chronic fatigue syndrome
differential regulation insulin like growth factor \( igf \) igf ii release cultured neonatal mouse parathyroid hormone , transforming growth factor beta , 1 , 25 dihydroxyvitamin d3 previous study found pth stimulated bone resorption release insulin like growth factor \( igf \) igf ii cultured neonatal mouse since igf igf ii stimulate proliferation collagen synthesis , results suggested increased release igfs resorption could mediate part coupling bone formation bone resorption present study two agents , transforming growth factor beta \( tgf beta \) 1 , 25 dihydroxyvitamin d3 1 , 25 \( oh \) 2d3 examined effects igf release neonatal mouse like pth , tgf beta stimulated resorption increased release igf igf ii 1 , 25 \( oh \) 2d3 , however , stimulated resorption igf ii release comparable pth , inhibited release igf 1 , 25 \( oh \) 2d3 \( 0 1 100 nm \) inhibited basal release igf , 10 nm 1 , 25 \( oh \) 2d3 inhibited release igf induced pth tgf beta effects 1 , 25 \( oh \) 2d3 specific vitamin metabolite occur 25 hydroxyvitamin d3 24 , 25 \( oh \) 2d3 concentration calcitonin \( 50 mu ml \) decreased 1 , 25 \( oh \) 2d3 stimulation resorption , affect 1 , 25 \( oh \) 2d3 stimulation igf ii release inhibition igf release evidence effects 1 , 25 \( oh \) 2d3 release igfs independent bone resorption supports conclusion 1 , 25 \( oh \) 2d3 modulated production secretion igf igf ii calvarial cells results previous study suggest pth , tgf beta , 1 , 25 \( oh \) 2d3 differentially regulate mouse calvarial cell igf igf ii production
cyclosporin vitro decreases bone resorption , osteoclast formation , fusion cells monocyte macrophage lineage studied vitro effect cyclosporin \( cya \) bone resorption using fetal rat long bone assay cya inhibited pth stimulated unstimulated bone resorption inhibitory effect cya basal resorption dose dependent , pronounced second period \( less equal 0 1 microgram ml \) culture \( days 5 7 \) first period \( days 2 4 \) cytotoxic effect ruled absence decrease 3h thymidine incorporation bones concentration 5 micrograms ml cya performed 4 7 days culture showed cya \( 1 microgram ml \) decreased number osteoclasts per bone section 7 days culture \( 23 5 4 0 vs 41 7 2 9 osteoclasts bone section p less 0 05 \) , 4 days \( 25 6 3 3 vs 23 0 2 5 \) data suggested effect cya osteoclastic differentiation rather function mature osteoclasts assessed mechanisms inhibitory effect cya osteoclastic differentiation order determine 1 \) level action \( proliferation fusion osteoclast precursors \) , 2 \) action direct indirect autoradiographic studies performed bone sections incubation bones 3h thymidine last 48 h culture cya decreased slightly significantly percentage labeled nuclei per osteoclast number osteoclasts containing least one labeled nucleus \( 20 2 0 7 vs 33 2 3 5 p less 0 02 \) moreover number nuclei per osteoclast decreased 7 days cya treated bones \( 2 4 0 05 vs 3 0 0 1 p less 0 02 \) taken together results demonstrate cya slightly decreased proliferation osteoclast precursors , markedly decreased fusion similar effects observed cultures rat marrow macrophages cya \( 1 microgram ml \) inhibited fusion macrophages multinucleated cells elicited 1 nm 1 , 25 dihydroxyvitamin d3 , slight effect proliferation cells , assessed autoradiography cya also inhibited formation multinucleated cells fusion index long term cultures human cord blood monocytes , cellular model osteoclastic differentiation contrast , cya effect formation myotubes fusion cultured rat myoblasts \( abstract truncated 400 words \)
recurrent mutations growth hormone receptor patients laron dwarfism addition classical effects growth , growth hormone \( gh \) shown number actions , initiated interaction specific high affinity receptors present variety tissues purification rabbit liver protein via ability bind gh allowed isolation cdna encoding putative human growth hormone receptor belongs new class transmembrane receptors previously shown putative growth hormone receptor gene genetically linked laron dwarfism , rare autosomal recessive syndrome caused target resistance gh nevertheless , inability express corresponding full length coding sequence lack test growth promoting function hampered direct confirmation role growth identified three mutations within growth hormone receptor gene , positions corresponding amino terminal extremity causing truncation molecule , thereby large portion gh binding domain full transmembrane intracellular domains three independent patients laron dwarfism born consanguineous parents homozygous defects two defects identical consisted tg transition results confirm growth promoting activity receptor also suggest may represent hot spots mutations growth hormone receptor gene responsible hereditary dwarfism
characteristics respondents prospective study osteoporosis 1981 1982 , cohort elderly japanese americans living recruited epidemiologic study osteoporosis male subjects simultaneously examined epidemiologic study heart disease baseline data collected men women previous heart disease examination used compare responders vs nonresponders target population osteoporosis study consisted men women , men \( 81 8 \) women \( 72 0 \) participated initial osteoporosis examination sex , older higher systolic blood pressure levels respondents male nonresponders higher stroke prevalence frequent recent use vasodilator medicine female nonresponders less frequent history ever taken female hormones responders responders nonresponders reasonably similar respects , indicated comparison 40 variables suggests bias probably major influence exposure disease associations osteoporosis cohort believe first published report dealing characteristics cohort study osteoporosis
nursing management adolescent idiopathic scoliosis management adolescent idiopathic scoliosis patient many considerations whether patient surgery recommended , lot teaching , assessing , dealing adolescents whose concern like peers important allow much independence decision making possible , whether bracing surgical intervention , long clearly understand consequences newer , better surgical instruments , anesthesia , nursing care , postoperative mobility changed management operative scoliosis patient significantly nursing assessment neurologic , respiratory , function , emotional , developmental needs adolescent patient , however , changed , nurses , understand rationale assessments , treatments , restrictions , patients families
spinal stenosis arthritis arthritis spinal stenosis result disc degeneration narrowing accompanied facet joint changes nerve root entrapment symptoms back leg pain appear gradually usually period years slowly patients usually older patients treated initially nonoperative measures concentrating pain relief maintenance activity symptoms , surgical intervention relieve pain affected nerve roots appropriate patients instability require fusion patients satisfied results surgery relieving preoperative leg pain pain relief often dramatic , allowing patients return normal activity elderly patients tolerate procedure surprisingly well old age alone indication surgery therefore , elderly denied benefits surgical decompression nursing interventions help patients learn spinal stenosis assist appropriate treatment resulting improved quality living
rectal examination general practice objective investigate factors influencing general practitioner 's decision rectal examination patients anorectal urinary symptoms design postal questionnaire survey setting general practices inner london subjects general practitioners , \( 71 \) returned questionnaire main outcome measures number rectal examinations done month indication score , derived answers question asking whether would rectal examination various symptoms confidence score , indicated 's confidence diagnosis made rectal examination results 279 general practitioners five fewer rectal examinations month 96 10 month factors significantly associated fewer rectal examinations small female general practitioner , expectation examination would repeated lack time surgery , waiting time less two weeks urgent outpatient also important general practitioners rectal examinations patient \( 278 \) , expectation examination would repeated \( 141 \) , lack time \( 123 \) \( 39 \) confidence diagnosis significantly associated rectal examinations , perception well rectal examination medical school , male general practitioner conclusions factors clinical judgment influence frequency rectal examination general practice rectal examination may become trend towards larger group practices diagnostic confidence increased greater emphasis put rectal examination undergraduate teaching
gracilis muscle transposition faecal incontinence transposition gracilis muscle faecal incontinence performed 13 patients six gained satisfactory continence , four improved , two benefit operation one patient died intercurrent disease closure pre existing colostomy anal manometry compared control group showed alteration resting pressure median 35 mmhg \( range 5 63 mmhg \) , whereas maximum squeeze pressure increased median 38 mmhg \( range 5 79 mmhg \) 59 mmhg \( range 10 143 mmhg \) \( p 0 041 \) , however , significantly lower 130 mmhg \( range 81 236 mmhg \) control group patients benefited operation increase maximum squeeze pressure ability retain viscous fluid rectum measured seven patients , four gained satisfactory continence three improved continence able retain median volume 200 ml \( range 50 225 ml \) without leakage compared 325 ml \( range 250 400 ml \) control group patients could retain maximum amount viscous fluid 5 8 min , whereas control subjects could 15 min concluded , although gracilis transposition never results normal continence , acceptable continence may achieved selected patients provided careful attention paid technical details procedure provided systematic postoperative exercises performed
anatomy anal sphincters related structures continent women studied magnetic resonance imaging five continent reproductive age studied magnetic resonance imaging internal external anal sphincters could easily delineated , could intervening longitudinal musculature , muscle , , anorectal lumen , vagina , uterus , bladder , urethra , , shape sphincters nearly , anterior component averaging 18 3 mm thick 28 0 mm long fifty four percent anterior thickness attributable internal sphincter anorectal angle varied considerably , mean 86 8 19 1 degrees \( range 60 112 \) angle portion rectal lumen supported , levator plate , plane muscle consistent 149 0 6 3 degrees \( 138 154 \) finding anterior anal sphincters substantial thickness length contrasts markedly view often literature female anal sphincter anteriorly half posterior length forms small bundle muscle rather broad band knowledge relationships important primary repair obstetric sphincter lacerations well surgical correction anal incontinence
final outcome ursodeoxycholic acid treatment 126 patients radiolucent gallstones one hundred twenty six patients radiolucent gallstones gallbladders treated 8 10 mg ursodeoxycholic acid \( udca \) kg day followed treatment conclusion complete partial gallstone dissolution achieved 74 \( 59 per cent \) however , 22 achieved complete gallstone dissolution , judged two normal oral performed 16 patients , normal udca stopped 76 patients cystic duct obstruction \( n 12 \) , severe biliary pain \( n 13 \) , non response \( n 25 \) partial stone dissolution arrested progress \( n 26 \) life table analysis showed complete gallstone dissolution rates four years 25 30 per cent \( two normal oral \) 17 19 per cent \( two normal oral plus one \) patients complete gallstone dissolution shown partial stone dissolution 6 12 months partial stone dissolution six months , 25 per cent went complete gallstone dissolution , always within two years efficacy correlated inversely stone size age , sex , obesity treatment saturation indices acquired surface gallstone calcification developed 13 patients \( life table analysis 22 7 per cent four years \) none patients achieved complete gallstone dissolution five achieved partial stone dissolution thus , despite relatively high partial gallstone dissolution rates , ultimate efficacy udca achieving complete gallstone dissolution low
reactivation hepatitis b virus replication patients receiving cytotoxic therapy report prospective study one hundred chinese patients received induction cytotoxic therapy malignant lymphoma prospectively studied determine incidence , morbidity , mortality , predisposing factors reactivation hepatitis b virus replication cytotoxic therapy 18 \( 67 \) hepatitis b surface antigen positive 10 \( 14 \) hepatitis b surface antigen negative patients , hepatitis developed cytotoxic therapy \( p less 0 0001 \) hepatitis could attributed exacerbation reactivation chronic hepatitis b 13 \( 72 \) hepatitis b surface antigen positive patients 2 \( 20 \) hepatitis b surface antigen negative patients \( p less 0 0001 \) sudden increase reactivation hepatitis b virus replication gave rise hepatitis , nonfatal hepatic failure , death 22 3 , 3 7 , 3 7 patients positive hepatitis b surface antigen 2 , 2 , 0 positive hepatitis b antibodies none seronegative among hepatitis b surface antigen positive patients , male sex factor associated increased risk reactivation hepatitis b virus replication recommend hepatitis b surface antigen positive patients malignancies receiving cytotoxic therapy closely monitored
safety day sequential extracorporeal shock wave lithotripsy dissolution gallstones methyl tert butyl ether dogs passage stone fragments extracorporeal shock wave lithotripsy \( eswl \) gallstones resulted biliary , duct obstruction , pancreatitis patients rapid dissolution fragments methyl tert butyl ether \( mtbe \) may prevent side effects achieve complete clearance gallstones within hours rather several months year longer study examines safety day eswl fragmentation mtbe dissolution surgically implanted human gallstones 15 dogs animals randomly assigned one four treatment groups assess mtbe absorption gallbladder observe hematology chemistry profiles 0 , 400 , 1 , 200 shock waves lithotriptor followed mtbe dissolution therapy sacrificed either immediately treatment \( 12 dogs \) 2 weeks later \( 3 dogs \) results demonstrated although eswl causes moderate trauma gallbladder , result increased mtbe absorption histologic evidence mucosal disruption blood profiles demonstrated increase level aspartate aminotransferase three dogs sacrificed 2 weeks combined treatment residual evidence gallbladder injury remaining stone material animals , severe injury occurred shock waves passed lung air filled colon study suggests day sequential fragmentation gallstones eswl followed dissolution stone fragments use mtbe may associated mild moderate reversible gallbladder trauma rapidly achieve clearance gallstones
familial occurrence inflammatory bowel disease background methods assessed familial occurrence inflammatory bowel disease county , long term interest epidemiology disorders 1987 interviewed 662 patients inflammatory bowel disease diagnosed 1979 , asking whether first second degree relatives disorder ninety six percent patients \( 504 ulcerative colitis 133 crohn 's disease \) provided adequate information results compared general population , first degree relatives patients ulcerative colitis crohn 's disease 10 fold increase risk disease patients , standardization age sex risk two diseases also increased , less , increase risk crohn 's disease significant relatives patients ulcerative colitis risk ulcerative colitis first degree relatives patients ulcerative colitis appeared virtually independent generation first degree relative sex patient relative risk ulcerative colitis first degree relatives tended higher disease diagnosed patient age 50 , risk seemed independent current age relatives prevalence disease patient \( either ulcerative colitis crohn 's disease \) among second degree relatives increased prevalence disease increased conclusions 10 fold increase familial risk ulcerative colitis crohn 's disease strongly suggests disorders genetic cause
retained intrahepatic stones treatment piezoelectric lithotripsy combined stone extraction extracorporeal shock wave lithotripsy \( eswl \) performed 11 patients intrahepatic stones associated segmented strictures intrahepatic ducts patients previously undergone biliary surgery basket extraction via tube tract time lithotripsy indication eswl failure , anticipated difficulty , basket extraction stones via tube tract piezoelectric lithotriptor used procedures average total number shock waves administered 29 , \( range , 10 , 000 61 , 395 \) average number treatment sessions 3 1 \( range , 1 6 \) number shock waves used single session ranged 10 , 000 15 , 000 frequency five per second 30 50 power six patients , stones successfully fragmented completely removed three others stones fragmented removed overall success rate , including complete \( 54 \) incomplete \( 27 \) success , 82 difficulty targeting stones , severe strictures deformities intrahepatic ducts , factors responsible failure significant complications observed
oral cholecystography contemporary gallstone imaging review introduction nonoperative alternatives elective cholecystectomy management gallstones use oral cholecystography \( \) article reviews basic principles involved proper performance interpretation resulting images role current management gallstones discussed
resting total energy expenditure patients inflammatory bowel disease patients inflammatory bowel disease often present weight loss among possible causes , elevated energy expenditure frequently suggested least documented study resting metabolic rate \( rmr \) total daily energy expenditure \( \) measured 15 outpatients inflammatory bowel diseases eight healthy control subjects measured rmr percentage predicted fat free mass significantly different control subjects \( 102 9 8 , mean sd \) patients \( 100 13 3 \) , expressed multiple rmr , 1 70 0 31 control subjects 1 78 0 24 patients patients greater equal 90 less 90 desirable body weight , mean increase rmr predicted fat free mass seen patients \( 106 9 3 \) normal weight patients \( 99 0 15 6 \) mean rmr values patient subgroups 1 70 0 30 1 88 0 08 , respectively conclude stable outpatients inflammatory bowel disease minimal increase energy needs
factors affecting circulation oral contraceptive steroids oral contraceptive steroids may undergo circulation , relevant estrogens , compounds directly conjugated liver animal studies show convincing evidence importance circulation , studies humans much less convincing importance route rate metabolism ethinyl estradiol reviewed antibiotics reported reduce efficacy oral contraceptive steroids , controlled studies confirmed observation although gut flora altered oral antibiotics , blood levels ethinyl estradiol reduced , one antibiotic least \( \) enhances activity ethinyl estradiol
efficacy octreotide acetate treatment severe postgastrectomy dumping syndrome present study evaluates acute chronic use long acting somatostatin analog , octreotide acetate , treatment patients severe postgastrectomy dumping syndrome acute phase , 10 patients severe dumping studied 2 consecutive days 3 hours ingestion randomized double blind fashion one day octreotide \( 100 micrograms \) given subcutaneously 30 minutes test meal day equal volume vehicle injected additional group six postgastrectomy patients without dumping studied similar fashion acted controls placebo treatment test meal resulted immediate increase \( p less 0 01 \) pulse rate plasma levels glucose , glucagon , pancreatic polypeptide , , insulin similar changes seen control group respect placebo however glucagon \( p less 0 05 \) show magnitude increase seen placebo treatment octreotide acetate prevented development vasomotor gastrointestinal symptoms completely ablated responses plasma peptides changes associated complete ablation diarrhea \( p less 0 001 \) pretreatment octreotide acetate completely suppressed rise plasma insulin response meal ablated late hypoglycemia dumping treatment octreotide acetate resulted delayed gastric emptying transit time \( 244 minutes \) versus 76 23 minutes placebo 125 36 minutes controls \( p less 0 05 \) chronic daily treatment octreotide acetate resulted minimal side effects patients demonstrated stable fasting plasma glucose , normal liver function tests , average weight gain 11 12 month period addition patients able resume employment long acting somatostatin analog , octreotide acetate , highly effective preventing development symptoms severe dumping syndrome , vasomotor gastrointestinal
autologous implant peritoneal rabbits man purpose studying peritoneal physiology , original biopsy methods devised human rabbit peritoneal mesothelial cells cultured characterized verify whether cells could implanted peritoneal dialysis cases acute loss mesothelial surface staphylococcal peritonitis induced 12 rabbits 4 days antibiotics , 6 cultured mesothelial cells , previously marked 3 cases thymidine \( \) implanted rabbits sacrificed 3 6 days showed taking new mesothelial cells direct morphological observation autoradiography four uremic capd patients recovering severe peritonitis implanted 300 million peritoneal mesothelial cells , previously cultured frozen morphological signs taking evident laparoscopy peritoneal biopsies performed 3 6 days implant fact implants possible may interesting applications medicine surgery
attenuation alcohol induced hepatic fibrosis polyunsaturated lecithin characteristic features alcoholic liver injury include fibrosis striking membrane alterations , associated phospholipid changes offset abnormalities , 10 yr study conducted baboons 12 animals \( eight females , four males \) fed liquid diet supplemented polyunsaturated lecithin \( 4 1 mg kcal \) 8 yr , either ethanol \( 50 total energy \) isocaloric carbohydrate compared another group 18 baboons fed equivalent amount diet \( without ethanol \) , devoid lecithin two groups , comparable increases lipids developed ethanol fed animals , striking differences degree fibrosis seen whereas least septal fibrosis \( cirrhosis two \) transformation lipocytes transitional cells developed seven nine baboons fed regular diet ethanol , septal fibrosis develop animals fed lecithin \( p less 0 005 \) progress beyond stage fibrosis \( sometimes associated fibrosis \) significantly lesser activation lipocytes transitional cells furthermore , three animals taken lecithin , continued amount ethanol containing diet , rapidly \( within 18 21 mo \) progressed cirrhosis , accompanied increased transformation lipocytes transitional cells results indicate component lecithin exerts protective action effects ethanol previously found choline , amounts present lecithin , comparable action , polyunsaturated phospholipids might responsible protective effect
hepatitis b virus pre s2 fusion proteins expressed attenuated salmonella oral vaccination hybrid hbv pre \( 2 \) fusion proteins stably expressed several dependent attenuated salmonella typhimurium salmonella strains live recombinant bacteria administered p balb c mice induced high titer anti hepatitis b virus core ag \( \) detectable anti pre s2 serum antibodies upon oral feeding recombinant mice , rate seroconversion anti dependent salmonella strain used best carrier strain high titer anti antibodies lower titer anti pre s2 serum igg antibodies observed two weeks single oral immunization ig class igg subclass distribution anti antibodies p oral immunization consistent induction functional cell help
isolation characterization cdna encoding human nuclear antigen predominantly recognized autoantibodies patients primary biliary cirrhosis autoantibodies novel nuclear ag , sp100 , recently described recognize nuclear protein apparent molecular mass 95 100 kda dot like distribution within cell nuclei lambda cdna expression library derived hela cells anti sp100 autoimmune serum 0 7 kb cdna \( \) coding fragment sp100 isolated expression cdna use recombinant protein elisa revealed fragment carries major sp100 anti sp100 autoantibodies predominantly occur patients suffering primary biliary cirrhosis \( 50 184 \) cdna used hybridization probe isolation longer cdna human liver placenta derived lambda cdna overlapping fragments assembled generate full length cdna coding protein molecular mass 53 kda isoelectric point 4 7 sp100 autoantigen expressed vitro cdna capture immunoblot assay , sds page hela autoantigen 95 100 kda thus showed aberrant electrophoretic mobility computer based protein sequence analysis sp100 autoantigen revealed regions striking sequence similarities alpha 1 alpha 2 domains various human non human mhc class ag several transcriptional regulatory proteins
evidence targeting 2 oxo dehydrogenase enzymes cell response primary biliary cirrhosis primary biliary cirrhosis \( pbc \) chronic autoimmune liver disease includes presence lymphoid infiltrates portal tracts , high titer autoantibodies pyruvate dehydrogenase e2 \( pdh e2 \) branched chain ketoacid dehydrogenase e2 \( e2 \) , biliary tract destruction mechanism autoimmune response induced , specificity damage biliary epithelium , role cells pbc still unknown address issues , taken advantage mouse mab , c355 1 , studied reactivity panel liver tissue normal subjects well panel liver specimens patients pbc , progressive sclerosing cholangitis , chronic active hepatitis \( \) c355 1 , much like human autoantibodies pdh e2 , reacts exclusively immunoblotting pdh e2 , binds inner domain protein , inhibits pdh e2 activity vitro addition , also attempted develop cloned cell lines react pdh e2 e2 using liver biopsies patients pbc , compared although monoclonal c355 1 produced typical mitochondrial fluorescence sections normal liver , pancreas , lung , heart , thyroid , kidney , produced distinct intense reactivity used stain bile ducts patients pbc nine 13 pbc liver biopsies studied herein contained bile ducts light microscopy , reacted intensely 1 100 culture supernatant dilution monoclonal c355 1 contrast , although bile ducts liver specimens normals , , progressive sclerosing cholangitis also reacted c355 1 , reactivity exclusively mitochondrial readily detectable dilution 1 2 importantly , generated cd4 , cd8 , alpha beta tcr cloned cell lines patients pbc , , produced il 2 specifically response pdh e2 e2
health consultant ten years later pharmacists remain readily accessible source information health order assess quality counseling health progress profession activity last decade , study similar one reported 1978 conducted visited 46 community requested advice pharmacists concerning proper treatment infant diarrhea additional information , questions asked answered according predetermined hypothetical case involving 18 month old infant diarrhea vomiting findings include following approximately one third pharmacists recommended product without caution less 20 percent fever , nausea , vomiting , diet , infant 's condition believe pharmacists approach health counseling increased awareness harmful potential providing inappropriate medical information
lecture intestinal epithelial barrier major route passive permeation across intestinal epithelia intercellular tight junction lies serves rate limiting barrier pathway viewed static , clear structure permeability tight junction highly dynamic may inflammatory events \( cytokines , neutrophil \) reversibly effect tight junction key barrier also regulated physiologic events activation cell na \( \) nutrient physiologic regulation junction major importance absorption nutrients via solvent
clinical features misdiagnosed appendicitis children study objective compare clinical features children misdiagnosed appendicitis children appendicitis initially diagnosed correctly design retrospective review hospital , emergency department , clinic records setting university medical center annual ed census 40 , 000 patients participants children less 13 years old admitted may 1 , 1979 , april 30 , 1989 , discharge diagnosis appendicitis measurements records reviewed historical , physical examination , laboratory , pathologic features patients initial presentation physician final presentation correct diagnosis made using chi 2 analysis student 's test , clinical features misdiagnosed patients patients diagnosed correctly compared results one hundred eighty one cases identified 50 initially misdiagnosed initial presentation , misdiagnosed patients younger likely vomiting pain onset , constipation , diarrhea , , signs symptoms upper respiratory infections misdiagnosed cases less likely right lower quadrant tenderness documentation bowel sounds , peritoneal signs , rectal examinations final presentation , misdiagnosed patients likely pain duration two days , temperature 38 3 c , appear irritable \( p less 05 measurements \) conclusion clinical features children misdiagnosed appendicitis differ children appendicitis initially diagnosed correctly
effect cognition , function behaviour alzheimer 's disease objective determine efficacy \( tha \) alzheimer 's disease design randomized , double blind , multiple crossover trial three treatment periods , consisting 3 weeks active drug therapy 3 weeks placebo administration setting referral based geriatric practice community hospital patients thirty four patients moderate severe alzheimer 's disease subjects included stage 3 6 disease \( determined scale \) taking psychotropic drugs least 1 month informed consent obtained patients next interventions fifty 100 mg tha daily matched placebo results initial 34 patients 14 experienced liver toxicity 3 gastrointestinal side effects study however , 22 completed study able tolerate least minimum dose 22 patients clinically statistically significant effect tha cognition , functional status behaviour results individual patients showed subgroup tha responsive patients conclusion tha clinically important benefits alzheimer 's disease associated appreciable toxic effects
primary cytomegalovirus infection gastric ulcers normal host 42 year old woman presented epigastric pain vomiting upper gastrointestinal endoscopy revealed three gastric ulcers histologic examination biopsies ulcers showed cytomegalovirus inclusion bodies appearance igm antibodies cytomegalovirus indicated recent primary infection stored serum last pregnancy 17 months previously contained cytomegalovirus antibodies thorough evaluation immune system revealed abnormality aware two cases seroconversion documented normal hosts cytomegalovirus infections gastrointestinal tract normal hosts unusual common cause morbidity immunocompromised hosts believe cytomegalovirus may role pathogenesis gastrointestinal lesions patients
noninvasive measurement portal venous blood flow patients cirrhosis effects physiological pharmacological stimuli present study aims evaluate usefulness combined pulse doppler real time ultrasonography noninvasive method measurement portal blood flow man measurement technique performed 12 healthy subjects 20 patients portal hypertension ten patients \( group 1 \) evaluated prior ingestion standard meal \( ensure plus \) placebo remaining 10 patients \( group 2 \) , effects isosorbide dinitrate \( 5 mg \) administration placebo studied group 1 , food intake caused significant increase portal blood flow \( 539 ml min , p less 0 02 \) effect due significant rise mean blood velocity \( 18 5 3 7 23 9 3 9 cm sec , p less 0 02 \) group 2 , isosorbide dinitrate significantly reduced portal blood flow \( 625 355 ml min , p less 0 05 \) significant decline mean blood velocity \( 18 8 4 5 14 5 2 5 cm sec , p less 0 02 \) observed placebo administration significant hemodynamic effects either group results suggest doppler measurements gave accurate noninvasive estimations portal blood flow technique may used monitor physiological stimuli patients portal hypertension
ulcerative proctitis central sweden 1965 1983 population based epidemiological study ulcerative proctitis regarded subgroup ulcerative colitis population based epidemiological studies ulcerative proctitis , however , virtually epidemiological study inflammatory bowel disease health care region , cases ulcerative proctitis diagnosed 1965 1983 males predominated , male female ratio 1 4 1 annual incidence rates higher urban rural areas annual incidence rates increased threefold 2 8 per 10 \( 5 \) 6 6 per 10 \( 5 \) period , affecting age groups 14 years age , urban rural areas sexes differences temporal trends certain epidemiological characteristics ulcerative proctitis extensive ulcerative colitis suggest ulcerative proctitis specific disease whose etiology differs extensive ulcerative colitis
epidemiology inflammatory bowel disease large , population based study sweden previous population based incidence studies inflammatory bowel disease limited small numbers , short duration , inadequate case finding address problems , identified persons confirmed ulcerative colitis \( n \) crohn 's disease \( n \) health care region 1965 1983 age specific incidence rates sex slightly greater males ulcerative colitis females crohn 's disease incidence rates ulcerative colitis crohn 's disease higher urban rural areas annual incidence rate ulcerative colitis increased less 7 per 100 , 000 12 per 100 , 000 study period , rate crohn 's disease remained 5 7 per 100 , 000 increase incidence ulcerative colitis result marked increase number patients ulcerative proctitis analyses 5 year birth cohorts suggest born higher risk ulcerative colitis crohn 's disease , effect accounted born first half year cohort effect , combined urban preponderance disease , suggests environmental causes may involved ulcerative colitis crohn 's disease
induction ps2 hsp genes markers mucosal ulceration digestive tract recently discovered ps2 protein expressed estrogen control subset estrogen receptor positive breast cancers estrogen independent manner normal stomach mucosa ps2 gene belongs family genes encoding peptides contain conserved 5 cysteine domain , p domains although function ps2 protein unknown , suggested may cell growth stimulatory activity report expression ps2 gene digestive tract , normally restricted stomach , strongly induced mucosal ulcerations elsewhere tract , notably crohn 's disease ps2 gene expression restricted mucosal layers adjacent ulcerations , region novel epidermal growth factor secreting cell lineage shown induced mucosal ulceration human hsp gene , contains tandem duplication ps2 gene p domain coexpressed ps2 gene normal stomach mucosa breast cancers , also expressed crohn 's disease suggest ps2 gene expression may provide useful marker mucosal ulcerations digestive tract
diarrhea fish poisoning preliminary evaluation pathophysiological mechanisms fish poisoning clinical syndrome consisting combination gastrointestinal neurological symptoms occurring eating toxin containing tropical fish major cause morbidity , south , australia , effort define pathophysiological mechanisms responsible component illness , examined effect crude fractionated toxin preparations isolated rabbit ileal tissue chamber model crude toxin preparation \( prepared toxic \) 10 50 methanol toxin fraction \( prepared pool toxic fish samples \) gave striking increase electrical potential difference short circuit current activity seemed mediated calcium examined light microscopy , intestinal mucosa damaged toxin preparations used data demonstrate involved fish poisoning directly stimulate intestinal fluid secretion without accompanying tissue damage suggest calcium second messenger mediating process
localization calcitonin gene related peptide human esophageal langerhans cells previously undescribed calcitonin gene related peptide immunoreactive intraepithelial cells seen specimens esophageal mucosa obtained biopsy surgical resection 14 individuals calcitonin gene related peptide immunoreactive cells seen normal mucosa increased markedly esophagitis routine histological stains , showed dendritic forms resembling langerhans cells skin cytological identity determined immunocytochemical tests human antigenic markers ia , hla dr , langerhans cells , leu leu m3 intraepithelial macrophages , cd3 tcr 1 lymphocytes , leu 14 b lymphocytes , 100 merkel cells , chromogranin amine precursor uptake cells double localization showed calcitonin gene related peptide immunoreactivity ia , hla dr , markers studies show intraepithelial langerhans cells esophageal mucosa contain calcitonin gene related peptide , may serve
cirrhosis portal hypertension patient adult pick disease woman known pick disease , type b , presented age 33 upper gastrointestinal bleeding , ascites , peripheral edema evaluation showed massive hepatosplenomegaly , infiltration liver pick cells , cirrhosis , evidence portal hypertension chronic gastrointestinal bleeding , , platelet dysfunction treated successfully splenectomy cirrhosis portal hypertension reported previously adult pick disease absence cause
mechanisms gallstone formation women effects exogenous estrogen \( premarin \) dietary cholesterol hepatic lipid metabolism aim define mechanisms whereby conjugated estrogens \( premarin , exogenous estrogen laboratories , new york \) increase risk developing cholesterol gallstones determine role , , dietary cholesterol studied gallbladder motor function , biliary lipid composition secretion , cholesterol absorption , cholesterol synthesis esterification peripheral blood mononuclear cells , clearance chylomicron remnants , bile acid kinetics 29 women 13 studied low \( 119 mumol \) high \( 2 , 262 mumol \) cholesterol diet premarin increased index bile \( p less 0 05 \) , increased biliary cholesterol secretion \( p less 0 005 \) , lowered \( \) pool \( p less 0 001 \) synthesis \( p less 0 05 \) , altered biliary bile acid composition \( ca increases , p less 0 005 \) , stimulated cholesterol esterification \( p less 0 03 \) , enhanced clearance chylomicron remnants \( p 0 07 \) increases dietary cholesterol stimulated biliary secretion cholesterol \( p 0 07 \) , bile acid \( p less 0 05 \) , phospholipid \( p 0 07 \) , result , alter index reduction pool synthesis premarin reversed increasing dietary cholesterol premarin , 24 increase cholesterol entering body diet recovered biliary cholesterol newly synthesized bile acid premarin , 68 increase cholesterol recovered biliary lipids conclude premarin increases biliary cholesterol enhancing hepatic lipoprotein uptake inhibiting bile acid synthesis actions premarin dietary cholesterol bile
non specific reactions enzyme linked immunosorbent assays serum antibody histolytica lamblia non endemic areas serum samples 20 indian children diarrhoea compared 20 children resident united kingdom diagnosed ulcerative colitis , crohn 's disease , indeterminate colitis using enzyme linked immunosorbent assays specific histolytica lamblia 50 united kingdom patients high igg responses e histolytica g lamblia confirmatory elisa showed british sera reacted specifically bovine serum proteins rather antigens prior incubation sera 5 bovine serum reaction bovine serum integral part crude soluble antigen used e histolytica g lamblia needs replaced purified antigen preparations british sera also reacted commonly used blocking agents bovine serum albumin , , normal sheep serum reactions attributed uptake dietary antigens enhanced immunological response antigens patients inflammatory bowel disease
biphasic modulation acetaminophen hepatotoxicity pretreatment interferon inducer acid interferons interferon induction inhibit p 450 reduce hepatotoxicity acetaminophen however , since p 450 inhibition often followed p 450 induction , would enhance acetaminophen hepatotoxicity , possibility biphasic modulation acetaminophen hepatotoxicity interferons investigated male cd 1 mice various ages , young inbred male c57bl 6 mice given interferon inducer , acid \( poly c \) , 10 mg kg intraperitoneally , followed 1 48 days later single dose acetaminophen , 300 450 mg kg intraperitoneally hepatotoxicity assessed peak plasma concentration alanine aminotransferase \( alt \) occurring 0 48 hr acetaminophen treatment poly c inhibited hepatotoxicity acetaminophen given within 8 days , maximal inhibition 1 4 days conversely , maximal 7 fold enhancement alt concentration observed cd 1 mice 300 mg kg acetaminophen given 32 days poly c \( p less 0 05 \) c57bl 6 strain , poly c inhibited hepatotoxicity acetaminophen given within 16 days , whereas maximal 20 fold enhancement alt concentration observed 300 mg kg acetaminophen given 24 days poly c \( p less 0 05 \) mechanism toxicologic enhancement examined male c57bl 6 mice using treatment regimen biochemical assessment hepatotoxicity confirmed detailed histologic evaluation plasma concentrations acetaminophen metabolites determined high performance liquid chromatography acetaminophen quantified production glutathione derived cysteine acid conjugates acetaminophen poly c pretreatment produced 5 fold increase acetaminophen induced alt release \( p less 0 05 \) , correlated histologic evidence necrosis poly c pretreatment produced respective 3 fold 1 3 fold increases production cysteine acid conjugates \( p less 0 05 \) , correlated peak alt concentrations \( cysteine , r 0 92 , p less 0 001 acid , r 0 75 , p 0 006 \) thus , hepatotoxicity acetaminophen inhibited given within days interferon induction , conversely enhanced given several weeks toxicologic enhancement appears due increased p 450 catalyzed acetaminophen
glutathione disulfide formation oxidant stress acetaminophen induced hepatotoxicity mice vivo protective effect allopurinol acetaminophen \( 500 mg kg p \) induced hepatotoxicity fasted mice vivo acetaminophen also caused long lasting 50 reduction hepatic atp content , irreversible loss hepatic xanthine dehydrogenase activity transient increase xanthine oxidase activity effects occurred parenchymal cell damage , e , release cellular enzymes hepatic content gsh gssg initially depleted acetaminophen without affecting gssg gsh ratio \( 1 200 \) , however , recovery phase hepatic gsh levels gssg content increased faster gsh , resulting gssg gsh ratio 1 18 24 h acetaminophen administration mitochondrial gssg content increased 2 controls greater 20 acetaminophen treated mice extremely elevated tissue gssg levels accompanied 4 fold increase plasma gssg concentrations enhanced biliary efflux , although hepatic gssg formation biliary excretion affected acetaminophen allopurinol protected dose dependently acetaminophen induced cell injury , loss atp increase gssg content total liver mitochondrial compartment without inhibiting reactive metabolite formation high , protective well low , doses allopurinol almost completely inhibited hepatic xanthine oxidase dehydrogenase activity , high doses prevented increase mitochondrial gssg content data indicate long lasting , primarily intracellular oxidant stress progression phase acetaminophen induced cell necrosis protective effect allopurinol unlikely involve inhibition reactive oxygen formation xanthine oxidase could result antioxidant property
experimental reduction portal hypertension mechanical increase liver portal flow studies isolated perfused rat liver demonstrated increase portal pressure associated increase portal blood flow normal cirrhotic livers two pigs portal hypertension mesenteric portal pressure lowered mechanically increasing liver portal blood flow means balloon pump around portal vein
cholecystokinin enhanced hepatobiliary scanning ejection fraction calculation indicator disease gallbladder chronic cholecystitis represents 5 20 per cent treated diseases gallbladder 70 per cent success rate relieving patients chronic pain reported surgical treatment recommended based symptoms alone cholecystokinin ejection fraction , quantitative measure emptying gallbladder , 95 per cent accurate predicting patients would relieved symptoms surgical treatment study , report consecutive experience 20 month period 83 patients
computerized identification pathologic duodenogastric reflux using 24 hour gastric ph monitoring duodenogastric reflux naturally occurring sporadic event , incidence , occurrence , detrimental effects difficult assess reliability 24 hour gastric ph monitoring detect duodenogastric reflux studied central use ph monitoring purpose confidence ability measure display ph data way reflects changes gastric ph environment sufficient sensitivity test gastric ph 10 dogs measured fasting state , feeding , pentagastrin stimulation antrum alkaline fasting state \( p less 0 01 \) display data frequency distribution sensitive enough reflect induced ph changes test consistency gastric ph given position , simultaneous 24 hour gastric monitoring performed 12 normal subjects two probes placed either 5 10 cm lower esophageal sphincter 5 cm position two probes read within 1 ph unit 90 time based principles , gastric ph monitoring performed 5 cm lower esophageal sphincter 30 normal subjects 11 patients , ritchie 's clinical criteria pathologic duodenogastric reflux data obtained arranged 71 variables subjected discriminant analysis sixteen variables identified , corresponding coefficient used derive score score 2 2 indicated high probability pathologic duodenogastric reflux test applied validation population consisting 10 additional normal subjects 10 patients meeting ritchie 's criteria normal subjects normal score one \( 90 \) patients abnormal score compared acid \( \) scintigraphy another group 22 normal subjects 60 patients , 24 hour gastric ph monitoring superior detection pathologic duodenogastric reflux study shows application computer technology used diagnose pathologic duodenogastric reflux patients complex complaints
tongue force measurement system assessment oral phase swallowing disorders computer aided measuring system using highly sensitive beam transducer developed provide quantitative , reliable measure tongue strength tool application diagnosis treatment patients oral stage dysfunction device adapt individual feedback used enhance subject interest motivation device proven reliable measurements upward side tongue six able subjects measured five separate sessions also used two patients
intussusception diagnostic value testing stool occult blood retrospective review performed determine diagnostic value testing occult blood stool children suspect intussusception ninety six children barium enema studies suspected intussusception 57 children barium enema confirmed intussusception , 29 history physical findings gross blood per rectum stool tested occult blood 16 29 patients , 12 \( 75 \) positive comparison , three \( 20 \) children intussusception stool positive occult blood stool occult blood significantly associated intussusception \( p less 002 \) clinical factor significantly associated intussusception abdominal mass \( p less 02 \) vomiting , episodic irritability , poor feeding , abdominal pain significantly different two groups conclusion , authors suggest stool testing occult blood evaluating children present nonspecific signs symptoms supportive intussusception
plasma thrombin antithrombin iii complexes diagnosis primary hepatocellular carcinoma complicating liver cirrhosis detection state might helpful diagnosis primary hepatocellular carcinoma \( hcc \) complicating liver cirrhosis \( lc \) plasma levels thrombin antithrombin iii complex \( tat \) determined 50 patients lc without hcc levels 2 ng ml 80 25 hcc patients , 12 25 non hcc patients \( p less 0 01 \) levels 2 ng ml occurred even five six hcc patients whose serum alpha fetoprotein levels 20 ng ml well two three patients hcc less 2 cm diameter levels hcc patients significantly decreased within 8 days treatment transcatheter arterial embolization infusion antitumor agents , without affecting plasma antithrombin iii levels results suggest plasma tat levels may useful diagnosis hcc complicating lc
appraisal gut lavage study intestinal humoral immunity direct investigation intestinal humoral immunity requires collection intestinal secretions mucosal biopsy specimens , non invasive technique gut lavage , electrolyte lavage solution means collecting intestinal secretions immunoglobulin antibody studies , evaluated fifty patients studied 25 immunologically normal patients volunteers , 15 patients untreated coeliac disease , 10 patients active crohn 's disease protease inhibitors added promptly samples prevent immunoglobulin content treated lavage samples assayed enzyme linked immunosorbent assay immunoglobulin antibody content studies serial lavage specimens showed early , contaminated specimens contained negligible quantities immunoglobulin , specimens became clear steady state reached , little variation immunoglobulin content serial specimens uniform dilution \( around 20 \) ingested gut lavage fluid iga predominantly secretory , comprising 92 , 81 6 , 76 7 respectively total iga gut lavage fluid content control , coeliac , crohn 's groups high values total igm iga igm antigliadin antibodies detected coeliac group , high values igg crohn 's disease group method gut lavage effective bowel , also noninvasive means obtaining intestinal secretions study humoral immunity gastrointestinal disease
jejunal immunoglobulin antigliadin antibody secretion adult coeliac disease compared local intestinal immunoglobulin \( ig \) secretion six adult patients coeliac disease nine control subjects perfusion small bowel segment occluding balloon analysis perfusion fluid content ig secretory component results compared number ig containing plasma cells test segment , respectively , two fold fivefold increase jejunal secretion rates iga \( monomeric polymeric \) igm patients coeliac disease compared control subjects high iga igm secretion rates parallel increase ig containing plasma cells lamina propria contrast , igg plasma cell density increase significant patients coeliac disease result high igg secretion rate jejunal secretion rate secretory component significantly increased patients coeliac disease free dimeric iga present jejunal fluid antigliadin iga detected serum jejunal fluid six patients coeliac disease antigliadin iga , however , almost entirely polymeric iga linked secretory component jejunal fluid , whereas 61 dimeric iga linked secretory component serum result , combined raised secretory component secretion rate evidence secretory component saturation , suggests serum intestinal antigliadin iga might different origins coeliac disease
inflammatory bowel disease tobacco smoke case control study case control study carried , sweden 1984 1987 evaluate association cigarette smoking exposure environmental tobacco smoke childhood subsequent development inflammatory bowel disease information smoking obtained postal questionnaire relative risk crohn 's disease current smokers compared never smoked 1 33 \( 95 confidence limits 0 7 2 6 \) men 4 99 \( 2 7 9 2 \) women corresponding results ulcerative colitis 0 96 \( 0 5 1 8 \) 0 72 \( 0 4 1 4 \) relative risk ulcerative colitis recent compared never smoked 2 18 \( 0 9 5 0 \) furthermore , increase risk crohn 's disease found exposed environmental tobacco smoke childhood , relative risk 1 50 \( 1 0 2 3 \) corresponding relative risk ulcerative colitis 0 98 \( 0 6 1 5 \)
mortality causes death crohn 's disease review 50 years' experience university hospital six hundred seventy one patients \( 52 5 women \) crohn 's disease seen university hospital 1984 identified follow 98 2 complete sixty four \( 9 7 \) patients died cause death related crohn 's disease 34 patients , probably related disease four , unrelated , incidental causes , 25 cause death could identified one patient significant decrease deaths related disease 1973 causes death amyloidosis malnutrition disappeared postoperative deaths decreased standardised mortality ratio showed excess mortality 2 23 patients higher women \( 3 30 \) men \( 1 76 \) comparison two recent 10 year periods showed significant decrease standardised mortality ratio men women patients whose disease started age 20 years excess mortality compared older patients study supports view prognosis crohn 's disease improved general high quality medical surgical management important particularly younger patients
efficacy biofeedback training improving faecal incontinence anorectal physiologic function efficacy biofeedback treatment faecal incontinence anorectal function evaluated eight patients faecal incontinence treated biofeedback training medical therapy outcome anorectal function compared nine faecal incontinent patients received medical therapy alone three month follow showed 50 patients biofeedback plus conventional treatment group 56 treated conventionally improved one year follow showed 13 biofeedback group free soiling additional 25 improved results similar conventionally treated group 11 free soiling additional 44 improved anal pressures rest squeeze , rectal distension volume induced sustained inhibition external internal anal sphincter , continence infused saline significantly reduced groups patients compared controls \( p less 0 05 \) biofeedback treatment effect abnormal anorectal functions either patients improved improvement faecal incontinence probably due medical intervention regression symptoms time , , result biofeedback training
comparison gall bladder bile endoscopically obtained duodenal bile 10 patients gall stone disease \( eight women , two men mean \( sd \) age 47 4 \( 13 \) years \) , bile obtained endoscopic aspiration stimulation gall bladder also fine needle puncture gall bladder local anaesthetic total lipid concentration puncture bile samples mean \( sd \) 11 9 \( 4 7 \) g dl , significantly higher endoscopic bile samples \( 3 9 \( 3 3 \) g dl , p less 0 001 \) total bile acids , phospholipids , biliary cholesterol \( expressed mol \) cholesterol saturation index showed significant differences two types samples acid concentration endoscopically obtained bile \( 27 7 \( 6 6 \) mol v 23 3 \( 5 4 \) mol p less 0 01 \) significantly higher puncture bile samples puncture bile exhibited significantly shorter nucleation time \( 3 5 \( 3 3 \) days v 19 6 \( 11 9 \) days p less 0 001 \) determination nucleation time , endoscopic bile aspiration gall bladder stimulation led adequately concentrated samples 50 study subjects cholesterol monohydrate crystal formation native bile observed six samples puncture bile three samples endoscopically obtained bile presence cholesterol crystals determination nucleation time puncture bile best cholesterol pigment gall stones correlated well computed analysis
isolated lipase deficiency two brothers two brothers arab origin , aged 15 10 years , isolated congenital lipase deficiency described normally developed history passing stools since early infancy remarkable low serum carotene vitamin e concentrations exocrine pancreatic stimulation , lipase activities duodenal fluid almost completely absent , amylase trypsin , bile salt , ph values normal aetiology exocrine pancreatic insufficiency found first report congenital combined lipase deficiency two brothers
stimulation glucagon secretion gastric inhibitory polypeptide patients hepatic cirrhosis porcine gastric inhibitory polypeptide \( gip \) infused iv \( 120 micrograms 60 min \) seven patients biopsy proven hepatic cirrhosis surgical porta caval anastomoses postabsorptive state infusions resulted elevation blood levels immunoreactive gip upper range observed ingestion large mixed meals accompanied significant increments immunoreactive glucagon \( irg \) plasma similar infusions two cirrhotic patients surgical porta caval anastomoses normal plasma irg levels postabsorptive state effect plasma irg level ingestion triglyceride \( 60 g \) cirrhotic patients porta caval anastomoses also resulted elevation plasma immunoreactive gip , associated significant elevation plasma irg level chromatography studies showed increments plasma irg administration gip triglyceride largely accounted increases pancreatic type glucagon significant effects administration gip triglyceride blood levels glucose immunoreactive insulin concluded porcine gip patients cirrhosis liver show elevated levels irg plasma postabsorptive state effect due diversion portal blood systemic circulation may attributable hypersensitivity alpha cells stimulation gip
treatment duodenitis cimetidine clinical , endoscopic , histologic study studied effectiveness cimetidine treatment endoscopically diagnosed duodenitis sixty nine patients solitary endoscopic finding duodenitis \( 6 1 , 200 patients underwent fiberoptic endoscopy upper gastrointestinal tract unit 3 years \) studied retrospectively good clinical response apparent 45 69 patients treated cimetidine \( 65 \) , fair response another four \( 6 \) controlled , randomized prospective study , evaluated effectiveness cimetidine duodenitis statistically significant improvement clinical endoscopic scores found 10 patients treated cimetidine \( p less 0 01 \) improvement histologic score reach statistical significance improvement demonstrated seven placebo treated patients believe duodenitis peptic syndrome , good response cimetidine treatment , much like duodenal ulcer disease
colonic volvulus complication celiac sprue colonic volvulus rarely reported complication celiac sprue describe two patients long standing celiac sprue , one recurrent sigmoid volvulus developed , , cecal volvulus following surgery , asymptomatic gluten free diet association celiac sprue colonic volvulus first reported 1953 isolated cases documented , surprisingly two major predisposing conditions colonic volvulus often seen patients celiac sprue colonic bacterial fermentation carbohydrate \( celiac sprue \) leads excess gas production bowel loops sigmoid , long mesentery , cecal hypermobility uncommon motility disorder celiac sprue also proposed thus factors together would suggest likelihood development colonic volvulus celiac sprue would relatively great possibility underlying celiac sprue considered patients colonic volvulus background history recurrent abdominal distention symptoms
six physicians inflammatory bowel disease six physicians inflammatory bowel disease \( ibd \) emphasize important denial control become physician patient origin ibd suggests physicians never patients sick
erythrocyte sedimentation measure crohn 's disease activity opposite trends versus colitis test hypothesis erythrocytic sedimentation rate \( esr \) correlates well clinical activity inflammatory disease colon , small bowel , stratified 49 crohn 's disease patients according anatomic involvement measured correlations esr clinical activity within anatomical subgroups 18 patients crohn 's disease involving primarily colon , trend toward direct correlation clinical score esr \( p 0 15 \) 14 patients crohn 's disease limited colon , direct correlation even pronounced statistically significant \( p less 0 02 \) contrast , opposite trend observed patients small bowel disease 26 patients disease involving predominantly small bowel , well 22 disease limited small bowel , statistically significant inverse correlations clinical score esr \( p less 0 04 \) difference directions correlations crohn 's colitis versus statistically significant \( p less 0 05 \) study provides evidence importance analyzing putative indications disease activity separately forms crohn 's disease occurs
biliary sludge critical update biliary sludge many years poorly defined entity , usually low amplitude , within dependent part gallbladder , shift influence postural changes sonographic point view , detection sludge implies coexistence small sized , solid components gel like embedding material chemical nature biliary sludge recently recognized predominantly composed cholesterol monohydrate crystals liquid droplets , cases , obstructive jaundice symptomatic liver diseases , bilirubin granules , embedded gel matrix mucous glycoproteins pathogenic point view , biliary sludge often associated biliary stasis , conditions characterized impaired gallbladder contraction , prolonged total parenteral nutrition , fasting , pregnancy causes include mucus hypersecretion , may favor cholesterol nucleation crystal growth , bile infection sludge may intermediate step formation different types stones epidemiological point view , sludge quite rare asymptomatic , free living population , may common selected series symptomatic patients clinical point view , sludge often course , including frequent , suggesting early stages gallstone formation reversible
thoracic new symptom sign achalasia patient thoracic due achalasia described noted sensation chest related bending examination sound could mid posterior chest patient back forth
gallbladder perforation correlation sonographic findings classification retrospectively analyzed sonograms 36 consecutive patients gallbladder perforation \( \) determine sensitivity preoperative detection gallbladder perforation \( b \) correlate findings modified classification criteria perforation \( free , hepatic activity , scintigraphic gallstone ileus sign \) detected 14 28 \( 50 \) cases , sonographic criteria perforation \( fluid gallstones \) present 18 \( 4 22 \) patients \( p less 0 05 \) patterns perforation associated classification type \( acute free perforation \) , 3 7 scans demonstrated free type ii \( subacute abscess \) , 9 19 scans showed activity type iii \( chronic fistula \) , 1 3 scans showed scintigraphic gallstone ileus thus , although appears superior sonography , modalities relatively insensitive detection gallbladder perforation
supportive evidence validity epidemiologic necropsy gallstones objective epidemiologic necropsy measures occurrence unsuspected disease examination necropsy records patients died reasons estimates unsuspected disease derived epidemiologic necropsy approximate actually occurs living population design setting test hypothesis , necropsy records adult patients university kansas medical center 1950 1984 examined presence gallstones patients previous cholecystectomy whose gallstones diagnosed life excluded data stratified age race compared screening survey canada , surgical series new york , two screening surveys italy , one denmark crude necropsy detection rates rates screening surveys standardized 1970 census kansas city results conclusions standardized occurrence rates similar suggest epidemiologic necropsy accurately assesses occurrence asymptomatic gallstones living population , thus strengthening validity research tool
congenital hepatic fibrosis autosomal dominant polycystic kidney disease congenital hepatic fibrosis found four families autosomal dominant polycystic kidney disease congenital hepatic fibrosis commonly though characteristic autosomal recessive polycystic kidney disease , reported families , show also complicate autosomal dominant polycystic kidney disease three families close linkage mutation causing disease dna markers chromosome 16 demonstrated clinical course congenital hepatic fibrosis differed considerably one family children congenital hepatic fibrosis died soon birth , three families approximately 20 years follow showed detectable progression liver disease
sequential esophageal motility studies endoscopic injection sclerotherapy prospective investigation assess prospectively effects endoscopic sclerosis \( eis \) esophageal function , performed esophageal manometry 13 cirrhotic patients eis , 24 h second session 4 wk fourth session eis impact lower esophageal sphincter pressure however , significant decrease amplitude peristaltic waves observed immediately post eis lower two thirds esophagus modification duration velocity progression peristaltic waves four fold increase simultaneous contractions observed early eis changes reversible , assessed late esophageal testing eis correlations demonstrated esophageal motor parameters doses sclerosant conclude sclerosant injection esophageal wall acutely impairs esophageal motility , motor function partially restored 4 wk completion eis , suggesting reversible
reduction hepatic venous pressure gradient consequence volume contraction due chronic administration spironolactone patients cirrhosis ascites effect plasma volume contraction induced 4 wk administration spironolactone furosemide hepatic venous pressure gradient evaluated consecutively allocated patients cirrhosis ascites spironolactone group \( n 15 \) , hepatic venous pressure gradient decreased significantly \( p less 0 005 \) , 21 8 , significant contraction circulating plasma volume \( p less 0 01 \) although statistically significant correlations change hepatic venous pressure gradient changes circulating plasma volume simultaneously determined systemic hemodynamics , significant negative correlation \( r 0 74 , p less 0 01 , n 12 \) hepatic venous pressure gradient change post treatment plasma aldosterone levels found however , furosemide group \( n 10 \) , hepatic venous pressure gradient circulating plasma volume significantly decrease data demonstrated significant reduction hepatic venous pressure gradient chronic administration spironolactone , may due volume contractions patients cirrhosis ascites
combination prednisone colchicine patients primary sclerosing cholangitis primary sclerosing cholangitis cholestatic liver disease characterized inflammation fibrosis biliary tract cause disease unknown , effective medical treatment exists study , 12 patients received combination low dose prednisone \( 10 mg day \) colchicine \( 0 6 mg \) course compared group concurrent historical controls 6 12 months , significantly improvement liver test results baseline values patients receiving prednisone colchicine untreated controls 24 months , however , significant differences biochemical tests appreciated treated untreated patients analysis serial liver biopsies showed differences histologic change two groups 2 yr follow , two deaths control group none treated group four untreated patients developed ascites gastrointestinal bleeding developed three untreated patients , one developed ascites contrast , treated group , ascites bleeding developed one patient conclude combination colchicine prednisone histologic progression progression standard liver tests 2 yr therapy trend toward less clinical deterioration improved survival 2 yr treatment basis findings , would advocate empiric use drugs patients primary sclerosing cholangitis , suggest , used psc , evaluated controlled clinical trial treatment yet incurable disease
modified approach disease mid rectum modification dr 's approach removal mid rectal lesions used 11 patients 1977 1988 senior authors patients ranged age 56 89 yr , average 67 yr seven male four female patients indications surgery follows villous adenoma \( seven \) , carcinoid \( one \) , recurrent dysplasia previous endoscopic polypectomy site \( one \) , positive distal margin neoplasm following low anterior sigmoid resection \( one \) , adenocarcinoma one elderly poor risk patient lesions middle rectum \( 7 11 cm anal , average 9 cm \) postoperative stay ranged 6 12 days mean 8 days average follow 11 patients 3 1 2 yr \( 1 month 7 yr \) , one patient local recurrent lesion morbidity mortality conclude modification approach offers good alternative excision mid rectal lesions terms technical ease , efficacy , safety , patient tolerance modified approach indicated certain situations part surgeon 's armamentarium
chemical peritonitis secondary intraperitoneal vancomycin although previously reported literature , existence chemical peritonitis due vancomycin patients peritoneal dialysis remains controversial report four similar episodes sterile peritonitis three patients receiving intraperitoneal \( ip \) vancomycin prior report implicated change vancomycin preparation , , contributing factor noted occurrence episodes following switch preparation laboratories high performance liquid chromatographic \( hplc \) profiles three preparations show lower level two presence certain contaminants may contributing clinical difference observed conclude chemical peritonitis due ip vancomycin administration occur , increased awareness entity could allow cases identified
transmission fever virus adult ingestion virus larvae published erratum appears j med 1991 jun 44 \( 6 \) studied ability , , ae , exposed larvae liver tissue fever \( \) virus infected hamster , become infected transmit virus adult adults transmit virus bite hamsters exposure larvae , 9 \( 5 54 \) adult cx 8 \( 38 \) adult ae \( \) species infected infected cx half infected ae ae tested transmitted virus bite hamsters transmission rates orally infected larvae higher orally infected adults animals infected virus may die vicinity mosquito larvae infected tissue animals may water
importance intraoperative cholangiography laparoscopic cholecystectomy laparoscopic cholecystectomy \( lc \) using successfully performed 56 58 selected patients cholangiography performed 53 patients six patients common duct stones five unsuspected preoperatively gallbladder removed , three patients underwent open common duct exploration another five cases , anatomical anomalies discovered cholangiography performed via cystic duct structures divided prevent serious complication common duct injury cholangiography attempted patients undergoing lc
inguinal hernia complicating flexible sigmoidoscopy flexible sigmoidoscopy become part routine preoperative workup patients age fifty present inguinal hernia recent experience two patients left inguinal hernia allowing sigmoid colon bring awareness possibility increased risk perforation sigmoid colon flexible sigmoidoscopy , possible iatrogenic incarceration hernia cases presented clinical entity recognized complications prevented
plasma glucagon concentration cirrhosis related liver function portal systemic shunting , systemic vascular resistance , urinary sodium excretion tested hypothesis increased plasma glucagon concentration resulting portal systemic shunting liver dysfunction causes arterial vasodilation thereby stimulates sodium retention cirrhosis twenty seven studies performed patients alcoholic liver disease , 11 ascites liver function quantitated elimination rate , caffeine , stable isotopes acid administered orally \( 2 , 2 , 4 , 4 \) intravenously \( 24 13c \) portal systemic shunt fraction calculated ratio intravenous oral clearances isotopes acid cardiac output measured using doppler echocardiography plasma glucagon concentration increased patients ascites compared patients without ascites \( 180 pg ml vs 245 120 pg ml , p 0 \) unrelated urinary sodium excretion , heart rate , mean arterial pressure , cardiac output , systemic vascular resistance \( r 0 48 , 0 35 , 0 13 , 0 18 , 0 22 , respectively \) plasma glucagon concentration correlated half lives model compounds \( r 0 58 , p 0 002 r 0 62 , p 0 0008 r 0 62 , p 0 001 r 0 64 , p 0 0005 caffeine , , oral intravenous acid , respectively \) shunt fraction \( r 0 14 \) increased plasma glucagon concentration cirrhosis probably result diminished hepatic clearance however , increased plasma concentration glucagon appear cause hyperdynamic circulatory state sodium retention
elevated plasma aluminum levels normal infants receiving antacids containing aluminum aluminum toxicity documented cause encephalopathy , anemia , osteomalacia excretion primarily renal therefore , patients renal insufficiency risk aluminum accumulation toxicity demonstrated uremic children treated aluminum containing antacids purpose study determine whether plasma aluminum levels elevated infants normal renal function prolonged aluminum containing antacid use ten study infants \( mean age 5 8 months \) , receiving antacids least 1 week , compared 16 control infants \( mean age 9 8 months \) receiving antacids study patients consumed 123 16 mg kg per day \( mean sem \) elemental aluminum average 4 7 weeks plasma aluminum level \( 37 2 7 13 micrograms l \) significantly greater control group \( 4 13 0 66 micrograms l \) \( p less 005 \) concluded plasma aluminum levels may become elevated infants normal renal function consuming high doses aluminum containing antacids safety antacids containing aluminum assumed used infants , careful monitoring aluminum dose plasma level
gastric emptying infants children limited utility 1 hour measurement gastric emptying measurements performed infants children 1 2 hours liquid feeding 1 hour measurements predictive 58 variability 2 hour measurements , indicating 1 hour measurement good predictor 2 hour measurement gastric emptying measurements children continued 2 hours feeding unless rapid emptying observed 1st hour study
gallstone lithotripsy relevant physical principles technical issues basic understanding shock wave generation essential radiologist gallstone lithotripsy shock waves differ ordinary acoustic waves rapid rise time , positive pressure component gives rise compressive forces approaching 1 , 000 atm , low amplitude sustained negative pressure \( \) component shock waves created means three different types shock wave generators gap , electromagnetic , piezoelectric authors describe compare three types shock wave generators regard equipment selection regardless shock waves generated , share common interactions tissue interactions reviewed along proposed mechanisms stone fragmentation
air ligamentum new sign intraperitoneal air plain radiographs four patients acute spontaneous developed , vertically directed area right upper quadrant seen radiographs abdomen obtained patient supine finding , appeared absence characteristic signs free air plain radiographs , authors' knowledge , previously recognized , represented intraperitoneal gas confined ligamentum \( \) location area confirmed computed tomography laparotomy patient distinctive configuration air subtle reliable indicator
liver cirrhosis changes doppler waveform hepatic veins published erratum appears radiology 1991 100 \( 2 \) authors compared doppler ultrasonographic pattern hepatic veins \( \) group 60 patients affected liver cirrhosis 65 healthy subjects comparable sex age \( \) detect possible differences hv waveform two groups \( b \) investigate relationship differences severity disease \( according child pugh classification \) modifications systemic hemodynamics waveform classified three patterns , normal waveform , lower oscillations without reversed phase , completely flat waveform index superior mesenteric artery , reflecting peripheral splanchnic impedance hyperdynamic circulation , also measured subgroup 45 cirrhotic patients waveform healthy subjects corresponded pattern among cirrhotic patients , found 30 \( 50 \) , 19 \( 31 7 \) , 11 \( 81 3 \) severity functional impairment greatest group least group significantly correlated decrease index superior mesenteric artery subgroup 45 patients changes normal hv waveform could considered useful adjunctive tool noninvasive evaluation liver disease pathophysiology changes hv blood flow still unclear significant correlation severity disease decrease splanchnic resistances indicates changes hv waveform occur presence marked rearrangements liver tissue hyperdynamic systemic circulation
sclerotherapy esophageal varices endoscopic injection sclerotherapy \( eis \) frequently used patients esophageal varices , controlling acute hemorrhage prophylaxis old technique , interest eis increased methods improve patient outcomes clinical trials eis acute hemorrhage demonstrated efficacy improved outcome , although researchers findings recent data prophylaxis eis fail support value eis indication oleate compares favorably sclerosing agents , one currently approved eis method used frequently method better efficacy performed rapidly percentage patients developing significant complications eis may high 15 percent common complications include pain , , sepsis eis currently important clinical tool management esophageal varices
glucose intolerance hyperinsulinemia cirrhosis results spontaneous surgical portosystemic shunting assess spontaneous portosystemic shunting collaterals contributes hyperinsulinemia cirrhosis , 12 patients alcoholic cirrhosis underwent 5 hour oral glucose tolerance test 1 day 10 days elective side side shunt glucose , insulin , c peptide responses oral glucose post shunt exaggerated comparable preoperative values compared preoperative values , fasting molar ratio c peptide insulin postoperatively increased 40 \( 6 0 1 2 versus 8 4 0 7 \) , indicating improved hepatic function results suggest extrahepatic portosystemic shunting secondary spontaneous splanchnic collaterals plays little role hyperinsulinemia cirrhosis appears decreased hepatic degradation insulin patients secondary hepatocellular dysfunction rather result shunting portal blood around liver
somatostatin cause gallstones \? long term administration somatostatin analogue , octreotide , complicated gallstone formation somatostatin known inhibit hepatic bile secretion gallbladder emptying however , effect octreotide gallbladder bile composition remains unknown therefore , tested hypothesis would alter hepatic bile composition cause gallbladder stasis , thereby increasing gallbladder bile solute concentrations fourteen control dogs received daily saline injections , whereas 10 animals received 1 micrograms octreotide subcutaneously three times per day 5 days cholecystectomy common bile duct cannulation performed octreotide increased hepatic bile concentrations bilirubin \( p less 0 05 \) , total bilirubin \( p less 0 05 \) , total protein \( p less 0 01 \) rsa , index gallbladder stasis , decreased \( p less 0 01 \) octreotide group gallbladder bile total calcium \( p less 0 05 \) , bilirubin \( p less 0 05 \) , total bilirubin \( p less 0 01 \) , total protein \( p less 0 05 \) , total lipids \( p less 0 05 \) increased octreotide group animals receiving octreotide also decreased hepatic \( p less 0 05 \) gallbladder \( p less 0 001 \) bile ph differences cholesterol saturation index observed data suggest dog , octreotide \( 1 \) alters hepatic bile composition , \( 2 \) causes gallbladder stasis , \( 3 \) increases gallbladder bile calcium , bilirubin , protein , lipid , hydrogen ion concentrations conclude octreotide causes alterations gallbladder bile composition increase likelihood cholesterol calcium bilirubinate precipitation
gallbladder lithotripsy study results first 5 years patients objective evaluate long term results three types shock wave treatment patients radiolucent gallbladder stones design cohort study setting single center trial patients patients gallstones , 19 eligible patients treated interventions patients received extracorporeal shock wave lithotripsy well adjuvant therapy bile acids results lithotripsy done three ways , using water tank lithotriptor \( group \) , water lithotriptor low energy levels \( group b \) , water lithotriptor high energy levels \( group c \) rate complete fragment clearance 9 12 months lithotripsy done differed significantly among three groups among patients single stones 20 mm less diameter , rate fragment clearance group 76 group b , 60 group c , 83 \( p 0 03 \) among patients single stones 21 30 mm , rate fragment clearance group 63 group b , 32 group c , 58 \( p less 0 005 \) among patients two three stones , rate fragment clearance group 38 group b , 16 group c , 46 \( p 0 01 \) patients fragments 3 mm less 24 hours lithotripsy done showed higher probability fragment disappearance larger fragments \( p less 0 001 \) clearance rate higher patients compliant noncompliant bile acid therapy \( p less 0 001 \) adverse effects included liver hematoma 1 patients , biliary pain attacks 253 patients \( 36 \) , mild biliary pancreatitis 13 patients \( 2 \) , cholestasis 7 patients \( 1 \) elective cholecystectomy done 16 patients \( 2 \) , endoscopic sphincterotomy done 4 patients \( 1 \) conclusions rate complete disappearance stones shock wave therapy depends size number initial stones , diameter largest fragment , mode shock wave treatment adjuvant therapy bile acids appears important complete fragment clearance
nonsteroidal anti inflammatory drugs peptic ulcer disease evidence accumulated nonsteroidal anti inflammatory drugs \( nsaids \) cause clinically important gastroduodenal ulcers pathogenesis , involves impairment mucosal resistance injury acid peptic environment , multifactorial controversial ulcers caused nsaids occur either mucosa inflamed infection helicobacter pylori histologically normal mucosa use drugs linked unexpectedly high incidence ulcer complications , history peptic ulcer disease common cases nonsteroidal anti inflammatory drugs thus appear exacerbate underlying peptic cause de novo ulcers association use drugs ulcer complications supported ulcer prevalence data cross sectional studies , data case controlled cohort studies , randomized , experimental trials drug induced gastric ulcers prevented , h2 blocker therapy several therapies reported promote ulcer healing despite continued use nsaids , adequate controlled trials done small gastric duodenal ulcers readily heal , whereas larger gastric ulcers require vigorous prolonged therapy relative efficacies various therapies preventing ulcers , healing ulcers , preventing complications remain established
stationary vs mapping manometry evaluating dysphagia two methods used assess esophageal motility mapping technique uses catheter withdrawal 1 cm steps entire esophagus evaluated simpler method commonly used involves keeping catheter stationary entire evaluation compared 2 techniques 30 patients referred evaluation dysphagia emphasis placed distal 10 cm esophagus primary location esophageal motility disorders excellent correlation techniques mean distal amplitude \( r 0 \) , mean distal duration \( r 0 \) , percentage non peristaltic contractions \( r 0 \) overall manometry diagnosis similar methods 27 \( 90 \) patients three patients different manometry diagnoses resulting use two techniques however , change diagnosis clinically important one patient mapping technique identified segmental motility disorder missed stationary technique stationary manometry 94 sensitivity 93 specificity rate identifying motility disorders compared mapping manometry conclude stationary manometry simple accurate method evaluating esophageal pressures distal disorders patients normal results stationary studies may benefit mapping identify rare segmental motility disorders
radiographic techniques efficacy evaluating esophageal dysphagia radiographic examination esophagus determine structural functional causes dysphagia best performed multiple techniques include full column studies produce distended films without use solid bolus , mucosal relief films identify mucosal defects esophagitis presence varices , double contrast films , motion recording \( fluoroscopy \) efficacy technique depends quality study specific disorder detected esophageal lesions producing dysphagia classified extrinsic structural lesions , intrinsic structural lesions , esophageal motility disorders radiographic studies preferred screening techniques patients dysphagia although sensitive evaluation mucosal lesions , radiographic studies superior endoscopy detection abnormal motility , esophageal rings , strictures
symptoms achalasia young women mistaken indicating primary anorexia nervosa case young women dysphagia , regurgitation , weight loss , diagnosed anorexia nervosa reevaluation showed achalasia causing symptoms , presented together related observations misinterpretation esophageal symptoms may occur consequence inadequate history taking patient 's , age , gender , leads view certain aspects patient 's history behavior suggesting pathologic towards eating body weight , also consequence misinterpretation symptoms indicative eating disorder patients cases disordered toward eating body weight may develop together achalasia clinical evaluation patients symptoms suggestive anorexia nervosa also bulimia nervosa include taking thorough history regarding swallowing vomiting order recognize possible esophageal motor disorder
modulation mediator release human intestinal mast cells sulfasalazine 5 aminosalicylic acid intestinal mast cells thought contribute mucosal inflammation ulcerative colitis crohn 's disease release inflammatory mediators since sulfasalazine metabolite 5 aminosalicylic acid effective therapeutic agents inflammatory bowel disease shown inhibit generation inflammatory products cells , examined effect agents vitro human intestinal mast cell mediator release sulfasalazine \( 5 x 10 \( 4 \) 10 \( 3 \) \) found significantly enhance goat anti human ige induced histamine release intestinal mast cells , response seen human blood basophils , whereas metabolite 5 aminosalicylic acid effective inhibitor stimulated histamine release mast cells basophils 5 aminosalicylic acid also inhibited production prostaglandin d2 stimulated intestinal mast cells sulfasalazine alone , without immunologic stimulation , induce histamine release mast cells basophils , enhancement ongoing mast cell activation sulfasalazine may explain cases adverse reactions drug inhibition mast cell histamine release prostaglandin generation 5 aminosalicylic acid demonstrates potential therapeutic modality agent
rectal irrigation short chain fatty acids distal ulcerative colitis preliminary report colon cells patients ulcerative colitis utilize short chain fatty acids may exposed decreased concentrations compounds test whether irrigation inflamed mucosa short chain fatty acids useful , conducted six week preliminary trial 12 patients distal colitis patient used twice daily rectal 100 ml solution containing acetate \( 80 mm \) , \( 30 mm \) , \( 40 mm \) two patients stopped three weeks , one improvement complete resolution symptoms 10 completed trial , nine judged least much improved showed change mean disease activity index score 7 9 0 3 \( se \) 1 8 0 6 \( se \) \( p less equal 0 002 \) mucosal histology score 7 7 0 7 \( se \) 2 6 0 7 \( se \) \( p less equal 0 002 \) thus , ulcerative colitis patients appear benefit increased contact higher usual levels critical energy substrates
gallstone dissolution methyl tert butyl ether 120 patients efficacy safety patients cholesterol gallbladder stones , 120 eligible percutaneous transhepatic methyl tert butyl ether \( mtbe \) puncture gallbladder successful 117 120 \( 97 5 \) 113 117 \( 96 6 \) stones dissolved solitary stones , treatment lasted average 4 hr , multiple stones 10 hr mean hospitalization 3 6 days 3 117 \( 2 6 \) patients bile leakage developed 33 reported mild complaints end treatment 34 residue gallbladder two patients developed recurrent stones mtbe , distributed fatty tissue , excreted together metabolite tert butanol methanol found traces gallbladder histology six patients showed chronic cholecystitis since findings independent treatment time interval treatment end operation , consistent stone related changes rather caused mtbe
medical dissolution gallstones clinical experience simple , safe , effective solvent retained gallstones bile ducts account 60 70 cases postcholecystectomy syndromes solvent preparation injected directly biliary system 200 patients retained gallstones outcomes retained stones completely disappeared 96 cases \( 48 \) partial dissolution 29 \( 14 5 \) agent also used partial dissolution 16 \( 8 \) ineffective 59 \( 24 5 \) make method effective , several guidelines observed including vitro trial dissolution test observation possible side effects frequent hepatic pancreatic function tests treatment preparation also performed
evaluation portal systemic shunting rats mesenteric splenic beds rats partial portal vein ligation , 95 0 9 splenic blood flow portal systemic circulation injection microspheres used determine degree shunting despite magnitude portal systemic shunting , several biochemical endocrine consequences portal systemic shunting occur levels expected degree shunting found effort resolve discordant findings , shunting splenic mesenteric bed studied anesthetized portal hypertensive rats various degrees duration portal vein stenosis shunting mesenteric bed averaged 66 7 29 9 \( range 5 1 99 1 \) influenced degree duration portal vein stenosis contrast , shunting splenic bed averaged 97 3 4 0 \( range 79 99 9 \) demonstrated variation groups determined degree portal vein stenosis shunting splenic bed consistently greater found mesenteric bed mesenteric splenic shunting correlated serum bile acid levels mesenteric shunting related inversely weight adjusted liver mass serum testosterone levels based upon data obtained portal hypertensive rats , concluded splenic injections microspheres overestimate portal systemic shunting contrast , mesenteric injections microspheres yield values shunting correlate well independently determined biochemical endocrine consequences shunting observations support validity mesenteric shunting measurements obtained
distribution cholesterol vesicles human gallbladder bile influence treatment chenodeoxycholic acid ursodeoxycholic acid present study aimed determining relative distribution cholesterol vesicular phases gallbladder bile gallstone patients \( n 23 \) gallstone free subjects \( n 7 \) nine gallstone patients treated chenodeoxycholic acid seven treated ursodeoxycholic acid , 15 mg kg day , 3 wk cholecystectomy vesicular fractions bile separated sucrose density gradient ultracentrifugation , clear separation two phases obtained vesicles identified light scattering spectroscopy appeared uniform size mean radius 760 proportion cholesterol vesicular fraction significantly higher untreated gallstone group \( 40 4 \) compared gallstone free \( 28 3 \) , ursodeoxycholic acid \( 28 3 \) chenodeoxycholic acid \( 18 4 \) groups despite low cholesterol saturation bile latter three groups \( 88 12 , 51 9 65 5 , respectively \) , considerable part biliary cholesterol carried vesicular fraction cholesterol phospholipid ratio vesicular fraction averaged 0 49 0 58 gallstone , gallstone free chenodeoxycholic acid groups , whereas ursodeoxycholic acid group significantly lower ratio 0 24 nucleation time bile gallstone group short \( 2 1 days \) compared gallstone free , chenodeoxycholic acid ursodeoxycholic acid groups \( 23 3 , 24 6 14 3 days , respectively
prophylactic sclerotherapy esophageal varices long term results single center trial survival prophylactic sclerotherapy assessed single center study involving 99 cirrhotic \( 41 alcoholic \) patients enrolled 8 yr hepatic vein pressure gradient measured pressure greater equal 12 mm hg randomized receive sclerotherapy treatment rest randomized patients three groups bled treated emergency endoscopy sclerotherapy stratification according presence ascites also undertaken median follow 61 mo \( range 14 107 mo \) survival among patients significantly longer among randomized patients \( p less 0 006 \) , significant difference treated sclerotherapy controls \( p 0 27 \) alcoholic cirrhotic patients undergoing sclerotherapy better 2 yr survival controls \( 80 vs 43 p 0 09 \) , benefit sustained 5 yr survival nonalcoholic patient groups identical 10 50 deaths caused variceal bleeding forty eight percent patients large varices bled , compared 20 patients small varices hepatic vein pressure less 12 mm hg accurately identified alcoholic patients low risk variceal bleeding nonalcoholic patients four episodes variceal bleeding attributable elective sclerotherapy conclude population , prophylactic sclerotherapy alone improve survival discrepancy survival alcoholic nonalcoholic cirrhotic patients suggests factors variceal hemorrhage may responsible difference
dual association hla dr2 dr3 primary sclerosing cholangitis human leukocyte antigen typing performed 81 patients primary sclerosing cholangitis investigate reported associations human leukocyte antigen type disease results showed significant increase frequency antigens dr3 compared controls \( 53 vs 23 , p less 0 0005 , 56 vs 21 , p less 0 0005 \) caused significant rise frequency human leukocyte antigen a1 dr3 haplotype \( 32 81 patients , 40 vs 12 100 patients , 12 , p less 0 0005 \) contrast , significant reduction seen frequency antigens dr4 \( 12 vs 31 , p less 0 005 , 12 vs 34 , p less 0 001 , pc less 0 011 \) complete absence dr4 haplotype patient group \( p 0 027 , fisher 's exact test \) dr3 positive individuals \( including dr2 dr3 heterozygotes \) eliminated , significant secondary association dr2 noted , 25 \( 69 \) 36 remaining patients dr2 positive compared 27 \( 34 \) 79 dr3 negative controls \( p less 0 0005 , pc less 0 006 \) 9 patients dr2 positive dr3 positive kaplan meier analysis demonstrated survival influenced presence either haplotype individual antigens patients dr3 positive first seen significantly younger age dr2 positive \( mean ages 33 yr 44 yr , respectively , p less 0 002 , student 's test \)
significance natural polymerized albumin receptor hepatitis b infection hepatocytes lack information regarding presence native albumin polymer serum structural similarity one produced glutaraldehyde treatment postulate hepatitis b virus attachment hepatocytes mediated polymerized albumin used enzyme linked immunosorbent assay murine monoclonal antibodies raised glutaraldehyde polymerized albumin detect native albumin polymer human serum cross reactivity albumin polymers presence polymerized albumin receptor hepg2 cell studied assay purified hepatitis b virus synthetic peptide analogous part pre s2 sequence \( 120 145 \) used study polymerized albumin dependent attachment virus hepg2 cells antibodies raised pre s2 peptide used inhibit pre s2 hepatitis b virus attachment hepg2 cells glutaraldehyde treated polymerized albumin found immunologically cross reactive native albumin polymer levels found significantly raised sera patients liver diseases polymerized albumin specific receptor hepg2 cells two classes binding sites different equilibrium dissociation constant \( \( 16 9 6 \) pmol l \( 1 , 019 172 \) pmol l albumin monomer unable polymerized albumin receptor sites hepg2 cells anti pre s2 antibodies inhibit hepatitis b virus pre s2 binding hepatocyte 40 70 , respectively added polymerized albumin antibody interfere virus attachment hepg2 cells
assay hepatitis b virus dna polymerase chain reaction relationship pre encoded viral surface antigens polymerase chain reaction evaluated diagnostic tool 72 chronic hepatitis b virus carriers hepatitis b virus dna detectable serum hbsag positive virus carriers using small 100 al detection limit cloned hepatitis b virus dna 100 ag primer pairs different regions hbv genome resulted different sensitivity detection amplified hepatitis b virus dna southern blotting subsequent counting densitometry allowed semiquantitative assay using several primer pairs parallel optimal detection , hbeag positive hbsag carriers , 80 antibody positive symptomatic hbsag carriers 57 asymptomatic antibody positive hbsag carriers found hepatitis b virus dna serum antiviral therapy hepatitis b virus dna disappeared polymerase chain reaction assay patients became hbeag negative , polymerase chain reaction detected relapse earlier conventional dot blot pre antigens assayed serum liver samples chronic carriers enzyme linked immunosorbent assay immunoblot although carriers strongly positive pre s1 pre s2 antigens , hepatitis b virus dna positive hbsag carriers detectable pre antigens , vice versa data show assay hepatitis b virus dna serum polymerase chain reaction far dot blot cannot replaced serological assays hbeag pre antigen
detection hepatitis b virus dna polymerase chain reaction plasma volunteer blood donors negative hepatitis b surface antigen plasma samples 206 volunteer blood donors tested hepatitis b virus \( hbv \) dna dot blot hybridization polymerase chain reaction \( pcr \) donors negative hepatitis b surface antigen \( hbsag \) normal serum alanine aminotransferase levels none 206 plasma samples positive hbv dna dot blot hybridization assay however , nine samples positive hbv dna pcr using two primer pairs specific surface core regions nine persons received hbv dna positive plasma , one developed posttransfusion non , non b hepatitis others remained well 6 months later therefore , approximately 4 blood donors taiwan low titers hbv dna , sensitive method screen donors may needed future , although current serologic test remains practical present
comparison shunt fraction estimation using iodine 123 technetium 99m group dogs experimentally induced chronic biliary cirrhosis portosystemic shunt fraction estimation using iodine 123 \( imp \) previously validated relative portal vein albumin injections using experimental model cirrhosis technetium 99m \( \) proposed alternative tracer imp study portal circulation cirrhotic patients compared shunt fraction estimates paired imp studies performed group dogs common bile duct ligation surgery estimated shunt fraction 6 7 postoperative studies relative imp good correlation two methods demonstrated , however , slope regression line substantially less 1 0 values reaching 100 imp shunt values approximately 60 apparent inability accurately assess high shunt flows may limit quantitative aspects studies patients severe portosystemic shunting
quantification hepatobiliary function integral part imaging technetium 99m health disease study undertaken check feasibility measuring hepatic extraction fraction \( \) excretion 1 2 values integral part hepatobiliary imaging technetium 99m health disease 18 controls subjects , 100 1 2 excretion mean e value 15 23 1 4 min mean appearance times common bile duct \( \) , gallbladder \( \) , small intestine 15 8 1 52 , 20 2 2 7 , 23 8 3 08 min , respectively rising serum bilirubin patients decreased increased 1 2 excretion value resulting delayed appearance , , small intestine control subjects patients bilirubin less 5 mg , 1 2 excretion values 30 , 40 , 50 min similar values calculated using entire 60 min data , suggesting hepatic phase study time could reduced 30 40 min still use normal reference values established 60 min patients bilirubin greater 5 mg , data collection duration continued 60 min
intestinal obstruction distension foley catheter effective permitting postoperative nutritional support , particularly patient complicated gastrointestinal disease case presented , however , distension foley balloon catheter , used tube , led intestinal obstruction initially detected following radiographic identification problem , removal air foley balloon allowed patient complete surgery possibility obstruction foley catheter recognized potential problem postoperative period
norwalk virus genome cloning characterization major epidemic outbreaks acute result infections norwalk norwalk like viruses virus purified stool specimens volunteers experimentally infected norwalk virus used construct recombinant complementary dna \( cdna \) derive clones representing viral genome specificity clones shown hybridization post \( pre \) infection stool samples volunteers infected norwalk virus purified norwalk virus correlation observed appearance hybridization signals stool samples clinical symptoms acute volunteers hybridization assays overlapping clones , restriction enzyme analyses , partial nucleotide sequence information clones indicated norwalk virus contains single rna genome positive sense , tail 3' end size least 7 5 kilobases consensus amino acid sequence motif typical viral rna dependent rna identified one norwalk virus clones availability norwalk specific cdna new sequence information viral genome permit development sensitive diagnostic assays studies molecular biology virus
surgical options postgastrectomy syndromes various operations performed treatment peptic ulcer disease lead variety iatrogenic disorders collectively referred postgastrectomy syndromes although etiology disorders remains unclear , loss vagal innervation bypass , ablation , destruction clearly involved pathogenesis , , disorders unfortunately , often also poorly understood psychological element involved pathogenesis ulcer operations , proximal gastric vagotomy results fewest physiologic abnormalities postoperative symptoms continued popularity operation effect marked reduction incidence disabling postgastrectomy syndromes fortunately , symptoms severe enough operation uncommon , conservative medical management always indicated usually disabling symptoms refractory , thorough evaluation patient accurate classification syndrome essential satisfactory result surgical intervention although numerous surgical procedures developed deal different syndromes , varied results , roux en procedure emerged operation choice , , postgastrectomy syndromes however , roux en procedure universally successful , operation lead recently recognized postgastrectomy state roux en stasis syndrome prevention therefore remains best form therapy , operation undertaken adequate time elapsed since original operation forms conservative treatment failed
reoperation versus alternatives retained biliary calculi retained common bile duct stones treated operation , dissolution , extraction , fragmentation , , reoperation approach requires expertise , likelihood success depends composition size stones good results often obtained nonoperatively , especially multidisciplinary team reoperation rarely necessary
mechanical sutures perforation thoracic esophagus safe procedure patients seen late 1976 1988 , treated 13 perforations thoracic esophagus , excluding ruptured carcinoma intraoperative wounds , mechanical sutures without exclusion delay perforation treatment ranged eight 168 hours , 24 hours 11 length perforation 0 5 15 0 centimeters suture covered flap ten instances procedure associated five instances digestive performed one death patient comatose upon arrival results small series suggest myotomy exposing mucosa flap two essential elements technique perforations less 6 centimeters , even seen late , may treated primary surgical closure
perforation colon perforation colon rare 64 reported cases reviewed define syndrome perforation , facilitate accurate diagnosis treatment features localized generalized peritonitis universal however , 11 per cent correctly diagnosed operation recognition disease involves segment colon rather focal point perforation essential adequate surgical treatment postulated reason higher postoperative mortality following closure perforation proximal colostomy \( 57 per cent \) alone \( 43 per cent \) , compared resection diseased segment \( 32 per cent \) resection therefore treatment choice situations
adrenergic control internal anal sphincter abnormal patients idiopathic faecal incontinence histological functional evidence internal anal sphincter abnormal patients idiopathic faecal incontinence vitro responsiveness internal anal sphincter noradrenaline \( important sympathetic neurotransmitter \) electrical field stimulation \( known stimulate intrinsic innervation \) studied muscle strips eight patients incontinence undergoing repair five controls undergoing resection low rectal carcinoma studied contraction response curves noradrenaline significantly different , ec50 , concentration required produce 50 per cent maximum contraction , higher incontinent patients \( p less 0 001 \) electrical field stimulation produced initial contractions four control group blocked phentolamine contraction present incontinent patients \( p less 0 01 \) results indicate abnormality adrenergic innervation internal anal sphincter patients idiopathic faecal incontinence
achalasia cardia long term results posterior partial fundoplication forty eight patients achalasia cardia treated 's myotomy posterior fundoplication approximately 270 degrees , suturing gastric fundus edges myotomy mean \( \) postoperative follow period 5 4 \( 2 8 \) years clinical results good excellent 44 cases \( 92 per cent \) fair four cases \( 8 per cent \) \( two residual dysphagia two reflux \) barium studies showed decrease oesophageal diameter disappearance distal narrowing normal oesophageal emptying occur postoperative manometric studies \( 29 patients \) revealed significant decrease lower oesophageal sphincter pressure significant increase length segment oesophageal body recovery peristaltic waves proximal third seen ten patients \( 34 per cent \) twenty four hour ph monitoring showed pathological reflux three 25 patients studied , one asymptomatic technique effective , improving oesophageal symptoms controlling long term reflux
gallstone pancreatitis choosing timing treatment patients gallstone pancreatitis often seen initially primary care physicians prompt diagnosis timely intervention crucial reducing morbidity mortality initial management include supportive medical care surgical consultation timing surgery serum enzyme levels liver function test results well patient 's condition role endoscopic intervention currently evolving whether surgery endoscopic sphincterotomy preferable primary therapy gallstone pancreatitis remains unresolved however , sphincterotomy stone extraction viable option selected cases , especially patients severe gallstone pancreatitis
endoscopy versus x ray studies gastrointestinal tract future health care implications 147 patients colonoscopy 59 patients gastrointestinal x ray studies endoscopic procedure done within 7 days x ray study patient still symptomatic barium findings confirmed 40 60 , x ray findings could confirmed x ray findings false positive 37 4 , false negative 16 3 , suboptimal nondiagnostic 6 2 barium enema findings confirmed 32 68 , x ray findings false positive 42 3 , false negative 22 , suboptimal 3 3 conclude clinical private practice , x ray studies alone may associated high margin diagnostic errors factors considered , initial cost advantage x ray studies appears lost future recommendations continuing dilemma x ray studies versus endoscopy , consideration given factors initial lower price x ray studies
neuroendocrine design gut enteric nervous system \( ens \) thought third component autonomic nervous system vast network neurons widely dispersed throughout gut ens dominant regulator gut function action peptide non peptide neurotransmitters intensively studied roles ens regulation secretory processes , gastric acid secretion , motility clear , however , ens plays broader role regulation gut functions , including mucosal defense , gut immune response , sphincter function alterations regulation gut function ens likely suspected number conditions , including achalasia , hirschsprung 's disease , inflammatory bowel disease , disease , chronic intestinal , biliary dyskinesia , , irritable bowel syndrome improved knowledge pathophysiology troublesome conditions makes effective therapy likely future
roux operation postgastrectomy syndromes aim paper describe technique , indications , results roux operation used treatment postgastrectomy syndromes roux 40 cm roux limb procedure choice alkaline reflux gastritis , virtually eliminates reflux bile pancreatic juice stomach slow transit roux limb also used good advantage slow gastric emptying patients dumping patients delayed gastric emptying respond combination near total gastric resection , removes gastric remnant speeds emptying , roux , prevents reflux esophagitis provides reservoir upper gut roux operations , however , roux limb may slow emptying much pain , , nausea , food vomiting result , called roux stasis syndrome prevention roux stasis syndrome roux limb treatment syndrome using electrical pacing suppress ectopic pacemakers emerge limb offer possible new solutions problem
functional comparison double triple ileal loop pouches ileal pouch function 35 patients operated upon surgeon compared seventeen patients double loop \( j \) ileal pouch anal anastomosis \( \) 18 triple loop \( \) pouch patients examined mean 27 9 months 5 1 months , respectively , ileostomy closure ten pouch patients evaluated 6 months \( greater 6 months \) , mean 9 1 ileostomy closure differences mean maximum resting pressures maximum squeeze pressures groups incidence daytime nocturnal leakage lower pouch group , 22 29 percent , j group 29 , 53 percent though mean maximum tolerated volume \( \) pouch group greater j group , difference statistically significant difference mean compliance j pouch groups j greater 6 months group statistically significant \( p less 0 01 \) \( p less 0 008 \) patients could spontaneously difference 24 hour frequency defecation greater 6 months j group significant \( p less 0 05 \) , j groups median frequency nocturnal defecation greater 6 months j pouch groups significant \( p less 0 005 \) , j groups triple loop pouches compliant j pouches better functional result shown lower incidence nocturnal leakage , lower frequency defecation day night
ineffective treatment obstructed defecation symptoms obstructed defecation attributed rectal intussusception , thus advocated surgical management study , patients obstructed defecation underwent manometry seventeen patients \( 16 females one male , mean age 51 6 years \) studied eleven underwent anterior posterior fixation rectum six posterior fixation preoperatively five patients demonstrated fifteen significant pelvic descent significant change maximum resting pressure , maximum voluntary contraction , pelvic descent , anorectal angle seen postoperatively initial follow , many patients significant amelioration symptoms however , longer follow \( mean 30 8 months \) two long term improvement remainder poor clinical result spite complete resolution rectal intussusception many reported worsening symptoms reflected increase stool frequency two cases satisfactory result , could empty rectum completely demonstrated intussusception preoperative evacuation poor results , four complete emptying three intussusception conclusion ineffective treatment obstructive defecation patients
anal sphincter function resection stapled ileal pouch anal anastomosis study done determine effect direct ileal pouch anal anastomosis upon pressure sensory components anal canal ileal pouch findings related postoperative continence thirty three patients ileal pouch anal anastomosis \( 25 continent , eight episodic minor incontinence \) studied 3 0 3 25 5 months ileostomy maximum resting pressure anal canal significantly lower patients result \( 35 5 mm hg \) continent patients \( 44 5 mm hg \) \( p less 0 05 \) postoperatively maximum squeeze anal pressure slightly greater continent incontinent patients \( 99 8 mm hg vs 87 7 mm hg \) \( p greater 0 05 \) postoperative \( ileo \) anal inhibitory reflex present 27 percent linear correlation strength rectal \( ileal \) distension depth duration internal sphincter relaxation preoperatively observed disappeared postoperatively every group patients simultaneous measurements pouch anal pressure patients results revealed reduced positive pouch anal pressure gradient compared continent group low pouch anal pressure gradient thought responsible increased incidence soiling patients
studies autoimmunity initiation beta cell destruction vii evidence antigenic changes beta cells leading autoimmune destruction beta cells bb rats diabetic syndrome \( bb \) rats believed result destruction beta cells autoimmune responses however , initial events cause autoimmune destruction beta cells remain largely unknown investigation initiated see whether antigenic changes beta cells neonatal adult bb rats may lead autoimmune destruction beta cells pancreatic grafts neonatal bb rats remained largely intact without transplanted renal subcapsular space acutely diabetic bb rats similarly transplanted islet grafts neonatal bb rats also subject autoimmune destruction contrast , islet grafts obtained adult bb rats , treated silica prevent , rapidly destroyed diabetic recipients results indicate beta cells neonatal bb rats different beta cells adult bb rats , least regarding recognition immunologic considering observations previous information initial role macrophages dendritic cells development bb rats , suggest beta cell specific antigenic changes precede may result autoimmune destruction beta cells bb rats
minor papilla cannulation dorsal pancreas recently , pancreas represented major technical barrier complete evaluation pancreatic ductal anatomy technical refinements made possible achieve minor papilla cannulation dorsal 90 attempts 120 consecutive dorsal , structural pathology demonstrated 36 subjects \( 30 \) chronic pancreatitis 23 , pancreatic stones 10 , \( \) 4 , ductal cut 7 , pancreatic cancer 3 , partial agenesis 1 \( patients one finding \) patients alcohol abuse excluded , ductal pathology present 25 abnormal ventral present 8 cases , demonstrating dorsal appreciable additional diagnostic yield clinical situation indicates need , minor papilla cannulation performed major papilla cannulation fails reveals ventral pancreas
long term follow patients undergone balloon dilation gastric outlet obstruction although balloon dilation gastric outlet obstruction vagotomy plus drainage therapy institutions , long term data demonstrate percentage patients ultimately requires surgical intervention 23 evaluable patients treated hydrostatic balloon dilation institution , 70 asymptomatic mean follow 2 5 years five patients required surgery one acute perforation four symptoms continued obstruction , despite one three additional attempts dilation three seven patients previous gastric resection satisfactory long term result whereas endoscopic therapy initially cost one tenth one fifth surgical intervention , figures factor loss , one hand , potential need chronic h2 blockade , despite instruction contrary , 6 15 \( 40 \) active patients continue acid suppressive therapy conclude balloon dilation remains viable alternative selected patients gastric outlet obstruction
twelve hour overnight oesophageal ph monitoring patients reflux symptoms results continuous 12 hour overnight ph monitoring \( duration ph less 4 \) reviewed 112 patients heartburn regurgitation , , 56 normal subjects patients reflux normal subjects medically controlled patients \( n 51 \) less acid reflux patients subsequently underwent reflux surgery \( n 61 \) , considerable overlap two groups surgery followed reduction acid reflux value similar normal subjects patients surgery deemed failed reflux operation successful , difference could found preoperative reflux values two subgroups monitoring ph value selecting candidates surgery since results good predictor outcome , useful objective evaluation surgical results
effect increasing helicobacter pylori ammonia production urea infusion plasma gastrin concentrations proposed subjects helicobacter pylori infection caused action ammonia produced organism 's urease activity antral g cells investigate hypothesis examined effect plasma gastrin increasing 's ammonia production urea eight h pylori positive duodenal ulcer patients 60 minute control intragastric infusion dextrose solution 2 ml minute , similar infusion containing urea \( 50 mmol l \) continued four hours urea infusion , median gastric juice urea concentration rose 1 1 mmol l \( range 0 3 1 6 \) 15 5 mmol l \( range 7 9 21 3 \) resulted increase ammonium concentration 2 3 mmol l \( range 1 3 5 9 \) 6 1 mmol l \( range 4 2 11 9 \) \( p less 0 01 \) appreciable rise ammonia production result change plasma gastrin concentration experiment repeated one month eradication h pylori , time median basal gastrin 20 ng l \( range 15 25 \) , significantly less value eradication \( 30 ng l range 15 60 \) \( p less 0 05 \) occasion , gastric juice ammonium concentration considerably reduced 0 4 mmol l \( range 0 1 0 9 \) urea infusion raise ammonium concentration change plasma gastrin concentration conclusion , h pylori ammonia production cause early change plasma gastrin
dissociation systemic mucosal humoral immune responses coeliac disease examined humoral immunity coeliac disease expressed serum \( systemic immunity \) , saliva , jejunal aspirate , whole gut lavage fluid \( mucosal immunity \) aims define features secretory immune response \( iga igm concentrations antibody values food proteins measured enzyme linked immunosorbent assay \( elisa \) \) active disease remission , establish whether secretions obtained relatively non invasive techniques \( saliva gut lavage fluid \) used indirect measurements events jejunum serum , saliva , jejunal aspirate 26 adults untreated coeliac disease , 22 treated patients , 28 immunologically normal control subjects studied , together intestinal secretions obtained gut lavage 15 untreated 19 treated patients coeliac disease 25 control subjects jejunal aspirate iga igm gut lavage fluid igm concentrations significantly raised patients untreated coeliac disease lavage fluid igm concentration remained higher patients treated coeliac disease controls serum salivary immunoglobulin concentrations similar three groups patients untreated coeliac disease higher values antibodies compared treated patients control subjects body fluids tested predominantly iga igg classes serum , iga igm classes jejunal aspirate gut lavage fluid values salivary iga antibodies significantly higher untreated , though antibody values generally low , large overlap coeliac disease patients control subjects
impaired sulphation phenol colonic mucosa quiescent active ulcerative colitis substantial amounts phenols produced human colon bacterial fermentation protein colonic mucosa animals , phenols inactivated predominantly sulphate purpose study confirm sulphation phenols isolated colonocytes man evaluate mucosal sulphation inflammatory bowel disease using phenol , paracetamol , rectal dialysis bags incubation paracetamol colonocytes isolated resected colon specimens \( n 7 \) yielded mean \( se \) value 7 0 \( 0 9 \) mumols g dry weight paracetamol sulphate 60 minutes virtually undetectable values paracetamol glucuronide paracetamol sulphate detected rectal control subjects , mean \( se \) value 4 2 \( 0 8 \) nmol hour sulphation significantly impaired \( p less 0 01 \) 19 patients active ulcerative colitis \( 0 6 \( 0 2 \) nmol hour \) 17 patients ulcerative colitis remission \( 1 1 \( 0 4 \) nmol hour \) sulphation eight patients crohn 's colitis \( 4 3 \( 2 1 \) nmol hour \) similar control subjects impairment capacity mucosa sulphate phenols quiescent active ulcerative colitis may pose metabolic burden colonic epithelial cells , continuously exposed endogenous phenols colonic lumen
5 aminosalicylic acid potent inhibitor interleukin 1 beta production organ culture colonic biopsy specimens patients inflammatory bowel disease interleukin 1 beta biopsy specimens inflamed colonic mucosa patients active inflammatory bowel disease studied compared normal colonic mucosal biopsy specimens , significantly greater amount interleukin 1 beta present rectal mucosa \( median \( range \) 4 3 \( 2 0 11 8 \) v 119 2 \( 30 1 8 \) pg mg p less 0 01 \) produced organ culture \( 39 1 \( 9 4 106 8 \) v 97 6 \( 28 2 6 \) pg mg p less 0 01 \) values interleukin 1 beta culture correlated concentrations thromboxane b2 organ culture inflamed biopsy specimens presence 5 aminosalicylic acid dexamethasone reduced amount interleukin 1 beta detected doses studied , 5 aminosalicylic acid also reduced amount leukotriene b4 detected culture
activity crohn 's disease neutrophils ability normal crohn 's disease neutrophils kill candida albicans studied using neutrophils isolated peripheral blood suspended phosphate buffered saline 5 x 10 \( 6 \) cells per ml c albicans grown stationary phase broth culture suspended phosphate buffered saline 10 \( 7 \) organisms ml neutrophils candida incubated together 37 degrees c water bath presence fresh serum 30 60 minutes samples withdrawn , neutrophils lysed , candida survival assessed colony counting results compared control suspensions candida incubated serum alone 30 60 minutes presence autologous serum normal neutrophils killed significantly candida crohn 's disease neutrophils \( mean \( sd \) 61 0 \( 16 7 \) v 40 5 \( 16 2 \) 30 minutes , p less 0 0001 83 2 \( 7 \) v 70 8 \) 16 \) 60 minutes , p less 0 005 \) results alter significantly normal neutrophils incubated candida presence crohn 's disease serum instead normal serum crohn 's disease neutrophils incubated candida presence normal serum instead autologous serum improvement ability 30 minutes \( 48 9 \( 20 6 \) v 40 5 \( 16 2 \) , p less 0 03 \) 60 minutes phagocytosis , measured using assay , normal neutrophils patients crohn 's disease impaired ability kill granuloma organism due serum inhibitors defective phagocytosis
symptoms bowel dysfunction patients irritable bowel syndrome \? prospective , controlled study emphasis stool form since known whether symptoms bowel function patients irritable bowel syndrome truly abnormal used frequent telephone interviews 31 day period assess symptoms , defecation , stool types 26 unselected female hospital patients irritable bowel syndrome , 27 women admitted recurrent colonic pain consulted doctor \( non \) , 27 healthy control subjects unexpectedly , abdominal pain bloating occurred control subjects pain , however , six times frequent patients often considered severe bloating occurred three times often defecation frequent , timing stool form , likely produce stools extreme forms , indicating rapid fluctuations intestinal transit time urgency four times prevalent patients control subjects straining nine times prevalent often accompanied feelings incomplete evacuation combination could lead misdiagnosis constipation normal relation stool form symptoms distorted , possibly due rectal irritability non intermediate patients control subjects almost every parameter control subjects patients patients irritable bowel syndrome real cause complaint bowel function truly abnormal
provision gastrointestinal endoscopy related services district general hospital working party clinical services committee british society gastroenterology \( 1 \) number endoscopic examinations performed rising epidemiological data workload well developed units show annual requirements per head population approaching upper gastrointestinal 1 100 flexible sigmoidoscopy 1 500 colonoscopy 1 500 ercp 1 2000 \( 2 \) open access endoscopy general practitioners desirable increasingly sought district general hospital serving population 250 , 000 , workload procedures annually , performed 10 half day routine sessions plus emergency work \( 3 \) high standards training experience needed staff , must work purpose designed promote efficient safe practice \( 4 \) endoscopy unit adjacent day care facilities near x ray department easy access wards \( 5 \) endoscopy unit needs least two endoscopy fully ventilated cleaning area patient , preparation , recovery administration , storage , staff \( 6 \) service consultant based least 10 clinical sessions required , made six consultant sessions two four clinical , hospital practitioner , staff specialist sessions consultant expected least two sessions weekly endoscopy extra consultant sessions may needed provide efficient service \( 7 \) specially trained nursing sister \( grade g h \) five endoscopy nurses needed care patients work may supplemented care \( 8 \) new post endoscopy department \( analogous operating department \) proposed maintain prepare instruments , give technical assistance procedures \( 9 \) full time employed records , , audit computer based \( 10 \) ercp needs interventional radiologist working high quality x ray equipment specially prepared radiology screening room facility may need serve one hospital \( 11 \) gastrointestinal measurement laboratory combined endoscopy unit hospitals one gastrointestinal measurement may staff laboratory \( 12 \) endoscopy unit service department analogous radiology department needs annual
prevalence gallstone disease old institutionalized persons present results study undertaken large geriatric nursing home assess prevalence gallstone disease old institutionalized persons one hundred seventeen residents underwent ultrasound examination gallbladder two thirds 82 women half 35 men gallstone disease stratified age , 80 women men age 90 years positive disease summary , prevalence gallstone disease old nursing home population found unexpectedly high
self management dietary compliance coeliac disease means elisa home test detect gluten improve compliance gluten free diet coeliac disease simple prototype test kit developed detect gluten foods use home test based monoclonal antibodies heat stable gluten proteins appropriately proteins suitable use wide range raw foods food extracted dilute acid 1 drop extract transferred antibody coated tube enzyme labelled gluten detection antibody added 3 min tube washed colour added reaction stopped 2 min , blue colour home kit compared quantitative laboratory kit , qualitative agreement good kit could distinguish foods trace gluten contents \( acceptable gluten free diet \) slightly higher unacceptable gluten content trial prototype kit 47 coeliac disease patients diverse ages educational backgrounds , 93 tests correctly identified foods acceptable unacceptable
evidence role prostacyclin systemic hormone portal hypertension possibility prostacyclin could systemic hormone could mediate splanchnic hyperemia chronic portal hypertension evaluated rabbits normotensive state rabbits chronic partial ligation portal vein rabbits portal hypertension \( pht \) , 6 keto prostaglandin f1 alpha \( pgf1 alpha , prostacyclin degradation product \) elevated twofold vascular beds \( systemic arterial , systemic venous , portal venous \) compared levels control animals pht rabbits , exogenous prostacyclin infusion cyclooxygenase blockade systemic arterial , systemic venous , portal venous route resulted equal elevation 6 keto pgf1 alpha reciprocal vascular beds restored original blockade hemodynamics hemodynamic changes equal magnitude irrespective site infusion pht controls significant change 6 keto pgf1 alpha hemodynamics infusion conclude prostacyclin achieves systemic levels hepatic degradation resulting portosystemic shunting animal chronic portal hypertension
nonpropulsive esophageal contractions gastroesophageal reflux nonpropulsive esophageal contractions radiologically described tertiary contractions esophagus suggest presence underlying motility disorder may lead impaired acid clearance goals study determine prevalence role gastroesophageal reflux \( ger \) patients tertiary contractions thirty five consecutive patients spontaneous , repetitive , nonpropulsive esophageal contractions noted studied endoscopy , infusion esophageal manometry , 24 h ambulatory ph monitoring patients esophageal symptoms , mainly dysphagia , heartburn , chest pain , three found esophagitis endoscopy biopsy nineteen patients repetitive , , \( tertiary \) contractions , six esophagus , 10 , lumen simultaneous contractions \( bead esophagus \) twenty patients \( 58 \) ger ph criteria mean values time ph less 4 , 40 9 upright ph less 4 , 41 supine ph less 4 , 44 3 number episodes greater 5 min ph less 4 , 12 esophageal motility revealed esophagus eight , low two , nonspecific esophageal motility disorder 10 symptoms severity contractions correlate ger radiologically demonstrable free reflux presence heartburn predict ger conclude 1 \) ger occurs 58 patients nonpropulsive \( tertiary \) esophageal contractions , may play role induction abnormal peristaltic activity esophageal body 2 \) ger usually associated endoscopic evidence esophagitis characteristic symptoms , recognized 24 h ph monitoring speculate detection treatment ger may improve symptomatic management patients nonpropulsive esophageal contractions
symptom sensitivity index valuable additional parameter 24 hour esophageal ph recording twenty four hour esophageal ph monitoring useful quantitative measurement gastroesophageal reflux demonstration temporal relationship symptoms reflux symptom index , numerical score , developed quantify association symptoms reflux symptom index primarily assesses specificity patient 's reflux symptoms , propose refer score symptom specificity index certain limitations score , developed evaluated new score , symptom sensitivity index , subject 's sensitivity reflux fifty two consecutive patients , referred laboratory ambulatory 24 h ph recording studied conventional reflux variables , indexes calculated although statistically significant correlation indexes found , discordance specificity sensitivity indexes seen 17 patients \( 33 \) based findings study advocate symptom sensitivity index used , addition symptom specificity index , incorporated future ph studies interpretation results
radiographic evaluation suspected small bowel obstruction plain abdominal radiographs enteroclysis studies reviewed blindly 117 consecutive patients undergoing enteroclysis suspected small bowel obstruction plain radiographs predictive presence obstruction determined enteroclysis surgery among patients normal abnormal nonspecific plain radiographs , varying degrees small bowel obstruction demonstrated enteroclysis 22 conversely , patients obstruction plain radiographs , 42 either normal enteroclysis studies minor adhesions enteroclysis correctly predicted presence obstruction 100 , absence obstruction 88 , level \( proximal vs distal \) obstruction 89 , etiology obstruction 86 operated patients enteroclysis advocated definitive study patients clinical uncertainty diagnosis small bowel obstruction
extracorporeal piezoelectric lithotripsy complicated bile duct stones today , common bile duct stones extracted endoscopically endoscopic sphincterotomy , nearly 90 stones removed basket mechanical lithotripter problems encountered larger stones duct stenosis new conservative therapies serve alternative surgical intervention patients endoscopic measures failed stone fragmentation achieved extracorporeal shock wave lithotripsy , remaining fragments removed endoscopically far , authors reports successful disintegration common bile duct stones used lithotripter stone localization thus achieved x rays , shock waves generated discharge report experiences results extracorporeal piezoelectric shock wave lithotripsy \( epl \) 19 patients complicated bile duct stones lithotripter , stones visualized ultrasound , shock waves produced piezoelectric acoustic generator fragmentation achieved 84 2 , complete stone removal 78 9 results show piezoelectric lithotripsy also useful method treatment complicated bile duct stones , already proved electrohydraulic electromagnetic generated shock waves systems however , general anesthesia need analgesia sedation 25 treatments render lithotripter system attractive , especially elderly patients
annular pancreas cause extrahepatic biliary obstruction annular pancreas rare congenital abnormality increasingly diagnosed endoscopic retrograde \( ercp \) adult population , present duodenal gastric ulceration , duodenal obstruction , pancreatitis , , rarely , associated congenital abnormalities although suggested biliary obstruction may result associated pancreatitis , cases reported primary extrahepatic biliary obstruction annulus also reported report case , describe resolution symptoms return normal biochemical tests patient literature annular pancreas reviewed suggest entity added differential diagnosis extrahepatic biliary obstruction
endoscopic management retained cystic duct stones finding residual common bile duct stones cholecystectomy relatively frequently encountered problem effective nonoperative therapy exists retained stones cystic duct remnant rare present case multiple retained stones long variant cystic duct remnant following cholecystectomy common duct exploration , successfully managed endoscopic sphincterotomy balloon extraction
estrogen receptors external anal sphincter inasmuch anal competence women reduced age 50 years , may dependent effects estrogens study , samples external anal sphincter analyzed presence estrogen receptors found present median concentration 5 0 fmol per protein \( range , 1 9 13 \) women \( n 7 \) , 1 1 fmol per protein \( range , 0 3 2 \) men \( n 7 \) findings interest regard treatment idiopathic anal incontinence
alanine aminotransferase clinical practice review alanine aminotransferase enzyme produced mainly liver serum activity measured , provides marker hepatic disease review explores biochemistry laboratory analysis alanine aminotransferase terms significance human health disease cut levels define abnormality rather arbitrary decreases specificity test apparently healthy patients small , important , group patients alanine aminotransferase abnormality underlying liver disease may treatable diagnosed based history , physical examination , biochemical serological profiles liver biopsy complement diagnostic process selected circumstances literature pertaining critically reviewed
vagus nerve , gastric secretions , relationship peptic ulcer disease although peptic ulcer disease known , process disease produced remained advances made medicine science , advances made understanding digestion gastrointestinal disease treatment peptic ulcer disease improved understanding digestive process grew current surgical treatment peptic ulcer disease follows r , md , , based observations research laboratory present historical perspective role vagus nerve control gastric secretions relationship peptic ulcer disease , placing particular emphasis 's contributions
water electrolyte balance ileoanal anastomosis water electrolyte balance studied 30 patients ileoanal anastomosis j pouch , 10 patients conventional ileostomy , nine nonoperated patients quiescent ulcerative colitis serum electrolyte concentrations , daily urinary volume , daily losses sodium , potassium , chloride measured patients daily fecal weight daily losses sodium potassium analyzed patients ileoanal anastomosis conventional ileostomy serum chloride patients ileoanal anastomosis significantly lower \( p less 0 05 \) conventional ileostomy nonoperated patients daily urinary loss sodium nonoperated patients significantly higher patients ileoanal anastomosis \( p less 0 01 \) conventional ileostomy \( p less 0 05 \) daily urinary loss chloride patients ileoanal anastomosis significantly lower \( p less 0 05 \) nonoperated patients daily fecal loss potassium patients ileoanal anastomosis significantly higher \( p less 0 05 \) conventional ileostomy daily urinary volume fecal weight differ significantly patients ileoanal anastomosis conventional ileostomy present study indicates changes water sodium balance ileoanal anastomosis similar conventional ileostomy chloride balance altered ileoanal anastomosis
mini perforation colon perforations require laparotomy 10 year experience 4 , consecutive colonoscopic , need operative intervention two seven perforations indicates patients specially defined , limited perforations usually treated nonoperatively specific complication , termed mini perforation , generally detected within 6 24 hours polypectomy , characterized local pain tenderness , without signs diffuse spreading peritoneal irritation free intra abdominal retroperitoneal air x ray documents actual perforation complete resolution symptoms within 24 48 hours confirms diagnosis mini perforation success depends good bowel preparation colonoscopy , early recognition perforation , institution bowel rest intravenous antibiotics mini perforation spontaneously , probably omental adherence frequent serial clinical examinations mandatory frank perforation advancing peritonitis promptly recognized treated surgically understanding three levels cautery injury colon wall serosal burn , mini perforation , frank perforation essential managing complications colonoscopic polypectomy
incarceration inguinal hernia technique removal relative safety , colonoscopy become accepted diagnostic therapeutic procedure evaluation patients colorectal disorders many unusual complications colonoscopy described , anecdotal reports incarceration published present case right sided incarceration would permit reduction hernia removal instrument conventional means mechanism incarceration , size hernia risk incarceration , explained technique , used remove instrument without surgical intervention , described
gender differences manning criteria irritable bowel syndrome objective study determine gender differences exist using manning criteria diagnosis irritable bowel syndrome outpatient setting , 61 women 36 men entry complaints abdominal pain , altered bowel habits , underwent full evaluation board certified eligible also systematically rated presence absence six manning criteria irritable bowel syndrome defined absence organic disease explanation entry complaints determination made two board certified patients study 9 months independent study rated transcripts patients' clinic visits , available clinical data clinics , laboratory data obtained 9 month study period , results 9 month telephone follow patients physicians sixty five percent study population organic disease explanation entry symptoms , thereby representing irritable bowel syndrome study similar proportion type organic disease irritable bowel syndrome experienced men women total sample 97 subjects , correlation manning criteria irritable bowel syndrome 0 22 \( p less 0 01 \) 61 women , correlation manning criteria irritable bowel syndrome significant \( r 0 47 p less 0 01 \) 36 men , however , correlation opposite direction , although significant \( r 0 16 \) concluded significant gender differences exist using manning criteria diagnosis irritable bowel syndrome manning criteria diagnostic value men
impairment esophageal emptying hiatal hernia concurrent manometry used analyze esophageal emptying barium 22 patients axial hiatal hernias 14 volunteers subjects divided three groups \( \) volunteers maximal phrenic ampullary length less 2 cm \( controls \) \( b \) patients volunteers maximal ampullary hiatal hernia length greater equal 2 cm reduced \( reducing hernia group \) \( c \) patients hernias reduce complete esophageal emptying without retrograde flow achieved 86 test controls , 66 reducing hernia group , 32 hernia group \( p less 0 05 \) impaired emptying reducing hernia group attributable late retrograde flow , whereby barium retrograde hernia emptying impaired emptying hernia group attributable early retrograde flow occurred immediately les relaxation hernia group also longer acid clearance times controls \( p less 0 05 \) conclude gastroesophageal junction competence severely impaired patients hiatal hernias , suggesting mechanism whereby subgroup hiatal hernia involved pathogenesis reflux disease
small intestinal transit portal hypertensive rat purpose study determine effects portal hypertension gastrointestinal transit portal hypertension induced group 15 rats staged portal vein ligation technique control group 15 rats underwent sham operation ten days later , 51cr labeled buffer solution instilled duodenum distribution radioactivity along length small intestine determined 15 , 30 , 60 minutes portal hypertension consistently established study group splenic pressure \( mm hg , mean sd , portal hypertensive vs control \) 20 0 3 9 vs 12 7 3 9 , p less 0 002 various measures intestinal transit revealed delayed transit portal hypertensive group retention radioactivity proximal quartile intestine greater percentage retained \( portal hypertensive vs control \) 57 9 17 3 vs 31 2 15 3 , p less 0 02 , 49 1 15 5 vs 28 3 4 8 , p 0 03 , 42 4 17 6 vs 29 0 8 8 , p 0 08 , 15 , 30 , 60 minutes , respectively geometric mean transit located proximally \( p less 0 02 \) study interval portal hypertension group concluded portal hypertension associated delayed intestinal transit abnormality could predispose bacterial overgrowth contribute altered digestion absorption
increased uptake bromodeoxyuridine hepatocytes early stage primary biliary cirrhosis relationship dna synthesis activities hepatocytes biopsied specimens liver volume studied various stages primary biliary cirrhosis using vitro bromodeoxyuridine \( thymidine analogue \) anti bromodeoxyuridine reaction computed tomography mean bromodeoxyuridine \( se \) labeling index 10 patients early histological stage \( stage , 4 , stage ii , 6 , 3 4 0 4 \) primary biliary cirrhosis 17 times 6 control subjects \( 0 2 0 1 , p less 0 001 \) , significantly higher 19 female patients chronic aggressive hepatitis \( 0 9 0 2 , p less 0 001 \) , 14 compensated cirrhotic patients viral origin \( female , 1 1 0 3 , p less 0 01 \) , 5 patients stage iii primary biliary cirrhosis \( 0 5 0 1 , p less 0 001 \) mean \( se \) liver volume early stage primary biliary cirrhosis \( 40 cm3 \) 1 5 times control subjects \( 42 cm3 , p less 0 001 \) results suggest liver volume already become large early stage primary biliary cirrhosis perhaps markedly increased dna synthesis hepatocytes
glucose fat metabolism short term starvation cirrhosis evaluate metabolic consequences short term \( e , less 24 hours \) starvation , glucose fat metabolism studied eight healthy subjects eight patients stable cirrhosis 16 hour 22 hour starvation 3 3h glucose 14c palmitate turnover indirect calorimetry although patients controls showed significant increases free fatty acid concentration \( respectively , 48 12 53 17 \) turnover \( 55 14 71 21 \) short term starvation , values 16 22 hour starvation higher cirrhosis fat oxidation enhanced patients , increase fasting contrast controls \( increase 19 17 , p less 0 05 \) net glucose oxidation decreased postabsorptive cirrhotics \( p less 0 05 \) although postabsorptive glucose turnover different controls , starvation induced greater decrease glucose turnover patients \( 25 3 vs 10 3 , p less 0 05 \) reflected plasma glucose concentrations conclusion , effects starvation glucose fat metabolism enhanced cirrhosis fasting hypoglycemia prevented decreased use glucose remains established whether changes merely explained defective liver function , per se
ascites increases resting energy expenditure liver cirrhosis purpose study investigate effect ascites energy metabolism patients liver cirrhosis resting energy expenditure determined 10 patients liver cirrhosis ascites moderate large volume resting energy expenditure measurement performed using indirect calorimetry resting energy expenditure predictive value calculated equation , removal ascitic fluid metabolic stress factors absent cases interval 11 2 7 7 days measurements , weight loss 16 6 10 3 kg observed resting energy expenditure measured indirect calorimetry showed statistically significant decrease 240 kcal day \( p less 0 005 \) removal ascites indirect calorimetry method allowed analysis results 4 10 patients ascites removal produced consistent decrease resting energy expenditure statistically significant differences measurements obtained indirect calorimetry provided equation , latter moderate reliability predicting real resting energy expenditure every patient results suggest , far inert volume , ascites may associated , least patients , increased resting energy expenditure therefore accelerate appearance protein energy malnutrition corresponding complications
incidence gallstones danish population five year incidence gallstone disease assessed ultrasonography age sex stratified random population danish origin aged 30 , 40 , 50 , 60 years response rate 82 8 \( \) differ respondents regarding variables concerning gallstone disease 5 year incidence gallstone disease men aged 30 , 40 , 50 , 60 years 0 3 , 2 9 , 2 5 , 3 3 corresponding figures women 1 4 , 3 6 , 3 1 , 3 7 incidence gallstones significantly higher subjects aged 45 years compared aged 35 years sex difference gallstone incidence decreased increasing age significantly higher incidence gallstone disease found among subjects former polyps gallbladder spontaneous disappearance gallstones seen 4 5
prostaglandin e2 induced diarrhea mice importance colonic secretion present study investigated basis induction diarrhea prostaglandin \( pg \) e2 mice given p , pge2 induced dose time dependent diarrhea shortest post treatment time diarrhea onset approximately 7 min , pge2 dose 200 micrograms kg dose , pge2 also produced accumulation fluid small intestine colon \( \) reached maximum 9 min decrease approximately 11 min \( e , 2 4 min mean time diarrhea onset \) pge2 treatment altered neither gastric emptying gastrointestinal , strongly enhanced expulsion glass bead colon \( e , decreased time bead expulsion \) shortest time expulsion glass bead observed 200 micrograms kg p induction diarrhea pge2 unaffected , sham , dose response curve time onset diarrhea p pge2 displaced right animals ileo colonic \( \) junctions intraluminal fluid accumulation colon , evaluated mice , increased pge2 administration within 2 min remained greater vehicle treated animals onset diarrhea stimulation colonic bead expulsion produced p pge2 control mice observed animals acute , even p doses 800 micrograms kg
enteroclysis small bowel series comparison radiation dose examination time respective radiation doses total examination fluoroscopy times compared 50 patients 25 underwent enteroclysis 25 underwent small bowel series \( n 17 \) without \( n 8 \) examination upper gastrointestinal \( gi \) tract enteroclysis , mean skin entry radiation dose \( 12 3 rad 123 \) mean fluoroscopy time \( 18 4 minutes \) almost 1 1 2 times greater small bowel series examination upper gi tract \( 8 4 rad 84 11 4 minutes \) almost three times greater small bowel series without upper gi examination \( 4 6 rad 46 6 3 minutes \) however , mean total examination completion time enteroclysis \( 31 2 minutes \) almost half small bowel series without upper gi examination \( 57 5 minutes \) almost four times shorter small bowel series upper gi examination \( 114 minutes \) higher radiation dose enteroclysis considered along short examination time , age clinical condition patient , reported higher accuracy deciding appropriate radiographic examination small bowel
peptic ulcer disease ct evaluation authors retrospectively describe computed tomographic \( ct \) findings 35 patients peptic ulcer disease three eight patients gastritis duodenitis bowel wall thickening ten remaining 27 patients ct evidence ulcer perforation \( n 2 \) penetration \( n 8 \) , four cases unsuspected clinically patients acute free perforation , one showed free extravasation orally administered contrast material precise site perforation could established either case ct eight patients ulcer penetration ct evidence bowel wall thickening \( n 3 \) inflammatory changes adjacent soft tissues organs \( n 8 \) , including pancreas \( n 4 \) , liver \( n 1 \) , lesser omentum \( n 1 \) ulcer seen two ct findings penetration mimic disease processes ct useful detecting uncomplicated peptic ulcer disease
diagnostic fine needle puncture gallbladder us guidance february 1988 january 1990 , 118 fine needle diagnostic gallbladder \( \) performed continuous ultrasound \( us \) guidance symptomatic patients gallstones first attempt gallbladder puncture aspiration successful every patient use 22 gauge needle continuous us visualization needle tip aspirated volume varied 3 88 ml \( average standard deviation , 25 0 ml 15 3 \) biliary analysis revealed elevation cholesterol saturation index patients cholesterol gallstones \( attenuation computed tomographic examination 50 hu less \) relative patients pigment stones \( attenuation 50 hu \) \( 1 3 0 2 vs 1 0 0 1 , p less 05 \) nucleation time prolonged patients pigment stones \( 19 3 days 3 5 vs 1 8 days 0 8 patients cholesterol stones , p less 001 \) patients remained hospitalized 24 hours reexamined outpatient basis 1 3 months thereafter complications detected either short term observation long term follow authors conclude safe valuable technique diagnostic work gallstone patients establish suitability nonoperative treatment
receptor function benign liver disease evaluation mr imaging coated iron oxide \( ag uspio \) preparation specific \( asg \) receptors hepatocytes used magnetic resonance \( mr \) imaging contrast agent evaluation spectrum benign liver diseases animal models activity hepatocyte asg receptors , directly reflects liver function , directly assessed measuring liver relaxation times vitro mr signal intensity vivo following measurements allowed three dimensional assessment liver function \( \) liver relaxation time , \( b \) native mr signal intensities liver , \( c \) response liver ag uspio probe \( percentage decrease liver signal intensity intravenous administration 10 mumol kg ag uspio normal liver 55 , fatty liver 57 , acute hepatitis 36 , chronic hepatitis 29 , cirrhosis 46 \) , \( \) redistribution hepatocyte specific ag uspio spleen \( present hepatitis cirrhosis normal liver fatty liver \) results study indicate cellular hepatic abnormalities detected quantitated mr receptor imaging
percutaneous rotational contact biliary lithotripsy initial clinical results kensey percutaneous rotary new concept fragmentation percutaneous removal gallstones fluid generated , pulling calculi high speed blade fragments stones predominantly 500 microns results treating first 10 patients instrument reveal large stone well small stones \( 2 3 mm \) composition removed gallbladder sufficient size six basket rotation times 7 39 minutes required nine 10 procedures completed access lost one case one major complication occurred repeat oral cholecystography , gallbladder visualized 3 6 weeks eight nine patients ursodeoxycholic acid administered 3 12 months five patients either residual stones aggregates hospital stay ranged 48 72 hours patients \( except patient underwent surgery \) resumed light activity 3 4 days strenuous activity full diet within 3 weeks
sulphasalazine prednisone compared sulphasalazine treating active crohn disease double blind , randomized , multicenter trial objective determine whether sulphasalazine plus prednisone effective sulphasalazine alone treating active crohn disease design randomized , double blind , placebo controlled trial setting multicenter trial one university hospital nine general hospitals patients patients active crohn disease van activity index 140 71 patients randomly assigned , 60 completed treatment analyzed interventions 16 weeks , 30 patients received sulphasalazine , 6 g \( 4 g adverse effects occurred \) prednisone , 30 mg initially prednisone therapy tapered increments 5 mg 2 wk 10 mg 8 weeks thirty patients received sulphasalazine placebo measurements main results first 6 weeks treatment , van activity index decreased median 70 \( interquartile range , 57 81 \) initial value patients treated sulphasalazine prednisone median 87 \( interquartile range , 70 94 \) patients treated sulphasalazine alone \( p 0 001 \) last 4 weeks treatment , corresponding figures 63 \( interquartile range , 40 75 \) 70 \( interquartile range , 54 90 \) \( p 0 10 \) crohn 's disease activity index decreased first 6 weeks median 65 \( interquartile range , 57 86 \) patients receiving sulphasalazine prednisone median 75 \( interquartile range , 58 101 \) patients receiving sulphasalazine alone \( p 0 13 \) last 4 weeks treatment , corresponding figures 65 \( interquartile range , 42 90 \) 76 \( interquartile range , 49 110 \) \( p 0 19 \) conclusions use prednisone addition sulphasalazine patients active crohn disease results significantly faster initial improvement , significantly better result 16 weeks treatment , disease activity measured van activity index
management extensive tracheoesophageal fistula cervical esophageal exclusion giant tracheoesophageal fistulae occurring ventilator dependent patients usually result significant ventilatory embarrassment cervical exclusion fistula safely control fistula quickly restore adequate ventilation critically ill patients
medical treatment esophageal achalasia double blind crossover study oral nifedipine , verapamil , placebo calcium channel blockers previously shown decrease lower esophageal sphincter \( les \) pressure improve symptoms achalasia performed placebo controlled , double blind , crossover study assess effects oral nifedipine verapamil les pressure , amplitude esophageal body contraction , clinical symptomatology eight patients symptomatic achalasia diagnosed endoscopy , barium , manometry patients randomized receive 20 mg nifedipine , 160 mg verapamil , placebo underwent esophageal manometry \( baseline \) four weeks drug diary cards kept record grade symptoms drug plasma level determinations correlated manometric clinical findings nifedipine verapamil caused statistically significant decrease mean les pressure , nifedipine caused significant decrease amplitude contractions smooth muscle portion esophagus statistically significant differences overall clinical symptomatology noted drugs , although individual improvements dysphagia chest pain noted conclude , despite reduction les pressure contraction amplitude distal esophageal body , oral nifedipine verapamil significantly alter clinical symptomatology patients achalasia
management dysphagia suspected esophageal motor disorders fifty three patients suffering dysphagia suspected esophageal motor disorders treated pneumatic dilatation using technique fifteen achalasia demonstrated manometric studies forty nine remarkable clinical improvement procedure mean period follow \( average 5 years , range 1 11 \) , 75 patients needed new dilatation , delay two years results dilatation excellent good 80 cases early complications consisted two esophageal perforations surgically treated mortality observe late complications procedure conclude pneumatic dilatation initial procedure treatment dysphagia suspected esophageal motor disorders
reevaluation manometric criteria vigorous achalasia distinct clinical disorder \? clinical manometric data 97 consecutive patients idiopathic achalasia analyzed see distinct subset vigorous achalasia could identified statistical analyses failed detect unique group subjects based distribution contraction wave amplitudes alone , patients falling 95th percentile \( n 4 , mean wave amplitude greater 100 mm hg \) compared mean amplitudes conventional threshold diagnosis vigorous achalasia \( mean amplitude 60 100 mm hg , n 4 \) , remainder \( n 89 , mean amplitude less 60 mm hg \) subjects mean amplitudes less 60 mm hg mean amplitudes 60 100 mm hg closely resembled measured clinical features , whereas subjects mean amplitudes greater 100 mm hg male , older \( 67 4 years vs 47 2 years p less 0 01 \) , appeared somewhat longer duration symptoms compared remainder \( 82 41 vs 44 10 months p 0 4 \) chest pain esophageal symptoms , basal residual lower sphincter pressures , response first treatment differ among three groups data indicate high fidelity manometry techniques identify rare subset achalasia patients mean contraction amplitudes exceeding 100 mm hg , although older possibly greater duration symptoms , presents similarly others idiopathic achalasia outcome conventional treatment also similar vigorous patients , making distinction questionable value
ulcerative colitis disease activity subjectively assessed patient completed questionnaires following orthotopic liver transplantation sclerosing cholangitis assess whether liver transplantation subsequent immunosuppression cyclosporine prednisone affect ulcerative colitis symptomatology , surveyed questionnaire 23 surviving patients pretransplant colonoscopy documented ulcerative colitis transplanted primary sclerosing cholangitis june 1982 september 1985 follow 89 8 7 6 weeks \( mean sem , six patients asymptomatic colonoscopy documented ulcerative colitis reported continued ulcerative colitis among 17 patients symptomatic colonoscopy documented ulcerative colitis time liver transplantation , 88 2 reported improvement overall ulcerative colitis severity \( p less 0 001 \) , significant improvement frequency bowel movements reported 100 , abdominal pain 87 5 , bowel urgency 75 , occurrence mucus stool 87 5 , incidence ulcerative colitis 81 8 , number days unable function normally due ulcerative colitis symptoms 78 6 \( least p less 0 01 \) data demonstrate ulcerative colitis symptom severity significantly improves following liver transplantation immunosuppression cyclosporine prednisone
carbon induced alterations hepatic calmodulin free calcium levels rats pretreated chlordecone calmodulin , low molecular weight ca2 binding protein , regulates large number cell activities including cell division previous studies laboratory indicated excessive accumulation ca2 hepatocytes rapid glycogen breakdown suppressed cell division rats receiving ccl4 previous dietary exposure 10 ppm chlordecone since calmodulin plays major role ca2 \( \) regulated events reported localized mitotic apparatus cell division , assessed subcellular distribution calmodulin estimated cytosolic indicate cytosolic free ca2 levels livers rats fed 0 ppm 10 ppm \( chlordecone \) diet 15 days ccl4 \( 100 microliters kg \) administration understand role ca2 \( \) calmodulin chlordecone ccl4 toxicity hepatotoxicity assessed determining serum alt histopathological observations liver sections serum significantly elevated 6 hr ccl4 administration normal rats returned control level 24 hr however , serum alt elevations higher , progressive increase observed starting 4 hr ccl4 administration chlordecone rats histopathological observations liver sections necrotic , swollen lipid cells provided findings serum enzyme data data indicate normal rats recover ccl4 hepatotoxicity however , ccl4 hepatotoxicity progressive chlordecone rats without recovery normal rats , ccl4 administration resulted slight increase starting 6 hr
collagenous colitis cause chronic diarrhea usual workup chronic diarrhea fails provide diagnosis endoscopic findings normal , alternative etiologies must considered case collagenous colitis represents alternative diagnosis patient 65 year old woman complained abdominal diarrhea 8 month span key element diagnosis subepithelial collagen deposits mucosa colon symptoms resolved supportive care , diet , essential features treatment collagenous colitis reviewed
simple score identification patients high risk organic diseases colon family doctor room local ibs study group order develop scoring system selecting patients high risk organic diseases colon , would need colonoscopy barium enema , conducted study 14 gps local health care district one year , 254 consecutive patients consulted gp chronic abdominal pain asked answer guided questionnaire checklist simple parameters suggestive presence organic diseases colon also registered gp final diagnosis , patients underwent either colonoscopy barium enema data collected analysed means stepwise logistic regression analysis obtain weighted score diagnosis either irritable bowel syndrome \( score less 0 \) organic disease \( score greater 0 \) 25 parameters explored , six significantly common among patients organic disease weighted positive score \( namely esr greater 17 mm , first hour , history blood stool , leukocytosis greater 10 , 000 cm3 , age greater 45 years , slight fever presence neoplastic colonic diseases first degree relatives \) contrary , five parameters frequent among patients irritable bowel syndrome weighted negative score \( namely visible distension abdomen , feeling distension , presence irritable bowel syndrome first degree relatives , bowel movement \) scoring system correctly classified 83 5 cases , sensitive \( 82 4 \) diagnosis organic disease
breakdown gastric mucus presence helicobacter pylori potential helicobacter pylori degrade gastric mucus examined colonies h pylori cultured antral mucosal biopsy specimens patients non autoimmune gastritis washed sterile saline , passed filter , examined urease , protease , activity failed bovine serum albumin , degrade stable mucus glycoprotein structures high particle weight separated human gastric mucus sepharose 2b high particle weight mucus glycoprotein , however , extensively degraded incubated h pylori \( possessed urease activity \) presence 2 urea , release fragments mr approximately 2 x 10 \( 6 \) high particle weight mucus glycoprotein also broken comparable extent incubated urease presence 2 urea , 1 ammonium carbonate , 40 mm carbonate bicarbonate buffer \( ph 8 7 \) , treated 4 urea alone , urease alone results indicate loss high particle weight mucus glycoprotein gastric mucus patients gastritis gastric ulcers unlikely due action extra cellular protease produced h pylori , may result effects carbonate bicarbonate buffer , generated mucosal surface h pylori urease plasma urea
valproate metabolism hepatotoxicity associated drug plasma concentrations valproate certain metabolites patterns excretion urine described three adults developed hepatotoxicity treatment epilepsy sodium valproate one patient also developed degree reversible renal insufficiency , whilst another may associated infectious three cases showed evidence impaired mitochondrial beta oxidation valproate one impairment stage fatty acyl coa dehydrogenase , another stage 3 coa dehydrogenase third stage coa possibly also next stage 3 coa dehydrogenase impaired beta oxidation meant valproate metabolism diverted various alternative pathways plasma concentrations suspected metabolite 4 en valproate normal valproate treated population cases analogy certain spontaneous acquired human disorders branched chain amino acid metabolism , suggested valproate associated hepatotoxicity may represent consequences valproate overload limited mitochondrial beta oxidation capacity , causing accumulation toxic product endogenous branched chain amino acid metabolism
colon interposition esophageal disease histologic finding colonic mucosa follow 5 months 15 years thirty six patients , subjected colon interposition benign esophageal disease carcinoma esophagus gastric cardia , studied endoscopy signs mucosal disease colon five months 15 yr \( mean 57 months \) operation , endoscopic finding colon macroscopically normal 28 patients signs inflammation , including hyperemia hyperemia , observed seven patients histologic specimens obtained endoscopy examined microscopically , findings compared seen preoperative graft two patients , chronic inflammatory changes observed graft mucosa , consisting mononuclear cell infiltration lamina propria accompanied crypt dilatation deformation one patients , inflammation proximal third graft , also seen endoscopy remaining 34 patients , graft mucosa microscopically comparable normal alterations unexpectedly mild considering marked change location function colonic segment
gluten challenge patients celiac disease evaluation alpha 1 antitrypsin clearance aim study monitor changes intestinal structure alpha 1 antitrypsin clearance \( alpha 1 atcl \) order offer alternative gluten challenge biopsy addition , evaluated possibility reducing time gluten challenge twelve patients presumptive diagnosis celiac disease based clinical histological grounds studied jejunal histology normal gluten free diet alpha 1 atcl normal gluten introduced returning normal diet challenge lasted 4 wk measured alpha 1 atcl end 1st 4th wk , new jejunal biopsy obtained end 4th wk wk 1 , alpha 1 atcl abnormal 11 patients normal one wk 4 , alpha 1 atcl abnormal 10 patients still normal one post challenge biopsies showed atrophy 11 normal patient normal alpha 1 atcl wk 1 4 one patient abnormal alpha 1 atcl stop challenge first week patient normal clearance wk 1 4 normal biopsy wk 4 abnormal results 6 months data support hypothesis alpha 1 atcl used evidence gluten toxicity gluten challenge , test abnormal early 1 wk gluten
gastric adaptive relaxation symptoms vagotomy gastric adaptive relaxation reported impaired vagotomy abnormality implicated pathogenesis symptoms , association previously demonstrated two gastric adaptive relaxation measured 15 healthy volunteers 33 patients 1 year highly selective vagotomy vagotomy drainage seventeen patients asymptomatic remainder symptomatic including seven patients persistent diarrhoea fasted subjects intubated 's tube containing pressure within \( 800 ml \) plastic bag gastric corpus fundus pressure recorded distension bag air \( 15 ml \) 30 pressure indices derived areas pressure curves median \( range \) pressure indices healthy volunteers 12 7 \( 7 5 17 1 \) cmh2o , highly selective vagotomy 14 0 \( 9 8 15 9 \) cmh2o \( n \) , vagotomy drainage 14 5 \( 8 6 26 8 \) cmh2o \( p 0 04 \) patients diarrhoea abnormally high pressure indices \( p less 0 001 \) pressure indices patient groups within normal range conclude gastric adaptive relaxation remains abnormal patients diarrhoea asymptomatic symptoms
advantages narrow range , medium molecular weight hydroxyethyl starch volume maintenance porcine model fecal peritonitis objective compare effectiveness two hydroxyethyl starch solutions different molecular weight ranges volume maintenance porcine model fecal peritonitis design randomized prospective trial setting laboratory investigation subjects adolescent female pigs weighing approximately 30 kg interventions compared 6 pentastarch 6 high molecular weight hetastarch volume maintenance porcine model fecal peritonitis number average molecular weight pentastarch higher hetastarch , although weight average molecular weight lower , e , narrow range medium weight molecules infusion rate agent adjusted maintain baseline arterial hct less equal 7 hr instrumentation induction fecal peritonitis main outcome measurements volume fluid required maintain arterial hct compared along comparisons hemodynamic histologic responses associated two agents results significantly less pentastarch required prevent hetastarch \( 109 22 8 vs 150 10 3 ml kg p less 05 \) hemodynamics , colloid osmotic pressure , oxygen transport responses similar capillary patency greater \( 21 99 3 68 vs 10 09 1 17 p less 05 \) mean alveolar capillary barrier thickness less \( 2 36 0 13 vs 3 06 0 17 microns p less 05 \) pentastarch hetastarch , judged electron microscopy conclusions data suggest pentastarch better retained circulation capillary leak syndromes compared hetastarch
incontinence rectal prolapse prospective manometric study prospective , manometric study performed 23 female patients rectal prolapse varying degrees incontinence seven 14 incontinent patients regained continence surgery , two patients improved improvement internal external sphincter function follows correction rectal prolapse preoperative resting anal pressure significantly higher continent patients incontinent patients \( p less 0 05 \) , maximum voluntary contraction pressure \( p less 0 027 \) postoperatively significant increase resting anal pressure \( p less 0 0001 \) maximum voluntary contraction pressure \( p less 0 003 \) whole group preoperative resting anorectal angle significantly acute \( p less 0 028 \) continent patients incontinent patients significant change resting anorectal angle following prolapse repair patients remained incontinent significantly lower preoperative resting anal pressure \( p less 0 01 \) patients improved regained continence similarly , maximum voluntary contraction pressure lower preoperatively patients \( p less 0 02 \) preoperative resting anal pressure 10 mm hg maximum voluntary contraction pressure 50 mm hg associated persisting incontinence surgery
vascular responsiveness obstructed gut system failure due hypotension sepsis important cause death patients bowel obstruction investigated pathophysiology entity animal model 5 days bowel obstruction , blood flow superior mesenteric artery measured without norepinephrine given separate experiments controls , moderate dosages caused substantial fall gut blood flow , seen obstructed animals \( blood flow reduction 52 percent vs 11 percent sham obstructed animals respectively , p less 0 01 \) similarly , norepinephrine infusion less effect gut blood flow obstructed animals \( blood flow reduction 79 percent vs 58 percent sham vs obstructed animals \( p less 0 05 \) thus , agents dose related effects gut blood flow , maintained higher level throughout drug infusion periods bowel obstructed animals , demonstrating splanchnic flow less responsive vasoactive drug infusion experimental conditions splanchnic vasoconstriction important feature normal hemodynamic homeostasis , suggest results may help explain aspects pathophysiology failure caused worsened systemic hypotension seen bowel obstruction
development application vitro model screening anti hepatitis b virus therapeutics development effective anti hepatitis b virus agents hampered lack reliable vitro systems screening new therapeutics effort problem , developed vitro system screening anti hepatitis b virus drugs using hepatitis b virus dna transfected hep g2 cells cell line designated 2 2 15 produces replicative viral dna intermediates , mature particles high levels viral antigens 2 2 15 cells treated variety commonly used anti hepatitis b virus therapeutics , efficacy determined analyzing changes replicative cellular extracellular hepatitis b virus dna content southern blotting slot blot hybridization slot blot method sensitive , reproducible rapid correlated well southern blotting analysis media hepatitis b virus dna indicative changes intracellular , replicative hepatitis b virus dna , permitting sampling media therefore 2 2 15 cells may provide valuable method identifying monitoring effective anti hepatitis b virus therapeutics using system test various agents , confirm 2' strongly inhibited viral replication , whereas others tested less effective correlation vivo systems needed
hepatic amino nitrogen clearance urea nitrogen control subjects patients cirrhosis simplified method functional hepatic nitrogen clearance amino acid infusion measure liver cell mass clinical feasibility test far limited methodological problems simplified procedure used measure urea nitrogen synthesis rate functional hepatic nitrogen clearance nine subjects normal liver function nine patients cirrhosis method based four consecutive 2 hr urine collections five blood samples total body water calculated nomogram based age anthropometric data , whereas gut urea hydrolysis assigned one fixed fraction synthesis \( 0 17 control subjects 0 26 patients cirrhosis \) finally , solution single amino acid , alanine , infused substrate urea synthesis urea nitrogen synthesis rate increased linearly increasing alpha amino nitrogen concentration , slope regression \( functional hepatic nitrogen clearance \) reduced cirrhosis 37 5 7 0 l hr 18 4 6 7 l hr p less 0 005 hepatic nitrogen clearance linearly related clinical status \( child pugh score \) , routine liver function tests elimination capacity \( r 0 \) , well established , quantitative , liver function measure simplified method makes measurement hepatic nitrogen clearance suitable routine clinical use test might prove useful study alterations nitrogen metabolism cirrhosis , special reference hepatic encephalopathy
autoantibodies primary biliary cirrhosis analysis reactivity eukaryotic 2 oxo acid dehydrogenase complexes six components mammalian 2 oxo acid dehydrogenase complexes previously identified m2 autoantigens primary biliary cirrhosis report , present data showing polypeptide specific cross reacting antibodies present patients' sera antibodies reacting e2 pyruvate dehydrogenase complex cross react protein x mammalian antigen main immunogenic region protein x localized within single domain polypeptide specific antibodies bind e1 alpha e1 beta pyruvate dehydrogenase complex antibodies reacting e2 polypeptides 2 dehydrogenase complex branched chain 2 oxo acid dehydrogenase complex show cross reactivity recognize antigens pyruvate dehydrogenase complex antibodies e2 component mammalian pyruvate dehydrogenase complex cross react effectively corresponding protein yeast e2 escherichia coli antibody titer mammalian antigens significantly higher bacterial antigens , bacterial origin primary biliary cirrhosis
quantitation intrinsic drug capacity human liver biopsy specimens support intact hepatocyte theory hepatic drug metabolism decreased patients severe liver disease , unclear extent due altered hepatic blood flow reduced intrinsic metabolic capacity study quantitated needle biopsy specimens intrinsic capacity liver tissue 67 patients mild liver disease \( n 36 \) , chronic active hepatitis \( n 16 \) cirrhosis \( n 15 \) two model compounds vitro hydroxylation low extraction drug resulted formation 251 25 nmol gm wet wt hr mildly diseased liver tissue significantly \( p less 0 01 \) reduced liver tissue exhibiting chronic active hepatitis \( 166 23 nmol gm wet wt hr \) cirrhosis \( 124 21 nmol gm wet wt hr \) formation rates , main metabolite high extraction drug lidocaine , varied widely significantly different among three groups relate drug capacity hepatocyte content liver tissue , study performed biopsy pieces originally submitted metabolic activity biopsy piece related fractional volume hepatocytes calculated contain mildly diseased liver tissue 355 35 nmol ml hepatocytes x hr 12 4 1 0 mumol ml hepatocytes x hr cirrhotic liver tissue 306 49 nmol ml hepatocytes x hr 15 3 3 0 mumol ml hepatocytes x hr formed , respectively , differences significant
micronodular cirrhosis , hepatocytes retain normal c 25 hydroxylation capacity toward vitamin d3 study using rat carbon induced cirrhotic model test competence cirrhotic liver vitamin d3 c 25 , hepatocytes isolated controls ccl4 induced cirrhotic rat livers , well partially rats transformation d3 25 hydroxyvitamin d3 studied presence 10 \( 7 \) hepatocytes d3 concentrations 20 nmol l 15 4 mumol l histologically , micronodular cirrhosis present ccl4 treated rats , whereas controls normal livers portal venous pressure \( p less 0 008 \) intrahepatic collagen content \( p less 0 0001 \) significantly increased ccl4 treated rats , whereas difference found two groups total ionized serum calcium , d3 metabolites , alt , alkaline phosphatase cytochrome p 450 0 27 0 02 0 25 0 02 nmol 10 \( 6 \) hepatocytes controls cirrhotic rats \( n \) , significantly increased groups phenobarbital 3 administration \( p less 0 0001 \) 25 hydroxyvitamin d3 formation best described power law equations varied 0 02 0 0004 29 57 2 8 controls , 0 024 0 0004 32 0 7 0 pmol hr 1 10 \( 6 \) hepatocytes 1 cirrhotic rats statistically significant difference found slopes 25 hydroxyvitamin d3 formation , axis intercept found lower cirrhotic rats basal resting conditions \( p less 0 005 \) mixed function significantly increased 25 hydroxyvitamin d3 formation controls well cirrhotic rats \( p less 0 005 \) moreover , groups found respond similarly addition enzyme calcium ionophore a23187 parathyroid hormone partial hepatectomy also without effect activation d3 furthermore , cell sequestration d3 also found hepatocytes obtained either cirrhotic partially livers data indicate well compensated micronodular cirrhosis , c 25 hydroxylation d3 generally normal cellular level also remains fully responsive vivo vitro activity
rapid induction hepatic fibrosis parenteral administration iron dextran complex parenteral administration iron dextran complex gerbils caused hepatic fibrosis 6 wk type iii collagen synthesis liver developed stellate cells often referred myofibroblasts immunohistologically cells shown large intracellular deposits ferritin hepatic fibrosis appeared associated aggregates cells rather aggregates kupffer cells , also occur liver appreciable necrosis hepatocytes trigger fibrotic response found , fibrosis appeared related accumulation ferritin stellate cells contrast , rats mice accumulate ferritin cells develop hepatic fibrosis response parenterally administered iron , although accumulated similar greater amounts total iron livers rapid induction hepatic fibrosis gerbils response parenterally administered iron provide model investigate mechanism induction collagen deposition response iron overload means quickly evaluating therapeutic treatments iron overload induced fibrosis vivo using iron drugs
regulation collagen production freshly isolated cell populations normal cirrhotic rat liver effect lactate previous work shown lactic acid , lesser extent acid , able increase collagen synthesis significantly liver slices ccl4 treated rats normal rats purpose report document cells cirrhotic liver responsible lactate stimulated increase collagen synthesis found \( \) incorporation 3h proline protein bound 3h hydroxyproline increased threefold fourfold hepatocytes ccl4 treated rats compared normal rat hepatocytes \( b \) neither hepatocytes normal ccl4 treated rats modify collagen synthesizing capacity 30 mmol l lactic acid added incubation medium \( c \) nonparenchymal cells obtained livers ccl4 treated rats synthesize much less collagen hepatocytes , synthesis stimulated twofold lactic acid \( \) different nonparenchymal cells , fat storing \( \) cells increase collagen synthesis lactic acid present incubation medium results suggest increased lactic acid levels observed patients alcoholic hepatic cirrhosis may play important role development fibrosis stimulating collagen production fat storing \( \) cells
apical secretion lysosomal enzymes rabbit pancreas occurs via secretagogue regulated pathway increased pancreatic duct obstruction lysosomal cathepsin b secreted rabbit pancreatic acinar cells via regulated opposed constitutive pathway intravenous infusion cholecystokinin analogue caerulein results highly correlated apical secretion digestive lysosomal enzymes , suggesting discharged compartment \( granules \) lysosomal enzymes appear enter compartment result 7 h duct obstruction relieved , caerulein stimulated apical secretion cathepsin b amylase increased , ratio cathepsin b amylase secretion different following caerulein stimulation animals never obstructed findings indicate duct obstruction causes increased amount lysosomal digestive enzymes accumulate within secretagogue compartment duct obstruction increase degree lysosomal enzyme compartment pancreatic duct obstruction causes lysosomal become digestive enzymes organelles , size distribution , resemble granules subject secretion response secretagogue stimulation organelles may importance development pancreatitis
laparoscopic cholecystectomy laparoscopic cholecystectomy new endoscopic technique throughout surgical community great rapidity although considered procedure appropriate respect safety effectiveness , recognition made comparative trials technique vs open cholecystectomy virtually literature complication rates society american gastrointestinal endoscopic surgeons developed minimal criteria determining competence laparoscopic surgery includes completion approved residency training general surgery , training laparoscopic technique either surgeon experienced procedure completion approved course technique requiring hands laboratory practice , observation actual surgical procedure many \( 35 40 87 5 \) importance requiring procedure performed first animals subsequent laparoscopic procedures patients done supervision expert laparoscopic cholecystectomy
abnormal liver enzyme levels evaluation asymptomatic patients chronic elevation serum aminotransferase levels , even absence symptoms , often reflects chronic hepatitis significant underlying liver disease patients persistently abnormal alkaline phosphatase levels may extrahepatic biliary tract disease chronic cholestatic disorder physicians discover unsuspected liver disease without risk , expense , patient means following carefully taken history thorough physical examination , appropriate timing follow blood tests , timely referral percutaneous liver biopsy endoscopic retrograde
pancreatic drain , acute pain upper abdomen patient recovering pancreatitis abdominal trauma may pancreatic although small cysts resolve spontaneously , larger 6 cm across usually require treatment prevent complications rupture adjacent structures infection authors describe operative nonoperative treatment methods success reported
peptic ulcer disease treat options treatment peptic ulcer disease becoming diverse new agents effective yet offer real advantage traditional therapy however , omeprazole \( \) may benefit owing potent inhibition acid secretion , yet approved purpose whether treatment helicobacter pylori infection prove beneficial yet known , answer finally , disease process , alleviation risk factors always important appropriate counseling regarding use nonsteroidal anti inflammatory drugs cigarette smoking necessity
laparoscopic cholecystectomy 500 , 000 cholecystectomies performed per year , great interest developed laparoscopic cholecystectomy procedure offers patient reduced hospital stay , faster return work , less pain , improved cosmetic results september 1988 , developed technique performing laparoscopic cholecystectomy performed 800 cases good results technique allows surgeon fully evaluate common duct via operative cholangiography allowed us use laparoscopic approach patients candidates cholecystectomy technique offers minimally invasive alternative open cholecystectomy
los angeles experience laparoscopic cholecystectomy surgeons competent diagnostic laparoscopy performing laparoscopic cholecystectomy \( lc \) well structured courses experienced faculty important within 12 months , performed hospital number open cholecystectomies decreased one third cholecystectomies performed cholangiography attempted routinely duct successfully cannulated 90 made 6 hospitals within 5 radius total 220 performed following gray areas need addressed patients slightly increased liver function tests jaundice , unsuspected stones discovered cholangiography new progress explore common bile duct via cystic duct directly common bile duct insertion tube authors recommend proper training well caution sound judgment lc
training , , clinical laparoscopic general surgery despite lack scientific data comparing traditional open operations , laparoscopic surgery gained rapid acceptance implementation general surgeons individual hospitals , responsibility developing criteria , guidance amount type additional training required clinical laparoscopic general surgery laparoscopic surgery involves techniques different learned general surgery residency training therefore , techniques regularly included general surgery residency programs , additional training separate laparoscopic surgery appropriate adequate training surgeons already experienced abdominal biliary tract surgery acquired diagnostic laparoscopy , attending course laparoscopic surgery includes instruction live animal experience , procedures humans , certified competent experienced general surgeon
atracurium decay formation laudanosine humans several groups investigators reported plasma concentrations laudanosine , metabolite atracurium , high immediately administration atracurium thereafter decline time profile metabolite plasma unusual authors describe model atracurium decay laudanosine disposition explains data model reveals following 1 \) atracurium molecule degraded two laudanosine 2 \) generation laudanosine occurs two processes rapid one , involving approximately 31 atracurium dose proceeding half life 0 25 min , slower one , involving residual 69 proceeding half life 51 min 3 \) atracurium degradation elimination central compartments 4 \) laudanosine formed atracurium gains access central compartment plasma pattern 5 \) cirrhotic patients , 18 atracurium dose degraded rapidly laudanosine slowly authors propose rapid degradation atracurium plasma substitution reaction , plasma laudanosine moiety atracurium laudanosine moieties atracurium required establish sustain plasma concentrations laudanosine , excretion atracurium degradation pathways generating laudanosine must small
comparative study temporomandibular symptoms following mandibular advancement bilateral sagittal split osteotomies rigid versus fixation rigid fixation proximal distal segments bony healing osteotomy sites become increasingly popular effects rigid fixation temporomandibular joints questioned purpose study evaluate effects rigid fixation bilateral sagittal split osteotomies temporomandibular dysfunction symptoms forty patients mandibular advancement surgery evaluated temporomandibular joint dysfunction twenty received rigid fixation , twenty received fixation determined statistically significant difference temporomandibular signs symptoms patients treated rigid internal fixation bilateral sagittal split osteotomies mandibular advancement patients treated wire fixation
retrospective evaluation 301 tmj teflon implants retrospective review 301 teflon implants performed factors opening , occlusion , joint sounds , joint degeneration , patient satisfaction examined overall surgical success rate 88 7 , average follow period 33 months although many patients demonstrated significant condylar degeneration 1 year follow , change necessarily result symptomatology joint dysfunction 10 implants resulted removal surgical postoperative procedures contrasted clinicians experiencing lower success rates
microleakage associated apical two thirds amalgam investigation effect increasing thickness amalgam sealing ability studied compared sealing ability laterally gutta percha apical two thirds canals 118 upper central incisors , filled laterally gutta percha , sealed amalgam amalgam also used seal roots six teeth filling canals effectiveness techniques determined ability inhibit penetration methylene blue dye periods 24 hours , 1 week , 1 , 3 , 6 months 24 hours materials showed comparable sealing ability however , sealing ability laterally gutta percha significantly better amalgam 1 week period end study depth marginal penetration around materials increased time amount dye penetration increased acutely around amalgam , whereas increase around gutta percha uniform end study , specimens amalgam exhibited total dye penetration exceeded full thickness amalgam \( 6 mm \) spread root canal space hand , mean value marginal penetration dye around laterally gutta percha 2 6 mm end study present investigation proved beyond use thickness retrograde amalgam seal apex , filling within canal , failure
prevalence shovel shaped incisors saudi dental patients prevalence maxillary studied radiographically saudi patients according characteristics , new classification developed shovel teeth categorized findings study showed 9 shovel shaped incisors among , 4 central incisors 5 lateral incisors frequency occurrence shovel shaped incisors also investigated eight percent shovel shaped incisors showed presence prevalence found 4 central shovel shaped incisors , whereas lateral shovel shaped incisors 11
one stage closure entire primary palate timing closure anterior palate subject debate late repair defect complicated high fistula formation subjects patient problems palate fistula extended periods time utilized single procedure performed child 3 months age completely anterior hard palate along cleft lip series consisted 61 consecutive patients unilateral clefts primary secondary palate mucosal turnover flaps along lateral nasal mucosal flaps provide nasal lining buccal sulcus flap flap oral repair ninety five percent \( 58 61 \) patients complete stable closure anterior palate 1 year incidence fistula formation series \( 3 61 \) much lower reported utilization protocols excellent exposure anterior palate alveolar defect lip repair , early restoration anatomic relationships , establishment good nostril floor , low fistula formation among benefits procedure increase operative time considered minimal light aforementioned advantages
congenital lateral cleft palate new anomaly \? case atypical cleft palate abnormality identified 9 year old girl presented cleft localized laterally oblique position soft palate patient cleft palate repair finally , acceptable soft palate movements speech
surgical treatment stomatitis affecting children developing countries may leave around mouth , amputation lips , cheek , nose , , maxilla , palate , reconstruction take account size defect , presence constriction mandible , age child , child 's general condition last 3 years , eight patients treated unit plastic reconstructive surgery except one case , tracheostomy avoided , intranasal intubation children , aged 2 9 years , underwent 31 general complex reconstructive procedures , including latissimus dorsi musculocutaneous free flaps , cranial flaps , cranial bone skin grafts , temporal skin flaps patients able return africa dramatic functional cosmetic improvements however , satisfactory mouth opening mandibular function always obtained
maintenance condyle proximal segment position orthognathic surgery twenty patients underwent bilateral sagittal ramus osteotomy correction mandibular condylar positioning device \( cpd \) used intraoperatively 10 patients maintain preoperative condyle proximal segment position , cpd used 10 patients postoperatively , condyle proximal segment positions groups compared evaluated vertical , horizontal , rotational changes significant improvement \( p less 05 \) observed vertical horizontal condylar position group cpd used however , significant difference proximal segment rotation
potential periodontal pocket formation associated untreated accessory root canals teeth extracted endodontic involvement , six patients , treated root amputation roots processed histologically cases showed presence accessory root canals remnants tissue , bacteria , necrotic debris demonstrated cases studied residual necrotic tissue untreated root canals result may speculate inflammatory process persists drainage results via sulcus , time , plaque may develop
retrospective clinical study treated mandibular incisors selected chinese population clinical studies incidences number canals human teeth correlate percentages obtained laboratory samples study incidence two canals mandibular incisors compared figures obtained vitro extracted teeth , well one clinical study low percentage obtained examination clinical records , could due racial differences samples examined
cross sectional tomography diagnostic technique determining relationship impacted mandibular third molars inferior alveolar neurovascular bundle twenty two patients 31 impacted mandibular third molars examined new , precise , cross sectional tomographic technique assess radiographic size , shape , branching pattern , location , degree mandibular canal , impacted mandibular third molars plane mandibular canal , including canals , accurately identified 30 cases \( 96 8 \) cross sectional appearance canal , partially , radiolucent oval measured average \( sd \) 2 9 0 7 x 2 5 0 6 mm diameter located frequently \( 45 2 \) buccal aspect impacted mandibular third molar 60 mandibular canals inner cortical plate mandible third molar root surface cystic expansion quantification cortical bone destruction readily assessed technique concluded diagnostic information obtained cross sectional tomograms significantly aids oral maxillofacial surgeon preoperative diagnostic workup radiation risks comparable accepted localization techniques
assessment salivary function healthy premenopausal postmenopausal females elderly represent rapidly growing segment u population , majority group females average woman anticipate living third life beyond menopause , many u women undergo hormonal replacement attempt relieve menopausal symptoms little understood relationship menopause , hormonal replacement therapy , oral structures , although oral discomfort , , salivary associated postmenopausal women effects menopausal status estrogen therapy subjective reports oral discomfort objective measurements major salivary gland output assessed 43 healthy premenopausal postmenopausal females complaints mouth alterations quantity saliva occurred population study suggests among healthy women salivary gland function significantly influenced menopause hormonal replacement therapy
randomized , double blind trial mazindol duchenne dystrophy evidence growth hormone may related progression weakness duchenne dystrophy conducted 12 month controlled trial mazindol , putative growth hormone secretion inhibitor , 83 boys duchenne dystrophy muscle strength , contractures , functional ability pulmonary function tested baseline , 6 12 months treatment mazindol \( 3 mg \) placebo study designed power greater 0 90 detect slowing 25 expected rate progression weakness p less 0 05 mazindol benefit strength point study side effects attributable mazindol included decreased appetite \( 36 \) , dry mouth \( 10 \) , behavioral change \( 22 \) , gastrointestinal symptoms \( 18 \) mazindol dosage reduced 43 patients effect mazindol gh secretion estimated indirectly comparing postabsorptive igf levels obtained following 3 , 6 , 9 , 12 months mazindol treated placebo groups although mazindol treated patients gained less weight height placebo treated patients , significant effect igf levels observed mazindol doses slow progression weakness duchenne dystrophy
sensitivity restored class v abrasion erosion lesions effectiveness restorative treatment reducing sensitivity associated class v erosion abrasion lesion evaluated efficacy three tooth restorative materials reducing sensitivity compared 108 lesions restored either glass ionomer restorative material , composite resin dentin bonding agent , composite resin dentin bonding agent glass ionomer composite resin glass ionomer restorations significantly reduced sensitivity air hot cold water glass ionomer restorations restorations composite resin dentin bonding agent significantly reduced sensitivity also associated increased sensitivity air cold respectively 20 30 lesions restored evaluated 6 months
microleakage gingival dentin margins class v composite restorations lined light cured glass ionomer cement study compared microleakage light cured auto set glass ionomer used class v composite glass ionomer restorations determining amount microleakage gingival dentin margins standardized v shaped class v cavities gingival margins junction prepared distal surfaces 40 molars , establishing total 80 cavities , randomly divided four groups lined glass group 1 , bond \( \) , served control group 2 , ionomer \( \) group 3 , ionomer acid \( \) pretreatment \( \) group 4 , \( 3m \) specimens 300 cycles 0 5 aqueous solution basic 4 55 c 1 minute dwell time , individually embedded epoxy resin statistical analysis indicated differences among groups using light cured glass ionomer \( groups 2 4 \) , showed significantly less leakage control \( group 1 \) p less 0 00001 \) removal smear layer using 10 acid solution influence microleakage restorations light cured glass ionomer
effect endodontic access preparation resistance root fracture investigation involved creation coronal radicular fractures vitro compared fracture resistance intact human mandibular molars , molars varied tooth preparation forty freshly extracted , non , human mandibular molars randomly divided four treatment groups molars subjected constantly increasing occlusal load coronal radicular fracture occurred tooth preparations significantly diminished resistance coronal radicular fracture
parotid approach duct surgery removal parotid stones simple procedure stone accurately located relation skin surface combination sonography provide information case report demonstrates step step approach diagnosis , localization , surgery management
indications simultaneous orthognathic surgery orthognathic surgery combined successfully certain guidelines understood relative indications contraindications established generally yield predictable results tip position \( rotation projection \) may difficult aspect predict , therefore , best avoided simultaneous surgery major deformities easily corrected conjunction maxillary surgery three cases demonstrating guidelines presented discussed
relationship indications surgical removal impacted third molars incidence alveolar osteitis six hundred forty two impacted third molars surgically removed 412 patients surgery , patient assessed clinically radiographically , reason removal tooth specifically recorded one hundred eighty two impacted teeth removed prophylactic reasons 460 therapeutic reasons much possible , standardization operating procedure environment , preoperative postoperative regimens observed surgery , case followed determine absence presence signs symptoms alveolar osteitis found several factors seem contribute development alveolar osteitis however , significant related finding reason extraction , , whether extraction undertaken therapeutic prophylactic reasons
location abnormalities panoramic radiographs edentulous patients series 308 panoramic radiographs edentulous patients examined presence determine whether predictive basis could found occurrence abnormalities sex , age , location radiolucencies , , retained roots teeth recorded size anterior posterior location edentulous frequently found abnormality \( 18 subjects \) , followed retained roots \( 8 \) , radiolucencies \( 3 \) , retained teeth \( 3 \) significant correlation found chi square test type location abnormality sex patient , however , significant relationship location type abnormality radiolucent lesions frequently found mandible , teeth retained roots frequently seen posterior maxilla selective radiographs detect retained roots teeth posterior maxilla may terms treatment outcome otherwise , study basis selection intraoral sites specific intraoral radiographs asymptomatic edentulous patients
pancreatic autoantibodies pancreatic function sjogren 's syndrome pancreatic autoantibodies determined 49 patients sjogren 's syndrome related functional parameters pancreatic duct autoantibodies \( pda \) detected sera three patients , showed abnormal exocrine pancreatic function islet cell antibodies \( ica \) detected sera 49 patients , including two individuals diabetes mellitus conclusion , pda occur patients sjogren 's syndrome , may associated exocrine pancreatic dysfunction
medical dental implications cocaine abuse ever increasing supply cocaine use , potent form cocaine , dangers cocaine abuse , high morbidity mortality , become recognized oral maxillofacial surgeons may frequently treating patients use cocaine , , therefore , must educated cocaine related problems prepared deal complications article discusses nature cocaine , pharmacology , systemic affects , oral manifestations cocaine abuse , recommended clinical management patient
prevention dry socket overview , , oral surgeons , oral maxillofacial surgeons complication , commonly known dry socket , since profession attached years include alveolar osteitis , osteitis , syndrome , alveolar , , , fibrinolytic alveolitis attempts eliminate painful condition made , nonetheless , significant progress made reduce incidence perhaps time take inventory proven methods assist practitioner reducing incidence complication practice article presents review past investigations appear merit regard , summary recommendations conclusion article
effects removing inferior alveolar neurovascular structures mandibular growth eruption permanent dentition puppies investigation performed effects removing inferior alveolar neurovascular structures permanent dentition mandibular growth five puppies teeth inferior alveolar neurovascular structures removed test animals 28 weeks old , examination revealed teeth side operated permanent teeth replace hand , permanent teeth side operated replaced teeth second period 28 weeks , permanent teeth side operated still mandibular bone , permanent teeth side operated normally mandibular measurements demonstrated growth developmental processes normal sides operated sides operated
orofacial infections review microbiology current treatment orofacial infections common current evidence indicates play major role infections common microbial isolates bacteroides , fusobacteria , , well streptococci drainage must established possible penicillin still drug first choice therapy , metronidazole good alternative nevertheless , clinicians aware current views , therefore , article state art review practicing clinician microbiology antimicrobial therapy orofacial infections
comparison signs temporomandibular joint dysfunction occlusal discrepancies symptom free population men women date , conclusive explanation predominance female patients temporomandibular joint \( tmj \) dysfunction purpose study survey normal population without symptoms presence certain putative signs tmj dysfunction association certain signs occlusal discrepancy determine presence gender variation subjects \( 217 men 217 women \) examined presence three putative signs tmj dysfunction limited mandibular opening \( 37 mm \) , deviation opening , joint sounds subjects also examined presence four signs occlusal discrepancy anterior slide relation \( cr \) occlusion \( co \) , lateral slide cr co , nonworking occlusal contacts , working contacts distal cr mandibular position condyles superior position posterior aspect articular co mandibular position mandibular maxillary teeth maximum significant differences prevalence putative signs tmj dysfunction occlusal discrepancy men women concluded factors presence signs tmj dysfunction occlusal discrepancy responsible high predominance female patients tmj dysfunction
radiolucencies within teeth case report review literature panoramic radiograph obtained treatment revealed radiolucency within permanent second molar unusual entity successfully treated surgical endodontic intervention , followed restorative treatment treatments enabled tooth maintain , , complete root formation , function report review proposed etiologies condition , discuss need surgical intervention , present details case
comparison two temporary restorations light cured resin versus self temporary restoration temporary restorative materials important component endodontic therapy must adequately seal access preparation visits protect canal \( \) microleakage permanent restoration placed efficacy e r \( new light cured composite product \) compared use carbon black coronal microleakage protocol teeth examined previously received coronal restorations teeth , restored e r , exposed dye , cleared three dimensional assessment revealed consistently provided effective seal addition , great deal microleakage observed around permanent restoration tooth interface indicates perhaps leaking permanent restorations removed initiation endodontic treatment
primary parotid malignancies clinical pathologic review one hundred ninety four patients primary malignant tumors parotid gland underwent surgery mayo clinic \( 1970 1987 \) reviewed survival patterns analyzed using kaplan meier product limit method separated histologic results three significantly different groups survival rate highest patients cell , adenoid cystic , low grade mucoepidermoid carcinomas intermediate patients high grade mucoepidermoid carcinomas lowest remaining six histologic types encountered cox multiple linear regression used identify patient tumor characteristics greatest prognostic significance order decreasing strength , regional metastatic involvement , pain , male gender , grade , stage , advancing age demonstrated independent prognostic significance fifty three percent patients requiring facial nerve sacrifice asymptomatic presentation high positive correlation observed advancing grade stage
dry mouth diagnosing treating multiple causes dry mouth elderly common occurrence multiple etiologies normal phenomenon aging , therefore , attempt cause made sjogren 's syndrome may occur , diagnosed biopsy medications also frequently associated dry mouth , dosages may need adjusted drug discontinued symptoms severe strategies management dry mouth explored
inhibition fluorouracil induced stomatitis oral cryotherapy mucositis significant dose limiting toxicity associated fluorouracil \( 5fu \) , particularly combined leucovorin hypothesized oral cryotherapy would cause local vasoconstriction would decrease blood flow oral mucous membranes cryotherapy used time peak serum 5fu levels , oral mucous membranes would less exposure 5fu thus develop less mucositis test hypothesis , 95 patients scheduled receive first cycle 5fu plus leucovorin randomized oral cryotherapy time chemotherapy administration serve control group subsequent mucositis significantly reduced group assigned receive cryotherapy judged attending physicians \( p 0002 \) patients \( p 0001 \) routinely recommend cryotherapy procedure patients receiving daily bolus 5fu plus leucovorin
fine needle aspiration biopsy salivary glands january 1 , 1973 , december 31 , 1988 , authors performed fine needle aspiration biopsies patients clinically significant masses salivary glands patients presented medical college virginia hospitals clinics virginia university followed periods ranging 1 16 years available , fine needle aspiration diagnoses correlated histologic diagnoses long term patient outcomes sensitivity neoplasm 93 3 specificity absence neoplasm 99 diagnostic efficiency 96 4 , predictive value positive aspiration neoplasm 98 3 fine needle aspiration , surgical excision salivary gland masses often unnecessary patients primary metastatic neoplasms involving salivary glands , fine needle aspiration aids surgeon mapping extent surgical procedure preoperatively patient procedure cost effective
aerobic anaerobic microbiology abscess thirty four aspirates abscesses studied aerobic anaerobic bacteria showed bacterial growth total 107 bacterial isolates \( 58 anaerobic 49 aerobic \) recovered , accounting 3 1 isolates per specimen \( 1 7 anaerobic 1 4 aerobic \) anaerobic bacteria present 6 \( 18 \) patients , aerobic 2 \( 6 \) , mixed aerobic anaerobic flora 26 \( 76 \) single bacterial isolates recovered 4 infections , 2 streptococcus pyogenes 2 anaerobic bacteria predominant bacterial isolates staphylococcus aureus \( 6 isolates \) , bacteroides sp \( 21 isolates , including 15 bacteroides group \) , sp \( 16 \) pyogenes \( 10 \) beta lactamase producing organisms recovered 13 \( 52 \) 25 specimens tested retrospective study highlights nature importance anaerobic bacteria abscess
100 protein antibodies label normal salivary gland implications salivary gland tumors modified myoepithelial cells key role developing histologic characteristics salivary gland tumors 100 protein expressed certain tumors suggested support role , principal component human salivary gland reported 100 protein positive confirmation important aspect required immunoperoxidase staining parotid salivary gland shows considerably different patterns obtained antibodies 100 protein , neuron specific enolase , compared muscle specific actin cytokeratin 14 many cells processes associated ducts evident latter two antibodies double immunofluorescent staining antibodies either 100 protein neuron specific enolase combined muscle specific actin reveal antigens myoepithelial cells former localize nerve fibers adjacent , separate , , latter myoepithelial cells apparent 100 protein staining rich network nerves interstitial tissues , evident ultrastructurally , misinterpreted result important implications classifications salivary gland tumors
vitro natural killer lymphokine activated killer activity patients bronchogenic carcinoma authors examined peripheral blood mononuclear cells 45 patients bronchogenic carcinoma determine natural killer \( nk \) lymphokine activated killer \( lak \) activity vitro incubation media alone media plus interferon gamma \( ifn , 200 u ml \) interleukin 2 \( il 2 , 100 u ml \) results show lymphocytes patients bronchogenic carcinoma acquire lak activity , level activity acquired significantly lower compared lymphocytes 25 control subjects il 2 cultures supplemented 10 autologous human serum \( \) \( 15 6 2 1 specific release versus 26 0 2 9 specific release , p 0 004 \) lak activity , defined cytotoxicity nk resistant cell line , patients' lymphocytes augmented cells cultured il 2 ifn compared il 2 alone \( p 0 0001 , paired test \) control subjects unchanged \( p 0 09 \) significant difference groups patients different histologic types tumor different stages disease nk activity , defined killing nk sensitive k 562 target cells , patients' lymphocytes significantly different lymphocytes \( 42 8 3 0 specific release versus 49 3 3 3 specific release , p 0 16 \) studies indicate feasibility il 2 ifn therapy patients bronchogenic carcinoma
spirometric findings mortality never smokers relation ventilatory function overall mortality studied 662 male female never smokers period 1976 1978 participated city heart study , prospective community study 14 , 000 men women randomly selected general population city end 1986 , 195 subjects said never smokers died mortality analyzed using proportional hazards model cox addition measures ventilatory function , mortality analysis included age , sex , body mass index , alcohol consumption , school education , diabetes mellitus , heart disease bronchial asthma confounding factors forced expiratory volume 1 second \( fev1 \) percentage predicted , forced vital capacity \( fvc \) percentage predicted ratio fev1 fvc significant risk factors mortality among sexes relative risk death associated 50 decrease fev1 fvc percentage predicted value 1 65 1 81 , respectively study confirms lowered ventilatory function strong risk factor mortality among never smokers sexes
effect sulindac abnormal cough reflex associated dry cough order determine possible role prostaglandins abnormal cough reflex patients dry cough , effects cyclooxygenase inhibitor cough symptoms examined measured cough symptom score cough reflex sensitivity inhaled capsaicin double blind , randomized , cross study comparing effects placebo sulindac , 200 mg daily 1 week studied six hypertensive patients angiotensin converting enzyme inhibitor associated cough six patients idiopathic , dry , cough , increase sensitivity cough reflex change blood pressure control hypertensive patients sulindac therapy patients angiotensin converting enzyme associated cough significant reduction cough symptom score also significant increase dose capsaicin causing two coughs \( threshold sensitivity \) causing five coughs \( near maximum response \) sulindac therapy compared placebo patients idiopathic , dry , cough , sulindac alter symptom cough cough reflex response capsaicin results suggest prostaglandins may involved cough associated angiotensin converting enzyme inhibitor therapy , less likely important pathogenesis common dry coughs unknown cause
immune reactivity bronchogenic carcinoma relation 5 year survival rate performed prospective study correlation various parameters immune response 5 year survival rate patients bronchogenic carcinoma parameters initially examined starting treatment delayed hypersensitivity skin tests , , natural killer \( nk \) cell activity , interleukin 2 \( il 2 \) production employed assess immune competence reaction classified four five grades accordance intensity 5 year survival rate patients showing grade immune response calculated correlation response treatment survival rate clearly noted skin tests nk cell activity showed poorer correlations , exact correlation noted il 2 production immune response
laryngeal mask airway tracheal tube insertion personnel short training programme 11 medical trainees inserted laryngeal mask airway \( lma \) tracheal tube \( \) random order total 110 patients allowed 40 attempt success defined detection expired carbon dioxide within 40 airway removal subsequently rose end tidal value least 4 kpa , together satisfactory lung expansion ventilation , without airway intervention anaesthetist 104 lma insertions successful compared 56 \( p less 0 01 \) first attempts lma insertion successful , whereas satisfactory placement progressive insertion also lma \( 20 \) \( 35 \) \( p less 0 01 \) studies indicated assess value lma emergencies
new method needle electrode placement posterior muscle electromyography 1979 authors developed new method needle electrode placement posterior muscle \( pca \) electromyography pca muscle easily reached inserting needle electrode membrane midline penetrating lamina cartilage subglottic cavity access pca muscle electrode insertion best afforded approach report details new technique used laboratory knowledge , first report needle electrode placement pca muscle approach new electrode insertion technique applied 100 dogs research purposes 1200 patients laryngeal motor disorders clinical diagnosis simple technique requiring usual skills reliable electromyographic recordings obtained new method untoward effects , hematoma infection repeated observed approximately examinations performed date reasonable assume route electrode insertion pca muscle feasible man techniques electrode placement intrinsic laryngeal muscles reviewed compared
serial munchausen syndrome proxy five cases munchausen syndrome proxy \( \) presented one child family high incidence maternal psychiatric histories , marital difficulties , syndrome mothers seventy one percent children families known victims four children \( 31 \) died multiple child may reflect significant maternal psychopathology found cases , may indicate deteriorating consequences mother children family syndrome identified first child effective interventions made
acute respiratory infections first three months life clinical , radiologic physiologic predictors etiology usefulness clinical , radiologic , physiologic characteristics identify pathogens assessed 90 infants aged two 12 weeks , presenting outpatient clinic acute respiratory infection eighty four cases cultures rapid diagnostic tests rsv , 25 positive eighty two infants cultures rapid diagnostic tests chlamydia , 16 positive additional respiratory pathogens identified included \( 6 cases \) , \( 3 cases \) , pertussis \( 2 cases \) , cmv \( 1 case \) multiple pathogens identified four cases chlamydia rsv \( 2 cases \) , chlamydia \( 1 case \) , chlamydia cmv \( 1 case \) clinical characteristics need hospitalization useful predictors specific pathogens x rays obtained 20 \( 80 \) rsv infections , 13 \( 81 \) chlamydia infections , six infections , two pertussis infections , 25 cases without identification pathogen x ray findings could distinguish patients without pathogen pathogens severe findings present 28 \( 11 40 \) cases pathogen identified , compared 12 \( 3 26 \) cases without pathogen identified \( ns \) moderate findings present 58 \( 23 40 \) cases pathogen identified compared 62 \( 16 26 \) cases without pathogen identified slight negative findings present 15 \( 6 40 \) cases pathogen identified , compared 27 \( 7 26 \) cases without pathogen identified pulse oximetry done 30 cases , 22 pathogen identified \( rsv 14 , chlamydia 7 , pertussis 1 \)
double blind randomized study prolonged higher dose oral amoxycillin purulent bronchiectasis thirty eight patients bronchiectasis daily purulent sputum despite conventional antibiotic courses randomly allocated receive amoxycillin \( 3 g \) matched placebo twice daily 32 weeks double blind study nine patients \( four amoxycillin , five placebo \) withdrawn study treatment response two patients \( amoxycillin \) withdrawn within first six weeks assessed pretreatment characteristics two groups similar independent assessment overall response based patients' diary cards showed higher proportion improved amoxycillin group \( 11 17 \) placebo group \( four 19 p 0 02 \) patients amoxycillin group spent significantly less time confined bed away work treatment frequency exacerbations study treatment phase similar two groups less severe study treatment amoxycillin group greater reduction purulent sputum volume exacerbations study treatment amoxycillin group 20 per cent pretreatment volume placebo group \( 88 per cent pretreatment volume , p 0 008 \) , although concentrations haemophilus sputum exacerbations similar two groups adverse effects experienced minor except one patient \( amoxycillin \) withdrawn developing rash six patients \( three amoxycillin , three placebo \) diarrhoea lasting one week necessitating withdrawal two patients \( one amoxycillin , one placebo \) study treatment sputum stool cultures collected regularly study showed important changes bacterial flora either group prolonged higher dose antibiotic therapy patients severe purulent bronchiectasis significantly reduced host \( patient \) inflammatory response microorganisms reduced morbidity
hemoptysis ct correlations 58 cases computed tomographic \( ct \) chest radiographic findings retrospectively correlated found fiberoptic bronchoscopy \( fob \) 58 patients presenting hemoptysis abnormalities involving airways depicted ct total 28 cases \( 48 \) 18 \( 31 total group 58 \) , focal abnormalities involving central airways identified \( 17 subsequently proved malignant \) 10 \( 17 total \) , ct showed bronchiectasis focal airway abnormality shown fob 18 cases \( 31 \) depicted ct malignancy diagnosed 24 patients , including three results fob normal malignant cells identified biopsy ct abnormalities identified cases malignancy 10 21 cases \( 48 \) non small cell lung cancer , ct allowed definitive staging documenting either direct mediastinal invasion metastatic disease , fob allowed definitive staging three cases ct studies provided false negative results concluded carefully performed , ct may effective modality evaluating patients presenting hemoptysis
worker 's ct assessment exposed workers correlation radiographic findings study signs worker 's \( cwp \) computed tomography \( ct \) , authors obtained thoracic ct scans 170 dust exposed workers concomitantly evaluated conventional lateral radiography extent disease assessed means ct two groups miners group 1 \( n 86 \) , miners worker 's compensation radiographic evidence cwp , group 2 \( n 84 \) , miners applied compensation without radiographic evidence cwp ct signs cwp consisted , nodules , progressive massive fibrosis comparative analysis demonstrates superiority optimal ct technique chest radiography evaluation simple , improved sensitivity detection small parenchymal opacities ct provides additional information stage disease also classification small opacities ct equivalent radiography complicated , except identification necrosis ct evaluations complementary plain radiography assessment cwp , addition high resolution ct useful achieving accurate evaluation small parenchymal opacities
cross sectional physiology lung well known influences physiology lung thereby affects intrapulmonary localization disease processes less well known anatomic physiologic differences axial cross sectional plane , also affect distribution disease physiologic gradients ventilation , perfusion , lymph flow stresses lung present axial plane anatomic difference branching patterns , interstitial design , development secondary pulmonary also found regional anatomy physiology applied old concept organization lung used consider diseases exhibit propensity central peripheral portions lung analysis applied anatomy physiology secondary pulmonary
airway evaluation children use ultrafast ct pitfalls recommendations ultrafast computed tomographic \( ct \) evaluation airway performed either 50 msec low resolution images \( cine ct \) 100 msec high resolution images \( high resolution ct \) determine best imaging strategy ultrafast ct pediatric airway , authors prospectively compared ultrafast ct endoscopy 20 children studies performed 11 patients cine ct alone performed six high resolution ct alone three six patients normal anatomy six patients focal tracheal stenoses , four laryngomalacia , one cleft , one irregularity narrowing subglottic area , one laryngeal , one focal stenosis stoma granuloma cine ct results agreed endoscopy 10 17 cases five cases focal stenosis misinterpreted cine ct high resolution ct results agreed endoscopy 10 14 cases results technique combined high resolution ct entire airway cine ct selected areas agreed endoscopy 10 11 cases tracheoesophageal cleft missed combined technique greatest diagnostic accuracy ultrafast ct evaluation pediatric airway , cine high resolution modes used
simple method correcting single breath total lung capacity single breath method underestimates total lung capacity comparison multiple breath method \( \) ventilation distribution study proposes simple correction single breath tlc \( \) , using inert gas phase iii slope account effects ventilation distribution model non uniform lung ventilation designed , composed serial dead space two alveolar compartments arranged parallel , whose relative determined phase iii plateau correction 104 44 64 subjects \( 17 diffuse interstitial disease , 42 chronic obstructive pulmonary disease , five healthy subjects \) limit acceptability correction \( \) determined 95 confidence interval healthy subjects correction resulted significant increase \( p less 0 004 \) remained limit acceptability 12 patients emphysema , 12 showed large improvement tlc estimate presence poorly ventilated zones single breath patients may explain partial correction
lung fibrosis induced 63 year old woman developed progressive shortness breath , pulmonary hypertension , respiratory failure died pulmonary fibrosis 45 years thoracic fistulography acute respiratory failure occurred features pulmonary oedema lung tissue obtained biopsy necropsy showed abundant radioactive particles dioxide lungs particles walls blood vessels perivascular fibrous zones , consistent causal role development lung fibrosis suggested fibrosis due combined effects alpha radiation interstitial perivascular zones recurrent pulmonary oedema due endothelial damage
effect \( thermal \) water lymphocyte proliferative response studied effect water thermal therapy phenotype proliferative response peripheral lymphoid cells ten subjects affected chronic upper respiratory disease six suffering articular disorders water \( h2o \) therapy modify phenotype function peripheral blood mononuclear cells \( pbmc \) modify systemic immunologic reactivity different result obtained analyzing response mitogens peripheral blood mononuclear cells cell cultures containing graduated amounts h2o vitro studies shown important dose dependent inhibitory effect h2o mitogen induced lymphocyte proliferation production present h2o seems primary component responsible inhibition results consistent local immunosuppressive role h2o , may explain part observed therapeutic effect inhalation therapy upper respiratory allergic disorders
human serologic response envelope associated proteins adenylate cyclase toxin bordetella pertussis human serologic response several envelope associated proteins adenylate cyclase toxin bordetella pertussis examined using immunoblot techniques antigens recognized sera individuals culture confirmed pertussis sera infants immunized three doses conventional whole cell pertussis vaccine included 63 , 000 da protein shown antigenically related mycobacterial heat shock protein 29 , 000 da protein reacted sera individuals , whereas 91 , 000 da protein reacted sera vaccinated individuals antibodies adenylate cyclase toxin common sera individuals diagnosed pertussis b pertussis also recognized antibodies sera data suggest antigens may play role immunity pertussis
surfactant treatment full term newborns respiratory failure surfactant inactivation shown significant factor animal models lung injury may also important forms respiratory failure full term newborns fourteen full term newborns respiratory failure associated pneumonia \( 7 patients \) meconium aspiration syndrome \( 7 patients \) treated 90 mg kg calf lung surfactant extract , given every 6 hours maximum four doses group mean fraction inspired oxygen \( \) treatment 0 99 0 01 sem , mean airway pressure \( map \) 14 6 1 0 cm h2o patients showed significant improvement oxygenation initial surfactant treatment , arterial alveolar oxygenation ratio \( ratio \) rising 0 09 0 01 surfactant treatment 0 22 0 05 15 minutes \( p 03 \) remaining improved 6 hours oxygenation index , incorporating map well oxygen variables , also improved significantly 26 2 3 1 11 2 1 7 15 minutes \( p less 001 \) , improvement sustained 6 hours chest radiographs blindly scored 0 \( normal \) 5 \( severe opacification \) , improved marginal significance initial surfactant treatment \( 2 9 0 2 2 5 0 2 , p 05 \)
intravenous streptomycin streptomycin effective drug treatment tuberculosis currently recommended use intramuscular route method drug delivery accompanied considerable pain unacceptable many patients advent many improvements intravenous therapy occurred past 40 years , reevaluation intravenous use drug warranted describe short term use intravenous streptomycin four patients pulmonary tuberculosis
central pulmonary embolism normal ventilation perfusion scan diagnosis nuclear pulmonary artery flow studies pulmonary embolism , although uncommon children , occurs many 104 per 100 , 000 pediatric patients undiagnosed untreated pulmonary embolism high mortality rate thus , high index clinical suspicion reliable diagnostic modalities necessary ensure prompt accurate diagnosis report case patient severe central pulmonary embolism normal ventilation perfusion scan embolus identified nuclear pulmonary flow study using dynamic imaging , need contrast pulmonary angiography traditional ventilation perfusion scan may appear normal despite severe central pulmonary embolism situation , early dynamic imaging necessary detect severe obstruction central pulmonary arteries approach may obviate need contrast pulmonary angiography hemodynamically stable patients
oral corticosteroid therapy patients stable chronic obstructive pulmonary disease meta analysis purpose evaluate effectiveness oral corticosteroid therapy patients stable chronic obstructive pulmonary disease data identification english language literature search using medline \( 1966 1989 \) review retrieved articles identified 33 original studies oral corticosteroid use chronic obstructive pulmonary disease published since 1951 study selection submitted study 's methods section three physician investigators used nine criteria independently assess study quality ten studies met criteria five studies met criteria data extraction compare outcomes across qualifying studies , defined response therapy 20 greater increase baseline forced expiratory volume 1 second \( fev1 \) defined treatment effect size study proportion patients responded corticosteroid therapy minus proportion patients responded placebo potential confounding variables related eligibility criteria treatment protocols also assessed study results data synthesis among ten studies met nine criteria , found significant differences eligibility criteria , treatment protocol , study design association found treatment effect size publication date , study size , mean patient age , fev1 studies reported effect sizes ranging 0 56 calculated weighted mean effect size 10 \( 95 ci , 2 18 \) studies meeting criteria included calculation , weighted mean effect size 11 \( 95 ci , 4 18 \) conclusions patients stable chronic obstructive pulmonary disease receiving oral corticosteroid therapy 20 greater improvement baseline fev1 approximately 10 often similar patients receiving placebo
mechanism bronchodilator effect chronic airflow limitation objective examine mechanisms two \( theophylline salbutamol \) influence dyspnea daily activities methods twenty four patients chronic airflow limitation participated multiple crossover , randomized , placebo controlled trial effect theophylline salbutamol , alone combined , pulmonary function dyspnea daily activities examined correlations changes forced expiratory volume 1 second \( fev1 \) maximum expiratory pressures \( \) \( independent variables \) changes dyspnea score daily activities \( dependent variable \) also examined results two drugs proved beneficial effects general additive rather synergistic drugs improved fev1 theophylline significantly improved correlation changes fev1 dyspnea score , adjustment changes , 0 55 \( p less 0 001 \) correlation changes dyspnea score , adjustment changes fev1 , 0 39 \( p less 0 001 \) conclusions changes airway respiratory muscle strength play independent important role dyspnea daily activities patients chronic airflow limitation changes airway may greater importance
current status etoposide management small cell lung cancer etoposide schedule dependent drug excellent activity small cell lung cancer \( sclc \) single agent etoposide achieves overall response rates ranging 15 84 , depending schedule drug administration characteristics treated population route etoposide administration \( intravenous versus oral \) little impact response rate , provided appropriate dose adjustments made oral therapy combination active agents , etoposide proven particularly effective management sclc etoposide substituted doxorubicin vincristine cyclophosphamide , doxorubicin , vincristine \( cav \) regimen without loss efficacy etoposide cisplatin \( ep \) combination thought synergistic proven effective salvage regimen cav failures regimen cav ep found investigators modestly effective sclc cav alone however , ep alone may useful alternating regimen studies date demonstrated ep induction least effective standard induction regimen however , ep potential advantage easily integrated thoracic radiation therapy \( rt \) particularly important limited disease patients two recent pilot studies employing ep induction hyperfractionated thoracic rt yielded 2 year survival rates greater 50 promising results evaluated ongoing phase iii trial united states available data indicate etoposide one active agents sclc therefore included component induction therapy patients new schedules etoposide administration warrant study
randomized trial compare intravenous oral etoposide combination cisplatin treatment small cell lung cancer randomized multi center study , 83 patients small cell lung cancer randomly assigned treatment cisplatin 100 mg m2 intravenously \( iv \) day 1 etoposide 120 mg m2 iv days 1 , 2 , 3 cisplatin 100 mg m2 iv day 1 etoposide 120 mg m2 iv day 1 240 mg m2 orally days 2 3 regimens repeated every 4 weeks prior randomization , patients stratified extent disease , performance status , gender total 41 patients randomly assigned parenteral treatment regimen , 42 patients received cisplatin iv oral etoposide therapy treatment arms comparable regarding patient characteristics limited disease \( ld \) patients constituted 52 49 patient population oral iv etoposide regimens , respectively overall complete response \( cr \) partial response \( pr \) rate 50 \( 95 confidence interval ci 35 65 \) oral etoposide regimen 59 \( 95 ci 44 74 \) iv etoposide regimen \( p 0 438 \) regimens , 55 ld patients achieved either cr pr time progression survival comparable treatment arms hematologic toxicity comparable treatment arms , 80 patients experiencing grade 3 4 neutropenia thrombocytopenia moderate severe anemia weight loss predominant iv oral regimen
target flow inspiratory muscle training pulmonary rehabilitation patients copd effects additional target flow inspiratory muscle training \( tf imt \) performance inspiratory muscles , general exercise capacity , psychologic parameters pulmonary rehabilitation program \( pr \) studied 40 patients copd selected ventilatory limitation exercise mean age patients 59 years , mean fev1 approximately 50 percent predicted patients participated ten week pr program randomized receive either additional tf imt \( pr imt \) \( pr \) tf imt performed means target flow resistive device generated mouth pressure duration inspiration respiratory cycle imposed training period , maximal inspiratory mouth pressure emg diaphragm significantly better pr imt group pr group maximal work load psychologic symptoms increased extent groups 12 minute walking distance also increased groups , increased significantly pr imt group pr group believe additional tf imt pr selected group patients copd ventilatory limitation extra beneficial effect performance inspiratory muscles exercise performance
combined thermodilution two dimensional echocardiographic evaluation right ventricular function respiratory support peep ten patients requiring respiratory support episode acute respiratory failure \( arf \) , best therapeutic level peep determined measurement changes lung chest wall compliance \( ct \) peep challenge 0 20 cm h2o challenge , hemodynamic monitoring combined thermodilution measurement right ventricular \( rv \) ejection fraction \( ef \) two dimensional echocardiographic measurement rv size permitted assessment effects increasing levels peep rv function rv preload , reflected rv end diastolic volume \( edv \) two dimensional rv end diastolic area \( \) , remained unchanged rv diastolic compliance progressively decreased hand , rv systolic function , assessed two dimensional rv fractional area contraction \( \) , progressively depressed substantial deleterious effects peep noted high levels peep including reduced ct augmented pulmonary vascular resistance inadequate increase rv preload compensate increased rv afterload resulted depressed rv systolic function contributed reduction cardiac output finally , two dimensional echocardiography proved sensitive fast response thermodilution evaluate change rv function
natural killer cell activity rat model amiodarone induced interstitial lung disease role lymphocytes pathogenesis amiodarone induced lung disease controversial increases percentages lymphocytes bronchoalveolar fluid patients animals amiodarone pulmonary toxicity reported assess whether lymphocytes functionally activated , measured natural killer cell activity lungs blood rats amiodarone induced pulmonary toxicity amiodarone treated rats exhibited pathologic evidence amiodarone induced lung disease one week treatment injury sustained extensive remainder study period control rats histologically normal lungs blood nk activity equally present amiodarone treated control groups significantly different course study \( 16 3 percent 13 2 percent , respectively p greater 0 05 \) thus , nk cells activated lungs rats treated amiodarone , suggesting local immune response lung data support concept lymphocytes play important role pathogenesis amiodarone induced lung disease
fiberoptic bronchoscopy refractory cough fiberoptic bronchoscopy \( fb \) low yield diagnosis chronic cough \( greater 3 weeks \) unselected patients assessed yield fb cough four year period patients chest roentgenograms refractory diagnostic efforts empiric bronchodilator therapy seven \( 28 percent \) 25 patients undergoing fb cough \( greater 1 , 500 \) diagnostic findings \( , two , two tuberculous , laryngeal dyskinesia , polyp , one \) tracheobronchial neoplasms detected age greater 50 years female sex independently predicted positive results \( p 0 02 fisher 's exact test \) , duration cough \( two 240 months \) , airflow , smoking status patients prior pulmonary neoplasms excluded , seven \( 35 percent \) 20 studies diagnostic diagnoses potentially could made thoracic computed tomographic scanning four patients indirect laryngoscopy two fiberoptic bronchoscopy yield diagnosis refractory chronic cough reasonable procedure carefully selected patients
comparison spirometry intermittent positive pressure breathing coronary artery bypass graft fifty two patients randomized receive either spirometry \( \) intermittent positive pressure breathing \( \) addition conventional chest physical therapy following coronary artery bypass grafting slow vital capacity peak expiratory flow readings decreased rapidly equal extent groups surgery , partly recovered sixth postoperative day \( \) arterial po2 values similar groups first three 2 , 3 , 6 , number chest films showing well number individual patients revealed statistically significant differences two groups based three variables studied , consider devices equal efficiency coronary surgery
managing lung disease late life new approach advanced pulmonary disease \( \) , progressive , incurable condition , ultimately leading death , associated significant , distressing symptoms paper reviews approach care , emphasis treating symptoms causing patient distress , might used physicians outpatient setting improve patient 's quality life important aspects care include management hypoxia , malnutrition , osteoporosis , adverse drug reactions , , especially , symptomatic relief dyspnea relief emotional symptoms \( depression , anxiety , panic \) also discussed
compensation respiratory alkalosis induced simulated altitude conscious intact rats previously 3 wk pressure 370 380 torr \( 3whx \) made 3 h decrease inspired o2 fraction 0 10 0 075 ambient pressure \( 730 torr \) controls normoxic littermates \( nx \) inspired o2 fraction lowered approximately 0 21 0 10 3 h arterial pco2 decreased progressively similarly groups \( 65 70 control 15 min \) initially , arterial ph increased less 3whx \( 0 09 0 004 vs 0 15 0 008 \) continued , delta hco3 delta ph \( mmol l 1 ph \) became negative nx , 15 2 2 5 15 min 37 0 2 9 3 h , indicating compensation alkalosis 3whx , delta hco3 delta ph change alkalosis cumulative renal excretion base \( 100 g \) alkalosis increased 73 2 11 1 nx 25 4 7 3 3whx difference mainly due larger increase hco3 excretion nx data suggest smaller compensation alkalosis 3whx partly due smaller increase renal base excretion base availability limits renal base excretion , smaller renal response 3whx may secondary low plasma hco3 concentration altitude
effects ligation embolization kf multiple tracer measurements dog lungs isolated blood perfused dog lungs , capillary filtration coefficient \( kf \) permeability surface area product urea \( ps \) measured determine responses two different methods altering filtration area lobe ligation \( , n 5 \) glass bead embolization \( , n 4 \) constant perfusion rates \( 700 45 ml min \) two three lobes ligated , kf decreased \( 1 36 0 13 0 58 0 23 g min 1 cmh2o 1 p less 0 05 \) , ps change \( 2 02 0 4 1 71 0 3 ml \) kf per gram perfused blood free dry lung weight unchanged \( 0 0 17 0 0 18 g min 1 cmh2o 1 \) , indicating surface area per gram measured kf remained however , ps per gram dry lung doubled \( 0 07 0 016 0 146 0 06 ml p less 0 05 \) , suggesting recruitment occurred remaining lobe three lobes 200 microns glass beads \( 0 48 0 01 g beads kg body wt \) , ps decreased \( 2 1 0 22 0 94 0 09 ml p less 0 05 \) , kf altered \( 1 01 0 17 1 04 0 18 g min 1 cmh2o 1 \) kf implies vascular pressure increase kf measurement transmitted blocked vessels thereby measured filtration area ps decreased significantly loss perfused surface area beads blocking flow small arterial vessels
time course changes lung permeability edema rat exposed 100 oxygen rats exposed 100 oxygen 60 h determine early changes lung permeability leading development pulmonary edema time course development increased solute flux assessed clearance 99mtc labeled \( 99mtc dtpa \) lung accumulation 125i labeled albumin \( 125i albumin \) lung end points related development pulmonary edema measurement wet dry weight ratio lung weight fluid pleural cavity significant changes occurred 48 h hyperoxia , sharp increases indexes lung permeability wet dry weight ratio occurred 60 h exposure , pleural effusions developed volume effusion significantly correlated 99mtc dtpa clearance 125i albumin flux
stimulation rat endothelial cell transforming growth factor beta production bleomycin study examines hypothesis mediators lung endothelial cells could promote lung collagen synthesis pulmonary fibrosis since bleomycin induces pulmonary fibrosis humans animals , effects drug endothelial cells examined endothelial cell conditioned media prepared presence various doses bleomycin , tested ability stimulate lung fibroblast collagen synthesis results show dose dependent stimulation endothelial cell secretion collagen synthesis stimulatory activity bleomycin , peaked dose greater equal 100 ng ml stimulation selective collagenous protein synthesis gel filtration analysis showed activity reside fractions estimated molecular mass range 10 27 kd activity inhibited anti transforming growth factor beta \( tgf beta \) antibody , nonimmune control igg presence tgf beta confirmed using lung epithelial cell assay northern blotting revealed significant increases tgf beta mrna bleomycin stimulated endothelial cells thus vitro stimulation endothelial cells bleomycin tgf beta production , presumably increased transcription view chemotactic matrix synthesis stimulatory properties cytokine , increase tgf beta production may play important role bleomycin induced pulmonary fibrosis
purification characterization major human pneumocystis carinii surface antigen previous studies pneumocystis carinii identified major surface antigen rat human isolates proteins 116 , 000 95 , 000 mol wt , respectively , antigenically identical study rat human p carinii proteins purified followed molecular ion exchange chromatography native proteins apparent mol wt 290 , 000 greater , based molecular studies well cross linking studies proteins glycoproteins treatment h resulted 9 decrease mol wt carbohydrate composition rat p carinii glycoprotein distinct human isolate glucose , mannose , , occurred approximately equimolar ratios human p carinii protein , whereas glucose mannose predominant sugars rat p carinii protein evaluate humoral immune responses human p carinii protein , enzyme linked immunosorbent assay using purified protein developed , , patients subsequently developed p carinii pneumonia demonstrated serum antibody response surface antigen nearly subjects without history p carinii pneumonia detectable antibodies purified p carinii proteins greatly facilitate investigation host p carinii interactions
double blind comparison intranasal budesonide placebo nasal polyposis intranasal budesonide , 400 micrograms two times day , evaluated 36 patients referred treatment nasal polyposis age range 20 68 years polypectomy done 5 6 \( mean \) times previously 5 week , treatment free , baseline period , patients treated double blind fashion either budesonide placebo 4 weeks treatment period , placebo treated patients started receiving budesonide open trial additional 4 weeks patients rated nasal symptoms daily nasal examinations nasal inspiratory flow rate \( \) measurements done clinic visits 3 4 weeks treatment , response budesonide significantly greater response placebo greater reduction nasal blockage caused polyps , observed physical examination , p 0 005 , increase nasal \( p 0 0001 \) patient rating severity frequency nasal blockage reduced budesonide placebo \( p less equal 0 0005 \) switching placebo treated patients budesonide treatment resulted reduction nasal blockage \( p less 0 001 \) increase nasal \( p less 0 001 \) results demonstrate topical nasal budesonide , 400 micrograms two times day , effective treatment nasal polyps
expression neurophysin related precursor cell membranes small cell lung carcinoma monoclonal antibody \( mab \) small cell lung carcinoma surface antigen recognizes common epitope vasopressin neurophysin oxytocin neurophysin hypothalamic nuclei report identification neurophysin like precursor human lung carcinoma \( 1 \) cell membrane mab chromatography solubilized membranes resulted single band approximately 45 kda western blot analysis demonstrated immunoreactivity band mab , anti vasopressin , antibody vasopressin precursor , pro pressophysin n terminal sequencing band demonstrated 21 amino acid homology n terminus human pro pressophysin , substitution residue tumor antigen absence immunoreactivity antibodies described cytosolic extracts culture medium suggests processed intact pro pressophysin like peptide northern analysis 1 mrna 30 mer c terminus rat pro pressophysin resulted band approximately 1000 base pairs , 250 base pairs larger hypothalamic message situ hybridization 1 tumor bearing nude rat brain probe demonstrated specific hybridization rat hypothalamus tumor findings suggest expression pro pressophysin like protein tumor cell line preferentially targeted cell membrane
laryngeal changes exercise exercise induced asthma exercise induced asthma defined bronchospasm within distal airways initiated exercise whether larynx responds produce exacerbation alleviation symptoms attack never evaluated thirty subjects tested , including 15 normals 15 exercise induced asthma laryngeal response exercise determined measuring area glottic aperture , , exercise visualized flexible video images recorded monitoring asthma induced subjects exercise ergometer 10 minutes breathing dry air 10 degrees c measurements subsequently made recorded images relative glottic areas compared groups data quantify normal physiologic response larynx exercise demonstrate substantial laryngeal contribution asthma induced exercise
altered cellular immune function atelectatic lung pulmonary atelectasis common may predispose lung infection previously shown atelectasis impairs alveolar macrophage antibacterial function study examines effect atelectasis cytotoxic function lymphocytes harvested bronchoalveolar space atelectatic lung segments bronchoalveolar lavage specifically , studied natural killer lectin dependent cell mediated cytotoxicity peripheral blood bronchoalveolar lavage lymphocytes atelectatic lower lobes contralateral normal lobes group 8 dogs observed decline natural killer lectin dependent cell mediated cytotoxicity 62 7 61 5 , respectively , control values affected lung lobes \( p less 0 01 \) simultaneous measurements cytotoxic activity bronchoalveolar lavage lymphocytes harvested unaffected contralateral normal lungs comparable control values hand , natural killer lectin dependent cell mediated cytotoxicity activities peripheral blood lymphocytes significantly increased animals right lower lobe atelectasis \( 166 7 154 7 pretreated normal control , respectively , p less 0 01 \) atelectasis also associated influx polymorphonuclear leukocytes bronchoalveolar compartment findings confirm presence natural killer cells cytotoxic lymphocytes bronchoalveolar compartment demonstrate atelectasis induced impairment local bronchoalveolar lymphocyte function dysfunction local lung cellular host may render atelectatic lung susceptible infection
hemoptysis indications bronchoscopy indications bronchoscopy patients hemoptysis normal chest roentgenogram continue controversial reviewed records 119 performed hemoptysis patients normal \( n 75 \) \( n 44 \) chest roentgenogram bronchogenic carcinoma identified 2 5 additional neoplasms found another 2 5 presence abnormalities associated increase either rate bronchogenic carcinoma diagnostic yield \( specific anatomic diagnosis bleeding site identified \) bronchoscopy compared patients normal chest roentgenograms factors male sex , age 40 years , 40 pack year smoking history appear useful identifying patients yield bronchoscopy likely high
ultrasound assessment position tongue induction anaesthesia tongue position assessed 15 female patients induction anaesthesia either thiopentone propofol video recording midline sagittal section tongue made using ultrasound transducer placed chin , representative figures analysed observer aware patient 's state 11 satisfactory recordings , tongue movement inconsistent direction 8 mm anterior tongue 6 mm posterior tongue movements detected suggest tongue likely important cause airway obstruction induction anaesthesia
factor analysis difficult tracheal intubation laryngoscopy induced airway obstruction studied eight patients history difficult tracheal intubation , using x ray laryngoscopy local anaesthesia , curved blade standard position view obtained better recorded previously general anaesthesia two patients , third x ray showed positioning blade tip beneath would improved vision , suggesting reproducibility assessment may consistent ease intubation complementary angles may helpful assessment patients effect described whereby laryngoscopy , became posterior pharyngeal wall result tongue compression absence muscle paralysis , removal blade caused immediate correction however , anaesthesia neuromuscular block suggested occurs readily , may correct blade removed iatrogenic airway obstruction moderately difficult tracheal intubation may common anticipated
diagnostic sensitivity different techniques diagnosis lung tumors flexible fiberoptic bronchoscope comparison brush biopsy , imprint cytology forceps biopsy , histology forceps biopsy brush forceps biopsies done consecutively 186 cases pulmonary neoplasia flexible fiberoptic bronchoscope guided x ray television fluoroscopy imprint histologic sections prepared forceps biopsy specimens three techniques compared diagnostic sensitivity result 84 9 , 80 6 brush biopsy specimens , 62 9 histologic sections positive malignancy sensitivity brush biopsy specimens independent location morphology tumors , sensitivity forceps biopsy specimens lower neoplasms unidentified bronchoscopy sensitivity diagnostic accuracy three methods used jointly 97 3 , specificity 100 agreement final morphologic tumor type found 130 150 cases \( 86 7 \) positive brush biopsy specimens , 136 158 cases \( 86 1 \) positive imprint cytology , 104 117 cases \( 88 9 \) positive histology forceps biopsy specimens routine bronchoscopy , three methods used combination obtain highest diagnostic yield
prolonged venous infusion cisplatin concurrent radiation therapy lung carcinoma feasibility study fifty patients non resectable inoperable bronchogenic carcinoma entered feasibility study cisplatin \( cddp \) given continuous infusion concurrent radiation therapy radiation therapy regimen consisted 2 gy given 5 days week first 3 last 2 weeks 7 week split course \( 50 gy total dose \) cddp \( daily dose 4 6 mg m2 \) administered cover days radiation treatment means central venous catheter portable pump less 1 predicted duration infusion lost due complications related venous access pump toxicity moderate overall probability locoregional major response \( complete partial \) within 1 month treatment completion 86 twenty three patients underwent resection 1 year actuarial probability survival 64 high response survival rates warrant studies concurrent cddp continuous infusion radiation therapy inoperable lung carcinoma
life threatening airway obstruction presentation hodgkin 's disease mediastinal involvement hodgkin 's disease common significant symptoms resulting disease site less common rarely severe airway obstruction occur authors report six cases hodgkin 's disease life threatening airway obstruction major feature clinical presentation early clinical course literature describing complication reviewed general anesthesia endobronchial intubation avoided possible patients airway obstruction alternative methods diagnosis management discussed
vocal fold sulcus vocal fold sulcus cause recognized recently awareness existence combined use would enhance management group patients five cases treated initially voice therapy subsequently combined teflon injections vocal cord representative end results treatment presented good voice , subjectively objectively , obtained three patients , satisfactory improvement two
tracheostomy closure restrictive respiratory insufficiency retrospective study presented 31 patients required ventilatory support via tracheostomy periods one month 27 years whilst tertiary referral centre care patients restrictive respiratory insufficiency patients underwent closure long standing tracheostomy post operative follow periods 16 years documented indications complications tracheostomy closure patients severe chronic restrictive respiratory insufficiency requiring long term respiratory support discussed concluded benefits operative tracheostomy closure disadvantages unusual type patient
differential diagnosis lung tumor positron emission tomography prospective study predict nature non lung tumors , performed prospective study 46 cases l methyl 11c methionine \( met , 24 cases \) 18f fluorodeoxyglucose \( fdg , 22 cases \) using positron emission tomography \( pet \) mean tumor muscle radioactivity ratios 5 3 2 0 \( n 14 \) malignant 1 9 0 9 \( n 10 \) benign met \( p less 0 001 \) , 4 4 2 2 \( n 12 \) 1 5 0 3 \( n 10 \) , respectively , fdg \( p less 0 001 \) ratios indicate malignant tumors higher metabolic demand benign lesions tumors less 1 cm diameter difficult accurately evaluate due pet resolution compared diagnosis pathology , met study showed sensitivity 93 \( 13 14 \) , specificity 60 \( 6 10 \) , accuracy 79 \( 19 24 \) fdg study showed 83 \( 10 12 \) , 90 \( 9 10 \) , 86 \( 19 22 \) , respectively significant differences observed two tracers study suggests pet studies using either met fdg may useful differential diagnosis lung tumors
effectiveness antihistamine combination young children common cold randomized , controlled clinical trial tested hypothesis antihistamine combinations cause clinically significant relief symptoms upper respiratory tract infections young children randomly 96 children one three treatment groups antihistamine , placebo , treatment differences among three study groups proportion children considered better overall parent 48 hours initial assessment \( drug , 67 placebo , 71 treatment , 57 p 0 53 \) differences among groups individual composite symptom score changes two thirds parents whose children eligible drug trial believed child needed medicine cold symptoms proportion parents child needed medicine , difference participate refused parents wanted medicine initial visit reported improvement follow , regardless whether child received drug , placebo , treatment conclude clinically significant improvement symptoms upper respiratory tract infection , including significant placebo effect , young children antihistamine prescribed
prognosis idiopathic pulmonary fibrosis patients mucous hypersecretion order determine prognosis patients chronic idiopathic pulmonary fibrosis \( ipf \) , evaluated clinical , laboratory , bronchoalveolar lavage \( bal \) data onset ipf 25 patients survived beyond 1 yr \( nine women 16 men , 59 3 yr age , mean se \) patients divided two groups according whether mucous hypersecretion , 11 patients hypersecretion \( group \) poorer survival rate \( 6 yr \) 14 patients without hypersecretion \( group b \) \( 10 yr \) \( p less 0 01 \) , significant negative correlation sputum volume duration survival 25 patients \( r 0 55 , p less 0 01 \) glucocorticoid treatment , also found significantly larger numbers neutrophils \( 17 \) eosinophils \( 5 \) differential cell counts bronchoalveolar lavage fluid \( balf \) group group b \( neutrophils , 1 eosinophils , 0 6 \) \( p less 0 05 \) chest radiographic findings laboratory data including pulmonary function tests correlate survival rate findings suggest mucous hypersecretion well neutrophils eosinophils balf among determinants prognosis patients chronic ipf
serum lavage lactate dehydrogenase isoenzymes pulmonary alveolar pulmonary alveolar \( pap \) rare disease characterized accumulation material alveolar space serum lactate dehydrogenase \( ldh \) noted elevated patients pap previous studies sought extend observation series patients pap looking total serum ldh concentrations ldh isoenzyme fractions measured whole lung lavage total ldh ldh isoenzymes also determined lavage effluent total serum ldh elevated lavage 10 16 patients serum ldh alveolar arterial o2 gradient showed significant correlation \( r 0 62 , p less 0 05 \) decrease serum ldh found lavage patients data available \( paired test , p less 0 01 , n 11 \) , although magnitude decrease varied considerably isoenzyme pattern lavage , pattern unchanged whole lung lavage marked contrast ldh isoenzyme pattern observed lavage effluent , showed lower percent higher percent , , compared corresponding isoenzyme percentages serum \( test , p less 0 001 \) correlation total serum ldh concentration total lavage ldh concentration data confirm elevated serum ldh common finding pap furthermore , ldh elevation found consistently alveolar fluid points source serum ldh
breathing circuit respiratory work infants recovering respiratory failure objective compare cardiopulmonary function spontaneous breathing three continuous flow breathing circuits major difference circuits degree flow resistance offered valve design randomized crossover trial patients twelve infants less 12 months age recovering respiratory failure variable etiology patients weighing 3 10 kg studied interventions patients connected respiratory circuit random sequence , 15 min allowed assessment cardiopulmonary function airway pressure \( paw \) fio2 maintained unchanged measurements main results ventilation , gas exchange , circulatory function altered significantly changing breathing circuit however , paw esophageal pressure fluctuations altered largest breathing circuit valve high flow resistance paw recorded patient breathing flow circuit increased weight exceeded 2 cm h2o patients weighing greater 4 5 kg paw could decreased greater 2 cm h2o ten 12 patients using threshold circuit conclusions results indicate need evaluating characteristics respiratory circuits used spontaneous breathing infants children , avoid unnecessary equipment related increase respiratory work
reliability magnitude estimation dyspnea measurement reliability magnitude estimation open scale evaluated physiologically stable population adults chronic respiratory disease experienced chronic dyspnea magnitude estimation used measure one dimension dyspnea , perceptual sensitivity relationship external inspiratory resistive loads \( stimuli \) numbers reflected perceived intensity breathing effort \( response \) expressed power function measured three visits 3 5 days apart correlations power function visits high stable
lung abscess ct guided drainage lung abscesses drained means catheters guided computed tomography \( ct \) 19 patients still sepsis despite standard medical therapy patients received antibiotics least 5 days , 11 19 patients undergone bronchoscopy abscess cured \( clinical radiographic criteria \) 19 patients \( 100 \) , surgery avoided 16 19 patients \( 84 \) three patients underwent surgery removal organized tissue lung abscess complications included required chest tube one patient three minor complications \( catheter two patients transient elevation intracerebral pressure one patient \) occurred one two patients catheter traversed normal lung percutaneous drainage catheters traversed abnormal pleura route abscess 17 patients ct guided drainage lung abscess effective method treat lung abscesses refractory conventional therapy procedure obviate major operation patients catheter route abscess pleural preferable , ct useful planning route
respiratory rate greater 50 per minute clinical indicator pneumonia children cough diagnosis epidemiology acute respiratory tract infection \( \) 199 children less 5 years old investigated part study , children treated one two outpatient clinics cough less 3 weeks' duration studied test validity use respiratory rate \( rr \) greater 50 minute identifying severity necessitating treatment antibiotics first population , 69 children radiologically confirmed pneumonia , sensitivity rr greater 50 minute 54 , specificity 84 , false positive rate 16 , false negative rate 46 second population , 29 children pneumonia , sensitivity positive predictive values low validity rr greater 50 minute may vary populations different prevalences
aspiration pneumonitis risk factors management critically ill patient pulmonary aspiration gastric contents significant source patient morbidity , mortality , increased costs prevention identifying patients risk aspiration initiating prophylaxis effective method reducing complications associated aspiration pneumonitis h2 receptor antagonists among best prophylactic agents efficacy reducing gastric acidity convenience administration
diagnosis pneumocystis carinii pneumonia non invasive sampling respiratory secretions infant infected hiv presented fever , , hypoxia , radiological evidence bilateral pneumonitis fluorescent antibody technique identified pneumocystis carinii within 24 hours secretions obtained nasopharyngeal aspiration rapid , non invasive method first line investigation suspected p carinii pneumonia immunocompromised patients
air pollution fatal lung disease three utah counties unique situation found two utah counties made possible estimate fraction respiratory cancer nonmalignant respiratory disease \( \) deaths , attributable community air pollution \( cap \) one county two counties similar many ways , including low smoking rates , steel constructed ii caused substantial cap one subsequent differences mortality rates respiratory cancer striking third county , similar many counties outside utah , included analysis comparison one county , 30 40 respiratory cancer deaths attributable cap county , deaths \( respiratory cancer deaths \) slightly frequent salt county smoking rates twice high
health effects ash repeat study , japan , proximal large residential area , amount ash frequent eruptions previous study , investigated , first time , respiratory effects chronic exposure ash study demonstrated low prevalence respiratory symptoms , even area highest exposure slight excess prevalence symptoms appeared associated exposure ash confirm findings previous study , prevalence study chronic respiratory symptoms residents repeated kanoya tashiro , located 25 50 km , respectively , mt concentration suspended particulate matter kanoya frequently exceeded national environmental quality standards , summer , 2 3 times higher found tashiro women 30 59 age resided kanoya tashiro 3 completed modified questionnaire prevalence nonspecific respiratory disease low , e , 6 5 kanoya 6 2 tashiro similar prevalences found women never smoked restricted analysis individuals without history occupational exposure exposure passive smoking , slightly higher prevalence nonspecific respiratory disease kanoya tashiro , difference significant eye symptoms equally prevalent two areas
interaction chemical high vascular pressure injury isolated canine lung published erratum appears j 1991 mar 70 \( 3 \) chemical mechanical insults lung may occur concomitantly trauma , hypothesized pressure threshold vascular pressure induced \( mechanical \) injury would decreased chemical insult lung normal isolated canine lung lobes \( n , n 14 \) injured either airway acid instillation \( aai , n 18 \) intravascular oleic acid \( oa , n 25 \) exposed short \( 5 min \) periods elevated venous pressure \( hipv \) ranging 19 130 cmh2o hipv stress , capillary filtration coefficient \( kf , c \) 0 12 0 01 , 0 27 0 03 , 0 31 0 02 ml min 1 cmh2o 1 x 100 g 1 capillary pressure \( pc , \) 9 2 0 3 , 6 8 0 5 , 6 5 0 3 cmh2o n , aai , oa lungs , respectively however , pattern response hipv similar groups kf , c different pre hipv value peak venous pressure \( pv \) remained less 55 cmh2o , increased reversibly peak pv exceeded 55 cmh2o \( p less 0 05 \) reflection coefficient \( sigma \) total proteins measured pressure exposure averaged 0 60 0 03 , 0 32 0 04 , 0 37 0 09 n , aai , oa lobes respectively however , contrast result expected pore stretching occurred high pressure , groups sigma measured hipv stress pv exceeded 55 cmh2o significantly larger measured recovery period
cough enhanced mucus clearance normal lung studied effectiveness cough clearing mucus 12 nonsmoking subjects normal lung function 2 separate study days , subject 6 microns mass median diameter 99mtc labeled iron oxide particles controlled breathing conditions seated front gamma camera retention \( r \) lung activity measured initial 2 h 24 h particle inhalation control day subject front camera , cough day subject performed 60 controlled coughs 1st h retention measurements paired analysis , 1 2 h \( r2 , respectively \) cough measurements significantly less control \( mean control 85 vs mean cough 72 , p less 0 002 mean control r2 75 vs mean cough r2 65 , p less 0 02 \) retention 24 h \( \) significantly different cough control measurements \( mean cough 35 mean control 32 \) thus coughing increased rate radiolabeled particles cleared bronchial airways individuals follow experiments subjects performing rapid inhalations rather cough showed similar enhanced particle clearance seen cough results suggest observed enhancement mucus clearance cough \( rapid inhalation \) normal lung may due stimulation apparatus rather via two phase gas liquid flow mechanism
intensive weekly chemotherapy good prognosis patients small cell lung cancer weekly , intensive chemotherapy regimen used treat 70 patients small cell lung cancer \( sclc \) forty five patients limited disease \( ld \) 25 extensive disease \( ed \) good prognostic features regimen consisted cisplatin 50 mg m2 intravenously \( iv \) day 1 etoposide 75 mg m2 iv days 1 2 , alternating weekly ifosfamide 2 g m2 iv day 8 doxorubicin 25 mg m2 iv day 8 , total 12 weeks dose modifications made according defined hematologic criteria responding patients limited disease subsequently received mediastinal radiotherapy overall response chemotherapy 91 complete response \( cr \) rate 50 forty five patients limited disease \( ld \) achieved overall response rate 91 cr rate 51 , 25 patients extensive disease \( ed \) achieved overall response rate 92 cr rate 48 median survival whole group 54 weeks \( ld , 58 weeks ed , 42 weeks \) hematologic toxicity predictable , without wide fluctuations wbc count seen conventional 3 weekly regimens , one quarter treatment courses delayed , frequently leukopenia dose reductions required 63 cases average delivered dose intensity calculated shown 73 projected toxicity mild nausea vomiting common weekly schedule chemotherapy proved active well tolerated currently compared conventional 3 weekly chemotherapy randomized study
water 's edge obstetrics anesthesia meet conflict exists 's desire oral intake traditional restrictive standards obstetric anesthesia departments surveys institutions providing obstetric services reveal greatly varying oral intake policy neither evidence benefit withholding fluids evidence risk allowing prolonged fasting potential maternal mortality rare , anesthesia related causes among common etiologies aspiration significant factor modern era higher risk anesthesia morbidity associated general anesthesia , particularly difficult intubation instead implicating oral intake risk factor pulmonary aspiration , literature consistently emphasizes critical role properly trained obstetric anesthesia personnel unless candidates regional anesthesia , diet allowed use regional anesthesia well antacid prophylaxis recommended
lung scanning pulmonary embolism clinical pulmonary angiographic correlations group 78 patients suspected pulmonary embolism studied ventilation perfusion lung scanning pulmonary angiography symptoms clinical signs analysed using techniques produce pre test odds pulmonary embolism individual patients , group , embolism could discriminated without basis , major overlap existed groups , use approach individual patients strict diagnostic criteria interpretation lung scans accurate using pulmonary angiography , expense significant number patients \( 38 per cent \) indeterminate \( non diagnostic \) group 48 patients test yielded diagnostic result , sensitivity 100 per cent \( 15 15 \) specificity 97 per cent \( 32 33 \) series whole , likelihood lung scanning correctly diagnosing pulmonary embolism 55 per cent \( 15 27 \) correctly excluding embolism , 63 per cent \( 32 51 \) use strict criteria interpretation lung scanning , reliable information obtained presence absence pulmonary embolism large proportion patients suspected condition information discriminating clinical signs symptoms
natural history transplanted lung rates pulmonary functional change long term survivors heart lung transplantation long term pulmonary function well preserved evidence functional decline result transplant aging , providing allografts remain free complications long term survivors ob appear able maintain adequate oxygenation despite marked alterations pulmonary function ability preserve gas exchange reasonable levels oxygenation may factors permitting extended survival ob mean periods 36 0 months greater preliminary studies suggest declining fvc , time pulmonary function normal , may index airway disease physiologically , long term point view , remains viable option selected patients end stage cardiopulmonary disease
single lung transplantation pulmonary vascular disease six patients end stage pulmonary vascular disease received right though patients generally difficult early postoperative courses , four six survived 3 23 months achieved good recovery right ventricular function good functional results viable option selected patients severe pulmonary hypertension even right ventricular function severely impaired
body composition impedance analysis compared dilution patients chronic obstructive pulmonary disease body composition important measure nutritional status patients chronic obstructive pulmonary disease \( copd \) generated regression model impedance \( bi \) using dilution \( \) reference method 32 copd patients , aged 63 9 \( mean sd \) , stable pulmonary cardiac condition height squared divided resistance \( ht2 \) correlated well total body water \( \) measured \( r 0 93 , p less 0 001 , see 1 9 l \) best fitting regression equation predict comprised ht2 body weight \( r2 0 89 , see 1 8 l , p less 0 001 \) bi predicted used estimate bi fat free mass \( ffm \) compared thickness based ffm predictions \( ffm \) relative bi ffm significant overestimation 4 4 0 8 kg found ffm results suggest bi useful measure body composition patients severe copd
pulmonary embolectomy 20 year experience one center 1968 1988 , 96 consecutive patients acute massive pulmonary embolism underwent pulmonary embolectomy cardiopulmonary bypass operative mortality rate 37 5 analyzed 12 clinical hemodynamic variables univariate multivariate analyses assess predictive factors postoperative outcome multivariate analysis disclosed cardiac arrest associated cardiopulmonary disease independent predictors operative death long term follow \( range , 2 144 months mean , 56 months \) information available 55 60 discharged patients 6 died , 5 complained persistent mild severe exertional dyspnea \( new york heart association class ii \) results help assess preoperative risk patients undergoing pulmonary embolectomy also show , patients benefit optimal medical therapy , pulmonary embolectomy remains acceptable procedure view long term results
improved outcomes tertiary center pediatric intensive care statewide comparison tertiary nontertiary care facilities objective compare outcomes pediatric intensive care hospitals different levels resources design prospective , blinded comparison outcome care setting tertiary \( n 3 \) nontertiary \( n 71 \) hospitals southwestern washington patients critically ill children admitted respiratory failure head trauma 6 months measurements main results severity illness adjusted mortality rates determined using admission day , physiologic profiles \( pediatric risk mortality score \) care modalities assessed daily crude mortality rate tertiary patients four times higher nontertiary patients \( 23 4 vs 6 0 , p less 0001 \) tertiary patients , numbers outcomes accurately predicted physiologic profiles \( observed 30 deaths 98 survivors predicted 29 3 deaths 98 7 survivors , z 25 , p greater 4 \) however , nontertiary patients , number deaths significantly different predicted \( observed 20 deaths 315 survivors predicted 14 4 deaths 320 6 survivors , z 2 08 , p less 05 \) odds ratios dying nontertiary vs tertiary facility 1 1 , 2 3 , 8 \( p less 05 \) mortality risk groups less 5 , 5 30 , greater 30 patients tertiary facilities received \( p less 05 \) invasive \( e g , arterial catheters \) complex \( e g , mechanical ventilation \) care , whereas patients nontertiary facilities received \( p less 05 \) labor intensive care \( e g , hourly vital signs \) conclusions care seriously ill children tertiary pediatric icus could improve chances survival
inhibition methylprednisolone leukocyte induced pulmonary damage background methods purpose study twofold development chronic model leukocyte mediated pulmonary injury evaluation protective effects methylprednisolone rabbits inoculated ip zymosan blood gases circulating leukocytes evaluated survivors killed day 10 microscopic studies evaluation lung lipid peroxidation product malondialdehyde results intraperitoneal zymosan resulted marked decrease pao2 circulating leukocytes , increased cellularity alveolar septa , interstitial edema , increased lung malondialdehyde pulmonary damage partially prevented methylprednisolone administered zymosan inoculation , methylprednisolone given 24 hr later conclusions authors conclude local nonseptic inflammatory stimulus may provoke remote changes lungs methylprednisolone may counteract process administered early onset inflammation
use biotinylated dna probe specific human chromosome evaluation allograft lung cloned 3 4 kilobase dna probe derived chromosome used investigate regeneration allograft lungs nine recipients received sex mismatched donor organs patients monitored varying periods time , four years , biopsy situ hybridization paraffin embedded biopsies utilizing probe revealed bronchial alveolar epithelium arterial venous endothelium peripheral lung retained donor phenotype , irrespective episodes acute chronic rejection \( obliterative bronchiolitis \) known cellular subsets contrast , cells , lymphocytes macrophages , gradually , varying rates , infiltrated lungs , replacing preexisting donor elements cases active ob manifested infiltration bronchioles sex mismatched lymphocytes however , instances , quiescent recipient lymphocytes allograft histologic rejection macrophages similar sex seemed cluster together within air spaces use dna probe chromosome situ hybridization techniques allow monitoring cellular alterations time recipients sex mismatched allografts
lymphokine activated killer cell activity lung cancer study evaluates local pulmonary immune effector cell lytic activity purified lymphocyte populations isolated balf obtained 18 patients bronchogenic carcinoma , six patients lung disorders cancer , ten normal control volunteers matched age smoking history cells evaluated nk lak cell lytic activity nk resistant lak sensitive tumor targets \( pulmonary tumor tumor cells \) nk sensitive tumor \( k562 \) lak activity detected balf 6 18 patients cancer remaining patients cancer , subjects pulmonary disease cancer , normal volunteers detectable lytic activity peripheral blood lymphocytes subjects nk lytic activity kill pulmonary tumor target ams interleukin 2 , required lak cell activation , detected balf recovered six patients pulmonary lak lytic activity results demonstrate activated lak cells , capable killing pulmonary tumor cells , present balf patients bronchogenic carcinoma lytic lak cell population represents local pulmonary response lung cancer absence systemic activity functional status pulmonary immune effector cells , well type quantities cytokines lung determine local responsiveness bronchogenic carcinoma may well control course disease
magnetic resonance imaging diagnosis pulmonary infarction report first time , knowledge , mri features could differentiate noninvasively pulmonary infarction pneumonia three subjects angiographically proven pulmonary infarction showed high t1 weighted mri signals located embolic territory three patients pneumonia one patient emboli , without infarction , t1 weighted images
amiodarone induced pulmonary toxicity tests bronchoalveolar lavage phospholipid content amiodarone \( \) widely used antiarrhythmic drug pulmonary toxicity serious adverse effect estimated mortality 1 33 percent order determine element helpful diagnosis , examined four patients amiodarone induced pulmonary toxicity , three patients treated , without evidence pulmonary toxicity main underlying pulmonary disease , four healthy volunteers daily cumulative doses duration treatment similar first two groups pulmonary function tests \( spirometry , co diffusing capacity , arterial blood gases \) , roentgenographic examinations , pulmonary biopsies tests \( skin reaction , lymphoblastic transformation test human degranulation test \) provide discriminatory element apt , observed increased cellularity bronchoalveolar lavage neither differential cell count presence macrophages distinguishable apt apt phospholipid composition bal fluid showed decreased total phospholipid phospholipid protein ratio patients compared normal subjects changes reflect severity pulmonary disease specificity causative agent however , observed unique pl decreases apt remains normal apt phosphatidyl serine phosphatidylinositol \( ps pi \) confirmed evaluated different stages disease determine eventual specific element conclude data currently available establish diagnosis apt except perhaps analysis bal pl content
effect fast vs slow intralipid infusion gas exchange , pulmonary hemodynamics , prostaglandin metabolism intralipid \( 20 percent , 500 ml \) infused fast \( 5 h \) slow \( 10 h \) randomly patients lung injury relate changes plasma prostaglandin \( pg \) concentrations gas exchange pulmonary hemodynamics data collected baseline , infusion , 2 h following infusion vasodilator vasoconstrictor pg metabolites , 6 keto pgf1 alpha , thromboxane b2 , respectively , measured radial arterial blood samples slow intralipid infusion increased shunt fraction \( qs qt \) without changing mean pulmonary artery pressure \( mpap \) , whereas fast intralipid infusion increased mpap without changing qs qt prostaglandin levels change significantly either infusion however , groups pg substrate removed , hemodynamic metabolite values decreased parallel conclusion , unable demonstrate cause effect relationship plasma levels 6 keto pgf1 alpha thromboxane b2 observed pulmonary hemodynamic response slow fast intralipid infusion
treatment atelectasis selective bronchial suctioning use curved tipped catheter guide mark applied technique selective bronchial suctioning \( \) treatment atelectasis \( \) middle lower lobes nine patients refractory successfully treated considered using curve tipped catheter guide mark \( \) technique choice treatment refractory conventional respiratory therapy effective available
giant cell interstitial pneumonia giant cell interstitial pneumonia distinctive uncommon form interstitial pneumonia distinguished prominence large , actively phagocytic alveolar giant cells origin presence chronic interstitial pneumonia multinucleated type 2 granular also identified multinucleated cells lack viral intranuclear inclusions type seen measles pneumonia giant cell interstitial pneumonia may idiopathic may occur occupational exposure hard cobalt report case give recognition uncommon interstitial pneumonia
return tuberculosis screening preventive therapy approximately 25 percent individuals exposed mycobacterium tuberculosis become infected , 10 percent develop clinically active tuberculosis time lives tuberculin skin test used screen patients , especially greatest risk contracting disease , young old , immune systems poor nutrition , alcohol drug abuse , chronic illness human immunodeficiency virus infection depending characteristics local population individual medical risk factors , reaction \( \) 5 15 mm \( \) generally represents infection isoniazid therapy persons positive skin tests decrease risk disease 60 80 percent family physicians play critical role efforts eliminate tuberculosis united states year
adult respiratory distress syndrome basic scientists clinicians written numerous articles diverse causes adult respiratory distress syndrome \( ards \) specific diagnostic test ards condition characterized interstitial lung edema , reduction lung compliance , alveolar small airway closure , decrease functional residual capacity , persistent hypoxia increasing amounts pulmonary blood flow poorly ventilated recent studies emphasized roles macrophages polymorphonuclear neutrophils lung defense injury advances understanding pathophysiology ards produced little significant change clinical management syndrome specific treatment ards therapy early recognition elimination initiating factors sepsis ards single disease process , appears represent final common pathway manifestation variety lung injuries goal therapy eliminate predisposing condition support patient new modes ventilatory pharmacologic therapy presented
quantitation abnormal 67ga uptake pulmonary interstitial vascular disease new test detect diffuse lung disease gallium 67 used modality diagnose follow clinical course diseases tumors , infections , inflammatory disorders , interstitial lung disease appreciated , however , mild moderate changes scan activity , disorders followed time , less optimal spect \( single photon emission computed tomography \) scanning new technique designed obviate problem spect scanning utilizes computer acquisition provide three dimensional scanning additional benefit aid differences uptake spect scanning performed 22 patients interstitial lung disease various etiologies additionally , 7 patients follow spect scanning determine response treatment two patients presented examples
immunoglobulin g cytoplasmic antibodies produced respiratory tract patients wegener 's granulomatosis wegener 's granulomatosis \( wg \) small vessel vasculitis unknown etiology usually involves upper lower respiratory tract kidneys recently , association made presence serum cytoplasmic antibodies \( anca \) wg wg frequently involves lung , sought evaluate bronchoalveolar lavage \( bal \) fluids obtained 14 patients wg presence anca immunoglobulin \( ig \) g anca found bal staining patterns observed serum patients active disease highest serum bal igg anca titers iga igm anca detected serum bal patients protein analysis bal fluid revealed patients active , untreated wg approximately fourfold elevation total protein \( 41 3 versus 10 5 mg dl \) , disproportionately greater increase ratio igg albumin \( bal igg index 1 49 , normal 0 74 p 0 027 \) increase igg index patients active wg suggests local production igg anca occurs lungs
size distribution human lung elastin derived peptide antigens generated vitro vivo protease hypothesis emphysema development suggests degradation elastin lung interstitium may give rise abnormal quantities circulating elastin derived peptides \( edp \) periods inflammation recent studies shown relationship emphysema high levels edp human plasma report characterizes elastin basis antigenicity , size , method preparation , well size distribution edp found nonsmokers , smokers , emphysema patients gel filtration elastin prepared hydrolysis human lung elastin using low \( 1 500 \) ratio neutrophil elastase elastin generated broad protein peak approximately 70 , 000 daltons contrast , high \( 1 25 \) ratio neutrophil elastase human lung elastin gave broad protein peak , size distribution 10 , 000 30 , 000 range digest showed distinct immunochemical properties polyclonal antibody directed low ratio digest showed minimum detection 2 ng ml homologous antigen required 1 , 000 ng ml high ratio digest detectable inhibition indirect elisa assay gel filtration normal nonsmokers majority normal smokers revealed single immunoreactive edp fraction approximately 70 , 000 daltons selected normal smokers emphysema patients high levels circulating edp \( greater 90 ng ml \) fractionated complex pattern peptides 70 , 000 component represented 50 immunoreactive material several lower molecular weight peptides represented remaining circulating elastin antigens
ten year follow study cotton textile workers follow study respiratory function cotton textile workers performed 10 yr original cross sectional study \( 1975 1985 \) 35 nonsmoking female 31 smoking male textile workers restudied original group 116 majority lost follow left industry prevalence among female workers time follow 15 35 \( 42 9 \) compared 8 35 \( 22 9 \) time initial study \( p 0 \) men prevalence follow 16 31 \( 51 6 \) compared 8 31 \( 22 9 \) time initial study \( p 0 03 \) similarly , prevalence almost respiratory symptoms significantly higher follow time initial study significant across shift decrements fev1 fvc documented surveys mean annual decline ventilatory capacity greater expected female \( fvc 0 036 0 005 l yr fev1 0 059 0 009 l yr \) male workers \( fvc 0 059 0 008 l yr fev1 0 0 006 l yr \) \( mean se \) mean total airborne dust concentration measured time follow study 3 95 mg m3 average dust concentration 0 97 mg m3 conclude continued exposure high dust concentrations cotton textile industry associated increasing prevalence respiratory symptoms progressive impairment lung function increase respiratory impairment seen smokers nonsmokers
relationship respiratory symptoms pulmonary function , nicotine , carbon monoxide yield cigarettes data consecutive surveys epidemiologic study \( 1981 1988 \) used evaluate relationship cigarette smokers respiratory symptoms pulmonary function , nicotine , carbon monoxide \( co \) yields cigarette subjects reported smoking regularly least one survey , age 15 adjustment intensity duration smoking depth inhalation , risk chronic , cough , dyspnea related nicotine yields subjects pulmonary function tested least one three surveys spirometric indices used significantly related daily dose , nicotine , co \( product cigarette yield daily number cigarettes smoked \) effects pronounced past current doses however , differentiation pulmonary function due various yields cigarettes small comparison difference pulmonary function smokers nonsmokers
protective effect theophylline bronchial hyperresponsiveness patients allergic rhinitis disorders upper respiratory tract , particularly allergic rhinitis commonly associated bronchial hyperresponsiveness latter may responsible chronic cough , common symptom patients allergic rhinitis , , previously shown , sole presenting manifestation bronchial hyperresponsiveness theophylline widely used patients asthma bronchodilator effect , whereas action bronchial reactivity controversial aim study determine effect theophylline administration bronchial hyperresponsiveness patients allergic rhinitis complaining chronic cough fourteen patients studied judged atopic basis positive skin tests common allergens control , spirometry , flow volume curves specific airway conductance \( sgaw \) measured bronchial challenges performed increasing concentrations carbachol , dose response curves constructed concentration carbachol , decreased sgaw 35 baseline \( pd35 \) determined dose response curve control measurements patients received randomized , double blind crossover fashion either theophylline 10 mg kg day orally placebo 30 days measurements washout period 8 days measurements repeated , patients received theophylline placebo second period 30 days measurements performed end last study period control patients normal baseline lung function data showed marked bronchial hyperresponsiveness , pd35 26 7 micrograms carbachol \( normal value greater 160 micrograms \) significant changes pd35 noted placebo washout compared control values
lymphokine induced airway hyperresponsiveness rat evaluated potential role lymphocyte chronic airway inflammation responsiveness repeated administration rats interleukin 2 \( il 2 \) , principal lymphokine responsible lymphocyte proliferation lewis rats \( mean weight , 184 2 g \) received either 120 , 000 units il 2 \( n 10 \) vehicle \( n 7 \) subcutaneously twice day 4 5 days animals anesthetized intubated measurements pulmonary resistance \( rl \) airway responsiveness aerosol methacholine \( mch \) lung lavage performed , animals , lungs fixed 10 formalin histologic edema extent infiltration bronchi , pulmonary veins , arteries cells scored blindly il 2 increased airway responsiveness mch concentrations mch causing doubling rl 0 14 versus 1 39 mg ml \( geometric mean \) il 2 vehicle group , respectively \( p 0 001 \) il 2 significantly increased total cellular return percentage lymphocytes , neutrophils , eosinophils lavage il 2 caused edema mixed cellular infiltration tree lymphocytes predominated around airways veins correlation \( r 0 50 \) present airway responsiveness airway inflammation edema vascular infiltration release il 2 lymphocytes airways may important mediator airway hyperresponsiveness
acute effects interleukin 2 lung mechanics airway responsiveness rats studied acute effects interleukin 2 \( il 2 \) , principal lymphokine responsible lymphocyte proliferation , lung mechanics airway responsiveness methacholine \( mch \) rats lewis \( n 12 \) fisher 344 \( n 13 \) rats anesthetized intubated , intravenous intra arterial lines inserted il 2 \( 750 , 000 u kg \) infused intravenously 2 4 min seven lewis seven fisher rats , vehicle alone administered five lewis six fisher rats blood pressure , heart rate , respiratory frequency \( f \) , tidal volume \( vt \) , minute ventilation \( \) , lung resistance \( rl \) measured every 5 min 45 min infusion il 2 lung compliance measured 30 min il 2 bronchial provocation testing mch performed 45 min infusion il 2 subsequently , animals , lungs removed histologic examination infused il 2 alter heart rate blood pressure , vt , f , , rl increased significantly 15 min \( p less 0 05 \) , returned baseline 45 min lung compliance decreased significantly rat strains il 2 increased airway responsiveness lewis rats concentration mch caused doubling rl \( \) 0 6 mg ml 4 3 mg ml \( p 0 003 \) il 2 treated control rats , respectively airway responsiveness change significantly fisher rats 0 13 0 35 mg ml il 2 treated control rats , respectively \( p 0 09 \)
morphometric analysis lung bronchopulmonary dysplasia studied lung development children without bronchopulmonary dysplasia \( bpd \) using light microscopic morphometry thick lung sections stained elastic fibers one lung obtained autopsy eight patients bpd \( ages , 2 28 months \) six children \( ages , 5 days 51 months \) died without lung disease patients bpd demonstrated severe somatic growth retardation reduced lung volumes abnormal lobar volume proportions central bronchi mean volume proportion glands smooth muscle increased bpd bronchiolar density also increased , tended normalize advancing age mean bronchiolar diameter slightly smaller bpd , bronchiolar smooth muscle hypertrophy constant histologic feature striking change , however , noted alveolar structure development total alveolar number severely decreased patients bpd compared control subjects , little evidence compensatory alveolar development increasing age lung internal surface area correspondingly reduced , mean linear intercept increased sections stained elastic tissue demonstrated patients bpd simplified acinar structure thickened , tortuous , distributed alveolar elastic fibers conclude severe , fatal bpd marked impairment lung development alveolar hypoplasia reduced internal surface area addition , bronchial bronchiolar smooth muscle hypertrophy bronchial gland hyperplasia may important contributing factors airflow limitation
characteristics children develop complication pulmonary edema review performed 234 consecutive cases occurred 20 year period delineate rate , clinical characteristics associated , complication pulmonary edema result prior utilization dual management protocol , 170 children received endotracheal intubation , 64 children managed without placement artificial airway , five children \( 2 1 \) varying ages developed complication experienced severe airway obstruction progressing respiratory arrest , evidence pulmonary edema developing shortly endotracheal intubation two five children died due complications resulting upper airway obstruction induced cardiorespiratory arrest contrast , child milder degrees airway obstruction managed without artificial airway exhibited clinical evidence pulmonary edema several possible mechanisms development complication described pulmonary edema associated uncommon complication occur following endotracheal intubation patients marked respiratory insufficiency artificial airway instituted cases pediatric potential complication pulmonary edema anticipated placement artificial airway , especially patients severe degree upper airway obstruction
screening lung cancer mayo lung project national cancer institute united states recently three large scale , randomized controlled trials screening early lung cancer trials conducted medical institutions , memorial sloan kettering cancer center , mayo clinic participants middle aged older men chronic heavy cigarette smokers thus high risk developing lung cancer screening procedures chest radiography sputum cytology , screening tests established value detecting early stage , asymptomatic lung cancer memorial trials study population offered yearly chest radiography plus sputum cytology every 4 months control population offered yearly chest radiography trials addition sputum cytology appeared confer lung cancer mortality rate advantage mayo clinic trial compared offering chest radiography sputum cytology every 4 months offering advice two tests obtained year trial demonstrated significantly increased lung cancer detection , resectability , survivorship group offered screening every 4 months compared control group however , significant difference lung cancer mortality rate two groups statistical power trials somewhat limited nevertheless , results justify large scale radiologic cytologic screening early lung cancer time
applications imaging lung cancer applications imaging lung cancer patient become focused recently screening high risk patients recommended even though clinical judgment practice justify use chest radiographs patient category cross sectional imaging procedures tailored staging process individual large central primary confirm abnormality noted chest radiographs patient high risk thoracotomy generally also subjected radiologic staging radiologic staging process reviewed , emphasizing role identifying disease sites would suggest
differentiation intensity breathlessness distress normal subjects exercise 1 study designed examine whether normal subjects could differentiate 'intensity' breathlessness amount 'distress' evoked , specific 2 preliminary study showed significant difference 'distress' score exercise measured two separate occasions \( p 0 3 \) 3 ten subjects performed two identical incremental cycle ergometer exercise tests separate occasions asked quantify either 'intensity' 'distress' using modified scales 4 subjects significant correlation \( p less 0 001 \) 'intensity' minute ventilation eight subjects significant correlation \( p less 0 05 \) 'distress' minute ventilation one subject displayed significant correlation one registered distress 5 mean 'intensity' greater mean 'distress' \( p 0 0001 \) slope 'intensity' minute ventilation greater slope 'distress' minute ventilation \( p 0 0001 \) 6 within individuals significant correlation 'intensity' 'distress' \( p less 0 05 \) wide scatter slope relationship subjects maximum 'intensity' 'distress' correlate 7 different elements breathlessness sensation could identified selectively measured depending given subject 8 wide variation magnitude breathlessness 'intensity' 'distress' estimates , differences subjects two components sensation appear follow common pattern
pneumonia update diagnosis treatment pneumonia common infectious disease necessitating hospitalization elderly patients number exist regarding clinical radiological features pneumonia elderly patients early recognition appropriate therapy reduce morbidity enhance survival article explores manifestations pneumonia elderly , well diagnostic approach contemporary therapy
ever role salvage operations limited small cell lung cancer \? combined modality treatment chemotherapy radiation produces tumor regression patients small cell lung cancer , impact survival small , less 20 patients limited disease survive 2 years survival time extremely short failure respond relapse treatment local control remains problem , one third patients recurrence primary site attempt prolong survival perhaps achieve cure , undertook surgical resection 28 patients limited small cell lung cancer complete remission standard treatment local recurrence treatment 28 patients , 22 male six female , median age 61 years \( range 41 76 \) patients treated chemotherapy 13 received preoperative radiotherapy primary site mediastinum eight patients underwent operation relapse complete remission five patients response treatment , three slight response followed progression chemotherapy , 12 achieved partial response greater 3 cm residual masses twelve patients required pneumonectomy , 15 lobectomy , one patient unresectable disease , two bulky residual masses operation three others microscopic residual disease pathologic examination showed small cell lung cancer 18 patients , mixed small cell non small cell four , non small cell lung cancer six four patients stage disease , 10 stage ii , 14 stage iii median survival date diagnosis entire group 105 weeks date operation , 74 weeks projected 5 year survival rate 23 two patients residual masses died local progression , distant metastatic disease developed 17 others one patient died 6 years without recurrent disease eight patients alive 2 5 years diagnosis seven patients required lobectomy , four stage disease , two stage ii , two stage iii disease five pure small cell lung cancer three mixed small cell non small cell tumors patients pathologic stage disease remain alive compared one 10 stage ii disease two 14 stage iii summary , relapse failure respond chemotherapy may due non small cell lung cancer mixed tumor \( abstract truncated 400 words \)
radon health radon daughter decay products thought cause 5 lung cancer uk assessment made national radiological protection board \( \) national survey radon levels homes , anticipated found high levels , reappraisal effectiveness radon daughter products causing lung cancer review scientific evidence reveals direct evidence radon decay products levels found homes lung cell carcinogenesis issue involves different scientific highly complex debate scientists required epidemiological studies lung cancer low radon exposure necessary indirect evidence linking low levels radon exposure lung cancer insufficient warrant action proposed accepted uk
modified muscle sparing posterolateral thoracotomy modified posterolateral thoracotomy described combines advantages complete muscle sparing thoracolumbar fascial slide excellent exposure technique easy perform procedure associated relatively little postoperative pain , coughing effective , early ambulation achieved experience approach first 49 patients suggests offers attractive alternative standard muscle cutting posterolateral thoracotomy approach elective procedures
inhaled gentamicin powder new delivery system forty patients undergoing routine bronchoscopy randomised receive inhaled gentamicin powder \( 180 mg \) gentamicin solution \( 160 mg \) one hour procedure similar levels gentamicin detected bronchoalveolar lavage fluid two groups \( powder \( n 20 \) 9 3 \( sd 9 3 \) mg l , solution \( n 20 \) 8 0 \( 7 8 \) mg l \) gentamicin powder preparation caused cough half patients stop receiving full dose dry powder gentamicin may convenient formulation long term inhaled treatment problem cough overcome
selective differences macrophage populations production resolving pulmonary granuloma fibrosis alveolar macrophages \( \) production interleukin 1 like activity \( il 1 \) macrophage derived growth factor fibroblasts \( \) examined chronic inflammatory reactions leading either granuloma formation fibrosis groups five rats received , respectively , single injection , , short chrysotile , chrysotile b asbestos , saline one month later , treatments induced either change \( \) , granuloma formation \( short chrysotile \) , fibrosis \( chrysotile b \) 8 months , however , granulomatous reactions resolved greatly diminished , whereas fibrosis persisted irreversibly parallel examination cell populations obtained bronchoalveolar lavage revealed multinucleated giant macrophages \( \) present lavage fluids animals resolving granulomatous reactions absent obtained animals lung fibrosis evaluation production inflammatory macrophages also revealed significant differences enhanced production il 1 like activity seen types lung injury , although especially early stage \( 1 month \) decreased thereafter \( 8 months \) contrast , augmentation production observed animals lung fibrosis persisted 9 months taken together , data indicate production selected cytokines , well differentiation along given pathway , may modulate outcome chronic inflammatory response
treatment intractable aspiration using laryngeal stent twenty five patients treated laryngeal stent potentially reversible chronic aspiration life threatening magnitude causes intractable aspiration diverse included chronic neurologic disease , extensive head neck surgery , severe gastroesophageal reflux advantages technique noted comparison invasive procedures disadvantages laryngeal stent complications encountered also covered long term results show one patient significant improvement chronic aspiration stent place however , eight patients achieved adequate oral without aspiration following stent removal
surgical applications flexible infants flexible controlled distal allow conventional diagnostic examination lower airways even smallest infants instruments may passed small endotracheal tracheostomy tubes ventilation maintained thus possible , direct visualization , control manipulation surgical instruments could otherwise seen , study airway dynamics anatomy intraoperatively without patient
radiological abnormalities among sheet metal workers construction industry united states canada relationship asbestos exposure investigated possible adverse health effects sheet metal workers past exposure asbestos cross sectional medical examination 1 , 330 workers conducted 1986 1987 seven cities united states canada total 1 , 016 workers employed least 35 industry , mean duration onset asbestos exposure 39 5 \( sd 7 41 \) chest x ray abnormalities found half group pleural fibrosis , frequently found abnormality , present 47 0 cases abnormality found 27 8 cases parenchymal interstitial fibrosis , found 33 1 cases , abnormality found 16 2 cases radiologic abnormalities increased duration exposure increased positive smoking history associated higher prevalence radiologically detectable parenchymal abnormalities , finding confirmed us others dyspnea exertion graded medical research council questionnaire , 's self assessment , detailed 12 point scale questionnaire persons marked shortness breath , approximately one third slight dyspnea individuals radiologic abnormalities experienced shortness breath radiologic abnormalities cigarette smoking also resulted higher prevalence dyspnea results indicate past , construction sheet metal workers significantly exposed asbestos job every effort made minimize anticipated serious health consequences , asbestos exposure continue trade avoided
lymphocytes cells human nasal polyps immunohistochemical performed polyp specimens 48 patients mucosal biopsy specimens middle inferior turbinates 23 28 patients , respectively significantly cd8 \( suppressor cytotoxic \) cd4 \( helper inducer \) cells found polyps number cd2 , cd4 , cd8 lymphocytes nasal polyps similar number macroscopically unaffected mucosa middle turbinates , whereas scores inferior turbinates lower healthy subjects , differences smaller b cells detected varying numbers polyps less organized clusters significantly hla dr cells found polyps middle turbinates inferior turbinates eosinophils found moderate large numbers polyps 77 patients mast cells plasma cells detected moderate numbers , whereas neutrophils found 35 patients middle inferior turbinates varying small numbers eosinophils , mast cells , plasma cells , neutrophils found considering findings , role chronic inflammation cell dependent disturbances discussed regard pathogenesis nasal polyps
bronchopulmonary dysplasia improvement lung function 7 10 years age evaluate natural history bronchopulmonary dysplasia , studied 32 patients mean age 7 10 years group whole normal height weight percentiles , child grew along established somatic growth curve although children abnormal values , group maintained normal mean total lung capacity functional residual capacity mean residual volume residual volume total lung capacity ratios elevated ages age 7 years 19 patients \( 59 \) forced expiratory volume 1 second \( fev1 \) less 80 improvement 10 years age \( 65 11 72 16 predicted value p less 0 05 \) children normal fev1 7 years age continued normal fev1 age 10 years resting single breath carbon monoxide uptake lung normal measured age 10 years majority patients positive methacholine challenge test result ages , although low incidence clinically diagnosed asthma study demonstrates patients bronchopulmonary dysplasia normal lung function age 7 normal lung growth evidence mild moderate lung disease continued lung growth repair , , school years
pulmonary atelectasis signal patterns mr imaging assess signal characteristics different types pulmonary atelectasis magnetic resonance \( mr \) images , authors studied obstructive atelectasis \( oa \) 17 patients nonobstructive atelectasis \( noa \) 25 patients patients underwent electrocardiographically gated mr imaging studies thorax standard spin echo sequences signal differences observed either type atelectasis t1 weighted images conversely , oa noa appeared significantly different spin density weighted images \( p less 001 \) t2 weighted studies \( p less 0001 \) t2 weighted images , 17 cases oa appeared , whereas 22 25 cases noa demonstrated low signal intensity differences pathophysiology oa noa presumably account observation oa , alveolar air totally resorbed secretions accumulate obstructed lung resulting increase free fluid prolongs t2 relaxation times leads high signal intensity t2 weighted images noa , short t2 relaxation time lung tissue absence secretions potential magnetic susceptibility effects due residual air likely responsible low t2 signal pattern
apical opacity associated pulmonary tuberculosis high resolution ct findings elucidate nature apical opacity commonly seen patients tuberculosis usually referred apical cap apical pleural thickening 18 patients upper lobe tuberculosis studied high resolution computed tomography \( \) homogeneous apical opacity least 1 cm thick chest radiographs fifteen 18 history pulmonary tuberculosis 5 years duration , nine showed evidence ipsilateral scans apex thorax nine patients scanned level showed extrapleural fat vessels accounted plain radiographic opacity scans obtained level slightly visible lung showed extrapleural fat 3 25 mm thick peripherally atelectatic lung centrally caudal levels , lung thickened pleura visible plain radiographs , showed extrapleural fat \( 3 20 mm thick \) , thickened pleura \( 1 3 mm thick \) , atelectatic lung peripherally areas bullae , bronchiectasis , atelectatic lung centrally
interstitial lung disease impact digital storage imaging ability resolve fine linear structures interstitial lung disease one measure limiting performance characteristics imaging system conventional screen film radiography compared six algorithms storage digital radiography \( 0 2 mm x 10 pixel matrix \) detection interstitial lung abnormality documented means computed tomography 40 patients abnormalities 25 healthy control subjects performance evaluated analysis variance \( fisher paired comparison test p less 05 \) average receiver operating characteristic area 2 , 730 observations six readers moderately markedly high frequency edge enhanced algorithms storage digital radiographs equivalent performance screen film radiography mode , low medium frequency edge enhanced algorithms , gray scale reversed mode storage digital radiography inferior screen film radiography authors conclude high frequency edge enhanced algorithms perform well screen film radiography detection interstitial disease
outpatient assessment infants bronchiolitis two hundred thirteen infants younger 13 months bronchiolitis prospectively followed identify historical , physical , laboratory clues initial emergency department evaluation would help predict disease severity based total course illness , patients classified mild \( 139 patients \) severe \( 74 patients \) disease , initial emergency department evaluation findings two groups compared six independent clinical laboratory findings identified strongly associated severe illness \( 1 \) ill toxic general appearance \( 2 \) oxygen saturation less 95 , determined pulse oximetry \( 3 \) gestational age , younger 34 weeks \( 4 \) respiratory rate , 70 min greater \( 5 \) atelectasis chest roentgenogram \( 6 \) age , younger 3 months infant 's oxygen saturation determined pulse oximetry single best objective predictor severe disease
role passive immunity bovine respiratory syncytial virus infected calves role passive immunity bovine respiratory syncytial virus \( brsv \) infections neonatal calves evaluated calves divided groups follows colostrum deprived , sham inoculated colostrum deprived , brsv inoculated colostrum fed , brsv inoculated calves inoculated low passage field isolate brsv 4 consecutive days combined respiratory tract route 6 days receiving last inoculation arterial oxygen tension \( pao2 \) decreased significantly time colostrum deprived , brsv inoculated calves \( p less 01 \) significantly different among treatment groups \( p less 05 \) significant decrease arterial oxygen saturation observed group time \( p less 01 \) mean percentage lung volume \( determined computer data \) significantly greater infected , colostrum deprived calves compared groups \( p less 01 \) , brsv antigen detected calves avidin biotin immunoperoxidase staining thus , passive immunity derived colostrum feeding decreased severity brsv infections calves
immune responses bordetella pertussis infection vaccination assess antibody cellular immune responses , 156 healthy children immunized approximately 18 months age diphtheria tetanus pertussis vaccine changes antibody responses filamentous \( fha \) pertussis toxin \( pt \) similar pattern , antibody titers reached values equal patients stage pertussis fha induced dna synthesis peripheral blood mononuclear cells maximum 4 weeks primary series , levels equal patients pertussis high amounts pt induced dna synthesis observed immunized children thus , pt seemed act mainly nonspecific mitogen almost responses several mitogens activate different subsets lymphocytes observed young infants compared older children furthermore , young infants bordetella pertussis infection responded fha stimulation almost well older children
detection characteristic fungal protein elongation factor ef 3 pneumocystis carinii status pneumocystis carinii uncertain , p carinii categorized fungus recent comparisons rna sequence p carinii several fungi suggest p carinii affinities systems fungi , however , require three soluble protein factors peptide chain elongation rather two necessary eukaryotic systems date additional protein elongation factor \( ef 3 \) appears unique fungi western blot analysis cell free extracts p carinii , derived rat , done using polyclonal antibody raised rabbits saccharomyces cerevisiae ef 3 anti ef 3 cross reacting material detected lysates candida albicans cerevisiae included fungal controls cross reaction detected lysates p carinii , p carinii infected rat lung , control \( \)
meta analysis epidemiology , special reference studies association exposure environmental tobacco smoke lung cancer meta analysis , set statistical tools combining results independent studies given scientific issue , useful stringent conditions integration valid met report point difficulties obtaining sound meta analyses either controlled clinical trials epidemiological studies demonstrate designed meta analyses lead results may scientifically valid note much care typically taken meta analysis applied results clinical trials food drug administration , example , requires strict adherence principles discuss paper allows drug 's use meta analysis separate clinical studies support new drug application care always carry epidemiological studies , demonstrated 1986 report national research council concerning association exposure environmental tobacco smoke risk lung cancer basis meta analysis 13 studies , 10 retrospective remaining 3 prospective nature , council concluded non smokers exposed environmental tobacco smoke greater risk acquiring lung cancer non smokers exposed opinion , conclusion given poor quality studies based
monoclonal immunofluorescence compared silver stain investigating pneumocystis carinii pneumonia two hundred eighty two specimens 220 patients positive hiv respiratory tract symptoms , febrile illness , , examined presence pneumocystis carinii specimens either induced sputum samples bronchoalveolar lavage fluids establish optimal method laboratory diagnosis comparison made detection organism use monoclonal antibody immunofluorescence conventional silver staining methods three commercially available reagents immunofluorescence also compared immunofluorescence significantly sensitive silver stain best results immunofluorescence obtained using reagents
pneumothorax patient wegener 's granulomatosis treatment immunosuppressive agents present case 16 year old woman wegener 's granulomatosis , developed pneumothorax receiving treatment cyclophosphamide glucocorticoids lung expanded tube drainage , patient recovered completely immunosuppressive treatment continued combination trimethoprim possible role antimicrobial drug treatment wegener 's granulomatosis briefly discussed
upper respiratory tract infections upper respiratory tract infections among common acute infections humans review discusses clinically important aspects epidemiology , etiology , clinical presentation , diagnosis , management , complications , prevention common cold , , otitis media , episodes common cold viral origin , curative therapy available streptococcal , acute otitis media , secondary bacterial infections , antibiotic therapy important
pharmacokinetics cefepime patients respiratory tract infections steady state pharmacokinetics cefepime evaluated 10 middle aged elderly patients acute lower respiratory tract infections receiving 1 g intravenously every 12 h one 15 serum samples total urine output collected one dosing interval days 3 8 therapy cefepime concentrations serum time exhibited profile peak trough concentrations serum determined validated high performance liquid chromatography method 71 2 17 2 \( mean standard deviation \) 6 0 4 9 mg liter , respectively steady state volume distribution 0 22 0 05 liter kg elimination half lives ranged 1 93 6 04 h \( 3 92 1 28 h \) , total body clearances ranged 36 9 102 ml min per 1 73 m2 \( 73 0 19 7 ml min per 1 73 m2 \) disposition cefepime steady state patients comparable previous observations healthy elderly volunteers predictive performance regression equations derived single dose studies volunteers relating creatinine clearance total body renal clearances cefepime exhibited slight \( mean predictive errors , 9 7 2 1 ml min per 1 73 m2 , respectively \) similar predicted observed total body clearances \( 63 3 25 1 versus 73 0 19 7 ml min per 1 73 m2 , respectively \) renal clearances \( 51 3 24 4 versus 49 3 19 6 ml min per 1 73 m2 , respectively \) significantly different pharmacokinetics cefepime infected patients appeared unaltered illness , steady state disposition cefepime predictable data derived single dose studies volunteers
computed tomography guided resection small peripheral pulmonary nodules small peripheral pulmonary nodules ranging size 1 mm 20 mm excised 58 patients computed tomography used mark skin overlying nodules minimize surgical exposure needed operative identification nodules 1 cm less maximum diameter 76 patients twenty six patients single nodules 32 patients multiple nodules preoperative diagnosis inaccurate 67 patients 61 patients malignancy suspected , tumor demonstrated conversely , 20 patients malignant nodule excised , preoperative diagnosis correct 50 thirty one patients required treatment apart biopsy 27 required additional intervention small peripheral pulmonary nodules require biopsy diagnosis percutaneous needle aspiration biopsy unsuccessful , technically difficult , computed tomography guided thoracotomy effective minimally invasive surgical alternative
bilateral iliac vein filtration effective alternative caval filtration patients filters placed bilaterally iliac veins five 250 patients undergoing percutaneous filter four five patients \( inferior vena cava diameter greater 28 mm \) patients , filters effective preventing pulmonary embolism follow 9 months two patients revealed changes chronic venous insufficiency venous stasis iliac filtration considered patients caval filter cannot placed large caval size technically difficult due iliac vein tortuosity
exercise testing assessment pulmonary disease , different types exercise tests indications particular type test discussed normal physiological responses exercise reviewed examples abnormal responses seen variety disease states discussed relatively small number responses limits specificity exercise tests actually establishing diagnosis , helpful narrowing differential diagnosis perhaps exercise tests valuable cases patient 's symptoms mainly limited exercise investigations done rest failed resolve diagnostic question exercise testing used circumstances , serves unique function diagnosis management pulmonary disease
bronchoalveolar lavage technique bal performed fiberoptic bronchoscope , two decades , provided clinicians researchers ability safely sample inflammatory immune cell milieu human lung standardized bal processing lavage constituents provides assistance determining optimal care patients variety lung diseases , renders diagnosis selected cases become diagnosis pulmonary infiltrates immunocompromised patients , plays important role improving clinical management finally , continues yield ever increasing amount data researchers studying mechanisms pathogenesis lung disease likely bal become even valuable tool increasing relevance practice chest medicine 1990s
stable reproducible porcine model acute lung injury induced oleic acid background methods previous studies acute lung injury induced oleic acid attempt limit influence secondary changes pulmonary circulation , cardiopulmonary variable data collected processed study designed continuously monitor following variables five swine systemic pulmonary pressure mixed venous oxygen saturation \( svo2 \) arterial oxygen saturation \( sao2 \) minute oxygen consumption co2 production , , 4 hr infusion oleic acid personal computer programmed produce 20 sec ratio \( vd vt \) , venous admixture \( qt \) , pulmonary \( pvr \) systemic vascular resistance \( svr \) , cardiac output \( qt \) data results oleic acid infusion , increases pvr , svr , heart rate \( hr \) , mean pulmonary arterial pressure \( mpap \) , qt , vd vt , decrease qt , sao2 , svo2 thirty minutes oleic acid infusion , increase hr , qt , vd vt , mpap , pvr , svr gradually decreased pre oleic acid infusion levels decrease sao2 , svo2 , qt observed time 30 min period , change cardiopulmonary variables conclusion method continuous monitoring able demonstrate swine dynamic changes , stability , oleic acid infusion
target feedback device ventilatory muscle training previous study , successfully used target feedback device , together external , train ventilatory muscles patients chronic obstructive pulmonary disease article , describe details design function target feedback device used conjunction external resistance , target feedback device provides timing pressure targets , together feedback information , whether targets achieved target feedback device consists readily available electronic components relatively simple construct adjustment external pressure permits setting pressure targets adjustment internal components possible allows control breathing frequency , inspiratory time , breathing waveform
treatment limited small cell lung cancer concurrent etoposide cisplatin radiotherapy followed intensification high dose cyclophosphamide southwest oncology group study march 1986 may 1988 , southwest oncology group enrolled 58 previously untreated patients limited small cell lung cancer treatment program administered high dose cyclophosphamide \( 150 mg kg \) late intensification treatment consisted induction chemo radiotherapy , \( weeks 1 11 \) , consolidation chemotherapy \( weeks 11 18 \) , intensification \( week 18 \) median age 61 5 years eighty nine percent patients southwest oncology group \( \) performance status 0 1 twenty one patients completed prescribed treatments seven treatment related deaths , four result intensification fifty six patients available response analysis thirty two patients achieved complete remission \( cr \) \( 57 \) fifteen achieved partial remission \( pr \) \( 26 \) median survival patients 11 1 months among 21 patients received intensification , nine remain alive cr median survival 27 months sequence treatments associated survival advantage group whole , possibly toxicity induction consolidation treatment delayed administration high dose cyclophosphamide
dose intensity meta analysis chemotherapy regimens small cell carcinoma lung determine chemotherapy dose intensity \( di \) influences treatment outcome , 60 published studies limited extensive stage small cell carcinoma lung \( \) retrospectively analyzed relationship intended di response \( complete response cr partial response pr \) median survival \( ms \) agents used regimens included cyclophosphamide \( c \) , doxorubicin \( \) , vincristine \( v \) , etoposide \( e \) , cisplatin \( p \) relative di \( rdi \) study regimen calculated reference regimen , weighted regression analysis used additionally , analysis individual drug rdi within combinations performed cav , increasing rdi regimen showed correlation outcome individual drugs , c rdi correlated positively , rdi correlated negatively attainment cr limited disease , influential observations eliminated extensive stage disease , rdi correlated positively cr , pr randomized trials , correlation lost statistical significance influential observations eliminated , rdi regimens correlated positively ms extensive stage disease c rdi limited disease , c rdi correlated negatively ms ep , significant correlations seen conclude di outcome correlations consistent chemotherapy regimens meta analysis retrospective data generate hypotheses testing prospective clinical trials , study sample method analysis appreciably affect conclusions
surgical treatment limited small cell lung cancer university toronto lung oncology group experience since 1977 , 119 patients limited small cell lung cancer undergone combined modality therapy including surgery institution seventy nine patients \( 58 male , 21 female median age 63 years \) surgery first , 67 adjuvant chemotherapy forty \( 27 male , 13 female median age 59 years \) chemotherapy first , 94 complete partial response operation pretreatment staging revealed 69 stage , 27 stage ii , 23 stage iii tumors twenty six patients required pneumonectomy , 88 lobectomy , five resection four patients gross six microscopic residual disease postoperative pathologic examination showed small cell lung cancer \( n 95 \) , non small cell lung cancer \( n 3 \) , mixed \( n 17 \) , residual tumor \( n 4 \) postoperative staging revealed 35 stage , 36 stage ii , 48 stage iiia tumors median survival entire group 111 weeks projected 5 year survival rate 39 survival difference seen patients treated chemotherapy operation undergoing initial operation followed chemotherapy \( p 0 \) median survival patients pathologic stage disease reached , projected 5 year survival rate 51 significantly better patients stage ii \( median 82 weeks , p 0 001 \) stage iii \( median 83 weeks , p 0 001 \) disease , projected 5 year survival rates 28 19 , respectively seven 12 patients adjuvant chemotherapy remain alive 6 48 months sixty seven patients died \( 11 evidence disease \) 10 patients relapse primary site alone , seven primary distant sites , 39 distant sites summary , resection improves control primary site , significant proportion patients stage \( n0 \) disease achieve long term survival cure combined modality therapy including surgery stage ii iiia patients survival predictions similar stage iiia non small cell lung carcinoma treated surgically
surfactant concentration sputum diagnosis pulmonary alveolar pulmonary alveolar \( pap \) , disease accumulation surfactant , diagnosed basis invasive biopsy procedures measured \( sp \) concentrations sputum see useful diagnosis pap sputum samples three patients pap twenty patients pulmonary disease assayed using monoclonal antibodies sp sp concentrations 400 times higher patients pap controls , suggestions measurement useful diagnosis pap especially lung biopsy contraindicated
origin nasal polyps complexes 6 patients nasal polyps systematically examined first , location place origin polyps recorded polyps places origin removed , serial sectioned , examined 6 patients , polyps originated nasal mucosa polyps extended laterally mucosa anterior part middle several polyps originated mucosa near ethmoid cell ostium directly mucosa lining edge ostium blocked polyps , indication polyp formation ethmoid cells
perioperative effect methylprednisolone given lung surgery plasma concentrations c3a c5a methylprednisolone saline \( placebo \) solution infused intravenously 28 patients undergoing elective lobectomy lung cancer state complement system surgery effects methylprednisolone biologically active products complement studied measurements plasma c3a c5a leukocyte counts peripheral blood perioperatively placebo group plasma concentrations c3a significantly increased postoperative days 1 2 , whereas c5a significantly 6 hours surgery days 1 2 methylprednisolone infusion surgery eliminated postoperative elevation c3a c5a postoperative leukocyte count peripheral blood higher methylprednisolone group controls observations indicated methylprednisolone may reduce influx leukocytes peripheral blood airways attenuating production biologically active complements
intratracheal administration endotoxin cytokines iii interleukin 1 \( il 1 \) receptor antagonist inhibits endotoxin il 1 induced acute inflammation endotoxin , lipopolysaccharide \( lps \) component gram negative bacteria , induces alveolar macrophages express interleukin 1 \( il 1 \) lipopolysaccharide il 1 cause severe acute neutrophilic inflammation lung intratracheal injection , suggesting lps induced il 1 expression contributes pathogenesis lps induced acute inflammation present study , role il 1 lps induced acute pneumonia investigated acute inflammation occurring 6 hours intratracheal injection lps compared intratracheal lps il 1 receptor antagonist \( il 1ra \) il 1ra found inhibit lps induced acute inflammation \( p greater 0 0001 \) measured number neutrophils recovered bronchoalveolar lavage lps induced neutrophils inhibited much 45 recombinant il 1 beta induced neutrophil lung inhibited 95 il 1ra il 1 beta recombinant il 1 beta lps increased neutrophilic compared intratracheal injection either agent alone intratracheal injection lps induces progressive increase il 1ra mrna expression whole lung rna preparations , suggesting endogenous il 1ra may play important role negative feedback mechanism lps initiated il 1 mediated acute inflammation conclusion il 1ra inhibits lps il 1 induced neutrophilic inflammation may therefore prove clinically useful anti inflammatory agent therapy either septic aseptic il 1 mediated acute inflammation
contrasting roles tumor necrosis factor iga igg immune complex lung injury recent studies suggest development acute gamma g immunoglobulin \( igg \) immune complex lung injury partially dependent tumor necrosis factor \( tnf \) dependent mechanisms neutrophil \( pmn \) recruitment authors sought define role intrapulmonary tnf igg alveolitis examine role iga immune complex alveolitis , neutrophil independent model acute lung injury igg immune complex lung injury resulted marked rise intrapulmonary tnf activity accompanied progressive pulmonary pmn accumulation intratracheal instillation neutralizing concentrations anti tnf markedly reduced pmn influx measured 4 hours effect pmn recruitment quantitated 2 hours iga immune complex deposition resulted acute lung injury accompanied increased numbers intrapulmonary mononuclear phagocytes neutrophils lung lavage fluids obtained iga immune complex injured rats contained neutrophil monocyte chemotactic activities , albeit twofold fourfold lower concentrations observed igg mediated alveolitis contrast igg complex mediated alveolitis , lung lavage fluids iga injured rats contained tnf activity intratracheal administration anti tnf antibodies effect development iga lung injury assessed morphology measurements vascular permeability vitro exposure isolated alveolar macrophages performed igg immune complexes resulted dose dependent tnf secretion , exposure iga complexes resulted low levels tnf secretion data suggest tnf mediated pulmonary neutrophil recruitment \( igg lung injury \) manifest late phase \( approximately 4 hours \) developing alveolitis absence intrapulmonary tnf activity evolving iga immune complex alveolitis may part account limited pmn recruitment observed model
role bacterial adherence otitis media effusion adherence haemophilus influenzae streptococcus pneumoniae nasopharyngeal epithelial cells investigated vitro strains higher affinity epithelial cells children adults children , adherence significantly greater patients otitis media effusion normal subjects secretory iga nasopharyngeal secretions found antibody activity bacteria adherence bacteria significantly smaller group secretory iga antibody activity group activity results suggest bacterial adherence nasopharynx may play important role pathogenesis otitis media effusion children , secretory iga nasopharyngeal secretions may related decrease adherence
lidocaine middle ear anesthesia ear canal produced injection lidocaine hydrochloride skin lateral external ear canal ear canal , tympanic membrane , middle ear surgeries performed injection fluid found middle ear collected analyzed percentage lidocaine fluid calculated enzyme immunoassay technique fifteen surgical cases undertaken fluid middle ear would suspected , otosclerosis lidocaine found middle ears sufficient fluid collect authors question validity using presence clear fluid middle ear , even , sole criterion identifying cerebrospinal fluid
stapedotomy technique results ten years' experience comparative study stapedectomy fifty 810 patients underwent stapedotomy otosclerosis 1969 1988 randomly chosen follow least 5 years patients \( 65 \) follow 10 years stapedotomy , another 50 patients underwent stapedectomy follow ups longer 10 years 50 patients , stapedectomy local anesthesia performed removal stapes , using incision , covering oval window 50 patients , stapedotomy performed general anesthesia , using incision , making small hole , covering hole blood surgical area although groups showed improvement hearing operation , air bone gap stapedotomy group significantly better stapedectomy group use incision general anesthesia preferable incision local anesthesia operative field wider , convenient surgeon , patient safety significant complications either group
improved stent method atresia repair short intranasal stents number advantages provide secure fixation without external ligature across short length stents allows operative area plate removed chance intranasal formation eliminates possibility erosion anterior septal nasal alar region pressure exerted stent since stents nose , cannot infants young children visible school aged children undergone repair unilateral atresia attend school without suffer embarrassment tube nose compared stenting methods , posterior stent secure less likely become
fat guinea pig fat simple office technique repairing tympanic membrane perforations involves piece fat ear perforation search literature failed reveal controlled studies efficacy method , may allow patients avoid invasive procedures controlled perforations guinea pig tympanic membranes treated fat , paper patches , intervention four weeks following procedures , ears examined microscope studied histologically fat healing rate exceeded rates control paper patch groups results stratified respect location size perforations results histological studies suggest controlled studies humans warranted
differential caloric testing patients meniere 's disease differential caloric test allows determination vestibular recruitment , variables may help discriminate peripheral central vestibular lesions previous reports indicated strong association vestibular recruitment meniere 's disease study examined patients unilateral meniere 's disease nystagmus beat frequency \( \) slow component velocity \( \) responses recorded \( \) findings showing unilateral dysfunction present 54 patients slow component velocity 31 nystagmus beat frequency unilateral frequent finding absolute vestibular recruitment occurred less 10 patients relative recruitment found nearly 20 patients slow component velocity higher sensitivity nystagmus beat frequency , excellent clinical concordance caloric testing described study best detects peripheral vestibular disease meniere 's patients using slow component velocity determine unilateral relative vestibular recruitment
paranasal sinus bony anatomic variations mucosal abnormalities ct analysis endoscopic sinus surgery coronal plane computerized tomographic \( ct \) scanning dramatically improved imaging paranasal sinus anatomy compared sinus radiographs increasingly , subtle bony anatomic variations mucosal abnormalities region detected data regarding background prevalence findings needed determine clinical relevance detailed analysis coronal plane ct scans paranasal sinuses obtained 202 consecutively imaged patients conducted special attention directed toward identifying bony anatomic variations mucosal abnormalities anatomic variations studied included middle , paradoxical curvature middle , 's cells , uncinate process bony anatomic variations detected 131 \( 64 9 \) 202 patients found similar frequency patients scanned sinus complaints scanned reasons mucosal abnormalities detected 168 \( 83 2 \) 202 patients patients scanned evaluation sinus like complaints , mucosal abnormalities noted 153 \( 92 2 \) 166 cases , predominantly detected anterior ethmoid region patients scanned evaluations , mucosal abnormalities detected 15 \( 41 7 \) 36 cases , without predilection anterior ethmoid region discussion regarding prevalence clinical significance paranasal sinus bony anatomic variations mucosal abnormalities included guide assist radiologist evaluation coronal sinus ct scans
whole blood filterability sudden deafness sixteen patients sudden deafness \( sd \) , diagnosed basis battery tests , medical surgical pathology requiring drug treatment , underwent monitoring profiles see whether disturbances microcirculation could linked sd plasma viscosity , , \( using low shear positive pressure system \) 5 microns diameter pore filters , whole blood red unfractionated white cells monitored 16 sd patients 32 controls matched age , sex socioeconomic status whole blood filterability filterability red blood cells significantly impaired sd patients , suggests alterations microcirculation linked , way , sudden deafness
conservative management epistaxis retrospective study assess clinical usefulness non surgical management epistaxis performed 340 patients requiring ent department la hospital \( \) previous history , type management , time , volume transfusion considered nasal packing employed 94 1 per cent patients patients \( 82 9 per cent \) less seven days , 84 1 per cent patients required transfusion one death study supports clinical usefulness conservative management treatment patients epistaxis
improved technique inserting tube patients subglottic stenosis improved method inserting silicone tube tracheostomy stoma patients subglottic stenosis presented silicone tube pulled trachea catheter inserted tracheostomy stoma , advanced stenotic subglottic space , pulled mouth cone shaped dilator placed proximal end vertical limb tube facilitate passage end stenotic subglottic space method used 4 patients good results suggest technique tried attempts insert tube usual method fail , performed local anesthesia without special instruments technically easy
acoustic assessment hearing loss children middle ear effusion sought associations acoustic hearing loss ears without middle ear effusion 137 new zealand children ages 3 16 years significantly associated conductive hearing loss associations present entire sample correlation coefficients varied 0 31 2000 hz \( p less 0 001 \) 0 55 three frequency pure tone average \( p less 0 001 \) associations persisted sample ears deemed filled entirely effusion correlation coefficients varied 0 27 hz \( p 0 026 \) 0 47 500 hz \( p less 0 001 \) using 6 0 greater detect three frequency pure tone average loss 30 db , sensitivity 88 specificity 44 technique acoustic explored extended permit rational decisions management middle ear effusions
quantitation dna ploidy squamous intraepithelial neoplasia laryngeal dna contents 56 laryngeal glottic biopsy specimens spectrum squamous intraepithelial neoplastic \( sin \) changes evaluated image analysis combination dna histogram features used define abnormal dna containing cell populations interpreted representing intraepithelial neoplastic transformation eighteen biopsy specimens classified dysplasia keratosis graded sin , six \( 33 \) aneuploid eighteen \( 78 \) 23 biopsy specimens graded sin ii aneuploid , 15 biopsy specimens graded sin iii abnormal quantities nuclear dna twelve biopsy specimens \( six sin ii grade six sin iii grade \) considered represent forms dysplasia , 12 \( 100 \) found contain increased \( aneuploid \) quantities dna conclude proposed sin grading scheme laryngeal epithelial abnormalities exhibits strong correlations nuclear dna content addition , aneuploidy observed sin ii sin iii graded biopsy specimens prominent
modification fluorescent test inhibition assay determination cross reactivity among fluorescent test adapted inhibition assay determine cross reactivity method , similar antigenic determinants found short ragweed giant ragweed , , 's quarter , rough , , giant ragweed highly potent ability competitively bind short ragweed ige demonstrated lower potency cross reacting antigens fluorescent test inhibition assay appears useful method determine cross reactivity among
point period prevalence otitis media effusion evaluated daily previous studies daily screening using automatic impedance indicated relatively high incidences type b one day 's duration , contrary pathogenesis pathology otitis media effusion therefore repeated study 51 otherwise healthy children \( 100 ears \) attending performed daily one month using conventional impedance apparatus automatic impedance impedance apparatus indicate one day type b short lasting episodes occurring either beginning end study period several ears type b days examined point prevalence 15 per cent period prevalence 17 per cent , well findings previous epidemiological studies secretory otitis impedance indicated 16 cases b curves lasting one day considerably higher point period prevalences , make impedance scientific clinical purposes
cochlear otosclerosis statistical analysis relationship spiral ligament hearing loss paper presents analysis relationship amount spiral ligament , secondary cochlear otosclerosis \( \) , amount hearing loss relationship previously studied found larger amount , greater hearing loss measure amount toxic enzymes excreted inner ear fluid enzymes suspected affect metabolic function hair cells
isolated congenital round window absence adult unilateral round window atresia presented care , ct scanning may used demonstrate round window occlusion cochlear resulted modest hearing improvement previously reported cases reviewed
burkitt 's lymphoma case burkitt 's lymphoma involving 10 year old boy , presented biological behaviour clinical presentation unusual neoplasm discussed english language literature reviewed diagnosis made histological examination , electron microscopy confirmed immunohistochemistry patient showed excellent symptomatic response surgery chemotherapy
glasgow benefit plot new method reporting benefits middle ear surgery conventionally , results middle ear surgery reported terms postoperative closure air bone gap improvement air conduction thresholds relevant assess technical success procedure disability , necessarily assess whether patient benefited determined many factors , least hearing nonoperated ear paper , suggest preoperative postoperative air conduction thresholds ears used additional method presenting results first , proportion patients fall three main preoperative impairment groups identified important , potential benefits surgery group thereafter , percentages patients achieve various postoperative hearing categories calculated , allowing surgeons audit results make comparisons series
reaction erythromycin report case bilateral hearing loss patient treated intravenous erythromycin reaction occurred despite patient 's normal renal hepatic function fact serum erythromycin levels within predicted normal range addition hearing loss , marked also observed hearing loss improved treatment discontinued , abnormalities persisted suggesting erythromycin caused permanent vestibular damage
versus perforator stapedotomy purpose study compare hearing results performing stapedotomy using either perforator two groups patients , otherwise similar , followed least 2 years stapedotomy possible create 0 8 mm 91 6 patients significant difference two groups hearing results results showed continuous improvement first 6 post operative months hearing stabilized hands , proved traumatic perforator inner ear
pilot study pemirolast patients seasonal allergic rhinitis pemirolast potent , long acting , orally effective antiallergic agent evaluated clinical activity prevention symptoms seasonal allergic rhinitis evaluated randomized , double blind , placebo controlled parallel group season trials test safety , tolerance , prophylactic activity thirty one patients history fall seasonal allergic rhinitis treated 6 weeks pemirolast , 50 mg , placebo beginning approximately 2 weeks onset ragweed season atlanta daily evaluation symptom scores disclosed statistically significantly less , rhinorrhea , nose treatment pemirolast , however , difference evaluated symptoms use rescue medicines side effects short study preliminary study indicates pemirolast may warrant evaluation treatment allergic rhinitis
concentrations middle ear fluid concentrations plasma middle ear fluid \( \) measured specimens obtained approximately 2 h doses 7 5 15 mg kg mean standard deviation concentrations 2 0 2 6 mg liter \( 48 concentration plasma \) smaller dose 3 9 2 6 mg liter \( 42 concentration plasma \) larger dose larger dose , concentrations greater mic 90 strains usual pathogens acute otitis media tested 16 17 specimens
hereditary hearing loss children prospective documentation younger siblings children sensorineural hearing loss possible hereditary cause underwent interval audiologic examination seven siblings \( unrelated families \) found progressive sensorineural hearing loss despite early documenting normal hearing levels age continued testing children allowed early identification intervention advocate regular audiologic follow even normal audiologic assessments made younger siblings children documented sensorineural hearing loss , unless definite nongenetic origin hearing loss older child known recessive sensorineural hearing loss onset infancy childhood may present antecedent family history normal behavioral early life
usefulness immunotherapy patients severe summer hay fever uncontrolled antiallergic drugs objective evaluate efficacy safety immunotherapy \( \) patients severe summer hay fever design randomised , double blind , placebo controlled study biologically standardised grass pollen extract setting allergy clinic , royal national heart hospital , london patients 40 adults \( mean age 35 years \) history severe grass pollen allergy uncontrolled standard antiallergic drugs patients asthma specifically excluded intervention patients randomised receive either active preparation \( sq , grass pollen \( \) extract \) placebo rate two subcutaneous injections week increasing doses maintenance dose reached maintenance dose given month main outcome measures clinical efficacy evaluated symptom drug diary cards , visual analogue scores grass pollen season , assessment patients doctor conjunctival skin sensitivity local allergen provocation measured eight months treatment results highly significant decrease \( median sq v median placebo \( 95 confidence interval difference total symptom scores \( p 0 001 \) sq treated group \( 360 v \( 238 significant differences also found total drug use \( p 0 002 , 129 v \( 178 visual analogue symptom scores also reduced active group \( p 0 02 , 2 2 v 5 5 \( 4 8 0 5 assessment , either doctor patients , showed large improvement \( p less 0 001 \) sq provocation tests showed greater 10 fold reduction active group immediate conjunctival allergen sensitivity \( p 0 001 \) , 40 decrease early phase response \( p 0 02 \) , 57 decrease late phase \( p 0 001 \) cutaneous response intradermal allergen total active injections given one systemic reaction 10 minutes injection , rapidly reversed intramuscular adrenaline one mild delayed reaction 2 1 2 hours conclusion immunotherapy effective patients severe summer hay fever , immediate anaphylactic reactions limit use centres patient selection extremely important , chronic asthma specifically excluded serious reactions occur within minutes two hour patients injection seems unnecessary
management posterior epistaxis use fibreoptic posterior epistaxis usually treated repeated nasal packing failed situations ligation feeding arteries considerable morbidity mortality logical approach location bleeding site arrest haemorrhage local treatment exact location bleeding area identified actively bleeding fibreoptic bleeding arrested chemical , thermal cautery failed situations using small nasal confined bleeding site approach management posterior epistaxis effective reduces duration hospital stay significantly reduces discomfort patient current practice blind nasal packing hope nasal haemorrhage incidental pressure bleeding site evaluated
argon laser stapedotomy lasers used 10 years reports excellent hearing results using laser energy surgery otosclerosis used argon laser 75 consecutive primary stapedotomy procedures postoperative air bone gap 10 db less 87 patients 20 db less 95 one ear \( 1 5 \) postoperative hearing secondary granulomatous reaction complications otherwise uncommon mild patients treated outpatient basis results compare favorably reports laser surgery otosclerosis conclude excellent hearing results obtained using argon laser stapedotomy procedures
response human ril 1 , ril 2 , rtnf middle ear guinea pigs human recombinant interleukin 1 \( ril 1 \) , interleukin 2 \( ril 2 \) , tumor necrosis factor \( rtnf \) injected middle ear normal guinea pigs effusion volume cellular content determined sacrifice rapid dissection ear 24 hours , ril 2 \( 100 u \) produced cellular effusion \( 77 92 polymorphonuclear neutrophil leukocytes \) , cleared 72 hours rtnf \( 10 u \) yielded cellular effusion \( 12 67 lymphocytes \) 24 hours , cleared 48 hours ril 1 \( 100 u \) produce significant effusion compared control ril 2 rtnf cause inflammatory effusion middle ear extent generated middle ear otitis media , cytokines potential contribute pathogenesis otitis media effusion
age related balance changes hearing impaired children study compared balance skills hearing impaired children hearing children order determine whether deficit balance exists hearing impaired children ascertain whether deficit age related twenty eight hearing impaired subjects chosen sample convenience pennsylvania school placed one three age groups ten subjects 4 5 6 5 year old age group , 8 8 10 year old age group , 10 12 5 14 5 year old age group selection criteria included bilateral sensorineural hearing loss greater equal 65 db normal intelligence \( iq greater equal 80 \) balance measured use balance test motor proficiency age group , z test used compare subjects' scores balance standard scores results showed age group , mean score hearing impaired children lower standard score older groups significantly higher scores youngest group , mean scores older groups significantly different difference subjects' balance scores balance standard scores found among age groups , suggesting balance deficit age related gender differences found balance scores
botulinum toxin treatment torticollis botulinum toxin administered 19 patients double blind placebo controlled trial toxin effective placebo improving head position pain measured objective rating scale assessments following controlled trial , treatment botulinum toxin continued open fashion total 60 patients torticollis received toxin total 117 treatment periods mean follow period 8 4 months 39 patients pain benefit 77 treatment periods improvement neck posture occurred 83 treatment periods mean duration 12 weeks side effects frequent dysphagia common \( 28 treatment periods \) botulinum toxin effective treatment treatment initiated doses lower end range used study \( 400 600 mouse units \)
simultaneous motor performance impaired ability shift attention parkinson 's disease ability share time shift attention simultaneous motor tasks studied 18 patients parkinson 's disease \( pd \) 19 age intelligence matched controls task consisted drawing dominant hand squeezing rubber bulb hand motor performance measured using variables amplitude squeezing , frequency squeezing velocity drawing eliminating variance due baseline differences single handed performance , simultaneous performance pd controls turned similar frequency squeezing velocity drawing amplitude squeezing , however , differed two groups significantly reduced pd disturbance performance pd patients due disorder time , decreased ability shift attention visually cued task non visually cued task results agree current evidence pd patients impaired rely upon internal control regulation shifting attention external cues available
comprehension difficulties stroke patients doctors , nurses relatives doctors , nurses relatives involved 30 recently stroke patients asked predict patient would perform comprehension test results show doctors , nurses relatives underestimate receptive disability patients , also illustrate lack agreement health professionals implications management considered
practice effects discrete movements parkinson 's disease effects practice simple choice reaction times \( rts \) parkinson 's disease \( pd \) control subjects discrete task analysed controls , practice led selective decrease choice rts , reported previously opposite effect seen pd group , little change choice rts substantial reduction simple rts results suggest pd subjects use advance information initiate discrete movements rapidly , ability movements requires practice results studies reporting inability pd made discussion task characteristics may allow preclude
surgical management hypothalamic tumors childhood sixteen children underwent 18 operations radical resection hypothalamic tumors clinical presentation correlated age infants 1 year age presented , failure thrive , severe visual failure children aged 1 5 years predominantly precocious puberty mild visual deficits older children \( greater 5 years old \) slowly progressive loss vision three infants biologically aggressive tumors spite low grade histology , died progressive tumor growth eleven 13 children aged 1 year alive well , without clinical radiographic evidence disease progression , 4 months 4 1 2 years following surgery six patients , follow period 10 months 4 1 2 years \( mean 27 months \) , adjuvant therapy following radical surgical resection authors conclude 1 \) radical surgical resection hypothalamic tumors performed minimal morbidity 2 \) radical resection may delay time disease progression older children need irradiation 3 \) resection recurrent tumors may provide neurological improvement long lasting clinical remission 4 \) hypothalamic tumors infancy aggressive neoplasms require multimodality therapy
long term follow review 31 children severe closed head trauma thirty one children aged 3 15 years followed 5 11 years suffering severe closed head trauma caused coma 1 week \( median duration coma 3 weeks \) one patient remained persistent vegetative state death 9 years later 30 recovered consciousness discharged suffered diminution abilities , 24 major permanent disability common motor disabilities pure spastic hemiparesis \( seven cases \) , basal ganglia syndromes \( four cases \) , ataxia \( three cases \) , combination hemiparesis ataxia \( five cases \) 30 patients , 26 regained independent ambulation , seven epileptic , 14 various degrees 10 cognitive ability profit normal educational system , none attempted education social problems common worst outcomes associated intracranial bleeding brain contusion seen computerized tomography \( ct \) scans acute stage best associated normal ct scans degree residual disability children seems less adults trauma similar severity
neurobehavioral outcome 1 year severe head injury experience traumatic coma data bank outcome 1 year sustained severe head injury investigated patients admitted service one four centers participating traumatic coma data bank \( \) 300 eligible survivors , quality recovery 1 year injury assessed least glasgow outcome scale \( gos \) 263 patients \( 87 \) , whereas complete neuropsychological assessment performed 127 \( 42 \) eligible survivors capacity patients undergo neuropsychological testing 1 year injury criterion recovery reflected significant relationship neurological indices acute injury gos score time hospital discharge neurobehavioral data 1 year injury generally comparable across four samples patients characterized impairment memory slowed information processing contrast , language ability recovered within normal range lowest glasgow coma scale \( gcs \) score pupillary reactivity predictive 1 year gos score neuropsychological performance lowest gcs score especially predictive neuropsychological performance 1 year postinjury patients least one pupil following resuscitation limitations related scope follow material , results indicate characteristic pattern neurobehavioral recovery severe head injury encourage use neurobehavioral outcome measurements clinical trials evaluate interventions head injured patients
intracarotid hydroxyethyl solution causing stroke dogs hydroxyethyl \( hema \) advocated solution prevent deflation detachable balloons interventional pertinent know hema would untoward effects released carotid artery balloon rupture deflation seven mongrel dogs underwent catheterization common carotid artery subsequent injection hema solution volumes 1 cc five dogs , 2 cc one , 4 cc one angiography performed time injection revealed evidence intravascular thrombosis well possible spasm three surviving animals sacrificed 48 hours brains fixed examined histopathologically one brain normal one could examined five seven animals histopathologically documented cerebral infarctions varying size foreign substance seen within blood vessels suggest intravascular polymerization animals injected 2 4 cc hema solution survive 48 hours literature review reveals little documentation toxicology intravascular hema increasing popularity compound polymerization detachable balloons introduced brain , investigations warranted understand physical properties compound potential risks use
complication reservoir case report authors describe case 28 year old woman developed following symptoms right hand lasting resting tremor , transient focal rigidity , deficits occurred following treatment intrathecal methotrexate via reservoir placed , resulting trauma contralateral mesencephalon
stereotactic investigation limbic epilepsy using multimodal image analysis system technical note methodology developed stereotactic investigation limbic epilepsy using image analysis system simultaneously displays different structural functional images brain validity accuracy system established phantom studies surgical planning electrode implantation guided stereotactic magnetic resonance imaging , digital subtraction angiography , position emission tomography methodology provides relationship cerebral structure function necessary identify seizure onset propagation human limbic system epilepsy
evaluation sensory changes pain relief trigeminal neuralgia following intracranial microvascular decompression trigeminal glycerol rhizotomy nineteen patients trigeminal neuralgia treated either trigeminal ganglion intracranial microvascular decompression good degree pain relief receiving glycerol alone \( group \) , 50 subjectively reported mild reduction fine tactile sensation similar response reported treated glycerol decompression \( group b \) degree sensory loss mild thermal testing discriminatory tool degree sensory loss greater surgical procedures performed less invasive trigeminal ganglion alone used
transcranial doppler ultrasonography clinical applications cerebrovascular disease transcranial doppler ultrasonography introduced 1982 noninvasive procedure assessment intracranial cerebral circulation portable equipment used transcranial doppler examination facilitates use bedside assessment critically ill hospitalized patients outpatients clinical applications include diagnosis vasospasm patients subarachnoid hemorrhage , assessment intracranial collateral flow patients extracranial arterial occlusive disease , detection intracranial arterial stenosis , identification feeding arteries arteriovenous malformations monitoring hemodynamic effects treatment , confirmation clinical diagnosis brain death , intensive care unit monitoring brain injured patients , intraoperative postoperative monitoring neurosurgical patients transcranial doppler technology also providing new insights pathophysiologic mechanisms variety cerebrovascular conditions clinicians find transcranial doppler technology helpful specific question status intracranial circulation investigations may expand clinical research utility technology
arterial responses migraine headache superficial temporal artery thought main focus pain migraine attacks , diameter never measured directly use new , high resolution ultrasound machine measure arterial size 25 migraine patients unilateral head pain showed lumen wider painful non painful side migraine attack diameters radial arteries temporal artery non painful side smaller attacks generalised vasoconstriction shared temporal artery affected side , suggests local vasodilatory response findings suggest arteries may play role migraine pathogenesis
evoked potentials assessment follow patients wilson 's disease treatment 9 patients wilson 's disease prospectively studied evoked potentials magnetic resonance imaging \( mri \) oral penicillamine therapy led decrease auditory brainstem \( \) somatosensory \( sep \) conduction times 6 4 neurologically symptomatic patients , respectively sep normal 3 symptom free patients mri showed cerebral lesions 4 7 patients quantified indices brain atrophy unaffected treatment sep may reveal reversible component disease cannot detected mri , may sensitive measure treatment efficacy
effects sleep architecture patterns obstructed breathing retrospective study , 72 obstructive sleep apnea patients taken evaluated postoperatively , significant improvement sleep architecture respiratory indices addition , second group 17 patients also position recordings time spent supine lateral sleep positions changed postoperatively significant decrease apnea plus index lateral position study indicates significant improvement sleep architecture respiratory indices majority patients , particularly lateral sleep position
molecular biology occlusive stroke childhood likely many factors involved occlusive disease adult operative child major difference may factors damage endothelium two age groups thereby initiate \( atherosclerosis versus causes endothelial changes \) task next decade rational exploration effects endothelium mediated kinins , endothelial secretory products , , platelet , prostaglandins , lipoproteins pediatric stroke
infantile spasms infantile spasms seizure disorder young infants diverse etiologies , suggesting arise disturbance central nervous system function susceptible periods development prognosis normal intellectual neurologic development parallels underlying etiology early appropriate treatment acth may lead seizure control majority patients treating physician must anticipate side effects modality
rett syndrome autistic disorders rett syndrome disorder noted date females characterized developmental disability following apparently normal early infancy addition gait difficulties , hand movements , loss communication hand skills , autistic like behavior early sign often results misdiagnosis despite significant clinical abnormalities , neuropathologic features modest , consistent laboratory abnormality diagnostic marker identified current status research rs considered within context autism disorders autistic features may occur , fragile x syndrome concept autism based behavior developed , autism regarded category containing ever expanding list specific disorders
tourette syndrome recent advances clinical genetic studies allowed limits tourette syndrome strong evidence chronic motor tics tourette syndrome different manifestations autosomal dominant gene high penetrance genetic link obsessive compulsive disorder also appears established 10 cases tourette syndrome may nongenetic , however also association tourette syndrome attention deficit hyperactivity disorder therapy , drugs may precipitate exacerbate tics individuals high proportion patients tourette syndrome also neuropsychological deficits learning disabilities pathophysiology incompletely understood best supported hypothesis dopamine receptor , although strong suggestions abnormalities serotonin metabolism possibility abnormalities neuropeptide systems explored treatment tics relies primarily neuroleptics dopamine receptor blocking activity clonidine may useful patients , especially behavior problems obsessive compulsive symptoms treated using appropriate pharmacologic agents treatment attention deficit disorder patients tics begin behavioral strategies clonidine tried first line drug , used necessary great caution rare instances may necessary combine neuroleptic
infant recent advances understanding disorders affecting neuromuscular junction clinician often asked evaluate infant numerous conditions cause infancy briefly outlined article conditions may affect brain , spinal cord , motor unit several disorders neuromuscular transmission , including four distinct recently described congenital myasthenic syndromes infant botulism , discussed thereafter
rehabilitation pediatric patient neuromuscular disease rehabilitation program patient neuromuscular disease developed accurate diagnosis established diagnosis suggest natural course disease , , improved upon rational realistic program program best developed interdisciplinary team , including pediatric neurologist , greatest understanding patient 's problem ultimately responsible implementation monitoring program child cerebral palsy commonly requires services physical occupational therapists well knowledgeable program appropriate \? consider child 's potential well limitations \? child traumatic brain injury requires , addition , psychological intervention intensive educational program child family need help mental health professionals \? child motor unit disease duchenne 's muscular dystrophy requires , addition services , care child ever independently \? , cost \? necessary child reach potential , including items orthoses adaptive equipment \? care become necessary \? issues must addressed form care established \? one program children programs must individualized meet needs patient family point cannot
use ultrasound evaluating neurologic diseases childhood real time cranial sonography , intracranial doppler , neuromuscular sonography sonographic techniques applicable neurologic evaluation infants children although limited age , specificity , skill experience , advantages real time cranial intracranial doppler sonography make useful techniques evaluation young infant , particularly serial assessment ventricular size study critically ill infant use neuromuscular sonography assessment infant guidance biopsy makes increasingly valuable tool
dwarf locus mutants lacking three pituitary cell types result mutations domain gene pit 1 mutations mouse dwarf locus \( \) normal development anterior pituitary gland , resulting loss expression growth hormone , prolactin thyroid stimulating hormone , hypoplasia respective cell types disruptions gene encoding domain transcription factor , pit 1 , occur characterized alleles dwarf locus data indicate pit 1 necessary phenotype three cell types anterior pituitary , directly link transcription factor commitment progression events mammalian
tonic ocular tilt reaction due unilateral diencephalic lesion studied 4 patients tonic ocular tilt reactions due unilateral , , lesions contrast 2 previously reported patients ocular tilt reactions due unilateral lesions , paroxysmal ocular tilt reaction new finding considered context previous clinical experimental data various types ocular tilt reactions follow stimulation destruction peripheral central vestibular system inputs interstitial nucleus contralateral vestibular nucleus motor outputs interstitial nucleus cervical ocular could involved ocular tilt reaction propose patients unilateral diencephalic lesions , tonic ocular tilt reaction could due persistently decreased resting activity ipsilateral interstitial nucleus neurons , whereas paroxysmal ocular tilt reaction could due transiently increased activity interstitial nucleus neurons cases ocular tilt reaction due unilateral diencephalic lesion point existence crossed pathway vestibular nucleus contralateral interstitial nucleus
estimate incidence dementia idiopathic parkinson 's disease proportion patients idiopathic parkinson 's disease \( pd \) considered demented ranges 10 15 dementia may affect survival pd , incidence rate dementia , rather proportion , would accurate measure disease frequency previously estimated proportion patients pd dementia 10 9 records cohort idiopathic form pd major medical center reviewed clinical records cohort 4 years 9 months estimate incidence rate dementia identified 65 new cases dementia 249 patient records available using number person years follow case , estimated overall incidence rate 69 per 1 , 000 person years observation mean age cohort 71 4 years cumulative incidence dementia increased age 85 years age , 65 surviving members cohort demented age specific incidence rates dementia cohort pd significantly greater similarly aged cohort healthy elderly people age specific standard morbidity ratios indicated , compared people similar ages , patients pd highest increase risk dementia ages 65 75
diagnosis diffuse body disease using presence widespread cortical bodies \( lb \) pathologic criteria diffuse body disease \( dlbd \) , describe serial neurologic mental status examinations 6 patients dlbd , 3 patients alzheimer 's disease \( ad \) , 1 patient parkinson 's disease \( pd \) 6 patients dlbd included 3 \( \) consistent coincident ad patients dlbd gait impairment concurrent mild moderate dementia abnormalities tone resting tremor also prominent early symptoms subjects dlbd , ad patients dlbd frequently abnormal eegs background posterior slowing dominant burst pattern time mild moderate dementia agitation , hallucinations , frequent early symptoms dlbd patients patients dlbd without concomitant ad numerous 50 negative cortical plaques patients dlbd distinct clinical syndrome differentiated ad pathologic features , including absence 50 immunoreactivity , also differentiate dlbd ad
abnormal pulsatile secretion luteinizing hormone men epilepsy relationship nature paroxysmal discharges compared pulsatile secretion luteinizing hormone \( lh \) 13 men clinically documented temporal lobe seizures 8 age matched controls serum lh measurement drawn every 15 minutes 8 hours eeg groups 2 groups differ significantly average mean baseline lh secretion , total lh secretion , average pulse amplitude group seizures , however , showed significantly greater \( p less 0 05 \) variability baseline lh secretion pulse frequency among men unilateral paroxysmal eeg findings , pulse frequency significantly greater \( p 0 05 \) right epileptiform discharges left slowing \( 6 4 0 4 \) left epileptiform discharges right slowing \( 3 0 1 3 \) relationship pulse frequency nature paroxysmal discharges makes unlikely endocrine abnormalities attributed medication alone strengthens notion temporal lobe epileptiform discharges may disrupt hypothalamic regulation pituitary secretion
plasma amino acids elevated migraine investigate role glutamic \( glu \) aspartic acid \( asp \) migraine , measured plasma amino acids migraine patients without aura , attacks , compared profiles plasma amino acid profiles tension headache patients healthy controls attacks , migraineurs \( notably aura \) substantially higher plasma glu asp levels controls tension headache patients addition , patients migraine without aura showed low plasma histidine levels migraine attacks , glu \( lesser extent asp \) levels even increased results suggest defective cellular mechanism glu asp migraineurs , hypothesize similar defect neuronal glial cell level , predisposing brain migraineurs develop spreading depression
borderzone hemodynamics cerebrovascular disease investigate possible existence chronic selective hemodynamic impairment arterial borderzone regions brain , used positron emission tomography \( pet \) measure regional mean vascular transit time \( rt , equal ratio regional cerebral blood volume cerebral blood flow \) regional oxygen extraction fraction \( \) 32 patients either severe internal carotid artery stenosis occlusion 11 normal controls twenty four patients tias 1 60 days pet normal brain ct used stereotactic localization method locate anterior posterior borderzone regions middle cerebral artery \( mca \) territory calculated ratios borderzone ipsilateral mca territory rt significant difference control ratios patient subgroup including greater equal 75 stenosis occlusion , without contralateral greater equal 50 stenosis , abnormal hemodynamics mca territory therefore found evidence selective borderzone hemodynamic impairment group patients severe carotid artery disease
comparison algorithms testing use automated evaluation sensation estimates detection threshold may used detect , characterize , follow course sensory abnormality neurologic disease approach especially useful epidemiologic controlled clinical trials studied algorithm testing finding threshold used automatic systems comparing among algorithms stimulus conditions index finger healthy subjects great toe patients mild neuropathy appearance thresholds obtained linear increasing rate less 4 15 microns sec provided accurate thresholds compared thresholds obtained forced choice testing rates would acceptable sensitive sites studied , slow use automatic testing insensitive parts appearance thresholds obtained fast linear rates \( 4 15 16 6 microns sec \) overestimated threshold , especially sensitive parts use mean appearance disappearance thresholds , stimulus increasing exponentially rates 0 5 1 0 noticeable difference \( \) units per second , null stimuli , null stimuli , provided accurate , , fast estimates threshold sensitive parts despite good performance testing , prefer forced choice evaluation sensation patients neuropathy
right left dementia alzheimer type demonstrated right left orientation \( r l \) subject impaired patients dementia alzheimer type patients multi infarct dementia comparable degree dementia impairment r l independent aphasia spatial
dopamine beta hydroxylase activity cerebrospinal fluid idiopathic torsion dystonia since postmortem biochemical study genetic linkage study idiopathic torsion dystonia suggested possible involvement dopamine beta hydroxylase \( \) , determined csf activities jewish non jewish patients childhood onset idiopathic torsion dystonia found differences control population
inconsistent response sodium report 6 patients vascular origin treated sodium \( \) four 6 responded initially marked improvement seen 2 patients 1 recurred despite continuing therapy sodium uniformly effective treatment
oxidation reactions parkinson 's disease free radicals generated oxidation reactions may contribute pathogenesis parkinson 's disease \( pd \) free radicals capable reacting almost membrane lipids causing lipid peroxidation , membrane injury , cell death dopamine metabolized oxidation reactions capable generating free radicals recent evidence indicates substantia nigra patients pd contains increased iron , enhances oxidation , decreased glutathione , protects formation free radicals , end products lipid peroxidation increased substantia nigra patients pd , supporting free radicals generated may contribute dopamine neuronal death hypothesis suggests antioxidant therapies may slow rate progression pd raises concern metabolites levodopa therapy may accelerate rate neuronal degeneration
levels mrna putative receptor affected seizures situ hybridization rna blot hybridization techniques used \( \) examine regional distribution mrna putative receptor adult rat brain ii \) test possibility seizures affect expression receptor gene highest densities hybridization distributed within hippocampal pyramidal granule cells , medial , purkinje cells molecular layer cerebellum , olfactory bulb recurrent limbic seizures caused massive , delayed , reversible reduction levels receptor mrna dentate gyrus lesser decreases found pyramidal cell fields hippocampus superficial cortex findings provide evidence unusual patterns physiological activity alter genomic expression subclass glutamate receptors brain
immunodominant regions helper cell sensitization human receptor alpha subunit myasthenia gravis myasthenia gravis autoimmune response acetylcholine receptor \( achr \) occurs alpha subunit achr contains epitope \( \) antibody response \( main immunogenic region \) epitopes involved helper cell sensitization study , overlapping synthetic peptides corresponding complete achr alpha subunit sequence used polyclonal achr specific helper cell lines four myasthenic patients different hla types response helper lines individual peptides studied four immunodominant sequence segments identified e , residues 48 67 , 101 120 , 304 , regions include residues known form main immunogenic region cholinergic binding site , frequently contained sequence proposed related epitope formation
conditioning spinal stretch reflex implications rehabilitation purpose article describe new technique potentially applied patients hyperactive spinal stretch reflexes \( \) progression clinical research conditioning individual muscles muscle groups \( electromyographic biofeedback \) conditioning explained research data primates addition first human experiments reviewed potential applications conditioning discussed , issues requiring delineation research specificity training effect ascertained
wilson 's disease 35 years' experience thirty seven chinese patients criteria wilson 's disease seen 35 year period reviewed males females equally affected twenty two patients symptomatic 15 asymptomatic presented third decade thirty one per cent relatives screened showed evidence disease , parents rarely affected \( 13 per cent \) half adult symptomatic females presented primary liver laboratory tests abnormal 50 per cent patients , gamma sensitive index renal disease infrequent serum level single biochemical parameter prognostic significance \( p 0 0001 \) seventy per cent symptomatic patients showed improvement treatment penicillamine
bicarbonate buffered lidocaine epinephrine hyaluronidase eyelid anesthesia double masked , randomized clinical trial conducted determine subcutaneous eyelid injections bicarbonate buffered lidocaine epinephrine hyaluronidase mixture less painful injections twenty one patients received buffered \( ph 7 4 \) \( ph 4 6 \) injections injection , patients recorded pain scale 0 , pain , 10 , severe pain mean pain score buffered injections 2 0 versus 4 1 injections \( p 0 0003 \) seventeen \( 81 \) 21 patients ranked buffered injection less painful use bicarbonate buffered lidocaine epinephrine hyaluronidase mixture effective making ophthalmic anesthesia less painful
optic nerve sheath clinical radiographic features 13 cases review literature thirteen patients dilated optic nerve sheaths expanded , cerebrospinal fluid \( csf \) space studied high resolution computed tomography \( ct \) magnetic resonance imaging \( mri \) eleven patients bilateral findings headache visual complaints , , present patients signs optic nerve dysfunction present eight patients three patients visual acuity worse 20 200 cerebrospinal fluid pressure mildly elevated two patients three patients underwent surgical procedure visual acuity improved one authors propose term condition suggest mri fat suppression techniques axis sagittal views radiographic procedure choice
strategies underlying control disordered movement purpose article fourfold first , theory motor control dual strategy hypothesis outlined second , theoretical framework used develop theory examined third , motor dysfunction discussed context theory particular , syndrome , parkinson 's disease , cardiovascular accidents , spasticity discussed finally , potential applications theory physical therapy considered
new challenge rehabilitation neurologically motor impaired rehabilitation research area , originating engineering , emerged last decade broad aim use technology assist people movement dysfunction neurologically impaired population might gain considerably provision therapy , interface machine must match physical intellectual abilities user therefore consider multidisciplinary approach , encompassing behavioral engineering perspectives , essential achieving aim however , date , published reports largely restricted engineering conference reports , relatively little appeared therapy literature article introduce physical therapists , describe possible applications rehabilitation neurologically impaired patients , suggest issues investigation
brain potentials associated movement traumatic brain injury brain potentials may used assess functional abnormalities underlie impairments movement purpose article illustrate usefulness examining potentials addition overview topic , article includes report study demonstrating differences brain potentials five patients traumatic brain injury four healthy control subjects five patients phase slow cortical potentials associated simple goal directed forearm finger movements recorded frontal parietal electrodes two seconds movement related electroencephalographic activity \( movement related potential \) recorded patients showed reduced brain potentials movements associated limb , lesser extent , reduced brain potentials movements associated limb waveforms obtained patients unusual , cross cortical movement related potential correlations associated specific electrode , well specific movement conditions brain potentials associated period interval simple reaction time paradigm later recorded two patients traumatic brain injury control subject help determine functional significance relative positivity apparent movement related potential data preliminary study indicates electroencephalographic potentials obtained preparation movement provide information regarding basis motor dysfunction
movement disorders limb movement basal ganglia primary concern article review experimental methods may lead better understanding functional role basal ganglia control movement two models basal ganglia impairment considered parkinson 's disease huntington 's disease review focuses primarily bradykinesia key abnormalities basal ganglia dysfunction general , electromyography kinematic analysis movement , may possible characterize specific movement disorders specifically , damage sustained central nervous system traced certain structure , may provide insight extent involvement functional role structure control movement much data reviewed suggests basal ganglia may play specific role initiation regulation force control
return work persons traumatic brain injury supported employment approach supported employment used place 41 persons competitive employment 30 months individuals experienced severe head injuries almost 70 injuries due motor vehicle accidents mean seven years passed since injury referred clients , mean 53 days 36 referred clients achieved competitive postinjury employment , compared 91 group competitively employed injury job retention rate 71 reported , , , service related occupations mean hours job required place maintain clients supported employment
functional evaluation quadriplegic patients using hand neuroprosthesis objective retrospective study compare abilities quadriplegic patients complete activities daily living without use portable hand neuroprosthesis neuroprosthesis provided synthetic hand functional neuromuscular stimulation paralyzed forearm hand muscles data obtained telephone interviews , patient records , twenty two quadriplegic patients included study 15 functional c5 spinal cord injury level seven c6 level median success rate \( ie , percentage patients could complete activity \) across ten activities 89 hand neuroprosthesis 49 without hand neuroprosthesis patients could perform tasks neuroprosthesis used , although relative improvement c5 patients larger c6 patients
impaired awareness behavioral limitations traumatic brain injury sixty four brain injured patients divided three groups patients group overestimated behavioral patients group ii showed behavioral ratings similar relatives' reports concerning behavioral patients group iii underestimated behavioral group patients greater evidence bilateral multiple site lesions group ii iii patients speed left hand finger also worse group groups ii iii , standard neuropsychologic test findings failed separate groups specific brain lesion sites related group membership impaired awareness behavioral limitations traumatic brain injury may related neuropsychologic changes measured standard tests bilateral impairment cortex may important phenomenon exists several months years postinjury
maximal exercise testing mentally retarded adolescents adults reliability study data available regarding maximal exercise testing mentally retarded individuals data available reliability maximal exercise testing mentally retarded individuals purpose study determine reliability graded exercise testing mentally retarded adolescents adults testing conducted two geographically different centers center , 14 mentally retarded adolescents \( 11 boys , three girls \) syndrome , , recruited school subjects completed two treadmill protocols exhaustion treadmill time heart rate \( hr \) recorded time tests approximately one week center b , 21 mentally retarded adults \( 14 women , seven men means iq 56 \) recruited local group homes subjects completed treadmill walking protocol , metabolic measurements , exhaustion time tests varied one four months center , subjects achieved mean treadmill time 8 test one 8 test two \( means hr 174 , respectively \) reliability coefficient two tests 94 center b , subjects achieved mean \( 2 \) max 27 kg 1 min 1 test one 26 kg 1 min 1 test two reliability coefficient 93 data show maximal exercise testing reliable populations mentally retarded individuals , exhibiting similar values peers
familial trigeminal anesthesia familial congenital trigeminal anesthesia isolated abnormality unusual disorder knowledge , one family previously reported report family three affected members demonstrating facial anesthesia , bilateral corneal changes , nasal septal damage secondary self magnetic resonance imaging demonstrated hypoplasia ganglia trigeminal nerves affected father two affected sons pathogenesis disorder appears congenital hypoplasia trigeminal nerves ganglia inherited dominant fashion
enhanced vitro uptake retention 3h nervous system tumor cells photodynamic therapy promising treatment human brain tumors selective retention certain compounds tumor cells certain lipophilic cationic compounds , \( tpp \) , selectively taken variety carcinomas although preferential retention tpp demonstrated breast carcinoma cell line mcf 7 , compound tested previously cells derived nervous system tumors present study , tritiated tpp \( 3h tpp \) uptake retention eight different cell cultures three histologically different types nervous system tumors measured data compared positive control \( mcf 7 \) negative controls \( normal african green monkey kidney epithelium \( 1 \) normal human fibroblast \( 38 \) cell lines \) uptake retention characteristics could grouped specific pathological tumor types , individual tumor variability notable malignant astrocytoma \( grade iii iii glioblastoma \) malignant cells showed preferential uptake retention 3h tpp relative meningioma cells normal controls clonogenic assay utilizing cytotoxic lipophilic cationic compound showed strong 3h tpp susceptible effects weak data demonstrate certain human experimental animal nervous system tumor cell lines retain lipophilic compounds possessing positive charge lipophilic cationic compounds may useful intraoperative delineation tumor margins photodynamic therapy certain nervous system tumors
tension pneumocephalus treatment controlled decompression via closed water seal drainage system case report successful treatment patient tension pneumocephalus controlled decompression via external drainage described advantage technique includes immediate release high pressure capability maintaining constant low pressure enable facilitate sealing dural tears method used three patients , leading resolution tension pneumocephalus without recurrence complications
cerebrospinal fluid rhinorrhea following acoustic neurinoma surgery technical note authors describe method preventing cerebrospinal fluid \( csf \) rhinorrhea following surgery acoustic neurinoma air cells exposed craniectomy packed bone dust , covered fibrin glue use technique reduced number acoustic neurinoma cases requiring secondary csf leakage 16 5
effect glucose administration carbohydrate metabolism head injury role intravenous infusion glucose limiting effect glucose cerebral metabolism following severe head injury studied 21 comatose patients patients randomly assigned without glucose systemic protein , arterial concentrations energy substrates , cerebral metabolism energy substrates monitored 5 days postinjury groups negative nitrogen balance , systemic proteins despite substantial protein intake blood cerebrospinal fluid \( csf \) glucose concentrations highest day 1 , remained higher normal fasting levels days study , even patients received exogenous glucose although differences blood csf glucose concentrations two groups patients , glucose group higher plasma insulin levels , mean standard deviation 14 8 7 3 microu ml compared 10 3 4 2 microu ml saline group blood concentrations beta hydroxybutyrate , , pyruvate , glycerol , free fatty acids higher saline group glucose group cerebral oxygen consumption similar two groups , cerebral metabolism glucose ketone bodies dependent whether glucose administered glucose group , glucose energy substrate utilized brain saline group , ketone bodies beta hydroxybutyrate replaced glucose extent 16 brain 's total energy production cerebral lactate production csf lactate concentration lower saline group studies suggest administration glucose early recovery period severe head injury major cause suppressed , may increase production lactic acid brain limiting availability energy substrates
management meralgia paresthetica meralgia paresthetica syndrome pain , , anterolateral thigh caused entrapment neurinoma formation lateral femoral cutaneous nerve conservative treatment successful relieving symptoms 91 277 patients syndrome however , 24 patients required surgical treatment intractable symptoms although transposition common procedure , sectioning lateral femoral cutaneous nerve performed 24 cases successful 23 one patient early symptomatic relief , subsequently developed different neurological signs symptoms undetected pelvic neoplasm anatomical variations nerve , occur frequently , easily sectioning may lead recurrence transposition
post traumatic intracerebral case report pneumocephalus occurs 0 5 1 0 head trauma , may also occur neurologic surgery , result infection neoplasm pathophysiology involves presence fistula allowing air ball valve mechanism may allow air enter exit , csf leak permits air entrance fluid intracranial space considered diagnostic pneumocephalus , patients nonspecific signs symptoms headache therefore , high index suspicion patient recent head trauma necessary diagnosis made radiographically ct scan generally performed rule intracranial hematoma cerebral contusion head trauma , reveal even small quantities air physician therapy often noninvasive , allowing defect heal spontaneously selected situations require immediate operative repair fistula
headache public health problem headache , apparently always , frequent pain syndrome reported american western european societies high percentages population headache , specifically severe headache , also reported prevalent variety societies worldwide , although prevalence rates varied \( low , example , people 's republic china \) whether prevalence varies different socioeconomic groups remains uncertain severe headache specifically migraine , reasons still unknown , much common women , , studies , reported decrease prevalence older age groups positive family histories common , precise role genetics unknown major problem epidemiologic studies remains difficulty uniform definition headache syndromes
classification diagnosis headache disorders headache disorders recently , new diagnostic criteria assist making correct diagnosis diagnostic criteria accepted worldwide
basic mechanisms vascular headache better understand treat painful conditions , one needs identify cause , discover source , develop knowledge peripheral central pain transmission headaches exception development appropriate animal models important accordingly , reviewed anatomy , , electrophysiology , pharmacology system experimental animals emphasized whenever possible relevance final common pathway migraine , cluster , headache syndromes humans example , based recent anatomic dissections , cavernous sinus plexus suggested important focus investigate cluster headache pathophysiology plexus anatomic point convergence nerves giving rise signs sympathetic parasympathetic activity sensory symptoms develop cluster patients nociceptive systems , axons assume least two important roles one concerns transmission nociceptive information electrophysiologic evidence supports trigeminal nucleus important site convergence visceral \( vessel \) somatic \( forehead \) inputs mediate referral vascular pain superficial tissues second important role concerns initiation local increases blood flow enhanced protein permeability \( sterile inflammation \) via axonal release vasoactive neuropeptides plasma extravasation develops within dura following trigeminal stimulation extravasation blocked administration , new serotonin like agonist , \( neuronal \) mechanism action drugs \( blockade release \) suggested based experimental evidence whether vasoconstriction also relates therapeutic efficacy remains determined organ systems , real threatened tissue injury provides important stimulus sensory fibers stimulus may come external conditions reduced blood flow hypoglycemia brain may also possess intrinsic neuronal mechanisms may synthesized \( e g , glutamate induced neurotoxicity , seizures \) molecules relevance include bradykinin , prostaglandins , leukotrienes , potassium experimental evidence presented demonstrating trigeminal nerve mediates hyperemia within cortical gray matter reflex like mechanisms important role nerve established hyperemic period recirculation ischemia severe hypertension limits autoregulation \( abstract truncated 400 words \)
concept migraine state central neuronal article explores hypothesis migraine aura associated state central neuronal authors propose central neuronal involves overactivity excitatory amino acids , glutamate , possibly aspartate stimuli activate migraine attack evoke neuronal depolarization , slow depolarization shifts , spreading suppression spontaneous neuronal activity possible glutamate k dependent mechanisms low brain mg2 consequent reduced receptors may provide link physiologic threshold migraine attack mechanisms attack promoting glutamate hyperactivity , neuronal , susceptibility glutamate dependent spreading depression
developments 5 hydroxytryptamine receptor pharmacology migraine satisfactory animal model migraine exist , attempts determine common mechanism action effective antimigraine agents may benefit pathogenesis neurologic syndrome present review demonstrates clinical data developed past 30 years may allow elucidation role specific 5 ht receptor subtypes pathophysiology migraine large number acute prophylactic antimigraine agents share ability interact 5 ht receptor subtypes human brain summarized table 3 , acute antimigraine drugs \( e g , , \) share high affinity 5 receptors somewhat lower affinity 5 receptors receptors present certain intracranial blood vessels 5 receptors also located nerve act inhibit release 5 ht neurotransmitters theoretically , 5 receptor agonists may acutely inhibit release vasoactive pain inducing substances perivascular space , drugs acting receptor would stop progression perivascular process addition , number prophylactic antimigraine drugs display relatively high affinity 5 ht2 5 receptors human brain although receptors also found certain blood vessels , present throughout nervous system receptors appear mediate neuronal cellular level moreover , 5 ht2 receptor appears play key role development inflammation certain smooth muscle systems theoretically , ability 5 ht2 antagonists protect perivascular inflammation may account efficacy prophylactic treatment migraine data offer novel approach analysis antimigraine agents drugs could selected use clinical migraine studies based selectivity specific 5 ht receptor subtype example , agent displays high affinity selectivity 5 receptors could clinically evaluated effectiveness , lack , would indicate importance specific 5 ht receptor site pathogenesis migraine future attempts determine common mechanism action effective antimigraine agents facilitate elucidation pathogenesis neurologic syndrome
manifestations migraine migraine disorder multiple manifestations affecting circulation , gastrointestinal tract , central nervous system involvement autonomic nervous system responsible many clinical features attack migraine vary fragment clinical spectrum one several phases potentially permanent sequelae
modern pharmacotherapy migraine rectal naproxen major candidates ad hoc treatment migraine attacks particularly dramatic episodes , intravenous author 's preference long term stabilization , simpler measures fail , valproate appears major addition migraine therapy
advances cluster headache physician may combine art science medicine management human choice drugs length treatment prescribed greatly influenced individual physician 's experience , convictions , reasoning , chronic use narcotics avoided author 's regimen use combinations prophylaxis either verapamil prednisone episodic cluster headache lithium chronic cluster headache management treatment resistant patient remains problematic , carefully performed trigeminal radiofrequency procedure may worthwhile
drug induced headache headache induced medications used conditions , importantly , headache symptomatic medications used primary headache disorders discussed detail article clinical features mechanisms drug induced headaches reviewed analgesic rebound phenomena described management strategies drug induced headaches outlined
disorders headache critical appraisal disorders functional disorders associated pains anatomic region temporomandibular joint diagnosis treatment controversial lack concerning disorders among health care providers article provides clear classification disorders critically reviews evaluation treatment
psychologic behavioral aspects chronic headache important physicians aware expectations psychologic needs patients , understand psychologic personality variables impact care , importance patient education , environmental factors influence headache pain behaviors empirical data indicate nonpharmacologic treatments biofeedback , relaxation , stress coping training serve useful adjunctive alternative procedures , combined use medication nonpharmacologic treatments yields greatest clinical outcome certain headache types show minimal response therapies alone \( cluster , menstrual , post traumatic headache \) age personality variables bearing treatment outcome well
surgical decompression without transposition ulnar neuropathy factors determining outcome fifty one surgical without nerve transposition ulnar neuropathy performed 46 patients patients men average age 59 years time surgery follow range 5 32 months \( average , 17 8 months \) disease involved arm 24 patients \( 52 \) bilateral 5 \( 11 \) 23 cases \( 50 \) , predisposing condition could identified , whereas 15 patients \( 33 \) abused alcohol 8 patients \( 17 \) diabetes mellitus fifty seven percent patients helped surgery symptoms less 1 year , whereas 30 patients symptoms 1 year symptomatic improvement relative magnitude slowing ulnar nerve conduction velocity across elbow significantly correlated success decompression relieving symptoms ulnar nerve conduction velocities across elbow 36 13 11 76 responding surgery 38 97 13 91 responding \( c 0 06 , df 50 , p less 0 3 \) total 37 patients showed symptomatic improvement decompression simple decompression ulnar nerve performed local anesthesia without transposition nerve cases , compression nerve occurred predominantly groove narrowing nerve groove present 28 cases \( 55 \) scar tissue found nerve 21 cases \( 41 \) two found \( 4 \) forty one operations \( 80 \) resulted symptomatic improvement , typically noted patient within first month postoperatively
blood flow direction lumbar nerve root effect clipping lumbar nerve root blood flow rates region nerve root canal studied experimentally blood flow rate measured using hydrogen washout technique entrance zone clipped microvascular clip , blood flow rate nerve root decreased 37 comparison initial control rate clipping exit zone reduced blood flow rate 69 blood flow direction lumbar nerve root within nerve root canal found predominantly proximal current data indicate lateral impingement nerve root occurs , ischemic changes induced
preventing stroke modification risk factors epidemiologic research revealed major risk factors cerebrovascular disease review three important risk factors elevated blood pressure , common important , since responsible 70 strokes raised cholesterol smoking factors important increase risk stroke , also amenable modification drugs , diet , interventions strategies avoid stroke either 1 \) try produce substantial reductions , usually drugs , level risk factor individuals population high levels \( high risk approach \) , 2 \) try produce modest reductions level risk factor every individual population , usually drugs lifestyle modification \( mass approach \) prevention stroke could best achieved continuing medical efforts deal high risk individuals strategies encourage lifestyle population whole
cytosolic free calcium focal cerebral ischemia effects nimodipine calcium histologic damage role calcium mediator neuronal death ischemia quite strong evidence supporting link includes studies cell cultures measurements calcium accumulation mitochondria ischemia , well direct measurements shifts extracellular calcium using since high concentrations intracellular free calcium hypothesized lead neuronal damage , direct vivo measurements parameter ischemia important technique measurement intracellular free calcium described , along data studies dramatically demonstrate time course changes intracellular free calcium induced focal ischemia additional data also presented indicate cellular damage attenuated use agents block calcium channels \( nimodipine , blocks voltage sensitive calcium channels , mk 801 , blocks receptor operated channels \) support concept agents beneficial effects ability reduce accumulation intracellular calcium
effect nimodipine acute ischemic stroke pooled results five randomized trials review pooled data five double blind , placebo controlled studies nimodipine acute ischemic stroke , compared effect 120 mg nimodipine given orally placebo five studies , patients followed , adhered entry inclusion criteria end points mortality outcome end treatment period \( 21 28 days \) outcome assessed 's scale physician 's clinical judgement treatment control groups well matched respect demographic data , risk factors , baseline scores treatment group , 34 patients \( 7 9 \) died treatment period , whereas 54 \( 12 3 \) control group died , corresponding mortality reduction 36 significantly less neurologic impairment end treatment period documented nimodipine treatment , impairment improved patients moderate severe stroke \( baseline score less 66 \) administration nimodipine occurred within 12 hours stroke onset patient 65 years old overall incidence adverse reactions relatively modest , minor severity appeared remote relation study medication
sleep disturbances survivors objective method sleep disturbances commonly reported victims stress persist decades study designed test hypothesis survivors would significantly different sleep problems depressed healthy comparison subjects severity problems would correlated length time spent concentration camp forty two survivors , 37 depressed patients , 54 healthy subjects age , living community , described sleep patterns preceding month pittsburgh sleep quality index , self rating instrument quality , latency , duration , efficiency , disturbances sleep , use sleep medication , daytime dysfunction results survivors significantly greater sleep impairment healthy comparison subjects , measured subscales index , less impairment depressed patients except sleep disturbances daytime dysfunction subscales however , specific items within subscales , survivors significantly frequent awakenings due dreams less loss enthusiasm depressed subjects sleep disturbances frequency significantly positively correlated duration concentration conclusions findings suggest survivors , impaired sleep frequent considerable problems even 45 years
large scale networks distributed processing attention , language , memory cognition neural networks allow high level including parallel distributed processing cognitive problems resolved sequential progression toward predetermined goals instead simultaneous interactive consideration multiple possibilities constraints satisfactory fit achieved resultant mental activity characterized almost infinite flexibility according model , complex behavior mapped level multifocal neural systems rather specific anatomical sites , giving rise brain behavior relationships localized distributed network contains anatomically addressed channels transferring information content chemically addressed pathways modulating behavioral tone approach provides neurological attention , language , memory , frontal lobe function
impairment sequences memory guided saccades supplementary motor area lesions different saccades recorded electro 2 patients infarction affecting left supplementary motor area saccades made toward visual targets \( visually guided saccades \) away \( \) normal patients memory guided saccades , made position flash occurring 2 seconds , preserved 1 patient slightly impaired however , sequences two three memory guided saccades severely impaired patients previously reported supplementary motor area plays important role programming sequential limb movements data suggest area plays similar role control sequential eye movements
brain ph head injury image guided 31p magnetic resonance spectroscopy study suggested brain acidosis may follow head trauma , therapies aimed correcting acidosis proposed direct measurements intracellular ph , however , thus far possible clinical situations studied intracellular brain ph 22 patients head injury \( mean glasgow coma score 6 1 \) patients investigated combined approach phosphorus 31 magnetic resonance spectroscopy magnetic resonance imaging \( overall examination time 50 75 min \) mean time 11 days injury \( 36 hours 24 days \) 31p spectra obtained 11 patients assisted ventilation 11 patients spontaneous ventilation spectra analyzed yield ph regions studied patients ph values normal range compared 6 age matched normal controls differences found patients assisted ventilation patients spontaneous ventilation analyzed group , brain ph focal lesions appeared increase first days , reach peak range second week , return toward normal within 3 weeks acute injury results suggest evidence posttraumatic intracellular brain acidosis recent human head injury , therefore , therapies aimed brain cells need
magnetic motor evoked potentials epilepsy effects disease anticonvulsant medication magnetic motor evoked potentials recorded 53 patients medically intractable , mainly temporal lobe epilepsy compared potentials 110 healthy volunteers motor evoked potentials 16 53 patients substantial reduction antiepileptic drug doses objective assess effect epilepsy anticonvulsant medication central motor system subjects receiving antiepileptic treatment , cortical threshold intensities markedly elevated peripheral latencies prolonged cortical threshold intensities peripheral latencies decreased approach control values anticonvulsant medication reduced increased patients treated 2 3 anticonvulsant agents instead 1 additionally , high levels interictal epileptiform activity high frequency seizures significantly decreased central motor conduction time , part , threshold intensities central motor conduction time diminished reduction anticonvulsant treatment increased several drugs administered duration epilepsy , location epileptic focus , type epileptic seizure affect motor evoked potentials conclusively , central motor pathways endogenously facilitated epileptiform activity even clinical signs involvement absent anticonvulsant medication exerts major reversible effects magnetic motor evoked potentials
follow study intractable seizures childhood one hundred forty five children seizures refractory medical therapy least 2 years followed 5 20 years onset majority children seizures \( 61 \) mentally retarded , \( 73 \) onset seizures younger 2 years age age onset significantly later \( mean 5 0 0 5 yr sem \) group children borderline normal intelligence follow data showed remission seizures significant proportion children borderline normal intelligence , linear decrease percentage persistent seizures rate 4 per year remission seizures much less frequent \( 1 5 yr \) group mental retardation seizure type effects outcome children focal atrophic brain lesions worse without definable pathology brain imaging studies
relationship clinical features psychological status primary fibromyalgia clinical features psychological status determined minnesota personality inventory \( \) 103 patients primary fibromyalgia syndrome \( \) analyzed univariate multivariate techniques determine clinical features related psychological status intrinsic per se central features , e g , number pain sites , number tender points , fatigue , poor sleep , independent psychological status however , discriminant analysis identified 4 variables patient reported depression , anxiety , stress , pain severity together predicted 3 subgroups accuracy 55 \( p less 0 001 \) musculoskeletal feature pain severity alone provided accuracy 34 \( p greater 0 05 \) data suggest new concept , central features fibromyalgia independent psychological status likely related however , pain severity may influenced psychological factors
brain death organ donation neurosurgical unit audit recent practice objective assess potential increasing yield donors comparing current pattern brain death organ donation neurosurgical unit reported 1981 recent national audit design retrospective review deaths 1986 , 1987 , 1988 prospective data 1989 setting regional neurosurgical unit serving 2 7 million population results deaths , 35 \( 191 \) patients died ventilator 17 \( 92 \) discontinuation ventilation medical contraindications donation found 23 \( 32 \) 141 patients tested brain death , 38 \( 19 \) 50 patients died ventilated tested , 12 \( 11 \) 92 patients longer ventilated consent donation sought 88 \( 96 \) 109 medically suitable brain dead patients 70 \( 67 \) half donation kidneys removed conclusions organs may lost owing transplant team failure seek consent relatives brain dead patients estimated size pool potential donors depends types patients might considered ensuring die ventilated tested brain death considering potential donation ventilation could yield donors patients brain damaged secure donors raises ethical economic issues
treatment fulminant hepatic failure insulin glucagon randomized , controlled trial insulin glucagon among therapeutic modalities investigated treatment fulminant hepatic failure \( \) completed randomized , controlled trial insulin glucagon 38 patients either viral toxin exposure control treatment groups consisted 21 17 patients , respectively , differ significantly etiology admission laboratory values mortality significantly different control treatment groups 67 82 , respectively time randomization death discharge significantly different two groups peak levels alpha fetoprotein statistically higher survivors nonsurvivors \( p less 0 01 \) conclude even though type 2 error may exist , combination insulin glucagon useful treatment
analgesic use study treatments used patients migraine prior attending city london migraine clinic eighty three unselected patients attending city london migraine clinic first time asked drug intake use alternative treatment thirty one questioned took regular daily doses medication fifteen taking combination drugs \( otc \) drugs prescribed gp eleven took otc drugs 5 took prescription drugs noticeable taking drugs prescribed gp obtainable counter likely groups taking several drugs rather single type thirty five 83 \( 42 2 \) tried alternative treatments attacks
vasospasm contributes monosodium glutamate induced headache consumption monosodium glutamate long considered precipitate headaches susceptible patients study direct effects glutamate metabolite , glutamine , arterial contractility examined using rings rabbit aorta high concentration glutamate caused significant concentration dependent contractions \( ec50 , 10 \( 1 \) maximum tension , 188 4 33 3 mg wt tension mg tissue \) agonists antagonists alpha adrenergic , , , cholinergic , gaba receptors well inhibition prostaglandin synthesis failed influence glutamate contractions high concentrations \( 10 \( 5 \) \) calcium channel blocker , verapamil , inhibited glutamate response glutamate glutamine exhibited concentration dependent relaxation norepinephrine \( ne \) , phenylephrine \( pe \) , histamine , serotonin \( 5 ht \) , prostaglandin f2 alpha \( pgf2 alpha \) induced contractions acid \( 10 \( 4 \) \) , agonist one subpopulation central glutamate receptor , potentiated glutamate induced vasoconstriction higher concentration \( 10 \( 3 \) \) produced irreversible inhibition glutamate contractility central glutamate receptor antagonist , ketamine \( 10 \( 4 \) 10 \( 2 \) \) , induced reversible , concentration dependent inhibition glutamate induced contractions glutamate contractility dependent extracellular calcium , intact endothelium neuronal function results demonstrate direct effect glutamate peripheral arterial tone dietary consumption large quantities may represent serious health hazard certain individuals pre existing vascular disease
blink reflex cluster headache investigate involvement trigeminal system cluster headache , twelve subjects electrically elicited blink reflex symptomatic period examined eleven cases , amplitude contralateral r2 response symptomatic side significantly lower , stimulus intensity , asymptomatic side \( p 0 005 \) blink reflex useful evaluate biological drug induced phenomena cluster headache
assessment treatment children 's headaches developmental perspective childhood headache common pediatric problem clinical researchers evaluated several behavioral treatment , biofeedback relaxation training , may viable interventions adding developmental perspective evaluation treatment childhood headache likely way increase effectiveness strategies paper presents developmental issues related assessment treatment childhood headache three major areas development examined impact areas treatment assessment headache discussed three major areas cognitive development , self regulation psychosocial development provided practical suggestions application child development principles assessment intervention practices may appropriate
health status patients tension headache treated acupuncture physiotherapy sixty two female patients chronic tension headache randomly divided two treatment groups acupuncture physiotherapy overall function \( sickness impact profile \) , mental well \( mood check list \) intensity frequency headache assessed treatment treatment patients showed significantly dysfunction less positive mental well general population sample treatment groups improved overall function , physiotherapy group somewhat mental well increased physiotherapy group intensity frequency headache significantly reduced physiotherapy group acupuncture group intensity headache significantly improved physiotherapy group improvement headache intensity persisted unchanged 7 12 months treatment
nocturnal sleep recording eeg chronic headaches many headache patients poor sleep , sleep disturbance shown play role chronic pain recorded nocturnal sleep 4 channel eeg monitoring device 10 common migraine patients , 10 individuals muscle contraction \( tension \) headache , 10 chronic tension vascular headache migraine patients essentially normal sleep , although rapid eye movement \( rem \) sleep rem latency increased patients tension headache reduced sleep time sleep efficiency , decreased sleep latency frequent awakenings , increased nocturnal movements , marked reduction slow wave sleep , without change rem sleep latency mixed element headaches tension vascular features associated reduced sleep , increased awakening , diminished slow wave sleep , rem sleep decreased amount reduced latency findings suggest patients intermittent migraine may minimal sleep disturbance , chronic headache may worsened chronically poor sleep muscle contraction headache may associated frequent awakenings decreased slow wave sleep similar sleep changes , chronic tension vascular headache may depressive substrate four channel sleep recording may contributory sleep apnea , nonetheless eeg may facilitate outpatient evaluation refractory headaches
contingent negative variation migraine contingent negative variation \( \) event related slow potential recorded healthy volunteers \( n 8 \) patients suffering migraine without \( n 12 \) \( n 5 \) aura , one \( \) three second \( \) reaction time task recorded recorded multiple electrode sites assess differences seven twelve migraine patients without aura increased amplitudes amplitudes increased well , electrode positions c3 c4 , allows analysis early late component , could improve discrimination migraine without aura beyond migraine aura parameters control levels , confirming previous results data obtained discussed terms arousal , activation stress model migraine \( , 1986 \)
centrifugal intensity duration soleus muscle atrophy mechanical acceleration may employed prevent atrophy slow twitch muscle non weight bearing present study , daily centrifugation rats different durations \( 1 2 h \) different gravitational intensities \( 1 5 2 6 g \) used test whether mechanical acceleration could ameliorate atrophy soleus muscle induced non weight bearing \( tail traction model \) soleus muscle 32 7 days non weight bearing without centrifugation treatment completely prevent atrophy relative wet weight soleus muscle non weight bearing groups receiving 2 h daily treatments 1 , 1 5 , 2 6 g 48 , 56 , 65 , respectively , atrophy observed non weight bearing group compared group evidence obtained centrifugation 2 6 g effective exposure 1 1 5 g non weight bearing induced atrophy soleus muscle
effects carotid denervation ventilatory response co clarify mechanisms involved ventilatory response inhalation low concentrations co \( 0 18 0 22 air \) , roles arterial chemoreceptors forebrain structures investigated adult cats ventilatory response observed conscious animals intact , carotid denervation \( cd \) , results show initial small ventilatory depression unaffected cd subsequent characteristic blunted cd even prolonged exposure co co observed , residual hyperventilation noted higher concentration used may concluded carotid chemoreceptors mediate co , may originate structures shown comparison intact animals cd may caused relative hypercapnia observed cd animals residual hyperventilation observed animals may caused central acidosis peripheral potentiation chemoreceptor activity resulting decrease arterial blood pressure accompanied co inhalation animals
florid refractory turn treatable variants hla associated component unusually prominent may lead development illness indistinguishable schizophrenic syndrome psychotic symptoms symptomatology , primary illness five patients described conventional antipsychotic drugs , treatment produced substantial improvement diagnosis confirmed human leukocyte antigen typing sleep laboratory testing results support rem hypothesis causation schizophrenia many 7 series schizophrenic patients implications diagnosis treatment discussed
neurotoxic action veratridine rat brain neuronal cultures mechanism ca antagonists nonselective slow ca channels effect various ca antagonists local anesthetics neuronal cell degeneration induced veratridine studied primary rat brain neuronal cultures cell death quantified measuring lactate dehydrogenase \( ldh \) released culture medium neuronal cell degeneration ca \( \) dependent , absence extracellular ca , 16 hr exposure 30 microm veratridine failed produce release ldh ca antagonists , nonselective slow ca channels \( flunarizine , cinnarizine , , bepridil \) inhibited veratridine induced release ldh ic50 values 0 11 0 47 microm ca antagonists selective slow ca channels less potent inhibited veratridine induced release ldh concentrations following order potency nicardipine greater verapamil greater greater nitrendipine greater nifedipine greater nimodipine greater diltiazem tested local anesthetics incomplete inhibitors veratridine induced release ldh good correlation found potency drugs inhibit released ldh induced 30 microm veratridine neuronal cultures binding affinity binding site na channels rat cortex preparation concluded protection veratridine induced neurotoxicity mediated blocking veratridine sensitive na channel property certain nonselective ca antagonists apparently direct relationship ca activity effect unrelated local anesthetic activity
central system involvement ethanol induced motor incoordination mice clarify behavioral interaction ethanol adenosine reported previously occur centrally due peripheral hemodynamic change , effect c v adenosine agonists , \( r \) adenosine \( r \) , \( \) adenosine , 5' \( n \) , antagonists , theophylline 8 p \( \) theophylline well ethanol \( p \) induced motor incoordination evaluated adenosine agonists antagonists dose dependently accentuated attenuated , respectively , ethanol induced motor incoordination , thereby suggesting central mechanism adenosine modulation effect ethanol confirmed previous reports adenosine agonists antagonists given p , weak adenosine antagonist potent inhibitor cyclic amp phosphodiesterase , alter ethanol 's motor incoordination , supporting involvement brain adenosine receptor mechanism \( \) ethanol adenosine interactions results r \( \) adenosine experiments showed nearly 40 fold greater potency r vs , suggesting predominance adenosine a1 subtype however , 5' \( n \) data indicate complexity mechanism \( \) point toward additional involvement yet unknown subtype adenosine a2 effect ethanol blood brain levels 3h r noted sufficient amount latter entered brain suggest adenosine receptor activation adequate produce behavioral interaction ethanol escape c v administered 3h r brain peripheral circulation peripheral supporting central mechanism ethanol adenosine interaction
interactions n methyl aspartate cgs 19755 administered intramuscularly intracerebroventricularly pigeons behavioral effects n methyl aspartate \( nmda \) competitive nmda antagonist cis 4 2 acid \( cgs 19755 \) studied pigeons nmda decreased responding fixed ratio schedule food presentation times potent administered intracerebroventricularly \( c v \) compared intramuscularly \( \) cgs 19755 times potent producing catalepsy administered c v however , duration catalepsy similar two routes administration administered cgs 19755 decreased response rates doses also produced catalepsy administered c v doses cgs 19755 decreased responding without producing behavioral effects rate decreasing effects nmda attenuated cgs 19755 however , cgs 19755 administered c v , little antagonism nmda rate decreasing effects c v nmda attenuated c v cgs 19755 doses produced catalepsy eliminated responding large difference potency c v administration nmda cgs 19755 , well slower onset catalepsy cgs 19755 administered , suggests compounds readily cross blood brain barrier administered parenterally inability cgs 19755 attenuate rate decreasing effects nmda cgs 19755 nmda administered c v suggests nmda might decrease responding different mechanisms administered c v pigeons together results indicate antagonism nmda study , perhaps studies , nmda cgs 19755 administered parenterally , might result peripherally mediated interaction moreover , agonist antagonist interaction simple , competitive antagonism
mechanical restraint use among residents skilled nursing facilities prevalence , patterns , predictors patterns risk factors mechanical restraint use determined 12 skilled nursing facilities restraints used 59 residents beginning study 31 remaining residents follow year facility characteristic associated restraint use resident characteristics independently associated initiation restraints older age , , dependence dressing , greater participation social activities , antidepressants \( 72 \) , behavior agitation \( 41 \) , \( 20 \) frequently cited reasons initiation restraints
response treatment antihistamines family myotonia congenita family myotonia congenita found five generations , great index case affected subsequent generations mild severely affected cases clearly segregated parallel lines family index case noted improvement antihistamine index case prescribed , showed striking reduction severity symptoms antihistamines seem deserve evaluation safe effective treatment myotonia congenita
transcranial doppler acute hemispheric brain infarction studied cerebrovascular anatomy using intra arterial digital angiography , blood flow velocity middle cerebral artery \( mca \) using transcranial doppler \( tcd \) ultrasonography 42 patients acute hemispheric ischemic brain infarction compared angiography tcd clinical findings within 6 hours onset symptoms location extent chronic ischemic brain damage assessed ct performed 1 3 months ictus abnormal tcd , manifested either mca flow signal significantly depressed mca flow velocity , highly associated proximal mca occlusions demonstrated angiography abnormal tcd predicted larger chronic ct lesions extensive ischemic change within mca territory data demonstrate early tcd useful information concerning cerebral tissue prognosis following hemispheric ischemia
guillain barre syndrome report woman guillain barre syndrome developed flexion posture right arm hand resembling upper motor neuron dysfunction emg demonstrated involuntary peripherally generated continuous motor unit discharges caused posture
suppression carbamazepine induced rash prednisone report experience 20 patients developed rash shortly introduction carbamazepine treated prednisone antihistamine sixteen patients successfully continued carbamazepine 4 drug
neuropathies compressive neuropathy due tight application occurred 5 patients superficial radial nerve affected 8 hands median nerve two neurologic deficits persisted long 3 years nerve conduction studies helped exclude diagnoses patients intoxicated arrested force mechanism , allows accidental application , unrecognized factor neuropathies
cholinergic nuclei progressive supranuclear palsy using antibody choline acetyltransferase \( chat \) , cholinergic cell nuclei studied autopsy material 3 cases progressive supranuclear palsy \( \) 4 controls chat immunoreactive neurons quantified sections extent nucleus , significant decrease number neurons detectable immunoreactivity chat adjacent central gray substance following nuclei nucleus \( 69 \) rostral interstitial nucleus medial longitudinal \( 97 \) interstitial nucleus \( 78 \) cell loss also evident group neurons found deep layers superior \( 93 \) contrast , estimated number chat immunoreactive cell bodies cranial nerves iii iv , reticular formation , nucleus different controls results compatible notion , , selective destruction cholinergic neurons
central nervous system involvement von disease fifty individuals von disease \( vhl \) studied gadolinium enhanced magnetic resonance imaging \( mri \) determine frequency distribution cns lesions associated clinical features also reviewed thirty six \( 72 \) 50 1 cns tumors frequently affected sites cns excluding retina cerebellum \( 52 \) , spinal cord \( 44 \) , brainstem \( 18 \) new regional junction demonstrated study forty one percent vhl patients cns tumors neurologically asymptomatic cerebellar tumors \( 50 \) , spinal cord tumors \( 50 \) , brainstem tumors \( 44 \) often without clinical signs symptoms multiple lesions common mean age vhl patients \( 34 5 years \) similar mean age cns vhl patients \( 34 4 years \) , suggesting lack age association cns lesions commonly occurred 2nd decade life patients risk vhl evaluated using gadolinium enhanced mri 10 years age , although ophthalmic examination initiated within 1st 2 years life enhanced mri particularly useful detection cns tumors patients vhl gene
study cervical myelopathy using evoked spinal cord potentials one hundred twenty three cases cervical ossification posterior longitudinal ligament \( \) myelopathy cases long tract signs subjected surgical treatment studied identify important factors influence postoperative outcome using evoked spinal cord potentials \( \) disappearance positive wave changes potentials level responsible lesions slow conduction velocity 40 indicated unsatisfactory outcome localized lesion cases diagnosed excellent results , significantly extensive lesion cases , regardless operative methods 123 cases , 76 found localized lesions , 24 showed extensive lesions concerning difference , 54 14 demonstrated extensive lesions
cerebral blood flow oxygen metabolism patients vascular dementia type performed clinical neuroradiologic studies , including positron emission tomography , five patients vascular dementia type clinical features cases consisted slowly progressive dementia , together vascular risk factors hypertension often history minor stroke , characteristic white matter lesions brain computed tomograms magnetic resonance images digital subtraction angiography cervical intracranial arteries demonstrated occlusive lesion patient cerebral blood flow cerebral metabolic rate oxygen markedly reduced white matter \( 54 77 control values \) , decreased parietal \( 73 control \) , frontal \( 74 80 \) , temporal \( 74 83 \) , abnormalities detected brain computed tomography magnetic resonance imaging conclude vascular dementia type may caused cerebral cortex subcortical structures due ischemic damage white matter
open trial high dosage antioxidants early parkinson 's disease high dosages tocopherol ascorbate administered patients early parkinson 's disease preliminary open labeled trial eventual controlled double blind study evaluating antioxidants test endogenous toxin hypothesis etiology parkinson 's disease primary endpoint trial need treat patients levodopa time levodopa became necessary treated patients compared another group patients followed elsewhere taking antioxidants time levodopa became necessary extended 2 5 group taking antioxidants results pilot study suggest progression parkinson 's disease may slowed administration antioxidants large multicenter , controlled clinical trial currently north america evaluating tocopherol potential confirm results
four chromosomal breakpoints four new probes mark 10 cm region encompassing fragile x locus \( fraxa \) report validation use cell hybrid panel allowed us rapid physical localization new dna probes vicinity fragile x locus \( fraxa \) seven regions defined panel , two lie dxs369 dxs296 , closest genetic markers flank fraxa two interesting regions , one distal dxs369 defined probe 2 71 \( \) , polymorphic next one contains probes \( \) 2 34 \( \) , within 130 kb detect rflps combined two probes 30 cloned irradiation reduced hybrid line another new polymorphic probe , \( 42 heterozygosity \) probe maps dxs296 region , proximal chromosomal breakpoint corresponds syndrome locus \( \) physical order thus dxs369 \( , \) \( dxs296 , \) performed linkage analysis five markers centre du families large set fragile x families establishes dxs296 distal fraxa relative position respect fraxa remains uncertain , results place genetically halfway dxs369 thus cluster defines presently either closest proximal closest distal polymorphic marker respect fraxa three new polymorphic probes described combined heterozygosity 60 represent major improvement genetic analysis fragile x families , particular diagnostic applications
identification highly polymorphic within synthetase locus exclusion dystonia gene 34 cause dopa responsive dystonia large kindred dopa responsive dystonia clinical variant idiopathic torsion dystonia distinguished forms dystonia frequent occurrence parkinsonism , diurnal symptoms , dramatic therapeutic response l dopa linkage gene causing classic dystonia large non jewish kindred \( \) group ashkenazi jewish families , \( \) succinate synthetase \( \) loci chromosome 34 , respectively , recently determined report discovery highly informative \( gt \) n repeat polymorphism within locus analysis large kindred dopa responsive dystonia , using new polymorphism conventional rflps 34 region , loci region cause form dystonia provides proof genetic heterogeneity classic idiopathic torsion dystonia dopa responsive dystonia
sudden cervical pain spontaneous cervical epidural hematoma three cases cervical epidural hematoma reported acute neck pain usually associated mild effort , closely followed radicular pain neurologic deficit lesion typical presentation extremely rare difficult diagnosis prognosis depends preoperative neurologic state , authors emphasize importance prompt identification lesion diagnosis confirmed computed tomography , emergency neurosurgical laminectomy mandatory
associated midazolam erythromycin 8 yr old boy suffering asymptomatic ventricular septal defect given erythromycin antibiotic prophylaxis adenoidectomy sixty minutes premedication oral midazolam 0 5 mg kg 1 oral atropine 0 03 mg kg 1 , infusion erythromycin 400 mg started 200 mg erythromycin infused , patient lost consciousness , vital functions remained normal 45 min , spontaneously time plasma concentration midazolam 134 ng ml 1 order investigate possible interactions midazolam erythromycin , studied pharmacokinetics midazolam six children age undergoing minor surgery plasma concentration midazolam patient lost consciousness significantly greater six children without concomitant administration erythromycin altered pharmacokinetics midazolam may result reduced hepatic clearance midazolam caused enzyme inhibiting drug , erythromycin
radiosurgery acoustic eighty five patients acoustic underwent stereotactic radiosurgery gamma unit university pittsburgh \( pittsburgh , pa \) first 30 months operation neuroimaging studies performed 40 patients 1 year follow showed tumors smaller 22 \( 55 \) , unchanged 17 \( 43 \) , larger one \( 2 \) 2 year actuarial rates preservation useful hearing hearing 46 62 , respectively previously undetected neuropathies trigeminal \( n 12 \) facial nerves \( n 14 \) occurred 1 week 1 year radiosurgery \( median , 7 6 months , respectively \) , improved median intervals 13 8 months , respectively , onset hearing loss significantly associated increasing average tumor diameter \( p 0 04 \) deterioration cranial nerve function yet developed seven patients average tumor diameters less 10 mm radiosurgery important treatment alternative selected acoustic neurinoma patients
effects discontinuation phenytoin , carbamazepine , valproate concomitant antiepileptic medication report prospective , controlled study effects reduction discontinuation phenytoin \( pht \) \( 22 patients \) , carbamazepine \( cbz \) \( 23 patients \) , valproate \( vpa \) \( 25 patients \) concomitant antiepileptic drugs \( aeds \) principal changes serum concentrations concomitant aeds \( \) phenobarbital \( pb \) concentrations decreased mean 30 discontinuation pht \( b \) total cbz concentrations increased mean 48 free cbz concentrations increased mean 30 discontinuation pht , change cbz 10 , 11 \( cbz e \) concentrations \( c \) vpa concentrations increased mean 19 discontinuation pht \( \) vpa concentrations increased mean 42 discontinuation cbz \( e \) \( \) concentrations increased mean 48 discontinuation cbz \( f \) pht concentrations decreased mean 26 discontinuation cbz \( g \) pht free fraction decreased mean 0 11 0 07 discontinuation vpa \( h \) mean concentrations total free cbz increased mean 10 16 , respectively , vpa discontinuation , concomitant mean 24 decrease total cbz e 22 decrease free cbz e apart decrease pb concentrations pht discontinuation , significant changes occurred 1 week end aed discontinuation implication clinical practice serum aed concentration time reflects new steady state free concentrations add clinically useful information gained analysis total serum concentrations
cognitive function time day variation serum carbamazepine concentration epileptic patients treated monotherapy different parameters antiepileptic drug \( aed \) treatment shown affect cognitive function drug , dose , duration treatment studied present study assessed cognitive function relation time day variation serum carbamazepine \( cbz \) concentration epileptic patients treated monotherapy studied 10 males 12 females mean age 36 years mean duration cbz therapy 4 4 years patients seizure free least 1 month took two daily cbz doses test battery included tests motor speed , reaction time , attention , memory experimental design , subjects tested twice times close expected daily maximum minimum serum cbz concentration studied two balanced blocks \( block 1 tested 8 noon , block 2 tested noon 8 p \) blood samples collected every 2 hr 8 8 p subjects showed significant differences serum cbz concentration testing times , suggested maximum concentration 10 noon test battery showed consistent differences performance times high versus low serum concentration supplementary analysis correlations mean performance level cognitive tests variables related cbz treatment show consistent trends
immunologic aspects carbamazepine treatment epileptic patients immune abnormalities found epileptic patients receiving antiepileptic drugs \( aeds \) phenytoin \( pht \) produces decrease serum iga igm levels decrease transformation circulating lymphocytes stimulated \( pha \) effects carbamazepine \( cbz \) immune response still conflicting elucidate effects cbz immunologic parameters , serum concentrations iga , igg , igm , phagocytosis killing properties polymorphonuclear leukocytes \( pmns \) , cytotoxic activity natural killer cells response lymphocytes mitogenic agents studied forty healthy individuals 39 epileptic patients treated carbamazepine \( cbz \) monotherapy \( age range 18 40 years \) entered study student 's test used evaluate data cbz effect serum immunoglobulin concentrations lymphocytic reactivity \( pha \) mitogen cbz produced significant enhancement phagocytosis killing properties pmns increase natural killer \( nk \) cell activity therefore , negative effect cbz therapy immune system observed study
effect plasma levels carbamazepine metabolites \( fbm \) novel antiepileptic drug \( aed \) currently undergoing clinical evaluation united states controlled clinical trial conducted national health clinical center , fbm added constant carbamazepine \( cbz \) monotherapy cbz total concentrations reduced active fbm treatment \( mean reduction 25 , range 10 42 , p less 0 001 \) effect evident first week treatment reached plateau 2 4 weeks clarify interaction mechanism , free total concentrations cbz plasma metabolites determined high performance liquid chromatography \( hplc \) ultrafiltration four patients patients , fbm treatment reduced cbz concentrations increased cbz \( cbz e \) concentrations \( p less 0 01 \) free fractions compounds unmodified fbm appears capable inducing cbz metabolism cbz fbm interaction may clinically relevant
double blind , placebo controlled , cross trial add therapy epileptic patients double blind , cross trial , \( pgb \) placebo compared add therapy 59 patients moderate severe epilepsy eight patients complete study , 4 adverse drug reactions \( elevation liver transaminases , 2 gastritis , 1 acute psychosis , 1 \) 4 reasons among remaining 51 patients , seizure frequency reduced greater 50 18 patients pgb treatment 8 patients placebo \( p less 0 05 \) number days seizures significantly \( p 0 034 \) reduced pgb treatment patients' physicians' preferences end trial favor \( p less 0 01 \) pgb mild clinical side effects present 54 7 patients treated pgb 37 7 placebo increase liver transaminases observed 2 patients double blind study 1 follow period data show pgb , previously reported , useful 30 40 patients responding completely antiepileptic drugs \( aeds \) compound well tolerated , liver function must monitored
development reversal contingent tolerance anticonvulsant effects carbamazepine relationship timing drug administration anticonvulsant efficacy amygdala kindled seizures studied kindling development , rats received carbamazepine \( cbz , kg \) \( cbz \) amygdala stimulation \( cbz \) kindling full seizures , animals given cbz stimulation , cbz group showed good anticonvulsant response rats received cbz \( development kindled seizures \) remained unresponsive cbz treatment \( contingent \) drug naive cbz animals repeatedly received cbz electrical stimulation , developed tolerance anticonvulsant effects \( contingent tolerance \) tolerance could reversed period treatment cbz kindling animal drug free , cbz administration alone time drug seizures findings suggest tolerance cbz may affected temporal drug administration responsiveness altering
kindling susceptibility genetic seizure predisposition inbred mice olfactory bulb kindling rates studied two inbred strains genetically seizure prone mice \( dba 2 el \) three non epileptic inbred strains c57bl 6 \( b6 \) , , c3h \( c3h \) none dba 2 mice stimulated seizure kindling mice studied 4 6 weeks age , development spontaneous movement induced seizure activity el strain seizure susceptible dba 2 mice required fewest number reach stage 5 seizure \( mean se 4 0 0 6 \) nonepileptic c3h mice required reach stage 5 seizures \( 22 6 1 4 \) kindling rates b6 \( 9 6 0 6 \) , el \( 14 8 1 1 \) , \( 18 5 1 0 \) strains intermediate , kindling rate strain significantly different strains findings show seizure susceptible el mouse rapidly genetically similar nonepileptic control suggest inherited seizure susceptibility accelerates kindling rate nonepileptic b6 mice kindled rapidly el mice , however , suggesting genetic factors influence seizure susceptibility primary importance determination kindling rate
changes hippocampal glucose utilization subsequent amygdaloid kindled generalized seizures local changes cerebral glucose utilization phase amygdaloid kindled generalized seizures studied quantitative autoradiographic 2 14c deoxyglucose method conscious rats measurement initiated either termination behavioral seizure \( gs \) 30 seizure termination \( gs ii \) determine dynamic metabolic changes phase although glucose utilization neocortex remarkably depressed gs gs ii , hippocampus significantly increased gs decreased gs ii compared control changes hippocampal glucose utilization observed sectors pyramidal cell layer \( ca 1 4 \) molecular layer metabolic changes associated development amygdaloid kindled seizures begin limbic structures including hippocampus , transient increase hippocampal glucose utilization observed early phase indicates hippocampus one key structures initiating maintaining also kindled seizures
panic disorder seizure patients diagnostic panic disorder psychiatric diagnosis whose main feature paroxysmal attacks anxiety suddenly without apparent provocation physicians explain attacks ictal phenomenon patients known seizures similarities complex partial seizures report eight patients seizures panic disorder recognition second diagnostic entity resulted beneficial change treatment six eight find increased incidence panic disorder seizure clinic population compared general population
effect epilepsy sleep deprivation rate benign epileptiform transients sleep seventy eight individuals eeg records containing benign epileptiform transients sleep \( bets \) identified among 7 , 400 records reviewed laboratory 6 year period records contained abnormality 51 patients \( 65 \) genuine epileptiform discharges found records 19 patients 14 history epilepsy thirty five patients \( 45 \) proven history epilepsy antiepileptic drug \( aed \) therapy records patients , mean number bets per unit time significantly higher \( 11 88 2 \) record rest laboratory population bets \( 6 89 0 9 \) \( p less 0 02 \) among five conventional surface , ipsilateral ear \( \) showed significantly higher number bets per unit time surface used study thirty nine records \( 50 \) performed sleep deprivation \( sd \) considered , sd records showed significantly higher number bets per unit time \( 7 36 1 1 \) non sd records \( 3 89 0 69 \) \( p less 0 01 \) findings support general consensus individual bets may normal variants , high occurrence bets record raise suspicion underlying epilepsy
dreams epilepsy relationship dreams epilepsy illustrated two patients whose awake epileptic seizures recurrent dreams night sleep similar content cases eeg showed right anterior temporal spike discharge , suggesting role temporal lobe association dreams seizures
epilepsy continuous spike waves slow sleep treatment five children epilepsy continuous spike waves slow sleep \( \) reported main clinical features include \( \) onset 5 7 years age , \( b \) occurrence several types seizure \( e , partial motor , generalized motor , atypical absence \) , \( c \) presence language disturbances abnormal behavior based emotional impairment eeg findings characterized sleep tracings showing almost continuous \( greater 95 \) , diffuse slow spike wave activity treatment valproate \( vpa \) \( , \) \( \) , spike wave complex status disappeared symptoms signs also decreased suggest combined treatment appropriate treatment
sexual behavior sample females epilepsy sample 700 female epileptic outpatients examined 1985 1987 incidence disorders 18 epileptic females disorders compared epileptic females without sexual disorders normal female controls selected clinical eeg parameters epileptic females sexual disorders showed lower marriage rates , longer duration illness , sexually , predominance partial complex seizures \( 83 \) higher incidence menstrual abnormalities disorders frequently noted temporal lobe eeg abnormalities significantly higher
attitudes major toward employment people epilepsy 30 year study beginning 1956 , major san francisco bay area sampled 10 year intervals 30 year period assess attitudes toward employment epileptic workers time , documented trend sustained positive change appears validate efforts organizations focused raising public awareness disorder
antiepileptic drug monitoring epilepsy clinic prospective evaluation assess value site therapeutic drug monitoring epilepsy clinic , management decisions recorded immediately antiepileptic drug \( aed \) concentrations became available first year prospective study , 277 carbamazepine \( cbz \) , 170 phenytoin \( pht \) , 113 valproate \( vpa \) , 72 phenobarbital \( pb \) assays performed clinic 182 actively managed epileptic patients results drug analysis led alterations management 114 patients visits , e , 23 monitored dosage increased response circulating aed concentration 12 consultations decreased another 7 5 unsuspected poor compliance eight patients , three others aed added discontinued basis assay result time next rearranged 58 50 results therapeutic ranges four major aeds dosage adjusted \( 50 , 16 \) 54 low results therapeutic levels followed change aed dose \( 52 , 31 \) 26 29 concentrations therapeutic range doctor alter dosage regimen , 20 increase dose recommended site aed monitoring immediate impact clinical decision making greater 23 consultations form subtle simple therapeutic result
effects lactulose lactitol protein digestion metabolism conventional germ free animal models relevance results use treatment portosystemic encephalopathy protein digestion metabolism studied laboratory rats pigs investigate mechanisms action lactulose lactitol used treatment patients portosystemic encephalopathy lactulose \( beta \( 1 4 \) beta \) lactitol \( beta \( 1 4 \) \) increased excretion material decreased nitrogen excretion urine similar degree reported human patients studies germ free rats given lactulose effect observed , suggesting , lactulose least , effects mediated gut flora measurement alpha , epsilon acid content confirmed enhancement faecal nitrogen due increased contribution bacteria similarity results lactulose lactitol suggests , perspective protein metabolism , lactitol acts similar way lactulose treatment portosystemic encephalopathy
relation pain depression among institutionalized aged nursing home residents \( n \) classified basis dsm symptom checklist suffering possible major , minor , depression also completed geriatric depression scale \( \) profile mood states \( \) possible major reported intense pain greater number localized pain complaints minor individuals reported least intense pain fewest localized complaints effect remained strong even functional disability health status controlled statistically pain intensity number localized complaints correlated factor scores , strength direction associations varied level depression item item examination localized complaints indicated depressed individuals likely report pain , particularly physicians identified physical problem might account pain results compared previous research pain among younger individuals implications treatment depressed elderly discussed
oestrogen progesterone receptors acoustic neuroma tissue samples fourteen consecutive \( 8 male 6 female \) acoustic assayed hormone receptors using either monoclonal antibody \( \) , dextran coated charcoal \( dcc \) isoelectric focusing \( \) technique series unequivocally positive results , finding variance previously published results
effect nicardipine somatosensory evoked potentials patients acute cerebral infarction evaluated effect nicardipine , calcium channel blocker , somatosensory evoked potentials \( sep \) 26 patients acute cerebral infarction post treatment , 58 \( 15 26 \) n20 latencies prolonged affected 8 \( 2 26 \) shortened 35 \( 9 26 \) change mean n20 latencies significantly prolonged two hours post treatment affected hemisphere \( n20 , p less 0 01 , p less 0 01 \) nicardipine \( ni \) effect sep components intact seventy five per cent 12 patients hypertension decrease blood pressure \( bp \) taking nicardipine , undesirable side effects worsening neurological signs study demonstrates nicardipine prolongs latencies short latency components sep affected hemisphere acute ischaemic stroke also decreases bp observations suggest nicardipine therapy might impair neuronal function ischaemic zone
platelet monoamine oxidase b activity parkinsonian patients monoamine oxidase b \( mao b \) plays pivotal role n methyl 4 1 , 2 , 3 , 6 \( \) induced parkinsonism increased mao b activity platelets patients idiopathic parkinson 's disease \( pd \) reported study possibility high mao b activity may represent trait vulnerability pd enhancing neurotoxic effects environmental compounds discussed
specificity affective autonomic symptoms depression parkinson 's disease previous investigators suggested numerous symptoms used diagnose depression , sleep appetite disturbance , non specific medically ill patients , alternative diagnostic criteria developed study hypothesis tested parkinson 's disease \( pd \) comparing patients pd reported depressive mood patients pd without depressive mood depressed patients showed significantly higher frequency autonomic affective symptoms depression depressed patients pd reported significantly higher frequency , , loss interest , , , social withdrawal , self , reference , anxiety symptoms , loss appetite , initial middle , loss compared non depressed patients significant group differences , however , observed frequency , motor retardation , early morning awakening
neurophysiological observations projections upper limb subjects rett syndrome aim present study investigate excitability neurons integrity projections alpha motor neurons tract subjects different ages rett syndrome electromagnetic stimulation motor cortex cervical motor roots used evoke motor action potentials biceps brachii muscles phasic stretch reflex biceps brachii also recorded study excitability spinal alpha motor neurons motor cortex stimulation evoked motor action potentials low threshold abnormally short latencies prolonged durations contrast cervical motor root stimulation resulted responses normal latency duration phasic stretch reflex low threshold , short latency prolonged duration concluded rett syndrome pathway intact results suggest disordered synaptic control cell motor cortex spinal alpha motor neuron , although involvement latter might consequence dysfunction descending motor pathways
stroke rehabilitation patient profile functional outcome prospective , multi institutional , population based study identified non surgical stroke admissions hospitals major city 1984 demographic diagnostic profile nature functional recovery 258 first stroke survivors referred inpatient rehabilitation presented median duration rehabilitation stay 49 days mean functional independence score , measured modified barthel index admission 44 , compared 78 discharge , mean improvement 34 stair climbing lowest mean value admission \( 12 \) , bowel control lowest residual deficit discharge \( 95 \) stroke study group representative unimpaired aged population respects except ethnicity , differences attributed age variables identified significant side severity paralysis , age sex , marital status ethnicity stroke rehabilitation outcome influenced etiology , site lesion , arterial distribution , occupation education
status cochlear implantation children american academy otolaryngology head neck surgery subcommittee cochlear implants cochlear implant medical device , part placed surgically , uses electrical stimulation provide hearing almost decade , investigational studies ongoing define safety efficacy profoundly children period , 500 children aged 2 17 years implanted either single electrode device extensive auditory , speech , educational , psychologic testing performed implantation results show cochlear implant provides auditory detection much speech signal compared period , significant improvement auditory discrimination speech production skills limited open set recognition possible least children complications device minimal cochlear implant provide sound children unable benefit hearing aids complex assessment , rehabilitation , parent counseling performed centers multidisciplinary necessary provide effective care patients specialized auditory prosthesis
phenotypic variability glutaric aciduria type report fourteen cases five canadian indian kindreds describe 14 patients glutaric aciduria type 1 five canadian indian kindreds living manitoba ontario patients marked clinical variability disease , even within families eight followed typical clinical course normal early growth development onset neurologic abnormalities , often precipitated infection , 6 weeks 7 1 2 months age five patients early developmental delay one thought normal 8 years age three patients died , seven severely mentally physically handicapped , four mild mental retardation incoordination six patients neonatal period computed tomography done 12 patients , findings abnormal 11 glutaric acid 3 acid detected increased amounts urine patients , concentrations much lower reported patients coenzyme dehydrogenase activity skin fibroblasts , interleukin 2 dependent lymphocytes , , ranged 0 13 control values correlation clinical severity urine glutaric acid concentration level residual enzyme activity recommend organic acid analysis urine done patients unexplained cerebral palsy like disorders , especially computed tomographic scan abnormal suspicion glutaric aciduria , coenzyme dehydrogenase measured fibroblasts lymphocytes even glutaric acid increased urine
management mid face fractures intracranial injury recent advances radically changed management facial fractures ct scanning , extensive exposure , rigid plate fixation setting trauma center permitted early operation improved results subset patients facial fractures also intracranial injuries \( ici \) sought identify parameters associated increased risk ici also sought examine safety limits early craniofacial repair patients intracranial injuries 114 mid face fractures treated 1 year period , 43 \( 38 \) concomitant ici majority , 36 \( 84 \) , motor vehicle accidents \( mva \) frontal sinus fractures highest risk ici , although orbitozygomatic fractures caused also surprisingly high incidence ici results show early craniofacial repair performed safely appropriate general surgical neurosurgical support
feasibility reversing benzodiazepine tolerance flumazenil examine whether benzodiazepine antagonist flumazenil reverse tolerance benzodiazepines without precipitating withdrawal seizures , antiepileptic effect flumazenil ability reverse tolerance dose would leave sufficient receptors free binding benzodiazepines investigated electroencephalographic studies 6 patients partial 6 generalised seizures showed flumazenil short \( 20 min \) non dose dependent effect epileptic discharges partial seizures receptor occupancy studies 12 patients showed 1 5 mg flumazenil given intravenously occupied 55 receptors , whereas 15 mg occupied nearly receptors 3 patients partial seizures become tolerant given 1 5 mg flumazenil , seizure free 6 21 days injection value intermittent therapy benzodiazepine antagonist preventing reversing tolerance benzodiazepine agonists investigated
carpal tunnel syndrome correlations pressure measurement intraoperative electrophysiological nerve study 19 carpal tunnel syndrome \( cts \) patients 4 control subjects catheter introduced carpal tunnel slowly retracted 5 mm steps pressure measured continuous infusion technique group patients controls , median nerve antidromic sensory action potential \( \) detected intraoperatively stimulating proximally \( s1 \) , center \( s2 \) , distally \( s3 \) carpal tunnel recording third finger \( r \) sensory conduction velocity \( \) amplitude considered s1 s2 , s2 s3 s3 r segments tunnel pressure significantly higher cts patients controls , highest values located 25 35 mm distal proximal border flexor amplitude also decreased often distal part \( s2 s3 \) carpal tunnel
vector short latency somatosensory evoked potentials median nerve stimulation new method developed recording short latency somatosensory evoked potentials median nerve stimulation negative electrical forces recorded three bipolar electrodes neck direction opposite conduction proximal peripheral cervical somatosensory pathway sequential tracings vectors opposite electrical forces made three dimensional display , thus actual time sequence electrical events structures fixed generators subcortical nuclei also analyzed technique , multiple generators n13 potential \( \) visualized technique may useful functional evaluation somatosensory pathway cervical cord
painful shoulder part extrinsic disorders shoulder disorders commonly manifested pain limited function careful history examination help physician localize problem shoulder joint , surrounding tissues adjacent sites cause referred pain shoulder common extrinsic causes shoulder pain include postural problems cervical spine disorders
estimation individual risks fetal neural tube ventral wall defects , incorporating prior probability , maternal serum alpha fetoprotein levels , ultrasonographic examination results provided estimation risk open patients elevated maternal serum alpha fetoprotein levels normal results detailed anatomy ultrasonographic scan risks provided various prior population risks , various levels elevated maternal serum alpha fetoprotein , various assumptions sensitivity ultrasonographic examination formula used based sequential odds use , arbitrary reduction \( power 0 5 \) degree ultrasonographic information odds made allow ultrasonography maternal serum alpha fetoprotein tests wide range resulting risks shows decision offer amniocentesis negative scan individualized
relationship laparoscopic findings self report pelvic pain assessment battery including standardized measures behavioral psychosocial factors associated chronic pain conditions administered 102 women scheduled laparoscopic surgery surgeons blinded patient 's self reported pain data completed american fertility society classification endometriosis adhesions basis observed physical disease although american fertility society classification scores significantly related self assignment pain pain groups , extent physical disease evaluated procedure significantly correlated ratings pain levels number indexes impairment group patients laparoscopically diagnosed pathologic conditions reported higher pain levels greater interference group reported pain negative laparoscopic results however , women observable pathologic conditions reported pain symptoms
acute tolerance morphine analgesia continuous infusion single injection rats study aimed determine whether decline analgesic effect morphine continuous infusion single injection correlates changes brain concentration morphine analgesic effect morphine brain serum concentrations determined continuous 8 h infusion constant rate single subcutaneous injection agent analgesic effect determined measuring threshold motor response stimulation brain serum concentrations morphine detected radioimmunoassay use 125i labeled morphine constant rate \( 4 mg kg 1 h 1 , intravenous \) morphine infusion , peak analgesia could maintained increase pain threshold 2 h 1 , 003 g g \( decrease analgesia 72 , p less 0 0002 \) time , brain morphine concentration tended increase , 278 ng g 2 h 329 ng g 8 h single morphine injection \( 6 mg kg , subcutaneous \) , recovery analgesia occurred much faster rate decrease morphine brain concentration decrease pain threshold 79 90 vs 30 min injection \( p less 0 0001 \) , corresponding decrease brain concentration 28 \( ns \) absence correlation analgesia morphine brain concentration constant rate morphine infusion single injection suggests development acute tolerance , pharmacodynamic nature
effect systemic medetomidine , alpha 2 adrenoceptor agonist , experimental pain humans effect systemic \( intravenous \) medetomidine , alpha 2 adrenoceptor agonist , pain thresholds studied healthy human subjects \( n 6 \) medetomidine produced dose dependent \( cumulative doses 25 50 micrograms \) sedative effect evaluated visual analog scale also , dose dependent decrease blood pressure heart rate seen administration medetomidine pain threshold electric stimulation tooth cutaneous heat pain threshold medetomidine index cutaneous thermal sensitivity stimuli , width zone , also medetomidine medetomidine produced significant attenuation affective motivational component \( \) tourniquet induced ischemic pain , whereas sensory component \( pain magnitude estimate \) ischemic pain attenuated results suggest systemic medetomidine alone subanesthetic sedative hypotensive doses significantly influence intensity thresholds experimental pain , whereas affective motivational component pain attenuated
pupil sparing oculomotor nerve palsy due midbrain infarction oculomotor nerve palsies pupillary sparing thought due ischemic damage nerve subarachnoid space cavernous sinus present two cases patients isolated pupil sparing oculomotor nerve palsies due midbrain infarcts focal ischemic midbrain lesions considered cases pupil sparing oculomotor nerve palsies
initial therapy patients wilson 's disease patients wilson 's disease present acute neurological symptoms often become clinically worse initially treated penicillamine available drug therapies appear offer solution treatment problem developing evaluating new drug , ammonium purpose theoretically , optimal properties , including immediate blockade copper absorption property forming complexes copper blood , copper nontoxic article , present results six patients treated 8 weeks initial therapy none five patients presented acute neurological symptoms worsened also presented methods assay , preliminary stability studies , methods evaluating therapeutic end points respect copper metabolism
cognitive behavioural impairment among elderly people institutions providing different levels care objective compare prevalence degree cognitive behavioural impairment elderly patients institutions providing different levels care design prevalence study setting nursing home , home aged wards provincial psychiatric hospital patients subjects 65 years age older eligible inclusion random sample selected comprising 25 residents nursing home home aged 119 asked participate 95 agreed \( 44 nursing home 51 home aged \) 50 wards agreed participate main outcome measures mini mental state examination \( \) dementia rating scale \( \) results score less 24 \( cognitive impairment \) given 37 \( 84 \) residents nursing home , 43 \( 84 \) home aged 48 \( 96 \) patients psychiatric hospital corresponding numbers score 0 \( cognitive impairment \) 41 \( 93 \) , 48 \( 94 \) 50 \( 100 \) seven patients receiving highest level care home aged \( special care \) behavioural problems psychiatric hospital \( p less 0 001 \) conclusions cognitive behavioural impairment widespread three institutions regardless level care planning services resources funding agencies consider degree prevalence impairment among elderly people institutions
evolution energy expenditure nitrogen excretion severe head injured patients objective aim study estimate influence therapeutic changes level energy expenditure \( ee \) n excretion homogeneous group patients usually considered hypermetabolic design ee n excretion head injured patients measured simultaneously phases 1 2 \( patients treated 4 3 18 8 days injury , respectively \) setting acute care hospital patients eight severe head injured patients , mean weight 63 1 6 1 \( sd \) kg , mean age 21 3 8 \( sd \) yr interventions phase 1 , patients sedated fentanyl \( 6 7 1 9 micrograms kg hr \) plus \( 9 1 4 8 micrograms kg hr \) mechanically ventilated patients received continuous total parenteral nutrition nonprotein caloric intake averaged 200 kcal day , including 77 glucose 23 fat \( intralipid 20 \) total n intake averaged 7 5 g day , consisting amino acids phase 2 , patient received sedative breathing spontaneously via tracheostomy patients received parenteral enteral nutrition nonprotein caloric intake averaged 200 kcal day consisting 65 carbohydrates 35 fat total n intake averaged 13 2 g day measurements main results ee significantly higher phase 2 phase 1 \( vs kcal \) , interindividual variability low phases n excretion high two periods study correlated level ee 0 75 periods , indicating predominant fat oxidation conclusions could demonstrate evolution ee protein catabolism head injured patients therapeutics \( mechanical ventilation , sedation , nutrition \) major effect ee little n excretion
noninvasive cerebral optical spectroscopy monitoring cerebral oxygen delivery hemodynamics objective present algorithm noninvasive measurement cerebral oxygen saturation \( cerebral oximetry \) cerebral hemodynamics near infrared spectroscopy design vitro correlation oximetry measurements reference measurements cases hemodynamic recordings setting tertiary care icu patients brain injured patients prolonged , decreased level consciousness chosen examples interventions two channel multiple wavelength diffuse infrared transmission spectroscopy interfaced scalp using adhesive transmission data collected gross superficial deep spatial resolution saturation calculation based deep signal observed longitudinally patient technology , arterial input cerebral response functions , generated iv tracer bolus , measure mean cerebral transit time measurements main results positive linear regression fit diffuse transmission oximetry measured blood oxygen saturation range 23 99 \( r2 98 , p less 001 \) noted conclusions approach used previously identified difficulties cerebral oximetry , demonstrates excellent vitro correlation technique performed clinically without difficulty simultaneous measure mean cortical transit time possible
individual differences children 's response pain role parental characteristics sixty five families study factors associated distress behavior 5 year old children receiving diphtheria tetanus pertussis immunizations home visit 1 month immunization , following measures obtained \( 1 \) behavioral style questionnaire , measure \( 2 \) parental self reports medically related attributes \( eg good patient \) \( 3 \) parental attitudes toward pain children responsiveness child 's pain \( 4 \) parental prediction distress immunization child 's distress behavior immunization evaluated using modification procedure rating scale revised , procedure , child 's assessment pain elicited using children 's mean procedure rating scale revised score 2 57 possible 11 thirty one \( 48 \) low \( less equal 1 \) 7 \( 11 \) high distress scores \( greater equal 2 sd mean \) factors positively correlated behavior included difficult child cluster characteristics , individual dimension adaptability , parental attitudes attributes parent 's predictions distress strongest correlates findings document variation children demonstrate response pain offer insight associated environmental factors results imply treatment strategies derived parental knowledge tailored individual characteristics child may effective alleviating pain related distress medical settings
intractable childhood seizures added therapeutic regimens 25 children intractable epilepsy 15 patients drug well tolerated resulted 50 greater reduction seizure frequency serious irreversible adverse effects seen frequently overlooked may effective adjunctive antiepileptic children intractable seizures
sucrose analgesic newborn infants effectiveness sucrose analgesic agent newborn infants assessed two standard painful hospital procedures blood collection via heel circumcision infants drank 2 ml 12 sucrose solution prior blood collection 50 less blood collection procedure control infants received 2 ml sterile water infants ingested sucrose returned baseline levels within 30 60 seconds blood collection whereas control infants required 2 5 3 0 minutes return baseline like findings obtained infants received sucrose prior circumcision specifically , control infants underwent standard circumcision procedure without intervention 67 time water reduced 49 \( p less 01 \) reduced 31 \( p less 05 \) providing infants sucrose findings , parallel results obtained studies pain infant rats , provide potent yet simple , benign intervention help alleviate stress pain routinely experienced human infants
cerebral venography mr authors describe two dimensional time magnetic resonance \( mr \) angiography technique create projection head technique applied 27 healthy volunteers 39 patients superior sagittal straight sinuses , internal cerebral veins , vein visualized volunteers veins seen high percentage subjects systematic comparison digital subtraction angiography \( dsa \) intraarterial contrast medium injection mr venography patients showed good correlation two techniques mr venography proved helpful identifying thrombosis patency cerebral veins sinuses showed collateral venous drainage venous drainage arteriovenous malformations good correlation conventional contrast angiography mr venography conclusion , mr venography considered reliable showing cerebral venous system provides information additional conventional spin echo imaging
marked cerebrospinal fluid void indicator successful shunt patients suspected normal pressure hydrocephalus authors blindly reviewed charts 20 patients normal pressure hydrocephalus \( disease unknown cause characterized radiologically chronic communicating hydrocephalus clinically gait , dementia , incontinence \) undergone creation shunt initial clinical response surgery graded excellent , good , fair , poor 5 year follow available 55 cases magnetic resonance \( mr \) images obtained patients also blindly reviewed magnitude cerebrospinal fluid \( csf \) flow void \( graded basis extent rather degree signal loss \) cerebral significant \( p less 003 \) correlation existed good excellent response surgery increased csf flow void presence associated deep white matter infarction mr images correlate poor response surgery basis findings , suggested patients fulfill clinical criteria nph increased csf flow void undergo creation shunt
functional outcome measures stroke rehabilitation examine statistical considerations analysis functional outcome following stroke discuss mathematical relation improvement function discharge functional score demonstrate mathematically predictor variables improvement discharge functional score regression coefficients improvement discharge functional score equal , except admission functional score , mathematically defined relation exists argue relation admission functional score discharge functional score must positive strong relation admission functional score improvement must negative stroke population believe statistical concepts , especially confounding , differences raw correlations , partial correlations , predictors led much confusion functional outcome research
platelet volume , aggregation , adenosine triphosphate release cerebral thrombosis compared whole blood platelet aggregation , adenosine triphosphate release , platelet count , platelet \( percentage volume platelets \) , mean platelet volume acute , subacute , chronic periods cerebral thrombosis 22 patients value 29 controls acute subacute periods , platelet aggregation , platelet count , platelet , mean platelet volume significantly less patients controls \( p less 0 05 0 01 \) adenosine triphosphate release rate per volume platelets significantly greater \( p less 0 05 \) acute period , infarct size showed significant positive correlation platelet aggregation \( r 0 59 , p less 0 01 \) adenosine triphosphate release rate \( r 0 70 , p less 0 001 \) negative correlation platelet count \( r 0 44 , p less 0 05 \) results suggest platelet aggregation reduced acute period due consumption platelets remaining individual platelets hyperactive platelet consumption acute period increases infarct size chronic period , platelet mean platelet volume significantly less patients controls \( p less 0 01 \) adenosine triphosphate release rate significantly greater \( p less 0 01 \) , suggesting sustained platelet consumption chronically enhanced secretion individual platelets
novel treatment ischemic intracranial hypertension cats accepted efficacious treatment ischemic cerebral edema show cat model focal cerebral ischemia infarct volume reduced \( p less 0 05 \) perfusion oxygenated emulsion \( bis \) accompanying effect perfusion reduction intracranial pressure 18 hours following start perfusion , significant \( p less 0 05 \) difference intracranial pressure controls \( mean 11 4 range 2 3 23 0 torr , n 6 \) cats perfused oxygenated nutrient solution containing \( mean 11 3 range 3 0 29 0 torr , n 8 \) animals perfused oxygenated emulsion \( mean 2 21 range 0 3 5 torr , n 7 \) perfusion oxygenated emulsion warrants study treatment elevated intracranial pressure
persistence remission depressive symptoms late life objective relation poor health onset depression symptoms late life well recognized , little attention given characteristics might predict persistence remission depressive symptoms previous analyses authors found increasing disability declining health preceded emergence depressive symptoms older community residents accounted 70 variance explained discriminant analyses aim present analysis examine relevance changes health disability persistence depressive symptoms method representative sample 1 , 855 adults aged 65 older assessed center epidemiologic studies depression scale baseline twenty four months later , 1 , 577 individuals available second assessment depressive symptoms characteristics 97 community residents whose depressive symptoms persisted 24 months compared 114 whose symptoms results changes health , differences age , sleep disturbance , added formal support services accounted 30 variance persistently depressed remission groups advanced age worsening health associated persistent symptoms , improved health remission conclusions previous studies indicated untoward changes health disability play major role onset depressive symptoms findings show substantial contribution chronicity well
cerebral palsy must plan survival survival children south east region , born 1970 1979 diagnosed form cerebral palsy investigated children studied , \( 90 \) still alive , hence cerebral palsy must regarded condition people live rather condition die survival varies considerably among different diagnostic groups suffering , dyskinetic cerebral palsy severely affected evidence suggests , though severe mental strongest predictors mortality children cerebral palsy , majority even severely affected patients survive adulthood therefore appropriate plan survival funding evaluating health , independence , quality life
neuralgia associated cardiac syncope long term treatment permanent pacing carbamazepine neuralgia associated cardiac syncope developed 53 year old man symptoms controlled temporary permanent transvenous pacing carbamazepine
99mtc hm spect pediatric migraine 99mtc hm spect brain imaging performed headache free period 19 young migraineurs , affected common migraine \( cm , 10 cases \) , classic migraine \( , 6 cases \) migraine \( hm , 3 cases \) spect findings negative 10 patients cm , 3 cases 2 cases hm positive findings remaining 4 patients \( 3 cases 1 hm \) showed decreased tracer distribution occipital regions \( 2 cases \) parietal regions \( 2 cases \) two decreased occipital perfusion reported symptoms exclusively contralateral areas hypoperfusion impaired regional cerebral vascular autoregulation may exist even headache free intervals patients suffering classic migraine
cerebral vein thrombosis shown mri 46 year old man short history left facial pain numbness , subsequently headaches , normal physical examination normal ct scan head lumbar puncture yielded normal csf increased pressure mri showed thrombosis superior sagittal sinus , subsequently confirmed angiography mri sensitive test detecting intracranial venous thrombosis , may investigation choice disorder suspected
cluster present evidence sympathetic defect vasomotor control anterior cerebral artery \( aca \) side headache cluster periods 119 cluster headache patients , utilizing transcranial doppler , measured co2 reactivity major intracranial vessels , cluster reactivity significantly lower cluster period , aca side headache nineteen patients followed sequentially full cycle \( ie cluster period \) showed changes 3 6 patients active cluster period , describe lesion gallium single photon emission computerized tomography \( spect \) region cavernous sinus patient cluster felt lesion may represent cavernous sinus plexus lesion postulated central lesion cluster changes sympathetic outflow point could explain changes described aca co2 reactivity cluster
relaxation training school classes reduce headache complaints effect presented progressive relaxation training \( \) headaches , fear failure school problems studied school students ten physical education , students received either \( n 110 \) placebo training \( n 92 \) effect training investigated students indicated presence headaches pre training diary significant differences found training groups regarding headache frequency , duration intensity psychological variables basis previous findings , recommended present fairly small groups self selected subjects instead complete classes
pharmacokinetics tiaprofenic acid oral administration fasting patients migraine attacks study examined pharmacokinetics 300 mg tiaprofenic acid , nsaid belonging 2 class , single oral dose , 10 migraine patients migraine attacks plasma concentration tiaprofenic acid determined hplc analysis drug absorption appeared migraine attacks \( absorption half life attack , 0 249 0 122 hr attack , 0 249 0 105 hr maximum plasma concentration attack , 37 8 9 8 ml attack , 40 1 13 2 ml \) pharmacokinetic parameters evaluated affected headache attacks well conclude tiaprofenic acid absorption metabolism affected migraine attacks also , data suggest tiaprofenic acid might useful treatment migraine
framework related cross reactive idiotopes anti acetylcholine receptor antibodies cross reactive idiotopes possible target interventions autoimmune diseases investigate role pathogenesis experimental autoimmune myasthenia gravis \( \) analyzed id rat anti achr mab 6 , 35 , 61 , 65 control myeloma protein anti id 6 , 35 , 61 , 65 bound direct binding assay various affinity rat anti achr mab tested anti id recognized none anti achr mab specificity confirmed inhibition studies anti achr mab two control rat myeloma proteins \( \) addition , id expression mab , mouse anti human achr mab recognized anti id 6 , 35 , 65 anti id , except anti id , bound affinity purified igg sera rats , lewis igg results suggest extensive idiotopes among anti achr mab , also present serum anti achr mab main immunogenic region \( 6 , 35 , 65 \) different rat strains , shared least one related cross reactive idiotopes view fact anti main immunogenic region antibodies might form predominant fraction polyclonal response achr , anti id recognizing antibodies could applications example selective immune immunotoxin therapy
skin epidural recording spinal somatosensory evoked potentials following median nerve stimulation correlation absence spinal n13 impaired pain sense clinical lesion study intraoperative epidural recordings made test origin clinical significance spinal n13 somatosensory evoked potentials \( sep \) follow median nerve stimulation intraoperatively , respective peak latencies spinal n13 coincided component dorsal cord potential phase reversed positivity ventral dorsal sides cervical epidural space , maximal amplitude c5 vertebral level nerve input c6 dermatome main modality sensory impairment hand dermatome examined selected patients cervical lesions , showed normal conventional sep components erb , far field , , , cortical n20 , without loss spinal n13 statistically , loss spinal n13 associated decrease pain sensation c6 dermatome interpreted due damage central matter cord , including dorsal horn results suggest spinal n13 originate source c6 spinal cord segment good indicators detection cervical cord damage
development infratentorial atrophy patients idiopathic cerebellar ataxia late onset ct study development infratentorial atrophy six patients suffering idiopathic cerebellar ataxia late onset studied retrospective evaluation consecutive computed tomography \( ct \) scans four patients evidence atrophy \( \) clinical testing magnetic resonance imaging \( mri \) four patients , atrophy cerebellum brain stem became visible time progressed roughly parallel manner , whereas remaining two brain stem left intact patients , definite brain stem atrophy visible earlier appearance non cerebellar clinical symptoms present data suggest ct investigations regular intervals may prognostic value cerebellar
impairment vertical motion detection palsy due rostral midbrain infarction present two cases acute onset vertical gaze palsy , mainly consisting impaired downward head movements , together neuropsychological deficits \( , impaired attention disorders memory affective control \) ct mri revealed bilateral post ischaemic lesions thalamus junction , red nucleus , thus restricted territory posterior artery , includes region rostral interstitial nucleus medial longitudinal fascicle main nucleus generation vertical saccades patients , examination electro magnetic search coil recording showed severe impairment downward upward saccades minor deficits vertical ocular reflex visual functions normal , one exception test motion perception revealed significant deficit detection vertical movements could due central adaptive mechanism , order minimize , might elevate thresholds vertical motion perception cases vertical gaze palsy alternative explanation , lesions within midbrain could damaged subcortical visual pathways involved motion perception
cerebral palsy rhizotomy 3 year follow evaluation gait analysis recent increase popularity selective rhizotomy reduction spasticity cerebral palsy led demand objective studies outcome long term follow results authors present results gait analysis 14 children spastic cerebral palsy , underwent selective posterior rhizotomy 1985 sagittal plane gait patterns studied surgery 1 3 years surgery using digital camera system parameters measured included range motion knee thigh , length , speed walking , range motion knee significantly increased 1 year surgery improved nearly normal range 3 years surgery contrast , postoperative measurements thigh range exceeded normal values 1 year , decreased toward normal range 3 years improvements range motion continued years 1 3 , children developed extended thigh knee position , indicated upright walking posture length speed walking also improved , remained essentially unchanged 3 year follow study , first examine rhizotomy using objective approach , provided encouraging results regarding early functional outcome
spontaneous decompression magnetic resonance imaging findings case report case 30 year old woman chiari malformation presented patient followed clinically 2 1 2 year period spontaneous complete resolution , documented serial magnetic resonance studies , accompanied minimal change objective symptomatology
carbon monoxide induced delayed amnesia , delayed neuronal death change acetylcholine concentration mice investigated delayed amnesia , delayed neuronal death changes acetylcholine concentration induced carbon monoxide \( co \) exposure mice test retention passive avoidance task , amnesia observed 5 7 days co exposure mice exposed co 1 day training case mice exposed co 5 7 days training , amnesia also observed retention test given 1 day training number pyramidal cells hippocampal ca1 lower control 3 , 5 7 days co exposure parietal cortex , area 1 , observed 7 days co exposure findings indicated amnesia neuronal death produced delay mice exposed co addition , delayed amnesia closely related delayed neuronal death hippocampal ca1 moreover , 3h glutamate 3h glycine binding sites change co exposure , 7 days co exposure , concentration acetylcholine binding 3h frontal cortex striatum found significantly changed , hippocampus show significant change therefore , suggest delayed amnesia induced co exposure may result delayed neuronal death hippocampal ca1 dysfunction neurons , frontal cortex , striatum hippocampus
self administered hand symptom diagram diagnosis epidemiologic study carpal tunnel syndrome noninvasive tests carpal tunnel syndrome \( cts \) limited diagnostic value self administered hand symptom diagram developed use diagnosis epidemiologic study cts rated classic cts , probable , possible unlikely diagram ratings compared nerve conduction diagnoses 110 patients upper extremity complaints hand diagram rating classic probable cts sensitivity 0 64 , specificity 0 73 positive predictive value 0 58 negative predictive value unlikely diagram 0 91 conclude diagram useful diagnostic tool may valuable occupational population screening
motor neuron disease \( amyotrophic lateral sclerosis \) amyotrophic lateral sclerosis developing , adult onset , progressive anterior horn cell degeneration associated degeneration descending motor pathways recognized important clinical syndrome since middle century despite increasing clinical research interest condition , cause remains obscure , even terms epidemiologic characteristics disease interpreted evidence genetic environmental causes major change view disease widely developing perception disease elderly persons middle aged adults previously etiologic hypotheses broad range postulated pathophysiologic mechanisms , review detail clinical limits disease better defined using modern diagnostic techniques although interest supportive symptomatic therapy growing , intervention yet shown modify biologically determined motor system degeneration
tourette syndrome tic disorders diagnosis , pathophysiology , treatment report , discuss definition , characteristics , pathophysiology , treatment tic disorders major emphasis tourette syndrome although diagnosis tic disorder depends presence motor tic \( \) , patients problems also variety co morbid features including obsessive compulsive symptoms , attention deficit hyperactivity disorder , behavioral difficulties , learning disabilities conservative estimates tourette syndrome suggest prevalence rate 0 1 1 0 per 1000 syndrome inherited sex influenced autosomal dominant pattern either chronic multiple tic disorder obsessive compulsive disorder alternative phenotypes putative gene current evidence continues support pathophysiologic mechanism involving synaptic , dopaminergic system primary candidate therapeutically , essential clarify whether patient 's problems related tics associated behavioral difficulties pharmacotherapy motor tics strictly symptomatic reserved functionally disabling symptoms comprehensive individualized treatment program often required care individuals tic disorders
effect hydrocephalus prostaglandins thromboxane b2 ventricular cerebrospinal fluid concentrations prostaglandin f2 alpha , prostaglandin e2 , 6 f1 alpha \( prostacyclin metabolite \) , thromboxane b2 assayed ventricular cerebrospinal fluid obtained 28 patients hydrocephalus \( 17 obstructive , 11 communicating \) seven patients received dexamethasone hydrocortisone day sampling patient received nonsteroidal anti inflammatory compounds 48 hours sampling median values differ significantly two types hydrocephalus concentrations lumbar cerebrospinal fluid obtained patients without intracranial pathology lumbar myelography possible lumbar disc disease hence , evidence eicosanoids accumulate ventricles hydrocephalus , unlikely significant role symptomatology
reflex sympathetic dystrophy syndrome consensus report ad hoc committee american association hand surgery definition reflex sympathetic dystrophy syndrome report proposes reflex sympathetic dystrophy defined pain syndrome pain accompanied loss function evidence autonomic dysfunction clinical setting , diagnosis usually associated anatomic psychological diagnoses may associated variety systemic illnesses medicolegal factors components assessed treatment plan established priorities go emergency care , acute injuries , systemic illness , psychiatric problems , chronic anatomic problems , order early , accurate diagnosis improves prognosis
congenital demyelinating motor sensory neuropathy focally myelin sheaths six patients \( 5 index cases 1 \) congenital motor sensory neuropathy described clinical , genetic electrophysiological features resembled disease hereditary motor sensory neuropathy \( \) type iii sural nerve biopsy 5 patients revealed segmental demyelination hypertrophic changes , although ubiquitous classical type iii striking discriminating feature type iii abundance focal myelin thickenings \( \) present nearly fibres possible pathogenic implications discussed cases heterogeneity congenital motor sensory neuropathies
phenomena temporal lobe epilepsy hypotheses phenomena occur temporal lobe seizures reproduced electrical stimulation temporal lobe structures typically perceptual , affective features , either combination isolation , commonly relate patient 's individual past experience phenomena raise interesting questions concerning brain mechanisms involved human anatomical substrates phenomena widely distributed within temporal lobe include temporal limbic structures \( amygdala , hippocampus parahippocampal gyrus \) presented indicate phenomena positive expressions temporal lobe limbic function result ictal paralysis recent concepts parallel distributed processing \( , 1986 \) importance parallel distributed cortical networks higher cognitive functions \( , , b \) provide theoretical framework hypothesis explaining phenomena based concepts hypothesis temporal lobe epileptic discharge electrical stimulation temporal lobe structures induce elaboration patterns excitation inhibition widely distributed neuronal networks , capable forming specific matrix representing substrate given experience neuronal networks engaged parallel distributed processing \( 1 \) capacity given experience fragment network activated , \( 2 \) tolerate great deal degradation random inactivation components interference random noise without serious loss information content features compatible assumption localized epileptic neuronal discharge electrical stimulation involving temporal lobe structures could create matrix representing features individual experience kind activated course temporal lobe seizures experience could , certain limit , resist degrading influence noise must attend seizure discharge
role diencephalic pathology human memory disorder evidence penetrating paranasal brain injury patient \( b j \) reported developed severe memory impairment following penetrating brain injury caused entered left nostril basal regions brain initially , memory disorder clinical features dense syndrome , anterograde retrograde amnesia , b j subsequently showed significant recovery memory function formal memory testing carried 21 months injury demonstrated marked verbal memory impairment , severe seen patients syndrome memory tests , impairment relatively mild patchy retrograde amnesia regressed mainly affect 6 month period injury cognitive tasks , performed average average level , neuropsychological evidence frontal lobe dysfunction investigations various stages injury failed demonstrate lesion thalamic nuclei magnetic resonance imaging showed lesion hypothalamus region bodies study demonstrates marked , relatively focal , memory disorder diencephalic injury occur without direct pathology body thalamus also indicates structures adjacent hypothalamus , bodies , may play important role human memory functioning hitherto considered
single unit analysis human ventral thalamic nuclear group activity correlated movement neurosurgical operations relief movement disorders , single thalamic neurons \( n 107 \) identified activity related cued active movements \( movement related cells \) activity neuron examined different contralateral movements order determine movement associated consistent pronounced change firing rate \( optimal response \) optimal response determined analysis histograms neuronal activity constructed using onset emg activity successive active movement movement related cells exhibited optimal responses associated movements making , extension flexion wrist , extending elbow , pointing entire upper extremity , extending tongue lifting leg movement related cells recorded single plane individual patient optimal responses related movements involving part body movement related cells classified activated response somatosensory stimulation \( combined cells , n 20 \) \( voluntary cells , n 87 \) combined cells activated advance emg activity active movement could distinguished cells responding sensory stimulation \( sensory cells \) movement related cells \( combined voluntary cell types \) located anterior sensory cells tended show organization parallel sensory cells cutaneous receptive fields combined cells responded somatosensory stimulation part body involved active movement related optimal response cell combined cells responding passive movements joint always optimal response active movement joint activity combined cells parkinsonian tremor may clarify role sensory feedback tremor
spongiform encephalopathy transmitted experimentally creutzfeldt jakob familial diseases comparison made effects experimental intracerebral inoculation brain homogenates case creutzfeldt jakob disease \( cjd \) member family cerebral amyloid spongiform encephalopathy \( gss \) syndrome inoculated developed spongiform encephalopathy \( se \) incubation times 20 23 months cjd group 25 32 months gss group subsequent passage 1 affected animal group resulted se developing 17 months incubation every animal inoculated cjd gss material 2 passage experiments severely affected region brain thalamus cases almost totally occupied vacuoles matter masses less severely less consistently affected observed cerebellar granule cell layer well molecular layer brain stem cases minor inconsistent differences disease transmitted cjd compared gss differences original se caused severe astrocytic gliosis accompanied spongiform changes amyloid identified experimentally transmitted disease pathogenesis spongiform change thalamus studied series light electron microscopy 3 22 months intracerebral inoculation cjd gss homogenates compared controls dilated shaped large complex vacuoles typical se , present abundance 18 22 months incubation , considered probably derived neuronal smooth endoplasmic reticulum
hemodynamic effects nasal cpap examined doppler echocardiography effects incremental application nasal continuous positive airway pressure \( 0 15 cm h2o \) heart rate , pulmonary artery pressure , cardiac index studied noninvasively doppler echocardiography two way analysis variance within two groups \( 19 normal volunteers six sleep apnea patients \) , significant effects heart rate , pulmonary artery pressure , ventricular size , cardiac index could found increasing positive intrathoracic pressures consequent lung subjects normal cardiac function , nasal cpap safe hemodynamic simple , noninvasive technique may used assess clinical safety efficacy prescribed nasal cpap cardiac hemodynamics individual patients
respiratory muscle strength control ventilation patients neuromuscular disease assess relationship respiratory mechanics muscle strength control ventilation patients neuromuscular disease \( nmd \) , compared pimax pemax rv , frc tlc , total respiratory elastance \( ers \) vt , ti , tt , , vt ti , ti tt , p 01 , p 01 \( vt ti \) effective impedance 21 patients nmd 21 healthy control \( c \) subjects , seated position breathing room air ers nmd patients 79 percent higher c subjects ti , tt , vt nmd approximately half corresponding c values , p 01 66 percent greater c subjects \( p less 0 001 \) nmd pimax pemax ranged 37 52 percent corresponding c values , respectively despite significant respiratory muscle weakness , 7 16 patients demonstrated paco2 greater 45 mm hg ventilatory output nmd modulated respiratory mechanics indicated increased p 01 spite muscle weakness , central drive patients nmd decreased , fact , often increased accurate measure central drive abnormal intrinsic respiratory mechanics effects conscious responses reflexes
effect cardiac output reduction rate desaturation obstructive apnea nadir sao2 obstructive apnea dependent upon apnea 's duration rate fall saturation \( dsao2 dt \) postulated low q , patients congestive heart failure sleep apnea , reduction q , seen humans obstructive sleep apnea , might dsao2 dt mechanism postulated lowering svo2 increased pulmonary capillary blood oxygen uptake faster depletion alveolar oxygen study examines dsao2 dt following onset apnea eight spontaneously breathing adult baboons obstructive apneas \( 30 , 45 , 60 seconds \) created clamping indwelling endotracheal tube end expiration following baseline measurements , animals given bolus rapid acting beta adrenergic blocker followed continuous infusion reduce cardiac output limit cardiovascular response obstructive asphyxia fiberoptic catheters used continuous monitoring sao2 , svo2 , cardiac output esophageal pressure relative thoracic gas volume \( \) monitored lung volume onset apnea beta adrenergic blockade reduced resting q mean 25 percent blocked vs dsao2 dt 0 73 vs 0 72 percent , 0 76 vs 0 73 percent , 0 70 vs 0 71 percent 30 second , 45 second , 60 second apneas , respectively thus , mean dsao2 dt durations apneas unaffected beta adrenergic blockade concluded dsao2 dt influenced limited q preceding induced obstructive asphyxia
hyperprolactinemia increases decreases tyrosine hydroxylase messenger ribonucleic acid levels arcuate nuclei , substantia nigra zona effects experimentally produced hyperprolactinemia tyrosine hydroxylase \( th \) mrna signal levels examined dopaminergic neurons ovariectomized rats th mrna signal levels relative th quantity arcuate nuclei , zona , substantia nigra evaluated situ hybridization immunocytochemistry , respectively catalytic activity th median eminence \( \) determined vitro rate 3 , 4 dihydroxyphenylalanine \( dopa \) accumulation inhibiting dopa decarboxylase chronic administration \( \) , dopamine \( da \) agonist , 3 days reduced circulating rat prl \( \) levels compared vehicle treated controls treatment decreased th mrna signal levels arcuate nuclei , intensity th immunostaining arcuate median eminence area , rate dopa accumulation concomitant administration ovine prl \( oprl \) reversed effects th , resulting markedly increased th mrna signal levels , intensity th immunostaining , rate dopa accumulation treatment oprl 3 days increased th mrna signal levels arcuate nuclei th activity , compared vehicle chronic treatment haloperidol , da antagonist , increased circulating levels endogenous increased th activity values similar oprl treatment however , contrast oprl , mrna levels arcuate nuclei haloperidol treated rats similar levels vehicle treated animals evaluate whether effect prl th species specific , oprl continuously infused jugular vein using osmotic th mrna levels arcuate nuclei elevated control levels either oprl administration th mrna levels da located zona substantia nigra altered treatment da agonist , da antagonist , prl results indicate hyperprolactinemia selectively reduce augment , respectively , th mrna levels dopaminergic neurons alterations th mrna content probably contribute decrease increase th activity associated hyperprolactinemia , respectively
humor , , aging humor response aggressive investigated using ratings pain 154 young elderly men women significant age differences found however , sex differences found young elderly females , inverted u described relationship pain ratings young elderly males , relationship pain preliminary step age differences humor may relevant working elderly persons
approach diagnosis meningitis cerebrospinal fluid evaluation csf evaluation single important aspect laboratory diagnosis meningitis analysis csf abnormalities produced bacterial , mycobacterial , fungal infections may greatly facilitate diagnosis direct initial therapy basic studies csf performed patients meningitis include measurement pressure , cell count white cell differential determination glucose protein levels gram 's stain culture bacterial meningitis , lysate assay tests identify bacterial antigens may allow rapid diagnosis strong suspicion tuberculous fungal meningitis , csf also submitted acid fast stain , india preparation , antigen unless contraindicated increased intracranial pressure , large volumes \( 40 50 ml \) obtained culture history residence southwest elicited , complement fixing antibodies also ordered newer tests based immunologic methods gene amplification techniques hold great promise diagnosis infections caused organisms difficult culture present small numbers despite great value lumbar puncture diagnosis meningitis , use procedure may result death brain herniation lumbar puncture avoided focal neurologic findings suggest concomitant mass lesion , brain abscess , lumbar puncture approached great caution meningitis accompanied evidence significant intracranial hypertension institution antibiotic therapy suspected meningitis delayed neuroradiologic studies obtained exclude abscess measures instituted reduce intracranial pressure
fluctuations interictal brain imaging repeated 123i imp spect scans epileptic patient single photon emission computed tomography \( spect \) brain scans n \( iodine 123 \) p \( 123i imp \) performed three times interictal periods 35 year old man intractable frontal lobe epilepsy normal x ray ct findings first scan showed decreased 123i imp uptake right frontal lobe abnormal image regarded primary focus epilepsy basis regional agreement focal epileptic discharges eegs second scan , showed normal imaging , third scan showed abnormal image , right frontal lobe frequency clinical seizures almost unchanged intervals scans eegs recorded soon scan showed almost changes basic activities frequency epileptic discharges fluctuations spect brain imaging suggest severity functional inactivation underlying focal hypoperfusion image epileptic focus may considerably interictal state relation clinical features epilepsy
aberrant regeneration case selective co activation facial nerves saccades patient suffering exhibited phasic contraction ipsilateral facial muscles , mainly levator , whenever looked left right facial muscle twitches occurred exclusively saccades selective co activation facial nerves interpreted result bilateral neurons reticular formation facial nerve
familial eating epilepsy eating related seizures affecting 20 individuals among 59 siblings belonging nine families presented type epilepsy partial affected individuals , seizures complex 15 simple 5 , secondarily generalized majority onset epilepsy , cases , second decade life remarkable degree intra family consistency observed regard age onset , symptomatology seizures timing eating seizures study demonstrates sibling clustering partial epilepsy , implicating first time genetic susceptibility aetiology eating epilepsy
transient ischaemic attacks small vessel disease dutch study group histories computed tomograms patients transient cerebral ischaemia studied symptoms signs completely resolved within 24 hours , episodes suggestive posterior fossa ischaemia excluded computed tomography , done clinical features resolved , showed 79 relevant infarcts 46 small , deep , lacunar infarcts \( 58 , 95 confidence interval ci 47 69 \) , 33 larger cortical infarcts histories type infarct 79 patients compared see whether lacunar infarcts preceded history unilateral motor sensory symptoms without features usually attributed cerebral cortex positive predictive value lacunar symptoms 0 74 , negative predictive value 0 61 11 patients cortical infarct despite history lacunar tias , one occurred left hemisphere speech affected patients transient ischaemic attacks without relevant infarct visible computed tomography , \( 64 \) history suggestive lacunar ischaemia , whereas several studies 20 25 patients ischaemic stroke evidence lacunar infarcts lacunar tias may therefore better prognosis cortical tias may often precede cortical infarcts alternatively , many cortical infarcts may occur without warning
role conditioning verbal expectancy placebo response conditioning expectancy models offered recent years explanations placebo response following earlier work conditioning placebo responses human subjects current study examined relative contribution made conditioning verbal expectancy group 1 received combined expectancy conditioning manipulation group 2 received expectancy alone group 3 , conditioning alone group 4 control group subjects' responses compared without placebo cream , using pain stimulation results suggest conditioning powerful verbal expectancy creating placebo response
profiles opioid analgesia humans intravenous bolus administration alfentanil , fentanyl morphine compared experimental pain report examines relationship plasma drug concentration analgesic effect following bolus doses alfentanil , fentanyl morphine assesses individual differences analgesic response among volunteers predicted 3 opioids would yield analgesic profiles physicochemical pharmacokinetic characteristics differ ten healthy volunteers received intravenous bolus doses either alfentanil , fentanyl , morphine normal saline different days stimulated teeth electrically measured brain evoked potential \( ep \) pain report \( pr \) repeatedly 2 h assess analgesic effect concurrently , 18 blood samples assess opioid plasma concentrations test period relationship opioid plasma concentration analgesic effect well defined alfentanil ambiguous morphine fentanyl exhibited marked hysteresis observed individual differences analgesic response 3 drugs differences greatest morphine least alfentanil inter variability analgesic response across drugs related physicochemical properties drugs tested
heart rate changes autonomic component pain response autonomic variables recommended measures affective motivational component pain response objective present study components heart rate responses painful heat stimuli relation stimulus sensation variables analyzed twelve healthy subjects served sixty phasic stimuli varying temperatures pain threshold delivered 1 session heart rate , respiration , subjective stimulus ratings recorded simultaneously phasic heat stimulation pain threshold induced tonic increase heart rate lasting 20 sec high intensity stimulation generated steeper rises greater mean increase low intensity stimulation general , heart rate responses closely related subjective sensation stimulus intensity however , differential temporal analysis demonstrates , 3 sec stimulation , autonomic response determined solely stimulus temperature , whereas , approximately 6 sec , related subjective judgement accordingly , heart rate responses reflect brief reflex induced sensory component , subsequently , longer lasting response seems related affective cognitive evaluation separation different stages pain processing autonomic indicator may useful clinical
effects calcium antagonist focal cerebral ischemia spontaneously hypertensive rats studied efficacy preischemic postischemic systemic treatment new calcium antagonist permanent focal cerebral ischemia model spontaneously hypertensive rats rats underwent microsurgical middle cerebral artery occlusion blindly assigned single intraperitoneal injection \( 0 32 mg kg \) amount polyethylene glycol either 15 minutes , immediately , 1 hour , 3 hours occlusion left middle cerebral artery neurologic conditions rats closely examined , rats killed 24 hours later removed brains , stained triphenyltetrazolium chloride , size infarct determined although neurologic improvements observed treated rats , area infarcts significantly reduced groups treated , immediately , 1 hour occlusion middle cerebral artery treatment started 3 hours occlusion ineffective
single case huntington 's disease simultaneously occurring obstructive hydrocephalus case simultaneously occurring huntington 's disease obstructive hydrocephalus presented huntington 's diseases described normal pressure hydrocephalus however , description obstructive hydrocephalus reported obstructive hydrocephalus displays familial tendency presentation
autism fragile x syndrome associated \? conceptual methodological issues investigations association autism fragile x syndrome yielded conflicting results studies indicating strong correlation others indicating relation disorders paper , review relevant research controversy discuss conceptual methodological problems involved inquiry conclude autism fragile x associated relation prove understanding role x chromosome variety behavior disorders various theoretical accounts etiology autism
progress search genetic linkage tourette syndrome exclusion map covering 50 autosomal genome gilles de la tourette syndrome neuropsychiatric disorder autosomal dominant mode inheritance reduced penetrance single genetic locus several research groups genetic linkage studies detect chromosomal location gene disorder strong clear evidence linkage yet produced tourette syndrome paper presents overview methods progress groups centered university university excluding linkage large portion genome screened 228 genetic marker loci linkage gene disorder series affected families united states , canada , netherlands , norway 50 \( perhaps much 66 \) autosomal genome excluded assumption genetic heterogeneity important factor tourette syndrome pedigrees pooled summary
molecular genetic basis urine disease family two defective alleles branched chain acyltransferase localization gene human chromosome 1 urine disease humans results inherited defects branched chain alpha ketoacid dehydrogenase , mitochondrial complex variety genetic changes may produce phenotype affecting function three complex specific subunits varied clinical expression observed patients may partially explained defects involved subunit report localization gene branched chain acyltransferase component complex human chromosome 1 describe proband compound heterozygote locus one allele , inherited father , produces transcripts 124 nucleotides deleted coding region deletion found branched chain acyltransferase gene , implying deleted transcripts arise error transcript processing cells patient 's mother contain 50 normal amount mrna subunit , proband inherited allele result , proband produces acyltransferase protein therefore greatly impaired complex activity phenotypically normal sibling shown genetically similar mother inherited mother 's allele father 's normal allele
tay sachs disease moroccan jews deletion phenylalanine alpha subunit beta hexosaminidase tay sachs disease inherited lysosomal storage disorder caused defects beta hexosaminidase alpha subunit gene carrier frequency tay sachs disease significantly elevated ashkenazi jewish moroccan jewish populations jewish groups found mutations underlying tay sachs disease ashkenazi moroccan jews different analysis moroccan jewish tay sachs patient revealed frame deletion \( delta f \) one two adjacent phenylalanine codons present positions 304 305 alpha subunit sequence mutation impairs subunit assembly beta hexosaminidase , resulting absence enzyme activity moroccan patient found also carry , alpha subunit allele , different , yet unidentified , mutation causes deficit mrna analysis obligate carriers six unrelated moroccan jewish families showed three harbor delta f mutation , raising possibility defect may prevalent mutation ethnic group
propofol infusion control status two patients status resistant conventional treatment responded propofol infusions reported confirmed seizures successful treatment
32 gauge spinal catheters 26 gauge needles small diameter intrathecal catheters potentially combine intrathecal injection advantage , without risk high incidence headache dural puncture report problems placing catheters
lumbar epidural catheters comparison air saline loss resistance technique epidural space located 32 obstetric patients using loss resistance air , 35 saline used incidence 56 air group 57 saline group significant difference groups terms complications quality analgesia provided
telephone use elicit voice speech brain injured subjects initiation speech often delayed early stages recovery serious brain injury found high percentage patients speech swallowing problems makes bedside assessment swallowing safety difficult one cannot sound aspirated material vocal cords patient high risk silent aspiration often unable study use telephone described several times aphasia treatment , elicit speech assess swallowing safety early brain injury study , therefore , recruited subjects brain injuries \( 1 \) referred early swallowing evaluations , \( 2 \) coma able follow , \( 3 \) initiate voice asked subjects asked three questions two different conditions face face ringing telephone another room results recorded videotape analyzed another investigator differences six seven subjects responded better telephone stimulus without technique may elicit voice speech early brain injury patients may useful bedside assessment swallowing safety may also serve example appropriate stimulation brain injured subjects coma
disabled driver challenge survey undertaken determine driving impairment secondary disabling injury addressed state training programs 35 states drivers reevaluation disabling injuries , provision made reporting individuals 15 states physicians report impaired drivers , seven require reporting based survey capital major city every state , \( likely source information injured persons \) generally aware reporting requirements slightly better informed 100 rehabilitation centers surveyed , 36 provided site training disabled drivers voluntary reevaluation head injury often occur despite asked , none 35 head injured patients , followed two years post onset , sought reevaluation , although 21 resumed regular driving two 21 involved subsequent traffic accidents common guidelines need established across states ensure reevaluation individuals disabling conditions , delivery accurate information concerning , availability training programs
costs operating supported work program brain injured individuals paper presents preliminary analysis costs associated return work program emphasizing supported employment approach persons sustained severe traumatic brain injuries analysis almost three years results indicated mean 237 8 hours staff intervention time required achieve job stabilization , cost ongoing follow along support services averaged 1 64 hours per week cost 47 56 68 total staff time costs job site training efforts application findings state level level policies weighed individual characteristics needs clients , program design , outcomes clients achieve result services
reversible nerve conduction block patients polyneuropathy ultrasound therapeutic dosage study investigated effect ultrasound nerve conduction patients polyneuropathy eight able controls \( group c \) 16 patients clinical physiologic evidence polyneuropathy tested eight patients \( group np \) pain symptoms eight patients \( group p \) severe pain , sensation , , lower extremities two minutes , therapeutic ultrasound doses 0 5 , 1 0 , 1 5w cm2 applied anterior surface leg along pathway deep peroneal nerve peroneal nerve conduction studies performed , , ultrasound treatment compound muscle action potential \( \) recorded extensor digitorum muscle nerve conduction studies eight patients group p revealed significant decrease \( 41 4 44 reduced doses 1 cm2 1 5w cm2 , respectively p less 05 \) amplitude \( baseline first negative peak \) , increase \( 6 4 6 7 increased doses 1 cm2 1 5w cm2 , respectively p less 05 \) proximal latency one minute ultrasound application dose 1 0 1 5w cm2 , dose 0 5w cm2 \( p greater 0 1 \) changes returned pretreatment values within five minutes cessation ultrasound therapy groups c np , significant changes amplitudes proximal latency , , ultrasound therapy dose 0 5 , 1 0 , 1 5w cm2 concluded ultrasonic therapy therapeutic dosage may cause reversible conduction block patients painful polyneuropathy
goal attainment scaling outcome measurement brain injury rehabilitation relationships among two month final goal attainment scaling \( gas \) scores , final adaptability inventory \( pai \) scores , work outcome 16 graduates comprehensive , brain injury rehabilitation program examined final gas scores higher program graduates obtained desirable work outcomes , final pai scores lower successful program graduates final gas scores significantly correlated outcome measures pai scores predicted work outcome , two month gas scores predicted final gas scores initial pai scores distinguished program successes failures , program successes dropouts brief look one case illustrates modified application gas brain injury rehabilitation results study case analyses support gas , individualized measure useful \( 1 \) monitoring patient progress , \( 2 \) team , \( 3 \) ongoing rehabilitation planning decision making , \( 4 \) , relevant communication family , referral sources , funding sources , \( 5 \) overall program evaluation used context objective outcome measures although results support clinical utility gas , study recommended assess psychometric characteristics gas application
factors predicting satisfactory home care stroke study prospectively investigated factors predicting optimal home care one hundred thirty five first occurrence stroke patients primary support persons evaluated initial hospitalization stroke one year discriminant function analysis used identify two groups baseline data home care situations rated optimal group membership predicted validated 72 6 accuracy patients risk less optimal home care \( 1 \) likely depressed , \( 2 \) less likely married patient , \( 3 \) average knowledge stroke care , \( 4 \) reporting family dysfunction findings suggest related problems collective effect rehabilitation outcome treatment reduce depression , minimize family dysfunction , increase family 's knowledge stroke care
visual patient lateral medullary syndrome disturbance visual perception associated nystagmus rare phenomenon case 61 year old woman developed progressive right deficit , left facial sensory deficit , vertigo , left , left ptosis , vertical , ataxia left upper extremity nystagmus primary position , increased amplitude left gaze signs symptoms consistent lateral medullary syndrome rehabilitation , patient complained visual disturbances typical disturbances , , compensatory mechanisms nystagmus resultant retinal error purpose case presentation study pathophysiology underlying patients nystagmus stimulate awareness visual disturbances stroke patients
higher incidence carpal tunnel syndrome women determine whether hormonal changes menopause related onset carpal tunnel syndrome \( cts \) , 53 healthy women , younger 44 years , subjected bilateral oophorectomy 1 4 years study , evaluated seventy healthy women matched age used controls complaining symptoms presenting signs suggestive cts , sensory motor nerve conduction studies done group , 17 53 \( 32 \) clinical cts , seven 70 control group \( 10 \) \( relative risk group 4 25 95 confidence intervals 1 47 12 61 \) nerve conduction studies abnormal 14 16 women \( 87 5 \) , one seven control group \( 14 2 p less 0 002 \) symptoms tended milder controls symptoms developed first year oophorectomy 14 17 women cts suggests women develop cts oophorectomy frequently controls
advances treatment complex cerebrovascular disorders interventional neurovascular techniques treatment complex cerebrovascular disorders , including intracranial aneurysms , carotid cavernous sinus fistulas , vertebral fistulas , arteriovenous malformations , atherosclerosis brachiocephalic vessels , arterial vasospasm , performed selected cases interventional neurovascular techniques recent advances technology , permanent polymers , newer embolic agents , high resolution digital subtraction angiography mapping technique , micro guide wires catheters greatly improved access distal intracranial circulation markedly reduced morbidity associated procedures interventional emerging important adjunct selected cerebrovascular disorders
antiepileptic drugs , cognitive function , behavior children evidence recent studies effects antiepileptic drugs \( aeds \) cognitive function behavior children reviewed basis published studies individual aeds shown differ deleterious effects phenytoin generally contrasting relatively minimal effects valproate carbamazepine differences results may attributed psychological tests used age differences however , appears dissociation aeds affect higher cognitive function , e g , phenytoin , mainly affecting motor function , e g , carbamazepine , appears increase speed performance , aeds prescribed care children epilepsy , taking account differing effects cognitive function behavior
computerized neuropsychological assessment cognitive functioning children epilepsy value range computer aided tests neuropsychological assessment investigated 94 177 children epilepsy , aged 8 18 years , compared 68 161 controls age group children age 8 years could rather complex tests wide range functions reaction time measurements , motor speed , information processing , memory speed performance tended increase age groups , differences information processing becoming apparent age 12 years precise control stimulus response required define mainly minor differences epilepsy control groups fulfilled computerized testing , undergo refinement including voice language recognition , followed artificial intelligence
electroencephalographic parameters assessing cognitive function children epilepsy many biological psychological possibilities considered attempting explain cognitive dysfunction individual child epilepsy electroencephalographic \( eeg \) information , may particularly relevant children , mainly studied relation possible direct effects seizure discharges learning behavior discharges divided transient , brief prolonged prolonged seizure discharges includes status wakefulness status slow wave sleep addition influence seizure discharges , preliminary findings suggest children epilepsy might subtle disorder arousal mechanisms sleep , possibly associated impaired daytime performance
discontinuation antiepileptic drugs children epilepsy effects cognitive function cognitive function frequently impaired children epilepsy , compared age matched controls hard evaluate significance various contributory factors effects antiepileptic drugs may studied children epilepsy still treated multicenter study assess various aspects cognitive function children different forms epilepsy , treatment antiepileptic drugs , currently way definitive results yet available interim analysis findings suggests short term memory decreased subgroups children treated epilepsy , compared controls
mri , ct , spect , pet use diagnosing dementia differential diagnosis dementia syndrome may pose difficult clinical problem , since common dementia , alzheimer 's disease \( ad \) , marked normal laboratory tests neuroimaging played important role evaluating demented patient , uses growing computed tomography \( ct \) useful excluding reversible treatable causes dementia , hematoma tumor recently , magnetic resonance imaging \( mri \) improved ability diagnose vascular disease may show presence cerebral infarcts white matter disease visible ct single photon emission computed tomography \( spect \) positron emission tomography \( pet \) , techniques visualize cerebral functions glucose metabolism blood flow , may provide positive evidence supportive diagnosis ad
intravenous administration phosphorylated acid alpha glucosidase leads uptake enzyme heart skeletal muscle mice lysosomal storage disorder type ii caused acid alpha glucosidase deficiency study investigated possible applicability mannose 6 phosphate receptor mediated enzyme replacement therapy correct enzyme deficiency affected tissues bovine testes acid alpha glucosidase containing phosphorylated mannose residues intravenously administered mice found taken heart \( 70 increase activity \) skeletal muscle \( 43 increase \) major target organs uptake human placenta acid alpha glucosidase heart skeletal muscle appeared significantly less efficient , whereas uptake bovine testes enzyme detectable phosphorylated bovine testes acid alpha glucosidase remained present mouse skeletal muscle 9 15 administration , half life 2 4 besides measured skeletal muscle heart , uptake phosphorylated bovine testes human placenta acid alpha glucosidase measured several organs , brain increase acid alpha glucosidase activity highest liver spleen concluded application mannose 6 phosphate receptor mediated enzyme replacement therapy may offer new perspectives treatment type ii
timed go test basic functional mobility elderly persons study evaluated modified , timed version get go test \( et al , 1986 \) 60 patients referred geriatric day hospital \( mean age 79 5 years \) patient observed timed rises arm chair , 3 meters , , back , results indicate time score \( 1 \) reliable \( inter intra \) \( 2 \) correlates well log transformed scores balance scale \( r 0 81 \) , gait speed \( r 0 61 \) barthel index adl \( r 0 78 \) \( 3 \) appears predict patient 's ability go outside alone safely data suggest timed go test reliable valid test quantifying functional mobility may also useful following clinical change time test quick , requires special equipment training , easily included part routine medical examination
mini mental state exam scores vary education blacks whites previous studies suggested education race may affect performance standardized mental status tests order clearly define relationships , prospective longitudinal study devised answer two questions \( 1 \) whether race level education affects scores mini mental state \( mms \) exam non demented people \( 2 \) numerical maximize sensitivity specificity utilizing mms help diagnose dementia blacks varying educational attainment total 100 white 258 black individuals , recruited two city hospital primary care geriatric clinics , evaluated subsequently followed longitudinally 2 1 2 year period order assess accurately presence absence dementia non demented , total mms scores performance item mms analyzed , revealing people grade less education consistently significantly \( p less 01 \) worse results better educated \( grade better \) , attention items , recall table dog , , writing , , total score furthermore , total 25 lower education group mms score 18 23 range , traditionally thought suggest dementia consistently significant differences blacks whites equal education better educated groups , using score 23 less define dementia sensitivity specificity using mms diagnosis 93 100 , respectively lower education group , using 17 less define dementia sensitivity specificity 81 100 , respectively
physician practices diagnosis dementing disorders treatable untreatable causes dementia , physician 's ability conduct \( refer patient \) differential diagnosis could profound effect health outcomes patients health care costs study undertaken assess physician practices regard diagnosis dementing disorders data 53 physicians \( response rate 48 \) several specialties obtained self administered mail questionnaire results indicate majority physicians provided history taking , physical examination , neurological examination physicians likely refer patients psychiatric neuropsychological examinations provide services results also point deficiencies two key areas use formal , published diagnostic criteria , use mental status cognitive function tests 75 physicians surveyed use either dsm iii diagnostic criteria , 42 physicians provide mental status tests need continuing education close knowledge gaps emphasized
localization technetium 99m glucarate zones acute cerebral injury potential structural similarity technetium 99m labeled glucaric acid \( 99mtc glucarate \) fructose suggests agent may enter cells sugar transport system studies cells demonstrated inhibition 99mtc glucarate uptake fructose , confirming potential relationship since anaerobic metabolism use either glucose fructose , hypothesized 99mtc glucarate may areas acute ischemic injury test hypothesis , 63 adult rats middle cerebral artery \( mca \) occlusion followed reperfusion injected 99mtc glucarate vivo ex vivo images acquired seven animals also studied 18fdg high resolution pet imaging radionuclide images compared results tetrazolium chloride \( ttc \) staining conventional histopathology thirty five rats significant accumulation 99mtc glucarate ttc staining \( indicating infarction \) involved hemisphere remaining 28 rats ttc staining \( suggesting viability \) involved hemisphere , 16 \( 57 \) 99mtc glucarate accumulation seven rats studied 99mtc glucarate 18fdg , 99mtc glucarate accumulated center occluded mca territory 18fdg activity decreased region results suggest 99mtc glucarate sensitive marker acute severe cerebral injury , mechanism localization probably different 18fdg
meralgia paresthetica coronary bypass surgery meralgia paresthetica neurologic disorder characterized localized numbness anterolateral aspect thigh involving lateral femoral cutaneous nerve involves motor deficits meralgia paresthetica , may result variety causes , observed rare complication heart operations cause associated operations uncertain may prolonged relaxed positioning operating table recovery room another possible cause meralgia paresthetica heart operations leg position legs vein harvesting patients condition advised untreatable , benign self limiting , nature
type 2 report family review current evaluation treatment significant advances past decade greatly improved understanding type 2 , genetic disease results bilateral acoustic emergence gadolinium enhanced magnetic resonance imaging allowed early detection minute eighth nerve tumors , less 1 cm diameter recombinant dna studies clarified genetics underlie type 2 separate variety related conditions , von 's early diagnosis surgical removal tumors may offer hope preserving hearing facial nerve function report evaluation treatment family multiple affected individuals conclusions
reversible nitrous oxide abuse serial electrophysiological studies detailed electrophysiological studies performed 4 patients induced abuse nitrous oxide 1 4 years presented paresthesias , weakness , 's phenomena , exhibited signs sensorimotor polyneuropathy , ataxia , two subnormal serum vitamin b12 levels baseline electrophysiologic testing revealed reduced motor unit potentials , prolonged f wave latencies , absent h reflexes , denervation potentials , delays motor sensory conduction three peripheral delay median nerve stimulation 3 12 months' abstinence treatment vitamin b12 , showed substantial clinical improvement parallel improvement electrophysiologic findings occurred , residual minor conduction delays , loss h reflexes , electromyographic evidence denervation , abnormalities posterior tibial sep noted findings confirm reversibility nitrous oxide abuse describe profile electrophysiologic recovery subjects neurotoxic exposure
nerve muscle involvement large family mitochondrial electrophysiological studies thirteen patients mitochondrial investigated represent different generations , ages , stages , disease assumed metabolic defect disease multisystem disorder metabolic defect located complex 1 respiratory chain clinically , disorder gives symptoms hearing loss , retinal degeneration , ataxia , cardiomyopathy , muscular neuropathy patients investigated nerve conduction studies , concentric needle emg , , macro emg examinations studies revealed signs myopathy younger members slight muscular symptoms advanced stages , neuropathic changes axonal type seen well macro emg interpreted indicating muscle fiber membrane abnormalities early stages single fiber emg studies indicate metabolic defect neuromuscular transmission
diagnostic prognostic value electrophysiologic tests meralgia paresthetica electrophysiologic diagnosis unilateral meralgia paresthetica usually assessed side side comparison amplitudes , , sep latencies following stimulation lateral femoral cutaneous nerves determine relevance diagnosis tests side side comparison , results compared patients unilateral meralgia paresthetica normal subjects long term outcome also considered , order determine whether electrophysiologic findings contribute prognosis study , amplitude comparison found useful diagnosis sep latency comparisons however value amplitude affected side , results tests , found predictive outcome also results tests depend methods used nerve 's route
effects short mechanical characteristics rat muscles aim study investigate contractile protein characteristics 5 day \( \) 7 day \( \) experiments performed fibers soleus , gastrocnemius lateralis , plantaris muscles isolated wistar rats reduction fiber diameter might explain decrease maximal tension soleus , whereas tension unaltered gastrocnemius plantaris moreover calcium sensitivity appeared modified soleus gastrocnemius tension pca relationships shifted toward higher calcium concentrations , indicating decrease apparent calcium binding constant troponin c tension pca relationship appeared unaltered plantaris finally , studies time reach steady tension indicated increase rate force development soleus , contrary , slowing plantaris change gastrocnemius found results analyzed references different muscle functions disuse atrophy
patient perception tics movement disorders determine subjective perception patients abnormal movements , 170 patients various interviewed questions directed voluntary intentional versus involuntary aspects symptoms one hundred two 110 patients non tic disorders thought abnormal movements entirely involuntary forty one 60 tic disorder patients stated motor tics produced fifteen others voluntary involuntary components , usually former voluntary response could used predict correct diagnostic category \( tic versus non tic \) 8 9 patients referral category incorrect results suggest large proportion motor symptoms experienced tic patients executed , involuntary commonly discussed
symptoms disease associations idiopathic intracranial hypertension \( pseudotumor \) case control study identify symptoms coexisting medical conditions associated idiopathic intracranial hypertension \( iih \) , administered 83 item questionnaire time diagnosis 50 iih patients 100 aged matched controls ninety percent iih patients women mean age 33 obesity recent weight gain much common among patients controls symptoms commonly reported iih patients headache \( 94 \) , transient visual \( \) \( 68 \) , intracranial \( \) \( 58 \) daily occurrence symptoms much common among patients controls controls also reported iih symptoms , lower frequencies several conditions previously associated iih common patients controls including iron deficiency anemia , thyroid disease , pregnancy , antibiotic intake , use oral contraceptives conclude previous studies iih , mostly uncontrolled retrospective , underestimated frequency symptoms iih patients reported chance spurious associations common medical conditions medications profile young obese woman headaches either alert clinician diagnosis iih , especially symptoms occur daily
infarction anterior rostral cerebellum \( territory lateral branch superior cerebellar artery \) report 9 patients isolated infarct anterior part rostral cerebellum , ie , territory lateral branch superior cerebellar artery correlations based ct , mri , 8 patients pathologic data main clinical features ipsilateral axial , dysarthria , 1 patient , clinical presentation mimicked lacunar stroke \( dysarthria hand syndrome \) cerebellar infarcts signs brainstem compression , patients spontaneously improved without significant angiography 2 patients pathologic examination arteries 1 patient disclosed occlusion vertebrobasilar system six patients cardiac source emboli conclusion , infarcts anterior part rostral cerebellum regarded benign condition , frequently , cardiac source emboli
comparison functional structural brain disturbances wilson 's disease assessed functional structural brain disturbances wilson 's disease \( wd \) evoked potentials \( eps \) magnetic resonance imaging \( mri \) 25 neurologically symptomatic 44 16 asymptomatic patients , assessed eps \( n 48 \) imaging \( n 41 \) , least 1 abnormality either prolonged ep conduction times , imaging outlined presence cerebral lesions , brain atrophy findings indicate eps mri sensitive techniques evaluation brain involvement wd
interictal spiking wakefulness sleep localization foci temporal lobe epilepsy examined variations interictal spiking sleep wakefulness assess differences reliability epileptic foci forty patients studied prospectively spikes assessed rates , field , appearance new foci final localization determined surgery , , seizure onset comparison interictal eeg foci final localization made 39 patients , slow wave sleep activated spiking compared wakefulness patients showed maximal spiking sleep stages 3 4 restriction field rapid eye movement \( rem \) sleep wakefulness , extension field slow wave sleep occurred new foci appeared non rapid eye movement sleep 53 patients similar identical spiking rates , foci , field distributions seen wakefulness rem sleep rem foci unilateral findings suggest localization primary epileptogenic area reliable rem sleep wakefulness , wakefulness slow wave sleep
phenytoin toxicity due interaction clobazam benzodiazepine antiepileptic drug clobazam added existing aed treatment , usually without clinical toxicity report 3 patients addition clobazam led within several weeks clinically obvious phenytoin \( pht \) intoxication patients taking maximum tolerable pht doses symptoms high pht levels resolved lowering pht dose clobazam levels elevated interaction probably related interference hepatic degradation pht clinicians aware possible pht intoxication patients starting clobazam
prediction free phenytoin levels based total phenytoin albumin ratios potential errors hypoalbuminemia therapeutic monitoring pharmacologically active \( free drug \) fraction protein bound medications \( e g , phenytoin \) represents major diagnostic challenge clinical laboratory medicine free drug levels may beneficial many clinical situations , current methods predicting free phenytoin concentrations unreliable recommended general use authors demonstrated linear relationship \( r2 0 98 \) serum levels total bound phenytoin 56 patients seizure disorders significant correlations observed total phenytoin albumin levels compared independently measured concentrations free phenytoin percent free phenytoin good correlation \( r2 0 89 \) existed free phenytoin levels total phenytoin albumin ratios patients normal elevated albumin levels , significantly weaker correlations found patients hypoalbuminemia thus , total phenytoin albumin ratios may clinical value predicting free phenytoin levels uncomplicated patients without hypoalbuminemia
critical appraisal mitogen induced lymphocyte proliferation depressed patients objective authors' goal evaluate utility mitogen induced lymphocyte proliferation assays clinical research method examined 23 depressed patients 23 matched comparison subjects assay significant differences groups combined results study results previous study 20 depressed patients 20 comparison subjects examine possible determinants lymphocyte proliferation depression results depressed patients lower proliferative responses matched comparison subjects lower depression subscale , subscale , total scores brief psychiatric rating scale patients higher proliferative responses matched comparison subjects finding unexpected unexplained depressed patients lower proliferative responses matched comparison subjects also fewer less psychomotor agitation according schedule affective disorders schizophrenia interview patients higher proliferative responses matched comparison subjects stepwise discriminant analysis cluster analysis contributed little understanding determinants vitro lymphocyte proliferation cells depressed patients conclusions longitudinal studies using multiple serial determinations mitogen induced lymphocyte proliferation minimal design needed make assay useful evaluating immune system changes depression
depressive symptoms following stroke objective primary purpose study assess relation lesion location mood vegetative disturbance following stroke method fifty two inpatients outpatients single , unilateral strokes included patients past cns psychiatric disorders excluded modified visual analogue scale used allow inclusion impaired patients sleep eating disturbances measured using self report nursing assessments location lesions determined ct scan classified according three dimensions right left , dorsal ventral , frontal results measures dysphoric mood sleep disturbance , results indicated significant three way interactions among three lesion dimensions differences found regard eating disturbance greater sleep disturbance found subjects left parietal occipital , left inferior frontal , right superior frontal , right temporal lesions subjects lesions locations depressive symptoms associated functional impairment measured activities daily living , motor strength , severity aphasia conclusions results support hypothesis lesion location valid significant factor mixture influences may result dysphoric mood state following stroke relation site lesion subsequent depressive symptoms , however , may complex reported previously
nature course olfactory deficits alzheimer 's disease objective aim study determine specific nature course olfactory deficits alzheimer 's disease previous studies noted impaired odor identification , presence odor detection deficits method odor identification tested 55 patients alzheimer 's disease 57 elderly control subjects using university pennsylvania smell identification test odor detection assessed 46 subjects alzheimer 's disease 40 control subjects using forced choice threshold test results significant deficits olfactory identification present subjects earliest stages cognitive impairment , deficits increased alzheimer 's disease progressed overlap individual smell identification test scores impaired patients normal elderly subjects hand , odor detection deficits appear alzheimer 's disease relatively advanced smell identification test scores correlated mini mental state scores , detection conclusions odor identification impaired early alzheimer 's disease may influenced cognitive status acuity odor detection , altered later disorder pattern alzheimer 's disease suggests disorder may begin nose , previously refinement olfactory testing may useful diagnostic evaluation early dementia
nonfearful panic disorder neurology patients validated lactate challenge objective nonfearful panic disorder meets dsm iii r criteria panic disorder associated subjective fear anxiety authors determined prevalence group neurology patients assessed diagnostic validity panic disorder subtype evaluating response patients nonfearful panic disorder sodium lactate pharmacotherapy method subjects neurology patients referred 1 year university hospital 's psychiatric consultation service negative medical symptoms \( n 48 \) patients met dsm iii r criteria panic disorder report subjective anxiety fear panic episodes diagnosed nonfearful panic disorder afterward , patients received sodium lactate infusion , 5 hours later , sodium chloride infusion treated medication followed least 6 months results 48 neurology patients referred psychiatric evaluation , 11 \( 23 \) met criteria panic disorder , 11 met criteria nonfearful panic disorder 11 responded positively lactate placebo , experienced least 75 reduction symptoms 6 month follow period detailed case reports three patients presented conclusions findings support construct predictive diagnostic validity nonfearful panic disorder subtype panic disorder suggest lack attention group leads prevalence panic disorder withholding potentially successful treatments group
organ procurement patients fatal head injuries fate potential donor 46 month , retrospective review victims fatal head injury level 1 trauma center undertaken estimate donor organ availability , determine causes procurement failure , analyze functional results organs transplanted group donors causes procurement failure 126 patients died principally head injuries included failure initial resuscitation \( 14 \) , \( 28 \) , failure physiologic support \( 14 \) , denial consent \( 20 \) 73 eligible donors , 29 \( 41 \) able one vascular organs \( heart , liver , kidney \) one instance eligible donor appropriately identified failure physiologic support prevent early death \( 25 \) , denial consent \( 34 \) found two major , potentially remediable causes procurement failure series based data , estimated 29 patients million population year survive initially meet eligibility requirements organ donation data 47 kidneys transplanted donor group demonstrated 77 overall graft survival rate follow period averaging 23 months prolonged donor hypotension , use high dose , adversely affected allograft survival current limitations organ procurement victims fatal head injury stem limited ability maintain cardiopulmonary function long enough procurement process completed high overall rate \( 46 \) denial consent organ harvest next
p300 brain activity seizure patients preceding temporal lobectomy event related potentials recorded occipital parietal scalp 20 patients suffering intractable partial complex seizures prior undergoing temporal lobectomy subjects presented language visual stimuli using divided field , ball paradigm although behavioral performance \( button press accuracy , reaction time , running counts \) comparable across groups \( although accuracy worse left temporal group \) , patients showed tremendous variability amplitude latency p300 response particularly notable observation slow wave activity present among patients among control subjects , scheduled left temporal resection amplitude reduction scheduled right temporal resection addition , number patients appeared show p300 response results discussed context utility using noninvasive event related potential measures examine memory impairment integrity neural structures mediate memory functioning certain patient populations
age onset alzheimer 's disease relation language dysfunction later age onset alzheimer 's disease \( ad \) found related diminished language performance 86 patients probable ad linear model constructed assess effects age onset disease duration performance patients ad four language tasks \( , reading , auditory comprehension , writing \) controlling disease severity results univariate analysis , dependent variable averaged language task performances , revealed significant effect age onset ad , disease duration assess possibility relationship age onset ad language performance reflects effects normal aging , language tasks given 33 normal subjects similar ages scored dementia severity measures convincing relationship found test score age
distribution cerebral muscarinic acetylcholine receptors vivo patients dementia controlled study single photon emission computed tomography high affinity muscarinic receptor antagonist , \( 3 4 labeled iodine 123 \) , used single photon emission computed tomography image muscarinic acetylcholine receptors 14 patients dementia 11 healthy controls high resolution single photon emission computed tomographic scanning performed 21 hours intravenous administration approximately 5 mci normal subjects , images retained ligand showed consistent regional pattern correlated postmortem studies relative distribution muscarinic receptors normal human brain , high radioactivity counts basal ganglia , occipital cortex , cortex , low counts thalamus , virtually counts cerebellum eight 12 patients clinical diagnosis alzheimer 's disease obvious focal cortical defects either frontal posterior temporal cortex patients clinical diagnosis pick 's disease obvious frontal anterior temporal defects region interest statistical analysis relative regional activity revealed significant reduction bilaterally posterior temporal cortex patients alzheimer 's disease compared controls study demonstrates acetylcholine receptor imaging single photon emission computed tomography data suggest focal abnormalities muscarinic binding vivo may characterize patients alzheimer 's disease pick 's disease , studies needed address questions partial volume artifacts receptor quantification
widespread functional effects discrete thalamic infarction order investigate functional effects various thalamic structures metabolism remote , morphologically intact cerebral regions , used positron emission tomography \( 18f \) 2 fluoro 2 deoxy glucose study regional cerebral metabolic rates glucose \( rcmrglu \) 11 patients chronic unilateral bilateral infarcts strictly confined thalamus patients grouped according computed tomographic scans showing anterior \( three \) , medial \( four \) , posterior \( four \) lesions compared matched group 11 healthy subjects \( hemispheric cmrglu 35 2 3 49 mumol 100 g per minute \) , glucose metabolism significantly lower hemisphere ipsilateral infarction \( 31 2 2 97 mumol 100 g per minute \) patients bilateral infarcts lower hemispheric cmrglu \( 29 9 2 74 mumol 100 g per minute \) unilateral lesions \( 32 2 2 97 mumol 100 g per minute \) depending infarct location within thalamus , differential depression rcmrglu , largest effects frontal occipital areas medial infarctions except ipsilateral thalamic , metabolic patterns anterior thalamic infarcts close normal , posterior infarcts mostly depressed rcmrglu visual inferior limbic cortex cerebellar metabolic rates within normal limits cases patterns regional cerebral may related categories thalamic projections , limbic system basal ganglia , diffuse cortical areas , specific defined areas even small brain lesions may widespread functional sequelae , potentially demonstrable positron emission tomography
effect sleep dyskinetic movements parkinson 's disease , gilles de la tourette syndrome , huntington 's disease , torsion dystonia effect sleep involuntary movements parkinson 's disease , huntington 's disease , primary secondary torsion dystonia , gilles de la tourette syndrome studied total 52 patients 10 normal subjects using video electroencephalographic movements typical wake pattern seen occasionally unequivocal sleep two completed studies , condition similar circumstances movements likely occur awakenings sleep , stage one sleep movements rare deeper phases sleep movements occurred sleep without awakenings usually preceded arousal phenomena , rarely , sleep slow waves control group showed normal movements conditions sleep rare appearance different normal movements similar circumstances sleep could result common effects generator systems changes excitability final common motor pathway
posttraumatic torticollis report six cases torticollis precipitated neck trauma dystonia began 1 4 days trauma differed clinically idiopathic torticollis marked limitation range motion , lack improvement sleep \( period \) , absence worsening action present improvement support seen idiopathic torticollis onset pain immediately trauma marked spasms muscles predominant features anticholinergic therapy without benefit however , improvement occurred botulinum toxin injection concluded torticollis caused peripheral trauma unique clinical characteristics
early description slowly progressive aphasia slowly progressive aphasia without generalized dementia become important issue present day neuropsychological research historically , first description usually given pick another german author published description pertinent cases pick 's contemporary , max author also observed patient slowly progressive spatial visual recognition deficit , discussed patients remarkably modern way context partial atrophy brain
frontal impairment hypoperfusion neuroacanthocytosis cerebral blood flow tomography , 133 inhalation hmpao \( 99mtc , l propylene amine oxime \) technetium tc 99m injection , revealed severe hypoperfusion frontal lobes 40 year old woman confirmed neuroacanthocytosis finding occurred conjunction neuropsychological deficits consistent selective frontal lobe dysfunction observation first documentation type dementia neuroacanthocytosis
comparison motor response levodopa parkinson 's disease magnitude pattern motor responses single doses subcutaneous oral levodopa compared 14 patients parkinson 's disease although produced much shorter motor responses levodopa , quality response two drugs virtually indistinguishable clinical observations support notion integrity striatal post synaptic dopamine receptors key determinant responsiveness dopaminergic treatment parkinson 's disease
evaluation add drug management severe epilepsy effects addition , new anti epileptic drug , therapy 128 patients severe medically refractory epilepsy reported forty two \( 33 \) patients experienced side effects , predominantly 28 \( 22 \) , drug withdrawn side effects commonest side effects behavioural change remaining 100 patients followed mean 30 weeks \( range 12 75 \) forty one patients showed marked improvement seizure frequency \( 50 reduction compared pre trial period \) , nine \( 7 \) rendered seizure free apparent tolerance effects drug noted five patients exacerbation seizures may occur drug withdrawn quickly appears promising new anti epileptic drug
diurnal differences response oral levodopa diurnal differences duration quality motor response levodopa frequently described patients quality duration motor responses objectively assessed morning afternoon oral levodopa doses five patients parkinsonian motor fluctuations complained diurnal variation response normal levodopa medication results suggest controlled conditions eliminated effects diet overlapping levodopa effects response levodopa remained unchanged throughout day , duration response could predicted plasma levodopa levels
accuracy predictions progress patients stroke unit aim study check accuracy predictions factors affect progress , physical abilities activities daily living , patients admitted stroke unit series 60 patients admitted consecutively stroke unit assessed tests motor , functional cognitive abilities admission basis assessments predictions made abilities patients discharge patients assessed level motor abilities activities daily living discharge accuracy predictions checked predictions found significantly correlated outcome relationships close useful clinical management individual patients
syndrome effect l 3 , 4 blood pressure regional cerebral blood flow nine cases syndrome , changes blood pressure cerebral blood flow sitting supine position studied influence , synthetic mineralocorticoid , l 3 , 4 \( \) , precursor norepinephrine , changes examined sitting , regional cerebral blood flow \( \) measured inhalation showed tendency decrease reduced fall mean blood pressure significantly reduced fall diastolic blood pressure significantly
functional outcomes following selective posterior rhizotomy children cerebral palsy recent increase popularity selective posterior rhizotomy demands objective documentation surgical outcome reason , authors analyzed status 25 children spastic cerebral palsy rhizotomy determine effects therapy muscle tone , range movement , motor function postoperative tests showed reduction muscle tone compared preoperative assessments range motion lower extremities significantly increased improvements functional gross motor skills noted increase range motion knees thighs gait detected 18 ambulatory patients studied computerized two dimensional motion analysis preliminary findings indicate selective posterior rhizotomy reduced spasticity , thereby increasing range motion contributing improvements active functional mobility
spontaneous neuronal hyperactivity medial thalamic nuclei patients deafferentation pain electrical activity recorded single cells thalamus 10 patients chronic pain associated deafferentation local anesthesia , patients underwent either electrode implantation treatment pain eight 10 patients , single units identified spontaneously high frequency , often , bursts discharges two types short bursts comprised two six spikes burst frequency one four per second long 30 80 spikes similar frequency reconstruction electrode indicated recordings made region corresponding lateral aspect thalamic nucleus , central lateral nucleus , small part central median nucleus , nucleus eight patients spontaneous neuronal burst activity exhibited , impossible study activity evoked natural cutaneous stimulation due continuous spontaneous neuronal discharges animal human studies suggested pain related deafferentation accompanied spontaneous hyperactivity dorsal horn spinal cord ventral posterior thalamic nuclei authors present evidence spontaneous neuronal hyperactivity thalamic nuclei patients pain related deafferentation findings suggest spontaneous neuronal discharge patients pain related deafferentation widespread central nervous system previously appreciated results important implications surgical treatment chronic pain
relationship body brain temperature brain injured recent work shown mild moderate levels hypothermia may profoundly reduce histological biochemical sequelae cerebral ischemic injury present study , authors examined effect fluid injury brain temperature anesthetized rats effect anesthesia brain temperature uninjured rats relationship brain , rectal , temporalis muscle temperatures , hypothermia , hyperthermia studied following moderate magnitude fluid brain injury \( 2 10 2 25 \) rats results showed mean brain temperature 10 anesthetized injured rats , 21 anesthetized uninjured rats , 10 uninjured rats mean \( standard error mean \) 36 04 degrees 0 20 degrees c , 36 30 degrees 0 08 degrees c , 37 95 degrees 0 09 degrees c , respectively significant difference temperature general anesthesia injured uninjured rats \( p greater 0 05 \) absence brain injury , mean brain temperature significantly lower anesthetized rats rats \( p less 0 001 \) anesthetized brain injured rats , temporalis muscle temperature correlated well brain temperature 30 degrees 40 degrees c range , even brain temperature rapidly changed induction hypothermia hyperthermia \( r 0 , p less 0 0001 \) contrast , rectal temperature varied brain temperature observations indicated 1 \) brain injury influence brain temperature model 2 \) anesthesia alone decreases brain temperature levels producing cerebral protection model 3 \) external monitoring temporalis muscle temperature provide reliable indirect measure brain temperature course experimental brain injury authors believe essential monitor control brain temperature studies experimental brain injury
anticonvulsant behavioral effects two novel competitive n methyl aspartic acid receptor antagonists , cgp 37849 cgp 39551 , kindling model epilepsy comparison mk 801 carbamazepine orally active competitive n methyl aspartate \( nmda \) receptor antagonists cgp 37849 \( dl e 2 amino 4 methyl 5 3 acid \) ethyl ester cgp 39551 evaluated amygdala kindled rats , model complex partial secondarily generalized seizures anticonvulsant behavioral effects novel compounds compared noncompetitive nmda receptor antagonist mk 801 \( \) 5 methyl 10 , 11 dihydroxy \( , \) 5 , 10 e antiepileptic drug carbamazepine , one major drugs treatment partial generalized seizures humans comparative evaluation , compounds injected p following doses 1 10 mg kg \( cgp 37849 cgp 39551 \) , 0 05 0 3 mg kg \( mk 801 \) 20 40 mg kg \( carbamazepine \) , respectively contrast carbamazepine , cgp 37849 , cgp 39551 mk 801 exerted weak anticonvulsant effects fully kindled rats increase focal seizure threshold weak anticonvulsant effects nmda receptor antagonists kindled rats associated profound untoward behavioral effects behavioral syndrome induced nmda receptor antagonists kindled rats characterized marked ataxia , hyperactivity , case cgp 37849 mk 801 , , head low absent effectiveness novel nmda receptor antagonists kindled seizures suggests compounds clinically useful partial secondarily generalized seizures furthermore , view recent clinical findings effects mk 801 epileptic patients , similarities excitatory effects produced cgp 39551 , cgp 37849 mk 801 kindled rats may indicate competitive nmda receptor antagonists may also produce effects humans
tactile eighty four patients damage various levels nervous system , ranging peripheral nerves cerebral cortex , underwent assessment order determine degree basic complex perceptual motor disorders affect tactile recognition \( tor \) determine whether tor impaired absence basic sensorimotor results suggest \( 1 \) basic intermediate disorders function impair tor severe given degree tor impairment patients peripheral lesions patients cortical lesions \( 2 \) neither hemiparesis alone precludes normal tor \( 3 \) contributes substantially tor impairment \( 4 \) impairment tor occur absence basic dysfunction constitutes tactile \( 5 \) tactile subtle , disorder distinguished , severe disabling disorder , \( 6 \) tactile results unilateral damage , possibly including second somatosensory cortex , either hemisphere
monitoring cortical blood flow temporary arterial occlusion aneurysm surgery thermal diffusion method aneurysm surgery , regional cortical blood flow \( cobf \) continuously monitored 12 patients thermal diffusion flow probe attempt assess effects temporary major arterial occlusion blood flow outcome cobf 30 ml 100 g min , safe period temporary clipping applied distal 15 minutes occlusion time shortened cobf 30 ml 100 g min two patients suffered basal infarction , detected cobf monitoring attention paid blood flow deep structures temporary clip applied site proximal branches direct measurement cobf may value estimating time temporary occlusion major vessel tolerated
chronic headache associated functioning shunt usefulness pressure monitoring chronic headaches shunt dependent patient small ventricles long treated little regard intracranial pressure study , pressure monitoring 12 patients demonstrated fell three distinct categories 3 headaches caused intracranial hypertension , 2 headaches hypotension , 7 showed relation symptoms pressure therapeutic procedures treating three categories entirely different sometimes , clear intracranial pressure monitoring essential successful management complaint
intracranial aneurysms interventional neurovascular treatment detachable balloons results 215 cases patients complex surgically difficult intracranial aneurysms treated interventional neurovascular techniques neuroleptic anesthesia femoral approach , silicone micro balloon flow directed intracranial circulation , guided directly aneurysm , detached aneurysm thus eliminated circulation , parent artery preserved broad based ectatic aneurysms , test occlusion followed permanent occlusion aneurysm parent vessel performed since 1981 , 211 patients 215 aneurysms , including 177 cases involving anterior 38 cases involving posterior circulation , treated technique 127 cases \( 59 1 \) , parent vessel occluded 88 cases \( 40 9 \) , primary occlusion aneurysm achieved preservation parent artery therapy related complications included 21 deaths \( 9 8 \) 16 strokes \( 7 4 \) follow examinations performed 1 , 3 , 12 months treatment , follow ranged 5 months 9 years patients standard surgical therapy fails aneurysms surgically anatomic locations , interventional techniques make use detachable balloons may useful therapeutic alternative
mapping distribution amobarbital sodium intracarotid test use tc 99m hmpao spect intracarotid amobarbital sodium , , test used localize speech memory function prior surgical treatment temporal lobe seizures authors mixed technetium 99m oxime \( hmpao \) amobarbital sodium injected mixture 25 patients epilepsy single photon emission computed tomography \( spect \) brain performed determine intracerebral distribution amobarbital sodium results spect compared conventional digital subtraction angiography \( dsa \) distribution tc 99m hmpao , presumably , amobarbital sodium varied patient patient spect revealed statistically different distribution predicted conventional angiography distribution also often differed dsa , although difference significant spect revealed infrequent delivery temporal lobe structures emphasizes need caution use intracarotid amobarbital sodium test predict outcome removal areas
developmental women findings three patients brains male cases show predominantly left sided report three women brains , symmetrical also , two brains , multiple foci glial scarring present women , many scars myelinated , suggesting late intrauterine early postnatal life one , scars mainly left involved portions vascular border zone temporal cortex , scars numerous occurred border zone anterior , middle , posterior cerebral arteries three cases showed variable extent brain warts , molecular layer , focal dysplasia identical seen male cases two women primary brain neoplasms , low grade astrocytoma , respectively , two women showed small angiomas previously reported male cases disclosed one myelinated glial scars two control brains showed myelinated glial scars well significance anatomical findings discussed , possible etiological factors considered known effects autoimmune diseases nervous system
timing cerebral blood flow , aura , headache migraine attacks ten years study resulted considerable fragmented knowledge regional cerebral blood flow migraine aura \( classic migraine \) present study , number repeatedly studied patients \( n 63 \) large enough determine statistically significant sequences events statistically significant spatial relations first observable event decrease regional cerebral blood flow posteriorly one cerebral hemisphere development pathological process accompanied aura symptoms thereafter headache occurred regional cerebral blood flow remained decreased headache phase , regional cerebral blood flow gradually changed abnormally low abnormally high without apparent change headache patients headache disappeared regional cerebral blood flow remained increased although regional cerebral blood flow reduction aura symptoms great majority patients unilateral , one third bilateral headache unilateral headache usually localized side regional cerebral blood flow reduced aura symptoms originated \( e , aura symptoms perceived occur presumably originated hemisphere \) results suggest simple model migraine attacks pathological disturbance one cerebral hemisphere causes aura symptoms time delay , also causes headache stimulating local vascular bilateral headache caused unilateral cerebral disturbance may explained recent neurophysiological findings
ataxia peripheral neuropathy benign variant dysgenesis 5 year old boy dysfunction described clinical features included , , ataxia cognition , vision , hearing , hepatic function normal panel markers , including long chain fatty acids , acid , acid , catalase , abnormal uniquely benign syndrome disordered
okt3 encephalopathy okt3 therapy induction immunosuppression patient underwent renal transplantation produced associated computed tomographic scan evidence brain edema findings resolved 3 days supportive therapy okt3 withdrawal
transit time duchenne muscular dystrophy smooth muscle degeneration may occur duchenne muscular dystrophy measured fasting transit time patients advanced duchenne muscular dystrophy muscular dystrophies healthy controls significant differences found contrast reports gastric duchenne muscular dystrophy , found evidence impaired small intestinal motility
effect ph buffering reducing pain associated subcutaneous infiltration bupivicaine published erratum appears j med 1991 jul 9 \( 4 \) 410 authors propose ph buffering bupivicaine sodium bicarbonate reduces pain associated local subcutaneous infiltration double blind , prospective study , 62 healthy adult volunteers received 0 5 ml subcutaneous infiltration 0 5 buffered bupivicaine randomly chosen hand ph adjusted 7 0 adding 0 05 ml sodium bicarbonate \( 1 meq l corrected \) 10 ml vials commercially available bupivicaine \( 1 200 dilution \) control hand injected amount agent pain scored infiltration using visual analogue scale student 's test paired measurements used analyze intergroup pain score differences forty three subjects \( 69 \) reported less pain buffered bupivicaine 17 \( 27 \) noted modest increase two subjects \( 3 \) reported difference mean pain score buffered agent 22 mm compared 30 mm control mean difference \( control experimental \) 8 mm \( 4 64 , df 61 , p less 001 \) authors conclude addition sodium bicarbonate bupivicaine reduces pain associated local infiltration
research physical medicine rehabilitation measurement tools application brain injury basic principles techniques measurement relevant across purpose article explain important medical rehabilitation , illustrate use choose assessment instruments describe nature measurement medical rehabilitation examples brain injury rehabilitation reliability basic scientific measure validity , ultimate criterion , closely associated purpose measure content validity , criterion validity construct validity explained sensitivity rehabilitative interventions significance patients' real lives \( ecological validity \) emphasized measures functional outcomes \( disability \) may show improvement rehabilitation even impairment measures extensive selected list measures coma , global status , disabilities , cognitive impairments , presented , main uses illustrated examples illustrate choose measures study comprehensive program level outcomes , study learning based interventions develop general purpose database although many measures activities daily living mobility , little published evidence reliability validity could found even well known scales valid sensitive outcome measures especially needed studies clinical utility measures also scarce many gaps clinical researchers limited resources physical medicine rehabilitation benefit formal studies old new measurement instruments increased choice measures
recovery time independent function post stroke stroke patients undergoing physical rehabilitation monitored daily determine length time needed recover independent function 93 patients admitted , 45 could attain sitting position independently , 75 could walk independently 75 could independently discharge , 25 45 patients \( 55 6 \) able attain sitting supine independently , 35 75 patients \( 46 7 \) achieved ability walk independently 25 75 patients \( 33 3 \) learned independently time admission achievement independent function time onset stroke achievement independent function modeled relation variables age , sex , side lesion , comorbidity , presence depression extent impairment perception , cognition , auditory comprehension verbal expression four variables found influence recovery time age influenced rate recovery walking stair climbing perceptual impairment influenced rate achieving independent sitting stair climbing depression comprehension influenced walking
ventilatory function predictor fatal stroke objective investigate relation ventilatory function subsequent mortality due cerebrovascular disease design prospective longitudinal study subjects total 18 , 403 male aged 40 64 years entry examination study main outcome measure mortality cerebrovascular disease \( 430 438 \) 18 years follow results , 262 men sinus rhythm entry died due stroke 18 years follow compared men forced expiratory volume one second greater equal 3 5 value less 3 0 almost twice likely die cerebrovascular disease \( rate ratio adjusted age systolic blood pressure 1 88 , 95 confidence interval 1 32 2 69 \) increased risk occurred within tertile systolic blood pressure case control analyses used control precisely confounding effects age , height , smoking \( matching \) employment grade physiological risk factors \( modelling \) effect forced expiratory volume one second independent age , height , smoking habits , employment grade , blood pressure , weight , cholesterol concentration , glucose tolerance , electrocardiographic abnormalities , history chest pain , history intermittent claudication conclusions measurements ventilatory function may assist clinical decisions whether treat mild hypertension impaired ventilatory function stroke may share common causes
availability transplantable organs brain stem dead donors intensive care units objective audit january june 1989 quantify , separately hearts , kidneys , liver , lungs corneas , possible increases transplantable organs brain stem dead potential donors intensive care units compare increases achieved october november 1989 , intense , national publicity transplantation design prospective audit deaths intensive care units england 1 january 30 june 1989 subsequent case study impact publicity offers donations october november 1989 setting 15 regional special health authorities england patients patients dying intensive care units , 497 confirmed brain stem dead general medical contraindication organ donation main outcome measures organ specific suitability transplantation \( reported intensive care units \) consent donation specific suitable organs procurement specific organs reported suitable transplantation offered results 497 \( 8 6 \) brain stem dead potential donors estimated organ specific suitability heart 63 , kidneys 95 , liver 70 , lungs 29 , corneas 91 refusal relatives \( 30 \) accounted major losses suitable organs types kidneys loss equivalent 44 brain stem dead actual kidney donors discussion organ donation second important reason missed kidney donors , loss equivalent 10 brain stem dead actual donors non procurement difficulties organs second notable cause missed suitable liver lung donors 29 \( 55 \) offered total 189 liver donors 27 \( 21 \) 78 offered suitable lung donors six months non procurement suitable , offered organs rare kidneys modest , order 13 10 respectively , heart corneas corneal donation brain stem dead potential donors might improved nearly much \( , 78 increase brain stem dead actual corneal donors \) specific measures promote corneal donation organs offered reducing overall refusal rate restricted offers , non procurement , discussion donation accounted nearly equal numbers lost donations hearts \( equivalent 15 donated hearts \) october november 1989 intense , positive publicity transplantation rates refusal non discussion fell compared january june \( 22 , 36 163 v 30 , 138 460 7 , 33 497 v 2 , 4 167 respectively \) offers suitable donors increased significantly \( p less 0 02 \) compared first six months 1989 , notably heart donors \( 80 v 60 1 expected \) kidney donors \( 122 v 102 1 expected \) kidneys noticeable 17 increase actual donors \( 118 actual donors v 100 8 expected donors p 0 09 \) conclusions four strategies increase supply transplantable organs brain stem dead potential donors intensive care units identified \( \) reducing refusal relatives \( b \) avoiding non procurement actually suitable organs \( initiatives \) deterioration initially suitable organs \( donor care initiatives \) \( c \) converting restricted offers offers \( \) ensuring discussion families early referral transplant team gives time discussion donor care agreement medical suitability donation specific organs problems non procurement may prerequisite increased offers translated increased donations impact publicity therefore needs measured offers suitable donors well actual donations
dacron woven pacemaker pouch influence long term pacemaker mobility pacemaker migration interfere correct pacing system function patient comfort dacron pouch developed may prevent problems assess efficacy pouch , measured various factors pacemaker mobility 100 patients long term follow patients divided three groups basis operative reports group 1 , pouch anchoring group 2 , pouch group 3 , anchoring pacemaker pouch average age study population 74 3 11 years total follow time 42 28 months \( group , 53 32 months group 2 , 36 23 months group 3 , 34 25 months \) significant differences pacemakers measured movement directions , difference distance incision scar pacemaker group significant difference group 1 groups 2 3 degree tilt pacemaker chest wall compared 46 degrees 34 degrees group 1 27 degrees 26 degrees 26 degrees 27 degrees groups 2 3 , respectively \( p less 0 02 \) data suggest dacron pouch restrict pacemaker mobility parallel chest wall long term follow reduce angle pacemaker relative chest wall
precipitated treatment sleep apnea nasal cpap 33 year old man long history , observed apneic episodes , excessive daytime , underwent night polysomnography , demonstrated severe obstructive sleep apnea nasal cpap trial , two episodes observed period delta sleep rebound
alzheimer 's disease related disorders state mental hospitals data nationwide survey three decades transferring elderly nursing homes , geriatric patients continue reside state mental hospitals many patients , perhaps one third , thought suffer alzheimer 's disease related disorders \( \) study reports data nationwide survey state hospitals provides exploratory look patients currently served state hospitals admission trends , reasons admission , sources referral described commitment nursing home patients dementing illnesses place state hospital continuum care patients discussed
differences membrane interaction scrapie amyloid precursor proteins normal scrapie creutzfeldt jakob disease infected brains membrane interaction normal \( \) infectious isoform \( cjd \) scrapie creutzfeldt jakob disease amyloid precursor proteins studied normal isoform hamster human scrapie amyloid precursor protein found microsomal membranes anchored solely c terminal glycolipid glycolipid cleavage resulted dissociation membranes change behavior highly hydrophobic hydrophilic protein , susceptible proteases contrast , cjd isoform resistant release glycolipid enzymes part cjd released membranes prolonged trypsin treatment , yielding protease resistant product 27 30 kda results demonstrate proteolytic resistance membrane bound cjd isoform also indicate presence different , apparently disease induced mechanism membrane interaction scrapie cjd infected microsomal membranes
creutzfeldt jakob disease allogeneic dura review risks safety surgeons lay public recently expressed concern safety allogeneic dura relates transmission creutzfeldt jakob disease indeed , two cases resulted use tissue commercial adhere criteria accepted american association tissue banks southeast organ procurement foundation review discusses risks safety allogeneic dura findings surgeon safety allogeneic dura properly processed , tissue bank date , documented cases reported center disease control creutzfeldt jakob disease transmitted allogeneic dura obtained registered tissue bank
clinical diagnostic considerations cocaine abuse following review research literature effects cocaine , study described group 120 cocaine addicts 120 patients , 10 \( 8 33 \) exhibited , , organic hallucinations case reports 10 cases presented quality adverse subjective effects cocaine emphasized , differential diagnosis cocaine disorder schizophrenia discussed guidelines accurate differential diagnosis provided
neurobehavioral effects phenytoin prophylaxis posttraumatic seizures order determine potential negative neurobehavioral effects phenytoin given prevent development posttraumatic seizures , 244 subjects randomized phenytoin placebo received neurobehavioral assessments 1 12 months postinjury receiving assigned drug 24 months receiving drugs severely injured , phenytoin significantly impaired performance 1 month significant differences found function phenytoin moderately injured patients 1 month either severity group 1 year patients stopped receiving phenytoin according protocol 1 2 years improved corresponding placebo cases several measures conclude phenytoin negative cognitive effects , combined lack evidence effectiveness preventing posttraumatic seizures beyond first week , raises questions regarding use long term prophylaxis findings phenytoin 's proven efficacy controlling established seizures indicate cognitive effects worse anticonvulsant drugs
physical pharmacologic restraint nursing home patients dementia impact specialized units case control study 31 specialized dementia units 32 traditional units five states investigated use physical pharmacologic restraints among 625 patients diagnosis dementia physical restraints observed use 18 1 dementia unit patients 51 6 comparison unit patients bed day \( adjusted odds ratio , 0 283 95 confidence interval , 0 129 0 \) pharmacologic restraints routinely given 45 3 dementia unit patients 43 4 comparison unit patients \( adjusted odds ratio , 0 95 confidence interval , 0 1 \) used multivariate logistic regression identify residence nursing home unit , status , transfer dependency , mental status impairment , hip fracture history , high nursing staff patient ratio , found independent predictors physical restraint use physically behavior , severe mental status impairment , frequent family found significant predictors pharmacologic restraint use , advanced patient age , large nursing home size , patient status protective use results support conclusion physical pharmacologic restraint constitute separate treatment modalities different risk factors use , indicate specialized dementia units successful reducing use physical pharmacologic restraints
retrovirus induced spongiform mice regional distribution infected target cells neuronal loss occurring absence viral expression neurons br e murine leukemia virus \( mulv \) induces spongiform resulting progressive hindlimb paralysis used situ hybridization br e mulv specific probe study viral expression central nervous system infected cells concentrated regions spongiform lesions gliosis detected \( lumbosacral spinal cord , brainstem , deep cerebellar regions \) , suggesting causative link level virus expression degree pathological changes disease however , viral expression sufficient cause disease , since significant viral expression observed regions exhibit pathological changes \( cerebellar cortex , hippocampus , corpus , peripheral nervous system \) diseased regions , endothelial glial cells identified main target cells neurons diseased regions show viral expression regional distribution spongiform changes appears early following infection , since expression could detected 10 days regions become diseased results indicate cells distinct properties various regions central nervous system suggest indirect mechanism neuronal loss consequent viral expression cells
response suxamethonium myasthenic patient remission cumulative dose followed infusion used determine dose response suxamethonium patient diagnosed myasthenia gravis true remission \( asymptomatic receiving therapy \) ed50 values suxamethonium 0 08 mg kg 0 20 mg kg , infusion rate 3 2 mg kg hour required maintain 90 95 depression single twitch response monitored integrated electromyography values within range normal patients , conclude myasthenic patients true remission may demonstrate resistance suxamethonium
modification pain injection propofol comparison lignocaine pain injection propofol assessed controlled , randomised study 273 patients received either lignocaine 10 mg , 10 mg isotonic saline 0 5 ml , 15 seconds injection propofol vein back hand incidence pain injection control group \( 51 \) comparable studies lignocaine significantly reduced pain \( 35 34 respectively , p less 0 05 \) statistical difference two groups
lidocaine potentiation cocaine toxicity study hypothesis toxic effects cocaine enhanced presence lidocaine study population male sprague dawley rats weighing 200 300 g methods animals received intraperitoneal injections cocaine \( 10 , 20 , 35 , 50 mg kg \) , lidocaine \( 30 40 mg kg \) , combination doses cocaine given simultaneously 30 40 mg kg lidocaine incidence time seizure death recorded groups compared chi 2 analysis variance analyses , respectively results doses 30 40 mg kg , lidocaine induce seizures death effect simultaneous injection cocaine lidocaine dramatically increase incidence seizures death cocaine alone incidence seizures animals receiving 35 mg kg cocaine alone 10 increased 50 80 addition 30 40 mg kg lidocaine , respectively \( p less equal 05 p less equal 01 \) death occur animals receiving 35 mg kg cocaine alone addition 30 40 mg kg lidocaine resulted death 30 60 animals , respectively \( p less equal 01 group \) similarly , rats receiving 50 mg kg cocaine , incidence death increased 0 60 80 30 40 mg kg lidocaine , respectively \( p less equal 01 \) conclusion rat , overall toxicity cocaine significantly increased simultaneous exposure lidocaine
genetic cause juvenile form tay sachs disease child abnormality beta hexosaminidase alpha gene underlying clinical phenotype patient juvenile form tay sachs disease studied clinical features progressive spasticity , ataxia , cognitive decline protein coding sequence several beta hexosaminidase alpha chain complementary dnas isolated polymerase chain reaction completely normal except g transition nucleotide position within exon 13 , resulted substitution normal arginine 504 \( \) histidine \( \) although patient first marriage , heterozygous mutation abnormality allele , carried father , identified , except neither two mutations responsible infantile jewish tay sachs disease biosynthetic immunoprecipitation studies cultured fibroblasts showed synthesis alpha chain precursor , mature form alpha subunit detected
fragile x syndrome posterior fossa occurrence specificity posterior fossa abnormalities measured magnetic resonance images brain investigated group 14 males fragile x syndrome comparison groups consisting 17 males causes developmental disability 18 males normal size posterior cerebellar significantly decreased fourth ventricle significantly increased group males fragile x syndrome compared males comparison groups abnormalities appeared secondary hypoplasia rather atrophy
visual dysfunction alzheimer 's disease relation normal aging published erratum appears ann 1991 mar 29 \( 3 \) 271 patients alzheimer 's disease \( ad \) , compared age matched young healthy control subjects , visual deficits following functions observed color , , contrast sensitivity , \( homogeneous pattern \) critical fusion thresholds normal , relative age matched healthy subjects color , majority errors \( blue axis \) color deficits unrelated severity dementia , accordance models vision describe functions rather diffuse cortical localization although contrast sensitivity depressed throughout frequency range ad , patients impaired low high spatial frequencies , contrasting observed normal aging pattern high frequency loss healthy elderly subjects showed depressed critical fusion thresholds reduced contrast sensitivity high frequencies , relative young group differences groups found vision tests subset ad group received detailed neuro examination , abnormalities found finding , taken together normal thresholds critical fusion , suggests widespread visual dysfunction reported likely related known pathological changes primary visual association cortex ad changes retina optic nerve
nerve growth factor prevents toxic neuropathy mice taxol promising new antitumor drug therapeutic use limited toxic sensory neuropathy taxol also cytotoxic dorsal root ganglion neurons vitro , effect prevented trophic protein , nerve growth factor sought develop animal model determine whether nerve growth factor prevent taxol neuropathy vivo administration taxol mice resulted profound sensory neuropathy characterized decreases dorsal root ganglion content peptide neurotransmitter , substance p , elevated threshold induced pain , diminished amplitude compound action potential caudal nerve coadministration nerve growth factor prevented signs neurotoxicity findings suggest administration nerve growth factor may prevent certain toxic sensory neuropathies
localization 3h dihydroergotamine binding sites cat central nervous system relevance migraine dihydroergotamine \( \) treatment choice acute attack migraine although efficacy known 40 years , mechanism action still data regarding site action dihydroergotamine may provide insight mechanism action thus identify locus potentially abnormal pathophysiology migraine using vitro ex vivo autoradiographic techniques , localization specific binding sites 3h dihydroergotamine cat brain examined binding seen dorsal horn cervical spinal cord , medulla , associated nucleus , area , descending spinal trigeminal nucleus , mesencephalon cerebral cortex highest density binding sites found dorsal medial nuclei midbrain furthermore , brain regions also labeled intravenous administration 3h dihydroergotamine important brain areas specifically labeled key nuclei involved cranial pain transmission , suggesting dihydroergotamine may act central sites migraine
neurologic status patients orthopedic surgeon purpose paper review recent developments neurologic assessment patients determination level lesion , recognition spasticity progressive paralysis , potential deformity , functional expectations described status neurologic deficit remains important factor determining patient 's ultimate functional abilities accurate neurologic assessment assist meeting aims orthopedic management , include preventing joint contracture , correcting deformity , preventing skin , obtaining best possible locomotor function
gait analysis treatment ambulatory child cerebral palsy surgical treatment children cerebral palsy changed staged , single joint procedures comprehensive simultaneous bony soft tissue regimen treating multiple joint levels planes abnormality subject error based solely clinical examination scientific evaluation provided use clinical gait analysis preoperative postoperative analyses provide clinician information neurologic patterns determined surgical protocols judged
impact day care dementia patients costs , well relatives' views forty seven patients day centre analysed regarding use resources , costs well level well based interviews staff relatives related economic outcome cost utility analysis 6 month period prior day care compared first 6 months care use resources home increased 20 use institutional care reduced 22 fifty three percent patients improved well participation day care cost utility analysis applied , cost well year pounds
serum creatinine independent predictor survival stroke prospectively studied relationship serum creatinine survival among 492 elderly subjects admitted stroke monitored mean period 18 months post stroke multivariate proportional hazards models , serum creatinine remained independent predictor mortality \( p 0 0001 \) accounting important predictors level consciousness mini mental state score , age , leucocyte count , presence heart disease , diabetes , heart failure , atrial fibrillation use cardiovascular medication association elevated serum creatinine mortality also found patient subgroups ct proven infarction intracerebral concluded serum creatinine independent predictor survival stroke studies required confirm relationship elucidate underlying mechanism
intracranial hypertension relation memory functioning first year severe head injury relationship intracranial hypertension residual memory deficit closed head injury evaluated using 6 month 1 year neurobehavioral outcome data obtained traumatic coma data bank intracranial pressure analyzed using percentage time exceeded 20 mm hg maximum value recorded first 72 hours injury memory measures included recall lists , recall , visual memory designs obtained 6 months \( n 149 \) 1 year \( n 132 \) injury intracranial hypertension occurred half traumatic coma data bank cohort met criteria neurobehavioral follow study linear regression analysis disclosed effect elevated intracranial pressure , , measures memory 6 months , whereas results negative 1 year follow examination conclude elevation intracranial pressure exerts little effect later memory functioning , effect 1 year survivors severe head injury
influence calcium antagonist nimodipine induced hypertension behavior cerebral arteries , blood brain barrier , cerebral edema , cerebral infarction cats one hour occlusion middle cerebral artery thirty anesthetized cats randomly assigned one three groups 10 cats nimodipine treatment , nimodipine treatment combined induced hypertension , control group behavior cerebral arteries measured means microscopic observation cranial window middle cerebral artery cat clipped 1 hour via transorbital approach five hours circulation middle cerebral artery , evans blue dye injected intravenously 30 minutes later , animal killed administration nimodipine saline treated control group started 5 minutes middle cerebral artery clipped maintained end experiment induced hypertension produced administration dopamine occlusion damage blood brain barrier \( bbb \) judged extravasation evans blue dye cerebral edema infarction evaluated histological findings prominent control group extent hemisphere affected follows \( mean standard error \) extravasation , 40 5 8 8 edema , 43 2 5 7 infarction , 35 5 9 6 hand , extravasation evans blue dye cerebral edema significantly extensive group treated nimodipine induced hypertension \( extravasation , 28 2 9 6 hemisphere edema , 30 3 7 1 \) group treated nimodipine alone \( extravasation , 18 5 8 7 hemisphere edema , 19 4 6 3 \) , infarction size similar groups \( 16 6 4 9 hemisphere former 17 0 6 2 latter \)
, cushing , early neurosurgical treatment torticollis , dr trained hospital dr cushing time , patient torticollis came cushing treated innovative operation disorder good results case interest dr , published case 1 year later reviewing surgical histories hospital , found original records well documented case record includes postoperative intraoperative field dr cushing , dr illustrating postoperative sensory examination , pre postoperative photographs patient
spinal man brain death complex spinal patient brain dead described movements tend appear cerebrospinal shock postulate manifestations reflection physiological potential isolated spinal cord spinal movements included revised guidelines determination cerebral death
comparison midazolam without intravenous sedation introduction intravenous sedation midazolam added little quality sedation short operative procedures greater tendency patients received midazolam sleep afternoon treatment compared received midazolam significantly patients nausea vomiting midazolam group patients midazolam group
genetic mapping new dna probes defines strategy dna studies fragile x syndrome fragile x syndrome common cause familial mental retardation characterized fragile site end long arm x chromosome unusual genetics cytogenetics x linked condition make genetic counseling difficult dna studies limited value genetic counseling , polymorphic dna loci recombination fractions 12 fragile x mutation , fraxa five polymorphic loci recently described region x chromosome positions loci relation fraxa defined genetic linkage study 112 affected families five loci dxs369 , , dxs296 , , recombination fractions 4 less fraxa closest locus , dxs296 , distal fraxa recombination fraction 2 polymorphisms loci detected dna enzymatically limited number restriction strategy dna studies based three restriction five probes detect one polymorphisms 94 women strategy greatly increases utility dna studies providing genetic advice families fragile x syndrome
intermediate resulting compound heterozygosity reductase mutations four subjects thermolabile reductase \( mthfr \) discovered among 16 obligate heterozygotes severe mthfr deficiency family members four subjects less 25 normal mean mthfr specific activity lymphocyte extracts three normal serum folate intermediate , one high serum folate excessive accumulation serum biochemical features four subjects distinguishable subjects homozygous thermolabile mthfr , whose specific activity approximately 50 normal mean , heterozygotes severe mthfr deficiency , enzyme thermostable specific activity 50 normal mean propose four subjects genetic compounds allele severe mutation allele thermolabile mutation mthfr gene postulated subjects genetic compound susceptible development intermediate despite normal folate b12 levels nonetheless , due compound heterozygosity oral folic acid therapy
distribution three alpha chain beta hexosaminidase mutations among tay sachs carriers dna 176 carriers tay sachs gene tested presence three mutations commonly found among ashkenazi jews called insertion , splice junction , adult mutations among 148 ashkenazi jews tested , 108 insertion mutation , 26 splice junction mutation , five adult mutation , nine none three among 28 non jewish carriers tested , obligate carriers , four insertion mutation , one adult mutation , remaining 23 none three
muscle rehabilitation impaired elderly nursing home residents based observations changes muscle function associated aging , exacerbation changes , program muscle strengthening developed correct specific defects muscles pilot study undertaken 18 functionally impaired nursing home residents \( age range 60 90 years \) markedly deteriorated muscle function \( 50 \) secondary age , disuse , multiple chronic illnesses fourteen subjects completed six week program without adverse effects 75 patients , improved muscle function , endurance , strength , speed increasing 35 , 15 , 10 , respectively program , many subjects increased spontaneous activity decreased dependency improvements still evident four months rehabilitation results suggest may possible , carefully supervised , short term program muscle rehabilitation , nursing home residents achieve enhanced level physical functioning
wrist flexion adjunct diagnosis carpal tunnel syndrome effects five minutes wrist flexion median motor sensory evoked potential latencies 87 individuals studied nineteen subjects carpal tunnel syndrome \( cts \) diagnosed increased median nerve latencies across wrist , 68 values normal range assigned control group slight prolongation 0 sec evoked potential latencies observed groups flexion , differences two groups significant establish value adding wrist flexion conventional screening methods
detecting lower motor neuron dysfunction pharynx larynx electromyography study assessed utility clinical electromyography \( emg \) detecting lower motor neuron \( \) upper motor neuron \( \) dysfunction affecting intrinsic muscles larynx pharynx twenty nine subjects examined clinical diagnoses included perioperative nerve injury , cerebral infarction , lateral medullary infarction resting activity , motor unit action potential \( \) morphology , recruitment evaluated every case medical records \( excluding emg data \) analyzed clinical evidence dysfunction intrinsic muscles larynx pharynx diagnosis dysfunction clinical data consistent cranial nerve injury , , syndrome , unilateral bulbar palsy criteria dysfunction included previous cerebral \( brainstem \) infarction mass lesion presence hemiparesis electromyographic abnormalities significantly associated dysfunction \( p less 05 \) , significantly associated dysfunction parameters tested , recruitment sensitive \( 82 \) specific \( 92 \)
neurobehavioral effects phenytoin , carbamazepine , acid implications use traumatic brain injury due risk posttraumatic epilepsy , phenytoin , carbamazepine , acid often prescribed patients traumatic brain injury \( tbi \) review literature examined evidence neurobehavioral impairment due carbamazepine , phenytoin , acid comparative studies performed tbi population , making difficult determine one medications preferable direct studies epilepsy patients tbi patients hazardous due underlying differences two populations reported findings epilepsy patients subtle consistent across studies three drugs appear exert effect cognitive motor functions epileptic patients , impairments increasing serum levels varied length experience drug makes difficult relative weight evidence comparative assessment cognitive behavioral effects anticonvulsants done tbi population
neuroacanthocytosis clinical , pathological study 19 cases nineteen cases described , including 12 cases three different families 7 cases , multisystem neurological disease associated peripheral blood normal plasma lipoproteins mild easily overlooked , scanning electron microscopy may helpful neurologically asymptomatic relatives significant identified family screening , including clinically affected mean age onset 32 \( range 8 62 \) yrs clinical course usually progressive marked phenotypic variation cognitive impairment , psychiatric features organic personality change occurred half cases , one third seizures involuntary movements disturbance commonly caused dysphagia dysarthria sometimes severe , lips tongue rarely seen seen almost symptomatic cases dystonia , tics , involuntary akinetic rigid features also occurred two cases movement disorder computerized tomography often demonstrated cerebral atrophy caudate atrophy seen less commonly , nonspecific focal symmetric signal abnormalities caudate nuclei seen magnetic resonance imaging 3 4 cases depression absence tendon reflexes noted 13 cases neurophysiological abnormalities often indicated axonal neuropathy sural nerve biopsies 3 cases showed evidence chronic axonal neuropathy prominent regenerative activity , predominantly affecting large diameter myelinated fibres serum creatine kinase activity increased 11 cases without clinical evidence myopathy postmortem examination 1 case revealed extensive neuronal loss gliosis affecting corpus striatum , , substantia nigra , especially pars reticulata cerebral cortex appeared spared spinal cord showed evidence anterior horn cell loss two examples mcleod phenotype , x linked abnormality expression blood group antigens , identified single family included 1 female genetics neuroacanthocytosis unclear probably heterogeneous , available pedigree data association mcleod phenotype suggest may locus disorder short arm x chromosome
idiopathic intracranial hypertension prospective study 50 patients management patients idiopathic intracranial hypertension \( iih \) based presence progression visual loss characterize clinical course iih completely , monitored clinical status , especially visual function , 50 consecutive newly diagnosed patients period 2 39 months \( average follow 12 4 months \) mean age onset symptoms 31 \( range 11 58 \) yrs 46 \( 92 \) women 47 \( 94 \) obese \( mean weight 90 kg \) common symptoms headache \( 92 \) , transient visual \( 72 \) intracranial \( 60 \) 13 patients \( 26 \) initially complaints sustained visual loss visual loss determined perimetry 96 automated perimetry 92 contrast sensitivity testing abnormal 50 acuity 22 two patients \( 4 \) became blind eyes visual field grade improved 60 patients visual function deteriorated 5 \( 10 \) deterioration visual field grade significantly associated weight gain year diagnosis visual loss patients iih common often reversible patients evaluated perimetry using appropriate strategy contrast sensitivity testing , along careful examination optic discs
dual task performance processing resources normal subjects patients parkinson 's disease recent years , growing consensus among investigators presence absence external cues guiding behaviour attention important factor determining whether deficits found patients parkinson 's disease \( pd \) earlier study , authors suggested pattern impaired intact performance could explained terms differential resource demands tasks , combined depleted levels central processing resources pd patients two experiments reported , employing dual task first assessed , normal subjects , relative processing demands cued version task results supported task made greater demands subject 's limited processing resources , performing resource demanding secondary task concurrently test produced , normal subjects , pattern impaired performance reported previously pd patients second experiment dual task paradigm employed group pd patients normal aged matched controls patients showed increase reaction time task performing resource demanding secondary task patients also showed interfering effect concurrent foot suppression task results taken support hypothesis pd patients depleted central processing resources considering present data , alternative explanations results considered , particular possibility represent deficit switching processing resources two tasks combined demands available resources
short term memory comprehension investigation patient crossed aphasia relationship short term memory impairment comprehension explored right handed patient focal temporoparietal lesion right hemisphere general clinical profile , well characteristics patient 's immediate memory lists , suggests occurrence crossed aphasia detailed analysis patient 's ability repeat , however , indicates important differences case previously reported patients short term memory impairment suggested differences , may related unusual pattern organization cognitive functions , involve symptom implications models normal language memory interactions
task dependent variations parkinsonian motor impairments studies visually guided arm movements patients parkinson 's disease \( pd \) suggested relationship movement reduction ratio movement amplitude peak velocity recent studies indicate , however , pd impairments may different well learned , natural movements performed without visual guidance , movements associated sequential motor speech address issue , pd subjects age sex matched controls compared performance three tasks , required lowering jaw \( 1 \) single , rapid , visually guided movements \( 2 \) equivalent movements associated single speech \( inherently without visual guidance \) , \( 3 \) well learned speech movements produced natural sequence pd subjects manifested similar deficits visually guided jaw lowering previously reported arm movements , namely reduced velocity amplitude ratios increased movement durations contrast , analogous jaw movements sequential speech tasks unimpaired measures results suggest pd motor impairments influenced variety factors , including degree tasks familiar natural , availability visual information
effects anticonvulsant treatment low levels folate thiamine amine metabolites cerebrospinal fluid total 157 epileptic patients studied respect \( 1 \) amine precursors metabolites csf , \( 2 \) levels folate thiamine blood csf , \( 3 \) length treatment phenytoin \( pht \) , \( 4 \) pht intoxication , \( 5 \) cns atrophy alterations csf amine metabolite levels related primarily pht intoxication , low csf folate thiamine levels , length treatment cns atrophy pht intoxication increased csf 5 acid \( \) low folate levels associated decreased csf homovanillic acid , low thiamine levels associated decreased csf 3 4 glycol remains seen extent alterations amine metabolism , mediated low cns vitamin levels , also lead deficits cerebral function
human olfactory discrimination unilateral frontal temporal lobectomy olfactory discrimination detection studied 106 patients unilateral cerebral excision right left temporal lobe , right left frontal lobe , left parietal lobe , right frontal temporal lobes , 20 normal control subjects detection thresholds n butyl alcohol , measured separately nostril , differ across subject groups across , thus excluding primary sensory loss discrimination task involved presentation repairs , subjects judged different quality results showed significant deficit discrimination confined nostril ipsilateral lesion patients temporal lobe patients frontal lobe also impaired , patients right frontal lesions including orbital cortex , impairment found patients left parietal lesions demonstrate significant deficits normal subjects showed consistently better performance right left nostril results interpreted reflecting importance cortex olfactory discrimination temporal lobe lesions may disrupt input cortex , thereby producing poorer performance nostril difference normal subjects , together impairment patients right damage , suggest relative advantage right orbital region olfactory processing
sequencing parkinson 's disease abnormalities programming controlling movement central programming deficits parkinson 's disease \( pd \) studied two reaction time \( rt \) experiments experiment 1 , pd patients controls performed sequences hand postures varied length , number different postures \( repetitive vs heterogeneous \) , delay interval movement movement , pd group planned repetitive movements like controls whereas heterogeneous sequences rt increased less sequence length pd group , implying less time \( \) data repetitive sequences showed pd group difficulty controlling movement faster sequences longer , thus allowing time schedule termination sequence course movement heterogeneous sequences , pd group made errors slower controls changing hand postures , suggesting deficit switching different responses rt decreased longer delay similarly groups , continued improve pd group similarly types sequences , suggesting deficit specific programming first response experiment 2 , subjects made decisions number different hand postures contained within sequence pd patients' decision times improved longer delay heterogeneous sequences , suggesting problem identifying number different hand postures results implications levels motor dysfunction pd emphasize influence sequence length complexity
pain control ambulatory elderly pain control elderly , matter etiology setting , major clinical challenge aging causes unique physiologic changes , eg , decreased perception pain enhanced sensitivity opioid analgesics principles regarding evaluation patients pain reviewed , including use objective instrument pain assessment physician patient good pain control achieved , acetaminophen nonsteroidal anti inflammatory drugs , opioid analgesics , , cases , adjuvant agents discussed also concerns patient addiction cancer pain relief program
plasticity integrin expression nerve derived connective tissue cells human schwann cells , cells , fibroblasts express markedly different patterns beta 1 integrins nerve development , neoplasia , vitro strikingly selective expression patterns beta 1 , alpha 2 , alpha 3 , alpha 5 integrin subunits revealed , , fetal adult human peripheral nerve immunostaining specific antibodies alpha 2 subunit expressed schwann cells fetal adult nerve , whereas alpha 3 epitopes expressed exclusively adult tissue primarily present cells alpha 5 epitopes expressed cell layer fetal adult nerve tumor cells within cutaneous expressed alpha 2 alpha 3 subunits , indicating schwann cells potential express also alpha 3 subunit vivo cell cultures established human fetal nerve revealed expression alpha 2 alpha 5 epitopes schwann cells , cells , fibroblasts , whereas schwann cells contained alpha 3 epitopes occasionally concentrated adjacent schwann cells cell cell contacts findings emphasize nerve connective tissue cells change profiles expression extracellular matrix receptors conditions different regulatory control signals exerted , example , axons , humoral factors , extracellular matrix peripheral nerve plasticity may play important role nerve development neoplastic processes affecting connective tissue compartments peripheral nerve
differential diagnosis mut cbl methylmalonic aciduria dna mediated gene transfer primary fibroblasts methylmalonic aciduria caused mutations gene encoding methylmalonyl coenzyme mutase \( mut \) genes required provision cofactor b12 \( cbl \) mut cbl forms differentiated somatic cell describe novel method differential diagnosis mut cbl methylmalonic aciduria using dna mediated gene transfer methylmalonyl coa mutase cdna clone gene transfer functional methylmalonyl coa mutase cdna clone mut fibroblasts activity measured metabolism 14c culture identical gene transfers cbl fibroblasts effect method used differential diagnosis mut cbl genotypes cells patients clinical diagnosis methylmalonic aciduria shown , sensitive , specific method genetic diagnosis work establishes principle using dna mediated gene transfer identify genotype diseases result mutations several different genetic loci type differential genotypic diagnosis particularly important establishing applicability somatic gene therapy individual patients
modifying approach preserve hearing acoustic tumour surgery removing acoustic schwannoma using approach previously considered incompatible hearing preservation modifying approach preventing loss , successfully removed acoustic schwannoma , originated inferior vestibular nerve , preserved hearing operated ear report represents preliminary findings using particular technique management acoustic tumour
clinical features associations 560 cases motor neuron disease 560 cases motor neuron disease , studied retrospectively case notes three teaching centres , age onset ranged 13 87 years \( mean 56 years \) , mean duration illness death 2 6 years subgroup disease presenting progressive bulbar palsy presenting age 59 years , previously excess females sufficient sex ratio incidence disease age group potentially causative clinical associations emerged relation noted occupational exposure products , trauma surgical procedures disease trend patients motor neuron disease give history alcohol
progressive degeneration right temporal lobe studied positron emission tomography 79 year old man twelve year progressive history recent difficulty , intellectual skills preserved , described positron emission tomography \( pet \) revealed area right temporal lobe , additional area less severe left temporal pole may represent example progressive focal cortical degeneration similar associated primary progressive , affecting right temporal lobe
cyclosporin associated akinetic mutism syndrome liver transplantation three patients developed akinetic mutism third day introduction intravenous cyclosporin , given immunosuppression liver transplantation one patient addition developed florid orofacial dyskinesia , resolved completely , akinetic mutism , withdrawal cyclosporin patients time course akinetic mutism syndrome , developed absence identifiable cause , suggests cyclosporin precipitating factor subsequently , two patients showed signs palsy abnormalities pons mri scanning , suggesting central pontine \( \) none patients experienced significant fluctuations serum sodium risk factors central pontine exact relationship earlier cyclosporin related mutism clear
grading white matter lesions ct mri simple scale developed tested simple three point scale grading white matter lesions anterior posterior regions brain twenty four ct scans 24 mri scans separately judged 11 five observers , respectively , presence severity white matter lesions observers radiologists neurologists ct scans , periventricular changes graded according extent absent , partly involving white matter , extending subcortical region mri lesions graded lesion single one , multiple focal lesions , multiple confluent lesions pairwise possible combinations observers scan corrected chance \( kappa statistics maximal agreement 1 0 \) weighted kappa value , anterior posterior regions combined , 0 63 ct scans , 0 78 mri scans three point scale two separate regions seems suitable basis cross sectional longitudinal studies large series patients
community hospital based stroke programs north carolina , new york v stroke diagnosis factors influencing diagnostic evaluation patients following acute stroke among patients community hospital based stroke program , 30 unspecified stroke diagnosis since specific diagnosis , perhaps , eventual treatment , part diagnostic testing , examined effect clinical condition , geographic demographic factors incidence certain diagnostic tests acute stroke analysis , race , sex , history hypertension history diabetes influence chance test , older age strongly reduced chances receiving extensive evaluation ct scanning available , utilization ct well diagnostic studies including cerebral angiography , radionuclide brain scan , eeg increased odds receiving ct scan increased patient married , decreased history previous stroke history previous increased chance cerebral angiogram history cardiac disease decreased chance striking regional geographic differences use ct , radionuclide brain scanning cerebral angiography may , part , reflect differences availability technologies urban rural hospitals results indicate evaluation stroke patients remains heterogenous
intrathecal baclofen spasticity cerebral palsy seventeen patients congenital spastic cerebral palsy six patients forms spasticity injected doses placebo baclofen , 25 micrograms , 50 micrograms , 100 micrograms , randomized , double blind manner muscle tone upper lower extremities assessed scores injections every 2 hours afterward 8 hours function upper extremities evaluated injections 4 hours afterward muscle tone lower extremities significantly decreased within 2 hours baclofen injection remained lower baseline 8 hours afterward upper extremity tone function significantly affected single doses confusion occurred two youngest children study 50 micrograms dose , cleared within 2 hours findings indicate intrathecal baclofen reduces spasticity children cerebral palsy , adults spasticity spinal origin
confirmation visual evoked potential diagnostic test migraine attempted replicate results studies diagnostic test reported 90 sensitivity 89 96 specificity migraine technique based peak peak measurements fast background electroencephalographic activity visual evoked potential \( vep \) study vep latencies amplitudes differ significantly , showed substantial overlap , group eight migraine patients ten age matched healthy controls could previously described fast activity measure objectively peak peak measurements cannot confirm measurement fast wave activity vep background useful diagnosis migraine
abnormal pattern detected fragile x patients pulsed field gel electrophoresis fragile x syndrome frequent inherited form mental retardation , incidence 1 1 , 500 males characterized presence fragile site 3 induced vitro folate deprivation inhibitors synthesis mode inheritance unusual x linked trait , incomplete penetrance males females phenotypically normal males transmit mutation daughters rarely express symptoms , penetrance high sons daughters carrier women genetic physical mapping region confirmed disease locus located near fragile site hypotheses proposed account abnormalities inheritance disease include sequence rearrangements meiotic recombination mutation affects reactivation inactive x chromosome differentiation female germ cells detect rearrangements , changes may reflect locally inactive x chromosome , used pulsed field gel analysis dna fragile x patients probes close fragile x locus probe \( \) detected abnormal patterns fragile x patients , normal controls non expressing male
lexical organization brain analysis neuropsychological disorders lexical processing provided important clues general organization lexical system internal structure processing components reports patients selective dysfunction specific semantic categories abstract versus words , living things versus , animals , fruits vegetables , proper forth , support hypothesis neural organization semantic processing component organized categories reports selective dysfunction categories , suggesting dimension lexical organization class words results reported studies provided unambiguous evidence concerning two fundamental questions nature locus organization within lexical system distinction represented semantic \? class knowledge represented independently lexical forms represented separately within modality specific \? report performance two brain damaged subjects modality specific deficits restricted principally \( h w \) virtually \( j \) oral written production , respectively contrasting performance suggests class represented output lexical components
nature opioid responsiveness implications neuropathic pain new hypotheses derived studies opioid infusions recent years , observation response patients opioid drugs may influenced properties inherent pain pain syndrome , pathophysiology , evolved belief certain types pain , e g , neuropathic pains , may unresponsive drugs concept important implications clinical practice basic understanding opioid mechanisms critically evaluate opioid responsiveness , particularly relates neuropathic pain , propose clinically relevant definition paradigm investigation paradigm illustrated analgesic responses opioid infusion 28 patients neuropathic pains detailed presentation pharmacokinetic pharmacodynamic relationships one patients , whose central pain responded promptly infusion analysis , hypothesize \( 1 \) opioid responsiveness man defined degree analgesia achieved dose escalation either side effects occurrence analgesia \( 2 \) opioid responsiveness continuum , rather phenomenon \( 3 \) opioid responsiveness determined diverse group patient characteristics pain related factors , well drug selective effects \( 4 \) neuropathic mechanism may reduce opioid responsiveness , result inherent resistance drugs given complexity factors contributing opioid responsiveness observation outcome cannot reliably predicted , opioids assumption pain mechanism , factor , precludes favorable response clinical use opioids investigate opioid responsiveness include dose escalation maximally tolerated levels repeated monitoring analgesia effects
pain phantom limbs review clinical observations paper reviews reports phantom limb sensations resemble somatosensory events experienced limb amputation also presents descriptions phenomenon 68 took part series clinical studies somatosensory memories predominantly distressing pre amputation lesions pains experienced near time amputation , described sensation pre amputation pain patients experience pains emphasize suffering real pain describe detail , experience merely cognitive earlier pain reports somatosensory memories less common , pain free interval , experience pain amputation among somatosensory memories reported cutaneous lesions , deep tissue injuries , bone joint pain painful pre amputation postures experience somatosensory memories appear related duration pre amputation pain , time since amputation , age , gender , prosthetic use , level amputation , number limbs , whether amputation followed accident illness results suggest somatosensory inputs sufficient intensity duration produce lasting changes central neural structures combine cognitive memories pre amputation pain give rise experience past pain referred phantom limb implications pre post operative pain control discussed
diphtheria tetanus pertussis vaccine serious neurologic illness review epidemiologic evidence widespread impression dtp vaccine cause brain damage based first historical rabies vaccines recognized sometimes causing devastating neurologic illness analogy pertussis disease cause encephalopathy recently anecdotal evidence , particularly case series relationship could explain temporal relation dtp vaccine neurologic illness , inasmuch dtp vaccine given age emergence idiopathic neurologic disease relationship dtp vaccine neurologic illness lacks specificity case series impact physicians' lay public 's impression safety pertussis vaccine greatly proportion scientific importance case series useful generating hypotheses cannot provide evidence pertussis vaccine causally related acute neurologic illness brain damage observational studies using cohort designs find association dtp vaccine serious neurologic illness , powerful enough detect association rare observed investigators case control design offers best chance providing causal evidence regarding dtp vaccine serious neurologic illness published case control study issue study found rare association dtp vaccine types acute neurologic illness bias chance unlikely account entirely association demonstrated however , association yet case control studies demonstrate dtp vaccine causes permanent brain damage
clinical judgment detect children speech language problems \? pediatricians often rely clinical judgment derived observation parental concern identify children developmental problems less popular recommended alternative repeatedly standardized screening tests tests time consuming , unlike clinical judgment , known detection rates preliminary research concerning clinical judgment showed clusters parental concerns related performances screening tests present study , previous research refined assessment meaning parents' concerns speech language development study 157 families seeking pediatric care , 72 children whose speech language screening yielded positive results parents concerned speech language development children negative screening results , 83 parents concerns speech language development although standardized screening tests used occasionally developmental surveillance process , findings show problems children developmental problems detected clinical judgment based parental concern
pain management orthopedic patient pain familiar phenomenon orthopedic nurses said , things patients fundamental quality life relieving pain orthopedic nurses position contribute positive management pain using comprehensive approach pain management involves participation patient need believe patient 's pain , try new approaches , help patients achieve pain relief
help elderly safe use drugs relieve pain pharmacologic management pain elderly patients common difficult clinical problem altered drug metabolism pharmacodynamics elderly , drugs choice different younger patients side effects occur often however , judicious use monitoring toxicity , oral medications given part multimodality approach achieve adequate analgesia elderly patients
movement analysis aid early diagnosis cerebral palsy purpose article review research related use clinical analysis movement aid early diagnosis cerebral palsy historical perspective clinical techniques used physicians physical therapists early diagnosis cerebral palsy presented first , including recent research findings clinical signs predictive movement disorder predictive behaviors common across several recent studies highlighted future trends use movement analysis , including digitized kinematic analysis term preterm infants fetal ultrasound techniques , discussed well
implications dynamical systems approach understanding infant behavior implications dynamical systems approach understanding movement dysfunction infants discussed traditional theories motor development attribute changes movement maturation central nervous system dynamical systems approach emphasizes movement self result interaction participating developmental real time article , discuss , theoretical perspective dynamical systems approach , organization leg movements low high risk preterm full term infants , developmental changes movement low risk preterm infants 34 weeks' gestational age 40 weeks' age , differences movement low risk preterm infants 40 weeks' age full term infants preliminary data high risk preterm infants presented based data , necessity review traditional concepts motor development explored suggestions offered questions dynamical systems perspective may influence practice physical therapy evaluation , treatment infants risk movement dysfunction
cognitive strategies coincident timing tasks research findings suggest experience cognitive strategies contribute successful performance perceptual motor tasks article critically reviews selected literature effects information processing skills , preferred movement time , experience , task difficulty performance coincident timing tasks theoretical information research findings discussed , applications clinical practice considered clinical recommendations include assessment coincident timing skills use functional activities provide opportunities explore interact environment
measurement treatment cerebral palsy argument new approach article describes need shift therapeutic strategies patients cerebral palsy changes functional abilities must stressed therapy coincident emphasis must development functional assessments used documenting intervention outcomes research functional arm movement using kinematic analysis described patient group
dorsal rhizotomy children cerebral palsy support concepts motor control results selective dorsal rhizotomy research suggest therapists need question common clinical assumptions movement dysfunction rationale performing selective dorsal rhizotomy based clinical assumptions spasticity underlying cause disordered movement reducing eliminating spasticity improve movement article reviews literature related movement dysfunction , effects selective dorsal rhizotomy , evidence disordered motor control children spastic cerebral palsy selective dorsal rhizotomy appears reduce spasticity increase joint range motion abnormal movement patterns , however , persist spasticity reduced well coordinated movement patterns acquired slowly appear related intense period physical therapy argue results provide evidence presence spasticity alone insufficient explanation abnormal movement patterns propose physical therapists efforts developing methods reducing spasticity developing adequate assessment , treatment , measurement techniques assessing motor control children cerebral palsy believe maximize functional potential children cerebral palsy identifying problems related motor control applying sound principles motor learning treatment
cerebellar degeneration 's syndrome reported case 's syndrome middle aged man eventually cerebellar degeneration syndrome symptoms preceded cerebellar signs symptoms 5 years patients idiopathic 's syndrome show improvement high dose anticholinergic therapy patient 's lack response agents subsequent cerebellar symptoms situation seen parkinsonian patients respond medications , indicating widespread degenerative disease association symptoms disorders , pathologic changes seen one reported autopsy case , place group disorders high differential list
experience surgical treatment takayasu 's disease reviewed 28 patients takayasu 's disease determine incidence stroke relationship involvement thoracic aortic arch branches describe surgical experiences 10 28 patients required 21 vascular surgical procedures critical thoracic aortic arch arterial stenoses , upper lower extremity ischemia , renal artery stenoses four 28 patients initially stroke caused occlusion one thoracic aortic arch arteries six 10 patients underwent 7 bypass procedures critical thoracic arch stenoses remained free stroke 5 years four patients five anastomotic stenoses graft occlusions late follow development stenoses relate disease activity time operative procedure bypass grafts originating subclavian axillary artery developed anastomotic stenoses anastomotic stenoses occurred bypass grafts originating ascending aorta contrast reports , anastomotic false aneurysms occurred occlusions major aortic arch arteries takayasu 's disease cause stroke bypass critically stenoses aortic arch arteries protects stroke best performed grafts originating ascending aorta anastomotic stenoses anastomotic aneurysms common study suggests aggressive surgical treatment performed good results
murine retroviral correlates enhanced ability infect selectively , replicate , activate resident microglial cells published erratum appears j 1991 may 138 \( 5 \) determine biologic basis ts1 momulv vivo , newborn mice inoculated ts1 momulv wt momulv temporal response virus infection central nervous system \( cns \) , spleen , thymus studied comparatively experimental procedures included single double labeling situ immunohistochemistry selective morphometric analyses , steady state immunoblotting viral proteins cellular targets virus infection identical ts1 wt momulv consisted sequentially 1 \) splenic megakaryocytes , 2 \) splenic thymic lymphocytes , 3 \) cns capillary endothelial cells , 4 \) cns microglia resident microglial cells served major virus infection cns ts1 momulv infected mice similar much less significant role played microglia wt momulv infected mice genesis progression severe spongiform lesions ts1 momulv infected mice temporally spatially correlated amplified virus infection microglia , hyperplasia hypertrophy virus infected infected microglial cells direct virus infection neurons never observed development clinical neurologic disease spongiform lesions ts1 momulv infected mice correlated accumulation viral gag env gene products cns selective accumulation env precursor compared wt momulv infected mice , ts1 momulv infected mice occurred enhanced ability replicate cns infect activate microglia , rather fundamental change cellular tropism virus infection
secondary deposition beta amyloid within extracellular alzheimer type dementia hippocampal areas 34 autopsy specimen brains aged demented subjects examined using double staining beta protein 18 cases \( 75 5 7 4 years old \) , none extracellular \( e nfts \) immunoreactive beta protein 16 cases \( 82 9 5 4 years old \) , minority e nfts immunoreactive beta protein antiserum beta immunoreactive e nfts frequently appeared areas senile plaques , observed area lacking beta immunoreactive senile plaques ultrastructure beta immunoreactive e nfts revealed consisted extracellular amyloid fibrils , located bundles paired helical filaments , processes findings suggest beta immunoreactivity e nfts comes secondary deposition amyloid fibrils
induction dose propofol infants 1 6 months age children 10 16 years age propofol dose needed satisfactory induction anesthesia determined 22 infants 1 6 months age 22 children 10 16 yr age single bolus propofol given 10 thirty seconds injection lid reflex tested anesthesia mask applied patient considered gross movements next 30 patient o2 dose required satisfactory induction 50 patients \( ed50 \) \( se \) 3 0 0 2 mg kg infants 2 4 0 1 mg kg older children \( p less 0 02 \) pain injection occurred 50 infants 18 children
changing indications penetrating keratoplasty , 1978 87 indications penetrating keratoplasty \( \) assessed review corneal submitted 1978 1987 ophthalmic pathology service leading indications bullous \( 22 2 \) , \( 17 1 \) , scarring without chronic inflammation \( 13 5 \) , graft failure \( 12 1 \) , scarring active keratitis secondary virus \( 9 0 \) dystrophy \( 8 3 \) principal factors responsible graft failure also judged correlation authors compare findings series
management survey ontario owing variability lack standardization management , survey ontario undertaken results highlight consider problems management suggest operation treated respect given operation
thromboxane a2 potent microvascular permeability factors conjunctiva studies demonstrate thromboxane \( tx \) a2 u 46619 , u txa2 elicit microvascular permeability response conjunctiva u 46619 u among potent microvascular permeability factors described date conjunctiva potency exceeded reported leukotrienes e4 conjunctival microvascular permeability response u 46619 inhibited txa2 antagonists \( bm \) sq prostaglandin \( pg \) d2 also increased conjunctival microvascular permeability , less potent u 46619 far less susceptible pretreatment sq pge2 , pgf2 alpha prostacyclin analog increase conjunctival microvascular permeability appears conjunctiva exhibits unique microvascular permeability response txa2 view experimentally supported absence cutaneous microvascular permeability response u 46619 , u txa2
retinal degeneration rd mouse caused defect beta subunit rod phosphodiesterase mice homozygous rd mutation display hereditary retinal degeneration classic rd lines serve model human retinitis pigmentosa affected animals retinal rod photoreceptor cells begin postnatal day 8 , four weeks left degeneration preceded accumulation cyclic gmp retina correlated deficient activity rod photoreceptor phosphodiesterase recently isolated candidate complementary dna rd gene mouse retinal library completed characterization cdnas encoding subunits bovine photoreceptor phosphodiesterase candidate cdna shows strong homology cdna encoding bovine phosphodiesterase beta subunit present evidence candidate cdna murine homologue bovine phosphodiesterase beta cdna conclude mouse rd locus encodes rod photoreceptor phosphodiesterase beta subunit
hard lens nucleus posterior segment foreign body forceps used hard lens nucleus posterior segment technique allows removal hard lens nucleus minimal manipulation without need larger incision
glaucoma laser trial \( \) 2 results argon laser trabeculoplasty versus topical medicines glaucoma laser trial research group glaucoma laser trial , multicenter , randomized clinical trial involving 271 patients , designed assess efficacy safety argon laser trabeculoplasty \( alt \) alternative treatment topical medication controlling intraocular pressure \( iop \) patients newly diagnosed , previously , untreated primary open angle glaucoma \( \) patient one eye randomly assigned alt \( laser first lf eye \) eye assigned timolol 0 5 \( medication first mf eye \) medication initiated changed either eye according stepped regimen iop controlled throughout 2 year follow , lf eyes lower mean mf eyes \( 1 2 mmhg \) , fewer lf eyes mf eyes required simultaneous prescription two medications control iop \( p less 0 001 \) 2 years follow , 44 lf eyes controlled alt , 70 controlled alt alt timolol , 89 controlled within stepped medication regimen 2 years , 30 mf eyes remained controlled timolol , 66 controlled within stepped regimen major differences two treatment approaches respect changes visual acuity visual field 2 years follow
nystagmus 's syndrome incidence characteristics nystagmus 's syndrome unclear 188 consecutive patients , 56 nystagmus clinically recognizable ocular pathology account nystagmus twenty nine fine rapid horizontal nystagmus , 14 dissociated nystagmus appeared , whereas 9 form latent manifest latent nystagmus total patients nystagmus , 41 findings suggest fine rapid horizontal nystagmus , sometimes dissociated , occurs frequently patients 's syndrome
intraocular lens implantation penetrating keratoplasty improved visual acuity , astigmatism , safety patients combined corneal disease cataract twenty two eyes combined corneal disease cataract followed prospectively intraocular lens \( \) placement penetrating keratoplasty majority penetrating keratoplasty planned extracapsular cataract extraction \( \) followed later placement mean follow placement 25 months \( range , 3 55 months \) graft failures occurred secondary surgery graft sutures removed 86 \( 19 22 \) eyes surgery ninety five percent \( 21 22 \) eyes achieved refractive errors within 2 diopters \( \) desired result corneal astigmatism decreased 4 88 2 92 secondary surgery wound revision visual acuity 20 40 better 68 \( 15 22 \) 20 100 better 91 \( 20 22 \) eyes advantages excellent visual acuity , reduced astigmatism , lack graft failure disadvantage delay final visual rehabilitation \( 11 months \) increased secondary rate \( 85 \) series two separate surgeries compared previously reported triple procedure results
results surgery early postoperative adjustment authors reviewed 157 cases \( 207 eyes \) corrected external levator resection twenty eight patients \( 29 eyelids \) unsatisfactory results authors adjusted 13 eyelids within 1 week surgery eleven eyelids 6 weeks surgery mean delay initial final surgery early group 2 0 weeks , late group , 33 5 weeks reoperations , difference number procedures required achieve satisfactory outcomes four patients \( 5 eyelids \) unsatisfactory results offered , declined , late repair early late reoperation effective correcting unsatisfactory results external levator resection benefits early surgery reduction time final result , ease performed , potential cost savings , opportunity one correct unsatisfactory results
visual prognosis correlated presence internal limiting membrane histopathologic specimens obtained epiretinal membrane surgery forty one patients unilateral , macular epiretinal membrane \( \) underwent pars vitrectomy membrane improve visual acuity authors retrospectively reviewed histopathology vitrectomy specimen instance determine whether presence internal limiting membrane \( ilm \) adverse effect visual acuity eleven specimens contained long segment ilm , determined light microscopy minimum 6 months follow , none 11 eyes achieved visual acuity better 20 60 30 eyes ilm present , 41 achieved visual acuity 20 60 better overall , 29 eyes entire series achieved 20 60 better visual acuity difference group ilm versus without ilm statistically significant \( p 0 01 \) presence long segments ilm within histopathologic specimen vitreous surgery removal macular appears indicate less favorable visual outcome
semiconductor diode laser photocoagulation retinal vascular disease authors successfully performed clinical retinal photocoagulation 30 eyes 26 patients retinal vascular disease using gallium \( \) diode laser nm retinal photocoagulation performed treatment 300 mw exposure durations 0 2 0 5 seconds 200 microns diameter treatment spot patients treated diode argon green lasers required 4 5 1 8 times greater mean laser energy diode compared argon create similar lesions parallel experimental retinal photocoagulation rabbits required 3 1 0 9 times power create similar lesions diode laser argon laser intraoperative subretinal hemorrhage occurred rarely patients incidence 4 \( 0 44 \) treatment spots patients complained moderate marked pain 10 \( 43 \) 23 treatments initiated topical anesthesia diode laser may used clinically perform therapeutic retinal photocoagulation
repair rhegmatogenous retinal detachments american academy ophthalmology current techniques rhegmatogenous retinal detachment repair allow retinal detachments repaired successfully success repair depends careful preoperative examination choice appropriate surgical procedure surgical procedure must tailored individual eye based detailed preoperative examination retina vitreous postoperative complications infrequent compared many ophthalmic surgical procedures cataract extraction strabismus repair surgeon must observe eye carefully postoperative period monitor treat complications arise improvements surgical techniques coupled better understanding pathophysiology rhegmatogenous retinal detachment continue improve anatomic functional success retinal detachment repair
retinal pigment epithelial tears preservation good visual acuity describe two patients spontaneous retinal pigment epithelial tears maintained least 20 40 visual acuity 1 year 3 years following patients long standing serous detachments retinal pigment epithelium associated age related macular degeneration prior development tear tear least five disc areas size centered foveal fixation documented despite presumed absence pigment epithelium observation suggests either may remaining pigment epithelium pigment epithelium directly beneath central required maintenance 20 40 visual acuity
inflammatory mediators postoperative baboon eyes measured prostaglandin e2 leukotriene b4 aqueous humor baboon eyes , 1 8 days , without posterior chamber lens implantation also evaluated effects steroid eye drops cyclooxygenase inhibitor eye drops synthesis mediators inflammation eyes undergone showed significant elevation prostaglandin e2 postoperative periods compared normal , control eyes level prostaglandin e2 significantly \( p less 05 \) higher eyes posterior chamber lens implantation without , significantly \( p less 05 \) higher eighth first postoperative day amount leukotriene b4 detection limit , except eyes complications developed cyclooxygenase inhibitor eye drops significantly reduced amount prostaglandin e2 postoperative days , steroid eye drops effect
potential mental status changes associated systemic absorption anticholinergic ophthalmic medications concerns elderly several cases reported anticholinergic toxicity following administration commonly used cases reported children , adults , elderly risk developing mental status changes secondary anticholinergic ophthalmic medications particular concern elderly drug induced mental status behavior changes mistaken exacerbation underlying disorder onset new disease \( e g , alzheimer 's disease , dementia \) clinicians aware potential complications , monitor changes mental status , take appropriate action
pathophysiologic effect interleukin 1b rabbit retina interleukin 1 potent shown initiate many aspects inflammatory response determine effects il 1b central nervous system \( cns \) , rabbit retina used , adjacent factors injected minimal trauma pathologic physiologic effects monitored injection 300 units il 1b induced alteration visual evoked potentials \( vep \) associated marked intravascular red blood cell , hemorrhage , cellular inflammation epiretinal vessels analysis events showed slowing occasional excitability compound action potential optic tract cortical vep correlate maximum inflammatory response histologic studies show following apparent response occurs within first 1 5 hours intraocular challenge 3 6 hours injection extensive intravascular red blood cell accumulation progressive hemorrhage accompanied increase number mononuclear \( mn \) cells appearance polymorphonuclear \( pmn \) cells polymorphonuclear cells continue increase time give single wave inflammation peaks 24 hours injection , number mn cells steadily increases events associated changes permeability blood brain barrier correlate electrophysiologic dysfunctions forty one hours injection , mn inflammation , reactive gliosis , residual pmn inflammation evident neutralization specific antibody inhibited responses 6 hours injection concluded rabbit retina provides valuable model vivo analysis cns inflammation
eyelid movements botulinum therapy patients lid spasm quantitative analysis lid motility presented 4 individuals hemifacial spasm 1 's syndrome data obtained , means magnetic search coil technique , prior 1 week injection botulinum toxin orbicularis muscle treatment , peak velocity blink related lid lowering lid raising slower normal , yet lid saccades normal botulinum treatment , significant decreases occurred \( 1 \) amplitude lid saccades , \( 2 \) peak velocity blink phase botulinum treatment significantly alters blink lid lowering kinematics , saccadic lid lowering kinematics normal , providing evidence orbicularis muscle play primary role downward lid saccades
scientific basis medical therapy cataracts antioxidants cataract one major causes age dependent visual impairment blindness geographic distribution cataract known associated intensity duration sunlight especially ultraviolet frequency particular places exposure animals humans oxygen also known result cataract formation studies described communication indicate ocular lens physiologically damaged exposed environment active species oxygen , commonly referred several models described results suggest intraocular generation active oxygen may constitute significant risk factor overall pathogenesis senile cataracts effect , however , nutritional metabolic antioxidants ascorbate , vitamin e , pyruvate agents , therefore , may useful prophylaxis therapy cataracts
possible role vitamins c e cataract prevention biochemical evidence suggests oxidative stress caused accumulation free radicals involved pathogenesis senile cataracts , appropriate amounts antioxidant vitamins c e might expected prevent process activity observed several vitro vivo studies experimentally induced cataracts recent epidemiologic study found cataract patients tended lower serum levels vitamins c , e , carotenoids control subjects present investigation , compared self reported consumption supplementary vitamins 175 cataract patients 175 individually matched , cataract free subjects , revealed latter group used significantly supplementary vitamins c e \( p 0 01 0 004 , respectively \) results suggested reduction risk cataracts least 50 , randomized , controlled trial vitamin supplementation cataract prevention may warranted
epidemiologic evidence role antioxidant vitamins carotenoids cataract prevention relationship antioxidant nutrient status senile cataract examined 77 subjects cataracts 35 control subjects clear lenses subjects low \( percentile \) moderate \( percentiles \) plasma nutrient nutrient intake levels vitamin c , vitamin e , carotenoids compared subjects high levels \( percentile \) odds ratio \( \) cortical \( cx \) cataract among subjects low plasma carotenoid levels 7 2 \( p less 0 05 \) posterior subcapsular \( psc \) cataract persons low plasma vitamin c 11 3 \( p less 0 10 \) low vitamin c intake associated increased risk cx \( 3 7 , p less 0 10 \) psc \( 11 0 , p less 0 05 \) cataract subjects consumed fewer 3 5 fruit vegetables per day increased risk cx \( 5 0 , p less 0 05 \) psc cataract \( 12 9 , p less 0 01 \)
prevalence lattice degeneration relation axial length severe myopia studied 436 eyes 218 patients myopia 6 00 diopters eyes 218 patients , 72 \( 33 0 \) lattice degeneration retina among 72 patients , lattice lesions 39 \( 54 2 \) 33 \( 45 8 \) 105 males , 33 \( 31 4 \) lattice degeneration 113 females , 39 \( 34 5 \) lattice degeneration contrary previously published data , found inverse relationship axial length prevalence lattice degeneration severely eyes greatest prevalence lattice degeneration \( 63 154 eyes , 40 9 \) found eyes axial length 26 0 26 9 mm \( 6 00 8 70 diopters \) , least prevalence lattice degeneration \( five 71 eyes , 7 0 \) found eyes axial length 32 0 mm \( 24 00 diopters \) greater may explain observation retinal detachment cataract surgery noted commonly among patients moderate severe myopia
retinal injury vitrectomy treated patient developed area light induced retinal damage endoscopic membrane removal postoperative color photographs showed complete absence membrane , fluorescein angiography demonstrated previously absent superior lesion consistent injury operative microscope eliminated corneal shielding , implicated source injury recommend following procedures avoid complication careful planning vitreous surgery membrane removal using filters minimizing length surgery keeping light output low maintaining maximal light distance retina orientation light use intermittent variable site techniques
light damage detached retina injected homologous fibroblasts retinal vascular five rabbits induce retinal detachment eleven days later , focal area detachment exposed 30 minutes visible light intraocular fiberoptic probe histologic damage detached retina exposed light demonstrated outer retina affected severely
correlation intraocular pressure control progressive glaucomatous damage primary open angle glaucoma fifty five patients primary open angle glaucoma early glaucomatous damage medical therapy laser trabeculoplasty followed four 11 years progressive glaucomatous damage documented factors associated stability progression glaucoma evaluated eyes mean intraocular pressure higher 21 mm hg follow period uniformly progressive glaucomatous changes conversely , eyes mean intraocular pressure less 17 mm hg remained stable , approximately half eyes mean intraocular pressure 17 21 mm hg progressive glaucomatous changes patients remained stable slightly younger progressive glaucomatous changes \( p less 05 \) , initial optic nerve head appearance , initial visual field findings , number medicines used , medical history , patient gender race statistically associated stability progression glaucoma findings reinforce importance intraocular pressure control primary open angle glaucoma need identify markers help determine proper level intraocular pressure individual patients
new method documenting lens opacities tested anterior segment camera digital analyzer 32 eyes 22 patients determine whether measurement lens opacities correlated measurements obtained standardized clinical grading system lenses graded clinically nuclear opacity , nuclear color , cortical opacity , posterior subcapsular opacity lenses analyzed new device , results compared camera system showed good reproducibility results correlated well clinical nuclear capacity \( p 001 \) cortical opacity \( p 001 \) less well posterior subcapsular opacity \( p 3 \) , although seven eyes posterior subcapsular opacities camera system could help document follow lens opacity accuracy reproducibility previously possible
causes failure initial vitreoretinal surgery severe proliferative vitreoretinopathy performed initial vitreoretinal surgery 81 eyes rhegmatogenous retinal detachments complicated severe proliferative vitreoretinopathy 81 eyes , 68 \( 84 \) undergone previous scleral buckling performed vitreous base dissection 18 eyes \( 22 \) anterior proliferative vitreoretinopathy one vitreoretinal operation , 66 81 eyes \( 81 \) remained totally reattached main cause initial anatomic failure reoperation either new recurrent proliferation vitreous base additional vitreoretinal surgery mean follow period 19 months , 73 81 \( 90 \) totally reattached final causes anatomic failure anterior proliferative vitreoretinopathy proliferation relaxing 73 successfully reattached eyes , 62 \( 85 \) postoperative visual acuity 5 200 better
visual fields automated perimetry accurate testing visual field patients demanding due optical distortion induced high plus corrective lenses testing procedure improved using contact lens instead full aperture loose trial lens found contact lens enhances ability pattern deviation analysis identify glaucomatous visual field abnormalities program 30 2 visual field analyzer
infant visual evoked response testing future visual acuity reviewed records 27 infants abnormal eye examinations visual evoked response \( ver \) testing \( mean age , 10 5 months \) subsequently underwent long term follow ophthalmology examination \( mean duration , 41 months \) infants initially diagnosed various ocular disorders including cortical blindness \( eight \) , optic nerve hypoplasia \( six \) , congenital cataract \( two \) , retinopathy prematurity \( one \) standard visual acuity determinations available follow records 11 children \( 21 eyes \) , fixation behavior obtained remaining 16 children \( 32 eyes \) results revealed pattern reversal ver p1 latency predictive \( 87 \) whether visual acuity equal \( better \) worse 20 100 whether patient would good fixation behavior \( follow , ff \) poor fixation \( ff \) \( 86 \) \( p less 001 \) although flash ver p1 latency also predictive later visual acuity good fixation \( 73 \) , statistically significant pattern ver p1 amplitude flash ver p1 amplitude predictive later visual function predictive power pattern ver p1 latency later visual function probably relates reflection macular function low variability analysis variability four ver factors normal infants \( n 50 \) indicated pattern ver p1 latency least variable , consequently sensitive , ver factor detecting quantifying pathology overall , results retrospective study suggest pattern ver p1 latency may important predictive power later visual function infants initially abnormal ophthalmologic examination
clear ultraviolet blocking lenses use puva patients well recognized patients receiving \( puva \) need wear uv blocking day ingestion 8 methoxypsoralen many patients wearing sun causes difficulties interfere colour perception , reduce definition conditions low background light often considered study uv blocking properties number lenses little assessed following lenses lens found suitable use puva patients uv 400 , , lambda 400 , uv 400 lenses
graves' disease current concepts graves' disease organ specific autoimmune disorder universal agreement mechanism graves' disease , activity thyroid due antibody capable activating tsh receptor follicular cells features caused either antibody hyperthyroidism clinical diagnosis generally straightforward confirmed vitro measurement thyroid hormones tsh measurement radioiodine uptake also valuable treatment specific immunologic defect , purpose lower thyroid hormone levels normal achieved medication , radioiodine iodine 131 , thyroidectomy clinical situations , strong argument made iodine 131 therapy , safe definitive , although posttreatment hypothyroidism need thyroxine expected
ophthalmopathy graves' disease fortunately , patients thyroid related eye disease mild ocular involvement spontaneously less 5 patients hyperthyroidism develop sufficiently severe ocular abnormalities require surgical intervention patients thyroid eye findings symptomatically managed require use either topical drops oral steroids alleviate eye problems approximately one half patients present acutely severe thyroid orbital finding , nonsurgical therapies sufficient control eye disease half , eventually multiple surgical procedures may required , discussed previously , timing sequence procedures crucial achieve optimal results
cyclocryotherapy selected cases congenital glaucoma investigated efficacy cyclocryotherapy , procedure ciliary epithelium , thereby decreasing production aqueous humor , retrospectively studying 109 eyes advanced primary congenital glaucoma undergone procedure eyes divided two groups group comprised 75 eyes \( 69 \) undergone conventional surgical procedures congenital glaucoma prior cyclocryotherapy group ii , 34 eyes \( 31 \) undergone previous procedures eyes followed least 12 months last cyclocryotherapy success defined iop greater equal 8 mmhg , greater equal 19 mmhg without medication , success rate eyes 30 , significant difference success rates groups ii \( p greater 05 \) chronic \( iop less 8 mmhg \) found seven eyes \( 6 \) six eyes \( 6 \) developed cataract course treatment cyclocryotherapy cyclocryotherapy appears reasonable addition treatment eyes advanced , uncontrolled , primary congenital glaucoma
factors associated delay diagnosis childhood amblyopia prevention permanent visual impairment amblyopia important goal pediatric vision screening unfortunately , many cases amblyopia diagnosed child old benefit maximally treatment review patient records practice private pediatric confirmed late detection frequent occurrence among children amblyopia good access health care case control study used identify factors associated delayed diagnosis , children adverse outcome \( diagnosed 5 years age \) compared optimal outcome \( diagnosed 5 years age \) chart review identified 161 children amblyopia participated study 75 late diagnoses \( case patients \) 86 served control patients children early diagnoses often following characteristics positive family history strabismus , greater degrees strabismus \( strabismus present \) , higher maternal educational level , greater parental suspicion eye problem existed , increased chance parents requested eye examination led diagnosis parents children late diagnoses expressed less concern seriousness amblyopia likely report children suffered adverse consequences amblyopia diagnosed early , amblyopia often detected child 's primary health care provider physicians children early diagnoses often reported compliance american academy pediatrics guidelines vision screening infancy referral vision problems
differentiation detached retina vitreous membrane color flow doppler sonographic criteria diagnosis retinal detachment vitreous membranes well established , cases diagnosis made however , difficult cases , differentiation two may difficult study use high resolution color flow doppler evaluated differentiating retinal detachments vitreous membranes sonographic evaluation , including color flow doppler , performed 25 symptomatic eyes seven eyes areas retinal detachment , detectable blood flow within least portion detached retina fifteen eyes vitreous membranes flow detected two diabetic patients vitreous membranes retinal detachment flow detectable within neovascular membranes another patient , complete detachment surgery , demonstrated good flow within area detachment concluded difficult cases high resolution color flow doppler enable differentiation area retinal detachment vitreous membrane patient without diabetes
effects intraocular pressure investigated effects topical application intraocular pressure \( iop \) 27 adult rhesus monkeys monkeys divided two groups group 1 \( 16 monkeys \) eyes normal , group 2 \( 11 monkeys \) experimental chronic glaucoma one eye normal eye one drop 1 solution instilled one eye monkeys group 1 glaucomatous eye monkeys group 2 eye served control iop measured drug administration 1 , 4 , 8 , 24 , 32 hours , detailed slit lamp examination anterior segment produced change iop eyes group 1 , produced fall pressure eyes high iop group 2 , evident 1 hour instillation , maximal 4 8 hours , still remaining 32 hours pupil showed change size , transient ptosis observed treated eye monkeys
conjunctival retraction suture adjustable strabismus surgery approach strabismus surgery advantageous incision made eyelid , need conjunctival sutures , comfortable patient , minimal postoperative scarring major disadvantage approach adjustable suture technique poor exposure muscle suture apparatus poor postoperative exposure describe herein use retraction suture adjustable suture surgery approach suture conjunctiva , exposing adjustable muscle suture apparatus simultaneously globe novel way around pole sutures preventing slippage also presented technique provides excellent exposure , fixation globe , complete coverage conjunctiva adjustment
multiple dose , dose response relationship topical carbonic anhydrase inhibitor mk 927 multiple dose , dose response curve mk 927 studied five center , double masked , randomized , placebo controlled , parallel study 2 , 1 , 0 5 mk 927 76 patients bilateral primary open angle glaucoma ocular hypertension intraocular pressure greater 24 mm hg following washout ocular hypotensive medications patients received doses 8 8 pm 14 days , parallel 12 hour intraocular pressure curves performed day 14 , 4 hour curves days 1 4 significant dose response relationship , 0 5 mk 927 twice daily minimal effect dose 1 2 mk 927 active 12 hours postdose , peak mean percent decrease pressure 2 hours postdose 18 6 20 6 , respectively
multiple dose efficacy comparison two topical carbonic anhydrase inhibitors sezolamide mk 927 multiple dose twice daily efficacy topical carbonic anhydrase inhibitor mk 927 , compound , compared pharmacologically active four center , double masked , randomized , placebo controlled , parallel study 1 8 sezolamide hydrochloride \( mk \) , 2 mk 927 , placebo , given twice daily 48 patients bilateral primary open angle glaucoma ocular hypertension morning intraocular pressure greater 24 mm hg eyes following washout ocular hypotensive medications parallel 10 hour modified diurnal curves performed study day 14 , 4 hour curves days 1 4 compounds demonstrated significant lowering intraocular pressure 8 , 12 hours following evening dose , 10 6 hours following 8 dose sezolamide mk 927 , respectively morning trough \( evening \) activity measured mean percent change intraocular pressure 9 2 sezolamide 11 1 mk 927 \( 13 5 9 6 \) peak effect occurred 2 hours dose administration 19 4 19 2 sezolamide mk 927 , respectively 2 hours dose administration , sezolamide consistently demonstrated slightly greater decrease intraocular pressure mk 927 however , differences statistically significant
relationship visual acuity , refractive error , pupil size radial keratotomy better define relationship residual refractive error , uncorrected visual acuity , pupil diameter , compared 42 eyes eight incision radial keratotomy according prospective evaluation radial keratotomy study protocol 42 matched control eyes parameters measured best corrected visual acuity , uncorrected visual acuity , change refraction pupil diameter best corrected visual acuity 20 16 radial keratotomy control groups , variability \( sd \) higher radial keratotomy group average uncorrected visual acuity 0 35 \( 35 \) better radial keratotomy group , variability 1 77 times higher change refraction dilation occurred 9 controls 36 radial keratotomy patients , indicating significant difference \( p 002 \) change refraction dilation eyes radial keratotomy almost equally split change \( 17 \) change \( 18 \) , much different control eyes , 2 changed direction 7 direction radial keratotomy patients change best uncorrected visual acuity , indicating positive spherical aberration yielded best surface uncorrected visual acuity
clinically detectable nerve fiber atrophy precedes onset glaucomatous field loss standardized perimetry nerve fiber layer color fundus photography performed annually eyes elevated intraocular pressures 83 eyes , glaucomatous field defects developed met rigid criteria manual kinetic static perimetry individual nerve fiber layer photographs read two masked observers sensitive two identified nerve fiber layer defects 88 photographs time field loss first occurred 60 \( 6 10 \) eyes already nerve fiber layer defects 6 years field loss contrast , nerve fiber layer considered abnormal 11 \( 3 27 \) normal eyes 26 \( 84 \) hypertensive eyes location nerve fiber layer field defects closely corresponded , nerve fiber layer loss generally widespread examiner experience severity optic nerve damage influenced results mild focal defects readily recognized severe diffuse atrophy nerve fiber layer defects expanded time , often development adjacent areas damage
radiation safety considerations post iodine 131 hyperthyroid therapy purpose study develop guidelines based patient measurements iodine 131 \( 131i \) treated hyperthyroid patients may resume close personal contact external exposure rates measured 59 patients using survey meter upright position initial measurement recorded within 20 min post dose administration one meter exposure rates measured 2 11 days post dose administration 1 , 0 6 , 0 3 meters patient 's thyroid administered dose range 3 less 12 mci 131i , 40 patients measured less equal 2 0 mr hr one meter day 0 , 25 patients \( 25 29 \) less equal 2 0 mr hr 0 6 meter days 2 4 guidelines prepared based administered dose rational existing radiologic health standards
treatment exophthalmos current procedures graves' exophthalmos fail achieve complete correction standard orbital therefore modified maximize degree volumetric increase behind axis globe 15 , preoperative exophthalmos averaged 9 5 mm , whereas postoperative exophthalmos 4 1 mm postoperative ct study demonstrated remaining posterior orbital wall , combined persistently increased intraocular muscle volume , blocked globe , despite adequate total volumetric increase increased muscle volume varied 2 5 cc despite residual exophthalmos , modified four wall expansion provides excellent aesthetic results visual improvement resolution exposure keratitis
systemic drug interactions topical glaucoma medications topically administered ophthalmic medications capable clinically important serum concentrations , evidenced variety systemic side effects produce drugs therefore also capable interacting drugs administered orally intravenously especially important medications administered elderly population , often receiving multiple medications physician 's reference united states drug information contain numerous potential interactions topical glaucoma medications systemically administered drugs unfortunately , literature supporting interactions limited , quantity quality , anecdotal many cases report summarizes available information regarding interactions topical ophthalmic glaucoma medications systemically administered medications clinical evidence interactions lacking many cases
fifty years ophthalmology glaucoma expert began residency came existence , followed shortly , dr shares insights gained half century ophthalmology practice
safe stop patching \? prior reports indicate half amblyopia patients successfully treated occlusion subsequently require maintenance patching retrospective study designed discover clinical characteristics might associated stable outcome following primary occlusion included 188 patients \( 1 \) amblyopia related strabismus , media opacity \( 2 \) followed least one year successful primary occlusion patients comply treatment achieve equal vision excluded ages ranged 2 119 months \( mean 29 months \) eighty eight patients \( 47 \) required occlusion designated clinically stable group \( \) remaining 100 \( 53 \) , subsequently needed patching , constituted maintenance patching group \( \) patients older beginning \( mean 33 months \) end \( mean 40 months \) primary occlusion patients \( means 26 31 months \) primary occlusion likely discontinued equal recognition patients , equal fixation behaviour preferential looking likely patients distribution diagnoses , severity amblyopia presentation , length follow similar two groups visual outcomes last follow slightly better \( p 0 002 \) conclude , general , patching safely discontinued third although follow primary occlusion important ensure stable results patients , children likely require maintenance patching
peripheral contrast sensitivity glaucoma ocular hypertension contrast sensitivity measured patients glaucoma ocular hypertension , latter graded high , medium , low risk clinical groups measurements made centrally peripherally 10 degrees , 15 degrees , 20 degrees , 25 degrees axis four 45 degrees , 135 degrees , 225 degrees , 315 degrees wave 1 9 cycles degree , reversing 1 hz used displayed 100 hz rate monitor normal values established compare 41 eyes patients either primary open angle glaucoma \( \) minimal field loss detectable perimeter , raised iop disc changes field loss \( oh \) normal central contrast sensitivity , 20 degrees 25 degrees eccentricity values greater 2 standard deviations normal mean also case high risk oh , low risk patients high risk patients except one abnormal peripheral contrast sensitivity possible field defects \( threshold elevation one points 5 less 10 db normal mean \) one normal peripheral contrast sensitivity results assessed terms screening glaucoma
film aging human lens precursor \? many older patients observed layer subtle opacification anterior lens capsule , appearing ground glass film film \( \) could uniform often radial lines mid zone , region , occasionally lens capsular material obtained cataract extraction studied patients without film scanning electron microscopy appeared , incomplete fibrillar layer , edges suggesting loose attachment ultrastructurally component fibrils 3 6 nm diameter , similar fibrils \( \) material life material layer stained positively elastic associated protein , fibrillin , lens radial similarities suggested two conditions relationship may precursor finding patches fibrillar network control patients implies common patients cataract age , though seldom detected clinically
diode laser trabeculoplasty \( \) primary open angle glaucoma ocular hypertension pilot study carried examine efficacy diode laser trabeculoplasty treatment primary open angle glaucoma ocular hypertension device used portable could attached standard slit lamp microscope 0 8 1 2 w used , spot size 100 microns pulse 0 20 second laser trabeculoplasty carried 20 eyes glaucoma resulted mean ocular hypotensive effect 10 2 mmhg two weeks treatment 9 55 mmhg 6 months concluded diode laser trabeculoplasty effective mode treatment eyes open angle glaucoma ocular hypertension
century cerebral review early clinical evidence colour centre cerebral cortex man successfully best part century evidence cannot reason , evidence rejected earlier accepted today instead , prevalent concepts vision function , role cerebral cortex , prevented acceptance evidence showing colour visual cortex concepts demonstration functional visual cortex primate evidence colour centre human brain became acceptable today , new knowledge colour areas pathways primate brain allows us give complete account pathophysiology cerebral man
ocular muscle visual localization targets man passive deviation one eye 18 degrees , 30 degrees 42 degrees , achieved force applied contact lens , caused direction visual targets seen eye direction passive movement amount roughly one sixth angle passive deviation result perceived direction indicated hand , instant moving target seemed straight result interpreted considering muscular identical normal eye subjects main difference two target localization conditions results output eye data demonstrate assessment direction target seen eye free move depends part information received brain orbit \( case contralateral orbit \) would surprising ipsilateral orbit contribute much therefore consider constitutes clear evidence pure outflow theory visual direction judgement \( , \) , additional provided nothing situation complete versus incomplete oculomotor paralysis two models previously proposed describe function visual localization mechanism assume necessary information derived coding position eye orbit , either copy muscular activation eye muscle propose alternative model afferent efferent signals actively contracted muscles provide necessary information cns data gathered far normal subjects made suction lens , fair proportion patients , support model describing mechanism localization single target darkness
audit ophthalmology waiting list hospital case notes 209 \( 98 \) 213 patients placed adult ophthalmic surgical waiting list mid 1984 mid 1985 reviewed information referral sources , previous eye surgery , outpatient visits , treatment end 1987 recorded vital status patients end 1988 also ascertained waiting list patients \( 123 women , 86 men \) elderly \( 73 65 years \) \( 70 \) listed cataract surgery end 1987 \( 30 42 months waiting list entry \) 64 patients \( 56 cataract patients \) received surgery care health remainder either died \( 12 \) , received surgery elsewhere \( 7 \) , still waiting list \( 7 \) , longer wanted surgery \( 6 \) , left district \( 4 \) end 1988 \( 42 54 months waiting list entry \) 28 original waiting list population died
mast cell numbers staining characteristics normal allergic human conjunctiva study report numbers metachromatic dye staining characteristics mast cells \( mcs \) conjunctiva normal subjects patients seasonal allergic caused addition , used monoclonal antibody mc specific enzyme , tryptase , tryptase positive cells immunohistochemically conjunctival mcs found present increased numbers allergic compared nonallergic subjects mcs exhibited staining formaldehyde resistant , compatible identification connective tissue mcs basophils high positive staining tryptase confirmed metachromatic cells stained blue mcs basophils , normal allergic subjects
photoreceptor peripherin normal product gene responsible retinal degeneration rds mouse retinal degeneration slow \( rds \) retinal disorder inbred strain mice outer segment photoreceptor cell fails develop candidate gene recently described rds defect , g h , , b , , p e , , c , j g \( 1989 \) nature \( london \) 338 , 70 73 neither identity normal gene product intracellular localization determined report amino acid sequence bovine photoreceptor cell protein peripherin , previously localized rim region photoreceptor disk membrane , 92 5 identical sequence mouse protein encoded normal rds gene differences two sequences attributed species variation monoclonal antibodies used western blot analysis localize wild type mouse peripherin rds protein isolated mouse rod outer segments show , like bovine peripherin , exists two subunits linked one disulfide relative amounts peripherin rds protein rhodopsin retinal extracts normal rds mutant mice also compared identification peripherin protein encoded normal rds gene localization membranes rod outer segments serve basis studies directed toward defining role protein maintenance outer segment toward understanding mechanism rds mutation causes retinal degeneration
comparison penetrating keratoplasty epikeratoplasty surgical management 40 patients contact lenses , 47 eyes surgically corrected either epikeratoplasty \( n 31 \) penetrating keratoplasty \( n 16 \) percentage eyes groups visual acuity 20 40 better contact lenses one year equal \( 14 15 eyes 93 3 penetrating keratoplasty group 27 29 eyes 93 1 epikeratoplasty group \) however , penetrating keratoplasty procedure resulted higher percentage eyes visual acuity 20 20 epikeratoplasty group \( 11 15 eyes 73 compared seven 29 eyes 24 1 , respectively \) procedures resulted significant corneal flattening , penetrating keratoplasty group producing average 3 diopters reduction epikeratoplasty group one year postoperatively although irreversible graft failures occurred , five 16 eyes \( 31 \) penetrating keratoplasty group graft reactions serious complications noted eyes epikeratoplasty group procedures effective surgical management
quantitative analysis lens changes vitrectomy measured amount autofluorescence lens evaluate quantitatively lens changes vitrectomy thirteen patients , ranging age 12 75 years , studied unilateral vitrectomy , follow period two years \( range , 26 55 months \) autofluorescence lens measured center along ocular axis lens autofluorescence eyes underwent vitrectomy significantly higher contralateral eyes operated \( p 0003 \) increase autofluorescence correlated significantly age time vitrectomy \( p 0008 \) correlation increase autofluorescence length postoperative follow use air vitrectomy based results , believe oxidation lens proteins intraoperatively may one causes development nuclear cataract vitrectomy
reproducibility topographic measurements normal glaucomatous optic nerve head laser tomographic scanner acquired five independent topographic images optic nerve head eight normal eyes eight eyes primary open angle glaucoma laser tomographic scanner image field view 15 x 15 degrees resolution 256 x 256 pixel size approximately 15 x 15 microns value pixel topographic image represented height position mean height standard deviation five topographic images calculated 65 , pixel positions standard deviation single height measurement normal eyes 38 7 microns \( range , 23 4 62 2 microns \) areas peripapillary retina 42 6 microns \( range , 24 4 53 7 microns \) measurements within optic nerve head area glaucomatous eyes , standard deviation 41 2 microns \( range , 23 2 59 6 microns \) peripapillary retina 49 4 microns \( range , 28 1 72 8 microns \) within optic nerve head significant difference standard deviation single height measurement normal glaucomatous eyes \( p 34 within optic nerve head area p 57 peripapillary retina \) correlation found standard deviation measurements pupil size age subject
falls elderly patients glaucoma analyzed determinants serious falls among ambulatory aged 65 years older received comprehensive examination glaucoma consultation service previous year , least one fall requiring medical attention restricted activity reported 9 6 \( 95 confidence interval ci , 7 0 12 2 \) participants using logistic regression adjust potential confounding variables , greatest single risk factor falls use topical eye medications \( odds ratio , 5 4 95 cl , 1 8 16 4 \) additional risk factors falls female sex \( , 2 3 95 cl , 1 1 4 7 \) use cardiac medications \( , 2 5 95 cl , 1 1 5 6 \) three characteristics also associated risk falls use eye medications \( , 3 2 95 cl , 1 0 10 1 \) visual field impairment 40 greater \( , 3 0 95 cl , 0 94 9 8 \) use \( , 2 4 95 cl , 0 89 6 7 \) findings suggest ocular systemic medications major predictors falls even elderly population seeking ophthalmologic care glaucoma medications appear pose greater risk falls even major visual impairment
fluid previously undescribed fluorescein angiographic finding choroidal neovascularization associated macular degeneration macular photocoagulation study reading center foveal photocoagulation study , component macular photocoagulation study , designed evaluate whether laser treatment reduce risk severe visual loss eyes well defined choroidal neovascular membranes associated macular degeneration extend foveal center one third 554 baseline angiograms study patients enrolled whose eyes graded study january 31 , 1990 , reading center staff noted unusual pattern late transit frames described previously pattern , call fluid , consists well area appears represent pooling fluorescein space anterior choroidal neovascular leakage although fluid may pattern typical macular edema , also pool within area deep sensory retina shape bear macular edema pattern important recognize \( 1 \) confused angiographic pattern extent choroidal neovascularization \( 2 \) differentiated serous detachment tear retinal pigment epithelium
low dose aspirin risks cataract randomized trial us physicians observational studies raised question possible benefit aspirin development cataract physicians' health study , randomized double masked placebo controlled trial among 22 , male physicians , aged 40 84 years , provided opportunity collect information whether low dose aspirin therapy \( 325 mg alternate days \) affects development extraction cataract 173 age related cataracts among physicians assigned aspirin therapy 180 among given placebo \( relative risk , 0 95 95 confidence interval , 0 74 1 22 \) cataract less frequent aspirin placebo group , difference statistically significant \( relative risk , 0 80 95 confidence interval , 0 56 1 15 \) among younger men \( aged 40 59 years \) , relative risks 0 62 \( 95 confidence interval , 0 40 0 94 \) cataract development 0 67 \( 95 confidence interval , 0 38 1 31 \) cataract extraction randomized trial data tend exclude large benefit aspirin overall findings concerning cataract development seem null , data extraction age related cataract , statistically significant , cannot exclude possible small moderate benefit alternate day aspirin therapy extraction age related cataract
exposure drugs risk cataract clinical reports indicated increased risk ocular opacities users drugs , recent epidemiologic studies found association cataract history use examine effects major \( haloperidol \) risk cataract extraction , controlling suspected risk factors diabetes steroid use , matched cohort study performed using information large health maintenance organization seattle , wash use either antipsychotic drugs increased risk cataract extraction roughly 3 5 times individuals current users exposed time 2 5 years prior extraction risk also increased individuals prior use agents , systemic steroids , benzodiazepines contrary prior reports , elevated risk associated use antihypertensives , protective effect aspirin , acetaminophen , ibuprofen
effects antiflammins endotoxin induced uveitis rats antiflammins phospholipase a2 inhibitory , anti inflammatory , synthetic derived region highest amino acid sequence similarity endotoxin induced uveitis model anterior uveitis eye , suggested induced phospholipase a2 activation preliminary report demonstrated topical administration antiflammins could inhibit endotoxin induced uveitis rats study , anti inflammatory effects antiflammins compared corticosteroids endotoxin induced uveitis measured phospholipase a2 enzyme activity , inflammatory cell counts aqueous humor , histopathologic features antiflammins effective corticosteroids ability suppress endotoxin induced uveitis
autogenous fascial grafts exposed retinal three patients exposed scleral buckling elements received autogenous fascial grafts alternative buckle removal three patients successful coverage scleral infections one patient postoperative ptosis required repair autogenous fascial grafts useful procedures patients exposed retinal significant risk retinal buckle removal
longitudinal study children family history strabismus factors determining incidence strabismus longitudinal study ocular refraction , position , fixation performed children family history strabismus children examined regular intervals 3 months 4 years age , results discussed terms changes refraction different ages correlations refraction development strabismus amblyopia six 34 children \( 17 6 \) developed constant intermittent strabismus first noted 18 30 months age except one case children 4 6 months , hypermetropia remained almost unchanged years seven additional children 4 6 months develop contrast children hypermetropia children changed towards pronounced first 2 years age implications results early diagnosis strabismus amblyopia discussed
association fuchs 's corneal endothelial dystrophy axial hypermetropia , shallow anterior chamber , angle closure glaucoma series 24 patients fuchs 's dystrophy presented detailed clinical measurement showed association axial hypermetropia shallow anterior chamber 14 patients one cornea developed oedema , 11 required penetrating keratoplasty comparison eyes eyes without corneal oedema revealed anomalies measurement due process decompensation 14 patients compared remaining 10 patients without corneal oedema either eye , similar profile anomalous measurements observed whole group 24 patients compared three separate control groups , case significant trend towards hypermetropia , short axial length , shallow anterior chamber noted mean spherical equivalent refractive error patients fuchs 's dystrophy 2 48 compared 0 31 controls corresponding means axial length 22 1 mm compared 23 4 mm anterior chamber depth 2 2 mm compared 2 7 mm differences statistically significant , significant difference measurements patients controls five 24 \( 21 \) patients problems related shallow anterior chambers 3 \( 12 \) manifest angle closure glaucoma requiring surgical peripheral aetiology fuchs 's dystrophy discussed possible modes association outlined previously association gives rational basis widely accepted practice combining penetrating keratoplasty lens extraction several practical implications important differential diagnosis treatment fuchs 's dystrophy angle closure glaucoma
effect beta blocker altered body position induced ocular hypertension intraocular pressures \( iop \) measured eyes 25 healthy volunteers various body positions one eye pretreated 0 5 placebo applied masked , randomised fashion , served control iop changes response changes position significant \( p less 0 0001 \) however , pressure rises relative position significantly different eyes treated drug vs placebo alter relative changes iop changes body position however , overall lowering effect may offer protection patients glaucoma
functional vagotomy induced unilateral forced right nostril breathing decreases intraocular pressure open closed angle glaucoma evidence central regulation intraocular pressure , suggested vagal tone might increased glaucoma simplex nasal cycle , simultaneous congestion response nasal cavities , reflects dynamic autonomic nervous system since presents sympathetic activity induced left brain hemisphere stimulation parasympathetic activity induced right hemisphere stimulation , subsequently demonstrated forced unilateral nostril breathing induces selective contralateral hemispheric stimulation measured relative increases electroencephalographic amplitude contralateral hemisphere well alternating plasma catecholamines using functional vagotomy , report left hemispheric stimulation 20 minutes forced unilateral right nostril breathing led significant bilateral decrease 4 6 mmhg \( 25 \) intraocular pressure 46 patients open closed angle glaucoma however , significantly increased iop three patients neovascular , one juvenile onset , one closed angle glaucoma
highly viscous silicone oil syringe device injection evacuation highly viscous silicone oil developed problem removing air interfering providing special handle conventional glass syringe slightly modified commercial motor chosen power device , proved good fail safe 100 cases
amblyopia age group 2 years prospective study results treatment forty four children aged 2 9 years amblyopia prospectively followed amblyopia treatment efficacy treatment terms number cured children , time achieve cure , rate initial improvement visual acuity evaluated relation age start treatment , type initial degree amblyopia , adherence treatment regimen compliance treatment critical factor predicting successful outcome among compliant children 35 36 cured \( visual acuity difference non eyes one line \) within five months regardless age , treatment regimen , type initial degree amblyopia compared none group low compliance compliant children cured within three months , shorter treatment times average younger children initial improvement visual acuity also faster 2 years 4 years age moderate amblyopia start treatment represented group low compliance conclude early diagnosis strabismus combination general population screening age 4 detect amblyopia caused seems efficacious cure cases major factor treatment failure found inadequate adherence treatment regimen
postural studies pulsatile ocular blood flow ocular hypertension normotension measurements pulsatile ocular blood flow \( pobf \) recorded group healthy , ocular normotensive volunteers ocular hypertensive patients recruited outpatients use probe linked ocular blood flow system enabled readings intraocular pressure variation heart rate \( ocular pulse \) taken supine positions pulsatile ocular blood flow calculated values means pressure volume relationship previously described living human eyes assumption supine posture accompanied significant rise intraocular pressure normal eyes \( mean , sem \) \( 3 1 \( 0 4 \) mmhg , p less 0 0001 \) greater extent ocular hypertensive eyes \( 4 7 \( 0 6 \) mmhg , p less 0 0001 \) pobf differ significantly normotensive ocular hypertensive groups either supine postures groups , however , assumption supine posture accompanied significant fall pobf \( normals 121 \( 21 \) microliters min , p less 0 0001 ocular hypertensives 75 \( 16 \) microliters min , p less 0 0002 \) reductions pobf represent decrements 27 5 \( 3 0 \) 17 1 \( 3 8 \) respectively pulsatile ocular blood flow reduced supine posture , may result tissue hypoxia subjects risk developing glaucoma paper describes measurement pobf group patients chronic open angle glaucoma treated topical timolol 0 25
prognostic significance pattern visual evoked potential ocular hypertension paper reports prospective study 49 ocular hypertensive patients evaluate prognostic significance transient abnormalities pattern visual evoked potential \( vep \) development glaucoma seven 24 patients vep abnormalities diagnosis ocular hypertension developed glaucomatous field defects follow period compared none 25 patients normal veps diagnosis conclude appropriately designed pattern vep testing valuable complement careful \( preferably , static \) perimetry addition , findings support , glaucomatous disease optic nerve , pattern processing mechanisms type units pathways may affected earlier processing mechanisms
cocaine induced iritis case 31 year old man presented emergency department iritis intranasal cocaine use described second episode iritis patient casual cocaine use differential diagnosis iritis proposed pathophysiologic mechanism discussed
eye infections article provides overview diagnosis treatment eye infections seriousness eye infections range benign self limiting lethal primary care physician must determine seriousness particular infection , based determination , must treat refer patient
hereditary hemorrhagic macular dystrophy treated two brothers hemorrhagic macular lesion one eye similar problem affected eye patients within eight months generalized fine retinal pigment epithelium peripheral transillumination defects observed siblings study family suggested disorder dominantly inherited probably 's macular dystrophy macular lesions one brother treated argon green laser photocoagulation brother red laser photocoagulation although brother treated red laser photocoagulation attained better final visual function , additional differences treatment methods also may contributed final outcome
simple transposition procedure complicated strabismus combined recession resection muscles vertical horizontal transposition correct complicated ocular deviation eight patients muscles reattached globe parallel spiral adjacent paralyzed muscle postoperatively , seven patients demonstrated fusion primary position required slight head turn fuse surgical complications , patient developed symptomatic , , anterior segment ischemia
comparison total partial tenonectomy trabeculectomy compared results two methods tenonectomy time trabeculectomy 49 eyes , 23 randomly assigned partial tenonectomy 26 total tenonectomy statistically significant difference success rate two surgical groups using upper limit intraocular pressure either 18 21 mm hg criterion success difference need postoperative medications surgical intervention two groups although certain advantages exist technique , findings suggest equivalent results anticipated either total partial tenonectomy
therapeutic ultrasound treatment glaucoma published erratum appears j 1991 jul 15 112 \( 1 \) 105 multicenter clinical trial therapeutic ultrasound treatment glaucoma included 20 centers united states 1 , 117 treatments performed eyes study limited patients refractory glaucoma benefited conventional medical surgical techniques approximately 1 , 117 treatments \( 70 \) showed initial decrease intraocular pressure pretreatment mean 38 1 mm hg 22 mm hg less kaplan meier survival analysis , single treatment success rate \( intraocular pressure 6 22 mm hg \) 48 7 six months posttreatment used subsequent failure , one year success rate 79 3 common complications immediate posttreatment intraocular pressure increase lasting hours mild iritis complications included scleral thinning 28 1 , 117 treatments \( 2 5 \) 12 1 , 117 treatments \( 1 1 \)
flexible cystoscopy adjunct extracorporeal shockwave lithotripsy ancillary procedures associated extracorporeal shockwave lithotripsy \( eswl \) include placement subsequent removal double pigtail ureteric stents simple new technique developed insertion stents using flexible , procedure performed patient basis local anaesthesia placement stents successful 30 34 patients removal successful 14 14 patients
use double pigtail stent stone retrieval following unsuccessful ureteroscopy insertion double pigtail stent known cause ureteric dilatation analysed effect indwelling double pigtail stent success rate calculus extraction second ureteroscopy initial ureteroscopy fails 12 month period , first ureteroscopy failed 42 patients 30 treated ureteroscopy combined ureteric stent 12 treated without ureteric stent group indwelling stent successful second ureteroscopy spontaneously passed calculus 24 cases \( 84 \) compared 5 cases \( 45 \) ureterolithotomy necessary 2 patients stent 3 stent concluded following failed manipulation calculi , insertion double pigtail stent associated higher subsequent success rate removal stone ureteroscopy consequent lower rate ureterolithotomy
immunofluorescent histochemical staining confirm identification many diseases called interstitial cystitis interstitial cystitis comprises complex diseases symptoms pelvic pain functional complaints aid clinician determining loss anatomical capacity histochemical staining pas iron van 's offers improved diagnostic ability pathologist correlates well immunofluorescent findings four distinct diseases identified immunofluorescent staining , indicating result different responses endothelium injury loss bladder capacity associated diseases expected age , immunofluorescent staining igm within capillaries interstitium sensitive predictor
women idiopathic sensory urgency early interstitial cystitis \? interstitial cystitis rarely considered cause urinary symptoms referrals clinics recent concepts diagnosis condition mean emerging much common entity , early late forms disease described mast cell density detrusor muscle reported useful disease marker substantiate diagnosis interstitial cystitis classical diagnostic features exist assessed mast cell counts bladder biopsies 27 women idiopathic sensory urgency 10 control patients undergo procedure pure genuine stress incontinence 30 study group clear increase detrusor muscle mast cell population \( detrusor mastocytosis \) control patient showed increase early interstitial cystitis considered possible cause lower urinary tract symptoms patients apparently idiopathic sensory urgency
symptoms versus flow rates versus selection patients prostatectomy many performed basis symptoms alone 39 patients referred family doctors 23 patients waiting lists prostatectomy hospitals , undergone urodynamic investigations , found urodynamic criteria screening peak urinary flow rate 12 ml less associated urodynamic evidence obstruction 95 cases 35 patients symptoms outflow obstruction flow rate greater 12 ml also found obstructed one year post operatively , 84 patients selected surgery combined symptomatic urodynamic criteria symptomatically result failure detrusor instability resolve following prostatectomy associated symptomatic failure treatment residual obstruction demonstrated 5 patients undergone prostatectomy asymptomatic time study illustrates objective measures necessary assessment patients prior prostatectomy order select patients obstructed importance screening flow rate patients underwent surgery cystometric evidence obstruction symptomatic results surgery better results patients assessed according non urodynamic selection criteria thus failed identify need routine cystometry pre operative assessment patients cystometry , however , role assessing patients pre operative flow rates greater 12 ml remain symptomatic following prostatectomy
pathologic delineation type cystic partially differentiated review 11 cases eleven cases previously unrecognized variant cystic partially differentiated \( cpdn \) described type cpdn features conventional type cpdn however , addition , grossly demonstrable projections extending septa cyst septa show tumor masses like cases conventional type , new type cpdn usually diagnosed infants nephrectomy \( total 10 partial 1 \) done cases additional chemotherapy without radiation therapy given seven cases recurrence noted period extending 21 months 8 years eight cases follow data available nephrectomy regular follow visits possible recurrence may management choice pathologists aware variant cpdn avoided revised criteria cpdn summarized follows \( 1 \) discrete entirely cystic tumor contains luminal cases \( 2 \) septa , present , solid portion tumor contain cells admixed normal aberrant derivatives \( 3 \) tumor without classified conventional type cpdn , respectively
acute effects captopril ibuprofen proteinuria patients nephrosis captopril decreases protein excretion patients nephrosis evaluate whether captopril acute effect evaluate role changes renal hemodynamics glomerular effect , renal clearance studies performed patients without diabetes nephrosis protein excretion renal hemodynamics measured baseline administration captopril measure contribution renal prostaglandins , patients restudied separate day , combined administration captopril prostaglandin synthetase inhibitor ibuprofen treatments significantly reduced mean protein excretion , change greater combined therapy captopril alone \( 40 6 vs 20 0 \) mean glomerular filtration rate \( gfr \) decreased 4 8 \( significant \) 16 5 \( p less 0 001 \) , filtration fraction \( ff \) decreased 13 6 \( p less 0 001 \) 14 9 \( p less 0 001 \) captopril alone combined therapy , respectively significant correlation found changes proteinuria changes gfr ff treatment captopril alone contrast , decrease proteinuria correlated change gfr combined drug administration \( r 0 68 , p 0 06 \) ratio immunoglobulin g albumin clearance , index glomerular , unaffected captopril decreased significantly \( 43 \) combined drug administration results suggest acute effect captopril due changes ff , gfr , glomerular addition ibuprofen enhances effect captopril decreasing gfr well enhancing glomerular capillary membrane
combined versus sequential chemo endocrine therapy advanced prostate cancer final results randomized southwest oncology group study cytotoxic chemotherapy provided survival benefit metastatic prostate cancer , although used frequently patients far advanced , refractory disease evaluate effects chemotherapy given earlier course disease , southwest oncology group \( \) performed randomized trial september 1982 october 1986 comparing endocrine therapy \( diethylstilbestrol des orchiectomy \) alone followed cyclophosphamide adriamycin \( doxorubicin laboratories , , oh \) chemotherapy progression versus initial combined chemo endocrine therapy one hundred forty three patients registered , six patients combined chemo endocrine therapy arm slightly higher response rate \( 63 \) compared endocrine therapy alone \( 48 \) log linear model tumor response treatment arm adjusted stratification factors favored combination arm \( p 059 \) three 27 patients endocrine therapy alone arm objective partial response crossed chemotherapy , two others stable disease despite difference initial response rate , time treatment failure survival identical two treatment arms seventy seven percent patients initial endocrine therapy alone arm died \( median survival , 25 6 months \) compared 78 chemo endocrine therapy arm \( median survival , 22 0 months \) significant effect treatment survival observed even adjustment stratification variables cox regression model exploratory survival analyses patients arms combined show marginally significant time treatment failure survival advantage patients treated des rather orchiectomy initial endocrine therapy eighty six percent patients treated orchiectomy died compared 65 treated des data support addition cytotoxic chemotherapy initial endocrine therapy patients metastatic prostate cancer
cardiovascular effects microinjection angiotensin ii brainstem renal hypertensive rats cardiovascular effects microinjection angiotensin ii \( aii \) area \( ap \) , nucleus solitary tract \( nts \) medulla studied anesthetized sham normotensive \( nt \) two kidney , one clip renal hypertensive rats microinjection aii \( 2 2000 ng \) ap renal hypertensive rats elicited dose dependent decrease blood pressure , heart rate renal sympathetic nerve activity similar effects observed nts nt rats , low doses aii \( 2 20 ng \) , either ap nts , also depressor high doses aii \( 200 2000 ng \) needed observe modest pressor effect nt animals decrease heart rate renal sympathetic activity observed pressor effect aii antagonist , , , aii , nts ap increased blood pressure heart rate inhibited cardiovascular effects low doses aii group rats contrast , , , aii affect pressor action high doses aii nt group microinjection aii medulla produce significant cardiovascular effect renal hypertensive group , resulted modest pressor effect nt rats results indicate acute activation aii receptors ap nts contribute pressor effect aii renal hypertensive rats
problems clinical diagnosis stress incontinence significant number women suffer urinary incontinence , often requires surgical intervention prior proceeding surgery , essential women undergo thorough preoperative assessment detect nonsurgical causes urinary leakage paper reviews reliability initial history basic clinical tests evaluation women lower urinary tract abnormalities
nonsurgical treatment detrusor overactivity postmenopausal women detrusor overactivity subsequent incontinence becomes increasingly prevalent women age , women treated detrusor instability postmenopausal always good candidates treatments given younger counterparts nonsurgical treatments detrusor overactivity available postmenopausal women
histology connection vagina levator ani muscles implications urinary tract function proximal urethra mobile structure , voluntary control position integral part initiation continence paper describes histology vagina 's attachment medial portion levator ani muscles , , attachment vagina urethra , responsible , part , control urethral position histologic examination 1 , 500 serial microscopic slides eight women , dissection four bodies study whole pelvis cross sections two cadavers performed smooth muscle , collagen elastin fibers vaginal wall tissues directly muscle fibers medial portion levator ani , region proximal urethra strong connection lies level entry urethra bladder extends downward level perineal membrane \( diaphragm \) area corresponding mobile portion urethra nature vagina urethra region makes possible connection levator ani vagina control proximal urethral position observations suggest specific role medial levator ani muscle controlling vesical neck position open question specific part played arrangement voiding continence relative factors known influence lower urinary tract function
urethral mobility relationship stress incontinence women multiple physiologic factors , one urethral support , make female continence mechanism abnormal urethral support leads deficient transmission abdominal pressure urethra , results genuine stress incontinence women many techniques available measuring urethral mobility determination urethral mobility useful diagnosis urinary incontinence however , provides information surgical procedure appropriate correction genuine stress incontinence
rise prostatic cancer incidence associated increased use transurethral resection examined association prostatic cancer incidence rates rates transurethral prostatectomy explore reasons nationally reported dramatic increases incidence rates prostatic cancer 1973 1986 strong correlation incidence stages prostatic cancer combined localized disease increasing use transurethral resection , common surgical procedure usually performed relieve urinary obstruction due benign enlargement prostate analyses suggest increased detection existing tumors via transurethral resection primary reason observed increase incidence rates prostatic cancer however , analyses mortality trends , particularly among , laboratory studies histologic nature clinically asymptomatic tumors suggest part increase may reflect changes real risk prostatic cancer
unexplained excess risk bladder cancer men nearly populations studied , risk bladder cancer two four times great men women estimated gender specific incidence rates would absence exposure known carcinogenic factors data used obtained interviews 2 , white individuals bladder cancer 5 , 258 white controls national bladder cancer study incidence data 1978 national cancer institute surveillance , epidemiology , end results program total age adjusted incidence bladder cancer 27 5 cases per 100 , 000 person years men 7 0 women , yielding ratio 3 9 even absence exposure cigarettes , occupational hazards , urinary tract infection , gender related risk persisted incidence bladder cancer 11 0 men 4 1 women , yielding ratio 2 7 possible explanations excessive risk men include environmental dietary exposures yet identified sexual characteristics anatomic differences , habits , hormonal factors
contraceptive efficacy testosterone induced azoospermia normal men world health organization task force methods regulation male fertility multicentre study \( ten centres \) seven countries done assess contraceptive efficacy induced azoospermia 271 healthy fertile men subject received 200 mg testosterone weekly intramuscular injection 157 men \( cumulative rate 6 months 65 \) became three consecutive semen samples men entered 12 month efficacy phase continuing testosterone injections form contraception 1 pregnancy months efficacy phase \( 0 8 95 confidence interval 0 02 4 5 per 100 person years \) study mainly azoospermia achieved within 6 months injection schedule mean time become 120 days \( sd 40 \) spermatozoa detected 11 men case led discontinuation study pregnancy testosterone injections stopped , estimated median time azoospermia recovery \( sperm concentration least 20 million ml \) 3 7 months \( 3 6 3 9 \) subject 's mean baseline sperm concentration 6 7 months \( 6 2 8 7 \) hormonal regimens induce azoospermia provide highly effective , sustained , reversible male contraception minimum side effects
epidemiology clinical aspects hemolytic uremic syndrome minnesota background frequency hemolytic uremic syndrome , characterized hemolytic anemia , thrombocytopenia , renal failure , increasing although escherichia coli serotype implicated causative agent , information needed basic epidemiology clinical aspects syndrome methods conducted retrospective population based study hemolytic uremic syndrome minnesota residents less 18 years age 1979 1988 assess trends disease occurrence , describe clinical illness , identify predictors disease severity outcome also conducted case control study patients illness 1986 1988 examine risk factors results one hundred seventeen patients identified mean annual incidence increased 0 5 case per 100 , 000 child years among children less 18 1979 \( 6 cases \) 2 0 cases per 100 , 000 1988 \( 26 cases \) \( p 0 \) e coli isolated 13 28 patients \( 46 percent \) stool specimens submitted testing presented typical hemolytic uremic syndrome , elevated polymorphonuclear leukocyte count hospital admission , shorter duration , presence diarrhea predictive severe disease case control study , patients likely attend large centers \( 50 children \) controls \( odds ratio , 10 2 p 0 03 \) , suggesting day care attendance may risk factor basis population attributable risk , however , factor could account 16 percent cases conclusions study provides evidence increase incidence hemolytic uremic syndrome , probably related increased incidence e coli infections hemolytic uremic syndrome become important pediatric public health problem
successful renal transplantation accelerates development young uremic children examine impact renal transplantation subsequent development children chronic renal failure , 37 children undergoing primary renal transplantation 30 months age whose allograft functioned least 1 year prospectively studied psychometric tests performed average 4 months transplantation reevaluation done average 14 months surgery comparison individual mental development scores 33 patients , assessed either bayley mental development index stanford intelligence , revealed average increase 12 6 \( p less 001 \) transplantation , significant improvement mental performance 12 18 patients \( p less 02 \) range mild delay \( mental development index stanford iq score 50 69 \) range normal mental development \( greater equal 70 \) bayley psychomotor development index scores frequently lower mental development index scores also increased average 14 4 \( p less 01 \) transplantation 12 patients paired data significant individual improvement occipital frontal circumference standard deviation score \( p less 001 \) noted 24 children transplantation concluded successful renal transplantation young children chronic renal failure often associated significant improvements cognitive psychomotor function , well improved growth
prostate cancer comparison digital rectal examination transrectal ultrasound screening prostate cancer screening study 315 asymptomatic men comparing digital rectal examination transrectal ultrasound identified 23 cancers , detection rate 7 3 cancers 17 \( 5 4 \) diagnosed digital rectal examination contrary experience others , higher rate achieved transrectal ultrasound \( 14 cases 4 4 \) systematic multiple needle biopsies lobes ultrasound guidance routinely performed result technique 7 23 cancers \( 30 \) diagnosed addition , unilateral disease suspected 4 7 patients bilateral disease biopsy digital rectal examination transrectal ultrasound identified number patients small \( less 1 5 cm \) cancers , contrary reports found transrectal ultrasound superior digital rectal examination considered effective screening examination , equivalent transrectal ultrasound preferable lower cost algorithm screening outlined digital rectal examination prostate specific antigen determinations
trace elements urinary stone formation new aspects pathological mechanism urinary stone formation urinary stone , serum 24 hour urine concentrations 14 trace elements determined urinary stone patients coupled plasma emission spectroscopy data obtained 25 active stone patients 32 whose last stone episode occurred least 12 months previously compared 25 healthy individuals urinary nickel , manganese lithium excretion , serum nickel , manganese cadmium concentrations statistically significantly lower active stone patients compared previous stone episodes healthy individuals difference concentrations trace elements could found , however , patients previous stone episodes healthy individuals nickel , manganese , lithium cadmium could significance pathological mechanism stone formation , smooth flow enzymatic reactions biological systems
nonpalpable cancer prostate assessment transrectal us palpable cancer prostate widely believed clinically significant authors compared clinical significance palpable prostate cancer nonpalpable prostate cancer discovered transrectal ultrasound \( us \) strong association lesion volume measured preoperative transrectal us volumetric measurements 60 radical prostatectomy specimens permitted use tumor size measured transrectal us reasonable estimation gross tumor volume subsequent clinical series , 147 biopsy proved cancers grouped according size measured us , findings digital rectal examination \( dre \) , score 147 patients known prostate cancer , statistically significant difference scores palpable nonpalpable cancers could demonstrated size tumor location within prostate held constant assuming score reliable indication malignant potential clinical significance , authors conclude nonpalpable prostatic cancer detected transrectal us alone may clinically significant prostatic cancer discovered dre
knowledge hemodialysis capd patients prescribed medicines questionnaire designed determine compare extent knowledge 40 continuous ambulatory peritoneal dialysis \( capd \) 40 hemodialysis \( hd \) patients medicines administered orally outpatients attending clinic investigator unknown patients data collected pertaining following target drugs calcium supplements , phosphate binders , vitamins b c folic acid hd capd groups closely matched age sex sixty percent capd 49 hd patients taking four medications dose folic acid accurately recalled 91 71 capd hd patients indications calcium supplements phosphate binders known 8 30 capd patients compared 72 73 hd patients hd patients knew indications target drugs \( p less 0 01 \) capd hd patients knew expected duration therapy \( p less 0 01 \) trend decreased knowledge whether medication working increasing age capd patients drug information supplied physicians , many capd patients \( 21 \) obtained information lay sources given opportunity ask questions medicines , 56 capd 46 hd patients knowledge capd hd patients studied grossly deficient terms indications , effectiveness , duration action taken doses missed
post traumatic priapism treated case report 30 year old male post traumatic priapism 7 days treated successfully injection corpus result suggests alpha agent injection corpus considered post traumatic priapism first
angiotensin ii maintenance gfr renal blood flow renal artery narrowing time course renal blood flow gfr responses narrowing renal artery conscious dogs reviewed initial response threat renal perfusion renal vasodilatation , within minutes secondary vasoconstriction mediated angiotensin ii begins develop angiotensin ii mediated contraction mesangial cells also demonstrable , apparently reduce filtration surface area glomerular capillaries intrarenal effects angiotensin ii restore gfr back normal within one two weeks , time circulating plasma angiotensin ii levels longer elevated contrast effects gfr , angiotensin ii minimal effects renal blood flow stenosis may , \( \) blood flow mainly determined hydraulic resistance stenosis \( ii \) renal vasoconstriction relatively little effect flow due particular hemodynamic properties stenoses , \( iii \) major site action angiotensin ii may within glomerulus thus angiotensin ii role maintenance gfr renal artery narrowing one component role may involve mesangial contraction
angiotensin converting enzyme inhibitors progression chronic renal failure renal failure , established loss critical amount functional renal mass , tends progressive large body experimental evidence supports hypothesis glomerular capillary hypertension important pathogenesis progressive chronic renal failure diverse types , including subtotal renal ablation diabetic nephropathy converting enzyme inhibitors effective slowing progression glomerular injury experimental models , association normalization systemic intrarenal pressures clinical studies diabetic nephropathy chronic renal failure etiologies support concept renal hemodynamic factors important human renal disease treatment converting enzyme inhibitors may prove useful therapeutic intervention whether converting enzyme inhibitors specific advantages antihypertensive agents due beneficial renal hemodynamic effects , suggested experimental studies , question awaits investigation furthermore , pathogenesis hypertensive glomerular injury complex involves participation diverse biologic systems predict wide variety therapeutic maneuvers , mechanisms action , may effective preventing glomerular injury
molecular biology renal renin angiotensin system paper describes interrelated series studies designed examine molecular cellular aspects renin expression release within kidney using immunocytochemical techniques , northern blot analysis , situ hybridization , measurement renin activity , reverse hemolytic plaque assay , possible demonstrate intrarenal distribution renin , renin gene expressing cells number renin secretory cells vary diverse physiologic pathologic conditions overall , studies demonstrate renal vasculature plasticity capacity elicit recruitment renin containing renin gene expressing cells
distribution endogenous albumin glomerular wall proteinuric patients glomerular proteinuria seems related , part , loss impairment normal barrier function glomerular capillary wall investigate functional properties barrier , endogenous albumin revealed glomerular wall proteinuric patients compared control immunoelectron microscopy using protein gold method control biopsy , peaks albumin accumulation noted subendothelial area inner portion lamina , gradual distribution toward epithelial side basement membrane urinary space epithelial cells weakly labeled tissues proteinuric patients , albumin distributed throughout entire width glomerular basement membrane , although pattern accumulation varied patients urinary space showed significant labeling associated material mesangial areas heavily labeled tissues control proteinuric patients latter , glomerular tubular epithelial cells also accumulated albumin , evidence reabsorption results reveal existence , normal conditions , barrier located subendothelial area glomerular basement membrane , loss , idiopathic nephrotic syndrome , leads diffuse distribution albumin glomerular capillary wall
guanidino compounds increased cerebrospinal fluid brain uremic patients inhibit gaba glycine responses mouse neurons cell culture four guanidino compounds found markedly increased cerebrospinal fluid brain tissue uremic patients , namely , guanidine , methylguanidine , creatinine , guanidinosuccinic acid , applied mouse spinal cord neurons primary dissociated cell culture evaluate effects postsynaptic responses gamma aminobutyric acid \( gaba \) glycine intracellular recording techniques used guanidine , methylguanidine , creatine , guanidinosuccinic acid reversibly dose dependent manner inhibited gaba glycine responses guanidinosuccinic acid potent inhibitor amino acid responses , followed decreasing potency methylguanidine , guanidine , creatinine guanidinosuccinic acid inhibited responses gaba glycine , concentrations similar found cerebrospinal fluid brain tissue patients terminal renal insufficiency guanidino compounds tested exerted effects concentrations higher found uremic biological fluids tissues inhibitory effect guanidine methylguanidine responses gaba additive effect guanidino compounds gaba responses antagonized benzodiazepine receptor antagonist cgs results suggest guanidine , methylguanidine , creatinine , guanidinosuccinic acid inhibited responses inhibitory neurotransmitters gaba glycine blocking chloride channel observed action studied guanidino compounds might contribute pathogenesis complex neurological symptomatology encountered uremia
alterations renal medullary hemodynamics pressure natriuretic response genetic hypertension concept kidney plays major role long term control arterial pressure based pressure natriuretic response according hypothesis , hypertension develop relationship sodium excretion arterial pressure altered transplantation studies indicated form renal dysfunction underlies development genetic forms hypertension spontaneously hypertensive rat \( shr \) dahl salt sensitive \( \) rat nonetheless , factors responsible kidney hypertension remain unknown reported pressure natriuretic relationships shr dahl rats strains shifted toward higher pressures prior development disease papillary blood flow also reduced young shr recent studies mechanism pressure indicate mediated inhibition sodium reabsorption proximal tubule thin descending limb deep also associated changes renal interstitial pressure pressure flow vasa circulation observations suggest elevation renal medullary vascular resistance may responsible shifting pressure natriuresis relationship toward higher pressures hypertension
incidence advanced chronic renal failure need end stage renal replacement treatment objective determine age related incidence advanced chronic renal failure two areas england design prospective study patients newly identified advanced chronic renal failure within two year period subsequent monitoring patients' clinical course 26 months setting subjects patients population , developed advanced chronic renal failure \( serum creatinine concentration greater 500 mumol l \) first time two year period main outcome measures results 210 patients \( 148 per million population per year \) developed advanced chronic renal failure , 117 \( 51 \) 70 age related incidence rose 58 per million per year aged 20 49 per million per year aged 80 54 \( 113 \) patients referred 120 patients \( 57 \) needed dialysis died within three months presenting without receiving dialysis , 187 \( 89 \) died needed dialysis within three years unsuitable treatment excluded , 78 patients per million population per year aged 80 needed start long term renal replacement treatment conclusions many patients suitable renal replacement treatment still referred opinion denied treatment treatment rate united kingdom rose 1988 rate 55 1 per million per year 78 per million per year number patients receiving treatment would rise 800 per million double present number considerable predictable resource implications nhs
prevalence advanced renal failure northern objective determine prevalence advanced chronic renal failure northern part assessment renal association level service provision treatment patients design prospective notification patients reaching defined level advanced chronic renal failure \( serum creatinine concentration greater equal 500 mumol l blood urea concentration greater equal 25 mmol l \) within one year follow least three , , , four years notification setting northern patients 122 patients serum creatinine blood urea concentration higher defined level newly detected 1 march 1985 28 february 1986 main outcome measure survival notification results 77 patients ages million population year advanced chronic renal failure compared 67 million year ages 5 80 found earlier study population 62 patients older 50 years seventeen \( 14 \) patients either required dialysis died within one month notification , 51 \( 42 \) survived least three months , 23 \( 19 \) one year longer three patients , attending renal clinic , survived periods 43 , 45 , 46 months respectively without renal replacement treatment conclusions increased number new patients disclosed survey compared earlier survey mainly owing increased number older patients patients often disabilities renal failure , less likely capable self treatment , may develop complications often require frequent hospital admissions , may suitable transplantation consequently considerable resource implications nhs
etoposide therapy testicular cancer past two decades , dramatic made treatment metastatic testicular cancer early 1970s , cisplatin , vinblastine , bleomycin \( pvb \) produced durable complete remissions \( cr \) approximately 70 treated patients early 1980s , etoposide emerged drug single agent activity cisplatin refractory patients based preclinical data demonstrating synergy cisplatin plus etoposide , two drug combination proved useful salvage therapy , approximately 25 patients evaluation etoposide part initial therapy southeastern cancer study group \( \) compared pvb bleomycin , etoposide , cisplatin \( \) previously untreated patients metastatic germ cell tumors significantly less toxicity , proved superior pbv patients advanced disease varying dose schedule etoposide also may provide patients potentially useful treatment high dose etoposide plus carboplatin drug refractory patients produced durable cr cohort treated patients currently evaluated part initial salvage therapy schedule dependency etoposide small cell lung cancer led us evaluate daily oral administration etoposide patients refractory previous etoposide therapy objective response rates approximately 15 25 observed summary , etoposide remains integral part treatment regimen testis cancer however , incorporation innovative dose schedule combinations etoposide may improve therapeutic index disease
mechanism impaired insulin secretion chronic renal failure suggested sustained rise resting levels cytosolic calcium ca2 pancreatic islets responsible impaired insulin secretion chronic renal failure \( crf \) evidence event lacking mechanisms may affect insulin secretion known studies conducted normal , crf , , \( \) crf rats answer questions resting levels ca2 islets crf rats higher \( p less 0 01 \) control crf rats 3h 2 deoxyglucose uptake camp production islets different three groups insulin content , glucose induced insulin secretion islets crf rats lower \( p less 0 01 \) control crf rats contrast , induced insulin release crf islets normal basal atp content , glucose stimulated atp content atp adp ratio , net lactic acid output , vmax phosphofructokinase 1 , ca2 atpase islets crf rats lower \( p less 0 02 less 0 01 \) normal crf animals data show \( \) glucose induced insulin secretion impaired crf \( b \) impairment glucose induced insulin release crf due defect metabolism glucose \( c \) latter defect due reduced atp content induced partly high ca2 islets \( \) high ca2 islets crf rats due augmented pth induced calcium entry cells decreased calcium extrusion islets secondary reduced activity ca2 atpase
evaluation efficacy safety doxazosin hypertension associated renal dysfunction japanese doxazosin study group doxazosin administered daily 26 patients renal hypertension hypertension associated renal dysfunction doxazosin produced significant reduction blood pressure stable throughout treatment period significant change observed heart rate blood pressure markedly decreased decreased 80 patients receiving doxazosin monotherapy , 78 6 patients receiving combined therapy , 79 2 patients cumulative efficacy ratio according final daily dose 62 5 1 4 mg day 75 0 79 2 8 16 mg day side effects observed three patients \( 12 0 \) , none severe , side effects disappeared continued administration doxazosin abnormal laboratory values six items observed four patients serum creatinine blood urea nitrogen values , regarded renal function parameters , show significant changes , negative influence observed respect doxazosin therapy overall clinical usefulness considered useful useful 80 patients receiving doxazosin monotherapy , 78 6 patients receiving combination therapy , 79 2 patients conclusion , daily administration doxazosin considered useful antihypertensive therapy renal hypertension hypertension associated renal dysfunction
glomerular structures lipids progressive renal disease last years , remarkable advances made understanding lipoprotein metabolism pathogenesis renal disease animal models vitro cell culture central work problem progression renal disease humans review theory \( 1982 ii \) progression disease depends part damage glomerulus lipoproteins glomerular environment high low pressure , basement membrane damage , destruction damage mesangial epithelial cells permits filtration protein , consequence hyperlipidemia whatever therapeutic measures employed , proteinuria persists , hyperlipidemia follow suggest lipoprotein toxicity may contribute final common path renal damage progressive renal disease lipoprotein toxicity arteries called atherosclerosis , term complexity glomerulus possible tubular damage might caused filtered lipoprotein clear insufficient knowledge metabolism damaged kidney attribute pathology progression disease single process
similarities glomerular sclerosis atherosclerosis human renal biopsy specimens role lipoprotein glomerulopathy much recent work focused progressive nature renal injury , hemodynamic alterations implicated pathogenesis predominant lesion , focal glomerulosclerosis despite well documented atherogenic toxicity lipids cardiovascular morbidity , little known lipid associated renal injury however , lipids toxic endothelium , glomerulus vascular bundle several authors participating presented evidence association hyperlipidemia glomerulosclerosis animal models association particularly significant given expanded therapeutic armamentarium available treat hyperlipidemia fact , glomerular injury may pharmacologic treatment hyperlipidemia rat renal ablation model little evidence exists , however , similar association human renal disease , course clinical practice , made certain observations renal biopsy specimens may first time link atherogenesis lipid deposition human glomerular injury
serum lipids patients chronic renal failure long term , protein restricted diets disordered lipid metabolism believed play important role accelerating progression chronic renal disease toward uremia examine role lipids large population patients long term dietary protein restriction experience , conclusive evidence lipids may accelerate progression functional deterioration patients reduced renal function hyperlipidemia seems one among many factors affecting prognosis primary renal disease dietary protein restriction effective maintaining normal slightly elevated serum lipid levels patients early renal failure moreover , patients renal failure maintained diet , provides elevated ratio polyunsaturated saturated fatty acids , favorable lipid composition erythrocyte membrane \( low percentage saturated fatty acids high percentage polyunsaturated fatty acids \) compared patients diet
desmopressin induced improvement bleeding times chronic renal failure patients correlates platelet serotonin uptake atp release hemostatic defects resulting life threatening hemorrhagic episodes common occurrence chronic renal failure patient hemorrhagic correlate best laboratory tests bleeding times identification specific hemostatic defect role bleeding yet elucidated studies demonstrate factor viii activity factor viii related antigen \( vwf ag \) normal greatly elevated uremic renal failure patients greatly prolonged bleeding times state von willebrand factor also normal patients bleeding times normalized 15 patients , 90 minutes post infusion desmopressin \( ddavp \) significant changes factor viii vwf associated properties , blood cell counts , coagulation factors observed post ddavp treatment however , significant increase platelet serotonin uptake \( p less 025 \) atp release \( p less 025 \) detected ddavp treatment results indicate ddavp acts platelet membrane ability ddavp block vasopressin induced platelet aggregation dose time dependent fashion perturbations movement storage serotonin release adenosine 5' triphosphate \( atp \) platelets uremic individuals proposed play critical role regulating bleeding times
rate progression chronic renal failure altered \? cost renal replacement therapy end stage renal disease united states exceeds three dollars per year mechanisms may contribute progressive renal injury renal failure diverse etiologies based potential adverse renal effects processes , number dietary pharmacologic interventions proposed potentially beneficial slowing rate progression chronic renal failure end stage renal disease article reviews current evidence animal models humans supporting efficacy proposed interventions
excretion urinary protein induced extracorporeal piezoelectric lithotripsy investigation carried renal injury caused extracorporeal piezoelectric lithotripsy \( epl \) using lithotriptor four urinary proteins , molecular weight range , immunoglobulin g \( igg \) , n acetyl beta \( nag \) , albumin lysozyme , monitored 27 patients 1 day 1 , 7 , 30 , 90 180 days unilateral epl treatment patients non obstructive renal stones , previously untreated apart 5 patients hypertension 6 persistent urinary infections due infected stones , patients appeared healthy , confirmed clinical , biochemical investigations albumin levels increased significantly 1 day treatment statistically nonsignificant increases decreases recorded levels nag respectively igg beyond limit detection \( less 0 5 mg \) patients albumin level returned normal 7 days treatment epl induced increase albumin recorded 88 patients , compared increased levels nag 46 lysozyme 64 , mainly infected stones findings indicated transient glomerular injury epl treatment
stone lower urinary fibrinolytic activity controls \? comparison urinary fibrinolytic activity 31 stone 50 controls failed demonstrate significant difference failed confirm earlier independent observation may due methodological design differences 2 studies , suggest significance lowered urinary fibrinolytic activity risk factor renal stone disease dietary information taking part study suggests reduction meat intake stone might associated increased urinary fibrinolytic activity might account discrepancy 2 studies , case observation could significance
small cell carcinoma urinary tract small cell carcinomas urinary tract rare , lethal report 3 cases primary small cell carcinoma kidney , urinary bladder prostate light microscopic , immunohistochemical electron microscopic findings one patient small cell carcinoma prostate died disseminated disease 2 years diagnosis another patient small cell carcinoma urinary bladder free tumour 6 months partial remission induced third patient distant metastases small cell carcinoma kidney using chemotherapy protocols similar drug regimens small cell carcinomas lung patient survived 5 months immunohistochemical studies revealed absence immunostaining tumour cells 3 cases , positive staining keratin 2 staining neuron specific enolase 3 third patient , reactivity prostate specific antigen negative dense core , membrane bound granules identified cytoplasm 2 patients paraneoplastic syndrome found , indicating considering occurrence ectopic hormones , specific cytoplasmic granules origin need implicated recognition distinct entity requires full consideration morphological , , ultrastructural biological features order define origin tumour clearly evaluate effectiveness chemotherapy , larger series patients needed
effect verapamil anti tumour action doxorubicin renal carcinoma cells vitro ten renal carcinomas established culture sensitivity verapamil , measured \( \) incorporation , studied 5 tumours spread beyond kidney sensitivity enhanced verapamil 4 10 tumours 1 carcinoma , similar experiments performed using doxorubicin drug active , anti tumour action related concentration verapamil effective potentiation doxorubicin action increased proportion concentration verapamil added
caffeine affect bladder \? patients symptoms frequency urgency often symptoms exacerbated tea coffee series 20 women confirmed detrusor instability 10 asymptomatic women given 200 mg caffeine citrate urodynamic studies performed group detrusor instability statistically significant increase detrusor pressure bladder filling following administration caffeine , difference volume first contraction , height contraction bladder capacity normal women abnormality cystometry
experience simplified technique treatment female stress urinary incontinence 9 year period simple procedure correction stress urinary incontinence performed 86 consecutive patients , 31 failed previous anti incontinence procedure success achieved 81 cases \( 94 \) 5 failures , 2 successfully treated repeat procedure operative time ranged 14 49 min \( median 27 \) average hospital stay 2 days simplicity reliability , technique recommended surgical correction female stress urinary incontinence
treatment benign prostatic hyperplasia randomised , double blind study , preparation , obtained seeds dwarf palm plants \( l \) , compared placebo treatment symptoms caused prostatic hyperplasia 53 patients took part study , carried 3 month period urinary flow , micturition time , residual urine , frequency micturition subjective assessment effect treatment significantly improved treatment group untoward side effects noted
semen analysis patients operated impalpable testes semen analysis performed 48 men undergone , 40 unilateral impalpable testes 8 bilateral impalpable testes patients unilateral impalpable testes varying sperm analysis 18 \( 86 \) 23 patients unilateral impalpable testes normal sperm analysis patients bilateral impalpable testes subsequent quality semen dependent upon original anatomical positions testes
comparison urethral reaction full silicone , hydrogen coated latex catheters indwelling urinary catheter may induce inflammatory reaction even stricture urethra catheter encrustation urinary infection disadvantages associated long term catheterisation present study , 77 male patients randomly part normal treatment 1 3 different types catheter 22 latex , 28 coated latex 27 full silicone catheters mean duration catheterisation 2 2 days urethral inflammatory reaction assessed cytological urethral specimens catheter encrustation studied using scanning electron microscopic \( sem \) analysis full silicone catheters induced degree inflammation urethra , percentage mean inflammatory cells smears 20 latex catheter groups value 36 neither age patients duration catheterisation effect inflammatory reaction , marked patients haemodynamic abnormalities coating effectively prevented encrustation , latex catheters least resistant encrustation inflammatory reaction variable patients use urethral catheters restricted tubes used instead , particularly patients shock like circulatory changes developing biocompatibility physical properties urinary catheters , compatible devices may
black tobacco , mate , bladder cancer case control study case control study bladder cancer involving interviews 111 incident cases 222 controls carried , analysis conducted separately sex point estimates relative risk associated smoking variables , ingestion infusions \( mate \) , selected dietary items obtained stratified logistic regression analysis among men , smokers black tobacco showed relative risk \( rr \) 2 7 higher tobacco smokers mate exposure showed significant dose response , adjustment age , residence , social class , hospital , type tobacco , smoking intensity , smoking duration , vegetable consumption , seven fold increase risk heavy joint exposure type tobacco mate consumption showed effect women showed similar increase risk mate consumption results suggest high mortality rates bladder cancer observed could explained combined effect black tobacco smoking mate ingestion
extrarenal production calcitriol normal uremic humans previously reported low serum levels 1 , 25 dihydroxyvitamin d3 1 , 25 \( oh \) 2d3 increased 1 , 25 \( oh \) 2d3 production administration 25 \( 25ohd \) humans since normal alveolar macrophages known synthesize 1 , 25 \( oh \) 2d3 stimulated gamma interferon lipopolysaccharide , determined whether macrophages derived peripheral blood monocytes could extrarenal source 1 , 25 \( oh \) 2d3 results demonstrated macrophages normal individuals synthesize 1 , 25 \( oh \) 2d3 apparent km 6 6 0 5 nm maximum velocity 47 4 13 7 fmol 1 , 25 \( oh \) 2d3 h microgram dna activity enzyme reduced 37 2 3 1 physiological concentrations \( 96 pmol l \) 1 , 25 \( oh \) 2d3 incubation medium normal macrophages 1 , 25 \( oh \) 2d3 polar metabolites , catabolic activity significantly enhanced physiological concentrations 1 , 25 \( oh \) 2d3 chronic renal failure , peripheral macrophages exhibited enhanced 1 alpha hydroxylase activity \( 8 2 0 8 vs 4 2 0 5 fmol 1 , 25 \( oh \) 2d3 microgram dna h controls \) decreased capacity degrade 1 , 25 \( oh \) 2d3 exogenous 1 , 25 \( oh \) 2d3 , physiological concentrations , reduced 1 , 25 \( oh \) 2d3 synthesis degree \( 23 6 8 5 \) comparable observed normal cells 1 , 25 \( oh \) 2d3 production macrophages correlate severity hyperparathyroidism moreover , human pth \( 1 34 \) concentrations \( 20 , 000 100 , 000 ng l \) stimulate 1 alpha hydroxylase activity macrophages either normal uremic subjects results demonstrate 1 \) normal peripheral macrophages 1 , 25 \( oh \) 2d3 2 \) macrophages uremia display higher rates 1 , 25 \( oh \) 2d3 synthesis lower rates catabolism normal macrophages 3 \) 1 , 25 \( oh \) 2d3 deficiency , hyperparathyroidism , may play role stimulation 1 , 25 \( oh \) 2d3 production macrophages chronic renal failure
progression renal insufficiency analgesic nephropathy impact continuous drug abuse twenty three patients analgesic nephropathy apparent cessation drug abuse tested blood acetaminophen occasion routine renal control examinations 12 patients \( mean creatinine level 2 74 1 09 mg dl \) deterioration renal function noted within 1 year observation period \( group 1 \) 11 patients significant progression renal insufficiency observed \( mean creatinine level rose 3 86 1 06 6 40 3 18 mg dl within observation period group 2 \) blood tests acetaminophen positive 2 patients group 1 9 patients group 2 \( chi 2 7 326 \) , p less 0 01 \) data emphasize importance continuous analgesic abuse hidden medical staff regard progression renal insufficiency analgesic nephropathy
functional status quality life predictors early mortality among patients entering treatment end stage renal disease investigated association functional status quality life newly entered dialysis patients subsequent risk mortality enrolled patients 37 dialysis facilities two southeastern states \( n 294 \) functional status assessed karnofsky performance scale \( \) quality life quality life index \( \) mean \( se \) follow 6 \( 109 4 \) days 49 patients \( 16 4 \) cohort died mean score \( se \) survivors 7 31 \( 0 11 \) non survivors 5 89 \( 0 26 \) , p less 0 0001 mean score \( se \) survivors 6 74 \( 0 15 \) non survivors 4 95 \( 0 28 \) , p less 0 0001 strong gradients risk mortality found measurements controlling covariates including age , race , sex , primary cause renal failure presence comorbidity , scores independently correlated risk mortality conclude functional status quality life strong independent risk factors subsequent mortality new dialysis patients easily measured indicators may serve predict subsequent risk mortality adjust case mix estimates comparisons dialysis populations
effects probucol renal function rats bilateral ureteral obstruction ascertain potential role reactive oxygen metabolites pathophysiology obstructive , examined effect probucol , antioxidant agent , renal function normal rats rats unilateral release bilateral ureteral obstruction \( buo \) 24 hours duration rats fed either standard diet standard diet containing one percent probucol two weeks prior study probucol lowered serum cholesterol normal buo rats probucol significantly affect renal function normal rats buo rats given probucol greater inulin clearances three five hours three days following release buo rats buo given probucol kidneys obstructed rats higher levels malondialdehyde , index lipid peroxidation , greater number leukocytes cortex , decreased levels reduced glutathione increased levels oxidized glutathione renal cortex obstructed rats treated probucol significantly higher levels reduced glutathione kidneys obstructed rats given probucol decrease cholesterol , using another lipid lowering agent , lovastatin , modify renal function rats buo data interpreted indicate role reactive oxygen species pathophysiology obstructive nephropathy improved renal function seen probucol treated rats buo may due effect agent affecting accumulation reactive oxygen metabolites decreasing number leukocytes infiltrating renal cortex
three dimensional morphometric analysis segmental glomerulosclerosis rat idiopathic nephrotic syndrome , experimental models nephrosis , changes visceral epithelial cells involve entire glomerular population segmental sclerotic changes reported affect certain number glomeruli conventional determination percentage glomeruli affected sclerotic lesions usually based examination randomly selected sections , whether glomeruli appearing normal given section could affected sclerosis regions capillary \( ct \) assess real incidence spatial extension sclerotic changes level single glomerulus , used serial section morphological analysis measure volume glomerulus sclerosis lesions glomeruli control rats glomeruli adriamycin \( adr \) treated rats surface area 's capsule \( bc \) , ct sclerotic regions measured using techniques consecutive sections containing individual glomerulus , corresponding volumes calculated mean volume bc ct significantly different control adr rats \( 0 71 0 03 0 53 0 03 vs 0 76 0 04 0 53 0 02 microns 3 x 10 \( 6 \) , respectively \) distribution glomerular volume parameters adr rats spread control animals , indicating glomeruli became smaller became larger sclerotic changes found control rats , three adr rats 94 , 90 92 glomeruli , respectively , affected sclerotic lesions
prevents hyperfiltration decreases proteinuria post transplant hypertensives hypertension renal mass reduction induce glomerular hypertension \( gh \) , hyperfiltration \( hf \) renal injury gh may contribute allograft loss post transplant hypertensive patients \( pt x ht \) hf gh may evaluated renal response acute protein intake \( api \) since ace inhibition may prevent gh , effects \( fos \) evaluated 10 pt x ht azathioprine prednisone patients received 5 40 mg day fos 12 months baseline map \( 111 1 2 9 mm hg \) significantly reduced 10 12 mm hg , rising 114 7 2 7 mm hg fos administered gfr \( 63 7 5 9 ml min \) decreased 4 \( 48 1 4 6 , p less 0 05 \) 12 months \( 50 7 4 6 , p less 0 05 \) , rising 59 4 5 6 fos given gfr response api one month fos , however , clear response became apparent 4 \( 27 p less 0 05 \) , 12 months \( 18 , p less 0 05 \) , fos discontinuation proteinuria \( 8 6 mg \) decreased 4 \( 72 3 21 6 mg , p less 0 05 \) 12 months , rising 8 172 3 mg day therapy gfr response api 22 controls 17 donors 13 11 , respectively lack response api pt x ht suggests hf gh reduction gfr , restoration response api reduction proteinuria , indicate ace inhibition hf gh effect may beneficial preventing hemodynamic mediated allograft injury
l lactate high efficiency hemodialysis hemodynamics , blood gas changes , potassium phosphorus , symptoms hemodynamic changes measured high efficiency hemodialysis \( hehd \) using three dialysis solutions l lactate \( 46 mm \) , bicarbonate \( 35 mm 4 mm acetate \) , acetate \( 39 mm \) cardiac output determined changes thoracic electrical although appeared subtle differences hemodynamic response l lactate versus bicarbonate , blood pressure , cardiac output , total peripheral resistance affected less either solutions acetate particular , neither l lactate bicarbonate hehd associated change cardiac output , whereas acetate hehd marked \( 22 \) increase cardiac output seen concurrently moderate fall blood pressure tpr acetate l lactate hehd associated hypoxemia , whereas bicarbonate hehd po2 change l lactate hehd , correction ph plasma hco3 concentrations delayed values significantly different obtained bicarbonate hehd one hour dialysis potassium removal comparable three dialysis solutions phosphorus removal l lactate tended slightly less bicarbonate , less acetate results suggest l lactate \( 46 mm \) dialysis solution may suitable alternative acetate hehd , associated hemodynamic profile similar bicarbonate better acetate results suggest hypoxemia associated use acetate dialysis solution intrinsic acetate , due either low dialysis solution pco2 level accelerated consumption oxygen substrate metabolism
multicenter trial l carnitine maintenance hemodialysis patients carnitine concentrations lipid effects previous studies reported conflicting results carnitine supplementation plasma lipids patients chronic renal failure therefore performed four center , double blind placebo controlled trial evaluate effects post hemodialysis intravenous injection l carnitine esrd patients maintenance hemodialysis thirty eight patients received six months l carnitine infusions \( 20 mg kg \) post dialysis 44 patients received placebo infusions groups patients , baseline pre dialysis plasma red blood cell total carnitine levels normal , pre dialysis plasma free carnitine concentrations free total ratios subnormal , plasma acyl levels elevated post dialysis plasma free total carnitine concentrations also subnormal plasma red blood cell total carnitine levels rose eightfold carnitine recipients , unchanged baseline receiving placebo significant changes observed plasma triglycerides , hdl cholesterol lipoprotein parameters either carnitine placebo treated groups conclude carnitine metabolism altered uremia furthermore , randomly selected hemodialysis population , l carnitine injection dose 20 mg kg results significant increases blood \( perhaps tissue \) carnitine levels , associated major effects lipid profiles
influence calcium acetate calcium citrate intestinal aluminum absorption risk aluminum \( al \) accumulation patients chronic renal failure led use non al phosphate binders frequently , al non al phosphate binders co administered unfortunately , calcium citrate \( ca \) , given al gel , markedly enhances al absorption determine whether calcium acetate \( ca acetate \) also augments al absorption , 10 normal volunteers given orally , three day courses following drug combinations four times daily 1 \) aluminum gel \( al oh 3 \) \( 5 ml \) alone 2 \) al oh 3 \( 5 ml \) plus ca acetate \( mg \) 3 \) al oh 3 \( 5 ml \) plus ca \( mg \) nine day wash occurred course al levels measured using absorption daily urine al excretion measured two day baseline course three day drug course plasma al obtained baseline drug course mean 24 hour al excretion \( micrograms g creatinine day \) baseline versus treatment combination 1 \) 5 9 3 2 versus 42 0 40 7 \( mean sd \) 2 \) 5 7 3 0 versus 40 3 28 6 3 \) 6 3 3 4 versus 175 8 103 3 al excretion significantly greater combination 3 either 1 2 \( p less 0 05 \) difference 1 2 significant plasma al \( micrograms liter \) baseline versus treatment combination 1 \) 5 3 4 2 versus 8 1 2 5 \( mean sd \) 2 \) 3 1 2 2 versus 7 3 2 9 3 \) 3 0 2 3 versus 12 0 6 1
two prostate carcinoma cell lines demonstrate abnormalities tumor suppressor genes two prostate carcinoma cell lines , du 145 pc 3 , examined abnormalities retinoblastoma \( \) p53 putative tumor suppressor genes found abnormal gene product du 145 using western blot analysis polymerase chain reaction amplification followed direct dna sequencing demonstrated base substitution mutation generates stop codon exon 21 northern , southern , western blot analysis , p53 gene product appear normal du 145 pc 3 , however , failed demonstrate expression either p53 transcript northern blot analysis p53 protein western blot analysis , gene products appeared normal northern western blot analysis work extends correlation abnormal expression putative tumor suppressor genes human malignancies
effect ileal conduit patients' activities following radical cystectomy last twenty months , 110 patients undergone radical cystectomy bladder cancer university texas anderson cancer center surveyed assess effect ileal conduit urinary diversion postoperative activity postoperatively , 47 3 percent patients active , 34 5 percent moderately active , 18 2 percent sedentary chemotherapy patient 's gender found statistically significant effect postoperative activity level chemotherapy resulted decrease active patients 55 6 percent 27 9 percent increase sedentary patients 11 2 percent 30 2 percent \( p 0 005 \) difference activity levels seen 73 9 percent patients fifty one percent men active compared 19 1 percent women , whereas 20 percent women men moderately active 13 percent sedentary experience indicates ileal conduit significant negative effect activity effects chemotherapy controlled 82 6 percent patients receiving chemotherapy experienced either change increase activity
cecal lengthening technique creation conduit creation continent , stoma integral component successful continent urinary diversion technique described allows lengthening continent technique extends applications principle urinary tract reconstruction
use biofeedback treatment voiding dysfunction young man psychologic problems long history social presented voiding dysfunction revealed normal filling phase normal initiation voiding interrupted considerable straining patient marked sphincter electromyographic \( emg \) activity temporary amelioration achieved infiltration sphincter lignocaine hydrochloride biofeedback therapy cases optimal results expected long term behavioral therapy
treatment renal transplant stones extracorporeal shock wave lithotripsy prone position two patients renal transplant successfully treated extracorporeal shock wave lithotripsy \( eswl \) prone position pathogenesis treatment transplant discussed performing eswl renal transplant patients prone position advantages standard positioning techniques
study nipple valves kock ileal urinary reservoir experimental investigation dogs better assess construction , maintenance , function kock ileal urinary reservoir continent nipple valves , laboratory investigations dogs done simultaneously clinical trials humans 1983 fifteen dogs underwent creation kock ileal \( without efferent valve limb \) anastomosed bladders afferent nipple valves 7 cm underlying mesentery removed stabilized metal absorbable \( \) staples right ureters anastomosed afferent limb contralateral systems left intact controls ten dogs able followed twelve thirty six months studied nipple valves remained intact , viable , without revision kidneys remained histologically normal except dogs dilated ureters secondary stenosis concurrent calculi formation calculi formed exposed metal staples absorbable staples found promote appropriate healing never stone formation appears nipple valve \( mesentery removed \) reproducible functionally reliable preventing reflux also appears valves histologically preserve diverted kidneys upper urinary tract drainage normal calculi minimized proper placement staples elimination anchoring indicated minimize calculi
radiographic spectrum renal chronic renal failure often results bone changes , collectively known renal changes include osteitis , , soft tissue calcifications , osteomalacia \( adults \) rickets \( children \) early recognition renal allows aggressive clinical control serum calcium phosphate levels intervention may patient late complications fractures , pain loss skeletal function
effect angiotensin converting enzyme inhibition dietary protein restriction treatment proteinuria angiotensin converting enzyme inhibitors dietary protein restriction reported reduce urinary protein losses patients chronic glomerular diseases evaluated two therapies 12 patients ingesting constant metabolic diet containing 1 6 g protein kg body weight per day steady state achieved 3 week baseline period , patients randomly assigned either enalapril , titrated reduce mean arterial pressure 10 mm hg , isocaloric 0 8 g kg protein diet five patients group completed 3 additional weeks observation treatment period enalapril resulted average reduction urinary protein albumin losses 26 33 , respectively , without reducing creatinine clearance albumin synthesis unchanged nitrogen balance increased slightly \( 142 8 85 7 mmol 2 0 1 2 g , p 0 075 \) dietary protein restriction consistent effect proteinuria , whereas albumin synthesis \( 25 9 3 4 v 21 5 2 9 g 1 73 m2 , p less 0 05 \) nitrogen balance \( 135 6 92 8 mmol 1 9 1 3 g , p 0 10 \) decreased therapies resulted modest increase plasma potassium concentration whether maintenance albumin synthesis presence reduction urinary protein losses long term advantage treatment proteinuric patients angiotensin converting enzyme inhibitors remains determined
preservation renal reserve chronic renal disease protein induced increases glomerular filtration rate \( gfr \) , termed renal reserve , said abrogated onset renal disease however , notion inconsistent results animal studies suggest alterations protein intake modulate glomerular hemodynamics experimental renal disease accordingly , 12 normal subjects 15 patients renal disease received protein meal providing 1 g kg body weight protein subjects pretreated either placebo angiotensin converting enzyme inhibitor , enalapril significant \( p less 0 05 \) increase inulin para \( \) clearance noted normal subjects well patients renal disease increase gfr basal values normal subjects \( 28 9 \) , patients moderate renal failure \( 20 13 \) , advanced renal failure \( 21 14 \) different plasma renin activity unchanged following protein meal placebo studies although increased following enalapril administration enalapril pretreatment alter glomerular vasodilation hyperfiltration following protein meal conclude protein meal induces glomerular hyperfiltration renal disease protein induced hyperfiltration mediated angiotensin ii glomerular hyperfiltration implicated progression renal disease , data suggest even patients advanced renal failure , high protein diets may exert detrimental effect kidney
survival patients end stage renal disease based age medical condition time treatment , 138 patients beginning dialysis treatment chronic renal failure january 1 , 1984 december 31 , 1988 , classified low , average , high risk death survival three groups shown significantly different little 6 months classification scheme simple , performed bedside efforts monitor quality assurance dialysis unit must account significant differences expected survival reflect case mix observed particular unit
x linked hypophosphatemia skeletal mass adults assessed , computed tomography , absorptiometry purpose patients methods x linked hypophosphatemia \( xlh \) common inherited form rickets , yet influence skeletal mass adulthood controversial incompletely characterized accordingly , measured bone mass several skeletal sites using histomorphometric radiographic techniques 19 adults \( four men \) xlh \( age range 20 66 years \) subjects received medical therapy xlh since puberty results eight 14 subjects underwent bone biopsy elevated cancellous bone volume \( osteoid calcified bone \) , group 's mean value \( p less 0 01 \) bone volume , however , normal three subjects \( ns \) another measure trabecular bone density , vertebral mineral density computed tomography , elevated three 13 subjects , mean value group increased \( p 0 05 \) integral spine bone mineral density \( bmd \) assessed dual photon absorptiometry \( dpa \) elevated six 16 subjects , mean also normal \( p less 0 01 \) however , total body calcium , total body bmd \( dpa \) , forearm bone mineral content assessed single photon absorptiometry \( predominantly cortical bone \) normal almost subjects , group means parameters mean regional bmd \( dpa \) normal upper lower limbs \( p less 0 001 \) normal spine \( p less 0 005 \) \( p less 0 01 \) relationship indices bone mass either biochemical clinical parameters disease severity , although men tended higher z scores axial bone density premenopausal women whose values , turn , tended higher postmenopausal women \( ns \) conclusion conclude axial bone mass tends increased adults xlh , sometimes dramatically , partially attributable peripheral bone mass , however , tends diminished despite group trends , adults untreated xlh normal indices bone mass assessed variety techniques commonly used measurement sites findings suggest fractures unlikely develop late complication xlh adults
interstitial cellular infiltration detected fine needle aspiration biopsy nephritis fine needle aspiration biopsy \( fnab \) used detect renal mononuclear interstitial inflammation 56 patients various types nephritis \( 20 iga nephropathy , 8 focal necrotizing glomerulonephritis , 7 interstitial nephritis , 6 non chronic glomerulonephritis , 5 mesangial proliferative \( non iga \) chronic glomerulonephritis , 4 focal glomerulosclerosis , 6 normal histology , examined microscopic hematuria , 7 controls \) regular renal biopsies histological immunofluorescence studies simultaneously obtained , available comparative analysis \( controls \) differential counts mononuclear infiltration cell infiltration helper \( h \) suppressor cytotoxic \( c \) cells , detected immunoperoxidase stains fnab , correlated clinical manifestations renal function tests generally , results indicated increased mononuclear cell infiltration \( monocytes , lymphocytes , activated lymphocytes \) fnab patients iga nephropathy , interstitial nephritis focal necrotizing glomerulonephritis \( especially monocytes iga nephropathy interstitial nephritis , p less 0 05 compared controls , lymphocytes focal necrotizing glomerulonephritis , non glomerulonephritis , p less 0 02 0 05 , respectively \) number infiltrating activated lymphocytes significantly increased focal necrotizing glomerulonephritis , interstitial nephritis focal glomerulosclerosis , p less 0 05 , less 0 01 less 0 01 , respectively fnab least sensitive histological examination quantification interstitial cellular infiltration , allowed cytological differential counts patients decreased h increased c cell counts , accentuated fnab compared peripheral blood , although strong positive correlations local peripheral counts \( p less 0 0001 \)
acute renal failure critically ill patients prognosis recovery kidney function prolonged dialysis support objective clarify prognosis eventual recovery kidney function patients experience prolonged dialysis dependence acute renal failure \( arf \) design retrospective , chart review setting inpatients large , referral based hospital patients twenty six consecutive survivors arf required greater 4 wk dialysis support results 26 patients critically ill developed arf treatment icu clinical course patients characterized multiple episodes renal ischemia exposure dialysis dependence however , despite multiple renal insults prolonged dialysis support \( mean duration 8 4 0 7 wk \) , 23 \( 88 \) 26 patients recovered sufficient kidney function dialysis preexisting renal impairment associated greater risk irreversible renal failure , , patients able dialysis , renal recovery often incomplete conclusions despite renal damage , critically ill patients survive arf requiring prolonged dialysis support recover life sustaining kidney function
study bilateral histology meiotic analysis men undergoing varicocele ligation fifty men underwent testicular biopsy time varicocele ligation biopsies scored also portion biopsy subjected meiotic analysis men followed \( mean follow 19 3 months \) consistent histologic meiotic abnormalities , evidence varicocele side defective contralateral side thirteen pregnancies recorded , occurred mean score one testis greater 6 0
concentrations transferrin , beta 2 microglobulin , albumin seminal plasma relation sperm count number studies shown relationship transferrin levels seminal plasma sperm count present study , levels transferrin , beta 2 microglobulin albumin measured 171 samples seminal plasma \( 50 subjects normal sperm count 32 azoospermia 49 10 31 \) three proteins related sperm count concluded general relationship seminal plasma proteins sperm numbers products sperm must control entry plasma proteins seminal plasma
rapid baroreceptor chronic hypertension implications normalization arterial pressure purpose study examine ability renal hypertensive rabbits rapidly acute changes arterial pressure carotid sinus \( cs \) isolated baroreceptor activity recorded slow increases cs pressure hypertensive \( one kidney , one 127 3 mm hg \) normotensive \( one kidney , 85 3 mm hg \) rabbits anesthetized control measurements made holding pressure 10 15 minutes level arterial pressure recorded experiment baroreceptor threshold pressure \( pth \) higher hypertensives \( 78 4 mm hg \) compared normotensives \( 55 3 mm hg , p less 0 05 \) , nerve activity less hypertensives wide range pressure cs distensibility \( \) significantly different two groups increasing holding pressure control 30 60 mm hg 10 15 minutes , extent baroreceptor \( delta pth delta holding pressure x 100 \) normotensives 39 6 33 2 , respectively , 14 5 9 3 hypertensives \( p less 0 05 \) decreasing holding pressure 30 60 mm hg , similar normotensives \( 32 6 28 3 \) hypertensives \( 34 3 30 4 \) hypertensive rabbits , acute \( 10 15 minutes \) exposure normotension \( 71 4 mm hg \) decreased pth 62 4 mm hg increased nerve activity levels significantly different normotensive animals without altering cs distensibility
penile duplex sonography diagnosis impotence study tested hypothesis measurements cavernous arterial diastolic velocity resistance index could provide quantitative noninvasive measure penile venous leakage seventy four men studied duplex ultrasonography intracavernosal injection 60 mg papaverine fourteen men normal erection served controls sixty men 1 year history transient incomplete erections subjects peak systolic velocity end diastolic velocity measured , resistance index calculated \( peak systolic velocity end diastolic velocity peak systolic velocity \) men normal erections peak systolic velocities greater 35 cm sec end diastolic velocities less 4 5 cm sec \( group 1 \) patients incomplete erections \( group ii \) could classified three subgroups twenty three patients end diastolic velocities greater 4 5 cm sec normal peak systolic velocities greater 35 cm sec suspected venous leakage \( group \) eighteen patients normal end diastolic velocities less 4 5 cm sec twelve group peak systolic velocities less 35 cm sec , six peak systolic velocities ranging 37 44 cm sec patients suspected arterial insufficiency \( group b \) fifteen patients end diastolic velocities greater 4 5 cm peak systolic velocities less 35 cm suspected venous leakage arterial insufficiency \( group c \) twenty one patients abnormal diastolic flow underwent infusion determine saline maintenance infusion rate necessary maintain intracavernosal pressure 90 100 mm hg full erectile response
efficacy bladder training older women urinary incontinence efficacy bladder training evaluated randomized clinical trial involving 123 women 55 years older urinary incontinence subjects categorized urethral incompetence \( n 88 \) detrusor instability without concomitant incompetence \( n 35 \) bladder training reduced number incontinent episodes 57 effect similar urodynamic diagnostic groups quantity fluid loss reduced 54 greater patients detrusor instability without diurnal nocturnal voluntary also reduced effect nocturnal micturition , however , observed subjects unstable detrusor function recommended bladder training considered initial step treatment women urinary incontinence provided prior comprehensive clinical evaluation done , prescribed without need urodynamic characterization
simple renal cysts children diagnosis follow us assess sonographic frequency simple renal cysts children , authors retrospectively reviewed results abdominal sonographic studies 16 , 102 children performed 5 year period january 1 , 1985 , december 31 , 1989 patients abnormal renal function , dysplastic kidneys , family history polycystic kidney disease excluded study authors' review sonograms revealed 37 simple cysts 35 patients \( 0 22 \) cysts distributed age sex measured 0 3 7 0 cm maximum diameter sixteen cysts \( 43 \) upper pole right kidney follow sonographic studies 23 cysts 22 patients 5 years showed change size 17 cysts \( 74 \) largest cyst drained percutaneously cysts managed conservatively patient showed deterioration renal function therefore , authors concluded pediatric patient demonstrating normal renal function , intervention necessary simple renal cyst identified sonography
nonpalpable prostate cancer detection mr imaging pathologic specimens magnetic resonance \( mr \) images 53 patients clinically palpable prostate cancer confined one lobe studied evaluate ability mr imaging clinically nonpalpable prostate cancer patients undergone imaging 1 5 t1 t2 weighted sequences axial sagittal planes undergoing radical prostatectomy pathologic examination , palpable tumor present 30 53 patients \( 57 \) , 33 unsuspected tumors present area distinct palpable tumor 23 patients \( 43 \) mr imaging successfully depicted 51 palpable tumors sensitivity 96 19 33 unsuspected tumors sensitivity 58 sensitivity mr imaging detection nonpalpable , posteriorly located tumors greater located anteriorly \( 85 vs 15 \) mr imaging false positive nonpalpable tumor 17 30 patients specificity 43 basis data , mr imaging greater sensitivity posteriorly located cancer limited high false positive rate nonpalpable tumors
determination prostate volume transrectal us cancer screening part comparison prostate specific antigen assays investigate whether radiologists objectively define high risk group prostate cancer , researchers measured gland volume compared results screening blood test , prostate specific antigen \( psa \) assay total men , aged 55 71 years , self referred two prostate cancer screening programs using transrectal ultrasound \( us \) digital rectal examination patients evidence cancer , statistically significant increases mean psa values noted increasing gland volume ranges \( p less 05 \) psa values patients cancer likely exceed volume adjusted 95th percentile \( mean 1 65 standard deviation \) patients negative biopsy results \( p less 005 \) patients psa values volume adjusted 95th percentile estimated risk prostate cancer nine times general screening population researchers conclude knowledge transrectal us gland volume prostate specific antigen assay type important objective variables future prostate cancer screening programs volume adjusted 95th percentiles presented may help guide cost effective management current early detection efforts
primary signet ring cell carcinoma urinary bladder primary signet ring cell carcinoma uncommon malignancy arising urinary bladder authors report 12 cases collected institution median age ten men two women 58 years frequent presentation hematuria two nine cases mucosal lesion visible eleven tumors origin one diagnosis , one tumor stage b , two stage c , seven stage , two stages unknown nine 12 patients dead disease \( range , 1 16 months median , 9 months \) , 1 alive metastatic disease , 1 alive well , 1 dead unrelated cause literature review , authors accepted 35 cases met criteria combined 12 cases statistical analysis prognosis worse pure diffuse versus mixed tumor \( p 0 004 \) versus origin \( p 0 005 \) difference five year survival rates stages b disease \( p less 0 05 \) also statistically significant
transforming growth factor beta production anti glomerular basement membrane disease rabbit purpose study assay presence collagen synthesis stimulatory activity kidney immune induced renal injury results severe fibrosis glomerular interstitial compartments model basement \( anti gbm \) disease rabbit induced day 0 injection anti gbm antibody renal cortex tissues sampled various time points conditioned media prepared diseased renal cortical samples showed collagen synthesis stimulatory activity tested rabbit mesangial cells activity estimated molecular weight range 16 25 kd neutralized antibody transforming growth factor beta \( tgf beta \) standard assay tgf beta using lung epithelial cell line confirmed increase tgf beta activity conditioned media diseased cortex day 7 day 14 animals , significantly activated previous acidification suggests tgf beta present renal conditioned media active form increase renal cortical secretion active tgf beta accompanied increases renal cortical tgf beta mrna content days 4 7 induction , subsequent return control levels similar increase tgf beta activity present conditioned media purified glomeruli diseased days 7 14 animals , also accompanied significant increases tgf beta mrna however acidification significant differences noted control diseased samples , suggesting presence substantial latent tgf beta activity control glomerular conditioned media control conditioned media contained inhibitor activity added exogenous tgf beta results support conclusion association increased tgf beta secretion increased renal cortical collagen synthesis model consistent role cytokine fibrogenesis kidney
less frequent lithium administration lower urine volume objective study designed determine whether patients maintained regimen lithium per day schedule lower urine volumes patients receiving multiple doses per day method cross sectional study 85 patients lithium clinic received different dose schedules patients admitted hospital measurement lithium level , creatinine clearance , urine volume , maximum osmolality results multiple daily doses lithium associated higher urine volumes dosing schedule , duration lithium treatment , daily dose lithium affect maximum osmolality creatinine clearance conclusions urine volume reduced giving lithium daily lowering total daily dose lithium induced seems related extrarenal well renal effects
analysis urinary protein comparison chemstrip 9 multistix 10sg chemstrip 9 multistix 10sg urine assays detection proteinuria evaluated chemstrip 9 precise multistix 10sg \( 13 inconsistencies vs 32 among duplicate pairs \) precision poorest group using multistix 10sg \( chemstrip 9 yielded two inconsistencies vs 15 multistix 10sg \) use urine supplemented protein standard evaluation protein supplemented consecutively acquired patient specimens , multistix 10sg chemstrip 9 performed statistically similar fashion regarding sensitivity predictive value negative test result supplemented sample sensitivity , patient sample sensitivity , predictive value negative test result 90 3 , 46 8 , 68 6 , respectively , multistix 10sg compared 80 6 , 31 5 , 63 5 , respectively , chemstrip 9 conclude neither test sufficiently sensitive detection low levels proteinuria \( 1 range \) function screening test renal disease
effect function isolated perfused rat kidney 1 minimal change nephrotic syndrome occurrence heavy proteinuria explained basis reduction charge selectivity glomerular filtration barrier , proposed might caused neutralization groups circulating factor 2 effects two , protamine poly l lysine , function isolated perfused rat kidney examined 3 poly l lysine polymers relatively high molecular weight \( 17 , 800 \) induced heavy proteinuria , simultaneously causing marked increase renal vascular resistance fall filtration rate protamine \( approximate molecular weight \) relatively high concentration induced modest proteinuria absence effects vascular resistance filtration rate 4 poly l lysine polymer lower molecular weight \( \) induce proteinuria protamine concentration 40 micrograms ml affect protein excretion either provoked substantial natriuresis appeared largely due effect tubular handling sodium since filtration rate remained steady fractional sodium excretion rose markedly 5 natriuretic effect protamine blocked heparin , indomethacin verapamil , suggesting mechanism natriuresis depend upon either prostaglandin production entry calcium verapamil sensitive channels
sex survival trade quality quantity life patients localized prostate cancer may treated either surgery \( radical prostatectomy \) radiotherapy although controversial , many physicians believe surgery offers higher survival rate however , surgical treatment may also produce higher rate sexual study assessed men value survival sexual potency asked trade one using treatment choice technique , interviewed 50 men aged 45 70 years without known prostate cancer hypothetical rates survival \( 90 5 years surgery \) \( 90 surgery 40 radiotherapy \) representing published estimates , 32 respondents trade survival , 68 willing trade 10 greater advantage 5 year survival \( choosing radiotherapy \) maintain sexual potency median 5 year survival 10 \( range , 0 80 \) trade survival sexual potency significantly related level education , age , interest sex , frequency sexual intercourse , ability achieve erection conclude men may choose treatment lower long term survival increase chance remaining sexually potent men may difficult identify clinical practice , physicians discuss surgery radiotherapy options patients localized prostate cancer
post transplant renal artery stenosis possible immunological phenomenon retrospective review 110 consecutive kidney transplants performed 4 years revealed development renal artery stenosis 9 patients \( 8 18 \) comparison group control group similar patient age interval elapsed since transplantation revealed significant differences donor recipient ages , degree hla serum creatinine levels however , significant difference number acute rejection episodes series male patients affected sizable proportion patients \( 50 \) detectable murmur graft area despite high blood pressure increased creatinine levels absence surgical injury extraction implantation grafts , together anatomical site stenosis correlation degree immunological intolerance suggest immunological factor underlying cause post transplant renal artery stenosis
acute changes renal function following extracorporeal shock wave lithotripsy patients solitary functioning kidney twelve consecutive patients solitary functioning kidney treated renal stone extracorporeal shock wave lithotripsy \( eswl \) modified lithotriptor studied 3 days treatment urinary excretion electrolytes , n acetyl beta \( nag \) , alkaline phosphatase , kallikrein , glycosaminoglycans , albumin beta 2 microglobulin , clearances creatinine , inulin para acid determined , serum levels creatinine , urea , beta 2 microglobulin aldosterone , plasma renin activity urinary flow rate , free water clearance , urinary excretion nag , kallikrein beta 2 microglobulin significantly increased 0 24 hours eswl urinary excretions alkaline phosphatase , albumin glycosaminoglycans unchanged glomerular filtration rate significantly decreased effective renal plasma flow unchanged filtration fraction stable serum lactic dehydrogenase increased significantly eswl remained high period observation serum levels creatinine , beta 2 microglobulin aldosterone unaltered decrease plasma renin activity immediately treatment explained water immersion extracellular volume expansion treatment
ureteral calculi natural history treatment era advanced technology patients ureteral stones may managed , treated variety invasive noninvasive techniques depending stone composition , size location , expectations patient experience surgeon patients documented ureteral calculi 60 passed stones spontaneously passage rates proximal , middle distal ureter 22 , 46 71 , respectively fluoroscopic control distal stones successful 79 attempts approach failed ureteroscopy performed , success rate 90 ureteroscopy used initial treatment distal stones removal achieved 81 patients statistics serve reminder traditional therapy ureteral stones lost role contemporary practice
management upper tract calculi patients urinary diversions retrospective review patients urinary diversion presented stone center 3 5 year period 9 underwent 20 procedures suspected stone episodes eventual outcome excellent 1 patient particular , attempts retrograde trans manipulation successful present cases , note technical considerations management principles frequently , patients best served combination percutaneous antegrade , trans retrograde extracorporeal shock wave lithotripsy
vacuum devices role papaverine selection patients conducted prospective study determine positive predictive value papaverine testing select patients vacuum constriction device would successful alternative operative management impotence total 30 men presenting impotence clinic evaluated series papaverine dosages 60 mg patients received physician administered trial vacuum constriction device , followed 3 months home use repeat objective evaluation initial responses device poor , 46 patients \( 14 \) achieving rigid erection however , 3 months home use 83 patients \( 25 \) achieved rigid erection positive predictive value good response papaverine trial 94
intracavernous self injection vasoactive drugs treatment impotence 8 year experience cases patients impotence varying etiologies followed 12 96 months institution intracavernous self injection therapy vasoactive drugs \( papaverine alone , papaverine alpha blockers , , new multilevel acting drug \) 87 \( patients \) returned followup visits regularly contacted patients sexual activity restored 91 dropout rate 11 25 114 episodes prolonged erections among 51 patients \( 4 57 \) represented less 3 per 1 , 000 34 , recorded injections patients treated without complications percentage patients suffering nodules permanent deformations 2 8 cases intracavernous fibrosis percentage satisfied patients \( satisfaction index 7 greater \) 84 8 improvement spontaneous erections sexual intercourse obtained 65 cases 15 longer needed self injections 50 used occasionally 35 remained entirely dependent
interstitial temperature measurements transurethral microwave hyperthermia microwave hyperthermia presently investigated treatment alleviating symptoms urinary outlet obstruction associated benign prostatic hyperplasia two clinical techniques using intracavitary microwave evaluated safety efficacy various institutions transrectal technique uses microwave inserted rectum adjacent prostate transurethral approach uses applicator located within prostatic urethra transrectal prostatic heating techniques require surface cooling prevent hazardous temperatures intervening rectal mucosa since transurethral within prostatic urethra , heating confined obstructive tissue immediately surrounding applicator concern expressed regarding possibility thermal injury prostate adjacent rectum transurethral hyperthermia treatment report present interstitial temperature measurements prostatic rectal temperatures 5 patients temperature observed decrease rate cm outward applicator clinically significant temperature increase observed beyond 1 cm , outside prostatic capsule rectal mucosa
treatment benign prostatic hypertrophy long acting gonadotropin releasing hormone analogue 1 year experience benign prostatic hypertrophy , common among elderly men , usually treated surgery since androgens enhance prostatic hypertrophy , withdrawal seems logical way treat condition recently gonadotropin releasing hormone analogues , known produce chemical castration , tried cases benign prostatic hypertrophy report experience 20 men treated monthly injection gonadotropin releasing hormone prolonged periods 17 men treated 6 months prostatic volume decreased average 63 initial volume however , correlate clinical objective improvement 6 men attained normal flow rates residual urine volume remained unaltered ten patients experienced subjective amelioration , 7 \( 40 \) reported objective subjective improvement maximal decrease prostatic volumes reached 9 months treatment treatment cause additional shrinkage 3 months discontinuation treatment prostatic volumes returned 95 10 5 pre treatment values similar decrease flow rates also noted symptoms remained improved longer periods conclude mode treatment offers little majority men benign prostatic hypertrophy proper patient selection , based perhaps serum prostate specific antigen , might augment positive results therapy restricted patients considered high risk surgical anesthetic intervention , continued
bioavailability potassium magnesium , response potassium magnesium citrate bioavailability potassium magnesium , response determined new compound , potassium magnesium citrate , 14 normal volunteers results compared potassium citrate magnesium citrate subject participated 4 phases study potassium magnesium citrate , potassium citrate , magnesium citrate potassium chloride stabilization metabolic diet , subject ingested single load test medication followed timed urine collections next 24 hours test loads included potassium magnesium citrate \( 49 meq potassium , 24 5 meq magnesium 73 5 meq citrate \) , potassium citrate \( 50 meq \) , potassium chloride \( 50 meq \) magnesium citrate \( 25 meq \) urinary potassium , magnesium citrate measured collection period potassium magnesium citrate provided equivalent potassium bioavailability potassium citrate potassium chloride , comparable magnesium bioavailability magnesium citrate however , gave highest response , since cumulative increment urinary citrate post load 129 mg daily potassium magnesium citrate , 105 mg daily potassium citrate 35 mg daily magnesium citrate thus , potassium magnesium citrate gave optimum response addition providing absorbable potassium magnesium
laser treatment obstruction ureteral catheter may develop ureteral catheters cause obstruction report case obstruction relieved laser lithotripsy inside lumen catheter completely noninvasive technique may prove useful selected cases
endopyelotomy secondary ureteropelvic junction obstruction children percutaneous endopyelotomy shown successful treating ureteropelvic junction obstruction adults little data published regarding procedure children describe 4 patients 6 5 weeks 5 5 years old underwent percutaneous endopyelotomy treat ureteropelvic junction obstruction following failed open preoperative obstruction demonstrated , diuretic ultrasonography percutaneous endopyelotomy successful relieving obstruction 4 patients , although 2 required secondary endoscopic procedures one patient persistent obstruction 40 days endopyelotomy ureteropelvic junction , subsequently , required percutaneous resection persistent flap tissue another patient stricture noted time stent removal , treated endoscopic incision patients followed 1 5 3 years postoperatively followup diuretic , ultrasound excretory demonstrated patent ureteropelvic junction patients remained asymptomatic endopyelotomy appears safe effective treating secondary ureteropelvic junction obstruction children
cavernous nerve grafts restore erectile function denervated rats although potency preserved men following radical prostatectomy , patients one cavernous nerves must sacrificed order tumor patients considered nerve reconstruction time surgery using interposition nerve graft possibility tested rat model animals divided three groups sham control group , pelvic exploration conducted without division cavernous nerves nerve ablation group , five mm segment cavernous nerve excised graft group , five mm cavernous nerve excised bilaterally replaced interposition graft femoral nerve one month intervals postoperatively animals group underwent tests determine potency ratio vaginal unsuccessful \( ratio \) determined following tests animals explored attempts made stimulate erections electrically via pelvic nerve results two months show ratio rats grafts \( 0 05 \) nerve \( 0 14 \) low compared sham operated animals \( 1 0 \) month four graft group \( 0 89 \) approached sham group \( 0 91 \) ablation group \( 0 18 \) remains unchanged \( p less 05 \) electrical stimulation month two produced erections nerve ablated grafted rats 100 erections sham operated animals month four , 50 rats grafts , 10 nerve ablated animals , 100 intact animals produced erections upon electrical stimulation \( p less 05 \) results suggest cavernous nerve grafting rats successful restoring potency surgical injury application techniques man may indicated
obstruction recanalization ureter embryonic development major controversies still exist regarding , etiology pathogenesis congenital obstructive diseases ureter try provide additional information controversial subject , comparative study ureteral development rat human embryos , using light electron microscopy , performed fetal development observed demonstrated existence obstructive phenomena , level junction \( 's membrane \) along ureter end embryonic period , ureter undergoes physiologic recanalization process
color doppler ultrasound compared radionuclide scanning spermatic cord torsion canine model high resolution color doppler ultrasound simultaneously display blood flow superimposed detailed gray scale anatomic images using single blind study design , nine adult male dogs underwent spermatic cord torsion subsequent evaluation technetium 99m radionuclide , color doppler ultrasound imaging techniques 90 degrees created surgically , followed examination modality one hour \( four animals \) , four hours \( five animals \) following procedure testicular torsion diagnosed perfusion absent markedly diminished color doppler imaging radionuclide scan cases 360 degrees greater , torsion diagnosed either modality one four hour time delays observers diagnose torsion , asked assess relative testicular perfusion color doppler ultrasound radionuclide scanning without error correctly detecting relative decrease perfusion instances furthermore , color doppler imaging spectral analysis able detect enhancement diastolic component arterial signal 180 degrees torsion spectral pattern coupled relative decrease blood flow allowed presumptive diagnosis one hour partial torsion subsequently apparent absent perfusion 4 hours radionuclide repeat color doppler ultrasound color doppler ultrasound proved superior radionuclide scanning detecting diminished perfusion experiment detailed information provided spectral anatomic display color doppler ultrasound evaluation acute scrotal pathology uncertain etiology
bladder training older women urinary incontinence relationship outcome changes urodynamic observations purpose study clarify mechanism bladder training affects urinary incontinence urodynamic data specific urodynamic diagnoses 108 women urinary incontinence compared 6 months treatment bladder training treatment , 76 women incompetence , 11 detrusor instability , 16 treatment , 33 women longer fulfilled urodynamic diagnostic criteria either sphincter detrusor dysfunction controlling severity treatment , number incontinent episodes post treatment associated change urodynamic diagnosis first sensation void , voided volume , compliance , functional urethral length , flow time showed significant changes pre post treatment evaluations however , none correlated change number incontinent episodes bladder training appear affect lower tract urodynamic variables specific urodynamic diagnosis , likely mechanism action reflects adaptive behavioral changes physiologic changes detected techniques criteria used study may still occur
adipose tissue fatty acid composition relations diet plasma lipid concentrations hemodialysis patients adipose tissue fatty acid composition , serum lipid profile , dietary intake 37 patients maintenance hemodialysis studied august 1982 , 1984 , 1986 , analyses carried 15 \( \) 22 \( htg type iv hyperlipidemia \) patients correlations found dietary intake polyunsaturated fatty acids \( \) , ratio polyunsaturated saturated fatty acids \( p ratio \) , carbohydrate content one hand serum lipid concentrations two groups adipose tissue linolenic acid correlated negatively serum cholesterol groups strong correlations found dietary intake adipose tissue linoleic acid content , double bond index , p ratio adipose tissue linoleic acid content , p ratio double bond index significant differences dietary intake adipose tissue fatty acid composition observed htg patients thus , evidence found exogenous dietary influences serum lipid concentrations adipose tissue linoleic acid content reflect dietary intake
bed child current management problem bed problem experienced significant number children role physician exclude serious underlying problems , time , educate family concerning treatment options may best suited child parents child better understanding problem nighttime bladder control excellent , easier start long term care
human papillomavirus prostatic cancer evidence found situ dna hybridization human papillomavirus associated benign squamous tumors , intraepithelial neoplasia , invasive squamous cancer role human papillomavirus likely precursor cervical dysplasia well studied know available information possible role human papillomavirus prostatic hyperplasia cancer studied formalin fixed paraffin embedded tissues 20 cases glandular hyperplasia 20 cases prostatic cancer situ dna hybridization human papillomavirus using commercially available biotinylated dna probes detected avidin biotin peroxidase technique found evidence dna hybridization human papillomavirus 6 , 11 , 16 , 18 , 31 , 33 , 35 prostate tissue results show association prostatic cancer hyperplasia human papillomavirus genomes studied
fibrin formation vessel walls hyperplastic malignant prostate tissue explore mechanisms coagulation activation adenocarcinoma prostate , occurrence distribution components coagulation fibrinolysis pathways situ studied means immunohistochemical techniques applied frozen sections fresh malignant benign hyperplastic prostatic tissue obtained transurethral resection fibrinogen distributed throughout perivascular tumor connective tissue malignant benign disease present adjacent areas normal prostate antibodies specific fibrin dimer sites stained vascular endothelium focally malignant benign tissues neoplastic cells benign hyperplastic glandular epithelial cells stained weakly patchy distribution tissue factor focally low molecular weight urokinase type plasminogen activator focal staining vascular endothelium also observed tissue plasminogen activator antiplasmin complex contrast , tissue staining observed factor vii , factor x , factor xiii subunit , high molecular weight urokinase type plasminogen activator , plasminogen activator inhibitors 1 3 , protein c , protein thus , similarity findings benign hyperplastic neoplastic prostate tissue , lack either intact tumor cell associated coagulation pathway fibrin formation , presence fibrin vascular endothelium consistent concept coagulation activation prostatic cancer may due direct effect tumor cells clotting mechanism rather , activation may induced soluble tumor product activates procoagulant activity certain host \( example , vascular endothelial \) cells findings , together lack effect warfarin anticoagulation clinical course patients prostatic cancer , contrast findings certain tumor types suggest coagulation activation may contribute progression adenocarcinoma prostate
antibiotics potential hazards male fertility individual agents within major classes antibiotics shown significant adverse effects spermatogenesis spermatozoal function mammals humans , infertility significant alterations semen parameters well documented patients sulfasalazine commonly used antibiotics , , shown toxic sperm concentration information available , clinicians must keep mind treatment antibiotics may adversely affect fertility potential men possible classes antibiotic agents , quinolones , may minimal effects male fertility maintain clinical efficacy patients requiring long term antibiotic suppressive therapy investigation needed relative toxicity antibiotics mechanisms antibiotics affect spermatogenesis spermatozoal function background current state knowledge regarding adverse effects antibiotics male fertility presented review
parathyroid function renal transplant recipients evaluation calcium infusion extent secondary hyperparathyroidism may remains poorly defined renal transplantation offers clinical situation metabolic stimuli hyperparathyroidism removed examine whether hyperparathyroidism transplantation , evaluated 11 renal transplant recipients 6 months transplantation using sensitive 2 site immunoradiometric assay intact serum pth nine 11 pth concentrations within normal range 9 , 6 found abnormal parathyroid function challenged iv calcium infusion 2 patients demonstrated significantly elevated basal pth concentrations elevated ionized calcium despite normal total serum calcium albumin concentrations , pth response infused calcium markedly abnormal , confirming hyperparathyroidism estimated renal threshold phosphate concentration low 4 9 patients normal basal pth concentrations elevated basal pth bone mineral density , measured radius single photon absorptiometry spine dual energy x ray absorptiometry , normal 8 9 transplant recipients normal basal pth concentrations
macrophages nephrotic rats regulate apolipoprotein e biosynthesis cholesterol content independently effects nephrotic syndrome rats cholesterol content biosynthesis apolipoprotein e \( apoe \) resident peritoneal macrophages investigated since nephrotic syndrome associated increased risk coronary atherosclerosis , hypothesized macrophages nephrotic rats would accumulate cholesterol undergo transformation foam cells , concomitant increase apoe biosynthesis nephrotic syndrome induced rats peritoneal macrophages exposed vivo 7 21 ascites fluid derived plasma containing sixfold elevations lipoproteins accumulate esterified cholesterol nevertheless , immunoprecipitation assays incubation isolated cells 35s methionine , immunoblot analysis incubation medium demonstrated 2 6 fold increase apoe secretion compared normal macrophages increase accompanied 5 10 fold increases cellular apoe messenger rna determined quantitative solution hybridization assay peritoneal macrophages cultured nephrotic rats period hypercholesterolemia also showed distinct highly reproducible morphologic changes dissociation apoe biosynthesis macrophage cholesterol content provides new insight response peritoneal macrophages vivo endogenous
randomized comparison nephrotoxicity iopamidol diatrizoate high risk patients undergoing cardiac angiography three hundred seven high risk patients renal impairment \( serum creatinine greater equal 1 5 mg dl \) randomized double blind manner either iopamidol \( nonionic , low osmolar agent \) diatrizoate \( conventional agent \) cardiac angiography subsequent follow study renal function baseline clinical angiographic variables similar iopamidol \( n 155 \) diatrizoate \( n 152 \) groups change renal function angiography less pronounced iopamidol compared diatrizoate measured mean \( sd \) increase 24 h serum creatinine \( 0 11 0 2 versus 0 22 0 26 mg dl , p less 0 001 \) , mean maximal increase serum creatinine \( 0 2 0 44 versus 0 38 0 73 mg dl , p less 0 0001 \) percent patients maximal increase serum creatinine greater 0 5 mg dl \( 8 versus 19 , p less 0 01 \) differences could documented diabetic patients using insulin significant difference agents number patients developing clinically severe acute renal dysfunction concluded iopamidol less diatrizoate high risk patients cardiac angiography however , difference nephrotoxicity small , major clinical significance majority high risk patients could documented insulin using diabetic patients iopamidol may preferred agent certain patients advanced renal impairment , study warranted
simple standing incremental cystometry screening method detrusor instability one hundred consecutive neurologically normal women complaining urinary incontinence underwent standing incremental retrograde medium fill water two different days followed sitting standing continuous retrograde medium fill water third visit november 1987 february 1989 studies done assess reproducibility , sensitivity , specificity , predictive values simple standing incremental , retrograde cystometry found relatively inexpensive , simple , reproducible , sensitive two yielded similar results 84 patients sensitivities found 84 3 90 2 first second , respectively using together , able detect detrusor instability sensitivity 92 3 predict absence negative predictive value 86 7 detrusor instability found 64 patients based results , concluded available high prevalence population , standing retrograde incremental water cystometry done two occasions may offer physician accurate alternative diagnosis detrusor instability
use cyproterone acetate prostate cancer cyproterone acetate antiandrogen potent activity results rapid suppression serum testosterone used single agent , cyproterone acetate yields total androgen blockade may combined low dose diethylstilbestrol , orchiectomy , lhrh agonists improve , theory , results therapy clinical testing , cyproterone acetate proved equivalent diethylstilbestrol markedly less toxicity useful conjunction lhrh agonists , either transiently block flare phenomenon , continuously block peripheral androgen receptors necessity latter action yet proved cyproterone acetate may afford transient objective improvement patients responding forms hormone deprivation experience role limited drug may used suppress hot associated orchiectomy lhrh agonist therapy cyproterone acetate induces local tumor regression owing reversible effects , useful neoadjuvant adjuvant androgen withdrawal therapy patients lower stage disease undergoing radical surgery radiotherapy adverse effects mostly related hormone withdrawal , namely , impotence , infertility , breast tenderness occur less 18 cardiovascular complications approximately 10 treated men
use suramin treatment prostatic carcinoma refractory conventional hormonal manipulation suramin related compounds , view growth factor enzyme binding properties , represent many respects novel approach treatment cancer although preliminary analysis suramin use treatment metastatic prostate cancer , objective response rate appear impressive , much work still needs done optimize suramin 's administration patients elucidate various postulated mechanisms action development related compounds specific enzyme growth factor antagonist properties way
advanced prostatic carcinoma early versus late endocrine therapy since observations , androgen deprivation treatment advanced stage prostate cancer although early , poorly controlled studies suggested enhanced survival hormonal therapy , view fell result observations first second studies recently , proliferation experimental clinical data supporting early androgen deprivation , including data , suggests survival advantage younger patients stage disease high grade tumors undergo androgen ablative therapy time diagnosis risk benefit analysis presented review strongly supportive early hormonal therapy finally , long term survival patients metastatic prostate cancer require development novel treatment strategies effective androgen resistant tumor cells use concert early androgen deprivation
future developments systemic therapy prostatic carcinoma prostate cancer common type cancer men despite increased public awareness new screening methods , significant proportion men continue present metastatic disease men respond initially hormonal intervention however , given time , majority recurrences unresponsive tumor present therapies little impact research continues identify new cellular molecular aspects prostate cancer implications possible sites therapeutic intervention
total androgen ablation canadian experience multicenter randomized , double blind trial comparing total androgen blockade obtained use castration pure anti androgen \( nilutamide \) simple castration begun one hundred five patients received combined treatment 103 orchiectomy plus placebo several features used evaluate efficacy bone pain responded better combined treatment 6 months \( p 0 \) number favorable responses , evaluated criteria , 61 simple castration 78 combined treatment \( p 0 013 \) statistically significant difference two groups time progression \( test p 0 462 \) survival \( test p 0 137 \) despite increase median survival 5 4 months measures showed difference two treatments total androgen blockade , 50 patients disease progression 1 year , 45 dead 2 years review results similar reported studies suggests improvement modest improvement total androgen blockade testicular androgen ablation alone
megestrol acetate plus low dose estrogen management advanced prostatic carcinoma megestrol acetate plus low dose estrogen may effective , low cost alternative pharmacologic surgical castration plus flutamide management patients advanced prostate cancer potential benefit combined androgen ablation achieved means comparison conventional hormonal therapy appears limited
role 5 alpha reductase inhibitors treatment advanced prostatic carcinoma know biology prostate supports concept obligate androgen responsible normal hyperplastic growth whether selectivity maintained malignant transformation unknown consistent emergence androgen insensitive disease highlights spectrum biologic evolution cancer capable tumor dependent neoplastic growth , unique characteristics 5 alpha reductase inhibitor offer several potential actions warrant systematic evaluation
use nonsteroidal anti androgen advanced prostatic carcinoma pure anti androgens advantages steroidal anti androgens cyproterone acetate type treatment patients advanced prostate cancer steroidal side effects marked inhibitory effect addition , long half life pure anti androgen results maintenance high serum anti androgen concentrations , concern clinical significance small rise serum testosterone concentrations anti androgen choice treatment androgen responsive diseases yet defined however , choice based extensive clinical evaluations drug monotherapy always , clinical efficacy tolerability drug important factors determining anti androgen choice however , favorable pharmacokinetics emphasized treatment disease high sustained concentrations antagonist must present prevent androgenic stimulation , pure anti androgen relatively long half life , produces objective subjective responses similar surgical pharmacologic castration well tolerated profile makes strong candidate consideration future anti androgen choice treatment advanced prostate cancer
use standard contraceptive diaphragm management stress urinary incontinence management stress urinary incontinence \( sui \) consists either surgical intervention pharmacologic manipulation twelve patients sui evaluated management use fitted standard contraceptive diaphragm complete resolution sui achieved 11 12 patients \( 91 \) two 12 patients achieved continence withdrew study associated discomfort diaphragm , therefore , complete resolution sui achieved 9 12 patients \( 75 \)
multilocular cysts kidney study 29 patients review literature multilocular renal cyst distinct renal tumor whose gross external appearance absence normal renal tissue within septa distinguish clearly renal cystic lesions septa may contain either \( 1 \) fibrous tissue alone \( 2 \) embryonic tissue separating adjacent 29 patients multilocular renal cysts , 24 underwent renal sparing procedure , 5 radical nephrectomy none histologic specimens showed evidence immature renal tissue neoplasia patients followed three months eight years \( mean , 39 months \) , evidence local recurrence metastatic disease found difficult distinguish multilocular renal cyst cystic wilms tumor clear cell carcinoma basis imaging studies alone , surgical intervention effective method differentiate multilocular renal cyst malignant lesion kidney
mobile epididymis new clinicopathologic entity genesis male infertility treatment mobile epididymis plays important role genesis male infertility constituted 9 percent consecutive series idiopathic infertility 200 patients examined \( 100 fertile 100 infertile \) , mobile epididymis detected 9 infertile patients clinical picture characteristic epididymis widely separated testicle side side body tail ill formed angle azoospermia persistent 3 patients intermittent 6 patients testicular biopsy showed tubular dilatation performed 9 patients epididymis testicle 3 patients showed improvement semen quality two resultant pregnancies failures due advanced testicular damage infertility mobile epididymis appears result obstruction efferent ductules , testicular ischemia , interference sperm maturation , transport , delivery
simple urodynamic evaluation incontinent elderly female nursing home patients descriptive analysis present descriptive analysis functional , mental , urodynamic status population incontinent elderly female nursing home patients one hundred fifty five intermediate care female patients mean age 85 5 years identified incontinent urine least daily evaluation , patient classified one four categories incontinence normal 68 \( 44 \) , detrusor instability \( di \) 52 \( 34 \) , stress incontinence \( si \) 27 \( 17 \) , incontinence \( \) 7 \( 4 \) thirteen weeks later , patients studied using simple water cystometry follow evaluation , 45 patients \( 33 \) urodynamic findings differed initial evaluation women , 10 di , 12 si , 2 found normal cystometric parameters time follow study , 19 \( 14 \) initially normal cystometric findings evidence di \( 11 \) si \( 3 \) strong correlation urinary incontinence patients normal cystometric findings moderate severe cognitive impairment present simple urodynamic evaluation identify patients si might benefit specific therapy urodynamic evaluation incontinent elderly female nursing home patients indicated may provide direction planning treatment strategies
pharmacokinetics metabolism nilutamide data available pharmacokinetics metabolism nilutamide rat , dog , human \( normal volunteers patients advanced prostatic carcinoma \) studies using nilutamide , radioimmunoassay , high performance liquid chromatography \( hplc \) reviewed rat , bioavailability oral route complete majority plasma radioactivity unchanged nilutamide six hours , t1 2 seven hours , clearance 150 ml hour kg body weight metabolism studies identified 6 urinary metabolites major metabolites result reduction group initially \( 17 \) primary amino \( 26 \) group normal volunteers compound rapidly absorbed , displayed linear kinetics dose range 100 300 mg , declined slowly plasma terminal phase t1 2 forty three forty nine hours studies 12 patients advanced \( stage \) prostatic carcinoma , single dose kinetics 14c nilutamide kinetics repetitive twice daily dosing two seven weeks measured terminal phase plasma t1 2 unchanged nilutamide 56 19 hours total radioactivity 87 27 hours \( mean sd \) area curve plasma radioactivity 23 38 percent unchanged nilutamide urinary excretion radioactivity slow incomplete collection time long enough regard t1 2 \( mean 5 days , 62 10 \) consisted almost entirely metabolites steady state plasma levels nilutamide reached two weeks concluded humans , unlike species , plasma decay nilutamide slow elimination almost exclusively metabolism single daily dosing appropriate hepatic impairment could expected prolong plasma decay renal impairment likely little effect
castration plus nilutamide vs castration plus placebo advanced prostate cancer review combination antiandrogen treatment surgical medical castration improve efficacy endocrine treatment prostatic cancer blocking effects adrenal androgens nonsteroidal antiandrogen , nilutamide , shown promising results preliminary open studies short term \( 29 days \) comparison nilutamide plus plus placebo , nilutamide \( 300 mg day \) , significantly reduced bone pain , fewer patients experienced worsening pain control group initial induced increase prostatic acid phosphatase prevented nilutamide , similar increase testosterone gonadotropin concentrations seen control group thus , nilutamide prevent tumor flare associated start luteinizing hormone releasing hormone \( lh rh \) treatment , even though endocrine responses affected three multicenter , randomized , double blind placebo controlled trials castration nilutamide involving patients , combination nilutamide castration decreased bone pain , improved performance status , increased number patients objective regression , compared patients receive nilutamide nilutamide generally well tolerated , though visual disorders , gastrointestinal disorders , alcohol intolerance reported patients receiving nilutamide results suggest nilutamide improves efficacy castration patients prostatic cancer current studies investigating effects treatment survival risk benefit ratio
pharmacology antiandrogens value combining androgen suppression antiandrogen therapy antiandrogens compounds able block effect androgens directly target cells inhibiting binding androgen receptor \( ar \) two chemical classes antiandrogens presently market clinical trials steroids \( cyproterone , megestrol \) , \( flutamide , nilutamide \) steroid antiandrogens interact ar also progestin glucocorticoid receptors thus give rise progestin glucocorticoid effects contrast , antiandrogens interact ar thus devoid hormonal activities nilutamide need transformed active metabolite , unlike flutamide , dog , rat , human prostate ar vitro kinetics lead prolonged interaction ar vivo administration rats prostate cancer treatment , necessary combine antiandrogen surgical chemical \( estrogens , lh rh agonists \) castration obtain complete suppression androgens antiandrogen block specifically , target site , trophic effect adrenal androgens left intact castration , secretion suppressed treatments \( adrenalectomy , , ketoconazole \) also suppress synthesis shown nilutamide trophic effect , prostate rats , adrenal androgens administered continuously \( \) circulating levels similar recorded men nilutamide also flare effect testosterone increase induced lh rh agonists beginning treatment shown rat treated increase prostate weight observed initial days treatment lh rh agonist inhibited combined treatment nilutamide combined treatment nilutamide plus castration tested experimental androgen dependent cancer model , tumor administration nilutamide mice , twenty four hours inoculation tumor cells , delayed appearance tumors reduced number finally , absence androgen effect antiandrogen activity product also demonstrated human tumor cells culture \( 47 cells \) transfected androgen dependent promoter coupled cat reporter gene
antisperm antibody detection using concurrent indirect immunofluorescence microscopy anti sperm antibodies serum seminal plasma detected concurrent flow cytometry microscopy using fluorescein conjugated antihuman immunoglobulins experimental conditions designed , taking advantage several monoclonal antisperm antibodies , test aspects assay clinical application perturbation membrane integrity altered localization binding number sperm cells positive bound antibodies specimens selected infertility patients , 21 6 females 40 8 males significant levels antisperm antibodies differences incidence female partners antibody positive antibody negative males differences localization antigens targeted serum versus seminal plasma antibodies men support idea , cases , immunity sperm cells may result altered sperm antigens
effects polysulfone dialyzers beta 2 microglobulin removal hemodialysis patients published erratum appears j kidney 1991 jul 18 \( 1 \) 144 define relationship dialyzer reuse removal beta 2 microglobulin \( beta 2m \) dialysis , 26 patients received hemodialysis studied thirteen patients dialyzed conventional dialyzers , thirteen patients dialyzed high flux polysulfone dialyzers patients group dialyzed new dialyzers primary use phase study , dialyzers reuse phase dialyzers used six times reuse phase serum beta 2m levels measured predialysis , adjusted fluid loss dialysis conventional new dialyzers primary use phase study resulted 3 3 increase serum beta 2m levels , 2 4 increase serum beta 2m levels reuse phase difference change concentration beta 2m primary use reuse phases statistically significant dialysis high flux polysulfone new dialyzers primary use phase associated decrease 59 5 mean concentration serum beta 2m compared predialysis level corresponding decrease 62 6 serum beta 2m levels observed dialysis high flux polysulfone dialyzers reuse phase data show evidence adverse effect clearance beta 2m dialysis reuse dialyzers six times results confirm previous studies reported high flux dialysis polysulfone dialyzers removes substantial amounts beta 2m , dialysis conventional dialyzers
concomitant iron aluminum mass transfer following deferoxamine infusion hemofiltration variable tissue alter removal rate iron aluminum owing higher affinity deferoxamine \( dfo \) higher plasma concentrations , fe could impair al removal cases simultaneous body burden fe al plasma kinetics mass transfer therefore studied 12 uremic patients different fe al status six normal ferritin levels \( less 400 micrograms l ng ml \) , al 1 4 4 7 mumol l \( 40 131 micrograms l \) \( group \) six increased ferritin \( greater 2 , 000 micrograms l \) , al 1 7 17 mumol l \( 47 micrograms l \) \( group b \) dfo \( 40 80 mg kg random sequence \) administered week first hour first hemofiltration \( hf \) results show groups dfo doses , maximum fe al mass transfer achieved first second hf , respectively 80 mg kg dose dfo significantly raised al mass transfer groups , whereas fe mass transfer slightly affected even though plasma fe levels almost always higher al , al mass transfer eventually exceeded fe , fe normal fe overload patients bias towards al mass transfer enhanced groups second hf , higher dfo doses thus , dfo week reduced fe loss less 30 mumol wk patients normal ferritin levels fe al overloaded patients , al removed , al mass transfer may often exceed fe mass transfer , depending degree tissue burden , time dfo infusion , dfo dose
calcitriol metabolism patients chronic renal failure studied calcitriol metabolism white patients chronic renal failure age sex matched normal subjects plasma levels calcitriol \( 21 9 1 6 pg ml , n 7 , v control , 37 4 2 9 pg ml , p less 0 001 \) , metabolic clearance rate \( \) calcitriol \( 0 45 01 ml min kg v control , 0 58 02 ml min kg , p less 0 001 \) , production rate \( pr \) calcitriol \( 14 2 1 0 ng kg v control , 31 8 3 2 ng kg , p less 0 001 \) significantly lower patients moderate renal failure \( average creatinine clearance , 0 59 0 01 ml 35 1 6 1 ml min \) compared respective values normal control subjects calcitriol determined patients renal failure received calcitriol , 1 microgram , 1 week remained unchanged \( 0 46 04 ml min kg , n 7 \) plasma levels calcitriol increased 34 6 2 77 pg ml mechanism calcitriol decreases renal failure partly due presence inhibitory factors degradation enzymes uremic plasma uremic plasma obtained hemodialysis patients infused normal sprague dawley rats , calcitriol \( 0 20 01 ml min kg , n 6 \) markedly suppressed comparison rats infused normal plasma \( 0 37 01 ml min kg , n 6 , p less 0 001 \) uremic plasma also contained factors inhibit synthesis calcitriol conclude metabolic degradation calcitriol decreased patients renal failure , uremic plasma contains inhibitory factors suppress synthesis degradation calcitriol
community acquired acute renal failure acute renal failure usually occurs hospitalization , may also present admission hospital define causes outcomes community acquired acute renal failure , undertook prospective study patients admitted hospital acute elevations serum creatinine concentrations 17 month period , admission serum creatinine determinations screened patients values greater 177 mumol l \( 2 mg dl \) values compared baseline select patients acute elevation serum creatinine occurring outside hospital one hundred patients entered study , overall incidence 1 hospital admissions seventy percent patients , 11 intrinsic acute renal failure , 17 obstruction , 2 could classified mean peak serum creatinine \( 18 mumol l 3 6 0 2 mg dl \) mortality \( 7 \) lowest group group , volume contraction due vomiting , decreased fluid intake , diarrhea , fever , , diuretics common underlying cause group intrinsic acute renal failure severe renal failure highest mortality \( 55 \) although ischemic acute tubular necrosis common cause hospital acquired intrinsic acute renal failure , etiology seen one patient drug induced nephrotoxicity infection related causes common underlying etiologies intrinsic acute renal failure obstructive renal failure mortality 24 commonly due benign prostatic hypertrophy
serial glomerular tubular dynamics rats remnant kidneys serial measurements performed wistar rats five nephrectomy undergone prior selective thyroidectomy \( tx group \) thyroidectomy thyroxine replacement \( txt4 group \) determine effects tx glomerular tubular dynamics relation tx attenuation renal failure progression 1 week , inulin clearance rates \( cin \) txt4 tx rats 0 0 171 0 120 0 036 ml min , respectively , different p less 0 01 corresponding single filtration rate \( \) , glomerular plasma flow \( \) , glomerular hydraulic pressure \( delta p \) , proximal tubular reabsorption \( \) reduced tx compared txt4 rats \( p less 0 01 \) protein excretion \( \) 151 40 txt4 rats , 9 5 mg tx animals glomerular mesangial matrix expansion focal changes frequent txt4 tx rats 4 weeks , cin , , , glomerular ultrafiltration coefficient \( kf \) similar tx txt4 glomerular capillary pressure \( \) remained lower tx rats \( 35 3 v 50 3 mm hg txt4 , p less 0 001 \) 161 24 txt4 17 12 mg tx rats 7 4 glomeruli showed focal sclerosis txt4 rats , none tx group maximal glomerular planar area increased 1 4 weeks txt4 group , tx group however , measurement significantly different txt4 tx glomeruli 1 4 weeks minimal focal changes found txt4 , progressive observed 1 week reduced 1 week result disproportionately greater increase afferent \( ra \) efferent arteriolar resistance \( \) tx rats \( p less 0 025 \) however , 4 weeks , ra decreased values identical txt4 animals lower tx rats result reduced mean arterial pressure conclusion , reduced sole functional correlate decreased proteinuria glomerulosclerosis afforded tx partial nephrectomy model suppression either nephrectomy related hypertrophy injury tx could excluded least partially protective factors
platelet complement interactions mesangial proliferative nephritis rat complement reported mediate glomerular rat model glomerulonephritis \( gn \) induced anti thy 1 antibody investigate mechanism complement mediated , authors first determined effect complement depletion inhibit cell proliferation whether effect primarily inhibit leukocyte infiltration rats depleted complement venom factor \( \) 1 \) significantly less controls day 5 \( 0 6 0 1 versus 3 4 0 4 , scale 0 4 , p less 0 001 \) 2 \) less cell proliferation , assessed immunostaining proliferating cell nuclear antigen \( \) , cell cycle dependent antigen \( 0 5 0 1 versus 2 4 0 7 cells glomerular cross section , p less 0 01 \) 3 \) less leukocyte infiltration assessed immunohistochemical labeling \( 0 6 0 1 versus 1 9 0 3 cells glomerular cross section , p less 0 01 \) reported recently platelets also mediate glomerular cell proliferation model , study examined whether mechanism complement mediated cell proliferation involved effect glomerular platelet localization glomerular uptake 111in labeled platelets quantitated normal treated rats 1 , 4 , 12 , 24 hours induction gn rats anti thy 1 gn substantial glomerular accumulation platelets times studied , peaking 4 hours \( 171 platelets per glomerulus \) complement depletion profoundly reduced glomerular platelet localization anti thy 1 gn \( mean less 35 platelets per glomerulus times studied , p less 0 05 \) thus studies demonstrate important role complement mediating platelet localization anti thy 1 gn , effect may account complement dependent , neutrophil independent glomerular model
glomerular basement membrane expansion passive nephritis absence increased synthesis type iv collagen , laminin , fibronectin distribution synthetic rate glomerular basement membrane components examined passive nephritis model experimental membranous nephropathy extensive tissue injury developed included subepithelial electron dense deposits , foot process , expansion glomerular basement membrane levels mrna type iv collagen , laminin , fibronectin isolated glomeruli quantitated slot blot analysis showed change experimental animals compared controls either 1 week , 3 weeks , 3 months disease induction immunoelectron microscopy gold labeled anti laminin igg revealed difference number particles bound glomerular basement membrane experimental animals controls immunofluorescence type iv collagen antisera anti laminin antibody showed difference intensity pattern staining despite extensive glomerular damage glomerular basement membrane thickening , evidence found either increase synthetic rate type iv collagen , laminin , fibronectin accumulation basement membrane laminin within damaged glomeruli alternate processes , diminished density matrix components accumulation matrix constituents , presumably account expansion glomerular basement membrane seen experimental membranous nephropathy
management stones using combination lithotripsy , percutaneous nephrolithotomy solution r irrigation treatment partial calculi remains complex despite modern methods stone removal describe results following treatment 112 stones three methods used percutaneous nephrolithotomy , extracorporeal shockwave lithotripsy solution r irrigation , either alone combination 57 stones \( 55 8 \) completely cleared , solution r irrigation helping achieve complete clearance 6 24 stones completely cleared \( small asymptomatic fragments less 3 mm remained \) satisfactory outcome \( stone free asymptomatic fragments less 3 mm \) achieved 81 stones \( 79 \)
impact extracorporeal piezoelectric lithotripsy management ureteric calculi audit presentation management 153 patients ureteric calculi requiring active treatment 12 month period reviewed 74 patients primary ureteric calculi 26 ureteric calculi composed fragments resulting extracorporeal piezoelectric shockwave lithotripsy \( epl \) renal calculi 32 patients \( 21 \) 1 calculus primary procedures included situ epl \( n 54 \) , push \( 44 \) , retrograde ureteroscopy \( 40 \) , basket extraction \( 6 \) , push \( 1 \) , antegrade ureteroscopy \( 1 \) combinations \( 7 \) success primary procedure could predicted stone size , site duration ureter , upper tract dilatation significantly less \( p less 0 01 \) successful group overall success rate complete stone extraction 97 , 54 patients \( 35 \) required 1 procedure achieve situ epl push , either primary secondary procedures , successful treating 79 patients \( 52 \) 2 patients required ureterolithotomy \( 1 3 \) overall complication rate 18 since epl successful treating approximately half ureteric calculi , range treatments available maintain low rate open surgery
extracorporeal shock waves affect urinary excretion glycosaminoglycans \? urinary excretion glycosaminoglycans \( \) studied 9 dogs 10 patients single kidneys animals studied 4 5 hours administration shock waves 1 kidney , contralateral organ serving control urinary excretion measured sides patients studied 0 24 32 56 h extracorporeal shock wave lithotripsy \( eswl \) animals increased mean urinary excretion observed sides marked treated kidney increase reflects tissue injury exposed kidney induced extracorporeal shock waves increase mean urinary excretion observed patients
night studies primary diurnal nocturnal enuresis preliminary results modified conventional urodynamic apparatus used provide overnight monitoring bladder rectal pressure group 26 patients primary diurnal nocturnal enuresis underwent daytime rapid fill cystometry overnight natural fill cystometry overnight study effective detecting detrusor instability 10 patients deemed normal rapid fill cystometry 6 undergone 5 dry 3 awaiting procedure remains effective management patients resistant nocturnal diurnal enuresis careful selection adopted overnight cystometry proved invaluable adjunct investigation patients primary diurnal nocturnal enuresis previously felt normal
voided urine suitable flow cytometric dna analysis \? samples bladder washings frequently used provide cellular material flow cytometric dna analysis since voided urine potential source similar material , aim study determine whether voided urine yields satisfactory specimens compared qualitative results flow cytometric dna analysis cells 53 specimens voided urine 109 samples bladder washings 45 \( 24 53 \) urine specimens gave satisfactory dna histograms compared 93 \( 101 109 \) bladder washings difference apparent regardless whether bladder contained tumour concluded bladder washings provide superior material flow cytometric dna analysis flow cytometric dna analysis freshly voided urine may deficiencies preclude use routine clinical practice
radical radiation treatment invasive locally advanced bladder carcinoma elderly patients total 146 patients invasive locally advanced carcinoma bladder \( t2 t4 \) underwent radiation treatment significantly higher complete response rate observed doses equal 55 gy doses corresponding cumulative radiation effect \( cre \) values radiation effect units \( \) multivariate analysis , decreasing time first diagnosis bladder carcinoma radiation treatment 1 transurethral resections associated significant increase survival increases category sedimentation rate negative prognostic factors although radiation dose cre levels significant effect survival univariate analysis , increase cre levels alone associated significant increase survival multivariate analysis however , important predictor survival whether patient showed complete local response study importance treating patients adequate radiation dose short period time order achieve maximum effect thereby increase possibility cure
activation complement , kallikrein , fibrinolysis coagulation systems urinary catheters effect time temperature biocompatibility studies urethral strictures induced use latex catheters combined silicone latex catheters following open heart surgery reported strictures differ post catheterisation type affecting greater length urethra recently shown complement activated catheters cause inflammation , contrast clinically silent catheters present study designed investigate possible association catheter induced inflammation activation another mediator inflammation , contact system also investigated various vitro conditions biocompatibility studies data indicate complement kallikrein system activated potentially harmful silicone latex catheters may involved pathophysiology catheter induced urethral strictures vitro biocompatibility tests may performed 20 37 degrees c glass test tubes may used vitro complement kallikrein investigations
prospective study prospective study 74 men presented \( 76 \) experienced 1 2 episodes 9 \( 12 \) 40 years old simple investigations led diagnosis 9 men 40 , pathology could detected 48 diagnosis made 32 remaining 34 men simple investigations patients 40 years age , potentially treatable cause normally found routine investigation include cystoscopy younger men , non invasive investigation alone identify pathology invasive investigations reserved patients problem prolonged , excessive association symptoms
intravascular retention renal handling purified natural cross linked hemoglobins plasma half time unmodified hemoglobin \( \) two cross linked hemoglobins \( alpha alpha xl beta beta xl \) measured anesthetized rats intravenous bolus 20 mg 100 gm 1 rule possibility differences among plasma half times might caused differences acute effects renal excretory function , glomerular filtration rate \( gfr \) effective renal plasma flow \( \) measured simultaneously plasma half time experiments also done determine whether higher doses \( 60 100 mg 1 100 gm 1 \) compounds delayed effect \( 48 hours \) gfr massive urinary excretion occurred however , 1 alpha alpha xl none beta beta xl excreted plasma half time alpha alpha xl beta beta xl averaged 3 3 hours , four times longer case decrease gfr occur instead , transient increase gfr , , urine flow , systemic blood pressure seen similar increases occurred albumin administration , suggesting expansion vascular volume initiating factor renal functions 48 hours 60 100 mg 100 gm 1 , alpha alpha xl beta beta xl different control \( albumin \) hemoglobin intravascular precipitates evident acute 48 hour studies 48 hours staining material found one alpha alpha xl specimen 3 hours administration staining material present renal tubule cells albumin treated kidneys
factor xiii substrates , fibronectin , fibrinogen , alpha 2 antiplasmin , plasma urine patients nephrosis plasma urine concentrations factor xiii circulating substrates \( fibronectin , fibrinogen , alpha 2 antiplasmin \) measured group 36 patients nephrotic syndrome results compared obtained group 32 normal volunteers \( control group \) 12 patients end stage renal disease \( esrd \) mild significant reduction plasma level abnormal urinary excretion alpha 2 antiplasmin found nephrotic group plasma concentrations factor xiii , fibronectin , fibrinogen significantly elevated patients nephrosis contrast , patients esrd showed significant difference plasma concentrations either factor xiii , fibronectin , alpha 2 antiplasmin modest elevation fibrinogen compared normal controls significant correlation found serum creatinine concentration plasma levels factor xiii circulating substrates nephrotic group measurable quantities factor xiii small quantities fibronectin found urine patients nephrosis elevation plasma factor xiii , fibronectin , fibrinogen concentrations nephrotic group considered result combination increased synthesis possibly contracted intravascular distribution proteins face negligible urinary losses presence observed abnormalities nephrotic group absence non nephrotic esrd group tends exclude renal failure cause abnormalities although clinical significance abnormalities uncertain , potentially contribute platelet nephrotic syndrome
fluorouracil recombinant human interferon alfa 2a treatment metastatic chemotherapy refractory urothelial tumors thirty patients advanced metastatic chemotherapy refractory urothelial tumors received combination fluorouracil \( 5 fu \) recombinant human interferon alfa 2a thirty six sites metastases present 30 study patients , median eastern cooperative oncology group performance status 3 \( range , 1 4 \) patients failed respond primary combined methotrexate cisplatin based chemotherapy nine \( 30 confidence interval , 15 47 \) patients achieved partial response mean duration response 5 2 months \( median , 6 months range , 3 8 months \) two patients achieved partial response 5 7 months' duration , respectively , control residual disease \( one radiation one surgical excision \) remained disease free additional period 7 13 months , respectively data suggest combination 5 fu recombinant human interferon alfa 2a synergistic , clinical significance treatment urothelial tumors response rate combination drugs higher anticipated either agents used alone additional confirmatory trials needed evaluate significance findings
kidney family member primary care physicians help prepare potential donors relative needs kidney survive , family members often offer one without stopping consider physical , emotional , financial , considerable family 's primary care physician helpful guiding potential donors , screening done community , ease financial strain authors discuss things potential kidney donor consider
comparative study cephradine amoxicillin clavulanate treatment recurrent urinary tract infections eighty eight female patients history recurrent urinary tract infections treated according randomization scheme either 1 g cephradine every 12 h \( 47 patients \) mg amoxicillin clavulanate every 8 h \( 41 patients \) 7 days treatments equally effective \( cure rates 89 cephradine 88 amoxicillin clavulanate \) showed similar relapse rates \( cephradine , 14 amoxicillin clavulanate , 11 \) adverse effects similar groups \( cephradine , 23 amoxicillin clavulanate , 22 \)
self administered chlorpromazine unusual cause priapism priapism prolonged , painful penile erection sexual desire ejaculation etiologies priapism numerous diverse priapism serious adverse effect psychotropic medications case 36 year old man demonstrated priapism , 48 hours inserting chlorpromazine urethral , reported priapism induced route drug administration previously described pathophysiology treatment priapism reviewed
impact breakthrough clinical trials survival population based tumor registries three statistical models developed study impact two breakthrough clinical trials \( mopp hodgkin 's disease pvb disseminated testicular cancer \) survival connecticut tumor registry national cancer institute 's surveillance , epidemiology , end results \( \) registry program segmented regression model used conjunction cox semi parametric proportional hazards model , well parametric exponential cure models models allow us determine approximately survival first began improve dramatically , indicating improved treatments become available , long took survival level indicating full population survival impact realized addition , degree parametric models fit allows us determine survival improvements occur within parametric family results modelling indicate dissemination took approximately 11 years hodgkin 's disease 3 years disseminated testicular cancer disease sites survival first prior trends time breakthrough trial started publication , indicating earlier moderately successful trials combination chemotherapy may initiated improved population survival trends reasons difference dissemination time two cancer sites examined order understand factors may responsible speed dissemination effective utilization new therapies
routine screening cancer prostate value screening prostate cancer remains unclear although digital rectal examination , transrectal ultrasonography , determination serum prostate specific antigen levels may lead early detection malignancy , procedures never shown reduce disease specific mortality prostate cancer unfortunately , several potential errors found uncontrolled trials may suggest benefit screening none exists large , randomized , controlled clinical study demonstrating decreased mortality prostate cancer prove screening beneficial study performed , patients informed potential benefits risks screening treatment
transient renal tubular dysfunction 90 km running race course 19 study renal function five runners , , 90 km race , one developed transient renal tubular dysfunction immediately race features renal failure 84 fold increase urine beta 2 microglobulin excretion \( 0 19 16 0 micrograms min 1 \) much smaller increase urine total protein excretion \( 0 07 0 18 mg min 1 \) post race period post race creatinine clearance remained pre race levels throughout study , varying 42 8 72 9 ml min 1 , contrast post race 49 increase remaining runners \( 138 1 12 9 205 5 59 9 ml min 1 \) clearance also remained low \( 0 31 0 98 ml min 1 \) compared pre race values \( 1 46 0 02 ml min 1 \) , urine flow rates \( 0 11 0 18 ml min 1 \) compared pre race values \( 0 34 0 02 ml min 1 \) renal dysfunction persisted despite patient receiving 2 l intravenous fluids immediately race probably resulted fluid restriction race full recovery renal function 1 yr later subject
destruction human bladder carcinoma cells treated e6 conjugated microspheres conjugate , e6 \( ce6 \) covalently bound 1 micron diameter microspheres , investigated photodynamic destruction u1 human bladder carcinoma cells vitro microspheres taken carcinoma cells laser scanning fluorescence microscopy showed localized cytoplasm , apparently within , visualized labeling acridine orange contrast , fluorescence unconjugated ce6 present within cellular membranes use ce6 microsphere conjugates led 20 fold higher mean intracellular concentration , compared unconjugated ce6 cells incubated presence ce6 microsphere conjugates \( 0 43 microm equivalent \) subsequently irradiated nm dye laser pumped argon ion laser showed dose dependent , leading total inhibition colony formation radiant exposure cm2 contrast , cells incubated either unconjugated ce6 \( 0 43 microm \) unconjugated microspheres laser irradiation unaffected cells pretreated ce6 microsphere conjugates irradiated presence 90 showed significantly increased , effect consistent important role state oxygen mechanism injury solution , however , generation oxygen ce6 microsphere conjugates 9 times less efficient unconjugated ce6 markedly greater ce6 microsphere conjugates compared unconjugated ce6 therefore consequence high intracellular ce6 concentration attained phagocytosis conjugates particular sites intracellular localization thus , conjugates efficient system delivery drugs carcinoma cells
immunotactoid glomerulopathy past 10 years , immunotactoid glomerulopathy become recognized increasing frequency lesion characterized histologically highly organized ultrastructural deposits appear composed immunoglobulin complement negative amyloid red stain clinically serologically , patients evidence , amyloidosis , systemic lupus erythematosus , , disorders associated glomerular deposits , also highly organized fibrillar characteristic immunotactoid glomerulopathy appear disease process thus may represent primary glomerulopathy patients immunotactoid glomerulopathy present proteinuria \( nephrotic range 60 \) half patients hypertension , hematuria , renal insufficiency progression end stage renal disease occurred 40 patients reported date experience treating disorder using prednisone immunosuppression limited impressive four patients successfully undergone renal transplantation , proteinuria recurred two associated recurrence immunotactoid glomerulopathy renal allograft although gained insight clinical course histopathology disorder past years , still know little pathogenesis , area research
prolonged survival remnant kidney surgical ablation five renal mass wistar rats fed high protein diet leads focal sclerosis remnant kidney progressive renal failure experimental data suggest injury results hypertension chronic glomerular hyperfiltration data humans largely limited patients unilateral renal agenesis , either unilateral renal disease kidney transplant donation isolated case reports documented focal sclerosis progressive renal failure two patients remnant kidney obtain data humans remnant kidney , surveyed 800 united states criteria inclusion study \( 1 \) surgical resection \( one operations \) resulting presence remnant kidney \( 2 \) adequate period follow , defined 5 years greater total 13 patients identified \( 13 different centers \) twelve patients renal cancer one tuberculosis six patients observed 10 years postoperatively stable serum creatinine levels less 270 mumol l \( 3 0 mg dl \) two six patients 25 30 years seven patients , observed 5 7 years , serum creatinine levels less 270 mumol l \( 3 mg dl \) , one increasing serum creatinine level two longest surviving patients undergone successful pregnancy overall change serum creatinine observations demonstrate possible humans survive 30 years stable serum creatinine , despite presence remnant kidney
evaluation hemodialysis patients treated erythropoietin evaluated 20 hemodialysis patients treated erythropoietin \( epo \) patients hemoglobin levels 8 5 g dl randomized receive either epo \( 100 u kg \) placebo three times per week 12 weeks patients epo significant \( p less 0 001 \) elevation hematocrit levels \( 19 7 v 35 7 \) also significant \( p less 0 05 \) increase predialysis blood urea nitrogen \( bun \) levels , 27 8 versus 29 6 mmol l \( 78 v 83 mg dl \) , serum phosphorus , 1 8 versus 2 1 mm l \( 5 7 v 6 6 mg dl \) protein catabolic rate also increased significantly \( p less 0 05 \) changes seen levels serum creatinine potassium , episodes hyperkalemia frequent patients epo changes seen patients placebo hematocrit increased , clearance blood water urea decreased 9 , clearance creatinine , potassium , phosphorus decreased 15 patients epo increased appetite protein intake frequent episodes hyperkalemia elevated phosphorus level resulted combination increased intake decreased dialyzer clearance may need blood water clearance calculate kt v
management acute pyelonephritis emergency department observation unit study objectives determine whether moderately severely ill patients acute pyelonephritis treated successfully outpatient basis , whether aspect history , physical examination , initial laboratory data predicts failure outpatient therapy need hospitalization design retrospective chart review patients diagnosis acute pyelonephritis seen three year period setting emergency department observation unit urban teaching hospital serving residents city county denver type participants women ages 15 50 symptoms , physical examination , initial laboratory data consistent diagnosis pyelonephritis interventions patients received iv antibiotics , rehydration , analgesics , observation unit 12 hours , either admitted hospital discharged home oral antibiotics measurements main results sixty three 87 patients \( 72 \) acute pyelonephritis managed successfully outpatients , nine \( 22 \) hospitalized directly observation unit considered ill go home , five \( 6 \) returned persistent symptoms ed therapy hospitalized clinical laboratory variable predicted success failure ed observation unit therapy time initial presentation conclusion selected patients , observation unit may used initiate therapy acute pyelonephritis adequate clinical response initial treatment may discharged oral antibiotic therapy appropriate follow
treatment pyelonephritis observation unit study objective determine feasibility managing patients acute pyelonephritis outpatients initial treatment iv antibiotics emergency department observation unit design prospective uncontrolled setting ed observation unit type participants nonpregnant female patients 14 years old older without serious underlying disease evidence septic shock interventions patients received two iv doses trimethoprim sulfamethoxazole 12 hour dosing interval acetaminophen needed nausea fever , respectively baseline laboratory data , urinalysis , urine blood cultures obtained measurements main results patients observed signs septic shock , nausea , vomiting , ability tolerate oral intake end observation period , 43 44 patients discharged oral trimethoprim sulfamethoxazole one additional patient well clinically recalled admitted positive blood culture conclusion patients acute pyelonephritis , despite significant fever nausea vomiting , treated effectively outpatients brief period observation iv antibiotics
kinetic modeling intracellular ph comparison 31p nmr experimental values uremic patients changes intra erythrocytic ph values time , bicarbonate hemodialysis , studied 31p nuclear magnetic resonance simultaneously , ph values whole blood obtained method two compartment model appeared kinetic model explain shifts proton concentrations extra intra cellular media non linear regression used determine exchange constant values good correlation experimental calculated proton concentrations model describe patients individual experimental constants must determined conditions single blood ph determination dialysis permit determination initial intra erythrocytic ph monitoring intra erythrocytic ph hemodialysis
new cause female placental aromatase deficiency description presented first documented case placental aromatase deficiency deficiency caused maternal pregnancy female fetus 24 yr old showed progressive third trimester urinary excretion estrogen less 14 mumol day 35 38 weeks pregnancy , although tests showed reactive patterns serum levels human placental lactogen 460 nmol l maternal serum levels estrogens low , androgens high third trimester dehydroepiandrosterone sulfate loading test induced marked increase maternal serum levels androgens , whereas increase observed estrogens woman delivered vaginally live full term infant exhibited female cord serum levels estrogens extremely low , androgens high aromatase activity placenta , determined conversion 7 3h 17 beta 7 3h estradiol 7 3h estrone , less 0 03 fmol microgram protein min \( control , 9 6 2 2 fmol microgram protein min \) activity placenta 0 63 pmol microgram protein min compared 0 46 0 16 pmol microgram protein min controls rate normal control placentas obtained samples normal placentas patient thus , presence aromatase inhibitor patient 's placenta excluded
n terminal sequence major erythropoietic factor patient identical insulin like growth factor erythropoietic factors present patient nearly normal hematocrit isolated plasma reversed phase gel permeation hplc active fraction purified analysis n terminal sequence identical published sequence human insulin like growth factor \( igf \) recombinant human igf identical elution positions isolated erythropoietic factor reversed phase hplc molecular weight gel permeation hplc furthermore , stimulated erythroid colony formation human bone marrow cultures previously shown isolated human erythropoietic factor results suggest igf may replace erythropoietin stimulator erythropoiesis patients anemia renal failure
measurement urinary lipopolysaccharide antibodies elisa screen urinary tract infection five hundred twenty two clinical urine specimens submitted routine examination tested parallel conventional microscopy culture lipopolysaccharide antibodies enzyme linked assay \( elisa \) assess elisa screen urinary tract infection elisa alone compared routine methods specificity sensitivity , predictive value positive negative tests 73 2 , 75 7 , 51 1 38 5 elisa microscopy variables 71 1 , 82 2 , 92 4 94 7 , respectively elisa absorbency increased increasing bacterial numbers , results varied widely 65 4 contained greater equal 10 \( 5 \) bacteria ml positive elisa 36 8 less 10 \( 3 \) bacteria ml positive elisa 100 greater equal 10 \( 5 \) bacteria ml cultures pseudomonas sp \( n 4 \) , staphylococcus aureus \( n 3 \) , streptococcus \( n 2 \) positive elisa 71 4 sp \( n 7 \) , 61 4 \( n 70 \) , 25 negative staphylococci \( n 4 \) concluded development required elisa used routine screening urinary tract infection
percutaneous nephrolithotomy calculi horseshoe kidneys 1983 1988 , 15 patients \( 18 kidneys \) underwent percutaneous nephrolithotomy unit calculi horseshoe kidneys standard 1 stage percutaneous access technique minor modifications used situ disintegration ultrasound electrohydraulic lithotripsy necessary 15 moieties \( 83 3 \) nephrostomy drainage required 12 \( 66 7 \) percutaneous access problem minimal perioperative problems blood transfusion required postoperatively 2 patients total 14 kidneys \( 77 8 \) rendered free stone percutaneous nephrolithotomy alone 2 kidneys left asymptomatic stone fragments 2 mm less another 2 kidneys became free stone extracorporeal shock wave lithotripsy , thus giving stone clearance rate 88 8 conclude percutaneous nephrolithotomy acceptable treatment stones horseshoe kidneys treatment choice patients imaging difficult impossible
extracorporeal shock wave lithotripsy urinary calculi experience treatment 3 , 278 patients using lithostar lithostar plus march 1986 june 1989 , 3 , 278 patients upper urinary tract calculi treated medical center lithostar lithotriptor stones located 41 9 cases , renal pelvis 25 7 ureter 32 4 hematoma noted 0 5 patients resolved spontaneously within days procedures performed 37 3 cases , including double j stent ureteral catheter 26 8 , 2 1 , percutaneous nephrostomy 1 6 , loop 4 3 percutaneous 3 5 treatments 83 1 performed without general regional anesthesia followup 3 months showed 63 8 rate free stone lithostar lithotripsy called lithostar plus total 25 patients upper urinary stones underwent treatment initial experience revealed fragmentation stones first session 20 patients , second session necessary 5 analgesic sedation used 4 patients double j stent inserted
treatment repeat extracorporeal shock wave lithotripsy experience piezoelectric lithotriptor among patients renal stones underwent extracorporeal shock wave lithotripsy \( eswl \) monotherapy using piezoelectric lithotriptor developed 55 \( 5 7 \) 55 cases stone fragments passed spontaneously 35 \( 63 6 \) treated successfully \( residual stone fragment ureter \) repeat eswl 18 \( 32 8 \) 2 patients \( 3 6 \) required management open ureterolithotomy therefore , repeat eswl considered good initial method treat complicated
findings patients right colonic segment bladder replacement urodynamic evaluation performed 13 men 4 18 months bladder replacement using right colonic segment patients continent day 3 incontinent night degree use condom catheter two patients every 2 3 hours void remainder comparable normal men age residual volume 0 70 ml urethral closure pressure normal , 3 patients studied preoperatively postoperatively significant change observed shortening profile length maximal flow rates normal although pattern intermittent 2 patients contractions recorded 2 patients amplitude contractions less 40 cm water simultaneous bladder urethral pressure recordings bladder filling demonstrated change urethral pressure 10 patients although creation reservoir low pressure careful preservation urethra important continence patients , believe absence normal sacral route reflexes important contributing cause nocturnal incontinence
detection reflux nephropathy infants dimercaptosuccinic acid studies dimercaptosuccinic acid \( dmsa \) studies performed 113 infants less 1 year old risk renal scarring patients 86 presented urinary tract infection 27 asymptomatic voiding performed cases excretory \( \) done 99 abnormalities detected dmsa study compared scars studies abnormal excellent correlation site site basis fever systemic disorder reliable sign determine whether upper tract involvement infection incidence dmsa abnormalities infants increased high grade reflux decreased low grade reflux significant difference incidence abnormal kidneys infected groups , suggesting renal scarring may occur sterile reflux
continuous intravesical drug delivery system rat describe self contained system continuous infusion drugs rat urinary bladder reversible model hydronephrosis used prepare one renal unit nephrostomy tube placement 0 8 mm silastic nephrostomy tube introduced kidney via 16 gauge nephrostomy tube connected mini osmotic pump implanted subcutaneous location ability system deliver continuous dose test agent bladder evaluated pumps filled 1 solution methylene blue phosphate buffered saline following pump implantation , urinary samples collected daily basis subsequently analyzed concentration methylene blue completion experiment , specimens kidney , ureter , bladder histologically examined results demonstrated average 102 recovery theoretically delivered dose 14 day period renal histology demonstrated chronic inflammatory changes site nephrostomy tube placement upper lower tract urothelial changes identified model provides system continuous delivery drugs rat urinary tract results histological alteration lower urinary tract
determination coefficient kinetic friction urinary catheter materials coefficient kinetic friction plays important role biocompatibility urinary catheters method determination vivo coefficient kinetic friction described allows comparison catheter urethral interaction various materials used production urinary catheters different types
radio contrast enhancement urinary tract stones treating stone disease method \( eswl , pcl , \) encountered problems poor stone visualization fluoroscopy difficulty localize urinary tract \( \) stones fragments may result incomplete stone extraction , prolonged surgery increased risk recurrence post operative complications sought found means increase mineral stones simple pre operative perfusion technique capacity first demonstrated vitro incubations fragments human mineral stones aqueous solutions barium , two natural incubations led considerable radio contrast enhancement heavy metal incorporation , measured x ray fluorescence analysis dogs implanted human stone fragments used vivo model perfused retrograde catheter heavy metal salts solutions , ensuing implanted stones estimated abdominal metal incorporation measured retrieved stones considerable enhancement together heavy metal incorporation observed following elements sr , gd pathological evaluation urothelial animals treated salt showed toxic effects
cytostatic effects suramin prostate cancer cells cultured primary tumors suramin currently undergoing clinical trials chemotherapeutic agent prostate cancer effects suramin cultured human epithelial cells derived normal , benign hyperplastic , malignant prostate tissues examined serum free medium , suramin inhibited clonal growth prostate cells half maximal dose approximately 10 micrograms ml growth inhibition suramin completely reversible even 24 hours exposure conjunction , suramin alter cellular phenotype regard expression keratins prostate specific antigens although suramin antagonist growth factor mediated mitogenesis , ten fold excesses growth factors appreciably suppress cytostatic activity suramin comparison activities possible chemotherapeutic agents , suramin would appear suboptimal inhibitory effects reversible induce terminally differentiated cellular phenotype
chronic effects focused electrohydraulic shock waves renal function hypertension chronic effects focused electrohydraulic shock waves studied model fifteen animals underwent unilateral nephrectomy compensatory renal hypertrophy allowed take place minimum six months baseline studies carried consisting 1 \) serum creatinine , blood urea nitrogen , plasma renin levels 2 \) intra arterial blood pressure measurement 3 \) 3h inulin clearance ten animals underwent 8 shockwave treatments \( 2500 shocks per treatment \) , alternately upper lower pole kidney , two weeks intervals total 20 , 000 shock waves administered four month period five control pigs underwent sham procedures renal function blood pressure evaluations repeated significant decrease renal function noted experimental animals compared controls addition , renin mediated hypertension observed despite excessive number total shock waves delivered kidney
renal arterial duplex doppler ultrasound dogs urinary obstruction recent clinical studies using duplex doppler sonography identified alteration renal arterial blood flow obstructed kidneys used distinguish obstructive nonobstructive collecting system dilatation attempted verify clinical findings establish temporal relationship alteration doppler spectrum onset urinary obstruction evaluating surgically induced urinary obstruction dogs performed laparotomies 11 dogs , left ureter isolated ligated five dogs , left intact six dogs \( control group \) duplex doppler examination left renal arteries performed nine times first postoperative month identified statistically significant difference \( p less 05 \) doppler resistive index calculation two groups days 1 , 2 , 4 , week 4 resistive index discriminatory threshold 0 7 \( greater 0 7 , obstructed less 0 7 , \) produced test sensitivity 74 specificity 77 conclude study renal arterial duplex doppler sonography detect change renal perfusion result urinary obstruction change detected early 24 hours obstruction however , high false positive false negative rates may limit ability modality reliably distinguish obstructive nonobstructive collecting system dilatation
effect radiation therapy hyperthermia human prostatic carcinoma cell line grown athymic nude mice effect radiation hyperthermia human prostatic carcinoma xenograft athymic nude mice investigated human prostate carcinoma subline \( 1 ln pc 3 1a \) inoculated subcutaneously thigh male athymic nude mice tumors reached size approximately 200 mm 3 , treated either radiation \( x \) hyperthermia \( h \) alone , combination \( x h \) combined treatment , hyperthermia delivered immediately radiation exposure comparison time required reach twice tumor volume observed time treatment used define therapeutic impact tumor growth combined treatment resulted median tumor volume doubling time 35 5 days , compared 18 days 25 5 days , respectively , hyperthermia radiation alone analysis tumor doubling time using proportional hazards regression indicates conditions experiment , effect radiation hyperthermia 1 ln pc 3 1a tumors additive impact treatment regimen management prostatic cancer requires investigation
image guided localized 31p magnetic resonance spectroscopy acute urinary tract obstruction using 31p magnetic resonance spectroscopy , localized spectroscopy magnetic resonance imaging studied effects acute urinary obstruction vivo pig kidney accumulation urine renal pelvis collecting ducts resulted appearance new peak localized phosphorus spectra originating renal papilla , 3 43 4 56 ppm inorganic phosphate ph 5 60 6 79 \( urine ph \) imaging show dilatation renal pelvis significant time dependent fall renal atp urinary obstruction followed rapid overshoot atp disappearance phosphate peak release obstruction possible mechanisms phenomenon discussed conclude 31p magnetic resonance spectroscopy provides early evidence urinary obstruction vivo could value clinical diagnosis
preliminary experience pulsed dye laser treatment report initial experience using pulsed dye laser 26 patients patients ranged age 27 82 years 11 patients female 15 male 26 patients , 4 stones kidney , 21 ureter , one bladder surgical time ranged 32 130 minutes patients treated spinal general anesthesia size ureteral stones ranged 0 2 1 5 cm , renal stones 3 0 4 0 cm chemical analysis stones available patients , available , chemical analysis revealed stones calcium monohydrate , calcium dihydrate , use 11 patients permitted access without ureteral dilation 19 patients , ureteral stents placed one patient suffered ureteral perforation success defined adequate disintegration stone passage fragments without necessity secondary procedure using criterion , 22 26 patients successfully treated overall success rate 85
diagnosis heterozygous states adenine deficiency based detection vivo somatic mutants blood cells application screening heterozygotes accurate diagnosis heterozygotes autosomal recessive disorders unknown mutations difficult using unique phenomenon occurring vivo , designed method diagnosis heterozygotes adenine \( \) deficiency makes way qualitative distinction normal heterozygous subjects cultured peripheral blood mononuclear cells 2 , 6 , dependent cytotoxin , search vivo mutational cells fifteen putative heterozygotes examined found possess mutant cells rather high frequencies thus , false negative diagnosis unlikely analysis genomic dna 82 resistant clones two heterozygotes clarified 64 \( 78 \) lost intact alleles thirteen members deficient families examined eight proved heterozygotes among 425 individuals two separate residential areas japan , two heterozygotes found heterozygosity validated two separate methods two heterozygotes hence , false positive diagnosis ruled data showed calculated heterozygote frequency 0 47 \( 95 confidence limits 0 05 1 7 \) , value compatible \( 1 2 \) calculated data concerning incidence 2 , 8 novel genetic approach identifying heterozygotes tested search enzyme deficiencies humans
pharmacokinetics bioavailability intravenous oral enoxacin elderly patients complicated urinary tract infections pharmacokinetics oral antibiotics normal volunteers studied extensively however , limited patient data exist enoxacin steady state pharmacokinetics bioavailability determined following repeated 400 mg intravenous \( v \) oral dosing using methods 10 elderly \( mean age , 73 8 years \) men complicated urinary tract infections average peak enoxacin concentrations following v oral dosing 8 15 5 45 mg liter , respectively mean values major pharmacokinetic parameters \( \) similar following v oral administration , respectively area concentration time curve 0 12 h , 47 6 41 0 mg h liter volume distribution volume distribution bioavailability , 1 61 1 99 liters kg total body clearance total body clearance bioavailability , 2 58 3 01 ml min per kg half life , 8 2 9 1 h parameters analysis enoxacin plasma concentration data using two compartment pharmacokinetic model also revealed marked similarities two administration routes enoxacin highly \( mean , 86 97 \) following oral administration
distal urethral electrical conductance \( \) preliminary assessment role quick screening test incontinent women measurement distal urethral electrical conductance \( \) used detect movement urine along distal urethra used screening test 100 women attending urodynamic clinic incontinence 33 women voided 250 ml , findings correlated well subsequent urodynamic diagnosis urethral sphincter incompetence detrusor instability
regulation pulsatile luteinizing hormone secretion experimental uremia previous studies shown male rats experimental uremia manifest profound suppression circulating lh testosterone levels , yet , paradoxically , castration gonadotropin levels elevated greatly control rats investigate phenomenon , characterized pulsatile lh secretion experimental uremia mature male wistar rats subtotal nephrectomy demonstrated 43 reduction lh pulse frequency , 157 increase pulse amplitude increase mean lh levels compared sham operated controls pulse parameters highly correlated plasma creatinine \( r 0 53 0 75 \) determine mechanism increased pulse amplitude , tested responsiveness uremic pituitary exogenous gnrh \( 0 01 10 micrograms kg \) latin square design plasma lh response linearly related gnrh dose uremic control rats , markedly increased uremic rats conclude uremia causes decreased lh pulse frequency independent testicular feedback pituitary hypersensitivity gnrh lh pulse amplitude thereby major factor causing paradoxical lh castration
small artery resistance increases development renal hypertension vascular pressures measured principal \( a1 \) upstream small arteries rat muscle investigate vascular resistance changes associated one kidney , one clip hypertension pressure measurements made proximal distal site vessel using system vessel diameters measured using video microscopy a1 external spermatic artery diameters decreased 2 4 weeks hypertension mean arterial pressure elevated 2 weeks hypertension \( 106 4 mm hg versus 140 5 mm hg \) likewise , vascular pressures elevated every site artery \( 36 \) , external spermatic artery \( 47 \) , a1 \( 38 \) pressure drop along external spermatic artery increased \( 87 \) 2 weeks hypertension mean arterial pressure elevated 2 4 weeks hypertension \( 105 4 mm hg versus 162 7 mm hg \) proximal epigastric artery pressure elevated time 2 4 weeks \( 131 5 mm hg versus 147 7 mm hg \) hypertension development associated increased pressure drop \( 87 \) along artery compared situation 2 weeks data indicate small arteries upstream microcirculation contribute significantly increase vascular resistance hypertension addition , data indicate increases small artery resistance develop uniformly throughout vessel branches
renal nerves modulate renin gene expression developing rat kidney ureteral obstruction chronic unilateral ureteral obstruction \( uuo \) newborn rats activates renin gene expression obstructed kidney , increases renin distribution along afferent glomerular arterioles kidneys investigate role renal nerves response , 2 old sprague dawley rats subjected uuo sham operation chemical performed injection , whereas , control groups received saline vehicle 4 5 wk , renal renin distribution determined immunocytochemistry , renin mrna levels determined northern blot hybridization compared saline treated rats uuo , renin remained localized region kidneys rats uuo receiving \( p less 0 05 \) moreover , renin mrna levels eightfold lower obstructed kidneys rats receiving receiving saline additional groups rats uuo subjected unilateral mechanical renal denervation renin gene expression obstructed kidney suppressed ipsilateral contralateral renal denervation findings indicate either chemical mechanical denervation suppressed increase renin gene expression neonatal kidney ipsilateral uuo conclude renal sympathetic nerves modulate renin gene expression developing kidney chronic uuo
expression smooth muscle cell phenotype rat mesangial cells immune complex nephritis alpha smooth muscle actin marker mesangial cell proliferation mesangial cell proliferation common glomerulonephritis unclear proliferation associated vivo alteration phenotype investigated whether mesangial mesangial proliferative nephritis induced antibody thy 1 antigen present mesangial cells day 3 glomeruli displayed de novo immunostaining alpha smooth muscle actin mesangial pattern , correlating onset proliferation , persisting day 14 increase desmin vimentin mesangial regions also noted immunoelectron microscopy confirmed actin positive cells mesangial cells , double demonstrated smooth muscle actin positive cells actively proliferating northern analysis isolated glomerular rna confirmed increase alpha beta gamma actin mrna days 3 5 complement depletion platelet depletion prevented reduced proliferation , respectively maneuvers also prevented smooth muscle actin actin gene expression studies five experimental models nephritis confirmed smooth muscle actin expression marker mesangial cell injury thus , mesangial cell proliferation glomerulonephritis rat associated distinct phenotypic change mesangial cell assume smooth muscle cell characteristics
percutaneous needle biopsy preceding preoperative chemotherapy management massive renal tumors children national wilms' tumor study \( \) group united states emphasis accurate staging histology therapy given wilms' tumor , international society pediatric oncology \( \) europe focuses preoperative therapy safer surgery current approach combines benefits policies management massive renal tumors children seven consecutive patients first obtained percutaneous posterior needle biopsy obtain adequate tissue histology , preoperative chemotherapy vincristine dactinomycin tumor shrinkage sufficient tumor feasible uneventful time operation , two tumors found totally almost totally necrotic others , still included viable tumor , histology corresponded well needle biopsy findings one case unfavorable histology one rhabdoid sarcoma would missed given suboptimal therapy without primary needle biopsy possible biopsy related complications , subcapsular intratumoral bleeding recognized two patients conclude percutaneous posterior needle biopsy safe yields definite , detailed histology massive renal tumors children preoperative chemotherapy facilitates surgery patients
molecular characterization major domain autoantigen anti tubular basement membrane disease anti tubular basement membrane \( alpha \) disease form primary interstitial nephritis mediated autoimmune cells alpha antibodies mice humans immune response directed glycoprotein \( 3m 1 \) found along proximal tubule kidney isolated cdnas expression library encodes common framework domain 3m 1 antigen common domain related family intermediate filament associated proteins northern hybridization revealed isoforms 3m 1 range base pairs situ hybridization studies indicate transcripts found tubular epithelium candidate peptide fragments deduced synthesized sequence encoding common framework domain , one peptide residues able bind monoclonal 3m 1 reactive alpha antibody , stimulate growth 3m 1 reactive helper cells , induce effector cells capable producing interstitial nephritis results indicate unique , immunodominant region 3m 1 antigen informative participant emergence autoimmune injury certain basement membranes
early detection program prostate cancer results identification high risk patient population three hundred sixty two men underwent transrectal ultrasound prostate \( \) , digital rectal examination \( dre \) , serum prostate specific antigen \( psa \) determination part early detection program prostate cancer thirty seven \( 10 \) cancers detected dre highest sensitivity specificity , 89 percent 84 percent , respectively psa comparable sensitivities \( 84 81 \) specificities \( 82 82 \) positive predictive values dre , , psa determination 39 percent , 35 percent , 33 percent , respectively found cancer detection rate 16 percent among patients symptoms bladder outlet obstruction 5 percent patients without symptoms detection rate 36 percent physician referred patients 3 percent self referred patients suggests us present time best utilization medical resources increase prostate cancer detection educate men annual medical evaluations primary care physicians encouraged incorporate risk assessment screening dre part routine practice man either abnormal findings examination increased risk referred evaluation
incontinence management scale elderly inpatient men many elderly inpatients , urinary incontinence cannot successfully treated management objective identifying suitable method containment urine loss elderly inpatient men , external catheter utilized many cases incontinence management role severity incontinence use external catheter investigated 66 elderly inpatient men quantitative incontinence measurements showed incontinent patients external catheter approximately 6 3 \( sd 2 5 \) episodes per day compared 3 2 \( sd 2 0 \) episodes per day incontinent patients clinical management method used patients associated measured severity incontinence
endoscopic treatment reflux children neurogenic bladders endoscopic injection teflon performed 12 children \( 20 ureters \) neurogenic bladders reflux \( grades iii iv \) follow evaluation ultrasonography voiding three month intervals two years revealed successful correction reflux 70 percent ureters
pediatric testicular tumors experience testicular neoplasms constitute 1 percent childhood malignancies rank eighth childhood cancer mortality 1970 1988 , 25 testicular tumors children eighteen years seen majority patients white \( 88 \) pathologic analysis tumors revealed 68 percent 32 percent staging undertaken patients serum markers , chest x ray film , computerized tomography scans patients underwent radical orchiectomy , therapy given dependent tumor type stage survival among cohort excellent , 3 patients disease detailed results treatment , approaches avoid excess treatment morbidity reviewed
causes post prostatectomy retention forty eight patients urinary retention following prostatectomy underwent urodynamic evaluation fifteen patients \( 31 \) found persistent residual obstruction , 14 patients \( 29 \) detrusor 9 patients \( 19 \) combination outflow obstruction detrusor demonstrated 6 patients \( 13 \) , urinary retention due compromised mental status abnormality detected remaining 4 patients \( 8 \) urodynamic evaluation proper evaluation unsatisfactory voiding prostatectomy cystoscopy limited value urodynamic testing essential
stripping fetal membranes term procedure safe efficacious \? prospective , randomized investigation undertaken low risk group pregnant women term \( 38 42 weeks' gestation \) determine stripping fetal membranes would safely result earlier delivery ninety nine patients entered study 51 underwent stripping membranes , 48 controls fifty nine percent patients group delivered within one week compared 21 group \( p less 0003 \) two pregnancies group advanced beyond 42 weeks' gestation compared six pregnancies control group \( p 12 \) single control group developed chorioamnionitis labor infections complications stripping membranes associated earlier delivery associated complications
coexistence intrauterine pregnancy ectopic pregnancy salpingitis right fallopian tube case report current epidemic pelvic inflammatory disease recent advances gynecologic techniques resulted marked increase incidence combined pregnancy case reported coexistence intrauterine pregnancy acute salpingitis ectopic gestation fallopian tube led early diagnostic errors
transcervical balloon multicenter study transcervical balloon represents noninvasive technique treat proximal tubal occlusion multicenter study , 77 women confirmed bilateral proximal tubal occlusion underwent procedure 71 patients \( 92 \) , least one proximally obstructed fallopian tube concomitant distal bilateral tubal occlusions diagnosed successful proximal tubal balloon 13 patients \( 17 \) remaining 64 patients , 22 clinical pregnancies \( 34 \) confirmed median follow period 12 months among , 17 \( 77 \) resulted normal deliveries five \( 23 \) resulted first trimester miscarriage one patient diagnosed ectopic pregnancy among 25 patients conceived within 6 months procedure , 17 \( 68 \) demonstrated continuing tubal patency repeated conclude transcervical balloon safe outpatient technique may represent alternative vitro fertilization microsurgical fallopian tubes
hypothesis inhibition endothelium derived relaxing factor haemoglobin pathogenesis pre eclampsia although aetiology pre eclampsia unknown , haemodynamic studies suggest many clinical findings may explained generalised disorder abnormal endothelial cell function vasoconstriction may attributed increased concentrations haemoglobin found pre eclampsia compared normal pregnancy free haemoglobin may derived placental haemorrhage , concentrations known present pre eclampsia , vasodilatation mediated endothelium derived relaxing factor inhibited infusion human coronary arteries inhibits acetylcholine induced vasodilatation suggest increased free haemoglobin concentration cause vasoconstriction pre eclampsia
preliminary report oocyte donation extending reproductive potential women 40 background fertility women 40 years age older decreased , ovarian failure thought lost donation oocytes young \( less 35 years old \) women ovarian failure allowed many considered infertile chance become pregnant women gonadal hormone replacement results endometrium receptive implantation known whether endometrial response replacement decreased women age 40 methods test efficacy oocyte donation older women , enrolled seven women 40 44 years old ovarian failure trial hormone replacement embryo transfer , using oocytes obtained women undergoing ovarian solely gamete donation results seven stimulated cycles donors synchronized nine cycles recipients resulted eight embryo transfers five viable pregnancies established , one twins sixth pregnancy ended miscarriage five normal infants delivered cesarean section , one infant delivered vaginally outcomes compared women age 40 ovarian failure also participating donor oocyte program infertile women 40 older undergoing standard vitro fertilization significant differences rates implantation ongoing pregnancy noted older women compared younger women receiving donated embryos rates , however , higher rates infertile women similar age undergoing standard vitro fertilization conclusions preliminary results suggest endometrium retains ability respond gonadal steroids provides receptive environment embryo implantation gestation even older women
premature rupture membranes term nulliparous women hazard \? one hundred five consecutive women premature rupture membranes \( prom \) term managed least 24 hours seventy six went spontaneous labor , 38 augmented oxytocin twenty nine labor induced subjects delivered study interval artificial rupture membranes served controls statistically significant differences frequency , , cystitis , neonatal infection , low apgar score , low cord arterial blood ph , instrumental delivery , cesarean delivery morbidity seen often induced labor whether membranes ruptured long time concluded management prom term increase perinatal morbidity
zinc status women premature rupture membranes term zinc concentrations measured absorption spectrometry whole blood , scalp hair , hair , colostrum patients term without premature rupture membranes \( prom \) maternal zinc index established patient , expressed average ranking four determinations mean sd value maternal zinc index patients prom significantly lower patients without complication \( 4 33 1 18 versus 5 97 1 39 , respectively p 0002 \) inverse relationship maternal zinc index parity statistically significant \( r 0 61 p 04 \) results suggest subnormal tissue zinc content pregnancy may play role causative factor prom term
real time microcomputer based analysis spontaneous augmented labor attempt develop reproducible , objective measure adequate uterine activity labor , real time measurements intrauterine pressure amplitude contraction frequency , interval , duration , integral made 54 patients , 11 received oxytocin augmentation determined active pressure integral required per centimeter cervical dilatation , expressed kpa seconds , mean active pressure , expressed kpa augmented group significantly higher mean active pressure integral per centimeter normal labor \( p less 01 \) trend , reach statistical significance , subjects required oxytocin augmentation labor develop higher mean active pressure normal labor however , correlation uterine contractility index \( units , units , mean active pressure \) progress labor poor conclude women labor require uterine activity progress labor women normally progressing labor , computer derived area curve better predictor labor progress units
accuracy safety transvaginal sonographic placental localization transvaginal sonographic localization placenta performed 100 patients suspected placenta except one patient , diagnosis confirmed cesarean delivery cases placenta found sonography delivery , resulting 93 3 predictive value positive test predictive value negative test 97 6 two patients low insertion placenta diagnosed sonography found placenta delivery sensitivity specificity technique 87 5 98 8 , respectively although instances transvaginal sonography performed vaginal hemorrhage , bleeding never observed transvaginal sonographic localization placenta proved accurate safe diagnostic procedure
effect peritoneal fluid endometriosis patients endometrial stromal cell proliferation vitro late proliferative phase endometrial stromal cells grown short term culture used model stromal component implants cells grown medium alone medium supplemented 5 , 10 , 20 concentrations cell free fractions peritoneal fluid obtained patients without endometriosis nine fluid sample pairs matched based presence absence endometriosis laparoscopy similarity peritoneal fluid estradiol concentrations stromal cell proliferation reflected 3h thymidine incorporation sequential cell harvests 72 hours greater cells exposed endometriosis peritoneal fluid exposed non endometriosis peritoneal fluid reached statistical significance exposure peritoneal fluid concentrations 10 20 \( p less 05 \) linear dose response relationship 3h thymidine incorporation peritoneal fluid concentration could derived stromal cells exposed fluid samples obtained endometriosis patients \( r 0 51 p less 001 \) addition , proliferation 72 hours significantly greater cells grown 20 endometriosis peritoneal fluid grown nutrient medium alone \( p less 001 \) data imply factor \( \) secreted peritoneal fluid endometriosis patients may play role proliferation maintenance disease implants
intrapartum events women exposed utero diethylstilbestrol using retrospective cohort design , analyzed effects intrauterine diethylstilbestrol \( des \) exposure various intrapartum events gravidas exposed des higher likelihood delivered , undergoing manual removal placenta , postpartum period increased risk events remained controlling age , race , parity also constructed labor curves des exposed women cervical dilation time curves similar nulliparous des exposed women nulliparous controls , des exposed parous women experienced prolonged findings suggest , addition well known adverse effects intrauterine des exposure , interaction uterus placenta altered des exposed patients
experimental clinical studies radiofrequency induced thermal endometrial ablation functional menorrhagia method endometrium introduced clinical practice uses radiofrequency electromagnetic energy heat endometrium , using probe inserted cervix preliminary studies suggest 80 patients treated develop either amenorrhea significant reduction flow advantages radiofrequency endometrial ablation laser ablation resection avoidance intravascular fluid absorption , simplicity \( special operative hysteroscopic skills required \) , speed operation , reduced cost compared nd yag laser paper , describe experimental studies performed development new technique
preoperative angiographic uterine artery embolization management cervical pregnancy diagnosis cervical ectopic pregnancy often made intraoperatively presence extensive hemorrhage attempted evacuation cases , hysterectomy necessary treatment control bleeding report two cases cervical pregnancy detected ultrasound pregnancy termination , uterine arteries successfully using angiographic techniques result , surgical evacuation performed minimal hemorrhage hysterectomy required patients' potential fertility retained
successful treatment cervical pregnancy oral etoposide cervical ectopic pregnancy uncommon entity associated significant morbidity devastating effects future fertility woman cervical gestation quantitative serum beta hcg levels higher 46 , 000 ml fetal cardiac activity ultrasound treated successfully one course oral etoposide , agent , avoided operative intervention preserved patient 's fertility
pregnancy associated ataxia pregnancy woman ataxia complicated onset preterm labor preeclampsia administration magnesium sulfate \( mgso4 \) usual intravenous dosage resulted dramatic development profound motor weakness respiratory distress magnesium acts action acetylcholine motor end plate neuromuscular junction may synergistically underlying neuromuscular disorders therefore , use magnesium sulfate patients ataxia similar diseases contraindicated
fetal levels tobramycin following maternal administration single dose tobramycin 2 mg kg given intravenously woman presented 22 week heterotopic pregnancy intrauterine ovarian gestations two living fetuses excision , tobramycin levels measured maternal serum fetal fluids tissues antibiotic levels especially high fetal spleen kidney
university utah epidemiologic survey autism prenatal , perinatal , postnatal factors recent epidemiologic survey conducted utah , 241 autistic patients \( dsm iii criteria \) found medical records 233 surveyed presence 36 potentially pathologic prenatal , perinatal , postnatal factors results compared identical survey 62 siblings , results four previously published surveys , normative data potentially pathologic factor group factors occurred significantly frequently among autistic patients also , previous observations significant differences occurrence certain factors histories single vs multiple siblings autism confirmed , exception increased viral type illness gestation single incidence cases thus , etiology brain pathology characteristically normal development produces syndrome autism remains obscure data epidemiologic survey , however , suggest role genetic factors needs explored
barrier contraceptive methods preeclampsia recent investigations suggested women use barrier methods contraception may increased risk preeclampsia used data two prospective pregnancy studies examine relationship contraceptive use conception preeclampsia preeclampsia rates among women using barrier contraceptives significantly higher rates women using contraceptives rates women using contraceptives either study odds ratios preeclampsia barrier contraceptive users two studies 0 89 \( 95 confidence interval cl , 0 71 1 12 \) 0 85 \( 95 cl , 0 49 1 45 \) compared contraceptive users 0 91 \( 95 cl , 0 71 1 16 \) 0 81 \( 95 cl , 0 48 1 35 \) compared women using contraceptives adjusting risk factors , found association preeclampsia barrier contraceptive use additional studies needed resolve issue however , would recommend women advised avoid barrier contraceptives unless data linking use preeclampsia appear
umbilical artery doppler velocimetry labor admission test doppler ultrasound umbilical artery flow velocity waveform studied prospectively admission test labor ward recordings made women various stages labor , , uterine contractions , evaluated relation intrapartum fetal outcome variables association found abnormal flow velocity waveforms cord complications , meconium stained amniotic fluid , abnormal fetal heart rate tracing , association operative delivery fetal distress low apgar scores 1 5 minutes small gestational age fetuses significantly abnormal flow velocity waveforms appropriate gestational age fetuses , umbilical artery acidemia compared normal ph results indicate doppler recording umbilical artery flow velocity waveform admission test labor ward good predictor fetal distress unselected population
clinical pathologic correlation endometrial cavity fluid detected ultrasound postmenopausal patient registry ultrasound procedures spanning nearly 5 years retrospectively discover cases endometrial cavity fluid collections postmenopausal women twenty cases identified medical records available review one patient lost follow seventeen patients surgical procedures 11 c , six primary evaluation laparotomy removal uterus five women cancer \( two ovarian , one tubal , one endometrial , one cervical \) eight women benign gynecologic conditions , including uterine \( five \) , ovarian serous \( two \) , cervical dysplasia \( one \) two cases apparent subclinical five women endometrial pathology consistent prescribed hormone therapy breast cancer \( four \) endometrial hyperplasia \( one \)
cocaine abuse associated decreased birth weight , shorter labor many patients report ingested cocaine decrease duration labor reviewed computerized records women abused cocaine compared controls , women ingested cocaine older higher parity birth weight , birth weight percentile , gestational age delivery significantly decreased among neonates , incidence nearly doubled among women although factors tend shorten labor , total duration labor significantly different two groups data add accumulating evidence cocaine abuse associated increased obstetric morbidity , support belief cocaine labor
vulvar paget disease fluorescein aided visualization margins two women extramammary paget disease given fluorescein intravenously order visualize disease margins use ultraviolet light diagnostic modality , technique found positive predictive value 97 4 negative predictive value 99 9 accuracy fluorescein technique compared gross visualization using histologic mapping technique total fields mapped predictive accuracy test determined chi 2 test demonstrated fluorescein visualization significantly better predictor disease state fluorescein visualization suggested adjunct surgical management patients primary vulvar paget disease
successful use gamete intrafallopian transfer reverse decline fertility women 40 years age assess impact assisted reproductive technologies potential fertility older women , report experience gamete intrafallopian transfer \( gift \) large number women 40 years age older one hundred twenty two gift cycles initiated 59 women 18 months seventy three tubal transfers performed , resulting seven clinical pregnancies , rate 9 6 per transfer contrasts 27 3 clinical pregnancy rate per transfer women 40 thus , older patients require thorough counseling regarding decreased likelihood success despite use assisted reproductive technologies
sensitivity specificity screening syndrome alpha fetoprotein , hcg , unconjugated , maternal age published erratum appears 1991 may 77 \( 3 \) 462 sensitivity specificity maternal serum screening syndrome different biochemical markers evaluated detection rates different combinations maternal serum alpha fetoprotein \( msafp \) , hcg , unconjugated \( \) established analyzing 54 serum specimens women confirmed syndrome pregnancies , compared 657 specimens women normal outcomes risk cutoff 1 270 second trimester , detection rate msafp , hcg , two three times higher msafp alone three markers , detection rate syndrome increased 50 77 maternal age increased , 60 representative screened population omitted , detection rate decreased 60 48 one thousand women screened prospectively , either msafp three markers prospectively , either msafp three markers 4 1 msafp three markers , positive predictive value syndrome 2 2 overall high 5 9 older women therefore , addition hcg maternal serum screen increases positive predictive value 50 300 , depending maternal age results confirm efficacy screening syndrome using maternal age three serum markers
factors associated postpartum hemorrhage vaginal birth case control study performed study risk factors postpartum hemorrhage cases hemorrhage defined hematocrit decrease 10 points admission post delivery need red cell transfusion patients antenatal bleeding excluded among vaginal deliveries , postpartum hemorrhage occurred cases \( 3 9 \) three controls matched case multiple logistic regression used control covariance among predictor variables factors significant association hemorrhage prolonged third stage labor \( adjusted odds ratio 7 56 \) , preeclampsia \( odds ratio 5 02 \) , \( 4 67 \) , previous postpartum hemorrhage \( 3 55 \) , twins \( 3 31 \) , arrest descent \( 2 91 \) , soft tissue lacerations \( 2 05 \) , augmented labor \( 1 66 \) , forceps vacuum delivery \( 1 66 \) , asian \( 1 73 \) hispanic \( 1 66 \) ethnicity , midline \( 1 58 \) , \( 1 45 \) data may help predict postpartum hemorrhage may useful counseling patients home delivery , intravenous access labor , autologous blood donation
contrast sonography uterus fallopian tubes results clinical trial new contrast medium 120 patients feasibility , diagnostic efficacy , patient tolerance new diagnostic modality , contrast sonography \( \) , evaluated clinical study 120 patients suspected infertility new contrast medium ultrasound administered conventional tools balloon catheter flow multiple fractions contrast medium fallopian tube observed real time appropriate imaging planes means transvaginal probe patent tubes diagnosed correctly , results comparing well findings laparoscopy b mode scanning , sensitivity 88 right tube 90 left specificity 100 tube supplementary use doppler techniques \( duplex , color doppler \) provided additional information special cases suspected tubal occlusion led improvement diagnostic accuracy contrast agent well tolerated demonstrates normal anatomy tubal patency high reliability permits advance selection patients invasive diagnostic procedures may required
potential prenatal predictions syndrome statistical analysis determine feasibility combining several screening tests prenatal detection syndrome , evaluated potential relationship among three proposed predictors determined concentration chorionic gonadotropin frozen serum samples women known maternal age weight , fetal biparietal diameter , femur length , alpha fetoprotein concentration corrected gestational age maternal weight , potential predictors independent , except slight correlation \( r 0 10 \) maternal serum alpha fetoprotein maternal serum human chorionic gonadotropin maternal serum human chorionic gonadotropin biparietal diameter femur length demonstrated approximately log normal distribution similar maternal serum alpha fetoprotein therefore scientifically sound use variables combination identification pregnancies increased risk syndrome
course labor endurance exercise pregnancy study designed test hypothesis continuation regular running program , , latter half pregnancy would negative effect course outcome labor onset , course , outcome labor independently monitored 131 well conditioned recreational athletes uneventful first half pregnancy daily exercise performance quantitated conception throughout pregnancy comparisons made 87 women continued exercise regularly 50 level throughout pregnancy 44 discontinued regular exercise regimen end first trimester incidence preterm labor similar two groups \( 9 \) labor began significantly earlier exercise group \( 277 6 vs 282 6 days \) women continued exercise lower incidence abdominal \( 6 vs 30 \) vaginal \( 6 vs 20 \) operative delivery , active labor shorter \( 264 149 vs 275 min \) delivered vaginally finally , clinical evidence acute fetal stress \( meconium , fetal heart pattern , apgar score \) less frequent exercise group \( 50 vs 26 \) , although birth weight reduced \( vs 401 gm \) data initial hypothesis indicate , well conditioned women regularly perform run , continuation exercise regimens beneficial effect course outcome labor
growth factor activity blood women preeclampsia develops elevated early pregnancy preeclampsia pregnancy specific disorder uncertain cause pathophysiology appears associated endothelial cell injury current studies demonstrate pregnancy growth factor activity elevated compared postpartum values blood women preeclampsia months onset clinical manifestations cohort women followed throughout pregnancy multiple serial plasma samples six women preeclampsia six matched normal women assayed mitogenic activity data indicated ratio plasma mitogenic activity greater women meet strict criteria diagnosis preeclampsia compared matched normal women growth factor activity could distinguish women preeclampsia would develop normal peers throughout pregnancy , early first trimester gestation \( p less 0 05 \) similar studies performed plasma obtained greater 6 weeks post , two groups patients clinically indistinguishable , revealed differences index mitogenic activity results indicate elevated mitogenic activity ratios versus postpartum plasma clinical recognition preeclampsia , return normal resolution syndrome
effect nifedipine therapy fetal placental doppler waveforms preeclampsia remote term twenty patients preeclampsia gestational age 26 35 weeks treated oral nifedipine delivery mean oral daily dose 45 1 11 mg day \( range , 40 80 mg day \) fetal aorta , internal carotid artery , umbilical artery , uteroplacental doppler flow velocity waveforms recorded treatment serially mean nifedipine concentration time doppler studies 60 3 ng ml \( range , 10 90 ng ml \) use nifedipine therapy associated significant decrease maternal systolic blood pressure \( baseline , 154 135 mm hg , p less 0 001 \) diastolic blood pressure \( baseline , 100 88 mm hg , p less 0 001 \) however , significant difference resistance index baseline doppler studies either fetal uteroplacental vessels use oral nifedipine control blood pressure preeclampsia affect resistance indices fetal uteroplacental vessels measured doppler technique
inhibition spontaneous uterine contractions last trimester pregnant baboons oxytocin antagonist effect potent oxytocin antagonist , produced laboratories , spontaneous uterine contractions pregnant baboon examined three types uterine contractions studied immediately operation , nocturnal period , near labor bolus intravenous injections oxytocin antagonist given uterine activity examined 1 hour injection oxytocin antagonist caused precipitate decrease \( approximately 70 \) contractile force \( mean amplitude x frequency \) first 15 minutes injection \( p less 0 05 \) force diminished approximately 90 end 1 hour nocturnal labor contractions contrast , uterine contractions immediately operation diminished 60 within 60 minutes oxytocin antagonist results indicate oxytocin antagonist potent inhibitor suggest oxytocin primary regulator spontaneous nocturnal labor uterine contractions pregnant baboon
observations cause oligohydramnios prolonged pregnancy increasing evidence implicates reduced amnionic fluid volume major determinant fetal risk prolonged pregnancy sought determine whether reduced fetal urine production might associated oligohydramnios pregnancies reach 42 weeks ultrasonographic measurements fetal bladder obtained every 2 5 minutes 1 hour 38 gestations verified least 42 weeks oligohydramnios present eight prolonged pregnancies similar measurements performed 15 normal pregnancies delivered elective repeat cesarean section 38 40 weeks' gestation hourly fetal urine production rates calculated sequential bladder volume measurements result investigation suggest diminished fetal urine production associated oligohydramnios prolonged pregnancy mechanism fetal urine production reduced prolonged pregnancy remains unknown likely possibility reduced fetal swallowing already diminished amnionic fluid volume , latter result placental senescence
mechanism leading reduced lung expansion lung hypoplasia fetal sheep oligohydramnios aim determine mechanism whereby causes reduced fetal lung expansion eventual lung hypoplasia studied 20 fetal sheep 2 9 days oligohydramnios produced drainage amniotic allantoic fluids last third gestation oligohydramnios led reversible reduction lung liquid volume 19 5 within 48 hours oligohydramnios tracheal pressure , relative amniotic pressure , rose 1 7 mm hg \( p less 0 001 \) pressures also tended rise fetal pleural space abdomen , relative amniotic pressure , fall amniotic sac pressure increments , relative amniotic pressure , normally occur fetal trachea , pleural cavity , abdomen uterine contractions , significantly increased 1 9 2 5 mm hg oligohydramnios oligohydramnios increased flexion fetal thoracolumbar spine , quantified reduction ratio spinal radius curvature spine length \( 0 76 controls vs 0 40 oligohydramnios , p less 0 001 \) three sets twins , fetus exposed oligohydramnios affected similar degree spinal flexion imposed normal fetal sheep cadavers increased abdominal \( 1 6 mm hg \) , pleural \( 1 5 mm hg \) , tracheal \( 2 0 mm hg \) pressure , caused significant reduction fetal lung expansion conclude oligohydramnios fetal sheep increases spinal flexion , leading compression abdominal contents , upward displacement diaphragm , lung compression , favoring loss fetal lung liquid changes , accentuated uterine contractions reversible , may lead pulmonary hypoplasia prolonged
isolation characterization gene human genome encoding 17 beta estradiol dehydrogenase comparison jar bewo choriocarcinoma cell lines 17 beta estradiol dehydrogenase required enzymatic estradiol weaker related sex steroid , estrone isolated sequenced complementary deoxyribonucleic acid clone 17 beta estradiol dehydrogenase bewo choriocarcinoma cell line comparison bewo complementary deoxyribonucleic acid sequence previously derived placental complementary deoxyribonucleic acid sequence yields greater 98 homology also isolated gene 17 beta estradiol dehydrogenase jar human choriocarcinoma cell line elucidated primary nucleic acid structure significant differences jar deduced complementary deoxyribonucleic acid sequence clearly differentiate human placental bewo forms 17 beta estradiol dehydrogenase , indicating existence two genes 17 beta estradiol dehydrogenase human genome evaluation 17 beta estradiol dehydrogenase gene expression bewo jar cells compared expression luteinized granulosa cells messenger ribonucleic acid human placental 17 beta estradiol dehydrogenase identified three cell types 1 3 kilobase band northern blot analysis second messenger ribonucleic acid species measuring 2 1 kilobase abundantly present granulosa cells whether two species messenger ribonucleic acid involved regulation estradiol dehydrogenase genes yet determined
turner syndrome variants turner syndrome suspected females short stature , gonadal dysgenesis , however , features turner syndrome , disorder considered girl short stature delayed puberty article discusses natural history turner syndrome complications occur various organ systems reviews physical features complications seen various changes turner syndrome age specific screening therapies covered
almitrine mimics hypoxia fetal sheep lateral pontine lesions almitrine potent long lasting respiratory adult species acts stimulating peripheral chemoreceptors , shown accumulate specifically , although exact mechanism action uncertain fetal , however , produces profound inhibition breathing even denervation peripheral chemoreceptors respect action similar hypoxia investigate whether almitrine hypoxia mimetic , examined effect almitrine nine fetal lambs 120 130 days gestation five lesions lateral pons changed fetal depressive response hypoxia one stimulation remaining four fetuses , lesions bilaterally appropriate area pons thus still showed normal fetal depressive response hypoxia acted controls almitrine \( 10 mg iv \) caused pronounced stimulation breathing lasted 26 min five fetuses lesions caused stimulatory response hypoxia however , remaining four fetuses , response hypoxia inhibitory , almitrine caused inhibition breathing lasted 184 28 min conclude action almitrine like hypoxia , acts specifically chemoreceptors , may prove useful tool study possible central chemoreceptor mechanisms
elevated plasma norepinephrine levels infants substance abusing mothers infants substance abusing mothers \( isam \) significant growth neurodevelopmental abnormalities origin abnormalities unknown postulated isam increased sympathetic nervous system tone altered catecholamine levels therefore , measured plasma norepinephrine , epinephrine , dopamine levels number receptor affinity beta adrenoreceptor binding sites lymphocytes alpha adrenoreceptor binding sites 22 otherwise healthy isam \( age , 2 1 0 5 months mean sd \) 15 healthy controls \( age , 2 5 0 8 months \) norepinephrine levels venous blood 1 8 fold higher isam control infants \( 6 30 3 85 nmol l vs 3 55 2 45 nmol l \) differences plasma epinephrine dopamine levels differences number binding sites receptor affinity beta alpha adrenoreceptors conclude isam elevated circulating norepinephrine levels compared controls speculate associated increased sympathetic nervous system tone isam absence adrenoreceptor regulation may create catecholamine
attention deficits children exposed alcohol prenatally twenty children fetal alcohol syndrome fetal alcohol effect \( \) compared 20 attention deficit disorder \( add \) children 20 normal controls three experimental tasks designed isolate four different components attention parents completed three questionnaires regarding child 's activity level overall functioning , children completed short form iq test children group ranged 5 12 years results indicate although children significantly impaired , attentional deficits behavioral problems similar children add findings imply treatments known facilitate learning children add may also benefit children
long term behavioral effects prenatal alcohol exposure rats prenatal exposure alcohol cause variety behavioral disturbances later life many reports animals behavioral effects alcohol focused assessing younger animals purpose paper review longer lasting behavioral consequences gestational alcohol exposure animals meant comprehensive review , rather focuses selected studies concluded prenatal alcohol exposure long lasting effects , although might occur challenging stressful circumstances hypothesized animal compensatory mechanisms strategies develop compensate dysfunctions thus , behavioral problems may detected compensatory systems break , either result stress , complex testing procedures , old age
neurochemical abnormalities nonhuman primate infants exposed weekly doses ethanol gestation ethanol orally administered per week 54 gravid macaques \( \) doses 0 0 , 0 3 , 0 6 , 1 2 , 1 8 , 2 5 4 1 gm kg 1st week gestation doses 2 5 , 3 3 4 1 gm kg 5th week mean maternal peak plasma ethanol concentrations \( mppec 's \) ranged 24 6 mg dl 0 3 g kg dose 71 mg dl 4 1 g kg dose thirty three live born infants assessed abnormalities physical behavioral development ocular pathology , neuropathologic neurochemical done 31 animals 6 months postnatal age noted three 26 animals exposed ethanol retinal ganglion cell loss significantly associated intra uterine ethanol exposure retinal ganglion cell loss observed delayed full gestational exposed animals structural anomalies found brains via gross inspection light microscopy chemical abnormalities striatal nuclei identified striatal dopamine concentrations increased increasing mppec exposure \( 0 249 mg dl \) among animals exposed weekly ethanol throughout gestation striatal dopamine concentrations decreased increasing mppec exposure \( 260 540 mg dl \) among animals whose weekly exposure ethanol delayed 5th week gestation pattern association also noted mppec ultrastructural alterations caudate nucleus extent ultrastructural alterations increased increasing mppec among full gestational exposed animals decreased increasing mppec among delayed dose animals
effects ethanol hexose uptake cultured rat brain cells effects ethanol hexose uptake glial cells investigated using primary cultures prepared term rat fetuses specific 3h 2 deoxy glucose \( 2dg \) uptake significantly reduced 4 hr exposure ethanol concentrations 25 , 50 , 100 mm , 200 300 mm inhibitory effect 50 mm ethanol increased duration exposure , 2dg uptake inhibited 36 18 hr astrocytes cultured brains term fetuses rats fed ethanol pregnancy showed essentially 2dg uptake response vitro ethanol treatment kinetics 2dg uptake showed significant decrease vmax presence ethanol interaction found ethanol insulin , stimulated 2dg uptake protein content cultures data suggest ethanol modulate hexose uptake astrocytes cultured fetal rat brain however , insulin actions glial cells affected ethanol
factor analysis patients history failed tracheal intubation pregnancy eight patients history failed tracheal intubation pregnancy investigated x ray laryngoscopy delivery partial elevation view glottic structures found five patients therefore considered still present difficulty five patients blade tip failed make contact four explained tongue compressed shape prevented larynx relatively abnormal anatomical indices seen patients keeping level difficulty encountered angular measure jaw line joining upper incisors point anterior vocal cords , mid point inner surface mandible useful lower angle triangle important angle incisors
comparison two techniques urine cytology two methods preparation urine cytology compared retrospectively method 1 cells urine fixed preparation smear method 2 cells fixed smear preparation urine cytology reports correlated subsequent histological analysis specificities urine cytology using methods high \( 99 \) sensitivity using method 1 87 using method 2 65 difference significant cell preparation technique therefore significantly changes sensitivity urine cytology cellular fixation smear preparation preferable smear preparation fixation
gene mapping alport families different basement membrane antigenic phenotypes present study undertaken determine whether differences among alport kindreds antigenic phenotypes basement membranes result defects distinct genetic loci allelic mutations single locus analyzed linkage alport gene polymorphic loci x chromosome three families alport syndrome two families , epidermal basement membranes affected members showed altered immunohistologic reactivity discriminating antibody \( \) identified 26 kd peptide domain basement membrane collagen third family epidermal basement membranes affected individuals reacted normally antibody disease gene mapped region long arm x chromosome two families altered basement membrane antigenicity family normal basement membrane antigens conclude alport syndrome kindreds arose allelic mutations single genetic locus , although cannot time exclude possibility two tightly linked genes involved genes known chains type iv collagen chromosome 13 , findings suggest alport gene may encode new basement membrane collagen chain
obstetric complications young teenagers compared pregnancy outcome \( less equal 16 years old \) adult \( 21 25 years old \) similar prenatal care , socioeconomic status , racial balance incidence preterm labor delivery low birthweight infant significantly higher teenagers incidence preeclampsia significantly higher adults cesarean delivery done frequently teenagers , higher incidence infants small gestational age , anemia , abnormal presentation labor birthweight infants black teenagers significantly lower birthweight white teenagers , overall birthweight significantly lower infants teenagers adults although prenatal care , socioeconomic factors , racial balance comparable young teenagers adults , teenagers still significantly greater risk delivery smaller infants , preterm labor , low birthweight infants
accuracy clinical findings laparoscopy pelvic inflammatory disease accuracy clinical diagnosis pelvic inflammatory disease determined 95 women presented pelvic pain primary care physicians referred gynecologists laparoscopy laparotomy endometrial biopsy revealed prevalence pelvic inflammatory 46 \( 44 95 \) positive negative predictive values gynecologists 74 \( 23 31 \) 67 \( 43 64 \) \( p 0 0002 \) histopathologic diagnosis standard , clinical gynecologists better chance \( p 0 43 \) , suggesting expectation bias visual diagnosis laparoscopy sensitivity 50 \( 12 24 \) specificity 80 \( 40 50 \) salpingitis standard histopathologic diagnosis \( p 0 01 \) results support routine use laparoscopy , supplemented negative endometrial , accurately diagnose pelvic inflammatory disease
heterotopic pregnancies vitro fertilization embryo transfer seventeen cases heterotopic pregnancies reported among clinical pregnancies vitro fertilization high prevalence tubal damage among ivf patients use multiple embryo transfer might predispose patients condition nine patients reported abdominal pain vaginal bleeding , five patients symptoms , three acute abdominal emergencies transvaginal ultrasonography superior ultrasonography diagnosis extrauterine pregnancies presence intrauterine gestation sac patient without symptoms exclude diagnosis concomitant extrauterine pregnancy pelvis carefully visualized early diagnoses viable ectopic pregnancies rupture mortality morbidity offers chance patient selection conservative treatment two patients extrauterine gestation sac treated transvaginal aspiration injection potassium chloride ultrasonographic guidance outcome intrauterine pregnancy favorable regardless method treatment ectopic pregnancy
forskolin methotrexate induce intermediate trophoblast phenotype cultured human choriocarcinoma cells human placenta associated membranes vital maintenance , nutrition , protection developing fetus placental development give rise chorionic membrane whereas others fuse form differentiated cells responsible placental protein steroid hormone production mechanisms involved differentiation unknown however , intermediate stage characteristic phenotype documented vivo observed chemically dissimilar agents induced bewo choriocarcinoma cells change usual phenotype acquire morphologic functional characteristics typical intermediate trophoblast incubation bewo cell cultures presence 1 mumol l methotrexate 48 hours stimulated human chorionic gonadotropin secretion \( 2 3 fold \) aromatase activity \( 4 9 fold \) morphologic findings associated hormonal changes , including increased nuclear size cytoplasmic expansion , also observed use computer interfaced image analyzer , morphometry nuclear area cells revealed 1 8 fold increase incubation methotrexate effect forskolin , direct activator cyclase , also evaluated means model differentiation addition 10 mumol l forskolin bewo cultures also resulted dramatic changes trophoblast cell phenotype increases human chorionic gonadotropin synthesis \( 7 3 fold \) , aromatase activity \( 13 5 fold \) , nuclear area \( 3 0 fold \) induced untreated cells addition , increases 3h thymidine incorporation \( 1 7 fold \) afforded treatments results suggest biochemical cytologic changes associated human trophoblast differentiation induced vitro via activation cyclase pathway forskolin unknown apparently independent signals methotrexate
endometrial thickness measured endovaginal ultrasonography identifying endometrial abnormality diagnostic curettage many years method choice diagnose endometrial cancer women postmenopausal bleeding costs curettage performed today huge , approximately 10 group women diagnosed endometrial cancer thus less techniques obtain endometrial samples evaluated , invasive value endovaginal ultrasonography identifying endometrial abnormality group women evaluated study used endometrial thickness measured endovaginal ultrasonography indicator endometrial abnormality demonstrated 205 women postmenopausal bleeding endometrium less 9 mm thick , endometrial cancer found curettage mean endometrial thickness women endometrial cancer 18 2 6 2 mm compared 3 4 1 2 mm women atrophic endometrium cutoff limit endometrial abnormality 5 mm , positive predictive value identifying endometrial abnormality 87 3 limit used study , 70 curettage procedures could avoided
fetal urine output influence residual amniotic fluid volume premature rupture membranes fetal urine production 12 women premature rupture membranes differ control group , correlation fetal urine output residual amniotic fluid volume residual amniotic fluid volume premature rupture membranes appear depend alter fetal renal function
clinical implications placental lucencies forty six patients identified perinatal diagnostic referral center placental lucencies lucencies varied simple covered 50 placental surface clinical follow 40 patients demonstrated increase incidence adverse pregnancy outcome conclude pregnancies higher risk placental lucencies associated fetal anomalies
evidence human chorionic gonadotropin luteinizing hormone receptor regulation involves decreased levels receptor messenger ribonucleic acid injection pseudopregnant rats pharmacological doses hcg leads characteristic decrease lh hcg binding isolated luteal cells steady state levels lh hcg receptor mrna determined rat ovaries hcg induced regulation receptor northern blots performed using 20 mer probe corresponding guanine cytosine rich carboxyl terminal untranslated region lh hcg receptor cdna hybridization probe lh hcg receptor mrna highly specific , since probe hybridized rat luteal cell rna fraction , signal detected tissues lh hcg receptor level quantitated 125i hcg binding isolated membrane fractions corresponding treatment control groups examination mrna levels receptor hcg induced regulation showed steady decrease 0 24 h , followed gradual increase control levels 24 72 h corresponding days 8 9 pseudopregnancy 125i hcg binding activity regulation paralleled mrna profile experimental control groups examination levels mrna alpha actin showed change period , suggesting loss lh hcg receptor mrna 24 h due general loss mrna luteal cells results suggest hcg induced regulation lh hcg receptor luteal cells involves regulation receptors message level
retinoic acid stimulates placental hormone secretion choriocarcinoma cell lines vitro retinoic acid \( ra \) , active metabolite vitamin , important mediator cellular differentiation shown stimulate human \( hcg \) secretion jeg 3 choriocarcinoma cells vitro order determine whether ra stimulates hcg secretion trophoblastic cell lines , evaluated effect ra hcg , hcg alpha subunit \( hcg alpha \) , progesterone secretion three choriocarcinoma cell lines jeg 3 , jar , bewo ra stimulated hcg hcg alpha secretion dose dependent fashion three cell lines time required give statistically significant increment hcg hcg alpha control cells 48 h addition ra cholera toxin \( 10 micrograms ml \) resulted additive synergistic stimulation hcg hcg alpha secretion three cell lines cycloheximide \( 1 microm \) abolished effect ra hcg hcg alpha secretion bewo cell line progesterone secretion response ra inconsistent progesterone secretion jeg 3 bewo cell lines stimulated high concentrations ra \( 1 x 10 \( 6 , whereas progesterone secretion jar cells stimulated intracellular levels camp affected ra treatment jeg jar cells dosages used , ra significantly alter cell number cell lines ra physiologic concentrations stimulates hcg hcg alpha secretion three choriocarcinoma cell lines vitro whether ra physiologic mediator placental hormone production unknown
vitro fertilization embryo transfer \( ivf et \) united states 1989 results ivf et registry medical research international , society assisted reproductive technology , american fertility society fourth annual report united states registry vitro fertilization embryo transfer \( ivf et \) related practices present report describes 1989 experiences 163 united states member clinics respect treatments outcomes 1989 , clinics reported performing 24 , 183 ovarian stimulation cycles treatments , including frozen et ivf donor oocytes , 4 , clinical pregnancies 3 , live deliveries ninety eight percent clinics least one delivery , overall total 4 , babies born overall live delivery rates 14 ivf \( based 15 , 392 retrievals \) , 23 gamete intrafallopian transfer \( gift \) \( based 3 , retrievals \) , 26 ivf gift combination \( based retrievals \) , 17 intrafallopian transfer \( \) related practices \( based retrievals \) addition treatments , results presented frozen ets ivf donated oocytes
handling tubal infertility introduction vitro fertilization changes consequences study aimed quantifying important social economic consequences altered handling tubal infertility establishment ivf treatment number tubal operations reduced 50 important positive implications availability operating elective operations , availability hospital beds patient groups , total duration illness calculated costs per live birth 17 , 000 tubal surgery , compared 12 , 000 ivf treatment life table analyses demonstrated highly significant increased rate deliveries complete ivf treatment \( 72 3 per patient \) compared tubal surgery \( 23 7 , p less 0 001 \)
fertility surgery primary ovarian pregnancy primary ovarian pregnancy usually occurs parous fertile women accidental event probably related presence affecting implantation rather indicator altered fertility reproductive performance postoperatively remains unmodified
oocyte pre embryo donation women ovarian failure extended clinical trial outcome series pre embryo transfers 31 women ovarian failure described twenty six fertile women functioned donors , providing oocytes vitro fertilization undergoing controlled ovarian transvaginal ultrasound directed oocyte aspiration recipients , 24 44 years age , received hormone replacement therapy pre embryo transfer \( et \) mean 13 7 1 1 oocytes obtained per aspiration resulting transfer 4 5 0 2 pre embryos recipient twenty five 47 et resulted pregnancy \( 53 2 per et \) 5 preclinical , 20 clinical , 18 ongoing delivered overall implantation rate per individual transferred fresh pre embryo 21 1 conclude oocyte donation safe highly efficient means achieving pregnancy women ovarian failure
treatment tubal ectopic pregnancy salpingotomy without tubal suturing salpingectomy published erratum appears 1991 jun 55 \( 6 \) 4 thirty four women unruptured tubal ectopic pregnancy \( ep \) randomly assigned undergo salpingotomy without tubal suturing \( n 15 \) salpingotomy tubal suturing \( n 19 \) reproductive performance patients compared 24 patients underwent salpingectomy ep \( historical control \) using life table analysis , cumulative probability intrauterine pregnancy \( \) 12 24 months 45 45 salpingotomy without tubal suturing 21 47 salpingotomy tubal suturing , respectively cumulative probability salpingectomy \( 21 26 12 24 months , respectively \) significantly lower salpingotomy without tubal suturing difference cumulative probability ep salpingotomy without tubal suturing , significantly higher salpingectomy 18 women subsequently underwent laparoscopy laparotomy , significant difference found degree adhesions salpingotomy without tubal suturing findings suggest conservative treatment higher salpingectomy , recurrent ep also higher intrauterine pregnancy occurs earlier salpingotomy without tubal suturing salpingotomy tubal suturing might rapid return tubal function healing secondary
ovarian role sensitivity gonadotropins determine ovarian represents enhanced gonadotropic stimulation , augmented ovarian sensitivity gonadotropins , , undertaken evaluate \( 1 \) 24 hour integrated concentrations serum total testosterone \( \) luteinizing hormone \( lh \) \( 2 \) ovarian response exogenous gonadotropic stimulation end , two groups women , \( n 4 \) early follicular phase \( n 4 \) normally cycling controls , subjected continuous blood withdrawal 24 hours portable pump \( inc , , ny \) exogenous stimulation human chorionic gonadotropin current observations support notion ovarian represents combined impact overall increase gonadotropic support coupled augmented ovarian sensitivity gonadotropic stimulation
endometrial antibodies versus ca 125 detection endometriosis detection endometrial antibodies using indirect immunofluorescence method along well established human endometrial carcinoma cell line evaluated compared ca 125 detecting endometriosis two hundred two patient sera infertility , , oncology services evaluated sensitivity antibody testing 83 1 specificity 78 8 , contrast sensitivity 27 3 specificity 82 6 ca 125 preliminary findings offer promise antibody detection methods may useful adjunct diagnosis endometriosis
maturation immature oocytes granulosa cells increase number embryos available transfer , immature human oocytes granulosa cells follicles greater numbers immature oocytes incubated granulosa cells dispersion cells compared immature oocytes cultured media alone fifty four percent immature oocytes granulosa cells compared 20 fertilization immature oocytes cultured without granulosa cells cases embryos developed immature oocytes transferred , thus could determine immature oocytes could contribute pregnancy
comparison doppler flow velocity waveforms , amniotic fluid columns , test means monitoring post pregnancies five hundred thirty four pregnancies exceeding 294 days monitored weekly sonographic estimations amniotic fluid columns , daily maternal recordings fetal movements , weekly tests addition , woman received twice weekly studies uteroplacental umbilical circulations means doppler ultrasound fetal deaths study individual methods fetal surveillance , absence end diastolic frequencies umbilical artery sensitive , predicting 91 fetuses developed fetal distress first stage combining test sonographic estimation amniotic fluid columns improved prediction 100 , minimal fall specificity results strongly suggest combination umbilical artery doppler waveforms amniotic fluid determinations adequate method monitoring post pregnancy
low incidence positive amnionic fluid cultures preterm labor 27 32 weeks absence clinical evidence chorioamnionitis order determine utility amniocentesis detecting subclinical chorioamnionitis asymptomatic women preterm labor intact membranes , enrolled 47 women 27 32 weeks' gestation prospective study enrollment , 38 women fulfilled clinical laboratory criteria study nine women excluded leukocyte count exceeding 15 , 000 microl none 38 asymptomatic women positive culture amnionic fluid bacteria , fungi , hominis , ureaplasma , chlamydia trachomatis , viruses sepsis proved 38 infants delivered patients clear relationship histologic evidence chorioamnionitis failure therapy fetal lung profiles mature 29 amnionic fluid samples 30 32 weeks' gestation , none amnionic fluid samples 30 weeks amniocentesis seem useful detect chorioamnionitis asymptomatic women preterm labor intact membranes 27 32 weeks' gestation , reserved cases information fetal lung maturity would helpful
comparison continuous versus sequential estrogen progestin therapy postmenopausal women pilot study performed comparing efficacy safety continuous versus sequential schedules two commonly prescribed medications ovarian hormone replacement , conjugated estrogens medroxyprogesterone acetate bleeding patterns , endometrial histology , metabolic parameters studied 48 postmenopausal women prospectively randomized continuous schedule \( daily estrogen progestin \) sequential schedule \( conjugated estrogen days 1 25 , medroxyprogesterone acetate days 16 25 \) doses studied 0 625 1 25 mg conjugated estrogens 10 mg medroxyprogesterone acetate significantly greater bleeding observed 1 25 mg dosage conjugated estrogens bleeding patterns similar schedules , exception amenorrhea prevalent women using 1 25 mg dosage estrogen continuous progestin schedule frequent endometrial atrophy observed continuous schedule , supporting concept prolonged use schedule may promote amenorrhea patients doses schedules associated modest insignificant increases high density lipoprotein cholesterol sequential therapy prevent estrogen induced decrease low density lipoprotein cholesterol , whereas continuous schedule , particularly 0 625 mg dosage conjugated estrogens significant increases triglycerides also seen continuous sequential schedule reports continuous schedule using 2 5 mg dosage medroxyprogesterone acetate elicit actions circulating lipids , attention directed toward examining long term effects lower dosage given continuously
endotoxin vaginal fluid women bacterial concentration endotoxin vaginal fluid measured 19 women bacterial nine controls normal vaginal flora vaginal fluid women bacterial contained significantly greater amounts endotoxin 0 308 0 versus 0 008 0 002 endotoxin units mg vaginal fluid endotoxin vaginal fluid may contribute activation prostaglandin system , could provoke premature labor
persistent tubal pregnancy persistent tubal pregnancy may manifest either acute symptoms persistent rising beta hcg titer following conservative surgery condition relatively new complication , related recent practice conservative surgical management tubal pregnancy much written identification possible therapy condition little known pathophysiology eight cases persistence studied , well three cases failed conservative procedures nine instances , surgeon concentrated appropriately maximally dilated portion tube , contained blood clot aborted products conception unfortunately , implantation site located , toward uterus ways avoiding complication include medial exploration possibly use injection vasopressin understanding natural history pathologic process might also valuable management cases persistence identified solely continuing beta hcg titer
regulation gene expression choriocarcinoma methotrexate hydroxyurea choriocarcinoma , highly malignant neoplasm trophoblastic origin , remarkable marked degree sensitivity chemotherapeutic agents treated two cell lines derived choriocarcinoma patients two antineoplastic agents , methotrexate hydroxyurea \( hu \) , cause nucleotide depletion previously shown effective choriocarcinoma , found regulation several genes three genes , hcg alpha subunit , beta subunit , placental alkaline phosphatase , strongly induced methotrexate hu expression c myc , oncogene associated proliferation , reduced nearly undetectable levels drug treatment , expression beta 2 microglobulin , component class 1 major histocompatibility locus , unchanged addition , mechanism induction hu one genes , hcg alpha subunit gene , found occur level transcription similar effects methotrexate hu , two unrelated , induction specific gene expression choriocarcinoma cells suggest effects due nucleotide pool alteration , rather specific ligand effects furthermore , hcg alpha subunit promoter contains regulated hu responsive element
changes women 's mental physical health pregnancy six months postpartum longitudinal study conducted investigate changes women 's mental physical health around time childbirth , determine whether health related length maternity leave thirty seven married , employed first time mothers completed questionnaires pregnancy , 6 weeks , 3 months , 6 months postpartum results showed , pregnancy postpartum month , number days mothers ill infections steadily increased addition , depressive symptoms new mothers rose pregnancy week postpartum , declined thereafter women return work period study , significant decline depressive symptoms observed prenatal period postpartum month findings demonstrate significant changes mental physical health group first time mothers
endometrial ablation roller ball electrode endometrial ablation control menorrhagia safe , effective alternative hysterectomy selected patients endometrial ablation equipped roller ball electrode used 12 patients technique appears effective nd yag laser endometrial ablation offers gynecologists advantages speed , low cost safety compared laser approach
increased risk ectopic pregnancy maternal cigarette smoking part case control study ectopic pregnancy , evaluated potential etiologic role cigarette smoking maternal cigarette smoking time conception associated increased risk ectopic pregnancy dose response relationship \( adjusted odds ratios 1 30 2 49 \) hand , partner 's smoking associated ectopic pregnancy study provides supplementary argument towards causal effect smoking development ectopic pregnancy
carcinoma female reproductive organs value cross sectional imaging cross sectional imaging techniques e , computed tomography \( ct \) magnetic resonance imaging \( mri \) , play integral role evaluation patients carcinoma female reproductive system neither ct mri , however , tissue specific , benign malignant disease cannot differentiated using techniques alone therefore , diagnosis clinical based history , physical examination , histology diagnosis made , ct mri recommended noninvasive evaluation tumor extent , often helping designing optimal therapy , thus facilitating effective treatment ultimately influencing patient prognosis evaluating tumors uterus , including endometrial cervical carcinomas , ct limited evaluation extensive disease believed value ct rises proportionately size extent disease major limitation suboptimal tissue contrast resolution , making differentiation small tumor surrounding normal tissue difficult mri renders excellent soft tissue contrast , allowing direct tumor visualization assessment tumor volume , depth penetration , extension adjacent tissues assessment parameters crucial deciding choice therapy , whether surgery , radiation , chemotherapy , combination initial management ovarian cancer usually includes surgical staging tumor debulking ct remains primary staging technique value resides primarily identification tumor metastases patient follow despite progress use ct mri , second look laparotomy ovarian cancer technical advances radiologic cross sectional imaging significantly improved accuracy noninvasive tumor staging although still limitations techniques , additional technical improvement better tissue characterization
laparoscopic cautery treatment endometriosis related infertility life table analysis two parameter exponential method applied pregnancy rates 72 patients undergoing laparoscopic cautery exclusively patients male factor infertility excluded estimated cure rates patients stage ii disease 98 2 76 6 , respectively \( significantly different \) significant difference seen complicated endometriosis \( 68 6 \) greater one infertility factor present , significant difference observed \( 50 6 \) patients stage disease average 10 30 decreasing values observed stage ii \( 7 59 \) , \( 6 67 \) , one infertility factor \( 3 33 \) conclude laparoscopic effective mode therapy treatment stage ii endometriosis associated infertility
endometrial epithelial cells peritoneal fluid early follicular phase peritoneal fluid \( pf \) obtained early follicular phase 24 women laparoscopy part infertility investigation cells present pf pelleted cultured developing endometrial epithelial cell colonies identified 19 women \( 79 \) identification cell colonies facilitated using monoclonal antibody bw 36 specific marker number endometrial epithelial cell colonies showed large variation \( 1 200 pf sample \) significant distinction incidence number cell colonies found women minimal \( n 11 \) without endometriosis \( n 12 \) significant correlation number cell colonies found women infertility mechanical male infertility factors data indicate retrograde transport viable endometrial cells menstruation occurs women patent tubes implications results relation retrograde menstruation , endometriosis , infertility discussed
detection progesterone induced secretory protein synthesized uteri implants rats induced endometriosis steroids modulate secretory activity uterus , little known effect ectopic endometrium protein synthesis secretion utilized two dimensional electrophoresis visualize proteins produced uteri implants steroid treated cyclic rats without surgically induced endometriosis greater 300 proteins visualized , uterine cultures progesterone \( p \) stimulated , estrogen suppressed rats contained distinctive glycoprotein \( p induced uterine protein 1 molecular weight mr 70 , 000 isoelectric point pi 5 7 \) protein detected implant cultures progesterone induced uterine protein 1 could play role luteal endometrial physiology may valuable assessing endometrial function aberrant secretory behavior ectopic endometrium suggests possible involvement reproductive dysfunction associated endometriosis
intraoperative management ureteral injury operative laparoscopy injury ureter operative laparoscopy rare diagnosis usually made radiologically , postoperative period , patient presents symptoms signs suggestive ureteral injury report herein case ureteral injury resulting operative laparoscopy endometriosis injury diagnosed treated via laparoscopy procedure increased utilization operative laparoscopy perform complex procedures increases potential operative injury ureter prior visualization retroperitoneal dissection ureter , appropriate cases , help reduce complication permit prompt diagnosis event injury
predictive value active renin assay diagnosis ectopic pregnancy increasing frequency ep need early diagnosis focused interest research biochemical markers established hormonal values plasma 99 spontaneous ongoing pregnancies 4th 10th weeks amenorrhea , 21 eps , 20 cases early abortion examined predictive values trophoblastic cl production pathological pregnancies association low hcg low active renin appears able discriminate ectopic spontaneous gestations
bone mineral density lumbar spine endometriosis subjects compared age similar control population purpose study compare lumbar bone mineral density \( bmd \) women endometriosis age similar controls eighty five women nine north american centers \( mean age , 30 7 yr \) laparoscopically proven endometriosis \( study patients \) enrolled study efficacy , gnrh agonist fifty two women \( mean age , 32 yr \) area , regular menstrual cycles major medical problems , served age similar controls groups predominantly \( greater 92 \) white mean bmd lumbar spine 1 1 g cm2 study subjects controls study patients 104 8 controls 104 8 normal values age bmd significantly different two groups bmd correlated severity time diagnosis endometriosis bmd positively correlated weight \( r 0 28 p less 0 05 \) groups , height \( r 0 30 p less 0 01 \) study patients , marginally height \( r 0 26 p less 0 07 \) controls study showed difference bmd endometriosis patients age similar controls groups normal bmd
nifedipine treatment severe preeclampsia conducted randomized clinical trial patients severe preeclampsia 26 36 weeks gestation received either nifedipine \( 10 30 mg , 40 120 mg day orally n 24 \) hydralazine \( 6 25 12 5 mg intravenously , 80 120 mg day orally n 25 \) effective control blood pressure achieved nifedipine 95 8 subjects hydralazine 68 , statistically significant difference \( p less 05 \) maternal side effects minor groups acute fetal distress developed one nifedipine subject 11 treated hydralazine mean prolongation gestation 15 5 10 days nifedipine 9 5 11 days hydralazine , difference reach statistical significance \( p less 07 \) infants born women treated nifedipine delivered advanced gestational ages \( 34 6 2 3 versus 33 6 2 4 weeks statistically significant \) , weighed \( versus g statistically significant \) , tended fewer , mainly minor , complications average number days spent neonatal intensive care unit significantly lower nifedipine group \( 15 1 versus 32 7 days p less 005 \) , leading average 31 reduction total \( maternal neonatal \) hospitalization related charges nifedipine treated pregnancy conclude nifedipine effective , convenient , low cost treatment patients severe preeclampsia , associated undesirable side effects
etiologies preterm birth population prevention logical expectation \? assess expectations preterm birth prevention , determined causes preterm birth population women studied 13 , 119 singleton births predominantly black , population occurring november 1982 april 1986 identify proportion preterm births may prevented using current treatment modalities forty four percent preterm births occurred 35 36 weeks' gestational age , time practitioners attempt remainder , 17 occurred 35 weeks indicated maternal medical obstetric complications , another 17 occurred 35 weeks followed spontaneous premature rupture membranes therefore , preterm births , calculated 336 \( 23 2 \) theoretically preventable fourth presented less 3 cm cervical dilatation treated appropriately , delivered therefore , potentially preventable births occurred group presented cervical dilatation 3 cm conclude improving preterm birth rate significantly current levels may difficult achieve
risk factors shoulder engineering study clinician applied forces report engineering risk factors associated clinician applied forces vaginal delivery newborns specifically , present interpret data series experiments using force sensing devices 29 randomly selected vaginal births , including two shoulder deliveries one birth injury results indicate clinician applied peak forces typically 47 n routine deliveries , 69 n difficult deliveries , 100 n shoulder delivery \( p less 01 \) time required deliver fetal deliveries \( p less 01 \) addition , rate application force distinguish routine deliveries \( p less 03 \) conclude , properly perceived , force , force rate , duration force objective parameters used recognizing managing shoulder predicting thresholds birth injury
light microscopic electron microscopic correlations published erratum appears 1991 may 77 \( 5 \) 10 order examine ability diagnose pathology , 32 fallopian tubes evaluated histologically flexible rigid used , observations documented photography criteria established criterion assigned numerical value tube evaluated patency , mucosal fold architecture , erythema , adhesions , dilatation based criteria , tubes graded normal abnormal mild , moderate , severe changes histologically , tube evaluated patency , epithelial changes , vascularity , dilatation , adhesions , active inflammation six tubes significant histologic findings two histologically normal fallopian tubes also examined transmission electron microscopy five discordant cases , histology revealed epithelial stromal changes detected fallopian tubes severe disease diagnosed methods transmission electron microscopy histologically abnormal tubes showed flattening epithelium markedly reduced ciliary distribution , secretory epithelial cells large intracellular vacuoles , swollen nuclei containing sparse chromatin results indicate observations consistent histologic findings disease severe however , moderate pathologic changes documented light microscopy transmission electron microscopy frequently diagnosed , even magnification
serial endovaginal sonography ectopic pregnancies treated methotrexate methotrexate therapy newly established treatment modality ectopic pregnancy performed study determine time frame resolution identifiable mass therapy determine role sonography management patients eighteen patients treated methotrexate laparoscopically proven ectopic pregnancy long term follow endovaginal sonography 18 patients constitute study group time required sonographic resolution mass variable , although poor patient compliance sonographic follow affected conclusions regarding resolution time one hundred eight days longest period accurately known resolution mass seven patients , mass persisted negative hcg titer enlargement adnexal mass therapy necessarily predict treatment failure , two ten patients required surgery rupture serial sonography alter management patients appears warranted routine basis follow sonography useful complications suspected patients considered methotrexate therapy first endovaginal , cardiac activity remains relative contraindication treatment determined mass ectopic pregnancy may remain hcg negative therefore , persistent mass interpreted treatment failure
measures sexual behavior risk pelvic inflammatory disease women 's sexual behavior affects risk acquiring pelvic inflammatory disease , risks well characterized study association pelvic inflammatory disease sexual behavior , analyzed data multicenter , case control study involving women hospitalized initial episode pelvic inflammatory disease hospitalized control women without history pelvic inflammatory disease study participants provided information frequency intercourse , number recent sexual partners , previous history gonorrhea logistic regression methods used adjust confounding factors women reported four sexual partners three times likely hospitalized pelvic inflammatory disease \( relative risk 3 4 95 confidence interval 2 2 5 3 \) women reported one recent sexual partner lesser extent , frequent sexual intercourse history gonorrhea also increased woman 's risk pelvic inflammatory disease frequent intercourse strong risk factor pelvic inflammatory disease among subgroup women low risk acquiring sexually transmitted disease married women one recent sexual partner intercourse six times per week risk pelvic inflammatory disease 3 2 \( 1 4 7 2 \) compared similar women intercourse less per week frequent intercourse , increase risk acquiring sexually transmitted disease , may increase woman 's risk pelvic inflammatory disease
epidemiologic characteristics preterm delivery etiologic heterogeneity preterm delivery \( less 37 weeks completed gestation \) known result diverse etiologic pathways , grouped idiopathic preterm labor , preterm premature rupture membranes , medical complications data providing sufficient detail preterm delivery cases groups tabulated spite inconsistent incomplete reporting , patterns identified black women markedly higher risk preterm delivery , especially pronounced preterm premature rupture membranes idiopathic preterm labor predominant lower risk , white populations observations encourage consideration preterm delivery studies etiology prevention
investigation placental circulations color doppler ultrasonography placental circulations 25 normal five complicated pregnancies studied color doppler ultrasonography flow velocity waveforms obtained 30 pregnancies could discriminate fetal maternal blood flow believe color doppler ultrasonography improve understanding pathophysiology various pregnancy disorders alter placental circulations color ultrasonography useful prenatal differential diagnosis intrauterine masses
reproductive factors risk endometrial cancer role reproductive factors endometrial cancer risk analyzed case control study conducted since 1983 greater milan area women \( cases \) histologically confirmed endometrial cancer women \( controls \) admitted acute , nonmalignant , hormonal , gynecologic conditions hospitals cover comparable area compared nulliparous women , parous women 30 lower risk endometrial cancer , evidence decline risk increasing number births risk disease decreased number spontaneous induced abortions multivariate relative risk estimates , compared respectively spontaneous induced abortions , 0 5 women two spontaneous abortions 0 3 women two induced abortions trends risk statistically significant parous women considered , association emerged endometrial cancer age first birth , risk decreased increasing age last birth compared women whose last birth occurred age 25 , relative risk 0 5 women greater equal 35 years old last birth , multivariate trend risk statistically significant reproductive factors considered , risk estimates tended greater younger age among premenopausal women subsequent age association endometrial cancer age first birth observed women less equal 49 years old , older groups observation later age last birth well later first birth younger women decreases risk endometrial cancer suggests short term protective effect pregnancy finding consistent late stage \( promotional \) effect reproductive factors endometrial carcinogenesis
pregnancy related mortality new york city , 1980 1984 causes death associated risk factors identify causes risk factors pregnancy related mortality new york city , analyzed 224 pregnancy related deaths occurred 1980 1984 leading causes death ectopic pregnancy complications , embolism , intrapartum cardiac arrest , hypertension mortality ratios determined comparing characteristics women whose death pregnancy related women survived delivery live infant new york city period black hispanic women mortality ratios respectively 4 2 2 0 times higher white , non hispanic women comparison women aged 20 24 , older 30 twice likely die pregnancy related causes , older 40 five times likely factors associated increased risk pregnancy related mortality included 9 11 years education , lack private medical insurance , five previous pregnancies , fewer five prenatal visits study suggests changes current maternal health family planning services required achieve reductions preventable pregnancy related mortality
human amniotic fluid modulation collagenase production cultured fibroblasts model fetal membrane rupture participation mechanical factor cause rupture fetal membranes normal labor premature rupture , involvement enzymatic mechanism proposed study analyzed effect human amniotic fluids different gestational ages collagenase synthesis cultured fibroblasts results show term amniotic fluids capable inducing synthesis collagenase proteases fibroblasts , revealed selective increases collagenase activity immunoreactive collagenase amniotic fluids failed phenomenon proposed model studying collagen degradation fetal membranes term gestation
early diagnosis vulvar neoplasia result vulvar self examination vulvar self examination used facilitate early diagnosis treatment vulvar neoplasia eight patients five found invasive squamous cell carcinoma , two carcinoma situ , one melanoma eight patients benefited early diagnosis , allowed definitive treatment vulvar conservation
prevalence marijuana use pregnancy pilot study examined prevalence marijuana use group pregnant women using qualitative , rapid urine screen detect marijuana metabolites july 1 , 1987 , 15 , 1987 , consecutive patients underwent anonymous urine toxicology screen time admission labor delivery unit patients identified consecutive number age , race , marital status , , parity obstetric service \( clinic vs private \) prevalence positive urine toxicologic screens marijuana 19 9 among study population \( 64 positive tests among women screened \) prevalence greater among clinic patients private patients \( 52 161 , 32 3 , vs 12 161 , 7 5 , respectively \) distribution race marital status among marijuana positive negative groups also significantly different specifically , proportions black single women higher among marijuana positive group findings suggest marijuana use common obstetric patients possible association marijuana use pregnancy perinatal morbidity , well unreliable nature patient drug histories , may support use rapid , inexpensive screening techniques , especially general screening considered
early laparoscopy management suspected ectopic pregnancy accuracy morbidity ninety nine patients suspected ectopic pregnancy \( ep \) subjected laparoscopy laparotomy 18 month period district hospital , london , third \( 32 99 \) cases ep , 67 potentially avoidable performed potentially avoidable laparoscopy followed laparotomy 27 cases \( 18 67 \) , least 13 laparotomies unnecessary addition , two false positive diagnoses ep made laparoscopy , resulting avoidable loss part single remaining fallopian tube use sensitive pregnancy testing least 62 , 13 laparotomies 1 case pulmonary embolus might avoided patients 195 hospitalization
ascertainment maternal deaths new york city maternal deaths new york city defined deaths cause woman pregnant within six months pregnancy termination pilot studies seeking improve maternal death ascertainment found selected medical examiner reports contributed additional 10 5 percent total maternal deaths , vital statistics review contributed 6 3 percent , linkage death women reproductive age live birth fetal death contributed 1 0 percent medical examiner cases incorporated surveillance data accurate ascertainment pregnancy associated deaths
effects maternal iodine supplementation pregnancy reduced maternal thyroid hormone concentrations pregnancy adversely affect fetal neurological development context national iodine supplementation , concern expressed theoretical possibility iodine supplementation pregnancy might adversely affect fetal development result maternal thyroid inhibition wolff effect double blind controlled trial five villages papua new guinea , several measures motor cognitive function showed significant differences either age 11 15 years children whose mothers received supplementary iodine pregnancy control children whose mothers received placebo
suicide pregnancy first postnatal year objectives calculate age adjusted mortality ratios suicide women first year childbirth pregnancy , identify characteristics postnatal suicide childbearing women design retrospective study based population data england wales 1973 1984 subjects women aged 15 44 committed suicide year childbirth pregnancy main outcome measures observed expected mortality ratios total postnatal sample , five year age groups , unmarried mothers , suicide stillbirth observed expected mortality ratios suicides pregnancy five year age groups timing suicides relation delivery frequency various methods suicide results standardised mortality ratio postnatal suicide calculated 0 17 , actual total one sixth expected low ratio found stillbirth , associated rate six times women childbirth low ratio less pronounced , still present , mothers unmarried mothers women committed suicide childbirth often first month , tendency use violent methods standardised mortality ratio suicide pregnancy calculated 0 05 pregnant women teenagers substantially increased risk conclusions women first year childbirth pregnancy low risk suicide despite high rate psychiatric morbidity maternal suicides unlikely explain findings , though may affect magnitude seems protect suicide concern may important focus suicide prevention clinical practice
duchenne becker muscular dystrophies genetics , prenatal diagnosis , future prospects dmd bmd understood genetic , biochemical , molecular levels genetic level , disorders result mutations x linked gene encoding dystrophin biochemical level , dmd results deficiency large protein called dystrophin , whereas bmd results dystrophin present , though abnormal either amount molecular structure date , patients analyzed mutations dystrophin gene peripheral blood dna alterations dystrophin protein muscle tissue severity clinical phenotype patients compared dystrophin gene mutations corresponding dystrophin protein alterations , revealing unexpectedly high degree correlation thus , information derived molecular analysis \( dna protein \) particular patient provides molecular diagnosis , highly predictive clinical course patient expected follow molecular diagnoses independent patient 's age , provide prognosis large majority muscular dystrophy patients even clinical symptoms disease become apparent prognostic molecular diagnoses proven particularly valuable patient isolated case , family history disorder prenatal genetic diagnosis dmd bmd may involve use southern blot pcr techniques search deletion dna risk fetuses complicated family linkage studies using flanking rflps recently , assay dystrophin content fetal skeletal cardiac muscle risk accomplished , allowing definitive discrimination affected normal fetuses cases deletion analyses family dna studies equivocal utero fetal skeletal muscle biopsy dystrophin protein assay actually accomplished least one risk pregnancy family dna studies dystrophin present skeletal muscle 20 week old male fetus , pregnancy continued , resulting term birth healthy male infant future holds opportunities neonatal screening treatment devastating neuromuscular diseases
intrauterine device pelvic inflammatory disease women 's health study women 's health study \( \) large , widely accepted influential case control study relationship use intrauterine contraceptive devices \( \) pelvic inflammatory disease \( pid \) data collected 16 hospitals 9 cities across u october 1976 august 1978 first paper research published 1981 concluded increase risk pid report cited estimated rr \( relative risk \) pid current users vs users 1 6 95 confidence interval \( 1 4 , 1 9 \) however , careful examination report reveals data support conclusions author arrived second report published 1983 , anticipated many shortcomings first report would corrected , 1983 undertook complete data using appropriate criteria results compared first two published reports revealed rr 1 02 \( 0 86 , 1 21 \) current users compared conclusion increase risk pid
coagulation screening epidural analgesia pre eclampsia questionnaire survey current practice small cross section obstetric units , covering 22 united kingdom deliveries , revealed marked lack standard practice regarding requests coagulation screens pre eclamptic patients require epidural procedures retrospective audit therefore carried coagulation screens requested pre eclamptic patients epidural analgesia might considered borderline abnormalities coagulation found 10 patients \( 2 \) platelet counts less 150 x 10 \( 9 \) litre present 28 cases thrombocytopenia \( less 100 x 10 \( 9 \) litre \) coagulation abnormalities encountered severe pre eclampsia \( diastolic blood pressure greater 110 mmhg proteinuria greater \) furthermore , coagulation abnormality always associated reduced platelet count \( mean , 97 x 10 \( 9 \) litre \) study would therefore support anaesthetic practice restricted requests coagulation testing severe pre eclamptic patients patients first line testing could limited platelet count
comparison food frequency questionnaire using reported vs standard portion sizes classifying individuals according nutrient intake individual intakes retinol , carotene , vitamin c , calculated food frequency questionnaire using reported portion size compared intakes calculated using standard portion size information data case control study determine association nutrient intake risk cervical dysplasia supplemented standard portion size information us department significant mean differences found intake calculated reported portion size data calculated standard portion size data nutrients correlation nutrient intakes obtained two methods data collection ranged 73 92 calculation statistic , measuring consistency classification participants groups high , medium , low nutrient intake , led values ranging 55 71 , indicating misclassification study participants determine effect misclassification study outcome , odds ratios calculated using nutrient amounts obtained methods collecting portion size data results indicate replacing reported portion size data standard portion size data may lead conflicting outcomes specific nutrients research concerning relationship diet disease
gender roles , social support , postpartum depressive symptomatology benefits caring although women assumed particularly vulnerable depressive symptomatology childbirth , extent symptomatology found men life cycle stage addressed study examined gender differences postpartum depressive symptomatology link postpartum symptomatology gender roles relationships sample obtained childbirth preparation classes data show gender difference depressive symptomatology 2 months childbirth women manifested decrease depressive symptomatology men showed slight increase point partially link women 's equivalent rather higher distress levels protective effects varied social supports contrast , men depended primarily spouses , experienced decrease spouse support childbirth female lack support strongly associated symptomatology compared employed women women maternity leave within context gender role changes , data highlight benefits female bonding contrast costs caring depicted researchers
external version term randomized controlled trial using objective assess role external version \( ecv \) term , using design randomized controlled trial 12 month period setting maternity hospital , , subjects 208 women presentation term recruited eligibility criteria 103 women study group 105 control group end study 104 women recruited ecv intervention ecv attempted intravenous injection 10 micrograms , using either forward maximum period 5 min main outcome measures success rate terms presentation labour , need caesarean section , various variables related fetal outcome results ecv reduced frequency presentation labour 83 17 caesarean section 33 13 troublesome complications procedure conclusion carefully selected women presentation , ecv term using , safely reduced rate presentation labour also caesarean section rate research needed determine role ecv early labour
insulin stimulates synthesis release human chorionic gonadotropin choriocarcinoma cell lines recent studies shown insulin regulates placental lactogen , progesterone , estrogen production human trophoblast cells study performed examine whether insulin also regulates production hcg type cell 24 36 h preincubation , jeg 3 jar cells \( 2 3 x 10 \( 5 \) cells ml well \) human term trophoblast cells \( 1 x 10 \( 6 \) cells ml well \) exposed test hormone serum free 's modified 's medium 24 96 h secretion hcg jeg 3 cells stimulated human insulin , human proinsulin , porcine insulin dose dependent manner , lowest effective doses 6 7 , 96 , 53 mg l , respectively time course studies showed hcg secretion peaked 72 96 h insulin exposure contrast , peak seen without insulin serum free media exposure jeg 3 cells 24 h 209 mg liter insulin stimulated hcg synthesis , 40 3 immunoreactive intracellular hcg \( p less 0 05 \) cells grown presence insulin 35s methionine 47 21 labeled intracellular hcg 56 13 35s methionine hcg secreted medium control cultures \( p less 0 05 \) time period , human placental lactogen release total acid 35s methionine protein increased insulin induced stimulation hcg synthesis inhibited cycloheximide additionally , insulin significantly affect total intracellular protein 24 96 h incubation insulin also increased hcg release jar cells , human term trophoblast cells mouse monoclonal antibody igf receptor inhibited stimulation insulin jeg 3 cells conclude insulin stimulates synthesis secretion hcg jeg 3 cells jar cells , hcg regulation choriocarcinoma cells differs primary human placental trophoblast cells effect insulin jeg 3 cells may mediated part insulin like growth factor receptor
effect beta carotene regression progression cervical dysplasia clinical experiment order gain insight relation beta carotene cancer , performed randomized placebo controlled trial effect beta carotene regression progression rates cervical dysplasia examined experimental group \( n 137 \) received supplemental dose 10 mg beta carotene daily 3 months control group \( n 141 \) received placebo capsules outcome parameter , two definitions regression progression used , based degree dysplasia medication period number patients showed progression small allow conclusions effect beta carotene regression percentages observed 0 68 \( 95 ci 0 28 1 60 \) using broad definition 1 22 \( 95 ci 0 43 3 41 \) strict definition secondary analysis , effect total intake beta carotene \( diet medication \) regression percentages cervical dysplasia studied , show positive effect either paper discusses extent issues study design may masked potential effect results affect evidence causal relation beta carotene cancer
selective fallopian tube infertility increasingly common problem occlusion fallopian tubes one principal causes , recently surgery available treatment success rate surgery often low , particularly occlusion proximal tube selective fallopian tube fluoroscopic guidance successful alleviating proximal tubal obstruction procedure may performed outpatient setting safe , cost effective alternative surgery
cause death emergency department retrospective review done consecutive emergency department deaths causes accounted 77 deaths group average age 64 years male female ratio 1 9 1 trauma caused 23 fatalities group younger average age 29 years male female ratio 4 6 1 common causes death sudden death uncertain cause \( 34 \) , coronary artery disease \( 34 \) , cancer \( 5 \) , heart disease \( 4 \) , chronic obstructive lung disease \( 3 \) , drug overdose \( 3 \) , sudden infant death syndrome \( 2 \) common causes trauma death motor vehicle accidents \( 61 \) gunshot wounds \( 16 \) overall autopsy rate 40 death certificates often error
efficacy potassium magnesium essential hypertension double blind , placebo controlled , crossover study objective evaluate antihypertensive activity potassium given alone combination magnesium patients mild hypertension design double blind , randomised , placebo controlled , crossover trial 32 weeks' duration settings cardiology outpatient department , general hospitals , , india patients 37 adults mild hypertension \( diastolic blood pressure less 110 mm hg \) intervention patients received either placebo potassium 60 mmol day alone combination magnesium 20 mmol day crossover design drug treatment allowed measurements blood pressure heart rate assessed weekly intervals biochemical parameters monthly intervals results potassium alone combination magnesium produced significant reduction systolic diastolic blood pressures \( p less 0 001 \) significant reduction serum cholesterol concentration \( p less 0 05 \) biochemical variables change magnesium additional effect urinary potassium excretion increased significantly groups received potassium alone combination magnesium drug well tolerated compliance satisfactory conclusion potassium 60 mmol day lowers arterial blood pressure patients mild hypertension giving magnesium well added advantage
upper extremity performed 27 patients \( eight bilaterally \) ischaemic hand phenomena extended operative technique , parts second third intercostal nerves surrounding tissue , used 35 procedures posterior extrapleural approach used follow 3 12 years sympathetic ganglia removed previous surgery axillary approach \( 67 per cent patients transient response 6 months 2 years 33 per cent response \) direct subjective improvement seen 27 35 reoperations \( 77 per cent \) 14 patients continuous wave doppler ultrasound studies available showed significant increase peak forward frequency operation \( p less 0 001 \) data may concluded possible obtain effect , reoperation reserved special cases survival essential
finger blood pressure versus brachial blood pressure recording study , recently marketed finger blood pressure monitor , , f 88 , compared standard brachial mercury 125 subjects measurements undertaken according standards set american heart association sensitivity finger blood pressure measurement 76 systolic 75 diastolic blood pressure diagnosis high blood pressure \( systolic greater 140 mm hg diastolic greater 90 mm hg \) specificity 86 systolic 82 diastolic blood pressure positive predictive values 58 systolic 38 diastolic blood pressure study population prevalence hypertension 12 correlation coefficient \( pearson \) systolic values devices 0 76 \( p less 0001 \) 0 57 \( p less 0001 \) diastolic pressure values obtained finger monitor found higher obtained mercury mean differences standard deviations \( paired test \) systolic diastolic pressures two devices 2 3 14 9 mm hg \( p less 08 \) 2 9 14 5 mm hg \( p less 02 \) , respectively values accordance proposed national standards 48 systolic 37 diastolic blood pressure measurements within 5 mm hg mercury measurements therefore , although differences may well due different techniques monitoring employed devices , device recommended evaluation blood pressure
leukocyte count predictor hypertension exploratory study persons observed progress normotension essential hypertension matched subjects remained normotensive , initial leukocyte count \( wbc \) found related development hypertension , risk increased 40 \( 95 confidence interval 12 82 \) persons highest compared lowest quartile wbc relationship proved largely independent body mass index , body fat distribution , alcohol tobacco consumption , parental history hypertension increased wbc may reflect greater sympathetic tone may directly increase peripheral vascular resistance circulation small blood vessels confirmed , study adds another condition growing list wbc predictive simple , test considered inclusion prospective epidemiological studies many different diseases
plasma fibrinogen coronary risk factors scottish heart health study plasma fibrinogen measured sample men women aged 40 59 years participating scottish heart health study , related cardiovascular risk factors women higher fibrinogen levels men sexes , multivariate analysis showed fibrinogen positively associated age , smoking , total cholesterol body mass index negatively associated alcohol consumption among women , early menopause systolic blood pressure also associated fibrinogen levels univariate analyses showed weak positive associations fish consumption sexes although male white fish consumption entered final model women history contraceptive pill usage significantly lower fibrinogen levels relationship fibrinogen physical activity complex , could largely explained smoking findings support hypothesis raised fibrinogen one mechanism several major risk factors may promote coronary heart disease however , known risk factors explained , , 10 total variance fibrinogen levels among general population
effects generation gender joint distributions lipid apolipoprotein phenotypes population large generation gender effects joint distributions total plasma cholesterol \( total c \) , ln triglycerides \( lntrig \) , hdl cholesterol \( hdl c \) , ldl cholesterol \( ldl c \) , apolipoproteins ai \( apo ai \) , aii \( apo aii \) , e \( e \) studied 184 male \( \) , 242 female \( \) , 237 male parents \( mp \) , 235 female parents \( fp \) , 202 male children \( mc \) , 200 female children \( fc \) homogeneity variance tests revealed lipid variances gender generation specific apolipoprotein variances homogeneous across absence heterogeneity variance , significant heterogeneity ldl lntrig lntrig apo aii found parental generation presence heterogeneity variance , significant heterogeneity correlation across generations found hdl c ldl c , total c ldl c , total c lntrig , lntrig ldl c , total c e hdl c e distributions analyses principal components revealed generation gender specific cohorts similar distinct first two principal components underlying seven dimensional lipid apolipoprotein distribution conclude amount variability explained first two principal components across cohorts interindividual variability distributed among lipid apolipoprotein traits generation gender specific study documents role variance covariance might play determining risk disease special subgroups population large also demonstrates variances risk factors traits characterize life processes aging sexual study future genetic epidemiological studies coronary artery disease must take account age gender effects interindividual variability risk factors
risk ratios risk differences estimating effect risk factors cardiovascular disease elderly article reviews nature effects hypertension , smoking cholesterol incidence cardiovascular disease emphasizes effects vary age methods section , discuss briefly concepts additive statistical models tools data results section , summarize available data association incident stroke coronary heart disease elderly major risk factors traditional model characterizes individual joint effects age high blood pressure terms risk ratios , smoking cholesterol , additive model appears discuss consequences observations study prevention cardiovascular disease elderly
significance fill thallium 201 reinjection following delayed imaging comparison regional wall motion angiographic findings identify reversible defects , reinjection small amount thallium 201 \( 201tl \) following 3 hr delayed imaging performed 60 patients coronary artery disease perfusion abnormalities post exercise 201tl images thallium 201 uptake visually scored judged normal \( group 1 \) , reversible defect \( group ii \) , new fill reinjection \( group iiia \) fill even reinjection \( group iiib \) new fill reinjection observed 27 segments 85 segments \( 32 \) , showing persistent defect stress delayed images wall motion group iiia worse group ii better group iiib group iiia showed q wave ecg often \( 69 \) group ii \( 27 \) \( p less 0 01 \) , less often group iiib \( 85 \) \( p less 0 05 \) data indicate reinjection 201tl imaging often identifies new fill areas redistribution delayed images may hold promise assessing tissue viability conventional imaging may underestimate
effects long term coenzyme captopril treatment survival functional capacity rats experimentally induced heart infarction effects coenzyme \( coq \) captopril functional capacity , hemodynamics survival studied 154 rats recovered experimental myocardial infarction rats randomized four groups receiving either coq , captopril , combination two drugs 1 ml water daily 12 weeks day coronary artery ligation coq well captopril combined treatment significantly improved exercise capacity evaluated lactate production standardized treadmill exercise test significant changes heart rate mean blood pressure observed study captopril treated group coq treatment increased maximum heart rate significantly , whereas effect mean blood pressure observed captopril coq decreased pulmonary congestion furthermore , data may suggest captopril prevents right ventricular hypertrophy seen placebo treated rats large infarcts observed coq treatment captopril treatment improved 3 month probability survival \( 93 \) compared placebo \( 74 \) \( p less 05 \) coq combined treatment tended improve survival , , however , statistically significant
temporal arteritis \? one characteristics art details represented pa em \( bc , \) might gives clues diagnosis eyes closed swollen , appears space round face , temporal ara heightened broken line joining extremity corner eye details found elsewhere 's blindness result temporal arteritis associated \?
propagation deep venous thrombosis identified duplex ultrasonography investigate efficacy anticoagulation preventing continuing thrombosis , prospectively evaluated 24 patients acute deep venous thrombosis using duplex ultrasonography patients hospitalized conclusive ultrasonic evidence deep venous thrombosis identified one four levels , calf ii , calf popliteal iii , calf popliteal femoral iv , calf popliteal femoral iliac duplex scans obtained admission three subsequent occasions therapy progression thrombosis defined advancement thrombus proximal venous level demographic data , symptoms , risk factors deep venous thrombosis , physical findings , anticoagulation regimens , hematologic variables ascertained adequacy anticoagulation defined elevation baseline activated partial thromboplastin time 150 nine patients \( 38 \) progression thrombosis , 15 \( 62 \) stable improving duplex scans progression occurred follows ii \( 2 \) , iii \( 2 \) , ii iii \( 1 \) , iii iv \( 4 \) demographic clinical variables examined , smoking correlated progression thrombus \( p 0 04 \) average heparin dose stable group 294 units hr units hr group progressed \( p 0 8 \) activated partial thromboplastin time 45 6 7 seconds stable group 49 8 9 seconds progression group \( p 0 7 \) nine patients stable group consistently adequate anticoagulation , whereas six six progression group consistently anticoagulated , three two patients \( one stable thrombus one progressive thrombus \) suffered nonfatal pulmonary emboli clot progression determined duplex scanning predict acute complications deep venous thrombosis
clinical spectrum symptomatic external iliac fibromuscular dysplasia external iliac fibromuscular dysplasia rare usually asymptomatic disorder report eight symptomatic patients seen 15 year period review pathophysiologic mechanisms accounting three following distinct lower extremity ischemic sequelae \( 1 \) emboli episodic focal digital ischemia \( blue toe \) seen three patients resection primary anastomosis focal iliac ulcerative fibromuscular dysplasia \( one patient \) resection replacement \( two patients \) removed embolic source relieved symptoms \( 2 \) chronic ischemia gradual onset full leg claudication four patients treated operative graduated intraluminal dilation three patients prosthetic bypass one arteriography subsequently showed lumen three patients underwent dilation \( 3 \) dissection acute onset leg ischemia resulted presumed dissection external iliac segment 4 months conservative management antiplatelet agents exercise , symptoms resolved completely , arteriogram showed spontaneous restoration normal lumen dissected segment clinical presentation fibromuscular dysplasia may mimic arterial processes atherosclerosis diagnosis made arteriography specific magnification views external iliac arteries careful surveillance renal arteries appropriate treatment tailored clinical presenting symptom disease , resection replacement required chronic ischemia , intraluminal dilation generally sufficient durable proved simpler acceptable alternative replacement bypass acute dissection , surgical intervention may deferred limb viable allow spontaneous healing remodeling persistent symptoms may indication intervention ischemic manifestation external iliac fibromuscular dysplasia
initial clinical evaluation carotid artery laser endarterectomy clinical study carotid artery laser endarterectomy began april 15 , 1988 report describes first 10 cases performed nine patients \( five men four women , mean age 70 years \) indications asymptomatic stenosis \( 5 \) , transient ischemic attacks \( 4 \) , stroke evolution \( 1 \) two emergency cases eight elective cases \( including one reoperative case \) surgical exposure , systemic , vascular control , longitudinal used cleavage plane media developed argon ion laser radiation \( 5 nm \) directed 300 microns fiber power 1 0 w laser radiation used cut arteries weld end points residual atheromatous debris individual laser exposures closed sutures , blood flow restored endarterectomies 3 9 1 1 cm long required 330 97 joules mean clamp time 22 5 7 9 minutes shunts used two cases arterial perforations injuries result laser light complications hematoma \( 1 \) , respiratory arrest \( 1 \) , transient neurologic deficit \( 1 \) carotid endarterectomy technically feasible argon ion laser radiation present series , postoperative observations , averaging 12 months ranging 5 19 months , shown satisfactory results angiographic follow examinations carried
influence extracorporeal circulation erythrocytes flow properties blood influence extracorporeal circulation red blood cells flow properties blood studied 10 patients undergoing aorta coronary bypass grafting blood samples drawn admission , general anesthesia operation , extracorporeal circulation , immediately extracorporeal circulation , 24 hours extracorporeal circulation found shortly extracorporeal circulation , disappeared within 24 hours washing cells buffer restored normal shape , indicated plasma factor responsible red cell membrane lipids affected analysis membrane proteins revealed decrease ankyrin extracorporeal circulation , prevented protease inhibitors preparation suggests increased proteolytic activity plasma extracorporeal circulation red cell deformability altered plasma viscosity hematocrit markedly reduced hemodilution priming solution low levels resulted low blood viscosity extracorporeal circulation , even lower 26 degrees c operation 37 degrees c conclude red cell affected extracorporeal circulation flow properties blood , however , impaired , improved hemodilution
prostacyclin prostaglandin e2 mediate reduction increased mean arterial pressure cardiopulmonary bypass aspiration shed pulmonary venous blood increased mean arterial pressure aortic period cardiopulmonary bypass usually treated us hypotensive drugs noticed , however , shed excess pulmonary venous blood open pleural cavities causes immediate reduction mean arterial pressure , need pharmaceutical intervention study investigated relationship reduction mean arterial pressure levels prostacyclin prostaglandin e2 peripheral pulmonary venous blood ten men undergoing coronary bypass operations 21 episodes increased mean arterial pressure \( 106 9 11 4 mm hg \) aortic , reduced 67 4 11 4 mm hg \( p less 0 001 \) mean ml \( range 150 ml \) pulmonary venous blood back circulation mean peripheral prostacyclin level , measured 6 keto prostaglandin f1 alpha , prostaglandin e2 level , measured radioimmunoassay technique , significantly lower peak mean arterial pressure \( 180 59 5 21 2 pg ml \) lowest mean arterial pressure \( 271 96 7 52 4 pg ml 6 keto prostaglandin f1 alpha prostaglandin e2 , respectively p less 0 001 \) prostaglandin f1 alpha prostaglandin e2 levels aspirated pulmonary venous blood pg ml pg ml , respectively hypotensive effect shed pulmonary venous blood aspirated back circulation seems mediated high levels prostacyclin prostaglandin e2 , powerful vasodilators
myocardial temperature cardiac operations influence right ventricular function maintenance right heart integrity frequently neglected coronary operations right ventricular dysfunction sometimes limits success surgical procedure , however addition use cardioplegic solutions , myocardial hypothermia ischemic cardiac arrest seems important factor right ventricular performance thereafter study designed measure myocardial temperature patients coronary artery disease significant stenosis right coronary artery comparison stenosis right coronary artery evaluate influence myocardial temperature right ventricular hemodynamics cardiopulmonary bypass right ventricular function assessed thermodilution technique , allows measurement right ventricular ejection fraction , right ventricular end diastolic volume , right ventricular end systolic volume right ventricular temperature differed significantly two groups , lowest value 15 1 degrees 1 8 degrees c group without stenosis right coronary artery value 22 2 degrees 2 1 degrees c group stenosis right coronary artery left ventricular septal temperatures without group differences within investigation period right ventricular hemodynamics impaired group stenosis right coronary artery decrease right ventricular ejection fraction 44 2 34 1 immediately termination bypass increase right ventricular end diastolic volume index \( 38 \) right ventricular end systolic volume index \( 70 \) cardiac index decreased group , \( 22 5 \) analysis covariance revealed significant correlation changes right ventricular ejection fraction , right ventricular end diastolic volume , right ventricular end systolic volume course right myocardial temperature concluded right ventricular hypothermia difficult achieve patients diseased right coronary artery constant myocardial hypothermia , however , seems important right ventricular function , easily evaluated thermodilution technique
intraoperative coronary artery endarterectomy excimer laser compared continuous wave lasers , excimer lasers exhibit several vitro advantages ablation process linear relation number pulses depth 308 nm , 20 pulse duration , 1 5 repetition rate laser specifically designed clinical application time cardiopulmonary bypass 10 symptomatic patients , bypass grafting , 1 mm diameter core specifically ultraviolet tipped fiberoptic scope introduced via coronary placed upstream \( seven patients \) downstream \( three patients \) contact stenosis laser power increasingly delivered clearing stenosis occlusion quality angioplasty controlled , cardioplegic solution output laser treated segment , eighth day sixth month coronary arteriogram first three patients studied eighth day , laser treated coronary artery segments showed early parallel linked patent despite competitive bypass graft flow patients studied 6 months , segments patent except one one patient venous graft occluded , upstream laser angioplasty patent main limitation method lies fact laser coronary recanalization confined fiber core diameter conclude \( 1 \) excimer laser angioplasty may safe efficient surgical procedure \( 2 \) catheter flexibility remains critical problem , assuming appropriate tool system suitable intraoperative well percutaneous routes
risk myocardial infarction death treatment low dose aspirin intravenous heparin men unstable coronary artery disease group men unstable coronary artery disease \( unstable angina non q wave myocardial infarction mi \) , randomised double blind placebo controlled treatment oral aspirin 75 mg day 5 days intermittent intravenous heparin risk mi death reduced aspirin 5 days risk ratio 0 43 \( confidence intervals , 0 21 0 91 \) , 1 month 0 31 \( 0 18 0 53 \) , 3 months 0 36 \( 0 23 0 57 \) aspirin reduced event rate non q wave mi unstable angina , independently electrocardiographic abnormalities concurrent drug therapy heparin significant influence event rate , although group treated aspirin heparin lowest number events initial 5 days treatment side effects high patient compliance
renin angiotensin aldosterone system autosomal dominant polycystic kidney disease background high incidence hypertension \( 50 75 percent \) occurs early course autosomal dominant polycystic kidney disease cyst enlargement , causing bilateral renal ischemia subsequent release renin , proposed cause form hypertension methods investigate hypothesis , measured plasma renin activity aldosterone concentrations short term long term converting enzyme inhibition 14 patients hypertension due polycystic kidney disease , 9 patients essential hypertension , 11 normotensive patients polycystic kidney disease , 13 normal subjects groups comparable respect age , sex , body surface area , degree hypertension , sodium excretion , renal function results short term study , mean \( se \) plasma renin activity significantly higher hypertensive patients polycystic kidney disease patients essential hypertension , supine \( 0 36 0 06 vs 0 22 0 06 ng per liter second , p 0 05 \) upright positions \( 1 03 0 14 vs 0 61 0 08 ng per liter second , p less 0 03 \) converting enzyme inhibition \( 1 97 0 28 vs 0 67 0 17 ng per liter second , p less 0 0006 \) mean arterial pressures measured supine upright positions plasma aldosterone concentrations measured upright position significantly higher normotensive patients polycystic kidney disease normal subjects six weeks converting enzyme inhibition , renal plasma flow increased \( p less 0 005 \) , renal vascular resistance \( p less 0 007 \) filtration fraction \( p less 0 02 \) decreased significantly hypertensive patients polycystic kidney disease patients essential hypertension conclusions renin angiotensin aldosterone system stimulated significantly hypertensive patients polycystic kidney disease comparable patients essential hypertension increased renin release , perhaps due renal ischemia caused cyst expansion , probably contributes early development hypertension polycystic kidney disease
predicting appropriate use carotid endarterectomy , upper gastrointestinal endoscopy , coronary angiography background methods nationally representative population 65 years age older , demonstrated one quarter coronary upper gastrointestinal two thirds carotid endarterectomies performed reasons less medically appropriate paper examine whether specific characteristics patients \( age , sex , race \) , physicians \( age , board certification status , experience procedure \) , hospitals \( teaching status , profit making status , size \) predict whether procedure performed appropriately results general , found little variability appropriateness care \( 4 percent less \) could explained basis standard , easily obtainable data patient , physician , hospital three procedures , however , performance teaching hospital increased likelihood reasons would medically appropriate \( p 0 09 angiography , p 0 30 endoscopy , p less 0 01 endarterectomy \) addition , often performed appropriate reasons older patients \( p less 0 01 \) treated surgeon performed high rather low number procedures decreased likelihood appropriate endarterectomy one third , 40 28 percent \( p less 0 01 \) conclusions appropriateness care cannot closely predicted many easily determined characteristics patients , physicians , hospitals thus , present , appropriateness improved assessed directly level patient , hospital , physician
regression coronary artery disease result intensive lipid lowering therapy men high levels apolipoprotein b background methods effect intensive lipid lowering therapy coronary atherosclerosis among men high risk cardiovascular events assessed quantitative arteriography 146 men 62 years age apolipoprotein b levels greater equal 125 mg per , documented coronary artery disease , family history vascular disease , 120 completed 2 1 2 year double blind study , included arteriography base line treatment patients given dietary counseling randomly assigned one three treatments lovastatin \( 20 mg twice day \) colestipol \( 10 g three times day \) niacin \( 1 g four times day \) colestipol \( 10 g three times day \) conventional therapy placebo \( colestipol low density lipoprotein ldl cholesterol level elevated \) results levels ldl high density lipoprotein \( hdl \) cholesterol changed slightly conventional therapy group \( mean changes , 7 5 percent , respectively \) , substantially among patients treated lovastatin colestipol \( 46 15 percent \) niacin colestipol \( 32 43 percent \) conventional therapy group , 46 percent patients definite lesion progression \( regression \) least one nine proximal coronary segments regression change 11 percent comparison , progression \( change \) less frequent among patients received lovastatin colestipol \( 21 percent \) received niacin colestipol \( 25 percent \) , regression frequent \( lovastatin colestipol , 32 percent niacin colestipol , 39 percent p less 0 005 \) multivariate analysis indicated reduction level apolipoprotein b \( ldl cholesterol \) systolic blood pressure , increase hdl cholesterol correlated independently regression coronary lesions clinical events \( death , myocardial infarction , revascularization worsening symptoms \) occurred 10 52 patients assigned conventional therapy , compared 3 46 assigned receive lovastatin colestipol 2 48 assigned receive niacin colestipol \( relative risk event intensive treatment , 0 27 95 percent confidence interval , 0 10 0 77 \) conclusions men coronary artery disease high risk cardiovascular events , intensive lipid lowering therapy reduced frequency progression coronary lesions , increased frequency regression , reduced incidence cardiovascular events
outcome predictors outcome pediatric submersion victims receiving prehospital care king county , washington predictors outcome pediatric submersion victims treated seattle king county 's prehospital emergency services studied victims less 20 years old identified hospital admissions paramedic medical reports proportion fatal severe outcomes patients compared various risk factors 135 patients , 45 died 5 severe neurologic impairment subset 38 victims found cardiopulmonary arrest 32 survival rate , 67 survivors unimpaired mildly impaired two risk factors occurred commonly victims died severely impaired submersion duration greater 9 minutes \( 28 patients \) cardiopulmonary resuscitation duration longer 25 minutes \( 20 patients \) factors ascertained prehospital phase care submersion duration associated steadily increasing risk severe fatal outcomes 10 risk \( 7 67 \) 0 5 minutes , 56 risk \( 5 9 \) 6 9 minutes , 88 risk \( 21 25 \) 10 25 minutes , 100 risk \( 4 4 \) greater 25 minutes none 20 children receiving greater 25 minutes cardiopulmonary resuscitation death severe neurologic impairment rates saving victims , particularly victims cardiopulmonary arrest , considerably higher reported children prompt prehospital advanced cardiac life support effective means medical intervention pediatric submersion victim prehospital information provided valuable predictors outcome
histologic investigation vascular malformations face embolization agents twenty one vascular malformations located facial area , 11 high flow arteriovenous malformations 10 slow flow malformations , underwent combined treatment embolization later surgery embolization performed simultaneously angiography branches external carotid artery new fibrosing agent used 16 cases histologic examination surgical specimens confirmed good target orientation injection limitations technique discussed agent proved thrombogenic properties vascular walls degenerated ruptured following embolization , instances necrosis interstitial tissue skin embolization treatment vascular malformations face curative , facilitated subsequent surgery examined cases
surgical augmentation skin blood flow viability pig musculocutaneous flap model porcine rectus abdominis musculocutaneous \( tram \) flap model designed validated nine pigs tram flap based deep inferior epigastric \( die \) vessels 8 x 18 cm transverse skin superior end rectus abdominis muscle model subsequently used test hypothesis surgical augmentation flap viability vascular territory expansion specifically , observed ligation superior epigastric \( se \) vessels 4 , 7 , 14 , 28 days \( n 6 8 \) prior raising tram flaps significantly increased \( p less 0 05 \) length area viable skin transverse skin treatment flaps compared contralateral control flaps significant increase skin viability seen accompanied significant increase \( p less 0 05 \) skin muscle capillary blood flow treatment tram flaps compared controls \( n 9 \) mechanism vascular territory expansion unclear postulate hypoxia resulting ligation superior epigastric vessels prior flap surgery may play role triggering deep inferior epigastric artery take territory previously perfused superior epigastric artery would increase skin muscle capillary blood flow transverse tram flap raised deep inferior epigastric vascular pedicle
critical ischemia times survival patterns experimental pig flaps previous work critical ischemia time suggested \( 1 \) greater susceptibility myocutaneous flaps skin flaps ischemia reperfusion injury \( 2 \) duration ischemia may affect survival area flap using pig model , 55 animals operated critical ischemia times survival patterns skin \( n 85 \) latissimus dorsi myocutaneous \( n 88 \) island flaps determined submitted 0 , 2 , 4 , 6 , 8 , 10 , 12 , 14 , 16 hours normothermic ischemia average critical ischemia times \( \) determined 9 10 hours skin latissimus dorsi myocutaneous flaps , respectively percentage total area surviving \( \) flaps survive adversely affected increases ischemic interval flap models statistically significant decrease percentage total area surviving found 6 8 hours ischemia skin latissimus dorsi myocutaneous flaps , respectively
clinical , autonomic therapeutic observations two siblings postural hypotension sympathetic failure due inability synthesize noradrenaline dopamine deficiency dopamine beta hydroxylase brother sister long standing symptoms postural hypotension described considerably worse morning , exercise warm male , erection unaffected ejaculation prolonged absent , urinary bladder , bowel abnormalities autonomic function tests confirmed sympathetic adrenergic failure spared sympathetic cholinergic intact parasympathetic function neurological abnormalities noradrenaline adrenaline undetectable plasma , plasma dopamine elevated urinary levels noradrenaline adrenaline metabolites detection limits , dopamine metabolites normal elevated dopamine beta hydroxylase activity undetectable plasma immunohistochemical studies perivascular cutaneous tissue confirmed normal tyrosine hydroxylase immunoreactivity , absent dopamine beta hydroxylase immunoreactivity findings consistent enzymatic deficit conversion dopamine noradrenaline parents clinically biochemically normal treatment patients synthetic amino acid , l , contains hydroxyl group converted noradrenaline dopa decarboxylase , reduced symptoms signs postural hypotension increased levels plasma noradrenaline urinary metabolites male , ejaculation became possible behavioural changes included feeling confidence , tendency isomer also raised blood pressure plasma noradrenaline levels drug direct pressor effects , actions prevented dopa decarboxylase inhibitor ,
clinical diagnosis tamponade consecutive series 25 patients tamponade secondary tuberculosis compared 25 patients congestive cardiac failure , without pericardial effusion retrospective study patients tamponade impalpable apex beat \( 21 1 \) , \( 13 0 \) , soft heart sounds \( 13 2 \) , paradoxical rise jugular venous pressure \( 6 0 \) , fewer murmur \( 1 14 \) results significant \( p less 0 05 \) chi 2 test correction presence two discriminating physical signs positive predictive value 75 per cent , negative predictive value 99 5 per cent diagnosis tamponade clinical diagnosis tamponade primary health care personnel possible , lead earlier treatment
effects long term verapamil therapy serum lipids metabolic parameters calcium antagonists used successfully management hypertension decade , less known long term metabolic effects define impact one calcium antagonist , verapamil , serum lipids metabolic parameters , placed 45 hypertensive patients verapamil monotherapy followed 4 8 years mean treatment period 5 3 years , total cholesterol triglyceride levels significantly different baseline , whereas mean high density lipoprotein cholesterol value increased significantly 1 17 0 41 mmol l initiation treatment 1 39 0 36 mmol l 5 3 years \( p less 0 05 \) important biochemical parameters , including serum glucose , potassium uric acid levels unaffected verapamil therapy serious side effects adverse cardiovascular events occurred verapamil therapy , study dropouts therefore seems likely agent become increasingly useful long term management essential hypertension
anti atherosclerotic actions calcium antagonists treatment hypertension may prevent many complications attributable blood pressure elevation , particularly pressure related , stroke however , atherosclerotic complications hypertension , e g , coronary artery disease manifested coronary morbidity mortality , reduced significantly antihypertensive therapy disappointing outcome may reflect adverse metabolic effects traditional therapies , diuretics beta blockers , lack specific properties increasing attention thus paid newer antihypertensive agents , typically fewer adverse effects perhaps physiologic mechanisms antihypertensive action since calcium plays key role genesis atherosclerosis , calcium antagonists may positively affect course vascular disease investigators observed calcium antagonists display clear properties experimental well clinical studies one recently published clinical study , coronary artery disease shown develop slowly , slower progression individual stenoses , higher regression rate less frequent occurrence new lesions patients treated chronically verapamil compared receiving conventional therapies similar investigations currently way evaluate properties calcium antagonists , including progression study \( \) , multicenter diuretic atherosclerosis study \( \) , international nifedipine trial atherosclerosis coronary therapy \( intact \) , large scale montreal heart institute study results studies , use precise end points myocardial infarction , cerebral infarction peripheral vascular disease , may treatment hypertension identifying therapeutic approaches control pressure related atherosclerotic complications disease
secondary prevention verapamil myocardial infarction danish study group verapamil myocardial infarction effect verapamil death major events \( e , death reinfarction \) acute myocardial infarction studied double blind , randomized , placebo controlled , multicenter trial , danish verapamil infarction trial ii \( ii \) eight hundred seventy eight patients started treatment verapamil 360 mg day patients placebo treatment continued 18 months \( mean 16 months \) ninety five deaths 146 major events occurred verapamil group 119 deaths 180 major events placebo group eighteen month mortality rates 11 1 13 8 \( hazard ratio 0 80 , 95 confidence limits 0 63 1 05 , p 0 108 \) , major event rates 18 0 21 6 \( 0 80 , 0 64 0 99 , p 0 027 \) verapamil placebo groups respectively combining results trial results first danish study verapamil myocardial infarction , meta analysis demonstrated treatment verapamil second week acute myocardial infarction resulted reduction pooled odds ratios 0 22 \( 95 confidence interval 0 01 0 37 , p 0 04 \) death , 0 21 \( 0 05 0 35 , p 0 02 \) major events , 0 27 \( 0 06 0 43 , p 0 02 \) first concluded long term treatment verapamil acute myocardial infarction associated significant reduction overall mortality well major event reinfarction rates
relation lipids atherosclerosis epidemiologic evidence clinical implications coronary artery disease \( cad \) leading cause death developed countries therefore , elucidation risk factors associated mechanisms cad high priority data framingham heart study large scale epidemiologic studies identified major risk factors associated cad , demonstrating adverse effects increased total low density lipoprotein cholesterol levels protective effect high density lipoprotein cholesterol recent investigations , including lipid research clinics trial heart study , shown lowering total cholesterol raising high density lipoprotein cholesterol significantly reduce risk cad hypertension also significant risk factor cad , assumption blood pressure reduction offer significant benefits terms cad risk however , despite antihypertensive efficacy , diuretics beta blockers failed significantly reduce cad morbidity mortality adverse effects antihypertensive agents lipid profiles , glucose metabolism metabolic parameters may account disappointing performance reducing cad morbidity mortality result , newer agents angiotensin converting enzyme inhibitors calcium antagonists appear free adverse effects considerable attention potential reduce cad risk
effects hydralazine prostaglandin e1 regional myocardial function ischemic canine heart effects hydralazine prostaglandin e1 regional myocardial function studied dogs sixteen dogs randomly assigned one two drug treatment groups eight dogs first group \( g1 \) treated 0 4 mg kg hydralazine administered bolus second group \( g2 \) received prostaglandin e1 given infusion total dose 0 8 micrograms kg regional myocardial function assessed measurement myocardial segment shortening systole call index percent systolic shortening \( ss \) ischemic heart preparation created partial occlusion coronary blood flow degree induced ischemia determined following reduction ss hydralazine reduced ss ischemic myocardium increasing cardiac index , stroke volume index , coronary blood flow prostaglandin e1 increased ss , cardiac index , stroke volume index ischemic heart preparation hydralazine , therefore , induced dissociation global ventricular function regional myocardial function whereas prostaglandin e1 present findings emphasize evaluation vasoactive drugs consider effects regional myocardial function well global hemodynamics
increase plasma cholesterol independent thyroid function long term amiodarone therapy dose dependent relationship objective determine whether long term amiodarone treatment associated rise plasma cholesterol , , , analyze relation thyroid function design consecutive entry trial , including cardiac patients initiated amiodarone medication excluding abnormal thyroid function \( defined peak thyroid stimulating hormone tsh response thyrotropin releasing hormone trh less 2 8 greater 22 0 mu l \) either amiodarone treatment patients twenty three patients remained euthyroid studied intervention oral administration amiodarone \( mean duration treatment , 17 months range , 6 30 months \) measurements fasting plasma lipids , thyroid hormones , peak tsh trh values recorded every 6 months amiodarone treatment results plasma cholesterol gradually increased 5 1 0 2 mmol l treatment 6 9 0 8 mmol l 30 months amiodarone medication \( p less 0 001 \) peak tsh response trh change age sex specific reference values applied , 30 patients cholesterol values percentile treatment number rose 69 2 years treatment rise plasma cholesterol associated equal increase b plasma cholesterol related daily dose amiodarone plasma concentrations amiodarone , desethylamiodarone , thyroxine \( t4 \) , triiodothyronine \( t3 \) , reverse triiodothyronine \( \) linear regression analysis indicated positive relation plasma cholesterol cumulative dose amiodarone \( r 0 25 , p less 0 05 \) conclusion long term amiodarone treatment associated dose dependent increase plasma cholesterol independent thyroid function
cardiac rehabilitation coronary artery bypass grafting effects exercise performance risk factors coronary artery bypass grafting \( cabg \) , 49 nonselected patients followed cardiac rehabilitation program included medical follow physical training , outpatient groups individual basis home effect program exercise test variables , coronary risk factors , medication one year surgery compared control group \( n 98 \) study group showed less increase rate pressure product , indicating favorable effect myocardial oxygen consumption \( 0 7 5 4 vs 2 8 5 6 , p less 05 \) lower frequency angina exercise testing \( 6 vs 18 , p less 01 \) reduction resting systolic diastolic blood pressure \( 9 , p less 01 \) fewer smokers \( 6 vs 17 , p less 05 \) fewer patients taking long acting \( 0 vs 10 2 , p less 05 \) suggested , therefore , organized cardiac rehabilitation program may advantageous cabg
frameshift mutation leading type 1 antithrombin deficiency thrombosis type 1 antithrombin iii \( atiii \) deficiency , commonest form inherited atiii defect , characterized quantitative reduction immunologically functionally detectable protein condition associated high incidence thromboembolic disorder previous investigations shown atiii genes majority cases grossly intact , precise underlying molecular defects remain unknown investigated molecular basis type 1 atiii deficiency italian kindred enzymatic amplification atiii gene sequences affected family members direct sequencing amplified genomic dna novel mutation , deletion single second position codon 119 , identified affected individuals resulting frameshift leads premature termination codon 126 , effectively resulting null allele
cardiac myosin induced myocarditis heart autoantibodies involved induction disease recently demonstrated cardiac myosin capable inducing autoimmune myocarditis genetically predisposed mice disease parallels induced autoimmune myocarditis many respects associated high titer autoantibodies specific cardiac myosin following lines evidence suggest autoantibodies involved induction autoimmune myocarditis 1 \) immunoperoxidase staining heart sections cardiac myosin immunized j sw mice revealed igg along damaged muscle fibres infiltrated areas , intact tissue 2 \) myosin autoantibodies bind surface viable cardiac myocytes isolated mice , reacted myocytes permeabilized detergent 3 \) mice treated single high dose cyclophosphamide , reduces humoral immune response , still developed severe myocarditis , despite fact autoantibody titers reduced level adjuvant injected controls 4 \) passive transfer high titer myosin autoantibodies failed induce myocarditis , although titers recipients comparable found mice cardiac myosin induced disease together , results suggest high titer myosin autoantibodies secondary rather primary disease
circadian variations myocardial ischemia implications management extended ambulatory electrocardiographic monitoring patient 's environment provides clear evidence circadian patterns myocardial ischemic episodes patients effort angina , highest activity occurs 6 noon coincides peaks diurnal variation frequency acute myocardial infarction , stroke , sudden death number potential underlying common triggering mechanisms , including catecholamine secretion , sympathetic nervous system activity , blood pressure , heart rate , cortisol secretion , aggregability platelets , exhibit similar result morning peaks , myocardial oxygen demand increased oxygen supply reduced person arises morning attention vulnerable period timing choice medication , prevent reduce ischemia modify potential disease triggering mechanisms
angiotensin forming extrarenal vasculature kidney study characterize angiotensin forming \( aifas \) rat extrarenal arterial walls clarify whether enzymes also present kidney aim identify aifas human vasculature establish whether affected essential hypertension sprague dawley rats vascular sections patients undergoing corrective surgery studied enzyme kinetic assays performed using angiotensin radioimmunoassay purified natural fast protein liquid chromatography employed biochemical characterization series aifas various isoelectric points , molecular weights ph detected rat extrarenal vascular , differing distributions enzyme activities , renal tissues extrarenal arteries main form renal renin present relatively low activity aifas also demonstrable human extrarenal vasculature like plasma renin essential hypertension results indicate existence intrinsic human vascular ras extrarenal \( renal \) arteries extrarenal arterial aifas generally stimulated essential hypertensives , previously postulated
role angiotensin renal vasoconstriction observed development genetic hypertension studies examined renal function determine role kidney pathogenesis maintenance phases hypertension strain spontaneously hypertensive rat \( shr \) compared age matched wistar kyoto rats \( wky \) , 4 6 week old shr moderately hypertensive reduced glomerular filtration rate \( gfr \) renal blood flow \( rbf \) , increased renal vascular resistance cross studies indicate reduction rbf gfr young shr genetically linked hypertension thus may primary pathogenetic importance combination elevated vascular resistance reduced rbf gfr young shr implicates increased activity vasoconstrictor system \( \) , decreased activity vasodilator system \( \) , observations several laboratories support notion endogenous angiotensin ii contributes renal vasoconstriction young shr developmental phase hypertension acute chronic inhibition angiotensin converting enzyme reduce arterial pressure , reduce renal vascular resistance increase renal blood flow young adult shr renal vascular tone shr dependent angiotensin converting enzyme activity wky ability angiotensin converting enzyme inhibitors produce renal vasodilation may responsible , least part , antihypertensive effects studies indicate renal vascular reactivity angiotensin ii exaggerated young shr strain differences renal reactivity angiotensin ii abolished cyclooxygenase inhibition indomethacin , indicating endogenous counteract action angiotensin ii , pronounced buffering activity wky
influences angiotensin renal function renal vascular hypertension scope magnitude roles angiotensin plays generation maintenance elevated blood pressure models renal vascular hypertension continuing expand clear specific angiotensin dependent mechanisms contribute importantly pathophysiology hypertension altered renal function models two kidney , one clip hypertension rats generation angiotensin local intrarenal environment kidney new potentially important mechanism contributing altered renal function models application antagonists renin angiotensin system rat models renal vascular hypertension indicate effects angiotensin attenuate renal hemodynamic excretory behavior , particularly kidney , angiotensin may attenuate efficiency autoregulation renal hemodynamics kidney evidence inhibition angiotensin reverses improves altered hemodynamic excretory functions indicate angiotensin may contribute importantly pathophysiology hypertension models altering ability normal kidney sodium volume
thromboxane biosynthesis cardiovascular diseases sudden fissuring atherosclerotic plaque suggested primary trigger transient spontaneous ischemia coronary cerebral circulation measurements urinary 11 txb2 2 , 3 dinor txb2 , well results aspirin trials , suggested episodic platelet activation site acute vascular lesion mediated , least partly , enhanced thromboxane \( tx \) a2 biosynthesis thus , episodic increases metabolite excretion detected unstable angina aspirin \( 75 325 mg day \) prevents one third fatal nonfatal thrombotic events setting similar dynamic thrombotic process occurs early phase acute myocardial infarction suggested thromboxane metabolite measurements results 2 trial showing similar impact short term aspirin therapy seen unstable angina percutaneous transluminal coronary angioplasty associated transiently enhanced txa2 biosynthesis aspirin thrombotic complications hand , non insulin dependent diabetes mellitus type iia hypercholesterolemia associated relatively reproducible persisting abnormality txa2 dependent platelet function association likely reflect systemic rather localized stimulus platelet activation continuous rather episodic alteration low dose \( 50 mg day \) aspirin largely suppress thromboxane metabolite excretion diseases thus , low dose aspirin selective prostaglandin h2 txa2 receptor antagonists may important tools test hypothesis txa2 dependent platelet activation represents important transducer enhanced thrombotic risk associated metabolic abnormalities
effect bay u 3405 , new thromboxane antagonist , collagen induced thromboembolism rabbits bay u 3405 \( \) 3 \( 4 \) 1 , 2 , 3 , 4 9 acid inhibits platelet aggregation , thromboxane a2 induced contraction smooth muscles , coronary artery thrombosis previously demonstrated inhibition arachidonic acid induced sudden death bay u 3405 purpose study investigate effects bay u 3405 thromboembolism provoked collagen collagen fibrils dissolved isotonic glucose solution injected marginal ear vein anesthetized rabbits sudden death occurred within minutes due elevated thromboxane a2 levels causing intravascular platelet aggregation myocardial ischemia vehicle treated group , 100 animals died one prominent parameters massive fall blood pressure animals pretreated 10 mg kg orally bay u 3405 survived , showing transient hypotensive effect tracings electrocardiogram heart rate unchanged bay u 3405 therefore useful elucidate role thromboxane a2 various cardiovascular respiratory diseases
aspirin reduces growth medial neointimal thickenings balloon injured rat carotid arteries analyzed effect aspirin growth experimentally induced vascular thickenings rat carotid arteries vascular thickenings induced denudation endothelium left carotid artery balloon catheter administration aspirin rich food \( 17 4 g kg body wt day \) started 1 week continued 2 weeks injury nine rats used control group equal size received normal food sizes tunica media , , open vessel lumen measured cross sections carotid segments aid system results show aspirin group , neointimal lesions significantly smaller control group \( 0 14 mm2 versus 0 23 mm2 p less 0 5 \) thickenings tunica media also reduced \( 0 11 mm2 versus 0 12 mm2 p less 0 5 \) suggested aspirin reduces medial hypertrophy neointimal injury induced atherosclerosis
effect naproxen sulindac blood pressure response atenolol twenty eight patients mild moderate essential hypertension well controlled atenolol entered five week , double blind , placebo controlled trial effects sulindac naproxen blood pressure \( bp \) control atenolol alone administered weeks 1 , 3 , 5 naproxen sulindac administered atenolol week 2 , crossover week 4 data analyzed 27 patients \( one dropped developing skin rash \) naproxen significantly increased systolic bp compared placebo \( mean 4 0 mm hg 95 percent confidence interval , 1 1 7 0 p less 0 05 \) significant differences systolic bp sulindac administration compared placebo naproxen significant effects diastolic bp observed weight increased naproxen sulindac compared placebo \( mean 0 6 0 8 kg , p less 0 05 \) , although clinically significant extent one week therapy naproxen greater potential sulindac increase systolic bp well controlled hypertensive patients receiving atenolol however , increase minor unlikely clinical significance
high dose epinephrine improves outcome pediatric cardiac arrest study objective animal studies suggest standard dose epinephrine \( sde \) treatment cardiac arrest human may low compared outcome sde high dose epinephrine \( hde \) children refractory cardiac arrest design prospective intervention versus historic control groups type participants two similar groups 20 consecutive patients \( median ages , 2 5 3 years \) witnessed cardiac arrest remained arrest least two \( 0 01 mg kg \) interventions treatment additional sde versus hde \( 0 2 mg kg \) measurements main results rates return spontaneous circulation long term survival compared fourteen hde group \( 70 \) return spontaneous circulation , whereas none sde group \( p less 001 \) eight children survived discharge hde , three neurologically intact follow significant toxicity hde observed conclusion hde provided higher return spontaneous circulation rate better long term outcome sde series pediatric cardiac arrest hde may warrant incorporation standard resuscitation protocols early enough point prevent irreversible brain injury
systemic atropine administration cardiac arrest cause fixed dilated pupils objectives systemic administration atropine cpr may brain death determination ability produce fixed dilated pupils studied effect atropine administered usual doses adjunct endotracheal intubation cardiac arrest determine would interfere neurological assessment design two groups children studied group 1 consisted 28 patients received atropine \( 0 03 0 003 mg kg \) prior endotracheal intubation group 2 consisted 21 patients previously without evidence brainstem disease suffered witnessed arrest prompt return spontaneous circulation received atropine dose 0 03 0 01 mg kg results group 1 , pupillary size averaged 4 02 0 78 mm 4 75 mm 84 mm atropine \( p less 001 \) group 2 , pupillary examination conducted 30 minutes return spontaneous circulation pupillary diameter 4 80 0 91 mm pupils reactive light groups conclusion atropine administration conventional dose causes slight pupillary dilation pupillary light reactivity
echocardiographic left ventricular mass electrolyte intake predict arterial hypertension objective identify predictors arterial hypertension patients one hundred thirty two normotensive adults large employed population methods echocardiography , standard blood tests , 24 hour urine collection , baseline interval 3 6 years \( mean , 4 7 0 8 years \) results follow , 15 subjects \( 11 7 men , 8 women \) systolic blood pressure greater 140 mm hg diastolic blood pressure greater 90 mm hg \( mean , 143 7 87 6 mm hg , respectively \) baseline , subjects developed hypertension greater left ventricular mass index \( 92 25 compared 77 19 g m2 body surface area p less 0 005 \) higher 24 hour urinary sodium potassium excretion ratio \( 3 6 1 7 compared 2 6 1 4 p less 0 04 \) differences race , initial age , systolic diastolic blood pressure , coronary risk factors , plasma renin activity likelihood developing hypertension rose 3 lowest quartile sex adjusted left ventricular mass index 24 highest quartile \( p less 0 005 \) parallel trend less regular quartiles sodium potassium excretion ratio \( p less 0 04 \) multivariate analyses , follow systolic pressures subjects 117 remained normotensive predicted initial age , systolic blood pressure , black race , sex adjusted left ventricular mass index final diastolic blood pressure predicted initial value , plasma triglyceride levels , urinary sodium potassium ratio , low renin activity , black race , plasma glucose level conclusions echocardiographic left ventricular mass normotensive adults directly related risk developing subsequent hypertension left ventricular mass improves prediction future systolic pressure , whereas diastolic pressure related initial metabolic status black race also independent determinant higher subsequent blood pressure
noninvasive detection occlusive disease carotid middle cerebral artery recently , transcranial doppler sonography introduced clinical practice noninvasive investigation large intracranial arteries determine accuracy detection occluding lesions , 133 consecutive patients studied transcranial doppler sonography selective cerebral arteriography statistical analysis findings done separately various arterial segments high values sensitivity specificity found detecting obstruction carotid main stem middle cerebral artery diagnostic reliability transcranial doppler sonography also confirmed calculation chance corrected measure agreement \( kappa \) , close 1 transcranial doppler sonography seems valuable tool noninvasive detection intracranial lesions middle cerebral artery carotid
use quinapril elderly patient quinapril hydrochloride angiotensin converting enzyme \( ace \) inhibitor extensively tested found effective administered day hypertensive patients sexes degrees hypertension cardiac compromise , including left ventricular hypertrophy , without congestive heart failure observations earlier ace inhibitors led reports class drugs relatively ineffective older hypertensive patients ascertain role quinapril \( greater equal 10 mg day \) older patients , blood pressure lowering effects 1 , 175 hypertensive patients less equal 65 years age compared 304 patients greater 65 years age excellent response observed patients greater 65 years age mild moderate hypertension \( diastolic bp , 95 105 mm hg \) moderate severe hypertension \( diastolic bp , 106 115 mm hg \) reductions blood pressure achieved quinapril least comparable obtained younger hypertensives , \( statistically \) greater mild moderate group \( 14 mm hg v 12 mm hg \) addition , percentage patients experienced adverse experiences lower greater 65 group less equal 65 group \( 15 v 19 \) main adverse experiences reported included dizziness , headache , cough , fatigue , hypotension findings indicate quinapril least safe effective older hypertensives younger patients
quinapril chronic heart failure angiotensin converting enzyme inhibitors firmly established treatment patients chronic heart failure \( chf \) beneficial acute chronic hemodynamic effects associated reflex tachycardia drug tolerance angiotensin converting enzyme inhibitors produce symptomatic improvement improve exercise capacity grades heart failure also improve prognosis patients severe heart failure quinapril recently introduced , ace inhibitor , whose intermediate half life makes well suited treatment patients chf acute chronic hemodynamic effects quinapril similar ace inhibitors large , multicenter , randomized , placebo controlled study 225 patients mild moderate chf , 10 40 mg day quinapril significantly improved clinical status exercise capacity dose related manner incidence side effects differ significantly placebo initial studies quinapril promising warrant clinical investigation compound
elevated insulin , norepinephrine , neuropeptide hypertension investigate relationship insulin sympathetic activity , plasma norepinephrine , neuropeptide , serum glucose insulin concentrations measured ten age , weight , sex matched normotensive untreated hypertensive subjects fasting 2 h following ingestion 75 g oral glucose dose hypertensives higher fasting serum insulin \( 27 6 v 12 2 microu ml p 02 \) plasma norepinephrine \( 38 v 235 35 pg ml p 03 \) concentrations normotensives glucose load increased serum insulin \( p less 001 \) plasma norepinephrine concentrations \( p 001 \) groups hypertensives still higher insulin \( p 003 \) norepinephrine levels \( p 003 \) normotensives fasting neuropeptide higher hypertensives normotensives \( p 03 \) correlated age groups \( r 0 7 r 0 77 \) serum insulin correlated positively plasma norepinephrine \( r 0 75 p 013 \) normotensives , parameters correlated negatively hypertensives \( r 0 7 p 036 \) hypothesize elevated plasma norepinephrine neuropeptide levels reflect increased level sympathetic nervous activity hypertensives , turn may responsible abnormal relationship plasma ne insulin levels
dietary calcium , vascular reactivity , genetic hypertension lyon rat strain order examine relationship existing dietary calcium development hypertension , developed long term study lyon hypertensive rat strain \( lh \) two control strains , lyon normotensive \( ln \) low blood pressure rats \( \) given enriched \( hca , 2 5 \) , deprived \( lca , 0 03 \) normal \( , 0 6 \) calcium diets evolution body weight , systolic blood pressure \( bp \) , plasma calcium magnesium monitored 4 23 weeks age total cardiovascular reactivity contractile response isolated aorta norepinephrine measured 23 weeks age lh rats hca diet failed develop hypertension \( bp less 150 mm hg \) whereas lh rats lca diet exhibited higher blood pressure levels controls fed diet moreover , ln rats hca diet slightly decreased bp whereas lca effect rats , contrary , lca diet slightly increased bp vivo responsiveness ne significantly higher lh compared ln rats fed diet hca lca diets induced significant decrease response lh rats hca diet increased response ln rats decreased contrast , age , vitro contractile response isolated aorta ne significantly decreased lh compared ln rats receiving diet moreover lh ln rats hca diet contractile response markedly increased significant difference observed lca diet
sodium sensitive sodium retaining hypertension differences sodium sensitive sodium retaining hypertension theoretically considered using water tank model body fluid volume blood pressure regulation outlet valve attached tank base area corresponding reciprocal total peripheral resistance \( tpr \) water tank rate corresponding amount na intake , equilibrium achieved certain water level , volume output outlet , represent mean arterial pressure \( map \) , cardiac output \( co \) urinary na excretion height outlet tank bottom size cross sectional area , outlet correspond x intercept slope renal function \( pressure natriuresis \) curve , respectively sensitive hypertension , due shift curve toward higher blood pressure level \( elevated height outlet \) without change slope \( size outlet \) , sodium sensitive hypertension , due depressed slope curve \( reduced outlet size \) , map \( water level \) also co \( water volume \) increased , resulting sodium retaining hypertension , tpr \( reciprocal base area \) remained unchanged , co relatively unchanged , resulting retaining hypertension , tpr elevated thus , map sensitivity sodium intake determined renal function curve since body fluid volume determined renal function curve tpr , however , changes tpr development hypertension major factor determining whether body fluid volume change small amount large amount therefore , sodium sensitivity blood pressure sodium retention must considered separately
hemodynamic endocrine effects mental stress untreated borderline hypertension mental arithmetic tracing compared 40 untreated patients borderline hypertension , tested random sequence standardized protocols tasks significantly increased systolic diastolic blood pressure , heart rate , cardiac index , plasma renin , decreased peripheral resistance mental arithmetic also increased cholesterol , triglycerides hdl plasma catecholamines changed significantly lipid changes correlated blood pressure changes methods useful relationships hemodynamic reactivity stress , presence progression atherosclerosis , well testing effects antihypertensive drugs stress induced changes may influence atherosclerotic complications hypertension
role protein kinase c calcium regulation norepinephrine release vascular adrenergic neurons hypertension study designed investigate role protein kinase c calcium vascular adrenergic transmission hypertension perfused mesenteric spontaneously hypertensive rats \( shr , 7 10 weeks old \) age matched wistar kyoto rats \( wky \) , examined effects protein kinase c inhibitor h 7 endogenous norepinephrine release vascular responsiveness nerve stimulation endogenous norepinephrine release pressor responses nerve stimulation significantly greater shr wky protein kinase c inhibitor h 7 inhibited stimulation induced norepinephrine release pressor responses dose dependent manner magnitude suppressive responses pronounced shr wky calcium removal extracellular fluid also reduced norepinephrine release strongly shr wky results demonstrate regulation norepinephrine release might dependent protein kinase c calcium blood vessels shr , could contribute , least partially , pathogenesis form hypertension
vascular renin hypertension uptake versus synthesis conventional radioimmunoassay techniques demonstrated aortic wall renin like activity derived plasma longer half life plasma renin blood pressure elevation renin injection rats correlates better aortic renin plasma renin vascular extrarenal tissue also synthesize renin using protection technique detection renin messenger rna able demonstrate wide variety extrarenal tissues contain renin message least two , brain liver , renin messenger rna levels unaffected changes dietary salt changes systemic blood pressure functional studies using isolated human resistance vessels also demonstrate presence renin like activity contractile response added renin substrate suggested extrarenal tissues therefore contain renin like activity derived uptake local synthesis systems may regulated different ways may carry different functions
role basic fibroblast growth factor vascular lesion formation present study investigated whether basic fibroblast growth factor \( bfgf \) plays role proliferative response smooth muscle cells \( smcs \) injury rat carotid smooth muscle found express mrna bfgf , bfgf protein found present rat aorta immunoblot analysis systemically administered bfgf potent mitogen vascular smcs arteries balloon catheter , increasing replication 11 5 controls 54 8 denudation device \( filament loop \) , causes minimal damage medial smcs , showed similar increase replication \( 1 3 versus 43 3 \) bfgf infusion vessels , however , smcs unresponsive infused bfgf infusion \( bfgf conjugated \) caused greater 50 decrease number viable smcs arterial wall balloon injury prolonged administration bfgf \( 12 micrograms day 2 weeks \) balloon injury caused approximately twofold increase intimal thickening results show bfgf , synthesized arterial wall , could potent mitogen smcs vivo suggest release endogenous bfgf may capable stimulating smc proliferation , may subsequently lead intimal lesion formation
myocardial capillary permeability regional ischemia reperfusion vivo canine heart effect superoxide dismutase study assesses effect superoxide anion scavenger superoxide dismutase myocardial capillary permeability surface area \( ps \) products small hydrophilic molecules ischemia reperfusion open chest dogs underwent 20 minute occlusion left anterior descending coronary artery followed 1 hour reperfusion myocardial plasma flow rate capillary extraction chromium 51 labeled edta technetium 99m labeled acid measured single injection , residue detection method ischemia 5 60 minutes start reperfusion 13 dogs , scavenger treatment given \( control group \) , whereas eight dogs treated systemically 15 , 000 units kg superoxide dismutase 1 hour , starting 20 minutes ischemia control group , three dogs developed reperfusion ventricular fibrillation contrast none superoxide dismutase group ischemia , plasma flow rate , myocardial capillary extraction fraction , ps values similar two groups five minutes start reperfusion , plasma flow rate increased significantly \( p less 0 01 \) groups control group , capillary extraction fraction increased 12 \( p ns \) spite higher plasma flow increases capillary extraction fraction plasma flow induced 69 increase ps \( p less 0 01 \) superoxide dismutase treated group , capillary extraction fraction decreased 32 \( p less 0 05 \) accordance increased plasma flow rate , resulting unchanged ps \( p ns \) sixty minutes reperfusion , plasma flow rate , capillary extraction fraction , ps returned values groups \( p ns \) increased capillary extraction fraction ps values seen control group suggest increased capillary permeability ischemia reperfusion superoxide anions seem participate , directly indirectly , response
mechanism early ischemic contractile failure , metabolite accumulation , vascular collapse \? basis early ischemic contractile failure investigated perfused ferret hearts 27 degrees c isovolumic left ventricular developed pressure fell 50 within 30 seconds onset total global ischemia reached zero 5 minutes monophasic action potential recordings revealed decrease excitability period phosphorus nuclear magnetic resonance spectra obtained 30 second resolution showed significant changes inorganic phosphate phosphocreatine first 30 seconds ischemia intracellular ph \( phi \) atp changed even slowly therefore , none metabolites could account rapid fall force gauge contribution intravascular pressure , compared ordinary aortic flow occlusion tissue level ischemia induced massive coronary level arterioles functional depression developed significantly slowly hearts , despite accumulation inorganic phosphate comparable ordinary ischemia , time course functional depression reflected much closely concomitant inorganic phosphate phi changes thus , results provide novel evidence supporting importance vascular collapse mechanism early ischemic contractile failure
significance number stimuli initiate ouabain induced arrhythmias intact heart ouabain induced arrhythmias well known model used study triggered activity resulting delayed afterdepolarizations intact heart , initiation arrhythmias promoted pacing , especially fast rates however , relevance number stimuli unknown conscious dogs formalin induced atrioventricular block , investigated effect variations pacing mode 1 \) behavior nonsustained triggered rhythms progressive levels ouabain intoxication , 2 \) induction sustained ventricular tachycardia \( vt \) twenty experiments analyzed ouabain administered bolus 40 micrograms kg followed continuous infusion every 15 minutes pacing protocol repeated , maximum 10 , completion induction vt vt could initiated , experiment repeated least 1 week later , adding 5 10 micrograms kg ouabain bolus increasing infusion rate correspondingly repeated vt could induced four intervals \( 200 , 400 , 600 , 800 msec \) seven numbers stimuli \( 5 , 10 , 20 , 35 , 50 , 100 , 150 \) given two pacing protocols effect protocols 1 \) number induced beats per stimulation train , 2 \) first interval , 3 \) induction vt studied initiation vt occurred 75 42 minutes bolus ouabain needed induce vt inversely related body weight animals progression ouabain intoxication resulted 1 \) significant increase number induced beats per stimulation train 2 \) significant shortening first interval stimulation faster rate stimuli resulted 1 \) significantly pronounced increase number induced beats higher levels 2 \) significantly shorter first interval successive levels ouabain intoxication
ca2 transients cardiomyopathic hamster heart intracellular ca2 transients studied isolated hearts healthy cardiomyopathic hamsters late failure perfused glucose pyruvate hearts healthy hamsters developed similar pressures perfused either glucose pyruvate , ca2 transients comparable amplitude perfused either substrate hand , hearts cardiomyopathic hamsters late failure developed normal pressure perfused pyruvate developed depressed pressure \( 50 \) perfused glucose amplitude ca2 transients fell severely associated high diastolic ca2 cardiomyopathic hamster hearts perfusate switched pyruvate glucose high phosphomonoester sugars evidenced 31p nuclear magnetic resonance studies depressed oxygen consumption cardiomyopathic hamster hearts perfused glucose reflect inhibition subsequent decrease mitochondrial activity without adequate delivery substrate mitochondria cardiomyopathic hamster , myocardium longer capable maintaining ca2 homeostasis
effect preconditioning ischemia reperfusion arrhythmias coronary artery occlusion reperfusion rat severe arrhythmias occur reperfusion 5 minutes coronary occlusion rat little data available whether ischemic preconditioning \( pc \) hearts reduce incidence arrhythmias effect pc \( three cycles 2 minutes coronary occlusion 5 minutes reperfusion \) development arrhythmias subsequent 5 minute coronary artery occlusion reperfusion studied rats \( n 16 group \) underwent 5 minute occlusion reperfusion alone preceded pc arrhythmias monitored ischemia 10 minutes reperfusion , biopsies taken creatine phosphate adenosine triphosphate ischemic nonischemic zones left ventricle pc reduced incidence ventricular tachycardia \( vt \) occlusion \( 81 control versus 13 pc , p less 0 001 \) subsequent reperfusion , ventricular fibrillation \( vf \) developed zero pc animals versus 13 \( 81 \) controls \( p less 0 001 \) , irreversible vf zero pc versus seven \( 44 \) controls \( p 0 007 \) vt occurred four \( 25 \) pc versus \( 100 \) controls \( p less 0 001 \) pc reduced mean duration vt plus vf 320 54 5 1 seconds \( p less 0 001 \) delayed arrhythmia onset 8 2 85 35 seconds reperfusion difference creatine phosphate levels ischemic zone end reperfusion pc animals compared controls without irreversible vf \( 16 2 4 1 versus 15 5 3 9 nmol mg protein , p ns \)
passive smoking heart disease epidemiology , physiology , biochemistry evidence ets increases risk death heart disease similar existed 1986 us surgeon general concluded ets caused lung cancer healthy nonsmokers 10 epidemiological studies , conducted variety locations , reflect 30 increase risk death ischemic heart disease myocardial infarction among nonsmokers living smokers larger studies also demonstrate significant dose response effect , greater exposure ets associated greater risk death heart disease epidemiological studies complemented variety physiological biochemical data show ets adversely affects platelet function damages arterial endothelium way increases risk heart disease moreover , ets , realistic exposures , also exerts significant adverse effects exercise capability healthy people heart disease reducing body 's ability deliver utilize oxygen animal experiments , ets also cellular respiration level mitochondria ets also accelerate , may initiate , development atherosclerotic plaque note , cardiovascular effects ets appear different nonsmokers smokers nonsmokers appear sensitive ets smokers , perhaps affected physiological systems sensitive low doses compounds ets , , also perhaps physiological smokers undergo result long term exposure cigarette smoke event , findings indicate , cardiovascular disease , incorrect cigarette equivalents passive exposure ets effects exposure nonsmokers effects direct smoking smokers results suggest heart disease important consequence exposure ets combination epidemiological studies demonstration physiological changes exposure ets , together biochemical evidence elements ets significant adverse effects cardiovascular system , leads conclusion ets causes heart disease increase risk 10 times many deaths ets induced heart disease lung cancer deaths contribute greatly estimated 53 , 000 deaths annually passive smoking makes passive smoking third leading preventable cause death united states today , behind active smoking alcohol
multicenter patency trial intravenous anistreplase compared streptokinase acute myocardial infarction team 2 study investigators thrombolytic therapy shown improve clinical outcome administered early onset symptoms acute myocardial infarction mechanism benefit believed maintenance coronary artery patency anistreplase second generation thrombolytic agent easily administered long duration action compare anistreplase \( 30 units 2 5 min \) therapy food drug administration approved regimen intravenous streptokinase \( 1 5 million units 60 min \) , randomized , double blind , multicenter patency trial undertaken 370 patients less 76 years age electrocardiographic st segment elevation could treated within 4 hours symptom onset coronary patency determined reading , blinded fashion , angiograms obtained early \( 90 240 minutes mean , 140 minutes \) later \( 18 48 hours mean , 28 hours \) beginning therapy early total patency \( defined thrombolysis myocardial infarction grade 2 3 perfusion \) high anistreplase \( 132 183 72 \) streptokinase \( 129 176 73 \) therapy , overall patency patterns similar , although patent arteries showed complete \( grade 3 \) perfusion often anistreplase \( 83 \) streptokinase \( 72 \) \( p 0 03 \) similarly , residual coronary stenosis , determined quantitatively validated computer assisted method , slightly less patent arteries early anistreplase \( mean stenosis diameter , 74 0 \) streptokinase \( 77 2 , p 0 02 \) patients patent arteries without early interventions , risk within 1 2 days defined angiographically found low \( anistreplase 1 96 , streptokinase 2 94 \) average coronary perfusion grade greater , percent residual stenosis less , follow initial evaluation differ treatment groups enzymatic electrocardiographic evolution significantly different two groups despite rapid injection , anistreplase associated small \( 4 5 mm hg \) , transient \( 5 10 minutes \) mean differential fall blood pressure hospital mortality rates comparable anistreplase streptokinase \( 5 9 , 7 1 \) stroke occurred one \( 0 5 \) three \( 1 6 \) patients , respectively one stroke hemorrhagic serious bleeding events adverse experiences occurred uncommonly similar frequency two groups thus , end points study \( patency , safety \) , anistreplase streptokinase showed overall favorable relatively comparable outcomes , differences \( abstract truncated 400 words \)
detection patients risk paroxysmal atrial fibrillation sinus rhythm p wave triggered signal averaged electrocardiogram determine whether patients risk paroxysmal atrial fibrillation could detected sinus rhythm , signal averaged electrocardiogram triggered p waves recorded 42 patients paroxysmal atrial fibrillation \( paf group \) 50 control patients root mean square \( , , \) last 10 , 20 , 30 msec duration \( ad \) filtered \( 40 300 hz \) p wave spatial magnitude measured significantly lower paf control group \( , 1 92 0 58 versus 2 49 0 78 microv , p less 0 001 , 2 47 0 78 versus 3 46 1 20 microv , p less 0 0001 \) , although significant difference found groups ad also significantly longer paf control group \( 137 0 14 3 versus 118 6 11 3 msec , p less 0 001 \) differences paf control groups remained significant even dividing presence absence organic heart diseases criteria 3 5 microv less ad greater 120 msec defining atrial late potential gave sensitivity 91 specificity 76 findings suggest patients risk paroxysmal atrial fibrillation could detected sinus rhythm using p wave triggered signal averaged electrocardiogram
vivo technetium 99m s12 antibody imaging platelet alpha granules rabbit endothelial neointimal proliferation angioplasty examine specificity technetium 99m monoclonal antibody \( s12 \) imaging identifying activated platelets interventional injury sites atherosclerotic rabbit arteries , subgroups rabbits \( n 39 \) underwent serial percutaneous transluminal aortic angioplasty \( pta \) procedures \( without intravascular stent placement \) followed vivo ex vivo gamma camera imaging , scanning , immunoelectron microscopy determine intravascular loci s12 fab' antibody binding despite angiographic vessel patency , image derived ratios vivo s12 binding injured versus uninjured vascular segments significantly increased \( p less 0 05 \) one pta \( 1 3 0 17 , n 7 \) , pta twice 6 week intervals \( 1 4 0 22 , n 7 \) , pta plus stent placement \( 1 6 0 28 , n 7 \) compared control experiments \( 1 1 0 13 , n 7 \) ex vivo imaging blood free excised aortas confirmed s12 localization pta \( 2 0 4 , n 3 \) pta plus stent placement \( 5 3 8 , n 7 \) sites \( p less 0 05 versus controls \) s12 antibody uptake decreased significantly \( p less 0 05 \) 1 week pta plus stent placement vivo \( 1 1 0 10 , n 4 \) ex vivo \( 1 6 0 7 , n 3 \) electron microscopic studies confirmed dense platelet , fibrin , red blood cell deposition regions acute injury , endothelial neointimal proliferation 1 week pta immunoelectron microscopic studies confirmed specific vivo s12 binding \( 22 1 versus igg \) sites alpha granule gmp 140 expression activated platelets therefore , s12 studies may useful localize sites platelet derived mitogen release arterial pta injury sites
reduction myocardial reperfusion injury intravenous adenosine administered early reperfusion period adenosine influences function several cell types thought involved pathogenesis myocardial reperfusion injury previously demonstrated intracoronary administration adenosine enhances myocardial salvage 24 hours reperfusion determine beneficial effects could obtained prolonged period reperfusion using intravenous route administration , 22 closed chest dogs subjected 90 minutes proximal left anterior descending coronary artery occlusion 72 hours reperfusion animals randomly received either intravenous adenosine \( 0 15 mg kg min \) equal volume ringer 's lactate first 150 minutes reperfusion area risk defined vivo blue , infarct size measured histologically mallory 's stain serial global regional ventricular function determined contrast ventriculography analyzed using computerized radial shortening method biopsies obtained central ischemic zone assess endothelial ultrastructure capillary obstruction significant effects heart rate blood pressure noted adenosine infusion transmural collateral blood flow ischemia similar groups infarct size expressed percentage anatomical area risk significantly less adenosine treated group \( 35 3 4 3 controls versus 17 1 4 3 treated animals , p less 0 01 \) progressive decrease transmural blood flow noted control animals reperfusion , resulting significant reduction 3 hours compared value \( 0 69 0 11 ml min g baseline versus 0 45 0 10 ml min g 3 hours , p less 0 05 \) contrast , flow adenosine animals 3 hours similar baseline values \( 0 91 0 15 ml min g baseline versus 0 98 0 14 ml min g 3 hours , p ns \) significantly higher \( p less 0 05 \) control group radial shortening ischemic zone significantly improved 3 \( 2 6 2 8 controls versus 11 6 3 3 treated animals , p less 0 01 \) 72 hours \( 5 5 2 0 controls versus 17 3 3 5 treated animals , p less 0 01 \) reperfusion treated animals electron microscopy showed reduced neutrophil erythrocyte capillaries relative preservation endothelial cell structure adenosine group \( abstract truncated 400 words \)
identification viable myocardium patients chronic coronary artery disease left ventricular dysfunction comparison thallium scintigraphy reinjection pet imaging 18f fluorodeoxyglucose patients chronic coronary artery disease left ventricular dysfunction , distinction ventricular dysfunction arising myocardial fibrosis ischemic , viable , myocardium important clinical implications positron emission tomography \( pet \) , enhanced fluorine 18 labeled fluorodeoxyglucose \( fdg \) uptake myocardial segments impaired function reduced blood flow evidence myocardial viability reinjection thallium 201 rest immediately stress redistribution imaging may also provide evidence myocardial viability demonstrating thallium uptake regions apparently irreversible defects compare two methods , studied 16 patients chronic coronary artery disease left ventricular dysfunction \( ejection fraction , 27 9 \) , irreversible defects standard exercise redistribution thallium single photon emission computed tomography \( spect \) imaging thallium immediately redistribution study , spect images patients also underwent pet imaging fdg oxygen 15 labeled water total myocardial segments analyzed comparable tomograms , 166 \( 38 \) irreversible thallium defects redistribution images reinjection fdg uptake demonstrated 121 \( 73 \) irreversible defects irreversible defects according degree thallium activity , relative peak activity normal regions irreversible defects mild \( 60 85 peak activity \) moderate \( 50 59 peak \) reduction thallium activity considered viable basis fdg uptake 91 84 segments , respectively contrast , irreversible defects severe reduction thallium activity \( less 50 peak \) , fdg uptake present 51 segments severe defects , identical number segments \( 51 \) demonstrated enhanced uptake thallium reinjection severe irreversible defects , data myocardial viability concordant two techniques 88 segments , 45 identified viable 43 identified scar pet thallium reinjection studies observations suggest thallium imaging used identify viable myocardium patients chronic coronary artery disease left ventricular dysfunction irreversible defects mild moderate reduction thallium activity represent viable myocardium confirmed fdg uptake \( abstract truncated 400 words \)
analysis baroreflex control heart rate conscious dogs pacing induced heart failure autonomic components baroreflex control heart rate evaluated conscious mongrel dogs 4 6 weeks ventricular pacing \( 250 beats min \) arterial baroreflex sensitivity \( brs \) determined slopes linear regression pulse interval versus preceding systolic arterial pressure response bolus injections either phenylephrine nitroglycerin brs significantly depressed heart failure state nitroglycerin slope , 5 0 2 7 \( mean sd \) versus 16 6 5 1 msec mm hg , p less 0 005 phenylephrine slope , 15 0 14 8 versus 32 0 26 7 msec mm hg , p less 0 005 depression brs dogs used time controls acutely paced 30 minutes beta 1 adrenergic blockade metoprolol , resting heart rate heart failure state depressed normal state \( 17 0 5 0 versus 3 2 3 4 , p less 0 001 \) atropine significantly increased resting heart rate normal state heart failure state \( 115 8 36 7 versus 25 4 14 5 , p less 0 005 \) thus , dogs heart failure state appear high resting cardiac sympathetic tone low resting vagal tone nitroglycerin administration , metoprolol depressed brs 47 6 26 3 normal state 63 6 58 5 heart failure state atropine decreased brs 86 7 7 8 normal state 39 5 30 2 heart failure state
reentrant ventricular arrhythmias late myocardial infarction period mechanism short long short cardiac sequence facilitates induction reentry electrophysiological mechanism short long short stimulated cardiac sequence facilitates induction ventricular tachyarrhythmia investigated dogs 4 days ligation left anterior descending coronary artery dogs , reentry develops surviving abnormal epicardial layer infarct zone premature stimulation results critically long arc functional conduction block activation wavefront around ends arc , , slowly distal arc sites proximal arc initiate figure eight reentrant circuit epicardial activation maps effective refractory periods \( \) determined three different stimulation protocols , basic train eight beats cycle length 300 msec followed single premature stimulus \( s2 \) b , basic train eight beats cycle length 300 msec abrupt lengthening last cycle train s2 600 msec c , basic train eight beats cycle length 600 msec followed s2 protocol b found result differential lengthening erp adjacent sites within border epicardial ischemic zone , whereas protocols c induced , respectively , comparable shortening lengthening sites differential lengthening adjacent sites resulted increased dispersion refractoriness premature stimulus induced functional conduction block sites development longer arc conduction block , hence , longer reentrant pathway well slower conduction circulating wavefront protocol b allowed time refractoriness proximal arc circulating wavefront sites initiate reentry lengthening erp , associated single long cycle \( protocol b \) , ranged 44 79 total increase erp series eight long cycles \( protocol c \) epicardial sites longer located close center ischemic zone showed lengthening refractoriness protocol b compared normal sites near border ischemic zone strongly suggests increased dispersion refractoriness protocol b caused shorter memory ischemic myocardium cumulative effects preceding cycle lengths
ischemic heart disease platelet aggregation caerphilly collaborative heart disease study caerphilly collaborative heart disease study based large cohort men \( 2 , 398 \) aged 49 66 years time study platelet aggregation induced collagen , thrombin , adp measured fasting blood samples related prevalent angina , past myocardial infarction , electrocardiographic evidence ischemic heart disease number subjects taken aspirin , nonsteroidal anti inflammatory drugs , drugs affecting platelet aggregation 7 days blood sample collection exclusion subjects , data available 1 , men relations demonstrated angina , significant relations shown past myocardial infarctions electrocardiographic evidence ischemia adp induced aggregation \( primary secondary \) electrocardiographic evidence ischemia thrombin induced aggregation strongest relation indicated twofold increase odds past myocardial infarction subjects highest fifth adp induced primary platelet aggregation compared lowest fifth significant relations detected collagen induced aggregation accounting number possible confounding factors relatively small impact relations platelet aggregation ischemic heart disease evidence , including well established effect aspirin reducing incidence ischemic heart disease , indicates relations describe unlikely simply effect ihd platelets
myocardial infarction mexican americans non hispanic whites san heart study mexican american men experience reduced cardiovascular mortality compared non hispanic white men corresponding ethnic difference cardiovascular mortality women difference men could result either lower incidence cardiovascular disease lower case fatality rate among mexican americans although incidence cardiovascular disease mexican americans unknown , collected data prevalence myocardial infarction 5 , 148 individuals examined san heart study , population based survey cardiovascular disease conducted 1979 1988 mexican americans non hispanic whites aged 25 64 years myocardial infarction assessed minnesota coded electrocardiograms self reported history physician diagnosed heart attack end points , age adjusted prevalence myocardial infarction lower mexican american men non hispanic white men adjustment age diabetes status \( present absent \) , odds myocardial infarction , defined either criterion , approximately one third lower mexican american men non hispanic white men \( p 0 06 \) women , prevalence myocardial infarction end points slightly higher mexican americans non hispanic whites , although neither differences significant although ethnic differences prevalence study statistically significant , pattern parallels pattern mortality due cardiovascular diseases therefore , results support hypothesis reduced cardiovascular mortality rate observed mexican american men reflects lower incidence myocardial infarction rather reduced case fatality rate latter would result higher prevalence
diltiazem increases late onset congestive heart failure postinfarction patients early reduction ejection fraction adverse experience committee multicenter diltiazem postinfarction research group multicenter diltiazem postinfarction trial \( \) reported consistent diltiazem effect new worsened congestive heart failure \( chf \) 12 52 months' follow acute myocardial infarction light observation patients findings suggesting left ventricular dysfunction \( lvd \) baseline diltiazem cardiac events \( cardiac mortality recurrent nonfatal infarction \) patients placebo hypothesized diltiazem increased frequency late chf well cardiac events , patients predisposed lvd using characterizing variables primary analysis , found patients pulmonary congestion , anterolateral q wave infarction , reduced ejection fraction \( ef \) baseline likely chf follow without markers lvd chf particularly frequent patients lvd randomized diltiazem among baseline ef less 0 40 , late chf appeared 12 \( 39 326 \) receiving placebo 21 \( 61 \) receiving diltiazem \( p 0 004 \) life table analysis patients ef less 0 40 confirmed frequent late chf taking diltiazem \( p 0 \) addition , diltiazem associated rise frequency late chf progressively greater increasingly severe decrements baseline ef diltiazem effect absent patients pulmonary congestion baseline ef 0 40 , suggesting unique association diltiazem related late chf systolic lvd
transesophageal doppler echocardiography evaluation coronary blood flow velocity baseline conditions dipyridamole induced coronary vasodilation transesophageal echocardiography allows evaluation proximal coronary artery anatomy coronary blood flow velocity \( cbfv \) assess potential transesophageal echocardiography evaluating cbfv variations induced coronary active drugs , studied 15 patients high quality pulsed wave doppler recordings cbfv patients , transesophageal doppler evaluation cbfv performed , 2 minutes cessation dipyridamole infusion \( 0 56 mg kg 4 minutes \) , 2 minutes infusion \( 240 mg injected 4 minutes cessation dipyridamole infusion \) following cbfv parameters evaluated three steps study protocol maximal mean diastolic velocities maximal mean systolic velocities furthermore , following indexes coronary flow reserve evaluated ratio maximal diastolic velocity recorded dipyridamole administration ratio mean diastolic velocity recorded dipyridamole administration nine 15 patients normal left anterior descending coronary artery \( group \) , whereas remaining six significant \( less equal 75 \) stenosis \( group b \) group patients , cbfv parameters increased significantly dipyridamole infusion returned near baseline values infusion group b patients , hand , none cbfv parameters increased dipyridamole infusion dipyridamole baseline maximal diastolic velocity mean diastolic velocity ratios , respectively , 3 22 0 96 3 04 0 88 group 1 46 0 45 \( p less 0 01 versus group \) 1 48 0 49 \( p less 0 01 versus group \) group b patients
regurgitant jet size transesophageal compared transthoracic doppler color flow imaging combined echocardiography doppler color flow mapping transthoracic imaging become standard method noninvasive assessment valvular regurgitation study compared regurgitant jet areas doppler color flow imaging derived newer transesophageal approach measurements obtained conventional transthoracic apical views maximal regurgitant jet area determinations overall visual estimate lesion severity obtained 42 patients underwent color flow examination techniques seventy three regurgitant lesions visualized transesophageal flow imaging 34 mitral , 22 aortic , 17 tricuspid jets transthoracic studies patients revealed fewer regurgitant lesions valve 20 mitral , 16 aortic , 12 tricuspid \( p 0 \) comparison maximal jet areas determined transesophageal transthoracic studies showed good overall correlation \( r 0 85 , see 2 8 cm2 \) systematic overestimation transesophageal technique \( tee 0 96 2 7 \) subgroup mitral insufficiency , valve lesions visualized techniques larger transesophageal approach \( n 18 , 6 0 versus 3 6 cm2 , p 0 008 \) semiquantitative visual grading individual valve lesions two independent observers revealed higher grade regurgitation jets classified mild \( 38 versus 25 \) , moderate \( 18 versus 13 \) , severe \( 17 versus 10 \) esophageal imaging transthoracic imaging thus , transesophageal color flow mapping techniques yield higher prevalence valvular regurgitation transthoracic techniques patients jet area overall estimate regurgitant lesion severity also greater transesophageal color doppler imaging compared standard transthoracic imaging
elevated pulmonary artery pressure independent predictor mortality analyses study based hemodynamic angiographic data obtained cohort 1 , 371 predominantly black patients right left heart catheterization patients followed prospectively mean 117 weeks , 103 fatal events recorded cox survival analysis , three variables found independently related survival pulmonary artery mean pressure \( pamp \) , number stenosed vessels , left ventricular \( lv \) ejection fraction \( p less 0 01 \) multivariate stepwise analysis , pamp entered model first largest chi 2 value three prognostic variables \( chi 2 33 4 p less 0 0001 \) pamp 32 percent higher compared survivors \( 25 11 mm hg vs 19 8 mm hg , p less 0 01 mean , sd \) 10 mm hg increase pamp associated fourfold increase relative risk dying finding independent pulmonary vascular resistance therefore could attributed primary pulmonary vascular parenchymal disease subgroup 1 , 118 patients normal lv ejection fraction \( greater 50 percent \) 253 patients reduced ejection fraction \( less 50 percent \) , pamp emerged independent predictor mortality \( p less 0 0001 0 01 , respectively \) , therefore marker cardiac disease beyond impairment systolic contractile function among patients without obstructive coronary artery disease , pamp alone provided prognostic information multivariate survival analysis
renal vein thrombosis initial manifestation 's syndrome report patient presented renal vein thrombosis nephrosis progressed alveolar hemorrhage renal failure renal biopsy immunofluorescence serum basement membrane antibody titer studies confirmed diagnosis 's syndrome knowledge , first report renal vein thrombosis initial presentation 's syndrome
safety efficacy thrombolytic therapy superior vena cava syndrome experience clinic 1982 1990 using thrombolytic therapy superior vena cava \( \) syndrome retrospectively reviewed sixteen patients , 11 indwelling central venous catheters , treated either urokinase \( n 11 \) streptokinase \( n 5 \) either urokinase \( 4 , 400 u kg bolus followed 4 , 400 u kg h \) streptokinase \( 250 , 000 u bolus followed 100 , 000 u h \) used , performed overall , 56 percent patients complete clot lysis relief symptoms thrombolytic therapy effective eight \( 73 percent \) 11 patients receiving urokinase one \( 20 percent \) five patients receiving streptokinase central venous catheter , eight \( 73 percent \) 11 patients successfully lysed , whereas one \( 20 percent \) five patients successfully lysed catheter present thrombolytic therapy performed less equal five days symptom onset , seven \( 88 percent \) eight patients successful , thrombolytic therapy performed greater five days symptom onset , two \( 25 percent \) eight patients successful symptoms relieved catheter preserved patients thrombolytic therapy effective factors predicting success follows \( 1 \) use urokinase compared streptokinase \( 2 \) presence central venous catheter \( 3 \) duration symptoms less equal five days
risk factors gestational diabetes black population long term longitudinal study gestational diabetes mellitus black women , risk factors identified age , obesity , family history diabetes , presence hypertension poor predictors history previous large date infant , parity , age first pregnancy prevalence smooth muscle nuclear autoantibodies higher gestational diabetic subjects gestational diabetic subjects required insulin glycemic control obese , lower frequency bf f phenotype higher frequency bf f1 phenotype , lower frequency type 2 allele polymorphic locus adjacent insulin gene restriction fragment length polymorphisms flanking insulin apolipoprotein c iii genes , although associated gestational diabetes mellitus , may associated hyperlipidemia subsequent atherosclerosis
calcium channel blockers geriatric hypertension though calcium channel blockers used treat angina pectoris almost decade , long acting forms agents become available last years made practical use antihypertensive agents well becoming increasingly popular role , especially treat elderly hypertensive patients vasodilators mild diuretic action , logical treatment choices majority hypertensive patients increased peripheral vascular resistance offer advantage dual benefit hypertensive patients angina , effect carbohydrate lipid metabolism disadvantages include cost side effect profile includes headaches , palpitations , ankle edema , constipation
congestive heart failure current overview congestive heart failure \( chf \) , disease seen primarily older patient , due either systolic diastolic dysfunction management quite different heart failure due filling abnormality compared poor ventricular systole disorder also poses many diagnostic pitfalls elderly current understanding chf influence diagnosis management focus review
training increases muscle blood flow rats peripheral arterial insufficiency study investigated effect physical training muscle blood flow \( bf \) rats peripheral arterial insufficiency treadmill running bilateral stenosis femoral artery adult rats \( 300 350 g \) performed reduce exercise hyperemia hindlimb limit resting muscle bf rats divided normal sedentary , acute stenosed \( stenosed 3 days experiment \) , stenosed sedentary \( limited cage activity \) , stenosed trained \( run treadmill progressively intense program , 50 60 min day , 5 days wk 6 8 wk \) hindlimb bf determined labeled microspheres low \( 20 min \) high treadmill speed \( 30 40 min depending ability \) maximal hindlimb bf reduced approximately 50 normal acute stenosed group total hindlimb bf \( 81 5 ml min 1 100 g 1 \) change stenosed sedentary animals 6 8 wk cage activity , redistribution bf occurred within hindlimb two factors contributed higher bf distal limb muscle trained animals redistribution bf within hindlimb occurred stenosed trained animals distal limb bf increased approximately 80 \( p less 0 001 \) proximal tissue addition , increase total hindlimb bf training indicates collateral bf enhanced \( p less 0 025 \) associated increase oxygen delivery relatively ischemic muscle probably contributed markedly improved exercise tolerance evident trained animals
paradoxical embolism underestimated entity comprehensive work forty one cases arterial embolism reviewed work included 2d echocardiography 29 patients \( 71 \) , arteriography 22 \( 54 \) , echocardiography arteriography 19 \( 46 \) , abdominal aortic ultrasound 18 \( 43 \) sources emboli probable cardiac \( 8 20 \) mural cardiac thrombus detected echocardiogram possible cardiac \( 12 29 \) arrhythmias cardiac pathology detected without mural thrombus probable arterial \( 7 17 \) proximal arterial thrombus detected probable paradoxical embolism \( 2 5 \) criteria cardiac defect right left shunt detected contrast echo one patient cardiac catheterization possible paradoxical embolism \( 3 7 \) meets two three criteria without evidence source unknown source \( 9 22 \) conventional work negative incomplete five nine patients \( 56 \) less 50 years old probable possible paradoxical embolism , two patients \( 22 \) , origin unknown conclusion \( 1 \) significant proportion patients arterial embolus discharged source emboli unknown , \( 2 \) paradoxical embolism must considered contrast saline transesophageal echocardiogram done patients 50 years old
splenorenal arterial shunt treatment renovascular hypertension approach lumbar retroperitoneal incision period 16 years , 29 consecutive patients operated splenorenal arterial shunt incision retroperitoneal approach 18 males 11 females medium age 42 years cases severe hypertension average medium time 48 months , 11 patients variable degrees renal insufficiency diagnosis made utilizing standard methods including cases angiography abdominal aorta , celiac axis renal arteries one patient died operation due intestinal infarction , remaining followed medium time 50 months patients improved cured renal insufficiency hypertension cured 23 , improved 4 failed 1 , latter patient successfully precise surgical technique presented advantages indications review literature surgical experience technique splenorenal arterial anastomosis done
clinical results femoropopliteal bypass using supported \( \) dacron grafts comparison knee anastomosis end september 1989 , 52 dacron grafts implanted femoropopliteal bypass operations distal ends 27 grafts anastomosed knee popliteal arteries 25 grafts knee popliteal arteries cumulative patency rate knee grafts 71 3 54 months , knee grafts 78 8 48 months \( n \) stenosis arteriosclerotic proximal mid popliteal artery knee angiographically remarkable changes may explain femoropopliteal grafts occlude time late results knee grafts much better knee grafts
crural artery bypass adjunctive arteriovenous fistula modification distal anastomosis carried crural artery bypass adjunctive arteriovenous fistula 8 lower extremities 7 patients severe ischemic symptoms poor distal run mean blood flow rates implanted grafts ranged 43 340 ml min reconstructed crural arteries 20 100 ml min stenotic lesion noted postoperative angiogram one patient stasis symptoms caused downward blood flow distal veins another patients remained well good function grafts 1 5 years surgery modified distal corner anastomosis follows three additional interrupted simple sutures made anterior wall concomitant incisions making common posterior wall vessel incisions vascular pocket formed distal corner anastomosis prevents stricture anastomosis vein finally ligated distal fistula intercept downward blood flow distal veins modification technique recommended prevent stricture distal anastomosis postoperative stasis symptoms
preoperative evaluation surgical treatment tricuspid regurgitation associated acquired valvular heart disease boyd method vs carpentier edwards ring method study compared results repair tricuspid regurgitation \( tr \) using doppler echocardiography sixty three patients underwent tricuspid annuloplasty studied thirty four patients received boyd annuloplasty 29 carpentier edwards ring annuloplasty new classification tr based direction area regurgitation flow doppler echocardiogram applied preoperatively boyd group , 10 cases showed massive tr 24 cases showed localized tr preoperatively localized tr well controlled cases , 8 9 cases massive tr showed grade iii residual tr c e group , 21 cases showed massive tr 8 cases showed localized tr cases well controlled postoperatively conclude \( 1 \) although boyd method acceptable localized tr , c e method employed massive tr \( 2 \) analyzing regurgitant pattern tr doppler echocardiogram useful selecting appropriate surgical technique
new quantitative method evaluating tricuspid regurgitation new quantitative method evaluating regurgitation \( tr \) proposed order select suitable treatment functional tr associated acquired valvular heart disease regurgitant volume per beat \( vtr \) calculated using two dimensional color doppler continuous wave doppler study 48 patients , preoperative vtr showed significant correlation tricuspid annular diameter end diastole , right atrial mean pressure right ventricular end diastolic pressure patients classified 3 groups according preoperative vtr group , vtr less 10 cc \( 18 \) group ii , vtr 10 20 cc \( 18 \) group iii , vtr greater equal 20 cc \( 12 \) classification correlated well intraoperative findings tr group patients , vtr decreased without tricuspid valve repair group ii , 17 18 patients underwent tricuspid annuloplasty , showed decrease vtr 10 cc surgery group iii , 10 underwent tricuspid annuloplasty 2 tricuspid valve replacement three 10 tricuspid annuloplasty showed significant degree postoperative vtr \( 10 20 cc \) 3 patients well 2 tricuspid valve replacement showed preoperative peak peak pressure difference across tricuspid valve ejection phase \( \) less equal 20 mmhg tricuspid annular diameter end diastole greater equal 50 mm conclusion , tricuspid valve repair required group \( tr \) group ii \( tr ii \) patients , tricuspid annuloplasty necessary adequate tr correction group ii \( tr iii \) patients , substantial procedure like tricuspid valve replacement performed , especially preoperative less equal 20 mmhg tricuspid annular diameter end diastole greater equal 50 mm
surgical indication aortic arch hypoplasia infants determine surgical indications aortic arch hypoplasia , distal arch outer diameter , distal arch index \( ratio distal arch diameter normal aortic ring diameter \) , postoperative pressure gradient across aortic arch studied 23 patients 6 months age underwent surgery coarctation aortic arch hypoplasia ratio pressure gradient across arch right radial artery used evaluate postoperative level stenosis maximum ratio pressure gradient could tolerated surgery considered 0 15 operative results negative correlations found distal arch outer diameter postoperative pressure gradient ratio \( r 0 80 \) , distal arch index postoperative pressure gradient ratio \( r 0 80 \) correlations proved order obtain postoperative pressure gradient ratio 0 15 less , distal arch outer diameter 3 9 mm distal arch index 0 63 necessary consequently , distal arch outer diameter 3 9 mm distal arch index 0 63 considered indicate aortic arch hypoplasia need repair
aortic type ii dissecting aneurysm gaucher 's disease aortic extremely rare complication gaucher 's disease report successful surgery patient gaucher 's disease complicated aortic aortic dissection 's operation accomplished without bleeding sternal adaptation problems
repair coarctation persistent fifth arterial arch atresia fourth aortic arch coarctation aorta persistent fifth arterial arch atresia fourth aortic arch left common carotid left subclavian arteries treated surgically two month old boy transposition great arteries double outlet right ventricle aortic arch repaired using side side anastomosis left common carotid left subclavian arteries , patch repair segment origin left subclavian artery , ligation patent ductus arteriosus pulmonary arterial banding balloon performed associated anomalies
use ptfe graft correct anomalous drainage persistent left superior vena cava new technique correct persistent left superior vena cava \( \) drainage left atrium described 14 year old patient , left atrial common atrium , mitral valve regurgitation surgery , occlusion markedly increased venous pressure , ligation heart unusual atrial anatomy , correction intra atrial attempted correcting intra cardiac anomaly , divided anastomosed right atrial appendage using segment ptfe graft postoperative course uneventful angiogram demonstrated excellent performance graft
rapid expression heat shock protein rabbit brief cardiac ischemia effect brief myocardial ischemia expression heat shock protein \( hsp 70 \) examined vivo rabbit model myocardial ischemia using northern blotting functional studies carried open anesthetized rabbit large marginal branch left circumflex occluded four times 5 min using piezoelectric crystals implanted ischemic zone , end diastolic length , end systolic length , percent segmental shortening assessed expression hsp 70 measured northern blotting single 5 min coronary occlusion doubled expression hsp 70 whereas four cycles 5 min ischemia 5 min reperfusion resulted threefold increase hsp 70 mrna \( p less 0 001 \) measurements piezoelectric crystals showed mild myocardial dysfunction concomitant increase hsp 70 increase hsp 70 mrna repetitive brief ischemia transient , occurring early 1 h returning baseline 24 h ischemia western blot analysis monoclonal antibody hsp 70 used compare sham postischemic myocardial hsp 70 levels changes amount hsp 70 evident early 2 h even striking 24 h
payment mechanism patterns use medical services example hypertension study explores relationship use medical services hypertensive patients mechanisms payment within single primary care practice three payment mechanisms explored public assistance , health maintenance organization \( \) , service patterns examined across reimbursement type following variables age , sex , visit reason , number visits , medications , tests ordered , referrals made , recommendations follow visits illness severity controlled two ways \( 1 \) study focused one diagnosis mild moderate hypertension , \( 2 \) concurrent chronic illnesses enumerated included analysis medical visits physician examined 2 year period 25 30 patients randomly sampled three payment mechanisms statistically significant differences found patient behaviors \( total number patient visits \) physician behaviors \( number medications recommendations \) highest visit frequency found public assistance , followed closely covered , choosing service cost consciousness , study needed explore impact reimbursement mechanisms use health care services
association post dexamethasone cortisol level blood pressure depressed inpatients examined clinical data 230 depressed inpatients completed dexamethasone suppression test \( dst \) determine whether elevated post dst serum cortisol level exhibited classic physiological cushing 's syndrome hypertension significantly frequent among dst \( 21 2 \) among normal \( 11 3 \) percent blood lymphocyte count significantly lower among gender , age , body weight , use antihypertensives account findings implications morbidity mortality rates among patients affective disorder discussed
free peptide bound amino acids indicators ischemic damage rabbit spinal cord concentrations free peptide bound amino acids aspartate \( asp \) , glutamate \( glu \) , glycine \( gly \) gamma aminobutyric acid \( gaba \) studied following ischemia recirculation ventral dorsal gray matter rabbit spinal cord changes concentration amino acids following ten minutes \( min \) ischemia four days recovery found significant change 20 min , especially 40 min , ischemia decrease free asp gaba levels parts gray matter relatively greater decrease concentration free amino acids ventral horns corresponds greater morphological damage part spinal cord following ischemia following 40 min ischemia recirculation decrease peptide bound glu ventral horns asp glu dorsal horns found
selective vasopressin inhibition rats heart failure decreases afterload results hemodynamic effects selective inhibition arginine vasopressin \( avp \) v1 antagonist , \( \) cl 1 , studied normal rats \( n 17 \) rats 4 weeks coronary artery ligation large myocardial infarctions elevated left ventricular end diastolic pressures \( n 22 \) normal rats avp inhibition 35 micrograms kg bolus avp v1 antagonist change heart rate , right atrial , left ventricular systolic , left ventricular end diastolic aortic pressures also changes mean circulatory filling pressure , vascular volume , blood volume venous compliance rats infarction elevated left ventricular end diastolic pressures , avp inhibition change heart rate , right atrial pressure , mean circulatory filling pressure blood volume , mean aortic pressure decreased 103 3 88 2 mm hg \( p less 001 \) , venous compliance increased \( p less 001 \) 2 17 0 07 3 04 0 11 ml mm hg kg vascular volume decreased 42 3 3 1 34 7 2 6 ml kg \( p less 05 \) conclude inhibition avp specific v1 antagonist effect venous arterial circulations normal rats , rats left ventricular dysfunction heart failure chronic myocardial infarction , avp inhibition decreased arterial pressure caused
pharmacologic activity \( web 2170 \) , new selective antagonist platelet activating factor web 2170 \( international name \) , structurally related recently described platelet activating factor \( paf \) antagonist web 2086 , potent selective paf antagonist vitro vivo web 2170 inhibited paf induced human platelet neutrophil aggregation vitro \( ic50 values 0 3 0 83 microm , respectively \) little inhibitory action aggregation induced agonists potency vitro comparable described recently web 2086 \( , j , , g , k h j 241 , 1987 \) guinea pigs given v infusions paf 30 ng x kg 1 x min 1 , oral \( 0 005 0 5 mg kg \) well intravenous \( 0 005 0 05 mg kg \) treatment web 2170 abrogated intrathoracic accumulation 111in labeled platelets , bronchoconstriction hypotension well finally occurring death dose dependent fashion oral \( 0 01 1 mg kg \) intravenous \( 0 005 0 1 mg kg \) web 2170 shared beta 2 agonist fenoterol steroid dexamethasone property protecting elderly mice lethal effect paf anesthetized rats , intravenous \( 0 001 0 1 mg kg \) oral \( 0 05 1 mg kg \) web 2170 inhibited paf induced hypotension dose related manner coadministration web 2170 inhibited paf induced increase vascular permeability rat skin effectively half time duration action rat estimated 5 6 h oral administration 1 1 2 3 h intravenous application conclusion , web 2170 strong selective paf antagonist , vitro less web 2086 contrast , vivo oral web 2170 depending species considered parameter 5 40 times potent exogenous paf induced alterations recently described web 2086 particularly mice rats , oral web 2170 far superior web 2086
risk angina pectoris plasma concentrations vitamins , c , e carotene relation risk angina pectoris plasma concentrations vitamins , c , e carotene examined population case control study 110 cases angina , identified chest pain questionnaire , controls selected sample men aged 35 54 plasma concentrations vitamins c e carotene significantly inversely related risk angina significant relation vitamin smoking confounding factor inverse relation angina low plasma carotene disappeared plasma vitamin c substantially reduced adjustment smoking vitamin e remained independently inversely related risk angina adjustment age , smoking habit , blood pressure , lipids , relative weight adjusted odds ratio angina lowest highest vitamin e concentrations 2 68 \( 95 confidence interval 1 07 6 70 p 0 02 \) findings suggest populations high incidence coronary heart disease may benefit eating diets rich natural antioxidants , particularly vitamin e
blood pressure measurements dental representative 26 hour registration effect dental blood pressure investigated 27 normotensive patients \( 13 men 14 women \) aged 22 64 years \( mean 39 75 10 5 years \) , 26 hour continuous , noninvasive blood pressure registration carried patient least 175 blood pressure measurements registered 26 hours , giving total amount blood pressure measurements dental family included blood pressure values displayed well known diurnal variation , visit dental surgeon accompanied rise blood pressure significant difference blood pressure values 26 hour period period rest period dental , neither systolic diastolic pressure fell degree relation 26 hour values visit surgeon
assessment stable ischemic heart disease tests best patients \? understanding importance various risk factors , pathogenesis myocardial ischemia , appropriate use various noninvasive invasive tests essential management patients known suspected coronary artery disease \( cad \) although coronary angiography remains gold standard diagnosis cad , much data obtained risk factor assessment , medical history , various noninvasive tests provides information may even important cardiac catheterization data alone defining prognosis management
prevalence hemodynamically significant stenosis carotid artery asymptomatic population results previous studies suggested significant stenosis carotid artery occurs less 6 per cent asymptomatic patients however , populations studied representative seen vascular surgeons accordingly , examined two cohorts patients veterans administration medical center using duplex scanning 153 volunteers group 1 , 50 years age , treated outpatient department problems 116 patients similar age group 2 known significant arterial occlusive disease lower extremity majority patients men mean age 64 4 years risk factors total population included hypertension , diabetes mellitus , coronary arterial disease , peripheral vascular disease smoking , significant \( greater 50 per cent diameter \) stenosis carotid artery discovered 25 269 patients prevalence group 1 6 5 per cent versus 12 9 per cent group 2 \( p 0 \) prevalence patients cardiac disease 15 2 per cent compared 6 8 per cent without cardiac disease \( p 0 \) smoking associated 10 6 per cent rate significant disease compared 2 3 per cent rate nonsmokers \( p 0 \) hypertension diabetes significant risk factors significant stenosis carotid artery found seven 40 patients coronary arterial disease , peripheral vascular disease smoking present
syndrome bilateral hemispheric border zone ischemia symptoms compatible vertebrobasilar ischemia reported patients unilateral bilateral carotid occlusive disease intracranial steal phenomena proposed explain symptoms review 54 patients angiographically documented severe bilateral carotid stenosis \( less equal 2 mm residual lumen \) occlusion , eight symptoms suggesting vertebrobasilar insufficiency five patients identified retrospectively , three evaluated prospectively symptoms included various combinations hemodynamically mediated , transient bilateral motor , sensory , visual impairment dysarthria , dysphagia , generally absent patient also described additional symptoms compatible transient hemispheric retinal ischemia anatomic regions bilateral vertebrobasilar like symptoms could correlated angiographically estimated arterial border zones may thus represent bilateral hemispheric border zone ischemia rather brain stem ischemia intracranial steal need
correlation amino acid release neuropathologic outcome rat brain following middle cerebral artery occlusion using vivo brain microdialysis , studied amino acid release striatum cortex eight rats following permanent middle cerebral artery occlusion processed brains histopathologic assessment volume ischemic damage 4 hours occlusion ischemic damage varied occlusion middle cerebral artery point either proximal \( n 4 \) distal \( n 4 \) vessels proximal occlusion elevated dialysate contents amino acids largest increases occurred potentially neurotoxic amino acids aspartate glutamate taurine \( 800 2 , 800 basal efflux \) observed smaller increases metabolic amino acids \( 280 basal efflux \) distal occlusion affect amino acid efflux striatum , release cortex significantly lower following proximal occlusion compared release data acute histopathologic outcome proximal occlusion resulted large volume ischemic damage cortex striatum \( 25 48 hemispheric volume \) smaller volume ischemic damage noted following distal occlusion \( 0 21 hemispheric volume \) volume ischemic damage amount amino acid release significantly correlated \( p less 0 05 \)
angiographic contrast media interference laser induced fluorescence excitation detection atherosclerotic human coronary arteries laser induced fluorescence used conjunction angiography laser angioplasty guidance effect contrast media excitation detection arterial fluorescence previously reported accordingly , fluorescence emission spectra human coronary artery necropsy specimens \( n 7 \) excitation pulsed excimer laser excitation \( 308 nm \) examined addition three different contrast media , sodium meglumine diatrizoate , sodium meglumine ioxaglate , iopamidol decrease overall fluorescence intensity observed wavelengths contrast agent examined decrease intensity fluorescence emission marked wavelengths less 410 nm wavelengths 425 nm similar effects observed contrast media diluted whole blood absorption spectra three contrast media demonstrated absorption ultraviolet centered around 240 nm conclude preferential absorption ultraviolet range contrast media interferes excitation detection laser induced fluorescence use visible light excitation may obviate interference laser induced fluorescence analysis plaque
normalization doppler indices diastolic dysfunction pacing sign ischemic mitral regurgitation twenty three patients angina undergoing diagnostic cardiac catheterization underwent cardiac pacing simultaneous hemodynamic doppler echocardiographic evaluation assess effects pacing induced ischemic mitral valve velocity seventeen patients significant coronary artery disease , six patients normal coronary arteries doppler hemodynamic measurements performed rest immediately pacing discontinued 91 7 maximal predicted heart rate seven patients experienced new significant increases severity mitral regurgitation pacing revealed doppler examination group significant increase \( p 0 007 \) early late peak filling velocities immediately pacing discontinued , resultant decrease late early ratios , decreased 1 01 0 12 0 70 0 19 \( p 0 006 \) left ventricular end diastolic pressure increased significantly 16 7 6 8 mm hg 29 4 5 3 mm hg cardiac pacing \( p less 0 001 \) patients coronary disease develop mitral regurgitation also significant increases left ventricular end diastolic pressure 18 7 5 8 mm hg 24 3 8 6 mm hg \( p less 0 05 \) changes late early wave amplitude , late early ratio , doppler measurements groups conclude mitral regurgitation caused pacing induced myocardial ischemia doppler indices mitral inflow , turn , may mask persistent worsened left ventricular diastolic dysfunction
pulse rate , coronary heart disease , death nhanes epidemiologic follow study determine whether associations elevated resting pulse rate chd incidence death white men independent risk factors whether associations exist women blacks , data examined nhanes epidemiologic follow study follow period 6 13 years , elevated rr chd incidence found older white men baseline pulse greater 84 beats min compared less 74 beats min controlling multiple risk factors \( rr 1 37 , 95 cl 1 02 , 1 84 \) risks death causes , cardiovascular diseases , noncardiovascular diseases also elevated white men elevated pulse rate independent risk factors chd incidence increased white women elevated pulse rate risks death causes , cardiovascular diseases , noncardiovascular diseases , also elevated white men elevated pulse rate independent risk factors chd incidence increased white women elevated pulse rate risk death causes cardiovascular diseases elevated black men women elevated pulse rate risk death noncardiovascular disease elevated black men elevated pulse rate association cardiovascular death particularly striking black women , even adjusting baseline risk factors \( rr 3 03 , 95 cl 1 46 , 6 28 \) studies needed assess associations pulse rate chd blacks elucidate mechanisms groups
utility echocardiography diagnostic strategy postinfarction ventricular septal rupture comparison two dimensional echocardiography versus doppler color flow imaging diagnostic accuracy doppler color flow imaging diagnosis postinfarction ventricular septal defects established study , 43 patients unexplained hypotension new murmur period evaluated conventional two dimensional echocardiography doppler color flow imaging presence ventricular septal defect confirmed oximetry , ventriculography , operative repair , autopsy case two dimensional doppler color flow imaging 100 specific excluding ventricular septal defect doppler color flow imaging correctly identified 12 confirmed ventricular septal defects study \( 100 sensitivity \) , whereas combination two dimensional criteria correctly identified seven \( 58 sensitive \) \( p less 0 05 \) doppler color flow imaging superior conventional two dimensional imaging diagnosis postinfarction ventricular septal defect addition , doppler color flow imaging localized septal defect , thus guided therapy technique repair carefully performed doppler color flow examination exclude result rapid diagnosis ventricular septal defect , eliminates need time consuming confirmatory testing
dipyridamole perfusion scintigraphy experience application one hundred seventy patients known suspected unstable angina evaluated safety , accuracy , potential clinical utility intravenous dipyridamole perfusion scintigraphy thallium 201 170 patients , 78 suspected 92 known unstable angina coronary angiography noncardiac side effects \( 26 \) , induced chest discomfort \( 44 \) , st segment changes \( 12 \) similar two groups significant arrhythmias occurred two patients prolonged chest pain , extensive reversible image abnormalities associated creatinine kinase mb release elective bypass surgery twenty eight patients normal coronary arteries , 35 single vessel disease scintigraphic per patient sensitivity specificity 91 79 per vessel sensitivity 74 per vessel specificity 78 without group differences brief follow period , 62 patients image abnormalities coronary revascularization , seven deaths without intergroup differences similar patient group angiography , scintigraphic defects less frequent less extensive , revascularization performed , subsequent deaths occurred less often dipyridamole perfusion scintigraphy accurate alternative exercise testing evaluation patients unstable angina pectoris although without risk , method appears relatively safe considered guide diagnosis , probably prognosis management
myocardial metabolic hemodynamic effects sustained intravenous infusion nifedipine without metoprolol patients unstable angina tested usefulness sustained intravenous infusion nifedipine combination nifedipine metoprolol early management 14 patients unstable angina pectoris 24 hour run period , nifedipine titrated stepwise fashion \( mean dose 27 7 micrograms min \) nifedipine treatment coronary blood flow increased 150 66 183 74 ml min \( p less 0 05 \) , whereas double product , myocardial oxygen consumption , arterial coronary sinus \( \) epinephrine levels unchanged myocardial lactate uptake increased 3 4 26 1 31 3 26 6 mumol min \( p less 0 005 \) free fatty acid uptake 7 2 22 1 34 5 33 7 mumol min \( p less 0 05 \) small nonsignificant improvement amino acid metabolism observed metoprolol added seven patients led decrease double product \( 2 2 1 6 x 10 \( 3 \) p less 0 01 \) myocardial oxygen consumption \( 3 2 3 8 ml min p less 0 05 \) lactate uptake oxygen uptake ratio increased 18 metoprolol \( p ns \) number episodes chest pain decreased 2 4 1 1 24 hours 0 1 0 2 nifedipine group 2 9 1 1 24 hours 0 3 0 5 nifedipine plus metoprolol group \( p less 0 01 \) conclude acute phase unstable angina , intravenous nifedipine carefully titrated improve coronary blood flow oxidative metabolism addition metoprolol also associated reduction myocardial oxygen demand treatment results significant hemodynamic stability
fragmented atrial activity patients transient atrial fibrillation prediction atrial fibrillation \( af \) important patients wolff parkinson white syndrome selection pacemaker therapeutic modality 25 patients transient af , response atrial activity width extrastimuli examined comparison 25 patients without af see results could used index subsequent occurrence af programmed electrical stimulation using eight basic stimuli followed single double extrastimuli \( \) delivered high right atrium , atrial activities examined prolongation atrial activity caused extrastimuli termed fragmentation \( frg \) , defined prolongation 150 basic stimuli frg zone defined zone coupling intervals extrastimuli \( \) caused frg , delta max frg defined difference frg atrial wave width basic stimuli fragmentation reproducibly induced extrastimuli , inverse relationship frg duration coupling interval extrastimuli \( \) frg zone delta max frg wider longer patients transient af comparison control group single double extrastimuli \( p less 0 001 \) af using double extrastimuli significantly high patients af
management multiple risk factors coronary heart disease patients hypertension hypertension intervention trials , involved mainly use diuretics beta blockers , demonstrated disappointing benefit terms reduction coronary heart disease \( chd \) rather suggesting elevated blood pressure chd causally related , data suggest antihypertensive agents used optimal management hypertension review currently recommended therapies needed major risk factors chd , include increased blood pressure , elevated serum cholesterol levels , smoking , highly prevalent general population appear cluster patients hypertension therefore treatment hypertension demands multifactorial approach , one takes consideration risk factors chd diuretics beta blockers adversely affect serum lipid profile , could chd benefit afforded blood pressure reduction
effects doxazosin serum lipids review clinical data molecular basis altered lipid metabolism goal antihypertensive treatment must reduction high blood pressure , also effective management elevated cholesterol levels risk factors coronary heart disease \( chd \) controlled clinical trials , doxazosin shown antihypertensive efficacy comparable classes antihypertensive agents lower levels total cholesterol , low density lipoprotein \( ldl \) cholesterol , triglycerides increasing levels high density lipoprotein cholesterol doxazosin appears inhibit development chd two first , doxazosin binds alpha 1 adrenoreceptor inhibits receptor mediated responses epinephrine norepinephrine second , doxazosin direct indirect effects lipid metabolism increasing ldl receptor activity , decreasing intracellular ldl synthesis , reducing synthesis secretion low density lipoprotein cholesterol , stimulating lipoprotein lipase activity doxazosin may also inhibit platelet aggregation long term studies determine actions reductions morbidity mortality rates chd first year results treatment mild hypertension study \( \) demonstrated expected reductions blood pressure antihypertensive agents studied lipid changes varied type antihypertensive treatment favorable doxazosin
preliminary results norwegian doxazosin postmarketing surveillance study twelve week experience study designed investigate safety efficacy doxazosin control blood pressure general medical practice results presented concern first patients evaluated 12 week period blood pressure significantly reduced treatment doxazosin \( 13 9 mm hg \) , heart rate significantly altered addition , doxazosin significantly reduced total cholesterol levels \( 6 7 \) , reduced triglyceride levels \( 19 8 \) , increased high density lipoprotein cholesterol levels \( 2 5 \) , high density lipoprotein total cholesterol ratio \( 9 7 \) calculated risk coronary heart disease reduced 20 5 12 week period thirty five percent patients reported least one side effect , number patients experiencing severe adverse reactions small twenty patients \( 2 7 \) discontinued treatment adverse events , 2 7 dose doxazosin reduced
doxazosin study cohort patients hypertension general practice interim report objective study assess safety efficacy doxazosin substantial cohort hypertensive patients drawn general practice total patients entered study , \( 36 6 \) untreated hypertensive patients patients advised change diet , smoking habit , life style study twenty one percent cigarette smokers , concurrent diabetes present 2 3 baseline blood cholesterol exceeded 200 mg dl \( 5 2 mmol l \) 90 250 mg dl \( 6 5 mmol l \) 56 patients mean decrease blood pressure produced doxazosin 22 15 mm hg 10 weeks therapy mean decrease heart rate 1 beat min mean maintenance dose patients 3 1 mg day side effects considered related possibly related treatment reported patients treatment discontinued 233 patients \( 5 8 \) adverse events related possibly related treatment doxazosin doxazosin produced significant \( p less 0 001 \) decrease total cholesterol , low density lipoprotein cholesterol , triglyceride levels significant increase high density lipoprotein cholesterol ratio high density lipoprotein total cholesterol potential reduction 10 year coronary heart disease risk \( according framingham equation \) calculated 20 4
open , study doxazosin essential hypertension experience general practice netherlands antihypertensive efficacy , safety , lipid effects doxazosin , selective alpha 1 inhibitor , assessed general practice setting three hundred twenty six patients entered study , involved three phases \( 1 \) 2 week baseline period , \( 2 \) 8 week period patients received 1 8 mg doxazosin daily , \( 3 \) 4 week maintenance period 12 weeks , 78 8 efficacy evaluable patients considered therapy successes \( sitting diastolic blood pressure either less equal 90 mm hg greater equal 5 mm hg reduction baseline greater equal 10 mm hg reduction baseline \) mean daily dose patients considered therapy success 2 8 mg final visit , sitting systolic diastolic blood pressures patients reduced 16 4 13 5 mm hg mean baseline 170 106 mm hg investigators' global assessment efficacy daily doxazosin therapy excellent good 70 patients 326 patients , 30 7 reported total 160 side effects 78 side effects mild moderate severity , 24 patients \( 7 4 \) discontinued treatment adverse experiences investigators' global assessment excellent good 87 patients doxazosin produced significant decrease total cholesterol \( p 0 02 \) triglyceride \( p less 0 001 \) levels baseline final visit also highly significant reduction 17 \( p less 0 001 \) calculated risk score coronary heart disease basis framingham heart study risk equation
doxazosin atenolol monotherapy mild moderate hypertension randomized , parallel study three year follow efficacy safety doxazosin \( n 83 \) atenolol \( n 81 \) compared 3 year period doxazosin \( mean dose 3 years , 5 2 mg day \) atenolol \( mean dose , 66 4 mg day \) produced sustained overall similar reduction blood pressure , evidence tolerance doxazosin decreased mean blood pressure 158 104 mm hg 146 90 mm hg atenolol decrease 160 103 mm hg 144 88 mm hg whereas reduction blood pressure atenolol paralleled significant \( p less 0 05 \) decrease heart rate \( mean 74 60 beats min \) , doxazosin produced clinically meaningful changes heart rate contrast atenolol , doxazosin reduced triglyceride levels 5 9 \( atenolol 22 5 \) , increased high density lipoprotein cholesterol levels 3 7 \( atenolol , 11 2 \) , increased high density lipoprotein total cholesterol ratio 5 9 \( atenolol , 10 3 \) values significantly \( p less 0 001 \) different atenolol treated patients doxazosin also reduced calculated low density lipoprotein cholesterol levels 3 3 \( atenolol , unchanged \) adverse effect atenolol lipid levels apparently beneficial effect blood pressure reduction , calculated coronary heart disease \( chd \) risk actually increased significantly contrast , reduction calculated chd risk doxazosin group statistically significant points study safety profile drugs similar added potential reduction calculated risk chd among hypertensive patients , doxazosin represents appropriate first line drug treatment essential hypertension
cardiovascular disease risk profiles article presents prediction equations several cardiovascular disease endpoints , based measurements several known risk factors subjects \( n \) original offspring subjects framingham heart study , aged 30 74 years , initially free cardiovascular disease equations predict risk following developed myocardial infarction , coronary heart disease \( chd \) , death chd , stroke , cardiovascular disease , death cardiovascular disease equations demonstrated potential importance controlling multiple risk factors \( blood pressure , total cholesterol , high density lipoprotein cholesterol , smoking , glucose intolerance , left ventricular hypertrophy \) opposed focusing one single risk factor parametric model used seen several advantages existing standard regression models unlike logistic regression , provide predictions different lengths time , probabilities expressed straightforward way cox proportional hazards model
double blind comparison doxazosin enalapril patients mild moderate essential hypertension antihypertensive efficacy safety doxazosin enalapril compared general practice setting \( n 54 \) agents produced comparable , statistically significant \( p less 0 05 \) reductions mean blood pressure clinically relevant changes heart rate side effects two groups mild moderate disappeared tolerated continued treatment doxazosin , contrast enalapril , produced significant \( p less 0 05 \) reduction total serum cholesterol concentration , reduction level triglycerides , favorable increase high density lipoprotein total cholesterol ratio reduction calculated coronary heart disease risk produced doxazosin \( 27 58 \) highly significant \( p less 0 0002 \) greater produced enalapril \( 18 49 p less 0 02 \)
double blind comparative study doxazosin prazosin administered beta blockers diuretics antihypertensive efficacy safety doxazosin \( daily \) prazosin \( twice daily \) compared patients mild moderate essential hypertension \( diastolic blood pressure dbp 95 114 mm hg \) adequately controlled diuretics beta blockers doxazosin produced significantly greater mean reductions standing \( p 0 01 \) supine \( p 0 04 \) dbp prazosin significant group differences either mean systolic blood pressure heart rate overall mean daily doses efficacy evaluable patients 4 7 mg doxazosin 6 7 mg prazosin sixteen patients \( 84 2 \) treated doxazosin 13 patients \( 56 5 \) treated prazosin considered therapeutic successes \( decrease standing dbp greater equal 10 mm hg less equal 90 mm hg greater equal 5 mm hg reduction baseline \) 19 efficacy evaluable patients treated doxazosin , 15 \( 78 9 \) showed improvement severity category hypertension improvement severity reported 14 patients \( 60 9 \) treated prazosin doxazosin produced favorable effect serum lipid levels prazosin , although statistically significant within group differences observed side effects experienced either doxazosin prazosin mild moderate tolerated disappeared continued treatment overall evaluation excellent good 18 \( 90 \) doxazosin 21 \( 91 \) prazosin treated patients clinical efficacy rated excellent good 16 patients \( 80 \) treated doxazosin 15 patients \( 68 \) treated prazosin
addition doxazosin treatment regimen patients hypertension adequately controlled beta blockers doxazosin given patients hypertension adequately controlled beta blockade , blood pressure normalized 94 34 patients \( blood pressure less equal 140 85 mm hg \) reduction blood pressure obtained doxazosin combination metoprolol mean final daily dose 1 3 mg pindolol atenolol 2 0 mg day exercise induced increase systolic diastolic blood pressure also lower combined beta blocker doxazosin therapy beta blocker alone 12 weeks treatment , combination doxazosin beta blocker significantly reduced total serum cholesterol triglyceride levels side effects mild one patient withdrawn therapy
double blind comparative study doxazosin prazosin treatment essential hypertension two hundred sixty six patients took part multicenter comparative study doxazosin prazosin drugs produced significant reduction \( p less 0 001 \) blood pressure increase heart rate blood pressure considered markedly decreased decreased 70 8 patients treated doxazosin 70 0 patients treated prazosin statistically significant group differences antihypertensive efficacy observed doxazosin prazosin well tolerated seven patients \( 5 6 \) group therapy withdrawn
clinical experience doxazosin general medical practice new zealand study investigated safety efficacy doxazosin treatment large population patients \( n 336 \) essential hypertension assessed effect doxazosin serum lipid profile calculated risk developing coronary heart disease patients assigned two groups baseline diastolic blood pressure greater equal 95 mm hg \( group 1 \) baseline diastolic blood pressure less 95 mm hg \( group 2 \) controlled previous antihypertensive therapy doxazosin treatment \( monotherapy 76 2 patients \) significantly \( p less 0 05 \) reduced blood pressure patients group 1 \( 23 17 mm hg \) 10 weeks maintained control blood pressure patients group 2 heart rate essentially unchanged groups mean final daily doses 3 6 3 2 mg achieved groups 1 2 , respectively treatment doxazosin improved severity category hypertension 88 4 patients group 1 87 3 patients considered therapy success doxazosin favorable effect serum lipid profile groups patients majority lipid changes achieved statistical significance resulted significant 27 decrease calculated risk developing coronary heart disease doxazosin well tolerated 24 1 patients side effects related possibly related treatment nine \( 2 7 \) patients dose doxazosin reduced 26 \( 7 7 \) patients withdrew doxazosin therapy side effects
doxazosin treatment essential hypertension general medical practice latin america latin american study assessed general practice setting efficacy tolerance daily doxazosin treatment mild moderate essential hypertension \( sitting diastolic blood pressure , 95 115 mm hg \) patients \( n 220 \) treated doxazosin 12 weeks monotherapy combination antihypertensive agents final visit , doxazosin produced mean change sitting systolic diastolic blood pressure 18 4 14 4 mm hg , mean daily dose 4 3 mg one hundred sixty three \( 77 6 \) 210 evaluable patients considered therapeutic success lipid analyses identified statistically significant \( p 0 02 \) reduction total serum cholesterol \( 4 85 \) overall decrease triglyceride levels \( 5 12 \) according framingham heart study equation , doxazosin produced highly significant \( p less 0 001 \) 20 reduction calculated probability developing coronary heart disease 10 years 220 patients evaluated , 54 \( 24 5 \) reported side effects considered related treatment ten \( 4 5 \) patients reported side effects unrelated treatment 37 \( 16 8 \) reported events unknown relationship side effects mild moderate tolerated disappeared continued treatment nine patients \( 4 1 \) discontinued therapy 13 \( 5 9 \) dose reduced prevalent side effects headache dizziness investigator 's overall assessment antihypertensive efficacy excellent good 176 patients \( 80 4 \) tolerance considered excellent good 193 patients \( 88 5 \)
multicenter study doxazosin treatment essential hypertension france study designed assess efficacy tolerance doxazosin patients mild , moderate , severe essential hypertension general practice setting ninety six adults mean age 55 1 2 years took part 14 week study , consisting placebo phase \( 2 weeks \) , dose adjustment phase doxazosin \( 8 weeks \) , maintenance phase \( 4 weeks \) doxazosin , final mean daily dose 3 4 mg , produced significant \( p less 0 05 \) reduction blood pressure points measurement study mean change sitting blood pressure end treatment 15 4 15 8 mm hg 85 patients could categorized success failure , 78 \( 92 \) considered therapeutic success 78 \( 89 \) 88 efficacy evaluable patients demonstrated improvement severity category hypertension treatment doxazosin produced reduction serum cholesterol \( 3 1 \) triglyceride \( 3 8 \) levels , although changes attain statistical significance calculated probability developing coronary heart disease 10 years \( according framingham equation \) significantly \( p less 0 001 \) reduced 22 , 16 7 chances per 100 \( baseline \) 14 3 chances per 100 \( final visit \) twenty six patients \( 27 1 \) reported side effects possibly related treatment , prevalent vertigo \( 7 3 \) headache \( 6 3 \) four \( 4 2 \) patients dose doxazosin reduced two \( 2 1 \) withdrawn prematurely investigator 's assessments tolerance reduced two \( 2 1 \) considered excellent good 85 \( 88 \) patients
clinical experience doxazosin general medical practice netherlands study designed investigate efficacy daily doxazosin treatment essential hypertension \( sitting diastolic blood pressure 95 115 mm hg \) general medical practice fifty three patients mild moderate essential hypertension entered study 14 weeks' duration consisted baseline run period 2 weeks , dose adjustment phase doxazosin \( 8 weeks \) , maintenance phase 4 weeks doxazosin initiated 1 mg day , every 2 weeks dose doubled unless blood pressure normalized \( sitting diastolic blood pressure less equal 90 mm hg greater equal 5 mm hg reduction baseline \) significant side effects emerged maximum daily dose administered 8 mg doxazosin produced significant \( p less 0 05 \) final mean change sitting blood pressure 17 4 12 2 mm hg final mean daily dose 4 1 mg heart rate significantly altered nonsignificant decrease total cholesterol concentration \( 2 66 , p 0 06 \) triglycerides \( 8 80 , p 0 09 \) also observed effect doxazosin blood pressure serum cholesterol resulted significant \( p less 0 001 \) reduction 19 calculated risk coronary heart disease investigators' assessment patient doxazosin excellent good 86 8 patients
long term study doxazosin treatment mild moderate essential hypertension general medical practice study assessed long term \( 54 weeks \) antihypertensive efficacy safety doxazosin treatment mild moderate essential hypertension , defined sitting standing diastolic blood pressure 95 114 mm hg 153 patients successfully completed initial 14 week trial , 61 continued 40 week extension study optimal antihypertensive efficacy achieved week 12 maintained patients duration 1 year final mean sitting blood pressure 148 84 mm hg reduced mean baseline level 173 102 mm hg occasional decreases heart rate observed , considered clinically relevant \( 1 3 beats min \) mean final dose doxazosin patients evaluable efficacy 2 4 mg day 91 7 patients taking less equal 4 mg day increase daily maintenance dose observed initial phase long term extension study 1 year treatment , 93 3 patients considered therapeutic success \( sitting diastolic blood pressure greater equal 10 mm hg reduction baseline less equal 90 mm hg greater equal 5 mm hg reduction \) patients worsening severity category hypertension total serum cholesterol concentrations reduced significantly \( 6 6 p 0 03 \) end week 14 reductions total serum cholesterol levels persisted throughout extension study , final reduction 5 4
doxazosin treatment mild moderate essential hypertension echocardiographic study sixteen patients mild moderate essential hypertension received 1 8 mg day doxazosin \( mean daily dose , 2 7 mg \) blood pressure reduction \( supine standing \) highly significant \( p less 0 001 \) , significant changes heart rate observed significant reduction \( p less 0 01 \) left ventricular mass seen without change left ventricular systolic function side effects mild , one patient withdrew study
echocardiographic assessment doxazosin left ventricular mass patients essential hypertension single daily dose doxazosin taken 12 week period produced significant reduction blood pressure left ventricular mass index patients mild moderate hypertension systolic shortening coefficient also increased trend improvement ejection fraction , rate circumferential fiber shortening , systolic contraction time , ratio observed change heart rate recorded patients side effects serum lipid profile modified favorably , particularly regard low density lipoprotein cholesterol high density lipoprotein cholesterol ratio producing reduction blood pressure left ventricular mass favorably modifying serum lipid profile , doxazosin produced beneficial change overall coronary heart disease risk profile
efficacy safety doxazosin treatment patients mild moderate essential hypertension elevated levels cholesterol hypertensive patients , elevated serum cholesterol frequent additional coronary risk factor selective alpha 1 adrenoreceptor inhibitors appear unique ability control risk factors forty two patients , ages 42 65 years , including 21 men sustained hypertension elevated serum cholesterol levels , included trial monotherapy doxazosin administered daily \( range , 1 16 mg \) influence drug high blood pressure elevated serum cholesterol evaluated 28 week period , consisted 4 week , single blind placebo lead period , open 10 week dose adjustment period , finally 14 week maintenance period 39 efficacy evaluable patients , 25 \( 64 \) achieved adequate blood pressure control \( diastolic blood pressure less 90 mm hg decrease diastolic blood pressure greater 10 mm hg \) mean daily dose 2 mg doxazosin persistent changes occurred heart rate 32 patients evaluable lipid data , nonsignificant trends increase high density lipoprotein cholesterol reduction total cholesterol , together significant reduction serum triglyceride concentration combined changes blood pressure blood lipid levels resulted reduction 36 calculated risk coronary heart disease eleven patients reported side effects four withdrawn therapy results confirm antihypertensive efficacy daily treatment doxazosin
multicenter study doxazosin treatment patients mild moderate essential hypertension concomitant intermittent claudication study assessed efficacy safety daily doxazosin treatment patients \( n 19 \) mild moderate essential hypertension \( sitting diastolic blood pressure dbp 95 114 mm hg \) concomitant intermittent claudication \( doppler ankle arm ratio less 0 80 walking tolerance less 700 treadmill \) 14 weeks treatment doxazosin , significant \( p less 0 05 \) reduction systolic blood pressure dbp observed mean blood pressures reduced 170 100 mm hg baseline 161 93 mm hg end treatment minor changes heart rate occurred , continued treatment statistically significant baseline 12 16 \( 75 0 \) efficacy evaluable patients blood pressure normalized \( dbp less equal 90 mm hg greater equal 5 mm hg reduction baseline \) mean daily dose 7 6 mg day doxazosin improved hypertension severity category 13 16 \( 81 3 \) patients blood pressure ratios thighs arms arms showed statistically significant changes treatment doxazosin thigh blood flow rest reactive hyperemia 3 minutes arterial occlusion change statistically tendency pain free distance improve laboratory data significantly changed treatment doxazosin 19 patients studied , 5 reported mild moderate side effects either tolerated disappeared continued treatment patient therapy withdrawn patient required dose reduction
doxazosin treatment chronic congestive heart failure results randomized double blind placebo controlled study study evaluated effects daily administration oral doxazosin patients chronic congestive heart failure \( chf \) stabilization period least 2 weeks digitalis diuretics , 73 patients chronic chf randomized receive additionally either doxazosin placebo double blind fashion patients underwent weekly dose adjustments increasing doses doxazosin \( 1 , 2 , 4 , 8 , 16 mg daily \) placebo 5 weeks , 67 evaluated 12 additional weeks maximally tolerated doses blinded study drugs treatment groups evaluated respect symptoms heart failure , indexes quality life left ventricular function , frequency type arrhythmia , adverse events , mortality rates doxazosin \( 11 9 0 9 mg \) given daily produced favorable trend investigators' patients' assessments symptomatic change doxazosin associated significantly higher level voluntary submaximal exercise favorable trend left ventricular ejection fraction \( increase 9 8 baseline value vs 2 7 placebo p ns \) 3 month steady dosing period , patients treated doxazosin significant \( p less 0 004 \) reduction ventricular arrhythmias significantly fewer morbid cardiac events \( including episodes worsening heart failure severe enough prompt discontinuation study , myocardial infarction , death \) doxazosin well tolerated , producing major side effects slightly higher frequency minor treatment related side effects compared placebo \( p ns \)
effect doxazosin platelet aggregation normotensive subjects patients hypertension vitro study vitro assay used investigate effects doxazosin platelet aggregation induced epinephrine , collagen , adenosine diphosphate platelet rich plasma normotensive subjects patients hypertension compared doxazosin produced concentration dependent inhibition platelet aggregation groups , significantly lower concentrations required inhibit platelet aggregation plasma taken patients hypertension concentrations doxazosin inhibited platelet aggregation vitro similar used clinically control blood pressure patients hypertension
evidence antiplatelet aggregation action doxazosin patients hypertension ex vivo study eighteen patients mean age 54 7 years included study patients diagnosis mild moderate essential hypertension \( sitting diastolic blood pressure 96 114 mm hg \) study design single blind two phases phase , placebo \( 4 weeks \) , phase ii , active treatment \( 8 weeks \) increasing doses , needed , doxazosin every 2 weeks \( 1 , 2 , 4 , 8 mg day \) results show doxazosin antihypertensive effect dose dependent systolic , diastolic , mean blood pressures decreased significantly , effect heart rate observed doxazosin significantly inhibited platelet aggregation induced epinephrine , adenosine diphosphate , collagen dose dependent manner addition , treatment doxazosin lowered total serum cholesterol triglyceride levels , without changing standard biochemical parameters indicates doxazosin could offer distinct therapeutic advantage modulation atherogenic thromboembolic factors associated coronary heart disease
role oxygen free radicals ischemic reperfused myocardium recent years considerable interest concerning role oxygen radicals myocardial ischemia reperfusion injury sequential reduction oxygen gives rise reactive intermediate products normally , tissue concentration intermediate products oxygen limited aerobic myocardium existence balance generation various maintenance antioxidant defense mechanism several possible sources identified production active oxygen species ischemia reperfusion sources may interactive ability scavengers oxygen free radicals , including vitamin e , improve mechanical , mitochondrial , sarcoplasmic reticulum function animal models ischemic reperfusion injury also suggests oxygen free radicals partly responsible myocardial damage models , although caution interpretation data necessary
inverse correlation plasma vitamin e mortality ischemic heart disease cross cultural epidemiology essential antioxidants determined plasma middle aged men representing 16 european study populations , differed sixfold age specific mortality ischemic heart disease \( ihd \) 12 populations common plasma cholesterol \( 5 7 6 2 mmol l \) blood pressure , classical risk factors lacked significant correlations ihd mortality , whereas absolute levels vitamin e \( alpha tocopherol \) showed strong inverse correlation \( r2 0 63 , p 0 002 \) evaluating populations , cholesterol diastolic blood pressure moderately associated , correlation inferior vitamin e stepwise regression multiple regression analysis , mortality predictable 62 lipid standardized vitamin e , 79 vitamin e cholesterol , 83 inclusion lipid standardized vitamin \( retinol \) , 87 parameters plus blood pressure thus , present study cross cultural differences mortality primarily attributable plasma status vitamin e , might protective functions
inheritance abdominal aortic aneurysm determine mode inheritance abdominal aortic aneurysm , data first degree relatives 91 probands collected results segregation analysis performed data reported many models , including nongenetic genetic models , compared using likelihood methods nongenetic model rejected statistically significant evidence favor genetic model found among many genetic models compared , genetic model susceptibility abdominal aortic aneurysm determined recessive gene autosomal major locus multifactorial component addition major locus increase likelihood data significantly
chronic therapy congestive heart failure benazepril hcl , new angiotensin converting enzyme inhibitor benazepril hcl orally effective angiotensin converting enzyme \( ace \) inhibitor previously shown significant acute hemodynamic benefits patients congestive heart failure study , 21 patients new york heart association class iii iv congestive heart failure treated 2 15 mg benazepril hcl single daily oral dose 28 days determine clinical hemodynamic value chronic therapy patient underwent clinical evaluation 28 day period , well invasive hemodynamic studies first two last two days trial plasma ace activity aldosterone levels fell significantly renin levels rose therapy benazepril hcl produced significant \( p less 0 01 \) reductions arterial pressure systemic vascular resistance , corresponding increases cardiac output decreases pulmonary artery wedge pressure responses 28 days therapy equivalent initial doses clinical effects included reduced rest , exertional paroxysmal nocturnal dyspnea , well reduced peripheral edema one patient developed symptomatic orthostatic hypotension thus , benazepril hcl , given daily , effective well tolerated oral agent chronic treatment advanced congestive heart failure
cardiorespiratory effects antagonism diazepam sedation flumazenil patients cardiac disease specific benzodiazepine antagonist flumazenil currently intense study despite much clinical experience , detailed invasive hemodynamic studies use cardiac patients published present study , hemodynamic respiratory variables measured 10 cardiac patients undergoing catheterization right left sides heart , sedation intravenous diazepam , reversal sedation flumazenil sleep dose diazepam \( 12 2 5 1 mg , mean sd \) caused slight decreases mean arterial pressure \( 103 12 98 14 mm hg p less 0 05 \) , pulmonary capillary wedge pressure \( 13 2 6 3 11 7 6 6 mm hg p less 0 05 \) , left ventricular end diastolic pressure \( 20 8 7 5 17 3 10 0 mm hg p less 0 05 \) , significant changes respiratory gas homeostasis intravenous flumazenil \( 0 22 0 07 mg \) resulted spontaneous awakening return full orientation , yet caused significant alteration either hemodynamic respiratory variables measured reversal diazepam induced sedation flumazenil cardiac patients appears safe effective
surgical repair wolff parkinson white syndrome complicated myocardial bridging myocardial bridging causes myocardial ischemia supraventricular tachycardia present case wolff parkinson white syndrome combined myocardial bridging patient complained angina pectoris paroxysmal supraventricular tachycardia severe constriction left anterior descending coronary artery systole myocardial revealed myocardial ischemia wall paroxysmal supraventricular tachycardia myotomy prevent myocardial bridging interruption accessory conduction pathway successfully accomplished one stage operation
alternative technique repair sinus venosus atrial septal defect technique described closure sinus venosus atrial septal defect using single patch held place sutures placed outside right atrium superior vena cava superior vena cava require enlargement potential damage artery node avoided
comparison supraannular subannular sutures mitral valve replacement ten fresh canine hearts used compare peak left ventricular pressure required disrupt prosthetic mitral valves sutured place horizontal sutures either subannular supraannular group consisted 5 animals 29 mm medtronic mitral valve mitral position ten sutures aorta cannulated normal saline solution infused left ventricle valvar disruption occurred peak pressure location mechanism disruption noted peak left ventricular pressure required valvar disruption , individual sutures broken instead , specimens subannular myocardial rupture occurred posterior portion mitral annulus along extent atrioventricular groove addition , posterior wall left atrium dissected upward subsequently significantly greater pressures required group subannular suture placement compared supraannular group \( 354 37 versus 236 33 mm hg p less 0 \) data suggest placement horizontal sutures subannular position superior currently recommended method supraannular suture placement mechanical valves
cholesterol screening result negative labeling effects \? results massachusetts model systems blood cholesterol screening project several previous studies looked effects labeling individuals hypertensive found increases psychosocial distress , diminished feelings well , studies found effects thus far , similar studies relating labeling high blood cholesterol levels published massachusetts model systems blood cholesterol screening project investigated whether labeling effects occurred result community based screening , education , referral programs conducted nine questions concerning perceptions physical psychological well asked questionnaire given screening participants questions asked part follow questionnaire given individuals identified high blood cholesterol levels one comparison baseline follow results demonstrate significant overall negative effects among age , sex , racial , income , educational groups contrary , responses many questions revealed small statistically significant improvements perceptions physical psychological well absence negative labeling effects may attributable positive , supportive approach participant counseling taken project
weight gain time menopause studied prospectively weight change effect weight change changes coronary heart disease risk factors population based sample middle aged women women studied first 1983 1984 , premenopausal aged 42 50 years , restudied 1987 women gained average 2 25 4 19 kg 3 year period 20 women gained 4 5 kg , 3 lost 4 5 kg significant differences weight gain women remained premenopausal natural menopause \( 2 07 kg vs 1 35 kg \) weight gain significantly associated increases blood pressure levels total cholesterol , low density lipoprotein cholesterol , triglycerides , fasting insulin weight gain thus common occurrence women time menopause related changes coronary heart disease risk factors observed period efforts lose weight prevent weight gain may help worsening coronary heart disease risk factors middle aged women
lipoprotein related coronary risk factors patients angiographically defined coronary artery disease relation number stenosed arteries determine whether index estimating antagonism low density lipoprotein \( ldl \) high density lipoprotein \( hdl \) would improve separation groups without coronary , patients undergoing coronary catheterization \( 35 women 99 men \) analysed total cholesterol \( tc \) , hdl cholesterol \( \) , apolipoprotein \( apo \) apolipoprotein b \( apo b \) subjects categorized groups 0 , 1 , 2 3 according number stenosed arteries \( greater 75 stenosis \) thirty patients showed significant coronary atherosclerosis \( group 0 \) serum apo b tc concentrations directly related number stenosed vessels , whereas concentrations apo negatively correlated number stenosed arteries \( ath index \) calculated product serum concentrations apo b , tc minus divided product apo , proved satisfactory individual lipoprotein components discrimination subjects without stenosis accordingly , identification coronary groups may improved using ath index
effects long term treatment metoprolol hydrochlorothiazide plasma lipids lipoproteins order evaluate effects one year antihypertensive treatment plasma lipids lipoproteins , 65 patients whose diastolic blood pressure range 95 120 mmhg randomly allocated groups received either hydrochlorothiazide metoprolol , drugs response one insufficient control blood pressure blood pressure effectively reduced groups patients hydrochlorothiazide showed significant increase \( p less 0 01 \) low density lipoprotein cholesterol \( ldl c \) 3 months treatment significant increase triglycerides observed 6 12 months , together decrease high density lipoprotein cholesterol \( hdl c \) 12 months \( p less 0 05 \) treatment patients metoprolol patients treated hydrochlorothiazide metoprolol , total cholesterol increased 3 \( p less 0 001 \) 6 months \( p less 0 05 \) , triglycerides increased 6 \( p less 0 01 \) 12 months \( p less 0 01 \) , ldl c increased 3 \( p less 0 05 \) , 6 \( p less 0 001 \) 12 months \( p less 0 01 \) treatment , respectively 61 patients , three lipid parameters affected study period conclude long term antihypertensive treatment hydrochlorothiazide , metoprolol , particularly drugs , induce lipid effects deserve recognition , cases might counteract possible benefit reduction blood pressure prevention coronary heart disease
wives coronary high risk men also higher risk \? heart study blood lipids , blood pressure , body mass index \( bmi \) , smoking , dietary exercise habits studied 911 wives men high risk coronary heart disease \( chd \) following 1979 80 survey , men , aged 30 54 years , identified high risk chd \( hdl cholesterol total cholesterol less equal 17 6 total cholesterol greater equal 7 86 mmol l 1 \) men , 911 individuals wives also screening wives compared age matched , married women general population significantly higher total cholesterol level \( 5 98 mmol l 1 vs 5 78 mmol l 1 \) , lower hdl cholesterol total cholesterol \( 30 01 vs 31 58 \) , higher bmi higher coronary risk score \( 4 55 vs 3 82 \) found among wives high risk men furthermore , higher proportion individuals daily cigarette smokers \( 47 3 vs 42 1 \) , received fewer years education also dietary habits associated increased risk chd married women general population findings support hypothesis members household person increased risk chd also increased risk probably due shared lifestyle
verapamil increases serum alkaline phosphatase hypertensive patients rats , verapamil decreases intestinal absorption calcium , increases serum parathyroid hormone \( pth \) , induces osteopenia prospective study , verapamil 80 120 mg three times daily given 2 months 20 patients hypertension , effects calcium homeostasis recorded dose verapamil significantly reduced supine systolic diastolic blood pressure \( sd \) 158 100 9 8 mmhg 146 89 14 8 mmhg \( p 0 001 \) serum alkaline phosphatase \( alp \) increased significantly 2 77 1 06 mu l 1 3 19 1 22 mu l 1 \( p 0 004 \) , isoenzymes alp skeletal origin appeared verapamil treatment excretion sodium urine increased \( na creatinine ratio 8 95 6 01 13 16 8 26 verapamil p 0 04 \) , excretion calcium , phosphate potassium changed pth slightly increased end verapamil treatment \( 1 09 0 54 vs 0 98 0 74 microgram l 1 p 0 07 \) , 1 , 25 \( oh \) 2d3 also somewhat increased \( 22 3 14 4 vs 17 6 4 9 ng l 1 p 0 26 \) serum ca affected verapamil \( verapamil 2 43 0 11 mmol l 1 , verapamil 2 40 0 12 mmol l 1 p 0 28 \) increase serum alp demonstrates verapamil affects bone cell metabolism man effect could secondary enhancement pth secretion
lower extremity arterial disease elderly subjects systolic hypertension ratio ankle arm systolic blood pressure \( ankle arm index aai \) appears non invasive indicator flow significant atherosclerosis may useful measure burden disease high risk population prevalence lower extremity arterial disease \( lead \) assessed method systolic hypertension elderly program \( shep \) subjects aged 60 older systolic blood pressure greater 160 mmhg upon entry study aai 0 90 less considered indicative flow significant lead prevalence lead method 26 7 \( 50 187 \) , prevalence intermittent claudication \( ic \) 6 4 \( 12 187 \) ic , 66 7 \( 8 12 \) confirmed lead prevalence lead measured aai increased age women associated history current smoking lower levels high density lipoproteins study population systolic hypertension , lead , measured aai , prevalent previously described elderly populations associated risk factors atherosclerosis
prospective comparison rubidium 82 pet thallium 201 spect myocardial perfusion imaging utilizing single dipyridamole stress diagnosis coronary artery disease purpose present study prospectively compare myocardial perfusion imaging rubidium 82 \( 82rb \) positron emission tomography \( pet \) thallium 201 \( 201tl \) imaging single photon emission tomography \( spect \) recording studies single dipyridamole handgrip stress , reading sets images display technique series 202 patients previous coronary arteriography , sensitivity , specificity , accuracy 82rb pet 93 , 78 , 90 201tl spect 76 , 80 , 77 , respectively 70 patients previous therapeutic interventions excluded , remaining 132 patients showed sensitivity , specificity , accuracy 95 , 82 92 82rb pet 79 , 76 , 78 201tl spect improved contrast resolution pet resulted markedly superior images identification defects
reducing unnecessary coronary care unit admissions comparison three decision aids objective determine whether published decision ischemic heart disease practical value reducing unnecessary admissions coronary care units design prospective cohort study setting community hospital emergency room patients 235 consecutive patients presenting emergency room chief complaint chest pain measurements clinical information , including observations needed use previously published decision aids , collected special forms time emergency room visit follow information obtained medical records patients admitted telephone interviews patients discharged authors compared residents' actual decisions predictions decision aids regarding ability predict complications \( , identify patients needed admission intensive care \) main results conclusions none decision aids could reduce unnecessary admissions without seriously increasing rate inappropriate discharges however , within clinically relevant subgroup patients decision admit discharge obvious clinical grounds \( without complications presentation residents discharge \) , decision aids examined , used combination verify need admission , might safely unnecessary admissions
arginine vasopressin gene expression chronic cardiac failure rats arginine vasopressin \( avp \) known increased patients experimental animals chronic cardiac failure \( ccf \) importance increase biosynthesis avp hypothalamus , however , investigated purpose present study ccf secondary infarction myocardial tissue induced ligation left anterior descending coronary artery sham operated animals served controls four weeks later hypothalamic avp mrna determined solution hybridization using sense anti sense strand rna blood pressure lower ccf sham animals \( 131 2 3 1 vs 112 8 4 0 mm hg , p less 0 05 \) total heart , right left ventricle weights significantly higher ccf rats plasma avp higher ccf \( sham 6 78 0 30 ccf 11 46 0 64 pg ml , p less 0 001 \) plasma atrial natriuretic peptide also higher ccf sham animals \( 205 36 vs 554 56 pg ml , p less 0 001 \) avp mrna hypothalamus significantly higher ccf sham animals \( 55 5 3 7 vs 95 9 4 0 pg micrograms total rna , p less 0 001 \) difference beta actin mrna hypothalamus sham ccf rats , indicating avp mrna increase specific ccf results therefore demonstrate increased avp biosynthesis hypothalamus , addition release hormone posterior pituitary , may occur ccf
studies myocardial protection immature heart v safety prolonged aortic clamping glutamate aspartate blood cardioplegia study tests hypothesis multidose , aspartate glutamate enriched blood cardioplegia provides safe effective protection prolonged aortic clamping immature hearts 17 puppies \( 6 8 weeks age , 3 5 kg \) placed vented cardiopulmonary bypass , five subjected 60 minutes 37 degrees c global ischemia without cardioplegic protection seven underwent 120 minutes aortic clamping 4 degrees c multidose aspartate glutamate enriched blood cardioplegia \( ca 0 2 mmol l \) , preceded followed 37 degrees c blood cardioplegic induction reperfusion five puppies underwent blood cardioplegic perfusion 10 minutes without intervening ischemia assess effect cardioplegic solution delivery techniques left ventricular performance assessed 30 minutes bypass discontinued \( function curves \) hearts studied high energy phosphates tissue amino acids one hour normothermic ischemia resulted profound functional depression , peak stroke work index 43 control \( 0 7 0 1 versus 1 7 0 2 gm x kg , p less 0 05 \) 70 depletion adenosine triphosphate \( 7 6 1 versus control 20 3 1 mumol gm dry weight , p less 0 05 \) 75 glutamate loss \( 6 6 1 versus control 26 4 3 mumol gm , p less 0 05 \) contrast , 2 hours aortic clamping multidose blood cardioplegia preceded followed 37 degrees c blood cardioplegia , complete recovery left ventricular function \( peak stroke work index 1 6 0 2 gm x kg \) maintenance adenosine , glutamate , aspartate levels control levels adenosine triphosphate 18 2 mumol gm , aspartate 21 1 versus control 2 mumol gm , glutamate 25 4 2 mumol gm \) hearts receiving blood cardioplegic perfusion without ischemia complete recovery control stroke work index conclude methods myocardial protection used adults , amino acid enriched , reduced calcium blood cardioplegia , applied safely neonatal heart allow complete functional metabolic recovery prolonged aortic clamping
two types abnormal genes plasminogen families predisposition thrombosis published erratum appears proc natl acad sci u 1991 apr 1 88 \( 7 \) gene coding plasminogen compared several abnormal genes japanese patients polymerase chain reaction dna sequence analysis two types abnormal genes coding plasminogen identified patients type mutation , guanosine gct coding ala near active site histidine replaced adenosine resulting act coding threonine mutation also shown loss cleavage site endonuclease , restriction enzyme recognizes type ii mutation , guanosine coding val 355 replaced thymidine resulting ttc coding phenylalanine change readily shown digestion ii endonuclease , restriction enzyme recognizes type mutation found identical plasminogen variant identified japanese patients amino acid sequence analysis also detected isoelectric focusing , whereas type ii mutation unique amino acid substitution connecting region third fourth plasminogen dna sequence analysis also revealed abnormal genes carry several silent nucleotide substitutions located primarily within 5' 3' flanking regions
histopathologic study spinal cord ischemia using rat upper half body transplantation model study histopathologic changes spinal cords exposed long duration complete ischemia , authors developed upper half body transplantation model inbred rat model , infant lewis rat transplanted inguinal region another adult lewis rat using microsurgical vascular anastomosis even 2 week old donor rats exposed complete ischemia 90 minutes , functions spinal cord comparatively preserved histopathologic observations , degeneration proportional complete ischemia duration noted 60 minute ischemia group 2 week old donor rats , however , substantial differences normal spinal cord observed conditions equal ischemia duration , appeared younger animal greater ischemic tolerance
severity single vessel coronary arterial stenosis duration angina determinants collateral vessels balloon angioplasty occlusion determine factors influence presence collateral vessels coronary occlusion , performed standardized contrast injection contralateral coronary artery 58 consecutive patients , without previous myocardial infarction , undergoing percutaneous transluminal coronary angioplasty 1 vessel disease \( left anterior descending artery 45 , right coronary artery 10 left circumflex artery 3 \) presence collateral vessels coronary occlusion , defined partial complete epicardial opacification collateral vessels vessel dilated , related clinical , angiographic electrocardiographic parameters angiographic appearance collateral vessels balloon inflation showed weak , although statistically significant , correlation percent diameter stenosis angioplasty \( r 0 28 p 0 03 \) duration angina \( r 0 37 p 0 004 \) combining lesion severity duration angina , collateral vessels coronary occlusion particularly related lesion severity greater equal 70 duration angina greater equal 3 months \( p less 0 001 \) furthermore , presence collateral vessels associated absence st segment shift \( greater equal 1 mm \) 1 minute coronary occlusion \( p less 0 001 \)
characteristics black patients admitted coronary care units metropolitan seattle results myocardial infarction triage intervention registry \( \) since 1988 , black 11 , white patients chest pain presumed cardiac origin admitted coronary care units 19 hospitals metropolitan seattle black men women younger \( 58 vs 66 , p less 0 0001 \) , often admitted central city hospitals \( p less 0 0001 \) , developed evidence acute myocardial infarction \( ami \) less often \( 19 vs 23 , p 0 01 \) subset 2 , ami patients , blacks \( n 121 \) younger \( 59 vs 67 , p less 0 0001 \) less prior coronary artery bypass graft surgery \( 2 vs 10 , p 0 005 \) prior hypertension \( 67 vs 46 , p less 0 0001 \) hospitalization , whites \( n 2 , \) higher rates coronary angioplasty \( 18 vs 10 , p 0 03 \) coronary artery bypass graft surgery \( 10 vs 4 , p 0 04 \) , although thrombolytic therapy cardiac catheterization used equally 2 groups hospital mortality 7 4 black 13 1 white patients \( p 0 07 \) however , adjustment key demographic clinical variables logistic regression , difference apparent \( p 0 38 \) questions premature onset coronary artery disease , excess systemic hypertension , differential use interventions black persons raised investigators despite differences age , referral patterns use coronary angioplasty bypass surgery , black white patients ami metropolitan seattle similar outcomes
late results 200 repeat coronary artery bypass operations determine clinical outcome long term results second coronary artery bypass operation , studied preoperative clinical status catheterization data 200 consecutive patients 9 year period \( 1979 1987 \) \( mean follow time 34 months , maximum 120 \) study group included 169 men 31 women \( mean age 58 4 years 7 greater 70 years \) sixty four percent patients severe angina \( new york heart association class iv \) , 70 3 vessel coronary artery disease 21 poor left ventricular function reoperation performed mean interval 58 months first procedure mean 3 3 distal anastomoses placed operative mortality rate \( 30 days \) 7 5 , additional cardiac morbidity \( myocardial infarction , heart failure \) 11 5 patients multivariate analysis showed increased risk women \( risk ratio 3 6 \) patients poor left ventricular function \( risk ratio 3 1 \) cumulative 5 year survival rate estimated 84 , rate 77 patients poor left ventricular function \( difference significant \) probability remaining free cardiac related event \( myocardial infarction , angioplasty , third operation , cardiac death \) 64 5 years end follow , 79 surviving patients new york heart association class ii nearly 50 patients fifth year reoperation good functional status concluded reoperation effective carries increased , immediate , operative risk
cardiovascular risk factor clustering ratio total cholesterol high density lipoprotein cholesterol angiographically documented coronary artery disease high levels cardiac risk factors tend cluster together act synergistically develop suitable practical marker clustering , evaluated 380 consecutive patients time coronary angiography analyses lipid , , clinical arteriographic profiles indicated variety relations ratio total cholesterol high density lipoprotein \( hdl \) cholesterol \( total hdl cholesterol \) closely related presence extent greater equal 50 diameter reduction greater equal 1 coronary arteries , used divide patients quartiles clustering high low level risk factors demonstrated highest lowest quartiles total hdl cholesterol , respectively \( p less 0 001 \) highest quartile may characterized moderately elevated total cholesterol level patients quartile may low hdl cholesterol level , high triglycerides , tendency toward high hemoglobin fibrinogen levels , history smoking , previous myocardial infarction multivessel disease results suggest total hdl cholesterol serves marker obstructive coronary disease also cluster potentially risk factors
ventricular tachycardia accelerated ventricular rhythm presenting first month life fourteen infants aged less 1 month presented institution last 22 years ventricular tachycardia \( vt \) accelerated ventricular rhythm structurally normal heart 2 , vt associated long qt syndrome alive beta blocker therapy , 1 implanted pacemaker twelve infants accelerated ventricular rhythm , 2 died first 2 months life unrelated conditions 10 alive median age 4 years \( range 2 months 11 years \) , none lost follow hemodynamic compromise occur accelerated ventricular rhythm ventricular rate close sinus rate 12 , less 12 sinus rate mean qrs duration accelerated ventricular rhythm 92 5 ms , averaged twice qrs duration sinus rhythm fusion beats seen 12 , atrioventricular dissociation capture beats 10 2 , ventriculoatrial conduction present treatment attempted 5 10 survivors accelerated ventricular rhythm , thought successful 4 treatment later successfully withdrawn 5 , 10 survivors free accelerated ventricular rhythm receiving antiarrhythmic medications last follow excellent long term outcome lack hemodynamic compromise rhythm , seems reasonable antiarrhythmic therapy infants accelerated ventricular rhythm resolution rhythm
characterization spontaneous termination sustained ventricular tachycardia associated coronary artery disease characterize change cycle length qrs morphology spontaneous termination sustained ventricular tachycardia \( vt \) , electrocardiograms recorded vt cycle length measured periods 31 21 11 1 beats termination 55 episodes 28 patients coronary artery disease beats 31 21 designated period stable arrhythmia served reference changes occurring termination forty four episodes vt occurred setting antiarrhythmic drug therapy 11 episodes occurred patients treated antiarrhythmic drugs variability cycle length indexed standard deviation mean cycle length percentage consecutive cycles varying greater equal 40 ms \( greater equal 40 ms \) greater variability termination \( standard deviation mean cycle length , 25 8 ms greater equal 40 ms , 16 7 \) stable period \( standard deviation mean cycle length , 8 5 ms greater equal 40 ms , 5 4 p less 0 001 \) true irrespective antiarrhythmic drug use , although differences standard deviation mean cycle length beats 11 1 beats 31 21 greater antiarrhythmic drug group \( 29 6 vs 8 9 ms , p less 0 001 \) group receiving antiarrhythmic drugs \( 11 0 vs 6 7 ms , difference significant \) specific patterns cycle length variability characteristic vt termination found
comparison lisinopril versus atenolol mild moderate essential hypertension antihypertensive effects safety profiles lisinopril \( 10 40 mg \) atenolol \( 50 100 mg \) compared randomized , double blind , parallel group trial 144 patients essential hypertension 8 weeks therapy , seated blood pressure \( bp \) decreased 26 15 mm hg lisinopril 19 14 mm hg atenolol lisinopril produced greater reduction \( p less 0 05 \) sitting systolic bp atenolol standing bp decreased 25 15 mm hg lisinopril 19 14 mm hg atenolol important changes hematologic biochemical profiles seen either drug eleven patients , 7 receiving lisinopril 4 receiving atenolol , withdrawn adverse experiences another 3 patients treatment , 1 lisinopril group 2 atenolol group drugs well tolerated therefore suitable first line therapy essential hypertension
hemodynamic effects renin inhibition enalkiren chronic congestive heart failure previous efforts block renin angiotensin system patients chronic congestive heart failure \( chf \) focused 2 distal sites system , angiotensin converting enzyme angiotensin ii receptor recent work , however , led development agents directly inhibit renin , proximal step cascade study , investigated hemodynamic effects renin inhibition 9 patients chronic chf using enalkiren , primate selective , renin inhibitor , previously shown suppress plasma renin activity lower blood pressure hypertensive patients acute intravenous administration enalkiren \( 1 0 mg kg \) produced increases cardiac index \( 2 0 0 3 2 3 0 1 liter min m2 \) stroke volume index \( 26 3 34 4 ml m2 \) decreases left ventricular filling pressure \( 31 3 25 3 mm hg \) , mean right atrial pressure \( 15 1 13 2 mm hg \) , heart rate \( 78 5 72 6 beats min \) systemic vascular resistance \( 2 , 199 1 , 339 230 dynes cm 5 \) \( p less 0 01 0 05 \) observations indicate renin inhibition produces hemodynamic benefits patients chronic chf could potentially provide novel approach interfering renin angiotensin system patients disorder
effects bucindolol neurohormonal activation congestive heart failure examine effects beta adrenergic blockade neurohormonal activation patients congestive heart failure , 15 men assessments hemodynamics supine peripheral renin norepinephrine levels 3 months oral therapy bucindolol , nonselective beta antagonist baseline , plasma renin activity correlate hemodynamic parameter however , norepinephrine levels weak correlation left ventricular end diastolic pressure \( r 0 74 , p less 0 01 \) , stroke volume index \( r 0 61 , p less 0 02 \) pulmonary vascular resistance \( r 0 54 , p less 0 05 \) plasma renin decreased bucindolol therapy , 11 6 13 4 4 3 4 1 ng ml hour \( mean standard deviation p less 0 05 \) , whereas plasma norepinephrine unchanged , 403 231 408 217 pg ml wide diversity norepinephrine response bucindolol observed reduction levels patients elevation others although plasma norepinephrine decrease , heart rate tended decrease \( 82 20 vs 73 11 min 1 , p 0 059 \) beta adrenergic blockade , suggesting neurohormonal antagonism receptor level changes 123 uptake occurred bucindolol therapy , suggesting unchanged adrenergic uptake norepinephrine beta blocker therapy despite reductions plasma renin activity presence beta blockade , response renin norepinephrine levels long term bucindolol therapy predict patients improved hemodynamic status \( chi square 0 37 renin , 0 82 norepinephrine \)
outcomes direct coronary angioplasty acute myocardial infarction candidates non candidates thrombolytic therapy coronary angioplasty without prior thrombolytic therapy performed 383 patients acute myocardial infarction \( ami \) patients divided 2 groups depending whether candidates non candidates thrombolytic therapy patients considered thrombolytic candidates \( 1 \) presented cardiogenic shock , \( 2 \) greater equal 75 years age , \( 3 \) coronary artery bypass surgery , \( 4 \) reperfusion time greater 6 hours thrombolytic candidates similar rates reperfusion \( 92 vs 88 \) , nonfatal reinfarction \( 6 0 vs 5 9 \) recurrent myocardial ischemia \( 1 8 vs 0 \) thrombolytic candidates lower mortality rate \( 3 9 vs 24 , p less 0 0001 \) lower incidence bleeding \( 4 6 vs 10 9 , p less 0 05 \) improvement left ventricular ejection fraction follow angiography 4 4 thrombolytic 10 5 candidates \( p less 0 002 \) ejection fraction improved patients anterior wall ami \( 7 7 thrombolytic candidates , 15 1 candidates \) patients reperfusion times greater 6 hours \( 14 2 \) outcomes suggest direct coronary angioplasty viable alternative method reperfusion patients ami candidates thrombolytic therapy candidates high risk group patients direct coronary angioplasty may beneficial certain subgroups , especially patients cardiogenic shock patients presenting greater 6 hours onset chest pain evidence ongoing ischemia
effect calcium entry blocker , nicardipine , intrarenal hemodynamics essential hypertension effects calcium entry blocker , nicardipine , intrarenal hemodynamics studied essential hypertension 4 week study performed eight patients essential hypertension given regular sodium diet first third weeks , sodium restricted diet second fourth weeks nicardipine , 60 mg , administered third fourth weeks urinary sodium excretion rate \( \) plotted axis mean arterial pressure \( map \) x axis administration nicardipine assuming difference map x intercept renal function curve represents effective filtration pressure across glomerular capillaries , intrarenal hemodynamics afferent arteriolar resistance \( ra \) efferent arteriolar resistances \( \) , glomerular pressure \( pg \) , gross filtration coefficient \( \) calculated although map regular salt diet lowered 125 3 109 2 mm hg nicardipine , neither renal blood flow rate \( rbf \) \( 40 ml min \) glomerular filtration rate \( gfr \) \( 79 2 ml min \) altered ra estimated reduced 9 , 300 900 7 , 400 700 dyne cm 5 \( p less 0 01 \) , changes noted \( 4 , 900 400 dyne cm 5 \) , pg \( 50 1 mm hg \) , \( 0 180 0 041 ml mm hg \) essential hypertension characterized prominent increase ra , resulting maintenance normal pg ca entry blocker worked normalize intrarenal hemodynamics essential hypertension dilating afferent arterioles alone
twelve year incidence coronary heart disease middle aged adults era hypertensive therapy framingham offspring study published erratum appears j med 1991 apr 90 \( 4 \) purpose provide information incidence coronary heart disease \( chd \) offspring original cohort framingham heart study patients methods 1972 1974 , offspring original participants framingham heart study underwent baseline examination standard cardiovascular risk factors entry study , offspring 30 59 years old free chd followed 12 years , time 156 1 , men 55 1 , women developed chd results multivariate proportional hazards model , chd significantly associated age , lower high density lipoprotein cholesterol \( hdl c \) levels , number cigarettes smoked fasting glucose levels low density lipoprotein cholesterol \( ldl c \) highly associated chd men , borderline women , triglycerides low density lipoprotein cholesterol significantly associated chd adjustment hdl c glucose blood pressure medication used half hypertensive individuals , systolic pressure associated chd women conclusions study confirms importance common chd risk factors cigarette smoking ldl c , extends prognostic role hdl c middle aged cohort impact blood pressure , without use hypertensive medications , reduced study , data suggest attenuation due successful treatment
furosemide 131i hippuran renography angiotensin converting enzyme inhibition diagnosis renovascular hypertension purpose previously demonstrated greater sensitivity 131i hippuran renography 99mtc dtpa scintigraphy diagnose renovascular hypertension \( rvh \) study assesses predictive diagnostic value furosemide 131i hippuran renography angiotensin converting enzyme \( ace \) inhibition patients without rvh patients methods patients investigated university memorial medical center twenty eight patients rvh 22 twenty eight patients normal minimally decreased renal function \( serum creatinine level 1 5 mg dl less \) 22 renal insufficiency \( serum creatinine level 1 8 mg dl \) renography performed 60 minutes oral administration 50 mg captopril 10 minutes intravenous injection 40 micrograms kg forty furosemide administered intravenously 2 minutes injection 131i hippuran residual cortical activity \( rca \) 131i hippuran measured 20 minutes results rvh unlikely rca ace inhibition less 30 peak cortical activity conversely , rvh present 131i hippuran cortical activity steadily increased throughout test reach 100 20 minutes patients rca 31 100 , rvh differentiated intrinsic renal disease obtaining baseline without ace inhibition comparing rca study rca ace inhibition rca increased \( indicating worsening renal function \) ace inhibition , rvh likely whereas , intrinsic renal disease likely rca remained unchanged decreased \( indicating improved renal function \) ace inhibition test specificity 95 sensitivity 96 population direct correlation results angioplasty surgery high blood pressure changes rca intervention \( n 20 \) conclusion furosemide 131i hippuran renography ace inhibition highly predictive identifying patients rvh
infusion stable prostacyclin analogue , iloprost , patients peripheral vascular disease lack antiplatelet effect risk thromboembolism purpose prostacyclin , potent inhibitor platelet function vasodilator , used treat peripheral vascular disease aim study monitor thrombotic status patients treated infusion stable prostacyclin analogue , iloprost patients methods thirteen patients peripheral vascular disease underwent iloprost infusion 3 days \( 8 hours day \) dose ranging 0 5 2 ng kg minute variable parameters thrombosis platelet reactivity \( shear induced hemostatic plug formation thrombus formation collagen fiber \) , coagulation , spontaneous thrombolysis \( dislodgment hemostatic \) measured non anticoagulated blood samples immediately 1 hour infusion last day , 4 hours initiation infusion results analysis data patients 1 hour infusion showed changes platelet reactivity spontaneous thrombolysis , coagulation significantly enhanced four patients , significant platelet hyperreactivity observed infusion four five patients tested undergoing iloprost infusion showed enhanced thrombotic reaction markedly enhanced coagulation iloprost employed vitro concentration corresponds therapeutic peak blood level caused inhibition platelet function significantly enhanced coagulation threshold vitro iloprost concentration anti platelet effect increased spontaneous thrombolysis observed twice therapeutic blood level conclusions findings challenge view antagonism platelet function important factor iloprost therapy furthermore , platelet hyperreactivity patients markedly enhanced coagulation infusion iloprost general , represent risk thromboembolism , especially patients already condition
protamine heparin induced pulmonary hypertension pigs effects treatment thromboxane receptor antagonist hemodynamics coagulation adverse hemodynamic reactions protamine neutralization heparin infrequent important clinical problem pre treatment swine thromboxane a2 receptor antagonist reported prevent pulmonary hypertensive response occasionally seen protamine reversal heparin anticoagulation current study , control group pigs \( n 9 \) received intravenous heparin \( 300 iu kg \) , followed 10 min neutralizing dose protamine \( 3 mg kg \) treatment group pigs \( n 11 \) treated , except thromboxane a2 receptor antagonist l \( 2 mg kg \) infused intravenously 2 min protamine infusion hemodynamic coagulation profiles monitored procedures pulmonary hypertension developed reached peak within 2 min protamine administration , often time l administered treatment group statistical difference control treatment peak pulmonary arterial pressure peak pulmonary vascular resistance however , interval return mean pulmonary artery pressure peak baseline values 11 6 3 1 versus 5 5 1 9 min \( mean sd \) control treatment groups , respectively \( p less 0 01 \) thromboxane b2 plasma concentrations increased groups correlated pulmonary hypertensive response \( r 0 86 , p less 0 01 \) platelet aggregation collagen inhibited thromboxane a2 receptor antagonist \( p less 0 05 \) bleeding time prolonged beyond normal range 50 l treated pigs coagulation tests groups returned baseline reversal heparin protamine unaffected l
coronary left ventricular hemodynamic responses following reversal induced sedation flumazenil patients coronary artery disease effects reversal induced sedation flumazenil coronary hemodynamics , myocardial oxygen consumption \( \) , left ventricular \( lv \) performance investigated , double blind trial , 12 patients stable coronary artery disease undergoing cardiac catheterization coronary sinus blood flow measured continuous thermodilution arterial coronary sinus blood analyzed oxygen lactate contents determinants lv performance obtained cardiac output measured thermodilution left heart catheterization data reverse induced sedation , patients randomly allocated receive placebo flumazenil \( increment , 1 mg \) end procedure placebo group , significant hemodynamic changes observed flumazenil group , heart rate , cardiac index , maximum velocity shortening , relaxation time constant significantly altered contrast , mean aortic pressure lv end diastolic pressure \( 90 5 7 3 4 1 mmhg , respectively \) increased \( 9 , p less 0 05 67 , p less 0 05 , respectively \) flumazenil administration , changes represented mainly return toward values coronary resistance significantly altered , whereas increased slightly \( baseline 119 20 ml min increase 10 , p less 0 05 \) electrocardiographic evidence myocardial ischemia observed study data show reversal benzodiazepine effects flumazenil associated major alteration lv systolic function , relaxation , coronary hemodynamics patients coronary artery disease nevertheless , cautiously used lv end diastolic pressure increased time administration
morphometry subepithelial circulation sheep airways effect vascular congestion order quantitate subepithelial microvascular volume relation airway lumen , conducted morphometric analysis vascular compartment wall trachea \( within 55 microns depth epithelial basement membrane \) 1 0 0 5 mm bronchioles sheep lungs fixed bronchial pulmonary artery perfusion glutaraldehyde three experimental conditions \( 1 \) bronchial artery pressure , 100 mm hg pulmonary artery pressure , 20 mm hg \( control \) \( 2 \) bronchial artery pressure , 100 mm hg , pulmonary artery pressure , 40 mm hg \( pulmonary hypertension , ph \) \( 3 \) bronchial artery pressure , 100 mm hg , pulmonary artery pressure , 40 mm hg \( pharmacologic vasodilation sodium nitroprusside , ph v \) venous pressures atmospheric control conditions , microvascular volume fraction comprised 12 , 16 , 15 subepithelial tissue trachea 1 mm 0 5 mm bronchioles , respectively ph increased microvascular volume fraction bronchioles \( p less 0 05 \) , effect microvasculature trachea ph v approximately doubled microvascular volume fraction trachea bronchioles ph increased mean wall thickness , ph ph v decreased airway cross sectional area 1 mm bronchioles observations demonstrate microvasculature constitutes considerable volume fraction subepithelial airway tissue vascular congestion narrow bronchiolar lumen
estimating left ventricular filling pressure positive end expiratory pressure humans critically ill , accurate measurements left ventricular \( lv \) filling pressure using pulmonary artery occlusion pressure \( ppao \) important diagnostic therapeutic purposes patients receiving positive end expiratory pressure \( peep \) , ppao may reflect lv filling pressure elevated pericardial pressure \( ppc \) proposed humans , ppc right atrial pressure \( pra \) equal , ppao pra may improve assessment lv filling pressure ppc elevated similarly , also shown dog nadir ppao immediately airway peep \( nadir ppao \) , accurately reflects lv filling pressure lv filling pressure greater equal 10 mm hg examined methods estimating lv filling pressure using ppao measurements conditions increases ppc primary determinants differences two measurements using left atrial pressure \( \) relative ppc , called transmural \( \) , lv filling pressure , compared accuracy ppao , nadir ppao , ppao relative pra reflect 15 postoperative cardiac surgery patients air filled pericardial balloon catheter left atrial catheter inserted surgery peep sequentially increased zero 15 cm h2o found pra always exceeded ppc \( p less 0 01 \) increased less peep ppc \( p less 0 05 \) less equal 5 cm h2o peep , ppao nadir ppao similar
fibrin fibrinogen related antigens patients venous disease venous ulceration abnormalities systemic fibrinolysis implicated pathogenesis venous ulceration patients venous disease prolonged lysis time elevated plasma fibrinogen levels , yet little known metabolism fibrinogen fibrin patients study , used technique involves electrophoresis densitometric analysis fibrin related antigens measure concentration proportions individual fibrin fibrinogen degradation products patients venous disease lower extremity group , patients venous disease markedly elevated levels total fibrin related antigen dimer , terminal degradation product cross linked fibrin levels monomer , breakdown product fibrinogen non cross linked fibrin monomer , measure normal patients patients ulcers , levels dimer disproportionately higher expected fibrin monomer levels individual basis , significant elevations dimer present six \( 55 \) 11 patients venous disease ulcers three \( 43 \) seven patients venous disease without ulcers conclude patients venous disease uniform evidence enhanced fibrin formation , evidenced elevated levels total fibrin related antigen dimer regardless whether venous disease accompanied ulceration
deterioration following delay performing femoral angioplasty uncommon delay occur assessment arteriography angioplasty attempt reviewed retrospectively arteriograms 61 patients delay occurred assess progression superficial femoral artery \( \) disease interval mean delay 14 6 days \( range 2 60 days \) occurred arteriogram angioplasty attempt arteriographic deterioration found six 61 patients \( 9 8 \) three angioplasty six patients four initial arteriography via side disease whilst two arteriography via contralateral femoral approach discuss aetiology phenomenon suggestions made reduce incidence
hemodynamic profiles prostaglandin e1 , isoproterenol , prostacyclin , nifedipine experimental porcine pulmonary hypertension background methods compared hemodynamic effects four vasodilators experimental embolic pulmonary hypertension randomized controlled trial , using nine pigs weighing 16 23 kg anesthesia induction cannulation arterial , central venous , thermodilution output pulmonary artery catheters , animals glass beads \( 60 160 mu \) order establish pulmonary hypertension \( pulmonary artery pressure pap doubled baseline \) prostaglandin e1 \( pge1 \) , isoproterenol , prostacyclin \( pgi2 \) , nifedipine compared doses producing equivalent reduction systemic bp results pge1 pgi2 decreased pap pulmonary vascular resistance \( pvr \) pge1 decreased pap 39 1 33 1 mm hg prostacyclin decreased pap 38 1 31 1 mm hg produced largest increase cardiac output \( qt \) isoproterenol change pap , markedly increased heart rate \( 162 8 216 11 beats min \) , resulted significant arrhythmias nifedipine increased pvr 113 100 dyne sec cm 5 decreased qt conclusions vasodilators demonstrate unique hemodynamic drug profiles isoproterenol infusion characterized tachycardia arrhythmias pge1 pgi2 effectively decrease pap pvr nifedipine depressed qt significantly glass bead embolization model acute pulmonary hypertension
effects milrinone pulmonary vasculature normal dogs dogs pulmonary hypertension objective study effects milrinone pulmonary vasculature background suggested derivatives may selective pulmonary vasodilation effect methods preliminary study milrinone administration 12 normal dogs \( low dose bolus 75 micrograms kg 5 min followed continuous infusion 0 75 micrograms kg min , n 6 high dose bolus 150 micrograms kg 5 min followed continuous infusion 1 5 micrograms kg min , n 6 \) main study milrinone administration 18 dogs pulmonary hypertension due pulmonary embolism induced massive injection autologous muscle pulmonary hypertension dogs divided three groups \) group e \( n 6 \) received embolization , control b \) group l \( n 6 \) received low dose milrinone c \) group h \( n 6 \) received high dose milrinone , equivalent preliminary study group hemodynamic measurements blood obtained baseline 15 , 30 , 60 min start milrinone infusion results milrinone change mean pulmonary artery pressure \( mpap \) normal dogs milrinone decreased mpap significantly dogs pulmonary hypertension pulmonary vascular resistance index remained almost constant level normal dogs , decreased significantly dogs pulmonary hypertension mean arterial pressure maintained constant level groups high dose milrinone administration decreased systemic vascular resistance index \( \) significantly low dose milrinone administration decreased slightly conclusions milrinone may selective pulmonary vasodilatory effect dogs pulmonary hypertension mechanism produced selectivity pulmonary vasculature dogs pulmonary hypertension unknown however , inhibition platelet aggregation may decrease mpap resulting increase camp caused milrinone studies needed resolve pulmonary vasodilatory effect milrinone dogs pulmonary hypertension
prospective study sodium lithium countertransport hypertension utah 7 year prospective study cohort 1 , normotensive adults utah pedigrees , screened 1980 1985 , done determine whether baseline levels sodium lithium countertransport associated increased risk future hypertension subsequent new hypertension \( n 39 \) ascertained 1989 detailed follow medical questionnaires \( 67 response \) previous segregation analyses subset pedigree members responded \( n \) using family relationships addition countertransport levels shown statistically inferred major gene segregation sodium lithium countertransport levels normotensive adults inferred segregation analysis carry recessive major gene high sodium lithium countertransport , new onset hypertension occurred 18 8 \( 3 16 \) compared 3 7 \( 12 326 \) low sodium lithium countertransport genotype group \( relative risk , 4 6 1 6 , 13 9 p 0 03 \) however , elevated baseline sodium lithium countertransport level without genotype information segregation analysis increase risk future hypertension complete cohort adult pedigree members \( relative risk , 1 02 0 85 , 1 22 \) adjustment risk factors reduced relative risk 0 90 \( 0 72 , 1 11 \) conclude presence major gene sodium lithium countertransport another closely linked gene , rather actual level sodium lithium countertransport , may increase risk hypertension onset high sodium lithium countertransport levels increase risk future hypertension individuals environmental effects determine sodium lithium countertransport level
high normal blood pressure progression hypertension framingham heart study study sought determine individuals high normal blood pressure \( diastolic blood pressure 85 89 mm hg \) progress hypertension frequently normal blood pressure \( diastolic blood pressure less 85 mm hg \) , thus advancing higher cardiovascular risk category individuals framingham heart study placed normal high normal blood pressure categories followed 26 years development hypertension hypertension defined diastolic blood pressure 95 mm hg greater initiation antihypertensive therapy , 23 6 men 36 2 women normal blood pressure developed hypertension compared 54 2 men 60 6 women high normal blood pressure relative risk development hypertension associated high normal blood pressure 2 25 men \( 95 confidence interval ci , 1 8 2 8 p less 0 0001 \) 1 89 women \( 95 ci , 1 5 2 3 p less 0 0001 \) age adjusted relative risks estimated proportional hazards model 3 36 men 3 37 women \( p less 0 001 \) among risk factors examined , baseline systolic diastolic blood pressure , metropolitan relative weight , change weight time significant predictors future hypertension men women whose initial blood pressure normal men high normal blood pressure , systolic blood pressure change weight identified risk factors future hypertension results indicate probability individuals blood pressure high normal range developing hypertension twofold threefold higher normal blood pressure
renal manifestations nacl sensitivity borderline hypertensive rats compared normotensive wistar kyoto rat , spontaneously hypertensive rat exhibits exaggerated alterations renal sympathetic nerve activity excretory function volume expansion \( exaggerated natriuresis \) environmental stress \( \) borderline hypertensive rat first offspring spontaneously hypertensive rat wistar kyoto rat develops hypertension increased dietary nacl intake present investigation sought determine whether dietary nacl intake induced transition normotensive state wistar kyoto parent hypertensive state spontaneously hypertensive parent borderline hypertensive rat accompanied similar transition renal sympathetic nerve activity excretory responses volume expansion environmental stress borderline hypertensive rats fed 1 nacl diet remained normotensive exhibited renal sympathetic nerve activity excretory responses volume expansion environmental stress similar wistar kyoto parent borderline hypertensive rats fed 8 nacl diet developed hypertension exhibited responses similar spontaneously hypertensive parent thus , dietary nacl intake induced transition normotensive state wistar kyoto parent hypertensive state spontaneously hypertensive parent borderline hypertensive rat accompanied similar transition renal sympathetic nerve activity excretory responses volume expansion environmental stress results suggest increased dietary nacl intake able induce capabilities responses , genetically borderline hypertensive rat spontaneously hypertensive rat parent latent forms
exclusion na \( \) h candidate gene human essential hypertension primary abnormalities contribute pathogenesis human essential hypertension unknown known genetic contribution disorder suggests possible use genetic linkage analysis test whether specific candidate genes contribute pathogenesis either essential hypertension intermediate phenotypes among phenotypes , elevated erythrocyte na \( \) li countertransport \( slc \) best known , supporting major gene inheritance pedigree analysis striking similarities slc na \( \) h exchange suggest mutations na \( \) h gene locus \( apnh \) might result elevated slc contribute subsequent pathogenesis hypertension tested hypotheses genetic linkage analysis , apnh candidate gene determining genotypes apnh flanking loci pedigrees support major gene segregation elevated slc , excluded linkage apnh major slc locus lod score 5 91 , odds ratio almost 1 , 000 , 000 1 linkage analysis 93 hypertensive sibling pairs , demonstrated apnh explains none variance slc hypertensive individuals \( r2 6 x 10 \( 7 \) , p greater 0 99 \) finally , directly tested linkage apnh genes predisposing toward hypertension linkage hypertensive sibling pairs mean allele apnh greater expected random hypertensive siblings \( 0 92 versus 1 0 , p greater 0 80 \) , upper 95 confidence limit value \( 1 04 \) indicates mutations apnh rarely ever contribute pathogenesis hypertension population
methodology sodium sensitivity assessment example age sex article addresses methodology sodium sensitivity assessment reports suggest high sodium intake cause elevated blood pressure trials indicate reduction sodium intake may reduce blood pressure already high implications findings discussed many studies sodium sensitivity suffer could called normal probability without appropriate control conditions , intervention sodium restriction may incorrectly assigned pronounced response subgroup study population example , findings reviewed age sex determinants response blood pressure variations sodium intake limited data available suggest subjects older higher blood pressure levels seem benefit reduction sodium intake addition , elderly subjects high dietary sodium intake may higher risk developing hypertension findings experimental studies tend support view findings sex differences less consistent systematic approach assessment factors mechanisms responsible sodium sensitivity subjects needed determine might benefit data available , little basis discriminate sodium sensitive sodium resistant hypertensive subjects
racial ethnic modifiers salt blood pressure response relation sodium blood pressure centuries old question substantial body epidemiological experimental data accumulated strongly implicates nacl causal role genesis arterial hypertension prospective studies performed diverse populations nacl exposure diet infusion repeatedly documented nacl pressor effect , similar studies populations also demonstrated greater prevalence salt sensitivity blacks compared whites reasons observation entirely clear however , intrinsic hypertension induced renal abnormalities limit natriuretic capacity , reduced na , k \( \) atpase pump activity , membrane ion transport disturbances , differential exposure psychological stressors , greater insulin resistance , dietary factors \( reduced ca k intake \) suggested possibly playing role salt sensitivity appears widespread phenomenon however , critically important determine factors account racial differences salt sensitivity moreover , prevalence salt sensitivity general population unknown current definitions salt sensitivity varied unidirectional comparison bidirectional criteria \( blood pressure increase salt loading blood pressure decrease salt restriction \) , probably inadequate identify salt sensitive individuals manifest less extreme blood pressure change dietary sodium plasma volume manipulations sensitive criteria diagnosing salt sensitivity facilitate better understanding racial ethnic differences prevalence salt sensitivity
blood pressure differences blacks today hypothesis genetic factors known play important role variations blood pressure levels however , genetic factors explain higher average blood pressure levels western hemisphere blacks compared african blacks seriously considered genetic population largely determined biological ecological forces past , examination blacks , specifically era , conducted overview salient findings investigation included article published historical evidence trade new world \( century century \) reveals conditions existed natural selection , therefore , genetic changes virtually populations period history , mortality extremely high , fertility \( reproductive success \) low among survivors societies western hemisphere depended constant \( 12 million \) africa viability communities major causes death salt diseases diarrhea , , vomiting , argued individuals enhanced genetic based ability conserve salt distinct survival advantage others , therefore , likely genotype subsequent generations western hemisphere blacks thus , predicted blacks greater frequency individuals enhanced genetic based ability conserve salt african blacks
sodium potassium interaction hypertension hypertensive cardiovascular disease epidemiological evidence suggests low potassium intake associated probability occurrence hypertension stroke short term response increased potassium intake increased sodium excretion well increased potassium excretion short term response increased sodium intake increased potassium excretion well increased sodium excretion experimental studies , increased amounts potassium able block influences sodium sodium potassium must concomitantly considered investigation association either hypertension cardiovascular disease chloride ion also important sodium 's effects importance potassium 's effects extensively explored
consensus approach electrolytes blood pressure could right \? commentary sets forth hypothesis putative beneficial detrimental effects specific electrolytes blood pressure regulation fact reflect highly integrated responses interactions among cationic species paradigm , impact given intake electrolyte arterial pressure influenced concurrent consumption electrolytes thus , heterogeneous blood pressure response humans isolated manipulations nutrients sodium , calcium , potassium may determined , part , adequacy dietary intake mineral elements hypothesis validated continued research area , would new strategies available improve blood pressure control humans example , treatment nacl sensitivity humans might effectively approached correcting dietary deficiencies either potassium calcium restricting dietary nacl
dietary sodium reduction hypertension prevention treatment nutritional approaches treatment prevention hypertension great interest sodium reduction one primary methods recommended purposes general public reduction dietary sodium intake responded decrease table salt use , lowered sodium food products , use food labels help guide food trends use convenience foods increase difficulty individuals lower sodium intake clinical trials used sodium reduction alone combination lifestyle therapies demonstrated feasibility reducing dietary sodium intake 30 50 4 years , variety populations trials used lifestyle weight loss interventions also achieved significant reductions body weight alcohol consumption increases physical activity variety studies indicate long term sodium reduction feasible acceptable patients negative consequences interventions observed , cases improvement intake nutrients occurred interventions resulted hypertension control significant proportions trial populations studies demonstrate types interventions significantly contribute hypertension treatment prevention
perspective reducing salt intake epidemiological , clinical , experimental evidence links excessive salt consumption hypertension appears evidence beneficial conclude public policy help americans reduce salt intake even mild hypertension increases risk , overall problem appear amenable treatment , although treatment clinical hypertension always needed appears little likelihood identification risk successful , appear capacity time conduct successful preventive field trials difficult individual modify diet alone successful strategy modify food supply changing public demand public responds dietary advice acceptable identifiable products available salt commercially prepared foods consumption increase future , major responsibility lowering salt consumption fall food manufacturers beginning respond , appears opportunity reduce salt content foods markedly temporary objectives , however , modest , objectives attempt follow
overview randomized trials sodium reduction blood pressure test effects systolic diastolic blood pressure provide precise estimates magnitude , conducted overview randomized clinical trials aimed reduce intake sodium human subjects excluded pooled analyses trials designs , compared intake levels beyond usual range population , without published reports two reviewers information duplicate differences twenty three trials outcome data aggregate 1 , subjects included data pooled separately hypertensive normotensive subjects trials combined use sample size , blood pressure reductions \( net controls \) 4 9 1 3 2 6 0 8 mm hg \( systolic diastolic , respectively , 95 confidence limits \) hypertensive subjects 1 7 1 0 1 0 0 7 mm hg normotensive subjects combined blood pressure reductions 2 9 0 8 1 6 0 5 mm hg changes associated mean reduction urinary sodium excretion ranging 16 171 mmol 24 hr individual trials dose response relation across trials found , normotensive hypertensive subjects results indicate sodium reduction lowers mean blood pressure hypertensive normotensive individuals periods least several months findings highly consistent results observational epidemiological studies implications preventive strategies blood pressure control
neurovascular mechanisms sodium balance pathogenesis hypertension physiological studies clarified role brain salt balance hypertension neural mechanisms endocrine secretions play pivotal role adaptation mammals changes intake excretion sodium maneuvers alter concentration sodium plasma modify sensitivity baroreceptor reflexes alter vascular reactivity changes may mediated part release vasopressin research also suggests brain indirectly modulates ability vascular endothelium release vasoactive factors collectively , studies illustrate multiple effects sodium ion peripheral neural central endocrine mechanisms participate regulation arterial pressure
genetic traits related hypertension electrolyte metabolism genetic cultural traits related hypertension carried 98 utah pedigrees \( 2 , 500 person \) 58 two hypertensive persons \( 131 hypertensive persons \) although none traits established marker sodium sensitive hypertension , many related least indirectly electrolyte metabolism risk hypertension significant recessive effects high total \( 52 84 \) found urinary kallikrein , high fat pattern index , sodium , na li countertransport , ouabain binding sites familial correlations strongly attributable shared environment genetic effects found na , k atpase pump activity , magnesium , plasma digoxin like factor , plasma renin activity , plasma sodium concentration anthropometric variables tested showed highly significant genetic low insignificant shared family environmental effects several genetically determined cellular cation tests also correlated genetic traits including plasma lipids , anthropometric measurements , cellular cation tests among hypertensive individuals familial hypertension , plasma insulin levels correlated obesity lipid abnormalities several cellular cation flux tests associated hypertension
sympathetic neural contribution salt induced hypertension dahl rats dahl strain provides model examining mechanisms involved genetic sensitivity resistance salt induced hypertension dahl salt sensitive rats develop hypertension fed high salt diet dahl salt resistant rats remain normotensive based early experiments , thought hypertension dahl salt sensitive rats overriding importance renal humoral mechanisms salt induced hypertension , studies past 15 years demonstrated alterations sympathetic neural mechanisms also participate critically genetic predisposition salt induced hypertension dahl salt sensitive rats article briefly reviews sympathetic neural mechanisms dahl rats , including evidence role afferent baroreceptor well central neural peripheral adrenergic mechanisms salt induced hypertension dahl salt sensitive rats
relation sodium intake , renal function , regulation arterial pressure long term regulation arterial pressure requires maintenance balance sodium water intake sodium water excretion normal salt water balance leads stable body fluid volumes maintenance normal renal function critical establishing extracellular fluid volume homeostasis review focuses role kidney long term control salt water balance particular emphasis relations sodium intake , renin angiotensin aldosterone system , renal sympathetic nerve activity , regulation arterial pressure via renal sodium water excretion accumulation evidence recent years demonstrates low level elevation renin release , circulating angiotensin ii aldosterone , activation renal sympathetic outflow may alter renal function normal natriuretic diuretic responses arterial pressure significantly circumstances , maintenance normal sodium water excretion requires significant elevation arterial pressure thus , compromised renal function leads elevation arterial pressure maintain adequate sodium water balance periods increased sodium intake resultant chronic elevation arterial pressure becomes compromise used kidneys maintain normal extracellular body fluid volumes
dietary salt blood pressure perspective although dietary salt restriction often valuable sole adjunctive therapy hypertensive disorders , abundantly clear hypertensive patients comprise heterogeneous group regard salt sensitivity blood pressure apparent despite many methodological defining salt sensitivity individual patient currently , dietary trial means defining given patient responsive salt restriction easily definable markers salt sensitivity would allow appropriate targeting rather therapy promising leads include assessment membrane ion transporters sodium lithium exchange activity renin angiotensin system , including phenomenon non modulating hypertension volume regulatory hormones atrial natriuretic factor although less intensively studied hypertensive patients , blood pressure response normal subjects salt restriction also marked great variability given possibility deleterious consequences population wide salt restriction least people setting united states , seems recommend policy proven demonstrated clinical trial evidence development markers , salt restriction reserved demonstrated efficacy
avoiding pitfalls assessing arrhythmia suppression myocardial infarction insights long term observations placebo treated patients cardiac arrhythmia pilot study \( \) cardiac arrhythmia pilot study \( \) 1 year trial analyzed safety effectiveness arrhythmia suppression patients surviving acute myocardial infarction greater equal 10 ventricular premature h greater equal 5 runs ventricular tachycardia holter recording obtained 6 60 days acute infarction 100 patients received placebo double blind fashion 1 year , comprehensive objective analysis performed spontaneous arrhythmia changes based real data rather statistical estimates placebo group , 19 developed serious clinical event 1 year \( death , heart failure , \) could likely attributable antiarrhythmic drug toxicity significant reduction frequency ventricular premature \( p 0 004 \) occurred first weeks therapy significant \( p less 0 04 \) decrease 3 12 months initiation placebo antiarrhythmic therapy , 27 apparent ventricular premature depolarization suppression \( greater equal 70 reduction \) one holter recording evaluation nearly half \( 48 \) six holter recordings assess suppression performed
evaluation preload reserve isometric exercise testing patients old myocardial infarction doppler echocardiographic study estimate preload reserve response increase afterload patients old myocardial infarction , relation doppler echocardiographic inflow velocity pattern left ventricular end diastolic pressure investigated isometric handgrip exercise testing study population consisted 16 normal subjects 40 patients old myocardial infarction 40 patients subdivided two groups according left ventricular end diastolic pressure rest group \( 22 patients \) , less 18 mm hg group ii \( 18 patients \) , 18 mm hg rest , ratio peak velocity atrial contraction phase peak velocity early diastolic filling phase \( e \) significantly higher patients old myocardial infarction normal subjects values two subgroups myocardial infarction differ significantly e ratio left ventricular end diastolic pressure increased significantly exercise group conversely , change left ventricular end diastolic pressure exercise group ii significantly greater group , associated decrease e ratio thus , atrial compensatory mechanism operated effectively response increase afterload patients normal left ventricular filling pressure , whereas compensatory mechanism deteriorated patients elevated left ventricular filling pressure due limited preload reserve
noninvasive assessment intrinsic ventricular load dynamics dilated cardiomyopathy basis hemodynamic theory , new noninvasive method developed provide improved insights significance depressed doppler left ventricular ejection variables patients dilated cardiomyopathy net force \( f \) associated intraventricular flow throughout ejection written f dt b v2 , v ejection velocity b variables related geometry ventricle outflow tract levels force calculated 9 normal subjects 10 patients dilated cardiomyopathy using doppler , mode two dimensional echocardiography maximal ejection force \( \) 47 5 8 5 normal subjects 25 5 6 2 dilated cardiomyopathy \( p 0 0001 \) peak local acceleration outflow velocity severely depressed cardiomyopathy compared normal subjects \( 1 , 260 129 versus 2 , 430 cm s2 71 14 versus 109 7 cm , respectively p 0 0001 \) maximal ejection force attained early ejection significant linear correlation found peak outflow acceleration maximal ejection force \( n 19 r 0 91 , p 0 0001 \) time peak ejection velocity , net force decreased 64 peak value cardiomyopathy , whereas normal subjects , decreased 84 peak value \( p 0 008 \) normal subjects , ejection force positive first 75 ejection , cardiomyopathy , positive first 54 \( p 0 0003 \) peak value attained , total left ventricular systolic wall stress declined rapidly ejection normal subjects \( 33 peak value end ejection \) , whereas remained elevated throughout ejection patients cardiomyopathy \( 60 peak value end ejection , p 0 0001 versus normal \) maximal ejection force corresponded calculated intraventricular peak pressure gradient 9 8 1 6 mm hg normal subjects 6 1 2 mm hg cardiomyopathy \( p 0 0001 \) average contribution intrinsic component left ventricular systolic load \( , wall stress associated ventricular aortic pressure gradient \) total myocardial load 9 1 \( range 7 3 11 2 \) normal subjects 6 2 \( range 3 9 7 5 \) cardiomyopathy \( p 0 0001 \) \( abstract truncated 400 words \)
immediate reproducibility electrically induced sustained monomorphic ventricular tachycardia antiarrhythmic therapy immediate reproducibility sustained ventricular tachycardia induction evaluated prospectively 106 studies performed 53 patients clinical sustained monomorphic ventricular tachycardia programmed electrical stimulation performed twice , using protocol 53 drug free studies 53 subsequent studies antiarrhythmic therapy sustained monomorphic ventricular tachycardia reproduced 104 \( 98 \) 106 studies significant difference incidence reproducible tachycardia drug free state compared observed treatment different classes antiarrhythmic drugs increase number extrastimuli required tachycardia 9 \( 11 \) 83 studies single double extrastimuli initially required induce tachycardia 39 \( 37 \) 104 studies reproducible tachycardia induction , two tachycardias significantly differed electrocardiographic \( ecg \) configuration cycle length observations suggest overall reproducibility ventricular tachycardia induction sufficiently high provide reliable marker evaluating efficacy therapeutic interventions however , specific tachycardia characteristics cycle length ecg configuration variable even within study may less useful assessing effects subsequent interventions
differences qrs configuration unipolar pacing adjacent sites implications spatial resolution pace mapping examine spatial resolution unipolar pace mapping , 12 lead electrocardiograms \( ecgs \) recorded pacing catheter \( 5 mm distance \) examined unipolar pacing performed late diastolic threshold , twice threshold 10 cycle length 500 ms 15 patients , pacing performed right ventricular apex 14 various left ventricular sites pacing distal catheter pole threshold \( index ecg \) used simulate site origin ventricular tachycardia , ecgs compared index ecg electrocardiograms evaluated two independent observers 1 \) minor configuration differences \( notch , new small component , change amplitude individual components change qrs shape \) 2 \) major differences configuration \( new large component , marked change amplitude existing component two minor changes \) 3 \) peak peak changes amplitude minor differences configuration seen mean 2 4 1 9 , 4 6 2 4 4 4 2 9 leads pacing 5 , 10 15 mm distal electrode \( index site \) major differences configuration seen mean 0 3 0 5 , 2 1 2 1 3 7 2 3 leads pacing 5 , 10 15 mm index site differences amplitude seen mean 3 1 2 2 , 5 6 2 5 6 8 3 0 leads per ecg pacing 5 , 10 15 mm index ecg pacing site , respectively
longitudinal dissociation atrioventricular accessory pathways unusual properties atrioventricular \( av \) accessory pathways found electrophysiologic investigations four patients \( three men one woman \) anterograde longitudinal dissociation accessory pathway observed two patients retrograde longitudinal dissociation two others two patients accessory pathway slow conduction time , one anterograde direction one retrograde direction observations expand knowledge spectrum electrophysiologic properties accessory av pathways
late noninvasive evaluation cardiac performance mildly symptomatic older patients ebstein 's anomaly tricuspid valve role radionuclide imaging ten patients 8 54 years age isolated ebstein 's anomaly tricuspid valve evaluated electrocardiography , maximal exercise treadmill testing , 24 h electrocardiographic \( ecg \) monitoring , echocardiography rest radionuclide imaging left ventricle patients presented 1st year life undergone surgical intervention except one functional class ii patient preexcitation surface ecg , abnormal tachyarrhythmias seen five patients 24 h ecg monitoring subnormal exercise performance observed five patients echocardiography demonstrated typical variable tricuspid valve displacement paradoxic interventricular septal motion left ventricular end diastolic dimensions normal patients , posterior wall motion reduced two moderate severe tricuspid regurgitation doppler jet velocity less 2 5 demonstrated eight patients left ventricular radionuclide scintigraphy revealed subnormal ejection fraction \( less 50 \) 5 10 patients 5 previously shown suboptimal exercise performance two youngest patients \( less 15 years \) arrhythmia , normal exercise performance normal left ventricular ejection fraction correlation degree tricuspid valve displacement regurgitation presence rhythm disturbance , exercise performance radionuclide left ventricular function late evaluation patients ebstein 's anomaly may demonstrate significant unsuspected abnormalities cardiac rhythm , exercise performance left ventricular function radionuclide scintigraphy useful noninvasive technique assessing left ventricular dysfunction patients
hospital mortality balloon aortic valvuloplasty frequency associated factors percutaneous balloon aortic valvuloplasty accompanied significant early morbidity mortality identification factors associated increased mortality might allow improved selection patients mansfield scientific balloon aortic valvuloplasty registry analyzed identify frequency hospital death factors associated 492 patients undergoing procedure , 37 \( 7 5 \) died hospital stay valvuloplasty performed twenty four patients died within first 24 h remainder died within 7 days procedure significant differences baseline clinical hemodynamic characteristics well procedural variables patients dying surviving hospital period multivariate analysis identified four factors associated increased mortality 1 \) occurrence procedure related complication , 2 \) lower initial left ventricular systolic pressure , 3 \) smaller final aortic valve area , 4 \) lower baseline cardiac output thus , baseline hemodynamic , procedural variables complications identified associated increased mortality
predictors long term survival percutaneous aortic valvuloplasty report mansfield scientific balloon aortic valvuloplasty registry percutaneous balloon aortic valvuloplasty used prospectively treat 492 elderly , symptomatic , nonsurgical patients suffering severe aortic stenosis 27 centers north america europe 1 year overall survival rate 64 event free survival rate \( survival free valve replacement repeat valvuloplasty \) 43 clinical , catheterization procedural variables assessed define prognostic variables univariate analysis revealed patients survived lesser frequency previous myocardial infarction \( 2 versus 6 , p less 0 005 \) , lower incidence severe ventricular dysfunction \( 22 versus 48 , p less 0 001 \) lower incidence symptoms heart failure \( 60 versus 75 , p less 0 02 \) history angina \( 56 versus 45 , p ns \) syncope \( 23 versus 16 , p ns \) similar groups values obtained cardiac catheterization differed survivors nonsurvivors included lower pulmonary artery systolic pressure \( 43 1 versus 54 2 mm hg , p less 0 001 \) , lower mean pulmonary artery pressure \( 28 1 0 versus 36 1 0 mm hg , p less 0 001 \) larger initial valve area \( 0 52 0 01 versus 0 47 0 02 cm2 , p 0 006 \) discriminate function analysis performed identify variables independently predicted improved probability survival eight variables significantly independently predictive included age , initial cardiac output , initial left ventricular systolic pressures , initial left ventricular end diastolic pressures , presence coronary artery disease , new york heart association dyspnea classification , number balloon inflations final valve area
ventricular load optimization unloading therapy patients heart failure effects unloading depressed heart assessed terms optimal coupling ventricle arterial system assess effects preload ventricular load coupling , preload reduced lower body negative pressure 20 mm hg nitroprusside used evaluate effects afterload coupling condition preload reduction comparable lower body negative pressure 13 patients heart failure \( ejection fraction 32 3 , mean se \) , direct arterial pressure simultaneously recorded left ventricular echocardiogram pressure elevated phenylephrine left ventricular contractile properties defined slope \( ees \) end systolic pressure volume relation effective arterial elastance \( \) expressed slope end systolic pressure stroke volume relation left ventricular external work , end systolic potential energy work efficiency , defined external work per pressure volume area \( external work potential energy \) , determined baseline ventricular load coupling patients characterized increase ratio arterial elastance ventricular elastance \( ees \) \( 1 96 0 31 \) ratio decreased significantly , 1 45 0 22 , nitroprusside , increased 2 37 0 34 lower body negative pressure therefore , end systolic potential energy decreased nitroprusside unaltered lower body negative pressure external work decreased manipulations , indicating work efficiency significantly augmented nitroprusside declined lower body negative pressure
cardiovascular hormonal effects calcitonin gene related peptide congestive heart failure effects human alpha calcitonin gene related peptide studied eight patients congestive heart failure , five normal rabbits five rabbits adriamycin induced cardiomyopathy patients heart failure , calcitonin gene related peptide caused dose dependent increase cardiac output decrease pulmonary systemic vascular resistance pulmonary artery pressure systemic blood pressure right atrial pulmonary wedge pressures decreased highest infusion rate \( 16 ng kg per min \) heart rate remained unchanged plasma epinephrine increased \( p less 0 05 \) , whereas aldosterone , atrial natriuretic peptide prolactin concentrations decreased \( p less 0 05 \) plasma norepinephrine , renin activity , cortisol growth hormone concentrations remained unchanged groups rabbits , drug decreased blood pressure increased cardiac output heart rate significant increase renal blood flow \( p less 0 05 \) peptide affect contraction amplitude human rabbit ventricular myocytes findings suggest calcitonin gene related peptide vasodilator rabbit humans little direct effect ventricular myocardium peptide may useful forms heart failure
experimental pericardial effusion relation abnormal respiratory variation mitral flow velocity hemodynamics diastolic right heart collapse pericardial effusion associated abnormal increase respiratory variation mitral flow velocity however , relation changes flow velocity pericardial pressure , hemodynamics two dimensional echocardiographic findings established therefore , 11 sedated dogs extensive hemodynamic instrumentation studied two dimensional doppler echocardiography four stages progressively larger pericardial effusion stages effusion , respiratory variation peak mitral flow velocity early diastole left ventricular isovolumetric relaxation time increased compared baseline \( p less 0 05 \) increase seen earliest stage effusion \( mean pericardial pressure 4 2 1 4 versus 0 8 0 9 mm hg baseline , p less 0 05 \) , preceded appearance unequivocal diastolic right heart collapse every dog maximal respiratory variation coincided appearance right atrial collapse \( mean pericardial pressure 7 1 2 4 mm hg mean inspiratory decrease aortic pressure 9 5 2 6 mm hg mean aortic pressure 88 2 15 2 versus 102 2 11 2 mm hg baseline , p less 0 05 cardiac output 3 8 1 2 versus 5 5 1 3 liters min baseline , p less 0 05 \) , increase stages associated severe hemodynamic compromise addition , respiratory changes peak mitral flow velocity early diastole associated simultaneous changes diastolic transmitral pressure gradient concluded model acute pericardial effusion 1 \) increased respiratory variation early diastolic mitral flow velocity , peak mitral flow velocity early diastole left ventricular isovolumetric relaxation time occurs almost immediately pericardial pressure increases persists stages increasing pericardial effusion 2 \) abnormal respiratory variation occurs intracardiac pressures onset unequivocal right heart collapse 3 \) respiratory variation occurs result changes diastolic transmitral pressure gradient 4 \) magnitude respiratory change necessarily predictive pericardial pressure severity hemodynamic compromise , especially severe stages pericardial effusion
spontaneous alterations coronary blood flow velocity coronary angioplasty patients severe angina cyclic coronary artery flow variations spontaneous decline coronary blood flow low levels documented stenosed canine coronary arteries endothelial injury flow variations associated transient platelet aggregation dislodgment release selected mediators , including thromboxane a2 serotonin however , cyclic spontaneous flow variations demonstrated stenosed coronary arteries humans study , hypothesis tested spontaneous coronary blood flow velocity variations occur patients stenosed coronary arteries coronary artery angioplasty thus , 13 patients severe limiting angina underwent intracoronary pulsed doppler velocimetry dilated artery immediately percutaneous transluminal coronary angioplasty , whereas 9 control patients underwent velocimetry angiographically normal coronary artery catheter 20 mhz doppler crystal positioned achieve maximal stable signal , flow velocity signal recorded continuously 20 min spontaneous flow velocity variations \( greater equal 38 change doppler frequency shift wide morphologic changes \) present 3 13 patients tested spontaneous flow velocity variations occurred angioplasty one patient , angioplasty another angioplasty third addition , 2 13 patients , 1 spontaneous coronary artery flow velocity variations angioplasty , frank vasospasm adjacent area distal area coronary dilation immediately balloon inflation data establish spontaneous coronary artery flow velocity variations occur patients severe limiting angina coronary angioplasty variations may related platelet aggregation coronary vasoconstriction , , sites endothelial injury resulting plaque fissuring ulceration endothelial medial injury occurring coronary angioplasty
elevated plasma beta endorphin levels patients congestive heart failure recent experimental studies show opioid system important pathophysiology cardiovascular impairment congestive heart failure plasma beta endorphin levels measured 37 patients congestive heart failure compared 21 age gender matched normal subjects relation plasma beta endorphin levels cardiac function rest exercise capacity assessed 17 patients dilated cardiomyopathy exercise capacity determined symptom limited maximal treadmill exercise expired gas analysis plasma beta endorphin levels elevated correlated patients' new york heart association functional cardiac status \( control 14 0 4 4 pg ml class ii 17 9 3 6 pg ml class iii 28 3 8 8 pg ml class iv 46 7 14 6 pg ml , mean sd \) relation found plasma beta endorphin levels left ventricular systolic performance assessed mode doppler echocardiography plasma beta endorphin levels negatively correlated cardiac output determined doppler echocardiography positively correlated systemic vascular resistance \( r 0 , r 0 , respectively , p less 0 001 \) , correlated calf blood flow measured plethysmography good correlation found plasma beta endorphin levels rest exercise capacity correlations peak oxygen consumption , anaerobic threshold , peak rate pressure product r 0 , 0 , 0 , respectively \( p less 0 01 \) data show plasma beta endorphin levels elevated patients congestive heart failure reflect , degree , severity disease
implications echocardiographically assisted diagnosis pericardial tamponade contemporary medical patients detection hemodynamic embarrassment identification suspected pericardial tamponade decision perform invasive drainage pericardial space historically based classic bedside findings two dimensional echocardiography improved detection pericardial effusion , may sensitive evaluation patients hemodynamic embarrassment therefore , 50 consecutive medical patients examined identified echocardiography probable tamponade \( defined presence right heart chamber collapse presence pericardial effusion \) underwent combined right sided cardiac catheterization percutaneous pericardiocentesis patients elevated pericardial pressure however , many minimal evidence hemodynamic compromise \( 94 systolic blood pressure greater equal 100 mm hg 58 cardiac index greater equal 2 3 liters min per m2 \) pericardiocentesis resulted hemodynamic improvement , frequently alleviate dyspnea correct tachycardia patients malignancy cause tamponade high mortality rate \( cumulative probability survival patients 17 1 year \) echocardiographically assisted diagnosis pericardial tamponade medical patients results identification substantial subset patients subtle evidence hemodynamic compromise subset patients differs sharply medical patients described previous reports classic tamponade although patients managed invasive catheter pericardiocentesis complications , natural history optimal management strategy group resolved
recognition embolic potential intraaortic atherosclerotic debris atherosclerotic disease thoracic aorta common elderly patients clinical coronary artery disease although embolization occur atherosclerotic debris within thoracic aorta , commonly considered differential diagnosis source systemic embolism current study , prevalence , clinical significance embolic potential intraaortic atherosclerotic debris detected transesophageal echocardiography determined intraaortic atherosclerotic debris identified 38 \( 7 \) patients undergoing transesophageal echocardiography embolic event occurred among 11 \( 31 \) 36 study patients intraaortic atherosclerotic debris incidence embolic event higher debris highly mobile \( 8 73 11 patients \) \( 3 12 25 patients \) \( p less 0 002 \) among 15 patients undergoing invasive procedure aorta , incidence embolism 27 conclusion , patient embolic event , thoracic aorta considered potential source transesophageal echocardiography reliably detect intraaortic atherosclerotic debris , identified , invasive aortic procedure avoided possible
coronary arterial remodeling studied high frequency epicardial echocardiography early compensatory mechanism patients obstructive coronary atherosclerosis coronary arterial remodeling compensatory mechanism may limit adverse effects coronary obstructive lesions expansion entire vascular segment determine compensatory anatomic change occurs patients , high frequency epicardial echocardiography using 12 mhz transducer performed open heart surgery 33 patients \( 10 normal coronary arteries undergoing valvular surgery 23 coronary atherosclerosis \) stop frame videotape high frequency epicardial echocardiographic images , cross sectional measurements luminal area total arterial area \( lumen , intima , media dense \) made patients atherosclerosis site arterial lesions proximal portion artery remodeling defined enlargement total arterial area normal arteries measurements made proximal locations patients normal coronary arteries , total arterial area , determined high frequency echocardiography , decreased proximal site artery \( 10 4 0 9 8 4 1 0 mm2 , p less 0 05 \) luminal area also decreased \( 6 0 0 6 4 5 0 7 mm2 , p less 0 05 \) patients coronary arterial lesions , luminal area also decreased proximal site arterial lesion site \( 5 3 0 6 2 3 0 3 mm2 , p less 0 05 \) , total arterial area increased \( 11 6 1 0 13 0 1 0 mm2 , p less 0 05 \) 25 coronary arteries evaluated , 4 angiographic evidence coronary collateral formation data indicate coronary arterial remodeling important compensatory mechanism obstructive coronary disease
detection coronary blood flow associated left main coronary artery stenosis transesophageal doppler color flow echocardiography demonstration disordered blood flow coronary artery may helpful presence stenosis examine possibility disordered coronary blood flow associated left main coronary stenosis , left main coronary flow visualized transesophageal doppler color flow echocardiography 52 patients undergoing coronary angiography twenty patients significant left main coronary stenosis \( group 1 \) 32 patients \( group 2 \) adequate two dimensional echocardiographic images left main coronary artery obtained 17 patients group 1 30 patients group 2 sixteen patients group 1 , including five patients stenosis could clearly defined two dimensional echocardiography , exhibited reddish elements producing mosaic pattern stenotic segments , contrast , jets , suggesting flow away transducer , seen echocardiograms 27 patients group 2 group included four patients stenosis like images two dimensional echocardiography mosaic pattern found three patients group 2 \( p less 0 01 \) thus , sensitivity detect stenosis improved doppler color flow imaging applied flow velocity significantly higher site stenosis patients group 1 \( 116 28 cm , n 10 , mean sd \) group 2 \( 29 12 cm , n 21 , p less 0 01 \) , suggesting augmentation flow velocity without due stenosis contributed appearance mosaic flow images
forearm blood flow response posture change old non invasive measurement venous occlusion plethysmography little known peripheral vascular response posture change elderly people vulnerable development orthostatic hypotension due , part , risks currently utilized invasive vascular monitoring techniques elderly population studied forearm vascular response active standing 18 healthy young , 10 healthy old , 19 impaired elderly subjects , using non invasive technique venous occlusion plethysmography six subjects technique compared duplex doppler ultrasonography measurement postural changes forearm blood flow forearm blood flow changes determined venous occlusion plethysmography 11 larger doppler measurements , two methods strongly correlated \( r 0 90 , p less 001 \) mean forearm vascular resistance increased significantly greater extent 1 minute standing young subjects groups old , although response quite variable groups two healthy elderly \( 20 \) eight impaired elderly \( 40 \) subjects unexpected forearm vasodilatation 1 minute standing 3 minutes , forearm vascular resistance increased similar amounts three groups subjects five impaired elderly healthy young healthy old subjects orthostatic hypotension , defined greater equal 10 mm hg decline mean arterial blood pressure 1 3 minutes standing forearm vascular resistance changes correlate blood pressure response standing thus , forearm vascular response 1 minute active standing attenuated many elderly subjects abnormality may impair adaptation orthostatic stress advanced age
ostium secundum atrial septal defect elderly atrial septal defect \( asd \) one common congenital cardiac anomalies adults life expectancy shortened , almost 90 patients die age 60 years progression congenital disease congestive heart failure related several factors onset pulmonary hypertension , arrhythmias , bronchopulmonary infections , development cardiovascular disease describe three cases old patients significant late development symptoms given higher risks poorer long term results surgical closure defect advanced age , indications intervention elderly patients carefully evaluated
arterial aneurysms children clinicopathologic classification thirty one arterial macroaneurysms 23 pediatric aged patients \( 16 boys 7 girls \) treated university michigan average age time diagnosis 10 2 years \( range 6 months 18 years \) vessels involved aorta \( 4 \) , well hepatic \( 1 \) , splenic \( 2 \) , gastroepiploic \( 1 \) , renal \( 12 \) , iliac \( 1 \) , superficial femoral \( 4 \) , popliteal \( 1 \) , brachial \( 1 \) , radial \( 2 \) , ulnar \( 2 \) arteries twelve children exhibited overt clinical manifestations including presence mass \( 7 \) , local pain \( 3 \) , \( 1 \) , obstructive jaundice \( 1 \) eleven children asymptomatic lesions aneurysm existence confirmed arteriography operation one child underwent surgical therapy , 20 long term survivors \( mean follow 3 5 years \) one operative death occurred one death occurred 6 years surgery experience review previously reported cases served basis childhood aneurysmal disease true aneurysms associated \( \) arterial infection , \( ii \) giant cell , \( iii \) autoimmune connective tissue disease , \( iv \) kawasaki 's disease , \( v \) ehlers danlos syndrome marfan 's syndrome , \( vi \) forms noninflammatory medial degeneration , \( vii \) arterial , \( viii \) congenital idiopathic factors , well \( ix \) false aneurysms associated extravascular events causing vessel wall injury disruption knowledge varied clinicopathologic characteristics arterial aneurysms children important treating patients
role duplex scanning selection patients transluminal angioplasty part initial evaluation determine whether patients lower extremity ischemia candidates intervention , arterial duplex examinations performed noninvasive vascular laboratory patients isolated short stenoses duplex examination referred transluminal angioplasty one hundred thirty four arteriograms performed ischemic peripheral vascular disease 122 patients july 1987 march 1990 one hundred ten \( 82 \) arteriograms preceded lower extremity arterial duplex evaluation fifty cases \( 45 \) scheduled transluminal angioplasty based findings duplex examination transluminal angioplasty performed 47 50 cases \( 94 \) significant differences age , sex , diabetes found patients referred transluminal angioplasty data demonstrate duplex scanning lower extremities allows detection lesions amenable transluminal angioplasty think duplex scanning become standard screening tool detection treatable lower extremity lesions
ultrasound screening first degree relatives patients abdominal aortic aneurysm pedigrees constructed 43 patients \( probands \) underwent resection abdominal aortic aneurysm seven probands \( 16 2 \) first degree relative \( parent , sibling , child \) known abdominal aortic aneurysm \( multiplex family \) determine prevalence undiagnosed abdominal aortic aneurysm , ultrasound screening first degree relatives age 40 years undertaken 202 eligible relatives , 103 \( 51 0 \) screened occult abdominal aortic aneurysm defined infrarenal aortic diameter greater 3 0 cm infrarenal aortic diameter ratio greater 1 5 abdominal aortic aneurysm defined clear focal infrarenal aorta , less 3 0 cm greatest diameter four 103 relatives \( 3 9 \) found occult abdominal aortic aneurysm \( age sex , , , \) , three \( 2 9 \) found abdominal aortic aneurysm \( age sex , , \) smaller abdominal aortic aneurysms patients younger operated probands \( average age men , 67 years women , 69 years \) six seven individuals families previously considered simplex , increasing actual multiplex family frequency 16 2 27 9 seven new abdominal aortic aneurysms found 49 siblings age 55 years older abdominal aortic aneurysms found 39 relatives age 55 years , 14 children ages 50 59 years one parent therefore siblings age 55 years older , 5 20 men \( 25 0 \) 2 29 women \( 6 9 \) found previously undiagnosed abdominal aortic aneurysm
influence elastic compression stockings deep venous hemodynamics determine effect elastic compression stockings deep venous hemodynamics measured ambulatory venous pressure , venous time , maximum venous pressure exercise , amplitude venous pressure excursion , duplex derived common femoral popliteal vein diameter peak flow velocities without stockings 10 healthy subjects 16 patients chronic deep venous insufficiency effects knee knee 30 40 torr 40 50 torr gradient stockings studied despite documentation substantial compressive effects skin pressure measurements , neither knee knee elastic compression stockings significantly improved ambulatory venous pressure , venous time , maximum venous pressure exercise , amplitude venous pressure excursion healthy patients patients deep venous insufficiency \( p greater 0 05 \) patients deep venous insufficiency stockings modestly increased popliteal vein diameter flow velocity upright resting position \( p less 0 02 \) exercise without stockings deep venous peak flow velocity increased healthy patients patients deep venous insufficiency mean 103 popliteal vein 46 common femoral vein \( p less 0 01 \) application elastic compression stockings modest augmentation deep venous flow velocity occurred groups seen leg exercise thus elastic compression stockings improve deep venous hemodynamic measurements patients deep venous insufficiency beneficial effects stockings treatment deep venous insufficiency must relate effects changes deep venous hemodynamics
association skin color blood pressure us blacks low socioeconomic status determine association skin color , measured , blood pressure us blacks , studied community sample 457 blacks three us cities persons taking antihypertensive medications excluded systolic diastolic blood pressure higher persons increased 2 mm hg every 1 sd increase skin darkness however , association dependent socioeconomic status , whether measured education index consisting education , occupation , ethnicity , present person lower levels either indicator using multiple linear regression , systolic diastolic blood pressure remained significantly associated skin color lower levels socioeconomic status , independent age , body mass index , concentrations blood glucose , serum urea nitrogen , serum uric acid , urinary sodium potassium association skin color blood pressure low socioeconomic may due lesser ability groups deal psychosocial stress associated skin color however , findings also consistent interaction environmental factor associated low socioeconomic status susceptible gene higher prevalence persons skin color
erythrocyte sedimentation rate congestive heart failure background methods physicians long believed erythrocyte sedimentation rate low patients congestive heart failure , concept based misinterpretation results single report published concept modern era , measured sedimentation rate 242 patients referred treatment chronic heart failure results sedimentation rate low \( less 5 mm per hour \) 24 patients \( 10 percent \) increased \( 25 mm per hour \) 50 percent patients low normal sedimentation rates \( less equal 25 mm per hour \) severe hemodynamic abnormalities patients elevated rates lower cardiac index \( mean sem , 1 7 0 1 vs 2 0 0 1 liters per minute per square meter body surface area \) higher mean right atrial pressure \( mean sem , 12 1 vs 9 1 mm hg \) \( p less 0 0001 \) new york heart association functional class iv symptoms present 66 percent patients low normal sedimentation rate , compared 42 percent elevated rates \( p less 0 0001 \) one three months therapy , patients whose sedimentation rates decreased showed little hemodynamic clinical response treatment , whereas cardiac performance functional status improved patients whose rates increased \( p less 0 02 comparison groups \) sedimentation rate correlated plasma fibrinogen level \( r 0 64 , p 0 0025 \) , changes sedimentation rate treatment correlated inversely changes mean right atrial pressure \( r 0 57 , p 0 0002 \) long term follow , patients low normal sedimentation rates worse one year survival patients elevated rates \( 41 vs 66 percent , p 0 01 \) conclusions data indicate erythrocyte sedimentation rate correlated severity illness patients chronic heart failure lack discriminatory power , however , test limited value clinical management disorder
circadian rhythms blood pressure school age children normotensive hypertensive parents purpose study describe characteristics blood pressure rhythms school age children compare circadian amplitudes children normotensive parents children hypertensive parents sample consisted 40 healthy children 8 10 years old 20 children parental history hypertension 20 blood pressure measured every 2 hours day every 90 minutes night one 24 hour cycle using monitor equipped automatic analyses revealed statistically significant circadian rhythms systolic diastolic blood pressures 12 40 subjects systolic diastolic pressures occurred 1200 1800 hours mean systolic 108 50 mean diastolic 61 41 mean amplitudes 8 85 systolic pressure 7 44 diastolic pressure statistically significant differences circadian amplitudes children normotensive parents children hypertensive parents found
cineangiography heart single breath hold segmented turboflash sequence six healthy volunteers three patients cardiac anomalies studied comparison segmented turboflash \( fast low angle shot \) cine , method magnetic resonance imaging permits entire series high resolution cine images obtained one breath hold , standard cine segmented turboflash uses gradient echo sequence designed short imaging times combination segmented data acquisition method pulses applied eliminate blood pool signal signal noise ratio assessed phantom standard image reconstruction methods used breath hold images consistently showed reduced respiration short echo time used , segmented turboflash relatively insensitive caused local field disturbances flow authors conclude , reducing imaging times eliminating respiratory artifact , segmented turboflash useful performing cine studies heart great vessels
gynecologic vascular abnormalities diagnosis doppler us authors describe use duplex color doppler ultrasonography pelvis three women demonstrate presence venous malformations one patient pulsatile vaginal mass shown arteriovenous malformation vaginal wall second patient shown unsuspected venous endometrial cavity third patient shown adnexal varices closely mimicked latter two cases , duplex color flow capabilities endovaginal probe especially important
noninvasive assessment cerebral collateral blood supply ophthalmic artery assessed potential 2 mhz pulsed wave transorbital doppler ultrasonography delineate role ophthalmic artery source collateral cerebral blood supply comparing , transorbital doppler ultrasonography , continuous wave doppler ultrasonography , transcranial doppler ultrasonography 25 patients unilateral internal carotid artery occlusion five controls 10 normal internal carotid arteries systolic ophthalmic artery blood velocity reduced ipsilateral internal carotid artery occlusion \( 38 2 10 2 cm sec \) compared contralateral control velocities \( 46 0 10 3 47 5 6 8 cm sec , respectively p less 0 05 \) ophthalmic systolic pressure measured 94 7 13 2 mm hg ipsilateral internal carotid artery occlusion compared 108 4 15 3 mm hg contralateral side \( p less 0 01 \) transorbital doppler ultrasonography detected reversed ophthalmic artery blood flow ipsilateral internal carotid artery occlusion 44 0 40 0 patients , respectively systolic middle cerebral artery blood velocity 55 2 22 3 cm sec ipsilateral internal carotid artery occlusion compared 79 4 23 5 cm sec contralateral side \( p less 0 05 \) 101 2 18 9 cm sec controls \( p less 0 05 \) reversed ophthalmic artery blood flow associated low middle cerebral artery blood velocity lack major intracerebral collaterals transorbital doppler ultrasonography permits noninvasive evaluation ophthalmic artery
interpreting results exercise studies acute myocardial infarction altered thrombolytic therapy , coronary angioplasty bypass numerous studies assessed ability exercise modalities predict patient outcome acute myocardial infarction \( ami \) use prior data assess prognosis patients currently undergoing exercise studies assumption patients selected exercise assessment similar time data generated past therefore applicable current patient populations study retrospectively assessed clinical , exercise , rest exercise radionuclide angiographic data consecutive patients referred exercise radionuclide angiography within 1 month ami 5 year period determine clinical exercise characteristics patients referred exercise evaluation infarction changed significantly time parameters examined demonstrated significant increasing trends , including thrombolytic therapy time ami , revascularization procedure ami exercise assessment , age , beta blocker usage , q wave ami , inferior infarction , exercise double product , exercise capacity , significant st segment depression exercise , peak ejection fraction , change ejection fraction exercise data indicate characteristics patients selected undergo exercise ami large referral center changed significantly time data applicable referral centers exercise testing modalities , previously published results regarding exercise assessment ami need patients currently selected testing , since results may longer applicable current era aggressive medical interventional management
effect nifedipine total ischemic activity circadian distribution myocardial ischemic episodes angina pectoris randomized , double blind , crossover study conducted 10 patients assess effect nifedipine versus placebo total ischemic activity circadian distribution ischemic episodes baseline exercise treadmill testing 48 hour ambulatory electrocardiographic st segment monitoring , patients received either nifedipine \( mean dose , 80 mg day \) placebo administered 4 times per day , initial dose taken immediately upon arising morning patients maintained stable dose study drug 7 days , underwent repeat exercise treadmill testing 48 hour ambulatory electrocardiography exercise treadmill testing , greater exercise duration achieved patients receiving nifedipine receiving placebo \( 121 vs 155 seconds , respectively p less 0 05 \) time greater equal 1 mm st depression significantly greater nifedipine \( 282 146 seconds \) baseline \( 130 72 seconds , p less 0 003 \) placebo \( 150 98 seconds , p less 0 0005 \) ambulatory electrocardiographic monitoring , nifedipine reduced total number ischemic episodes \( 18 vs 54 baseline 63 placebo p less 0 02 \) total duration ischemia \( 260 vs baseline 927 minutes placebo p less 0 02 \) surge ischemia 06 00 12 00 noted baseline placebo therapy nearly abolished nifedipine treatment nifedipine dosage , administered manner , effective reducing total ischemic activity may prevent morning ischemic episodes
ablation atrioventricular junction radiofrequency energy using new electrode catheter percutaneous catheter ablation using radiofrequency energy used atrioventricular \( av \) conduction patients supraventricular tachycardia refractory drugs results radiofrequency ablation av junction using custom designed catheter large , 3 mm long distal electrode , 2 mm , shaft increased rigidity compared using standard electrode catheter \( ep \) \( \) supplied radiofrequency current 550 khz , applied distal electrode ablation catheter large skin electrode use modified catheter , 12 13 patients \( 92 \) persistent complete av block induced 7 5 applications 18 6 w radiofrequency power contrast , complete av block produced 9 18 \( 50 \) historical control patients treated standard catheter , despite similar number applications \( 7 5 \) power output \( 16 4 w \) rise impedance , due tissue formation , occurred earlier \( 28 18 vs 52 24 seconds , p less 0 001 \) frequently \( 54 vs 40 applications , p 0 \) patients treated standard catheter patients treated modified catheter use catheter designed increase surface area electrode tissue contact allows radiofrequency energy delivered rise impedance occurs appears increase effectiveness radiofrequency ablation av junction
relative importance activation sequence compared atrioventricular synchrony left ventricular function study evaluated relative hemodynamic importance normal left ventricular \( lv \) activation sequence compared atrioventricular \( av \) synchrony respect systolic diastolic function twelve patients intact av conduction av sequential pacemakers underwent radionuclide studies rest doppler echocardiographic studies rest submaximal exercise , comparing atrial demand pacing \( aai \) sequential av sensing pacing \( \) ventricular demand pacing \( vvi \) studies rest performed constant heart rate pacing modes , exercise study performed constant heart rate work load cardiac output higher aai vvi \( 6 2 1 vs 5 6 1 5 3 1 liters min , p less 0 05 \) lv ejection fraction likewise higher aai \( 55 12 vs 49 11 vs 51 13 , p less 0 05 \) vvi without av synchrony associated paradoxical septal motion pattern , resulting 25 impairment regional septal ejection fraction addition , lv contraction duration aai peak filling rate aai vvi higher \( 2 86 1 2 95 1 vs 2 25 1 end diastolic volume p less 0 05 \) vvi , time peak filling significantly shorter aai \( 165 34 vs 239 99 224 99 ms p less 0 05 \)
effects doxazosin blood pressure , renin angiotensin aldosterone urinary kallikrein doxazosin , new derivative postsynaptic alpha 1 adrenoceptor antagonist , studied randomized , double blind , placebo controlled 12 week study effects blood pressure \( bp \) , heart rate , metabolic functions renal hormones analyzed administration single oral morning dose 3 phase fashion administered 17 patients \( 11 women , 6 men , 21 59 years \) mild moderate uncomplicated essential hypertension antihypertensive effective dose 1 8 mg day mean end titration point dose 4 14 0 1 mg \( mean standard error mean \) week 8 treatment , adjusted maintain diastolic bp levels less equal 90 mm hg 12 weeks treatment , final mean dose 4 35 0 2 mg day , bp decreased patients mean 31 3 17 2 \( supine \) 39 3 15 3 \( standing \) mm hg \( p less 0 005 \) increase heart rate first dose phenomenon neither renin aldosterone system electrolyte excretion significantly affected renal function metabolic parameters also remained unchanged urinary kallikrein excretion augmented 2 47 fold \( p less 0 002 \) good tolerance 1 patient discontinued study dry nose results suggest long term monotherapy doxazosin effective safe antihypertensive agent mild moderate essential hypertension stimulates urinary kallikrein excretion
effect mitral regurgitation volume loading pressure half time balloon valvotomy mitral stenosis doppler pressure half time \( pht \) frequently used assess mitral valve area \( mva \) , reliability pht recently challenged , specifically setting balloon mitral valvotomy hemodynamics altered effect volume loading balloon mitral valvotomy mva gorlin pht 18 patients high fidelity micromanometer measurements left atrial left ventricular pressure therefore examined echocardiographic mva increased 0 91 0 15 1 97 0 42 cm2 valvotomy volume loading produced significant increases left atrial pressure \( 16 23 12 20 mm hg valvotomy \) , cardiac output \( 3 7 4 1 3 9 4 6 liters min valvotomy \) , mitral valve gradient \( 11 14 5 7 mm hg valvotomy \) hemodynamic changes associated modest significant decreases pht increases mva estimated 220 pht \( 0 66 0 81 1 64 1 96 cm2 valvotomy \) , whereas mva gorlin affected consistent fashion volume loading \( 0 85 0 89 1 66 1 69 cm2 valvotomy \) correlation gorlin mva 220 pht fair \( r 0 73 , p less 0 001 \) significantly poorer among patients greater 1 mitral regurgitation \( r 0 72 \) among less regurgitation \( r 0 79 \) \( p 0 001 analysis covariance mitral regurgitation effect \)
rarity preclinical alcoholic cardiomyopathy chronic alcoholics less 40 years age preclinical alcoholic cardiomyopathy , myocardial damage absence overt congestive heart failure chronic alcoholics , well characterized necropsy , attempts identify clinical entity death produced conflicting results studying subjects rest , inclusion older alcoholics limitations noninvasive techniques may explain disagreement determine preclinical alcoholic cardiomyopathy could identified independent aforementioned limitations , 25 asymptomatic chronic alcoholics aged less 40 years \( mean 34 \) , consumed minimum 1 one 6 pack beer greater equal 5 days per week greater equal 5 years , underwent radionuclide ventriculography measurements systolic diastolic function rest , peak supine exercise recovery , echocardiography assessment chamber size , wall thickness left ventricular mass red blood cell levels selenium thiamine measured determine whether abnormalities present 2 potential mediators alcoholic cardiomyopathy comparison , age matched group healthy control subjects also studied alcoholics control subjects rest , mean ejection fraction \( 67 7 vs 71 6 \) diastolic peak filling rate \( 3 4 0 6 vs 3 3 0 6 end diastolic volumes per second edv \) similar
prognostic value thallium 201 perfusion defects idiopathic dilated cardiomyopathy assess prognostic significance thallium 201 perfusion defects patients idiopathic dilated cardiomyopathy \( \) , 43 patients underwent thallium scintigraphy addition clinical , echocardiographic , angiographic hemodynamic evaluation eleven patients significant thallium perfusion abnormality , 19 multiple small defects 13 large defect 3 2 2 2 years , 14 patients disease related mortality patients died higher incidence ventricular tachycardia \( 71 vs 31 p less 0 02 \) , increased cardiothoracic ratio \( 60 6 vs 54 6 p 0 005 \) , decreased fractional shortening \( 11 6 vs 15 5 p less 0 05 \) , increased pulmonary wedge pressure \( 15 7 vs 10 6 mm hg p 0 05 \) , increased left ventricular end diastolic pressure \( 21 8 vs 14 6 mm hg p 0 02 \) abnormal thallium perfusion defects \( 13 14 vs 16 26 p less 0 05 \) compared survivors age , gender , left ventricular end systolic end diastolic dimensions , cardiac index ejection fraction statistically different survivors versus patients died kaplan meier survival estimates 1 , 3 5 years 100 patients without significant perfusion abnormality 89 , 77 64 , respectively , patients multiple small defects 84 , 76 30 , respectively , patients large defect \( p less 0 025 log rank test \)
unusual venous anomaly placenta authors present unusual vascular anomaly placenta placenta large , weighing 1 , g fetal surface , numerous dilated tortuous vessels observed chorionic membrane , three branches arose vein connected umbilical vein one 5 x 2 5 cm aneurysmal dilatation , three secondary branches arose venous channels dilated tortuous longest secondary branch 133 cm length 1 2 cm mean diameter led placenta multiple , severely straight small branches arising vessels also observed vascular smaller vessels also led placenta abnormal vessels veins umbilical cord also normal except membranous insertion , placenta unremarkable except large size
systemic non lytic state local thrombolytic failure anistreplase \( plasminogen streptokinase activator complex , \) acute myocardial infarction relation coronary thrombolysis coagulation variables administration anistreplase \( plasminogen streptokinase activator complex , \) studied patients acute myocardial infarction fifty eight consecutive patients acute myocardial infarction given 30 u anistreplase intravenously within 4 hours onset symptoms fall plasma concentration fibrinogen less 1 0 g l 90 minutes administration anistreplase considered reflect systemic lytic state coronary angiography performed 48 hours thrombolytic treatment overall patency rate 74 \( 43 58 \) patency rates significantly different patients systemic lytic \( 83 \( 43 52 \) \) systemic non lytic state \( 0 \( 0 6 \) \) absence systemic lytic state anistreplase administration seemed highly predictive failure coronary thrombolysis coagulation studies showed evidence inhibition anistreplase induced fibrinolytic activity may explain failure thrombolytic treatment patients evidence systemic non lytic state
dipyridamole magnetic resonance imaging comparison thallium 201 emission tomography limitation space motion artefact make magnetic resonance imaging dynamic exercise difficult pharmacological stress dipyridamole used alternative exercise thallium scanning forty patients history angina abnormal exercise electrocardiogram studied dipyridamole thallium myocardial perfusion tomography dipyridamole magnetic resonance wall motion imaging cine gradient sequence images scans obtained oblique horizontal vertical long axis short axis planes pharmacological stress dipyridamole myocardium divided nine segments direct comparison perfusion wall motion segments assessed visually grades normal , reduced perfusion , reduced perfusion dipyridamole reversible wall motion abnormalities 24 \( 62 \) 39 patients coronary artery disease 24 \( 67 \) 36 patients reversible thallium defects site wall motion deterioration always site reversible thallium defect thallium defects affecting two segments always associated wall motion deterioration single segment thallium defects undetected magnetic resonance imaging significant correlation detection wall motion abnormality , angiographic severity coronary artery disease , induction chest pain dipyridamole significant differences ventricular volume ejection fraction changes dipyridamole groups without detectable reversible wall motion changes magnetic resonance signal intensity abnormally moving segments significantly less signal intensity normal segments
controlled trial community based coronary rehabilitation two hundred patients suffered acute myocardial infarction 4 6 weeks entered randomised controlled trial exercise treatment community sports centre supervised general practitioner eighty one per cent treatment group continued exercise returned work 73 completed three months' exercise serious complications exercise course prevalence angina pectoris fell 10 treatment group rose 60 control group perceived energy level rose significantly treatment group controls rise predicted maximum oxygen uptake significantly greater treatment group control group reduction double product \( reflection myocardial workload \) peak exercise coronary rehabilitation community safe effective
new method haemodynamic assessment mitral stenosis atrial fibrillation construction nomogram accurate haemodynamic assessment mitral stenosis hydraulic formulas requires measurement mean valve gradient cardiac output calculation , particularly presence atrial fibrillation averaged values obtained multiple beat beat determinations must used relations valve area , end diastolic gradient , heart rate 20 patients mitral stenosis atrial fibrillation examined patient end diastolic pressure gradient cardiac cycle related linearly rr interval cycle , relation unchanged exercise slope \( \) intercept \( \) relation correlated degree mitral stenosis measured gorlin valve area regression equations describing relations used construct nomogram relating end diastolic pressure gradient mitral valve area different heart rates nomogram applied catheterisation data 30 patients results correlated well direct calculation valve area gorlin formula nomogram simple use , require measurement cardiac output , independent heart rate unnecessary patient exercise catheterisation
lipoprotein \( \) coronary heart disease prospective case control study general population sample middle aged men objective examine association serum lipoprotein \( \) concentration subsequent coronary heart disease design prospective case control study based six year follow general population sample men aged 50 baseline 1983 4 serum samples frozen time baseline examination kept 70 degrees c six years , lipoprotein \( \) concentrations samples measured cases controls setting city , sweden subjects 26 men , general population sample men , sustained myocardial infarction died coronary heart disease six years 109 randomly selected controls sample remained free myocardial infarction neither cases controls history myocardial infarction baseline main outcome measures proportion myocardial infarction deaths coronary heart disease , , relation serum lipoprotein \( \) concentration results men suffered coronary heart disease significantly higher serum lipoprotein \( \) concentrations controls \( mean difference 105 mg l 95 confidence interval 18 192 mg l \) men highest fifth serum lipoprotein \( \) concentrations \( cut point mg l \) suffered coronary heart disease rate twice men lowest four concentrations logistic regression analysis showed serum lipoprotein \( \) concentration significantly associated coronary heart disease independently risk factors conclusion serum lipoprotein \( \) concentration middle aged men independent risk factor subsequent myocardial infarction death coronary heart disease
primary defect alpha adrenergic responsiveness patients varicose veins responsiveness superficial hand veins local infusions noradrenaline compared patients primary varicose veins healthy volunteers use dorsal hand vein technique patients varicose veins required significantly higher doses noradrenaline half maximal dose required control subjects \( geometric mean , 11 6 ng min patients compared 4 8 ng min control subjects p 0 006 \) noradrenaline responsiveness varicose veins significantly different hand vein responsiveness patients findings indicate constitutional decrease venous alpha adrenergic receptor responsiveness patients varicosities dilation varicose veins affect noradrenaline induced
calcium entry blockade adrenergic vascular reactivity hypertensives differences nicardipine diltiazem interference nicardipine diltiazem infused brachial artery systemically ineffective rates , forearm vascular response graded exogenous norepinephrine , evaluated hypertensive patients nicardipine \( 1 3 micrograms dl forearm tissue min absence presence propranolol \) increased forearm blood flow \( venous plethysmography \) antagonized dose dependently vasoconstrictor effect norepinephrine , suggesting functional alpha antagonism may participate vasodilating possibly antihypertensive effect drug contrary , antagonism rather potentiation responses norepinephrine occurred diltiazem \( 0 5 1 microgram dl forearm tissue min \) intra arterial propranolol abolished potentiating action drug , whereas local vasodilation isoproterenol clearly reduced , diltiazem probably beta adrenergic receptor mediated mechanisms human forearm arterioles data stress heterogeneity calcium entry blockers humans
skeletal muscle metabolism heart failure 31p nuclear magnetic resonance spectroscopy study leg muscle 1 gastrocnemius muscle seven patients mild moderate chronic heart failure five healthy control subjects studied using 31p nuclear magnetic resonance spectroscopy spectra collected rest incremental , symptom limited , exercise protocol blood flow measured study brief exercise 2 phosphocreatine \( phosphocreatine plus inorganic phosphate \) ratio lower patients heart failure control subjects exercise rate 1 5 w , although intracellular ph blood flow similar 3 cytosolic free adenosine 5' diphosphate concentration markedly increased patients heart failure exercising 1 5 w compared control subjects exercising workload 4 although maximum workload achieved patients heart failure less half reached control subjects , ph phosphocreatine \( phosphocreatine plus inorganic phosphate \) ratio lower patients heart failure maximal load blood flow less maximal exercise patients heart failure control subjects keeping reduced work load 5 phosphocreatine depletion induced gastrocnemius muscle exercise severe previously described forearm patients heart failure 6 metabolic abnormalities skeletal muscle may contribute exercise intolerance heart failure , particularly submaximal exercise
dynamic association artery shear flow condition platelet cytosolic free ca2 concentration human hypertension 1 blood cells vascular endothelial cells subjected wide range generated shear stress forces vitro , membrane stretching shear stress observed activate ion channels cell metabolism facilitate erythrocyte platelet aggregation 2 present study designed evaluate participation shear stresses control apparent platelet cytosolic free ca2 concentration hypertensive patients 3 shear conditions platelet cytosolic free ca2 concentration vitro studied dynamic perturbation induced 3 months double blind treatment one two beta antagonists , atenolol brachial artery wall shear rate stress estimated means pulsed doppler , blood viscosity measured co axial shear rate 96 1 platelet cytosolic free ca2 concentration simultaneously measured using 2 fluorescent chelator direct effect atenolol platelet cytosolic free ca2 concentration vitro also measured addition beta blockers platelet rich plasma 4 atenolol decreased blood pressure similarly effects shear rate \( p less 0 02 \) , shear stress \( p less 0 01 \) platelet cytosolic free ca2 concentration \( p less 0 05 \) differed 3 months therapy contrast , neither drugs significantly altered platelet cytosolic free ca2 concentration , vitro per se 5 overall population , strong positive correlations existed changes platelet cytosolic free ca2 concentration shear rate \( r 0 81 , p less 0 001 \) shear stress \( r 0 83 , p less 0 001 \) , also absolute values , suggesting possible haemodynamic shear dependent modulation transmembrane ca2 transport
myocardial infarction prognostic scoring system myocardial infarction prognostic scoring system patients treated coronary care unit described prognostic significance 22 variables , available admission , analyzed prognostic index constructed modified stepwise logistic analysis technique variables used scoring system hemodynamic class , infarct location , maximal st segment elevation single lead scoring system validated independent group patients , including group patients treated intravenous streptokinase scoring system may prove useful individual patient management strategies , quantification infarct severity use clinical studies
motivation cardiac rehabilitation lack patient adherence prescribed regimens fundamental problem cardiac rehabilitation programs causative factor lack patient adherence may related failure address differences individual health behavior motivation cardiac rehabilitation group 52 patients myocardial infarction sampled test relationship social support systems , health locus control , health value , motivation pearson correlation coefficients indicated significant positive correlations health locus control variables , health value orientation variations , motivation health locus control health value orientation variables entered multiple regression equation explain 32 variation motivation awareness individual motivational responses influence health behaviors cardiac rehabilitation may enable nurses develop intervention strategies patients cardiovascular disease would benefit modifying risk producing life styles
phase 2 cardiac rehabilitation necessary early recovery patients cardiac disease \? randomized , controlled study study effects rehabilitation teaching plus exercise testing perceived self efficacy performance daily activities compared without exercise training subjects patients myocardial infarction cardiac surgery \( mean age 57 7 11 3 years \) already received inpatient rehabilitation services subjects randomly assigned one three groups treatment group 1 \( n 11 \) received teaching , treadmill exercise testing , exercise training \( three times weekly 5 weeks \) treatment group 2 \( n 15 \) received teaching exercise testing control group \( n 14 \) received routine care without supervised exercise teaching measurements self efficacy activity performance made hospital discharge 4 9 weeks cardiac event repeated measures analysis variance showed increase self efficacy scores \( p less 0 001 \) performance physical activity \( p less 0 001 \) groups treatment groups , especially training group , obtained highest scores , differences groups nonsignificant \( p greater 0 05 \) results indicate sample uncomplicated , motivated patients participated phase 1 inpatient rehabilitation program , substantial improvements self efficacy performance daily activities made early recovery , onset phase 2 , outpatient therapy
myocardial infarction young adult cad young male adults age 40 years generally found associated usual risk factors associated cad lesser number young adults , may related cocaine use sympathomimetic effects increase myocardial oxygen demand factors considered responsible acute mi cocaine abusing patients young adults asymptomatic following acute mi able pass treadmill exercise stress tests levels bruce stage 4 shown normal coronary arteriograms thus subset require routine coronary angiograms following acute mi
proton magnetic resonance exercise induced water changes gastrocnemius muscle exercise induced water concentration changes determined medial gastrocnemius muscle noninvasively image guided vivo proton magnetic resonance spectroscopy \( mrs \) measurements performed seven normal male volunteers isometric ischemic isometric exercise 5 , 10 , 20 maximum voluntary contraction \( mvc \) observed water flux changes different phases exercise interpreted terms fluid transfer vasculature exercising muscle good correlation individual mvc changes water decay water content observed 20 mvc exercise level mrs results found consistent reported literature based invasive biopsy techniques
effects etomidate cerebral metabolism blood flow canine model hypoperfusion effects etomidate , cerebral metabolic depressant , cerebral metabolism blood flow studied 29 dogs cerebral hypoperfusion three groups animals studied 45 minute normotensive 30 minute hypotensive period 10 control animals without etomidate , 11 animals receiving 0 1 mg kg etomidate bolus followed infusion 0 05 mg kg min etomidate \( low dose group \) , eight animals receiving doses etomidate sufficient suppress electroencephalographic bursts \( high dose group \) mean arterial pressure fell similar levels \( p less 0 05 \) hypotension three groups \( 40 5 , 38 3 , 27 6 mm hg , respectively \) mean cerebral oxygen extraction fraction rose \( p less 0 05 \) 0 23 0 02 0 55 0 08 five control animals tested 0 33 0 02 0 53 0 02 seven animals tested low dose group , increase \( p greater 0 05 \) four animals tested high dose group \( 0 24 0 03 0 23 0 05 \) mean cerebral blood flow levels decreased groups hypotension \( p less 0 05 \) 42 3 21 4 ml 100 gm min \( 52 12 decrease \) five animals tested control group , 60 8 24 6 ml 100 gm min \( 56 13 decrease \) four animals tested low dose group , 55 8 22 3 ml 100 gm min \( 60 4 decrease \) four animals tested high dose group summary , cerebral oxygen extraction fraction increased control animals low dose recipients hypotension , suggesting presence threatened cerebral tissue contrast , cerebral oxygen extraction change hypotension high dose etomidate administered concluded high dose etomidate may preserve cerebral metabolic state hypotension present model
myocardial metabolism fluorodeoxyglucose compared cell membrane integrity potassium analogue rubidium 82 assessing infarct size man pet potassium loss damaged myocardial cells linearly related cpk enzyme loss reflecting extent necrosis potassium analog , rubidium 82 \( 82rb \) , extracted v injection retained viable myocardium trapped washed necrotic regions compare myocardial cell metabolism membrane dysfunction indicators necrosis viability , 43 patients evolving myocardial infarction coronary arteriography positron emission tomography using fluorodeoxyglucose \( fdg \) potassium analog 82rb percent heart showing fdg defects 82rb washout sequential images indicating failure retain potassium analogue visually assessed quantified automated infarct size based rubidium kinetics correlated closely size location fdg images \( visual r 0 93 , automated r 0 82 \) , suggesting loss cell membrane integrity trapping potassium analog 82rb parallels loss intracellular glucose metabolism , comparable quantitative markers myocardial necrosis viability
clinical validation nuclear probe system continuous line monitoring cardiac function st segment new , iodide nuclear probe \( \) developed continuous line measurement left ventricular function st segment ejection fraction \( ef \) measurements 77 patients compared gated equilibrium radionuclide probe positioned left ventricle first using blind positioning algorithm using gamma camera background measured automatically good correlation probe \( positioned blind \) gamma camera ef manual \( r 0 80 , n 65 \) automatic \( r 0 78 , n 66 \) backgrounds use gamma camera significantly alter results correlation probe stroke counts thermodilution derived stroke index atrial pacing six subjects also satisfactory \( r 0 69 , n 102 \) thus , able provide reliable estimate ef track rapid changes cardiac volumes
uk 68 , 798 novel , potent highly selective class iii antiarrhythmic agent blocks potassium channels cardiac cells uk 68 , 798 increased duration effective refractory period cardiac action potentials recorded vitro canine ventricular muscle purkinje fibers concentration dependent manner 5 nm 1 microm resting membrane potential , amplitude maximum velocity action potentials unaffected uk 68 , 798 , indicating selective class iii antiarrhythmic properties agent uk 68 , 798 \( 5 nm 1 microm \) increased effective refractory period isolated guinea pig papillary muscles stimulation frequencies 1 hz 5 hz without influencing conduction velocity , confirming uk 68 , 798 devoid class antiarrhythmic activity including block sodium channel studies using single voltage clamped guinea pig ventricular myocytes indicated uk 68 , 798 concentrations 50 nm 2 microm blocks time dependent k current , appreciable effects time independent k current calcium current uk 68 , 798 therefore highly selective k channel blocking agent class iii antiarrhythmic properties , profile holds considerable promise therapy life threatening cardiac arrhythmias
characterization ly233569 5 lipoxygenase reperfusion injury ischemic myocardium ly233569 produced concentration dependent inhibition isolated guinea pig 5 lipoxygenase \( 5 \) 5 activity human polymorphonuclear leukocytes vitro ic50 values 0 4 0 1 microm , respectively ly233569 also inhibited \( ic50 approximately 1 8 microm \) zymosan stimulated production leukotriene b4 canine whole blood little concomitant effect production thromboxane b2 concentrations ly233569 high 10 microm inhibit production superoxide activated human neutrophils normal anesthetized dogs , infusion ly233569 \( 0 11 mg kg min , v \) 6 hr produced persistent inhibition \( approximately 80 \) leukotriene b4 production blood challenged ex vivo zymosan plasma concentration \( approximately 4 microm \) ly233569 consistent vitro data illustrating selective maximal inhibition 5 subsequent experiments , myocardial infarct size measured 1 hr occlusion circumflex coronary artery 5 hr reperfusion continuous infusion ly233569 \( 0 11 mg kg min , v \) little effect base line systolic arterial pressure , cardiac rate pressure rate product compared time related changes observed control dogs ly233569 infusion also alter degree st segment deviation intensity duration cardiac arrhythmias associated coronary artery occlusion reperfusion resultant myocardial infarct sizes 45 5 left ventricle placed risk control dogs 43 4 dogs given ly233569 myeloperoxidase activity infarcted myocardium differ groups
interaction nifedipine six men borderline hypertension took 5 mg water , grapefruit juice , orange juice mean bioavailability grapefruit juice 284 \( range 164 469 \) water auc ratio lower , diastolic blood pressure lower , heart rate higher grapefruit juice water vasodilatation related side effects frequent orange juice effects six healthy men took nifedipine 10 mg water grapefruit juice bioavailability grapefruit juice 134 \( 108 169 \) water
effect lateral tilt maternal fetal hemodynamic variables measured maternal blood pressure heart rate , fetal heart rate , umbilical artery velocity waveforms 25 healthy women placed supine right left 5 degrees 10 degrees lateral tilt positions although found significant difference among variables various maternal positions , two 25 women became hypotensive symptomatic supine 5 degrees tilt positions could predict women would become symptomatic , recommend lateral tilt pregnant women operative procedures beyond 20 weeks' gestation , including position vaginal delivery
fluosol oxygen delivery fluid use percutaneous transluminal coronary angioplasty fluosol \( 20 intravascular emulsion \) oxygen carrying emulsion used deliver oxygen ischemic myocardium percutaneous transluminal coronary angioplasty \( ptca \) fluosol composed two , high capacity oxygen solubility , low viscosity , small particle size following administration , fluosol metabolized rather , expired particles lungs remainder taken organs system later expired administered balloon inflation ptca , fluosol ventricular wall motion global left ventricular ejection fraction addition , minimizes st segment changes cardiac output fluosol may especially useful patients poor contractile reserve , multivessel disease , serious underlying illness uses investigation include limitation myocardial infarct size malignant tumors adverse effects secondary use fluosol include ventricular arrhythmias , pruritus , bradycardia , chest pain , dyspnea , increased respiratory rate fluosol must thawed , admixed , body temperature , oxygenated prior intracoronary administration usual administration rate 60 ml min balloon inflation
improving compliance increasing control hypertension needs special hypertensive populations approximately 60 million people united states hypertension half either untreated treated without blood pressure control , despite well known risks hypertension established benefits treatment major reason inadequate control hypertension poor adherence treatment approximately 50 patients hypertension fail keep follow , 60 take medications prescribed barriers effective therapeutic adherence include poor doctor patient communication , cost antihypertensive therapy , side effects drugs increase control hypertension , compliance therapy must improved physicians patients must committed achieving control blood pressure physicians clearly therapies effective , , minimal adverse effects patient quality life overall cardiac risk profile needs special hypertensive populations \( e , elderly , black , young patients \) must also recognized addressed patients must follow recommendations alert physicians problems medications particularly relating side effects cost selecting drug therapy noted older patients sensitive volume depletion sympathetic inhibition group patients , initial drug doses low increments smaller gradual younger patients black patients hypertension show accentuated response diuretics blunted responses beta blockers angiotensin converting enzyme \( ace \) inhibitors monotherapy however , used diuretic , racial differences blood pressure lowering effects beta blockers ace inhibitors
preclinical pharmacology celiprolol cardioselective beta adrenergic antagonist mild vasodilator celiprolol new antihypertensive agent represents new generation beta blockers combines cardioselective beta adrenergic antagonism \( beta 1 \) mild vasodilation via beta adrenergic \( beta 2 \) results animal studies show celiprolol beta 1 antagonist potency similar propranolol atenolol , slightly greater atenolol celiprolol produce bronchoconstriction mild propranolol resistant properties cats compound also vascular smooth muscle propranolol sensitive fashion , suggesting mechanism beta 2 beta 2 results selective downregulation beta 2 receptor number response tissue culture , well peripheral tissue celiprolol treated volunteers decreases beta 2 receptors blocked concomitant treatment propranolol celiprolol devoid cardiac depressant activity fact mild actions via beta 1 stimulation , since abolished beta blocking doses propranolol model severe myocardial ischemia , celiprolol attenuates ischemia induced myocardial acidosis improves regional segment function results suggestive myocardial protection summary , celiprolol distinguishes beta blockers virtue , via beta 2 , lack bronchoconstriction properties observed animal studies also documented clinical trials
clinical safety efficacy celiprolol management essential hypertension requires therapeutic effective reducing diastolic blood pressure also tailored individual patient , minimal effect patient demographics , concurrent illnesses , cardiovascular risk factors celiprolol hydrochloride new highly cardioselective vasodilating beta adrenoceptor antagonist proven effective safe treatment essential hypertension comparable therapies blood pressure control demonstrating excellent safety profile , favorable hemodynamic activity , minimal effects cardiovascular risk factors celiprolol may offer physician unique therapeutic alternative
metabolic considerations choice therapy patient hypertension objective treating patients hypertension simply reduce blood pressure rather prevent associated morbidity mortality recent assessments clinical trials shown risk stroke consistently lower antihypertensive therapy , degree success demonstrated coronary artery disease \( cad \) although many explanations done well preventing cad , one possibility therapy used clinical trials , primarily thiazide diuretics beta adrenoreceptor blockers , increased patient 's risk developing coronary atherosclerosis lethal arrhythmias four classes antihypertensive agents recommended initial therapy thiazide diuretics , beta adrenoreceptor blockers , angiotensin converting enzyme \( ace \) inhibitors , calcium entry blockers metabolic effects thiazide diuretics include electrolyte disturbances \( hypokalemia , hypomagnesemia , hyponatremia \) , dyslipidemia \( increased triglycerides \) , abnormalities glucose metabolism \( hyperglycemia , hyperinsulinemia , peripheral insulin resistance \) , beta adrenoreceptor blockers many metabolic adverse reactions beta adrenoreceptor blockers without intrinsic sympathomimetic activity \( isa \) also cause \( lowered high density lipoprotein cholesterol increased triglycerides \) abnormalities glucose metabolism \( hyperglycemia , hyperinsulinemia , peripheral insulin resistance \) beta adrenoreceptor blockers isa third generation beta blockers selective partial agonist activity \( celiprolol \) cause dyslipidemia date appear induce abnormalities glucose metabolism ace inhibitors may decrease triglycerides increase high density lipoprotein cholesterol , captopril may improve insulin sensitivity calcium entry blockers metabolically neutral
correlation fatty acids human adipose tissue clinical risk factors cardiovascular disease relationships adipose tissue concentrations 19 geometric fatty acid isomers 10 cardiovascular disease risk factors determined 76 free living adult males percentages trans isomers \( total mean sd 4 14 0 97 \) cis isomers \( total mean sd 2 91 0 34 \) adipose tissue generally agreed dietary estimates based consumption major exception percentage 11c 18 1 , twofold higher adipose tissue total level fatty acid isomers adipose tissue factor \( derived factor analysis \) representative isomers dietary origin significantly correlated cardiovascular risk factors three trans isomers \( 18 1 , 18 1 , 14 1 \) three cis isomers \( 11c 18 1 , 13c 18 1 , 16 1 \) weakly correlated either positively negatively age , body mass index , plasma lipoprotein cholesterol , blood pressure \( p less 0 05 , r greater 0 231 \)
blood pressure lowering elderly subjects double blind crossover study omega 3 omega 6 fatty acids 46 elderly \( aged greater equal 60 \) hypertensive subjects entry systolic blood pressure \( sbp \) greater equal 160 diastolic blood pressure \( dbp \) greater equal 90 mm hg , specific aim randomized , double blind , crossover study \( two 8 wk treatment periods separated 3 wk washout \) compare blood pressure lowering effects 9 g fish oil omega 3 \( n 3 \) fatty acid vs 9 g corn oil omega 6 \( n 6 \) fatty acid 4 wk baseline period , 22 subjects randomly assigned receive fish oil 24 receive corn oil 8 wk treatments group differences change blood pressure treatment difference standing dbp baseline values compared treatment 2 dbp decreased 5 1 mm hg fish oil group vs 0 72 mm hg corn oil group \( p 0 024 \) within groups first treatment , fish oil corn oil lowered four blood pressure measures \( p less 0 05 \) blood pressures lowered second treatment compared washout period significant group differences laboratory safety tests categorical side effects fish oil lowered triglycerides 0 47 mmol l \( p less 0 001 \) elderly subjects , diet plus omega 3 omega 6 supplements \( 9 g \) safely effectively lower sbp dbp
cerebral emboli appear open heart operations \? transcranial doppler study transcranial doppler technique enabled detection cerebral air emboli 10 10 patients open heart valve operations despite standard procedures technique , occurrence emboli right middle cerebral artery followed continuously patients undergoing aortic mitral valve replacement membrane used scattered emboli observed insertion aortic cannula , start cardiopulmonary bypass , aorta heart beating empty period aortic cross clamping , emboli detected despite careful procedures , recordings indicated large amount emboli filling empty beating heart 10 patients thus , study indicates cerebral emboli open heart procedures likely occur redistribution blood heart lung machine patient heart beginning actively , despite careful standard procedures meticulous aorta strongly advocated addition , short period filling beating heart final closure aortic incision may decrease incidence cerebral emboli concomitant reduction cerebral blood flow hyperventilation anesthetics filling empty beating heart may also beneficial
retrograde continuous warm blood cardioplegia new concept myocardial protection report presents results first clinical series patients receiving continuous warm blood cardioplegia coronary sinus warm oxygenated blood cardioplegia certain theoretical advantages , continuously supplying oxygen substrates arrested heart avoiding side effects hypothermia retrograde infusion cardioplegia also offers certain advantages \( eg , valve operations patients severe coronary artery disease \) complementary warm blood cardioplegia retrograde warm blood cardioplegia used 113 consecutive patients \( 85 men 28 women mean age 61 years \) undergoing various procedures three percent patients died , 7 needed transient intraaortic balloon pump support , 6 evidence perioperative myocardial infarction , 96 spontaneous return rhythm coronary sinus injuries new technique retrograde continuous warm blood cardioplegia simple , safe , reliable method myocardial protection may change way currently protect heart intraoperatively
dopamine high dose insulin infusion \( glucose insulin potassium \) cardiac operation effects myocardial metabolism myocardial insulin resistance , association surgical stress , availability carbohydrates increases load free fatty acids \( \) heart theoretical grounds adrenergic drugs may expected situation , whereas opposite expected insulin influence dopamine combination dopamine \( 7 micrograms kg body weight min \) high dose insulin \( 7 iu kg \) myocardial energy metabolism studied 19 patients 4 6 hours coronary operation infusion dopamine \( 7 micrograms kg body weight min \) induced metabolic changes may unfavorable myocardium increase myocardial ffa load rise myocardial oxygen expenditure 60 70 changes , however , matched increase myocardial substrate uptake oxygen wastage ffa metabolism high circulating catecholamine levels suggested also signs suggesting amplified systemic trauma response systemic oxygen consumption increased 15 , increase arterial levels , glucose , observed divergent metabolic effects dopamine insulin demonstrated prominent metabolic effects adding high dose insulin dopamine marked reduction arterial ffa levels shift toward myocardial carbohydrate utilization expense myocardial uptake ceased myocardial insulin resistance may thus significant extent overcome doses insulin , even infusion adrenergic drugs
transesophageal echocardiography acute aortic transection confirming diagnosis acute transection descending aorta problematic unnecessary patient movement time delay often associated conventional investigations describe patient injury clearly quickly defined bedside transesophageal echocardiography
apical aortic cannulation application old method new instrument assembly consisting special aortic cross clamp double lumen perfusion cannula presented application instruments allows occlusion ascending aorta traversed perfusion cannula inserted directly apex heart well simultaneous left ventricular
popliteal aneurysms identified intra arterial streptokinase changing pattern presentation five patients presenting chronic subacute leg ischaemia due thrombosed popliteal artery aneurysm described one aneurysms diagnosed intra arterial streptokinase infusion , successfully lysed thrombus cases one aneurysm symptomatic 5 years another 2 years popliteal aneurysm may well cause chronic leg ischaemia
influence low osmolality contrast media electrophysiology hemodynamics coronary angiography differences ionic \( ioxaglate \) nonionic \( iohexol \) agent recently suggested addition sodium low osmolality contrast media may reduce incidence ventricular fibrillation conduction disturbances coronary angiography randomized , double blind study 30 patients undergoing coronary angiography therefore examined electrophysiological hemodynamic effects two low osmolality contrast media ioxaglate \( sodium \) iohexol \( without sodium \) standard ecg , aortic blood pressure , bundle electrocardiogram recorded contrast media well tolerated serious arrhythmias observed induced transient decrement systolic blood pressure reduction heart rate 10 following contrast injection \( p less 0 01 \) ioxaglate prolonged qt interval 10 \( p less 0 01 \) also analysed whole observation period \( 120 \) \( p less 0 05 \) , whereas iohexol cause significant changes qt interval ah interval prolonged ioxaglate 10 \( p less 0 01 \) , altered iohexol thus , factors osmolality sodium content might contribute qt prolongation , since contrast agents sodium \( ioxaglate \) induced qt prolongation study
precertification percutaneous transluminal coronary angioplasty medicare beneficiaries need better national standards \? health care administration contracted state peer review organizations \( \) effort assure quality services eliminate inappropriate care provided medicare beneficiaries law , state pro must select 10 procedures precertification coronary angioplasty chosen 45 precertification criteria state developed advice local physicians report describes findings survey precertification criteria effort determine variability compare pro criteria published national criteria created expert panels current precertification criteria medicare beneficiaries show significant variability priorities clinical practice performing coronary angioplasty , despite established published guidelines safe efficacious use likely establishment locally based criteria coronary angioplasty geographically probably less expected impact care provided medicare beneficiaries
rib compression coronary arteries report describes finding coronary artery narrowing caused compression overlying rib two patients cardiomegaly probably clinical significance finding primary differential diagnostic entity myocardial bridging
coronary stent implantation acute vessel closure 48 hours unsatisfactory coronary angioplasty report implantation balloon expandable stent patient acute vessel closure state evolving myocardial infarction following 48 hr unsatisfactory coronary angioplasty stent implanted successful recanalization occluded left anterior descending artery , repeated unsatisfactory results balloon angioplasty adjunct thrombolytic therapy contraindicated residual stenosis documented immediate control angiograms , 24 hr , 3 weeks , 4 months
implantation prosthesis distal anastomosis bypass graft abrupt closure following balloon angioplasty coronary implanted 10 year old saphenous vein bypass graft following ptca complicated abrupt closure anterograde flow restored myocardial necrosis resulted one week later , bypass surgery performed due bleeding complication associated anticoagulation regimen
alfentanil pharmacokinetics patients undergoing abdominal aortic surgery pharmacokinetics alfentanil , 300 micrograms kg 1 iv , determined patients undergoing elective abdominal aortic reconstruction mean age \( sd \) patients 64 3 7 4 yr mean weight 74 7 13 8 kg five patients underwent aneurysm repair six aortobifemoral grafting serum alfentanil concentrations measured gas liquid chromatography samples drawn increasing intervals 24 hr period three compartment model fitted concentration versus time data volume central compartment volume distribution steady state \( \) 0 44 0 022 0 63 0 32 l kg 1 , respectively total drug clearance 6 4 1 9 ml min 1 kg 1 elimination half time 3 7 2 6 hr patient age positively correlated elimination half time significant correlations pharmacokinetic variables duration aortic cross clamping , duration surgery , rate total volume iv fluids infused intraoperatively general surgical patients , elimination half time alfentanil reported 1 2 2 0 hr although elimination half time alfentanil longer patients undergoing abdominal aortic surgery , alfentanil eliminated much faster either fentanyl sufentanil patient population
transoesophageal echocardiogram may fail diagnose perioperative myocardial infarction report case 55 yr old man undergoing aortocoronary bypass monitored electrocardiogram transoesophageal echocardiogram intraoperative electrocardiogram simultaneous ecg recordings using holter monitor showed st elevation greater 2 mm new q wave formation leads avf skin closure however , transoesophageal echocardiogram showed wall motion abnormalities significant haemodynamic abnormalities observed period intraoperative ecg changes treated nitroglycerin infusion confirmation perioperative myocardial infarct documented postoperative 12 lead ecg cpk mb post operative transthoracic echocardiogram showed left ventricle infarct thus transoesophageal echocardiography failed detect apical wall motion abnormality probe placed level limitation overcome periodically obtaining apical views using probes one imaging plane
cardioprotective effects nitric oxide myocardial ischemia reperfusion background methods purpose study determine effects nitric oxide \( \) , believed endothelium derived relaxing factor reperfusion injury myocardial ischemia \( mi \) effects investigated 6 hr model mi reperfusion open chest , anesthetized cats solution containing infused iv starting 30 min occlusion left anterior descending coronary artery , continuing reperfusion 1 hr later , lasting 5 5 hr estimated concentration circulation 1 2 x 10 \( 9 \) results areas risk expressed percentage total left ventricular weights significantly different among either mi groups however , necrotic area \( expressed percentage myocardial area risk \) significantly \( p less 01 \) lower treated mi cats compared mi vehicle group cardiac myeloperoxidase activities indicated significantly \( p less 05 \) fewer neutrophils necrotic zone treated mi cats compared mi cats receiving vehicle sodium nitrate \( \) \( ph 7 4 \) , major breakdown product , failed exert protective effect model mi reperfusion conclusions appears provide significant myocardial protection ischemia reperfusion may afford incorporation circulating blood cells \( e , neutrophils , platelets \) , thereby inhibiting accumulation adherence ischemic region , direct cardiac effect studies using donors rather would appropriate clinically relevant mode treatment mi
pulmonary function cardiovascular risk factor relationships black white young men women cardia study pulmonary function known related inversely incidence coronary heart disease , congestive heart failure , chronic obstructive lung disease , lung cancer , death causes reasons associations poorly understood relationships cardiovascular disease risk factors pulmonary function examined 5 , 115 18 30 year old black white male female participants study coronary artery risk development young adults \( cardia \) forced expiratory volume 1 adjusted height \( fev1 ht2 \) significantly lower smokers nonsmokers persons reported shortness breath fev1 ht2 correlated positively history strenuous physical activity , duration exercise treadmill , high density lipoprotein cholesterol associated negatively , serum triglycerides , fasting serum insulin , scale association pulmonary function heart disease risk may reflect associations physical fitness , , , lipid profiles , well cigarette smoking
ischemia reperfusion intermittent coronary occlusion man studies electrocardiographic changes cpk release course balloon inflations performed 38 single vessel coronary artery disease prospectively studied using continuous ecg recording ischemic ecg changes appeared 91 percent inflations mean 20 8 seconds inflation resolved 97 percent mean 11 5 seconds deflation elevation plasma cpk level found six patients ischemic ecg changes least 7 8 minutes duration ischemia exceed 5 4 minutes patients without cpk elevation resolution ischemic changes delayed patients cpk elevation last vs initial inflations conclude patients noninfarcted myocardium , ecg changes follow coronary occlusion reflow rapidly , detecting coronary events high sensitivity lack rapid regression predicts lack reperfusion , persistence ischemia 7 8 minutes sufficient cause myocardial necrosis
regression left main trunk lesion steroid administration takayasu 's 62 year old man unstable angina due severe narrowing left main trunk \( \) examined emergency bypass surgery performed internal mammary artery graft , instead saphenous vein graft , thickened , ascending aorta postoperative coronary angiography showed lesion markedly presumably , stenotic lesion caused active partially reversible steroid administration surgery steroid therapy added list treatments cases disease associated takayasu 's , signs active inflammation present
monitoring effect cpap left ventricular function using continuous mixed blood saturation benefit cpap cardiac performance reduction vo2 tested patient heart transplantation acute myocardial infarction using continuous svo2 monitoring cpap added inotropic support \( enoximone plus dobutamine \) intraaortic balloon pumping dramatically increased svo2 relation increase cardiac output decrease vo2 secondary respiratory work reduction , initial hypotheses
pseudo pre excitation effect tachycardia effect phenomenon qrs complexes reflect alternating phases gradual widening narrowing commonly due ventricular pre excitation , changes qrs morphology due variability ventricular zone undergoes pre excitation presentation reflects case effect due tachycardia rate nearly identical sinus rate variable degrees ventricular fusion therefore occur , effect , relation slight variations sinus cycle
traumatic spontaneous extracranial internal carotid artery dissections seventy patients spontaneous 21 traumatic extracranial internal carotid artery dissections studied clinically angiographically mean follow ups 64 \( spontaneous group \) 40 months \( traumatic group \) sixty percent patients spontaneous group 71 traumatic group also follow angiograms traumatic dissections aneurysms common , significantly fewer aneurysms resolved became smaller fewer stenoses resolved improved , whereas stenoses progressed occlusion traumatic dissections likely leave patients neurological deficits significantly higher percentage patients spontaneous dissections asymptomatic follow compared traumatic group although spontaneous traumatic dissections extracranial internal carotid arteries mostly carry good prognosis , outcome may somewhat less favorable traumatic group
prospective randomized multicenter comparison situ reversed vein bypasses performed prospective , randomized , multicenter study compare situ reversed vein grafts long limb salvage bypasses proximal thigh artery three hundred eighty four patients required bypass critical lower extremity ischemia , 259 excluded short vein bypass performed vein considered inadequate remaining 125 patients randomized vein bypass , 63 reversed , 62 situ two groups similar regard risk factors , indications , graft dimensions , outflow secondary patency 30 months similar techniques reversed 67 9 \( se \) situ 69 8 veins less equal 3 0 mm minimum distended diameter 24 month patency rates 61 22 12 situ veins 37 29 10 reversed veins \( p greater 0 05 \) angiographic evaluation failing grafts revealed lesions similar type frequency types grafts included focal \( situ , n 4 reversed , n 7 \) diffuse vein hyperplasia \( situ , n 2 reversed , n 1 \) , inflow outflow stenoses \( situ , n 4 reversed , n 3 \) incidence wound complications mortality rate similar two groups data show significant difference overall patency rates two types vein grafts 2 1 2 years
ruptured abdominal aortic aneurysm experience last decade \( 1980 1989 \) 186 patients ruptured abdominal aortic aneurysm admitted single urban hospital ninety six percent patients prehospital systolic blood pressure less 90 mm hg management included paramedic field resuscitation transport , emergency department diagnostic protocol completed average 12 minutes , rapid transport emergency operating room , general surgery chief residents supervision specialist vascular surgeons , skilled postoperative intensive care unit care nevertheless , 130 \( 70 \) patients died first 30 postoperative days 3 emergency department , 13 operating room , 51 intensive care unit , 3 ward home certain features age greater 80 years , female gender , persistent preoperative hypotension despite aggressive crystalloid blood replacement , admission hematocrit less 25 , transfusion requirements exceeding 15 units associated greater 90 likelihood death patient preoperative cardiac arrest survived 24 hours experience conclude , although optimal prehospital , emergency department , operating room , postoperative care improve outcome patients ruptured abdominal aortic aneurysms shock , patients die certain clinical features predict excessive mortality rates ruptured abdominal aortic aneurysms withholding operation may reasonable screening patients high risk abdominal aortic aneurysm , followed elective , clearly indicated
probability rupture abdominal aortic aneurysm unrelated operative procedure prospective study assumed authors patients abdominal aortic aneurysms may increased risk rupture unrelated operations july 1986 december 1989 , 33 patients \( 29 men , 4 women \) known abdominal aortic aneurysm underwent 45 operations twenty eight patients infrarenal abdominal aortic aneurysm , five patients thoracoabdominal aneurysm abdominal aortic aneurysm ranged transverse diameter 3 0 8 5 cm \( average 5 6 cm \) twenty seven patients underwent single operation , six patients two \( range 1 6 \) operations performed abdominal \( 13 \) cardiothoracic \( 9 \) head neck \( 2 \) vascular \( 11 \) \( 7 \) amputation \( 2 \) breast \( 1 \) general anesthesia used 29 procedures , spinal epidural 6 , regional local 10 one postoperative death occurred cardiopulmonary failure one patient died ruptured abdominal aortic aneurysm 20 days coronary artery bypass \( 1 33 patients 3 1 45 operations 2 \) fourteen patients repair abdominal aortic aneurysm later date , average 18 weeks operation four patients abdominal aortic aneurysm considered small warrant resection \( average 3 6 cm \) four patients considered excessive risk elective repair five thoracoabdominal aneurysm repaired four patients awaiting repair 40 month period , two patients , known abdominal aortic aneurysm , died ruptured abdominal aortic aneurysm another operative procedure , 21 days 77 days three ruptured abdominal aortic aneurysms 5 0 cm greater transverse diameter
accuracy ct scanning diagnosis abdominal thoracoabdominal aortic aneurysms ct scanning evolved reliable clinical tool , use angiography diagnosis aortic aneurysmal disease diminished fewer 25 patients aortic aneurysmal disease undergo aortic angiographic evaluation institution prospective clinical study undertaken assess validity policy one hundred patients clinical ultrasonographic evidence aortic aneurysms evaluated prospectively period july 1987 december 1989 patients underwent ct scanning initial evaluation patients selected angiography fulfilled following criteria radiographic evidence thoracoabdominal aneurysms , horseshoe kidney clinical suggestion renal artery stenosis , mesenteric arterial insufficiency , aortoiliac occlusive disease , lower extremity aneurysmal disease period 19 patients \( 19 \) underwent ct scanning angiography indications angiography thoracoabdominal aneurysms \( 7 \) , aneurysms \( 2 \) , clinical evidence mesenteric insufficiency \( 1 \) renal insufficiency \( 2 \) , evidence lower extremity aneurysmal disease \( 3 \) , severe aortoiliac occlusive disease \( 4 \) eighty one patients \( 81 \) underwent ct scanning radiographic evaluation patient adversely affected elimination angiographic evaluation ct scanning revealed inflammatory aneurysms \( 4 \) , renal veins \( 2 \) , horseshoe kidney \( 1 \) study suggests \( 81 \) patients aortic aneurysmal disease adequately evaluated ct scanning , selective policy angiographic evaluation indicated
lacunar transient ischaemic attacks clinically useful concept \? lacunar ischaemic stroke syndromes clinically , , distinguishable cortical ischaemic stroke syndromes could cerebrovascular transient ischaemic attacks \( tias \) share similar heterogeneity \? 130 patients tias prospectively studied , 71 underwent carotid angiography symptoms associated 50 greater stenosis ipsilateral internal carotid artery 36 \( 67 \) 54 patients presumed cortical tias , 1 \( 6 \) 17 patients presumed lacunar tias \( p less 0 0001 \) findings support view cortical tias associated ipsilateral extracranial internal carotid artery atheromatous disease , whereas patients lacunar tias may absent insignificant large vessel disease , probable intracranial small vessel disease accurate distinction lacunar cortical events may implications investigation treatment patients tias
degenerative aortic stenosis one effect america degenerative aortic stenosis evolving common geriatric problem symptoms develop , highly lethal disease respond well medical therapy aortic balloon valvuloplasty may offer palliation unlikely alter overall course disease aortic valve replacement therapy choice , high perioperative morbidity mortality rates expected elderly presence appreciable cardiac disorders may contribute occurrence postoperative complications patients asymptomatic aortic stenosis normal left ventricular function treated medically followed serial aortic valve area determinations using doppler echocardiography
pulmonary artery catheterization risks \? bedside pulmonary artery catheterization proven important addition clinical assessment critically ill patients properly used , procedure may provide hemodynamic information apparent physical examination radiography may safely accomplished various venous routes , care must taken avoid potential complications
relationship blood groups behavior patterns men myocardial infarction consistent correlations found physical states blood factors disorders possible components \( eg , duodenal ulcer , myocardial infarction \) study focused relationship blood types various indices behavior patterns \( eg , type behavior scores , ratings \) young patients initial myocardial infarction patients blood type scored significantly higher type behavior scales related indices blood type blood group b responded several scales types discuss utility blood future research prediction myocardial infarction , methodologic limitations , relationship results studies , activity survey patterns , anti h reactivity pattern , hypotheses relating blood factors behavioral traits patients disorders
comparative clinical pharmacology calcium channel blockers calcium channel blockers effective antihypertensive agents , initial monotherapy combination antihypertensive agents drugs also effective treatment chronic , stable angina , variant angina supraventricular arrhythmias drugs class different affinities calcium channels vascular smooth muscle , cardiac muscle , cardiac sinus atrioventricular node useful hypertension angina , verapamil diltiazem also useful control heart rate supraventricular arrhythmias nimodipine may control vascular spasm following subarachnoid hemorrhage calcium channel blockers also used treatment migraine headache raynaud 's phenomenon
complete left main coronary artery occlusion angiographic evaluation collateral vessel patterns assessment hemodynamic correlates angiographic study eight patients total occlusion left main coronary artery identified six patients chronic occlusion two acute complete occlusion six patients , two six different collateral pathways altogether , total 13 specific collateral channels recognized one patient evidence unique represented enlarged vasa , created vascular cuff totally obstructed left main artery ventricular function hemodynamic parameters patients depend collateral vessels may also affected severity coronary artery disease artery supplies collaterals
dilatation left ventricular cavity dipyridamole thallium 201 imaging new marker triple vessel disease investigate significance mechanism dilatation left ventricular cavity dipyridamole thallium 201 imaging , performed dipyridamole thallium 201 imaging dipyridamole radionuclide angiography 83 patients known angiograms dipyridamole delayed ratio left ventricular dimension thallium 201 image defined left ventricular dilatation ratio \( lvdr \) lvdr greater mean two standard deviations patients without coronary artery disease defined abnormal twenty two 83 patients showed abnormal lvdr , 18 22 patients \( 82 \) triple vessel disease defect washout analysis , sensitivity specificity correctly identifying patients triple vessel disease 72 76 , respectively , whereas lvdr sensitivity 72 specificity 93 lvdr used combination defect washout criteria , sensitivity increased 84 without loss specificity 22 patients abnormal , end diastolic volume measured radionuclide angiography change dipyridamole infusion dilatation left ventricular cavity dipyridamole thallium 201 imaging reflected relative subendocardial hypoperfusion induced dipyridamole rather actual chamber enlargement lvdr moderately sensitive highly specific triple vessel disease provided complementary information dipyridamole thallium 201 imaging
percutaneous balloon valvotomy patients mitral stenosis initial follow results percutaneous double balloon mitral valvotomy \( \) performed 25 patients severe mitral stenosis followed least 6 months procedure 22 women 3 men , mean age 51 14 years \( range , 27 74 \) hemodynamic angiographic findings evaluated clinical status assessed follow significant decrease mitral gradient following , 15 4 5 1 5 0 2 6 mm hg \( p less 0001 \) increase cardiac output , 4 6 1 1 5 2 1 1 l min \( p less 01 \) increase calculated mitral valve area , 0 9 0 2 2 2 0 6 cm2 \( p less 0 0001 \) mitral regurgitation developed increased severity six patients \( 24 \) time follow \( mean , 12 5 months \) , three patients required elective mitral valve replacement symptomatic mitral regurgitation 91 \( 20 22 \) remaining patients continued improvement functional class safely performed properly selected patients symptomatic mitral stenosis good immediate follow results
value limitations doppler pressure half time quantifying mitral stenosis comparison micromanometer catheter recordings purpose study compare doppler catheterization pressure half time methods estimating mitral valve area valve areas obtained gorlin equation group patients clinically significant mitral stenosis data analyzed 67 consecutive patients undergoing continuous wave doppler examination catheterization micromanometer catheters doppler pressure half time calculated interval peak transmitral velocity velocity divided square root 2 , measured outer border spectral envelope doppler mitral valve area \( mva \) obtained equation mva 220 divided pressure half time catheterization data , pressure half time measured directly simultaneously recorded left ventricular left atrial pressure \( 18 patients \) pulmonary capillary wedge pressure \( 49 patients \) catheterization half time taken time required peak pressure gradient fall one half initial value calculations mitral valve area catheterization obtained gorlin equation pressure gradient cardiac output determinations mitral valve area determined gorlin equation cases ranged 0 4 2 0 \( mean 1 03 0 37 \) cm2 linear regression analysis compared cardiac catheterization doppler half times yielded r 0 68 subgroup patients sinus rhythm , correlation improved r 0 76
flosequinan vasodilator positive inotropic activity flosequinan oral arterial venous vasodilator currently investigation treatment congestive heart failure effects flosequinan ventricular performance myocardial contractility studied 10 patients severe congestive heart failure right left cardiac catheterization sixty minutes 100 mg oral dose flosequinan , peak rate rise left ventricular pressure \( dp dt \) increased 180 240 mm hg sec \( p less 0 05 \) , left ventricular end diastolic pressure decreased 32 5 26 8 mm hg \( p less 0 05 \) , cardiac index increased \( 2 1 0 4 2 3 0 5 l min m2 , \( p less 0 05 \) mean pulmonary artery pressure vascular resistance decreased 40 8 33 12 mm hg \( p less 0 05 \) 330 240 290 170 dyne sec cm5 \( p less 0 05 \) , respectively heart rate , mean aortic pressure , right atrial pressure , systemic vascular resistance , serum norepinephrine levels change significantly increase left ventricular peak dp dt concomitant decrease left ventricular end diastolic pressure , change systemic arterial pressure sympathetic tone , argue direct positive inotropic effect flosequinan
dietary taurine deficiency dilated cardiomyopathy taurine deficiency implicated potential cause dilated cardiomyopathy however , relationship taurine myocardial function presently unclear purpose study determine whether dilated cardiomyopathy associated dietary taurine deficiency total 68 foxes farms history death caused dilated cardiomyopathy 14 foxes history dilated cardiomyopathy studied dilated cardiomyopathy diagnosed echocardiography 48 foxes one positive history none foxes control foxes less 9 months age commonly affected older foxes \( p 0 03 \) plasma taurine concentrations significantly less \( p less 0 01 \) foxes dilated cardiomyopathy \( 26 8 16 4 nmol ml \) control foxes \( 99 3 60 2 nmol ml \) significantly higher \( p less 0 01 \) incidence dilated cardiomyopathy present foxes history sibling offspring died dilated cardiomyopathy foxes without family history cardiac death one dilated cardiomyopathy tested , myocardial taurine concentration lower \( 1 7 mumol gm wet weight \) control foxes \( 7 3 1 6 mumol gm wet weight \) hepatic acid decarboxylase activity significantly less \( p less 0 001 \) foxes dilated cardiomyopathy \( 0 97 0 2 nmol mm mg protein \) control foxes \( 2 11 0 07 nmol co2 mm mg protein \)
beat beat detection ventricular late potentials high resolution electrocardiography detect dynamic changes vlps developed low noise , hr ecg gain 10 \( 5 \) 10 \( 6 \) x system allows beat beat detection low amplitude signals bedside room without averaging process analysis performed 39 normal subjects \( group 27 men , 12 women , mean age , 28 8 years \) , 98 patients coronary artery disease without documented sustained ventricular tachycardia \( group b 86 men , 12 women , mean age , 59 10 years \) 41 patients coronary artery disease sustained monomorphic ventricular tachycardia \( group c 36 men , 5 women mean age 63 9 years \) comparison made time domain signal averaging \( sa ecg \) cases electrode position identical band pass filtering group vlps detected total filtered qrs duration 84 8 msec \( mean sd \) , time interval terminal qrs exceed 40 microv \( 40 \) less 30 msec cases \( mean , 17 6 msec \) group b , vlps detected hr ecg 34 98 patients \( 35 \) total qrs duration 102 16 msec \( mean sd , p less 0 01 vs group \) , 40 29 13 msec \( mean sd , p less 0 01 vs \( group \) group c , vlps detected hr ecg 38 41 patients \( 93 \) total qrs duration 123 22 msec \( mean sd , p less 0 01 vs group group b \) , 40 40 14 msec \( mean sd , p less 0 01 vs group group b \) concordant results hr ecg sa ecg observed 91 cases \( 59 positive 103 negative results \) late potentials exhibited dynamic variations detected hr ecg alone 13 cases , low amplitude vlps detected sa ecg alone three cases conclusion , present study demonstrates feasibility body surface recording vlps beat beat basis , without averaging process , bedside room new approach may allow study dynamic changes vlps spontaneous ventricular arrhythmias ischemia
risk stratification survivors acute myocardial infarction routine cardiac catheterization angiography reasonable approach patients editorial noninvasive risk assessment survivors ami effectively patients groups differing risk profiles hospital discharge , patients risk late death recurrent ami may incorrectly identified data cardiac catheterization angiography provide complementary generally powerful prognostic information many patients may derive particular benefit early cardiac catheterization angiography , including \( 1 \) patients ami complicated recurrent myocardial ischemia , congestive heart failure , complex ventricular arrhythmias \( 2 \) patients abnormal inconclusive results noninvasive testing patients unable perform exercise test \( 3 \) patients abnormal left ventricular global systolic function increased left ventricular end systolic volume \( 4 \) young patients \( younger 50 years age \? \) \( 5 \) older patients \( older 65 70 years age \? \) \( 6 \) patients non q wave ami \( 7 \) patients receiving thrombolytic therapy performance early cardiac catheterization angiography virtually survivors ami , selective use appropriate noninvasive tests , may provide efficacious means risk assessment ami tests performed , cost approach need excessive combination invasive selected noninvasive tests probably provides optimal information risks routine performance diagnostic cardiac catheterization angiography survivors ami \( 1 \) adequate care attention may paid proper performance procedure \( \) detailed proper analyses data \( 2 \) need additional noninvasive testing selected patients may ignored importantly , \( 3 \) premature unnecessary revascularization procedures may performed subsequently optimal patient care , clinician must obtain necessary data , avoid unnecessary repetitive tests , know accuracy individual tests facility , interpret data proper context , counsel patients objectively available management strategies approach , patients might appropriately benefit coronary artery revascularization correctly identified , patients truly low risk \( minimal residual coronary artery disease preserved left ventricular function particularly associated patent infarct related artery \) may similarly identified managed appropriately elimination unnecessary additional testing pharmacologic therapy finally , whatever approach risk stratification one individual patient , importance need correct ameliorate risk factors coronary artery disease must recognized undertaken
prognostic importance delayed q wave evolution 3 24 hours initiation thrombolytic therapy acute myocardial infarction timing q wave evolution prognostic significance studied 201 patients received thrombolytic therapy first acute myocardial infarction \( ami \) one hundred forty one patients \( 70 \) evidence q wave ami within 3 hours initiation thrombolytic therapy , 31 \( 16 \) developed q waves 3 hours hospital discharge , 29 \( 14 \) discharged non q wave ami laboratory indicators myocardial damage hospital morbidity mortality greater among patients q wave amis non q wave amis indexes examined respect timing q wave evolution , prognosis patients delayed q wave development similar patients non q wave amis thus , compared patients early \( less equal 3 hours \) q wave evolution , patients delayed q wave evolution non q wave ami smaller creatine kinase peak \( mean 1 , vs 1 , 251 1 , iu p 0 005 \) , better preservation left ventricular function measured radionuclide ventriculography discharge \( mean standard deviation 54 11 vs 47 13 p less 0 01 \) , lower incidence congestive heart failure discharge \( 3 vs 15 p 0 02 \) hospital mortality lower among patients delayed q wave evolution non q wave ami \( 5 141 vs 0 60 difference significant \)
immediate short term results 1988 1989 coronary angioplasty registry determine relevance recent refinements angioplasty technology particular practice , records consecutive patients undergoing first percutaneous transluminal coronary angioplasty \( ptca \) center october 1988 may 1989 reviewed time ptca , 41 patients class iv angina 44 identified multivessel disease dilatation attempted lesions \( mean 1 5 per patient \) , 95 \( 13 \) chronic total occlusions overall , 69 lesions judged anatomically complex , , dilating lesions , type device used almost exclusively successful dilatation achieved \( 90 \) attempted lesions low incidences major complications death \( 0 4 \) , myocardial infarction \( 1 8 \) emergency bypass surgery \( 1 8 \) acute occurred 54 patients \( 11 \) patients , initial strategy repeat dilatation successful 38 47 patients \( 81 \) overall , primary clinical success ptca achieved 480 patients \( 95 \) mean follow 7 5 1 5 months 497 study patients , event free rate \( freedom cardiac death , myocardial infarction , repeat ptca coronary bypass surgery recurrence severe class iii iv angina \) 71 conclusion , despite often complex coronary disease patients currently presenting center , high initial success rate acceptable short term outcome ptca achieved
sustained reduction valvular regurgitation atrial volumes tailored vasodilator therapy advanced congestive heart failure secondary dilated \( ischemic idiopathic \) cardiomyopathy afterload reduction therapy acutely improve hemodynamic function patients advanced heart failure however , unknown initial reductions mitral tricuspid regurgitation atrial volumes sustained oral therapy atrial volumes atrioventricular valve regurgitation measured using 2 dimensional doppler echocardiography color flow imaging 14 patients dilated heart failure \( ejection fraction 17 4 \) 3 1 days intensive vasodilator diuretic therapy tailored hemodynamic goals echocardiography repeated 6 2 months oral vasodilators flexible diuretic regimen acute therapy reduced systemic vascular resistance 1 , 760 460 1 , 310 dynes cm 5 , pulmonary artery wedge pressure 30 5 17 4 mm hg , right atrial pressure 13 5 7 3 mm hg , led 61 increase stroke volume \( 36 10 58 14 ml \) \( p less 0 01 \) mitral tricuspid regurgitation , determined color flow fraction , initially decreased 0 34 0 17 0 20 0 20 0 33 0 15 0 13 0 13 , respectively \( p less 0 001 \) reduction sustained 6 months significant decreases occurred acute therapy , reductions 6 months mean left atrial volume \( 100 25 80 19 65 15 cm3 \) right atrial volume \( 85 23 64 23 52 14 cm3 \) \( p less 0 001 \)
frequency severity mitral regurgitation one year balloon mitral valvuloplasty mitral regurgitation \( mr \) evaluated doppler echocardiography 59 patients mitral stenosis , immediately 1 year balloon mitral valvuloplasty \( \) severity mr graded scale 1 4 echocardiographic hemodynamic variables analyzed study potential factor \( \) might predict long term persistence mr echocardiographic variables mitral valve thickness motion , subvalvular change , left atrial dimension , calcification effective balloon mitral diameters hemodynamic variables mitral pressure gradient , pulmonary arterial pressure , ejection fraction , mitral valve area index , age , gender cardiac rhythm mitral valve area index increased 0 9 0 5 1 5 0 8 cm2 m2 immediately , 1 4 0 3 cm2 m2 1 year follow \( p less 0 01 \) immediately , mr grading change 30 patients \( 51 \) , increased 1 23 patients \( 39 \) , 2 2 patients \( 3 3 \) 3 2 patients \( 3 3 \) , decreased 1 2 others 1 year follow , 1 patient severe mr required valve replacement fifty one patients \( 88 \) change extent mr \( less equal 1 \) 6 patients \( 10 \) 1 grade decrease mr 1 patient 1 grade increase mr clinical hemodynamic variables morphologic characteristics mitral valve could predict development significant mr concluded increment mr severity less equal 2 frequently seen
uses limitations transthoracic echocardiography assessment atrial septal defect adult two dimensional color doppler echocardiography accurately detected presence atrial septal defect \( asd \) 47 50 adults \( mean age 40 years \) confirmed surgery cardiac catheterization , correctly categorized patients ostium secundum ostium asd misdiagnosed 3 5 patients surgically proven sinus venosus asd shunt flow volume across asd calculated standard doppler equation , assuming asd circular correlated shunt flow volume obtained cardiac catheterization \( r 0 74 \) maximum width color flow signals moving across asd taken diameter mean flow velocity determined either placing pulsed doppler sample volume parallel flow across asd visualized color doppler color mode examination , allowed determination flow velocities using previously validated method computer analysis pixel color intensity pulmonary systemic blood flow ratio obtained color guided conventional doppler left right ventricular outflow tracts correlated poorly cardiac catheterization results \( r 0 38 \) patients associated tricuspid regurgitation , peak systolic pulmonary artery pressure obtained color doppler guided continuous wave doppler correlated well obtained cardiac catheterization \( r 0 89 \) maximum color doppler jet width flow across asd poorly correlated asd size estimated surgery \( r 0 50 \)
congestive heart failure , coronary events atherothrombotic brain infarction elderly blacks whites systemic hypertension without echocardiographic electrocardiographic evidence left ventricular hypertrophy hypertension present 50 196 blacks 36 whites \( p less 0 001 \) prospective study 84 elderly blacks \( 70 women \) 326 elderly whites \( 73 women \) hypertension correlated echocardiographic electrocardiographic left ventricular \( lv \) hypertrophy incidences congestive heart failure \( chf \) , coronary events atherothrombotic brain infarction \( \) echocardiographic lv hypertrophy \( p less 0 02 \) concentric lv hypertrophy \( p less 0 001 \) prevalent hypertensive blacks hypertensive whites hypertensive blacks younger \( 78 9 years \) hypertensive whites \( 82 7 years \) \( p less 0 001 \) coronary risk factors similar , except higher serum triglycerides whites blacks \( p less 0 02 \) follow 37 18 months blacks 43 18 months whites \( p less 0 01 \) incidences chf coronary events significantly different blacks whites incidence 38 blacks 21 whites \( p less 0 005 \) multiple logistic regression analysis showed prior chf \( p 0 000 \) , concentric lv hypertrophy \( p 0 018 \) echocardiographic lv hypertrophy \( p 0 022 \) independent risk factors chf echocardiographic lv hypertrophy \( p 0 001 \) , serum total cholesterol \( p 0 002 \) , concentric lv hypertrophy \( p 0 005 \) prior coronary artery disease \( p 0 \) independent risk factors coronary events prior \( p 0 001 \) , echocardiographic lv hypertrophy \( p 0 001 \) electrocardiographic lv hypertrophy \( p 0 034 \) independent risk factors
evaluation pharmacokinetics electrocardiographic effects intravenous verapamil intravenous calcium chloride pretreatment normal subjects evaluate effects calcium pretreatment disposition electrocardiographic effects verapamil , 8 healthy male volunteers received treatment 3 phases randomized , double blind , crossover manner phase 10 ml 0 9 intravenous sodium chloride followed 10 mg intravenous verapamil phase ii 10 ml 10 intravenous calcium chloride followed 4 ml 0 9 intravenous sodium chloride phase iii 10 ml 10 intravenous calcium chloride followed 10 mg intravenous verapamil blood samples determination verapamil concentrations drawn 5 , 10 , 15 , 20 , 30 , 45 , 60 90 minutes , 2 , 4 , 6 , 10 24 hours blood pressure , heart rate pr intervals also measured times pretreatment verapamil intravenous calcium alter disposition intravenous verapamil blood pressure significantly altered treatment phase , although calcium tended increase mean arterial pressure verapamil abolished effect calcium significant affect verapamil induced pr prolongation \( maximum percent change pr interval phase 19 11 , phase iii 18 7 time maximal prolongation phase 0 38 0 21 hours , phase iii 0 37 0 26 hours area percent change pr vs time curve phase 15 5 10 , phase iii 21 9 \) verapamil caused reflex increase heart rate similar magnitude phases iii \( 24 10 21 7 , respectively \)
people health conscious \? longitudinal study one community secular changes cardiovascular health awareness , knowledge behavior observed four cross sectional surveys cohort survey new england community changes related health promotion activities social milieu respondents , likely due national mass media health , effects may influence outcomes community based cardiovascular disease prevention studies
intraoperative detection patent foramen ovale transesophageal echocardiography study reports intraoperative use contrast doppler echocardiography techniques diagnose patent foramen ovale \( \) fifty patients without known atrial septal defects undergoing elective cardiovascular surgery studied 5 mhz esophageal echocardiographic probe used image fossa \( \) 10 ml saline injected right atrium apnea echocardiographic contrast injected end inspiration 20 cmh2o airway pressure opacification right atrium complete , airway pressure released maneuvers , color pulsed wave doppler atrial septum also performed right left passage saline contrast across interatrial septum seen 11 50 patients \( 22 \) doppler echocardiography demonstrated 2 patients without contrast evidence shunting thus , combination contrast doppler echocardiography identified 26 \( 13 50 \) prevalence , previously reported autopsy rate 25 contrast doppler techniques may useful detecting patients risk paradoxical emboli identifying candidates closure
active drainage cardiac lymph relation reduction size myocardial infarction experimental study active drainage cardiac lymph using hyaluronidase attempted dogs results satisfactory ischemic myocardium salvaged infarct risk area \( r \) ratio decreased drainage regional myocardial ischemia infarction provided means ligature left coronary artery 120 240 minutes respectively cardiac lymph collected conventional procedures enzymes released myocardium increased significantly cardiac lymph volume cardiac lymph gradually increased ligature coronary artery administration hyaluronidase increased cardiac lymph flow significantly decreased r ratio determined tetrazolium chloride \( ttc \) methylene blue staining drainage cardiac lymph salvaged ischemic myocardium reduction interstitial edema augmentation cardiac lymph flow hyaluronidase prevented development infarction first documentation effect active drainage cardiac lymph development infarction observation r ratio
therapy ischemic cardiomyopathy pentoxifylline abnormal blood known characteristics coronary artery disease authors evaluated effects pentoxifylline exercise capacity ejection fraction symptoms 9 patients ischemic cardiomyopathy patients signs symptoms left ventricular dysfunction least two major vessels obstructed determined coronary angiography pentoxifylline 400 mg three times daily administered twelve weeks seven 9 patients responded increases ejection fraction exercise tolerance exercise tolerance correlated improvement lack improvement ejection fraction patients twelve weeks post therapy mean ejection fraction increased 9 8 baseline \( p 07 \) , total treadmill time increased 15 \( p 27 \) , mean double product increased 13 \( p 03 \) anginal symptoms significantly improved baseline twelve weeks therapy \( p greater 001 \) , well dyspnea exertion \( p 03 \) pentoxifylline well tolerated pentoxifylline may benefit ischemic cardiomyopathy improving coronary perfusion owing favorable alterations properties
effect dopexamine hcl upon collateral perfusion acutely ischemic myocardium anesthetized dogs effects low dose \( 10 \( 9 \) 3 x 10 \( 9 \) mole kg min \) infusions dopexamine hcl , new synthetic catecholamine beta 2 adrenergic dopaminergic actions , tested anesthetized dogs , without acute ligation left anterior descending coronary artery infusions caused diastolic arterial blood pressure fall 12 4 23 5 mmhg , respectively microsphere estimated collateral blood flow ischemic myocardium change significantly drug infusions findings suggest low doses dopexamine hcl cause coronary steal acutely ischemic myocardium
aortic dissection communication right atrium case report case aortic dissection \( type 1 , de \) right atrium \( ra \) , diagnosed echocardiography \( echo \) confirmed aortography , reported patient presented cardiac failure continuous murmur right second third intercostal spaces patient survived two years medial treatment
relation three dimensional geometry inflow tract orifice area , shape , velocity regurgitant color doppler jets vitro study relation three dimensional geometry inflow tract orifice area , shape , velocity regurgitant jets studied pulsatile vitro color doppler flow model 2 5 mhz transducer connected diagnostic ultrasound machine placed water tank facing pulsatile jets \( duration , 0 5 second \) obtained calibrated flow rate 6 52 ml sec tested 5 mm diameter circular orifice four different three dimensional inflow tract compared \( \) sharp , \( b \) \( \) , \( c \) , \( \) mean velocities jets measured continuous wave doppler echocardiography driving pressures also measured means fluid filled catheter two observers independently digitized contours maximal color jet areas computer system two separate sets experiments results given mean values four measurements parameter jet areas correlated flow rate , difference shape \( eccentricity \) jets different b \( p less 0 05 \) , b \( p less 0 01 \) , c \( p less 0 01 \) shape jets correlated flow rate , continuous wave velocity , pressure gradient b , c , measured pressure gradients estimated gradients continuous wave doppler echocardiography similarly correlated
reproducibility intravascular ultrasound imaging vitro determine factors may affect image quality intravascular ultrasound catheter used vivo , influence blood , temperature change , contrast media evaluated addition , confirm reproducibility intravascular ultrasound imaging measure cross sectional lumen area , intraobserver interobserver variability determined findings indicated ultrasound images blood mildly attenuated , changes room temperature body temperature significant impact image quality , contrast media attenuates image intensity dose dependent manner , intravascular ultrasound imaging catheter provides reproducible method measuring arterial lumen area excellent intraobserver interobserver correlation
natural history left ventricular spontaneous contrast spontaneous contrast left ventricle unusual entity retrospectively studied 16 patients found spontaneous contrast present two dimensional echocardiograms , specifically clinical characteristics , reproducibility phenomenon , presence thrombi embolic events , prognostic implications diagnoses included ischemic heart disease nine patients , dilated cardiomyopathy six patients , hypertensive cardiomyopathy one patient mean ejection fraction 17 6 six thromboembolic events four patients spontaneous contrast reproducible periods time 39 months patients improvement left ventricular dysfunction underwent disappearance spontaneous contrast patients spontaneous contrast reproduced subsequent echocardiograms seem worse prognosis patients similarly depressed ventricular function , larger study necessary verify
role ultrasonic tissue characterization distinguish reversible irreversible myocardial injury tissue characterization reflects structural functional integrity tissues inasmuch reversible ischemia causes structural damage irreversible ischemia results persistent structural myocardial damage , postulated ultrasonic tissue characterization distinguish two types injuries anesthetized open chest dogs underwent 15 minutes \( group 1 , n 5 \) 90 minutes \( group 2 , n 8 \) acute total occlusion left anterior descending coronary artery , followed 3 hours reperfusion myocardial ischemia infarction confirmed segment shortening , examination , tetrazolium chloride staining integrated backscatter 5 \( \) , measure ultrasonic backscatter , fourier coefficient amplitude modulation \( \) , index cardiac cycle dependent variation backscatter , measured baseline , ischemia , reperfusion group 1 \( reversible ischemia \) showed increase 48 1 2 db control 45 1 0 db \( p less 0 01 \) ischemia , returned baseline reperfusion \( 47 1 3 db \) blunted ischemia \( 6 2 1 0 db control versus 1 2 1 0 db ischemia , p less 0 01 \) recovered completely reperfusion segment shortening abolished ischemia \( 18 3 control versus 12 5 ischemia , p less 0 01 \) recovered partially reperfusion \( 4 5 \) group 2 animals irreversible myocardial injury showed increase , 49 1 2 db control 44 1 0 db ischemia \( p less 0 01 \) paradoxical bulging ischemic region \( 17 3 7 3 , p less 0 01 \) ischemia
quantitative echocardiographic analysis global regional left ventricular function problem revisited recorded two dimensional echocardiograms simultaneously respiration measurements 20 normal subjects 20 patients anterior myocardial infarction apical long axis four chamber views quantitatively analyzed measurement variability global ejection fraction regional ejection fraction 100 regions calculated inspiration end expiration two observers minimize variability , endocardial contour traced improved computer assisted tracing system variability \( absolute mean difference \) two beats end expiration significantly less inspiration \( p less 0 05 \) ejection fraction variability end expiration 3 4 variability inspiration 6 4 \( mean , 54 sd , 7 \) regional ejection fraction variability end expiration 11 8 variability inspiration 21 5 \( mean , 56 sd , 15 \) intraobserver interobserver variability values one beat end expiration ejection fraction 3 1 3 8 , respectively , 9 5 12 8 , respectively , regional ejection fraction variability patients myocardial infarction comparable method recording respiration analyzing left ventricular function end expiration , new contour definition tracing system , provides measurement variability considerably less reported previous echocardiographic studies comparable angiographic methods
fenestrated atrial septal aneurysm diagnosis transesophageal echocardiography diagnosis atrial septal defect transthoracic echocardiography remains difficult small subset patients either suboptimal acoustic unusual anatomy , example , fenestrated defects report case 55 year old woman fenestrated atrial septal aneurysm incompletely visualized transthoracic echocardiography subsequent transesophageal echocardiography demonstrated three defects within atrial septal aneurysm left right shunting across defect normal pulmonary venous connections also defined echocardiographic findings confirmed surgery case demonstrates additional diagnostic accuracy transesophageal echocardiography detecting disease atrial septum
sustained improvement left ventricular function successful coronary angioplasty short long term effects successful percutaneous transluminal coronary angioplasty left ventricular function , rest exercise investigated 49 patients thirty four previous infarction \( group 1 \) 15 \( group 2 \) technetium 99m gated blood pool images obtained rest exercise , six weeks , mean fifteen months successful angioplasty angioplasty mean \( sd \) ejection fraction fell significantly exercise groups 58 \( 10 \) 53 \( 13 \) group 1 48 \( 10 \) 40 \( 16 \) group 2 change paralleled worsening wall motion score \( 0 6 \( 0 4 \) 1 6 \( 1 2 \) group 1 2 3 \( 1 9 \) 3 3 \( 2 4 \) group 2 \) six weeks procedure little change resting ejection fraction increased significantly exercise \( 62 \( 11 \) group 1 53 \( 13 \) group 2 \) concomitant significant improvement exercise wall motion score \( 0 4 \( 0 6 \) group 1 1 8 \( 1 1 \) group 2 \) improvement exercise ejection fraction wall motion maintained later follow significant deterioration either variable clearly sustained improvement ejection fraction \( 60 \( 10 \) group 1 51 \( 10 \) group 2 \) wall motion score \( 0 2 \( 0 2 \) group 1 1 3 \( 0 8 \) group 2 \) compared values angioplasty
post extrasystolic potentiation without compensatory normal diseased hearts variables derived left ventricular volume used study post extrasystolic potentiation left obtained 11 healthy individuals 49 patients coronary heart disease \( 30 previous myocardial infarction 19 without signs myocardial damage \) post extrasystolic potentiation induced regularly driven right atrial rhythm interrupted one atrial way post extrasystolic rr interval kept equal basic rr interval left ventricular end diastolic volumes pre extrasystolic post extrasystolic beats equal groups evidence post extrasystolic potentiation one indices left ventricular function \( ejection fraction , mean systolic ejection rate , systolic volume , stroke volume \) potentiation especially evident patients left ventricular damage suggests mechanism intrinsic property myocardium frank mechanism contribute increased performance post extrasystolic beat normal individuals patients coronary artery disease
streptokinase treatment femoral artery thrombosis arterial cardiac catheterisation infants children data 205 children underwent retrograde arterial catheterisation studied assess frequency femoral artery thrombosis safety efficacy systemic streptokinase treatment complication 29 \( 14 \) balloon dilatation performed 15 \( 7 3 \) patients impaired arterial perfusion due vascular spasm without thrombus formation seen cannulated leg catheterisation despite , signs impaired arterial circulation persisted nine patients \( 4 4 total \) patients femoral artery thrombosis strongly suspected six \( 53 \) undergone balloon dilatation therefore study risk femoral artery thrombosis developing 12 times greater balloon dilatation arterial catheterisation without dilatation \( 20 6 v 1 7 \) systemic infusion streptokinase started patients femoral artery thrombosis arterial perfusion became normal patients , though one delayed monitoring showed lengthening thrombin time decrease fibrinogen concentration streptokinase treatment serious complications systemic infusion streptokinase safe useful treatment children persistent femoral artery thrombosis arterial cardiac catheterisation
preoperative measurement pulmonary vascular resistance complete transposition great arteries transposition great arteries frequently complicated early onset pulmonary vascular disease difficult measure pulmonary blood flow fick principle pulmonary arteriovenous oxygen content difference small bronchial blood flow increased condition eight patients \( mean age 7 7 years , range 3 months 29 years \) transposition great arteries mass spectrometry used measure oxygen uptake predict pulmonary end capillary blood oxygen content effects bronchial circulation studied computer modelling close agreement pulmonary end capillary pulmonary vein blood oxygen contents resultant percentage difference arteriovenous content difference significant \( mean \( se difference \) \) \( 14 5 \( 3 8 \) \) effect bronchial circulation give high estimates pulmonary blood flow error greatest oxygen consumption low aortic blood
transmural myocardial deformation ischemic canine left ventricle myocardium complex three dimensional structure consisting myocytes dense collagen courses different directions regional ischemia expected produce complex changes ventricular deformation present study , examined effects ischemia two three dimensional finite strains acute transmural myocardial ischemia 13 open chest anesthetized dogs contrast systolic deformation observed control period circumferential shortening exceeded longitudinal shortening , results indicate 5 minutes acute ischemia , end systolic plane lengthening across left ventricular wall occurs approximately equal amounts circumferential longitudinal directions along changes strains , significant negative transverse shearing deformations ischemia myocardial ischemia also resulted loss normal end systolic transmural gradients shortening thickening three dimensional end diastolic strains indicate left ventricular wall undergoes significant passive varies lengthening epicardial plane wall thinning increasing epicardium toward endocardium large systolic changes shearing deformations ischemia could potentially influence collateral blood flow certainly indicate measurements deformation ischemic myocardium , account shearing deformation , incomplete must interpreted caution moreover , normal transmural systolic gradients deformation , would anticipated geometric grounds , lost ischemia , implying material properties ischemic tissue loading conditions imposed ischemic region partially impaired adjacent myocardium vary
protective effect increased substrate systolic diastolic dysfunction increased coronary resistance prolonged global underperfusion reperfusion isolated rabbit hearts perfused erythrocyte suspensions current therapy myocardial infarction may include early reperfusion simulated myocardial perfusion conditions evolving myocardial infarction isolated , normothermic , isovolumic rabbit hearts perfused buffer containing bovine red blood cells \( hematocrit 40 \) , assessed effects high levels glucose insulin therapy prolonged \( 150 minute \) severe underperfusion reperfusion protocol 1 consisted underperfusion constant coronary perfusion pressure 8 mm hg control group \( n 8 \) received 5 5 mmol l glucose 15 ml insulin group treated high levels glucose insulin \( g \) \( n 8 \) received 19 5 mmol l glucose 250 ml insulin underperfusion reperfusion relative control group , g group experienced 1 \) greater developed pressure underperfusion increased recovery reperfusion , 2 \) preserved diastolic function underperfusion reperfusion , 3 \) lower coronary resistance greater coronary flow underperfusion period , 4 \) increased flux preserved glycogen stores high energy phosphate levels , 5 \) less loss myocyte enzymes \( creatine kinase alanine aminotransferase \) protocol 2 , coronary flow kept identical control \( n 8 \) g hearts \( n 8 \) underperfusion period , left ventricular end diastolic pressure kept 10 mm hg groups minimize subendocardial damage vascular compression protocol , effect g intervention prevention increase coronary resistance underperfusion period distinguished metabolic effects high g substrate protective effects mechanical metabolic function less marked , similar , protocol 1 , indicating mechanisms protection underperfusion affected cardiac function coronary resistance conclude g intervention , clinically relevant concentrations , markedly protected severely myocardium 150 minutes may beneficial intervention combination reperfusion therapy acute myocardial infarction
effect coronary hyperemia emax oxygen consumption blood perfused rabbit hearts consequences 's phenomenon assess relation increases contractile function oxygen consumption \( vo2 \) increased coronary flow \( 's phenomenon \) , measured end systolic pressure volume relation relation vo2 left ventricular systolic pressure volume area \( , measure total mechanical energy output \) blood perfused , contracting rabbit hearts control intracoronary adenosine infusion adenosine infusion constant perfusion pressure \( 93 11 mm hg \) , coronary flow increased 99 76 \( p less 0 01 \) , slope end systolic pressure volume relation , emax \( ventricular contractility index \) , increased 18 15 \( p less 0 01 \) compared left ventricular volume , increased 20 14 \( p less 0 01 \) vo2 19 15 \( p less 0 01 \) adenosine vo2 relation linear condition \( median r 0 98 \) increased coronary flow , vo2 intercept vo2 relation \( unloaded vo2 \) increased 22 18 \( p less 0 01 \) without change slope , parallel upward shift observed , indicating contractile efficiency \( energy conversion efficiency contractile \) remained constant increases emax unloaded vo2 eliminated beta adrenergic blockade propranolol conclude increased coronary flow adenosine constant perfusion pressure augments emax cost excitation contraction coupling basal metabolism via mechanisms , without changing contractile efficiency
spontaneous termination reentry one cycle short nonsustained runs role oscillations excess dispersion refractoriness study describes factors contribute spontaneous termination reentry lasting one 10 cycles induction single premature stimulus reentry studied vitro rings canine atrial tissue around tricuspid valve orifice activation recorded circular array 10 extracellular bipolar electrodes equally spaced around ring experiments , transmembrane monophasic action potential recordings made near critical sites termination reentry within one cycle induction recorded 110 times 11 35 experiments important factors contributing termination 1 \) obligatory reversal activation sequence resulted long coupling interval critical region beyond site unidirectional block premature stimulus 2 \) much longer refractory periods limited critical region , facilitated unidirectional block contributed termination region first activated short coupling interval end first reentrant cycle termination nonsustained reentry lasting longer one cycle resulted oscillations conduction refractoriness initiated abrupt shortening cycle length initiation reentry oscillations conduction resulted interval dependent conduction reentrant encountered partially refractory tissue reentry become sustained , oscillations induction reentry must thus , cycle length oscillations induction may identify clinical tachycardias caused reentry partially gap
myocardial sulfhydryl pool alterations occur reperfusion brief prolonged myocardial ischemia vivo myocardial sulfhydryl \( sh \) containing compounds , including reduced glutathione \( gsh \) , potential markers reactive oxygen metabolite injury ischemia reperfusion examined alterations gsh myocardial sh pools reperfusion anesthetized dogs exposed brief \( 15 minutes , n 7 \) prolonged \( 90 minutes , n 6 \) regional ischemia caused occlusion left anterior descending artery ninety minutes ischemia followed 5 hours reperfusion , resulted myocardial necrosis 43 9 4 0 area risk , caused 22 reduction total myocardial sh groups \( p less 0 01 \) , 57 decrease nonprotein myocardial sh groups \( p less 0 01 \) , 56 decrease gsh \( p less 0 01 \) , 62 decrease non gsh , nonprotein sh groups \( p less 0 02 \) however , protein sh groups significantly reduced \( 12 decrease , p ns \) also , myocardial release gsh oxidized glutathione \( gssg \) coronary venous effluent occurred early reperfusion contrast , 15 minutes ischemia , followed 30 minutes reperfusion , alter myocardial total sh groups , protein sh groups , gsh \( 9 decrease , p ns \) reperfusion release gsh gssg however , even brief ischemia , nonprotein sh groups decreased 23 \( p less 0 05 \) , due mainly 59 decrease non gsh , nonprotein sh pool \( p less 0 05 \) changes brief ischemia occurred without alterations myocardial gssg gsh gssg ratio
accuracy exercise electrocardiography detecting physiologically significant coronary arterial lesions accuracy exercise electrocardiography detecting physiologically significant coronary artery stenosis assessed previously comparing exercise test coronary arteriogram inherent visually determined percent diameter stenosis measurements might lead conclusion exercise electrocardiogram less accurate truly determine accuracy exercise electrocardiography detecting physiologically significant coronary stenosis , studied 40 patients one vessel , one lesion coronary artery disease , normal resting electrocardiogram , hypertrophy prior infarction patient underwent exercise electrocardiography \( bruce protocol \) interpreted abnormal st segment developed 0 1 mv greater depression 80 msec j point physiological significance coronary stenosis assessed measuring coronary flow reserve \( peak divided resting blood flow velocity \) stenotic artery using doppler catheter intracoronary papaverine \( normal , 3 5 greater peak resting velocity \) percent diameter percent area stenosis produced lesion determined using quantitative angiography \( brown method \) 17 patients reduced coronary flow reserve \( 3 5 greater peak resting blood flow velocity \) stenotic artery , 14 abnormal exercise electrocardiogram \( sensitivity , 0 82 95 confidence interval , 0 70 0 94 \) conversely , 20 23 patients normal coronary flow normal exercise tests \( specificity , 0 87 95 confidence interval , 0 77 0 97 \) exercise electrocardiogram abnormal 11 patients markedly reduced coronary flow reserve \( less 2 5 peak resting velocity \) three six patients moderately reduced reserve \( 2 5 3 4 peak resting velocity \) products systolic blood pressure heart rate peak exercise significantly correlated coronary reserve patients truly abnormal exercise tests comparison , sensitivity \( 0 61 95 confidence interval , 0 46 0 76 \) specificity \( 0 73 95 confidence interval , 0 60 0 86 \) exercise electrocardiography detecting 60 greater diameter stenosis may significantly lower \( p less 0 05 \) exercise electrocardiography , therefore , good predictor physiological significance \( assessed coronary flow reserve \) coronary stenosis patients normal resting electrocardiogram hypertrophy prior infarction value broader larger patient population require study results , however , importance physiological gold standard assessing accuracy noninvasive studies detecting coronary artery disease
secular trends q wave non q wave acute myocardial infarction minnesota heart survey minnesota heart survey examined trends q wave non q wave acute myocardial infarction \( ami \) using 50 random sample hospital discharges patients ami another acute coronary disease 35 36 hospitals 1970 30 31 hospitals 1980 st metropolitan area total 1 , 1 , potential ami cases 1970 1980 , respectively electrocardiograms coded according minnesota code amis validated computerized algorithm based chest pain , enzymes , electrocardiograms , autopsy study shows use consistent , standard diagnostic algorithm , attack rates q wave ami change significantly 1970 1980 attack rates non q wave ami decreased significantly decade however , sensitive cardiac enzymes creatine phosphokinase creatine phosphokinase mb considered , attack rates q wave non q wave amis increased research documents four important trends community ami rates variance reported others decline non q wave ami attack rates 1970 1980 women outcomes equal worse men case fatality 7 year survival rates patients non q wave amis worse hospital prognoses q wave amis 7 year survival rates worse q wave ami 1980 findings demonstrate need standard diagnostic criteria q wave non q wave ami trends monitored future , new trials operative nonoperative therapies ami undertaken , considerations increase importance
impairment myocardial ultrastructure changes cytoskeleton dilated cardiomyopathy study designed determine morphological correlate chronic heart failure myocardial tissue eight patients undergoing transplantation surgery end stage dilated cardiomyopathy investigated electron microscopy immunocytochemistry using monoclonal antibodies elements cytoskeleton desmin , tubulin , , vimentin tissue showed hypertrophy , atrophy myocytes , increased amount fibrosis ultrastructural changes consisted enlargement varying shape nuclei , numerous small mitochondria , proliferation tubules , accumulation lipid droplets glycogen obvious ultrastructural alteration decrease , ranging complete absence cells filled unspecified cytoplasm immunocytochemistry showed desmin localized z lines diseased myocardium , amount desmin increased , arranged tubulin formed fine network throughout myocytes significantly increased cardiomyopathic hearts , protein closely associated cytoskeleton , occurred disc also within myocardial cells ultrastructural changes alterations cytoskeleton severe one third cells one third cells showed moderately severe changes , remaining cells normal vimentin present interstitial cells increased relation increase fibrosis conclude increase fibrosis , degeneration hypertrophied myocardial cells , alterations cytoskeleton morphological correlates reduced myocardial function chronic heart failure
hla class ii \( dr dq \) antigen associations idiopathic dilated cardiomyopathy validation study meta analysis published hla association studies previously reported antigen frequency differences hla dr4 hla idiopathic dilated cardiomyopathy \( \) patients healthy controls pilot study confirm findings , undertook independent study prospective hypothesis regarding frequencies dr4 typing second family class ii antigens \( hla dq \) included proximity dq loci dr loci strong linkage disequilibrium dr dq alleles comparing new consecutive series patients \( n 41 \) healthy blood bank controls \( n 53 \) , confirmed increase dr4 antigen frequency patients \( 49 versus 21 , p less 0 005 \) trend toward decreased expression among patients also noted \( 10 patients versus 23 controls \) hla significantly elevated patients compared controls \( 27 versus 6 , p less 0 005 relative risk , 6 1 etiologic fraction , 0 22 \) identified combined dr4 haplotype five 41 caucasian patients \( 12 \) none 53 controls \( p less 0 007 \) comparison specific antigen frequencies preliminary validation studies reveal significant differences therefore , data two studies examined combination combined studies , dr4 elevated \( 51 versus 27 controls , p less 0 001 \) , decreased \( 9 versus 24 controls , p less 0 01 \) relative risk dr4 2 8 , etiologic fraction 0 33
acute hemodynamic effects captopril children congestive restrictive cardiomyopathy acute hemodynamic effects captopril evaluated cardiac catheterization 16 children \( age , 0 3 18 years \) cardiomyopathy twelve children congestive cardiomyopathy , whereas four restrictive cardiomyopathy hemodynamic measurements obtained 30 60 minutes oral administration captopril \( 0 5 mg kg \) blood pressures measured aorta , pulmonary artery , right atrium , pulmonary capillary wedge position cardiac outputs measured thermodilution technique hemodynamic data could obtained administration captopril one child congestive cardiomyopathy immediate , severe hypotensive response 11 12 children congestive cardiomyopathy , cardiac index increased 22 , 2 3 2 8 l min m2 \( p less 0 05 \) , stroke volume increased 22 , 23 28 ml m2 \( p less 0 05 \) systemic vascular resistance decreased 32 21 units m2 \( p less 0 01 \) , mean aortic pressure change significantly contrast , four children restrictive cardiomyopathy change cardiac output captopril , trend toward significant arterial hypotension \( mean aortic pressure decreased 78 59 mm hg \) thus , captopril acutely reduced systemic vascular resistance increased cardiac output stroke volume children congestive cardiomyopathy children restrictive cardiomyopathy , however , captopril affect cardiac output , decrease aortic pressure data indicate captopril may benefit children congestive cardiomyopathy captopril probably used children restrictive disease
best method assessing long term outcome surgery accessory pathways atrioventricular junctional reentrant tachycardias \? success surgery supraventricular tachycardia \( svt \) evaluated variety methods different hospitals unfortunately , predictive values methods known therefore compared various methods 261 patients undergoing surgery svt hospital since 1981 surgical outcome assessed early tests first week surgery \( serial 12 lead electrocardiograms , monitoring electrocardiogram , electrophysiological study performed using epicardial wires \) later tests 6 months surgery \( 12 lead electrocardiograms electrophysiological study \) symptomatic review done telephone interview median 34 months surgery early tests obtained 97 , later tests obtained 76 , symptomatic review obtained 98 patients examined tests inaccurate methods surgical assessment compared late electrophysiological study large proportion patients proven surgical failures late electrophysiological study detected early tests \( 83 \) , later electrocardiograms \( 66 \) , symptomatic assessment \( 41 \) accurate assessment surgical outcome requires late electrophysiological study permit comparison surgical techniques late electrophysiological study also provides accurate information current risks benefits proposed surgery communication patients enable make informed decision future treatment patients willing late electrophysiological study usually benefit clarification true surgical outcome
relation leisure time physical activity blood pressure older women although evidence physical activity may decrease blood pressure young middle aged women , physical activity blood pressure association older women rarely studied part ongoing community based study chronic disease , caucasian women ages 50 89 years blood pressure measured following hypertension detection follow program protocol also answered selected health interview survey questions leisure time activity classified categories light \( 58 \) , moderate \( 24 \) , heavy \( 6 \) , physical activity \( 12 \) estimated metabolic rate required activity women engaged physical activity significantly younger sedentary women lower fasting 2 hour insulin levels differ alcohol consumption , cigarette use , prevalence coronary heart disease diabetes rates systolic diastolic hypertension significantly lower women participating light , moderate , heavy physical activity compared sedentary women blood pressure levels decreased increase reported activity intensity \( p less 0 005 trend \) , systolic blood pressure approximately 20 mm hg lower activity group compared systolic blood pressure sedentary women intergroup differences remained statistically significant adjustment age body mass index although physical activity associated lower fasting 2 hour insulin levels \( p less 0 01 trend \) , adjustment insulin levels alter blood pressure differences among activity groups
mechanisms reoxygenation injury cultured ventricular myocytes investigate factors contributing reperfusion reoxygenation myocardial injury , exposed layers cultured ventricular myocytes severe hypoxia 3 hours presence 20 mm 2 deoxyglucose , zero glucose , 5 mm pyruvate , exposed myocytes reoxygenation lactate dehydrogenase \( ldh \) release moderately increased 3 hours hypoxia increased markedly reoxygenation coincident changes intracellular calcium concentration \( ca2 \) cell motion also measured hypoxia reoxygenation hypoxia , ca2 increased 1 microm , reoxygenation , ca2 decreased slightly remained elevated 1 microm cells developed stable 30 minutes hypoxia reoxygenation caused marked within 5 minutes pretreatment myocytes either 2 , 3 , inhibits ca2 \( \) dependent force development , cyanide inhibited reoxygenation ldh release reoxygenation also significantly reduced presence 2 , 3 treatment myocytes superoxide dismutase catalase hypoxia also resulted decrease ldh release reoxygenation conclude abrupt increase ca2 reoxygenation account reoxygenation injury however , presence elevated ca2 , reoxygenation resulting probable atp causes ca2 dependent cycling , resulting contributes myocyte damage generation oxygen free radicals reoxygenation also appears contribute cell injury system
new method quantification regurgitant flow rate using color doppler flow imaging flow convergence region proximal discrete orifice vitro study color doppler flow mapping yielded quick relatively sensitive method turbulent jets generated valvular insufficiency , quantification degree valvular insufficiency limited dependence visualization turbulent jets hemodynamic well instrument related factors color doppler flow imaging , however , capability reliably showing spatial relations flows area flow accelerates proximal regurgitant orifice commonly visualized left ventricular side mitral regurgitant orifice , especially imaging performed high gain low pulse repetition frequency area flow convergence , flow , quantified velocity flow cross sectional area change inverse proportion along centered orifice study , driven constant flow system five sharp diaphragm orifices \( ranging 2 9 12 mm diameter \) imaged parallel perpendicular direction flow orifice color doppler flow images produced zero shifting abrupt change display color occurred different velocities boundary known velocity measurable radial distance center orifice used determine isovelocity hemisphere flow rate orifice calculated 2 pi r2 x , r radial distance center orifice color change velocity color change noted using values 54 14 cm sec obtained 3 75 mhz transducer 75 18 cm sec obtained 2 5 mhz transducer , calculated flow rates found correlate measured flow rates \( r 0 94 0 99 \) slope regression line closest unity lowest correspondingly largest r used calculation flow rates estimated color doppler flow imaging could also used conjunction continuous wave doppler measurements maximal velocity flow orifice calculate orifice areas \( r 0 75 0 96 correlation measured areas \)
effects pressure volume receiving chamber spatial distribution regurgitant jets imaged color doppler flow mapping vitro study regurgitant jet dimensions imaged color doppler flow mapping used evaluate severity valvular insufficiency clinical studies study effect pressure volume within receiving chamber magnitude spatial distribution regurgitant jets assessed color doppler techniques , designed simple constant flow model jet driven known orifice \( 1 5 mm2 \) compliant receiving chamber steady flow pump distal tube outflow closed system maintained volume chamber constant pump operation varied flow rate 60 270 ml min elastic balloons different static 1 , 2 , 4 5 , 9 ml mm hg \( pressures 57 , 28 , 18 , 8 mm hg , respectively \) balloons served receiving chambers constant volume 150 ml also evaluated effect different volumes receiving chamber \( 110 , 130 , 150 ml pressures 5 , 15 , 24 mm hg \) static compliance 2 ml mm hg range flow rates different balloons , jet area correlated linearly jet velocity across orifice \( r 0 98 , 0 99 , 0 98 , 0 97 \) also flow rate \( r 0 97 , 0 99 , 0 98 , 0 99 \) flow rate volume receiving chamber , however , jet area imaged color doppler decreased pressure receiving chamber increased , although receiving chamber volume constant
changes left ventricular volume , mass , function development regression supraventricular tachycardia induced cardiomyopathy disparity recovery systolic versus diastolic function chronic supraventricular tachycardia causes dilated cardiomyopathy man tachycardia appears result symptomatic improvement however , effects left ventricular \( lv \) volume , mass , function fully examined accordingly , hemodynamic studies using simultaneous echocardiography catheterization performed three groups pigs 1 \) subjected rapid left atrial pacing \( 240 beats min \) 3 weeks \( svt , n 8 \) , 2 \) subjected supraventricular tachycardia 3 weeks followed termination pacing 4 week recovery period \( psvt , n 9 \) , 3 \) sham operated controls \( ctr , n 10 \) systolic pump function assessed using fractional shortening \( fs \) , peak ejection rate peak \( \) dd dt , maximum rate pressure development peak \( \) dp dt diastolic function assessed using time constant isovolumic pressure decline \( tau \) , peak early diastolic filling rate peak \( \) dd dt , chamber stiffness constant \( kc \) , myocardial stiffness constant \( km \) supraventricular tachycardia caused lv dilation \( end diastolic dimension increased 3 5 0 4 cm ctr 4 9 0 5 cm svt , p less 0 05 \) change lv mass \( lv weight body weight ratio lv bw \) 2 58 0 3 g kg ctr 2 66 0 4 g kg svt \) , indexes systolic function became abnormal \( fs fell 30 4 ctr 13 5 svt , p less 0 05 \) , indexes relaxation filling slowed \( tau increased 36 3 msec ctr 51 13 msec svt , p less 0 05 \) significant changes kc km supraventricular tachycardia , lv volume fell remained greater ctr \( 4 2 0 4 cm psvt , p less 0 05 versus ctr \) substantial lv hypertrophy developed \( lv bw 3 48 0 5 g kg psvt , p less 0 05 versus ctr \) systolic function returned normal \( fs 31 5 psvt \) diastolic function remained abnormal psvt , tau remained prolonged \( 49 12 msec , p less 0 05 versus ctr \) , kc increased 3 7 1 0 ctr 7 4 1 2 \( p less 0 05 \) , km increased 4 4 1 5 ctr 13 9 9 7 \( p less 0 05 \) thus , improvement systolic function occurs termination supraventricular tachycardia associated development lv hypertrophy persistent diastolic dysfunction
load dependence left ventricular diastolic pressure volume relations short term coronary artery occlusion evaluated effect altered loading conditions left ventricular \( lv \) diastolic pressure volume relations acute coronary artery occlusion produced inflation intracoronary balloon open chest anesthetized dogs \( n 18 \) instrumented lv pressure \( micromanometer \) lv volume \( conductance \) could measured without pericardium effects brief periods occlusion \( 1 2 minutes \) assessed steady state conditions dextran infusion pericardium present absent vena caval occlusion steady state conditions dextran infusion pericardium removed , lv end diastolic pressure \( edp \) 8 4 1 4 mm hg , occlusion resulted rightward shift diastolic portion lv pressure volume loop \( delta lvedp , 2 7 2 3 mm hg delta , 6 3 4 7 ml , p less 0 05 versus control \) dextran infusion \( lvedp , 20 9 6 0 mm hg \) , occlusion resulted rightward upward shift diastolic portion lv pressure volume loop \( delta lvedp , 5 8 4 4 mm hg delta , 4 2 3 0 ml , p less 0 05 versus control \) low cardiac volumes dextran infusion , intact pericardium affect response occlusion contrast , dextran infusion presence intact pericardium , lvedp significantly increased \( delta , 6 4 3 6 mm hg , p less 0 05 \) \( delta , 0 7 1 5 ml , p ns \) parallel upward shift diastolic portion lv pressure volume loop eliminated removal pericardium thus , change lv diastolic pressure volume occlusion varied depended baseline cardiac volume presence pericardium dextran infusion pericardium present absent , coronary artery occlusion alter lv diastolic chamber stiffness parameter , calculated diastolic interval averaged steady state beat \( 0 0 019 versus 0 036 0 015 mm hg ml , p ns \) dextran infusion pericardium present absent , coronary artery occlusion increased lv diastolic chamber stiffness parameter \( 0 0 034 0 0 034 mm hg ml , p less 0 05 versus controls , respectively \) vena caval occlusion eliminated shifts diastolic portion lv pressure volume loop pericardium present absent \( abstract truncated 400 words \)
left ventricular diastolic dysfunction limits use maximum systolic elastance index contractile function tested hypothesis maximum systolic elastance \( emax \) fails detect decline left ventricular \( lv \) contractile function diastolic dysfunction present canine hearts studied isolated blood perfused heart apparatus \( isovolumic lv \) contractile dysfunction produced 60 90 minutes global ischemia , followed 90 minutes reperfusion nine normal hearts underwent 60 minutes ischemia , five underwent 90 minutes ischemia ischemia reperfusion sequence , developed pressure , pressure volume area , myocardial atp level significantly less baseline 14 hearts group undergoing 60 minutes ischemia , lv diastolic pressure increase , whereas emax decreased 5 2 2 5 2 9 1 4 mm hg ml \( p less 0 05 \) group undergoing 90 minutes ischemia , diastolic pressure increased \( 10 2 37 20 mm hg , p less 0 05 \) , emax change significantly \( 5 1 4 3 4 3 2 5 mm hg ml \) second series experiments performed 13 hearts pressure overload hypertrophy \( aortic band model echocardiography catheterization studies ischemia reperfusion protocol \) five evidence pump failure , whereas eight remained compensated 60 minutes ischemia 90 minutes reperfusion , developed pressure , pressure volume area , myocardial atp level significantly less baseline 13 hearts group compensated lv hypertrophy , lv diastolic pressure change , whereas emax decreased 6 9 3 0 3 1 2 3 mm hg ml \( p less 0 05 \)
natural history peripheral vascular disease implications management eventual complication rate endovascular therapy \( percutaneous transluminal angioplasty , laser assisted angioplasty , \) yet entirely clear , especially respect treatment atherosclerotic lesions femoropopliteal distal arterial segments therefore , indications use firmly established must take consideration natural history occlusive disease although type procedural intervention clearly warranted presence ischemic rest pain tissue necrosis , intermittent claudication complaint approximately 70 patients present either aortoiliac femoropopliteal involvement nondiabetic patients experience substantial symptomatic improvement daily exercise program , long term risks either abrupt deterioration \( 20 25 \) amputation \( less 10 \) relatively low comparison , 5 year mortality rate ranges 20 40 even , many 40 clinical indications associated coronary artery disease shown angiographically candidates myocardial revascularization observations suggest traditional indications surgical treatment \( truly disabling claudication limb salvage \) also applied endovascular therapy success confirmed beyond , incidental coronary disease deserves particular attention patients lower extremity ischemia
impact nonoperative therapy clinical management peripheral arterial disease nonoperative therapy includes conservative modalities endovascular interventional modalities percutaneous transluminal angioplasty variety laser systems devices role impact nonoperative treatments considered perspectives natural history lower extremity arteriosclerosis present surgical \( operative \) treatment nonoperative treatments may replace facilitate surgical treatment operative candidates nonoperative methods may also justify treatment patients cannot subjected surgery opinions relating uses nonoperative treatments presented , individuals treating patients lower extremity ischemia resulting peripheral arteriosclerosis discussed
diagnosis evaluation renovascular hypertension indications therapy renovascular hypertension caused two distinct conditions different causes , fibromuscular dysplasia atheroma diagnosis former simpler , whereas atheromatous lesions renal artery may secondary essential hypertension therefore important establish existence functional renal ischemia well anatomical lesion universal screening hypertensive patients recommended relatively low prevalence disease insufficient accuracy available screening tests renovascular hypertension clinically suspected , oral captopril test reliable office screening test , digital subtraction angiography renal vein captopril renography appropriate steps however , latter procedure , promising , requires evaluation duplex scanning renal arteries also comes category arteriography done last , renal ischemia indicated , angioplasty attempted time arteriography
clinical anatomical considerations surgery aortoiliac disease results surgical treatment variety surgical procedures available treatment occlusive disease involving aorta iliac arteries use appropriate operation patient , determined principally disease location patient risk , provide highly effective relief disabling claudication limb threatening ischemia low morbidity mortality rates excellent , durable results current surgical practice serve standard newer treatment modalities must compared
results complications angioplasty aortoiliac disease percutaneous transluminal angioplasty used treat 340 aortoiliac lesions 200 patients followed long 90 months \( mean , 28 7 months median , 23 months \) initial success rate 94 7 lesions 93 0 patients indications percutaneous transluminal angioplasty included claudication 117 patients \( 58 5 \) , rest pain ischemic night pain 47 \( 23 5 \) , limb salvage 33 \( 16 5 \) , wound healing three \( 1 5 \) series , 70 patients two cardiovascular risk factors angioplasty initially unsuccessful 14 patients , 10 patients lost follow follow obtained 176 patients long term results analyzed using life table method determine cumulative patency fourteen patients considered failures recurrent disease symptoms projected 7 5 year cumulative patency rate 85 response considered , projected 7 5 year cumulative patency rate 92 results indicate percutaneous transluminal angioplasty successfully correct aortoiliac lesions provide long term benefit long 7 5 years
standards evaluating results interventional therapy peripheral vascular disease uniform standards evaluating reporting results therapeutic interventions peripheral vascular disease clearly needed already established vascular surgery , represented several reports , always followed vascular surgeons largely ignored vascular article , major problematic reporting practices discussed illustrated , 14 recommendations advanced deal intended provide precise definitions , objective criteria success failure , standardized severity schemes peripheral vascular disease risk factors , proper procedures reporting outcome forms therapeutic intervention agreed upon reporting standards accepted followed , literature peripheral vascular disease management continue source confusion rather
clinical anatomic considerations surgery femoropopliteal disease results surgery 1980 1988 performed femoropopliteal bypass operations 231 patients health university indication procedure claudication 31 relief limb threatening ischemia 64 operative mortality occurred four operations \( 1 4 \) , including three deaths myocardial infarction one death stroke femoropopliteal bypass patients divided groups patency analysis , including undergoing bypass surgery good quality greater saphenous vein versus alternate bypass conduits patients undergoing primary limb bypass versus undergoing repeat bypass prior bypass failure overall primary graft patency femoropopliteal grafts 79 5 years patients undergoing bypass good quality greater saphenous vein primary graft patency 85 5 years patients undergoing bypass using conduit greater saphenous vein 5 year patency 73 patients undergoing repeat bypass prior failed bypass 5 year patency 57
femoropopliteal angioplasty factors influencing long term success prospective data recorded 217 percutaneous transluminal angioplasty \( pta \) procedures performed superficial femoral popliteal arteries 8 year period initial procedure , patients followed serial noninvasive studies , 71 patients , repeat angiography mean follow period 7 years \( range , 2 11 years \) standard life table survival analysis used assess factors potentially affecting long term outcome excluding initial technical failure rate 10 , overall 1 , 3 , 5 years 81 , 61 , 58 , respectively first year , prognosis \( e , failure rate \) appears linear long term \( e , 10 years \) factors negatively influencing long term patency include presence diabetes mellitus , diffuse atherosclerotic cardiovascular disease , threatened limb loss technical factors correlated failure include lesion length , moderate eccentricity , poor post pta appearance
clinical anatomic considerations surgery tibial disease results surgery bypass vein grafts arteries achieve 5 year cumulative patency equivalent vein grafts popliteal arteries technique situ vein grafting tibial arteries described results presented 5 year cumulative patency bypasses 5 year limb salvage patients approximately 80 results coupled reported centers sizable experience tibial artery reconstruction suggest real progress past decade salvage lower extremities patients far advanced peripheral vascular disease use autogenous venous bypass grafts
hot tip laser results complications hot tip laser system used since mid 1984 device indications extending applicability angioplasty management lower extremity atherosclerosis controversial device although system demonstrates occasionally useful management occlusive opposed stenotic disease infrainguinal arteries , close examination published data fails demonstrate consistent improvement either primary success long term patency rates thermal energy applied atheroma recanalization lower extremity arteries
prevention hypertension vascular changes captopril treatment treatment female spontaneously hypertensive rats \( shr \) control wistar kyoto \( wky \) rats captopril carried addition drug drinking water throughout pregnancy lactation weaning 28 weeks age , average systolic blood pressure treated shr 113 3 mm hg , control shr \( 188 3 mm hg \) wky rats \( 124 3 mm hg \) body weight heart rate shr affected treatment tissue level catecholamines increased captopril treatment superior cervical ganglia remained unchanged plasma , heart , mesenteric arteries , adrenal glands shr wky rats left ventricular weight , wall thickness , internal diameter left ventricle shr reduced treatment morphometric measurements mesenteric arteries showed vascular alterations present control shr prevented treatment superior mesenteric artery large mesenteric artery , smaller lumen size maximal relaxation found control shr normalized level wky rats hypertrophy medial wall superior mesenteric , large small mesenteric arteries , increase number smooth muscle cell layers large mesenteric artery shr prevented treatment perfusion study mesenteric vascular bed showed reactivity vessels norepinephrine reduced , sensitivity norepinephrine \( determined effective dose causes 50 maximal response \) increased shr captopril treatment sensitivity tail artery response norepinephrine altered treatment conclude long term treatment captopril shr birth prevented development hypertension , structural functional alterations mesenteric arteries , cardiac hypertrophy
isolation preferentially expressed genes kidneys hypertensive rats differential hybridization , three complementary dnas designated s3 , s2 , sa isolated , corresponding messenger rnas \( mrnas \) differentially expressed kidneys spontaneously hypertensive rats \( shr \) normotensive wistar kyoto \( wky \) rats s3 identical cytochrome iv a2 sa encoded protein amino acid residues , carboxyl terminal region slight homology homologous sequence reported s2 sequences s3 mrna four times abundantly expressed kidneys 28 day old shr age matched wky rats , difference age 16 weeks low nacl diet positively modulated expression s3 gene s2 mrna almost undetectable kidneys 28 day old wky rats clearly detected age matched shr expression level s2 mrna livers 16 week old shr five times higher age matched wky rats expression s2 mrna livers modulated dietary nacl captopril sa mrna 10 times abundantly expressed kidneys shr wky rats age 4 weeks administration captopril , expressions sa mrna livers shr positively modulated three genes differentially expressed shr wky rats also related sodium metabolism blood pressure control , identification genes may provide important probes examine mechanisms hypertension
impaired insulin action skeletal muscle metabolism essential hypertension previous studies shown essential hypertension frequently associated insulin resistance tissues responsible metabolic alteration defined tested hypothesis skeletal muscle site insulin resistance essential hypertension use perfused forearm technique eight hypertensive \( age 42 3 years , body mass index 27 1 kg m2 , intra arterial mean blood pressure 126 4 mm hg \) seven normotensive \( age 48 3 years , body mass index 26 1 kg m2 , mean blood pressure 95 4 mm hg \) male volunteers studied glucose ingestion \( 40 g m2 \) , normal glucose tolerance patients maintained expense heightened plasma insulin response , suggesting presence insulin resistance graded , local \( intra arterial \) hyperinsulinemia encompassing physiological range \( 12 120 l \) , glucose uptake forearm tissues significantly \( p less 0 03 \) reduced hypertensive subjects compared controls five insulin steps , 43 average addition , forearm lactate pyruvate release significantly less stimulated hypertensive normotensive group \( p less 0 01 \) , presumably consequence decreased glucose influx forearm exchange oxygen , carbon dioxide , lipid substrates \( free fatty acids , glycerol , beta hydroxybutyrate \) , potassium similar hypertensive normotensive groups basal state insulin effect oxygen consumption , carbon dioxide production , respiratory either study group , whereas stimulated free fatty acids , glycerol , potassium uptake extent hypertensive normotensive groups
nicotine impairs reflex renal nerve respiratory activity acetate salt rats smoking increase arterial pressure hypertension effect nicotine baroreceptor mediated reflex responses renal nerve activity \( rna \) , heart rate , respiratory activity \( minute diaphragmatic activity mda \) bolus injections phenylephrine compared acetate \( doca \) salt sensitive normotensive rats osmotic either nicotine \( 2 4 mg kg day \) saline implanted doca normotensive rats 18 days anesthetized doca nicotine , doca saline , control nicotine , control saline rats mean arterial pressures \( map \) 117 3 , 110 9 , 90 3 , 89 5 mm hg , respectively nicotine decreased sensitivity \( p less 0 05 \) baroreceptor reflex control rna \( delta rna delta map \) doca nicotine rats \( 0 92 0 08 \) compared doca saline \( 1 44 0 16 \) , control nicotine \( 1 45 0 08 \) , control saline \( 1 45 0 21 \) rats reflex decrease respiratory activity \( delta mda delta map x 100 \) impaired \( p less 0 01 \) control nicotine \( 24 5 3 3 \) doca nicotine \( 18 2 4 6 \) rats compared control saline \( 59 2 9 1 \) doca saline \( 52 5 9 9 \) rats reflex decrease heart rate \( absolute delta hr delta map \) doca nicotine \( 1 56 0 17 \) control nicotine \( 1 54 0 24 \) rats augmented compared doca saline control saline rats \( 0 91 0 12 0 97 0 14 \)
effect drug diet treatment mild hypertension diastolic blood pressure research group trial antihypertensive interventions management multicenter randomized trial designed examine diastolic blood pressure response various combinations pharmacological dietary interventions treatment mild hypertension \( diastolic blood pressure 90 100 mm hg \) eight hundred seventy eight participants 110 160 ideal weight randomly allocated nine drug diet treatment groups receiving either placebo , chlorthalidone \( 25 mg \) , atenolol \( 50 mg \) , combined usual , weight loss , low sodium high potassium diet primary outcome diastolic blood pressure change baseline 6 months seven hundred eighty seven participants follow data mean baseline diastolic blood pressure 93 8 mm hg 55 9 participants male , weight loss diet group lost average 4 7 kg multiple comparisons accounted analysis significantly greater lowering diastolic blood pressure \( 12 4 mm hg \) achieved atenolol group compared either low sodium high potassium diet group \( 7 9 mm hg , p 0 001 \) weight loss group \( 8 8 mm hg , p 0 006 \) adding weight loss chlorthalidone significantly enhanced blood pressure lowering \( 15 1 mm hg \) compared diuretic alone \( 10 8 mm hg , p 0 002 \) , adding low sodium high potassium diet \( 12 2 mm hg , p 0 \) short term treatment mild hypertension diastolic blood pressure sole consideration , drugs diet , weight loss beneficial , especially diuretics
characterization gaps external pulse recording three types gaps , called g1 , g2 , g3 , occur blood pressure measurement identified using external pulse recording previously shown external pulse recorded cuff deflation separated three components \( k1 , k2 , \) , one \( k2 \) closely related sound g1 occurs cuff pressure systolic characterized presence k1 k2 intermittent disappearance k2 g1 gaps related phasic decrease arterial \( systolic \) pressure exhibited 13 60 hypertensive patients g2 gaps related phasic increase arterial \( diastolic \) pressure , occur cuff pressure diastolic , characterized presence k1 , k2 , intermittent disappearance k2 seven 60 hypertensive patients exhibited g2 gap g3 gaps occur cuff pressure systolic diastolic characterized blunted k2 signal three 60 hypertensive patients exhibited g3 gap identification gaps relation external pulse provides qualitative measure existence , significant value better understanding aspects blood pressure measurement technique , provides objective basis better understand mechanisms cause
myocardial protein turnover patients coronary artery disease effect branched chain amino acid infusion regulation protein metabolism human heart previously studied 10 postabsorptive patients coronary artery disease , heart protein synthesis degradation estimated simultaneously extraction intravenously infused l ring 2 , 6 3h phenylalanine \( phe \) dilution specific activity across heart steady state subsequently examined effect branched chain amino acid \( bcaa \) infusion heart protein turnover myocardial balance amino acids branched chain \( \) patients postabsorptive state , net release phenylalanine \( arterial cardiac venous phe 1 71 0 32 nmol ml , p less 0 001 balance 116 21 nmol phe min , p less 0 001 \) , reflecting protein degradation \( 142 40 nmol phe min \) excess synthesis \( 24 42 nmol phe min \) net myocardial protein catabolism bcaa infusion , protein synthesis increased equal degradation rate \( 106 24 106 28 nmol phe min , respectively \) phenylalanine balance shifted \( p 0 01 \) negative neutral \( arterial cardiac venous phe 0 07 0 36 nmol ml balance 2 25 nmol phe min \) bcaa infusion stimulated myocardial uptake bcaa \( p less 0 005 \) ketoacid conjugates \( p less 0 001 \) proportion circulating concentrations net uptake bcaa greatly exceeded essential amino acids suggesting role bcaa metabolic plasma insulin levels , cardiac double product , coronary blood flow , myocardial oxygen consumption unchanged results demonstrate myocardium postabsorptive humans negative protein balance indicate primary anabolic effect bcaa human heart
sclerotherapy varicose telangiectatic leg veins minimal sclerosant concentration hypertonic saline relationship vessel diameter author reports results double blind , paired comparison study using saline sclerosant plus minus heparin additive study designed elucidate effects increasing concentrations hypertonic saline regard vessel diameter , clinical efficacy , complications , discomfort six hundred women bilaterally symmetrical varicose veins entered study sodium chloride 11 7 appeared minimal sclerosant concentration saline produced effective vein sclerosis vessels less 8 mm diameter , producing least morbidity optimal concentration sclerosant may vary diameter vessels therapeutic consideration
natural history moderate aortic stenosis natural history severe , symptomatic aortic stenosis well documented however , natural history moderate aortic stenosis remains poorly understood therefore , group 66 patients identified diagnosis moderate aortic stenosis time cardiac catheterization \( aortic valve area 0 7 1 2 cm2 \) surgical therapy 1st 180 days cardiac catheterization mean follow period 35 months , 14 patients died causes attributed aortic stenosis 21 underwent aortic valve replacement estimated probability remaining free complication aortic stenosis end first 4 years 59 symptomatic patients decreased ejection fraction hemodynamic evidence left ventricular decompensation greater risk complications concluded patients moderate aortic stenosis significant risk development complications
effect h1 receptor stimulation coronary artery diameter patients variant angina comparison effect acetylcholine suggested histamine involved pathogenesis coronary spasm exact role remains unclear h1 receptor stimulation coronary artery performed selective intracoronary infusion histamine \( 2 micrograms min \) 21 patients variant angina blockade h2 receptor cimetidine \( 25 mg kg \) effect coronary artery diameter examined intracoronary injection acetylcholine also performed 19 21 patients \( 0 2 mg \) intravenously administered one patient coronary artery diameter measured analysis mean plasma histamine concentration coronary sinus increased 4 x 10 \( 9 \) 7 x 10 \( 8 \) 5 min histamine infusion left coronary artery \( n 18 \) coronary spasm induced 6 patients \( 29 \) histamine , 18 \( 95 \) acetylcholine 1 effect histamine luminal diameter analyzed site spasm 26 coronary arteries spasm induced acetylcholine 20 coronary arteries normal arteriogram fixed stenosis less equal 50 luminal diameter , histamine decreased diameter 4 , increased 14 \( 70 \) caused change 2 6 coronary arteries fixed stenosis greater equal 75 , histamine decreased diameter 5 increased 1 coronary arteries spasm induced either acetylcholine , histamine increased diameter , especially without advanced atherosclerosis
percutaneous mitral valvuloplasty surgical high risk patients among 126 consecutive patients undergoing percutaneous mitral valvuloplasty , 34 judged high risk surgery basis age greater 70 years \( n 13 \) , new york heart association functional class iv \( n 11 \) , ejection fraction less equal 35 \( n 3 \) , severe pulmonary hypertension \( n 7 \) , need associated coronary bypass \( n 4 \) additional valve surgery \( n 20 \) severe pulmonary disease \( n 3 \) baseline features high risk group substantially worse patients age \( 65 11 versus 49 12 years p 0 0001 \) echocardiographic score \( 9 4 1 8 versus 8 2 1 5 p 0 005 \) higher , whereas cardiac output \( 2 9 0 9 versus 4 1 1 2 liters min p 0 0001 \) mitral valve area \( 0 9 0 4 versus 1 1 0 3 mm2 p 0 002 \) lower three high risk patients experienced technical failures three others major complications among remaining 28 patients , 18 \( 65 \) complete hemodynamic success , 4 \( 14 \) incomplete success 6 \( 21 \) hemodynamic failure stepwise logistic regression analysis retained echocardiographic score factor independently predictive success percent increase mitral valve area also correlated echocardiographic score \( r 0 51 , p less 0 01 \)
variable extent myocardium patients single vessel coronary artery disease quantification thallium 201 single photon emission computed tomography assess extent myocardium patients single vessel coronary artery disease variable severity location , quantitative exercise thallium 201 single photon emission computed tomography performed 158 consecutive patients angiographically proved single vessel coronary artery disease extent abnormal left ventricular perfusion quantified computer generated polar maps three dimensional myocardial radioactivity patients moderate \( 51 69 \) stenosis tended small perfusion defect irrespective coronary artery involved whereas perfusion defect measuring greater equal 10 left ventricle found 78 patients prior infarction severe \( greater equal 70 \) stenosis , observed 24 patients moderate stenosis perfusion defect size increased increasing severity stenosis entire group without infarction left anterior descending , right circumflex coronary artery stenosis however , correlation stenosis severity perfusion defect size best modest \( r 0 38 , p 0 0001 \) left anterior descending artery shown important three coronary arteries providing left ventricular perfusion proximal stenosis artery produced perfusion defect approximately twice large found patients proximal right circumflex artery stenosis however , marked heterogeneity perfusion defect size existed among three vessels despite comparable stenosis severity apparent left anterior descending coronary artery , mid vessel stenosis commonly produced perfusion defect similar size found proximally stenosed vessels
primary angioplasty myocardial infarction assessment improved myocardial perfusion technetium 99m isonitrile technetium 99m hexakis 2 methoxy 2 isobutyl isonitrile \( technetium 99m isonitrile \) new radiopharmaceutical compound reflects myocardial perfusion kinetics , especially lack redistribution intravenous administration , permits assessment changes myocardial perfusion without delay therapy tomographic images rest obtained immediately 6 10 days later 17 consecutive patients undergoing successful primary angioplasty first transmural myocardial infarction thirteen patients anterior infarction initial \( acute \) defect size angioplasty 48 17 left ventricle decreased significantly \( p less 0 0001 \) 29 19 late scans correlation time therapy reduction defect size twelve 17 patients , including 7 11 patients treated 4 h , demonstrated definite reduction initial defect size eight patients angiographically proved persistent coronary occlusion underwent similar imaging sequence initial defect size group remained unchanged late scans \( 24 16 versus 26 18 , p ns \) primary angioplasty effective approach toward myocardium comparison thrombolytic drug therapy must results controlled clinical trials
differentiating cardiomyopathy coronary artery disease nonischemic dilated cardiomyopathy utilizing positron emission tomography determine imaging blood flow \( using n 13 ammonia \) glucose metabolism \( using f 18 2 deoxyglucose \) positron emission tomography distinguish cardiomyopathy coronary artery disease nonischemic dilated cardiomyopathy , 21 patients severe left ventricular dysfunction evaluated cardiac transplantation studied origin left ventricular dysfunction previously determined coronary angiography ischemic \( 11 patients \) nonischemic \( 10 patients \) images visually analyzed three observers graded scale seven left ventricular segments revealed fewer defects dilated cardiomyopathy compared ischemic cardiomyopathy n 13 ammonia \( 2 7 1 6 versus 5 0 6 p less 0 03 \) f 18 deoxyglucose \( 2 8 2 1 versus 4 6 1 1 p less 0 03 \) index incorporating extent severity defects revealed homogeneity fewer less severe defects subjects nonischemic ischemic cardiomyopathy assessed imaging flow \( 2 8 1 8 versus 9 2 3 p less 0 001 \) metabolism \( 3 8 3 3 versus 8 5 3 6 p less 0 005 \) diagnostic accuracy distinguishing two subgroups visual image analysis 85 using previously published circumferential count profile criteria , patients dilated cardiomyopathy fewer ischemic segments \( 0 4 0 8 versus 2 5 2 per patient p less 0 01 \) infarcted segments \( 0 1 0 3 versus 2 4 1 4 per patient p less 0 001 \) patients cardiomyopathy coronary artery disease sensitivity differentiating two clinical subgroups using circumferential profile analysis 100 specificity 80 index incorporating number severity defects derived circumferential profile analysis significantly lower subjects dilated cardiomyopathy ischemic cardiomyopathy \( 0 3 0 8 versus 2 7 2 4 p less 0 005 \) thus , noninvasive positron emission tomographic imaging n 13 ammonia f 18 deoxyglucose helpful distinguishing patients severe left ventricular dysfunction secondary coronary artery disease nonischemic cardiomyopathy , semiquantitative index circumferential profile analysis superior visual analysis alone
comparison pre postoperative conduction patterns patients surgically cured atrioventricular node reentrant tachycardia patients atrioventricular \( av \) node reentrant tachycardia characteristically short constant retrograde atrium conduction times \( intervals \) introduction ventricular extrastimuli therefore suggested tachycardia circuit involves retrograde conduction accessory pathway located tissue mechanism surgical cure av node reentrant tachycardia interruption accessory pathway , postoperative changes retrograde conduction would expected thirteen patients drug refractory av node reentrant tachycardia underwent surgery preoperatively , intervals short constant av node reentrant tachycardia , earliest atrial activation seen near bundle 0 25 ms ventricular activation patients except one surgery consisted dissection right atrial septal anterior inputs av node central fibrous body postoperatively , interval remained short constant compared preoperative values although slightly prolonged \( 74 18 versus 61 21 ms , p less 0 005 \) twelve 13 patients free tachycardia 28 13 months patient evidence av node block thus , surgical cure av node reentrant tachycardia highly successful however , reason postulate accessory pathway use tissue part tachycardia circuit mechanism surgical success remains obscure
prolonged fractionated right atrial electrograms sinus rhythm patients paroxysmal atrial fibrillation sick sinus node syndrome intraatrial catheter mapping right atrium performed sinus rhythm 92 patients group 43 control patients without paroxysmal atrial fibrillation sick sinus node syndrome group ii 31 patients paroxysmal atrial fibrillation without sick sinus node syndrome group iii 18 patients paroxysmal atrial fibrillation sick sinus node syndrome atrial electrograms recorded 12 sites right atrium duration number fragmented atrial electrograms quantitatively measured mean duration number fragmented atrial electrograms group 74 11 ms 3 9 1 3 , respectively criteria abnormal atrial electrogram defined duration greater equal 100 ms eight fragmented , abnormal atrial electrograms observed 10 patients \( 23 3 \) group , 21 patients \( 67 7 \) group ii 15 patients \( 83 3 \) group iii \( group ii versus group , p less 0 001 group iii versus group , p less 0 001 \) mean number abnormal electrograms per patient abnormal electrogram 1 3 0 7 group , 2 5 1 9 group ii 3 5 2 5 group iii \( group versus group ii , p less 0 01 group ii versus group iii , p less 0 05 \) prolonged fractionated atrial electrogram characteristic paroxysmal atrial fibrillation closely related vulnerability atrial muscle
spontaneous changes ventricular tachycardia cycle length understanding spontaneous fluctuations ventricular tachycardia cycle length required develop algorithms ventricular tachycardia detection termination variations cycle length , time stable cycle length range rr intervals ventricular tachycardia analyzed 74 episodes sustained monomorphic ventricular tachycardia induced patients taking antiarrhythmic medication linear regression demonstrated cycle length variability decrease time \( 41 24 17 19 ms , p less 0 001 \) slower ventricular tachycardia cycle length variability faster ventricular tachycardia \( p less 0 001 \) ventricular tachycardia initially variable tended remain variable \( p less 0 001 \) fifty four percent episodes stabilized within first 15 beats , 75 30 beats 93 50 beats number beats stable cycle length independent ventricular tachycardia rate average range cycle length per episode 127 72 ms 12 ventricular tachycardia episodes varied less 50 ms 45 less 150 ms maximal range rr intervals single episode ventricular tachycardia 290 ms therefore , ventricular tachycardia demonstrates wide range cycle lengths time dependent changes variability stability cycle length changes considered algorithms ventricular tachycardia detection termination automatic antitachycardia devices
echocardiographic evaluation cardiac structure function elderly subjects isolated systolic hypertension one hundred four participants systolic hypertension elderly program \( shep \) trial \( mean age 71 6 years \) examined doppler echocardiography gain information cardiac structural functional alterations isolated systolic hypertension participants systolic blood pressure greater 160 mm hg diastolic blood pressure less 90 mm hg compared 55 age matched normotensive control subjects left ventricular mass index significantly higher participants normotensive subjects \( 103 28 versus 87 23 g m2 , p 0 \) 26 participants met echocardiographic criteria left ventricular hypertrophy compared 10 normotensive subjects left atrial index also greater participants normotensive subjects \( 2 26 0 32 versus 2 11 0 24 cm m2 , p 0 005 \) 51 participants left atrial enlargement doppler measures diastolic filling significantly different two groups , peak atrial velocity higher \( 76 17 versus 69 17 cm , p 0 02 \) ratio peak early atrial velocity lower \( 0 76 0 23 versus 0 86 0 22 , p 0 \) participants correlation left ventricular mass index doppler measures diastolic function , relative wall thickness correlated significantly peak atrial velocity \( r 0 22 , p 0 016 \) peak early peak atrial velocity ratio \( r 0 24 , p 0 007 \) difference mode ejection phase indexes systolic performance \( shortening fraction peak velocity circumferential fiber shortening \) two groups
immunosuppressive therapy management acute myocarditis children clinical trial assess whether steroid therapy influenced clinical course myocarditis pediatric population , findings 13 consecutive infants children \( 8 female , 5 male \) biopsy proved myocarditis reviewed mean age 5 7 4 8 years \( range 1 1 14 8 \) congestive heart failure present st wave changes , cardiomegaly pulmonary edema chest roentgenogram echocardiography demonstrated pericardial effusion five patients mitral regurgitation eight mean left ventricular ejection fraction 34 12 prednisone administered patients one patient also received azathioprine one death survivors showed clinical improvement normalization ecg changes , heart size systolic function significant side effects occurred repeat myocardial biopsy eight patients demonstrated improvement eight elimination inflammatory infiltrate six immunosuppressive therapy pediatric population appeared useful improving clinical course cardiac function acute myocarditis adverse side effects
effect atenolol diltiazem heart period variability normal persons several time frequency domain measures heart period variability reduced 1 2 weeks myocardial infarction , reduced standard deviation normal rr intervals 24 h period \( \) associated increased mortality predictive accuracy heart period variability may reduced drugs used treat patients myocardial infarction accordingly , randomized , three period , placebo controlled , crossover \( latin square \) design used determine effect atenolol diltiazem time frequency measures heart period variability calculated 24 h continuous electrocardiographic recordings treatment atenolol , diltiazem placebo 18 normal volunteers atenolol treatment , 24 h average normal rr \( \) interval increased 24 \( p less 0 001 \) three measures tonic vagal activity significantly increased \( p less 0 001 \) atenolol treatment percent successive normal rr intervals greater 50 ms 69 , root mean square successive difference normal rr intervals 61 high frequency power heart period power spectrum 84 low frequency power also increased 45 \( p less 0 01 \) , indicating variable also indicator tonic vagal activity 24 h diltiazem significant effect 24 h average interval measure heart period variability decreased mortality rate myocardial infarction associated beta adrenergic blocker calcium channel blocker therapy may attributed part increase vagal tone caused beta blockers
hypertrophy , fibrosis diastolic dysfunction early canine experimental hypertension examine relations among hypertrophy , fibrosis diastolic performance early experimental hypertension , 18 control dogs 12 dogs experimental left ventricular hypertrophy studied diastolic function impaired dogs left ventricular hypertrophy , decreased doppler early atrial inflow velocity ratio \( e \) \( 1 35 versus 1 72 \) , increased atrial filling fraction \( 35 versus 29 \) , decreased peak rates wall thinning \( 2 01 versus 3 37 liters \) filling \( 4 33 versus 6 64 liters \) prolonged time constant isovolumetric relaxation \( tau 34 3 versus 28 1 ms \) neither chamber stiffness \( k p \) passive elastic stiffness \( e e k sigma , sigma stress \) increased postmortem examination , hypertensive left ventricle weighed significantly normal \( 116 versus 80 g p less 0 01 \) greater muscle fiber diameter endocardial epicardial sampling sites apical free wall , basal free wall septum \( mean diameter 50 8 microns hypertensive dogs , 37 8 microns normal dogs p less 0 01 \) contrast , neither percent fibrosis \( 1 2 0 8 versus 0 9 0 6 normal dogs \) fibrotic volume \( 1 21 0 63 versus 0 72 0 42 g normal dogs \) significantly increased peak volumetric filling rate inversely related fiber diameter \( r 0 74 , p less 0 001 \) , although variable left ventricular function significantly related percent volume fibrosis \( r less 0 60 , p greater 0 05 \) thus , diastolic dysfunction may exist setting hypertrophy without significant fibrosis increased myocyte size associated early diastolic filling abnormalities characteristic hypertensive left ventricle fibrosis appears less important determinant diastolic performance
transesophageal echocardiography superior transthoracic echocardiography diagnosis sinus venosus atrial septal defect purpose study compare transthoracic transesophageal echocardiography diagnosis various types atrial septal defects forty one adult patients clinical diagnosis atrial septal defect studied transthoracic transesophageal echocardiography \( 30 women , 11 men 18 81 years age \) transthoracic echocardiography demonstrated atrial septal defect 33 patients \( secundum type 28 , type 3 sinus venosus type 2 \) transesophageal echocardiography demonstrated defect 41 patients thus , 8 \( 20 \) 41 patients atrial septal defect demonstrated transesophageal transthoracic echocardiography six eight sinus venosus type atrial septal defect two patients secundum atrial septal defect \( one two technically poor transthoracic echocardiogram small atrial septal defect \) transthoracic echocardiography , therefore , failed demonstrate sinus venosus defect six \( 75 \) eight patients anomalous venous connection associated sinus venosus defect visualized transesophageal echocardiography seven eight patients seen transthoracic echocardiography patient sinus venosus type atrial septal defects frequently visualized adults conventional transthoracic echocardiography transesophageal echocardiography recommended atrial septal defect clinically suspected cannot visualized transthoracic echocardiography
physicians' perspectives cholesterol heart disease early spring 1988 , questionnaires mailed 4 , 000 midwestern physicians survey attitudes practices regarding elevated serum cholesterol use referrals nutrition counseling physicians responded sixty eight percent physicians thought reducing high serum cholesterol levels would substantially affect heart disease however , physicians attributed considerably less preventive value reducing cholesterol level reducing blood pressure \( 80 3 \) smoking \( 90 0 \) range serum cholesterol diet therapy frequently initiated 5 70 6 20 mmol l frequent range initiation drug therapy 7 80 8 25 mmol l physicians reported although medical school training prepare adequately providing diet counseling , feel prepared provide , successful , counseling diet modifications reducing serum cholesterol \( 10 \) total sample reported registered available dietary counseling , \( 88 8 \) believed physician 's responsibility provide counseling although low response rate limits conclusions survey , likely physicians topic responded conclude registered explore need special services aggressive dietetic services could benefit physicians patients reduce serum cholesterol
influence dietary cod liver oil fatty acid composition plasma lipids human male subjects myocardial infarction randomized crossover study carried investigate fatty acid profile concentrations plasma lipids male patients myocardial infarction \( mi \) supplemented diet 20 ml cod liver oil daily 6 weeks subjects divided two groups , b group received cod liver oil daily 6 weeks hospital discharge , none subsequent 6 weeks group b start taking cod liver oil 6 weeks hospital discharge , took cod liver oil 6 weeks diet , medication smoking habits kept constant possible study period cod liver oil intake , eicosapentaenoic acid \( 20 5 \( n 3 \) , \) acid \( 22 6 \( n 3 \) , \) increased significantly phospholipids \( pl \) , triglycerides \( tg \) cholesterol esters \( ce \) , whereas linoleic acid \( 18 2 \( n 6 \) , la \) , gamma linolenic acid \( 20 3 \( n 6 \) , \) arachidonic acid \( 20 4 \( n 6 \) , aa \) significantly decreased phospholipids plasma level tg significantly decreased cod liver oil intake total cholesterol , high density lipoprotein \( hdl \) cholesterol , levels apolipoproteins a1 b affected cod liver oil mi patients
atrioventricular plane displacement severe congestive heart failure following dilated cardiomyopathy myocardial infarction echocardiographic recording atrioventricular \( av \) plane displacement cardiac cycle used assess left ventricular \( lv \) global function patients congestive heart failure \( chf \) study population consisted 70 patients chronic chf \( nyha functional groups iii iv \) following dilated cardiomyopathy \( dcm \) myocardial infarction \( mi \) , 35 age matched healthy subjects av plane displacement recorded apical 4 2 chamber views four lv sites located 90 degrees apart representing septal , anterior , lateral posterior parts lv wall mean value calculated sites \( av mean \) patients chf showed significant generalized reduction av plane displacement compared healthy subjects \( 5 6 mm vs 14 5 mm , p less 0 001 \) thirty chf patients also underwent radionuclide angiography order determine ejection fraction \( ef \) correlation av mean ef good \( r 0 82 , p less 0 001 \) selection av mean less 7 mm define severely depressed lv function \( ef less 30 \) gave sensitivity 92 specificity 67 concluded av plane displacement used estimate lv systolic function patients chf
elevation plasma neuropeptide like immunoreactivity noradrenaline myocardial ischaemia man plasma levels neuropeptide like immunoreactivity \( npy li \) noradrenaline studied 25 h 22 patients acute ischaemic heart disease admission , npy li levels normal 16 patients , 20 patients increased noradrenaline levels initial plasma npy li differ patients acute myocardial infarction \( ami \) angina pectoris initial plasma noradrenaline levels higher patients ami angina pectoris plasma levels noradrenaline remained elevated ami patients , decreased towards normal values patients angina pectoris levels npy li returned normal within 25 h patients tachycardia left ventricular failure related high npy li noradrenaline levels positive correlation found noradrenaline npy li plasma suggested neuropeptide \( npy \) , endogenous vasoconstrictor peptide , considered one mediators involved cardiovascular response sympathetic activation induced myocardial ischaemia
unnecessary deaths valvular aortic stenosis annual mortality aortic valvular stenosis calculated among potential candidates surgical replacement aortic valve swedish central register causes death , 70 patients age 80 years died aortic stenosis 1 year period county \( population 1 5 million \) , identified retrospective analysis medical records showed 37 individuals suitable candidates surgery presence aortic stenosis verified autopsy 31 \( 84 \) patients remaining six patients \( 16 \) aortic stenosis diagnosis established thorough non invasive investigation performed death although typical signs symptoms aortic stenosis recorded 37 patients , six \( 16 \) considered physicians suitable candidates surgery prior death deceased patients compared group 68 patients undergone aortic valve replacement aortic stenosis period significant differences two groups regard symptoms clinical findings , except higher incidence syncope operated group concluded , 105 \( 68 surgically treated 37 deceased \) eligible patients aortic stenosis , 37 individuals receive surgical care time reason probably insufficient knowledge disease
high urinary camp hypertensives despite careful drug treatment epidemiological study population correlation serum calcium \( ca \) , plasma parathyroid hormone \( p pth \) hypertension determined population based , cross sectional study carefully treated hypertensives \( n diastolic blood pressure 90 2 mmhg 57 years \) compared normotensive controls \( n diastolic blood pressure 82 1 mmhg 57 years \) levels urinary cyclic \( u camp \) , plasma camp \( p camp \) , higher \( p less 0 001 \) hypertensives controls case regardless type drug treatment blood pressure level reached u camp correlated adrenaline multivariate analyses ca levels higher \( p less 0 001 \) mg levels lower \( p less 0 001 \) hypertensives controls explained thiazide treatment thus , despite blood pressure reduction , substantial differences ca , mg u camp still exist hypertensives normotensive controls
increased whole blood viscosity combined decreased erythrocyte fluidity untreated patients essential hypertension erythrocyte fluidity variables studied 22 patients essential hypertension compared age sex matched healthy controls hypertensive patients displayed significantly lower erythrocyte fluidity \( p less 0 001 \) similarly , significantly elevated values haematocrit , plasma whole blood viscosity , well aggregation tendency observed compared controls although differing respects controls , obvious relationships variables either systolic diastolic blood pressure significantly lower erythrocyte fluidity changes variables red blood cells found hypertensive patients may explained enlarged metabolic pool free calcium ions red blood cells suggested molecular mechanisms underlying evolution essential hypertension multifactorial rather based single molecular derangement primary events resulting altered physicochemical properties red blood cells may work concert development essential hypertension , addition increased availability calcium ions potential role smooth muscle contraction
assessment myocardial perfusion patients arterial switch operation 21 patients undergone arterial switch operation , adequacy myocardial perfusion evaluated thallium 201 computed scintigraphy 2 6 2 \( 0 3 7 \) yr surgery fourteen patients undergone arterial switch procedure pulmonary artery banding seven primary repair isoproterenol stress increased heart rate least 55 tomographic imaging performed peak stress 3 hr later reperfusion phase nine patients perfusion defects perfusion defects located left ventricular apex four \( extension wall one \) , left ventricular anterolateral wall two , ventricular septum one , left ventricular inferior wall one , right ventricular free wall one defects could due myocardial damage time surgery , results also raise concern long term adequacy myocardial perfusion following arterial switch procedure
myocardial uptake carbon 11 acetate indirect estimate regional myocardial blood flow rate clearance myocardial carbon 11 \( 11c \) activity \( administration 11c acetate \) shown correlate closely myocardial oxygen consumption present study , hypothesized regional net myocardial uptake 11c acetate , reflects primarily delivery extraction tracer , would markedly flow dependent potentially useful indirect index regional myocardial blood flow 22 patients stable coronary artery disease , regional distribution early net uptake 11c acetate correlated estimates regional myocardial blood flow assessed oxygen 15 water myocardial images 11c acetate uptake high quality correlation two approaches close \( r 0 88 \) affected metabolic state tissue thus , patients stable coronary artery disease , resting conditions , direct estimates myocardial oxygen consumption relation level delivery tracer tissue obtained pet use single radiopharmaceutical , 11c acetate approach may prove particularly useful clinical protocols designed assess myocardial oxygen consumption
blood pool radionuclide angiography patients novacor left ventricular assist device blood pool radionuclide angiography used investigate left ventricular function eight patients received novacor assist device bridge cardiac transplantation studies performed maximal minimal tolerated assist device flows left ventricular ejection fraction , volumes , cardiac output , pump ejection fraction computer assessed patients severe left ventricular dilation insertion assist device , mean ejection fraction 18 4 improved 44 18 \( p less 0 01 \) maximal assist device flows , fell 25 15 \( p less 0 01 \) minimal flows ventricular volumes became normal maximal assist device flow increased significantly \( p less 0 05 \) minimal flow pump well visualized ejection fraction 82 7 data indicate assist device effectively left ventricle deterioration ejection fraction following decrease assist device flow keeping dependency patients device sustain adequate hemodynamics
early scintigraphic detection experimental myocardial infarction dogs technetium 99m glucaric acid recent data generated interest technetium 99m \( 99mtc \) glucaric acid vivo viability marker studied 99mtc glucaric acid retention canine models myocardial ischemia \( 20 min occlusion lad 40 min reperfusion \) , acute myocardial infarction \( mi \) \( 90 min lad occlusion 3 hr reperfusion \) , chronic mi \( 90 min occlusion either 48 hr 10 day reperfusion \) regional myocardial blood flow measured radiolabeled microspheres preferential uptake glucaric acid observed ischemic viable myocardium compound showed high affinity necrotic myocardial tissue several days following injury preferential uptake infarcted tissue disappeared 10 days following injury study shows 99mtc glucaric acid acts exclusively marker necrosis canine models mi technetium 99m glucaric acid may clinical utility early cardiac imaging myocardial infarction differentiating recent old injuries
effect coronary occlusion myocardial viability myocardial activity technetium 99m sestamibi timing effect sestamibi administration respect onset myocardial ischemia reperfusion studied swine different groups animals sestamibi administered prior coronary artery occlusion , occlusion , 1 2 hour following reperfusion sestamibi administered prior coronary occlusion resulted insignificant decrease 99mtc activity ischemic zone however , infarct zone activity reduced 62 14 nonischemic zone contrast , administration coronary occlusion resulted similar significant reductions ischemic infarct zone activity administration sestamibi reperfusion resulted normal ischemic zone activity markedly reduced activity infarct zone significantly reduced activity infarct zone found independent timing sestamibi administration respect onset myocardial ischemia reperfusion thus , cell viability appears required uptake retention isotope activity
management primary pulmonary hypertension primary pulmonary hypertension clinical syndrome characterized pulmonary hypertension absence sufficient underlying cardiac , parenchymal pulmonary , systemic disease account population patients primary pulmonary hypertension heterogeneous one , clinically histologically etiologic mechanisms unknown , therapy directed toward consequences pulmonary vascular process oxygen supplementation , use digoxin diuretics symptomatic heart failure , anticoagulation may role treating primary pulmonary hypertension , although vasodilator therapy main area investigation screening vasodilator responsiveness , defining favorable vasodilator effect , predicting long term effectiveness , deciding treat controversial new approaches , use high dose calcium channel blocking agents continuous intravenous infusion prostacyclin \( investigational agent \) , recently proposed medical therapies , heart lung lung transplantation increasingly become option selected patients
right ventricle children pulmonary atresia intact ventricular septum twelve children pulmonary atresia intact ventricular septum underwent closure tricuspid valve part new surgical procedure two cases concomitant fontan operation performed patient right ventricle small right ventricular pressure higher systemic pressure ventricle coronary connections provided flow blood right ventricle coronary arteries 11 12 cases five 12 children survive operation postmortem examination revealed severe acute chronic myocardial ischemic damage high grade obstruction interruption proximal left anterior descending coronary artery preoperative angiography demonstrated occlusive changes coronary arteries , resulting right ventricular dependent circulation , five children died one child survived operation seven children survived operation well 4 months 3 5 years later two undergone subsequent successful fontan operation two others considered suitable candidates operation tricuspid valve closure recommended carefully selected group infants pulmonary atresia intact ventricular septum provided right ventricular dependent coronary circulation excluded basis preoperative coronary cineangiography
left ventricular mechanics ejecting , postischemic hearts left ventricular circulatory assistance measured effects left ventricular circulatory assistance ventricular mechanics ejecting sheep hearts global ischemia flows left atrium femoral artery ranged 20 100 ml kg min circulatory assistance preischemic , ejecting hearts increasing flow left ventricular assist device progressively decreased stroke volume , end diastolic volume , circumferential systolic wall stress , slightly decreased end systolic volume postischemic , ejecting hearts left ventricular assistance progressively substantially decreased end diastolic volume end systolic volume high flows , end systolic volume returned normal range preischemic hearts high flows assist device also shifted end systolic points pressure volume loops leftward increased stroke work end diastolic volume ratio ejecting postischemic hearts observations raise possibility left ventricular circulatory assistance acutely improves myocardial contractility postischemic hearts
evolution human cardiac myocyte dimension prolonged mechanical support animal models using left ventricular assist systems long time periods , myocardial cellular atrophy reported , raising concern prolonged clinical use systems might lead deterioration left ventricular function university pittsburgh , long term clinical use novacor \( corp , novacor , , calif \) left ventricular support system patients awaiting heart transplants allowed study effects long term mechanical support human subjects study determined cardiac myocyte dimension initially greater patients end stage cardiac disease require support rather patients disease require support although myocyte dimension decrease within days support , decrease merely brings cell size values usual patients chronic end stage cardiac disease , shrinkage observed thus novacor left ventricular assist system appear associated left ventricular atrophy , long term use may detrimental left ventricular function
cerebral air embolism treated pressure hyperbaric oxygen used pressure hyperbaric oxygen treat 2 patients cerebral air embolism , occurring result invasive medical procedures , neither suffered permanent damage detectable clinical examination mri outcome contrasts reports infarct disability among untreated victims air embolism
abdominal aneurysms childhood report case review literature abdominal aneurysms rare children usually found association congenital cardiac aortic malformations , connective tissue disorders , trauma , previous arterial catheter placement 4 year old girl common iliac artery aneurysm , history arterial catheter placement trauma , evidence marfan 's ehlers danlos syndrome , arteritis , coarctation aorta , diseases associated childhood aneurysms presented resection aneurysm arterial reconstruction performed without use prosthetic material vein graft pathologic examination showed evidence inflammation medial degeneration layers arterial wall fourth report found literature documented idiopathic abdominal aneurysm child conditions associated abdominal aneurysms childhood discussed , literature reviewed
reduction cardiovascular disease related mortality among postmenopausal women use hormones evidence national cohort national sample white menopausal women greater equal 55 years old epidemiologic follow participants national health nutrition examination survey reviewed investigate role hormone therapy altering risk death cardiovascular disease women study observed 16 years baseline survey 1971 1975 1987 women died deaths due cardiovascular disease history diabetes \( relative risk , 2 38 95 confidence interval 1 73 3 26 \) , previous myocardial infarction \( relative risk , 2 12 95 confidence interval 1 56 2 86 \) , smoking \( relative risk , 2 18 95 confidence interval , 1 69 2 81 \) , elevated blood pressure \( relative risk , 1 49 95 confidence interval , 1 14 1 94 \) strong predictors cardiovascular disease related death cohort adjusting known cardiovascular disease risk factors \( smoking , cholesterol , body mass index , blood pressure , previous myocardial infarction , history diabetes , age \) education , use postmenopausal hormones associated reduced risk death cardiovascular disease \( relative risk , 0 66 95 confidence interval , 0 48 0 90 \) protective effect provided postmenopausal hormone therapy seen women experienced natural menopause \( relative risk , 0 69 95 confidence interval , 0 45 1 06 \)
prevalence retinal vascular abnormalities children adolescents essential hypertension studied 97 children adolescents essential hypertension evaluating photographs optic fundus fluorescein angiography photographs examined presence arteriolar narrowing , tortuosity , arteriovenous intraobserver interobserver variability determination abnormalities low agreement 75 narrowing , 90 tortuosity , 100 arteriovenous prevalence abnormalities 41 \( 95 confidence interval , 31 50 \) arteriolar narrowing , 14 \( 95 confidence interval , 19 21 \) tortuosity , 8 \( 95 confidence interval , 5 11 \) arteriovenous 97 patients , 50 \( 51 \) one abnormality retinal abnormalities relatively common young patients essential hypertension
vasculopathy unknown etiology new vascular disorder generalized deposition abnormal amounts acid \( \) material arteries , veins , observed large number autopsies author 's institution unlike known vascular diseases emerged distinct disorder vascular connective tissue named vasculopathy unknown etiology hitherto entity described
giant left atrium case report seventy seven year old woman , mitral stenosis , presented cardiomegaly evident chest roentgenogram cardiac enlargement due giant left atrium distorted cardiac structures echocardiogram first pass nuclear angiogram able delineate huge left atrium
sudden appearance coronary thrombus observed angiography case report sudden coronary thrombus formation documented chance cardiac catheterization patient postinfarction angina thrombus successfully treated intravenous urokinase heparin infusions , thereafter , coronary angioplasty performed without complication
spontaneous cerebral embolism descending thoracic aortic aneurysm case report case aneurysm proximal descending thoracic aorta likely source retrograde cerebral embolism described atherosclerotic disease descending thoracic aorta considered unusual source cerebral emboli
total occlusion left main coronary artery young woman survival case report total occlusion left main coronary artery \( \) rare , survival depends existence collateral circulation author presents case total occlusion left main coronary artery survival young woman rare case , owing sex age patient
axillary subclavian vein thrombosis changing patterns etiology , diagnostic , therapeutic modalities fifty two patients axillary subclavian vein thrombosis treated last 10 years available follow least 1 year eighteen treated first 5 years , group , 34 last 5 years , group b causes group group b included respectively effort spontaneous 28 per cent 29 per cent , catheter insertion related 17 per cent 47 per cent , malignancy systemic disease 55 per cent 24 per cent none patients group noninvasive vascular testing \( \) however , 27 patients group b duplex imaging \( \) 18 cases group 27 cases group b treated conventionally \( anticoagulants \) seventy three per cent residual pain exertion \( venous claudication \) swelling fourteen cases posttreatment venography four showed total resolution thrombus symptom free ten resolution , nine symptomatic seven cases group b treated thrombolytic therapy five total resolution thrombus symptom free \( 71 \) two resolution residual symptoms \( 29 \) \( statistically significant \) conclusion \( 1 \) patients axillary subclavian vein thrombosis seen recently catheter insertion related 2 \) diagnosis initiated duplex imaging \( 3 \) thrombolytic therapy significantly decreased residual symptoms yielded better resolution anticoagulants
relation left ventricular mass geometry morbidity mortality uncomplicated essential hypertension objective assess prognostic significance left ventricular mass geometry initially healthy persons essential hypertension design observational study prospectively identified cohort setting university medical center patients two hundred eighty patients essential hypertension pre existing cardiac disease evaluated using echocardiography 1976 1981 two hundred fifty three subjects family members \( 90 \) contacted follow interview average 10 2 years initial echocardiogram obtained survival status 27 patients lost follow ascertained using national death index data measurements main results left ventricular mass exceeded 125 g m2 69 253 patients \( 27 \) cardiovascular events occurred higher proportion patients without left ventricular hypertrophy \( 26 compared 12 p 0 006 \) patients increased ventricular mass also higher risk cardiovascular death \( 14 compared 0 5 p less 0 001 \) cause mortality \( 16 compared 2 p 0 001 \) electrocardiographic left ventricular hypertrophy predict risk patients normal left ventricular geometry fewest adverse outcomes \( cardiac deaths morbid events 11 \) , concentric hypertrophy \( death 21 morbid events 31 \) multivariate analysis , age left ventricular mass gender , blood pressure , serum cholesterol level independently predicted three outcome measures conclusions echocardiographically determined left ventricular mass geometry stratify risk patients essential hypertension independently strongly blood pressure potentially reversible risk factors may help stratify need intensive treatment
role calcium channel blockers treatment essential hypertension calcium channel blockers , originally developed treatment angina supraventricular arrhythmias , shown lower elevated blood pressure effectively hypertensive patients verapamil , nifedipine , diltiazem represent prototype compounds unique chemical classes differing pharmacologic properties drugs lower elevated blood pressure efficacy comparable commonly used antihypertensives combination therapy agents usually results additive response side effects usually mild reversible usually extension drug 's pharmacologic effects moreover , adverse metabolic effects lipid , glucose , potassium levels common excellent antihypertensive effects calcium channel blockers potential importance variety disease states , agents routinely considered use first line antihypertensive agent appropriately selected patients hypertension severity part comprehensive plan minimize cardiovascular risk
standard heparin nomogram management heparin therapy nomogram adjustment heparin dosage developed heparin therapy reduce delays achieving maintaining therapeutic activated partial thromboplastin time \( aptt \) result fifty consecutive patients acute venous thromboembolism continuous intravenous heparin therapy adjusted according heparin nomogram effect nomogram heparin therapy patients compared data 53 historical control patients proportion patients nomogram group reached therapeutic aptt 24 hours start heparin therapy 66 , increased 81 48 hours contrast , 37 58 control patients reached therapeutic aptt 24 48 hours , respectively percentage therapeutic aptt results total number aptt determinations greater nomogram patients controls use heparin nomogram resulted \( 1 \) achieving therapeutic aptt 24 48 hours large proportion patients \( 2 \) reduced periods inadequate anticoagulation heparin therapy
ventricular tachycardia routine treadmill testing risk prognosis exercise induced ventricular tachycardia exercise testing considered increase risk testing moreover , exercise induced ventricular tachycardia considered confer poor prognosis although specifically studied retrospective review patients undergone routine clinical exercise testing september 1984 june 1989 , identified 55 patients exercise induced ventricular tachycardia mean follow 26 months \( range , 2 58 months \) fifty patients nonsustained ventricular tachycardia exercise testing one patients died due congestive heart failure follow period five patients sustained ventricular tachycardia exercise testing one died suddenly 7 months test ventricular tachycardia reproduced two 29 patients underwent repeated exercise testing ventricular tachycardia routine clinical exercise testing occurred rarely \( prevalence 1 5 \) associated complications testing total mortality exercise induced ventricular tachycardia group \( 3 6 \) significantly different mortality entire population \( 5 1 \) nonsustained ventricular tachycardia occurring clinical exercise testing independent marker poor prognosis
echocardiographic assessment atrial mechanical behaviour relations movement atrioventricular ring changes left atrial ventricular dimensions studied echocardiography compared doppler mitral flow velocity traces 20 healthy controls patients left ventricular hypertrophy \( n 28 \) dilatation \( n 16 \) left ventricular systole atrioventricular ring , structure common ventricle atrium , moved towards ventricular apex , thus increasing left atrial volume action matched pulmonary venous return phase transverse left atrial dimension measured aortic root posterior left atrial wall early diastole , mitral ring moved rapidly towards atrium transmitral flow accelerated requires force directed ventricle atrium , likely result elastic recoil arising compression ventricular myocardium stretching atrial myocardium ventricular systole two additional mechanisms ventricular filling atrial systole recognised \( \) increase ventricular volume atrioventricular ring moved \( b \) transverse left ventricular expansion pressure driven transmitral flow former undetectable doppler apex accounted 10 ventricular filling healthy controls , significantly less ventricular dilatation left ventricular hypertrophy , left ventricular filling maintained mechanisms reduced increase volume early diastole interactions atrium ventricle functionally important ventricular systole , early diastole , atrial systole included traditional separation atrial function reservoir , conduit , pump functions
end diastolic flow velocity beneath aortic isthmus assessed pulsed doppler echocardiography new predictor aortic regurgitant fraction end diastolic flow velocity beneath aortic isthmus measured within 72 hours cardiac catheterisation pulsed doppler echocardiography 30 controls 61 patients aortic regurgitation end diastolic flow velocity determined peak r wave simultaneously recorded electrocardiogram controls reverse flow end diastole beneath aortic isthmus patients aortic regurgitation end diastolic flow velocity correlated well angiographic grade regurgitation \( r 0 81 \) regurgitant fraction \( r 0 82 \) mean \( sd \) values 6 3 \( 5 2 \) , 12 2 \( 4 3 \) , 22 1 \( 5 7 \) , 34 3 \( 9 3 \) cm patients regurgitant fraction less 20 , 20 40 , 41 60 , greater 60 , respectively end diastolic flow velocity greater 18 cm predicted regurgitant fraction greater equal 40 sensitivity 88 5 specificity 96 study suggests pulsed doppler derived end diastolic flow velocity useful index routine non invasive assessment severity aortic regurgitation
interatrial shunt flow profiles newborn infants colour flow pulsed doppler echocardiographic study interatrial shunt flow profiles 36 normal term infants examined serially colour flow pulsed doppler echocardiographic techniques within hour birth four five days birth shunt flow across foramen ovale detected 33 normal infants \( 92 \) within hour birth \( mean 40 minutes \) occurrence interatrial shunting decreased age , shunt signal still detected 17 infants \( 47 \) fourth fifth day life , ductus arteriosus already closed normal infants direction interatrial shunt flow predominantly left right , 64 coexistent small right left shunt diastole within hour birth four five days found 19 six patients persistent fetal circulation direction interatrial shunt flow predominantly right left biphasic peaks diastole systole early stage disease , period right left shunt flow cardiac cycle significantly longer normal infants examined within 1 hour birth patients ductus closed foramen ovale time ductal closure patients persistent fetal circulation right left shunt flow seen diastole period still prolonged findings suggest interatrial shunting , predominantly left right , common normal newborn infants
extrahepatic portal vein aneurysm associated tortuous portal vein portal vein aneurysm rare etiology controversial case extrahepatic portal vein aneurysm associated unusually tortuous portal vein described real time ultrasonography showed lesions porta communicating superior mesenteric vein intrahepatic portal branches suggested presence two portal vein aneurysms , 27 x 21 mm 21 x 13 mm size magnetic resonance imaging portal venography confirmed portal vein aneurysms unusually tortuous portal vein liver histologically normal evidence portal hypertension speculated portal vein aneurysms may congenital associated tortuous portal vein might secondary hemodynamic changes portal venous system
factors determining improvement left ventricular function reperfusion therapy acute myocardial infarction baseline ejection fraction improvement left ventricular ejection fraction measure salvage ischemic myocardium reperfusion therapy acute myocardial infarction degree improvement left ventricular ejection fraction may influenced many factors therefore , 137 patients paired radionuclide angiograms obtained within 24 h acute infarction hospital discharge retrospectively evaluated determine factors affect improvement ejection fraction baseline ejection fraction correlated significantly improvement ejection fraction univariate analysis \( ejection fraction continuous variable p less 0 001 ejection fraction categorical variable , less equal 45 versus greater 45 , p less 0 0001 \) multivariate analysis \( p less 0 0001 \) reperfusion status \( patent versus occluded infarct artery \) extent coronary artery disease \( one , two three vessel \) significant factors multivariate univariate analysis location infarction , treatment modality time treatment correlate change ejection fraction either statistical technique thus , factors tested , baseline left ventricular ejection fraction potent predictor improvement ventricular function acute infarction knowledge baseline ejection fraction may helpful deciding whether treat patients equivocal indications contraindications reperfusion therapy clinical trials reperfusion strategies stratify patients basis baseline ejection fraction ejection fraction used end point myocardial salvage
incidence clinical significance transient creatine kinase elevations diagnosis non q wave myocardial infarction associated coronary angioplasty assess incidence clinical significance elevated total plasma creatine kinase \( ck \) mb isoenzyme fraction apparently successful coronary angioplasty , prospective study 272 consecutive elective procedures undertaken total ck \( normal less 100 iu liter \) ck mb isoenzyme \( normal less 4 \) measured immediately successful completion procedure every 6 h 24 h procedures results american heart association american college cardiology task force criteria successful result excluded analysis 272 elective procedures , 249 \( 92 \) successfully abnormally elevated ck ck mb serum levels , , found 38 \( 15 \) successful outcomes three patterns abnormal enzymes identified 15 patients ck greater equal 200 iu liter ck mb greater equal 5 \( group 1 \) , 4 patients ck greater equal 200 iu ck mb less equal 4 \( group 2 \) 19 patients ck less 200 iu liter ck mb greater equal 5 \( group 3 \) three groups distinguishable nature complications causing enzyme release \( particular , etiology clinical manifestations \) significantly clinically apparent events group 1 groups \( 13 15 versus 11 23 , p less 0 01 \) events associated persistent electrocardiographic changes \( p 0 05 \) chest pain \( p less 0 05 \) however , clinically important sequelae recognizable group hospital discharge thus , abnormal cardiac serum enzyme release apparently successful coronary angioplasty 1 \) relatively common 2 \) many possible causes , including minor complications early reversibility major complications 3 \) results permanent clinical sequelae
long term follow medical versus surgical therapy hypertrophic cardiomyopathy retrospective study retrospective analysis 139 patients hypertrophic cardiomyopathy followed 8 9 years \( range 1 28 years \) patients divided two groups group 1 consisted 60 patients medical therapy group 2 79 patients surgical therapy \( septal myectomy \) groups 1 2 subdivided according medical treatment group 1a received propranolol , 160 mg day \( n 20 \) group 1b verapamil , 360 mg day \( n 18 \) group 1c , therapy \( n 22 \) group 2a received verapamil , 120 360 mg day , septal myectomy \( n 17 \) group 2b medical therapy surgery \( n 62 \) group 1 , 19 patients died \( annual mortality rate 3 6 \) group 2 , 17 patients died \( mortality rate 2 4 , p ns \) patients died , approximately one half two thirds groups 1 2 died suddenly one half one third died congestive heart failure 10 year cumulative survival rate 67 group 1 , significantly smaller group 2 \( 84 , p less 0 05 \) subgroups , 10 year survival rate 67 group 1a , 80 1b \( p less 0 05 versus 1a \) 65 1c \( p less 0 05 versus 1b \) 10 year survival rate 100 group 2a \( p less 0 05 versus 1a , 1b , 1c \) 78 group 2b \( p less 0 05 versus 2a \) concluded cumulative survival rate significantly better surgically medically treated patients
prediction frequency duration ambulatory myocardial ischemia patients stable coronary artery disease determination ischemic threshold exercise testing importance exercise protocol relation ambulatory myocardial ischemia results exercise testing patients ischemic heart disease remains undefined , dissimilar results previous reports investigate issue , particular , ascertain importance exercise protocol determining relation , 70 patients stable coronary artery disease underwent 48 h ambulatory electrocardiographic \( ecg \) monitoring treadmill exercise tests withdrawal medications patients exercised using two different protocols slow \( national health nih combined protocol \) brisk \( bruce protocol \) work load increments exercise duration longer nih combined protocol \( 14 1 5 versus 6 8 2 min p less 0 0001 \) , maximal work load peak heart rate achieved greater bruce protocol \( 9 8 2 versus 6 5 2 , 142 19 versus 133 22 beats min , respectively p less 0 0001 \) close inverse correlation exercise testing results ambulatory ecg monitoring observed using nih combined protocol strongest correlation observed time exercise 1 mm st segment depression number ischemic episodes \( r 0 86 p less 0 0001 \) bruce protocol significantly weaker inverse correlation found \( r 0 35 \) mean heart rate onset st segment depression similar monitoring exercise testing nih combined protocol \( 97 2 13 versus 101 0 17 beats min , respectively \) significantly higher \( 110 4 13 \) using bruce protocol \( p less 0 001 \)
effects standing induction paroxysmal supraventricular tachycardia evaluate effects standing induction paroxysmal supraventricular tachycardia , electrophysiologic studies performed supine standing positions 22 patients atrioventricular \( av \) reciprocating tachycardia 11 av node reentrant tachycardia av reciprocating tachycardia induced 9 22 patients av reciprocating tachycardia supine position 17 standing effective refractory period av node markedly shortened , 275 72 203 30 ms \( n 16 , p less 0 005 \) standing effective refractory period accessory pathway shortened slightly , 293 75 278 77 ms \( n 8 , p less 0 005 \) , standing av node reentrant tachycardia induced 3 11 patients av node reentrant tachycardia supine position 6 standing effective refractory periods slow pathway fast pathway shortened markedly , 293 72 216 40 ms \( n 6 , p less 0 025 \) 416 85 277 50 ms \( n 10 , p less 0 005 \) , respectively , standing plasma norepinephrine levels increased standing patients av reciprocating av node reentrant tachycardia \( n 11 , p less 0 005 , n 8 , p less 0 005 , respectively \) conclusion , standing , associated increased sympathetic tone , changed electrophysiologic properties reentrant circuits , facilitating induction av reciprocating tachycardia av node reentrant tachycardia
surgery ebstein 's anomaly clinical echocardiographic evaluation new technique ten consecutive patients \( age range 4 44 years , mean 22 \) underwent surgical repair ebstein 's anomaly vertical right ventricle tricuspid valve leaflets patient died operation intraoperative echocardiography documented good result nine patients severe tricuspid regurgitation one patient , underwent prosthetic valve replacement second period cardiopulmonary bypass two four patients right ventricular papillary muscle dysfunction early postoperative period showed improved papillary muscle function concomitant reduction tricuspid regurgitation 6 months later patients evaluated clinically echocardiography 2 23 months later patients showed clinical improvement , seven one functional class three two classes sinus rhythm mean cardiothoracic ratio decreased 6 \( p less 0 05 \) bicycle performed six patients , peak oxygen consumption exceeded 20 ml kg per min five tricuspid regurgitation diminished eight patients \( three grades two patients , two grades five one grade one patient \) remained unchanged two comparison preoperative postoperative pulsed doppler flow velocities across pulmonary valve showed increase peak velocity flow across valve \( mean 83 14 versus 97 11 cm , p less 0 005 \) decrease time peak velocity \( mean 130 16 versus 91 23 ms , p less 0 05 \)
role chronotropic impairment exercise mustard operation better understand role chronotropic impairment exercise performance atrial switch \( mustard \) operation , 20 patients undergone operation uncomplicated transposition great arteries exercised maximal using 1 min incremental treadmill protocol heart rate , oxygen consumption , carbon dioxide production minute ventilation monitored continuously two dimensional echocardiograms obtained testing calculate right ventricular inflow volume indexed body surface area patients achieved maximal aerobic capacity based ventilatory patterns respiratory exchange ratio maximal heart rate reduced \( 175 beats min 87 predicted age \) maximal oxygen consumption decreased \( 31 ml kg per min 75 predicted age gender \) correlation maximal oxygen consumption maximal heart rate right ventricular volume index , however , significant inverse correlation maximal heart rate \( r 0 62 , p less 0 005 \) correlation right ventricular volume index heart rate rest results suggest decreased maximal oxygen consumption patients mustard procedure result chronotropic impairment right ventricular dilation may compensatory response chronotropic impairment
effect captopril , angiotensin converting enzyme inhibitor , patients angina pectoris heart failure effects captopril placebo compared 18 patients chronic heart failure angina pectoris use double blind crossover trial design symptoms assessed patient treatment preference , visual analogue scores nitroglycerin consumption exercise performance assessed using two different treadmill protocols different work intensity simultaneous measurement oxygen consumption supine bicycle exercise simultaneous radionuclide ventriculography arrhythmias assessed 48 h ambulatory electrocardiographic monitoring patients generally preferred placebo captopril , appeared due increase symptoms angina captopril treadmill exercise time high intensity protocol shorter captopril placebo low intensity protocol , angina became frequent limiting symptom even though overall exercise performance changed heart rate blood pressure product reduced , largely reduction blood pressure rather heart rate supine bicycle exercise , differences symptoms , exercise performance , ejection fraction changes blood pressure noted ventricular arrhythmias reduced captopril appear clinically useful alleviating angina pectoris patients heart failure , effect may related decrease coronary perfusion pressure nonetheless , desirable metabolic effects , reduction arrhythmias potential effects survival require study captopril patients angina heart failure
regional myocardial blood flow left ventricular diastolic properties pacing induced ischemia relation left ventricular diastolic abnormalities myocardial blood flow ischemia studied eight open chest dogs critical stenoses proximal left anterior descending circumflex coronary arteries heart paced 1 7 times heart rate rest 3 min dogs coronary stenoses , left ventricular end diastolic pressure increased 8 1 14 2 mm hg pacing tachycardia \( p less 0 01 \) 16 3 mm hg \( p less 0 01 \) pacing , increased end diastolic end systolic segment lengths ischemic regions left ventricular diastolic pressure segment length relations ischemic regions shifted upward pacing tachycardia dogs coronary stenoses , indicating decreased regional diastolic distensibility dogs without coronary stenoses , left ventricular diastolic pressure segment length relation unaltered pacing tachycardia without coronary stenoses induced increase anterograde coronary blood flow \( assessed flow meter \) left anterior descending circumflex coronary arteries , decrease regional vascular resistance dogs coronary stenoses , regional vascular resistance pacing decreased 18 myocardial blood flow \( assessed microspheres \) unchanged left anterior descending circumflex coronary artery territories pacing tachycardia coronary stenoses , regional coronary vascular resistance decrease subendocardial myocardial blood flow distal left anterior descending coronary artery stenosis decreased \( 1 03 0 07 0 67 0 12 ml min per g , p less 0 01 \) , subendocardial blood flow ratio \( 1 04 0 09 0 42 0 08 , p less 0 01 \)
pressure length loop area components analyzed graded myocardial ischemia changes total pressure length loop area compared changes effective shortening area , systolic lengthening area shortening area \( defined respect end diastolic end systolic lengths \) pressure length loop myocardial ischemia seven anesthetized dogs instrumented measurement left ventricular pressure regional segmental wall motion \( \) minor axis apical region left ventricle ischemia induced gradual controlled snare around left anterior descending coronary artery , supplied apical myocardium data obtained normal flow , critical constriction \( loss pulsatile coronary flow \) , mild ischemia \( ischemia 1 onset regional dysfunction , e , shortening mild hypokinesia \) moderate ischemia \( ischemia 2 marked hypokinesia \) stage , acute performed partially occluding descending thoracic aorta pressure length loops analyzed terms four areas total loop area , effective shortening area , shortening area systolic lengthening area total loop area decreased marked hypokinesia present \( 176 18 3 mm hg x mm ischemia 2 versus 245 1 26 9 mm hg x mm ischemia 1 , p less 0 05 \) however , effective shortening area \( 98 2 0 8 total loop area baseline 93 8 2 4 critical constriction 76 3 7 2 ischemia 1 51 9 12 2 ischemia 2 \) shortening area \( 1 8 0 8 total loop area baseline 5 2 1 9 critical constriction 14 3 3 4 ischemia 1 23 8 5 1 ischemia 2 \) changed significantly progressive stage ischemia
follow patients low output , low gradient hemodynamics percutaneous balloon aortic valvuloplasty mansfield scientific aortic valvuloplasty registry symptomatic patients low cardiac output low aortic valve gradient poor prognosis high risk aortic valve surgery outcome percutaneous balloon aortic valvuloplasty subgroup patients unclear therefore , 67 patients \( group 1 \) underwent percutaneous balloon aortic valvuloplasty december 1 , 1986 november 1 , 1987 low cardiac index \( less 2 5 liters min per m2 \) low aortic valve gradient \( less equal 40 mm hg \) procedure results compared 200 patients \( group 2 \) low cardiac index low aortic valve gradient \( greater 40 mm hg \) procedure similar baseline presenting symptoms balloon aortic valvuloplasty , greater decrease aortic valve gradient patients group 2 patients group 1 \( mean sd 33 0 16 7 mm hg 14 6 6 9 mm hg , respectively p less 0 001 \) although significant difference improvement estimated aortic valve area \( 0 31 0 21 0 31 0 22 cm2 , respectively p ns \) hospital mortality 11 9 patients group 1 significantly different 7 5 mortality patients group 2 however , actuarial probability survival 12 months patients survived initial hospitalization 46 group 1 64 group 2 \( p less 0 05 \) moreover , follow \( mean 8 8 months \) 64 surviving group 1 patients displayed clinical improvement , compared 70 surviving group 2 patients
platelet thromboxane release delayed cerebral ischemia patients subarachnoid hemorrhage adenosine diphosphate induced platelet aggregation associated thromboxane b2 release studied 52 patients subarachnoid hemorrhage \( sah \) order detect possible association altered platelet function development cerebral ischemic complications sah compared values admission , patients showed significantly increased platelet aggregability \( p less 0 05 \) thromboxane release \( p less 0 001 \) 1 2 weeks sah highest values thromboxane release seen patients deteriorated due delayed cerebral ischemia permanent neurological deficit thromboxane release significantly higher \( p less 0 05 \) onset severe delayed ischemia six patients preoperative ischemia compared patients without delayed ischemia five others , ischemic deterioration elevated thromboxane release occurred operation patients preoperative values similar values without ischemic symptoms observations suggest increased platelet aggregability thromboxane release associated delayed cerebral ischemia surgery
endovascular occlusion vertebral arteries treatment vertebrobasilar aneurysms twenty one patients aneurysms vertebrobasilar circulation underwent unilateral bilateral endovascular occlusion vertebral artery six patients presented subarachnoid hemorrhage \( sah \) , 10 mass effect , four mass effect sah , one ischemic symptoms thirteen patients good outcomes complete clinical angiographic cure six patients partial thrombosis aneurysms one death one treatment failure one patient suffered transient stroke concluded endovascular occlusion vertebral artery following test occlusion safe effective treatment proximal aneurysms vertebrobasilar circulation
effect 21 u 74006f lipid peroxidation subarachnoid clot present study undertaken investigate effect u 74006f malondialdehyde \( product lipid peroxidation \) subarachnoid clot eighteen monkeys divided three groups six two u 74006f treated groups , receiving doses 0 3 1 0 mg kg , placebo treated group monkey underwent baseline cerebral angiography followed right sided craniectomy placement subarachnoid clot around middle cerebral artery \( mca \) treatment administered intravenously every 8 hours 6 days seven days experimental subarachnoid hemorrhage \( sah \) , angiography repeated animals killed placebo treated group , significant vasospasm occurred mca side clot \( p less 0 01 \) u 74006f treatment dosages , significantly less vasospasm developed clot side mca \( p less 0 01 \) content malondialdehyde measured thiobarbituric acid test high performance liquid chromatography \( hplc \) comparing two methods , hplc proved accurate thiobarbituric acid test , especially measurement low concentrations malondialdehyde placebo treated group , malondialdehyde content significantly increased day 7 clot \( p less 0 05 \) contrast , malondialdehyde content freshly prepared clot low 0 3 mg kg u 74006f group , malondialdehyde content clot significantly less day 7 compared clot placebo treated group \( p less 0 05 \) although malondialdehyde content clot 1 0 mg kg u 74006f treated group less placebo , significantly malondialdehyde detected actual vessel wall mca group results suggest lipid peroxidation subarachnoid clot may play role pathogenesis vasospasm salutary effects u 74006f vasospasm may mediated reduction lipid peroxidation sah
superior artery aneurysm report two cases two cases intracranial aneurysms arising superior artery take internal carotid artery presented angiographic findings technical details operative approach discussed particular attention focused use fenestrated
subarachnoid hemorrhage dissecting aneurysm middle cerebral artery case report case subarachnoid hemorrhage \( sah \) dissecting aneurysm inferior limb middle cerebral artery reported patient 's clinical status initial follow angiographic appearance aneurysm presented diagnosis treatment briefly discussed suggested , angiography demonstrates luminal narrowing vascular occlusion patient unexplained sah , dissecting aneurysm carotid system considered cause hemorrhage
role alpha adrenoceptor subtypes sympathetic control acral cutaneous microcirculation anesthetized rats , laser doppler flowmetry used evaluate role alpha 1 alpha 2 adrenoceptors mediating sympathetic responses acral regions cutaneous circulation intravenous administration selective alpha 1 agonist , phenylephrine , potent agent \( selective alpha 2 adrenoceptor agonist \) rats however , potent efficacious phenylephrine reducing cutaneous microvascular perfusion \( cp \) also caused greater increase cutaneous microvascular resistance neural humoral sympathetic effects cp characterized selective alpha 1 alpha 2 adrenoceptor antagonists \( prazosin rauwolscine , respectively \) found frequency related reductions cp elicited sciatic nerve stimulation antagonized prazosin , rauwolscine fact , rauwolscine enhanced evoked reductions cp highest stimulation frequencies however , prazosin rauwolscine antagonized reductions cp elicited electrical stimulation thoracolumbar outflow \( activation \) ganglionic stimulation \( intravenous 1 , 1 dimethyl 4 \) also caused profound , transient reduction cp abolished rauwolscine , significantly altered prazosin contrast , 1 , 1 dimethyl 4 induced increases mean arterial pressure reduced prazosin , rauwolscine ketamine anesthetized rats , rauwolscine caused dose related increase cp without altering mean arterial pressure , whereas prazosin lowered mean arterial pressure alter cp conclude acral regions cutaneous vasculature sensitive alpha 2 alpha 1 adrenoceptor mediated vasoconstriction
peripheral alpha 1 alpha 2 adrenergic receptors three models hypertension rats vitro autoradiography study vitro autoradiography used compare peripheral alpha 1 alpha 2 adrenergic receptor binding various tissues using 3h prazosin 3h rauwolscine , respectively , three models experimental hypertension rats models studied included two kidney , one clip hypertension , one kidney , one clip hypertension , salt hypertension , three normotensive control groups two kidney control , one kidney control salt loaded control blood pressures death significantly higher three hypertensive groups compared normotensive controls , significant differences among hypertensive normotensive groups plasma norepinephrine levels significantly elevated three hypertensive groups compared respective controls , significant differences among hypertensive control groups three hypertensive groups , significant reductions binding aortic mesenteric vascular alpha 1 receptors , renal tubular alpha 1 alpha 2 receptors , adrenal cortical alpha 2 receptors compared respective control groups reduced binding cardiac ventricular alpha 1 alpha 2 receptors also found hypertensive groups , statistically significant levels significant differences intestinal alpha 1 alpha 2 receptor binding detected either hypertensive normotensive groups results suggest increased peripheral sympathetic activity three models experimental hypertension , associated regulation alpha 1 alpha 2 receptors number peripheral tissues , especially control cardiovascular hemodynamics fluid salt balance evidence increase peripheral alpha receptor binding often found models genetic spontaneous hypertension
divergent effects serotonin coronary artery dimensions blood flow patients coronary atherosclerosis control patients background studies animals shown serotonin coronary arteries endothelium damaged , vitro studies revealed vasodilating effect isolated coronary segments intact endothelium investigate effect serotonin humans , studied coronary artery cross sectional area blood flow infusion serotonin seven patients angiographically normal coronary arteries seven coronary artery disease methods measured cross sectional area coronary artery quantitative angiography coronary blood flow intracoronary doppler catheter measurements obtained base line intracoronary infusions serotonin \( 0 1 , 1 , 10 micrograms per kilogram body weight per minute , two minutes \) repeated measurements infusion , antagonist serotonin receptors thought block effect serotonin receptors arterial wall endothelium results patients normal coronary arteries , highest dose serotonin increased cross sectional area 52 percent \( p less 0 001 \) blood flow 58 percent \( p less 0 01 \) effect significantly potentiated administration patients coronary artery atherosclerosis , serotonin reduced cross sectional area 64 percent \( p less 0 001 \) blood flow 59 percent \( p less 0 001 \) prevented effect conclusions serotonin vasodilating effect normal human coronary arteries endothelium damaged , coronary artery disease , serotonin direct , effect considered evidence , data suggest platelet derived factors serotonin may role certain acute coronary ischemic syndromes
effect intracoronary serotonin coronary vessels patients stable angina patients variant angina background serotonin , major product platelet activation , potent vasoactive effects animal models , role human coronary artery disease remains largely methods using quantitative coronary angiography , compared effects intracoronary infusion graded concentrations serotonin \( 10 \( 7 \) 10 \( 4 \) mol per liter \) coronary vessels two groups patients different clinical presentations coronary disease \( nine stable angina five variant angina \) , effects control group eight subjects normal vessels angiography results normal coronary vessels biphasic response intracoronary serotonin dilation concentrations 10 \( 5 \) mol per liter , constriction 10 \( 4 \) mol per liter vessels patients stable angina concentrations , mean \( sem \) maximal decreases diameter 23 9 3 6 , 33 1 3 9 , 41 7 3 1 percent base line proximal , middle , distal segments serotonin concentration 10 \( 4 \) mol per liter smooth segments irregular segments \( 42 0 4 6 vs 21 1 1 6 percent \) four patients stable angina marked reduction collateral filling patients stable angina angina intracoronary infusion serotonin , electrocardiographic changes noted six patients variant angina angina , electrocardiographic changes , localized occlusive epicardial coronary artery spasm concentrations 10 \( 6 \) \( n 2 \) 10 \( 5 \) \( n 3 \) mol per liter conclusions patients stable coronary disease normal vasodilator response intracoronary serotonin , rather progressive constriction , particularly intense small distal collateral vessels patients variant angina occlusive coronary artery spasm dose normal vessels causes slight constriction vessels patients stable angina findings suggest serotonin , released intracoronary activation platelets , may contribute cause myocardial ischemia patients coronary artery disease
orbitozygomatic approach high basilar tip aneurysm associated short intracranial internal carotid artery new surgical approach two cases high basilar tip aneurysm accompanied short intracranial internal carotid artery , orbitozygomatic approach consisting en bloc fronto orbitozygomatic temporal craniotomy approach carried angiograms , height bifurcation elongated basilar artery length intracranial internal carotid artery line anterior posterior process 20 mm 6 mm case 1 , 18 mm 5 mm case 2 , respectively skin flap separated preserve branch facial nerve fronto orbitozygomatic temporal bone flap made , part basal bony structures orbital roof , ridge , temporal bone removed basilar tip aneurysm could seen clipped easily upward oblique wide operative space consisting less retracted internal carotid middle cerebral arteries , oculomotor nerve , , anterior temporal fossa obtained partial division temporal bridging veins operative procedure presented detail compared surgical approaches described previously
impairment cerebral autoregulation development chronic cerebral vasospasm subarachnoid hemorrhage primates studied impairment autoregulation cerebral blood flow \( cbf \) effect electrical activity brain development chronic cerebral vasospasm subarachnoid hemorrhage , using vasospasm model primates fourteen animals divided two groups clot group \( 8 \) sham operated group \( 6 \) induce subarachnoid hemorrhage , animals underwent craniectomy , clot group , autologous blood clot located around arteries dissected free membrane cerebral angiography performed subarachnoid hemorrhage 7 days \( day 7 \) day 7 , regional cbf parietal lobe measured hydrogen clearance method central conduction time studied either graded hypertension hypotension clot group , mean vessel caliber cerebral arteries right side \( clot side \) circle showed significant \( p less 0 01 \) reduction \( 40 \) compared values contralateral , non clot side values bilateral parietal cbf sham operated group left parietal cbf clot group fairly constant mean arterial blood pressure \( mabp \) range 60 160 mm hg clot group , right parietal cbf significantly \( p less 0 05 \) smaller left side mabp level 40 100 mm hg , increased mabp level 180 mm hg right parietal cbf increased arterial blood pressure increased , showing impairment autoregulation
cavernous malformations capillary telangiectasia spectrum within single pathological entity cerebral vascular malformations traditionally divided four categories arteriovenous , venous , cavernous , capillary controversy exists separating latter two lesions separate entities distinction arbitrary unable present convincing evidence linking two types lesions reviewed histories 20 patients cavernous malformations analyzed clinical , radiographic , surgical autopsy data associated lesions patients , multiple lesions , including cavernous malformations , capillary , transitional forms two , identified based analysis , conclude capillary telangiectasia cavernous malformations represent two pathological within vascular malformation category propose single cerebral entity called cerebral capillary malformations
depression acute myocardial infarction role primary care physicians rehabilitation depression common problem myocardial infarction diagnosis facilitated use criteria depression diagnostic statistical manual mental disorders self rating questionnaires treatment may involve psychological pharmacologic interventions patient 's medical status must carefully assessed administration antidepressant medication antidepressants contraindicated immediately myocardial infarction signs symptoms depression exhibited early recovery phase , \( \) may offer advantages traditional antidepressants research necessary determine safety newer antidepressants
us assisted aspiration thrombectomy vitro investigations authors describe use new ultrasound \( us \) aspiration thrombectomy technique us probe inserted thin , large bore aspiration catheter experiments tested ability new device catheter combinations remove clot material , well small large vessel models made silicone glass tubes , respectively results experiments demonstrated 1 0 mm us probe inserted aspiration catheter \( 7 9 f diameter \) promoted clot fragmentation allowed continuous aspiration thrombi size compared simple large bore catheter aspiration mechanical fragmentation means us probe within catheter cool probe , us assisted aspiration thrombectomy demonstrated significantly better results percutaneous transcatheter removal fresh thrombi
renal vein inability predict response revascularization patients hypertension determine whether captopril stimulated renal vein renin ratio \( \) could enable identification patients hemodynamically significant renovascular lesions would respond revascularization , authors measured 143 consecutive patients hypertension selected clinical features suggestive renovascular hypertension patients underwent conventional renal arteriography renovascular hypertension final diagnosis revascularization resulted cure improvement blood pressure complete data available 133 patients twenty patients renovascular hypertension greater 1 5 13 20 patients \( sensitivity , 65 \) however , also greater 1 5 54 113 patients without renovascular hypertension \( false positive rate , 47 8 \) positive predictive value 18 6 negative predictive value , 89 3 concluded sufficiently sensitive enable prediction patients respond revascularization specific enough exclude patients renovascular hypertension
patient evaluation cardiac transplantation aim cardiac transplantation improve quality life survival patients end stage heart failure given donor organ availability , expense transplantation process follow care , well tremendous emotional burden process places patient family , essential carefully screen potential candidates symptomatic , functional , hemodynamic , psychosocial eligibility , rule coexisting hemodynamic comorbid conditions would successful transplantation immunosuppression comprehensive screening potential transplant candidates , best accomplished multidisciplinary team approach working closely patients families , essential maximum benefit derived scarce valuable resource
electrocardiographic subset analysis diltiazem administration long term outcome acute myocardial infarction multicenter diltiazem post infarction trial research group effect diltiazem long term outcome acute myocardial infarction \( ami \) assessed 2 , patients enrolled multicenter diltiazem post infarction trial subsequently followed 25 8 months study population included 855 patients \( 36 \) least 1 prior ami index infarction 1 , patients \( 64 \) first ami , \( 27 \) first non q wave ami , \( 44 \) first inferior q wave ami , 449 \( 30 \) first anterior q wave ami post hoc analysis revealed , among patients first non q wave first inferior q wave ami , fewer cardiac events follow diltiazem placebo group , reverse true patients first anterior q wave ami prior infarction diltiazem placebo cox hazard ratio \( 95 confidence limits \) trial primary end point \( cardiac death nonfatal reinfarction , occurred first \) first non q wave ami 0 48 \( 0 26 , 0 89 \) first inferior q wave ami 0 66 \( 0 40 , 1 09 \) first anterior q wave ami 0 82 \( 0 51 , 1 31 \) prior ami 1 11 \( 0 85 , 1 44 \) use cardiac death alone end point gave even sharply focused treatment difference first non q wave ami 0 46 \( 0 18 , 1 21 \) first inferior q wave ami 0 53 \( 0 27 , 1 06 \) first anterior q wave ami 1 28 \( 0 68 , 2 40 \) prior infarction 1 26 \( 0 90 , 1 77 \) analysis revealed differences effect diltiazem large part reflected different status 4 electrocardiographically defined subsets terms left ventricular function
exercise echocardiography technetium 99m mibi single photon emission computed tomography detection coronary artery disease compare relative diagnostic value exercise echocardiography perfusion technetium 99m single photon emission computed tomography \( spect \) detecting coronary artery disease \( cad \) , 75 patients suspected cad normal electrocardiogram \( ecg \) rest included prospective correlative study exercise echocardiograms spect studies performed conjunction symptom limited bicycle exercise test development either new wall motion abnormality reversible perfusion defect exercise , , regarded positive test exercise echocardiographic spect studies , respectively results 2 diagnostic tests compared coronary arteriography exercise echocardiography identified 35 \( 71 \) spect 41 \( 84 , p 0 13 \) 49 patients significant cad \( defined greater 50 diameter stenosis \) twenty five 26 patients \( 96 \) without significant coronary stenosis negative exercise echocardiographic results 23 26 \( 88 \) negative spect results exercise induced new wall motion abnormalities showed good correlation reversible perfusion defects , results 2 methods concordant 65 75 patients \( agreement 88 , kappa 0 75 0 14 \) diagnostic accuracy exercise echocardiography spect significantly higher exercise ecg \( 81 vs 64 , p less 0 02 88 vs 64 , p less 0 005 \) sensitivity specificity detecting individual diseased vessels 60 95 exercise echocardiography 67 94 spect
impaired left ventricular filling regional diastolic asynchrony rest coronary artery disease relation exercise induced myocardial ischemia impaired left ventricular \( lv \) diastolic filling rest frequently observed patients coronary artery disease \( cad \) normal lv systolic function previous infarction test hypothesis abnormal diastolic function rest might reflect functional severity cad , estimated exercise induced ischemia , relation regional global lv diastolic function rest exercise induced ischemia evaluated 49 patients radionuclide angiography patients normal systolic function rest group 1 \( n 26 \) patients manifested normal ejection fraction response exercise group 2 \( n 23 \) patients abnormal response data obtained 22 age comparable normal volunteers used comparison although regional global diastolic function different normal subjects group 1 patients , peak filling rate lower group 2 patients normal subjects \( 2 5 0 8 vs 3 2 0 6 end diastolic counts p less 0 01 \) moreover , regional diastolic asynchrony , assessed radionuclide data using regional sector analysis lv region interest , greater group 2 patients \( 46 44 ms \) normal subjects \( 25 16 ms p less 0 05 \) group 1 patients \( 23 16 ms p less 0 05 \) thus , among patients cad normal lv systolic function rest , impaired lv filling regional asynchrony predict greater degree exercise induced ischemia , suggesting greater extent myocardium
predictors cardiac survival percutaneous transluminal coronary angioplasty patients severe left ventricular dysfunction assess outcome percutaneous transluminal coronary angioplasty \( ptca \) patients severe left ventricular \( lv \) dysfunction determine predictors mortality , 73 patients lv ejection fraction less equal 40 underwent initial ptca analyzed majority patients prior \( greater 1 week \) myocardial infarction \( 62 patients , 85 \) congestive heart failure unstable angina present 24 \( 45 \) 49 \( 67 \) patients , respectively multivessel coronary artery disease present 60 \( 83 \) lv ejection fraction ranged 14 40 \( mean 34 \) intraaortic balloon pump \( 15 \) percutaneous cardiopulmonary bypass support \( 4 \) used infrequently angiographic success obtained 109 128 lesions \( 85 \) attempted complete revascularization obtained 16 60 patients clinical success procedure related mortality 5 \( 4 patients \) patients followed greater equal 6 less equal 71 months \( average 26 \) estimated survival 79 5 , 74 6 , 66 7 57 8 1 , 2 , 3 4 years , respectively cox regression analysis revealed presence congestive heart failure , lower lv ejection fraction higher myocardial jeopardy score contractile myocardium independent predictors survival ptca patients lv dysfunction conclusion , high risk subset identified among patients severe lv dysfunction undergo ptca
comparison left ventricular ejection fraction magnetic resonance imaging radionuclide ventriculography idiopathic dilated cardiomyopathy assess validity gated magnetic resonance imaging \( mri \) determining left ventricular \( lv \) ejection fraction \( ef \) , mri \( spin echo , technique short axis plane \) compared equilibrium radionuclide ventriculography 32 patients idiopathic dilated cardiomyopathy patients underwent mri radionuclide ventriculography , performed consecutively day \( mean time interval 2 examinations 40 minutes \) comparison lvef showed high correlation \( 0 79 x 3 51 , r 0 91 p less 0 001 \) mean difference radionuclide ventriculography mri data 1 7 , 95 confidence interval 0 71 2 68 mri slightly underestimated lvef mri interobserver variability \( assessed 15 32 patients \) showed high correlation \( r 0 91 , r 0 98 \) conclusion , data suggest mri , using short axis approach technique , accurate , noninvasive , highly reproducible method evaluating lvef patients idiopathic dilated cardiomyopathy
stroke volume submaximal exercise endurance trained normotensive subjects untrained hypertensive subjects beta blockade \( propranolol pindolol \) effect beta adrenergic blockade stroke volume \( sv \) increasing submaximal exercise intensities studied 12 endurance trained normotensive 12 untrained hypertensive \( diastolic blood pressure greater 95 mm hg \) men , aged 18 34 years subjects assigned 3 treatments double blind , randomized order placebo , propranolol \( 80 mg twice daily \) pindolol \( 10 mg twice daily \) 10 days , period 48 60 hours initial dose first treadmill test 4 day washout period drugs cardiac output measured using carbon dioxide method sv calculated cardiac output heart rate follows sv cardiac output heart rate cardiac outputs estimated rest walking treadmill 25 , 45 , 60 75 subject 's previously determined maximal oxygen uptake \( vo2max \) significant differences found cardiac output either drugs placebo rest , 4 rates work propranolol significantly increased sv placebo values \( p less 0 05 \) trained untrained groups intensities 45 , 60 75 significant differences sv found pindolol placebo intensities 60 75 trained group contrary expectations , sv showed indication plateau propranolol trained subjects throughout 4 different exercise intensities , whereas plateau established placebo conditions 45 vo2max trained untrained subjects results suggest trained untrained hypertensive persons exercise beta adrenergic blockade submaximal levels without compromised cardiac function
hypertension , endothelium , cardiovascular risk factors functions endothelium effects hypertension , atherosclerosis , diabetes endothelium reviewed endothelium affects vascular tone releasing vasodilators modulating effects vasoactive substances catecholamines , bradykinin , serotonin , angiotensin ii relaxation vascular smooth muscle depends upon functionally intact endothelium release endothelium derived relaxing factor nitric oxide endothelial cells also appear release factor smooth muscle activation sodium potassium pump , endothelium dependent contracting factors similarities found vascular injury resulting hypertension , atherosclerosis , diabetes risk factors , act synergistically vascular injury endothelium appears one major targets forms injury future therapeutic strategies focus ways prevent , arrest , reverse endothelial injury
cardiovascular risk reduction role antihypertensive treatment effects antihypertensive drugs mortality stroke , coronary artery disease \( cad \) , causes studied 14 trials involving 37 , 000 patients treated patients , blood pressure 5 6 mm hg lower placebo treated patients , whereas mortality stroke reduced 42 , cad mortality reduced 14 major reason lack effect cad mortality apparently adverse effects primary drugs used trials \( diuretics beta blockers \) glucose tolerance , lipid levels , insulin resistance angiotensin converting enzyme inhibitors favorably influence many cad risk factors , use expected reduce cad mortality patients treated hypertension
web coronary risk factors although epidemiologic , genetic , pathophysiologic studies shown low density lipoproteins \( \) involved development coronary artery disease , standard measurement ldl cholesterol comprises number separate components may contribute different ways disease process components appear particular pathologic importance intermediate density lipoproteins \( \) lipoprotein \( \) highly atherogenic species normally account 10 15 total ldl cholesterol may disproportionately elevated pathologic states may therefore contribute disproportionately coronary disease risk certain patients recently , another subclass ldl , characterized relatively small particle size increased density , also found associated relatively increased risk coronary disease furthermore , levels subclass , designated ldl iii , linked number interrelated hormonal metabolic factors , also associated risk coronary artery disease include male gender , , abdominal , elevated triglyceride levels , increased levels apolipoprotein b , reductions high density lipoproteins \( \) , particularly hdl2 subclass studies demonstrated many factors also commonly associated relative insulin resistance hyperinsulinemia thus , lipoprotein profile characterized relative increase ldl iii reduction hdl2 indicative metabolic features defines high risk state makes extremely difficult single one factors directly involved disease process combinations genetic environmental factors acting web risk factors may account much variation coronary disease susceptibility found general population
regression atherosclerosis mean \? angiographic evidence coronary artery atherosclerosis regression demonstrated controlled clinical trials significance regression appears depend complex way degree atherosclerosis present regression regimen initiated angiographic trials indicate lesion change continuum , gradual transition progression stability regression divergent lesion change seen patient progression lesions regression others makes necessary perform comprehensive survey visible coronary segments evaluating angiograms determine outcome clinical trial important finding clinical trials new lesion formation reduced indicates effective control atherosclerosis may possible procedures available , noninvasive coronary artery imaging methods need refined
insulin resistance , hyperinsulinemia , hypertriglyceridemia etiology clinical course hypertension patients untreated hypertension shown resistant insulin stimulated glucose uptake hyperinsulinemic matched groups patients normal blood pressure addition , insulin resistance , hyperinsulinemia , hypertriglyceridemia demonstrated spontaneous hypertensive rats sprague dawley rats fed fructose enriched diet defect insulin stimulated glucose uptake experimental models also shown cellular level experimental interventions prevent insulin resistance hyperinsulinemia developing fructose fed rats also greatly attenuate increase blood pressure since endogenous hyperinsulinemia hypertriglyceridemia identified factors increase risk coronary artery disease \( cad \) , likely contribute increased prevalence cad hypertensive patients antihypertensive treatment may exacerbated metabolic abnormalities , could help explain difficult show lowering blood pressure decreases risk cad observations raise possibility abnormalities carbohydrate lipoprotein metabolism may play role etiology clinical course hypertension
new treatment coronary artery thrombosis application recombinant dna methodology clinical medicine offers clinician new generation potent specific therapies recombinant methods offer great promise treatment coronary artery thrombosis review focuses characterization 1 \) molecules activate plasminogen locally \( vicinity thrombus \) rather systemically , 2 \) molecules offer new approaches inhibition platelet activation thrombin activity first describe methods used molecules characterization molecular level ways knowledge lead development agents tailored clinical needs explored
influence desflurane regional distribution coronary blood flow chronically instrumented canine model multivessel coronary artery obstruction influence desflurane myocardial perfusion measured microsphere technique total occlusion left anterior descending coronary artery concomitant moderate severe stenosis left circumflex coronary artery evaluated chronically instrumented dogs hemodynamics , regional contractile function , myocardial blood flow measured conscious state anesthesia desflurane \( 8 2 9 2 12 5 12 7 \) without control arterial pressure total left anterior descending occlusion produced combination left circumflex coronary artery stenosis significantly \( p less 0 05 \) increased heart rate left ventricular end diastolic pressure absence desflurane anesthesia desflurane , administered presence left anterior descending occlusion left circumflex stenosis , significantly \( p less 0 05 \) decreased mean arterial pressure , left ventricular systolic pressure , left ventricular positive dp without change heart rate blood flow normal myocardium reduced high concentration desflurane \( p less 0 05 \) , perfusion maintained conscious levels left circumflex stenosis moderate severity , blood flow distal stenosis reduced desflurane \( p less 0 05 \) presence severe stenosis , perfusion decreased , , stenotic zone \( p less 0 05 \) reduction arterial pressure produced desflurane , collateral blood flow left anterior descending region reduced dogs either moderate severe left circumflex stenosis \( p less 0 05 \) arterial pressure heart rate conditions observed conscious state restored high concentration desflurane , myocardial blood flow regions returned levels present conscious state \( p less 0 05 \) ratios flow occluded normal zones decreased hypotension produced desflurane uncontrolled , arterial pressure heart rate adjusted conscious levels using partial thoracic aorta occlusion atrial pacing , ratio remained conscious control levels regardless degree left circumflex stenosis severity \( p less 0 05 \) results investigation indicate desflurane blood flow away collateral dependent myocardium regions via coronary steal mechanism chronically instrumented canine model multivessel coronary artery disease
narrow qrs ventricular tachycardia objective determine frequency clinical characteristics narrow qrs ventricular tachycardia \( qrs duration less equal 0 11 seconds \) design consecutive survey patients ventricular tachycardia setting tertiary , referral based arrhythmia service university medical center patients sequential sample patients inducible ventricular tachycardia 12 lead electrocardiogram tachycardia available review measurements main results 106 patients ventricular tachycardia , 5 \( 4 7 95 ci , 2 1 10 6 \) ventricular tachycardia qrs duration less equal 0 11 seconds three five patients previously incorrectly diagnosed supraventricular tachycardia five patients least two electrocardiographic findings qrs duration suggest ventricular tachycardia conclusions narrow qrs ventricular tachycardia considered differential diagnosis narrow qrs tachycardias electrocardiographic findings qrs duration usually present suggest diagnosis
increased plasma endothelin 1 pulmonary hypertension marker mediator disease \? objective explore role endothelin 1 , potent endothelial derived vasoconstrictor peptide , pulmonary hypertension , measuring concentration arterial venous plasma design survey , case series study setting university affiliated hospitals outpatient clinics patients twenty seven patients pulmonary hypertension 7 primary , 20 secondary pulmonary hypertension various causes control groups \( n 16 \) comprised 8 healthy volunteers 8 patients coronary artery disease without evidence pulmonary hypertension measurements main results pulmonary artery pressure markedly increased \( 94 43 23 13 mm hg \) patients pulmonary hypertension venous plasma immunoreactive endothelin 1 , measured specific radioimmunoassay , significantly higher patients pulmonary hypertension \( 3 5 2 5 pg ml , p less 0 001 \) normal subjects \( 1 45 0 45 pg ml \) , patients coronary disease \( 0 75 0 64 pg ml \) arterial venous ratio immunoreactive endothelin 1 significantly greater unity primary pulmonary hypertension \( 2 21 0 72 , p 0 01 \) , whereas patients secondary pulmonary hypertension mean ratio different 1 \( 0 97 0 42 \) contrast , mean arterial venous ratios significantly less unity control groups \( 0 59 0 35 , 0 54 0 64 p less 0 02 , normal subjects coronary disease patients , respectively \) , indicating possible clearance endothelin 1 across healthy lung conclusions patient pulmonary hypertension substantial alterations plasma immunoreactive endothelin 1 , may reflect changes net release clearance endothelin 1 lung patients primary pulmonary hypertension , high levels arterial compared venous plasma suggest pulmonary production endothelin 1 , may contribute elevated pulmonary vascular resistance
evaluation drug therapy treatment hypertensive emergency department oral nifedipine \( n \) clonidine \( c \) often used treatment hypertensive however , recently , comparative studies using patient population authors reviewed records hypertensive patients treated emergency department october 1 , 1987 september 30 , 1988 selected patients diastolic blood pressure \( dbp \) greater 115 mm hg without evidence acute end organ damage patients stratified three treatment groups n , c , group 3 \( g3 \) g3 received variety drug therapies exclusively n c systolic blood pressure \( sbp \) , dbp , mean arterial pressure \( map \) , percent decrease map \( map \) , time lower blood pressure , admissions , discharges evaluated efficacy safety defined reaching dbp less 110 mm hg map greater either 25 40 , respectively thirty five n , 32 c , 27 g3 patients identified statistical difference groups race , gender , pretreatment sbp , dbp , map n , c , g3 significantly reduced sbp , dbp , map \( p less 01 \) comparing n , c , g3 , differences observed map , admissions , discharges , efficacy , safety time required decrease blood pressure differed three groups \( 44 32 n v 77 57 c v 152 94 min g3 \) \( p less 05 \) results indicate n , c , variety drug therapies equally effective safe treatment hypertensive
experience esmolol treatment cocaine associated cardiovascular complications authors report experience using esmolol , ultra short acting beta adrenergic antagonist , treatment seven patients cocaine associated cardiovascular complications consistent hemodynamic benefit found use drug although decline mean heart rate 23 \( range 0 35 \) , unable show consistent antihypertensive response adverse effects occurred three patients included one patient marked exacerbation hypertension one became hypotensive another patient developed emesis esmolol therapy required endotracheal intubation recommend routine use esmolol cocaine cardiotoxicity
high resolution real time ultrasound diagnosis venous thrombosis rehabilitation setting accurate , noninvasive testing deep venous thrombosis \( dvt \) conventional methods often possible rehabilitation patient lower extremity amputation , cast , skin problems present standard diagnostic methods report describes use duplex ultrasound \( us \) scanning noninvasive diagnosis dvt seventy year old man knee amputation , doppler plethysmography examinations could performed experience gained technique , use venography diagnosis dvt becomes difficult
retinal arterial macroaneurysms risk factors natural history case control study conducted identify systemic ocular risk factors retinal arterial macroaneurysms forty three patients 52 confirmed macroaneurysms located forty three age matched , race matched concurrent control patients also identified patients macroaneurysms decreased visual acuity \( p less 0 0001 \) higher prevalence hypertension \( p 0 \) , female sex \( p 0 \) , retinal vein occlusions \( p 0 \) controls patients venous occlusion 12 0 times higher prevalence macroaneurysms area retina drained occluded vein \( p less 0 05 \) common findings associated macroaneurysms included retinal haemorrhage \( 81 patients \) , retinal exudate \( 70 \) , vitreous haemorrhage \( 30 \) , macular involvement \( 30 \) , distal arteriolar narrowing \( 26 \) arteriolar occlusion occurred spontaneously \( 8 \) laser photocoagulation \( 16 \)
hirudin interruption heparin resistant arterial thrombus formation baboons determine role thrombin high blood flow , platelet dependent thrombotic hemostatic processes measured relative antithrombotic effects baboons hirudin , highly potent specific antithrombin , compared effects heparin , antithrombin iii dependent inhibitor thrombin thrombus formation determined vivo using three relevant models \( homologous aorta , collagen coated tubing , dacron vascular graft \) measuring \( 1 \) platelet deposition , using gamma camera imaging 111in platelets \( 2 \) fibrin deposition , assessed incorporation circulating 125i fibrinogen \( 3 \) occlusion continuous intravenous infusion 1 , 5 , 20 nmol kg per minute recombinant hirudin \( \) maintained constant plasma levels 0 16 0 03 , 0 79 0 44 , 3 3 0 77 mumol ml , respectively hirudin interrupted platelet fibrin deposition dose dependent manner profound highest dose three thrombogenic surfaces significant lowest dose thrombus formation aorta thrombotic occlusion prevented doses studied contrast , heparin inhibit either platelet fibrin deposition administered dose maximally prolonged clotting times \( 100 u kg \) \( p greater 1 \) , intermediate effects produced 10 fold dose \( 1 , 000 u kg \) moreover , heparin prevent occlusion test segments hirudin inhibited platelet hemostatic function concert antithrombotic effects \( bleeding times prolonged intermediate higher doses \) comparison , intravenous heparin failed affect bleeding time 100 u kg dose \( p greater 5 \) , minimally prolonged bleeding time 1 , 000 u kg dose \( p less 05 \) conclude platelet dependent thrombotic hemostatic processes thrombin mediated biologic antithrombin hirudin produces potent , dose dependent inhibition arterial thrombus formation greatly exceeds minimal antithrombotic effects produced heparin
serum sialic acid concentration cardiovascular mortality objective determine whether serum sialic acid concentration may used predict short long term cardiovascular mortality design prospective study men women serum sialic acid concentration measured part general health survey 1964 1965 followed average 20 5 years setting geographical part county , sweden subjects residents area participating health check 1964 5 \( 27 , men 28 , women \) , men \( 169 incomplete data 203 lost follow \) 345 women \( 143 202 respectively \) excluded thus 26 , men 27 , women entered study study sample restricted subjects aged 40 74 20 years' follow main outcome measures serum sialic acid concentration , serum cholesterol concentration , diastolic blood pressure , body mass index general health survey visit cardiovascular non cardiovascular deaths three periods follow \( 0 6 years , 7 13 years , 14 20 years \) , according swedish mortality register , subjects aged 45 74 results mean serum sialic acid concentration \( mg 100 ml \) 68 8 \( sd 8 0 \) men 69 2 \( 8 0 \) women average concentration increasing age sexes total \( 21 \) men \( 12 \) women died follow period , death \( 54 \) men \( 41 \) women cardiovascular causes short \( 0 6 years \) , medium \( 7 13 years \) , long \( 14 20 years \) term follow relative risk death cardiovascular disease increased increasing serum sialic acid concentration relative risk \( 95 confidence interval \) associated highest quartile sialic acid concentration compared lowest quartile 2 38 \( 2 01 2 83 \) men 2 62 \( 1 93 3 57 \) women similar results found deaths non cardiovascular disease relative risks 1 50 \( 1 34 2 68 \) men 1 89 \( 1 57 2 28 \) women , relative risks significantly lower deaths cardiovascular disease \( p less 0 001 p less 0 005 respectively \) multivariate analysis total mortality cardiovascular mortality sialic acid concentration , serum cholesterol concentration , diastolic blood pressure , body mass index independent variables impact sialic acid concentration virtually univariate analysis conclusion serum sialic acid concentration strong predictor cardiovascular mortality possible explanation findings serum sialic acid concentration may reflect existence activity atherosclerotic process , may warrant investigation
comparison exercise performance left main three vessel coronary artery disease consecutive series patients underwent rest exercise radionuclide angiography several years , retrospectively identified 34 patients left main coronary artery disease 103 patients three vessel coronary artery disease significant left main disease results gated equilibrium radionuclide angiography compared 2 groups multiple exercise hemodynamic , exercise electrocardiographic , exercise radionuclide angiographic parameters considered attempt separate 2 groups parameter significantly different 2 groups exercise heart rate however , value exercise heart rate could separate 2 groups despite known difference prognosis , patients left main three vessel disease similar exercise performance could distinguished one another exercise electrocardiography exercise radionuclide angiography inability distinguish two groups clear limitation noninvasive exercise modalities
atrial septal occlusion improves accuracy mitral valve area determination following percutaneous mitral balloon valvotomy investigated impact atrial communication mitral valve area calculation percutaneous mitral balloon valvotomy 17 patients \( 15 women , 2 men mean age 56 4 years \) hemodynamic measurements mitral valve area calculations performed without balloon occlusion atrial septal puncture site mitral valve area determined balloon occlusion significantly smaller mitral valve area determined without occlusion \( 1 6 0 1 vs 1 9 0 1 cm2 , p less 0 01 \) , similar echocardiographically determined valve area \( 1 6 0 1 cm2 \) decrease calculated mitral valve area occlusion associated decrease measured cardiac output , without change mitral valve gradient diastolic filling period occlusion atrial septal puncture site may permit accurate determination mitral valve area thus provide better reference point future comparison question restenosis arise
preservation regional myocardial function coronary angioplasty autoperfusion balloon catheter case report echocardiographic assessment regional myocardial function performed standard balloon coronary angioplasty followed autoperfusion balloon angioplasty proximal left anterior descending artery stenosis septal apical occurred within 60 seconds standard balloon inflation , regional function well preserved prolonged autoperfusion balloon inflation
successful mitral valvuloplasty using balloon patient mitral stenosis associated subvalvular fibrosis reduced left ventricular inflow cavity case report percutaneous transvenous mitral valvuloplasty \( \) performed two pigtail balloon catheters 52 year old woman symptomatic mitral stenosis subvalvular apparatus fibrous welded chordae subvalvular left ventricular space markedly reduced result distorted anatomy , inflations , two balloons constantly slipped back left atrium full inflation obtained procedure , mitral valve area \( mva \) , estimated echo doppler \( ed \) , increased 1 00 1 34 cm2 2 months mild clinical improvement , patient became symptomatic ed examination showed mva 1 25 cm2 second performed balloon , entire procedure taking less 1 hour stable position balloon complete dilatation achieved ed examination showed mitral valve area 2 30 cm2 mitral regurgitation atrial septal defect 3 months , n h class symptoms mva , estimated ed , 2 40 cm2
percutaneous right brachial artery approach 5f catheters studying coronary artery disease prospectively studied 60 ischemic patients 5f catheters \( pigtail \) using percutaneous right brachial artery approach \( group \) , order compare technique two groups 100 patients randomly studied femoral route either 5f \( group ii \) 8f \( group iii \) catheters \( pigtail \) following parameters analyzed need change initially elected catheter diameter artery approach technical difficulty obtaining lv , lca , rca angiograms total time x ray exposure quality image lv , lca , rca angiograms incidence arterial puncture related hematomas total arterial occlusion duration local compression sheath removal differences 5f brachial femoral approaches except arterial compression time \( p less 0 01 \) x ray exposure time \( p 0 03 \) longer brachial approach whatever route used , 5f showed mild increase difficulty \( brachial p 0 001 femoral p 0 01 \) mild decreased quality image lca \( p 0 006 femoral p less 0 05 \) mild hematomas frequent 8f catheters \( p less 0 05 \) procedure could completed elected first artery type catheter \( 5f 8f \) 57 60 patients group , 95 100 group ii , 96 100 group iii \( nonsignificant differences \) thus , percutaneous right brachial artery approach using 5f catheters similar femoral artery approach catheters although showed mild increased technical difficulty mild decreased quality image compared 8f , mainly lca angiograms , allowed complete reliable angiograms reading analysis
accuracy reproducibility quantitative coronary arteriography using 6 8 french catheters cine angiographic acquisition determine suitability 6 french catheters quantitative coronary arteriography , relative accuracy reproducibility one type catheters compared obtained standard 8 french catheters 20 stenoses duplicate injections polyurethane 6 french catheters obtained using hand power injection technique acquisition \( four 6 french catheter injections total per stenosis \) measurements percent diameter stenosis absolute dimensions compared obtained hand injection cine acquisition using 8 french catheters gold standard reproducibility dimension determination 6 french catheter generally similar obtained 8 french catheter \( 0 27 0 23 mm absolute diameter 8 1 7 4 percent diameter stenosis \) , accuracy significantly less 6 french catheter measurement absolute dimensions thus , apparently well suited serial measurements stenoses , 6 french catheters may accurate determination absolute artery dimensions 8 french catheters
coronary balloon angioplasty diagnostic 6 french catheters investigated use profile balloon catheters \( ace , probe , , \) coronary angioplasty 6 french diagnostic catheters \( , \) contrast injection assisted pump \( \) cases 21 procedures , angioplasty 27 lesions 20 selected patients attempted \( 1 3 lesion procedure \) twelve lesions right , 10 left anterior descending , 5 left circumflex coronary artery balloon size varied 2 5 3 5 mm twenty lesions could successfully dilated \( 74 \) 6 french catheter 7 lesions required exchange 7 french angioplasty guiding catheter 5 cases , another balloon also necessary complete procedure final overall success rate 100 per patient per lesion major complications despite small internal catheter lumen \( 1 22 mm \) coronary visualization adequate , mechanical support good failures 6 french catheters attributed insufficient torque control excessive friction balloon crossed tapered end diagnostic catheter coronary angioplasty diagnostic 6 french catheter feasible may represent reasonable alternative simple cases done session diagnostic angiography available , 6 french high flow angioplasty guiding catheters without tapered tip improve success retaining advantage small femoral puncture site
preliminary experience 5 6 french diagnostic catheters guiding catheters coronary angioplasty reduction profile balloon dilation catheters , recently , internal dimensions performance guiding catheter use 7 , 8 9 french \( f \) systems performance percutaneous transluminal coronary angioplasty \( ptca \) new 5f catheter design \( medical co , st , mo \) provided large inner lumen \( 0 4 \) permitting use 0 20 0 22 fixed wire ptca balloon catheters good coronary visualization potential advantages include reduced coronary artery ostial trauma catheter induced enhanced patient comfort report initial experience 14 patients undergoing ptca 5 guide fixed wire system mean age 63 10 \( 43 78 years \) ptca indications cardiogenic shock \( 1 \) , post myocardial infarction angina pectoris \( 2 \) , grade iii angina \( 5 \) unstable angina pectoris \( 6 \) vessel attempted left anterior descending \( 3 \) , circumflex \( 4 \) , marginal \( 2 \) , diagonal \( 1 \) , right coronary artery \( 3 \) , internal thoracic artery \( 1 \) twelve patients femoral approach two brachial approach probe \( division , , \) used 8 lesions ace \( life systems , , mn \) catheter 7 lesions successful 5 guide fixed wire dilations reduced stenosis \( 77 14 37 30 \) successfully performed 79 \( 11 14 \) one 5f patient required 8f guiding catheter dilated 2 0 fixed wire balloon second failed 5f ptca could dilated larger conventional system third total occlusion could crossed guidewire fixed wire balloon patient complication
application coronary angioplasty septal perforator arteries significant coronary artery disease affecting septal perforator arteries cause anginal pain , rhythm disturbances , septal infarction however , since vessels usually coronary bypass surgery , tendency among lesions septal perforator arteries experience suggests medical treatment sufficient treat clinical manifestations resulting septal perforator disease , coronary angioplasty considered therapeutic alternative revascularization herein present 11 patients underwent coronary angioplasty major septal artery discuss angiographic technical aspects procedure
cardiotoxicity interferon review 44 cases cardiovascular complications occurred clinical trials interferon review herein experience date cardiotoxicity types interferons cancer patients common presentations cardiotoxicity cardiac arrhythmia , dilated cardiomyopathy , symptoms ischemic heart disease , including myocardial infarction sudden death cardiac effects related daily dose , cumulative total dose , period therapy patients interferon caused cardiovascular sequelae history coronary heart disease previously given chemotherapy drugs known patients , cardiac toxicity reversible following cessation drug therapy
systemic pulmonary bronchial blood flow mitral stenosis measured systemic pulmonary bronchial blood flow qbr \( p \) total cardiopulmonary bypass 15 patients mitral stenosis elevated pulmonary venous pressure \( group , mean pulmonary wedge pressure 22 2 5 4 mm hg , mean sd \) 15 patients coronary artery diseases normal pulmonary venous pressure \( group b \) qbr \( p \) volume blood accumulating left side heart absence pulmonary coronary flows blood vented cannula introduced left atrium measured qbr \( p \) 76 3 13 9 ml min \( 2 18 0 37 percent extracorporeal circulation pump flow \) 22 3 2 1 \( 0 63 0 15 \) group b , respectively \( p less 0 01 \) total cardiopulmonary bypass , pulmonary venous pressure approximately atmospheric pressure , differences systemic blood pressure , extracorporeal circulation pump flow , airways pressure observed group b therefore , vascular resistance bronchial vessels draining pulmonary circulation reduced patients mitral stenosis elevated pulmonary venous pressure
catheter induced tricuspid regurgitation incidence clinical significance incidence severity catheter induced tricuspid regurgitation studied extensively given frequency right heart catheters employed measure cardiac output , important know whether severity catheter induced tricuspid regurgitation sufficient measurement thermodilution cardiac output accordingly , purpose present prospective study determine incidence severity catheter induced tricuspid regurgitation 25 men \( mean age , 58 1 1 4 years \) using doppler ultrasound tricuspid valve two orthogonal views using pulsed wave color flow doppler , either presence absence 7 french catheter across tricuspid valve severity catheter induced tricuspid regurgitation graded using validated scoring system pulsed wave doppler studies showed incidence catheter induced tricuspid regurgitation 48 percent , average tricuspid regurgitation score increased 0 41 0 16 0 61 0 17 \( p less 0 01 \) color flow doppler studies showed similar findings , incidence catheter induced tricuspid regurgitation related patient 's underlying hemodynamic status right ventricular geometry conclusion , study shows first time quantitative extent catheter induced tricuspid regurgitation small , therefore unlikely important clinically , particularly regard assessment thermodilution cardiac output
venous air embolism diagnosis spontaneous right sided contrast echocardiography report describes definitive diagnosis venous air embolism documentation spontaneous echo contrast right cardiac chambers following removal jugular venous catheter patient hepatic failure complication potentiated presence concurrent hepatic coagulopathy effective hemostasis central venous puncture site
effect thromboxane synthetase inhibition cardiopulmonary function endotoxemia sheep early pulmonary hypertension seen endotoxin \( lipopolysaccharide \) reported resulting release thromboxane a2 studied cardiopulmonary response endotoxin sheep without treatment thromboxane synthetase inhibitor , oky 046 animals implanted instruments dimension analysis left ventricle measurement left ventricular , aortic , left atrial , pulmonary arterial pressures cardiac index thirteen sheep received 1 0 micrograms kg escherichia coli endotoxin \( n 6 \) without \( n 7 \) oky 046 \( 10 mg kg bolus , 10 micrograms kg min \) oky 046 prevented increase pulmonary arterial pressure decrease cardiac index usually seen early phase endotoxemia 8 12 hours administration endotoxin , cardiac index increased 6 4 0 8 8 4 0 8 l min m2 concomitantly , end systolic pressure diameter relationship \( sensitive myocardial contractility index \) significantly decreased 14 7 0 6 7 7 0 7 mm hg mm another index left ventricular contractility , maximum rate pressure rise also reduced oky 046 prevented decreases end systolic pressure diameter relationship maximum rate pressure rise
platelet fatty acids function two distinct regions relationship age dietary habits compared dietary habits , fatty acid composition plasma platelet phospholipids , platelet function two groups healthy male subjects , known differ mortality rate coronary heart disease \( chd \) subjects , larger intake saturated lower intake \( n 6 \) polyunsaturated fats , confirmed fatty acid composition plasma platelet phospholipids plasma hdl total cholesterol similar present samples two communities , platelet aggregation epinephrine significantly higher subjects two populations divided younger \( 28 54 years \) older \( 55 73 years \) age groups , older subjects exhibited platelet aggregability agonists , compared three groups addition dietary fats , alcohol smoking habits , age important determinant platelet phospholipid fatty acids platelet reactivity present results reinforce previous studies , indicating platelet behaviour significantly affected main risk factors chd
potential complications high dose epinephrine therapy patients resuscitated cardiac arrest adults resuscitated nontraumatic cardiac arrest received intravenous epinephrine doses chosen treating physician survived least 6 hours studied determine high dose epinephrine produced complications standard dose total 68 patients enrolled evaluated complications attributable epinephrine , using two tailed test , analysis 33 patients receiving high dose epinephrine 35 patients receiving standard dose epinephrine similar demographics variables known affect outcome difference potential complications groups except serum calcium , 1 97 mmol l \( sd , 0 20 \) high dose epinephrine group 2 10 \( sd , 0 20 \) standard dose group hospital discharge rates \( 18 high dose vs 30 standard dose group \) neurological status discharge significantly different high dose epinephrine produce increased direct complications cardiac arrest population compared standard dose epinephrine
cardiomyopathy associated smoking crystal methamphetamine smoking crystal methamphetamine , ice , growing drug abuse problem united states toxic effects methamphetamine smoking well described describe two patients cardiovascular toxic effects associated smoking crystal methamphetamine first patient , use methamphetamine associated subsequent development pulmonary edema dilated cardiomyopathy second patient , smoking crystal methamphetamine likely produced diffuse vasospasm resulted acute myocardial infarction , cardiogenic shock , death recognition potentially lethal cardiac complications associated smoking crystal methamphetamine extreme significance emphasized potential abusers drug
caloric expenditure , life status , disease former male athletes non athletes study examined association aerobic , caloric exercise expenditure life status \( living vs deceased \) well prevalence rates hypertension \( \) cardiovascular disease \( cvd \) former male athletes \( ath \) non athletes \( n ath \) initial survey study done follow surveys respondents done 1960 , 1968 , 1976 , 1984 present study used subjects responded fully activity health questions 1976 reported either dead alive \( lost follow \) 1984 total subjects \( 185 ath , 163 n ath \) assessed caloric expenditure groups established \( kcal \) aerobic exercise per week 0 kcal \( group 1 \) , 1 kcal \( group 2 \) , 400 kcal \( group 3 \) , 900 kcal \( group 4 \) , 1500 kcal \( group 5 \) , 2500 kcal \( group 6 \) activity considered aerobic used establishment aerobic categories death rate highest groups 1 2 subjects group 1 tended oldest year birth \( age \) \( p less 0 001 \) cvd \( p less 0 05 \) reported 1976 significantly related mortality 1976 1984 college athletic status 1976 exercise level significantly related mortality prevalence cvd highest groups 1 6 , suggesting moderate amount aerobic activity optimal
selective inhibition synthetic hirudin peptide fibrin dependent thrombosis baboons determine importance thrombin substrate recognition fibrinogen binding formation arterial venous thrombi , evaluated antithrombotic effects tyrosine sulfated residues 53 64 hirudin \( h peptide \) nonhuman primate model peptide studied inhibits thrombin fibrinogen simple competition without blocking enzyme catalytic site function arteriovenous access shunt model used baboons \( \) , thrombus formation induced placing thrombogenic device made \( \) segment tubing coated covalently type collagen , generated platelet rich thrombi arterial flow conditions , \( ii \) two subsequent annular regions flow expansion produced fibrin rich thrombi typically associated venous valves veins thrombus formation quantified measurements 111in labeled platelet 125i labeled fibrinogen deposition arterial flow venous flow portions device continuous infusion h peptide \( 0 5 , 15 , 75 mg kg \) proximal device 40 min interrupted , dose response fashion , formation fibrin rich thrombus regions disturbed flow generation fibrinopeptide contrast , h peptide inhibit capacity platelets collagen surface \( p greater 0 2 doses \) form hemostatic \( assessed measurements bleeding time p greater 0 1 doses \) findings suggest , competitive inhibition fibrinogen binding thrombin , fibrin rich venous type thrombus formation may selectively prevented strategy may therapeutically attractive preserving normal platelet function conventional anticoagulant therapy contraindicated
home blood pressure readings borderline hypertensive patients home blood pressure monitoring provide valuable information physicians managing borderline hypertensive patients study conducted compare office home blood pressures 36 borderline hypertensive subjects , determine accuracy home monitoring unit used patients willing record home blood pressures extended period time home blood pressure found quite accurate , blood pressures measured home significantly lower readings obtained office 39 \( 14 36 \) subjects studied , average home blood pressures 10 mmhg lower office readings findings support hypothesis home blood pressure monitoring useful management borderline hypertensive patients
vasodilatory beta blockers systemic regional hemodynamic effects systemic regional hemodynamic alterations hypertension beta adrenergic receptor inhibiting agents reviewed hemodynamically , hypertension may regarded persistent elevation arterial pressure associated increased total peripheral resistance early mild essential hypertension , however , increased total peripheral resistance may readily recognized overriding effect increased cardiac output clearly , hemodynamics blood pressure control complex , mechanisms antihypertensive agents must used appropriately early beta blockers reduced heart rate cardiac output immediately intravenous administration without immediately reducing arterial pressure , calculated total peripheral resistance increased prolonged oral treatment , arterial pressure decreased maintaining reduced heart rate cardiac output total peripheral resistance , however , remained elevated recent beta blockers , celiprolol , provide improved physiologic response reducing arterial pressure total peripheral resistance without reducing heart rate cardiac output expanding intravascular volume
angina , ischemia , effort tolerance vasodilating beta blockers beta blockers known suppress exercise induced ischemia give rise problems fatigue dyspnea effort also bradycardia series double blind , placebo controlled studies celiprolol \( cardioselective beta 1 blocker beta 2 agonist vasodilatory properties \) patients hypertension angina normal volunteers , found celiprolol produce bradycardia given combination verapamil celiprolol reduce exercise induced ischemia , reduction cardiac output rest exercise compared placebo compared atenolol , celiprolol produced less dyspnea fatigue submaximal levels exercise concluded celiprolol possesses certain differences , compared conventional beta blockers , may direct clinical benefit
cardiovascular risk factors effects intervention cardiovascular risk factors substantially modified changes life style diet , exercise , smoking cessation , alcohol consumption turn , reduce blood pressure , heart rate rest , blood lipid concentrations epidemiologic evidence shows every 1 change serum cholesterol levels , 3 change likelihood developing coronary heart disease addition , long term \( 5 year \) change 5 6 mm hg diastolic blood pressure reduce chances stroke 35 40 coronary heart disease 20 25 full impact broad range interventions population health still fully realized many countries , including united kingdom , however likely considerable recent evidence support cardiovascular risk factor modification selectively reviewed
dialysis induced alterations left ventricular filling mechanisms clinical significance quantitative two dimensional \( 2 \) doppler echocardiography used determine whether hemodialysis results alterations left ventricular \( lv \) diastolic filling might contribute dialysis induced hypotension , well assess whether hemodynamic variables indices diastolic filling might used identify patients greatest risk becoming hemodynamically unstable dialysis sixteen male patients undergoing routine maintenance hemodialysis end stage renal disease prospectively studied hemodialysis following hemodialysis significant prolongation \( p less 0 05 \) lv isovolumetric relaxation time \( \) , well significant reduction rate extent early rapid ventricular filling \( p less 0 005 \) contrast , late atrial assisted filling change significantly multiple stepwise linear regression analysis predialysis hemodynamic parameters noninvasive indices lv filling showed significant independent inverse relationship frequency dialysis related hypotensive episodes duration early lv filling \( r 0 81 p less 0 001 \) results suggest hemodialysis results discrete alterations early lv filling , significant compensatory increase late atrial assisted ventricular filling , patients shortest early lv filling times appeared greatest predilection becoming hemodynamically unstable dialysis
use fistula assessment monitor detect stenoses access fistulae twenty three unselected hemodialysis patients functioning access arteriovenous fistulae studied prospectively determine best technique detecting stenoses within fistulae combined clinical assessment fistula assessment monitoring compared angiography fistula assessment monitoring accurate \( 96 \) combined clinical assessment \( accuracy , 52 \) stenosis detection complications angiography occurred 17 patients complications fistula assessment monitoring fistula assessment monitoring better combined clinical assessment predicting clinical outcome arteriovenous fistulae 6 months good angiography routine fistula assessment monitoring could reduce inappropriate angiography detect clinically significant silent stenoses ideal method monitoring arteriovenous access fistulae
cyclosporine induced thrombotic microangiopathy resulting renal allograft loss successful reuse report two cases cyclosporine induced thrombotic microangiopathy rare complication renal transplantation commonly leads graft loss mechanism entity unknown factors intrinsic donor kidney appear play important role describe two cases renal transplant patients lost first grafts secondary cyclosporine induced thrombotic microangiopathy patients successfully immunosuppressive protocol included long term cyclosporine conclude graft loss entity contraindication subsequent successful transplantation cyclosporine
unsuspected mitral stenosis purpose patients methods observed series patients diagnosis mitral stenosis first discovered echocardiography laboratory experience , examined records 152 patients echocardiographic evidence rheumatic mitral stenosis determine clinical characteristics course patients unsuspected mitral stenosis well factors may diagnosis results 152 patients , 18 mitral stenosis unsuspected clinically echocardiogram patients elderly , median age 72 years referred echocardiography cardiac symptoms eight patients referred evaluation congestive heart failure five patients referred evaluation aortic valve disease three patients referred cerebrovascular accidents atrial fibrillation doppler determined mean diastolic mitral gradient ranged 4 15 mm hg \( mean 7 mm hg \) mitral stenosis ranged severity trivial severe eight patients moderate severe mitral stenosis estimated mitral valve areas less equal 1 5 cm2 seven mild trivial mitral stenosis estimated mitral valve areas greater 1 5 cm2 evaluation , two patients underwent mitral valve surgery improvement congestive failure three patients , warfarin therapy begun prevent emboli thus , five 18 patients significant immediate change therapy discovery mitral stenosis conclusion diagnosis mitral stenosis may suspected presence advanced age , serious cardiac medical conditions , mechanical factors complicate physical examination patients , mitral stenosis may hemodynamically significant may cause significant symptoms
prognostic significance valvular regurgitation patients infective endocarditis purpose doppler ultrasound sensitive modality detecting valvular regurgitation patients infective endocarditis valvular regurgitation leads heart failure , evaluated prognostic significance doppler detected valvular regurgitation patients endocarditis yet developed clinical heart failure patients methods reviewed medical records 65 patients clinical diagnosis infective endocarditis may 1985 march 1990 total 49 patients included study 33 patients native valve endocarditis 16 patients prosthetic valve endocarditis initial doppler echocardiogram examined patients determine presence degree valvular regurgitation results significant \( moderate severe \) valvular regurgitation detected 23 \( 47 \) patients presence absence significant valvular regurgitation predict development congestive heart failure , need surgery , death \( p ns \) development congestive heart failure significantly associated need surgery \( p less 0 0001 \) death \( p less 0 05 \) conclusion conclude detection significant valvular regurgitation patients infective endocarditis yet developed heart failure predictive future complications absence significant valvular regurgitation identify group patients favorable prognosis series , patients developed congestive heart failure significantly higher incidence surgery death therefore , decisions regarding clinical management patients infective endocarditis made solely presence absence echocardiographically detected valvular regurgitation
comparison labetalol versus enalapril monotherapy elderly patients hypertension results 24 hour ambulatory blood pressure monitoring purpose study compared safety efficacy labetalol enalapril antihypertensive therapy elderly patients patients methods randomized , open label , parallel controlled trial conducted completing 4 week placebo phase , 79 elderly \( 65 years older \) patients average standing diastolic blood pressure \( bp \) 95 mm hg 114 mm hg less randomized receive 12 week course either labetalol enalapril open label design patients' bp heart rate evaluated trained observers unaware treatment status , drug dosage titrated \( 400 mg twice day labetalol 40 mg daily enalapril \) achieve standing diastolic bp less 90 mm hg decrease 10 mm hg baseline patients underwent 24 hour ambulatory bp monitoring \( \) end placebo phase 8 weeks active treatment results treatment groups comparable reduction supine diastolic bp , significant differences two treatments labetalol demonstrated significantly greater reduction \( p less 0 05 \) standing diastolic bp end titration period compared enalapril , difference significant end study period based 24 hour readings , labetalol reduced mean 24 hour diastolic bp \( p less 0 05 \) mean heart rate \( p less 0 05 \) enalapril labetalol treated patients significantly less often diastolic bp goal throughout 24 hour period \( p less 0 01 \) two treatments equally well tolerated conclusions results indicate labetalol enalapril equally effective lowering supine diastolic bp elderly , labetalol effective lowering ambulatory bp heart rate throughout day
elderly patients congestive heart failure care purpose concern quality care received medicare patients health maintenance organizations \( \) , care patients congestive heart failure \( chf \) eight compared care service \( ffs \) medicare cases patients methods compared care 170 patients chf enrolled one eight medicare care 191 similar ffs patients panels expert physicians developed criteria evaluating quality care , specially trained nurse clinicians medical records results outpatient evaluation management similar settings , although patients significantly likely advised restrict salt intake however , ffs patients uncontrolled hypertension likely medication regimens changed \( 62 versus 36 , p less 0 01 \) ejection fractions obtained equally often , inpatient management similar groups nonetheless , providers scheduled follow visits within 1 week hospital discharge often \( 42 versus 27 , p less 0 01 \) conclusions study suggests financial care detrimental aspects care chf patients rapid follow hospital discharge patients chf suggests may effective delivering continuity care patients chronic illness
muscular dystrophy syndrome rare form muscular dystrophy associated cardiac complications lead sudden death disorder potential anaesthetic implications management patient presented orthopaedic surgery described
drug induced supraventricular tachycardia case report fluoxetine report occurrence supraventricular tachycardia hypotension 54 year old woman maintenance therapy fluoxetine although cases tachycardia palpitations reported , supraventricular tachycardia hypotension directly attributed fluoxetine
de pointes therapy phenytoin present case woman myocardial infarction complicated malignant ventricular arrhythmia de pointes de pointes refractory conventional therapy responsive phenytoin case suggests clinical usefulness phenytoin adjunct therapy life threatening ventricular arrhythmias standard treatment modalities fail
plasma concentrations epinephrine cpr dog study objective purpose study evaluate whether marked increase plasma concentrations epinephrine cardiopulmonary arrest basic life support \( bls \) could due part decreased distribution elimination design interventions dogs randomly assigned undergo adrenalectomy sham operation adrenalectomized animals received epinephrine infusion measurements main results seven sham operated dogs , plasma epinephrine concentrations increased markedly bls expected seven adrenalectomized dogs receiving constant infusion epinephrine , cardiopulmonary arrest bls induced three sixfold increase plasma epinephrine concentrations , increase mean plasma epinephrine concentrations \( calculated area curve \) 1 21 0 12 ng ml \( p less 05 \) seven adrenalectomized dogs receiving constant epinephrine infusion subjected cardiopulmonary arrest , plasma epinephrine concentrations remained stable finally , seven adrenalectomized dogs receiving epinephrine infusion , mean plasma epinephrine concentrations bls \( calculated area curve \) increased 0 05 0 04 ng ml , significantly less adrenalectomized dogs receiving epinephrine infusion \( p less 01 \) conclusion increase plasma epinephrine concentrations cardiopulmonary arrest bls due part altered disposition epinephrine
demographic , social stress correlates hypertension among urban poor relationship demographic , social , psychological variables diagnosis hypertension population urban , poor , predominantly black patients reported subjects 182 patients presenting health care state university family practice clinic age , race , marital status , attendance religious services , education , employment status , income , source income interpersonal stress significantly related diagnosis hypertension sample characteristics found significantly related hypertension , analysis showed age , race , education frequency attendance important predicting diagnosis hypertension among patient sample urban poor implications clinical care future research needs considered
strain differences baroreflex inhibition centrally infused enalapril old rats determine whether inhibition brain renin angiotensin system would affect similarly old rats different strains , compared 24 month old male fischer 344 sprague dawley rats baroreflex sensitivity tested rats awake recording reflex heart rate responses elicited blood pressure elevated phenylephrine lowered sodium nitroprusside sprague dawley rats higher blood pressures lower heart rates initially chronic infusion enalapril , converting enzyme inhibitor , lateral cerebral ventricle \( icv \) two weeks lowered blood pressure sprague dawley fischer 344 rats furthermore , reflex bradycardia unaffected either rat strain , reflex tachycardia selectively suppressed fischer 344 rats thus , although time controls done rule spontaneous changes 14 day infusion period , results suggest central cardiovascular regulation change similarly age two rat strains removal brain renin angiotensin system lowered blood pressure one strain inhibited reflex tachycardia , could mean brain renin angiotensin system acts differently keep blood pressure elevated sprague dawley rats modulate reflex tachycardia fischer 344 rats
prostacyclin production myocardial infarction acute phase follow twenty five patients myocardial infarction monitored acute phase follow regard vivo production prostacyclin \( pgi2 \) thromboxane \( txa2 \) , measurement major urinary metabolites , 2 , 3 dinor 6 keto pgf1 alpha 2 , 3 dinor txb2 , respectively 22 patients pgi2 txa2 production also assessed , exercise test performed 6 weeks discharge approximately 24 patients vivo production prostacyclin increase acute phase infarction process inability usually associated decrease release heart muscle enzymes , mostly frequently observed women exercise tolerance test , none patients showed increase prostacyclin production , contrast healthy volunteers , significant increase seen differences patients without increase prostacyclin production acute phase follow 2 years myocardial infarction , eight cardiac events occurred , noted among patients exhibited expected increase prostacyclin production association infarction would seem reasonable , since patients group larger primary infarctions
rapid correct diagnosis myocardial infarction standardized case history clinical examination provide important information correct referral monitored beds value thorough examination case history diagnostic tool hospitalization patients suspected myocardial infarction investigated three independent prospective studies use limited number pain related elements \( \) , already obtained emergency room , could improve decision whether admit patients coronary care unit example , one studies , use criteria would reduced number coronary care unit admissions 298 162 , 46 reduction \( p less 0 001 \) patient sample , use criteria could reduced number patients definite acute myocardial infarction , admitted general wards , 47 22 , 53 reduction \( p less 0 01 \) results confirmed two independent , smaller scale studies
serological classifying raynaud 's phenomenon idiopathic twenty five patients idiopathic raynaud 's phenomenon followed prospectively mean period 48 months clinical laboratory assessments performed admission followup sera analyzed presence autoantibodies \( antinuclear , antibodies \) sixteen patients antinuclear antibody positive 2 antibody positive eight patients produced , 5 , 4 anti golgi complex , 3 antibodies eleven patients produced antibodies one patient \( anti antibody positive \) developed systemic disease \( mixed connective tissue disease \) followup initial screening sera may help classify raynaud 's phenomenon idiopathic accurately
angiographic morphology unstable angina relation transient myocardial ischemia hospital outcome complex stenosis morphology frequently occurs patients unstable angina pectoris however , relation transient myocardial ischemia hospital outcome ascertained address issue , 88 patients significant \( greater equal 50 \) coronary artery disease presenting angina new onset \( n 38 \) , worsening \( n 20 \) rest \( n 30 \) studied patients left main artery disease , normal coronary arteries occlusion ischemia related arteries included study continuous electrocardiographic recordings obtained first 24 hours angiography performed within 1 week admission complex morphology defined stenosis irregular borders , edges intracoronary thrombus data referring hospital outcome considered study adverse end points sudden death , myocardial infarction emergency revascularization analysis angiograms revealed complex morphology 58 patients \( group 1 \) remaining 30 patients served control subjects \( group 2 \) thirty two 58 group 1 patients unfavorable clinical outcome \( positive predictive value , 55 \) similar outcome occurred 2 30 group 2 patients \( negative predictive value , 93 \) 32 group 1 patients unfavorable clinical outcome , 29 cumulative duration transient myocardial ischemia greater equal 60 minutes per 24 hours similar duration ischemia , however , observed another 6 group 1 8 group 2 patients
anginal symptoms without ischemic electrocardiographic changes ambulatory monitoring men coronary artery disease episodes angina pectoris without electrocardiographic \( ecg \) signs myocardial ischemia 24 hour ambulatory monitoring studied 128 patients history stable angina , angiographically proven coronary artery disease positive exercise test results , episodes ischemic ecg changes \( st segment depression greater 1 mm greater 1 minute \) 190 episodes angina pectoris observed 86 episodes consisted ecg changes angina pectoris , 255 episodes consisted ecg changes , 104 episodes angina pectoris duration magnitude st segment deviation heart rate onset ischemia similar 86 symptomatic 255 asymptomatic episodes ecg changes 104 episodes angina pectoris without ecg changes detected 44 patients \( 34 \) \( group \) 29 episodes angina pectoris 15 patients episodes angina pectoris without ecg changes 84 patients \( 66 \) \( group b \) angina pectoris without ecg changes observed episodes accompanied ischemic ecg changes patients differences angiographic extent coronary artery disease exercise test data seen groups b however , maximal st segment depression exercise testing significantly greater group b group patients \( 2 4 0 8 mm vs 1 9 0 9 mm p less 0 05 \)
dependence doppler echocardiographic transmitral early peak velocity left ventricular systolic function coronary artery disease influence systolic function pulsed doppler echocardiographic transmitral flow velocity patterns assessed \( pes \) potentiation 12 normal subjects \( control group \) 25 patients previous healed myocardial infarction \( mi \) group simultaneous high fidelity left ventricular pressure measurements performed patients programmed single coupled right ventricular induced echocardiographic subsequent recordings adequate angiograms volumetric analysis baseline pes beats obtained 23 patients \( 7 control group 16 mi group \) pes potentiation contraction pronounced mi group control group pes changes ejection fraction , stroke volume end systolic volume significantly greater mi group control group \( 11 vs 5 , p less 0 005 15 vs 5 ml m2 , p less 0 005 13 vs 4 ml m2 , p less 0 01 , respectively \) contrast , pes potentiation prolonged time constants left ventricular pressure decline derived exponential curve zero \( tw \) non zero \( tb \) pressure mi group extent control group \( 4 vs 5 ms , difference significant ns , 9 vs 11 ms , ns , respectively \) pes beat , peak e velocity remained unaltered \( 48 vs 49 cm , ns \) control group , whereas increased significantly \( p less 0 0001 \) 47 51 cm mi group
relation serum lipoprotein cholesterol levels presence severity angiographic coronary artery disease assess relation lipid levels angiographic coronary artery disease \( cad \) , lipid profiles obtained 125 men 72 women undergoing diagnostic coronary angiography cad , defined greater equal 25 diameter narrowing major coronary artery , present 106 men \( 85 \) 54 women \( 75 \) multiple regression analyses revealed high density lipoprotein \( hdl \) cholesterol level men , age total hdl cholesterol ratio women , independently associated presence cad adjustment risk factors hdl cholesterol level age significantly correlated extent \( number diseased vessels \) severity \( percent maximum stenosis \) cad men women , age independent variable related severity , whereas age total hdl cholesterol ratio related extent 71 patients total cholesterol less 200 mg dl , 79 cad multiple regression analyses , hdl cholesterol variable independently related presence severity cad patients adjustment age gender extent significantly associated age male gender , unrelated lipid parameters use multiple logistic linear regression analyses group 197 patients , hdl cholesterol powerful independent variable associated presence severity cad adjustment age gender hdl cholesterol also independent predictor extent age independently associated end points examined , variable significantly related extent data add growing body information demonstrating important association hdl cad
edge detection versus densitometry assessing coronary stenting quantitatively optimal method used analyze quantitatively immediate angiographic results coronary stenting coronary arteries studied accordingly , minimal luminal cross sectional area determined 2 methods , edge detection densitometry , 19 patients underwent percutaneous transluminal coronary angioplasty \( ptca \) coronary stent implantation symptomatic coronary stenoses correlation coefficient , 0 73 angioplasty , decreased 0 59 coronary angioplasty increased 0 83 stent implantation mean differences edge detection densitometric determinations minimal luminal cross sectional area 0 31 0 51 mm2 ptca , 0 38 1 22 mm2 angioplasty 0 35 0 79 mm2 coronary stenting concluded , although correlation variability measurement minimal luminal cross sectional area edge detection densitometry ptca , improved stenting , probably vessel contours stent remodeling segment circular configuration therefore , coronary artery , edge detection densitometry equally acceptable methods analysis
frequency success complications coronary angioplasty stenosis ostium branch vessel authors study hypothesized percutaneous transluminal coronary angioplasty stenosis ostium branch vessel , whether isolated associated bifurcation stenosis , associated reduced procedural success increased hospital complications one hundred six patients 119 ostial branch stenoses compared 1 , 168 patients underwent angioplasty branch stenoses ostial branch stenosis defined stenosis proximal 3 mm major branch vessel \( diagonal n 58 , posterior descending n 21 , marginal n 34 intermediate n 6 \) ostial branch stenosis isolated 61 patients associated bifurcation stenosis 39 despite balloon artery ratio 1 05 1 , angiographic success 74 ostial branch stenoses versus 91 stenoses \( p less 0 01 \) furthermore , angioplasty ostial branch stenoses resulted complication rate 13 versus 5 angioplasty branch stenoses \( p less 0 01 \) therefore , angioplasty ostial branch stenoses results decreased procedural success significant residual stenosis despite adequate balloon , suggesting arterial elastic recoil significant increase complications
doppler echocardiographic comparison carpentier rings versus ring mitral valve repair mitral regurgitation compare hemodynamic results different techniques primary valve repair mitral regurgitation , 122 patients prospectively studied doppler echocardiograms 5 10 days operation seventy seven patients mitral valve prolapse , 27 coronary artery disease , 13 patients rheumatic mitral valve lesions 5 patients infective endocarditis forty eight patients received flexible ring , 46 received rigid carpentier ring 28 patients received ring doppler echocardiography demonstrated significant decrease mitral valve area estimated pressure half time method patients received either carpentier \( 2 6 0 8 cm2 \) ring \( 2 8 0 8 cm2 \) compared patients received ring \( 3 2 0 7 cm2 \) \( p 0 01 \) significant differences observed peak transmitral diastolic velocity , peak transmitral diastolic gradient , grade mitral regurgitation color flow doppler mapping patients without rings etiology mitral disease concomitant surgical procedures accompanying mitral valve repair significantly influence mitral valve area , peak velocity peak gradient data suggest carpentier rings decrease hemodynamic mitral valve area however , decrease valve area small associated clinically important increase gradient
thermolabile reductase inherited risk factor coronary artery disease severe reductase \( mthfr \) deficiency less 2 normal enzyme activity characterized neurological abnormalities , atherosclerotic changes , thromboembolism discovered new variant mthfr deficiency characterized absence neurological abnormalities , enzyme activity 50 normal value , distinctive specific conditions heat inactivation study , lymphocyte mthfr specific activities thermolabile variant control groups 5 58 0 91 10 33 2 89 nmol formaldehyde formed mg protein h , respectively difference significant \( p less 01 \) however , overlap among individual values two groups hand , residual mthfr activity heat inactivation 11 2 1 43 thermolabile variant 36 3 5 18 controls overlap enzyme studies 10 subjects thermolabile mthfr family members support hypothesis thermolabile mthfr inherited autosomal recessive trait elucidate association thermolabile mthfr development coronary artery disease , determined lymphocyte mthfr 212 patients proven coronary artery disease 202 controls without clinical evidence atherosclerotic vascular disease thermolabile mthfr found 36 \( 17 0 \) cardiac patients 10 \( 5 0 \) controls difference incidence two groups statistically significant \( p less 01 \) average age onset clinical coronary artery disease 36 patients thermolabile mthfr 57 3 7 6 years \( 35 72 years \) mean total plasma concentration patients thermolabile mthfr 13 19 5 32 nmol ml significantly different normal mean 8 50 2 80 nmol ml \( p less 05 \) association thermolabile mthfr major risk factors conclude thermolabile mthfr variant \( \) mthfr deficiency inherited autosomal recessive trait addition , positively associated development coronary artery disease determination vitro lymphocyte mthfr reliable method identifying subjects abnormality
spectrum portal vein thrombosis liver transplantation thrombosis portal vein without patency used contraindication orthotopic liver transplantation \( \) quite recently rapid progress surgical technique last years demonstrated patients portal vein thrombosis safely successfully transplanted presented series 34 patients portal vein thrombosis transplanted university pittsburgh since 1984 various techniques used treat various forms thrombosis described survival rate series 67 6 \( 23 34 patients \) survival best patients underwent placement graft superior mesenteric vein survival rate also correlated amount blood required transfusion surgery overall concluded vast majority patients thrombosis portal system technically transplanted survival rate comparable patients patent portal vein
fibrous skeleton ventricular outflow tracts double outlet right ventricle twenty four hearts great arteries arose right ventricle studied establish variations present within fibrous skeleton infundibular variations also noted location ventricular septal defect measurements obtained outlet septum arterial valves completely muscular present 9 \( 37 5 \) hearts , varying degrees fibrous continuity leaflets arterial atrioventricular valves remainder aorta rightward posterior 12 \( 50 \) hearts , subaortic ventricular septal defects present equal numbers group subaortic defects present aorta side side right sided defects present hearts posterior aorta mean ratio 0 91 0 36 subaortic length outlet septum significantly less value 1 54 0 41 noted previously hearts tetralogy fallot \( p less 0 001 \)
superiority retrograde cardioplegia acute coronary occlusion antegrade cardioplegia may limit distribution cardioplegia beyond coronary occlusion , study undertaken determine whether retrograde coronary sinus cardioplegia provides superior myocardial protection revascularization acute coronary occlusion 20 adult pigs , second third diagonal branches occluded snare 1 1 2 hours animals placed cardiopulmonary bypass underwent 30 minutes ischemic arrest multidose , potassium , crystalloid cardioplegia 10 animals , cardioplegia given antegrade aortic root , whereas 10 others , given retrograde coronary sinus arrest period , coronary released hearts reperfused 3 hours postischemic damage myocardium beyond occlusions assessed wall motion scores using two dimensional echocardiography \( 4 normal 1 dyskinesia \) , change myocardial ph , area necrosis area risk \( histochemical staining \) hearts protected retrograde coronary sinus cardioplegia less tissue acidosis \( change ph 0 08 0 03 versus 0 41 0 13 p less 0 05 \) , higher wall motion scores \( 2 0 0 6 versus 1 3 0 3 significant \) , less myocardial necrosis \( 43 4 3 6 versus 73 3 3 5 p less 0 0001 \) conclude retrograde coronary sinus cardioplegia provides optimal myocardial protection possible antegrade cardioplegia revascularization acute coronary occlusion
efficacy coronary sinus cardioplegia patients complete coronary artery occlusions myocardial areas distal complete coronary artery occlusions poorly protected antegrade cardioplegia assessed effects coronary sinus cardioplegia 30 patients undergoing bypass operations high risk cardioplegic following anatomical patterns coronary artery disease critical \( greater equal 50 \) stenosis left main trunk total occlusion right coronary artery \( 16 patients \) critical \( greater equal 70 \) stenosis right coronary artery total occlusion left anterior descending \( 11 patients \) circumflex artery \( 3 patients \) induction arrest aorta , coronary sinus cardioplegia given cross clamp period flow rate 100 ml min intraoperatively , occluded arteries consistently found filled infused solution one patient died early postoperatively low cardiac output second patient died later hospital stay , presumably arrhythmia autopsy , none pathological evidence inadequate myocardial protection one patient sustained myocardial infarction 3 others required 24 hours postoperatively postoperative values right left stroke volume indices significantly different levels overall , results consistent occurrence limited intraoperative ischemic damage , , suggest efficacy coronary sinus route preserving myocardial areas supplied completely occluded coronary arteries , hence , jeopardy inadequate cardioplegia delivery
repair posterior left ventricular aneurysm six year old boy left ventricular aneurysms rarely encountered pediatric age group paper reports case congestive heart failure mitral regurgitation 6 year old boy large posterolateral left ventricular aneurysm complete repair successfully performed excision aneurysm dacron patch reconstruction left ventricular free wall patch extended onto posterior annulus mitral valve , thus restoring mitral valve normal geometry correcting mitral insufficiency surgical literature congenital cardiac acquired aneurysms children reviewed summarized
silicone pouch protection automatic implantable cardioverter defibrillator leads automatic implantable cardioverter defibrillator become routine treatment recurrent , drug resistant ventricular tachycardia although documentation regarding clinical experience device performance , little information avoid complications related retrieval sensing defibrillation leads subcutaneous space reporting experience silicone pouch protection automatic implantable cardioverter defibrillator leads allows immediate simple retrieval leads case automatic implantable cardioverter defibrillator generator needed
dural spinal cord arteriovenous malformation multiple hospital admissions inpatient rehabilitation stay , 68 year old woman transferred rehabilitation facility unknown etiology previous studies included four ct scans three demonstrate lesion correct diagnosis , confirmed selective angiography , ultimately contingent upon recognition clinical features natural history dural spinal cord arteriovenous malformations \( \) unusual combination nondiagnostic imaging studies uncommon dural served delay diagnosis treatment delay may great functional consequences report illustrates importance recognizing features emphasis placed 's role proper diagnosis timely treatment obtain best functional outcome brief review classification , clinical features , pathophysiology , diagnosis , prognosis presented
detecting hypertension screening versus case finding norway objective evaluation detection hypertension adults county , norway design cross sectional survey clinical follow examinations setting health survey screening teams national health screening service , examinations 106 general practitioners county subjects 1984 6 , 74 , persons \( 88 1 aged 20 years \) participated health survey main outcome measures hypertension \( assessed standardised recording questionnaires drug treatment hypertension \) according blood pressure thresholds used norwegian treatment programme subjects positive screening grouped clinical examination treatment groups results , subjects positive hypertension screening \( 8 3 \) patients reported taking antihypertensive drugs another \( 5 1 \) blood pressure monitored regularly screened positive referred general practitioner evaluated according standard programme result , drug treatment started \( 0 5 \) participants screened blood pressure monitoring another \( 1 3 \) patients taking antihypertensive drugs screening , \( 94 0 \) diagnosed screening , whose blood pressure monitored screening , 79 3 diagnosed screening conclusions blood pressure screening thresholds used , hypertension defined overall clinical diagnosis , results indicate general practitioners find diagnose hypertensive patients case finding strategy
treatment deferoxamine ischemia improves functional metabolic recovery reduces reperfusion induced oxygen radical generation rabbit hearts background iron may play central role oxygen radical generation myocardial ischemia reperfusion conditions ischemia may also iron , hypothesized administration iron chelator deferoxamine ischemia would result improved functional metabolic recovery postischemic reperfusion methods results isolated , perfused rabbit hearts studied phosphorus 31 nuclear magnetic resonance spectroscopy hearts received one three treatments deferoxamine onset 30 minutes global ischemia \( n 9 \) , deferoxamine bolus followed continuous 15 minute infusion begun reflow \( n 9 \) , standard perfusate \( n 7 \) hearts treated deferoxamine ischemia showed better recovery developed pressure control hearts \( 63 2 7 5 versus 41 2 2 9 baseline \) \( p 0 02 \) better recovery myocardial phosphocreatine content \( 92 4 10 3 versus 68 2 4 5 baseline , p less 0 05 \) functional metabolic benefits comparable obtained deferoxamine treatment early reperfusion 15 additional hearts , treatment deferoxamine resulted reduction oxygen radical concentrations measured frozen tissue electron resonance spectroscopy end ischemia , treatment eliminated reperfusion induced increase free radical generation observed control hearts \( 2 9 0 01 versus 7 0 0 07 microm , p less 0 001 \) magnitude reduction similar deferoxamine given onset reflow \( 2 4 0 02 microm , p less 0 001 versus control \) conclusions results demonstrate improved functional metabolic recovery myocardium treated deferoxamine ischemia , accompanied reduction reperfusion induced oxygen free radical generation degree reflow treatment , confirming importance iron pathogenesis myocardial reperfusion injury
myocardial infarct size limiting effect ischemic preconditioning attenuated oxygen free radical scavengers rabbit background limiting effect ischemic preconditioning infarct size reported canine hearts , contain considerable amounts xanthine oxidase , free radical producing enzyme furthermore , recent study suggested free radicals generated preconditioning may contribute cardioprotective effect preconditioning present study examined 1 \) whether preconditioning limits infarct size rabbits , , like humans , lack myocardial xanthine oxidase 2 \) whether cardioprotective effect pc mediated free radicals methods results branch circumflex coronary artery rabbits occluded 30 minutes reperfused 72 hours myocardial infarct size area risk determined histology fluorescent particles , respectively five groups studied untreated control group , group \( pc group \) , high dose superoxide dismutase \( sod \) treated group \( high dose sod pc group \) , low dose sod treated group \( low dose sod pc group \) , sod plus catalase treated group \( sod cat pc group \) preconditioning performed four episodes 5 minutes ischemia 5 minutes reperfusion free radical scavengers \( 30 , 000 units kg sod high dose sod pc group , 15 , 000 units kg sod low dose sod pc group , 30 , 000 units kg sod plus 55 , 000 units kg catalase sod cat pc group \) infused intravenously 60 minutes starting 20 minutes preconditioning infarct size percentage area risk 45 1 3 5 \( mean sem \) control group \( n 11 \) , 13 3 3 0 pc group \( n 12 \) , 9 7 1 8 high dose sod pc group \( n 8 \) , 11 9 2 2 low dose sod pc group \( n 6 \) , 9 6 2 3 sod cat pc group \( n 6 \) \( p less 0 05 versus control last four values \) differences infarct size percent area risk among pc , high dose sod pc , low dose sod pc , sod cat pc groups significant conclusion ischemic preconditioning delays ischemic myocardial necrosis regardless myocardial xanthine oxidase content free radicals unlikely major role mechanism preconditioning rabbits
transvascular intracardiac applications miniaturized phased array ultrasonic endoscope initial experience intracardiac imaging piglets background recent advances phased array mechanical ultrasound devices resulted exploration alternative approaches cardiac vascular imaging form transesophageal intravascular imaging preliminary efforts phased array designed transesophageal use transvascular approach used full sized phased array devices introduced directly right atrium open animals purpose study assess feasibility using custom made , small phased array endoscope intracardiac imaging introduced jugular venous approach young piglets methods results experimental atrial septal defects created four piglets \( 3 4 weeks old \) closed atrial septal defect closure device consisting occluder left atrium right atrium five 15 days atrial septal defect closure , piglets returned experimental laboratory , 6 3 mm , 17 element , 5 mhz phased array probe mounted 4 mm endoscope introduced incision external jugular vein advanced right atrium right atrium four cardiac chambers , , four valves well imaged minimal superior inferior rotation high resolution imaging atrial septum defined anatomical accuracy , later verified autopsy , exact placement occluder left right sides atrial septal defects absence shunting across atrial septum four animals conclusions efforts indicate transvascular passage small phased array probes easily accomplished promising technique detailed visualization cardiac structures approach may provide alternative transesophageal echocardiography , particularly guiding interventional procedures placement transcatheter closure devices pediatric patients
contractility stiffness noninfarcted myocardium coronary ligation rats effects chronic angiotensin converting enzyme inhibition background previous studies shown global left ventricular function depressed myocardial infarction however , little known effects myocardial infarction contractility passive elastic properties residual myocardium methods results evaluated isometric function passive myocardial stiffness isolated , noninfarcted left ventricular papillary muscle rats 6 weeks sham operation myocardial infarction maximal developed tension peak rate tension rise \( dt dt \) significantly decreased untreated rats large myocardial infarction compared controls \( 3 3 1 1 versus 4 3 0 6 g mm2 49 5 17 5 versus 72 5 10 5 g mm2 sec , respectively \) time peak tension prolonged \( 120 8 versus 102 4 msec \) myocardial stiffness increased untreated myocardial infarction rats compared controls \( 35 2 4 9 versus 24 2 3 7 \) rats smaller myocardial infarctions differed controls respect prolongation time peak tension papillary muscle myocyte cross sectional area increased 44 \( p less 0 05 \) , myocardial hydroxyproline content increased 160 \( p less 0 05 \) rats large myocardial infarctions compared controls determine whether treatment improves left ventricular function myocardial infarction also improves myocardial function , rats treated captopril beginning 3 weeks myocardial infarction continuing 3 weeks treatment captopril attenuated prolongation time peak tension myocardial infarction rats however , developed tension , dt dt , muscle stiffness remained abnormal compared untreated myocardial infarction rats , captopril treated myocardial infarction rats 9 decrease myocyte cross sectional area \( p 0 1 \) persistent increase myocardial collagen content summary , large myocardial infarction rats causes contractile dysfunction , increased stiffness , myocyte hypertrophy , increased collagen content residual noninfarcted myocardium treatment captopril alters process cardiac remodeling hypertrophy improves one parameter contractility noninfarcted myocardium however , myocardial collagen content myocardial stiffness remain abnormal conclusions findings suggest angiotensin converting enzyme inhibition rat infarct model heart failure improves global cardiac performance via combined effects myocardial function peripheral circulation
coronary blood flow dogs contractile dysfunction due experimental volume overload background abnormalities coronary blood flow responsible stress induced reductions contractile function pressure overload hypertrophy less known coronary blood flow volume overload study , tested hypothesis coronary blood flow abnormalities responsible contractile abnormalities experimental volume overload hypertrophy methods results examined coronary blood flow rest pacing seven dogs contractile dysfunction secondary chronic experimental mitral regurgitation \( average regurgitant fraction 3 months , 0 58 0 05 \) 3 months mitral regurgitation , left ventricular mass increased 92 8 g baseline 118 10 g \( p less 0 002 \) slope end ejection stress volume relation , one indexes used estimate contractile function , fallen 5 4 0 3 baseline 3 0 0 3 3 months mitral regurgitation \( p less 0 001 \) mitral regurgitation dogs , coronary blood flow rest similar control dogs \( endocardial blood flow control dogs , 1 33 0 12 ml min g mitral regurgitation dogs , 1 16 ml min g , p ns epicardial blood flow rest control dogs , 1 30 0 16 ml min g mitral regurgitation dogs 1 13 0 2 ml min g , p ns \) pacing induced stress , coronary blood flow increased appropriately control mitral regurgitation dogs ultrasonic dimension placed endocardium epicardium demonstrated deterioration ventricular function pacing mitral regurgitation dogs separate group five control dogs five dogs mitral regurgitation left ventricular dysfunction , coronary blood flow examined conscious closed chest state rest , adenosine infusion , rapid atrial pacing \( 240 beats min \) blood flow increased similarly groups pacing adenosine infusion conclusions conclude dogs mitral regurgitation developed contractile dysfunction , abnormalities coronary blood flow explain resting contractile dysfunction furthermore , studies pacing induced stress coronary vasodilation adenosine demonstrate substantial coronary blood flow reserve present type volume overload hypertrophy
myocardial perfusion contraction matching implications coronary heart disease experimental studies demonstrate short term regional perfusion contraction matching , energy demands regional myocardial contraction reduced match diminished myocardial substrate supply , occurs states low coronary blood flow resting conditions exercise induced ischemia phenomenon rapidly reversible appears occur several clinical settings sustained perfusion contraction matching observed states partial experimental ischemia intermediate duration lasting several hours condition might called short term resembles clinical conditions unstable angina pectoris myocardial infarction residual perfusion contractile defect improved reperfusion provided ischemia severe enough cause transmural necrosis experimental clinical observations may may relate setting regional dysfunction rest patients chronic coronary heart disease , manifestations acute ischemia may absent improvement wall motion abnormalities occurs cabg balloon angioplasty condition may constitute hypothetical state chronic myocardial , evidence exists metabolic perfusion studies using pet whether condition prolonged perfusion contraction matching might associated adaptive processes could allow persistence long periods without manifest ischemia remains investigated
ten year incidence myocardial infarction prognosis infarction department veterans affairs cooperative study coronary artery bypass surgery background 10 year incidence myocardial infarction \( fatal nonfatal \) prognosis infarction evaluated patients stable angina randomly assigned medical surgical treatment veterans administration cooperative study coronary artery bypass surgery methods results myocardial infarction defined either new q wave findings clinical symptoms compatible myocardial infarction accompanied serum enzyme elevations without electrocardiographic findings treatment comparisons made according original treatment assignment 35 medical cohort bypass surgery 10 year follow period overall cumulative infarction rate somewhat higher patients assigned surgery \( 36 \) medical patients \( 31 \) \( p 0 13 \) due perioperative infarctions \( 13 \) accelerated infarction rate fifth year follow \( average , 2 4 yr surgical group versus 1 4 yr medical group \) 10 year cumulative incidence death myocardial infarction also higher surgical \( 54 \) medical \( 49 \) patients \( p 0 20 \) according cox model , estimated risk death infarction 59 lower surgical medical patients \( p less 0 0001 \) reduction postinfarction mortality surgery striking first month event 99 first month \( p less 0 0001 \) 49 subsequently \( p less 0 0001 \) estimated risk death absence infarction nearly identical regardless treatment \( p 0 75 \) exclusion perioperative infarctions alter findings conclusions although surgery reduce incidence myocardial infarction overall , reduce risk mortality infarction , particularly first 30 days event \( fatal infarctions \)
value peak exercise oxygen consumption optimal timing cardiac transplantation ambulatory patients heart failure background optimal timing cardiac transplantation ambulatory patients severe left ventricular dysfunction often difficult determine whether measurement peak oxygen consumption \( vo2 \) maximal exercise testing used identify patients transplantation safely deferred , prospectively performed exercise testing ambulatory patients referred transplant october 1986 december 1989 methods results patients assigned one three groups basis exercise data group 1 \( n 35 \) comprised patients accepted transplant \( vo2 less equal 14 ml kg min \) group 2 \( n 52 \) comprised patients considered well transplant \( vo2 greater 14 ml kg min \) group 3 \( n 27 \) comprised patients low vo2 rejected transplant due noncardiac problems three groups comparable new york heart association functional class , ejection fraction , cardiac index \( p ns \) pulmonary capillary wedge pressure significantly lower group 2 either group 1 3 \( p less 0 05 \) , although wide overlap patients preserved exercise capacity \( group 2 \) cumulative 1 2 year survival rates 94 84 , equal survival levels transplantation contrast , patients rejected transplant \( group 3 \) survival rates 47 1 year 32 2 years , whereas patients awaiting transplantation \( group 1 \) survival rate 70 1 year \( p less 0 005 versus patients vo2 greater 14 ml kg min \) deaths group 2 sudden univariate multivariate analyses , peak vo2 best predictor survival , pulmonary capillary wedge pressure providing additional prognostic information conclusions data suggest cardiac transplantation safely deferred ambulatory patients severe left ventricular dysfunction peak exercise vo2 14 ml min kg
catheter modification atrioventricular junction radiofrequency energy control atrioventricular nodal reentry tachycardia background utility transcatheter application radiofrequency energy eliminate atrioventricular nodal reentrant tachycardia \( avnrt \) investigated methods results thirty nine patients \( mean age , 53 20 years range 14 86 years \) medically refractory avnrt underwent ablation radiofrequency energy custom designed catheter large \( 3 mm long \) distal electrode pacing 2 mm used majority cases catheter used ablation initially positioned across tricuspid anulus obtain largest bundle electrogram , withdrawn obtain largest atrial ventricular electrogram ratio , small bundle electrogram \( less equal 100 microv \) application radiofrequency energy \( 350 550 khz , 16 2 5 2 w \) stopped 60 seconds pr prolongation impedance rise noted endpoints procedure persistent modification atrioventricular nodal conduction \( either first degree atrioventricular block impairment ventriculoatrial conduction \) avnrt isoproterenol administration radiofrequency energy applied mean 6 8 3 5 times per session mean follow 8 3 0 months , 32 39 patients \( 82 \) free avnrt , high grade av block three patients \( 8 \) developed complete atrioventricular block pacemakers implanted two patients unsuccessful initial procedures , two patients initially successful recurrences tachycardia 4 6 weeks later elimination avnrt appeared due effects retrograde fast pathway patients conclusions radiofrequency ablation right atrium appears safe effective treatment typical avnrt
fibrinogen , viscosity , white blood cell count major risk factors ischemic heart disease caerphilly collaborative heart disease studies background recent studies suggested hemostatic factors white blood cell count predictive ischemic heart disease \( ihd \) relations fibrinogen , viscosity , white blood cell count incidence ihd caerphilly prospective studies described methods results two studies common core protocol based combined cohort 4 , middle aged men general population first follow nearly constant interval 5 1 years caerphilly 3 2 years 251 major ihd events occurred age adjusted relative odds ihd men top 20 distribution compared bottom 20 4 1 \( 95 confidence interval , 2 6 6 5 \) fibrinogen , 4 5 \( 95 confidence interval , 2 8 7 4 \) viscosity , 3 2 \( 95 confidence interval , 2 0 4 9 \) white blood cell count associations ihd similar men never smoked , , current smokers , results suggest least part effect smoking ihd mediated fibrinogen , viscosity , white blood cell count multivariate analysis shows white blood cell count independent risk factor ihd either fibrinogen viscosity , possibly jointly , three variables significantly improve fit logistic regression model containing main conventional risk factors , model including age , smoking habits , fibrinogen , viscosity , white blood cell count predicts ihd well one three hemostatic variables replaced total cholesterol , diastolic pressure , body mass index conclusion jointly , fibrinogen , viscosity , white blood cell count important risk factors ihd
upward shift lower range coronary flow autoregulation hypertensive patients hypertrophy left ventricle background given perfusion pressure , coronary reserve expressed difference maximally flow hypertension raised coronary resistance reduces pressure flow relationship maximal vasodilatation presence cardiac hypertrophy line flow becomes higher reasons coronary reserve reduced point baseline flow approaches maximal flow might shifted higher perfusion pressure thus , reduction elevated critical value pressure would lower coronary flow methods results investigated patients normotensive \( controls , nine \) hypertensive normal \( group , seven \) augmented lv mass index concentric lv hypertrophy \( group ii , eight \) effort induced angina angiographically normal left epicardial branches flow great cardiac vein measured thermodilution baseline stepwise \( 5 mm hg every 5 minutes \) decrease coronary perfusion pressure titrated nitroprusside v infusion perfusion pressures 60 mm hg controls 70 mm hg hypertensives taken end points baseline flow averaged 102 ml min normotensives , 104 ml min hypertensive group 148 ml min hypertensive group ii end points flow similar baseline controls group group ii coronary flow started decline myocardial o2 extraction started slightly significantly rise perfusion pressures 90 80 mm hg end point flow reduced 26 \( p less 0 01 baseline \) perfusion patterns seem related changes tension time index heart rate conclusions association high blood pressure \( reduced ability coronary arterioles \) hypertrophy myocardium \( augmented baseline coronary flow \) may shift point exhaustion coronary reserve higher perfusion pressure make myocardium vulnerable treatment induced relative hypertension
concept maximal flow ratio immediate evaluation percutaneous transluminal coronary angioplasty result videodensitometry background setting percutaneous transluminal coronary angioplasty \( ptca \) , immediate information result intervention important , whereas morphological parameters often less reliable diagnostic coronary arteriography recently , new method introduced validated animal experiments , allows accurate comparison maximal myocardial perfusion situations different degrees stenosis method uses mean transit time \( \) contrast agent maximal hyperemia parameter maximal flow strictly accordance indicated dilation theory methods results 40 patients angina pectoris , single vessel disease , positive exercise test time acceptance ptca , approach applied evaluation improvement maximal flow achieved ptca maximal vasodilation induced immediately 15 minutes ptca intracoronary administration papaverine , digital angiographic studies performed special breath holding instruction , almost , triggered image acquisition possible 15 20 excellent subtraction images could obtained , reliable determination maximal hyperemia possible 33 patients ptca ratio maximal flow ptca , called maximal flow ratio \( \) , represented ratio intervention compared results exercise testing 24 48 hours 7 10 days procedure correction pressure changes , 2 2 1 5 33 dilated vessels 1 0 0 2 25 normal vessels serving control 94 patients , value 1 6 less 1 6 discriminated presence absence reversal exercise test result positive negative line judgment success based upon angiographic parameters measurement trans stenotic pressure gradient , relation noninvasive functional improvement present 66 74 patients , respectively definite range called normal maximal hyperemia could distinguished , post ptca values successfully dilated arteries returned completely normal range conclusions accurate comparison maximal myocardial perfusion ptca possible man , improvement maximal flow highly related functional improvement indicated exercise test results , , therefore , method provides straightforward way line evaluation result intervention
heart rate adjustment exercise induced st segment depression improved risk stratification framingham offspring study background simple heart rate adjustment st segment depression exercise \( delta st hr index \) pattern st depression function heart rate exercise recovery \( rate recovery loop \) shown improve ability exercise electrocardiogram detect presence coronary heart disease \( chd \) , performance methods prediction future coronary events remains examined methods results compared delta st hr index rate recovery loop standard electrocardiographic criteria prediction chd events 3 , 168 asymptomatic men women framingham offspring study underwent treadmill exercise electrocardiography , entry , free clinical electrocardiographic evidence chd mean follow 4 3 years , 65 new chd events four sudden deaths , 24 new myocardial infarctions , 37 incident cases angina pectoris cox proportional hazards model adjustment age sex used , positive exercise electrocardiogram standard criteria \( greater equal 0 1 mv horizontal st segment depression \) predictive new chd events \( chi 2 0 40 , p 0 52 \) contrast , stratification according presence absence positive delta st hr index \( greater equal 1 6 microv beat min \) positive \( counterclockwise \) rate recovery loop associated chd event risk \( chi 2 9 45 , p less 0 01 \) separated subjects three groups varying risks coronary events high risk , tests positive \( relative risk 3 6 95 confidence interval , 2 4 5 4 \) intermediate risk , either delta st hr index rate recovery loop positive \( relative risk , 1 9 95 confidence interval , 1 3 2 8 \) low risk , tests negative multivariate adjustment age , sex , smoking , total cholesterol level , fasting glucose level , diastolic blood pressure , electrocardiographic evidence left ventricular hypertrophy , combined delta st hr index rate recovery loop criteria remained predictive coronary events \( chi 2 5 45 , p 0 02 \) conclusions heart rate adjustment st segment depression delta st hr index rate recovery loop exercise electrocardiography improve prediction future coronary events asymptomatic men women
electrocardiographic body surface potential mapping wolff parkinson white syndrome noninvasive determination ventricular insertion sites accessory atrioventricular connections background reliable , noninvasive procedure determine location accessory atrioventricular connections patients wolff parkinson white syndrome would add important diagnostic tool clinical armamentarium methods results body surface potential mapping \( bspm \) using 180 electrodes various sized displayed calibrated color map used determine ventricular insertion site accessory atrioventricular \( av \) connections 34 patients wolff parkinson white syndrome attempts made determine 17 ventricular insertion sites described et al 34 patients electrophysiologic study \( eps \) cardiac catheterization , 18 surgery ventricular insertion sites could accurately located using eps surgery number physiologic observations also made bspm conclusions following conclusions drawn 1 \) bspm using qrs analysis accurately predicts ventricular insertion site accessory av connections presence delta wave electrocardiogram 2 \) ventricular insertion sites accessory av connections determined bspm eps surgery identical within one mapping site \( 1 5 cm less \) four 18 cases three four exceptions one accessory av connection , broad ventricular insertion 3 \) bspm eps locations accessory av connections correlated well 34 cases despite fact bspm determines ventricular insertion site eps determines atrial insertion site accessory av connection 4 \) suggested three cases multiple accessory av connections , eps bspm may complementary since bspm identified one pathway eps identified \( case broad ventricular insertion , bspm eps demonstrated different proportions insertion \) 5 \) bspm using st analysis much less accurate predicting ventricular insertion site accessory av connections unless marked preexcitation 6 \) standard electrocardiography using grid methodology \( attempt stimulating maximal preexcitation \) accurate qrs analysis bspm predicting ventricular insertion site accessory av connection however , exact comparison hampered different number size insertion sites 7 \) bspm using qrs analysis appears accurate predicting right ventricular versus left ventricular accessory av connections 8 \) typical epicardial right ventricular breakthrough , indicative conduction via specialized av conduction system , occurs patients left ventricular free wall accessory av connections 9 \) epicardial right ventricular breakthrough observed cases right ventricular free wall accessory av connections 10 \) epicardial right ventricular breakthrough occur presence accessory av connections , whether right left ventricular 11 \) delay epicardial right ventricular breakthrough cases left ventricular insertion may provide marker estimate degree ventricular preexcitation
diagnostic efficiency troponin measurements acute myocardial infarction background present study designed evaluate efficiency newly developed troponin enzyme immunoassay detection acute myocardial infarction methods results study comprised patients admitted chest pain suspected myocardial infarction 101 patients skeletal muscle damage additional suspected myocardial cell damage troponin elevated twice analytical sensitivity assay \( 0 5 microgram l \) patients non q wave \( range , 1 2 5 micrograms l \) q wave infarction \( range , 3 220 micrograms l \) troponin appeared serum early 3 hours onset pain 50 patients remained elevated patients 130 hours , revealing release kinetics free cytosolic structurally bound molecules diagnostic efficiency troponin superior creatine kinase mb \( 98 versus 97 \) remained 98 5 5 days admission , patients unstable angina excluded analysis 79 patients unstable angina , troponin elevated \( range , 0 55 3 1 micrograms l \) least one blood sample 37 patients \( 56 \) circulating troponin correlated presence reversible st segment wave changes electrocardiogram \( p less 0 005 \) frequency hospital complications 101 patients skeletal muscle damage suspected additional cardiac muscle damage , troponin useful test efficiency 89 94 \( depending value used \) compared 63 creatine kinase mb conclusions thus , data study indicate newly developed troponin test improves efficiency tools detection myocardial cell necrosis compared conventionally used cardiac enzymes
intravascular ultrasound imaging human coronary arteries vivo analysis tissue comparison vitro histological specimens background intravascular ultrasound imaging performed 27 patients coronary balloon angioplasty quantify lumen atheroma cross sectional areas methods results 20 mhz ultrasound catheter inserted 1 6 mm plastic sheath across dilated area obtain real time images 30 times sec ultrasound images distinguished lumen atheroma , calcification , muscular media presence dissection media atheroma well visualized observations tissue characterization compared vitro study 20 human atherosclerotic artery segments correlated ultrasound images histological preparations results indicate high quality intravascular ultrasound images controlled vitro conditions provide accurate information histological characteristics atherosclerotic plaques similar quality cross sectional ultrasound images also obtained human coronary arteries vivo quantitative analysis ultrasound images clinical studies revealed mean cross sectional lumen area balloon angioplasty 5 0 2 0 mm2 mean residual atheroma area level prior dilatation 8 7 3 4 mm2 , corresponded 63 available arterial cross sectional area segments coronary artery appeared angiographically normal , ultrasound images demonstrated presence atheroma involving 4 7 3 2 mm2 , mean 35 23 available area media conclusions intravascular ultrasound appears sensitive angiography demonstrating presence extent atherosclerosis arterial calcification intracoronary imaging balloon angioplasty reveals significant amount atheroma still present , may partly explain incidence restenosis high percutaneous transluminal coronary angioplasty
xanthine oxidase inhibition limit canine infarct size background evidence supporting role xanthine oxidase myocardial reperfusion injury based studies pharmacological interventions used inhibit enzyme function controversy exists , however , regarding true role xanthine oxidase reperfusion injury study performed determine whether xanthine oxidase inhibition limits myocardial injury due coronary artery occlusion reperfusion methods results anesthetized dogs underwent coronary artery occlusion \( 90 minutes \) reperfusion \( 6 hours \) oxypurinol \( 28 mg kg \) \( 30 mg kg \) , chemically unrelated inhibitors xanthine oxidase , vehicle infused intravenously 15 minutes 3 hours reperfusion regional myocardial blood flow determined radiolabeled microspheres infarct size determined tetrazolium method myocardial infarct size \( percent risk region \) less oxypurinol treated dogs , 32 16 , compared control group , 46 15 infarct size treated dogs , 40 21 , significantly different control group differences rate pressure product collateral blood flow account differences infarct size uric acid concentration coronary venous plasma increased reperfusion dogs treated vehicle drug treated dogs xanthine oxidase inhibition demonstrated drug treatment groups , oxypurinol limited extent myocardial injury conclusions previously reported cardioprotective effects allopurinol , noted occur drug administered chronically , may related property oxypurinol , major metabolite allopurinol beneficial effect oxypurinol unrelated inhibition superoxide formation xanthine oxidase catalyzed oxidation xanthine hypoxanthine
pulmonary effects ischemic limb reperfusion evidence role oxygen derived radicals objective evaluate lung reperfusion target limb ischemia reperfusion , measure specifically oxygen radical response reperfusion design paired simple randomized , continuous interval data dependent variable continuous nominal independent variables subjects intervention sprague dawley male rats \( n 195 \) anesthetized hind limbs occluded 3 75 hr , overnight ld50 alveolar lavage performed animals 1 hr reperfusion survivors 20 hr reperfusion groups either pretreated alpha tocopherol antioxidant \( 50 mg kg day \) 2 days ischemia measurements main results enhanced chemiluminescence measured phorbol myristate acetate stimulated unstimulated macrophages superoxide radicals per 10 \( 6 \) alveolar cells min also measured using cytochrome c reduction assay significant \( p less 01 , student 's test \) , time dependent increase response cells ischemic reperfused rats seen pretreatment antioxidant effect 1 hr , significant differences seen 20 hr survivors conclusions studies show alveolar lavage cells , 95 macrophages , reflect reperfusion ischemic reperfused hind limbs significant increase oxygen radical activity , effect partly suppressed antioxidant survivors
adrenergic stimulation renal lyon hypertensive rat young , genetically hypertensive lyon \( lh \) rats exhibited increased renal vivo turnover norepinephrine elevated urinary excretion thromboxane b2 compared normotensive \( ln \) low blood pressure \( \) controls therefore , effects norepinephrine \( 1 2 x 10 \( 8 \) 9 6 x 10 \( 7 \) \) phenylephrine \( 5 x 10 \( 8 \) 1 9 x 10 \( 6 \) \) renal function urinary excretion assessed isolated perfused kidneys 8 week old lh , ln , rats addition , effects norepinephrine assessed thromboxane a2 prostaglandin h2 receptor blockade \( 4 x 10 \( 6 \) \) drug infusion , lh kidneys differed ln controls elevated renal vascular resistance decreased natriuresis glomerular filtration rate urinary output prostaglandin e2 f2 alpha , 6 f1 alpha , thromboxane b2 similar three strains effects norepinephrine phenylephrine significantly increased lh rat kidneys compared ln controls , pressure natriuresis markedly reduced norepinephrine phenylephrine induced 10 20 fold dose dependent increase synthesis four , pronounced lh ln rats thromboxane b2 infusion significantly reduced vascular effects norepinephrine increased natriuretic response lh ln rat kidneys
kinetic abnormalities red blood cell sodium proton exchange hypertensive patients present study designed examine kinetics na \( \) h exchange red blood cells normotensive hypertensive subjects relation previously reported abnormalities na \( \) li exchange na \( \) h activation kinetics studied varying cell ph measuring net na influx \( mmol l cell x hr units \) driven outward h gradient na \( \) li exchange determined ph 7 4 sodium stimulated li efflux untreated hypertensive patients \( n 30 \) higher maximal rate na \( \) li exchange \( 0 43 0 05 versus 0 26 0 02 units , p less 0 0003 \) , higher maximal rate na \( \) h exchange \( 62 3 6 2 versus 47 4 units p less 0 02 \) , similar affinity cell ph compared normotensive subjects \( n 46 \) cell ph activation na \( \) h exhibited lower coefficient normotensive subjects \( 1 61 0 12 versus 2 56 0 14 p less 0 0001 \) index occupancy internal h regulatory sites found reduced hypertensive patients \( 73 \) whether hypertension untreated treated hypertensive patients na \( \) li exchange 0 35 units \( 0 68 0 units , n 16 \) exhibit elevated maximal rates na \( \) h exchange \( 57 3 10 units , ns \) comparison na \( \) li exchange 0 35 units \( 66 4 7 6 units , n 26 \) , groups exhibited reduced coefficients hypertensive patients enhanced na \( \) h exchange activity \( 90 units \) normal maximal rates na \( \) li exchange
specific mesenteric vascular bed dahl salt sensitive rats dahl salt sensitive \( ds \) salt resistant \( dr \) rats maintained diet containing normal \( 0 45 \) high \( 7 \) salt 5 days ds rats slightly higher systolic blood pressures dr rats , although high salt diet failed significantly elevate pressure either group compared appropriate \( low salt diet \) controls sensitivity isolated , perfused mesenteric vasculature ds rats fed high salt diet nerve stimulation greater compared groups presence absence cocaine \( 1 microm \) similar difference sensitivity high salt ds rats high salt dr rats bolus injections norepinephrine observed presence cocaine change sensitivity characterized leftward shift dose response curve without change maximum response difference sensitivity high salt ds group treatment group observed response pressor agents kcl , angiotensin ii , 5 hydroxytryptamine depressor agent acetylcholine data indicate ds rats short term , high salt diet possess significant specific elevation sensitivity nerve stimulation norepinephrine absence increase blood pressure differences effectiveness cocaine among groups suggest differences may exist neuronal uptake \( uptake 1 \)
high nacl diet enhances arterial baroreceptor reflex nacl sensitive spontaneously hypertensive rats previous studies laboratory shown arterial baroreceptor reflex control lumbar sympathetic nerve activity blunted nacl sensitive spontaneously hypertensive rat \( shr \) compared either nacl resistant spontaneously hypertensive rat \( shr r \) normotensive wistar kyoto \( wky \) rat current study , effect dietary nacl supplementation arterial baroreceptor reflex control lumbar sympathetic nerve activity heart rate assessed shr control shr r wky rats male shr , shr r , wky rats fed diets containing either 1 8 nacl beginning 7 weeks age studied age 9 10 weeks arterial baroreceptor reflex mediated changes lumbar sympathetic nerve activity heart rate recorded conscious , rats phenylephrine induced \( 15 40 micrograms kg min \) nitroprusside induced \( 15 300 micrograms kg min \) changes mean arterial pressure shr maintained 1 nacl diet blunted baroreceptor reflex control lumbar sympathetic nerve activity acute increases map compared shr r wky rats \( p less 0 05 \) ingestion 8 nacl diet , absent , indicating enhancement baroreceptor reflex control lumbar sympathetic nerve activity shr maintained 1 nacl diet also blunted arterial baroreceptor control lumbar sympathetic nerve activity nitroprusside induced decreases mean arterial pressure compared wky rats , significantly altered ingestion 8 nacl diet
effect age coronary circulation pressure overload rats examined effects pressure overload coronary circulation young adult \( 7 months old \) old rats \( 18 months old \) four weeks ascending aorta banded , vivo left ventricular pressure measured estimate degree pressure load two age groups , similar increases peak left ventricular pressure observed \( 113 7 mm hg sham operated rats versus 160 11 mm hg banded rats young adult group 103 7 mm hg sham operated rats versus 156 11 mm hg banded rats old group \) hearts , perfused 's solution containing bovine red blood cells albumin resting coronary perfusion pressure flow relations reactive hyperemic response 40 second ischemia obtained beating nonworking conditions young adult banded rats , significant myocardial hypertrophy observed organ level \( 124 controls left ventricular dry weight body weight ratio 119 left ventricular dry weight tibial length ratio \) cell level minimal coronary vascular resistance obtained perfusion pressure peak flow relation reactive hyperemia increased 150 controls , coronary flow reserve decreased significantly contrast , myocardial hypertrophy observed organ cell level old banded rats however , minimal coronary vascular resistance increased , flow reserve decreased significantly thus , pressure overload coronary arterial hypertension caused abnormalities coronary circulation old subjects even absence myocardial hypertrophy
systolic hypertension elderly program \( shep \) part 10 analysis shep randomized , placebo controlled trial follow standard clinical trial principles analyzing data relating proposed hypotheses protocol stated main objective well secondary subgroup hypotheses sample size calculations shep accounted drop active therapy well risk death sample size achieved \( 4 , participants \) adequate address proposed questions monitoring procedures described established data safety monitoring board uses procedures closely following data trial board periodically examine data determine whether termination study warranted
arterial mechanical properties dilated cardiomyopathy aging response nitroprusside effects aging arterial mechanical properties response nitroprusside examined 25 patients dilated cardiomyopathy high fidelity pressures recorded catheter pulse wave velocity determined two thoracic aorta arterial compliance determined analysis diastolic waveform cardiac output baseline , despite similar systemic vascular resistance , pulsatile load \( e g , arterial compliance \) wave transmission characteristics \( e g , pulse wave velocity \) altered aging arterial compliance reduced older \( greater 50 yr , n 8 \) versus younger \( less 35 yr , n 8 \) patients \( 0 51 0 17 vs 1 33 0 63 ml mmhg , p less 0 01 \) intermediate 35 50 yr age \( n 9 , 0 72 0 40 ml mmhg \) positive correlation age pulse wave velocity \( r 0 90 \) nitroprusside infusion decreased resistance , increased arterial compliance , lowered pulse wave velocity groups yet , advancing age associated greater fall wave velocity given fall aortic pressure slope \( k \) relation pulse wave velocity aortic diastolic pressure progressively increased age \( 0 01 0 03 , 0 06 0 02 , 0 09 0 03 mmhg \) multiple linear regression analysis revealed significant relation k age data demonstrate older patients dilated cardiomyopathy left ventricle coupled arterial circulation greater pulsatile load , despite similar steady load furthermore , age related changes arterial system affect hemodynamic response pharmacologically induced vasodilatation
diastolic dysfunction hypertrophic cardiomyopathy effect active force generation systole tested hypothesis intracellular ca \( ca \) overload underlies diastolic dysfunction patients hypertrophic cardiomyopathy myocardial tissue obtained time surgery transplantation patients hypertrophic cardiomyopathy compared control myocardium obtained patients without heart disease isometric contractions electrophysiologic properties myocardial specimens recorded standard techniques ca measured calcium indicator contrast controls , action potentials , ca transients , isometric contraction relaxation markedly prolonged hypertrophic myocardium , ca transients consisted two distinct components 38 degrees c 1 hz pacing frequency , state relative ca overload appeared develop , produced rise end diastolic ca , incomplete relaxation , fusion twitches resultant decrease active tension development also found drugs increase ca , digitalis , exacerbated abnormalities , whereas drugs lower ca , verapamil , agents increase cyclic amp , forskolin , prevented results may explain patients hypertrophic cardiomyopathy tolerate tachycardia poorly , may important implications regard pharmacologic treatment patients hypertrophic cardiomyopathy
thrombosis related markers unstable angina pectoris thrombus formation implicated pathogenesis unstable angina , value thrombus related markers distinguishing unstable stable angina well defined fibrin dimer plasminogen activator inhibitor prospectively analyzed peripheral blood 46 patients \( 26 unstable angina 20 stable angina normal coronary arteries \) baseline blood samples drawn within 24 h rest pain patients unstable angina 19 26 patients less 6 h patients unstable angina , mean sd \( median \) values fibrin dimer plasminogen activator inhibitor values measured 0 09 0 06 \( 0 07 \) microgram ml 9 1 9 6 \( 5 9 \) iu , respectively , compared 0 11 0 10 \( 0 05 \) microgram ml 5 5 1 9 \( 5 0 \) iu ml , patients control group \( p ns comparisons two groups \) recurrent hospital pain , coronary anatomy need intervention showed relation levels markers 19 additional patients \( 9 unstable angina 10 control patients \) samples coronary sinus peripheral blood also analyzed , patients unstable angina samples drawn less 24 h rest pain six nine patients samples drawn less 6 h coronary sinus peripheral blood gradient either markers could demonstrated differences peripheral coronary sinus dimer plasminogen activator inhibitor concentrations also similar patients unstable angina control patients
coronary vasodilation impaired hypertrophied myocardium patients hypertrophic cardiomyopathy study nitrogen 13 ammonia positron emission tomography assess regional coronary reserve hypertrophic cardiomyopathy , regional myocardial blood flow measured 23 patients hypertrophic cardiomyopathy 12 control subjects means nitrogen 13 ammonia dynamic positron emission tomography patients hypertrophic cardiomyopathy baseline study , regional myocardial blood flow 1 14 0 43 ml min per g hypertrophied \( 20 3 mm \) interventricular septum 0 90 0 35 ml min per g \( p less 0 05 versus septal flow \) \( 10 2 mm \) left ventricular free wall statistically different corresponding values control subjects \( 1 04 0 25 0 91 0 21 ml min per g , respectively , p ns \) pharmacologically induced coronary vasodilation \( dipyridamole , 0 56 mg kg intravenously 4 min \) , regional myocardial blood flow patients hypertrophic cardiomyopathy increased significantly less control subjects septum \( 1 63 0 58 versus 2 99 1 06 ml min per g , p less 0 001 \) free wall \( 1 47 0 58 versus 2 44 0 82 ml min per g , p less 0 001 \) addition , patients hypertrophic cardiomyopathy history chest pain pronounced impairment coronary vasodilator reserve without history chest pain dipyridamole , coronary resistance septum decreased 38 patients without history chest pain , decreased 14 history \( p less 0 05 \) coronary resistance free wall decreased 45 patients without 27 history chest pain \( p 0 06 \)
mechanisms left ventricular systolic dysfunction aortic regurgitation importance predicting functional response aortic valve replacement test hypothesis combined use time varying elastance concept conventional circumferential stress shortening relations would elucidate differential mechanisms left ventricular systolic dysfunction severe , chronic aortic regurgitation therefore predict functional responses aortic valve replacement , 31 control patients 37 patients aortic regurgitation studied studies included micromanometer left ventricular pressure determinations , biplane contrast control conditions radionuclide angiograms control conditions methoxamine nitroprusside infusions right atrial pacing patients aortic regurgitation classified three groups group normal emax stress shortening relations , group ii abnormal emax normal stress shortening relations group iii abnormal emax stress shortening relations left ventricular end diastolic end systolic volumes showed progressive increase ejection fraction showed progressive decrease group iii values differed control patients \( p less 0 001 \) group , decrease left ventricular volumes \( p less 0 05 \) significant change ejection fraction \( 61 7 versus 63 4 \) aortic valve replacement contrast , group ii , reduction left ventricular volumes \( p less 0 01 \) associated increase ejection fraction 50 8 64 11 \( p less 0 01 \) finally , group iii , reduction left ventricular volumes \( p less 0 05 \) associated decrement ejection fraction 35 13 30 13 group patients compensated adequately chronic volume overload however , group ii left ventricular dysfunction associated increase left ventricular volume mass ratio compared control patients group \( p less 0 05 \) , suggesting inadequate hypertrophy assumption spherical geometry finally , irreversible myocardial dysfunction group iii conclusion , combined analysis left ventricular chamber performance using time varying elastance concept myocardial performance using conventional circumferential stress shortening relations provides complementary information differential mechanisms left ventricular systolic dysfunction therefore predicts functional response aortic valve replacement
impact orifice geometry shape jets vitro doppler color flow study investigate influence orifice geometry three dimensional shape jets , vitro doppler color flow study performed jets formed blood round orifices orifices major minor axis ratios 2 1 , 3 1 5 1 repeated orifice areas 0 1 , 0 3 0 5 cm2 turbulent jets formed orifices , doppler color flow images obtained two orthogonal scanning planes aligned major minor orifice jet width measured 1 cm intervals 0 5 cm orifice used calculate jet eccentricity \( ratio major minor axis \) rate jet walls jets observed rapidly along walls aligned orifice minor axis rather along major axis differential spreading led development circular short distance orifice jet \( theta \) occurred rapidly turbulent jets jets formed larger orifices theta \( zero \) 0 80 6 3 7 0 0 47 e \( r 95 , p less 0 0001 , n 48 \) , orifice area \( cm2 \) 0 jets , 1 turbulent jets e combines orifice eccentricity scanning orientation , ranging 5 5 1 orifices imaged along major axis , 0 circular orifices 5 5 1 orifices imaged along minor axis within jet , eccentricity approximately exponentially distance orifice , rapidly turbulent jets , slowly larger orifices
patient age results balloon aortic valvuloplasty mansfield scientific registry experience mansfield scientific aortic valvuloplasty registry investigators patients enrolled mansfield scientific aortic valvuloplasty registry followed mean 7 months balloon aortic valvuloplasty results compared patients less 70 , 70 79 greater equal 80 years age time valvuloplasty assessed aortic valve area indexed body surface area , stenosis severe older patients incidence congestive heart failure also greater aged greater equal 80 years results valvuloplasty comparable three age groups , indexed final valve area significantly different among groups hospital mortality ranged 4 2 9 4 , complications significantly different among groups total 7 month mortality 23 performed registry study , balloon aortic valvuloplasty produced similar results older younger patients , despite initially severe disease older patients
drug response study patients ventricular tachyarrhythmias importance ventricular refractoriness clinical electrophysiologic predictors successful antiarrhythmic drug therapy patients inducible ventricular tachycardia evaluated 59 consecutive patients undergoing serial trials structural heart disease less frequently present patients effective therapy found \( p less 0 05 \) presence coronary artery disease history prior myocardial infarction significantly frequently present patients antiarrhythmic drug therapy could found \( p less 0 05 \) corrected qt interval ventricular effective refractory period measured pacing cycle length 400 ms significantly shorter responders compared nonresponders \( qt interval 52 versus 460 59 ms ventricular effective refractory period 237 28 versus 254 24 ms \( p less 0 05 \) addition , coupling interval ventricular initiating ventricular tachycardia significantly shorter responders compared nonresponders \( 223 37 versus 251 33 ms p 0 003 \) logistic regression analysis identified short ventricular coupling interval \( p less 0 01 \) absence prior myocardial infarction \( p less 0 05 \) independent predictors antiarrhythmic drug suppression induction ventricular tachycardia greater drug induced increments ventricular effective functional refractory periods observed responders nonresponders shortest ventricular coupling interval thus , baseline electrophysiologic measurements identify patients inducible ventricular tachycardia likely respond antiarrhythmic drug therapy furthermore , patients demonstrate greater drug induced electrophysiologic changes
tricuspid valve dysplasia displacement intrauterine life 450 cases structural heart disease diagnosed prenatally , 38 fetuses \( 8 5 \) either dysplastic displaced tricuspid valve tricuspid valve dysplastic 22 fetuses , evidence tricuspid regurgitation resulting right atrial dilation increased cardiothoracic ratio associated abnormality pulmonary valve occurred 16 fetuses remaining 16 fetuses ebstein 's malformation , 14 evidence tricuspid incompetence presentation 10 associated abnormality pulmonary valve 38 cases , pregnancy interrupted 17 , spontaneous intrauterine fetal death occurred 8 , 11 infants died 2 infants still alive additional abnormalities found 8 cases \( chromosomal anomalies 2 , ventricular septal defects 2 , corrected transposition 2 , chiari malformation 2 , supraventricular tachycardia 1 case coarctation aorta 1 \) fetuses severe abnormalities selected fetal echocardiography four chamber screening program high rate natural loss intrauterine life immediately birth observed 21 cases pregnancy continued would explain higher incidence tricuspid valve disease prenatal compared postnatal series although increased cardiothoracic ratio associated lesions right ventricular outflow tract contribute poor outcome cases detected prenatally , absence features always indicate good prognosis progression disease occur advancing gestational age absolute measurement single echocardiographic feature emerged consistent predictive factor prognosis
anti ischemic effects atenolol versus nifedipine patients coronary artery disease ambulatory silent ischemia anti ischemic effects atenolol nifedipine compared randomized double blind crossover manner 24 patients stable exertional angina transient silent ischemia ambulatory electrocardiographic \( ecg \) monitoring atenolol nifedipine effective \( p less 0 005 \) reducing average number duration transient ischemic events , therapy atenolol associated significantly greater reduction mean number \( p less 0 05 \) duration \( p less 0 01 \) silent ischemic events analyses silent ischemic activity morning hours revealed therapy atenolol produced significant reduction average duration per patient \( 139 54 vs 1 , , p less 0 01 \) average duration silent ischemia per event 6 12 noon \( 62 21 vs 208 24 , p less 0 005 \) fewer adverse experiences therapy atenolol results show although atenolol nifedipine effective reducing silent ischemic events , treatment atenolol associated significantly greater efficacy , particularly morning surge silent myocardial ischemia
value ventricular electrogram recordings diagnosis arrhythmias precipitating electrical device shock therapy antitachycardia pacemaker cardioverter defibrillator capable storing ventricular electrograms delivery device shock therapy implanted 16 patients three patients experienced hospital device shock therapy preceded minimal symptoms although limitations electrogram analysis exist discussed , careful analysis registration electrograms supraventricular ventricular rhythms observed hospital testing served important reference subsequent arrhythmia diagnosis analyzing electrogram rate rr interval stability configuration , definitive diagnosis established three patients \( atrial fibrillation , polymorphic ventricular tachycardia rate sensing lead disruption , respectively \) thus , ability store ventricular electrograms shock therapy represents major advance management patients receive electrical device treat ventricular tachyarrhythmia
case finding , data quality aspects myocardial infarction results south german register study population based coronary event register \( 330 , 000 residents , age 25 74 years \) registered total cases acute myocardial infarction \( ami \) 1985 ami 1986 categorized basis current diagnostic algorithm ami register designed longitudinal comparisons annual ami risk \( incidence , attack rate , death rate \) , risk ami patients \( 28 day case fatality \) methodology specific issues encountered registration data evaluation described estimated 95 completeness case finding , quality control data review register annually shows consistency specific data structures indicate stable case finding validation procedures however , local conditions affect case finding data completeness per case responsible creation subsets ami turn distinguished differences diagnostic category structures regard study objectives , differences among subsets appear least effect rate calculations definite possible ami combined implications methodological variations subset differences within across annual rate calculations result comparisons discussed
sequential fixed sample trial design \? case study simulation properties wilcoxon 's rank sum test fixed sample size wilcoxon type two sample sequential test illustrated compared means simulation data real fixed sample trial used , original data , construction theoretical distribution sequential fixed sample test obtain equal power , sequential test mostly includes considerably fewer patients reach conclusion , e mean median number patients included much lower fixed sample size hypotheses small fraction simulation runs exceed fixed sample size findings results obtained theoretical analyses simulation studies covering wide range distributions opinion sequential tests obvious advantages many cases better alternatives fixed sample tests clinical trials
inability demonstrate physiologic correlates subjective improvement among patients relaxation response objective assess whether regular elicitation relaxation response produces sustained physiologic changes coincident symptomatic relief improved psychological state design prospective , cohort pilot study setting clinical research center within teaching hospital patients thirteen athletic men , mean age 44 8 years , borderline labile hypertension , taking medication 13 completed study interventions three baseline assessments psychological state , symptom checklist , assessment autonomic response infusion beta agonist \( isoproterenol \) daily relaxation response exercises five consecutive weeks followed repeat assessment parameters discontinuation relaxation exercises subsequent five weeks followed repeat assessment parameters measurements main results eliciting relaxation response , subjects demonstrated significant decreases anxiety \( p less 0 014 \) somatic symptoms \( p less 0 02 \) psychological somatic variables returned toward baseline subsequent discontinuation relaxation exercises significant concomitant change urinary catecholamines , heart rate response isoproterenol , blood pressure , pulse rate , serum cholesterol demonstrated conclusion regular elicitation relaxation response improve psychological performance reduce symptoms however , physiologic mechanism whereby psychological symptomatic improvements occur remains poorly understood warrants investigation
cardiac performance infants referred extracorporeal membrane oxygenation performed cardiac evaluations 59 infants referred severe lung disease determine whether cardiac performance impaired requiring extracorporeal membrane oxygenation \( ecmo \) infants divided two groups group 1 \( n 25 \) received conventional therapy group 2 \( n 34 \) received ecmo therapy meeting established criteria ventilatory oxygenation indexes estimates right ventricular systolic pressure measured load dependent load independent echocardiographic indexes cardiac performance also measured infants two groups similar diagnoses , age , weight , inotropic support , ventilator oxygenation indexes admission , survival heart rate estimates preload afterload similar two groups ventricular shortening fraction 36 1 7 6 group 1 40 5 8 8 group 2 \( p value significant \) velocity circumferential fiber shortening \( sec \) 1 41 0 35 group 1 1 58 0 39 group 2 \( p value significant \) relationship wall stress ventricular shortening similar two groups differences cardiac output pulmonary artery pressure estimated 56 13 mm hg group 1 63 10 mm hg group 2 \( p 0 017 \) thus significant differences found load dependent load independent measures cardiac performance infants severe lung disease treated ecmo conventional therapy conclude cardiac failure primary cause clinical deterioration infants severe lung disease require ecmo therapy
abdominal aortic aneurysm results family study data pertaining abdominal aortic aneurysm among first degree relatives 91 patients abdominal aortic aneurysm presented percentage families least one affected first degree relative proband \( multiplex families \) 15 4 21 4 multiplex families parent offspring transmission abdominal aortic aneurysm noted remaining families siblings affected mean age onset among probands 67 3 years among affected 67 4 years statistically significant difference mean ages onset noted among affected siblings probands , sex ratio , male female , 1 33 1 , significantly different 1 1 relative risk developing abdominal aortic aneurysm 3 97 fathers , 4 03 mothers , 9 92 brothers , 22 93 sisters
revascularization ischemic limb use muscle pedicle flap rabbit model rabbit model hind limb ischemia designed demonstrate new , hemodynamically significant arterial connections develop ischemic skeletal muscle independently perfused muscle pedicle flap right common iliac artery divided 15 rabbits eight rabbits muscle flap based left deep inferior epigastric artery right thigh \( flap group \) seven rabbits sham operation performed flap sutured abdominal wall \( sham group \) 7 days angiography demonstrated arterial connections flap native limb circulation flap group animals flap increased muscle perfusion ischemic limb \( 2 99 ml 100 gm muscle minute flap group , vs 2 06 ml 100 gm muscle minute sham group , p less 0 005 \) hemodynamically significant vascular connections develop well perfused muscle flap ischemic limb augmentation perfusion provided connections quantified
limitations magnetic resonance imaging ultrasound directed \( duplex \) scanning diagnosis subclavian vein thrombosis investigate potential role magnetic resonance imaging duplex scanning diagnosis catheter induced subclavian vein thrombosis , correlated results 43 arm duplex scans 28 also correlated magnetic resonance imaging scans thoracic veins eighteen 43 normal , normal magnetic resonance imaging duplex studies eleven subclavian veins totally occluded duplex scans , five also scanned magnetic resonance imaging duplex scans detected 6 11 occlusions , whereas magnetic resonance imaging detected 4 5 occlusions scanned five occlusions detected either magnetic resonance imaging duplex scans short segmental occlusions medial one third left subclavian vein 14 thrombi seen , duplex scans correctly identified 8 magnetic resonance imaging done eight thrombi identified two abnormal findings duplex scanning magnetic resonance imaging confirmed short occlusions proximal portion left subclavian vein often undetected duplex scanning occasionally seen magnetic resonance imaging neither modality sensitive presence mural thrombi magnetic resonance imaging highly reliable presence thrombotic process subclavian vein , may occasion fail detect presence subclavian thrombi reason , cases suspected subclavian vein thrombosis magnetic resonance imaging cannot used diagnostic modality
versus long posterior flap knee amputations multicenter trial multicenter trial alternative techniques knee amputation described surgeons 11 centers randomized 191 patients end stage occlusive vascular disease two different methods stump construction technique performed 98 long posterior flap performed 93 two groups well matched respect age , sex , smoking , diabetes , indications amputation early outcome compared terms 30 day mortality rate 11 \( 11 \) deaths versus long posterior flap 16 \( 17 \) state wound 1 week \( primary healing 60 groups \) need surgical revision level 7 \( 7 \) versus 7 \( 8 \) , revision higher level 10 \( 10 \) versus 7 \( 8 \) follow information 6 months available records mailed questionnaire 188 \( 98 \) 6 months , 20 died interval showed prosthetic limb fitted 64 \( 84 \) flaps 50 \( 77 \) long posterior flaps walking , alone support , achieved 59 \( 78 \) 46 \( 71 \) , respectively none differences reached statistical significance concluded flap effective long posterior flap excellent option knee amputation
suggested standards reporting arterial aneurysms subcommittee reporting standards arterial aneurysms , ad hoc committee reporting standards , society vascular surgery north american , international society cardiovascular surgery literature arterial aneurysms subject potential misinterpretation inconsistencies reporting standards joint society vascular surgery north american international society cardiovascular surgery ad hoc committee address issue communication , prepared response need standardized reporting , defines arterial aneurysms standards describing causes , manifestations , treatment , outcome criteria important data aneurysmal disease
antihypertensive therapy stop stop \? benefits continuous antihypertensive therapy extensively documented however , lack compliance prescribed regimen , excessive cost , troublesome adverse effects antihypertensive agents led consideration intermittent therapy even complete discontinuation therapy effective alternative medication prospective studies dealing subject reported inconsistent results nevertheless , allowed us identify selection criteria candidates step discontinuation antihypertensive therapy candidates include patients mild essential hypertension one following characteristics young age , normal body weight , low salt intake , alcohol consumption , low pretreatment blood pressure , successful therapy one drug , minimal signs target organ damage stopping antihypertensive therapy without subsequent rise arterial pressure shown possible subset patients mild essential hypertension period months years approach appears safe , provided blood pressure monitored frequently , may improve compliance , save treatment costs , reduce adverse effects certain drugs , although long term consequences morbidity mortality remain determined
comparison two levels anticoagulant therapy patients substitute heart valves cardiac valve replacement patients blindly randomized two groups , receiving aspirin \( 330 mg \) dipyridamole \( 75 mg \) twice daily oral anticoagulant \( \) international normalized ratio 2 0 2 99 assigned group 3 0 4 5 group b groups subsequently analyzed thromboembolic hemorrhagic complications final evaluation included 51 48 patients , respectively follow months group \( 12 3 months patient \) 486 months group b \( 10 1 months patient \) frequency thromboembolism equal groups one transient ischemic attack group \( rate 1 92 100 patient years \) two transient ischemic attacks group b \( rate 4 94 100 patient years \) , however , statistical difference bleeding complications two groups \( p less 0 02 \) two patients bled group , rate 3 9 \( 3 8 100 patient years \) , represents incidence one episode 25 6 years treatment 10 patients bled group b , rate 20 8 \( 24 7 100 patient years \) representing incidence one episode 4 years treatment conclude international normalized ratio 2 3 safer ratio 3 4 5 confers good protection thromboembolism oral anticoagulant therapy used platelet function inhibiting drugs patients mechanical substitute heart valves
analysis predictors pulmonary vascular resistance cardiac transplantation elevated pulmonary vascular resistance known risk factor early death acute right ventricular failure orthotopic cardiac transplantation patients elevated pulmonary vascular resistance due primarily increased left atrial pressure \( reactive \) frequently normalization resistance transplantation , studies detailed time course magnitude changes analyze response pulmonary vascular resistance cardiac transplantation , analyzed data right heart 182 patients undergoing cardiac transplantation 1981 jan 1 , 1990 transplantation 18 patients pulmonary vascular resistance greater 4 wu , 16 pulmonary artery systolic pressure greater 60 mm hg , 16 gradient greater 14 mm hg overall group patients , pulmonary vascular resistance \( mean value 2 63 wu \) , gradient \( mean value 9 9 mm hg \) , pulmonary artery systolic pressure \( mean value 48 0 mm hg \) normalized within 1 week cardiac transplantation patients high preoperative pulmonary vascular resistance \( greater equal 4 wu \) , resistance fell promptly within 1 week transplantation continued slightly elevated throughout period follow multiple regression analysis , pulmonary vascular resistance 1 week 1 year transplantation significantly correlated resistance pulmonary vascular resistance transplantation related preoperative resistance , body surface area , pulmonary artery diastolic pressure \( 1 \) group , cardiac transplant recipients normal pulmonary vascular resistance , gradient , pulmonary artery systolic pressure within 1 week transplantation little change thereafter least several years \( 2 \) patients reversible elevation pulmonary vascular resistance cardiac transplantation typically reactive fixed component cardiac transplantation reactive fixed component result , pulmonary vascular resistance early \( within 1 week \) late transplantation fallen completely normalized
mechanism heart failure caused cardiac allograft rejection rejection cardiac allograft often associated reversible myocardial failure , mechanism understood examined phenomenon small animal model provides opportunity multimodality study rejection process heterotopic cardiac transplantation performed lewis rat lewis x brown norway \( allografts \) lewis \( isografts \) donors without immunosuppression , allografts completely rejected 6 8 days 3 days cardiac grafts explanted mounted modified langendorff apparatus functional measurements submitted pathologic examination biochemical determination high energy phosphates three day isografts \( n 9 \) minimal histologic changes pathologic examination 3 day allografts \( n 13 \) showed lymphocytic infiltrate myocyte necrosis , histologic features treatment usually given clinically grafts subjected functional studies \( n 11 \) , heart rate , cardiac output , coronary flow , stroke work determined baseline response isoproterenol \( 3 x 10 \( 8 \) mol ml \) three day allografts \( n 6 \) isografts \( n 5 \) similar baseline function chronotropic response isoproterenol similar allografts isografts , allografts diminished cardiac output stroke work isoproterenol adenosine triphosphate levels normal \( 41 9 nmol mg \) 3 day allografts \( n 4 \) evaluated functional , biochemical , pathologic changes associated myocardial dysfunction heterotopic cardiac transplant rejection small animal model reproducibly demonstrates diminished contractile reserve 3 day allografts normal baseline function high energy stores histologically significant rejection
mitral valve repair replacement chordae tendineae polytetrafluoroethylene sutures expanded polytetrafluoroethylene sutures used replacement diseased chordae tendineae reconstructive procedures mitral valve 43 patients 28 men 15 women whose mean age 55 years , range 21 76 three patients new york heart association class iii iv replacement primary chordae tendineae anterior leaflet performed 4 0 5 0 polytetrafluoroethylene sutures double suture passed twice fibrous portion papillary muscle head arm suture brought free margin leaflet passed area native attached lengths two arms adjusted , ends together ventricular side leaflet thirty patients degenerative disease mitral valve incompetence due prolapse anterior leaflet 14 patients prolapse anterior posterior leaflets 16 eleven patients rheumatic mitral valve disease four stenosis , three regurgitation , four mixed lesions two patients ischemic mitral regurgitation caused rupture papillary muscle head operative deaths patients followed 5 61 months , mean 13 doppler echocardiographic studies performed regular intervals operation revealed normal mitral valve function patients two failures necessitated mitral valve replacement one acute mitral regurgitation hemolysis two late deaths , neither one valve related replacement chordae tendineae polytetrafluoroethylene sutures simple allows reconstruction mitral valve many patients would otherwise require mitral valve replacement patients followed limited time , long term results procedure remain unknown
alcohol pyruvate cardioplegia twenty four hour situ preservation hamster hearts isolated hamster hearts first perfused normal krebs medium demonstrate comparable viability hearts storing 24 hours one three solutions three solutions physiologic saline pyruvate substrate 4 alcohol arrest heart \( group 1 \) , standard cardioplegic solution \( group 2 \) , alcohol free physiologic saline pyruvate substrate \( group 3 \) recovery terms rate pressure product oxygen consumption 30 minutes reperfusion 81 93 , respectively , group 1 , 13 32 group 2 , 70 72 group 3 percent physiologic recovery related recovery adenosine triphosphate adenosine triphosphate level returned approximately 40 control level three groups , three groups inorganic phosphate remained approximately 320 control level 30 minutes reperfusion phosphocreatine level significantly higher groups 1 3 group 2 , result improved oxygen consumption intracellular ph , determined 31 nuclear magnetic resonance spectroscopy , physiologic groups 1 3 alkaline group 2 may caused membranes pyruvate helped preserve mitochondrial function depressed oxygen delivery , seen 24 hour storage period four percent alcohol arrested heart combined pyruvate plus alcohol solution better standard cardioplegic solution maintaining functional capability
dynamics antegrade cardioplegia simultaneous coronary sinus occlusion effects aortic root infusion pressure , coronary sinus pressure , myocardial cooling suggested antegrade cardioplegia coronary sinus occlusion improves homogeneous myocardial cooling reduces myocardial injury presence coronary artery occlusion little data available exact relationships among basic elements intervention , including antegrade infusion rate , aortic root pressure , degree coronary sinus occlusion , coronary sinus pressure , myocardial cooling purpose study determine relationships provide basic guidelines better understanding intervention twenty two sheep placed cardiopulmonary bypass , distal left anterior descending artery occluded , proximal coronary sinus sixteen combinations infusion rate \( 3 , 5 , 7 , 9 ml kg min \) coronary sinus occlusion \( total , subtotal , moderate occlusion occlusion \) adopted 2 minutes antegrade cardioplegia , yielding 96 measurements myocardial temperatures occluded regions , aortic root infusion pressure , coronary sinus pressure measured infusion cardioplegic solution coronary sinus occlusion released , whole heart reperfused 30 minutes another infusion cardioplegic solution measurements results showed good degrees linearity infusion rate aortic root infusion pressure coronary sinus occlusion groups \( p less 0 01 \) positive effect coronary sinus occlusion aortic root infusion pressure observed graded increases infusion rate various degrees coronary sinus occlusion constantly associated elevation coronary sinus pressure \( p less 0 01 \) also noted myocardial temperatures region occluded left anterior descending artery significantly lower coronary sinus occlusion groups groups \( p less 0 01 0 05 \) myocardial temperature region decreased significantly stepwise increases infusion rate \( p less 0 01 \) , increases coronary sinus occlusion \( significant \) based previous studies , recommend induced coronary sinus pressure safely maintained range 25 35 mm hg studies focused infusion rate 5 ml kg min subtotal total coronary sinus occlusion intervention antegrade cardioplegia plus coronary sinus occlusion
allograft aortic valve replacement aortic root replacement utility intraoperative echocardiography doppler color flow mapping seventeen consecutive patients undergoing 20 planned aortic valve replacements allograft valves stanford university medical center studied intraoperative epicardial echocardiography doppler color flow mapping cardiopulmonary bypass native aortic valves replaced 12 20 patients , eight patients underwent second aortic valve procedures 17 20 patients allograft selection guided echocardiographic estimates annular diameter length allograft aortic root required findings included severe mitral regurgitation one patient \( allograft aortic valve replacement \) , left right shunts five patients , ascending aortic dissection one , aortic root disease necessitating coronary bypass two echocardiography demonstrated acceptable competency 18 19 allograft valves \( mild aortic insufficiency \) echocardiography also documented successful repair four five shunts mild mitral regurgitation 15 19 patients \( versus 11 19 bypass \) conclusions intraoperative echocardiography doppler mapping useful adjunct allograft aortic valve aortic root replacement allows selection appropriate tissue size aortic cross clamping , minimizes delay allograft procedures also provides helpful information extent aortic root disease coronary ostial anatomy bypass , confirms allograft competency bypass , detects accompanying valvular hemodynamic lesions allograft valve replacement
deprivation infancy adult life important mortality risk \? previous ecological studies suggested early life factors important causes adult cardiovascular respiratory disease , showing geographic correlations past infant mortality rates present adult mortality rates however , studies take account fact areas severely deprived earlier century remain deprived today thus ecological relation infant adult mortality rates could simply reflect persistence geographic distribution poor socioeconomic circumstances explore hypothesis infant mortality rates 43 counties england wales correlated cause specific adult mortality 1969 73 people aged 65 74 years , without adjustment present day social deprivation social class strong simple correlations found infant mortality adult mortality various causes 1969 73 generally much attenuated abolished controlling indices present day socioeconomic circumstances results suggest previous studies give strong support direct influence factors acting early life adult coronary heart disease mortality risk studies data infancy , childhood , full course adult life required clarify issue
raynaud 's syndrome using range therapies help patients raynaud 's syndrome common medical problem approach diagnosis must involve search underlying causes treatment includes avoidance precipitating factors , biofeedback , possibly pharmacologic therapy , careful consideration risks
heart transplantation patients severe pulmonary hypertension increased pulmonary vascular resistance irreversibly increased pulmonary vascular resistance contraindication cardiac transplantation hospital patients referred recipient evaluation systolic pulmonary artery pressure greater 50 mmhg pulmonary vascular resistance greater 2 units \( wu \) tested intravenous sodium nitroprusside reversibility 23 patients whose increased systolic pulmonary artery pressure \( 67 4 10 4 mmhg \) resistance \( 4 8 2 4 wu \) reduced nitroprusside , orthotopic heart transplantation performed without early mortality right heart catheterization transplantation revealed significant persistent fall elevated pulmonary artery pressure pulmonary vascular resistance conclude severe pulmonary hypertension elevated pulmonary vascular resistance reversible nitroprusside , patient safely undergo heart transplantation
ultrastructural changes rat hearts following cold cardioplegic ischemia differing duration differing modes reperfusion morphologic consequences prolonged global hypothermic \( 15 degrees c \) , cardioplegic ischemia two reperfusion techniques studied langendorff perfused rat hearts reperfusion technique , gradual rise perfusate temperature pressure physiologic levels 30 min , used 12 hearts following 2 hour 3 1 2 hour \( 6 group \) ischemia abrupt reperfusion , perfusate 37 degrees c 70 mmhg , performed 13 hearts \( 6 ischemic 2 hours 7 3 1 2 hours \) six nonischemic , perfused hearts served controls randomly selected specimens left ventricle 45 60 min reperfusion prepared transmission electron microscopy volume fractions myocardial structural components calculated point counting electron two way analysis variance revealed interstitial edema developed increasing ischemic time influenced reperfusion technique degree endothelial damage independent ischemic time , reperfusion mitochondrial injury myocyte edema less perfusate temperature pressure slowly raised 3 1 2 hour ischemia
coronary trapping complement activation product \( c3a des arg \) myocardial reperfusion open heart surgery accumulation complement factors found occur myocardium infarction studied possibility complement activation product c3a des arg trapped within coronary circulation reperfusion ischemic myocardium 11 patients undergoing routine coronary artery bypass grafting , arterial blood sampled , cardiopulmonary bypass blood drawn coronary sinus concomitantly arterial blood sampling 5 30 min release aortic cross clamp \( n 10 \) preoperative value 92 13 ng ml , c3a des arg rose cpb maximum end cpb following reperfusion 5 min , c3a des arg 232 ng ml arterial 100 coronary sinus blood , significant difference \( p less 0 05 \) amount c3a des arg trapped heart 5 min reperfusion showed positive correlation arterial concentration \( p less 0 05 \) significant difference found 30 min reperfusion complement activation products trapped heart early reperfusion period may play pathogenetic role myocardial ischemia reperfusion injury
subacute poisoning , illness characterized weakness , dizziness , gastrointestinal identified among crew 30 field workers employed county , california , august 1987 onset symptoms occurred august 24 august 30 median 9 days date first employment first crew member sought medical treatment august 26 , 10 crew members admitted hospital august 27 august 30 workers , gastrointestinal constitutional symptoms resolved shortly admission , 4 patients episodes severe sinus bradycardia persisting several days day admission , transient atrioventricular dissociation developed 2 persons interviews 16 crew members admitted hospital identified 1 additional worker ill gastrointestinal symptoms , 16 moderate severe inhibition plasma red blood cell cholinesterase four workers tested interviewed also cholinesterase depression crew exposure since august 19 , last applied july 21 , 29 days earlier although first report unequivocally linking field worker poisoning , delayed onset nonspecific nature symptoms associated subacute poisoning may recognition previous similar episodes
new developments cardiopulmonary resuscitation since last revision american heart association 's guidelines 1985 , several new developments clinical importance occurred field cardiopulmonary resuscitation include enhanced access earlier use defibrillation , use high dose epinephrine standard doses fail , assessment resuscitative efforts end tidal co2 monitoring addition two new drugs , amiodarone \( refractory ventricular fibrillation \) adenosine \( paroxysmal supraventricular tachycardia \) time determine ultimate role management cardiac arrest
late streptokinase infusion antithrombotic treatment myocardial infarction reduce subsequent myocardial ischemia 255 consecutive patients acute myocardial infarction , 111 eligible attempted late thrombolysis randomly assigned either thrombolytic antithrombotic treatment \( treatment group \) routine treatment \( control group \) patients treatment group received streptokinase initiated late \( mean 32 hours range 12 49 \) onset symptoms , followed heparin infusion least 5 days warfarin dipyridamole least 3 months patients examined clinically bicycle discharge hospital 3 12 months two groups differ respect deaths trend toward lower incidence angina pectoris treatment group exercise tolerance group significantly higher control group \( 3 months 124 39 w vs 107 41 w p less 0 05 \) difference entirely accounted patients previous history infarction angina pectoris \( 3 months 142 37 w vs 112 45 w p 0 01 \) ecg signs myocardial ischemia , silent symptomatic , occurred significantly lower levels exercise among patients control group compared patients treatment group results support notion thrombolytic therapy given late 12 49 hours onset symptoms may reduce incidence residual ischemia postinfarction period
immediate regional endocardial surface expansion following coronary occlusion canine left ventricle disproportionate effects anterior versus inferior ischemia exact time onset functional expansion acute myocardial infarction ischemia remains unclear spite potential link chronic pathologic infarct expansion potential implications therapy examine early change ventricular morphology , 14 open chest dogs studied two dimensional echocardiography occlusion \( 10 minutes \) left anterior descending coronary artery \( lad , n 7 \) circumflex artery \( circ , n 7 \) endocardial surface area \( esa \) area abnormal wall motion \( awm \) reconstructed echocardiographic data using previously reported technique quantitatively mapping esa extent awm total group \( n 14 \) , mean esa occlusion 48 9 9 8 cm2 , increasing 65 7 18 9 cm2 10 minutes occlusion \( p less 0 001 \) lad subgroup , mean esa occlusion 50 7 9 3 cm2 , increasing 79 1 14 1 cm2 10 minutes following occlusion \( p less 0 001 \) circ subgroup , mean esa occlusion 47 1 10 8 cm2 , increasing 52 3 12 6 cm2 10 minutes occlusion \( p less 0 001 \) esa increase lad subgroup significantly larger circ subgroup \( lad range 14 5 49 9 cm2 versus circ range 1 5 9 cm2 , p less 0 0001 \) coronary occlusion resulted similarly sized regions awm subgroups \( lad , 31 3 12 2 cm2 versus circ , 25 9 10 3 cm2 , p n \) lad group , largest increase endocardial circumference occurred within zone awm apex \( 39 9 12 \) endocardial surface area therefore immediately coronary occlusion magnitude process primarily related site \( \) rather extent awm
detection myocardial infarction presence wolff parkinson white syndrome qrst map dogs possibility detecting myocardial infarction \( mi \) presence wolff parkinson white \( wpw \) syndrome means body surface qrst maps studied eight dogs eighty seven body surface ecgs recorded simultaneously recordings taken right atrial \( ra \) right atrial right ventricular \( ra rv \) sequential pacing , simulated wpw syndrome , control periods 1 hour intervals 5 hours occlusion left anterior descending coronary artery ecgs ra drive , diagnostic findings mi abnormal q waves observed became obscure ra rv drive contrary , qrst values anterior chest positive soon coronary occlusion , decreased gradually time passed , became abnormally negative 5 hours qrst maps ra ra rv pacing showed quite similar patterns highly correlated throughout study \( r greater 0 95 \) findings demonstrate localized abnormalities resulting mi evident qrst maps even presence preexcitation fusion
acute reduction mitral valve area percutaneous balloon mitral valvuloplasty assessment doppler continuity equation method mitral valve areas balloon mitral valvuloplasty serially determined doppler continuity equation method 16 patients ultrasound examinations performed immediately balloon inflation 24 hours , 1 week , 1 month valvuloplasty mitral valve area determined doppler continuity equation method correlated well determined catheterization gorlin formula , also immediately balloon inflation \( 0 87 x 0 05 , standard error estimate 0 22 cm2 , r 0 90 \) serial calculation mitral valve area doppler continuity equation method showed slight significant decrease valve area 24 hours balloon mitral valvuloplasty change conclude doppler continuity equation method provides accurate estimation mitral valve area even balloon valvuloplasty mitral valve area dilated balloon inflation decreased slightly within 24 hours procedure , valve stretch one mechanism increasing mitral valve area balloon valvuloplasty estimation mitral valve area immediately balloon mitral valvuloplasty may overestimate long term efficacy procedure
acute hemodynamic effects intravenous diperdipine , new dihydropyridine derivative , coronary heart disease acute hemodynamic effects new dihydropyridine calcium channel blocker , diperdipine , suitable intravenous administration , studied right left cardiac catheterization 16 patients coronary heart disease diperdipine markedly reduced systemic vascular resistance improved stroke index left ventricular ejection fraction mean pulmonary artery wedge pressures slightly increased possible consequence enhanced venous return , whereas right atrial left ventricular end diastolic pressures significantly changed nevertheless , increase preload clearly indicated augmented left ventricular end diastolic volume index administration diperdipine left ventricular contractility , estimated end systolic pressure volume ratio dp dt max significantly changed , though analysis individual data suggests minimally negative inotropic effect however , minor effect left ventricular contractility largely marked reduction afterload , produced sharp improvement stroke index enhancement left ventricular ejection fraction reduction systemic vascular resistance inversely directly correlated control values overall , diperdipine well tolerated , one patient major untoward reaction consisted ischemic episode possibly related drug administration conclusion , intravenous diperdipine appears potent arteriolar dilating agent affect left ventricular contractility
ultra short acting intravenous beta adrenergic blockade add therapy acute unstable angina assess efficacy safety ultra short acting beta blocking agent , esmolol , acute unstable angina , administered esmolol 21 patients persistent angina despite conventional medical therapy following baseline doppler echocardiographic examination , esmolol titrated reduce rate pressure product least 20 patients receiving maintenance dosage 30 minutes , doppler echocardiographic studies repeated mean esmolol dose target response 17 16 mg min , dosage range 8 24 mg min esmolol effective alleviating anginal chest pain 18 21 patients seven patients eventually underwent percutaneous transluminal coronary angioplasty \( ptca \) eight coronary bypass surgery remainder discharged receiving medical therapy including oral beta blockade esmolol therapy , heart rate blood pressure decreased significantly \( 86 14 68 12 beats min 125 16 103 20 mm hg , p less 0 001 \) cardiac output decreased 5 4 1 3 4 5 1 1 l min \( p less 0 001 \) secondary decrease heart rate stroke volume remained unchanged left ventricular ejection fraction increased 47 12 49 13 esmolol therapy , although change statistically significant one third filling fraction well e ratio \( ratio early late diastolic filling velocities \) increased esmolol therapy \( 35 8 38 8 0 73 0 2 0 85 0 23 , p less 0 005 \) , indicating improvement left ventricular diastolic function
improvement systolic diastolic left ventricular wall motion serial echocardiograms selected patients treated unstable angina purpose study evaluate effect treatment left ventricular function selected patients unstable angina pectoris due severe proximal left anterior descending coronary artery narrowing identify subgroups adverse outcome \( mean term 2 7 years \) effect treatment systolic diastolic left ventricular wall motion studied 35 patients unstable angina pectoris electrocardiogram indicated severe proximal left anterior descending coronary artery narrowing treatment consisted either revascularization procedure \( 17 patients \) antianginal drug therapy \( 18 patients \) patients underwent two dimensional echocardiographic study within 48 hours \( mean 20 hours \) entry study study analyzed systolic performance ischemia related segments calculation total wall motion score 16 patients investigation combined continuous detailed recording apical interventricular septal wall motion detailed study included measurements regional function providing pattern systolic early diastolic excursion endocardial border apical interventricular septum repeat ultrasonic study performed least 1 month \( median 2 months , 7 days \) admission results systolic wall motion analyses 35 patients showed , treatment groups , significant improvement systolic wall motion anterior apical segments \( mean total wall motion score early study vs late study revascularization , 6 9 vs 2 2 medical therapy , 4 6 vs 1 0 \)
identification rate dependent functional refractory period atrioventricular node simulated atrial fibrillation continuously observed successive pairs r r intervals atrial fibrillation hypothesized shortest r r interval given preceding r r interval pair represents functional refractory period atrioventricular node preceding interval test hypothesis simulated atrial fibrillation 28 isolated cross perfused canine hearts obtained r r interval r r intervals function immediately preceding r r interval enabled us detect series shortest r r intervals wide range preceding r r intervals , allowed us estimate rate dependent functional refractory period atrioventricular node simulated atrial fibrillation estimated functional refractory periods correlated well measured conventional method \( r 0 93 \) conclude proposed method makes possible estimate rate dependent functional refractory periods atrioventricular node atrial fibrillation
septal ventricular pacing immature canine heart new perspective cardiac pacing initiated epicardial transvenous apical right ventricular electrodes causes ventricular contraction alters myocardial stress vectors results adverse cellular subcellular changes experimental animal clinically , changes may contribute adverse hemodynamics reported long term ventricular pacing determine feasibility direct stimulation ventricular specialized conduction systems therefore potential maintenance normalized depolarization patterns , 13 puppies studied baseline ventricular activation contraction patterns obtained using intracardiac electrograms nuclear acquisition \( \) imaging septal electrode insertion groove accomplished use two dimensional echocardiography continuous electrocardiographic \( ecg \) monitoring surface ecg pacemaker implantation five puppies standard right ventricular epicardial electrodes implanted five additional animals , three remaining age matched non paced controls 4 months observation , repeat imaging intracardiac electrograms demonstrated nearly normal biventricular activation contraction patterns among septal paced group histopathologic examination illustrated normal cellular morphology septal paced animals study demonstrates pacing electrode insertion proximal interventricular septum feasible results utilization normal ventricular conduction pathway approach initiation ventricular stimulation may attenuate adverse effects long term ventricular pacing
noninvasive estimation left atrial pressure patients congestive heart failure mitral regurgitation doppler echocardiography completely noninvasive method estimating left atrial pressure patients congestive heart failure mitral regurgitation devised use continuous wave doppler echocardiography brachial 46 patients studied mitral regurgitation , 35 \( 76 \) jets distinct doppler spectral recorded peak ventriculoatrial gradient obtained measuring peak mitral regurgitant velocity systole using modified equation gradient peak brachial systolic blood pressure , estimate left ventricular systolic pressure , yield left atrial pressure \( left atrial pressure systolic blood pressure mitral regurgitant pressure gradient \) noninvasive estimates left atrial pressure 35 patients plotted simultaneous recordings mean pulmonary capillary wedge pressure resulting correlation 0 3 3 , r 0 88 , standard error estimate 4 mm hg \( p less 0 001 \) therefore , continuous wave doppler echocardiography may used selected patients congestive heart failure mitral regurgitation noninvasive estimation left atrial pressure
myocardial imaging tc 99m teboroxime technique initial results study examined results tc 99m teboroxime imaging 22 patients aged 59 9 years compared results thallium 201 exercise rest teboroxime studies obtained within 3 hours using dose 15 mci study short wash half life teboroxime , imaging begun within 1 2 minutes injection spect planar images obtained spect protocol modified changing number frames , time per frame , filters used reconstruction images planar images obtained supine upright position shorter acquisition time spect \( 10 sec frame \) use filter frequency cutoff 0 3 cycle cm power 10 yielded best image quality close agreement thallium results identifying abnormal normal perfusion pattern 89 vascular territories scans abnormal techniques 12 patients , normal nine patients , discordant one patient thus tc 99m teboroxime myocardial imaging feasible rest exercise using either spect planar imaging shorter acquisition time appropriate filtering spect imaging upright position planar imaging improve image quality convenient patient
future directions vasodilator therapy heart failure vasodilator therapy become major pharmacologic approach improving left ventricular function , consequently , vasodilator drugs used increasingly treatment heart failure , vasodilator drugs used long term management heart failure show clearly defined pharmacodynamic effects include reduced impedance left ventricular ejection , increased venous capacitance , increased left ventricular ejection fraction reduced heart size , absence neurohormonal stimulation , slowed progression left ventricular dysfunction mechanisms action sites activity various vasodilator drugs currently available vary considerably , none yet proved ideal treatment heart failure hypertension complexity surrounding multiple vasoconstrictor mechanisms involved heart failure led rationale combined vasodilator therapy certain combinations discussed therapeutic standpoint , development drugs multiple mechanisms action particularly attractive flosequinan new vasodilator agent whose cellular mechanism action remains uncertain flosequinan advantage able relax arterial venous beds may particularly beneficial treatment heart failure
clinical efficacy flosequinan heart failure effects new arterial venous vasodilator flosequinan evaluated variety ways different groups patients chronic heart failure flosequinan improved central hemodynamic effects heart failure one group , benefits still apparent 24 hours single oral dose another group also improved calf blood flow , therefore , blood flow skeletal muscle also , using number different tests , improved exercise performance patients group improvement exercise tolerance produced similar captopril flosequinan necessary properties drug likely benefit treatment patients chronic heart failure
early beneficial effect streptokinase left ventricular function acute myocardial infarction effect intravenous streptokinase therapy time course functional recovery investigated controlled study 64 patients randomized within 3 hours onset acute myocardial infarction \( ami \) contrast ventriculography performed 1 4 days ami repeated 5 weeks later wall motion analyzed method central infarct , peripheral infarct regions patients data early catheterization , streptokinase treated patients less severe hypokinesia central infarct region control patients \( 2 9 0 9 n 29 vs 3 4 0 7 standard deviations normal n 21 , p less 0 05 \) benefit streptokinase marked peripheral infarct region \( 1 5 0 7 vs 2 1 0 6 , p less 0 001 \) result , ejection fraction slightly higher treated versus control groups \( 46 10 vs 43 7 , respectively difference significant \) 5 weeks , function streptokinase control groups continued improvement streptokinase treated patients study shows streptokinase benefits left ventricular \( lv \) function 1 4 days ami , earlier previously reported benefit limited peripheral infarct region , ischemia might less severe , also seen central infarct region implication thrombolytic therapy improve lv function period myocardial , myocardial function still recovering
effects nisoldipine myocardial ischemia exercise daily activity properties nisoldipine , dihydropyridine calcium antagonist , assessed multicenter , double blind , placebo controlled trial repeated exercise testing 72 hour ambulatory electrocardiographic monitoring 82 patients coronary artery disease patients positive treadmill stress test results greater equal 2 ischemic episodes per 24 hours included study administration chronic medications except beta blockers discontinued first week patients received placebo twice daily second third weeks , 41 patients received nisoldipine 10 mg 41 patients received placebo twice daily placebo group changes exercise parameters ambulatory electrocardiographic parameters nisoldipine group , exercise duration increased 403 seconds \( p 0 \) , time 1 mm st depression increased 224 298 seconds \( p 0 002 \) , time pain increased 241 seconds \( p 0 01 \) , maximal st depression reduced 2 6 2 3 mm \( p 0 002 \) among ambulatory electrocardiographic parameters nisoldipine group , number episodes reduced , 14 4 11 6 \( p 0 \) per patient significant reduction total ischemic time \( 132 vs 120 minutes per patient \) significant side effects observed largest clinical trial date effects nisoldipine myocardial ischemia results indicate nisoldipine effective improving exercise parameters partially effective suppressing ischemia daily activity
usefulness blood lactate predictor shock development acute myocardial infarction published erratum appears j cardiol 1991 apr 15 67 \( 9 \) data obtained analyzed 229 patients admitted coronary care unit november 1988 july 1989 patients classified 2 groups patients without mild left ventricular failure \( class ii \) hospital stay \( group \) , patients class ii admission developed cardiogenic shock hospitalization \( group ii \) discriminant function analysis performed using following variables patients' age , history previous myocardial infarction , diabetes mellitus , blood lactate , urea , creatinine , creatine kinase , aspartate aminotransferase , lactate dehydrogenase concentrations , chest x ray cardiothoracic ratio variables found significantly discriminate 2 groups patients age , previous infarction , x ray cardiothoracic ratio , blood urea lactate concentrations risk index computed , blood lactate variable greatest predictive power shock development sensitivity , specificity predictive value risk index , taking various cutoff points , calculated cutoff value 1 , sensitivity 65 , specificity 91 , positive predictive value 36 negative predictive value 97 cutoff value 2 , sensitivity 53 , specificity 99 , positive predictive value 82 negative predictive value 96
capabilities supine exercise electrocardiography versus exercise radionuclide angiography predicting coronary events ability supine exercise electrocardiography exercise radionuclide angiography predict time subsequent cardiac events \( cardiac death , nonfatal myocardial infarction late coronary bypass grafting angioplasty \) compared 265 patients normal resting electrocardiograms taking digoxin patients undergone coronary catheterization initially treated medically follow study performed median 51 months separate logistic regression models , previously developed predict 3 vessel left main coronary artery disease \( cad \) , compared using cox regression analysis predict time subsequent cardiac event exercise electrocardiography model , consisting magnitude st depression , exercise heart rate patient gender , powerful predictor \( chi square 30 8 , p less 0 0001 \) subsequent events exercise radionuclide angiography model , included exercise response pressure volume ratio addition exercise electrocardiography variables , similar prognostic power \( chi square 31 8 , p less 0 0001 \) separate analysis considering cardiac death nonfatal myocardial infarction , exercise electrocardiography model remained significant predictor events \( chi square 12 2 , p less 0 001 \) none radionuclide angiography variables added significantly prognostic power exercise electrocardiography model thus , patients normal resting electrocardiogram taking digoxin , supine exercise electrocardiography model predicts 3 vessel left main cad also predicts future cardiac events exercise radionuclide angiography provide additional prognostic information patients
relation cardiac output rest exercise age essential hypertension suggested decline cardiac output age due increased prevalence disease , particularly occult coronary artery disease therefore , relation cardiac output \( direct oxygen fick method \) age analyzed 110 sixteen 64 year old men world health organization stage ii essential hypertension time hemodynamic study , alive free cardiovascular complications 7 years later supine seated rest , upright bicycle exercise 50 w peak work load , cardiac output inversely \( p less 0 01 \) related age relations independent weight mean intraarterial pressure stroke volume decreased advancing age supine rest , rest exercise seated position heart rate affected age supine position , slower older patients upright rest peak exercise conclusion , patients essential hypertension remained free cardiovascular complications 7 years , cardiac output independently inversely related age various levels activity findings suggest occult cardiovascular disease explain decline cardiac output age patients essential hypertension
comparison effects guanadrel sulfate propranolol blood pressure , functional capacity , serum lipoproteins glucose systemic hypertension controlled , double blind , crossover study , effects guanadrel sulfate propranolol blood pressure \( bp \) selected cardiopulmonary metabolic variables compared 15 physically active moderately hypertensive subjects guanadrel sulfate reduced systolic diastolic bp rest 16 15 mm hg , maximal exercise 33 13 mm hg , respectively \( p less 0 005 \) , without affecting submaximal oxygen consumption \( vo2 \) , maximal vo2 , ventilatory threshold , forced vital capacity , forced expiratory volume 1 second , fatigue , assessed perceived exertion contrast , propranolol significantly decreased diastolic bp rest \( 16 mm hg \) systolic bp maximal exercise \( 44 mm hg \) however , significantly decreased submaximal vo2 \( 3 9 ml kg 1 min 1 \) , maximal vo2 \( 3 9 ml kg 1 min 1 \) , ventilatory threshold \( 0 3 liters min 1 \) , minute ventilation submaximal exercise \( 7 3 liters min 1 \) , forced expiratory volume 1 second \( 0 27 liters \) , concomitantly increased rating perceived exertion maximal exercise \( 1 9 u \) guanadrel sulfate also associated significant decreases mean fasting plasma glucose total serum cholesterol , whereas propranolol resulted increase serum triglycerides \( p less 0 05 \) contrast propranolol , guanadrel sulfate appears decrease bp without negative metabolic consequences exercise tolerance
abnormal baroreflex control heart rate congestive heart failure reversal compensation congestive heart failure \( chf \) causes impairment baroreflex control heart rate \( hr \) determine derangement reversible , cardiac chronotropic control assessed 10 patients class iv chronic chf various etiologies compensation achieved bed rest , salt restriction , diuretics vasodilators mean time 2 studies 15 3 days management modified 3 days second autonomic evaluation , diet pharmacologic conditions previous study compensation led significant reduction symptom based class , body weight , pulmonary systemic congestion mean standard error mean hr responses \( beats min \) compensation , respectively \( 1 \) atropine \( 0 04 mg kg \) 10 2 27 2 \( p less 0 01 \) \( 2 \) handgrip \( 30 maximum capacity , 1 minute \) 9 2 19 3 \( p less 0 005 \) \( 3 \) tilt \( 5 minutes \) 4 3 20 4 \( p less 0 005 \) mean standard error mean baroreflex sensitivity \( ms mm hg \) rr responses phenylephrine nitrate induced changes systolic pressure , respectively , condition phenylephrine , 0 9 0 2 8 2 3 \( p less 0 05 \) nitrate , 0 3 0 2 4 1 1 1 \( p less 0 05 \) significant correlation improvement hr responses atropine tilt changes body weight obtained findings show reversible component impaired baroreflex control hr severe chf , possibly due congestive effects
doppler echocardiographic study porcine bioprosthetic heart valves aortic valve position patients without evidence cardiac dysfunction study natural history hemodynamic performance bioprosthetic heart valves , doppler echocardiograms recorded group clinically stable patients 2 5 years replacement native aortic valves bioprosthetic valves eighteen patients completed 2 year 26 patients 5 year follow examination effective orifice areas identical models bioprosthetic valves \( ii \) determined vitro left sided heart pulse system vivo doppler derived effective orifice areas compared vitro measurements valve size 2 5 year follow examinations , doppler derived effective orifice area significantly less vitro area \( p less 0 0001 interval \) ten 16 valves evaluated serially decreased greater 0 20 cm2 doppler derived effective orifice area studies mean decrease effective orifice area valves evaluated serially 0 25 0 29 cm2 \( p less 0 005 \) peak gradient increased 21 6 27 8 mm hg \( p less 0 01 \) mean gradient increased 12 4 15 7 mm hg \( p less 0 05 \) concluded serial doppler echocardiographic studies demonstrate deterioration hemodynamic performance bioprosthetic valves time patients symptoms signs valvular dysfunction doppler echocardiography may useful identifying subclinical bioprosthetic valvular dysfunction
effects phospholipase inhibitor mepacrine injury ischemic metabolically inhibited adult isolated myocytes phospholipase inhibitor mepacrine shown delay cell death metabolically inhibited cultured present study initiated determine mepacrine also delays cell death development osmotic fragility metabolically inhibited ischemic adult rat isolated myocyte suspensions incubated 3 mmol l \( \) acid 6 mmol l \( inhibited \) pelleted oil \( ischemic \) presence absence 10 50 mumol l \( micromolar \) mepacrine rates contracture , cell viability determined blue permeability , cell viability osmotic swelling 170 mosm media \( osmotic fragility \) , cell morphology monitored mepacrine effects rates contracture , found significantly delay cell death isotonic incubations metabolically inhibited ischemic cells contrast , mepacrine effect development osmotic fragility incubation metabolically inhibited myocytes calcium free media delay contracture cell injury , attenuate protective effects mepacrine study confirms previous reports mepacrine protects cells injury , extends observations protection ischemic isolated adult myocytes , shows development osmotic fragility inhibited mepacrine
recombinant lipoprotein associated coagulation inhibitor inhibits tissue thromboplastin induced intravascular coagulation rabbit lipoprotein associated coagulation inhibitor produces back inhibition tissue factor \( tissue thromboplastin \) induced coagulation presence factor recombinant lipoprotein associated coagulation inhibitor \( rlaci \) tested ability modify thromboplastin induced intravascular coagulation rabbit model allows monitoring iodine 125 fibrin accumulation disappearance lung sampling blood measurement coagulation parameters infusion thromboplastin rabbit caused rapid increase radioactivity lungs , possibly due accumulation 125i fibrin lungs , followed rapid decline radioactivity , suggestive removal fibrin lungs thromboplastin also caused rapid decrease systemic fibrinogen accompanied lengthening activated partial thromboplastin time prothrombin time effect rlaci thromboplastin bolus injection rlaci thromboplastin infusion studied high dose rlaci \( 800 micrograms kg body weight \) , thromboplastin induced radioactivity increase lungs systemic fibrinogen decrease completely suppressed activated partial thromboplastin time prothrombin time plasma samples lengthened , possibly due presence thromboplastin circulation thromboplastin induced radioactivity increase lungs completely suppressed lower doses rlaci \( 135 270 micrograms kg body weight \) , doses rlaci prevented systemic fibrinogen decrease bolus dose 23 micrograms kg body weight , rlaci provided 50 protection fibrinogen consumption \( fibrinogen decreased 82 compared 65 rabbits treated thromboplastin alone \) results show rlaci effective inhibition thromboplastin induced coagulation vivo
effect recombinant human granulocyte macrophage colony stimulating factor administration lymphocyte subsets patients refractory aplastic anemia human recombinant granulocyte macrophage colony stimulating factor \( rhgm csf \) administered 14 patients refractory aplastic anemia \( aa \) effect rhgm csf therapy lymphocyte phenotype proliferative responses mitogen phytohemagglutinin , candida albicans , tetanus toxoid antigens natural killer \( nk \) activity circulating lymphocytes studied samples collected \( baseline \) twice rhgm csf administration absolute number circulating lymphocytes remained relatively constant first period , experienced significant increase \( p less 001 \) second period increase prominent b cells \( p less 001 \) , cells \( p less 016 \) also increased detailed investigation lymphocyte subsets showed increase markers cd38 \( \) , hla dr , transferrin receptor throughout treatment course giving evidence lymphoid cell activation nk cell activity suppressed \( p less 008 \) throughout treatment however , proliferative responses phytohemagglutinin , candida antigen , tetanus toxoid unaffected although mechanism yet defined , gm csf induce activation increase absolute lymphoid cell number , especially b cells , together decrease nk cytotoxicity implication immune cell changes relation host resistance microorganisms remains established
ultrastructure three dimensional organization hereditary hemorrhagic telangiectasia studied 10 cutaneous telangiectatic lesions hereditary hemorrhagic telangiectasia \( \) , ranging size 2 mm , light electron microscopy four representative lesions reconstructed computer serial 1 2 mm plastic embedded sections earliest clinically detectable lesion focal dilatation postcapillary venules , continue eventually dilated arterioles capillaries vascular lesion increases size , capillary segments direct venous communication formed entire sequence morphologic events associated perivascular mononuclear cell infiltrate majority cells lymphocytes minority monocytes macrophages ultrastructure comparison findings telangiectatic scleroderma angiomas revealed former , previously shown composed dilated postcapillary venules , also associated perivascular infiltrates , latter , produced capillary loop aneurysms ,
isolation quantitation human erythrocyte deformability classes new technique described erythrocytes according deformability method modification method et al \( j lab clin med 1976 88 33 \) , small cellulose columns used remove white cells blood samples find length width ratio columns increased , mixed cellulose bed also red cells measurement mean cell volume , mean corpuscular hemoglobin concentration , hemoglobin level , deformability index , cell density showed deformability physical property erythrocyte forms basis separation modality complements numerous density gradient techniques red cells following experimental results obtained using technique \( 1 \) number cells defined degree rigidity quantitated erythrocyte population \( 2 \) large numbers cells differ respect deformability isolated \( 3 \) application method sickle cells quantitated remarkable heterogeneity cells regard deformability
immune activation associated induced anemia rat long term \( phz \) treatment caused pronounced anemia concomitant increase numbers circulating leukocytes long evans rats leukocytosis caused mainly elevation mononuclear cells , notably lymphocyte population phz reported cause direct lysis erythrocytes nonimmune mechanisms however , recent reports indicate phz cross link red cell band 3 protein \( antigen \) , resulting binding autologous immunoglobulin g \( igg \) recognition complex macrophage fc receptor mechanisms triggers rapid spleen possibly liver well study , analysis blood , bone marrow , spleen cells long term \( 1 6 weeks \) phz treated rats performed using flow cytometry total serum igg levels determined radial , antibodies reactive red cells sensitized phz either vivo vitro using indirect method serum prostaglandin e2 titers also determined different time intervals phz administration results indicate phz induces increase circulating antibody prostaglandin e2 titers correlates onset anemia serum phz treated rats induce anemia normal recipients passive transfer studies revealed marked increase b cell population peripheral blood spleen altered ratio helper suppressor cells certain time intervals phz injection results indicate addition inducing senescence like alterations erythrocyte membrane proteins , phz stimulates production autologous igg recognizes sites promotes lymphoid , notably b cell lineage
benefits risks anemia correction recombinant human erythropoietin children maintained hemodialysis ten children renal failure \( age range 2 years 6 months 18 years 9 months median 11 years 10 months \) , maintained long term hemodialysis , successful correction anemia intravenous administration recombinant human erythropoietin dosage escalating every 2 weeks \( 75 150 300 450 iu kg wk \) mean hemoglobin concentration increased 6 4 0 9 11 5 1 0 gm dl blood cell counts used evaluate correction anemia done dialysis especially important children less compliant water restriction higher hemoglobin concentration resulted improvement quality life , greater tolerance physical effort \( exercise tolerance doubled ventilatory anaerobic threshold increased significantly \) , correction subclinical central nervous system abnormalities detected evoked potentials testing , reduction bleeding time side effects noted severe hypertension developed one patient hematocrit 28 , two episodes evidence liver dysfunction conclude children renal failure use recombinant human erythropoietin correct anemia safe strongly advisable , resolution many symptoms correlated anemia
rapid detection prenatal diagnosis beta thalassaemia studies indian populations uk application amplification refractory mutation system \( arms \) detection individual beta thalassaemia mutations heterozygous parents risk fetuses assessed indian populations uk 100 first trimester prenatal diagnoses done , detection 17 different mutations method , allows determination mutations parental fetal dna day , wide application carrier detection prenatal diagnosis diseases heterogeneous molecular defects
twin twin transfusion syndrome twin twin transfusion syndrome complication monozygotic serious perinatal implications extensive literature review revealed current understanding anatomy pathogenesis syndrome changed last 3 decades however , modern diagnostic modalities , sonography doppler studies , allow antenatal diagnosis therefore may change current definition syndrome based data , new composite definition syndrome suggested definition includes following criteria 1 \) sonographic signs \( inter twin differences abdominal circumference greater 18 mm , oligohydramnios , signs \) , 2 \) doppler velocimetry umbilical arteries \( inter twin difference systolic diastolic ratios 0 4 \) , 3 \) demonstration vascular shunt , 4 \) inter twin birth weight difference 15 , 5 \) inter twin hemoglobin difference 5 g dl addition , prenatal diagnosis may help management complication , seems intrauterine treatment placental vascular anomalies may effective antenatal therapeutic options
iron deficiency young athlete although overt anemia uncommon , depletion body iron stores common among adolescent female athletes poor dietary iron intake , menstruation , increased iron losses associated physical training appear important factors whether iron deficiency impair exercise performance uncertain nonetheless , athletes low ferritin levels risk impaired erythropoiesis receive therapeutic iron supplementation
incomplete synthesis n congenital anemia type ii caused defect gene encoding alpha ii congenital anemia type ii , hereditary positive serum lysis test \( hempas \) , genetic anemia humans inherited recessive mode enzyme defect hempas patients previously proposed lowered activity n ii , resulting lack proteins leading accumulation lipids recent hempas case , g c , analyzed cell surface labeling , fast mass spectrometry , activity assay glycosylation enzymes significantly decreased glycosylation proteins incompletely processed asparagine linked oligosaccharides detected erythrocyte membranes g c contrast earlier studied hempas cases , g c cells normal n ii activity low alpha ii \( alpha manii \) activity northern \( rna \) analysis poly \( \) mrna normal , g c , unrelated hempas cells showed double bands 7 6 kilobase position , detected alpha manii cdna probe , expression bands g c cells substantially reduced \( less 10 normal \) southern analysis g c normal genomic dna , restriction fragment patterns detected alpha manii cdna probe indistinguishable results suggest g c cells contain mutation alpha manii encoding gene results inefficient expression alpha manii mrna , either reduced transcription message instability report demonstrates hempas caused defective gene encoding enzyme necessary synthesis asparagine linked oligosaccharides
haemopoietic growth factors availability recombinant haemopoietic growth factors permitted precise vitro experiments human vivo studies performed general , results expectations previous vitro studies clinical haemopoietic growth factors offers great promise careful studies required define value effects growth factors multiple complex , cannot assumed improvements blood cell counts per se beneficial patient circumstances randomized controlled trials clinical end points essential situation chemotherapy induced neutropenia , large studies would required show improvement mortality although lesser morbidity would easier demonstrate field cancer therapy major benefit haemopoietic growth factors permit dosage escalation consequent improvement response rate long term survival require careful patient selection large , probably multicentre , trials also likely studies limited development severe thrombocytopenia effective means ameliorate \( perhaps \) required possibility using haemopoietic growth factors adjunct treatment severe infections , designing trial evaluate possibility difficulties finally , must noted studies reported date use single factors beginning use factors synergistic combinations may give greater efficacy without increased toxicity
sarcoidosis abdominal manifestations ct data literature abdominal manifestations sarcoidosis computed tomography \( ct \) determine whether differences nodal distribution appearance reliably used distinguish sarcoidosis non hodgkin lymphoma \( nhl \) , authors retrospectively reviewed abdominal pelvic ct scans 16 patients biopsy proved sarcoidosis 20 patients biopsy proved nhl eleven 16 patients sarcoidosis abdominal pelvic lymphadenopathy , common nodal sites except pelvic locations statistically significant lower frequency adenopathy sarcoidosis nhl mean nodal size significantly greater nhl nodes tended confluent nhl discrete sarcoidosis seen six 16 patients \( 38 \) sarcoidosis splenomegaly present nine 15 \( 60 \) ct depicted hepatic lesions three eight patients \( 38 \) biopsy proved hepatic involvement splenic lesions seen ct five 15 patients \( 33 \) authors believe overlap nodal appearance distribution poses limitation use criteria accurate disease characterization
reverses azidothymidine induced marrow suppression without impairment anti human immunodeficiency virus activity increased extracellular concentrations \( urd \) reported reduce , vitro , azidothymidine \( azt \) induced inhibition human granulocyte macrophage progenitor cells without impairment antihuman immunodeficiency virus \( hiv \) activity clinical toxicities associated chronic urd administration , ability \( \) effect , vivo , azt induced anemia leukopenia assessed agent inhibits urd catabolism , vivo , increases plasma concentration urd dose dependent manner , without urd related toxicity mice rendered anemic administration azt 28 days drinking water \( 1 5 mg ml \) , continued administration azt plus daily \( 300 mg kg , orally \) partially reversed azt induced anemia leukopenia \( p less 05 \) , increased peripheral reticulocytes \( 4 9 , p less 01 \) , increased cellularity marrow , improved azt onset drug administration , reduced azt induced marrow toxicity vitro , concentration 100 mumol l , possesses minimal anti hiv activity effect ability azt reverse hiv induced cytopathic effect cells clinical biochemical implications findings discussed
isolation characterization acquired antithrombin antibody 68 year old man , following mitral valve replacement , presented low grade chronic coagulopathy laboratory analysis showed mild fibrinolysis , minimal effect therapy , prolonged thrombin time \( greater 150 seconds using bovine iia \) purified human iia used thrombin time normalized within 17 seconds controls , suggesting possible inhibitor bovine iia anti iia antibody isolated protein sepharose \( sigma , st , mo \) chromatography followed affinity chromatography using bovine iia sepharose column effects purified anti iia antibody bovine human iia procoagulant anticoagulant functions studied isolated immunoglobulin g \( igg \) observed inhibit bovine iia assays tested igg also able slightly prolong fibrinogen clotting human iia using enzyme linked immunosorbent assay observed igg bound bovine iia , bovine ii , human iia , human ii , binding detectable approximately 50 fold lower concentrations bovine iia \( 1 nmol l igg concentration \) human iia \( 50 nmol l igg concentration \) effect antibody reaction iia iii heparin investigated human iia found protected iii heparin neutralization presence antibody results suggest patient developed antibody strongly binds inhibits bovine iia assays tested however , antibody significantly affects human iia neutralization iii heparin , little effect human iia procoagulant activity data suggest decreased effect iii heparin patient 's iia may contributing factor coagulopathy exact cause antibody development unclear , role bovine topical thrombin used cardiac valve replacement surgery suspect
fibrinogen baltimore polymerization defect associated gamma val \( \) mutation fibrinogen baltimore one first congenital abnormal reported several decades ago however , molecular defect identification fact , several reports functional defect baltimore , impaired fibrin monomer polymerization reversed phase high performance liquid chromatography analysis lysyl digest purified baltimore gamma chain showed abnormal peptide found co existing normal gamma chain heterozygote amino acid sequencing peptide indicated gamma chain replaced valine observation confirmed , genetic defect determined direct nucleotide sequencing polymerase chain reaction product containing codon gamma 292 , mutated molecular defect fibrinogen baltimore lies region gamma chain required fibrin polymerization , suggesting integrity gamma critical fibrin assembly
, private platelet antigen glycoprotein iiia associated neonatal thrombocytopenia new platelet , , described defined detected serum healthy mother delivered child typical clinical signs neonatal thrombocytopenia \( \) antibody reacted strongly child 's father 's platelets , platelets mother highly selected panel representing known platelet alloantigens platelets 300 unselected normal blood donors also tested negative , suggesting phenotype frequency german population less 0 01 antigen present 9 20 members within three generations paternal family , indicating autosomal inheritance immunochemical analysis using glycoprotein \( gp \) specific immunoassay variety gp iib iiia specific monoclonal antibodies antigen immobilization \( assay \) , radioimmunoassay , western blotting , could show antigen resides 68 kd proteolytic fragment gp iiia data gene dosage studies revealed antigen related known platelet alloantigens accordance established criteria , antigen represents first example private platelet bears significance rare instances
human neutrophils release leu 8 lymph node homing receptor cell activation leu 8 molecule , human homologue murine 14 peripheral lymph node homing receptor , expressed neutrophils species may important localization cells sites inflammation circulating human neutrophils express leu 8 molecule , activation neutrophils phorbol myristate acetate causes rapid decline leu 8 membrane fluorescence staining within 15 minutes northern blot analysis total cellular rna neutrophils demonstrated two species leu 8 messenger rna , major one 2 4 kb minor one 1 9 kb two different leu 8 cdna clones obtained human lymphocytes predicted encode transmembrane phosphatidylinositol \( pi \) anchored forms molecule , experiments conducted determine whether leu 8 anchored neutrophils pi anchor slight decrease expression leu 8 neutrophils treated pi specific phospholipase c \( pi plc \) however , leu 8 abundant neutrophils obtained patient paroxysmal nocturnal hemoglobinuria determine fate leu 8 molecule cell activation , neutrophils labeled 125i anti leu 8 activation antibody rapidly lost cell surface , suggesting leu 8 released cell membrane cell activation cell extracts neutrophils compared extracts lymphoid cells sodium dodecyl sulfate polyacrylamide gel electrophoresis immunoblotting , leu 8 species expressed neutrophils significantly higher variable relative mobility \( 70 120 kd neutrophils v 70 kd cells \) addition , leu 8 molecules detected supernatants activated neutrophils results indicate human neutrophils express high molecular weight form leu 8 molecule conventional transmembrane anchor rapidly released membrane activation loss leu 8 membrane glycoprotein activation may mechanism rapid alteration neutrophil adhesion characteristics
molecular basis spectrin ankyrin deficiencies severe hereditary evidence implicating primary defect ankyrin varying degrees spectrin deficiency found majority patients hereditary \( hs \) , combined severe deficiency spectrin spectrin binding protein , ankyrin , reported two patients severe hs elucidate molecular basis protein deficiencies , studied synthesis , assembly , mrna levels spectrin ankyrin peripheral blood reticulocytes one previously reported probands pulse labeling studies showed hs reticulocytes , synthesis alpha spectrin comparable control reticulocytes beta spectrin increased fourfold , presumably reflecting increased erythropoietic drive hs reticulocyte membrane , amount newly assembled spectrin reduced half control values , presumably reflecting decrease synthesis spectrin binding protein , ankyrin ankyrin synthesis nearly absent cytosol amounts membrane associated ankyrin reduced half normal values changes amounts spectrin ankyrin mrnas quantitated slot blot northern blot analyses comparable changes synthesis proteins alpha spectrin mrna within control range beta spectrin mrna slightly increased , amounts ankyrin mrna reduced 50 control values conclude primary defect underlying combined spectrin ankyrin deficiency deficiency ankyrin mrna leading reduced synthesis ankyrin , turn , underlies decreased assembly spectrin membrane
variation hemoglobin f production among normal sickle cell adults related nucleotide substitutions gamma promoter regions single nucleotide substitutions promoter regions gamma g gamma globin genes associated increased fetal hemoglobin \( hbf \) production wished determine whether unrecognized substitutions gamma promoter regions responsible 20 fold variation hbf production sickle cell patients normal adults random sampling 250 sickle cell \( ss \) patients 125 normal adults , 17 individuals representing highest lowest hbf selected study three common restriction fragment length polymorphism beta globin region haplotypes \( , central african republic , \) found highest lowest hbf ss disease using polymerase chain reaction amplification direct sequencing amplified dna product , examined promoter regions gamma g gamma genes 350 bp 50 bp cap site mutations found either gamma gene promoter region conclude nucleotide substitutions promoter regions \( 350 50 bp \) gamma genes responsible marked variation hbf production among ss normal individuals
platelet vitronectin receptor expression jewish arab patients israel rare , inherited disorder platelet glycoprotein iib iiia \( gp iib iiia \) complex previously identified two distinct populations disorder israel , jews groups indistinguishable hemorrhagic symptoms platelet gp iib iiia receptor deficiency , differ platelet gp iiia \( beta 3 \) , jewish population expressing detectable gp iiia arab population expressing small amounts examined platelets two populations well normal platelets alpha v beta 3 vitronectin receptor normal platelets contained approximately 50 100 alpha v beta 3 vitronectin receptors judged binding antibodies alpha v \( \) intact alpha v beta 3 vitronectin receptor complex \( \) addition , normal platelets bound immobilized vitronectin presence 1 mmol adhesion mediated predominantly gp iib iiia , distinct contribution alpha v beta 3 vitronectin receptor , determined monoclonal antibody inhibition studies jewish patients' platelets profound decrease alpha v beta 3 vitronectin receptors , platelets adhere well vitronectin contrast , arab patients' platelets normal increased numbers platelet alpha v beta 3 vitronectin receptors , receptors functioned well vitronectin adhesion assay , taking much adhesion mediated gp iib iiia normal platelets studies define heterogeneity molecular basis also widespread implications understanding synthesis function beta 3 family integrin receptors
mathematical model volume , ph , ion content regulation reticulocytes application pathophysiology sickle cell dehydration developed mathematical model reticulocyte , seeking explain cell similar volume much higher ionic traffic mature red cell \( rbc \) regulates volume , ph , ion content physiological abnormal conditions analysis required reticulocytes conserve volume composition predicted existence previously unsuspected na \( \) dependent cl entry mechanisms unlike mature rbcs , reticulocytes tend return original state brief perturbations model predicted hysteresis cell ph , volume , ion contents transient alterations membrane permeability medium composition irreversible cell dehydration could thus occur brief k , transient medium acidification , replacement external na cation hysteresis perturbations shown depend phi dependence k cl , major reticulocyte transporter behavior suggested novel mechanism generation irreversibly cells directly reticulocytes , rather stepwise , progressive manner experimental tests model 's predictions hypothesis described following paper
evidence direct reticulocyte origin dense red cells sickle cell anemia explore hypothesis direct reticulocyte origin irreversibly cells \( \) , fractionated light , reticulocyte rich , rich sickle anemia red cells gradients , examined effects induced sickling , external ca2 , acidification , replacing external na n methyl \( \) sickling permeabilized light reticulocyte rich cells \( na , k , ca2 \) without external ca2 , na influx matched k efflux , stable cell volume ca2 , many light , low hemoglobin \( hb \) f reticulocytes rapidly \( preventable quinine , ca2 \( \) dependent k channel inhibitor \) acidification oxygenated \( high mean hb f \) reticulocyte rich fractions yielded , reticulocyte enriched cells lower hb f \( light reticulocyte dense rich fractions \) light cells replaced na , supporting predictions na \( \) dependent volume control system demonstration sickling induced , ca2 \( \) dependent dehydration hb f free reticulocytes , conservation acid stimulated k cl among low hb f , reticulocyte enriched cells fractions support hypothesis ancillary new findings included heparin stimulation sickling induced na k , ca2 inhibition na leak
neutrophil nicotinamide adenine dinucleotide phosphate oxidase assembly translocation p47 phox p67 phox requires interaction p47 phox cytochrome b558 two cytosolic nadph oxidase components , p47 phox p67 phox , plasma membrane normal neutrophils stimulated phorbol myristate acetate \( pma \) studied translocation process neutrophils patients chronic granulomatous disease \( cgd \) , inherited syndrome oxidase system fails produce superoxide due lesions affecting one four known components phox phox subunits cytochrome b558 \( membrane bound terminal electron transporter oxidase \) , p47 phox , p67 phox contrast normal cells , neither p47 phox p67 phox membrane pma stimulated cgd neutrophils lack cytochrome b558 one patient rare x linked form cgd caused pro substitution phox , whose neutrophils normal levels mutant cytochrome b558 , translocation normal two patients p47 phox deficiency , p67 phox failed , whereas p47 phox detected particulate fraction pma stimulated neutrophils two patients deficient p67 phox data suggest cytochrome b558 closely linked factor provides essential membrane site cytosolic oxidase components p47 phox mediates assembly components membrane
preferential expression human fc gamma riiipmn \( cd16 \) paroxysmal nocturnal hemoglobinuria discordant expression phosphatidylinositol linked proteins isoform fc gamma riii \( cd16 \) expressed pmn gpi membrane anchor , paroxysmal nocturnal hemoglobinuria \( pnh \) deficiency fc gamma riii expression pmn contrary expectation , however , cd16 expression preserved \( albeit reduced levels \) affected pnh pmn completely lack gpi anchored proteins \( \) cd59 fc gamma riii negative pmn observed six pnh patients examined study analysis molecular weight glycosylated fc gamma riii pmn reduced fc gamma riii expression indicates variations size relative normal donor fc gamma riiipmn indeed , fc gamma riii expressed intermediate levels phosphatidylinositol specific phospholipase c \( pi plc \) sensitive thus , evidence suggestive expression transmembrane isoform data indicate fc gamma riiipmn affected cells pnh gpi linked isoform fc gamma riiipmn expression preserved reduced levels affected cells pnh , pmn pnh patients retain capacity fc gamma riiipmn specific probe e \( reduced levels \) well igg erythrocytes reduced expression gpi anchored molecules pnh pmn restricted fc gamma riiipmn since intermediate levels cd59 observed pnh pmn decay accelerating factor \( \) negative fc gamma riiipmn intermediate addition , discordant expression gpi linked molecules individual cells restricted pmn since cd14 monocytes observed one pnh patient data suggest , analyzed individual cell level , gpi anchor defect pnh absolute must involve either hierarchy access different protein molecules available gpi , distinct anchor different proteins , differential regulation protein anchor assembly
erythroid colony growth peripheral blood bone marrow polycythaemia erythroid colony growth presence absence erythropoietin compared 23 patients primary proliferative polycythaemia \( \) , nine idiopathic erythrocytosis , 10 secondary polycythaemia , 15 76 normal subjects erythroid colonies growing without erythropoietin stimulation \( endogenous erythroid colonies \) peripheral blood \( bfu e \) found 20 22 patients two seven idiopathic erythrocytosis none found secondary polycythaemia , , normal subjects small numbers endogenous colony forming units erythroid \( cfu e \) \( though bfu e \) cultured bone marrow three 24 normal subjects , suggesting peripheral blood cultures provide specific indicator clonal erythropoiesis peripheral blood endogenous erythroid colony growth effective convenient means distinguishing patients clonal erythrocytosis may particular value iron deficiency diagnosis conventional criteria
fetal hemoglobin , sickling , sickle cell disease increased numbers f cells large amounts hb f f cell appear produce clinical benefit rare variants sickle cell disease probably commonly encountered patients fetal hemoglobin interferes polymerization hb vitro , laboratory studies carried homogeneous hemoglobin solutions inadequate models events vivo , rbcs heterogeneous hb f content studies hemoglobin switching sheep , tissue culture , baboons led use 5 induction increased hb f synthesis ss patients drug trials successful theory led alternate theory , without , led use hydroxyurea chronic administration drug lead impressive increases hb f synthesis apparent clinical benefit clear clinical benefit real rather placebo effect entirely clear effect hydroxyurea related increased production f cells increased f f cell controlled clinical trials studies properties rbcs treated patients may answer questions also likely raise still questions probably show current understanding biology treatment sickle cell disease far complete
erythrocyte membrane protein deficiencies paroxysmal nocturnal hemoglobinuria paroxysmal nocturnal hemoglobinuria \( pnh \) acquired disorder characterized intermittent hemolytic anemia membrane abnormalities blood cells patients pnh reason unusual sensitivity lysis autologous plasma complement patient typical clinical disease consistent pnh described together strategies pitfalls treatment commonly used vitro assays discussed document complement mediated lysis aberrant pnh erythrocytes membrane associated proteins abnormal pnh cells , characteristics proteins , mechanism \( \) action described include decay accelerating factor inhibits c3 c5 complement pathways cell surfaces , binding protein modulates step terminal complement lysis , proteins regulate complement mediated lysis early late steps complement cascade
chloramphenicol toxicity 25 years research significant progress made recent years understanding pathogenesis two types hematologic toxicity chloramphenicol common , dose dependent , reversible bone marrow suppression chloramphenicol consequence mitochondrial injury greater erythroid susceptibility chloramphenicol appears function endogenous mitochondrial amino acid pools pathogenesis aplastic anemia chloramphenicol treatment remains uncertain large body indirect evidence complex mechanism involving metabolic transformation p group chloramphenicol predisposed subject , leading production toxic intermediate causing stem cell damage concept presented metabolites chloramphenicol generated intestinal bacteria undergo metabolic transformation bone marrow situ production toxic intermediate concept marrow metabolic site agent well target toxic metabolites likely apply potential
danazol danazol synthetic attenuated androgen interfere normal interactions pituitary hypothalamic axis gonads effects mediated complex mechanisms , including danazol natural steroids binding androgen receptors sex hormone binding globulin , possibly natural steroids protein , binding reactive sites enzymes required synthesis natural steroids , thereby synthesis danazol 's impairment pituitary hypothalamic interactions gonads , effective therapeutic agent treatment endometriosis cystic disease breast effective treatment hereditary edema , mechanism therapeutic success unclear danazol used , without universal success , treatment gynecologic certain hematologic disorders
nitrogen metabolism sickle cell anemia free amino acids plasma urine twenty four hour urinary levels fasting plasma concentrations free amino acids \( aa \) evaluated adult sickle cell anemia \( hbss \) age matched subjects comparable daily energy \( e \) protein \( n \) intake hbss elicited significant reduction sum plasma \( eaa \) change \( naa \) amino acids , resulting prominent \( p less 0 01 \) reduction eaa naa ratio 71 55 arg \( 38 \) , leu \( 32 \) , val \( 28 \) \( 32 \) among aa severely affected despite twofold increase 24 hour urine volume hbss compared subjects , total urinary losses eaa naa markedly reduced former group , arg \( 53 \) gly \( 56 \) levels prominently affected compared controls , hbss subjects showed three fourfold increase 24 hour urinary excretion relationship amount n intake results indicated adult subjects hbss , consumed adequate n e per healthy individuals , like normal controls low protein diet evidence hbss subject might state respect several amino acids , particularly l arg , classified human
ingestion long acting vitamin k antagonist , clinical metabolic studies three cases vitamin k metabolism three patients factitious purpura due ingestion studied patients , presented bleeding disorders due deficiency vitamin k dependent blood clotting proteins , refractory vitamin k1 standard doses required fresh frozen plasma control bleeding large doses vitamin k1 used metabolic studies demonstrated blockade vitamin k utilization , consistent presence vitamin k antagonist , patients denied use anticoagulants warfarin assays negative show factitious purpura patient due ingestion , potent second generation long acting vitamin k antagonist used responded long term therapy large doses vitamin k1 serum elimination half time ranged 16 36 days patients anticoagulant effect long duration , requiring chronic vitamin k treatment increasing availability new , factitious purpura due ingestion potent vitamin k antagonists emerging new problem , previously associated warfarin , important implications diagnosis treatment
immunochemical electrophoretic analyses phosphorylated native recombinant neutrophil oxidase component p47 phox human polymorphonuclear neutrophils \( pmns \) possess potent oxygen dependent system depends activity stimulus activated nicotinamide adenine dinucleotide phosphate \( nadph \) oxidase patients chronic granulomatous disease \( cgd \) lack activity oxidase consequently suffer severe frequent infections components oxidase include membrane bound factors \( notably , cytochrome , absent x linked form cgd \) least two cytosolic factors , one absent autosomal cgd patients cgd , particularly autosomal type , defective phosphorylation proteins 44 48 kd range polyclonal antiserum \( b 1 \) recognizes cytosolic oxidase components 47 67 kd used identify cell free oxidase system two dimensional gel electrophoresis showed identity 47 kd cytosolic protein \( p47 phox \) recognized b 1 cationic 47 kd protein phosphorylated normal p47 phox deficient cgd cytosol activation nadph dependent oxidase full length c terminal recombinant p47 phox proteins augmented superoxide generating capacity cell free system phosphorylated added cytosol normal subjects patient p47 deficient autosomal cgd studies provide compelling evidence 47 kd cationic protein substrate phosphorylation activation pmns , fact , p47 phox , cytosolic protein previously shown critical normal activity nadph dependent oxidase pmns
molecular basis alpha thalassemia associated structural mutant hemoglobin suan dok \( alpha 2 arg \) published erratum appears blood 1991 mar 15 77 \( 6 \) hemoglobin \( hb \) suan dok \( alpha \) rare alpha globin structural mutation linked alpha thalassemia \( alpha \) determinant inherited trans alpha 1 mutation \( \) , results hb h disease associated low levels \( 9 \) suan dok hb nature thalassemic defect associated alpha sd mutation investigated structural functional studies sequence analysis cloned suan dok allele showed mutation \( g \) codon 109 otherwise normal alpha 2 globin gene alpha globin gene introduced mouse erythroleukemia cells , steady state alpha globin messenger rna \( mrna \) level equivalent alpha globin gene control although vitro translation synthetic alpha globin mrna generated levels alpha globin equivalent alpha 2a globin mrna early time points , ratio alpha sd alpha globin decreased markedly later time points data suggest thalassemic defect associated suan dok mutation results significant instability alpha sd globin
molecular defect coagulation factor results substitution serine proline position 343 previous findings suggested coagulation factor could functionally defective owing point mutation portion factor x gene coding fully activated heavy chain verify existence postulated change , analyzed eight exons normal factor x gene exon amplified genomic dna using polymerase chain reaction cloned plasmid amplified dna subjected direct sequencing chain termination method forward reverse oligonucleotide sequencing primers point mutation \( c transition nucleotide position 19 , \) results coding serine \( \) place proline \( \) amino acid position 343 found substitution involves highly conserved proline residue oriented spatially close cleavage site active site enzyme explains previous observations discrete biochemical functional differences factor normal factor x mutation abolished restriction site present normal factor x gene , change constitutes basis convenient method screening individuals carrying molecular defect conserved region 5 serine protease factor x belongs part 14 residue l p c motif occurs least 16 enzymes computer analysis suggests motif may essential aspect conformational features important functional properties factor x well serine proteases
hemoglobin \( beta 60 e4 val glu \) novel unstable thalassemic hemoglobinopathy report describes patient thalassemia like phenotype born normal parents globin gene sequencing detected novel abnormal hemoglobin \( hb \) due substitution codon 60 beta globin gene arising de novo mutation normal sequences detected homologous beta globin locus mutation results substitution polar \( glutamic acid \) \( valine \) residue near corner pocket beta globin chain novel variant designated hb , place birth kinetics globin synthesis performed following splenectomy suggest new hb variant synthesized near normal rate undergoes rapid breakdown extreme variant explains clinical hematologic picture characterized marked ineffective erythropoiesis , thalassemia like bone changes , iron overload , high proportion hb f peripheral blood , reduced beta alpha globin chain synthesis ratio peripheral blood reticulocytes , absence abnormal hb peripheral blood extensive protein structural analysis splenectomy case indicates thalassemic hemoglobinopathy suspected presence patient thalassemia like phenotype born normal parents , even protein structural analysis fails detect abnormal hb dna sequencing may allow define mutation , thus making proper diagnosis
trimethoprim associated blood ten years' experience swedish spontaneous reporting system 10 year period 1976 1985 , total 154 cases blood reported sweden evaluated probable possible causal relationship trimethoprim \( sm \) 61 cases \( 16 agranulocytosis \) , 28 cases thrombocytopenia , two non also 32 cases 31 cases median age varied 38 years group 81 years overall fatality rate 17 , ranging 2 group mild 52 group relation prescription data , overall incidence reported sm blood 5 3 per million defined daily doses , among patients incidence one case per 18 , 000 thus overall incidence blood reaction sm appears low relation prescription data , elderly people among serious reactions
pathological follow study 10 cases essential type ii neuropathy ten patients essential type ii examined peripheral nerve damage six cases distal symmetrical nerve involvement present , three cases abnormalities restricted single nerves found electrophysiological morphological data consistent axonal damage , larger myelinated fibres affected although active signs vasculitis immunoperoxidase staining immunoglobulins present , vessels widely damaged , abnormally thick endothelial cells basal membranes findings , together patchy distribution myelinated fibre loss , suggest ischaemia cause peripheral neuropathy essential type ii follow examination , performed one year remission , revealed peripheral nerve damage occurred
recognition distinctive patterns gallium 67 distribution sarcoidosis assessment gallium 67 \( 67ga \) uptake salivary lacrimal glands intrathoracic lymph nodes made consecutive patients including 65 sarcoidosis distinctive intrathoracic lymph node 67ga uptake pattern , resembling greek lambda , observed sarcoidosis \( 72 \) symmetrical lacrimal gland parotid gland 67ga uptake \( panda appearance \) noted 79 sarcoidosis patients simultaneous lambda panda pattern \( 62 \) panda appearance radiographic bilateral , symmetrical , lymphadenopathy \( 6 \) present sarcoidosis patients presence either patterns particularly prevalent stages \( 80 \) ii \( 74 \) conclude simultaneous \( \) lambda panda images , \( b \) panda image bilateral symmetrical lymphadenopathy chest x ray represent distinctive patterns highly specific sarcoidosis , may obviate need invasive diagnostic procedures
development new radioimmunoassay erythropoietin using recombinant erythropoietin development 24 hour radioimmunoassay erythropoietin \( epo \) using epo derived recombinant dna ligand described present paper mixed rabbits immunized 10 micrograms kg epo derived stably transfected cell line \( inc , , washington , usa , corp , st , missouri , usa md \) produced antibodies epo high titer \( 1 , 000 final dilution tube \) , high affinity \( 8 4 x 10 \( 11 \) liter \) , good specificity purified epo source \( thousand , california , usa ag \) successfully method used ligand radioimmunoassay standard dose response curves prepared epo commercial sources significantly different showed sensitivity 0 75 0 96 mu tube dose response curves systems also showed serially diluted serum patient aplastic anemia within assay assay precision determined multiple serum pool recovery exogenous epo added serum pool averaged 97 systems range normal human serum epo determined sera 153 normal adult subjects found 1 1 27 3 mu ml md epo 0 5 16 7 mu ml ag epo sera several patients hematologic abnormalities also assayed , including 36 patients anemia end stage renal disease \( mean sem , 29 5 4 0 mu ml p less 0 01 \) conclusion , new , rapid sensitive radioimmunoassay system used measure epo levels sera normal human subjects patients several types anemia , also useful therapeutic drug monitoring patients receiving epo various commercial sources
evolution genetic disease ethnic isolate beta thalassemia jews kurdistan beta thalassemia hereditary disease caused 90 different point mutations beta globin gene specific populations generally carry small number mutations , common widely distributed present study constitutes extensive molecular characterization disease small , highly inbred ethnic group high incidence beta thalassemia jews kurdistan unusual mutational diversity observed 42 13 different mutations identified , 3 newly discovered c transversion 88 cap site , frameshift codon 36 37 , g transition signal four mutations unique jews discovered population fifth found outside jews , region kurdistan two thirds mutant chromosomes carry mutations unique jews traced origin mutations specific geographic regions within kurdistan information , supported haplotype analysis , suggests thalassemia central kurdistan \( northern \) evolved primarily multiple mutational events kurdistan , primary mechanism genetic admixture local population kurdistan , effect appears partly responsible conclude several evolutionary mechanisms contributed evolution beta thalassemia small ethnic isolate
antibiotic associated hypoprothrombinemia review prospective studies , 1966 1988 many antimicrobial agents associated hypoprothrombinemia precise mechanisms unknown , alteration vitamin k status utilization involved two postulated mechanisms implicate either direct inhibition biosynthesis vitamin k dependent clotting factors n \( \) moiety found certain antimicrobial agents eradication vitamin k producing intestinal patients reduced oral intake vitamin k english language review prospective studies reported 1966 1988 serial prothrombin times monitored adult patients revealed incidence hypoprothrombinemia varied 3 7 64 containing regimens 0 24 non containing regimens detailed evaluation studies suggests certain risk factors , including malnutrition , hepatic renal dysfunction , older age , severity illness , may major determinants hypoprothrombinemia hypothesis side chain primarily responsible hypoprothrombinemia may justified conclude patients high risk coagulopathy carefully monitored serious consideration given use prophylactic vitamin k cases
venous doppler ultrasonography fetus nonimmune hydrops eighteen pregnancies nonimmune hydrops referred fetal echocardiography rule congenital heart disease 14 cases , blood velocities recorded umbilical vein , normal population blood velocity pattern four cases without pulsations umbilical vein found intrauterine viral infections last 10 cases examined , umbilical venous pulsations found reflect abnormal central venous pulsations atrial systole suggesting increased fetal central venous pressure right ventricular shortening fraction significantly decreased group umbilical venous pulsations compared without \( 0 18 versus 0 32 , p less 0 05 \) fetuses without venous pulsations survived , four 14 pulsations survived \( p less 0 05 \) results suggest blood velocity recordings umbilical central veins fetus give valuable clinical information regard presence fetal congestive heart failure differentiate physiologic state causes nonimmune hydrops may implications fetal diagnostic work prognosis
combined use fine needle aspiration cytologic examination tuberculin skin test diagnosis cervical tuberculous lymphadenitis prospective study prospective study evaluate efficacy combined use fine needle aspiration \( fna \) cytologic examination test diagnosis cervical tuberculous lymphadenitis carried tuberculin reactions determined 59 control subjects preoperative fna cytologic examinations tests performed 74 patients cervical lymphadenopathy lymph nodes excised examined histologically cultured forty eight , 22 , 4 patients histologically confirmed tuberculous , non specific , malignant lymphadenopathy fine needle aspiration cytologic examination alone could detect cervical tuberculous lymphadenitis 37 patients \( 77 \) predictive value strong tuberculin reaction mycobacterial infection 100 combined use test fna cytologic examination able diagnose 43 \( 90 \) 48 cases tuberculous lymphadenitis cervical preoperatively combined use fna cytologic examination test efficient diagnosis tuberculous lymphadenitis
morphology sickle cells produced solutions varying effect varying \( 0 6 1 5 nacl solutions , 213 492 mosm kg h2o \) morphology sickle cells studied quantitatively computer assisted image analysis system rich , less dense fractions sickle cells \( density less equal 1 11 \) suspended buffered nacl solutions \( ph 7 4 \) various , room temperature 5 hours , stained 's solution microscopic images analyzed circular shape factor \( csf 4 pi x area perimeter 2 \) shape factor \( short axis long axis \) since two parameters yield different values elongated cells cells , shaped cells , morphologic changes sickle cells analyzed found rate degree deformation depended highly osmotic pressure media cells suspended hypertonic solution , sickle cells assumed shape deformation occurred quickly , degree deformation \( circular shape factor shape factor \) lower found isotonic slightly hypotonic solutions although elongated cells formed hypotonic isotonic solutions , deformation slower solutions hypertonic solutions results indicate shape degree deformation sickle cells highly dependent medium rate deformation inversely related relationship morphology sickle cells osmotic pressure media discussed
fibrinolysis , thrombocytopenia , coagulation abnormalities complicating high dose interleukin 2 immunotherapy high dose interleukin 2 \( il 2 \) immunotherapy cause hypotension , respiratory distress , interstitial edema , thrombocytopenia , similar endotoxic shock observed il 2 direct effect coagulation factors vitro , observed alter properties vascular endothelium accordingly , investigated possibility il 2 infusions initiate plasma fibrinolysis disseminated intravascular coagulation \( \) studied clinical course , platelet count , coagulation profile response il 2 infusion seven patients , two metastatic melanoma five metastatic renal cell carcinoma every patient experienced hemodynamic instability thrombocytopenia , one patient suffered unusual complication , mesenteric thrombosis patient appreciable changes prothrombin time partial thromboplastin time , factors v viii decline two patients observed four patients examined , found decreased titers factor \( factor \) , high molecular weight , , plasma thromboplastin antecedent , consumed reactions intrinsic pathway thrombin formation circulating dimer fragments found plasma every patient point infusion cycle , observed decreased titers plasminogen four patients mentioned , suggesting il 2 infusions initiated fibrinolysis taken together , clotting factor derangements related toxicity phenomena cannot ascribed firmly activation intrinsic \( contact \) system coagulation , however , may provide one link vascular endothelial surface alterations caused il 2 infusions development systemic toxicity resembles septic shock
middle cerebral artery blood velocity cerebral blood flow sickle cell disease understand better relationship blood velocity measured transcranial doppler cerebral blood flow measured inhalation method , examined 23 patients undergoing evaluation comprehensive sickle cell center columbia university blood velocity middle cerebral artery directly related cerebral flow \( r 0 77 p less 0 05 \) multivariate analysis sample made possible improve correlation account 90 variability cerebral blood flow use transcranial doppler measures velocity pulsatility along patient 's age hematocrit \( r 0 95 p less 0 001 \) likely combination doppler clinical demographic variables diseases similarly improve quantitative estimation cerebral blood flow
platelet aggregation platelet rich plasma whole blood 120 patients myeloproliferative disorders vitro platelet aggregation platelet rich plasma \( prp \) whole blood \( wb \) assessed 31 patients idiopathic , 32 essential thrombocytosis , 23 polycythemia vera , 34 chronic myelogenous leukemia prp subjects showed normal reduced platelet aggregation , whereas wb majority patients showed increased platelet function spontaneous platelet aggregation \( spa \) observed frequently wb , whereas seldom observed prp spa wb inhibited vitro addition aspirin , spa partially dependent high platelet count also occurred samples normal platelet content \( variance 13 subjects reactive thrombocytosis , spa observed samples high platelet concentration \) platelets patients idiopathic highest tendency undergo spa
polycythemia vera states diagnosis polycythemia requires accurate independent assessment plasma volume red blood cell mass patients increased red cell mass \( absolute polycythemia \) may hypoxic erythropoietin secreting tumor space lesion kidney reduced plasma volume \( relative polycythemia \) often tobacco smokers , taking diuretic cardiac medications , increased quantities caffeine containing beverages hand , polycythemia vera systemic disease multiple complications , best diagnosed complex findings outlined polycythemia vera study group
platelet abnormalities myeloproliferative disorders large number various platelet abnormalities described patients abnormalities serve diagnostic purposes appear little predictive value regarding clinical manifestations patients progress disease platelet characteristics consistently reported defective include decrease platelet content serotonin adenine nucleotides , decreased platelet density , abnormal ultrastructure characterized paucity granules hypertrophy surface connecting system , altered membrane glycoprotein profile includes reduced levels gpib , reduced lipoxygenase activity aggregation response epinephrine abnormalities may originate megakaryocyte level furthermore , released abnormal platelets may undergo modification functional biochemical characteristics result episodes intravascular thrombosis aging circulation result progression treatment disease , thus creating paradoxic often conflicting relationship thrombotic hemorrhagic events results platelet functional tests observed disorder
sarcoidosis cauda equina report three cases three cases sarcoidosis cauda equina presented two previous history suggestive sarcoidosis presentation one painful paralysis diagnosis made myelography laminectomy subsequent histology third patient previous diagnosis lupus magnetic resonance imaging \( mri \) used aid diagnosis two previous cases reported sarcoidosis presenting cauda equina systemic manifestations first report use mri sarcoidosis lower
hemoglobin columbia missouri alpha 2 88 \( f9 \) ala val beta 2 new high oxygen affinity hemoglobin causes erythrocytosis previously undescribed hemoglobin variant , hemoglobin columbia missouri , alpha 88 \( f9 \) ala val , detected 22 year old white man undergoing assessment erythrocytosis new hemoglobin variant separate hemoglobin electrophoresis conventional media , isoelectric focusing , electrophoresis purified globin chains 8 urea exhibits high oxygen affinity , \( oxygen tension 50 saturation \) 19 3 torr patient 's whole blood substitution hemoglobin columbia missouri internal residue near end f helix alpha chain hemoglobin residue substitution cysteinyl residue f9 \( beta 93 \) beta chain comparison hemoglobin , substitution hemoglobin columbia missouri pronounced effect oxygen affinity consequently , hemoglobin columbia missouri associated erythrocytosis , whereas hemoglobin
transfusion requirements effects patients thalassaemia major programme analysis data available 1985 italian greek patients registered , international cooperative programme quality assessment treatment delivery thalassaemia , gave following picture treatment requirements effects proportion patients undergoing splenectomy progressively decreased , age splenectomy increased time past 20 years age first transfusion exceeds 4 years small important group patients , indicates milder form thalassaemia exists group children receiving modern treatment remain near normal stature age 11 later tend mean blood requirement 35 higher non patients differences transfusion interval 2 4 weeks measurable effect blood requirement mean blood requirement rises gradually mean haemoglobin concentration , possibly non linear fashion prevalence red cell rises delay start transfusion transfusion reactions reported 1 transfusions \( 90 leucocyte depleted \) , 17 patients
three point approach anemia anemia sign underlying disease causing blood loss , sequestration red blood cells \( rbcs \) , impaired rbc production , primary marrow dysfunction efficient clinical approach patient anemia ask following three questions anemia microcytic , , \? pancytopenia present \? marrow response appropriate anemia determined reticulocyte count \? answers questions focus laboratory evaluation logical progression avoid shotgun approach
contemporary use disease concept iii failure change behavior regarding problem anemia frequency house staff noticed patients anemic , frequency tried find patients anemic , diagnostic accuracy measured next , intervention conducted teams subject anemia , given reading materials subject , given social problem follow improvement found outcome variables
ventilation gas exchange exercise sickle cell anemia adults sickle cell anemia \( sca \) restrictive lung impairment , increased alveolar dead space , hypoxemia factors , together increased anaerobic metabolism , thought cause exercise hyperventilation assess role children , 34 patients sca 16 control subjects performed pulmonary function exercise tests twenty eight patients sca spirometric values lung volumes , two patients sca arterial saturation greater 91 exercise despite low vo2max \( 30 07 6 55 ml min kg \) , ventilatory anaerobic threshold \( \) patients occurred similar vo2max control subjects \( 69 9 versus 63 12 \) slope delta delta relationship sub work steeper patients \( 29 4 6 5 versus 24 7 5 2 , p 0 01 \) , ventilatory equivalent co2 \( \) steady state exercise greater patients control subjects \( 33 2 3 5 versus 30 8 3 5 , p 0 03 \) end tidal pco2 differ \( 38 3 3 0 versus 39 2 3 1 \) , indicating equivalent alveolar ventilation patients higher dead space tidal volume ratio \( vd vt \) control subjects \( 0 204 0 versus 0 173 0 024 , p 0 0005 \) paco2 significantly lower lower hb , difference ph conclusion , children sca increased exercise ventilatory response caused part increased physiologic dead space , part low hb greater dead space may result sickle cells capillary perfusion ventilated
cardiac output oxygen delivery exercise sickle cell anemia desaturation patients sickle cell anemia \( sca \) lead intravascular sickling vascular occlusion increased metabolic demands exercise tend increase oxygen extraction , giving rise fall saturation capillary bed may predispose sickling could minimized increase cardiac output aims study assess role increased stroke volume \( sv \) cardiac output \( q \) estimate role enlarged arteriovenous o2 content difference maintaining o2 transport children sca group 30 children sca \( hb 65 133 g l \) 16 healthy controls racial group similar height weight performed incremental steady state exercise 50 cardiac output \( q \) measured indirect \( co2 \) fick method steady state slope delta hr delta vo2 incremental exercise higher sca subjects compared controls \( 4 01 1 73 versus 2 80 0 61 bpm per ml min kg vo2 , p 0 001 \) q vo2 abnormally high patients , particularly older ones lower hb levels hr \( predicted \) higher patients controls \( 106 11 versus 92 8 predicted , p less 0 0001 \) , sv \( 113 16 versus 98 14 predicted , p 0 002 \) multiple linear regression q predicted sv predicted hb age showed positive correlation age negative correlation hb \( r 0 84 q r 0 76 sv \)
prenatal detection foramen ovale obstruction without hydrops case prenatal echocardiographic diagnosis obstruction foramen ovale described presentation ultrasound detection unexplained marked right atrial right ventricular dilation without fetal hydrops speculated fetal outcome depends severity time onset foramen ovale obstruction utero
abnormal megakaryocytopoiesis laboratory rat laboratory \( b b \) rat hereditary microcytic anemia defective transmembrane iron transport erythroblasts present study prompted previous work showed b b rat thrombocytopenia associated increased megakaryocyte size define basic mechanism underlying abnormality b b rat studied megakaryocytopoiesis granulopoiesis anemic b b rats , chronically transfused b b rats , iron treated b b rats , controls found decreased concentrations megakaryocyte granulocyte progenitors marrow b b rats full correction severe anemia chronic transfusion resulted normalization megakaryocyte progenitors , small acetylcholinesterase positive cells , megakaryocyte size , platelet counts , along granulocyte progenitors contrast , partial correction anemia obtained iron treatment resulted improvement , normalization , parameters findings indicate abnormal megakaryocytopoiesis b b rat best interpreted consequence hypoxia severe anemia recently shown number erythroid progenitors b b rats also low , propose abnormal megakaryocytopoiesis animal reflection acquired stem cell disorder induced prolonged hypoxia resulting severe anemia
polycythemia vera blood burst forming units erythroid hypersensitive interleukin 3 polycythemia vera \( pv \) clonal hematopoietic stem cell disease hyperplasia , interleukin 3 \( il 3 \) stimulates hematopoiesis , studied response highly purified pv blood burst forming units erythroid \( bfu e \) recombinant human il 3 \( ril 3 \) whereas growth normal blood bfu e vitro rapidly declined 40 60 24 48 h incubation without 50 u ml ril 3 , growth pv bfu e declined 10 30 conditions , demonstrating reduced dependence ril 3 reduced dependence pv bfu e recombinant human erythropoietin \( rep \) also present dose response experiments showed 117 fold increase pv bfu e sensitivity ril 3 , 6 5 fold increase sensitivity rep , compared normal bfu e , whereas blood bfu e patients secondary polycythemia responded like normal bfu e endogenous erythroid colony \( \) formation , independent addition rep , reduced 50 erythroid colony forming cells generated pv bfu e vitro without ril 3 3 , whereas rep stimulated erythroid colonies unaffected studies demonstrate striking hypersensitivity pv blood bfu e ril 3 , may major factor pathogenesis increased erythropoiesis without increased ep concentrations
hyperplasia eosinophilia hyperplasia eosinophilia rare condition poorly recognized literature condition characterized appearance cutaneous nodules within head neck region especially around external ear variable lymphadenopathy peripheral eosinophilia occur condition mimic neoplasia important aware disease entity order avoid surgical removal treatment choice however , often poorly delineated lesion often precludes initial wide excision local recurrence common present three cases unusual condition brief resume literature
long term follow heterotopic splenic autotransplantation traumatic splenic rupture trapping function heterotopic splenic \( hsa \) 13 patients , aged 5 38 yr , evaluated using heat damaged technetium 99m labeled autologous red blood cells early \( 1 7 mo \) late \( 3 4 5 yr \) period heterotopic autotransplantation omentum intensity tracer accumulation graded comparison liver uptake splenic tissue surface calculated anterior projection time transplants compared new uptake foci suggesting spontaneous looked scans average surface hsa 28 2 \( 14 7 \) cm2 early 44 1 \( 14 3 \) cm2 late examination \( p less 0 003 \) increase intensity tracer accumulation occasions significant well \( p less 0 0001 \) three patients , additional foci found follow scans bodies peripheral blood detected six eight patients early remained detectable lower number three eight patients follow serious infection noticed group patients work confirmed excellent survival rates hsa improving trapping function important spread original implantation site long term follow
cold induced granulocyte agglutination cause transient cold agglutination granulocytes developed 60 year old woman left upper lobe pneumonia acute phase illness phenomenon manifested , multiple granulocytes peripheral blood smear , abnormal distribution granulocytes monocytes white blood cell histogram measured automated hematology analyzer \( plus iv , inc , , \) cause postulated igm autoantibody directed components granulocyte membranes spurious leukopenia encountered infrequently automated hematology cold induced granulocyte agglutination recognized potential cause white blood cell counts accurately reported unnecessary evaluation patients leukopenia avoided
cyclosporine therapy advanced langerhans cell histiocytosis prompted evidence langerhans cell histiocytosis \( \) nonmalignant disorder immune regulation , used cyclosporine \( 12 mg kg orally \) treat three young children advanced multisystem three patients partial responses cyclosporine within 2 months therapy , evidenced complete resolution organ dysfunction regression majority lesions complete responses attained adding relatively nontoxic chemotherapy \( ie , prednisone vinblastine \) toxicity cyclosporine comprised mild reversible elevations serum creatinine blood urea nitrogen results indicate evaluation cyclosporine treatment patients advanced warranted
transmembrane mobility phospholipids sickle erythrocytes effect diffusion asymmetry studied effect sickling transmembrane distribution phospholipids red blood cells patients homozygous sickle cell anemia \( ss \) purpose , followed redistribution kinetics trace amounts spin labeled analogues natural phospholipids first introduced membrane outer leaflet normal sickle erythrocytes exposed air nitrogen effect lipid redistribution kinetics normal \( aa \) cell membranes atmospheric po2 , unfractionated ss cells different normal cells however , inducing sickling , phosphatidylcholine passive diffusion accelerated rate adenosine triphosphate dependent transport reduced , especially stationary distribution two leaflets slightly less asymmetric , phenomenon pronounced changes rapidly reversible reoxygenation ss cells separated density , dense light cells exhibited properties cited however , dense cells exposed air possessed lower transport rate data favor relationship activity phospholipid transmembrane asymmetry sickle cell disease first case pathology
iron deficiency anemia elderly diagnostic process objective determine effectiveness physician probability estimates calculated basis findings history taking physical examination diagnosis iron deficiency anemia elderly patients design prospective study setting two community hospitals offering secondary tertiary care patients total 259 patients 65 years age found previously undiagnosed anemia measures physician estimates likelihood iron deficiency \( pretest probability \) \( post test probability \) laboratory test results available available physicians made pretest probability estimates serum ferritin level proved powerful laboratory test results studied , likelihood ratios associated post test estimates compared ratios associated serum ferritin level main results post test probability estimates influenced serum ferritin level pretest estimates post test estimates derived findings obtained history taking physical examination laboratory test results \( including serum ferritin level \) slightly less accurate predicting iron deficiency serum ferritin level alone nevertheless , model pretest estimates used addition serum ferritin level predict iron deficiency proved powerful serum ferritin level alone \( p 0 006 \) indicated limitations post test estimates due misinterpretation serum ferritin level findings history taking physical examination added important diagnostic information conclusions physicians must aware test properties provide optimal care patients test results properly interpreted , pretest probabilities derived findings obtained history taking physical examination add useful information lead accurate diagnoses
clinical spectrum thrombocytosis platelet production result highly ordered maturation developmental hierarchy megakaryocytic progenitor cells regulated variety cytokines gm csf , ii 3 ii 6 stimulatory effect several cytokines \( tgf beta , platelet released glycoprotein , platelet factor 4 interferons \) inhibitory effects regulating platelet production perhaps part autocrine control loop excess platelet production clinically characterized , thrombocytosis clinical features criteria defined term thrombocytosis reactive nature , absence arterial disease prolonged , poses little risk regardless platelet numbers contrast , , whether primary associated myeloproliferative lesions , significant events occur natural history , rationale , approach platelet reduction control clinical reviewed clinical therapeutic options include new agent ,
ingestion nitrite report case 2 year old girl ingestion containing nitrite availability products , poor labelling , intended presence domestic serve increase hazard pose young children
treatment aplastic anemia children recombinant human granulocyte colony stimulating factor twenty children \( aged 1 17 years \) severe moderate aplastic anemia treated recombinant human granulocyte colony stimulating factor \( rhg csf \) dose 400 micrograms m2 per day administered 30 minute intravenous \( iv \) infusion daily 2 weeks treatment increased neutrophil counts \( 2 7 28 0 fold \) 12 20 patients increasing doses \( 800 1 , 200 micrograms m2 per day \) administered five patients responded initial dose , three showed increase neutrophil count differential counts bone marrow \( bm \) aspirates showed increase myeloid erythroid ratio response transient , however , neutrophil count returned baseline within 2 10 days discontinuing treatment severe toxicity attributable rhg csf observed results suggest agent effective stimulating granulopoiesis children aplastic anemia study also indicates rhg csf particularly useful managing patients aplastic anemia complicated bacterial fungal infection
prophylactic effect self administered pump driven subcutaneous igg infusion patients antibody deficiency triple blind cross study comparing p igg levels 3 g l 1 versus 6 g l 1 eight adult patients randomly allocated initiation low high level igg substitution igg administered subcutaneously , 50 150 mg ml 1 , 20 ml per infusion , means pocket portable electric infusion pump infusions given 2 4 times weekly 24 months , change dose regimen 12 months desired plasma igg levels reached mean lag phase 3 months \( range 1 5 months \) median \( ranges \) individual mean plasma igg levels ensuing 9 month periods follows high level period , 6 5 g l 1 \( range 6 2 7 8 g l 1 \) low level period , 3 2 g l 1 \( range 3 0 4 0 g l 1 \) high level period , compared low level period , significant decrease following parameters bed , missed serious side effects observed concluded plasma igg concentration 6 g l 1 readily achieved subcutaneous igg substitution , prophylactic effect superior obtained plasma igg concentration 3 g l 1
fatal case ceftriaxone \( \) induced hemolytic anemia associated intravascular immune hemolysis fatal hemolytic anemia developed 52 year old woman treated cephalosporin , ceftriaxone patient 's red cells \( rbcs \) coated c3 , rbc bound igg , iga , igm detected serum contained antibody react cephalosporin coated rbcs reacted strongly rbcs vitro serum added drug rbcs first case immune hemolytic anemia associated ceftriaxone , first case fatal cephalosporin induced hemolytic anemia , second case cephalosporin antibody showed vitro vivo characteristics usually thought associated called immune complex mechanism
ceftazidime induced hemolysis patient drug dependent antibodies reactive immune complex drug adsorption mechanisms 35 year old woman developed acute intravascular hemolysis within five days beginning course ceftazidime direct antiglobulin test became strongly positive anti igg serum contained antibody , presence ceftazidime , sensitized unmodified reagent cells igg complement \( immune complex type \) serum also ceftazidime pretreated cells room temperature 37 degrees c \( drug adsorption type \) retrospective testing disclosed drug adsorption antibody , present current course antibiotics , demonstrable hemolysis reactivity immune complex antibody , developed second day ceftazidime , paralleled degree hemolysis strength direct antiglobulin test authors believe patient two separate ceftazidime dependent antibodies antibody reactive immune complex mechanism mediated episode acute intravascular hemolysis
comparison performance 20 pulse oximeters conditions poor perfusion performance 20 pulse oximeters finger probes evaluated comparison readings directly measured arterial blood oxygen samples taken patients undergone cardiac surgery hypothermic cardiopulmonary bypass poor peripheral perfusion mean difference \( bias , accuracy \) , standard deviation \( precision \) drop rate pulse oximeter determined overall ranking performance pulse oximeter calculated using five criteria \( accuracy , precision , number readings within 3 standard , percentage readings given within 3 standard , expected limit 95 cases \) two pulse oximeters achieved combination accuracy precision 95 measurements would expected within 4 co oximeter value two also lowest drop rate
acquired methemoglobinemia relationship cause course illness published erratum appears j child 1991 feb 145 \( 2 \) 158 better characterize methemoglobinemia children , reviewed charts 17 patients admitted children 's hospital last 10 years two distinct groups identified \( 1 \) endogenous group \( n 9 \) included patients methemoglobinemia associated intercurrent illness \( 2 \) exogenous group \( n 8 \) included patients methemoglobinemia secondary drug exposure despite similar initial levels endogenous \( mean , 29 \) exogenous \( mean , 28 \) groups , children endogenous group acidosis \( serum bicarbonate levels 5 9 vs 19 1 mmol l arterial ph 7 01 vs 7 35 \) children exogenous group methemoglobinemia secondary accidental ingestion stayed 1 day hospital , children endogenous group admitted average 19 days children methemoglobinemia secondary drug exposure benign illness shorter duration children methemoglobinemia associated intercurrent illness appears absolute level important underlying cause determining course severity illness
prenatal screening prospective regional trial prenatal hemoglobinopathy screening chosen model system study patient genetic information providers prenatal care rochester , ny , offered free testing prenatal patients genetic counseling women found positive 18 , prenatal samples tested 5 year period represented 35 1 pregnancies rochester metropolitan region hemoglobinopathy found 810 pregnancies \( 4 3 \) 21 different types detected , common sickle cell trait \( 59 \) , hemoglobin c trait \( 19 \) , beta thalassemia trait \( 11 \) , hemoglobin e trait \( 5 \) time phlebotomy , 75 pregnancies less 18 wk duration sixty six percent pregnancies occurred patients unaware diagnosis , 80 occurred patients unaware might risk child serious blood disorder 810 positive pregnancies , \( 68 \) occurred patients came counseling women counseled first screened pregnancy , 390 \( 86 \) said wanted partners tested 254 \( 55 \) partner tested 77 pregnancies thus found risk , late prenatal diagnosis 12 cases , condition fetus risk mild 12 cases prenatal diagnosis offered remaining 53 pregnancies accepted 25 couples \( 47 \) results indicate unselected patients primary care setting region , even though pregnant , receptive utilize genetic information
prenatal screening ii evaluation counseling learning genetic counseling often expectations , especially context genetic screening report describe learning result genetic counseling 298 pregnant women identified hemoglobinopathy carriers , 234 sickle cell trait 64 beta thalassemia trait counseling designed provide information needed simple , clear , manner special videotape produced purpose provided role model illustrating appropriate response videotape opportunity question corrected questionnaires revealed significantly increased knowledge result counseling three hemoglobinopathy subject areas tested namely , clinical manifestations , genetics , prenatal diagnosis five factors correlated higher knowledge scores counseling namely , younger patient age , years education , knowledge trait identification , knowledge baby 's father trait counseling , prior children
prenatal screening iii applicability health belief model comprehensive prenatal hemoglobinopathy screening program rochester , ny , described preceding paper issue journal woman identified carrier may face three decisions first whether accept offer counseling second whether partner tested partner also tests positive , third decision whether accept offer prenatal diagnosis report analyzes factors affecting decision , special attention given factors health belief model factors predicting patient identified carrier would come counseling included following patient prior knowledge carrier \( p less 001 \) , gestational age less 18 wk \( p less 01 \) , caucasian race \( p less 05 \) sickle cell trait beta trait , factors found predict patient 's intent partner tested following greater knowledge disease \( p less 009 \) , lesser perceived burden intervention \( p less 011 \) , belief partner also carrier \( p less 008 \) also sickle cell trait beta thalassemia trait , factors predicting partner actually tested following living partner \( p less 001 \) , gestational age identification less equal 18 wk \( p less 001 \) , lesser perceived burden intervention \( p less 002 \) , greater perceived seriousness disease \( p less 05 \)
decreased content surface expression alpha granule membrane protein gmp 140 one two types platelet alpha delta storage pool deficiency determine whether alpha granule membranes present platelets patients storage pool deficiencies alpha dense granules \( alpha delta \) , examined content surface expression alpha granule membrane protein gmp 140 one patient \( j c \) severe alpha granule deficiency three members family \( family c \) milder alpha granule deficiencies surface expression gmp 140 stimulated platelets , assessed flow cytometric measurements binding two anti gmp 140 monoclonal antibodies , 24 38 normal values platelets patient j c , vs 60 95 normal values family c total platelet content gmp 140 , determined platelet lysates antigen capture elisa , 49 normal patient j c , normal members family c platelets patient j c found heterogeneous respect gmp 140 content surface expression flow cytometry immunogold electron microscopy approximately 80 platelets expressed little gmp 140 stimulation , whereas remaining 20 expressed normal amounts gmp 140 showed extensive immunogold labeling typical alpha granules clear vacuoles heterogeneity found platelets family c findings severe alpha delta patient clear contrast observations normal gmp 140 content three alpha delta patients , patients gray platelet syndrome , reported previously others results illustrate phenotypic heterogeneity alpha granule deficiencies human platelets , suggest defect granule formation megakaryocytes may account alpha granule defect least one form alpha delta
successful treatment cat scratch disease ciprofloxacin cat scratch disease usually benign , self limited disease infection may asymptomatic commonly associated painful regional lymphadenitis occasionally , disease may result systemic symptoms dissemination five adult patients , aged 24 57 years , diagnosed cat scratch disease , based positive history cat followed typical symptoms including painful regional lymphadenitis , , positive cat scratch skin tests diagnostic evaluations revealed cause lymphadenitis three patients received prior treatment antibiotics , two patients failed improve antibiotics five treated oral ciprofloxacin , 500 mg mouth , twice daily patients dramatic improvement symptoms within days none relapsed follow first report successful treatment cat scratch disease ciprofloxacin , appears effective therapy cat scratch disease adults
aplastic anemia associated drugs prognosis aplastic anemia usually linked degree hypoplasia bone marrow pancytopenia blood authors , therefore , patient associated aplastic anemia satisfied criteria severe disease recovered rapidly completely drug withdrawn review english language literature revealed ten fully documented cases aplastic anemia associated use drugs , , propylthiouracil analysis ten case presented indicated disorder typically characterized severe pancytopenia profound marrow hypoplasia , yet surprisingly good prognosis , ie , minimum survival 70 partial complete recovery symptoms survivors within 2 5 weeks deaths , , brain hemorrhage patients transfused platelets discrepancy clinical laboratory severity drug associated aplasia , one hand , relatively good prognosis short term course , , kept mind considering patients bone marrow transplantation therapy globulin
dystrophin analysis differential diagnosis autosomal recessive muscular dystrophy childhood duchenne muscular dystrophy report 2 patients childhood autosomal recessive muscular dystrophy patients slight muscle weakness without enlargement calf muscles involvement facial muscles clinical courses static muscle histology revealed characteristic features muscular dystrophy dystrophin identifiable patients immunocytochemical staining antibody early age , immunocytochemical analysis antibody useful distinguishing childhood autosomal recessive duchenne muscular dystrophies
mutations within rhodopsin gene patients autosomal dominant retinitis pigmentosa background night blindness early symptom retinitis pigmentosa rod responsible night vision use rhodopsin pigment methods results found three mutations human rhodopsin gene occurred exclusively affected members families autosomal dominant retinitis pigmentosa two mutations c transitions involving separate nucleotides codon third c g transversion codon 58 mutation corresponded change one amino acid residue rhodopsin molecule none mutations found 106 unrelated normal subjects served controls incidence three mutations added previously reported mutation involving codon 23 , 27 150 unrelated patients autosomal dominant retinitis pigmentosa \( 18 percent \) found carry one four defects rhodopsin gene 27 patients abnormal rod function monitoring appears patients mutation involving codon 23 probably single conclusions patients autosomal dominant retinitis pigmentosa , disease caused one variety mutations rhodopsin gene
expression cystic fibrosis transmembrane conductance regulator corrects defective chloride channel regulation cystic fibrosis airway epithelial cells cystic fibrosis transmembrane conductance regulator \( cftr \) expressed cultured cystic fibrosis airway epithelial cells cl channel activation assessed single cells using fluorescence microscopic assay patch clamp technique expression cftr , mutant form cftr \( delta f508 \) , corrected cl channel defect correction phenotypic defect demonstrates causal relationship mutations cftr gene defective cl transport hallmark disease
expression characterization cystic fibrosis transmembrane conductance regulator cystic fibrosis \( cf \) common lethal genetic disease airway epithelial cells defective chloride ion absorption secretion , resulting least part defect cyclic amp regulated , cl channel apical surface gene responsible cf identified predicted encode membrane protein termed cf transmembrane conductance regulator \( cftr \) identification bacterial promoter within cftr coding sequence led us construct complementary dna low copy number plasmid , thereby avoiding deleterious effects cftr expression coli used cdna express cftr vitro vivo demonstrate cftr membrane associated glycoprotein vitro camp dependent protein kinase polyclonal monoclonal antibodies directed distinct domains protein immunoprecipitated recombinant cftr well endogenous cftr cells partial showed recombinant non recombinant proteins indistinguishable data , establish several characteristics protein responsible cf , enable cftr function studied provide basis diagnosis therapy
evaluation perinatal autopsy protocol influence prenatal diagnosis conference team study designed evaluate changes perinatal autopsy following adoption new autopsy protocol university utah medical center prenatal diagnosis conference team composed obstetricians , pediatricians , , health care professionals individuals involved care patients whose pregnancies risk congenital malformations autopsy protocol designed increase interaction pathologist prenatal diagnosis conference team evaluation perinatal death two years , 1982 1987 , protocol implemented , selected retrospective review autopsies 1987 made specific diagnoses compared 1982 additional congenital anomalies diagnosed , increased numbers patients found well described congenital disorders number attempted postnatal autopsy chromosome studies increased chromosomal abnormalities detected final autopsy diagnoses made 1987 provided information physician genetic patient counseling protocol adopted , increased numbers cases referred medical center evaluation autopsy came autopsy evaluated life members prenatal diagnosis conference team sonograms done earlier gestational age greater number anomalies detected fewer fetuses intrauterine death pregnancy terminated induction labor gestational age delivery declined
study growth promoted twins evaluated 56 twin pregnancies representing tenth mean twin birth weight distribution investigate whether larger twins face increased perinatal risk compared pregnancies , significant difference found means maternal age , parity , gestational age rates presentation combinations neonatal sex ratios however , incidence growth discordant pairs significantly higher heavier group \( p 034 \) compared general twin population , tenth group contained significantly fewer \( p \) maternal obesity diabetes infrequent could explain increased birth weight neonatal outcome excellent although comparison revealed insignificant differences , possible combination higher parity , rate , male female ratio may operative genesis large twins
modified superior based pharyngeal flap technique part ii anatomic study little literature topographic applied surgical anatomy related superior based pharyngeal flap surgery herein report applied surgical anatomy pharyngeal flap surgery , especially critical anatomic relationships vessels , muscles , nerves
single versus multiple dose surfactant replacement therapy neonates 30 36 weeks' gestation respiratory distress syndrome assess efficacy multiple dose protocol surfactant replacement therapy neonates 30 36 weeks' gestation , 75 neonates randomly assigned control , single dose surfactant , multiple dose surfactant groups neonates less 6 hours age diagnosis respiratory distress syndrome eligible subjects randomly assigned receive either 100 mg kg bovine surfactant air placebo neonates multiple dose group eligible receive three additional doses indicated neonates surfactant groups showed positive response treatment , marked improvement oxygenation 10 minutes \( p less 0001 \) surfactant groups better oxygenation control subjects lower ventilatory parameters first 24 hours deterioration oxygenation ventilatory requirements seen treatment groups starting 6 12 hours first dose deterioration oxygenation could minimized use multiple doses however , extra doses effect ventilatory requirements time concluded surfactant therapy less 6 hours age effective acutely reducing oxygen ventilatory requirements neonates 30 36 weeks' gestation respiratory distress syndrome appears multiple doses surfactant greater effect sustaining improvements oxygenation ventilatory requirements study required determine optimal dosage strategy
cloacal malformation radiologic findings imaging recommendations imaging studies records 65 patients cloacal malformation seen 1969 1989 reviewed malformations described according cloacal configuration \( urethral , vaginal \) , type urinary cloacal communication \( urethral , vesical \) , level rectal communication \( vaginal , cloacal , vesical , \) lower urinary tract abnormalities frequent \( reflux , ureteral , bladder , bladder duplication , remnants , urethral duplication \) , genital abnormalities \( uterine duplication , vaginal duplication , uterine atresia , vaginal atresia \) , abnormalities bony pelvis \( partial sacral agenesis , \) , renal abnormalities \( agenesis , obstruction , horseshoe kidney \) contrast material studies distal limb colostomy fluoroscopy various projections essential diagnosis voiding important detecting reflux sonography limited value evaluation malformation valuable imaging kidneys mr imaging revealed spinal cord abnormalities cannot predicted based appearance lumbosacral spine common previously thought
neonatal screening early treatment congenital dislocation dysplasia hip 14 264 consecutive newborn babies results screening early treatment congenital dislocation dysplasia hip \( cdh \) evaluated prospective follow study 's test done family history recorded babies positive \( n 140 \) immediately given abduction treatment screening result \( 133 \) test negative family history positive \( \) child 5 months abduction treatment started form cdh seen among negative children family history \( 13 , 306 \) , two reference groups selected age 5 months \( \) age 2 years \( \) dislocation missed screening 0 02 dysplasia seen 5 months 15 negative children positive family history 2 3 reference group children crude estimates lower limits validity indices screening test showed test efficient identification dislocation probably value dysplasia babies treatment started immediately 17 relapse dysplasia withdrawal therapy , 3 avascular necrosis , 78 normal 2 years treatment started 5 months found relapse dysplasia , 1 avascular necrosis , 53 63 success 2 years children dislocatable hips propose see treatment strategy , early ultrasonography radiography 5 months
controlled trial immediate splinting versus ultrasonographic surveillance dislocatable hips 79 infants dislocatable hips diagnosed clinically soon birth examined randomised controlled trial immediate splinting \( n 41 \) sonographic surveillance 2 weeks \( 38 \) infants second group age 2 weeks instability persisted \( 11 38 \) sonographic abnormality shown improvement \( 4 38 \) sonographic findings clinical outcome differ two groups birth 6 12 months' follow conclude dislocatable hips may safely 2 weeks birth allow spontaneous resolution , approach requires considerable resources attention detail experience confirms importance dynamic sonographic scan low specificity \( 70 \) sonographic examination first week life makes unsatisfactory primary method screening birth , useful adjunct clinical screening management congenital dislocation hip
body composition body composition measures obesity evaluated 59 subjects \( \) , aged 0 3 29 , measures body cell mass \( \) intra extracellular water \( \) , derived total body potassium isotope dilution results compared reference data body composition normal children beyond ages 3 4 significant depletion total body water , water \( increased decreased \) increased percentage body fat expected age sex findings pronounced females high lesions , less pronounced remained ambulatory changes may result metabolic nutritional stress relation , total body water depletion increased decreasing ambulatory activity suggests early nutritional mobility programs warrant study
effect maternal hyperoxia behavioral activity growth retarded human fetuses thirteen pregnant women subsequently delivered infants birth weights less 3rd percentile studied examination fetal heart rate fetal activity patients maternal administration oxygen concentration 50 room air 2 hours none fetuses birth maternal transcutaneous po2 levels increased 79 3 mm hg 158 10 mm hg 2 hours observation results indicated maternal hyperoxia produced sustained fetal breathing activity almost 100 higher room air \( analysis variance , p 0 024 \) gross fetal body movements , fetal heart rate , fetal heart rate variability increased significantly increasing observation time \( analysis variance , p less 0 01 \) , significantly altered maternal hyperoxia room air conclude despite significant change fetal breathing activity , ultrasonographic observation fetal behavioral activity maternal hyperoxia could used differentiate severely growth retarded normally grown human fetuses speculate altered fetal heart rate fetal body movement patterns usually associated intrauterine growth retardation might related altered development fetal central nervous system reversible prolonged maternal administration oxygen
color matching foveal densitometry patients carriers x linked progressive cone dystrophy describe family yet undescribed form x linked progressive cone dystrophy five generation pedigree , report results 17 male patients 31 obligate 13 possible female carriers affected males showed characteristic picture cone dystrophy foveal cone density impaired \( judged settings foveal densitometry \) , even early stage disease carriers showed fundus abnormalities , except occasional changes due myopia demonstrated mild 27 31 obligate carriers six 13 possible carriers foveal densitometry findings performed 11 carriers always agreed findings conclude findings abnormal density differences females family ocular abnormalities thus indicative carrier state
ultrasound diagnosis congenital dysplasia dislocation hip joints children older two years evaluate use ultrasound diagnosis congenital dysplasia dislocation hip \( cdh \) children older two years age , 64 patients normal hip joints 47 patients present previous cdh examined lateral anterior ultrasound scanning employed , coverage femoral head acetabular roof assessed ultrasound measurements compared standard , good accordance methods found lateral projection femoral head relation bony acetabular rim 8 mm children younger ten years age indicated subluxation 15 mm age two four years indicated dislocation reliable images obtained ultrasound age two 18 years ultrasound recommended primary imaging technique evaluation hip joints , even older children , ultrasound replace follow examinations children previous cdh
pulmonary atresia ventricular septal defect selection patients systemic pulmonary artery shunt based echocardiography january 1987 december 1988 , 22 infants , diagnostic results obtained echocardiography \( two dimensional , doppler , color \) prospectively compared findings classified group 1 patients confluent good sized pulmonary \( greater equal 3 mm \) arteries , single ductus arteriosus , normal pulmonary venous connections \( favorable pattern \) patients classified group 2 \( unfavorable pattern \) intracardiac anatomy , morphology pulmonary arteries , pattern pulmonary blood supply pulmonary venous connection correctly identified echocardiography one patient , considered group 2 false positive favorable pattern \( group 1 \) detected echocardiography effective tool infants , order discriminate cases favorable unfavorable patterns pulmonary arteries , pulmonary blood supply , pulmonary veins first group favorable pattern may considered systemic pulmonary shunt surgery without based experience january december 1989 , four patients favorable pattern underwent successful systemic pulmonary artery shunt echocardiographic diagnosis alone
di anomaly atrioventricular canal report first case di anomaly associated atrioventricular canal combination anomalies may represent chance occurrence two situations patient , alternatively , result single unknown mechanism
helping child understand testicular children think adults would therefore less adults diagnosis serious ominous implications , yet commonly left someone old enough understand , means delivery painful information vulnerable years better approach stage stage , matching simple statements child 's conceptual growth personal implications finally part process use approach child testicular described
characterization splicing mutation group molecular basis group \( xp \) investigated comparison nucleotide sequences multiple clones xp group gene \( xpac \) patient group xp normal gene clones showed g c substitution 3' splice site intron 3 , altered obligatory ag dinucleotide ac nucleotide sequencing cdnas amplified polymerase chain reaction revealed single base substitution 3' splice site , thus creating two abnormally mrna forms larger form identical normal mrna except dinucleotide deletion 5' end exon 4 deletion results frameshift premature translation termination exon 4 smaller form deletion entire exon 3 dinucleotide 5' end exon 4 result transfection study provided additional evidence single base substitution disease causing mutation single base substitution new cleavage site restriction nuclease analysis restriction fragment length polymorphism showed high frequency mutation japanese patients group xp 16 21 unrelated japanese patients homozygous 4 heterozygous mutation however , 11 2 blacks group xp mutant allele polymorphic restriction fragments concluded useful diagnosis group xp japanese subjects , including prenatal cases carriers
beliefs causes children 's genetic disorders beliefs causes children 's genetic disorders investigated means q consisting 54 statements possible beliefs nine groups six items basis subject 's beliefs subjects well educated , knowledgeable genetics child 's disorder , indicated high level belief genetic causes differences beliefs associated differences genetic etiology , indicating beliefs affected specific information provided genetic counseling factor analysis identified cluster q items characterized highly personal relationship cause disorder \( e g , personal attributes , selected , 's actions \) subjects rated items low belief pattern , designated , consistent scientific indicated psychological cause child 's disorder subjects rated items high , personal belief pattern , mixture scientific beliefs indicated sense personal involvement cause child 's disorder subjects two belief patterns equally knowledgeable genetics disorder thus , personal belief pattern appear interfere acceptance understanding information provided genetic counseling
syndrome \( \) analysis single family ws1 mutation showing linkage rflp markers human chromosome syndrome type \( ws1 \) caused , autosomal dominant mutation variable penetrance individuals mutation , 20 25 hearing impaired linkage analysis rflp data single ws1 family 11 affected individuals indicates ws1 mutation family linked following four marker loci located long arm chromosome 2 \( alkaline phosphatase , placental \) , \( fibronectin 1 \) , \( unique copy dna segment \) , \( collagen vi , alpha 3 \) rflp marker loci , linkage analysis using produced peak lod \( z \) 3 23 following linkage relationships recombination fractions \( theta \) \( 000 \) 122 co similar analysis produced z 6 67 following linkage relationships theta values among markers ws1 \( 000 ws1 000 \) 123 3 data confirm conclusion et al least ws1 mutations map chromosome
ocular clinicopathologic study atrophy performed histopathologic study whole obtained post patient well documented , vitamin b6 responsive atrophy retina posterior pole focal areas photoreceptor atrophy adjacent retinal pigment epithelial hyperplasia abrupt transition near normal retina zone near total atrophy retina , retinal pigment epithelium , present fundus electron microscopic examination disclosed abnormalities mitochondria corneal endothelium non pigmented ciliary epithelium similar , less severe , mitochondrial abnormalities present
staged repair pulmonary atresia ventricular septal defect major systemic pulmonary artery collaterals fifty eight consecutive patients pulmonary atresia , ventricular septal defect , hypoplastic pulmonary arteries defects , major aortopulmonary collaterals entered program staged surgical repair january 1979 july 1989 procedures designed \( 1 \) encourage native pulmonary artery growth increasing blood flow \( 2 \) pulmonary blood supply major collaterals total 121 staging procedures performed overall mortality 10 3 one hundred thirty four major collaterals either ligated transplanted thirty patients eventually underwent hemodynamic repair early mortality 3 3 late mortality 10 0 twenty six current survivors repair remain clinically well mean follow 3 6 years ten patients currently various stages preparation twelve patients \( 20 7 \) failed achieve minimum requirements repair staging palliation heart lung transplantation principles management evolved years discussed
abnormal ileal mucus cystic fibrosis histochemical study using peroxidase labelled lectins peroxidase conjugated lectins used glycoproteins small intestinal mucins normal infants cystic fibrosis ascertain whether detectable histochemical differences composition significant decrease \( \) binding fucose shown normal small intestinal mucin starting around 36 weeks' gestation total absence staining term beyond contrast , age matched patients cystic fibrosis showed persistent intense binding fucose results provide first clear histochemical evidence cystic fibrosis mucin abnormal confirm findings previous biochemical studies
abnormal ileal mucus cystic fibrosis ii histochemical study using monoclonal antibodies oligosaccharides abnormal cystic fibrosis mucin previously shown using peroxidase conjugated lectins ileal tissue sections abnormally glycoproteins investigated using monoclonal antibodies oligosaccharides based type 1 type 2 blood group precursor chains results study , using monoclonal antibodies blood group glycoproteins cystic fibrosis , negative , yet abnormal found using lectin histochemistry using monoclonal antibodies , lectins , appropriate enzymes , , possible delineate abnormality found glycoproteins cystic fibrosis appropriately fixed ileal sections , obtained infants term presenting meconium ileus
's nodule post cartilaginous nodule number minor variations configuration external ear well recognized paper brings attention one entity characterized small cartilaginous nodule prominence arising posterior surface named 's nodule prospective clinical survey 208 patients attending ent clinic revealed nearly one third population studied possess nodule equal sex incidence 's nodule identified within families distribution suggests autosomal dominant inheritance variable
cardiovascular abnormalities infants prenatally exposed cocaine study utilized historical cohort examine relationship maternal cocaine use pregnancy occurrence congenital cardiovascular abnormalities neonatal drug screens performed city hospital 18 month period reviewed \( n 554 \) 214 \( 39 \) screened high risk neonates , results toxicologic screens positive cocaine , 340 \( 61 \) neonates detectable cocaine compared occurrence cardiovascular malformations electrocardiographic abnormalities two groups sought 554 infants pediatric cardiology data base , consisted inpatient consultation , outpatient consultation , electrocardiography forty nine patients drug screens also entered cardiology data base 25 consultations electrocardiograms , 24 electrocardiograms rate cardiac anomalies among cocaine positive infants significantly higher \( relative risk 3 7 95 confidence interval \( 1 4 , 9 4 \) \) rate anomalies among cocaine negative comparison group \( 65 100 vs 18 1000 \) rate cocaine positive infants also significantly higher published rates general populations infants several electrocardiographic abnormalities , high grade ventricular ectopy , cardiorespiratory arrests also noted study population conclude cocaine exposure prenatal life appears predispose infants structural cardiovascular malformations , electrocardiographic abnormalities , , possibly , cardiopulmonary autonomic dysfunction
genetic disease detection dna amplification using cloned thermostable polymerase chain reaction , using thermostable dna polymerase , dna diagnostics another thermostable enzyme , dna , assay reported dna single base substitution cloned enzyme specifically links two adjacent oligonucleotides hybridized 65 degrees c complementary target nucleotides base paired junction oligonucleotide products exponentially amplified thermal cycling ligation reaction presence second set adjacent oligonucleotides , complementary first set target single base prevents ligation amplification thus distinguished method detect 200 target molecules well discriminate normal beta sickle beta globin genotypes 10 microliters blood samples
double blind comparison oral fentanyl citrate oral meperidine , diazepam , atropine medication children congenital heart disease effectiveness oral fentanyl citrate \( \) medication compared oral meperidine , diazepam , atropine \( mda \) 40 pediatric patients scheduled undergo repair congenital heart defects double blinded manner , patients received fentanyl \( 20 25 micrograms kg \) placebo oral solution \( 0 4 ml kg \) \( n 20 \) placebo oral solution \( 0 4 ml kg \) meperidine \( 1 5 mg kg \) , diazepam \( 0 2 mg kg \) , atropine \( 0 02 mg kg \) \( n 20 \) patient 's vital signs , systolic diastolic blood pressures , heart rate , respiratory rate , saturation \( spo2 \) , well activity scores evaluated recorded baseline 10 min intervals patient 's emotional status time parental separation induction anesthesia also assessed side effects onset action observed , onset sedation significantly faster oral solution meperidine , diazepam , atropine groups significant change heart rate although systolic blood pressure , diastolic blood pressure , respiratory rate showed statistically significant decreases , changes clinically significant child 's emotional status time separation parents induction similar groups side effects frequent nose occurred 65 , body 10 , vomiting 30 two patients \( 10 \) treated group became hypoxemic \( spo2 less 90 \) required supplemental oxygen group receiving oral meperidine , diazepam , atropine , 10 mild facial pruritus 5 complained dry mouth
expression genes insulin like growth factor \( igf \) , igf ii , igf binding proteins 1 2 fetal rat conditions intrauterine growth retardation caused maternal fasting evidence suggests insulin like growth factors ii \( igf ii \) play role regulating fetal growth development fetus , igf ii two specific binding proteins \( igfbp 1 2 \) , thought modulate actions igfs target tissues examined regulation genes igf , igf ii , igfbp 1 , igfbp 2 fetal rat liver experimental model intrauterine growth retardation caused maternal fasting days 17 21 gestation mean weight fetuses fasted dams 27 32 lower mean weight fetuses fed dams concentration immunoreactive igf decreased 71 serum fetuses fasting dams concentration immunoreactive igf ii slightly decreased \( 12 \) serum fetuses fasting dams , whereas concentration immunoreactive pro igf ii e domain peptide decreased 31 abundance hepatic igf mrna decreased 55 fetuses fasting dams contrast , abundance igf ii mrna fetal liver significantly decreased maternal fasting maternal fasting caused 2 fold increase abundance igfbp 1 mrna fetal liver , whereas change abundance igfbp 2 mrna induction igfbp 1 mrna liver growth retarded fetuses similar induction occurs liver fasting adults , lack regulation igfbp 2 mrna differs strong induction igfbp 2 mrna occurs liver fasting adults summary , results indicate maternal fasting causes decrease fetal igf gene expression , decrease fetal serum igf , slight decrease fetal serum igf ii pro igf ii e domain peptide concentrations maternal fasting also causes increase fetal igfbp 1 gene expression changes fetal insulin glucose may related changes expression igf igfbp 1 genes growth retarded fetuses decreased expression igf ii increased expression igfbp 1 gene may contribute fetal growth retardation observed model system
control sperm oocyte switch elegans fem 3 3' untranslated region elegans germ line , sperm oocytes made common pool germ cell precursors decision differentiate sperm oocyte regulated sex determining gene , fem 3 expression fem 3 germ line spermatogenesis must negatively regulated allow switch adult \( producing oocytes \) , fem 3 rna found germ line , consistent requirement fem 3 spermatogenesis maternal effects fem 3 embryonic sex determination whereas loss function mutants fem 3 produce oocytes , carrying nine fem 3 gain function \( gf \) mutations make none instead sperm produced continuously vast excess wild type amounts genetic analyses suggest fem 3 \( gf \) mutations negative control required switch report nine fem 3 \( gf \) mutants carry sequence alterations fem 3 3' untranslated region \( 3' \) increase steady state level fem 3 \( gf \) rna wild type , increase fem 3 \( gf \) rna coincident fem 3 activity results titration experiment support hypothesis regulatory factor may bind fem 3 3' speculate fem 3 rna regulated 3' binding factor inhibits translation , discuss idea control may part general regulation maternal rnas
autosomal dominant retinitis pigmentosa two families transversion mutation codon 23 rhodopsin cytosine adenine transversion codon 23 rhodopsin , rod visual pigment gene , reported recently et al 17 148 unrelated patients autosomal dominant retinitis pigmentosa , clinical findings associated deletion reported detail screening patients autosomal dominant retinitis pigmentosa codon 23 transversion , found positive results four affected individuals two families retinitis pigmentosa , 12 patients retinitis pigmentosa different families negative results , suggesting gene sites locations may give phenotypic change patients' history light exposure location degeneration retina , hypothesize light may playing role point mutation rhodopsin gene first report type retinitis pigmentosa associated specific molecular gene defect , although actual pathophysiologic mechanism currently unknown
ocular findings patients autosomal dominant retinitis pigmentosa rhodopsin gene defect \( pro 23 \) ocular findings presented 17 unrelated patients form autosomal dominant retinitis pigmentosa cytosine adenine transversion codon 23 rhodopsin gene corresponding substitution histidine proline amino acid rhodopsin \( designated rhodopsin , pro 23 \) average , patients \( mean age , 37 years \) significantly better visual acuity larger amplitudes 131 unrelated patients \( mean age , 32 years \) autosomal dominant retinitis pigmentosa without mutation however , 17 patients separate families , well 12 relatives mutation four families , showed variability respect severity ocular disease , suggesting factor \( \) gene defect involved expression condition form retinitis pigmentosa detected testing leukocyte dna peripheral blood mechanisms mutation rhodopsin gene could lead rod photoreceptor cell death suggested
anomalous subaortic position brachiocephalic vein \( vein \) echocardiographic study 24 \( 0 98 \) patients congenital heart disease brachiocephalic vein anomalous position aortic arch much higher proportion cases reported far high frequency may arise differences study population method diagnosis venous anomaly common patients tetralogy fallot ventricular septal defect pulmonary atresia patients venous anomaly likely right aortic arch anomalous course brachiocephalic vein neck junction superior vena cava shown cross sectional echocardiography cases , doppler study usually clarified anatomical arrangement
case report review literature rare anomaly approximately 70 cases reported literature may result transverse division ridge , hypothesis best explains anatomical features testicle primary accompanying disorders anomalies include testis , inguinal hernia torsion malignancy reported 3 cases absence concomitant disorder testicular tumor ruled magnetic resonance imaging ultrasonography , surgical exploration biopsy unnecessary
woven right coronary artery case report therapeutic implications report unusual anomaly right coronary artery consisting proximal branching artery subsequent branches , referred woven coronary artery implications differential diagnosis discussed
cystic fibrosis transmembrane conductance regulator nucleotide binding synthetic peptide multiple mutations gene responsible cystic fibrosis located within region predicted encode nucleotide binding fold amino terminal half cystic fibrosis transmembrane conductance regulator protein 67 amino acid peptide \( p 67 \) corresponds central region putative nucleotide binding site chemically synthesized purified peptide bound adenine nucleotides apparent dissociation constants \( kd 's \) \( tnp \) adenine nucleotides , tnp adenosine triphosphate , tnp adenosine diphosphate , tnp adenosine monophosphate , 300 , 200 , greater 1 micromolar , respectively kd adenosine triphosphate 300 micromolar circular spectroscopy used show p 67 predominantly beta sheet structure solution , finding consistent secondary structure predictions basis information , phenylalanine position , deleted approximately 70 percent individuals cystic fibrosis , localized beta strand within nucleotide binding peptide deletion residue predicted induce significant structural change beta strand altered nucleotide binding
tuberous sclerosis tuberous sclerosis inherited disorder characterized signs mental retardation , seizures adenoma commonly affect multiple organ systems seen plain film radiography computed tomography ultrasonography useful assessing whether lesions present abdomen , kidneys brain tend , causing symptoms need evaluation
dimorphic 4 bp repeat cystic fibrosis gene absolute linkage disequilibrium delta f508 mutation implications prenatal diagnosis mutation origin gene causing cystic fibrosis \( cf \) recently cloned , major mutation \( delta f508 \) accounting approximately 70 cf chromosomes identified 3' end intron 6 cf gene 4 bp tandem repeat \( \) exhibits interesting features first , pcr screening 103 normal individuals revealed repeat exists two polymorphic allelic forms , either two alleles equilibrium predict heterozygote frequency 41 \( p seven repeats 71 q six repeats 29 \) second , allele six repeats found linked delta f508 76 cf chromosomes investigated , demonstrating strong linkage disequilibrium suggesting delta f508 originated gene bearing six repeats third , repeat alleles linked dna markers , extended haplotypes generated new haplotypes become informative situations prenatal diagnosis cannot performed solely since repeat marker located cf gene would less likely gene , serve valuable dna marker haplotype analysis possible crossover , however , identified , transferring delta f508 different haplotype
two frameshift mutations cystic fibrosis gene cystic fibrosis \( cf \) recessive disease caused mutations cf transmembrane conductance regulator \( cftr \) gene identified exon 7 two frameshift mutations , one caused two nucleotide insertion caused one nucleotide deletion mutations , respectively , predicted shift reading frame protein introduce \( \) termination codons residues 369
closure ductus arteriosus indomethacin ventilated neonates respiratory distress syndrome effects pulmonary compliance ventilation reported effects indomethacin pulmonary compliance variable depending upon patient population degree indomethacin resulted successful ductal closure eleven fluid restricted , furosemide treated premature infants mechanically ventilated respiratory distress syndrome \( rds \) also significant patent ductus arteriosus \( pda \) pulmonary function testing performed successful closure pda diagnosis significant pda made clinical echocardiographic criteria indomethacin administered dosage 0 2 mg kg dose every 12 18 h 1 3 doses control 48 h time interval achieve ductal closure , nine premature infants ventilated rds significant pda also pulmonary function evaluations performed 48 h also , control independent effect fluid restriction diuretic therapy pulmonary compliance , eight premature infants pda pulmonary function evaluations performed 48 h interval successful closure ductus indomethacin associated improvement compliance ventilation parameters infants indomethacin treated infants indomethacin treated group , mean percent improvements noted following parameters , 59 2 , 78 3 , 63 3 vt , 63 3 , 54 6 significant changes pulmonary functions 48 h rds 48 h pda fluid restricted , furosemide treated control groups conclusion , successful closure ductus indomethacin causes significant improvement compliance ventilation parameters infants mechanically ventilated rds
lectin binding sites normal , , lattice dystrophy corneas normal , , dystrophic corneas probed panel 16 lectins means avidin biotin revealing system normal corneal epithelial cells , , endothelial cells expressed least two distinct n linked oligosaccharide subsets , non , , bi types corneal scars stained variably lectin subsets described , agglutinin lattice dystrophy corneas showed loss oligosaccharide expression observed plasma membranes normal epithelial cells , concurrent deposition extracellular glycoprotein within corneal stroma , oligosaccharide subsets lost epithelial cell plasma membranes extracellular stromal glycoprotein far widely deposited amyloid extended well beyond stromal scarring propose observations related lattice corneal dystrophy glycoprotein \( \) shed plasma membranes epithelial cells within corneal stroma , subsequently stimulates amyloid deposition
requirement replication protein ssb human dna excision repair replication repair essential processes maintain continuity genetic material dissection simian virus 40 \( \) dna replication resulted identification many eukaryotic replication proteins , biochemistry process dna excision repair less well defined one protein absolutely required replication dna vitro human single dna binding protein \( ssb , also called rf rp \) ssb consists three polypeptides relative molecular mass 70 , 000 , 34 , 000 13 , 000 , acts antigen dna , allowing access replication proteins human ssb also stimulate activity alpha delta , suggesting role elongation dna replication found role human ssb dna excision repair using cell free system carry nucleotide excision repair vitro monoclonal antibodies human ssb caused extensive inhibition dna repair plasmid molecules damaged ultraviolet light addition purified ssb reversed inhibition stimulated repair synthesis increasing number repair events results show mammalian dna replication protein also essential repair
detection tuberous sclerosis parents magnetic resonance imaging performed detailed physical examination mri without gadolinium dtpa contrast 60 couples least 1 child tuberous sclerosis \( ts \) eight parents ts diagnosed physical examination , family history , various diagnostic procedures including mri eight additional subjects 6 control subjects nonspecific high signal white matter changes mri mri confirmed diagnosis ts 1 parent without physical findings disease , similar results earlier studies using computed cranial tomography ct may less sensitive mri probably specific ts either ct mri may occasionally help substantiate diagnosis ts parent findings studies may need done parents maximize accuracy genetic counseling
brain growth among fetuses exposed cocaine utero growth retardation fetal growth retardation may associated maternal cocaine use pregnancy pattern fetal growth retardation analyzed infants born 80 women used cocaine , alcohol , pregnancy , two comparison groups 100 infants born mothers used neither alcohol cocaine pregnancy 67 infants whose mothers used alcohol cocaine pregnancy statistically significant differences head size cocaine exposed infants \( p less 001 \) notably , head circumference reduced proportionately birth weight cocaine exposed infants , pattern similar observed alcohol exposed infants alcohol cocaine exposed infants statistically different head circumference conclude brain growth cocaine exposed infants similar reported alcohol exposed infants , cocaine exposed infants may characterized growth retardation
cytogenetic study spontaneous abortions direct analysis chorionic villi 144 spontaneous determined using direct chromosome preparations chorionic villi frequency chromosome abnormality 69 4 , considerably higher figures cited previous cytogenetic surveys using conventional method cell culturing autosomal trisomy predominant abnormality \( 64 \) , followed polyploidy \( 9 \) , x \( 7 \) , structural rearrangements \( 6 \) , \( 6 \) , double trisomy \( 4 \) , double chromosome anomaly \( 3 \) direct preparations advantages results obtained rapidly , success rate satisfactory , maternal cell contamination minimal
first second trimester diagnosis fetal ocular defects associated anomalies report eight cases ocular cataract , , , , rare malformations commonly associated fetal anomalies previously , ocular malformations detected mid gestation transvaginal sonography allows detection many structural fetal anomalies describe case reports eight ocular anomalies among 1600 fetal transvaginal sonography 12 18 weeks' gestation severe cataract correctly diagnosed transvaginal sonography however , transvaginal sonography failed detect moderate cataract case repeat cataract subsequent gestation may sometimes secondary degenerative process middle late pregnancy five eight described cases , eye malformations associated defects central nervous system
postterm infants big small \? concern postterm pregnancy shifted difficult delivery large fetus current concern death utero , small date fetus studies postterm pregnancy availability ultrasonography may included large proportion menstrual present study infants undertaken fetal growth postterm pregnancies expected date last normal menstrual period confirmed \( 7 days \) early ultrasonography results show gradual shift toward higher birth weight greater heel length head circumference 273 300 days gestational age evidence postterm weight loss lower weight length could demonstrated concern postterm pregnancy fetal , intrauterine growth retardation
cerebral blood flow , cross brain oxygen extraction , pressure hypoxic ischemic injury newborn infants relationship mean arterial pressure , intracranial pressure , cerebral blood flow , cross brain oxygen extraction , cerebral metabolic rate , outcome studied therapy nine neonates 3 consecutive days severe hypoxic ischemic cerebral injury cross brain oxygen extraction significantly higher \( 5 06 0 5 vs 2 05 0 8 ml dl p 0 012 \) five neonates survived normal neurologic outcome four died sustained severe brain damage contrast , global cerebral blood flow five neonates normal neurologic outcome significantly lower \( 25 6 8 2 vs 83 2 44 9 ml 100 gm brain min p less 0 05 \) study period differences cross brain oxygen extraction global cerebral blood flow infants neurologic recovery died sustained brain damage occurred presence acceptable values intracranial pressure , mean arterial pressure , cerebral perfusion pressure preliminary data suggest cross brain oxygen extraction possibly global cerebral blood flow may important variables associated severe neuronal injury death hypoxic ischemic cerebral injury
common symptom tuberous sclerosis dental diagnostic sign tuberous sclerosis explored , protocol oral examination patients persons risk described study 50 patients tuberous sclerosis 250 control patients examined dental simple clinical protocol established examination use dental solution dry teeth incidence adult dentition patients tuberous sclerosis 100 , whereas adult dentition control group 7 simplicity test high probability occurrence tuberous sclerosis make examination useful diagnosis serious genetic disease
changes left ventricular diastolic filling patterns doppler echocardiography cystic fibrosis onset common terminal finding patients cystic fibrosis since doppler echocardiography detect changes diastolic filling patterns prior onset either systolic dysfunction clinical symptoms , utilized technique determine whether detectable changes left ventricular diastolic filling patterns exist patients cystic fibrosis among 25 patients , proportion left ventricular filling attributable atrial contraction significantly increased compared age matched control individuals filling patterns compared severity pulmonary disease , worsening pulmonary disease directly correlated shifts left ventricular filling patterns conclude changes left ventricular patterns relaxation detectable early course cystic fibrosis changes probably progressive early detection could lead therapeutic trials designed improve left ventricular filling delay onset overt
single nucleotide primer extension detect genetic diseases experimental application hemophilia b \( factor ix \) cystic fibrosis genes report , describe approach detect presence abnormal alleles genetic diseases frequency occurrence mutation high \( e g , cystic fibrosis sickle cell disease \) , others multiple mutations cause disease sequence variation affected member given family known \( e g , hemophilia b \) initially , subject , dna fragment containing putative mutation site amplified polymerase chain reaction fragment two reaction mixtures prepared contains amplified fragment , primer \( 18 mer longer \) whose sequence identical coding sequence normal gene immediately flanking 5' end mutation site , either alpha 32p labeled nucleotide corresponding normal coding sequence mutation site alpha 32p labeled nucleotide corresponding mutant sequence single nucleotide primer carried analyzed denaturing polyacrylamide gel electrophoresis autoradiography predicted base pair rule , wild type normal base , affected member mutant base , carriers normal mutant base incorporated primer thus , essential feature present methodology base immediately 3' template bound primer one altered mutant , since way extension primer single base give extended molecule characteristic either mutant wild type method rapid useful carrier detection prenatal diagnosis every genetic disease known sequence variation
neonatal screening cystic fibrosis wales west clinical assessment five years screening screening newborn cystic fibrosis measurement immunoreactive trypsin undertaken alternate weeks wales west five years since 1985 evaluate possible clinical benefits early diagnosis patients detected screening diagnosed clinical symptoms alone assessed annually differences clinical , anthropometric , biochemical variables fifty eight infants considered risk cystic fibrosis \( present meconium ileus sibling cystic fibrosis \) detected screening compared 44 children diagnosed clinically latter group includes nine children whose screening negative recognised subsequently cystic fibrosis mean age diagnosis screened group significantly lower group diagnosed clinically excluding admissions diagnostic tests cystic fibrosis , screened group spent significantly shorter time hospital first year life results comparisons made screened group diagnosed clinically similar age 4 years
controversies management study 40 patients forty infants referred two paediatric surgeons 13 year period overall survival 90 nine patients transferred utero 31 referred birth weights , gestational ages , apgar scores similar groups primary closure defect successfully achieved seven \( 78 \) patients prenatally transferred group compared 17 \( 55 \) postnatal group significantly less postoperative assisted ventilation , trend early discharge home , noted prenatal transfer problems arising postnatal transfer may contributed differences major differences resulting mode delivery identified patients treated primary closure significantly better undergoing staged repairs prosthetic material prospective randomised studies required confirm findings
endotracheal resuscitation neonates using bag thirty neonates resuscitated anaesthetic bag system limited either pressure volume chest movement used criterion adequate inflation inflation pressure flow recorded resuscitation , flow integrated obtain volume median mean pressure first 10 inflations 40 cm h2o dropped later resuscitation 29 cm h2o volume delivered change significantly , volume divided pressure increased median 0 18 0 35 ml kg cm h2o fourteen infants formed part functional residual capacity artificial ventilation five spontaneous breaths eleven infants showed evidence functional residual capacity formation 22 preterm infants strong association absence functional residual capacity formation later hyaline membrane disease required ventilation suggest pressures 30 cm h2o may helpful initial resuscitation study devices using positive end expiratory pressure resuscitation preterm infants
pelvic support osteotomy unusual congenital dislocation hip 52 year follow study structural changes anatomy soft tissues result long standing congenital dislocation hip \( cdh \) seldom described literature similarly , anatomy hip 52 years pelvic support osteotomy cdh seems previously observed long term follow autopsy study bilateral pelvic support osteotomies performed 91 year old autopsy subject showed unexpectedly flattened sciatic nerves
chemical dependency women description effects outcome adequate purpose article define chemical dependency women response inadequate description psychological variables characterize chemically dependent women offered well attributes women lack necessary effective child rearing patterns outcome children also described suggestions clinical intervention provided
radiographic manifestations congenital heart disease adult patient improvements preoperative evaluation , surgical treatment , postoperative care patients congenital cardiac disease allowed large patient population congenital cardiac abnormalities reach adolescence adulthood noninvasive diagnostic imaging procedures \( e g , plain film radiography , echocardiography , computed tomography , magnetic resonance imaging \) playing increasingly important role evaluation management adults treated untreated congenital cardiac disease role plain film radiology emphasized
mutation second nucleotide binding fold cystic fibrosis gene discovery last year deletion phenylalanine residue amino acid position cystic fibrosis \( cf \) gene meant approximately 70 mutant chromosomes associated cf accounted report finding substitution nucleotide position cf gene , resulting change asparagine lysine amino acid position believe disease causing mutation , involves amino acid change found cf chromosomes consistent haplotype background mutation detected using direct sequencing pcr amplified genomic dna confirmed dot hybridization normal mutant allele specific oligonucleotides mutation detected three chromosomes four individuals normal chromosome presence heterozygous state correlated clinical status individual patients
epidermolysis bullosa simplex \( \) keratin disorder ultrastructural immunohistochemical study skin biopsy specimen obtained 1 month old female epidermolysis bullosa simplex \( \) histologically , intraepidermal separation seen considered formed epidermal basal cells ultrastructurally , basal cells lacking cytoplasmic , initial change seemed cytoplasm immunohistochemically , basal cell keratin expressed suprabasal cell layer basal cell layer , keratin detected basal cell layer findings suggest keratin production epidermal cells may delayed , resulting weakness basal cells minor trauma skin
autogenous atrial tunnel direct cavopulmonary connection infants small children technique described construction autogenous right atrial tunnel direct cavopulmonary connection infants small children requiring fontan operation advantages , subset patients , method others previously described using prosthetic growth limited materials suggested
mutation dna binding domain androgen receptor gene causes complete testicular patient receptor positive androgen resistance androgen resistance associated wide range quantitative qualitative defects androgen receptor however , fibroblast cultures approximately 10 patients clinical , endocrine , genetic features characteristic androgen resistance express normal quantities apparently normal androgen receptor cultured genital skin fibroblasts \( receptor positive androgen resistance \) analyzed androgen receptor gene one patient \( \) receptor positive , complete testicular detected single nucleotide substitution nucleotide \( g c \) within second zinc finger dna binding domain results conversion arginine residue position proline residue introduction mutation androgen receptor cdna transfection expression plasmid eukaryotic cells lead synthesis receptor protein displays normal binding kinetics inactive functional assays receptor activity conclude substitution mutations dna binding domain androgen receptor one cause receptor positive androgen resistance
neuronal preferential metabolic alterations thalamus posterior association cortex demonstrated pet regional brain glucose investigated positron emission tomography \( pet \) fluorodeoxyglucose \( fdg \) four siblings neuronal consistent pattern found , namely decrease glucose structures marked level thalamus posterior association cortex severity metabolic anomalies correlated degree clinical impairment disease duration severe oldest patient , also affected clinically , intermediate two others , minimal subject shortest period development disease observations suggest pet useful definition anatomical targets metabolic diseases investigation pathophysiology
maternal age birth defects population study since women developed countries delaying childbearing older age , important find whether birth defects , resulting chromosomal anomalies , related maternal age studied 26 , children birth defects unknown aetiology identified among , consecutive british columbia records linked provincial birth records allow determination maternal age birth excluded children chromosomal anomalies birth defects known aetiology 3 43 birth defect categories studied showed significant maternal age specific trends decreasing linear trends maternal age patent ductus arteriosus \( chi 2 36 65 , 1 df , p less 0 01 \) hypertrophic pyloric stenosis \( chi 2 4 90 , 1 df , p less 0 05 \) bell shaped curve \( risk increasing maternal age 30 falling \) congenital dislocatable hip hip findings population based analysis association incidence birth defects unknown aetiology advancing maternal age healthy women delay childbearing
activation chloride channels normal cystic fibrosis airway epithelial cells calcium calmodulin dependent protein kinase cystic fibrosis associated defective regulation apical membrane chloride channels airway epithelial cells channels normal cells activated cyclic amp dependent protein kinase protein kinase c cystic fibrosis kinases fail activate otherwise normal cl channels cl flux cystic fibrosis cells , normal cells , activated raising intracellular ca2 \( 5 10 \) report whole cell patch clamp studies normal cystic fibrosis derived airway epithelial cells showing cl channel activation ca2 mediated ca2 calmodulin dependent protein kinase find intracellular application activated kinase atp activates cl current similar activated ca2 ionophore , peptide inhibitors either kinase calmodulin block ca2 \( \) dependent activation cl channels , peptide inhibitor protein kinase c block ca2 \( \) dependent activation ca2 calmodulin activation cl channels presents pathway therapeutic potential defective regulation cl channels cystic fibrosis
spatially localized magnetic resonance spectroscopy brains normal newborns phase modulated rotating frame imaging modification magnetic resonance spectroscopy , uses linear radiofrequency field gradient obtain spatially localized biochemical information phase modulated rotating frame imaging used study regional cerebral energy metabolism brains 9 normal newborns 25 newborns birth asphyxia relative concentrations phosphorus containing metabolites intracellular ph determined brain tissue three specified depths brain surface neonates wide variations metabolite ratios seen among normal neonates , considerable metabolic heterogeneity demonstrated individual neonates depth resolved spectroscopy neonates severe hypoxic ischemic encephalopathy poor neurodevelopmental outcome showed expected rise inorganic fall phosphocreatine concentrations global spatially localized spectra phase modulated rotating frame imaging showed metabolic derangement less superficial deeper brain tissue inorganic adenosine triphosphate ratio 1 2 cm brain surface accurate global metabolite ratio identification neonates poor short term outcome data consistent known vulnerability subcortical brain tissue hypoxic ischemic injury full term neonate
neuropsychological outcome pediatric liver transplantation children end stage liver disease undergo liver transplantation may unrecognized neuropsychological academic deficits , programs may available intellectual , academic , neuropsychological measures 28 pediatric patients received successful liver transplantation least 1 year previously compared 18 patients cystic fibrosis \( control effects growth retardation chronic illness \) matched age , age diagnosis , physical growth , parents' socioeconomic status liver transplant patients significantly lower scores intelligence tests \( mean sd liver transplant vs cystic fibrosis patients 89 1 19 1 vs 105 8 17 6 \) , lower academic achievement , lower scores age areas learning memory \( 0 68 1 09 vs 0 19 1 24 \) , concept formation \( 1 73 1 58 vs 0 79 1 37 \) , visual spatial function \( 0 66 1 09 vs 0 10 0 69 \) , motor function \( 0 13 0 85 vs 0 36 0 57 \) differences found tests verbal intelligence , concentration , perceptual motor , sensory perceptual areas cyclosporine levels found correlate positively motor speed \( r 41 , p less 05 \) thorough educational neuropsychological evaluations considered pediatric patients receive liver transplantation allow children maximize potential
bovine surfactant replacement therapy neonates less 30 weeks' gestation randomized controlled trial prophylaxis versus treatment influence timing surfactant replacement therapy treatment neonatal respiratory distress syndrome evaluated study 182 neonates less 30 weeks' gestation randomly assigned prior delivery one three study groups control \( instillation air given birth \) , early surfactant \( surfactant given birth \) , late surfactant \( surfactant given less 6 hours age \) subjects late surfactant group could avoid treatment clear chest roentgenogram required supplemental oxygen mean airway pressure less 7 cm water treated neonates eligible receive three additional doses first 5 days life three groups comparable respect birth weight , gestational age , perinatal parameters exception lower cord arterial ph 1 minute apgar score early surfactant group 60 neonates randomly assigned late treatment , 29 \( 48 \) deemed surfactant sufficient thereby avoided treatment 31 received first dose mean age 2 9 hours significant improvement gas exchange first week life surfactant groups compared control group , reflected differences fraction inspired oxygen , arterial alveolar po2 , ventilation index \( peak pressure x rate ventilator \) \( p less 001 \) surfactant therapy also resulted lower incidence pulmonary air leak severe chronic lung disease \( defined requirement respiratory support beyond 36 weeks post conceptional age \) differences early late surfactant groups parameters statistically significant difference surfactant groups early group higher incidence mild chronic lung disease \( respiratory support beyond 28 days age \) late treatment group \( p less 005 \) neonates late treatment group earlier shorter neonatal intensive care unit stay control neonates \( p less 05 \) , whereas early group significantly different control neonates parameters concluded replacement therapy bovine lung surfactant extract neonates less 30 weeks' gestation results decreased oxygen ventilatory requirements first week life lower incidence pulmonary air leak severe chronic lung disease \( abstract truncated 400 words \)
congenital orthopedic anomalies impact family baby born congenital limb deficiency presents challenge parents health care professionals lack information treatment options exacerbate crisis family treatment modalities available family generally depend child 's specific limb deficiency deficiencies surgery reconstruct deficiency option many patients abnormal joints soft tissues amputation may recommended patients whose deficiency difficult impossible manage limb lengthening option patients whose bones smaller normal widely used treatment modality immediately limb lengths improve function baby born congenital limb deficiency , initial response parents shock denial adjusting newborn , must first loss baby expected adjustment process begins , specific information limb deficiency treatment options available family adjustment child continual process child , management strategies need change adjust child 's changing needs appropriate timely health care family intervention , child congenital limb deficiency , successful person
pediatric cardiac surgery guided echocardiography established indications new trends cardiac surgery children preceded cardiac catheterization , diagnosis based clinical findings two dimensional doppler echocardiography 355 operations without cardiopulmonary bypass nine major seven minor diagnostic errors \( 2 5 2 \) among 247 cases open heart surgery major eight \( 3 2 \) minor errors malformations suitable surgery without catheterization seem reduced pulmonary blood flow requiring systemic pulmonary artery shunt , aortic coarctation patent ductus arteriosus open heart surgery without invasive investigation , atrial septal defect , partial atrioventricular canal , aortic pulmonary stenosis , cardiac tumor isolated valve disorder candidates recent experience indicated selected cases complete atrioventricular canal , tetralogy fallot , arteriosus , total anomalous pulmonary venous connection transposition great arteries may safely undergo primary repair without cardiac catheterization diagnostic , pediatric cardiac surgeons must become familiar echocardiography
effects transforming growth factor beta il 1 rheumatoid synovium investigated potential mechanisms lymphocytes infiltrating rheumatoid synovium become immunosuppressed 20 22 synovial fluids 12 13 synovial tissue culture supernatants , il 1 bioactivity could detected thymocyte proliferation assay preparations could , however , support proliferation fibroblast monolayers , consistent presence il 1 fibroblast growth factors addition either rheumatoid synovial fluids synovial culture supernatants exogenous il 1 il 1 bioassay caused marked inhibition assay indicative il 1 inhibitor inhibition il 1 could reversed treating effusions supernatants neutralizing antibody transforming growth factor beta \( tgf beta \) furthermore , monocyte macrophages isolated rheumatoid synovial fluid constitutively released latent active tgf beta culture levels sufficient completely block biologic activity 100 u ml il 1 production substantial levels tgf beta synovial macrophages , well apparent ability inflammatory macrophages activate latent tgf beta , implicates tgf beta important inhibitor il 1 induced lymphocyte proliferation , also key cytokine promoting synovial fibroblast hyperplasia pathology
evidence cutaneous antigen presenting cells migrate regional lymph nodes contact sensitization studies address hypothesis ag bearing epidermal langerhans cells migrate regional lymph node contact sensitization function apc skin c3h mice grafted onto balb c nude mice , 7 14 days later , recipients sensitized fitc grafts apc lymph nodes draining site sensitization capable sensitizing c3h recipients fitc sensitization mhc restricted , cells reaching lymph node grafted skin could induced contact hypersensitivity c3h mice examination fitc draining lymph node cells immunofluorescence immunoelectron microscopy demonstrated ia , 80 , contained granules studies demonstrate ia , fitc cells skin , least langerhans cells , leave skin sensitization fitc participate initiation contact hypersensitivity response within regional lymph node
aberrant proliferation lumen forming cells stratified epithelium porokeratosis skin present investigation based postulate , first proposed reed 1970 , porokeratosis lesions represent clonal growth epidermal cells comparative studies using immunocytochemical staining , epidermal cell culture , non equilibrium ph gradient \( \) gel electrophoresis analysis keratins extracted carried five patients various types porokeratosis positive type iv collagen staining stratum corneum found lesional skin specimens patients , normal controls search connections type iv collagen basement membrane epidermis skin surface disclosed infrequent intra epidermal type iv collagen one positively stained trans epidermal positive intra epidermal laminin staining porokeratosis lesions confirmed trans epidermal passage basement membrane materials epidermal cells cultured lesional skin showed low efficiency , colonies exhibited intracytoplasmic formation excessive top cell gel electrophoresis keratins extracted showed lesional profiles contained keratins normally present glabrous skin , also possibly additional proteins cells previous studies findings , taken together , strongly suggest porokeratosis epidermis consists epithelial cells lumen forming ability
cell layer outer root sheath positive ki 67 expression cell proliferation associated human nuclear antigen immunohistochemically studied human anagen hair hair follicles using monoclonal antibody ki 67 reaction ki 67 mature anagen hair follicles observed hair matrix cells outer root sheath \( \) cells nuclear staining seen small number matrix cells cells finding corresponded thymidine bromodeoxyuridine labeling studies previously reported addition , two different patterns cytoplasmic staining strong staining cells \( \) weaker staining cells isthmus ki 67 reactivity layer observed stage anagen regularly seen upper bulb isthmus ki 67 commercially available antibody detects cycling cells however , anagen hair follicles showed cytoplasmic labeling ki 67 matrix cells upper bulb distal portion isthmus
increased phospholipase c catalyzed hydrolysis phosphatidylinositol 4 , 5 1 , 2 sn diacylglycerol content psoriatic involved compared uninvolved normal epidermis evidence suggests phospholipase c protein kinase c signal transduction system regulation epidermal cell growth differentiation psoriatic epidermis characterized hyperproliferation , defective differentiation , inflammation report , determined activity phospholipase c catalyzed hydrolysis phosphatidylinositol 4 , 5 \( pip2 \) 1 , 2 diacylglycerol content normal psoriatic involved uninvolved epidermis 1 , 2 diacylglycerol formed phospholipase c catalyzed hydrolysis pip2 physiologic activator protein kinase c pip2 hydrolysis assayed soluble particulate fractions prepared biopsies normal psoriatic skin total lipids extracted normal psoriatic epidermis 1 , 2 \( mixture 1 , 2 diacylglycerol 1 ether , 2 acyl glycerol \) quantitated enzyme assay 1 , 2 diacylglycerol potent activator protein kinase c , relative proportions 1 , 2 1 ether , 2 uninvolved involved psoriatic epidermis determined accomplished separation acetate derivatives 1 , 2 diacylglycerol 1 ether , 2 acyl glycerol thin layer chromatography soluble membrane associated phospholipase c catalyzed pip2 hydrolysis increased 3 7 times \( p less 0 001 \) 3 times \( p less 0 004 \) , respectively , psoriatic involved compared uninvolved normal epidermis 1 , 2 content also significantly elevated \( 3 times , p less 0 01 \) psoriatic involved versus uninvolved normal epidermis analysis acetate derivatives 1 , 2 psoriatic uninvolved involved epidermis revealed 1 , 2 diacylglycerol major species \( 86 95 , respectively \) significant differences either phospholipase c catalyzed pip2 hydrolysis 1 , 2 diacylglycerol content uninvolved normal epidermis 1 , 2 diacylglycerol purified normal involved psoriatic epidermis capable activating protein kinase c normal epidermis vitro epidermal slices , activation protein kinase c addition 12 0 tetradecanoylphorbol 13 acetate 1 , 2 diacylglycerol \( 1 , 2 \) resulted subsequently decreased protein kinase c activity , process termed regulation data consistent possibility elevation lesional 1 , 2 diacylglycerol content may account , part , previously reported reduction protein kinase c activity psoriasis \( horn , , fisher , et al j invest 88 220 222 , 1987 \)
successful culture adult human melanocytes obtained normal vitiligo donors development growth conditions human melanocytes uninvolved skin vitiligo patients age matched normal adults prerequisite understanding etiology disorder using new growth conditions , pure cultures prepared normal adults pigmented skin vitiligo donors cell types grew without lag period maintained six months \( 4 8 passages \) cultures could expanded several thousand melanocytes original cell suspension several million cells \( 2 7 x 10 \( 6 pure culture obtain results , current standard conditions culture fetal melanocytes substantially modified medium less satisfactory 153 adult normal vitiligo cells also required presence exogenous catalase \( 20 micrograms ml \) isolation primary seeding thereafter , enzyme necessary melanocytes grew best gave highest yields concentrations calcium \( 200 microm \) phorbol ester 12 0 tetradecanoylphorbol 13 acetate \( tpa \) low \( 4 8 nm \) growth factors included 153 media bfgf , crude bovine pituitary extract , insulin , transferrin , hydrocortisone , 5 , antioxidant alpha tocopherol cholera toxin \( \) omitted 153 growth medium slowed growth even low concentrations results indicate adult vitiligo melanocytes cultured preliminary studies normal vitiligo cells indicate vitiligo melanocytes retain ultrastructural abnormalities observed skin even grown culture
clinical significance immune reactions streptococcal antigens rheumatoid arthritis level antibodies delayed type hypersensitivity group specific cell wall proteins groups , b , c g streptococci determined 247 patients rheumatoid arthritis \( ra \) well healthy persons patients articular disorders means enzyme linked immunosorbent assay , passive leukocyte migration inhibition tests increase immune response antigens group b streptococcus found patients ra greatest sensitization antigens typical high disease activity short duration , rapidly progressive course ra high titers antibodies polysaccharide group b streptococcus appeared synovial fluid early stages clinical development ra values immune response streptococcal antigens correlated well titer rheumatoid factor concentration immunoglobulins immune complexes presence group b streptococcus tract appeared often patients ra healthy persons possibility triggering role immune reactions antigens group b streptococcus process ra discussed , well diagnostic significance results
antibodies denatured type ii collagen rheumatoid arthritis negative association igm rheumatoid factor serum samples 129 patients definite classic rheumatoid arthritis \( ra \) assayed elisa antibodies denatured bovine type ii collagen \( dii \) patients active disease time serum sampling anti dii antibodies found 18 \( 14 \) 129 patients \( 95 confidence intervals 8 20 \) clinical laboratory feature associated presence anti dii antibodies igm rheumatoid factor \( igm rf \) 6 \( 37 5 \) 16 seronegative patients anti dii antibodies vs 12 \( 10 6 \) 113 seropositive patients \( 5 , p less 0 01 \) associations anti dii antibodies age , sex , race , disease activity , disease duration , functional class , presence hla dr1 , dr4 , dqw3 patients antibodies type ii collagen may pathophysiologic role ra , especially patients seronegative rf
pulsed suppressive treatment rheumatoid arthritis intravenous methylprednisolone nitrogen mustard persistent polyarticular rheumatoid arthritis \( ra \) aggressive disease resistant conventional therapy effectively controlled intravenous pulse methylprednisolone \( \) nitrogen mustard \( \) efficacy , toxicity immunologic effects agent reviewed clinical response evident within days start therapy persisting 6 weeks least 59 days morbidity agents minimal appropriate precautions taken directly related either modality reported ra
elevated serum levels soluble interleukin 2 receptor , interleukin 2 neopterin diffuse limited scleroderma effects study 48 patients systemic sclerosis \( ssc \) elevated serum levels soluble interleukin 2 receptor \( il 2r \) , interleukin 2 \( il 2 \) neopterin \( indicators lymphocyte monocyte activation \) noted 100 , 44 40 early untreated patients ssc \( 11 diffuse , 5 limited \) levels il 2r , il 2 neopterin , lower patients longer duration disease possibly therapy pharmacologic alterations markers humoral cell mediated immunity may accurate reflection clinical efficacy
double blind placebo controlled trial low dose clotrimazole rheumatoid arthritis seventy three patients rheumatoid arthritis randomized double blind study receive either clotrimazole \( 20 mg kg day \) 2 days week 12 weeks matching placebo patients receiving clotrimazole significant improvements \( p less 0 05 \) baseline measurements grip strength , joint count , patient assessment pain , show significant improvement patients treated placebo adverse experiences , predominantly gastrointestinal complaints , occurred patients taking clotrimazole resulting 9 patients discontinuing therapy
lack significant interaction low dose methotrexate ibuprofen flurbiprofen patients arthritis low dose methotrexate \( mtx \) widely used treatment rheumatoid arthritis current product recommendations accompanying mtx preparations concurrent usage nonsteroidal antiinflammatory drugs \( nsaid \) , adverse pharmacokinetic interactions reported combination six patients receiving mtx studied oral parenteral mtx , 10 25 mg dose , without nsaid ibuprofen \( mg day \) flurbiprofen \( 300 mg day \) 6 weekly doses serum mtx levels obtained frequent intervals serum separated mtx analyzed using radioimmunoassay \( ria \) observable interaction mtx either ibuprofen flurbiprofen , respect area curve per unit dose , , dose , , serum half life pharmacokinetic indices significantly influenced route administration
psychological screening rheumatoid arthritis objective examine utility symptom checklist 90 r \( scl 90 r \) psychological screening instrument patients rheumatoid arthritis \( ra \) subjects 81 male 3 female patients classic definite ra categorized 3 anatomic stage groups based roentgenograms erythrocyte sedimentation rates , joint counts , scl 90 r obtained subjects addition , surveyed , items analyzed identify potential disease related items scl 90 r survey item analyses supported utility scl 90 r psychological screening instrument population ra
reliability pain scales assessment patients rheumatoid arthritis assessment measure chronic pain , reliable , valid sensitive change study evaluated reliability 3 pain scales , visual analogue scale \( vas \) , numerical rating scale \( \) verbal rating scale \( \) patients rheumatoid arthritis \( ra \) patients ra attending outpatient rheumatology clinic interviewed asked score pain levels 3 pain scales scales presented random order , twice , regular medical consultation ninety one patients studied \( 25 66 \) pearson product moment correlation first second assessment 0 vas , 0 0 patient group 0 vas , 0 0 patient group results indicate higher reliability groups patients
estimating incidence prevalence rare rheumatologic diseases review methodology available data sources editorial need descriptive epidemiology great , population based registries established , considerable cost , provide desired data many instances , however , may existing data information systems provide morbidity information sufficiently large , well defined populations allow reasonable estimates incidence prevalence rare rheumatologic diseases
successful pregnancy outcome association diabetes mellitus diabetes mellitus rare syndrome characterized insulin resistant diabetes mellitus partial without clinical diabetes mellitus associated intrauterine growth retardation fetal death report successful pregnancy outcomes two women diabetes mellitus
vancomycin induced red man syndrome total 11 cases red man syndrome collected among children received vancomycin hospital 1986 1988 \( estimated prevalence 1 6 \) retrospectively analyzed 11 children compared 11 age matched children received vancomycin red man syndrome develop patients red man syndrome , 73 , patients reaction , 45 4 received vancomycin penicillin resistant staphylococcus epidermidis positive cultures , history penicillin allergy difference observed dose per kilogram given groups \( 12 9 3 5 mg kg per dose red man syndrome vs 12 3 6 9 mg kg per dose control children duration \( mean standard deviation \) vancomycin infusion 45 9 16 7 minutes \( range 10 90 minutes \) patients red man syndrome 54 5 7 6 minutes \( range 45 65 minutes \) control group \( p 07 \) 5 children red man syndrome vancomycin , slower infusion rates prevented reduced syndrome , emphasized fact rate administration important determinant red man syndrome susceptible cases clinically , syndrome developed end infusion patients , appeared early 15 minutes initiation infusion mostly manifested , erythematous rash face , neck , around ears less frequently , rash distributed body pruritus usually localized upper trunk also generalized \( 2 11 children \)
major histocompatibility complex haplotype studies ashkenazi jewish patients pemphigus vulgaris 26 ashkenazi jewish patients pemphigus vulgaris , 24 \( 92 3 \) carried major histocompatibility complex \( mhc \) class ii alleles hla dr4 , dqw3 , subtype dr4 , dqw8 studies patients families , haplotypes defined found , patients carried hla dr4 , dqw8 , 75 carried one \( one case , \) two haplotypes hla b38 , , dr4 hla , , dr4 former known extended haplotype among normal jews , frequency 0 102 , latter may also extended haplotype ethnic group , frequency 0 017 among normal haplotypes jews remaining dr4 positive patients , one presumed region segment \( defined , dr4 , dqw8 , dr4 , dqw8 variable hla b \) haplotypes one patient dr4 , dqw8 without markers extended haplotypes number homozygotes heterozygotes dr4 , dqw8 consistent dominant recessive \( p less 0 01 \) inheritance class ii class ii linked susceptibility gene disease since disease entirely attributable presence antibody intraepidermal intercellular cement substance , likely class ii susceptibility gene \( hla b38 , , dr4 , dqw8 , hla , , dr4 , dqw8 , segments , jewish patients \) controls production antibody dominantly expressed immune response gene
source significance raised serum enzymes rheumatoid arthritis hepatobiliary dysfunction rheumatoid arthritis suggested basis raised serum activity alkaline phosphatase , 5 nucleotidase , lactic dehydrogenase gamma transferase , specific pathological lesion demonstrated serum transaminases bilirubin almost invariably normal paper reports series studies designed determine tissues origin enzymes offers alternative interpretation findings results suggest alkaline phosphatase liver , lactic dehydrogenase 5 nucleotidase originate synovial fluid synovial lining cells , respectively serum alkaline phosphatase may induced inflammatory mediators interleukin 1 correlates acute phase response serum lactic dehydrogenase integrated measure lysis joints offers marker joint inflammation specific measures esr levels serum 5 nucleotidase provide information activity synovium finally , hepatic necrosis normally occur , transaminases may used monitor drug toxicity
cicatricial pemphigoid affecting conjunctiva conjunctival biopsy specimens 13 patients cicatricial pemphigoid 13 age matched healthy individuals undergoing cataract surgery analyzed light microscopy immunohistochemical techniques , including panel monoclonal antibodies used characterize inflammatory mononuclear cell phenotypes results histologic examination cicatricial pemphigoid specimens showed typical squamous metaplasia , vasculopathy , increased numbers mast cells , abundant plasma cells cicatricial pemphigoid specimens demonstrated epithelial basement membrane zone \( \) epithelium cicatricial pemphigoid conjunctiva showed significantly helper cells \( cd4 \) , dendritic cells \( \) , macrophages \( cd14 \) , significantly higher helper suppressor ratio controls substantia propria , pemphigoid specimens showed dramatically increased inflammatory infiltrate significantly cells staining , order frequency , cells \( cd3 , cd5 \) , helper cells \( cd4 \) , suppressor cells \( cd8 \) , macrophages \( cd14 , mac 1 \) , dendritic cells \( , hla dr \) ten percent cells expressed interleukin 2 receptor protein \( cd25 \) , indicating cell activation
case reconstruction using occipital island flap preliminary case reported large temporal scar including successfully reconstructed using occipital island flap combination tissue flap considered kind reverse flow island flap occipital artery means fine vascular connections temporal branch superficial temporal artery new method potentially good solution reconstruction
individual patterns immediate skin reactivity mold extracts one hundred atopic patients skin tested 2 year period 30 different mold extracts subjects monitored immediate reactions data suggest evaluate mold sensitivity atopic patients one must use multiple mold extracts
anogenital warts children clinical evaluation sexual abuse seventy three children anogenital warts examined sexual abuse 2 year period data suggest transmission common , particularly children 3 years age approximately 25 children younger age 1 year , another 50 ages 1 3 years evidence sexual abuse detected 66 children
type vii collagen 19 1 antigen comparison expression inversa generalized variants recessive dystrophic epidermolysis bullosa expression type vii collagen 19 1 antigen examined 73 71 patients , respectively , recessive dystrophic epidermolysis bullosa \( rdeb \) , comprising gravis , mitis , inversa , subsets , better determine specificity sensitivity two monoclonal antibodies directed dermoepidermal junction specific epitopes type vii collagen \( lh 7 2 epitope \) usually absent \( 90 \) patients gravis variant rdeb , whereas expression often diminished \( 67 \) mitis form disease 2 5 patients gravis mitis variants , respectively , apparent normal amounts type vii collagen within skin contrast , six \( 86 \) seven patients inversa variant normal expression antigen 25 patients rdeb lacked 19 1 antigen , however , gravis variant , although absence diminution also infrequently observed mitis inversa forms intermediate findings noted patients classified forms rdeb variability antigen expression also noted among affected siblings conclude assessment expression lh 7 2 epitope type vii collagen may useful , although considerable overlap exist individual patients gravis mitis forms 19 1 expression far less sensitive probe rdeb , although data may prove useful assessment newborns lacking characteristic features gravis disease addition , based experience inversa rdeb , would appear altered expression type vii collagen cannot attributed blister formation latter rare subset , since antigen usually strongly detected along dermoepidermal junction , even perilesional skin sites
synovial fluid polymorphonuclear patients rheumatoid arthritis reduced mpo nadph oxidase activity synovial fluid \( sf \) polymorphonuclear \( pmn \) patients rheumatoid arthritis \( ra \) compared ra normal circulating blood pmn ra sf pmn viable blood pmn remained viable 24 h culture measurement myeloperoxidase indicated ra sf pmn secreted myeloperoxidase prior isolation , 26 5 11 7 found compared less 2 9 ra normal blood pmn ra sf pmn alone showed decrease basal nadph oxidase activity well increase responsiveness stimulation chemotactic peptide culture stimulation pmn phorbol 12 13 acetate evoked equivalent responses population culture results demonstrate major difference resting receptor mediated activation superoxide release ra sf pmn together , results important implications identifying role activated pmn ra
limiting dilution analysis cells rheumatoid arthritis limiting dilution analysis shown autologous mixed lymphocyte reaction regulated least two cell populations , limiting dilution analysis nine patients rheumatoid arthritis shown significant decrease populations compared 10 control subjects mechanism consequences decrease known
laboratory clinical study pneumatic devices use inflated bags cuffs measure grip strength well established technique method number problems bags different diameter volume seen give statistically significantly different pressure readings subjects different initial pressures \( 20 mmhg 60 mmhg \) also gave significantly different results laboratory tests materials testing machine patients rheumatoid arthritis bag technique squeezing also affected results despite intrinsic system , likely remain general use familiarity convenience recommend minimum details required derived data published
cycling combination antirheumatic drug therapy rheumatoid arthritis open pilot study combination hydroxychloroquine , prednisolone alternating months treatment sulphasalazine oral weekly pulse methotrexate investigated 16 patients rheumatoid arthritis \( ra \) refractory total 67 disease suppressive medications results 3 months indicated significant improvements visual analogue score pain , joint count , ritchie index , scale disability related activities daily living , esr , rheumatoid factor c reactive protein degree improvement , however , maintained 6 12 months treatment pain score , ritchie index esr parameters demonstrating significant improvement 12 months therapy terminated eight patients , half due lack efficacy half side effects
rheumatoid arthritis , differs sulphasalazine addition one methyl group , may provide benefits parent drug fewer side effects rheumatoid arthritis \( ra \) describe outcome use ra 21 patients entered study , 10 successfully completed 6 months therapy five developed adverse effects , four withdrew reasons unrelated drug treatment two stopped serious adverse effects reported statistically significant improvement clinical assessments observed weeks 8 12 significant improvement plasma viscosity observed trend towards improvement serum crp , histidine igm concentrations good correlation mean serial changes clinical biochemical assessments indicating drug may exhibit properties second line agent median steady state serum concentrations 26 6 micrograms ml 2 85 micrograms ml respectively
analysis il 1 tnf alpha gene expression human rheumatoid normal monocytes situ hybridization human il 1 alpha , il 1 beta , tnf alpha mrna expression examined peripheral blood monocytes \( pbm \) normal individuals primary isolated patients rheumatoid arthritis northern blot situ hybridization cells cultured presence absence lps analyzed using vitro synthesized 35s labeled sense antisense rna probes determine relative abundance cell type expressing mrna potent inflammatory mediators results indicated 72 lps stimulated pbm expressed detectable levels il 1 alpha mrna , 89 il 1 beta mrna , 10 tnf alpha transcripts thus , majority activated pbm produced il 1 alpha il 1 beta experiments combining immunofluorescence il 1 beta protein situ hybridization tnf alpha mrna demonstrated monocytes expressing tnf alpha mrna also produced il 1 beta primary four patients ra also examined mrna expression cytokine northern blot analyses total rna isolated 0 72 h lps mock stimulation showed il 1 beta mrna abundantly expressed , followed tnf alpha situ hybridization revealed il 1 beta tnf alpha transcripts detected exclusively synovial tissue macrophages il 1 alpha mrna detected cultures either method
evidence epidermal cytokine network cytokines \( \) proteins synthesized secreted various cells , bind specific receptors target cells regulate activation , proliferation , differentiation immune well non immune cells keratinocytes upon injury release interleukin \( il \) 1 , il 6 , il 8 , colony stimulating factors , tumor necrosis factor , well growth suppressor factors also strong evidence network interacting cytokines , partially characterized far , maintaining proper balance however , excessive insufficient production mediators may contribute certain disease states , particularly infectious autoimmune genesis therefore understanding cytokine interactions may helpful diseases moreover , certain cytokines , well analogues antagonists , may prove therapeutic value
leukocyte chemoattractant cytokines epidermis constitutive production interleukin 1 alpha like material normal human epidermis , inflammatory properties , mechanism inflammatory action briefly reviewed isolation interleukin 8 psoriatic lesions , vitro production , leukocyte chemoattractant properties also described available evidence suggests 1 8 inflammatory cytokines major potential importance induction leukocyte infiltrates human skin
interleukin 1 interleukin 6 psoriasis report levels expression il 1 il 6 skin psoriasis patients different approaches pursued initially , levels il 1 beta il 6 measured suction blister fluid lesional uninvolved skin psoriasis patients , using sensitive enzyme linked assay \( elisa \) assay skin sections also examined presence il 1 il 6 using il 1 beta il 6 specific antibodies finally , expression il 1 il 6 mrna determined cultured keratinocytes \( kc \) fibroblasts psoriasis skin suction blister fluid lesional uninvolved psoriasis skin skin healthy individuals contain detectable levels \( greater 100 pg ml \) il 1 beta blister fluid psoriasis lesions contained low significant levels il 6 , whereas serum levels il 6 patients undetectable using cryostat skin sections il 1 beta specific monoclonal antibody \( moab \) indirect immunoperoxidase technique , diffuse staining entire epidermis observed sections uninvolved skin psoriasis patients cryostat sections psoriasis lesions , faint diffuse staining epidermis pronounced dot like intracellular staining pattern observed hand , il 1 beta specific moab showed , indirect immunofluorescence technique using epidermal cells , membrane staining epidermal cell suspensions psoriasis lesions slightly elevated levels il 1 beta il 1 alpha mrna observed cultured kc psoriasis lesions compared normal kc hep 2 cell line low levels il 6 mrna expressed kc psoriasis lesions healthy individuals fibroblasts psoriasis lesions expressed extremely low levels il 1 alpha il 1 beta , high levels il 6 mrna results point paradoxical situation psoriatic skin blister fluid psoriasis lesions contains il 1 beta , whereas il 1 beta overexpressed plasma membrane intracellular compartment epidermal cells finding may help explaining observed absence il 1 aqueous extracts psoriatic scales cultured kc psoriasis lesions express minimal levels il 6 mrna dermal fibroblasts , probably together inflammatory infiltrate , may represent major source il 6 psoriasis lesions vivo
possible role transforming growth factor beta systemic sclerosis cause systemic sclerosis remains unknown , cellular molecular mechanisms possibly responsible characteristic clinical manifestations fibrosis vascular damage \( raynaud 's phenomenon , , digital infection , renal \) becoming understood greater detail one possibly important cytokine transforming growth factor beta \( tgf beta \) involvement reviewed regard vascular lesions , tgf beta variably shown inhibit endothelial cell growth vitro promote angiogenesis vivo , paradox remains unresolved nonetheless , activity tgf beta microvascular endothelial cells could help explain intimal proliferation microvascular seen whether result cause endothelial cell damage , platelet activation well documented systemic sclerosis platelet alpha granule pool contains large quantity tgf beta tgf beta also produced activated macrophages cells , known occur within systemic sclerosis lesions important effect tgf beta stimulation fibroblast collagen fibronectin synthesis deposition extracellular matrix stimulation tgf beta may therefore account fibrosis seen dermis internal organs direct evidence tgf beta involvement systemic sclerosis , awaits discovery either abnormal expression response tgf beta biologic effects tgf beta appear regulated level activation latent polypeptide precursor form descriptions importance cytokine pathologic conditions need account activation regulation nonetheless , physiologic effects far attributed tgf beta make involvement systemic sclerosis attractive possibility explain manifestations disease
abnormal cutaneous molecular basis mononuclear cell patterns inflammatory skin disease identification characterization various adhesion molecules \( lymphocyte function associated antigen 1 , intercellular adhesion molecule 1 \) , chemotactic factors \( interleukin 8 , monocyte chemotactic activating factor \) , cytokines \( gamma interferon , tumor necrosis factor \) , possible begin specific molecules cutaneous cellular reaction patterns abnormal , altered spatial distribution , mononuclear cells , gives rise disease specific patterns , described molecular terms large number diverse skin diseases classified six different groups , group distinctive cell types , adhesion molecules , chemotactic factors , cytokines diseases within group , share functional anatomical reaction zones , postulated share common pathophysiologic pathways thus , possible , one scans microscopic field , look past static images red blue stained cells dynamic detailed defined events
response discoid subacute cutaneous lupus erythematosus recombinant interferon alpha 2a ten patients suffering discoid lupus erythematosus \( \) subacute cutaneous lupus erythematosus \( \) treated interferon alpha 2a marked improvement clearing cutaneous lupus erythematosus lesions observed eight however , response interferon short duration within weeks interferon withdrawal patients improved cleared relapsed study suggests interferon alpha 2a represents new interesting approach treatment ongoing trials define optimal treatment schedule maintenance interferon induced improvement cutaneous lupus erythematosus
application beta interferon virus induced eighty patients bilateral common warts extremities treated weekly intervals injections either human fibroblast interferon placebo interferon \( 3 x 10 \( 6 \) units \) diluted 3 ml normal sterile saline matched identical vials placebo eighty sets three vials human fibroblast interferon placebo labeled either b maintained code experiment completed patient received 0 1 x 10 \( 6 \) units interferon warts one side placebo injections matching extremity warts measured week progress lack scored scale 1 \( worse \) 3 \( cured \) therapy continued either least one extremity cleared patient received 10 weekly injections final evaluation scored measuring total progress patient study sixty four patients treated completion 81 interferon treated extremities either cured responded effectively therapy 17 placebo treated lesions responded fashion statistical analysis data confirms effectiveness interferon therapy average number interferon injections cure 5 9 1 7 adverse effects observed applications interferon patients flat warts also studied interferon beta , certain degree , effective benign lesions , systemic treatments effective subcutaneous interferon beta , uncontrolled study , effective 45 patients flat warts
atlantoaxial stabilization rheumatoid arthritis atlantoaxial subluxation patients rheumatoid arthritis common operative stabilization clearly indicated signs symptoms spinal cord compression occur however , many recommend early operative fusion evidence appreciable neural compression occurs 1 \) myelopathy patients may irreversible 2 \) overall prognosis poor symptoms cord compression present 3 \) risk sudden death associated atlantoaxial subluxation increased even asymptomatic patients authors believe rheumatoid arthritis patients relatively good health without advanced multisystem disease less 65 years age considered operative stabilization mobile atlantoaxial subluxation greater 6 mm seventeen patients severe rheumatoid arthritis atlantoaxial subluxation treated posterior arthrodesis presented new method fusion , devised senior author \( v k h \) , utilized cases indications operative therapy patients included evidence spinal cord compression 11 patients \( 65 \) mobile atlantoaxial subluxation greater 6 mm signs symptoms cord compression six patients \( 35 \) thirteen patients developed stable osseous fusion , two patients well aligned fibrous union , one patient fibrous union , one patient died prior evaluation fusion stability details operative technique management strategies presented several technical advantages method fusion make approach particularly useful patients rheumatoid arthritis multisystem involvement disease , high rate osseous fusion often difficult achieve
scar revision successful revision facial scars much art science , best continued experience however , common sense , broad knowledge available options , technical ability , necessary one practice challenging field patients facial scars vulnerable way others , responsibility facial plastic surgeon evaluate patients properly , prepare process may involve multiple procedures , see process expertise possible done , patient surgeon
autoantibody th ribonucleoprotein \( nucleolar 7 2 rna protein particle \) patients systemic sclerosis studied sera 371 consecutive new patients systemic sclerosis \( ssc scleroderma \) first evaluated 1984 1988 sera tested antinuclear antibodies immunofluorescence staining using hep 2 cells substrate excluded 219 sera showing dark nucleoli screened antibodies th remaining 152 sera immunoprecipitation 32p labeled hela cell extract fifteen \( 4 0 \) 371 sera anti th anti th antibodies present 14 \( 8 4 \) 167 ssc patients limited cutaneous involvement , 1 167 diffuse cutaneous involvement , 0 37 ssc overlap syndrome among 244 controls connective tissue diseases , anti th detected 3 patients , primary raynaud 's phenomenon less 2 years duration subgroup ssc limited cutaneous involvement , 14 anti th patients significantly greater frequency fingers , small bowel involvement , hypothyroidism , significantly lower frequency arthritis cumulative survival rate time onset symptoms lower anti th patients \( 78 versus 91 10 years \) , primarily due 3 deaths pulmonary arterial hypertension \( 2 primary pulmonary hypertension 1 pulmonary hypertension secondary pulmonary interstitial fibrosis \) serum anti th antibodies present almost exclusively patients ssc limited cutaneous involvement primary raynaud 's phenomenon whose disease may evolve ssc limited cutaneous involvement , antibodies may identify patients greater risk reduced survival
increased expression type vi collagen genes systemic sclerosis expression type vi collagen genes affected skin patients systemic sclerosis \( ssc \) examined situ hybridizations human alpha 2 \( vi \) collagen sequence specific complementary dna five patients diffuse , rapidly progressive ssc recent onset \( less 12 months \) studied results showed increased expression alpha 2 \( vi \) collagen messenger rna transcripts skin scleroderma patients compared skin normal subjects findings indicate alterations expression type vi collagen genes , similar previously described types iii collagen , present affected skin ssc patients alterations may result excessive tissue accumulation type vi collagen may play role progressive skin sclerosis prominent features ssc
increased expression intercellular adhesion molecule 1 fibroblasts scleroderma patients surface expression intercellular adhesion molecule 1 \( icam 1 \) class class ii major histocompatibility complex molecules cultured dermal fibroblasts 7 scleroderma patients 6 control donors compared scleroderma fibroblast lines contained 41 0 3 0 \( mean sem \) cells high levels icam 1 expression \( icam 1 high \) , whereas 26 9 1 5 control fibroblasts icam 1 high \( p 0 0003 \) differences expression class class ii molecules icam 1 high icam 1 low fibroblasts produced equal amounts total protein procollagen increase number icam 1 high fibroblasts scleroderma patients may facilitate cell activation lymphokine production , thus indirectly contribute fibrotic process
association hla rheumatoid arthritis yakima indians evidence shared epitope hypothesis rheumatoid arthritis \( ra \) prevalent yakima indians , native american hla dr4 , hla specificity commonly associated ra , rare among yakima using specific oligonucleotide probe recognizes dr4 nucleotide sequences associated ra , rare hla gene identified 83 yakima patients ra 60 yakima control subjects shared sequence encodes discrete class ii epitope highly correlated ra dr4 positive dr4 negative individuals
identification platelet dense granule membrane protein deficient patient syndrome monoclonal antibodies raised injecting mice isolated human dense granules several found recognize 40 kd dense granule membrane protein western blot immunofluorescent analysis confirmed dense granule specificity thrombin activation , protein found patches external platelet membrane western blot slot blot analysis , protein found markedly deficient patient syndrome studies neutrophils endothelial cells show presence immunologically related granule membrane protein \( \) western blots using four anti synaptophysin antibodies three antibodies platelet 40 kd protein suggest protein may share homology , identical , membrane protein synaptophysin
transverse anatomy androgenic alopecia twenty five biopsy specimens frontal scalp five patients studied processing included vertical transverse \( horizontal \) sectioning , blue hematoxylin eosin staining , fixed frozen sectioning findings included decreased hair density , increased numbers , alteration normal follicular architecture transverse frozen sectioning blue staining appeared rapid reliable tool studying androgenic alopecia
urticaria clinical efficacy cetirizine comparison hydroxyzine placebo chronic urticaria problem physician patient effort avoid risks associated corticosteroid treatment , many first generation h1 receptor antagonists tried found induce undesirable levels sedation given amounts sufficient control urticaria cetirizine , pharmacologically active oxidized metabolite hydroxyzine , developed provide selective h1 receptor inhibition without depression central nervous system 4 week , multicenter , double blind , placebo controlled safety efficacy study , cetirizine , day dose \( 5 20 mg \) , equivalent efficacy hydroxyzine divided doses \( 25 75 mg day \) incidence somnolence cetirizine group significantly different placebo group however , hydroxyzine group , incidence somnolence significantly higher placebo group \( p 0 001 \) results study demonstrate cetirizine greater safety margin older parent drug hydroxyzine
langerhans cells monocytes capable antigen presentation vitro corticosteroid contact hypersensitivity corticosteroids suppress delayed type hypersensitivity \( dth \) reactions vivo impair lymphoid cell functions vitro contact hypersensitivity \( chs \) corticosteroids , however , corticosteroids capable inducing dth responses vivo present study examined capacity corticosteroids induce vitro proliferation lymphocytes patients chs corticosteroids peripheral blood mononuclear adherent cells antigen presenting cells \( apc \) hydrocortisone 17 \( h 17 b \) , proliferation responses detected lymphocytes patients chs h 17 b however , epidermal langerhans cells \( lc \) used apc , weak proliferation responses observed
validation sickness impact profile psoriasis disability index psoriasis prospective cross sectional questionnaire study 32 patients psoriasis carried order validate use sickness impact profile \( \) psoriasis compare sensitivity psoriasis disability index \( pdi \) overall pdi scores , overall scores , correlated well pasi scores \( p less 0 05 \) good correlation pdi overall scores \( p less 0 01 \) psychosocial factors severely impaired physical activities patients psoriasis possible directly compare disability experienced psoriatic patients experienced patients suffering systemic diseases , using pdi appropriate method give rapid overall measure psoriasis disability
double blind , right left comparison calcipotriol betamethasone valerate treatment psoriasis vulgaris published erratum appears 1991 apr 20 \( \) therapeutic efficacy tolerability calcipotriol ointment betamethasone valerate ointment psoriasis compared multicentre , prospective , randomised , double blind , right left trial 345 inpatients outpatients psoriasis vulgaris symmetrical distribution treated twice daily 6 weeks calcipotriol ointment 50 micrograms g betamethasone ointment 0 1 randomly assigned opposite sides body main outcome measures psoriasis area severity index \( pasi \) , investigators' assessments erythema , thickness , scaling , patients' assessments overall response treatment sought weeks 2 , 4 , 6 treatments significantly reduced pasi scores investigator 's assessment scores , visit pasi score significantly \( p less 0 001 \) lower calcipotriol betamethasone 6 weeks mean pasi reduction 68 8 calcipotriol 61 4 betamethasone \( 95 confidence interval difference 5 1 9 8 , p less 0 001 \) scores erythema , thickness , scaling significantly \( p less 0 001 \) lower calcipotriol betamethasone end treatment patients considered 82 1 calcipotriol treated sides 69 3 betamethasone treated sides improved greatly cleared end treatment \( p less 0 001 \) 57 adverse events reported 52 patients \( 15 1 \) common adverse event , lesional perilesional skin irritation , slightly significantly \( p 0 12 \) common calcipotriol treatment 15 \( 4 3 \) patients withdrawn study , 3 local adverse events changes serum calcium study thus , calcipotriol ointment superior betamethasone valerate ointment psoriasis vulgaris though long term results yet available , calcipotriol holds great promise agent
keratinocytes inflammation environmental stimuli responsible inducing cutaneous inflammation include contact allergens ultraviolet light postulate diverse stimuli trigger cutaneous inflammatory response directly inducing epidermal keratinocytes specific pro inflammatory cytokines adhesion molecules consequences activation dermal microvascular endothelial cells selective accumulation specific mononuclear cells dermis epidermis thus , keratinocytes may act signal transducers , capable converting exogenous stimuli production cytokines , adhesion molecules , chemotactic factors \( acting autocrine paracrine fashion \) responsible initiation antigen independent cutaneous inflammation initiation phase may facilitate promote amplification phase additional production tumour necrosis factor alpha interferon gamma via antigen dependent pathway , keratinocyte cell antigen presenting dendritic cellular associations direct activation keratinocytes , ability produce complete repertoire pro inflammatory cytokines , profoundly influence endogenous recruited immunocompetent cells , thereby providing critical trigger responsible clinically dramatic alterations occur following contact epidermis host agents
ultrastructural localization calcium psoriatic normal human epidermis ion capture , previously demonstrated distribution calcium ions murine epidermis , pattern consistent role ion regulation epidermal differentiation known proliferation differentiation defects psoriasis , compared calcium distribution involved vs uninvolved psoriatic lesions normal human epidermis whereas normal human uninvolved psoriatic epidermis revealed increased calcium containing precipitates stratum , contrast basal layer psoriatic lesions contained less extracellular calcium , condition favored enhanced proliferation moreover , psoriatic suprabasal cell layers displayed heavier normal concentrations calcium , indicating loss normal calcium gradient programs terminal differentiation abnormal profile may account differentiation defects \( eg , \) occur psoriasis finally , psoriatic lesions displayed retained ionic ca intercellular domains upper stratum absence normal intercellular , findings may underlie abnormal permeability barrier psoriasis
another case new disease describe case distinctive clinical entity characterized pruritus , red brown flat papules exhibiting chair sign , eosinophilia , propose langerhans cell may central role pathogenesis describe excellent response
newly identified u4 u6 snrnp binding proteins serum autoantibodies patient systemic sclerosis found serum autoantibodies directed proteins binding exclusively u4 u6 sm small nuclear ribonucleoprotein particle \( snrnp \) serum patient \( mas \) systemic sclerosis specificity , called anti mas , distinct known antibodies u snrnp u4 u6 small nuclear rna 32p labeled hela cell extract five proteins mr 150 , 000 , 120 , 000 , 80 , 000 , 36 , 000 , 34 , 000 , addition sm core proteins \( b , , , e , f , g \) 35s methionine labeled extract , immunoprecipitated anti mas isotonic solution however , sm core proteins u4 u6 small nuclear rna separated protein sepharose facilitated mas incubation solution containing 500 mm nacl immunoblots , anti mas antibodies reacted one protein mr 150 , 000 hela cell nuclear extract fractionated sds page transferred sheet purified antibody eluted immunoblot band immunoprecipitated u4 u6 small nuclear rna protein mr 150 , 000 data indicate anti mas antibodies recognize least one antigenic protein binds exclusively u4 u6 snrnp
abnormalities epidermal lipid metabolism patients atopic dermatitis atopic dermatitis inflammatory skin disease characterized skin study , measured phospholipid content fatty acid pattern lesional lesion free epidermal biopsies 15 patients comparison , epidermal biopsies obtained healthy individuals undergoing plastic surgery phospholipid content atopic epidermis nearly twice high healthy epidermis fatty acids significantly increased \( p less 0 001 \) n 6 fatty acids significantly decreased \( p less 0 001 \) lesional atopic epidermis compared lesion free epidermis content esterified arachidonic acid phosphatidylcholine lesional epidermis 49 found healthy epidermis \( p less 0 001 \) content free arachidonic acid 47 higher \( p less 0 05 \) , whereas content free long chain saturated fatty acids decreased 29 \( p less 0 01 \) , lesional compared lesion free atopic epidermis disease severity , calculated arbitrary index , correlated inversely n 6 fatty acid content lesion free atopic epidermis \( r 0 89 , p less 0 001 \) findings suggest atopic epidermis characterized increased activity phospholipase a2 incomplete transformation phospholipids lipid classes
effect retinoic acid platelet derived growth factor \( pdgf \) bioactivity type b pdgf receptors normal psoriatic human fibroblasts psoriasis common skin disease retinoids beneficial effects offers model study benign hyperproliferation abnormal differentiation dermis prominent role appearance epidermal lesions therefore interest study factors modulate dermal cell proliferation study , role retinoids modulating platelet derived growth factor \( pdgf \) bioactivity studied normal \( six subjects \) psoriatic fibroblasts involved uninvolved tissues \( six patients \) retinoic acid treatment \( 4 10 \( 6 \) \) psoriatic fibroblasts significantly increased chemotactic effect pdgf cells \( p less 0 01 p less 0 05 , respectively , involved uninvolved skin 20 ng ml platelet derived growth factor measured modified chamber assay \) way , retinoic acid treatment psoriatic fibroblasts increased platelet derived growth factor cells retinoic acid treatment significant effect mitogenic chemotactic activity pdgf normal fibroblasts binding bb pdgf type b receptor , mediates mitogenic chemotactic effect pdgf , modified retinoic acid treatment either psoriatic normal fibroblasts results suggest retinoic acid may modulate pdgf bioactivity psoriatic fibroblasts affecting binding ligand cells influencing post receptor event
characterization 230 kd bullous pemphigoid antigen associated detergent insoluble fraction cultured keratinocytes 230 kd protein identified antibodies patients bullous pemphigoid \( bp \) dual location cultured normal human epidermal keratinocytes part high speed supernatant cells part particulate fraction , resistant extraction non ionic detergent mild base antibodies affinity purified particulate 230 kd bp antigen , extracted presence urea affinity purified antibodies bind cytosolic 230 kd protein , showing related , identical , particulate form , also produce discontinuous granular pattern indirect immunofluorescence basement membrane zone rabbit esophagus epidermal cultures , expression 230 kd bp antigen limited basal cells data consistent 230 kd bp antigen involvement keratinocyte basal cell interaction extracellular matrix indicate cultured cell may provide useful model analysis 230 kd bp antigen function
calcium sensitive epitope pemphigus foliaceus antigen present murine tryptic fragment constitutes major antigenic region human autoantibodies recent findings indicate pemphigus foliaceus \( pf \) antigen involved epidermal cell adhesion characteristic pf lesions result loss function consequence autoantibody binding present communication present data epitopes involved human autoantibody binding immunologically reactive murine tryptic fragment pf antigen \( tf pf \) immunoprecipitation experiments showed 39 pf sera , obtained north american , , patients recognized calcium sensitive epitope \( \) tf pf immunofluorescence blocking experiments showed preincubation tf pf completely blocked immunofluorescence 80 sera tested human skin substrate , 86 sera tested murine skin substrate results show calcium sensitive epitope \( \) originally recognized human pf complex , \( \) present murine tf pf constitute \( \) major antigenic region human pf autoantibodies also implicate region pf antigen pathogenesis pf well epidermal cell adhesion
reduced neutrophil ltb4 release atopic dermatitis patients despite normal fatty acid composition abnormal fatty acid metabolism atopic dermatitis patients prompted us compare phospholipid fatty acid composition ltb4 release neutrophils 15 atopic dermatitis patients , well adipose tissue triglyceride fatty acid composition , 15 healthy controls matched age , gender , smoking habits found differences tissue fatty acid composition two groups release leukotriene b4 ca ionophore stimulated neutrophils patients average 42 \( p less 0 001 \) measured control group , despite similar arachidonic acid contents cells study support assumption abnormal fatty acid desaturation atopic dermatitis patients rather , capacity release convert arachidonic acid leukotrienes neutrophils appears affected disease
localization neutrophil activating peptide 1 interleukin 8 immunoreactivity normal psoriatic skin various cytokines past detected human skin among , neutrophil activating peptide nap 1 il 8 potent 8 kd proinflammatory peptide purified psoriatic scales chemotactic activity human neutrophils , well presence psoriatic scales , may relate role disease present study , tissue distribution peptide examined immunohistochemically using two monoclonal antibodies \( , \) recently produced characterized laboratory immunoreactivity detected normal psoriatic skin , resulting uniform suprabasal keratinocyte staining normal skin keratinocytes immunoreactivity psoriasis correlated inflammatory tissue reaction , varying uniform absence highly active psoriasis focally weak staining plaque type psoriasis cells hair follicles always positive unaffected inflammatory activity epidermal immunoreactivity detected study may associated closely related peptides family truncated extended forms nap 1 il 8
characterization skin infiltrating lymphocytes patients psoriasis study , skin infiltrating cells psoriasis patients characterized biopsies involved uninvolved skin histologic examination biopsies showed presence cd4 cd8 cells lack b lymphocytes skin biopsies also placed tissue culture medium supplemented human serum , interleukin 2 \( il 2 \) , irradiated autologous blood lymphocytes lymphocytes grew plaques skin biopsies consisted heterogeneous population cell subsets immunophenotypic analysis cultured cells comparable histologic examination frozen section , e , greater number cd4 cells cd8 cd45 cells cultures tested primed lymphocyte test \( \) cell mediated \( cml \) assays cultures tested demonstrated secondary proliferative cytolytic reactivity results indicate cell cultures generated found directed non human leukocyte antigens \( hla \) , e , minor hla restriction major hla antigens
iga binding structures dermatitis herpetiformis skin independent elastic microfibrillar bundles dermatitis herpetiformis \( dh \) characterized part presence granular deposits iga papillary dermis beneath dermal epidermal junction nature structures iga binds dh skin , however , clearly demonstrated previous immunoelectron microscopy studies using peroxidase technique concluded iga may bind abnormal elastic microfibrillar bundles recently , antibodies developed major component elastic bundles , fibrillin addition , another dermal matrix protein , , characterized found normal human skin distribution similar iga deposits dh utilizing antibodies fibrillin , , human iga immunogold staining techniques , examined skin patients dh order localize iga deposits normal appearing skin five patients dh exhibited electron dense patches within dermis , seen skin normal subjects structures sometimes adjacent basement membrane zone , appeared amorphous without well defined fibrillar structure electron dense patches labeled anti human iga , antibodies fibrillin anti iga antibody label normal basement membrane studies confirm presence abnormal electron dense , amorphous structures skin patients dh due lack association elastic bundles lack labeling antibodies fibrillin , suggest deposits distinct microfibrillar bundles elastic tissue may represent iga bound degraded basement membrane isolated dermal deposits iga
expression basement membrane proteins interstitial collagens dermal papillae human hair follicles expression basement membrane molecules interstitial collagens human hair follicle studied immunohistochemical staining tissue sections cells cultured dermal papillae type type iii collagens found dermal sheath dermal papilla throughout hair cycle laminin type iv collagen expressed outer root sheath basement membrane extracellular matrix dermal papilla anagen follicles follicles , volume dermal papilla extracellular matrix much reduced , outline staining dermal papilla cells laminin type iv collagen still apparent staining bullous pemphigoid antigen also seen outer root sheath basement membrane extending lower tip hair bulb anagen follicles , staining bullous pemphigoid antigen interface hair bulb epithelium dermal papilla staining within dermal papilla however , linear staining bullous pemphigoid antigen became continuous around hair follicle epithelium cells cultured human dermal papillae also stained interstitial collagens , type iv collagen laminin however , similar results obtained cultured dermal fibroblasts stained antibodies expression basement membrane proteins human dermal papillae resembles seen follicles mammalian species suggests relevant dermal papilla function cultured dermal papilla cells express similar pattern interstitial collagens basement membrane proteins seen tissue sections finding specific dermal papilla cells
cellular localization interleukin 8 inducer , tumor necrosis factor alpha psoriasis importance immunologic mechanisms psoriasis deduced ability immunosuppressive therapies ameliorate common chronic skin disease certainly histology psoriatic lesions suggests hyperplastic keratinocytes infiltrating lymphocytes macrophages begin dissecting cytokine network involved pathophysiology psoriasis , location , epidermal dermal compartments , tumor necrosis factor alpha , interleukin 8 , intercellular adhesion molecule 1 , transforming growth factor alpha protein mrna levels identified tumor necrosis factor alpha selected potentially key regulatory cytokine , first induces cultured keratinocyte interleukin 8 , intercellular adhesion molecule 1 , transforming growth factor alpha production , second intercellular adhesion molecule 1 expression keratinocytes psoriatic epidermis identified previously using immunohistochemical localization , tumor necrosis factor alpha identified 12 psoriatic lesions intense diffuse expression dermal dendrocytes \( macrophages \) papillary dermis \( without significant staining endothelial cells , mast cells , dermal langerhans cells \) , focally keratinocytes intraepidermal langerhans cells functional interaction dermal dendrocytes keratinocytes suggested presence interleukin 8 expression suprabasal keratinocytes immediately tumor necrosis factor alpha positive dermal dendrocytes interleukin 8 mrna transforming growth factor alpha mrna detectable epidermal roof psoriatic lesions , neither detectable protein mrna levels normal skin specimens treatment cultured human keratinocytes phorbol ester \( experimentally produces changes mouse skin \) tumor necrosis factor alpha also increased interleukin 8 transforming growth factor alpha mrnas elucidation cellular molecular basis genesis evolution psoriasis provide framework better evaluation cause treatment skin disease
monoclonal antibodies detect monocyte macrophage activation differentiation antigens identify functionally distinct subpopulations human rheumatoid synovial tissue macrophages monoclonal antibodies \( mabs \) functionally heterogeneous populations human rheumatoid arthritis \( ra \) synovial tissue macrophages lipopolysaccharide \( lps \) activated u937 cells generated mabs used characterize macrophages situ synovial study relative antigen expression surface cells isolated synovium normal peripheral blood monoclonal antibody , anti cd13 mab , reacts antigen expressed surface blood monocytes monocyte activation related antigen upregulated exposure monocytes interferon gamma \( ifn gamma \) lps expression antigen increases parallel mhc class ii antigen expression also upregulated culture monocytes mature macrophages antigen expressed strongly ra synovial tissue lining cells , thought composed macrophages antigen expression , detected mab , increases blood monocytes cellular activation lps interferon gamma , contrast antigen , increase monocyte maturation vitro antigen expressed differentially density defined macrophage subpopulations isolated ra synovial tissue expressed strongly macrophages angiogenic
treatment brittle onychoschizia biotin scanning electron microscopy pathologic changes swine normalized administration biotin vitamin given orally women brittle onychoschizia aim study test whether favorable clinical results could corroborated scanning electron microscopy investigated distal ends 32 persons placed three groups group consisted 10 control subjects normal nails , group b comprised eight patients brittle nails studied biotin treatment , group c 14 patients brittle nails administration biotin initial terminal clipping nails thickness nails group b increased significantly 25 group c , increase 7 nails reduced groups b c irregular cellular arrangement dorsal surface brittle nails became regular nails group b 8 11 nails group c
lymphocytic infiltrates skin association cyclosporine therapy three patients , one previously reported , erythematous papules nodules face upper part chest cyclosporine therapy inflammatory skin diseases histologic examination dna analysis \( performed two cases \) revealed benign dermal lymphocytic infiltrates two cases proliferation cells occurred third case , b cell populations expanded vacuolar degeneration basal layer epidermis igg , igm , c3 deposition along dermoepidermal junction findings may result cyclosporine induced immune dysregulation lesions resolved patients therapy stopped
antibodies synthetic peptides epstein barr nuclear antigen 1 sera patients early rheumatoid arthritis sera studied igg antibody levels synthetic peptides \( , e11 e3 \) epstein barr nuclear antigen 1 \( 1 \) protein sequence sera patients rheumatoid arthritis \( ra \) , pre ra rheumatoid factor \( rf \) positive non ra sera finland anti e11 anti e3 antibody levels significantly elevated ra sera , compared rf negative rf positive controls concentrations anti e11 anti e3 antibodies sera lower ra sera eight year followup samples patients ra slightly decreased levels anti e3 anti e11 antibodies compared samples taken within 6 months disease onset anti antibody levels differ significantly groups studied thus , elevated levels antibodies 2 glycine containing 1 peptides associated clinical ra
epidermal growth factor receptor fibroblasts patients scleroderma epidermal growth factor receptor \( egf r \) fibroblasts 3 patients scleroderma \( progressive systemic sclerosis , \) studied egf binding assay binding 60 9 4 0 normal fibroblasts , scatchard showed decrease affinity egf , number egf r fibroblasts expressed higher levels \( 1 15 2 45 fold \) rna v erbb \( egf r gene \) acid \( retinoid \) little effect egf r , v erbb gene expression proliferation fibroblasts data concerning abnormality egf r may constitute feature fibroblasts
reports erythematous macular skin eruptions associated diltiazem therapy diltiazem commonly prescribed calcium channel antagonist hypertension ischemic heart disease incidence rash associated diltiazem therapy reported 1 3 percent describe two patients developed erythematous , macular skin eruptions , approximately two weeks following institution diltiazem skin eruptions resolved symptomatic treatment patients received therapy another calcium channel antagonist diltiazem associated skin eruptions rare adverse effect however , incidence rash may occur frequently reported postmarketing surveillance studies
cyclosporine dermatoses article reviews indications , efficacy , possible mechanisms action cyclosporine treatment dermatoses dermatoses categorized according responsiveness cyclosporine therapy excellent , moderate , variable , advantages disadvantages cyclosporine discussed guidelines proposed use dermatoses
management patients side effects cyclosporine therapy cutaneous disorders cyclosporine used experimental treatment multiple inflammatory diseases presumed autoimmune origin , including insulin dependent diabetes mellitus , uveitis , rheumatoid arthritis , inflammatory bowel diseases , graves' disease , myasthenia gravis dermatology , drug used successfully primary therapy psoriasis psoriatic arthritis , alopecia , , 's disease , atopic dermatitis , dose 3 5 mg kg per day , cyclosporine well tolerated patients however , concerns potential short long term side effects , patients use drug require close monitoring review discusses appropriate clinical laboratory evaluations , common unusual side effects management , drugs might alter pharmacokinetics cyclosporine metabolism , criteria dosage adjustments
laboratory monitoring cyclosporine levels guidelines following guidelines recommended laboratory monitoring circulating levels cyclosporine dermatology patients measurements determined trough levels whole blood , plasma serum measurements performed assay specific parent cyclosporine compound \( e g , high performance liquid chromatography method specific monoclonal immunoassay \) results nonspecific immunoassays detect cyclosporine well metabolites difficult interpret cannot readily compared among different studies laboratories psoriasis patients , circulating concentration cyclosporine correlate reliably therapeutic response patients may achieve excellent response blood levels range 50 ng ml others may show little response despite blood levels high 200 ng ml patients poor clinical response , monitoring cyclosporine levels may useful confirm drug taken may provide estimate degree absorption metabolism parent compound upper limit safety circulating concentration cyclosporine clearly defined , one attempt achieve therapeutic response lowest possible dose clinicians must carefully monitor patients signs cyclosporine toxicity , regardless circulating concentration drug whole blood levels exceeding 250 ng ml avoided
effects cyclosporine renal function psoriasis patients several prospective studies documented effectiveness oral cyclosporine treatment psoriasis despite , use cyclosporine limited concern possibility drug induced renal dysfunction review effects cyclosporine renal function
immunity cyclosporine therapy cyclosporine cytotoxic inhibits production immunologic memory building growth factors cd4 lymphocytes also may inhibitory effects effector phase certain immune reactions inhibitory effects largely reversible treatment stopped , immune competence cyclosporine treated patients returns normal contrast , conventional cytotoxic immunosuppressive agents tend lymphocyte clones activated therapy , clonal deletions may cause permanent loss immunologic memory antigens lymphocytes readily restored adults thymus transplant patients received cyclosporine combination various immunosuppressive agents , reports suggest combination drug conventional immunosuppressive agents may associated increased early appearance non hodgkin 's lymphoma , possibly , endocrine related tumors increase cancers observed patients treated cyclosporine alone conditions psoriasis autoimmune diseases treatment adults cytotoxic immunosuppressive drugs may permanently lymphocyte clones required control latent oncogenic viruses certain malignant cells , patients treated cyclosporine , suppression cell function combined impairment cytokine mediated stimulation natural killer cells cytotoxic macrophages may facilitate tumor growth consequently , predicted cyclosporine monotherapy associated increased incidence tumors , would primarily affect psoriasis patients treated cyclosporine puva methotrexate therapy eventually , comparison cancer incidence different categories patients resolve issue
interactions epidermal cells cells inflammatory skin diseases multiple cell types factors cytokines involved regulating immune response inflammatory skin diseases stimulatory inhibitory factors interact determine whether immune response regulated normally , stimulatory signals inhibitory signals prevent immune reaction initiated however , exogenous antigens irritants endogenous factors altered immunogenic self peptides balance occurs , cells activated inflammatory skin reaction develops lymphokines released activated cells modify phenotype function normal keratinocytes induce expression adhesion molecules receptors involved antigen presentation furthermore , also stimulate keratinocyte proliferation may important development hyperplasia seen inflammatory skin diseases , especially psoriasis cytokines released activated keratinocytes stimulate cells epidermis thereby continue ongoing immune reaction
effects cyclosporine immunologic mechanisms psoriasis major investigation cellular immunologic mechanisms psoriasis discovery cyclosporine , potent immunosuppressive , highly effective treatment psoriasis cyclosporine significant inhibitory effects ability cells become activated however , direct activity drug human keratinocyte signal transduction growth difficult demonstrate relevant concentrations nevertheless , treatment psoriasis 12 phorbol 13 acetate treated murine skin cyclosporine reverse many epidermal abnormalities common two systems suggests compound exerts indirect effect epidermal keratinocytes vivo , perhaps inhibition treatment psoriasis patients , cyclosporine therapy resulted selective changes numbers functions certain antigen presenting cell subsets \( distinct langerhans cells \) cell subsets changes accompanied indirect evidence decreased cell lymphokine release lesional activity cyclosporine treated psoriasis patients closely correlated degree cell activation caused antigen presenting cells cyclosporine inhibition lymphokine cytokine release may result decreased recruitment non langerhans antigen presenting cells epidermis thus decreased immunoreactivity lesion
blistering diseases diagnostic help primary care physicians presentation , differential diagnosis bullous disease may seem difficult however , diagnosis may clarified considering factors 's sign , age patient onset , pattern distribution careful review family , recreational , occupational , drug histories may also help identify cause
rheumatoid arthritis new developments treatment patient active rheumatoid arthritis obtain significant relief nonsteroidal anti inflammatory drugs , prompt institution disease modifying antirheumatic drugs \( \) recommended one agent fails , another may tried present , hydroxychloroquine \( \) sulfate one widely used best tolerated careful follow essential , however , toxic effects may severe sometimes unpredictable
mutation pro alpha 2 \( \) gene \( \) type procollagen ehlers danlos syndrome type vii evidence suggesting skipping exon 6 rna splicing may common cause phenotype fibroblasts proband ehlers danlos syndrome type vii synthesized approximately equal amounts normal shortened pro alpha 2 \( \) chains type procollagen nuclease s1 probe protection experiments mrna demonstrated pro alpha 2 \( \) chains shortened deletion 54 nucleotides exon 6 , exon contains codons cleavage site procollagen n proteinase sequencing genomic clones revealed single base mutation converted first nucleotide intron 6 g therefore , mutation change , gt consensus splice site , produced efficient exon skipping allele specific oligonucleotide hybridizations demonstrated proband 's mother , father , brother mutation therefore , mutation sporadic one analysis potential 5' splice sites 5' end intron 6 indicated none favorable values two commonly employed techniques evaluating sites proband fourth reported proband ehlers danlos syndrome vii single base mutation causes skipping exon 6 splicing rna either gene gene mutations two type procollagen genes found syndrome therefore , mutations may common cause phenotype primers developed useful screening similar mutations causing disease
urticaria pigmentosa systemic evaluation successful treatment topical steroids nine patients adult onset urticaria pigmentosa studied incidence extracutaneous mast cell involvement efficacy potent topical corticosteroid therapy cutaneous lesions seven nine patients increased mast cells marrow biopsy specimens , five patients focal aggregates mast cells bone scan abnormal one patient liver spleen scans revealed shift colloid uptake liver spleen four patients abnormal gastrointestinal tract roentgenograms obtained urinary histamine metabolites correlated nodular bone marrow involvement , parameters results testing revealed significant deviation verbal memory deficit nine patients abnormalities minnesota personality inventory four patients nine patients treated 0 05 betamethasone ointment occlusion half body 6 weeks seven nine patients treated responded almost complete resolution lesions hypothalamic pituitary adrenal axis suppression evaluated intramuscular stimulation metyrapone administration treatment two patients , used medication , developed transient abnormalities slow return lesions noted 6 months completion therapy remissions could lengthened single weekly applications topical steroids systemic involvement frequent patients cutaneous mast cell disease best demonstrated bone marrow biopsy mast cell lesions safely effectively treated topical steroids motivated patients
intercellular iga childhood selective deposition monomer intercellular space epidermis describe 7 year old girl recurrent lesions involving trunk , extremities , face , oral mucosa histopathologic examination revealed intraepidermal bullae containing neutrophils eosinophils , direct immunofluorescence test showed deposition iga intercellular space epidermis circulating iga anti intercellular antibodies also detected indirect immunofluorescence test immunofluorescence studies using monoclonal antibodies human iga subclasses showed iga antibodies antisera j chain secretory component show specific intercellular staining surface iga \( \) b cells transiently increased peripheral blood active stage disease results indicated origin iga antibodies dapsone therapy shown effective
bleomycin sulfate therapy warts novel needle puncture technique multiple puncture technique using vaccination needle introduce bleomycin sulfate \( 1 u ml sterile saline solution \) warts resulted elimination 92 random series 258 warts single treatment recurrence observed 6 month follow period six 66 patients required two seven treatments eradication , four patients requested alternative therapy initial failure single bleomycin treatment
scar revision different scar revision techniques compared similar scars , patient comparison final results unique interesting provides insight choosing optimal technique procedures historical perspective provided
transferrin c subtypes patients rheumatoid arthritis transferrin \( tf \) subtypes investigated 128 patients rheumatoid arthritis \( ra \) frequencies subtypes compared results normal individuals frequencies tf genes c1 , c2 , c3 , d1 , d2 0 , 0 , 0 , 0 0 , respectively frequency gene significantly higher patients \( 0 \) compared value control group \( c2 0 247 \) relative risk ra association type 2 0 , 0 18 association type results statistically significant paper confirms significant association ra furthermore , appears results homozygous phenotype protective development ra results discussed light earlier suggestions subtype confers increased risk cellular damage enhancing hydroxyl radical formation , although possible exists genetic linkage tf variant locus influencing susceptibility ra
prevalence rheumatoid arthritis one thousand nine hundred twenty five adults aged 16 studied house house survey representative areas seven cases \( five female \) described satisfied 1987 ara criteria rheumatoid arthritis \( ra \) , indicating prevalence 3 6 per thousand adults adjusted population structure , prevalence 8 4 per thousand adults complementary data also presented cases ra ascertained special screening clinics rural health centres hospital rheumatology clinics parts study , cases ra less often seropositive european populations may account lower prevalence erosive disease
development use patient knowledge questionnaire rheumatoid arthritis multi choice patient knowledge questionnaire \( \) developed use patients rheumatoid arthritis \( ra \) test test used test stability \( r 0 81 \) , formula 20 \( r 0 72 \) internal consistency seventy randomly selected ra patients completed rheumatology patient clinic large teaching hospital wide variation total scores ranging 3 28 30 total scores correlated years general education \( p less 0 05 \) disease duration age sixty two per cent patients knew cause ra , yet , unknown 27 thought could caused injury 11 cold fifty two per cent idea blood tests four patients taking form medication widespread confusion disease modifying drugs non steroidal anti inflammatory drugs \( nsaids \) exercise reasonably well understood many patients unable differentiate methods energy conservation joint protection study highlights need careful individual knowledge assessment use tools effective patient education
recruitment neutrophils ige dependent cutaneous late phase reactions mouse mast cell dependent partial inhibition reaction antiserum tumor necrosis factor alpha much clinically important pathology associated ige dependent disorders thought reflect actions blood borne leukocytes recruited responses evaluate extent mast cells responsible leukocyte infiltration associated ige dependent cutaneous reactions , attempted elicit responses normal mice , genetically mast cell deficient w mice , w mice selectively repaired mast cell deficiency intradermal injection cultured mast cells derived normal \( \) mice found tissue swelling associated ige dependent passive cutaneous anaphylaxis reactions developed rapidly diminished markedly 2 4 h antigen challenge , remained detectable least 24 h elicitation responses infiltration leukocytes \( predominantly neutrophils \) also occurred sites , reached maximal levels 6 12 h antigen challenge , persisted high levels 24 h , largely 48 h virtually tissue swelling leukocyte infiltration associated ige dependent cutaneous reactions mast cell dependent intradermal injection 40 u recombinant murine tnf alpha \( alpha \) elicited neutrophil infiltration similar magnitude kinetics observed ige dependent mast cell degranulation rabbit anti alpha \( r anti alpha \) antiserum , able inhibit 84 neutrophil infiltration observed injection alpha , inhibited ige , mast cell dependent leukocyte infiltration 47 7 three separate experiments findings indicate tnf alpha contributes mast cell dependent recruitment leukocytes ige dependent cutaneous late phase reactions , suggest mast cell associated mediators probably also contribute response
growth factor induced acceleration tissue repair direct inductive activities rabbit dermal ulcer model roles polypeptide growth factors promoting wound healing specificity sequence responses different tissues wounds little understood investigated influence four growth factors rates healing novel full thickness dermal ulcer placed avascular base rabbit ear wound model precludes significant wound contraction requires new granulation tissue epithelial cells healing originate 5 micrograms \( 7 31 pmol mm2 \) platelet derived growth factor b chain \( pdgf bb \) , basic fibroblast growth factor \( bfgf \) , epidermal growth factor \( egf \) applied locally time wounding resulted twofold increase complete treated wounds \( pdgf bb , p 0 02 chi square analysis bfgf , p 0 04 egf , p 0 05 \) transforming growth factor \( tgf \) beta 1 significantly inhibited \( p 0 05 \) pdgf bb tgf beta 1 uniquely increased depth area new granulation tissue \( p less 0 005 \) , influx fibroblasts , deposition new matrix wounds explants 7 old pdgf bb treated wounds remained metabolically far active controls , incorporating 3h thymidine dna \( p 0 05 \) significantly 3h leucine 3h proline collagenase sensitive protein \( p 0 04 \) results establish polypeptide growth factors significant selective positive influences healing full thickness ulcers rabbit
identification two collagen domains within bullous pemphigoid autoantigen , bp180 bullous pemphigoid \( bp \) autoimmune disease characterized vesicles presence autoantibodies directed epidermal basement membrane zone previous studies identified two protein components , bp180 , primary antigenic targets bp autoantibodies recently reported isolation 1 0 kb bp180 cdna sequence analysis presented report reveals partial bp180 cdna encodes two protein domains primary structures characteristic triple helical domains collagens , e , glycine appears every third position one third remaining residues proline two collagen domains lengths 242 30 amino acids separated stretch 12 amino acids collagenase digestion bp180 cdna encoded fusion protein generated peptide fragment size consistent predicted locations collagenase digestion sites possible physiological function collagen domains bp180 protein may form stable interactions constituents extracellular matrix cutaneous basement membrane zone interactions may provide molecular framework adhesion basal keratinocyte basal lamina
punch graft facial scars punch graft procedure one surrounding scar area graft correction defect alternative procedure distinct advantages standard punch graft considered surgical correction ice pick facial scarring following normal reparative process , punch graft aesthetic appearance
incisional slit grafting incisional slit grafting , new greatly improved technique hair transplantation , described incisional slit grafting utilizes larger numbers smaller grafts traditional punch grafting tissue removed recipient bed vascular supply conserved , resulting increased graft yield effect associated traditional round grafting eliminated largely , natural frontal achieved
regional variation expression pemphigus foliaceus , pemphigus erythematosus , pemphigus vulgaris antigens human skin expression pemphigus foliaceus \( pf \) , pemphigus erythematosus \( pe \) , pemphigus vulgaris \( pv \) antigens 16 different regions normal human skin evaluated indirect immunofluorescence using sera high titer pf , pe , pv antibodies regional variations observed expression antigens expression pf pe antigens , measured endpoint titer antibody reactivity , highest skin specimens obtained upper torso , lowest buccal mucosa , lower torso , scalp distribution pattern differed pv antigen , whose expression highest buccal mucosa scalp patterns correlate , may provide partial explanation , different distribution skin lesions different forms pemphigus
glycosaminoglycans production cultured skin fibroblasts pasini cockayne touraine forms dominant dystrophic epidermolysis bullosa qualitative quantitative comparisons glycosaminoglycans e \( gag \) production made fibroblast lines cultured skin six patients pasini \( \) form dominant dystrophic epidermolysis bullosa , six non form \( cockayne touraine \) , eight lines patients simplex recessive dystrophic epidermolysis bullosa eight lines normal individuals reasonable match donor age gender , site , passage number achieved contrary earlier report , lines pasini group amount gag secreted proportions sulfated gag showed consistent difference cockayne touraine control lines pasini lines secreted 77 18 \( sem \) microgram gag acid per 10 \( 7 \) cells cockayne touraine lines 81 12 micrograms equivalent cells densities sulfated gag represented 19 4 pasini lines , 17 5 cockayne touraine , 14 3 controls findings consistent current views lesions unreliable clinical sign epidermolysis bullosa bring question validity pasini entity
drug induced pemphigus autoantibodies directed pemphigus antigen complexes present penicillamine captopril induced pemphigus pemphigus autoimmune blistering disease characterized circulating autoantibodies directed keratinocyte cell surface two variants , pemphigus foliaceus pemphigus vulgaris , distinguished molecular level immunochemical studies large majority patients pemphigus develop disease spontaneously however , small group patients develop pemphigus treatment certain medications , penicillamine captopril best documented patients drug induced pemphigus circulating tissue bound epidermal cell surface autoantibodies however , molecular specificity autoantibodies studied performed immunoprecipitation studies utilizing extracts 125i labeled suction blister epidermis sera three patients drug induced pemphigus foliaceus \( two due penicillamine one due captopril \) one patient captopril induced pemphigus vulgaris found three patients drug induced pemphigus foliaceus circulating autoantibodies directed pemphigus foliaceus antigen complex one patient drug induced pemphigus vulgaris circulating autoantibodies directed pemphigus vulgaris antigen complex study demonstrates autoantibodies drug induced pemphigus patients antigenic specificity , molecular level , autoantibodies pemphigus patients
vaginal birth cesarean meta analysis morbidity mortality cesarean birth rate continued despite efforts counteract major reason rise practice elective repeat cesarean conducted meta analysis included 31 studies total 11 , trials labor evaluate association birth route cesarean morbidity mortality mother infant summary odds ratios calculated maternal febrile morbidity significantly lower trial labor elective repeat cesarean intended birth route made difference rates uterine dehiscence rupture use oxytocin , presence recurrent indication previous cesarean , presence unknown uterine scar also dehiscence rupture excluding deaths , fetuses weighing less 750 g , congenital anomalies incompatible life , found difference perinatal death rates proportion 5 minute apgar scores 6 lower higher trial labor , unable exclude low birth weight fetuses congenital anomalies analysis findings argue trials labor women cesarean birth
distribution skin derived \( skalp \) marginal zone spreading psoriatic lesion two new elastase inhibitors \( skalp , skin derived \) recently described lesional skin psoriasis present study investigated distribution skalp activity marginal zone spreading psoriatic plaques 4 mm zone immediately adjacent squamous plaques , skalp activity slightly increased compared distant uninvolved skin within lesion anti elastase activity pronounced , significantly higher central zone plaque compared periphery appearance skalp psoriatic lesion appears late event compared endothelial involvement , intraepidermal accumulation pmns , epidermal proliferation abnormal observation lends support hypothesis induction anti elastase activity associated switch cutaneous inflammation
allergic contact dermatitis due patients psoriasis treated topical puva incidence clinical features allergic contact dermatitis due examined 371 patients psoriasis treated topical puva psoralen derivatives used study 8 methoxypsoralen \( \) , 3 \( \) , 4 , 6 , 4' \( \) 7 methyl \( \) 371 patients treated , three \( 0 8 \) developed acute dermatitis puva treated areas incidence significantly lower \( p less 0 01 \) \( four 10 patients \) \( six 17 patients \) none seven patients receiving puva reaction confirmed dermatitis reactions due contact allergy several methods include patch photopatch tests , photopatch test mapping , determination minimal erythema dose \( med \) immunohistochemistry
induction lesions dermatitis herpetiformis autologous serum present study various factors contribute initiation lesions dermatitis herpetiformis \( dh \) examined thirty one patients dh , seven bullous pemphigoid , two linear iga disease two healthy subjects studied either starting treatment stopping dapsone 5 days intradermal inoculation freshly prepared autologous serum followed 18 24 h formation dh like lesions 24 31 dh patients lesions erythematous papules , often vesicles microscopically showed papillary tip serum induced formation lesions occurred patients active dh spontaneous lesion formation occur non dh controls formation lesions dose related , declining proportionately dilution serum 1 16 plasma prepared various methods anticoagulation \( heparin , citrate , edta \) caused lesser reactions , addition heparin epsilon amino acid \( \) , citrate , serum substantially inhibited formation lesions suggested responsible factor might protease vasoactive agents including histamine \( 1 4 micrograms \) compound 48 80 \( 1 5 micrograms \) caused normal immediate dh like lesions occurred one 13 subjects challenged histamine two nine challenged 48 80 , autologous serum elicited large vesicular responses factor \( \) serum dh initiate formation lesions factor appears activated clotting inhibited heparin , suggesting may protease
erythema mimicking porphyria cutanea tarda case erythema \( \) closely resembling porphyria cutanea tarda \( \) reported initial skin biopsies suggestive levels urine , stool plasma normal biopsy early cutaneous lesion showed vasculitis necrosis vessel walls
acquired dermal face extremities four cases dermal symmetrical areas involving face extremities reported light electron microscopic studies showed changes similar seen naevus
\( \) , strong found yellow sodium , defined causative allergens contact dermatitis experimental screening method animals published erratum appears contact dermatitis 1990 23 \( 5 \) 383 12 young men developed allergic contact dermatitis wearing yellow cotton attempted identify causative agents experimental screening method animals guinea pigs sensitized acetone extract material , means guinea pig test \( \) active separated extract , step step patch test screening chromatographic fractions guinea pigs , finally analyzed gas chromatography mass spectrometry \( gc ms \) although 2 allergens important activity \( 1 fraction eluted silica gel column , 1 methanol fraction \) , present study fat soluble allergens fraction gc ms analysis revealed 4 kinds \( \) \( \) present fraction prepared laboratory showed strong eliciting activities , guinea pigs sensitized extract , also male volunteer sensitized exposure yellow testing \( 2 , 5 \) , main component among found , sensitized guinea pigs even 1 ppm level results , conclude one allergens responsible cases
patch prick test study healthy subjects recruits selected military health service healthy without history present previous dermatitis , ocular refraction defects , patch tested \( italian research group contact environmental dermatitis \) standard series , 336 also patch tested substances used processing prick tested 8 major allergens 74 \( 12 5 \) reacted 1 substances frequent \( 28 cases \) , mercury \( 7 cases \) , phenol formaldehyde resin \( 6 cases \) , , nickel red 17 \( 4 cases \) 113 recruits reacted 1 prick test allergens demonstrated importance establishing reference values healthy groups correct evaluation data collected selected groups
mercury ointment still use although severe mercury associated side effects , poisoning high irritant allergic potential , well weak potency mercury agent , well known , topical mercury preparations still listed several , including united states , uk several european countries thus , topical still use , even though effective less toxic drugs available report 2 cases severe allergic reaction mercury hope , agreement pertinent literature , contribute removal , , therapeutic armamentarium
occupational dermatoses epoxy resin compounds study comprises 40 patients skin disorders current previous occupational exposure epoxy resin compounds \( \) 1984 1988 3rd common cause \( 32 264 cases 12 1 \) currently relevant allergic contact dermatitis 23 cases epoxy based ether \( ers \) , 5 reactive , 1 amine \( \) , 3 epoxy acrylates 2 cases \( 0 8 \) irritant contact dermatitis due methyl \( , epoxy \) caused 1 case contact urticaria previously relevant occupational allergic contact dermatitis ers detected 5 cases patch testing , allergens gave following positive reactions epoxy resin standard series 35 cases \( 4 0 tested \) , epoxy reactive 10 \( 7 1 140 \) , epoxy 4 \( 11 1 36 \) , epoxy acrylates 4 \( 4 5 88 \) , amine compounds commonly used epoxy 17 despite extensive patch test series , testing patients' remains important
update immunologically mediated diseases specific diagnosis immunologically mediated blistering disease made , clinical histologic features results direct indirect immunofluorescence studies \( use multiple substrates cases \) must assessed intraepidermal groups blistering diseases , direct immunofluorescence testing perilesional tissue critical diagnosis conditions , indirect immunofluorescence testing serum important diagnosis role management selected diseases dermatitis herpetiformis , indirect testing serum iga antibodies useful diagnosis management indirect testing serum igg antibodies intercellular substance important diagnosis , conjunction clinical findings , used guide monitoring disease activity patients pemphigus immunoelectron microscopy , immunoprecipitation , immunoblotting studies identified sites immune deposits specific antigens immunologically mediated bullous diseases practical standpoint , however , direct indirect immunofluorescence testing , conjunction clinical histologic evaluations , simple , rapid , relatively inexpensive tool diagnosis management
elemental diet refractory atopic eczema total 37 children refractory wide spread atopic eczema treated antigen avoidance regimen comprising , exclusive feeding elemental formula median duration 30 days , measures reduce exposure pet dust mite antigens home initial period food exclusion , food challenges performed intervals seven days , patients followed least 12 months ten children \( 27 \) either failed respond regimen relapsed within 12 months improvement eczema seen 27 37 \( 73 \) patients , discharge hospital disease severity score fallen median 27 pretreatment figure , 3 27 required topical corticosteroids clinical laboratory findings could used predict outcome regimen prolonged \( median 70 days \) , fall body weight serum albumin concentration , risk anaphylactic shock \( 4 37 cases \) strict antigen avoidance regimen may associated improvement atopic eczema conventional treatments failed
treatment rheumatoid arthritis anti cd4 monoclonal antibody effect treatment monoclonal antibody cd4 antigen present helper cells studied 10 patients severe intractable rheumatoid arthritis open trial , monoclonal antibody infused dosage 0 3 mg kg body weight 7 consecutive days studies kinetics demonstrated depletion cd4 cells , low 25 cells microliters , 1 hour first infusion subsequent recovery cd4 cell numbers 24 hours infusion reach initial levels , full 7 day treatment cycle significant reduction number cd4 cells \( mean sd 51 28 p less 0 02 \) reduced even inverse cd4 cd8 ratio , generally persisted 3 4 weeks lymphocyte transformation assays demonstrated significantly reduced reactivity 5 9 patients completed 7 day course , whereas 4 individuals exhibited unexpected elevation cell response mitogens common antigens parallel laboratory studies showed significant decrease erythrocyte sedimentation rate \( p less 0 05 \) , rheumatoid factor titer \( p less 0 04 \) , total immunoglobulin values \( p less 0 01 \) , well reduction c reactive protein levels , 7 9 patients clinically , significant reduction ritchie articular index \( p less 0 05 \) number swollen joints \( p less 0 04 \) adverse effects urticaria 2 patients , led withdrawal therapy 1 , fever , suggestive lymphokine release syndrome , another 2 patients low levels human anti mouse immunoglobulin antibodies developed \( exceeding 1 7 mg liter \) therefore possible repeat treatment cycle , achieving still better efficacy , 4 patients \( reductions ritchie index number swollen joints p less 0 02 \) findings indicate treatment monoclonal antibodies cd4 antigen leads results clinical benefits , least initial observation periods \( 6 months \) however , remains determined whether long term remission induced therapeutic approach use immunosuppressive therapies repeated antibody treatments considered
clinical correlations serum c1q levels patients rheumatoid arthritis previous studies suggested serum c1q levels measured first 5 years rheumatoid arthritis \( ra \) may predictive extent subsequent joint damage evaluate clinical significance marker ra , levels c1q measured radial serum samples 107 well characterized patients ra mean levels c1q higher patients disease duration less equal 5 years \( 173 micrograms ml \) patients disease duration greater 5 years \( 148 micrograms ml \) \( p 0 \) serum c1q levels correlated total joint counts activities daily living scores , correlation observed erythrocyte sedimentation rates radiographic scores results suggest c1q may useful early marker disease activity patients ra
hla region antigens patients rheumatoid arthritis studied distribution hla region antigens 2 groups rheumatoid arthritis \( ra \) patients mild , disease , severe disease results demonstrate dr4 significantly increased ra patient populations frequencies dr1 dr4 associated alleles , however , different 2 groups patients dr1 significantly increased patients mild ra , dr4 associated significantly increased patients severe disease results present study , together previous data laboratory investigators incidence hla region antigens ra , suggest dr dq \( b \) genes may important susceptibility ra dr mild forms disease , dq severe ra
effect nifedipine myocardial perfusion metabolism systemic sclerosis positron emission tomographic study assessed effect nifedipine myocardial perfusion metabolism 9 patients systemic sclerosis , using positron emission tomography perfusion tracer \( potassium 38 \) metabolic tracer \( 18f fluorodeoxyglucose 18fdg \) nifedipine , 20 mg 3 times daily 1 week , induced significant increase myocardial uptake , significant decrease 18fdg myocardial uptake , significant increase myocardial 18fdg ratio results indicate increase myocardial perfusion associated modifications myocardial energy metabolism , probably result beneficial anti ischemic effect nifedipine patients systemic sclerosis
double blind evaluation effects etodolac naproxen gastrointestinal mucosa rheumatic patients aim clinical , study evaluate therapeutic efficacy gastric tolerability etodolac , new anti inflammatory , non steroidal drug , compared naproxen study conducted 48 patients suffering rheumatoid arthritis 44 completed trial initial exclude presence gastric mucosal lesions , patients randomly allocated double blind treatment either etodolac 200 mg b naproxen 500 mg b period 4 weeks endoscopic control followed treatment period drugs proved effective relieving clinical symptoms , without statistically significant difference gastric mucosal lesions observed 15 etodolac treated patients 46 patients treated naproxen \( p less 0 05 \) \( 95 ci 0 01 0 60 \) painful dyspepsia observed 15 patients treated etodolac vs 38 patients naproxen therapy study demonstrates etodolac least active naproxen relieving rheumatic symptoms , administration results significantly lower degree gastric damage
selective vivo removal rheumatoid factor extracorporeal treatment device rheumatoid arthritis patients prospective phase ii trial conducted assess feasibility , tolerance , efficacy device designed selective removal rheumatoid factor plasma rheumatoid arthritis patients device contained coated plates chemically attached , aggregated human immunoglobulin g , operated column sixty one patients aged 25 73 underwent weekly plasmapheresis treatments \( primary therapy phase \) trial , patients continued current rheumatoid arthritis medications without dose adjustments patients received two six treatments \( primary therapy \) responding patients eligible continue apheresis treatment every 2 6 weeks \( maintenance therapy \) serious , untoward side effects noted course study 640 treatments , 2 \( different patients \) aborted , one complaints dizziness angioedema chest shortness breath except significant \( p less 0 05 \) decrease serum iron , significant changes complete blood count , serum electrolytes , renal hepatic function tests , serum c3 c4 noted although trial designed determine clinical efficacy , patients noted less morning stiffness , longer time onset fatigue , improved global pain assessment \( p less 0 004 \) significant objective improvements noted joint pain , tenderness , swelling , number affected joints \( p less 0 001 \) one half treated patients least 50 percent improvement objective measures antirheumatic activity
computed tomography ultrasonography adrenal glands comparison cortisol aldosterone responses acth stimulation fifteen patients proven disseminated \( \) computed tomography \( ct \) ultrasonography \( us \) performed evaluate form , shape , density size adrenal glands plasma urinary cortisol determined adrenal reserve assessed measuring cortisol aldosterone responses synthetic acth adrenal ct showed unilateral lesions two cases bilateral another four us study showed frequent alterations , unilateral seven bilateral three subjects combining methods increased sensitivity 85 cases patients normal plasma cortisol concentrations normal increased urinary cortisol excretion plasma aldosterone concentration also normal except one patient hypokalemia seven patients showed diminished cortisol responses , five subnormal aldosterone responses five plasma aldosterone concentration increased normally stimulation acth incidence limited adrenal reserve 53 patients acth stimulation correlation evident disorders adrenal steroid responses acth changes morphology revealed ct us
new genetics relevance recent advances genetics practical importance patients orthopedic problems specific genes isolated , mapped chromosomes , defined surgical specimens used genetic studies define specific genetic abnormalities making specific genetic diagnoses important appropriate care patient family
, war \? another editorial rheumatoid arthritis major advances therapy ra likely require future scientific understanding pathophysiology suggest clinical investigations put hold entire focus research shifts laboratory bench clinical studies early ra , including early treatment interventions , would appear major importance however , better characterization early clinical course identification pathologic markers progressive disease needed formal randomized treatment studies early disease initiated entire role aggressive management , particularly combination chemotherapy , stage ra need answers clinical practice would appear combination chemotherapy widely used , often last treatment resistant patients failed conventional therapies published clinical studies would seem support , certainly prove , valuable potential role combination chemotherapy setting moreover , studies seem indicate increased risk drug toxicities , limitations readily apparent combinations based successes observed patients difficult treat , possibility fundamental role combination chemotherapy treatment disease advocated questions need resolved well designed , randomized controlled trials urgent need trials soon combination chemotherapy gains even stronger therapy
seronegative rheumatoid arthritis clinical study hla typing examined clinically determining hla , b , c dr antigens 50 patients thought seronegative erosive polyarticular rheumatoid arthritis \( ra \) finland patients fulfilled least 4 1987 ara criteria ra according hla typing clinical findings , part collected followup , patients fell 5 groups hla related diseases , putative psoriatic arthritis , putative juvenile chronic , seropositive seronegative ra results indicate patients seronegative ra disease remaining cases presence rheumatoid factors examined adequately , especially early phase disease classification erosive seronegative polyarticular patients discussed
phenotypic markers lymphocyte mononuclear phagocyte activation within rheumatoid nodules investigated rheumatoid subcutaneous nodules using monoclonal antibodies recognizing functional determinants mononuclear phagocytes \( \) lymphocytes center rheumatoid nodules showed strong expression leukocyte cr3 , 95 would consistent presence central chemotactic stimulus expression , gamma interferon regulated molecule , decreased 5 13 cases despite strong expression mhc class ii variable infiltrate lymphocytes , majority cd8 positive lymphocytes showed increased mhc class ii expression interleukin 2 receptor expression low relationship number , distribution phenotype cell infiltrate phenotype predominant population
administration folinic acid low dose methotrexate patients rheumatoid arthritis folinic acid \( leucovorin \) supplementation suggested possible means treating short term side effects occur low dose methotrexate \( mtx \) however , established whether leucovorin effect mtx entered 20 patients rheumatoid arthritis treated mtx 48 week randomized , double blind , crossover trial folinic acid vs placebo dose folinic acid equal dose mtx given orally 4 h following single , weekly mtx administration conditions , leucovorin decrease therapeutic effect mtx incidence stomatitis gastrointestinal toxicity lower leucovorin treatment , study lacked sufficient power establish statistically significant difference
a2 systemic sclerosis phospholipase a2 \( pla2 \) , total pancreatic , quantitated 91 sera patients systemic sclerosis \( ssc \) mean total pla2 216 161 u ml \( sd \) significantly lower \( p less 0 001 \) controls \( 128 u ml \) 55 91 patients \( 60 \) pla2 1 sd 6 \( 7 \) 2 sd normal mean serum pancreatic pla2 also significantly lower ssc prevalence low serum total pla2 significantly greater \( p less 0 001 \) healthy adults , patients rheumatoid arthritis , systemic lupus erythematosus vasculitis repeat assays pla2 activity 10 patients ssc documented persistence low pla2 among 76 patients ssc complete clinical laboratory assessment , 48 low 28 normal \( slightly elevated \) pla2 2 groups showed differences disease manifestation therapy group low serum pla2 lower erythrocyte sedimentation rates \( p less 0 0005 \) lower neutrophil \( p less 0 05 \) monocyte counts \( p less 0 025 \) peripheral blood finding low serum pla2 activity adds spectrum arachidonic acid pathway abnormalities associated ssc , may part related paucity inflammatory changes observed disease
childhood bullous pemphigoid clinical immunologic features , treatment , prognosis 2 1 2 month old female infant presented multiple bullae hands feet analysis biopsy specimens confirmed clinical impression childhood bullous pemphigoid confirmatory data included type iv collagen mapping basement membrane zone , readily available technique helps distinguish childhood bullous pemphigoid childhood epidermolysis bullosa knowledge , patient youngest described childhood bullous pemphigoid , use opportunity review literature examine clinical immunologic features , treatment , prognosis rare childhood disorder
coexistence pemphigus foliaceus bullous pemphigoid demonstration autoantibodies bind pemphigus foliaceus antigen complex bullous pemphigoid antigen pemphigus bullous pemphigoid autoimmune blistering diseases skin characterized circulating autoantibodies directed keratinocyte cell surface epidermal basement membrane zone , respectively coexistence pemphigus bullous pemphigoid uncommon describe patient pemphigus foliaceus later developed bullous pemphigoid show , means immunoprecipitation studies utilizing cultured keratinocytes suction blister epidermis , patient circulating autoantibodies directed pemphigus foliaceus antigen complex bullous pemphigoid antigen report first demonstrate coexistence pemphigus foliaceus bullous pemphigoid molecular level
revised clinical laboratory criteria subtypes inherited epidermolysis bullosa consensus report subcommittee diagnosis classification national epidermolysis bullosa registry inherited epidermolysis bullosa number diseases , common finding blister formation minor mechanical trauma skin forms significant , eventually fatal , extracutaneous disease activity may occur recent years application newer technologies contributed substantially overall understanding collection inherited diseases concurrently , many new phenotypes recognized , part result ongoing prospective patient registries united states unfortunately , resulted massive literature may appear seemingly excessive arbitrary subdivision epidermolysis bullosa variants concerns mind subcommittee established national epidermolysis bullosa registry summarize current literature make recommendations best clinical laboratory criteria practical diagnosis patients inherited epidermolysis bullosa
allergic contact dermatitis two antioxidants latex gloves 4 , 4' \( 6 tert butyl meta \) \( \) allergen alternatives glove allergic patients allergic contact dermatitis developed hands face two patients exposure latex examination gloves patients patch test negative usual rubber allergens , positive patch test reaction 4 , 4' \( 6 tert butyl \) \( \) patient 2 also patch test positive patients tested gloves , find gloves could safely use glove manufacturers ascertain occurrence different latex examination gloves list gloves associated allergens generated provided assist helping patients choose gloves free specific allergens
pathogenesis onychoschizia \( dystrophy \) onychoschizia dystrophy nails common , especially adult women , little information available cause theories involve environmental factors , supportive experimental data scarce therefore studied vitro nail changes produced several organic , , water , polar materials , acidic basic solutions challenged control examined grossly , microscopically , scanning electron microscopy regular intervals progressive increase severity prolonged 3 weeks , scanning electron microscopy demonstrated individual cells empty spaces separation prominent basic solutions caused , layering \( \) seen repeated hydration dehydration although factors may influence onychoschizia , typical changes produced normal nails 21 day challenge repeated exposure water followed dehydration findings suggest probable cause condition logical approach management
immune sensitization epidermal antigens polymorphous light eruption get insight pathogenesis polymorphous light eruption , studied nine patients polymorphous light eruption six healthy persons two skin biopsy specimens obtained person , one previously ultraviolet light irradiated skin another one unirradiated skin epidermal cell suspension , skin homogenate , prepared specimen autologous cultures made peripheral blood mononuclear cells combined irradiated unirradiated skin homogenate peripheral blood mononuclear cells combined irradiated unirradiated epidermal cell suspension cell proliferation assessed 3h thymidine incorporation assay response peripheral blood mononuclear cells unirradiated epidermal cells unirradiated skin homogenate similar patients controls however , peripheral blood mononuclear cells patients polymorphous light eruption showed significantly increased proliferative response irradiated epidermal cells irradiated skin homogenate results indicate ultraviolet light increases stimulatory capability polymorphous light eruption epidermal cells unidirectional mixed culture autologous peripheral blood mononuclear cells suggests immune sensitization autologous ultraviolet light modified skin antigens occurs polymorphous light eruption
propylene glycol dermatitis propylene glycol commonly used vehicle topical preparations although well suited purpose , capable producing primary irritant skin reactions allergic sensitization literature propylene glycol reviewed , particular attention nature adverse cutaneous effects guidelines patients sensitive propylene glycol discussed
persistent light reaction first patient appears persistent light reaction caused alone reported persistent light reaction may occur patients milder degrees photosensitivity , appropriate photopatch testing performed
hereditary lactate dehydrogenase subunit deficiency lactate dehydrogenase activity skin lesions hair follicles 16 year old japanese girl lesions mostly extensor surface extremities lesions worse summer patient also mild muscle pain strenuous exercise paternal maternal analysis lactic acid dehydrogenase \( ldh \) serum revealed single peak analysis ldh erythrocytes demonstrated complete lack ldh subunit patient substantial lack parents epidermis diseased skin scalp hair follicles patient virtually devoid ldh activity
hereditary deficiency c5 association discoid lupus erythematosus 29 year old woman discoid lupus erythematosus undetectable classic pathway complement activity due selective deficiency c5 one children also deficient knowledge first documented case association discoid lupus erythematosus c5 deficiency
safety immunological response recombinant vaccinia virus vaccine expressing hiv envelope glycoprotein randomised phase trial recombinant virus vaccine expressing envelope gene human immunodeficiency virus \( \) 35 healthy , hiv seronegative males , 31 history 4 vaccinia naive , vaccinated 8 weeks later standard ny strain vaccinia virus frequency , duration , virus isolation vaccination site occurrence local side effects similar two groups vaccinees vaccinia naive \( vac n \) subjects shed virus vaccination site longer higher vaccinia primed \( vac p \) individuals \( 19 vs 7 days 10 \( 7 \) vs 10 \( 5 \) ml , respectively \) vitro cell proliferative responses one hiv antigen preparations developed 13 16 vaccinia primed subjects inoculated cell responses , however , transient subject antibodies hiv become detectable 2 vaccinia naive subjects vaccinated showed strong cell responses homologous heterologous strains whole virus recombinant protein remained detectable year antibodies hiv envelope also developed recombinant vaccinia virus vaccines induce cell priming foreign gene products individuals used sole agent efficacious vaccinia naive individuals
suspect connective tissue disease connective tissue disease suspected , physical historical data collected build case clinical syndrome negative serologic results may helpful positive ones must used awareness limitations diagnosis clinically evident serologically confirmed , observation may preferable unnecessary treatment syndrome atypical , physicians look evidence clinical overlap regularly open mind
puva therapy puva psoralen plus ultraviolet radiation form therapy commonly used treatment psoriasis vitiligo , also beneficial diseases understanding psoralen 's mechanism action unique properties various psoralen preparations important ensuring optimal results therapy
community screening hypercholesterolemia study focused cholesterol screening education program conducted , arizona , determine prevalence hypercholesterolemia among volunteer participants , whether program lifestyle changes physician follow study also examined whether participants used program monitor known hypercholesterolemia 6 month program , individuals screened , 29 previous history elevated cholesterol 5 cholesterol lowering medication group previous history hypercholesterolemia , 41 cholesterol levels higher 5 17 mmol l \( 200 mg dl \) 10 levels higher 6 21 mmol l \( 240 mg dl \) subgroup 120 persons levels higher 6 21 mmol l \( 240 mg dl \) contacted 4 6 months screening group reported improvement diet exercise patterns , 58 consulted physician results suggest people known hypercholesterolemia using community screening programs monitor cholesterol levels , programs identity new high risk individuals program participants appear change diet exercise patterns seek physician follow
hospitalization experience navajo subjects type ii diabetes matched controls historical cohort study using historical cohort study design 12 year follow , found 77 navajo adults type ii diabetes mellitus hospitalized rate hospitalizations per 1000 patient years compared rate 167 hospitalizations per 1000 patient years 77 age , sex , residence matched non diabetic controls , yielding risk ratio 2 0 using matched pairs analysis \( sign test \) , observed difference number hospital admissions statistically significant \( z 2 30 , p less 0 05 \) average duration hospitalization , however , statistically different matched pairs analysis \( z 0 95 , p greater 0 05 \) 136 excess hospitalizations diabetic subjects included 45 admissions poor metabolic control diabetes , 50 excess admissions infectious disease , 26 excess admissions conditions heart , eye , kidney , non traumatic amputation multivariate analyses , variables found associated greater hospitalization experience among 77 diabetic subjects 12 years follow period included older age entry study , poorer metabolic control early study period , presence diabetic complications
body mass index 15 year mortality cohort black men women association body mass index \( bmi \) mortality investigated black male \( aged 30 79 years \) black female \( aged 40 79 years \) members foundation health plan 15 year follow male 283 female deaths identified analyses conducted separately lower upper range bmi \( well entire range \) , isolate separate effects low weight high weight mortality particular attention also paid potential bias cigarette smoking antecedent illness cox regression analyses showed entire range bmi adjusted bmi mortality association significantly j shaped men essentially flat women inverse association bmi mortality lower range bmi statistically significant men adjusted relative hazard increasing 10th percentile bmi 0 76 \( 95 confidence interval ci 0 59 0 98 \) positive association bmi mortality upper range bmi highly statistically significant men adjusted relative hazard increasing percentile bmi 1 37 \( 95 ci 1 14 1 63 \) whether controlled multivariate analysis , excluding first 5 years follow analyses , analyzing bmi mortality association smoking specific illness specific subgroups , smoking antecedent illness much impact bmi mortality association , either sex general observations bmi mortality association similar findings white cohorts
effects excess dietary tyrosine cholesterol , bile acid metabolism mixed function oxidase system rats excess dietary tyrosine \( 12 \) caused hypercholesterolemia male wistar rats significantly increased cytochrome p 450 contents bile flow biliary output total bile acids significantly increased rats fed diet biliary output cholesterol significantly altered , whereas acid significantly increased excess dietary tyrosine significantly decreased fecal excretion neutral steroids , whereas total steroid excretion significantly changed present results indicate excess dietary tyrosine causes hypercholesterolemia without modifying fecal total steroid excretion , thus supporting previous hypothesis stimulated synthesis cholesterol main reason excess dietary tyrosine leads hypercholesterolemia
effect vitamin c depletion serum cholesterol lipoprotein levels \( od od \) rats unable synthesize ascorbic acid effect ascorbic acid deficiency serum liver cholesterol , phospholipid triglyceride levels , serum lipoprotein levels serum lipoprotein cholesterol levels examined male rats hereditary defect ascorbic acid synthesis \( rats \) male homozygotes \( od od \) male rats parent strain \( \) divided four treatment groups fed vitamin c deficient vitamin c replete diets containing either 0 0 5 cholesterol 3 wk feeding period \( od od \) rats fed vitamin c deficient diet gradually decreased food intake , resulting lower body weight od od rats given ascorbic acid serum cholesterol level significantly higher vitamin c deficient od od rats fed cholesterol diet , tended higher fed control \( 0 cholesterol \) diet , whereas liver lipid levels remained unchanged relative od od rats fed vitamin c replete diet serum low density lipoprotein high density lipoprotein \( hdl \) cholesterol levels lower od od rats fed vitamin c deficient diet without cholesterol , intermediate density lipoprotein low density lipoprotein cholesterol levels markedly higher vitamin c deficient od od rats od od rats given ascorbic acid , regardless dietary cholesterol level ratio hdl2 cholesterol hdl3 cholesterol also higher vitamin c deficient od od rats parent strain od od rats \( \) showed change due vitamin c deficiency results suggest vitamin c deficiency delays low density lipoprotein metabolism produces hypercholesterolemia male od od rats
ascorbic acid effects vitamin hormone metabolism binding guinea pigs ascorbic acid deficiency guinea pigs fed vitamin replete diet caused moderate reduction ca level serum bone 25 hydroxy 25 \( 25 ohd \) serum concentration tended decline renal 25 1 hydroxylase \( 1 \) activity decreased 50 25 24 hydroxylase activity increased 1 6 fold chromatin 1 , 25 1 , 25 \( oh \) 2d3 receptor concentration intestinal mucosa decreased 20 30 , percentage occupied receptors decreased 12 15 6 8 receptor affinity 1 , 25 \( oh \) 2d3 change \( kd 0 24 0 26 nmol l , 0 06 0 10 nmol l \) , coefficient decreased 1 7 1 4 vitamin c deficiency potentiated effects vitamin deprivation impaired restorative action vitamin accompanied marked delay elevation 25 ohd concentration serum well decreased 1 activity kidneys lower concentration occupied 1 , 25 \( oh \) 2d3 receptors intestinal mucosa data demonstrate critical role ascorbic acid vitamin metabolism binding
vitamin deficiency decreases natural killer cell activity interferon production rats examined effect vitamin deficiency natural killer \( nk \) cell activity interferon \( ifn \) production rats 16 21 age onto semisynthetic diets containing either 0 4 micrograms retinol g diet time study , retinol depleted rats serum vitamin concentrations less 7 pair fed controls two studies , rats exhibited external signs retinol deficiency , depletion symptoms observed splenic nk cell activity chromium 51 labeled yac 1 cells significantly decreased vitamin depleted rats \( 22 80 values control rats , depending degree retinol deficiency \) , regardless ratio effector target cells used vitamin depleted rats orally retinol , nk cell activity consistently normalized understand possible mechanisms involved decreasing nk cell activity , investigated ifn production concanavalin stimulated spleen cells vitamin depleted , control animals ifn titers significantly decreased \( 22 33 values control rats \) supernatants spleen cell cultures vitamin depleted rats repletion vitamin resulted ifn activities ranging 80 130 controls adding alpha beta ifn vitro spleen cells vitamin depleted animals increased nk cell activity number spleen cells reacting monoclonal antibody specific rat nk cells slightly lower retinol depleted rats , enough account differences nk cell ifn activities data suggest vitamin deficiency affect nonspecific arm immune system , possibly altering functional capacity cells produce lymphokines needed generation appropriate cytolytic response
differential effects alpha beta adrenergic blockade glucose lactate metabolism acute stress study examined role alpha beta blockade glucose lactate metabolism acute stress insulin induced hypoglycemia three groups conscious dogs chronically fitted catheters femoral artery femoral , portal , hepatic veins studied 18 hr fast 1 hr basal period , hypoglycemia induced insulin infusion 5 mu kg min 3 hr group 1 received treatment groups 2 3 received , respectively , phentolamine \( 8 micrograms kg min \) propranolol \( 4 micrograms kg min \) beginning 30 minutes throughout experimental period despite similar hyperinsulinemia , plasma glucose dropped group 1 \( 115 10 40 3 mg dl \) group 2 \( 110 4 60 3 mg dl \) group 3 maintained 45 4 mg dl exogenous glucose infusion rate 2 2 0 4 mg kg min hepatic glucose production increased 50 13 , 127 30 , 55 30 groups 1 , 2 , 3 , respectively , within 60 minutes 56 19 , 55 17 , 0 04 12 last hour experiment glucose utilization change groups 1 2 increased group 3 plasma lactate increased group 1 \( 190 1 , 450 mumol l \) group 2 \( 180 4 , 500 mumol l \) , group 3 early rise \( 120 mumol l \) within 30 minutes gradually dropped near basal
effect long term monitoring glycosylated hemoglobin levels insulin dependent diabetes mellitus background value routine measurements glycosylated hemoglobin \( hemoglobin a1c \) care patients diabetes mellitus uncertain undertook study determine whether knowledge hemoglobin a1c values would result improved metabolic control group patients insulin dependent diabetes mellitus \( iddm \) methods randomly assigned 240 patients iddm one two groups comparable age , sex , duration diabetes , initial hemoglobin a1c levels patients followed year , hemoglobin a1c concentration measured three month intervals hemoglobin a1c values used assessing glycemic control modifying therapy one two groups , care aware hemoglobin a1c levels relied blood urine glucose measurements monitor treatment results among 222 patients still followed one year , mean hemoglobin a1c value decreased significantly 10 1 9 5 percent \( p less 0 005 \) group whose hemoglobin a1c level monitored \( n 115 \) , whereas initial one year values control group \( n 107 \) 10 0 10 1 percent , respectively proportion patients poor control , defined hemoglobin a1c value 10 0 percent , decreased 46 30 percent \( p less 0 01 \) group whose hemoglobin a1c level monitored change significantly \( 45 50 percent \) control group patients group whose hemoglobin a1c level monitored seen insulin regimens changed often , hospitalized acute care diabetes less often control group similar decrease hemoglobin a1c values occurred control group following year , care knew hemoglobin a1c values conclusions regular measurements hemoglobin a1c lead changes diabetes treatment improvement metabolic control , indicated lowering hemoglobin a1c values
prospective study development diabetes relatives patients insulin dependent diabetes background presence cytoplasmic islet cell autoantibodies recognized risk factor development diabetes mellitus relatives patients insulin dependent diabetes mellitus \( iddm \) , magnitude risk unknown , influence factors , age , sex , race methods 1979 1989 , studied initially nondiabetic relatives probands iddm determine risk iddm according presence titer autoantibodies , well factors results nondiabetic relatives , 125 \( 3 1 percent \) islet cell antibodies initial serum samples , 40 contracted iddm islet cell antibodies frequent \( 4 3 percent \) relatives 20 years age \( p 0 001 \) \( 4 8 percent \) families one affected member \( multiplex pedigree \) \( p 0 003 \) independent risk factors development diabetes relatives included age less 10 years time initial study \( p 0 001 \) , membership multiplex pedigree \( p 0 02 \) , positive test islet cell antibodies initial serum sample \( p 0 0001 \) twenty seven relatives diabetes developed \( 67 5 percent \) positive tests islet cell antibodies diagnosis iddm , giving relative risk iddm 68 \( 95 percent confidence interval , 34 134 \) antibody positive relatives islet cell antibody titers 20 juvenile diabetes foundation units higher associated increasing risk diabetes conclusions nondiabetic relatives probands iddm first two decades life , members multiplex pedigrees , increased titers islet cell antibodies likely iddm
increased high density lipoprotein levels caused common cholesteryl ester transfer protein gene mutation background methods plasma cholesteryl ester transfer protein \( cetp \) transfer cholesteryl esters high density lipoprotein \( hdl \) lipoproteins recently described japanese family increased hdl levels cetp deficiency due splicing defect cetp gene assess frequency phenotype condition , screened 11 additional families high hdl levels means radioimmunoassay cetp dna analysis results found cetp gene mutation four families three different regions japan analysis restriction fragment length polymorphisms mutant cetp allele showed probands homozygous identical haplotype family members homozygous cetp deficiency \( n 10 \) moderate hypercholesterolemia \( mean total cholesterol level sd , 7 01 0 83 mmol per liter \) , markedly increased levels hdl cholesterol \( 4 24 1 01 mmol per liter \) apolipoprotein , decreased levels low density lipoprotein cholesterol \( 1 99 0 80 mmol per liter \) apolipoprotein b members heterozygous deficiency \( n 20 \) , whose cetp levels lower part normal range , moderately increased levels hdl cholesterol apolipoprotein increased ratio hdl subclass 2 hdl subclass 3 , compared unaffected family members \( 1 5 0 8 vs 0 7 0 4 \) cetp deficiency found six unrelated subjects elevated hdl cholesterol levels different parts united states conclusions cetp deficiency appears frequent cause increased hdl levels population japan , possibly effect results observed heterozygotes suggest cetp normally plays part regulation levels hdl subclass 2 evidence premature atherosclerosis families cetp deficiency fact , lipoprotein profile persons cetp deficiency potentially may associated increased life span
worldwide differences incidence type diabetes associated amino acid variation position 57 hla dq beta chain presence amino acid aspartic acid position 57 hla dq beta chain \( non asp 57 \) highly associated susceptibility insulin dependent diabetes mellitus \( iddm \) , whereas aspartic acid position \( asp 57 \) appears confer resistance disease hypothesize 30 fold difference iddm incidence across racial groups countries related variability frequency alleles diabetic nondiabetic individuals evaluated five populations , including low , moderate , high risk hla dq beta genotype distributions among iddm case groups markedly different \( p less 0 001 \) , among nondiabetic controls \( p less 0 001 \) non asp 57 alleles significantly associated iddm areas population specific odds ratios non asp 57 homozygotes relative asp 57 homozygotes ranged 14 111 relative risk information case control study population incidence data combined estimate genotype specific incidence rates county , pa , rates used predict overall incidence rates remaining populations , within 95 confidence intervals actual rates established incidence registries results consistent hypothesis population variation distribution non asp 57 alleles may explain much geographic variation iddm incidence
defect thermoregulation malnutrition reversed weight gain physiological mechanisms clinical importance previous studies infants elderly shown low body weight associated defect thermoregulation increased risk hypothermia present study , responses cooling stimulus measured 10 young middle aged patients lost least 10 per cent body weight illness investigations performed restoration body weight \( mean weight gain 7 2 kg , se 1 2 kg , p less 0 001 \) cooling stimulus provided special perfused water 28 degrees c 23 degrees c weight gain , increase metabolic rate response cooling , despite fall core temperature following weight gain , response cooling restored towards normal peripheral vasoconstriction , principal mechanism heat conservation , similar weight gain response infusion adrenaline \( 25 ng kg min \) abolished weight loss , suggesting defect cold induced following weight loss due change central control mechanisms thermoregulation , tissue unresponsiveness phenomenon abnormal thermoregulation following weight loss return normal subsequent weight gain may clinically important , particularly elderly , since quite small falls core temperature may impair neuromuscular coordination cerebral function
genetic defects lipoprotein metabolism elevation atherogenic lipoproteins caused impaired catabolism certain proteins \( called apolipoproteins b e \) surface lipoprotein particles responsible mediating binding cholesterol rich particles specific lipoprotein receptors surface cells represent major pathway controlling blood cholesterol levels three important disorders lipoprotein metabolism , provide insights molecular mechanisms responsible elevation specific atherogenic lipoproteins , following \( 1 \) type iii results specific mutations apolipoprotein e prevent normal binding chylomicron remnants low density lipoprotein remnants lipoprotein receptors patients disorder elevated levels remnant lipoproteins develop atherosclerosis \( 2 \) familial defective apolipoprotein b 100 results single amino acid substitution apolipoprotein b prevents low density lipoprotein binding normally low density lipoprotein receptor plasma cholesterol levels \( 3 \) familial hypercholesterolemia , results elevated levels plasma low density lipoprotein premature atherosclerosis , caused variety mutations low density lipoprotein receptor interfere normal binding lipoproteins receptor observations provide insights mechanisms responsible normal lipoprotein metabolism , also highlight potential role specific lipoproteins atherogenesis
fatal hypernatremia exogenous salt intake report case review literature published erratum appears mayo clin proc 1991 apr 66 \( 4 \) hypernatremia common electrolyte disturbance , often caused volume depletion hypernatremia due sodium excess occurs less frequently , fatal hypernatremia solely ingestion table salt rare describe 41 year old man seizures hypernatremia ingestion supersaturated salt water solution intended consumed approximately third cup table salt \( approximately 70 90 g salt 1 , 200 1 , 500 meq sodium \) initial serum sodium concentration 209 meq liter hypotonic fluid therapy given provide free water correct hypernatremia gradually patient , however , failed recover initial insult died 3 days later review literature revealed 10 adult 20 pediatric cases hypernatremia attributable exogenous intake salt type therapy \( fluid peritoneal dialysis \) , type fluid used , rate correction hypernatremia influence survival age patient initial serum sodium concentration important prognostic indicators young patients lesser degrees hypernatremia better rate survival patients addition , review illustrates surprisingly small amount salt cause severe hypernatremia danger using salt saline
molecular basis different forms metachromatic leukodystrophy background metachromatic leukodystrophy autosomal recessive inherited lysosomal storage disorder caused deficiency arylsulfatase three forms disease distinguished according severity age onset late infantile \( 1 2 years \) , juvenile \( 3 16 \) , adult \( greater 16 \) methods results understand molecular basis different forms disease , analyzed arylsulfatase alleles associated metachromatic leukodystrophy two alleles \( termed \) identified accounted half arylsulfatase alleles among 68 patients metachromatic leukodystrophy examined sufficient information available 66 patients allow classification disease six instances allele , associated late infantile form disease eight instances allele , five associated adult form three juvenile form alleles present , juvenile form resulted \( seven seven instances \) heterozygosity allele \( allele unknown \) usually associated late infantile disease , heterozygosity allele later onset disease clinical variability explained different levels residual arylsulfatase activity associated genotypes conclusions like many lysosomal storage disorders , metachromatic leukodystrophy shows clinical heterogeneity seems reflect genetic heterogeneity one known alleles \( allele \) associated earlier severe disease \( allele \)
effect chronic alcohol administration transketolase brain liver rats estimate nutritional pathological states thiamin deficiency related diseases , especially wernicke syndrome , studied relationship among transketolase activity , transketolase concentration , thiamin phosphate esters rats chronically fed alcohol brain alcohol fed rats , enzyme activity concentration decreased although positive correlation two contrary , transketolase activity liver correlated positively concentration , transketolase activity concentration decreased thiamin deficient groups findings suggest transketolase brain may different liver alteration enzyme activity brain may based conformational change protein molecule caused chronic alcohol administration
influence different nutrient contents glucose , c peptide , insulin , glucagon , triglycerides , gip non insulin dependent diabetics examine influence fat protein mixed meal carbohydrate metabolism , subjects non insulin dependent diabetes mellitus \( niddm \) received three different varying amount fat protein \( group 1 \) amount fat \( group 2 \) compared changes standard breakfast , insulin increased protein rich meal decreased fat rich meal group 1 glucose gastric inhibitory polypeptide \( gip \) remained constant contrast , gip showed significant increase high fat meal group 2 thus , niddm subjects , glucose insulin responses different mixed meals appear exclusively mediated gip protein confirmed potent stimulator insulin secretion factors , altered beta cell response diabetics gip , must considered explain reported results
protein metabolism obesity effects body fat distribution hyperinsulinemia leucine turnover examine whether moderate obesity differences body fat distribution associated abnormalities protein metabolism , leucine turnover measured three groups age matched premenopausal women ten upper body obese \( ob \) , 10 lower body obese \( lb ob \) , 10 nonobese \( non ob \) women studied overnight postabsorptive condition \( basal \) infusion low physiologic amounts insulin \( insulin clamp \) results showed basal leucine carbon flux greater \( p less 0 05 \) ob lb ob women non ob women \( 2 96 0 08 vs 3 14 0 16 vs 2 68 0 08 mumol kg lean body mass 1 min 1 , respectively mean sem \) leucine carbon flux suppressed insulin clamp study ob women lb ob non ob women conclude moderate obesity associated increased insulin 's actions impaired upper body obesity findings could implications future studies treatment obesity
effect trestatin , amylase inhibitor , incorporated bread , glycemic responses normal diabetic patients effect incorporating pancreatic alpha amylase inhibitor trestatin bread postprandial plasma glucose insulin tested healthy volunteers non insulin dependent diabetic patients dose levels trestatin \( 3 6 mg 75 g starch \) peak values plasma glucose insulin reduced markedly \( compared placebo \) ingestion 75 g starch form bread healthy control subjects well diabetic patients , trestatin produced significantly lower insulin excretions also significant reductions incremental plasma glucose areas dose dependent fashion concluded feasible incorporate trestatin foods without loss activity impairment taste furthermore , positive effect trestatin glycemic responses diabetics lack serious side effects offer great potential dietary treatment diabetic patients
percent body fat obese white females predicted anthropometric measurements percent body fat \( \) 15 anthropometric measurements measured 221 obese white females randomly assigned validation cross validation groups two new anthropometric equations prediction percent body fat generated multiple regression equation 1 includes residual lung volume \( rv \) factor correlation coefficient \( r \) 0 85 standard error estimate \( see \) 3 9 equation 2 include rv r 0 82 see 4 3 equations precise two previous widely used equations subgroup 37 subjects underwent weight loss , equation 1 gave precise estimate change conclude new equations permit better prediction obese white females
vitreous insulin dependent diabetes mellitus correlation microalbuminuria diastolic blood pressure vitreous performed 240 eyes 120 young subjects insulin dependent diabetes mellitus \( type \) various grades retinopathy concentration fluorescein measured anterior chamber posterior vitreous 1 hour intravenous injection fluorescein significant association \( p less 001 \) grade retinopathy level posterior vitreous leakage amount posterior vitreous leakage eye also significant association borderline elevation diastolic blood pressure subjects excessive posterior vitreous leakage significantly higher levels urinary excretion multiple linear regression analysis posterior vitreous leakage , retinal grade consistently entered model significant level \( p less equal 00001 003 \) blood pressure also entered model posterior vitreous leakage significant level retinal grades right left eyes worst eye results demonstrate association leakage retinal renal vessels , possibly linked least part elevation diastolic blood pressure
incidence etiology hyponatremia intensive care unit evaluate incidence causes hyponatremia intensive care unit \( icu \) patients , retrospective prospective studies done hyponatremia defined serum sodium concentration equal less 134 mmol l \( 134 meq l \) prospectively , 29 6 patients displayed hyponatremia relevant data obtained twelve patients two patients serum ten patients serum , urine osmolality maximally dilute urine sodium concentration greater 30 mmol l \( 30 meq l \) suggesting inappropriate hormone secretion \( \) however , three patients exhibited suppressed levels despite absence maximal urinary dilution data suggest hyponatremia common icu patients renal defects frequent therefore , hypotonic fluid administered cautiously
rational electrolytes emergency department study objective validate predictive abilities retrospectively developed set clinical criteria detecting clinically significant electrolyte abnormalities , using different patient population design cross sectional study setting emergency department public hospital type participants nine hundred eighty two patients emergency physician ordered serum electrolytes interventions predictive properties ten clinical criteria evaluated included poor oral intake , vomiting , chronic hypertension , taking diuretic , recent seizure , muscle weakness , age 65 years , alcoholism , abnormal mental status , recent history electrolyte abnormality measurements main results seven hundred thirty patients \( 74 3 \) one electrolytes outside laboratory normal range , 143 \( 14 6 \) clinically significant electrolyte abnormalities clinical criteria predicted 135 clinically significant electrolyte abnormalities \( sensitivity , 94 4 \) eight false negative cases reviewed , none electrolyte abnormalities affected patient outcome implementation criteria would avoided unnecessary testing 233 patients \( 23 7 \) conclusion although set clinical criteria eliminate need clinical judgment , use set clinical criteria could substantially decrease electrolyte without compromising patient care
pediatrics residents' attitudes insulin dependent diabetes mellitus children diabetes nationwide , pediatricians provide substantial portion health care children diabetes beliefs attitudes diabetes children illness important influence treatment decisions attitudes beliefs 1988 sample pediatrics residents compared data 1987 national survey practicing beliefs attitudes children insulin dependent diabetes mellitus disease pediatrics residents second third years training considerably negative diabetes diabetic children either members national sample practicing pediatricians residents' first year colleagues
endothelin increased contractility adult rat ventricular myocytes role intracellular alkalosis induced activation protein kinase c dependent na \( \) h endothelin , 21 amino acid vasoactive peptide , among potent positively inotropic agents yet described mammalian heart demonstrated endothelin 's inotropic effect due , part , apparent sensitization cardiac intracellular calcium , determined whether could due rise intracellular ph \( phi \) isolated adult rat ventricular cells loaded h \( \) selective fluorescent probe , 100 pm endothelin increased contractile amplitude 190 26 baseline phi 0 08 0 02 \( n 8 \) , whereas 1 nm endothelin increased phi 0 13 0 03 little increase contractility amiloride \( 10 \( 4 \) \) prevented increase phi response endothelin reduced inotropic response 45 , although inotropic effect could readily restored subsequent induced similarly , inhibitors protein kinase c \( h 7 sphingosine \) diminished abolished rise phi endothelin causing decline inotropic effect comparable observed amiloride pretreatment pertussis toxin , demonstrated results complete adp alpha subunits go gi gtp binding proteins abolition endothelin 's positive inotropic effect , partially reduced intracellular induced peptide , suggesting complex signal transduction mechanism thus , positive inotropic action endothelin due part stimulation na \( \) h protein kinase c mediated pathway , resulting rise phi sensitization cardiac intracellular ca2
mechanical alternans acidosis ferret heart muscle acidosis leads mechanical alternans \( e , alternation large small contractions \) ferret papillary muscles alternation size contraction paralleled alternation size intracellular ca2 transient \( monitored using \) isolated myocytes , large contraction accompanied prolonged action potential mechanical alternans also induced acidosis isolated myocytes train voltage clamp pulses thus , appears unlikely mechanical alternans secondary changes action potential duration likely observed changes action potential duration secondary changes size ca2 transient observation ca2 \( \) activated current also shows alternation mechanical alternans provides possible mechanism link ca2 action potential duration alternation size ca2 transient may secondary slowed mechanical observed papillary muscles acidosis also could explain observation decreasing stimulation rate alternans
effect captopril glucose concentration possible role augmented postprandial forearm blood flow goal study evaluate effects captopril plasma glucose concentration daily profiles plasma glucose levels determined 12 non insulin dependent diabetic normotensive subjects , treated without captopril dose 25 mg 3 times day forearm blood flow also measured strain gauge plethysmography administration captopril improved daily profile plasma glucose level postprandial forearm blood flow also augmented 2 h meal results suggest angiotensin converting enzyme inhibitors may improve glucose metabolism diabetic subjects , possibly enhancement blood flow skeletal muscle
self care predictors metabolic control niddm patients objective study evaluate whether relationship self care behavior metabolic control comparable patients non insulin dependent diabetes mellitus \( niddm \) insulin insulin studied 84 niddm patients hospitalized elective admission washington university 's model demonstration unit admission , patients reported frequency exercise , blood glucose monitoring , meal skipping previous 2 wk metabolic control previous 8 12 wk determined glycosylated hemoglobin assays cross sectional analysis controlling patient sociodemographic health characteristics , glycosylated hemoglobin levels positively related meal skipping \( p 0 0008 \) negatively related frequency blood glucose monitoring \( p 0 0025 \) self care behaviors explained 26 variance glycosylated hemoglobin levels niddm patients multivariate modeling demonstrated significant interaction effects insulin treatment self care metabolic control conclusion , findings support clinical significance self care activities metabolic control niddm patients , particularly meal skipping blood glucose monitoring
theoretical baseline considerations diet weight control diabetes among blacks article outlines theoretical considerations diet weight control non insulin dependent diabetes mellitus \( niddm \) identifies factors may particular importance influencing success diet weight control niddm black population long term adherence dietary weight control regimens requires patient evaluate established eating physical activity patterns use social action theory conceptual framework , complex behavioral change task understood function various self regulatory mechanisms mechanisms influenced person 's capabilities making changes , physical condition general health status , physical social environmental context , person 's material social resources many factors may differ blacks whites direction suggests lesser potential effective diet weight loss therapy among black niddm patients example , compared whites , blacks likely limited , low educational attainment , weight control , multiple health problems , high fat high sodium low fiber diets food preferences however , evidence suggests state art counseling approaches effective blacks whites challenge adapt types approaches suggested social action theory appropriate cost effective delivery black community health care settings
exercise therapy prevention type ii diabetes implications blacks rationale use exercise treatment type ii \( non insulin dependent \) diabetes special implications blacks reviewed herein performed regular basis , exercise may improve glycemic control improve several risk factors coronary heart disease including hypertriglyceridemia , hypertension , hyperinsulinemia addition , may useful adjunct diet producing weight loss metabolic benefits exercise part appear related ability enhance insulin sensitivity benefits short lived discontinuing exercise problems compliance concurrent medical problems , many patients type ii diabetes good candidates exercise diet program reason , optimum target population may people risk type ii diabetes premature atherosclerosis population might include offspring patients disorders individuals impaired glucose tolerance , hyperinsulinemia , gestational diabetes , pattern fat distribution type ii diabetes common blacks general population instances , associated cardiovascular risk factors benefited exercise despite , available studies regarding effects regular exercise blacks type ii diabetes risk
cross sectional analysis renal function black americans niddm objective define glomerular filtration rate \( gfr \) renal plasma flow \( \) black americans non insulin dependent diabetes mellitus \( niddm \) cross sectional study 71 black niddm patients diagnosed diabetes duration 1 mo 21 yr hyperglycemia regulated stabilized patients entered study gfr determined clearance 125i iothalamate 131i labeled hippuran , respectively , constant infusion technique four urine collection periods hyperfiltration , defined gfr greater 140 ml min 1 1 73 2 , found 7 20 patients \( 35 \) newly diagnosed \( less 2 yr duration \) niddm percentage patients hyperfiltration decreased increasing duration diagnosed diabetes decreasing gfr occurred increasing duration diagnosed diabetes conclusion , renal hemodynamic changes black americans niddm similar known occur white populations iddm
effect exercise obesity skeletal muscle amino acid uptake genetically obese zucker rat reduced capacity dietary protein skeletal muscle determine whether amino acid uptake muscle obese zucker rats impaired , soleus strip \( sol \) \( epi \) muscles 10 wk old lean obese zucker rats studied vitro use 14c alpha acid \( aib \) muscles fasted rats incubated basal conditions rest 1 h treadmill run 8 grade total work completed , lean obese rats 27 20 min , respectively muscles resting length , 30 min 37 degrees c krebs ringer bicarbonate buffer containing 5 mm glucose 95 o2 5 co2 , incubated 3 h krebs ringer bicarbonate 0 5 mm aib , 14c aib , 3h inulin marker extracellular fluid basal aib uptake epi sol obese rats significantly reduced 40 30 \( p less 0 01 \) , respectively , compared lean rats lean obese rats , exercise increased \( p less 0 05 \) basal aib uptake epi sol , relative increases greater obese rats \( epi 54 sol 71 vs epi 32 sol 37 \) results demonstrate genetically obese zucker rats reduced basal skeletal muscle amino acid uptake suggest physical may partially contribute defect
regulation forearm lipolysis different types obesity vivo evidence adipocyte heterogeneity forearm systemic adipose tissue free fatty acid \( ffa \) release measured eight nonobese , six lower body obese , eight upper body obese women basal , hyperinsulinemic , conditions determine whether forearm fat regulated similar manner whole body fat results adipose tissue palmitate release greater forearm whole body \( 5 97 0 75 vs 3 84 0 34 mumol kg fat 1 min 1 , respectively , p less 0 005 , n 22 subjects \) systemic palmitate release , relative fat mass , significantly \( p less 0 01 \) greater nonobese upper body obese , upper body obese lower body obese women , forearm adipose tissue palmitate release followed pattern hyperinsulinemia suppressed systemic forearm lipolysis similar degrees , however , hypoinsulinemia consistently increased systemic palmitate flux without increasing forearm palmitate release results confirm heterogeneity adipose tissue vivo model emphasize need consider adipose tissue responsible differences systemic ffa flux obese nonobese humans
diacylglycerol accumulation microvascular abnormalities induced elevated glucose levels present experiments undertaken examine hypothesis glucose induced increased de novo synthesis 1 , 2 sn glycerol \( observed number different tissues , including retinal capillary endothelial cells exposed elevated glucose levels vitro \) associated activation protein kinase c may play role mediating glucose induced vascular functional changes report twice daily instillation 30 mm glucose 10 rat skin chamber granulation tissue model induces approximately 2 7 fold increase diacylglycerol \( \) levels \( versus tissues exposed 5 mm glucose \) association marked increases vascular clearance albumin blood flow glucose induced increase levels well vascular functional changes prevented addition 3 mm pyruvate pharmacological activation protein kinase c phorbol ester tpa presence 5 mm glucose increases microvascular albumin clearance blood flow , similar effects observed 1 \( \) , pharmacological inhibitor catabolism endogenous pharmacological inhibitor protein kinase c \( staurosporine \) greatly attenuates rise microvascular albumin clearance \( rise blood flow \) induced glucose findings compatible hypothesis elevated concentrations glucose increase tissue content via de novo synthesis , resulting protein kinase c activation , biochemical events among factors generate increased microvascular albumin clearance
anderson 's disease genetic exclusion apolipoprotein b gene two families anderson 's disease recessive disorder characterized intestinal fat malabsorption , absence postprandial , reduced levels cholesterol , triglycerides , b , ai , c studied two families , respectively , three two children anderson 's disease intestinal apo b apo mrnas two anderson 's patients normal size concentration decreased fivefold compared controls dna digestion seven restriction enzymes , restriction fragment length polymorphisms apo b gene show conclusive information except , revealed lack restriction fragment length polymorphism anderson 's phenotype linkage analysis performed using polymorphism apo b gene genomic dna parents children amplified polymerase chain reaction using oligonucleotide primers flanking apo b gene locus families child inherited different apo b alleles least one parent according recessive mode transmission disease , results incompatible involvement apo b gene likely posttranslational defect mutation another gene encoding protein essential lipoprotein assembly secretion may involved
treating serum lipid abnormalities high priority patients normalization serum lipid levels initiated soon possible patients myocardial , cerebrovascular , peripheral vascular disease clinical trials indicate coronary artery disease overall mortality rates reduced atherosclerosis stabilized reversed lipid lowering therapy treatment lower low density lipoprotein cholesterol levels 130 mg dl less total triglyceride levels 150 mg dl less increase high density lipoprotein cholesterol levels least 52 mg dl men 66 mg dl women coronary risk factors eliminated possible lipid lowering therapy may consist dietary modification drug treatment colestipol hydrochloride \( \) , cholestyramine \( , questran \) , lovastatin \( \) , gemfibrozil \( \) , acid \( \)
myo inositol pool utilized phosphatidylinositol synthesis depleted sciatic nerve rats streptozotocin induced diabetes peripheral nerve experimentally diabetic rats exhibits lowered levels myo inositol \( mi \) decreased incorporation 3h mi phosphatidylinositol \( pi \) indications diminished pi turnover may causally related reduced na , k \( \) atpase activity diabetic nerve investigated whether metabolic compartment mi essential pi synthesis decreased tissue sciatic nerve segments streptozotocin induced diabetic age matched normal rats incubated vitro either 3h presence propranolol cationic agent nerve phospholipid metabolism produce enhanced 32p incorporation pi decreased labeling phosphatidylcholine phosphatidyl accumulation phosphatidyl cmp \( cmp pa \) also demonstrated chromatographic enzymatic means incorporation 3h cmp pa normal nerve increased 15 fold 0 6 mm propranolol present diabetic nerve , incorporated 2 3 fold isotope readily labeled lower drug concentrations compared normal nerve 3h cmp pa reduced dose dependent manner presence mi incubation medium concentrations 3 mm however , mi added accumulation , preformed cmp pa could utilized pi synthesis difference labeling normal diabetic nerve nearly abolished 0 3 mm medium mi , concentration much less level tissue results strongly suggest presence nerve pool mi equilibrium bulk nerve mi preferentially used pi synthesis metabolic compartment depleted diabetic nerve readily exogenous mi may correspond mi pool proposed required turnover portion tissue pi involved maintenance normal na , k \( \) atpase activity
evidence regulation beta cell glucose transporters non insulin dependent diabetes may cause diabetic hyperglycemia non insulin dependent diabetes mellitus \( niddm \) attributed failure pancreatic beta cells maintain insulin secretion level sufficient compensate underlying insulin resistance rat , model niddm closely resembles human syndrome , previously reported profound glut 2 , high km glucose transporter expressed beta cells normal animals report islets diabetic rats exhibit marked decrease volume glut 2 positive beta cells reduction electron microscopic level number glut 2 immunoreactive sites per unit beta cell plasma membrane deficiency glut 2 cannot induced normal beta cells vivo vitro exposure high levels glucose prevented beta cells rats elimination hyperglycemia conclude glut 2 niddm secondary hyperglycemia therefore may well play causal role development hyperglycemia
vitamin e neurologic deficits past decade become apparent vitamin e essential nutrient maintaining structural functional integrity developing human nervous system , skeletal muscle , retina clinical histologic human neuromuscular disorder associated chronic fat vitamin e malabsorption observed experimental vitamin e deficient animal models striking chronic malabsorption vitamin e , children cf , chronic cholestasis , , short bowel syndrome risk development neurologic deficits caused vitamin e deficiency correction vitamin e deficiency state prevents , reverses , , least , neurologic dysfunction susceptible individuals advances stable isotope technology permit study hepatic discrimination among various forms vitamin e investigations cause primary form vitamin e deficiency , isolated vitamin e deficiency syndrome , promise delineate normal physiologic processes involved absorption , transport , tissue delivery vitamin e studies progress addressing optimal route form vitamin e therapy used predisposing condition one major task remaining better define mechanism vitamin e deficiency leads neurologic injury
localization island eye disease locus region x chromosome linkage analysis island eye disease \( aied \) x chromosomal disorder characterized reduced visual acuity , progressive axial myopia , regular astigmatism , latent nystagmus , foveal hypoplasia , defective dark adaptation , fundus syndrome originally reported 1964 family determine localization aied gene , linkage studies performed family total 37 polymorphisms , covering loci entire x chromosome , used two point analysis strongest evidence linkage obtained aied \( maximum lod score 4 92 maximum recombination fraction theta max 00 \) marker loci , , also showed recombination aied positive lod scores theta max 00 obtained markers localized xy homologous region , numbers informative small linkage analysis indicated probable location aied region results rule aied distal xp proposed others data exclude possibility aied incomplete congenital stationary night blindness caused mutations gene question resolved careful clinical comparison disorders ultimately molecular dissection genes
hyperlipidemia organ transplantation hyperlipidemia , long recognized difficult common problem following organ transplantation , may underlying cause accelerated atherosclerosis observed heart transplant recipients children renal transplants addition , hyperlipidemia may play role late renal graft loss cause post transplant hyperlipidemia unclear patients treated azathioprine prednisone , hypertriglyceridemia commonest finding probably results increased consumption calories carbohydrate fat following resolution uremia , conjunction glucose intolerance secondary steroid administration patients treated cyclosporine , hypercholesterolemia common form hyperlipidemia cyclosporine lipophilic drug transported plasma , largely association lipoproteins , may require low density lipoprotein \( ldl \) receptor internalization cells hypercholesterolemia may result interference basic cholesterol feedback mechanism via ldl receptor addition , cyclosporine affects bile acid synthesis glucose tolerance , factors may promote hyperlipidemia first therapeutic approach hyperlipidemia transplant recipient dietary calorie fat restriction supplementation soluble fiber ongoing clinical trials available pharmacologic lipid lowering agents addressing safety efficacy agents setting immunosuppression time , used cautiously low doses
schizophrenia fatal self induced water intoxication appropriately diluted urine 31 year old woman untreated chronic schizophrenia developed extreme rapidly led coma death due cerebral edema hyponatremia \( 120 meq liter \) serum osmolality \( 260 mosm kg \) associated marked \( ml hour \) appropriately low urinary osmolality \( 90 mosm kg \) responded treatment case qualifying previous reports reviewed support possibility pure self induced water intoxication major contribution inadequate release hormone may occur , extreme sometimes normal renal capacity psychotic patients
states composition extracellular fluid \( \) must remain stable cells function properly normal individuals vasopressin maintain total concentration , osmolality , within narrow range disruption regulatory mechanisms rapid addition solute lead serious neurologic symptoms accompany many forms explained understanding physiologic response cells osmotic stress review describes physiology , pathophysiology , differential diagnosis , therapy states
hypokalemia induction anesthesia prevention beta 2 adrenoceptor antagonism observed serum potassium levels measured immediately induction anesthesia \( preinduction k \) often lower measured 1 3 days preoperatively \( preoperative k \) purpose investigation determine , two studies , magnitude difference elucidate mechanism occurs first study , preinduction k \( 3 6 0 4 meq l , mean sd \) significantly lower k levels measured routine preoperative testing \( 4 4 0 4 meq l , n 47 , p less 0 001 \) twenty three patients \( 49 \) preinduction k levels considered hypokalemic \( less equal 3 5 meq l \) , 22 23 patients normal preoperative k levels second study tested hypothesis preinduction decreases serum k mediated beta 2 adrenergic receptors preinduction k changes determined patients given single preoperative dose propranolol \( beta 1 beta 2 antagonist \) , atenolol \( beta 1 antagonist \) , beta blocker \( control \) difference preoperative preinduction serum k patients receiving propranolol \( 0 1 0 4 meq l \) significantly attenuated \( p less 0 02 \) compared difference control subjects \( 0 5 0 4 meq l \) , significantly different controls patients pretreated atenolol \( 0 3 0 4 meq l \) results demonstrate serum k levels measured intraoperatively anesthetic induction consistently significantly less measured 1 3 days preoperatively ability propranolol atenolol block change suggests acute decrease k levels due beta 2 adrenergic receptor stimulation
role alpha 1 adrenoceptors adrenaline induced action adrenaline investigated 44 domestic pigs plasma epicardial concentrations k measured , latter case ion selective electrode adrenaline 10 micrograms kg 1 caused rapid increase plasma concentration k 4 2 5 9 mmol litre 1 magnitude time course epicardial concentration k similar alpha adrenoceptor block either phentolamine 5 mg kg 1 \( non selective block \) prazosin 0 1 mg kg 1 \( selective alpha 1 adrenoceptor block \) abolished effect adrenaline plasma epicardium alpha 1 adrenoceptor agonist phenylephrine increased k concentration , alpha 2 adrenoceptor agonist uk 14 304 cause change concentration results suggest induced adrenaline occurs interstitial fluid myocardium mediated alpha 1 adrenoceptors findings may important patients risk , implications , example , use suxamethonium induction anaesthesia
free protein levels elevated familial c4b binding protein deficiency plasma , 40 protein free functions cofactor anticoagulant effects activated protein c remaining 60 protein c4b binding protein functionally inactive family hereditary c4b binding protein deficiency identified c4b binding protein levels affected father daughter 37 micrograms ml 23 micrograms ml , respectively values significantly normal range protein 180 micrograms ml 44 micrograms ml \( mean 2 sd \) total protein \( free bound \) normal individuals \( 23 2 micrograms ml 17 8 micrograms ml , respectively normal 19 1 micrograms ml 6 0 micrograms ml \) free protein levels markedly increased 22 5 micrograms ml 17 4 micrograms ml , respectively \( normal 5 9 micrograms ml 2 4 micrograms ml \) experiment nature shows total protein levels plasma affected absence c4b binding protein chronic elevation free protein associated increased hemorrhagic
dual defects pulsatile growth hormone secretion clearance obesity man examined mechanisms underlying reduced circulating gh concentrations obese human computer assisted \( \) analysis used determine endogenous gh secretory clearance rates quantitatively entire 24 h plasma gh concentration profiles analyses revealed half life \( 1 2 \) endogenous gh significantly shorter obese \( 11 7 1 6 min \) normal weight subjects \( 15 5 0 81 min p less 0 01 \) accelerated blood disposal rate gh due decreased circulating concentrations gh binding protein , since latter similar obese \( 25 1 0 \) normal weight \( 24 2 3 \) men however , obese men significantly fewer gh secretory bursts \( 3 2 0 53 vs 9 7 0 67 day p less 0 01 \) among rare gh secretory bursts occurred obese subjects , significantly prolonged mean burst intervals \( 282 65 vs 131 11 min p less 0 05 \) resultant daily gh production rate obese men reduced one fourth normal weight individuals gh secretion rate burst frequency negatively correlated degree obesity \( index \) decreases gh burst frequency half life specific , since gh secretory pulse amplitude \( maximal rate gh release \) , mass gh released per burst , duration computer resolved gh secretory bursts different obese normal weight men conclude obese men harbor double defect gh dynamics involving gh secretion clearance , severity gh secretory deficiency degree obesity
influence thiamin supplementation health general well elderly population marginal thiamin deficiency published erratum appears j 1991 sep 46 \( 5 \) effect thiamin supplementation health general well 80 randomly selected healthy elderly women , population marginal thiamin deficiency , studied key variables affecting thiamin status controlled weekly dietary intakes , subjective feelings , activity assessments measured 4 week baseline 6 week double blind treatment period clinical assessments performed last week period treatment , subjects randomly assigned either thiamin \( 10 mg daily \) placebo groups compared baseline placebo supplemented values , thiamin supplemented women experienced significantly increased appetite , energy intake , body weight general well , decreased fatigue thiamin supplementation also tended reduce daytime sleep time , improve sleep patterns , increase activity data suggest evaluation thiamin status indicated nonspecific conditions anorexia , weight loss , fatigue , depression , sleep disorders present elderly persons
abnormal arginine vasopressin response cigarette smoking metoclopramide \( insulin induced hypoglycemia \) elderly subjects aging known reduce arginine vasopressin \( avp \) response volumetric increase avp responses osmotic stimuli administration metoclopramide \( mcp \) order gain better insight effect age avp secretion , evaluated avp responses cigarette smoking , mcp , insulin induced hypoglycemia 30 male subjects aged 22 81 divided 3 groups age basal avp concentrations similar groups avp response insulin tolerance test similar pattern magnitude \( 2 5 fold increase \) groups avp responses mcp cigarette smoking similar two younger groups , plasma avp levels increased 2 times mcp 2 5 times cigarette smoking contrast , mcp cigarette smoking induced avp rises significantly higher oldest group , plasma avp concentrations increased 2 5 times mcp 3 25 times smoking data mcp cigarette smoking tests combined , regression analyses showed significant positive correlation avp peak responses mcp cigarette smoking oldest subjects data show elderly humans increased avp responses mcp also cigarette smoking , suggesting common disorder alterations contrast , lack age related changes avp response insulin tolerance test demonstrates mechanism underlying avp response hypoglycemia affected aging
relationship clinically confirmed cobalamin deficiency serum methylmalonic acid 1 year period , examined 42 consecutive patients low serum cobalamin levels detected primary screening test \( protein , ria \) 31 patients \( 74 \) clinical cobalamin deficiency confirmed , whereas remaining 11 patients \( 26 \) characterized clinically non cobalamin deficient serum methylmalonic acid level higher 0 34 mumol l 1 \( 3 sd mean normal controls \) 30 31 clinically characterized cobalamin deficient subjects , level 10 11 non deficient patients conclude serum methylmalonic acid assay provides appropriate means discrimination cobalamin deficiency non cobalamin deficiency \( efficiency 0 95 \) , recommend assay adopted standard test diagnosis tissue cobalamin deficiency
drug related admissions cardiology department frequency three hundred sixty six consecutive patients admitted department cardiology evaluated drug events cause admission drug events considered adverse drug reactions \( adr \) dose related therapeutic failures \( \) drug events accounted 15 admissions \( 4 1 , 95 confidence limits 2 3 6 7 \) , eleven adr four inclusion six drug events , rate drug related hospitalizations \( \) 5 7 characterized preponderance acute admissions elderly patients \( less 3 5 mm \) observed 27 \( 16 \) patients receiving diuretics , could related four cases arrhythmias \( two two adr \) average serum potassium level similar diuretic treated patients without drugs counteract , irrespective drugs chosen among 15 , five considered due error prescription , five cases judged avoidable appropriate measures taken prescribing physicians educational intervention programme primarily deal non compliance prescription diuretics digoxin , since problems constitute majority cases specific group doctors could targeted responsible , avoidable
lowering cost lowering cholesterol policy lovastatin objectives describe medical center policy designed contain cost using lipid lowering drug lovastatin primary care setting , examine effect policy cost containment , examine physician acceptance policy setting veterans affairs medical center interventions policy made lovastatin available physicians failure therapy diet two first line drugs documented order form form also contained educational information including recommended niacin drug treatment first choice patients design evaluate effect policy , lipid lowering drug use medical center compared similar center restrict lovastatin use , lipid lowering drug use united states whole written questionnaire used survey physician reaction policy results use lovastatin percentage total lipid lowering drug use center lovastatin policy one fourth center nationwide , use niacin four times greater \( p less 0 0001 \) estimated savings drug costs center lovastatin policy due differences 30 , 000 per year survey physicians affected policy \( n 78 , response rate 100 \) , less one fourth viewed , 90 favored policy restricting drug subspecialty clinic conclusion authors' experience indicates policy permits limited use expensive drug primary care setting contain costs way acceptable physicians policy type could useful increasing number health care provider organizations cover cost outpatient medications
lovastatin therapy cholesterol ester storage disease two sisters administered lovastatin two sisters , aged 4 17 years , cholesterol ester storage disease , autosomal recessive disorder manifested hypercholesterolemia hypertriglyceridemia drug , competitive inhibitor 3 hydroxy 3 coenzyme reductase , taken orally 6 months serum lipid concentrations determined monthly computed tomography liver performed therapy evaluate liver fat content younger sister liver biopsies 6 months lovastatin therapy assess hepatic cholesterol stores patients marked decreases serum levels cholesterol , triglycerides , low density lipoprotein cholesterol high density lipoprotein cholesterol levels increased computed tomography treatment demonstrated significant increase linear attenuation , suggesting decreased liver fat content liver tissue obtained 6 months lovastatin therapy initiated 13 less esterified cholesterol liver sample obtained treatment conclude lovastatin may effective treating children cholesterol ester storage disease
estimates metabolic rate obese nonobese adolescents evaluate validity equations calculation basal metabolic rate , compared measured metabolic rates population included obese nonobese adolescents metabolic rates calculated five equations commonly used estimate metabolic rate available options , neither mayo clinic nomogram food organization world health organization united university \( \) equations produced estimates differed significantly measured values second cohort severely obese adolescent girls , equation included height weight provided accurate estimate metabolic rate simplicity , recommend use equations estimate metabolic rate adolescent populations \( boys 17 5 weight \( kg \) girls 12 2 weight \( kg \) \) however , obese cohorts studied , equation includes weight height predicts metabolic rate accurately \( boys 16 6 weight \( kg \) 77 height \( \) girls 7 4 weight \( kg \) height \( \) 217 \)
site responsible reduced response hypokalemia rats rats hypokalemia induced eating low k diet diminished response purpose study determine due lower rate net secretion k cortical collecting duct \( \) enhanced rate reabsorption k medullary collecting duct \( mcd \) secondary active secretion k raises k lumen compared plasma tf p \) k \) \( tf p \) k greater 1 , secondary active secretion k segment \( tf p \) k measured collecting duct three groups rats studied rats low k diet without acute administration doca , rats normal k diet treated doca chronic basis rats low k diet \( tf p \) k 0 8 0 11 value rise values significantly greater 1 acute administration doca \( 1 4 0 35 \) contrast , chronic administration doca rats fed normal k diet result \( tf p \) k significantly greater unity \( 3 1 0 39 \) degree hypokalemia significantly different rats absolute fractional reabsorption k mcd different rats low k diet without doca conclude segment responsible reduced response
effects chronic alcohol intake carbohydrate lipid metabolism subjects type ii \( non insulin dependent \) diabetes purpose study effects chronic alcohol intake carbohydrate lipid metabolism subjects non insulin dependent \( type ii \) diabetes \( niddm \) also evaluate effect alcohol withdrawal metabolic control patients methods study group consisted 46 alcohol consuming patients niddm \( niddm b group \) , 35 non alcohol consuming patients niddm \( niddm group \) , 40 normal control subjects patients admitted hospital carbohydrate lipid metabolism assessed individuals immediately admission hospital following days results niddm b group , blood alcohol \( ethyl alcohol \) concentration low however , chronic alcohol intake associated higher fasting postprandial glucose concentrations higher hemoglobin a1c significant differences found c peptide levels moreover , higher concentrations 3 hydroxybutyrate free fatty acids observed niddm b group niddm group differences found triglyceride concentrations , acid base patterns , electrolyte levels metabolic effects alcohol completely 3 days complete withdrawal conclusion chronic alcohol intake causes deterioration metabolic control persons niddm effects induced alcohol completely reversed days withdrawal strict metabolic assessment necessary alcohol important constituent diet
inspiratory muscle performance pulmonary function changes insulin dependent diabetes mellitus study examined pulmonary function parameters 36 patients insulin dependent diabetes mellitus analyzed inspiratory muscle performance control group consisted 40 healthy reference persons sex ratio , age , height , weight distribution similar patients pulmonary function test included measurement lung volumes maximal expiratory flow volume curves values maximal esophageal \( pes \) pressures \( pdi \) used parameters global inspiratory muscle strength diaphragm strength , respectively 12 maximum voluntary ventilation \( \) test supplied parameter inspiratory muscle endurance diabetic patients showed highly significant decreased value inspiratory vital capacity \( \) compared control subjects \( 4 75 0 84 versus 5 36 1 37 l p less 0 01 \) inspiratory muscle performance diabetic patients also restricted pes significantly lower diabetic group \( p less 0 05 \) pdi \( p less 0 01 \) \( p less 0 05 \) also low results correlate either duration diabetes quality metabolic control measured glycosylated hemoglobin concentration reduction diabetic patients may caused partly reduced capacity inspiratory muscles
evaluation albumin loss low density lipoprotein apheresis reduced plasma oncotic pressure causes hyperlipidemia , serum albumin levels maintained low density lipoprotein \( ldl \) apheresis amount albumin loss evaluated seven patients familial hypercholesterolemia ldl apheresis columns packed dextran sulfate cellulose beads used selective ldl serum albumin level significantly decreased 4 3 0 3 \( mean sd \) g dl 3 6 0 2 g dl albumin loss assessed two different methods 1 \) radioimmunoassay content fluid , 2 \) measurement changes plasma albumin reserve albumin losses one apheresis session 3 7 2 9 g 8 3 5 7 g , respectively , depending upon two different methods used significant correlation two methods \( r 0 84 , p less 0 02 \) amount albumin loss apheresis estimated 4 1 9 1 total plasma albumin reserve , half decreased serum albumin level appeared attributable dilution due electrolyte solution used priming extracorporeal circuit
diabetes associated impairment hepatic insulin receptor tyrosine kinase activity study mechanisms insulin receptor tyrosine kinase activity solubilized liver control streptozotocin diabetic rats studied using h2b poly glu tyr \( 4 1 \) substrates inhibited exogenous kinase activity added , , receptor activation atp h2b added atp , insulin stimulated exogenous kinase activity diabetic derived receptors significantly higher \( approximately 50 \) control values low h2b concentrations , significantly lower \( approximately 50 \) control values high h2b concentrations , suggesting decrease apparent km maximal velocity diabetic receptor tyrosine kinase toward h2b receptors allowed maximally addition h2b , maximal h2b kinase activity diabetic derived receptors approximately 25 lower controls effects attributable altered atp kinetics insulin receptor kinase activity toward substrate poly glu tyr \( 4 1 \) unaltered insulinopenic diabetes insulin receptor alpha beta dimers detectable either control diabetic derived preparations conclude impairment hepatic insulin receptor kinase activity associated insulinopenic diabetes reflects decreased ability maximally activate , enhanced receptor activated presence substrates , e g h2b impaired diabetic derived receptor appears dependent type substrate concentration
hypothalamic pituitary axis streptozotocin induced diabetic female rats normalized estradiol replacement studies diabetic rats found abnormalities hypothalamic , pituitary , ovarian level controlled changes estrogen levels induced diabetes purpose investigation study effect diabetes hypothalamic pituitary axis ovariectomized rats treated estradiol \( e2 \) ovariectomized 60 day old female rats assigned control \( c , n 42 \) , diabetic \( , n 47 \) insulin treated diabetic \( di , n 16 \) groups diabetes induced injection streptozotocin di groups c , , di groups , estrogen replaced , 5 micrograms 20 micrograms e2 sc pituitary lh responsiveness gnrh assessed c animals anterior hypothalamic concentrations gnrh , pituitary lh serum levels lh , e2 measured ria anterior hypothalamic concentrations decreased diabetic rats treated 5 micrograms e2 compared 5 micrograms e2 control animals \( p less 0 05 \) gnrh concentrations also reduced vs c animals despite comparable estrogen therapy \( p less 0 004 \) gnrh stimulated lh levels greater e2 treated diabetic females similarly treated control rats \( p less 0 001 \) di animals sensitive controls inhibitory effect estrogen basal lh levels pituitary lh content lower 20 micrograms e2 replaced animals influenced diabetic state data demonstrate diabetes induced decrease hypothalamic gnrh concentration corrected e2 replacement responsiveness diabetic rat pituitary gnrh also suggests chronic lack gnrh stimulation hypothalamus continued ability pituitary respond gnrh
long term studies mental health gastric bypass operation morbid obesity february 1 , 1980 , may 1 , 1989 , 462 patients underwent gastric bypass east carolina university school medicine operation effectively maintained satisfactory weight loss 9 years \( mean weight preoperatively , 293 24 months , 179 96 months , 194 \) gastric bypass favorably affected non insulin dependent diabetes , hypertension , physical role functioning recent 157 patients , studies extended study effects gastric bypass mental health significant improvements mental health indices observed 6 12 months surgery end 2 years return mental health indices preoperative status , plus late occurrence 3 suicides 2 deaths alcohol abuse among total 462 patients , suggest long term follow continued emotional support essential successful surgery
human isophane insulin \? double blind crossover trial insulin dependent diabetes mellitus fifty two children insulin dependent diabetes mellitus randomised receive human isophane insulin preparations combination soluble insulin double blind trial patients seen every two months , crossed four months treatment control assessed haemoglobin significantly lower children human isophane insulin , fasting blood glucose fructosamine concentrations number episodes hypoglycaemia similar regimens five children twice daily insulin regimens , insulin profiles throughout 24 hour period demonstrated greater variability compared isophane insulin despite administered insulin doses questionnaire completed end study showed two thirds children parents preferred isophane insulin , gave perceived improvement metabolic control major reason choice
comparison non retinal photography ophthalmoscopy patients mobile retinal camera study objective determine whether non retinal photography comparable ophthalmoscopy mydriasis routine clinic screening early , treatable diabetic retinopathy design prospective study findings according retinal camera screening ophthalmoscopy outcome referral setting outpatient diabetic clinics three teaching hospitals three district general hospitals patients adults selected randomly diabetic clinics , excluding registered blind unable enter screening vehicle main outcome measures numbers patients eyes correctly identified technique requiring referral potentially treatable retinopathy \( new vessel formation maculopathy \) numbers , , reported results camera screening missed two cases new vessel formation identify 12 indicated need referral ophthalmoscopy missed five cases new vessel formation indicated need referral another four reasons maculopathy reported 147 eyes camera screening alone 95 eyes ophthalmoscopy \( chi 2 11 2 p less 0 001 \) , 66 29 respectively maculopathy subsequently confirmed overall , 38 eyes received laser treatment maculopathy detection camera screening compared 17 detection \( chi 2 8 0 p less 0 01 \) camera screening underestimated numbers \( chi 2 12 9 p less 0 001 \) \( chi 2 7 4 p less 0 01 \) ophthalmoscopy underestimated hard \( chi 2 48 2 p less 0 001 \) conclusions non retinal photography least good ophthalmoscopy mydriasis routine diabetic clinics identifying new vessel formation absence retinopathy significantly better detecting maculopathy
xylose absorption test urine blood \? xylose absorption test used last four decades evaluation malabsorption small intestine however , disagreement still exists recommended method performing test 1 hr blood test , 5 hr urine test , evaluated test performing 125 combined blood urine tests 111 patients normal xylose absorption recorded blood urine 71 tests \( group , 56 8 \) abnormal test results blood urine recorded 29 patients \( group b , 23 2 \) one patient pathological blood value normal xylose excretion urine twenty four patients \( group , 19 2 \) normal 1 hr blood xylose \( greater 25 mg 100 ml \) abnormal 5 hr urine xylose \( less 4 5 g 5 hr \) fat bile salt malabsorption documented 21 patients \( 87 5 \) group using stool fat analysis 14c breath test data suggest adults 5 hr urine collection accurately reflects intestinal absorption comparison 1 hr blood value
bmy 30047 novel topically active retinoid low local systemic toxicity treatment various disorders , topically applied retinoids potential therapeutic use advantage improved localized activity lower toxicity systemically administered retinoids however , retinoids cause significant degree local irritation present study , ability produce local activity low local irritation potential evaluated novel retinoic acid derivative bmy 30047 \( 11 cis , 13 cis 12 acid delta \) one series retinoic acid derivatives carboxyl function polar end modified aim achieving reduced local irritation systemic toxicity retaining local therapeutic effect bmy 30047 evaluated compared trans retinoic acid topical retinoid activity several preclinical assay systems , including reduction assay mice , 12 tetradecanoylphorbol 13 acetate ester stimulated ornithine decarboxylase induction hairless mice uv light induced skin model hairless mice bmy 30047 assessed retinoid type side effects evaluating skin irritation potential rabbits repeated topical application , inducing potential mice p injection bmy 30047 demonstrated significant topical retinoid activity several vivo models less skin irritation potential relative used clinical concentrations trans retinoic acid bmy 30047 also showed little systemic activity produce evidence syndrome systemic doses 20 times greater effect dose trans retinoic acid
metabolic alterations following continent urinary diversion colonic segments study examined acid base metabolism patients continent colonic urinary diversions compared control population diverted patients demonstrated mild acidosis urinary acidification defect ammonium chloride loading failed demonstrate major differences ability patients handle acute acid challenge continent colonic urinary diversions appear create significant acid base changes patients normal hepatic renal function
urinary bladder function 6 months onset diabetes spontaneously diabetic bb rat urinary bladder function examined spontaneously diabetic bb rat six months onset diabetes diabetes caused significant decreases rat weight increases bladder body weights vivo bladder capacities compared age matched controls , changes weights bladder bases absolute contractile responses urinary bladder body base strips nerve stimulation , carbachol , 5 hydroxytryptamine , atp , phenylephrine , kcl unaltered diabetes however , data corrected tissue mass , slight significant decreases contractile responses strips diabetic rats increases total muscarinic receptor numbers calcium channel binding sites bladder bodies bb rats result increases tissue mass data indicate six month diabetic bb rat differs streptozotocin diabetic rat sensitivity urinary bladder complications diabetes , probably result insulin treatment required keep bb rats alive
comparison accuracy glucose reflectance meters pregnant insulin dependent diabetics home monitoring blood glucose reflectance meters shown accurate nonpregnant diabetic currently used outpatient glucose control pregnant diabetic well glucose results samples collected sodium fluoride used standard study comparisons made four glucose reflectance meters accu check ii , one touch , , although reflectance meters appeared useful assessing blood glucose trends pregnant diabetic , results obtained meters would unacceptable laboratory setting unfortunately , combination proportional constant bias , correction factors easily ascertained laboratories physicians use reflectance meters inpatient evaluation general population screening pregnant women
pharmacokinetics ranitidine morbidly obese women pharmacokinetics single dose ranitidine 50 mg iv determined ten normal weight ten morbidly obese \( greater 90 percent ideal body weight \) age matched female subjects significant difference normal obese subjects found ranitidine peak serum concentration , volume distribution , clearance , elimination rate constant ranitidine volume distribution clearance significantly smaller obese subjects per kilogram total body weight \( 1 45 vs 0 80 l kg 0 59 vs 0 33 l h kg , respectively p less 0 001 \) normalized ideal body weight \( 1 65 vs 1 45 l kg 0 68 vs 0 59 l h kg \) conclude obese patients receiving ranitidine therapy treated standard dosages dosages based ideal body weight
plasma lecithin cholesterol acyltransferase activity plasma lipoprotein composition concentrations published erratum appears j clin 1991 sep 54 \( 3 \) plasma lecithin cholesterol acyltransferase \( lcat \) activity , lipoprotein composition , lipoprotein concentrations measured 21 children \( day 1 \) , \( day 10 \) , treatment \( day 30 \) day 1 lcat activity \( 78 2 mumol l 1 h 1 \) decreased respect day 10 \( 139 2 mumol l 1 h 1 , p less 0 001 \) day 30 \( 108 0 mumol l 1 h 1 , p 0 08 \) plasma total cholesterol \( tc \) , cholesterol ester \( ce \) , lipoprotein ces \( vldl , , ldl , hdl \) reduced relative days 10 30 \( p less 0 001 \) treatment hdl composition abnormal days 1 , 10 , 30 , respective mean hdl apolipoprotein \( apo \) concentrations 23 33 , 39 66 , 36 08 mumol l ldl apo b concentrations 0 40 , 0 68 , 0 56 mumol l \( p less 0 01 , days 10 30 vs day 1 \) ldl particles day 1 decreased number , depleted ce , surface lipids lcat activity day 1 correlated ldl ce \( p less 0 05 , r 0 48 \) reduced plasma lcat activity important factor related abnormalities lipoprotein composition concentrations
blood glucose values glycemic responses insulin dependent diabetes mellitus constant influence blood glucose \( ppbg \) concentration glycemic responses studied seven subjects insulin dependent diabetes , means artificial pancreas , achieved ppbg concentrations 6 , 9 , 17 mmol l test meal 50 g rice given three different occasions constant insulin infusion provided observation periods mean postprandial blood glucose response area \( basal \) differed significantly three blood glucose concentrations 6 , 9 , 17 mmol l , reaching , , 179 mmol l x 240 min , respectively \( p less 0 01 \) negative correlation ppbg concentrations glycemic responses test meal found \( r 0 94 p less 0 001 \) fasting insulin concentration ppbg concentration 17 mmol l lower ppbg concentration 6 9 mmol l conclusion , glycemic responses carbohydrate meal inversely correlated ppbg concentration insulin dependent diabetic subjects
permanent muscle weakness familial periodic paralysis clinical , radiological pathological aspects myopathy accompanying familial periodic paralysis \( \) much less well documented attacks disease name eleven affected members large studied clinically radiologically presence myopathy 4 patients muscle biopsies also performed 1 histological findings obtained autopsy compared ct scans various muscles another patient previously biopsied , specimens legs examined histologically age studied individuals ranged 33 74 yrs 4 youngest patients showed clinical signs myopathy however , 2 ct scans demonstrated discrete lesions leg muscles , whereas 2 , muscle biopsies showed vacuolar myopathy 7 patients , older 50 yrs , presented clinical ct evidence myopathy proximal distal muscles ranging mild severe , males slightly affected females 11 patients mean ct grading made based abnormalities found different muscle groups myopathy appeared unrelated history attacks , strong correlation found age mean ct grading concluded myopathy permanent muscle weakness late onset patients expression attacks variable
treatment niddm insulin agonists substitutes non insulin dependent diabetes mellitus \( niddm \) common disorder occurring 3 6 adults western populations united states , 29 patients diabetes take insulin , 76 niddm insulin therapy usually required time niddm insulin therapy improves abnormalities niddm \( reduced beta cell function , increased hepatic glucose production , reduced peripheral glucose disposal , lipid abnormalities \) insulin sulfonylurea agents comparable effects mild forms niddm , severe forms , insulin usually superior combination insulin sulfonylurea treatment may improve response sulfonylureas , although long term well controlled trials conducted short term insulin treatment may restore response sulfonylureas promising treatments \( human proinsulin , nasal insulin , somatostatin \) shown advantage conventional insulin therapy insulin causes hypoglycemia peripheral hyperinsulinemia hazards hyperinsulinemia , e g , weight gain hypoglycemia , , questions atherogenic effects remain resolved effect glycemic control macro microvascular complications established however , maintaining fasting blood glucose levels less 6 7 mm may protect progression retinopathy , neuropathy , nephropathy reduce severity ischemic stroke dosage algorithms generally use intermediate long acting insulin control basal glycemia , regular insulin added meals needed control postprandial glycemia effective therapy depends patient informed , cooperative , willing self monitor blood glucose insulin treatment increases risk immune complications \( resistance allergy \) overall , patients niddm benefit insulin therapy
insulin use niddm effects insulin treatment pathophysiology non insulin dependent diabetes mellitus \( niddm \) reviewed herein short term studies indicate variable partial reduction excessive hepatic glucose output , decrease insulin resistance , enhancement beta cell function beneficial actions may due decrease secondary glucose toxicity rather direct attack primary abnormality insulin used initial treatment new onset niddm presence , significant diabetes induced weight loss \( despite residual obesity \) , severe hyperglycemic symptoms diet failure patients , prospective randomized studies comparing insulin sulfonylurea treatment show approximately equal glycemic outcomes slight advantage insulin key goal insulin therapy normalize fasting plasma glucose level contrast conventional use morning injections intermediate long acting insulin , preliminary studies suggest potential advantages administering insulins bedtime obese patients may require several hundred units insulin daily still achieve satisfactory control , addition sulfonylurea insulin may reduce hyperglycemia , insulin dose , however , long term benefits combination therapy remain demonstrated conclusively established adverse effects insulin treatment niddm hypoglycemia , particularly elderly , weight gain self monitoring blood glucose identify patients excessive weight gain caused subtle hypoglycemia whether insulin causes weight gain direct effects appetite energy utilization remains controversial potential adverse effect insulin suggested epidemiological studies showing associations hyperinsulinemia insulin resistance increased risk coronary artery disease , stroke , hypertension although potential mechanisms atherogenic action insulin exist , current evidence prove cause effect warrant withholding insulin therapy \( compromising dosage \) needed
intensive insulin therapy treatment type diabetes intensive insulin therapy best defined comprehensive system diabetes management patient management team partners system directed improvement glycemia patient well glycemic targets individually defined frequent self monitoring blood glucose , probably least four times per day , essential meticulous control benefits include improved psychosocial functioning potential risks chronic complications diabetes risks relate problems associated hypoglycemia , increased meticulous glycemic control sought one important elements intensive therapy multiple component insulin program designed provide effective major meal continuous basal throughout 24 h day may achieved continuous subcutaneous insulin infusion \( csii \) multiple injections various insulin regimens , although csii may offer real advantages terms pharmacokinetics insulin delivery pharmacokinetic issues considered involve selection injection sites , timing insulin , mixing insulins many studies shown , albeit effort , excellent glycemic control achieved various intensive insulin therapy regimens implementation program intensive therapy involves patient self management terms altering insulin dosages , food intake , activity attempt achieve target level glycemia selected motivated patients willing course therapy , intensive insulin therapy worthwhile considered patients type \( insulin dependent \) diabetes mellitus
retinoic acid able spermatogenesis vitamin deficient rats high replicate doses support full development cells effect various doses retinoic acid \( ra \) epithelium vitamin deficient rats studied although generally thought ra able spermatogenesis vitamin deficient rats , one injection 5 mg ra strongly stimulated proliferative activity spermatogonia within 24 h , evidenced 7 fold increase number bromodeoxyuridine labeled spermatogonia ten days ra administration , b spermatogonia spermatocytes seen tubules 15 days , spermatocytes present hence , ra able induce massive synchronized development spermatogonia spermatocytes ra given , combined ra containing diet , spermatocytes present day 15 able develop spermatocytes , develop spermatids subsequent epithelial cycles new b spermatogonia spermatocytes formed , although lower numbers first cycle ra injection ra given week , formation b spermatogonia spermatocytes continued higher level also , spermatocytes formed , able develop spermatids finally , ra injected twice week , even spermatocytes round spermatids found 36 days , 49 days elongated spermatids found animals concluded ra , similar retinol , able induce synchronous proliferation differentiation spermatogonia repeated injections given , ra able support full development cells elongated spermatids
failure insulin like growth factor \( igf \) infusion promote growth protein restricted rats despite normalization serum igf concentrations dietary protein restriction young rats induces gh resistance characterized growth arrest low serum insulin like growth factor \( igf \) concentrations determine whether low serum igf concentrations responsible growth , infused 4 week old protein restricted rats recombinant human igf \( 300 micrograms day \) rat gh \( 200 micrograms 100 g body wt day \) osmotic 1 week despite normalization serum igf concentrations igf infusion , carcass growth stimulated contrast , growth spleen kidney enhanced \( 45 28 , respectively \) serum igf binding protein 3 \( igfbp 3 \) , principal carrier igf serum age , decreased 34 protein restricted animals restored normal igf infusion contrary selective effects igf growth protein restricted rats , well rats infused 150 micrograms day recombinant human igf showed significant growth response , including carcass organ growth normalization igfbp 3 values responses indicate igf preparation mode delivery effective conclude 1 \) dietary protein restriction causes organ specific resistance growth promoting properties exogenous igf 2 \) igf mediates stimulatory effects growth hormone igfbp 3 synthesis 3 \) absence carcass growth presence normal serum igf concentrations infusion igf suggests growth arrest protein restriction mediated part resistance igf
pituitary insulin like growth factor content gene expression streptozotocin diabetic rat evidence tissue specific regulation insulinopenic diabetes mellitus rat associated reduced circulating levels insulin like growth factor \( igf \) , resulting primarily decreased igf synthesis liver extrahepatic sites plasma gh levels animals also suppressed , loss episodic secretion decreased pituitary synthesis igf postulated exert local autocrine paracrine negative feedback regulation gh synthesis secretion present studies designed examine regulation pituitary igf peptide content gene expression insulinopenic streptozotocin \( stz \) diabetic rats compared liver testis serum igf levels reduced 86 stz diabetic rats together reduction igf content liver \( 53 \) testis \( 74 p less 0 001 vs control \) concomitantly , liver testicular igf mrna levels reduced 90 \( p less 0 001 vs control \) insulin treatment restored igf peptide levels serum , liver , testis toward normal , partial significant increase liver igf mrna contrast , pituitary peptide content increased 69 stz diabetic rats \( p less 0 001 vs control \) , change igf gene expression insulin treatment completely reversed rise pituitary igf peptide content results demonstrate novel discordance regulation igf gene expression peptide content pituitary tissues stz induced diabetic rats elevated igf levels animals may partly explain suppressed gh synthesis secretion seen stz diabetic rats provide evidence potential autocrine paracrine role pituitary igf gh regulation
cerebrospinal fluid losses ventricular catheters leading hyponatremia two children presented two cases patients hyponatremia due excessive cerebrospinal fluid losses ventricular possibility losses exists whether drain used treat hydrocephalus monitor intracranial pressure find normal saline \( sodium concentration 154 meq l \) appropriate fluid replace ongoing losses cerebrospinal fluid ventricular drain currently start replacement therapy \( ml ml \) drain placed
effects serum lipids adding instant oats usual american diets study designed test serum lipid response dietary adaptation recommended daily inclusion instant oats otherwise regular diet hypercholesterolemic adults randomly assigned control intervention group participants intervention group given instant oats requested two per day \( approximately two dry weight \) , oats carbohydrate foods order maintain baseline calorie intake keep weight stable serum lipids measured blood collected venipuncture baseline , four weeks , eight weeks baseline mean total cholesterol \( tc \) levels 6 56 mmol l 6 39 mmol l intervention control groups , respectively eight weeks , mean serum total cholesterol intervention group lower 0 40 mmol l , mean net difference tc two groups 0 32 mmol l \( 95 ci 0 09 , 0 54 \) low density lipoprotein cholesterol similarly reduced mean net difference 0 25 mmol l \( 95 ci 0 02 , 0 48 \) two groups mean soluble fiber intake increased along slight self imposed reductions mean total fat , saturated fat , dietary cholesterol intake intervention group neither group changed mean body weight daily inclusion two oats appeared facilitate reduction serum total cholesterol ldl c hyperlipidemic individuals
microcirculation niddm patients authors studied 10 patients non insulin dependent diabetes mellitus 5 controls matched age , sex , blood lipids , smoking habit two groups also comparable characteristics evaluated whole blood , plasma serum , erythrocyte filtration aggregation microcirculation studied subjects groups microalbuminuria determination , retinal , examination bulbar nail folds none patients presented microalbuminuria values higher upper limit normal \( \) alterations observed 4 patients , 10 presented alterations bulbar conjunctiva \( , erythrocyte aggregates \) nail folds \( frequently fingers \) similar alterations detected controls thus abnormalities seem independent values
putative mechanisms impairment endothelium dependent relaxation aorta atheromatous plaque hyperlipidemic rabbits attenuation acetylcholine induced endothelium dependent relaxation thoracic aortas excised hyperlipidemic \( whhl \) rabbits linearly correlated percent area coated atheromatous plaque elucidate mechanisms related reduced endothelium dependent relaxation presence atherosclerosis , acetylcholine induced release endothelium derived relaxing factor \( edrf \) assessed functionally percent relaxation detector strips obtained tunica media beneath intact intima atheromatous plaque aortic ring preparation relaxations normal detectors containing edrf thoracic aortas stimulation acetylcholine \( 3 x 10 \( 6 \) \) heterozygous homozygous whhl rabbits 73 5 59 9 \( p less 0 01 \) phenylephrine induced , respectively relaxations atherosclerotic detectors \( edrf \) aortas stimulation acetylcholine \( 3 x 10 \( 6 \) \) heterozygous homozygous whhl rabbits 16 4 14 5 , respectively values significantly smaller seen normal detectors superoxide dismutase added perfusate donors homozygous heterozygous whhl rabbits , atherosclerotic detectors relaxed stimulated acetylcholine 73 65 \( p less 0 01 versus addition superoxide dismutase \) normal detector , respectively relaxations induced sodium nitroprusside well contractions acetylcholine , phenylephrine , kcl \( 118 mm \) comparable detector strips normal atherosclerotic portions thus , amount edrf released acetylcholine reduced presence atherosclerosis , tunica media beneath atheromatous plaque also extent responsible superoxide induced inactivation edrf
enhancing blood glucose awareness adolescents young adults iddm objective determine effectiveness intervention program designed improve blood glucose awareness research design methods eight young adult outpatients \( mean age 22 yr \) six adolescent inpatients \( mean age 14 5 yr \) insulin dependent diabetes mellitus participated intervention program nine adolescent inpatients \( mean age 13 9 yr \) served untreated comparison group one adult outpatient unreliable data removed treatment , patient completed minimum 40 blood glucose estimations , blood glucose tests , symptom rating symptoms hyperglycemia identified patient three session intervention focused internal \( e g , personal symptoms \) external \( e g , timing amount insulin , food , exercise \) cues could used enhance blood glucose awareness , patients completed minimum 40 additional blood glucose estimates tests comparison subjects completed pre receive intervention results blood glucose estimation accuracy evaluated error grid analysis estimated actual blood glucose values plotted one five zones accurate estimates \( zone \) , benign errors \( zone b \) , clinically dangerous errors \( zones c , , e \) overall accuracy index \( ai \) calculated percentage clinically dangerous estimates \( zones c , , e \) percentage accurate estimates \( zone \) study entry , adolescent mean ai 7 significantly poorer 32 mean ai exhibited outpatient young adult sample \( p less 0 02 \) , mean ai improved 30 \( p less 0 02 \) young mean outpatient ai improved 45 \( p less 0 06 \) treated sample whole exhibited increased sensitivity \( p less 0 005 \) hyperglycemia \( p less 0 05 \) similar improvements occur untreated comparison sample conclusions adolescents may exhibit poorer blood glucose awareness adults although intervention program improved blood glucose awareness adolescent adult patients , blood glucose estimation accuracy remained far ideal
racial differences metabolic control children adolescents type diabetes mellitus objective study evaluated racial differences metabolic control children adolescents insulin dependent \( type \) diabetes mellitus examined interactive effects race age sex research design methods data several demographic clinical variables obtained 102 black 108 white children , including percentage total hba1 , age , age diagnosis , duration diabetes , pubertal status , insulin dose \( u kg 1 day 1 \) , body mass index , number clinic visits kept missed , number hospitalizations diabetic ketoacidosis \( \) year , socioeconomic status \( \) results black children higher insulin dosages \( p less 0 05 \) lower \( p less 0 001 \) white children hba1 higher black white children \( p less 0 01 \) statistically adjusting effects insulin dose , diabetes duration , hba1 based criteria , black white children poor fewer good metabolic control \( p less 0 001 \) older children \( greater equal 13 yr \) higher hba1 levels younger \( less 13 yr \) children \( p less 0 002 \) , differences hba1 males females interactive effects race , sex , age group black children hospitalized frequently white children \( p less 0 04 \) black white children missed clinic visits \( p less 0 01 \) , differ number visits kept conclusions black type diabetes mellitus poorer metabolic control white
demonstration insulin transformation products insulin vials high performance liquid chromatography objective assess importance temperature , light , agitation , regular withdrawal insulin rates appearance three groups insulin transformation products \( \) vials human beef soluble insulin research design methods twelve insulin treated patients \( 6 receiving human soluble insulin , 6 receiving beef soluble insulin \) participated study reverse phase high performance liquid chromatography used measure serial samples vials stored various laboratory issued patients vials laboratory analyzed nine occasions 26 wk issued patients analyzed weekly results results expressed rates change \( total protein wk \) except human insulin stored 4 degrees c , sampling accelerate transformation storage higher temperatures caused rapid transformation groups , human insulin susceptible beef insulin exposure light accelerated transformation mainly group 3 fibrillation occurred beef human insulin carried pocket results patients' vials consistent reported storage conditions conclusions three groups form human beef soluble insulin rate production function temperature light exposure differences two insulins probably due differences formulation patients vials storing insulin direct sunlight one could contribute residual immunogenicity modern insulin preparations
international evaluation cause specific mortality iddm diabetes epidemiology research international mortality study group objective cross cultural study completed evaluate differences mortality patterns four population cohorts japan israel county , pennsylvania finland research design methods cases diagnosed 1 january 1965 31 december 1979 mortality determined 1 january 1985 147 deaths occurring insulin dependent diabetes mellitus \( iddm \) patients four countries standardized protocol assessing causes death \( cause specific mortality \) developed article , report causes results major overall mortality differences country appeared , iddm subjects japan much likely die countries japan , elevated mortality result acute diabetes related complications kidney disease countries , mortality acute diabetes related complications accounted surprisingly high percentage deaths \( greater 25 country \) larger percentage cases finland died result suicide three countries conclusions results suggest major cross country differences cause specific mortality much premature mortality associated diabetes potentially preventable
superiority assay elisa detection newly diagnosed type diabetic children objective liquid solid phase assays used insulin autoantibody \( iaa \) determination , method iaa measurement standardized research design methods determined assay \( rba \) enzyme linked immunosorbent assay \( elisa \) two large age matched groups nondiabetic newly diagnosed insulin dependent \( type \) diabetic children results positivity iaa rba \( greater equal nondiabetic mean \) 2 178 \( 1 1 \) 55 173 \( 32 \) nondiabetic diabetic children , respectively prevalence iaa rba significantly higher youngest age group \( 63 0 4 yr \) positivity iaa elisa 1 178 \( 0 6 \) 8 169 \( 4 7 \) nondiabetic diabetic children , respectively concordance rates assays 0 3 \( 0 \) control subjects 5 58 \( 8 6 \) diabetic children conclusions conclude rba appropriate elisa iaa detection onset disease addition , available data suggest detected rba high affinity antibodies , speculate reflect mature immune reaction endogenous insulin
vitamin e reduction protein glycosylation diabetes new prevention diabetic complications \? objective study evaluated possibility inhibiting protein glycosylation vivo vitamin e research design methods two groups 10 insulin requiring diabetic patients , matched duration disease metabolic control , received daily vitamin e supplementation 1200 600 mg , respectively , 2 mo third group 10 diabetic patients , matched duration disease metabolic control , served control group received placebo fasting plasma glucose , mean daily plasma glucose , fasting labile hba1 , glycosylated proteins measured basal state 1 2 mo treatment addition , hyperglycemic clamp studies performed basal state 1 mo vitamin e administration patients results glycemic indices show significant changes study , whereas fasting labile , glycosylated proteins decreased significantly 1 2 mo patients vitamin e administration stable hba1 decreased 2 mo mean glycemic incremental area hyperglycemic clamp procedure similar treatment , whereas significant reduction mean labile hba1 incremental area found vitamin e supplementation significant difference also found fasting incremental labile hba1 levels , stable hba1 , glycosylated proteins two groups diabetic patients two doses vitamin e diabetic patients received higher dose vitamin e showed greater reduction significant changes parameters observed diabetic patients placebo administration conclusions results demonstrate vitamin e administration may reduce protein glycosylation diabetic subjects independently changes plasma glucose , effect may due inhibition labile glycosylation , first step reaction long term studies help establish usefulness vitamin e administration prevention diabetic complications
niddm genotype since , numerous cases non insulin dependent diabetes mellitus \( niddm \) observed certain american indian populations extremely high prevalence rates niddm occur strikingly several indians , whose migrated north america greater 11 , 000 yr ago evidence period indicates certain groups indians maintained like life style area north america ranging arizona life style reliance unpredictable big species major food source however , time , big species becoming hypothesized indians relied big food source developed genotype allowed selective advantage periods fasting occurred big kills also hypothesized genotype indians may contribute niddm sedentary life style adopted food sources constant insulin resistance muscle major feature niddm , possible insulin resistance per se phenotypic expression genotype
lecture 1990 beta cells type ii diabetes mellitus 1960 , immunoassays insulin first demonstrated significant quantities circulating hormone non insulin dependent \( type ii \) diabetes 30 yr debate whether beta cell abnormality plays etiological role syndrome early efforts determine adequacy islet beta cell function showed obesity associated insulin resistance major confounding variables subsequently , recognized glucose directly regulated insulin synthesis secretion islet signals , including substrates , hormones , neural factors obesity glucose taken account , becomes clear patients fasting hyperglycemia abnormal islet function type ii diabetes characterized defect first phase acute glucose induced insulin secretion deficiency ability glucose potentiate islet nonglucose beta cell secretagogues resulting hyperglycemia defective glucose potentiation maintains nearly normal basal insulin levels insulin responses nonglucose secretagogues correct defect first phase glucose induced insulin release development fasting hyperglycemia , first phase glucose induced insulin secretion obviously defective progressive islet failure matched rising glucose levels maintain basal second phase insulin output relationship islet function fasting plasma glucose curvilinear , 75 loss beta cell function time diagnostic level 140 mg dl exceeded new steady state characterized glucose overproduction inefficient utilization insulin resistance also present patients contributes hyperglycemia glucose levels needed compensation decompensation absolute hypoinsulinemia occur renal threshold glucose exceeded prevents elevation circulating glucose etiology islet beta cell lesion known , hypothesis based basal islet amyloid deposits pancreas type ii diabetes reviewed recent discovery islet amyloid polypeptide \( iapp \) amylin , major constituent islet amyloid deposits , integrated hypothesis suggested pro iapp proinsulin processing mature peptide secretion normally occur together abnormal processing , secondary conjunction defects hormone secretion , lead progressive accumulation intracellular iapp pro iapp , cats , monkeys , humans form intracellular fibrils amyloid deposits loss beta cell mass \( abstract truncated 400 words \)
reduced neuroendocrine symptomatic responses subsequent hypoglycemia 1 episode hypoglycemia nondiabetic humans test hypothesis hypoglycemia causes reduced neuroendocrine symptomatic responses subsequent hypoglycemia , measured responses clamped hypoglycemia \( 2 8 mm \) consecutive two occasions , interval afternoon \( 1600 \) hypoglycemia \( 3 mm \) one occasion interval afternoon euglycemia \( 5 mm \) , nine nondiabetic humans none measured responses reduced interval euglycemia contrast , plasma epinephrine \( p less 0 005 \) , glucagon \( p less 0 005 \) , pancreatic polypeptide \( p less 0 01 \) , cortisol \( p less 0 02 \) , total \( p less 0 001 \) , neurogenic \( p less 0 001 \) \( p less 0 05 \) symptom responses morning hypoglycemia reduced interval afternoon hypoglycemia thus , single episode hypoglycemia caused generalized reduction neuroendocrine symptomatic responses subsequent hypoglycemia , finding may important pathogenesis iatrogenic hypoglycemia insulin dependent diabetes mellitus
impairment glycerol phosphate islets rats diabetes induced neonatal streptozocin islets adult rats injected streptozocin neonatal period , oxidative secretory responses glucose severely affected evoked l leucine possible explanation preferential defect sought comparing rate aerobic , taken sum 3 , 4 14c glucose conversion labeled co2 , pyruvate , amino acid , total flux , judged conversion 5 3h glucose preferential impairment aerobic relative total found islets diabetic rats incubated either low high glucose concentration coincided islet mitochondria diabetic rats severe decrease basal \( ca2 \) generation l 2 3h glycerol 3 phosphate ca2 \( \) induced increment 3h mitochondria diabetic rats also less efficient control animals generating 14co2 1 14c 2 diabetes induced alteration 2 dehydrogenase islet mitochondria less marked , however , linked dehydrogenase associated change responsiveness ca2 islet mitochondria diabetic rats displayed normal slightly elevated glutamate dehydrogenase activity propose , therefore , preferential impairment oxidative secretory responses islet cells glucose experimental model diabetes may least partly attributable altered transfer reducing equivalents mitochondria mediated glycerol phosphate
effects pp 56 vitamin e platelet , fatty acid abnormalities , clinical manifestations streptozocin induced diabetic rats effects vitamin e myo inositol 1 , 2 , 6 \( pp 56 \) investigated long term studies streptozocin induced diabetic rats fed purified diet 33 lipids polyunsaturated saturated fatty acid ratio 1 supplement vitamin e decreased plasma triglycerides , platelet lipid biosynthesis , delta 6 delta 5 abnormalities , urine ketone bodies affect response platelets aggregation pp 56 completely normalized platelet reactivity adp thrombin accompanied normalization platelet lipid biosynthesis diabetes induced abnormalities delta 6 delta 5 pp 56 treatment also reduced mortality rate certain extent urinary ketone bodies protective effect pp 56 platelet aggregation mortality rate dose related pp 56 , molecule derived acid , seems exert potent protective effects manifestations associated diabetes rats
insulin receptor cdna sequence niddm patient homozygous insulin receptor gene rflp resistance insulin action well established feature non insulin dependent diabetes mellitus \( niddm \) believed contribute etiology condition strong genetic contribution etiology niddm exists , previously identified insulin receptor gene restriction fragment length polymorphism \( rflp \) associated niddm phenotype attempt elucidate whether structural defects insulin receptor could primary cause insulin resistance niddm , analyzed insulin receptor cdna sequence subject niddm also homozygous rflp insulin receptor cdna sequenced polymerase chain reaction \( pcr \) mrna transformed lymphocytes reverse transcribed amplified five overlapping sets primers span coding sequence alpha beta subunits difference found predicted amino acid sequence subject 's insulin receptor compared normal insulin receptor nucleotide positions , subject heterozygous silent nucleotide polymorphisms affect amino acid sequence exon 11 encodes 12 amino acid insert alpha subunit , , due alternate splicing , expressed lymphocyte insulin receptor mrna consequently , exon 11 amplified genomic dna pcr sequence exon 11 found normal addition , patient 's transformed lymphocytes maintained culture , abnormalities insulin binding observed conclude insulin resistance seen niddm subject due structural alteration insulin receptor
production inhibitor insulin receptor tyrosine kinase fibroblasts patient insulin resistance niddm although non insulin dependent diabetes mellitus \( niddm \) associated defects insulin action , molecular basis resistance unknown studied fibroblasts markedly insulin resistant patient niddm without fibroblasts resistant insulin alpha acid uptake measured fibroblasts patient demonstrated normal insulin receptor content measured insulin receptor radioimmunoassay scatchard analysis however , compared nondiabetic control subjects , insulin receptor kinase assays wheat germ purified receptors prepared fibroblasts showed low basal insulin stimulated tyrosine kinase activity insulin receptor removed wheat germ fraction monoclonal antibody affinity chromatography insulin receptor deficient fraction inhibited basal insulin stimulated tyrosine kinase activity highly purified insulin receptors specificity inhibition tested , less inhibition seen insulinlike growth factor receptor tyrosine kinase , even less inhibition seen proto oncogene p60c src tyrosine kinase thus , studies indicate fibroblasts insulin resistant patient niddm produce relatively specific glycoprotein inhibitor insulin receptor tyrosine kinase therefore , studies raise possibility inhibitor may play important role insulin resistance seen patient
effects glucagon free fatty acid metabolism humans determine whether physiological changes plasma glucagon concentrations important regulating basal adipose tissue lipolysis , ffa flux \( 1 14c palmitate \) measured response increases decreases plasma glucagon eight volunteers insulin dependent diabetes mellitus \( iddm \) nine healthy nondiabetic volunteers studied using pancreatic clamp technique control plasma insulin , gh , glucagon concentrations desired levels palmitate flux chosen hormone infusion rates similar baseline values \( 1 73 0 12 vs 1 75 0 23 1 35 0 18 vs 1 35 0 16 mumol kg min , respectively , iddm nondiabetic subjects \) significant changes palmitate flux occurred response glucagon withdrawal mild \( nondiabetic volunteers \) high physiological \( iddm volunteers \) thus , conditions normal ffa availability , changes plasma glucagon concentrations within physiological range little effect adipose tissue lipolysis
acute changes serum osteocalcin induced humans although levels serum osteocalcin thought indicator osteoblastic activity bone formation , little information regarding acute effects changes calcium pth levels circulating osteocalcin concentrations study effect stepwise decreases ionized calcium \( cai \) osteocalcin levels , infused six normal subjects citrate four 30 min intervals using two different protocols one protocol \( pulse infusion \) used alternating rates infusion resulted rapid stepwise decrements serum cai second protocol \( continuous infusion \) used constant intermediate rates citrate infusion produced slower decrements cai , similar changes magnitude monitored serum cai , intact pth , osteocalcin concentrations course infusions step pulse infusion osteocalcin responses changes cai general parallel changes pth \( r 0 462 p 0 02 \) inversely correlated cai \( r 0 562 p 0 003 \) osteocalcin concentrations end 30 min period higher beginning period total 120 min , osteocalcin levels rose 3 46 0 63 6 88 1 08 micrograms l \( p less 0 05 \) contrast , first two periods continuous infusion , osteocalcin concentrations changed slightly last two periods continuous infusion osteocalcin respond manner characteristic observed pulse infusion data indicate osteocalcin concentrations circulation may acutely regulated calcium pth
nocturnal elevation glucose levels fasting noninsulin dependent diabetes define spontaneous diurnal variations glucose regulation fasting noninsulin dependent diabetes \( niddm \) , measured circulating levels glucose , insulin , c peptide , gh , cortisol , glucagon 15 min intervals 11 patients untreated diabetes 7 matched control subjects studied 24 h period rates insulin secretion derived concentrations c peptide using two compartment mathematical model c peptide distribution metabolism groups subjects , despite continued fasting , glucose levels stopped declining evening subsequently rose throughout night reach morning maximum elevated levels persisted noon morning glucose maximum corresponded relative increase 23 8 5 5 evening nadir niddm patients 13 2 4 6 nondiabetic subjects \( p less 0 05 \) niddm patients , insulin levels insulin secretion rates parallel nocturnal glucose changes contrast , control subjects , nocturnal glucose rise coincided similar increase insulin secretion rates cortisol concentrations patients niddm higher control subjects throughout study period \( p less 0 001 \) rose earlier evening control subjects , thus failing demonstrate normal nocturnal suppression groups subjects , nighttime glucose elevation temporally quantitatively correlated circadian cortisol rise gh secretion increased evening nighttime periods compared daytime values , niddm patients , control subjects , size morning glucose elevation directly related magnitude increase gh secretion \( r 0 88 p less 0 01 \) glucagon concentrations similar groups subjects remained essentially constant throughout study period hypothesize nocturnal glucose rise occurs fasting represents normal diurnal variation set point glucose regulation amplified counterregulatory mechanisms activated fasting condition
proglucagon products plasma noninsulin dependent diabetics nondiabetic controls fasting state oral glucose intravenous arginine investigated major products proglucagon \( pg \) processing plasma fasting state , intravenous arginine oral glucose load noninsulin dependent diabetics \( niddm \) weight matched controls using specific radioimmunoassays analytical gel filtration fasting state peptide 1 \( glp 1 \) immunoreactivity significantly elevated niddm group compared control group intravenous arginine oral glucose load rise plasma concentrations immunoreactive moieties measured seen integrated incremental responses intravenous arginine identical two groups oral glucose insulin concentrations plasma lower concentrations proglucagon products higher niddm group compared control group gel filtration analysis showed arginine stimulated secretion pancreatic glucagon \( pg 33 61 \) , major proglucagon fragment \( pg 72 158 \) probably glp 1 \( pg 72 107 \) groups , whereas oral glucose stimulated secretion \( pg 1 69 \) intestinal glp 1 \( pg 78 107 \) , hormone elevated levels immunoreactive glp 1 diabetics fasting state mainly due increased concentration major proglucagon fragment
advanced glycosylation products nitric oxide mediate defective endothelium dependent vasodilatation experimental diabetes nitric oxide \( endothelium derived relaxing factor \) induces smooth muscle relaxation important mediator regulation vascular tone advanced glycosylation end products , glucose derived moieties form accumulate long lived tissue proteins , implicated many complications diabetes normal aging demonstrate advanced glycosylation products nitric oxide activity vitro vivo acceleration advanced glycosylation process vivo results time dependent impairment endothelium dependent relaxation inhibition advanced glycosylation prevents nitric oxide , vasodilatory impairment results implicate advanced glycosylation products important nitric oxide activity endothelium dependent relaxation
normalization blood glucose diabetic rats treatment reverses insulin resistant glucose transport adipose cells without restoring glucose transporter gene expression evidence emerging direct role glucose , independent changes insulin , regulation cellular glucose transport glucose utilization vivo study investigate potential cellular molecular mechanisms regulatory effect glucose determining normalization glycemia without insulin therapy diabetic rats influences 3 transport expression translocation two genetically distinct species glucose transporters \( \) adipose cells results compared alterations glucose disposal vivo measured euglycemic clamp rats rendered diabetic 90 pancreatectomy , insulin stimulated glucose transport adipose cells decreased 50 parallel reduced insulin mediated glucose disposal vivo levels adipose muscle measured immunoblotting decreased adipose cell subcellular membrane fractions , corresponding mrna levels assessed northern blotting total adipose cell rna normalization blood glucose diabetic rats , impairs renal tubular glucose reabsorption thus enhances glucose excretion , restores insulin stimulated glucose transport adipose cells insulin mediated glucose disposal vivo importantly , levels adipose muscle gt protein remain 43 reduced low density microsomes basal state 46 reduced plasma membranes insulin stimulated state adipose muscle gt mrna levels remain approximately 50 depressed levels hepg2 brain gt protein mrna unaltered diabetes treatment thus , changes ambient glucose independent changes ambient insulin regulate glucose transport response insulin isolated adipose cells changes responsiveness parallel alterations glucose uptake vivo since effect occur without alteration expression two species glucose transporters present adipose cells translocation plasma membrane response insulin , may result changes gt functional activity
role increased cytosolic free calcium pathogenesis rabbit proximal tubule cell injury protection glycine acidosis assess role increased cytosolic free calcium \( caf \) pathogenesis acute proximal tubule cell injury protection afforded exposure reduced medium ph treatment glycine , fura 2 loaded tubules studied suspension singly system ca2 ionophore , ionomycin , increased caf micromolar levels rapidly produced lethal cell injury indicated loss lactate dehydrogenase medium suspended tubules accelerated leak fura failure exclude blue tubules decreasing medium ca2 100 nm prevented ionomycin induced increases caf injury reducing medium ph 7 4 6 9 adding 2 mm glycine medium also prevented cell death , prevent increase caf micromolar levels cells treated , oxidative phosphorylation produced severe adenosine triphosphate \( atp \) depletion , develop increases caf loss viability preventing increases caf 100 nm ca2 medium protect treated cells reduced ph glycine protected treated cells without ameliorating increases caf data demonstrate toxic potential increased caf proximal tubule show caf sharply increase prior loss viability atp depletion model injury , increase necessarily contribute outcome potent protective actions decreased ph glycine allow cells sustain increases caf micromolar levels spite severe , accompanying cellular atp depletion without developing lethal cell injury
single base substitution coding region neurophysin ii associated familial central diabetes elucidate molecular mechanism familial central diabetes \( fdi \) , sequenced arginine vasopressin neurophysin ii \( avp npii \) gene 2 patients belonging pedigree consistent autosomal dominant mode inheritance 10 patients idiopathic central diabetes \( \) 5 normals also studied avp npii gene , chromosome 20 , consists three exons encode putative signal peptide , avp , npii , glycoprotein using polymerase chain reaction , fragments including promoter region coding regions amplified genomic dna subjected direct sequencing sequences 10 patients identical normals , 2 patients fdi , single base substitution detected one two alleles avp npii gene , indicating heterozygotes mutation g transition nucleotide position second exon , resulting substitution gly ser amino acid position 57 npii moiety speculated mutated avp npii precursor mutated npii molecule , conformational changes , might responsible avp deficiency
nutrition management individuals noninsulin dependent diabetes mellitus 1990s review diabetes care education dietetic practice group noninsulin dependent diabetes mellitus \( niddm \) , type ii diabetes , characterized two primary defects insulin resistance insulin secretion two major goals management niddm achieve near normal metabolic control prevent delay microvascular complications diabetes nutrition , exercise , , necessary , medication three primary treatment modalities used niddm treatment regimens need individualized developed consideration diabetes management goals quality life issues lean individuals niddm encouraged maintain body weight modify food composition eating pattern minimize glucose primary treatment goal obese individual niddm weight loss process teaching nutrition meal planning involves developing cooperative , gathering information , setting realistic goals , intervention , maintaining change nutrition intervention involves providing information stages , beginning survival skill information progressing depth information 's responsibility promote continuity learning introducing new concepts altering learning environment expand role 1990s diabetes taking role ensure individual niddm receives comprehensive individualized care
dietary education program hypercholesterolemic children parents parent child dietary education program 4 10 year old , hypercholesterolemic children families developed pilot tested 10 program , designed weekly use home , uses talking approach \( accompanying picture \) child parents provided information ways make recommended dietary changes , along hands activities children help match approach wide developmental range within children 's age span , materials divided three program levels use different characters concept presentations program development , evaluation two children \( parents \) program levels guided design refinement pilot test among 22 hypercholesterolemic children \( whose treatment limited diet modification \) revealed children within 4 10 year age range talking approach identified positively characters parents indicated materials clear helpful baseline 3 month follow visits , children exhibited significant increase knowledge heart healthy foods , decrease total fat consumption approached significance , significant decrease plasma low density lipoprotein cholesterol values
recommended daily vitamin low elderly \? population sunlight deprived elderly studied determine daily intake vitamin whether dietary intake sufficient maintain normal vitamin status twenty two subjects 65 years old serum creatinine less 180 mumols l confined 6 months chosen community nursing home southeast baltimore three day food records obtained along serum levels 25 hydroxyvitamin \( 25 ohd \) , 1 , 25 dihydroxyvitamin \( 1 , 25 \( oh \) 2 \) , intact parathyroid hormone \( pth \) mean daily vitamin intake twofold greater adult recommended daily \( \) 200 iu mean 25 ohd level 40 nmol l \( normal 25 138 nmol l \) seven patients less 25 nmol l participants 25 ohd values less 25 nmol l , mean vitamin intake iu \( range 36 iu \) conclude current seems inadequate many older individuals get sun exposure particular population elderly risk develop vitamin deficiency associated complications
relationship symptomatic biochemical hypoglycaemia insulin dependent diabetic patients relationship symptomatic \( subjective feelings \) biochemical \( blood glucose concentration less 3 mmol l 1 \) hypoglycaemia studied 66 randomly selected insulin dependent diabetic patients normal conditions daily life conventional insulin injection regimens patients \( \) collected 7 point diurnal blood glucose profiles home three consecutive days weekly 3 weeks , \( b \) indicated whether felt hypoglycaemic sampling times , \( c \) collected extra samples felt hypoglycaemic time study period weekly frequencies symptomatic biochemical hypoglycaemia 0 99 1 75 per patient , respectively biochemical hypoglycaemia present 29 symptomatic episodes , symptomatic hypoglycaemia accompanied 16 biochemical episodes symptomatic hypoglycaemia experienced median blood glucose concentration 3 4 mmol l 1 \( range 1 4 14 9 mmol l 1 \) fifty per cent symptomatic biochemical episodes occurred , remainder distributed throughout day occurrence biochemical hypoglycaemia , symptomatic hypoglycaemia , inversely correlated hba1c median blood glucose concentration thus symptomatic hypoglycaemia unreliable indicator biochemical hypoglycaemia degree control blood glucose measurements prerequisite diagnosis hypoglycaemia
modulation dietary vitamin e compounds \( putative indigenous dna modifications \) rat liver kidney \( indigenous \) compounds age related , carcinogen adduct like , putative indigenous dna modifications detectable 32p assay untreated animals investigate origins dna derivatives , examined effects dietary vitamin e , natural antioxidant , compounds rat liver kidney dna female sprague dawley rats fed 's diets containing 0 , 100 , 1000 , 10 , 000 mg kg alpha acetate 6 mo dna four individual rats group analyzed nuclease p1 enhanced version 32p assay dna amount vitamin e liver measured high performance liquid chromatography rats fed vitamin e deficient diet \( 0 mg kg \) showed identical profiles similar levels compounds fed 100 mg kg diet spots significantly intensified one tissue specific extra spot found liver kidney dna rats fed 1000 10 , 000 mg kg vitamin e diet however , one five major spots detected kidney weaker 1000 10 , 000 mg kg groups 0 100 mg kg groups results show formation compounds affected vitamin e deficient diet , long term feeding diet containing high levels vitamin e may cause metabolic alterations leading increased formation dna reactive \( potentially carcinogenic \)
lovastatin efficacy reducing low density lipoprotein cholesterol levels high vs low fat diets effectiveness lovastatin compared high fat vs low fat diet hypercholesterolemic subjects studied metabolic ward conditions diet periods 3 weeks receiving lovastatin \( 40 mg \) placebo multiple lipoprotein levels measured final week diet period nineteen subjects completed study high fat \( 43 \) diet 16 low fat \( 25 \) diet lovastatin reduced total cholesterol 23 low density lipoprotein cholesterol 30 , compared placebo diets , significant diet drug interaction high density lipoprotein cholesterol raised 7 8 diet regimens addition lovastatin low fat diet permitted 80 subjects diet , less 50 high fat diet , achieve current guidelines although lovastatin produces comparable percentage reduction lipoprotein profiles either diet , accompanying low fat diet remains advisable additional reduction low density lipoprotein cholesterol levels specified goals
comparative study microporous cholestyramine analogue \( \) gemfibrozil treatment severe primary hypercholesterolemia short long term results effect gemfibrozil severe hypercholesterolemia well established fifty patients primary hypercholesterolemia \( including 18 patients familial hypercholesterolemia \) stable low density lipoprotein cholesterol levels greater 3 90 mmol l \( greater 150 mg dl \) \( 6 10 1 30 sd mmol l 236 50 mg dl \) diet assigned treatment 12 weeks either 9 g , microporous cholestyramine analogue , 1 2 g gemfibrozil randomized clinical trial tolerance good drugs gemfibrozil caused similar decrements total cholesterol \( 14 \) , low density lipoprotein cholesterol \( 20 18 , respectively \) , apolipoprotein b \( 16 21 , respectively \) close 40 patients decreases greater 25 low density lipoprotein cholesterol levels drugs gemfibrozil , , significantly increased plasma high density lipoprotein cholesterol \( 16 \) apolipoprotein \( 17 \) levels reduced triglyceride levels \( 35 \) loss efficacy observed either drug subsets patients good 12 week response rate extended therapy 12 months study demonstrates gemfibrozil may beneficial effect aspects plasma lipid profile patients severe hypercholesterolemia , clinical situation used potential advantages standard doses anion exchange
effects recombinant human macrophage colony stimulating factor plasma cholesterol levels recombinant human macrophage colony stimulating factor \( rhm csf \) hematopoietic growth factor stimulates growth , differentiation , proliferation , activation cells monocyte macrophage lineage rhm csf administered rabbits nonhuman primates evaluate effects cholesterol homeostasis decreases plasma cholesterol concentrations observed rhm csf administration observed mean \( sd \) decreases range doses nonhuman primates receiving rhm csf continuous intravenous infusion \( \) intravenous bolus \( \) injection approximately 16 8 43 10 , respectively low density lipoprotein \( ldl \) cholesterol levels decreased 55 9 pretreatment baseline values animals receiving rhm csf new zealand white rabbits receiving rhm csf range doses showed decrease baseline total cholesterol approximately 28 17 , ldl cholesterol levels decreasing approximately 72 33 , high density lipoprotein levels showed variable changes , including increased values decrease 36 26 total plasma cholesterol observed hyperlipidemic rabbits receiving rhm csf 7 days decrease attributable almost entirely decreases ldl cholesterol , fell approximately 34 24 baseline although mechanism cholesterol lowering effect unknown , results strongly suggest rhm csf may provide novel treatment hypercholesterolemia may useful investigations mechanisms cholesterol homeostasis atherogenesis
risk disability mortality due overweight finnish population published erratum appears 1990 3 301 \( \) objective investigate effect overweight premature mortality work disability young middle aged design prospective cohort study based data collected health examinations social insurance institution finland 1966 1972 follow 1982 setting 34 communities throughout finland subjects 12 , women 19 , men employed aged 25 64 baseline main outcome measures mortality work disability specified causes results body mass index weak predictor death strong predictor early work disability , increased linearly body mass index adjustment age , geographical region , occupation , smoking relative risks work disability women men body mass index greater equal 30 kg m2 , respectively , 2 0 \( 95 confidence interval 1 8 2 3 \) 1 5 \( 1 3 1 7 \) compared subjects body mass index less 22 5 kg m2 increased risks due excess cardiovascular musculoskeletal diseases mental diseases one fourth disability cardiovascular musculoskeletal causes women half many men could attributed overweight \( body mass index greater 25 kg m2 \) alone conclusions though modest overweight little impact mortality predicts severe functional impairment considerable proportion work disability could probably prevented efficient weight control
differential diagnosis crigler najjar disease , types 1 2 , bile pigment analysis phenobarbital response , bile pigment composition , fractional biliary excretion ratio bilirubin studied nine children crigler najjar disease five children , serum bilirubin levels decreased phenobarbital treatment 26 pigment composition bile changed decrease proportion unconjugated bilirubin 33 12 13 1 increase 57 14 10 2 , respectively , 72 4 16 3 four children , serum bilirubin levels change significantly phenobarbital treatment patients , bile comprised 91 10 unconjugated bilirubin , 9 11 , 1 1 basis differences , former group classified type 2 crigler najjar disease latter , type 1 bile pigment analysis parents patients crigler najjar disease showed increased proportion least one partners three four couples tested , despite normal serum bilirubin levels serum bilirubin levels type 1 2 patients 236 62 mumol l 214 82 mumol l , respectively addition fractional bilirubin excretion ratio , calculated ratio \( bilirubin bile bilirubin serum \) \( bile acid bile bile acid serum \) could differentiate two groups however , 10 fold 100 fold difference ratio patients crigler najjar disease 's syndrome patients crigler najjar disease controls fractional bilirubin excretion ratio proved excellent tool differentiate 's syndrome crigler najjar disease , whereas crigler najjar disease types 1 2 could differentiated basis bile pigment analysis
hypomagnesemia parathyroid hormone vitamin endocrine system children insulin dependent diabetes mellitus effects magnesium administration insulin dependent diabetes mellitus associated altered electrolyte metabolism derangement parathyroid hormone \( pth \) vitamin endocrine system , studied 23 children diabetes \( age 9 4 2 5 years \) found lower serum values total ionized calcium , magnesium , intact pth , calcitriol , osteocalcin age sex matched control subjects patients given magnesium orally \( 6 mg kg daily elemental magnesium \) 60 days treatment , serum magnesium , total ionized calcium , intact pth , calcitriol , osteocalcin concentrations significantly increased , reaching control values 3 day low calcium diet , patients significantly reduced delta increment pth calcitriol comparison values obtained hypomagnesemia magnesium repletion , delta increments pth calcitriol , response low calcium diet , significantly different control values data suggest magnesium deficiency plays pivotal role altering mineral homeostasis insulin dependent diabetes mellitus
diabetic retinopathy modify course \? exception laser photocoagulation , therapy shown modify course diabetic retinopathy success developing new therapies diabetic retinopathy depend well disease process understood whether interventions identified ameliorate critical stages development disease model disease process presented serve frame work pieces placed new areas potential interventional therapy
history phlebotomy therapy hemochromatosis hemochromatosis recognized iron storage disease 50 years proposed treat removing hemoglobin first report demonstrated value larger series provided statistically valid evidence improved quality life increased longevity earlier disease discovered , less risk morbidity mortality screening tests \( serum iron , total iron binding capacity , serum ferritin \) recommended blood relatives index cases hereditary disease clinics complications hemochromatosis may treated liver disorder however mild , diabetes mellitus , heart disease , , , impotence , premature menopause , abnormal pigmentation skin
comparison liver iron symptomatic asymptomatic hemochromatosis homozygotes homozygous relatives authors compared amount hepatic parenchymal cell iron 159 hemochromatosis homozygotes separated four groups group 1 59 symptomatic hemochromatosis probands hemochromatosis \( mean age 49 years \) identified symptoms signs iron overload group 2 38 asymptomatic probands hemochromatosis \( mean age 29 years \) identified population screening studies routine health maintenance evaluation group 3 47 homozygous relatives \( mean age 43 years \) group 1 probands group 4 15 homozygous relatives \( mean age 30 years \) group 2 probands symptomatic probands \( group 1 \) 20 years older much hepatic iron \( p less 0 0001 \) asymptomatic probands \( group 2 \) homozygous relatives \( group 3 \) symptomatic probands also older much hepatic iron homozygous relatives \( group 4 \) asymptomatic probands \( p less 0 0002 \) results study suggest population screening studies result early identification individuals hemochromatosis massive hepatic iron overload occurs symptoms iron overload develop
hereditary hemochromatosis hereditary hemochromatosis \( hh \) , iron overload disease caused intestinal iron absorption , recessive hla linked disease hh common inherited metabolic disorder one every 400 500 individuals genes likely develop disease thus , although product hemochromatosis gene unknown , mode inheritance allows hla proband siblings highly predictive genetic propensity develop clinical features hh view known immunoregulatory properties iron binding proteins , important determine high levels storage iron hh influence network hh patients whether clinical relevance defined certain alterations effector cells cellular arm immune system studied patient hh specific immune alterations , including delayed cutaneous type hypersensitivity , diagnosed poorly differentiated adenocarcinoma stomach four years hh diagnosis findings consistent interpretation certain clinical situations elevated body iron stores , immunoregulatory balance environment may tipped favor growth development cancer cells
immune system hereditary hemochromatosis quantitative functional assessment cellular arm objective investigation evaluate certain quantitative functional characteristics effector cells cellular arm immune system hereditary hemochromatosis \( hh \) respect treatment status two observations consistent postulate elevated levels storage iron vivo immunoregulatory properties \( 1 \) absolute number cd8 positive cells significantly elevated untreated hh patients \( n 7 \) reduced treated patients \( n 7 \) , compared controls \( 2 \) proliferative response peripheral blood mononuclear cells untreated hh patients mitogens suboptimal response peripheral blood mononuclear cells \( pbm \) treated hh patients normal furthermore , immunoglobulin secretion pbm treated hh patients compared controls altered finally , one effector cell abnormality unrelated treatment status subset mature , non activated lymphocytes formed thermostable erythrocyte rosettes \( te r \) , lymphoid surface marker usually expressed thymocytes activated cells taken together data define certain immune alterations consistent interpretation cellular immunity may influenced high level storage iron hh patients
psychosocial factors maternal prevention pregnancies background women \( \) treated prior conception pregnancy results serious fetal damage report , factors associated preventing \( hence late treated \) pregnancies described methods subjects included 60 women two comparison groups composed female diabetic women interviewed administered tests intelligence , general well , knowledge , personality results thirty five percent sexually active women used contraception variables best predicted reported frequency birth control use extent women felt social support use contraception \( r 64 \) along positive attitudes birth control \( r 66 \) knowledge family planning \( r 43 \) comparison groups , different pattern variables predicted contraceptive use , locus control prominently diabetics \( r 39 \) social support birth control important \( r 46 \) conclusions girls enter childbearing ages , increased need specific programs address psychosocial factors maternal
form familial due mutation apolipoprotein b gene familial \( \) dominant disorder lipoprotein metabolism characterized levels apolipoprotein b carrying lipoproteins \( vldl , ldl \) 50 normal levels heterozygotes almost absent homozygotes several reports recently shown underlying defect involves different mutations apo b gene lead reduced levels apo b mrna production truncated forms apo b either lower synthetic rate higher catabolic rate normal apo b present three generation family several members linkage analysis shows absence co segregation apo b gene alleles phenotype conclude dominantly transmitted mutation gene apo b responsible low plasma cholesterol levels
hypoglycaemic episodes intensified insulin treatment increased frequency effect cognitive function ninety seven patients insulin dependent diabetes mellitus \( iddm \) randomized intensified conventional treatment \( ict , n 44 \) regular treatment \( rt , n 53 \) mean hba1c level \( sem \) reduced 9 5 0 2 7 4 0 1 ict group \( p less 0 001 \) , 9 4 0 2 9 0 0 2 \( p less 0 01 \) rt group difference groups significant \( p less 0 001 \) period 3 years , 57 ict patients \( 95 confidence interval 44 73 \) 23 rt patients \( 95 ci , 11 34 \) \( p less 0 001 \) least one episode serious hypoglycaemia , need third party assistance resulting coma eighteen 32 ict patients initially adrenergic symptoms hypoglycaemia changed predominantly symptoms case 8 38 rt patients \( p less 0 01 \) change symptoms related increased frequency serious hypoglycaemia , neither symptoms frequency hypoglycaemia relationship insulin dose , body mass index , duration diabetes autonomic nerve function results several neuropsychological tests differ groups baseline , change study signs deteriorating cognitive function patients serious hypoglycaemic episodes
short term effects dehydroepiandrosterone treatment rats mitochondrial respiration administration dehydroepiandrosterone \( dhea \) rats results alterations liver serum factors study undertaken determine earliest metabolic change \( \) associated dhea treatment serum cholesterol , , glucose , insulin , glucagon , thyroid hormones hepatic glucose 6 phosphate dehydrogenase activity , general , unaltered obese zucker rats 7 24 , 12 3 h dhea treatment malic enzyme , long chain fatty acyl coenzyme catalase activities beta oxidation rates elevated 7 24 h dhea treatment , 12 h mitochondrial beta oxidation altered hepatic mitochondrial state 3 respiration per g liver glutamate elevated 7 24 , 12 3 h dhea treated rats elevated per mg protein except 7 succinate supported state 3 respiration per g liver also elevated 7 24 12 h dhea treatment mitochondria rats treated 7 lower levels increase phosphatidylcholine changes fatty acid composition phospholipids occurred 7 24 h dhea treatment additional study , rats treated dhea dhea plus bromide 3 bromide inhibited increase mitochondrial protein respiration associated dhea treatment findings indicate mitochondrial respiration earliest factor affected dhea may associated protein synthesis
endotoxin lipid peroxidation vivo selenium vitamin e deficient adequate rats effect salmonella typhimurium endotoxin injected intraperitoneally \( 0 5 mg kg body weight \) lipid peroxidation vivo assessed peroxidation monitored measuring ethane production , product \( n 3 \) unsaturated fatty acids rats fed selenium vitamin e deficient basal diet one supplemented 0 2 mg se kg 200 mg vitamin e kg 11 13 wk feeding , ethane production tripled lps treated se vitamin e deficient rats compared saline treated deficient rats deficient adequate rats , lps increased ethane production , greater extent se vitamin e deficient rats dietary se vitamin e supplementation alone significantly reduced ethane production lps treated rats vitamin e protective se lps induced lipid peroxidation escherichia coli salmonella minnesota lps also increased ethane production se vitamin e deficient rats results show low doses lps stimulate lipid peroxidation vivo se vitamin e deficient rats
endotoxin lipid peroxidation vitro selenium vitamin e deficient adequate rat tissues effect salmonella typhimurium endotoxin injected intraperitoneally rats \( 0 5 mg kg body weight \) subsequent lipid peroxidation vitro assessed peroxidation monitored measuring ethane production tissue slices , well thiobarbituric acid reactive substances conjugated dienes tissue homogenates rats fed selenium vitamin e deficient basal diet one supplemented 0 2 mg se kg diet 200 mg vitamin e kg 9 16 wk , ethane production thiobarbituric acid reactive substances liver lung generally increased lps treatment se vitamin e deficient rats conjugated dienes increased lps treatment liver se vitamin e deficient rats , paradoxically , higher se vitamin e adequate liver tissue daily injections 1 g hydroxyurea kg body weight , cell proliferation inhibitor , 2 prior lps injection significantly decreased lps induced ethane production se vitamin e deficient rat liver lung results show low doses lps injected rats stimulated lipid peroxidation vitro se vitamin e deficient rat liver tissue hydroxyurea decreased lps induced lipid peroxidation vitro suggests neutrophils macrophages involved lps induced lipid peroxidation
effects dehydration gastric emptying gastrointestinal distress running gastrointestinal distress commonly reported athletes ingestion beverage speculate ingestion may occurring dehydration taken place high prevalence gi disorders runners lost greater equal 4 body weight supports theory test theory , effects dehydration , dehydration combination endurance running , gastric emptying \( ge \) frequency gastrointestinal \( gi \) complaints tested experiment complete cross study designed sixteen subjects ingested 8 ml kg bw 1 7 carbohydrate \( mosm kg 1 \) , solution dehydration dehydration \( 4 bw loss \) produced 60 maximal speed running 30 degrees c intermittent exposure 100 degrees c experiments conducted 2 h rest period water administered 20 40 min gastric drink volumes measured every 10 min 40 min emptying curves compared using semi log transformation percentage emptying data simple linear regression slope line used measure average ge rate dehydration exercise resulted slower ge treatments \( p less 0 05 \) anova revealed significant effects dehydration \( p less 0 05 \) exercise \( p less 0 05 \) , two effects additive delaying ge gi complaints reported 37 5 subjects dehydration exercise experiments gi disturbance reported tests
two step model development non insulin dependent diabetes insulin resistance beta cell dysfunction occur development non insulin dependent diabetes mellitus \( niddm \) , controversy exists lesion primary based longitudinal studies indians , population world 's highest reported prevalence niddm , two step model development disease proposed first step transition normal impaired glucose tolerance , insulin resistance main determinant , second later step worsening impaired glucose tolerance diabetes , beta cell dysfunction plays critical role hypothesis consistent findings ethnic groups many parts world
feasibility effects diabetes type ii protocol blood glucose self monitoring general practice diabetes protocol characterized self monitoring blood glucose introduced four general practices aim making frequency consultations dependent metabolic regulation emphasizing body weight reduction feasibility programme investigated results 1 year compared conventional care four control practices experimental practices , 13 patients switched medical specialist 's general practitioner 's supervision , 20 remained supervision gp 33 started self monitoring self monitoring rate , consultation frequency according protocol , low number dropouts inadequate referrals adherence therapeutic scheme showed protocol feasible gps patients initial assessment , regulation diabetes worse patients experimental group , compared control group \( mean hba1 9 7 vs 8 9 p less 0 05 \) average , patients experimental group \( n 56 \) lost 0 4 kg body weight , whereas control group \( n 73 \) gained 0 1 kg \( n \) mean change hba1 , adjusted initial value , 0 4 experimental 0 5 control group \( p less 0 05 \) results protocol attributed combination greater participation patient , individualized consultation frequency prescription oral hypoglycaemic agents according body weight development
influence simvastatin adrenal corticosteroid production urinary mevalonate stimulation patients heterozygous familial hypercholesterolemia adrenal gland requires continuous supply cholesterol biosynthesis adrenal corticosteroids , supplied low density lipoprotein receptor mediated uptake local synthesis present study examined whether therapy potent hmg coa reductase inhibitor , simvastatin , compromises adrenal response acth stimulation adult patients heterozygous familial hypercholesterolemia adrenal response 36 h continuous acth infusion determined baseline 2 months simvastatin treatment \( 40 mg , twice daily \) eight patients simvastatin reduced total low density lipoprotein cholesterol levels 36 45 , respectively time course increase serum cortisol concentrations continuous acth infusion simvastatin therapy , rates urinary excretion free cortisol , 17 , 17 urinary excretion mevalonate , correlates rates whole body cholesterol synthesis , decreased 3 8 0 42 \( sem \) mu , 24 h baseline 2 75 0 56 simvastatin significant changes seen urinary mevalonate levels simvastatin therapy acth stimulation conclude effects simvastatin patients heterozygous familial hypercholesterolemia paralleled decrease urinary mevalonate , drug adversely affect acth stimulated adrenal corticosteroid production
suppression chromogranin release neuroendocrine sources man pharmacological studies chromogranin \( cga \) acidic soluble protein virtually ubiquitous occurrence normal human neuroendocrine tissues many potential tissue sources cga immunoreactivity , contribute basal \( unstimulated \) circulating cga \? explore question studied effects selective nonselective suppression secretion several sites within neuroendocrine system selective disruption sympathetic outflow decreased basal cga 25 , suggesting sympathetic neurons contribute circulating cga plasma cga patients unilateral bilateral adrenalectomy fell within range observed normal subjects , weighing adrenal medulla major source basal circulating cga selective suppression variety anterior posterior pituitary cell types decreased plasma levels usual resident peptide hormones , left plasma cga propranolol treatment , plasma cga remained unaltered secretin suppressed plasma pth calcitonin , alter plasma cga levels hand , widespread nonselective suppression variety neuroendocrine secretory cells somatostatin decreased plasma cga 48 plasma catecholamines unaltered somatostatin infusion , suggesting somatostatin inhibited cga release sources infusion somatostatin , plasma epinephrine increment response insulin induced hypoglycemia maintained , plasma cga fall , rise somatostatin cessation taken together , findings suggest somatostatin inhibit transport stimulation released cga adrenal medulla circulation conclusion , although adrenal medulla major tissue source cga immunoreactivity man , neuroendocrine sites , including sympathetic axons multiple endocrine glands , appear influence basal circulating concentration cga
subclinical vitamin deficiency postmenopausal women low vertebral bone mass define potential role subclinical vitamin deficiency postmenopausal bone loss , analyzed levels circulating 25 hydroxyvitamin \( 25ohd \) 539 midwestern caucasian women screened osteoporosis low 25ohd \( less 38 nmol l \) found 49 subjects \( aged 52 77 yr \) women low 25ohd reduced vertebral bone density \( \) , assessed quantitative computed tomography , compared age matched controls \( p less 0 001 \) also significantly lower levels serum calcium phosphate , lower urinary calcium , higher serum alkaline phosphatase , , cases , increased immunoreactive pth \( ipth \) concentrations , suggesting secondary hyperparathyroidism furthermore , low 25ohd group correlate directly 25ohd \( r 0 41 p less 0 01 \) , inversely ipth \( r 0 47 p less 0 01 \) multivariate analyses revealed ipth major determinant observed decrease seasonal variations serum 25ohd noted control population group 25ohd levels also correlated sunlight exposure \( r 0 48 p less 0 01 \) , assessed outdoor score thus , vitamin deficiency develops endogenous exogenous sources insufficient contributes reduced bone mass elderly women
hla antigens patients idiopathic thirteen unrelated patients idiopathic \( eight men , five women \) studied diagnosis based clinical , biological , histochemical findings hla typing performed 13 available first degree relatives \( n 31 \) hla present nine 13 probands \( 69 2 compared 18 8 group 53 healthy blood donors 22 4 selected population \( n \) hla present five 13 probands \( 38 4 compared 11 3 14 6 \) antigen association found five 13 patients haplotype found three , haplotypes found twice 10 probands pedigree studies showed one unaffected , 24 heterozygotes , six non carriers extended family population studies necessary establish prevalence gene association haplotypes
inpatient post discharge course malnourished patient retrospective review medical records 114 malnourished 106 non malnourished male veterans assessed inpatient 1 year post discharge dietetic care given treatment malnutrition malnourished sample consisted subjects discharged protein energy protein malnutrition comorbidity subjects diagnosis matched age matched control sample discharged without malnutrition comorbidity period data collected progress notes included diagnoses , inpatient dietetic feedings services provided , discharge dietetic care , intervening clinic visits , initial admission , 79 diagnoses malnourished group fell five diagnosis categories neoplasms respiratory system diseases digestive system diseases endocrine , nutritional , metabolic diseases mental disorders \( including alcohol related disorders \) malnourished subjects received specialized feedings dietetic services controls initial admission however , discharge post discharge care received surviving members groups similar fewer half members either group received post discharge care fifty four malnourished 54 control patients hospitalized findings indicate levels inpatient outpatient dietetic care need coordinated alleviate malnutrition
relationship obesity physical fitness cardiopulmonary metabolic function healthy older men relationship obesity physical fitness \( vo2max \) cardiopulmonary metabolic function examined 132 healthy obese , nonsmoking men age 45 79 obese men higher vo2max lower body fat waist hip ratio \( whr \) obese men low vo2max obese subjects high whr \( upper body fat distribution \) higher systolic blood pressure , hyperinsulinemia impaired glucose tolerance , lower high density lipoprotein cholesterol \( hdl c \) , higher triglyceride \( tg \) vo2max \( ml kg ffm min \) lower older men \( r 0 54 , p less 001 \) , 32 variation accounted age one second forced expiratory volume although pulmonary function normal , 50 variability predicted age , height , vo2max whr glucose tolerance insulin correlated better vo2max indices body composition age , plasma tg hdl c correlated body composition , vo2max age thus , age affects cardiopulmonary metabolic function obese older men , physical , obesity , abdominal body fat distribution \( increased whr \) contributed significantly reductions physiological function
dependency eating disorders female psychiatric inpatients research indicates oral dependent eating disordered individuals similar personality traits , attitudes , behaviors , suggesting dependency may factor dynamics anorexia bulimia investigate issue , compared proportions dependent food related protocols matched samples eating disordered \( n 16 \) , obese \( n 18 \) , non eating disordered , normal weight female psychiatric inpatients \( n 17 \) eating disordered patients reported significantly dependent obese normal weight control patients , difference proportion food related found among three groups results support hypothesis unresolved dependency issues underlie anorexia bulimia
comparison efficacy questran light , new formulation cholestyramine powder , regular questran maintaining lowered plasma cholesterol levels sixty one men known hypercholesterolemia \( plasma cholesterol greater 265 mg dl \) , previous participants coronary primary prevention trial u lipid research clinic program , chosen take part study test effectiveness new low calorie \( questran light \) cholestyramine formulation proven effectiveness currently marketed formulation questran maintaining lowered plasma cholesterol levels study recorded changes fasting plasma lipids , total cholesterol , high density lipoprotein cholesterol , triglycerides , calculated low density lipoprotein cholesterol establishing baseline lipid lipoprotein levels 3 week period participants received currently marketed formulation , men randomized 2 groups , 1 group \( n 31 \) taking new questran light formulation 4 g cholestyramine 5 g powder per pack , group \( n 30 \) continued take marketed questran formulation 4 g cholestyramine 9 g powder per pack group consumed total 24 g day cholestyramine 2 divided doses end maintenance phase study statistically significant mean changes percentage baseline end point lipid lipoprotein levels within either group , significant differences questran light group currently marketed questran formulation group new low calorie cholestyramine formulation appears equally effective maintaining lowered plasma cholesterol levels currently marketed formulation
effect educational program interview adoption guidelines management neonatal hyperbilirubinemia objectives determine \( \) whether physicians guidelines management neonatal hyperbilirubinemia , \( b \) influences decisions investigate treat condition \( c \) effect educational program clinical recall interview compliance guidelines design retrospective chart audit setting urban tertiary care hospital participants term neonates received phototherapy admitted neonatal intensive care unit interventions educational program clinical recall interview measures charts reviewed march may 1986 \( period , publication guidelines \) november 1986 january 1987 \( period ii , publication educational program \) repeated april june 1989 \( period iii , interview phase \) october december 1989 \( period iv , 6 months interviews \) two criteria determined appropriate use phototherapy serum bilirubin level postnatal day phototherapy started results proportion infants receiving phototherapy orders complete blood counts investigate hyperbilirubinemia increased 20 period 37 period iv frequency orders determine proportion reticulocytes change significantly number infants receiving phototherapy decreased study periods proportion receiving phototherapy accordance criteria serum bilirubin level increased 10 17 educational program \( insignificant difference \) 31 interviews \( p 0 02 \) compliance guidelines greater infants 2 days old 3 days old \( p 0 01 \) 45 physicians prescribed phototherapy \( 94 infants \) period iv 26 never prescribed accordance guidelines 19 prescribed accordance guidelines 30 52 infants decisions investigate treat phototherapy affected clinical parental factors addition guidelines two 25 physicians interviewed stated interview would influence management future cases hyperbilirubinemia conclusion clinical recall interview greater impact changing physician management practices communication group basis
arginine restores cholinergic relaxation hypercholesterolemic rabbit thoracic aorta background reduced synthesis endothelium derived relaxing factor \( edrf \) may explain impaired endothelium dependent vasodilation hypercholesterolemia accordingly , designed studies determine endothelium dependent relaxation hypercholesterolemic rabbits may restored supplying l arginine , precursor edrf methods results normal hypercholesterolemic rabbits received intravenous l arginine \( 10 mg kg min \) vehicle 70 minutes subsequently , animals killed , thoracic aortas harvested , vascular rings studied vitro rings contracted norepinephrine relaxed acetylcholine chloride sodium nitroprusside quantified determining maximal response \( expressed percent relaxation contraction \) ed50 \( dose drug inducing 50 relaxation expressed log \) vessels hypercholesterolemic animals receiving vehicle , fivefold rightward shift sensitivity acetylcholine compared normal animals \( p 0 05 , n 5 group \) vessels hypercholesterolemic animals , l arginine augmented maximal response acetylcholine \( 83 16 versus 60 15 , p 0 04 versus vehicle \) increased sensitivity acetylcholine \( ed50 value 6 7 0 2 versus 6 2 0 2 , p less 0 05 versus vehicle \) arginine affect maximal ec50 responses acetylcholine vessels normal animals arginine potentiate endothelium independent responses either group conclusions conclude endothelium dependent relaxation normalized hypercholesterolemic rabbit thoracic aorta vivo exposure l arginine , precursor edrf
comparison effects hypertonic sucrose intracellular potassium depletion growth hormone receptor binding kinetics regulation im 9 cells evidence sequential block receptor mediated endocytosis better understand complex kinetics human gh \( hgh \) binding receptors , investigated , im 9 cultured human lymphocytes , cellular locus corresponding slowly component hormone binding , homologous regulation hgh receptors first , detailed biphasic kinetics dissociation bound hormone control cells 30 c association 30 c extended 0 5 3 h , time required half dissociation fast component slightly decreased \( 30 15 min \) slow component increased considerably \( 6 h 30 h \) concomitantly , size slowly component increased 50 80 total indicates maturation bound hormone , rapidly slowly pool , latter , increase apparent affinity may reflect molecular rearrangement next , compared effect two procedures reported inhibit receptor mediated endocytosis level coated pits previously reported , depletion intracellular k abolished slowly component regulation hgh receptors contrast , upon incubation 0 4 sucrose , like k depletion virtually abrogated hgh internalization , dissociation kinetics remained non first order , regulation hgh receptor slightly reduced thus , procedures appear block receptor mediated endocytosis two successive compartments cell surface conclusion , propose conformational change hgh receptor cell surface \( possibly associated clustering \) may considerably slow dissociation may sufficient regulation
defective tolerance toxic metabolic effects interleukin 1 effect food intake , body weight , survival mice given recombinant lipopolysaccharide \( lps \) , tumor necrosis factor cachectin \( tnf \) , interleukin 1 \( il 1 \) \( 5 micrograms mouse , ip , twice daily \) studied agents induced rapid reduction food intake body weight 1 day treatment unlike tnf lps , il 1 given two daily 5 micrograms lethal within 3 days mice treated lps tnf rapidly developed tolerance anorectic effect , whereas tolerance il 1 required longer time develop complete investigated possible roles changes serum corticosterone glucose effects lps , tnf il 1 single injection lps , tnf , il 1 markedly increased serum corticosterone levels 2 h 2 days chronic treatment , mice given lps tnf refractory induction serum corticosterone subsequent injection lps tnf , mice given il 1 2 days still fully responsive il 1 il 1 , unlike tnf lps , induced marked hypoglycemic response repeated administration il 1 sensitized hypoglycemic effect lack adaptation increase serum corticosterone hypoglycemia also observed il 1 given lower , doses \( 0 25 1 0 microgram \) longer period \( 8 days \) defective tolerance metabolic toxic effects il 1 experimental model indicates major differences vivo biological responses il 1 tnf
frequency effects apolipoprotein e polymorphism mexican american niddm subjects typed 254 non insulin dependent diabetic \( niddm \) mexican americans living county , texas , three common apolipoprotein e \( apoe \) alleles typing performed via dna amplification restriction allele frequencies \( epsilon 2 0 041 , epsilon 3 0 , epsilon 4 0 \) equilibrium \( chi 2 0 60 , df 3 \) differ random sample population \( chi 2 0 16 , df 2 \) analysis variance used test mean differences lipid , lipoprotein , glucose levels among apoe types significant differences among types detected low density lipoprotein cholesterol \( ldl chol p 0 , r2 2 6 \) beta lipoprotein cholesterol \( p 0 019 , r2 3 3 \) levels mean ldl chol e2 3 individuals 2 69 mm , e3 3 3 26 mm , e4 3 3 36 mm mean beta lipoprotein cholesterol e2 3 individuals 3 05 mm , e3 3 3 64 mm , e4 3 3 67 mm based results , conclude effects apoe polymorphism lipid profiles glucose levels niddm subjects nondiabetic mexican americans populations studies investigating role apoe polymorphism diabetic subjects found increased triglyceride levels individuals possessing epsilon 2 allele increased frequency epsilon 2 allele hyperlipidemic diabetic subjects found significant difference mean triglyceride levels among genotypes possible reasons discrepancy discussed , including dna versus protein typing methods
blunted diuretic natriuretic responses central administration clonidine streptozocin induced diabetic rats purpose study determine whether diuretic natriuretic effects altered response \( icv \) infusion clonidine diabetic rats diabetes induced male sprague dawley rats 65 mg kg p injection streptozocin , control rats injected vehicle 2 wk experiment blood glucose levels significantly elevated diabetic group \( 26 3 1 3 mm \) compared control group \( 8 4 1 6 mm \) icv infusion clonidine \( 2 micrograms kg 1 min 1 45 min \) , urine flow sodium excretion measured intact denervated kidneys anesthetized diabetic control rats icv infusion clonidine significantly increased urine flow innervated denervated kidneys control rats diabetic rats significant increase sodium excretion icv infusion clonidine innervated kidneys control rats , denervation abolished effect diabetic rats , clonidine failed promote natriuresis intact kidneys , similar control rats , promote natriuresis denervated kidneys study demonstrates 1 \) diuretic response icv infusion clonidine blunted diabetic rats , 2 \) natriuretic response icv infusion clonidine blunted innervated kidneys diabetic rats
changes hepatic glutathione metabolism diabetes glutathione important regulation redox state , decline tissue level often considered indicative increased oxidative stress diabetes study diabetic rats , level hepatic glutathione normal unless food intake restricted thus , previous report reduction hepatic glutathione diabetes likely result food deprivation rather diabetes alone contrast changes characteristic oxidative stress , efflux glutathione bile diabetic animals significantly decreased , whereas hepatic mixed unchanged , hepatic gamma activity considerably increased changes reproduced food deprivation decrease biliary excretion glutathione diabetes may reflect attempt conserve glutathione activation hepatic gamma cycle conclude disturbances glutathione metabolism diabetes typical seen oxidative stress food restriction
lack evidence improvement long term glycemic control pulsatile insulin infusion streptozocin induced diabetic baboon assess potential therapeutic use pulsatile intravenous insulin delivery , five streptozocin induced diabetic baboons treated alternate 3 6 wk periods pulsatile continuous insulin infusion time averaged insulin concentrations matched two pulsatile administration periods \( p1 p2 \) intervening period continuous insulin administration \( c \) significant differences among overall means four daily glucose determinations performed three periods \( p1 , 5 7 1 mm c , 5 6 0 9 mm p2 , 5 3 0 9 mm \) mean value , measure stability glycemic control \( p1 , 4 1 7 c , 3 9 1 8 p2 , 3 6 1 5 \) percentage glucose values less 2 8 mm \( p1 , 13 8 5 c , 14 12 p2 , 13 9 1 \) glycosylated hemoglobin levels determined end p1 c \( 7 5 3 4 6 5 1 8 , respectively values means sd \) fasting hepatic glucose production suppressed similar degree pulsatile continuous insulin infusion \( p1 , 23 3 mumol kg 1 min 1 c , 24 8 mumol kg 1 min 1 \) arterial glucagon levels similar pulsatile continuous insulin infusion , fasting state \( 84 29 84 31 ng l , respectively \) \( 30 14 27 12 ng l , respectively \) pulsatile insulin infusion failed corresponding glucagon secretory rhythm data suggest metabolic consequences long term pulsatile continuous insulin infusion animal model human non insulin dependent diabetes comparable
independent effects poor diabetes control responses hypoglycemia children evaluate effects childhood poorly controlled insulin dependent diabetes mellitus \( iddm \) counterregulatory hormone symptomatic responses hypoglycemia , studied 16 nondiabetic children \( 13 2 yr \) , 19 nondiabetic adults \( 26 3 yr \) , 13 children iddm \( 14 2 yr , , 15 1 3 3 \) gradual reduction plasma glucose glucose clamp technique plasma glucose reduced approximately 5 approximately 2 8 mm 240 min serial assessment counterregulatory hormone levels symptom awareness plasma glucose level triggered sustained rise plasma epinephrine consistently higher nondiabetic children adults \( 3 9 0 06 vs 3 2 0 06 mm , p less 0 001 \) poorly controlled iddm elevated glucose threshold epinephrine release normoglycemic levels \( 4 9 0 2 mm , p less 0 001 vs control groups \) age iddm also produced upward shift glucose level growth hormone release symptom awareness initiated contrast effect glucose thresholds , maximal epinephrine responses symptom scores increased age iddm \( 2 fold higher children \) conclude childhood poor diabetes control independently contribute upward shift glucose thresholds counterregulatory hormone release symptom awareness mild hypoglycemia normoglycemic may interfere efforts control diabetes young patients
use x ray study human diabetic aging collagen extensive investigations solubility fluorescence collagen fibers diabetes revealed significant changes physical properties changes associated increased cross link formation used x ray study changes human extensor tendons molecular level relation aging diabetes results indicate diabetes induces significant alterations ultrastructure collagen lateral packing molecules axial structure specimen changes induced normal tendon incubation glucose 6 phosphate different associated normal process aging
suppression glucose transporter protein causes insulin resistance adipocytes patients non insulin dependent diabetes mellitus obesity major portion insulin mediated glucose uptake occurs via translocation glut 4 glucose transporter proteins intracellular plasma membrane examined gene expression glut 4 transporter isoform subcutaneous adipocytes , classic insulin target cell , better understand molecular mechanisms causing insulin resistance non insulin dependent diabetes mellitus \( niddm \) obesity subgroups lean \( body mass index bmi 24 1 \) obese \( bmi 32 2 \) controls obese niddm \( bmi 35 2 \) patients , number glut 4 glucose transporters measured total subcellular membrane fractions using specific antibodies western blots relative lean controls , cellular content glut 4 decreased 40 obesity 85 niddm total cellular membranes obesity , cellular depletion glut 4 primarily involved low density microsomes \( \) , leaving fewer transporters available insulin mediated recruitment plasma membrane \( pm \) niddm , loss glut 4 profound membrane subfractions , pm , , well high density microsomes observations corresponded decrements maximally stimulated glucose transport rates intact cells assess mechanisms responsible depletion glut 4 , quantitated levels mrna specifically hybridizing human glut 4 cdna northern blots obesity , glut 4 mrna decreased 36 compared lean controls , level well correlated \( r 0 77 \) cellular content glut 4 protein wide spectrum body weight glut 4 mrna adipocytes niddm patients profoundly reduced 86 compared lean controls 78 relative weight matched nondiabetic counterparts \( whether expressed per rna , per cell , amount b mrna \) interestingly , glut 4 mrna levels patients impaired glucose tolerance \( bmi 34 4 \) decreased level overt niddm conclude , obesity , insulin resistance adipocytes due depletion glut 4 glucose transporters , cellular content glut 4 determined level encoding mrna wide range body weight niddm , profound insulin resistance caused reduction glut 4 mrna protein attributable obesity per se suppression glut 4 mrna observed patients impaired glucose tolerance , therefore , may occur early evolution diabetes \( abstract truncated 400 words \)
differential regulation adipose tissue glucose transporters genetic obesity \( fatty rat \) selective increase adipose cell muscle glucose transporter \( glut 4 \) expression adipocytes young obese zucker rats exhibit insulin mediated glucose transport , together marked increase cytochalasin b binding compared lean rat adipocytes , examined cells expression two isoforms glucose transporter , erythroid \( glut 1 \) adipose cell muscle \( glut 4 \) types , rats aged 16 30 , e , emergence hyperinsulinemia glut 1 protein mrna levels identical two genotypes ages contrast , levels glut 4 protein obese rat adipocytes 2 4 4 5 fold lean littermates 16 30 age , respectively , perfect agreement genotype effect insulin stimulated glucose transport activity levels glut 4 mrna per fat increased 2 3 6 2 fold obese vs lean rats 16 30 old , indicating level regulation obese phenotype associated overexpression glut 4 mrna gastrocnemius muscle work indicates fa gene exerts differential control expression glut 1 glut 4 adipose tissue provides evidence independent hyperinsulinemia , genotype major regulatory factor glut 4 expression tissue
randomised prospective study short term long term initial stay hospital children diabetes mellitus assess isolated change pattern care influences outcome care hospital use , randomised prospective 2 year study done 31 61 consecutive children newly diagnosed insulin dependent diabetes mellitus \( iddm \) admitted hospital disease onset week compared 30 children admitted 4 weeks insulin treatment education diabetes similar two groups duration initial stay hospital effect metabolic control 2 years time since diagnosis significant respect effect haemoglobin a1 \( p 0 001 \) , haemoglobin a1c \( p 0 004 \) , insulin dose \( p less 0 001 \) 2 years , 45 children short term group 29 long term group c peptide positive \( p ns \) c peptide positivity correlated age change pattern care children iddm , led pronounced decrease hospital use patient group irrespective length initial stay hospital , equally good metabolic control obtained groups 2 years
intensive management type ii diabetes goals intensive treatment type ii diabetes restore blood glucose levels normal correct hyperlipidemia , hypertension , cardiovascular risk factors prevent hyperinsulinemia treatment begin attempts reduce weight diet exercise fact , diet exercise stressed vital components diabetic patient 's life style matter treatment method used drug treatment may consist sulfonylurea increase insulin secretion improve insulin resistance exogenous insulin achieve glucose control avoid dangers chronic hyperglycemia combination two appears attractive still investigation control hypertension mandatory may require use angiotensin converting enzyme inhibitor calcium channel blocker normalization serum lipid levels also important patients , agents adversely affect glucose levels must avoided
activity plasma lipoprotein response omega 3 polyunsaturated fatty acids patients primary hypertriglyceridemia action omega 3 \( n 3 \) fatty acids attributed primarily reduction hepatic triglyceride synthesis reduced secretion low density lipoproteins \( \) however , increased catabolism triglyceride rich lipoproteins reported could due increased availability peripheral lipoprotein lipase \( \) hepatic lipase \( hl \) study plasma lipoproteins activities hl determined 12 patients primary hypertriglyceridemia isocaloric substitution omega 3 fatty acids \( 10 g \) 4 wk omega 3 resulted 53 61 reductions plasma triglyceride vldl cholesterol concentrations , respectively \( p less 0 0001 \) however , low density lipoprotein \( ldl \) cholesterol concentrations increased 26 \( p less 0 001 \) activities hl essentially remained thus , patients primary hypertriglyceridemia , reduction plasma triglyceride concentrations increase ldl cholesterol concentrations mediated omega 3 seem occur without increase hl activities
fat absorption neonates comparison long chain fatty acid triglyceride compositions formula , feces , blood studied malabsorption fat neonates fed either modified formula \( n 22 , gestational age , 33 6 3 9 wk \) unmodified formula \( n 14 , gestational age , 34 1 3 7 wk \) groups fecal lipid consisted almost completely \( greater 90 \) free fatty acids , whose composition highly correlated corresponding formula 's fatty acid composition r 0 96 \( modified \) r 0 99 \( standard \) groups similar relative amounts compositions fecal cholesterol esters triglycerides plasma , lesser extent , erythrocyte membrane long chain fatty acid compositions correlated corresponding formulas suggest extensive intestinal hydrolysis limited absorption dietary lipids , least partly , due lipolysis colon appearance triglycerides colon may due rapid small intestinal passage relation small intestinal lipolysis
lactose milk intolerance healthy greek prevalence lactose greek adults 75 age activity declining known prevalences lactose intolerance investigated 150 randomly selected greek children 5 12 old using breath hydrogen analysis ingestion lactose \( 2 g kg body wt , maximum 50 g \) 0 240 l milk prevalence lactose increased age \( 7 30 6 , r 0 88 , p 0 004 \) , 29 4 80 0 ages 5 12 , respectively testing , reported prevalences milk related symptoms children high low lactose digestion capacity 21 1 39 7 \( chi 2 5 96 , p 0 015 \) , respectively however , corresponding prevalences lactose intolerance ingestion milk 7 3 8 6 \( chi 2 0 1 , p 0 72 \) three children delta h2 greater equal 20 ppm although intestinal activity declines age 5 many greek children report milk related symptoms , true malabsorption intolerance lactose glass milk rarely seen age
brain uptake glucose diabetes mellitus role glucose transporters known diabetes related reduction blood brain barrier \( bbb \) transport glucose due change functional capacity transporters yet unidentified mechanism occurring plasma membrane cytoplasm increase understanding problem , cerebral blood flow , brain uptake index \( \) 3 methyl glucose concentration 3h cytochalasin b binding sites determined diabetic rats diabetic rats treated insulin 3 methyl glucose significantly reduced \( less 0 001 \) diabetic rats \( 32 7 1 2 \) compared control rats \( 41 9 1 0 \) change could attributed alteration cerebral blood flow non specific change bbb permeability normalization blood glucose insulin therapy corrected measurements diabetic rats \( 42 2 1 4 \) level measurable glucose transporters measured 3h cytochalasin b binding assay appear reduced diabetic brain data indicate reduced brain uptake glucose chronic hyperglycemia occur absence change glucose transporter concentration
receptor autoimmunity endocrine disorders discovery 1956 long acting thyroid stimulator graves' disease , known thyroid stimulating antibodies , seminal new mechanism disease revealed appears applicable virtually endocrine systems , involving growth well function endocrine cells endocrine gland may fail least three autoimmune mechanisms destruction , atrophy , inhibition function destruction probably irreversible usually distinguishable clinically receptor blockade causing atrophy metabolic unresponsiveness contribution made receptor autoimmunity endocrine diseases thyroid disease present unclear , immunologic manipulation potentially reversible , improving replicative capacity gland , metabolic responsiveness ,
correlation first early third trimester glucose screening test results one hundred twenty four normal gravidas paired first early third trimester \( 26 32 weeks \) 1 hour oral glucose screening tests performed first trimester oral glucose screening test values correlated significantly third trimester glucose screening test results entire population , whites non whites , normal weight obese patients first trimester oral glucose screening test values 110 mg dl seldom associated third trimester oral glucose screening test results 135 mg dl associated abnormal 3 hour glucose tolerance test \( \) results nine gravidas \( 7 3 \) diagnosed gestational diabetes mellitus third trimester , first trimester glucose screening test results 110 mg dl difference incidence gestational diabetes mellitus gravidas first trimester glucose screening test results 110 mg dl \( 0 \) values 110 mg dl \( 16 4 \) highly significant \( p less 0001 \) patients first trimester glucose screening test values 110 mg dl , third trimester glucose screening may unnecessary contrast , gravidas first trimester glucose screening test results 135 mg dl , high positive predictive value elevated repeat glucose screening test results early third trimester patients elevated first trimester glucose screening values 140 mg dl particularly high risk elevated glucose screening test results later pregnancy repeat 1 hour third trimester glucose screening favor direct third trimester 3 hour
fructosamine compared glucose load screening test gestational diabetes five hundred seven women screened gestational diabetes 20 36 weeks' gestation received 100 g glucose \( \) load 28 weeks measurement plasma glucose 1 hour later fructosamine levels measured 4 week intervals 20 36 weeks 36 weeks , full 100 g 3 hour glucose tolerance test performed subjects eighteen women diagnosed gestational diabetes glucose load sensitivity 81 detection gestational diabetes , compared 50 fructosamine 36 weeks fructosamine useful screening test gestational diabetes currently defined
diagnosis management precocious puberty onset pubertal development age 8 years girls 9 years boys constitutes precocious puberty numerous causes precocious puberty , classified central peripheral precocious puberty central precocious puberty results premature activation hypothalamic pituitary gonadal axis thus presents physical hormonal findings similar found normal puberty peripheral precocious puberty results gonadotropin secretion secretion sex steroids independent pituitary gonadotropins types precocious puberty characterized rapid growth advancement skeletal age , leading paradox tall child becoming short adult result premature fusion long acting gnrh agonists afford effective , selective , reversible therapy central precocious puberty without significant toxicity gnrh agonists effective managing premature sexual maturation associated peripheral precocious puberty , number agents used success agents include , ketoconazole , medroxyprogesterone acetate gnrh agonist treatment leads increase predicted final height determine true benefit agents increasing ultimate height , need continuing studies treated cohorts follow growth patterns adult stature achieved
hyperthyroidism children adolescents hyperthyroidism infants children usually caused graves' disease however , several diseases also produce hyperthyroidism age groups pathophysiology clinical course conditions differ , optimal treatment depends precise diagnosis
cushing syndromes 10 years since journal 's last review cs seen advances understanding many aspects causes , diagnosis , treatment spectrum called cushing syndromes expanded considerably include cd , multiple sources ectopic acth secretion , apparent autoimmune cause improved assays acth availability crf provided new insight physiology pathophysiology hpa axis new tools diagnosis cs , especially combination selective catheterization sampling new imaging technology improved visualization pituitary adenomas provided powerful methods identifying tumors secreting acth primary adrenal tumors finally , refinement transsphenoidal surgery success treating cd provided safe effective therapy disease occasional patients require medical therapy , drugs available decrease steroid biosynthesis much better understanding disease process able diagnose treat correctly one see new pieces fall place next ten years
primary secondary testicular insufficiency possibility testicular insufficiency common problem pediatric practitioner presentation varies severity defect , developmental age achieved onset , presence associated abnormalities commonly , primary secondary testicular insufficiency present time puberty , presentation may birth early neonatal period appropriate investigations may diagnosis time allow intervention later appropriate age secondary testicular failure , although difficult diagnose differentiate simple delay development , offers possibility later development spermatogenesis attainment fertility use gonadotropins gnrh replacement programs primary testicular failure , implies intrinsic abnormality functioning elements testis , spermatogenesis hormonal stimulation treatment testicular failure neonatal period unnecessary unless associated pubertal boy , testosterone replacement treatment choice initiated carefully , taking consideration age subject , bone age , psychosocial circumstances goal therapy achieve normal progression physical changes puberty physical maturity normal potential sexual function
adolescent differential diagnosis management transient permanent disturbance steroid hormone physiology occurs male breast exposed decreased ratio androgen estrogen article discusses pubertal pathologic , diagnostic approach , treatment
disorders sexual differentiation development psychological aspects children abnormalities sexual differentiation development smooth course psychosocial development spite significant risks challenges face chances positive emotional outcome made likely careful handling patients time first presentation parents' unambiguous acceptance child 's sex rearing early surgical intervention normalize child 's external genital appearance critical elements positive outcome , patterns behavior documented materials reviewed article suggest difficulties immaturity social development rather significant psychopathology parent child interactions repeatedly found central child 's emotional well , need provide parents adequate counsel support patterns , however , represent findings across groups patients cannot predict emotional , social , academic functioning individual within clinical syndromes great individual variation social , emotional , physical presentation finally , rather minimizing problems , physicians need educate parents active children educational social
mathematical models myosin heterodimer formation rat heart thyroid hormone alterations characterize mechanisms involved formation myosin heavy chain \( mhc \) heterodimer v2 \( alpha beta mhc \) v3 \( beta beta mhc \) v1 \( alpha alpha mhc \) , 82 5 week old normotensive rats homogeneous v1 made hypothyroid propylthiouracil \( 0 8 , drinking water \) , proportion v2 , v3 , v1 determined pyrophosphate gel electrophoresis specimens left right ventricles switch alpha mhc beta mhc , beta mhc occurred initially form heterodimer 4 6 days , v2 greater \( p less 0 05 \) v3 day 8 , v2 smaller v3 , day 10 , v2 statistically different v3 day 12 , v2 smaller v3 21 days , propylthiouracil treatment stopped , remaining 34 hypothyroid rats injected daily dose thyroxine \( average , 0 1 mg kg body wt \) , resulting switch beta mhc alpha mhc 1 day , v2 still greater v1 however , already day 3 , v2 smaller v1 characteristic unexplained organization thick filament analyzed mathematical models involving probability calculations two principally different models established assume either exchange mhc dimers single mhc thick filament parameters models estimated using squared discrepancies experimental predicted isoenzyme populations based fit crucial model parameters , concluded characteristic organization thick filament accounted exchange involving predominantly mhc dimers single mhc fact v2 lower expected formation random attributed preferred 35 newly synthesized mhc
effects colchicine thyroxine induced cardiac hypertrophy adrenoceptor changes short term \( 5 days \) administration l thyroxine \( 0 1 mg kg p daily \) adult sprague dawley rats induces modest degree cardiac hypertrophy \( 22 increase heart weight body weight ratios \) opposite changes cardiac adrenoceptors \( 24 increase beta adrenoceptors 20 decline alpha 1 adrenoceptors \) pretreatment colchicine affect ability l thyroxine induce cardiac hypertrophy prevented effects beta alpha 1 adrenoceptors results suggest selective involvement action thyroid hormones expression cardiac adrenoceptor genes
chronic diabetic complications tissue glycosylation relevant concern diabetes prone black population significant segment black population affected chronic diabetes , subjected severe cardiovascular , renal , neurological complications shorten survival diminish quality life one important pathogenetic mechanisms intensive investigation advanced tissue glycosylation tissue cell surface proteins modified glucose shown highly active protein cross linking implicated tissue damage protein glucose interactions , called advanced glycosylation end products \( ages \) , processed macrophages high affinity receptor coupling age proteins age receptors results degradation removal , simultaneously , synthesis secretion cytokines tumor necrosis factor interleukin 1 suggests age may act normally signal growth promoting factor secretion coordinated replacement process tissue remodeling chronic diabetes , however , accelerated accumulation tissue age occurs , disturbance balance may lead several pathological , lytic , proliferative responses like vasculopathy diabetes progress made discovery hcl , age inhibitor , prevented significant pathology short term diabetic animal studies
low serum thyrotropin \( thyroid stimulating hormone \) older persons without hyperthyroidism studied large population \( n \) unselected ambulatory persons older 60 years determine prevalence low serum thyroid stimulating hormone \( tsh \) level , ie , less 0 1 mu l using sensitive assay , level suggestive hyperthyroidism younger adults one hundred one persons \( 3 9 \) low serum tsh level half \( 51 101 \) taking thyroid hormone remainder , 44 hyperthyroid become 4 years follow forty one 44 euthyroid persons serum thyroxine level less 129 nmol l repeated testing showed serum tsh level 0 1 mu l three euthyroid persons serum thyroxine level 129 nmol l six hyperthyroid became follow period serum thyroxine level 129 nmol l routine clinical examination sensitive indicator hyperthyroidism permit discrimination low value serum tsh alone , high sensitivity specificity hyperthyroidism , low positive predictive value \( 12 \) diagnosis addition thyroxine assay raised predictive value fivefold 67 low value serum tsh far common older persons hyperthyroidism low values euthyroid persons accompanied clearly normal serum t4 concentration \( less 129 nmol l \) serum tsh level 0 1 mu l repeated testing recommend measurement serum tsh thyroid concentration , using sensitive assay , initial step testing older person possible hyperthyroidism measurement serum t4 concentration free t4 index sample would needed approximately 2 serum tsh level less 0 1 mu l alternatively , tsh assay could repeated later time
nature altered growth hormone secretion hyperthyroidism hyperthyroidism accompanied various neuroendocrine regulatory disturbances affect , also gonadotropic , , examine nature alterations neuroendocrine control mechanisms direct axis hyperthyroidism , applied novel technique designed estimate number , amplitude , mass significant underlying gh secretory events influence gh metabolic clearance removed mathematically end , blood sampled 10 min intervals 24 h seven hyperthyroid seven age matched euthyroid men subsequent gh time series assayed immunoradiometric assay \( sensitivity , 0 08 ng ml \) submitted quantitative analysis found hyperthyroid compared euthyroid men 1 \) significantly gh secretory bursts per 24 h \( 15 1 0 vs 10 1 1 p 0 017 \) 2 \) secreted 3 times much gh per burst \( 3 7 0 80 vs 1 3 0 42 ng ml distribution p 0 013 \) 3 \) achieved maximal rate gh secretion burst 2 3 fold higher control men \( 0 14 0 028 vs 0 0 015 ng ml min p 0 017 \) 4 \) 3 7 fold higher 24 h endogenous gh production rates \( p less 0 01 \) neither hyperthyroid euthyroid men significant \( tonic \) gh secretion conclude axis hyperthyroid men marked higher frequency spontaneous gh secretory bursts , higher rate maximal gh secretion attained per burst , larger mass gh released per burst disturbances result nearly 4 fold increase 24 h production rate gh
falsely elevated serum parathyroid hormone levels due immunoglobulin g patient idiopathic hypoparathyroidism 73 yr old patient idiopathic hypoparathyroidism admitted hospital may 1981 immunoreactive pth \( ipth \) level determined ria using antiserum specific c terminal region pth \( 65 69 \) upper normal range \( 0 6 ng ml \) next 7 yr increased gradually 6 ng ml since ipth levels determined using commercial ria remained constantly decreased undetectable range , studied mechanism false elevation ipth patient patient 's serum contained binding protein tracer \( 125i \) human pth \( 46 84 \) \) , antibody first guinea pig immunoglobulin g \( igg \) second antibody \( goat igg \) detected consistent findings , dilution curve serum parallel standard bovine pth \( 1 84 \) gel filtration analysis revealed ipth like substance eluted void volume \( apparent mol wt , greater 70 , 000 \) almost ipth like substance protein sepharose column igg fraction purified protein sepharose affinity chromatography applied antihuman igg lambda sepharose column , 72 ipth like substance detected igg lambda results suggest falsely elevated ipth patient 's serum due \( mainly igg lambda \) , cross reactive antiserum highly specific c terminal region human pth \( 65 69 \)
3 alpha glucuronide premature normal investigate role adrenal androgens 3 alpha glucuronide \( 3ag \) production childhood , compared serum 3ag androgen levels dehydroepiandrosterone \( dhea \) , dhea sulfate \( ds \) , \( delta 4 \) , testosterone \( \) 32 children premature due idiopathic premature \( n 26 \) , partial 21 hydroxylase deficiency \( n 2 \) , 3 beta dehydrogenase deficiency \( n 4 \) 36 normal prepubertal \( 18 males 18 females \) 22 normal pubertal ii iii subjects \( 10 males 12 females \) serum 3ag \( 2 7 2 0 nmol l \) androgen concentrations children significantly higher \( p less 0 05 0 001 \) normal prepubertal children \( 3ag , 0 8 0 5 nmol l \) serum 3ag androgen levels , except , children premature due 21 hydroxylase deficiency 3 beta dehydrogenase deficiency higher normal prepubertal children serum 3ag androgen levels normal ii iii male \( 3ag , 3 8 1 7 nmol l \) female \( 3ag , 1 74 0 52 nmol l \) subjects also significantly higher \( p less 0 05 0 001 \) prepubertal children serum 3ag , dhea , ds , delta 4 levels children similar normal ii iii females males , serum children \( 0 37 0 2 nmol l \) significantly lower \( p less 0 05 0 001 \) normal pubertal females \( 0 71 0 37 nmol l \) males \( 4 5 2 6 nmol l \) combined group \( n 88 \) , 3ag levels correlated better serum ds \( r 0 7 \) , dhea \( r 0 6 \) , delta 4 \( r 0 52 \) , \( r 0 31 \) levels data suggest weak adrenal androgens ds , dhea , delta 4 contribute substantially 3ag production premature normal
pulsatile thyrotropin release thyroid function subcutaneous octreotide infusion pulsatile secretion tsh studied eight patients active treatment 1 month therapy consisting sc infusion 300 micrograms octreotide day mean gh levels decreased 37 1 7 2 5 2 1 4 mu l \( p 0 002 \) insulin like growth factor levels decreased 82 9 8 8 37 8 9 8 nmol l \( p less 0 01 \) normalized five eight patients one patient tsh levels undetectable octreotide therapy seven patients , cluster analysis revealed 11 9 0 8 pulses 24 h , mean pulse width 81 4 6 min , mean pulse height 1 33 0 42 mu l , mean pulse increment 0 36 0 12 mu l octreotide therapy pulse parameters remained unchanged pulse height amplitude increased significantly night \( e 2000 h \) untreated treated patients unchanged therapy therapy t3 levels decreased 2 05 0 17 nmol l 1 44 0 08 nmol l \( p 0 001 \) , levels increased 0 14 0 02 nmol l 0 19 0 03 nmol l \( p less 0 05 \) plasma t4 levels remained unchanged studies conclude tsh pulse generator unchanged active apparently unaffected chronic octreotide infusions
thyroid function healthy elderly population implications clinical evaluation evaluation thyroid function elderly people complex generated controversy normal study analyzed thyroid function assays identified healthy elderly population 216 subjects thyroxine , free thyroxine , triiodothyronine , t3 uptake , thyrotropin , thyroid antibody titers performed histories treatment thyroid conditions present 13 9 \( n 30 \) population , test results additional 4 3 \( n 8 \) revealed hypothyroidism subjects excluded statistical analysis test results revealed significant differences younger controls well skewed distributions t4 , , tsh significant correlations increasing age gender within elderly population 11 8 \( n 21 \) population exhibited elevated tsf levels normal t4 values , 23 0 \( n 41 \) exhibited titer one thyroid antibodies current reference ranges thyroid tests broad enough include range values seen healthy elderly , discussed
assessment pupillary light reflex latency darkness adapted pupil size control subjects diabetic patients without cardiovascular autonomic neuropathy increased pupillary light reflex latencies found often reduced darkness pupil size diabetic patients without abnormal cardiovascular reflexes finding suggests parasympathetic pupillary dysfunction precedes sympathetic pupillary denervation diabetic autonomic neuropathy
parathyroid autotransplantation thyroid surgery permanent hypoparathyroidism one distressing complications thyroid surgery incidence iatrogenic complication varies 3 25 percent among patients undergoing total thyroidectomy parathyroid injury may caused removal parathyroids , ligation blood supply , destruction secondary capsular hematoma attention technical details identification parathyroids , dissection close thyroid gland , preservation blood supply parathyroids , avoiding manipulation parathyroids reduces incidence temporary permanent however , parathyroids injured , best method preserving function autotransplantation past 7 years performed 250 attempt made identify preserve parathyroid gland case even lobectomy procedures , ipsilateral parathyroids identified preserved whenever parathyroids separated surrounding structures , muscle chosen autotransplantation rather forearm muscles avoid added incision selective measurement parathormone essential group patients prior autotransplantation , confirmation nature tissue made frozen section small portion parathyroid gland parathyroid autotransplantation performed 15 instances , even one parathyroid injured one member group 15 patients developed temporary hypoparathyroidism , disappeared 4 weeks calcium supplementation remaining patients uncomplicated recovery autotransplantation parathyroid glands performed whenever parathyroid damaged retraction hematoma essential every thyroid surgeon familiar technique parathyroid autotransplantation
epidermal growth factor induces functional expression dopamine receptors gh3 cell line gh3 cells clonal strain rat pituitary tumor prl gh cells express receptors dopamine thus hormone release insensitive inhibitory effect dopamine d2 receptor agonists exposure gh3 cells epidermal growth factor 4 consecutive days markedly altered cell morphology , spherical appearance elongated flattened shape , increased cell size morphological changes accompanied functional expression d2 dopamine receptors shown presence specific , , high affinity binding 3h epidermal growth factor treated cells fact selective d2 agonist recovered property inhibit prl secretion cell cultures exposed factor effect egf functional expression d2 receptors dose dependent \( ec50 8 pm \) reversible data suggest egf elicits major effects expression specific genes leading differentiation gh3 cells like cells dopamine d2 receptors
thyroid hormones 5' rat fetus late gestation effects maternal hypothyroidism previously observed t4 t3 levels fetal rat brain brown adipose tissue clearly higher expected low circulating levels , studied thyroid hormone concentrations 5' activities \( 5'd \) several rat fetal tissues last 6 days gestation \( \) , namely 17 22 period comprises onset fetal thyroid activity total t4 t3 contents increased 100 400 fold , respectively t4 concentrations increased 8 10 fold plasma , carcass , lung , liver , t3 increased 4 5 9 fold , except plasma liver , t3 levels increased less 2 fold plasma 3 fold liver developmental period 5'd activity increased 5 10 fold fetal liver lung , respectively fetuses hypothyroid \( \) dams , body weight lower fetuses normal dams total t4 t3 contents initially , decreased markedly fetuses dams end gestation earliest fetal ages studied \( 17 18 \) t4 t3 concentrations lower carcass , liver , lung , brain , although near term consistent differences fetal tissues control dams , probably compensatory stimulation secretion liver 5'd decreased 50 throughout gestation , lung 5'd activities lower end gestation thyroid hormones placentas dams low , increased end gestation contribution fetal thyroid present results describe profiles thyroid hormone concentrations 5'd activities late fetal development active regulatory mechanisms already present age frequently stated rat fetuses near term deficient thyroid hormones , thyroid hormone independent maternal thyroid status , present results show near term , t4 t3 concentrations several tissues reach levels 50 described adult animals , fetal thyroid function influenced maternal hypothyroidism
iodine thyroid disease iodine requisite substrate synthesis thyroid hormones , minimum daily requirement 50 micrograms autoregulatory mechanism within thyroid serves first line defense fluctuations supply iodine also permits escape inhibition hormone synthesis large quantity iodine induces \( wolff effect escape \) environmental iodine deficiency continues significant public health problem worldwide , geographic regions presence foods pathologic consequences severe iodine deficiency include endemic goiter , endemic cretinism , increased fetal infant mortality , increased prevalence community cognitive disabilities implementation program prevents endemic cretinism reduces frequency pathologic consequences iodine deficiency iodine excess results principally use iodine containing preparations radiographic contrast media pathologic consequences iodine excess thyroid autoregulation defective , escape wolff effect cannot occur , autoregulation absent defective autoregulation characterizes fetal neonatal thyroid , 's thyroiditis , radioiodine surgically treated graves' hyperthyroidism , thyroid patients cystic fibrosis , thyroid exposed weak inhibitors organic binding iodine circumstances , provision excess iodine may lead iodide goiter without hypothyroidism absent autoregulation may feature multinodular goiter , provision excess iodine may induce \( disease \) pathologic consequences iodine excess resolve source iodine addition role reversing iodine deficiency , iodine used adjunctive therapy hyperthyroidism inhibiting proteolytic release thyroglobulin , induces prompt slowing thyroid hormone secretion effect treatment crisis severe disease iodine also reduces thyroid cellularity vascularity therefore used preparation patient thyroidectomy finally , failure escape wolff effect , iodine may also used early management radioiodine treated graves' hyperthyroidism
problem nodular goiter nodular goiter worldwide problem involving persons endemic goiter , associated cretinism , totally preventable ensuring adequate dietary iodine intake eliminating malnutrition dietary therapy , hand , difficult goiters often regress changes irreversible goiter due autoimmune thyroid disease , genetic defects thyroid hormone biosynthesis , environmental neoplasia usually preventable usual therapy , involving tsh suppression administration l thyroxine orally , frequently bring regression early , diffuse goiters often ineffective regression large , multinodular goiters patients , surgical removal goiter may necessary alleviation obstructive symptoms research needed elucidate factors involved development multinodular goiters control autocrine paracrine factors involved nodule growth
estimated burden diabetes mellitus manitoba according health insurance claims pilot study objective estimate burden diabetes mellitus manitoba 1980 1984 design review manitoba health services commission \( mhsc \) database validity mhsc data established two one involved self reports survey elderly , involved people confirmed diabetes enrolled provincial diabetes education program subjects sample 100 , 000 people stratified age , sex mhsc health region 50 , 000 aged 25 64 years , 50 , 000 aged 65 mhsc claims containing icd 9 cm code diabetes mellitus gestational diabetes identified main results sample people found diagnosis diabetes , annual prevalence 0 8 among 25 44 years age , 3 5 among 45 64 7 6 among 65 older annual incidence rate among 25 years age 7 8 per 1000 pregnant women 25 44 years old 85 \( 1 9 \) diabetes 23 believed gestational diabetes conclusions incidence prevalence rates similar determined basis self reports canadian us national surveys use database mhsc provide key information planning health services diabetic patients permit monitoring long term trends incidence prevalence disease
cardiac sympathetic tone diabetics assess cardiac sympathetic nervous function diabetics , heart rates attained following pharmacological dose intravenous atropine , 23 micrograms kg 1 , studied n2o , isoflurane anaesthesia diabetics \( n 21 \) \( n 30 \) atropine induced heart rate diabetics significantly lower \( 95 14 \( sd \) bpm vs 109 12 bpm , p less 0 001 \) closely related preoperative orthostatic diastolic blood pressure change \( r 0 60 , p less 0 01 \) correlation atropine induced heart rate preoperative rr variation diabetics \( r 0 50 , p less 0 05 \) findings suggest cardiac sympathetic function may also impaired diabetics orthostatic hypotension
binding action insulin like growth factor pituitary tumor cells insulin like growth factor \( igf \) , target hormone mediating growth effects gh , suppresses gh gene expression feedback regulatory loop , may either endocrine paracrine nature although igf shown directly attenuate gh gene transcription , relationship igf binding action cell remains unclear therefore , igf binding action compared two different pituitary cell lines secreting gh recombinant human igf attenuated gh secretion gc cells 70 48 h dose dependent manner surprisingly , igf failed suppress gh secretion gh3 cells , related pituitary cell line binding studies showed although kd igf similar cell types , gc cells contain 3 fold igf binding sites compared gh3 cells , possibly explaining resistance igf action nevertheless , cell lines possessed abundant similar binding sites insulin results imply igf signal gh gene regulation receptor mediated directly correlated number pituitary igf binding sites availability pituitary igf binding sites may therefore important determining level gh expression
sexual pancreatic beta cell degeneration transgenic mice expressing insulin ras hybrid gene human h ras oncogene induces cell degeneration diabetes expressed pancreatic beta cells transgenic mice disease develops predominantly male mice 5 8 months age transgenic female mice manifest phenotype , even much greater ages however , induces female beta cell degeneration similar males contrast , castration presence testicular mutation alter course disease males treatment males ovariectomized females estrogen prevents development diabetes results suggest testicular androgens functional testosterone receptor required increased susceptibility male beta cells effects ras , relative resistance female beta cells mediated estrogen addition , genetic component female beta cell resistance ras revealed crossing transgenic mice mice , results pronounced increase incidence female diabetes
pulsatile luteinizing hormone secretion normal female mice hypogonadal female mice preoptic area implants pulsatile lh secretion driven gnrh , hypothalamic hormone lacking hypogonadal mutant mouse preoptic area grafts containing gnrh neurons correct many reproductive deficits hypogonadal mice study evaluated pattern lh secretion hypogonadal female mice preoptic area grafts \( hpg poa \) normal female mice normal females ovariectomized 10 weeks age , hpg poa mice ovariectomized 4 months graft surgery three weeks later , mice received catheters next day , sequential blood samples obtained every 10 min 4 h awake , moving mice , normal hpg poa ovarian weights 8 6 0 9 7 1 1 2 mg , respectively significant lh pulses detected 9 10 normal mice 9 13 hpg poa mice pulse frequency \( normal , 0 86 0 13 hpg poa , 0 61 0 13 pulse h \) interpeak interval \( normal , 81 7 20 3 hpg poa , 93 2 24 0 min \) significantly different \( p greater 0 2 \) , mean plasma lh levels \( normal , 1 07 0 16 ng ml hpg poa , 0 49 0 08 ng ml p less 0 005 \) mean lh pulse amplitude \( normal , 1 92 0 53 hpg poa , 0 63 0 28 p less 0 05 \) significantly lower hpg poa mice lower mean lh level lh pulse amplitude ovariectomized hpg poa mice consistent inability mice show increased lh secretion castration findings indicate preoptic area brain grafts capable supporting episodic lh release hypogonadal mouse suggest presence functional gnrh pulse generator majority mice grafts
's thyroiditis invasive fibrous \( 's \) thyroiditis rare thyroid condition unknown origin may associated inflammatory processes elsewhere body although condition benign self limiting , importance lies ability clinically mimic carcinoma almost completely , necessitating performing open biopsy establish correct diagnosis review 700 thyroid operations performed \( calif \) university medical center past 15 years , encountered one documented case 's thyroiditis patient presented firm thyroid mass , vocal cord paralysis , symptoms esophageal compression surgery performed obtain definitive diagnosis prevent possibility subsequent additional tracheal compression airway compromise pathologic findings , well medical surgical treatment condition , reviewed
lack effect isoproterenol unloaded velocity sarcomere shortening rat cardiac trabeculae several recent reports indicated catecholamines may act directly cycle , independent intracellular calcium concentration changes present study investigated effect isoproterenol peak force twitches constant sarcomere length unloaded velocity sarcomere shortening isolated right ventricular trabeculae hearts v1 v3 obtained euthyroid hypothyroid rats , respectively hypothyroidism induced treatment rats propylthiouracil 6 weeks electrophoretic analysis showed hearts hypothyroid animals composed v3 , whereas hearts euthyroid animals composed predominantly v1 force development measured strain gauge sarcomere length laser techniques shortening velocity determined contractions sarcomere length initially held constant followed quick release zero load controlled release zero load isometric twitch force unloaded sarcomere shortening velocity functions ca2 concentration isoproterenol optimal ca2 , unloaded shortening velocity 40 lower myocardium hypothyroid animals myocardium euthyroid animals isoproterenol increased sensitivity isometric twitch force unloaded shortening velocity ca2 trabeculae euthyroid hypothyroid animals isoproterenol increase unloaded shortening velocity optimal ca2 , regardless thyroid state results conclude beta adrenergic stimulation per se accelerate rate limiting step cycle determines unloaded sarcomere shortening velocity intact cardiac cell
low growth hormone levels related increased body mass index reflect impaired growth luteinizing hormone releasing hormone agonist treated children precocious puberty test hypothesis gh deficiency might explain low growth velocity lhrh agonist \( lhrha \) treated children central precocious puberty , measured stimulated \( n 81 \) spontaneous \( n 32 \) gh levels lhrha treatment gh stimulation tests children receiving lhrha treatment performed 2 days ethinyl estradiol administration thirty one 81 children \( 38 \) underwent gh stimulation tests subnormal responses \( less equal 7 micrograms l \) tests administered \( least 2 stimuli \) , including 22 67 \( 33 \) precocious puberty idiopathic associated hypothalamic eleven 32 children \( 34 \) underwent measurement mean nighttime spontaneous gh level levels normal range prepubertal children \( less 1 2 microgram l \) despite high incidence subnormal gh levels , appeared relationship gh levels children growth characteristics height , growth velocity , bone maturation rate , predicted height , insulin like growth factor levels different children low gh levels children normal gh levels conversely , gh levels different children subnormal growth rates children normal growth rates thus , variation growth rates lhrha treated children central precocious puberty could explained variation stimulated spontaneous secretion gh attempting understand high incidence low gh levels children precocious puberty , examined relationship gh level body mass index \( bmi \) stimulated \( r 0 33 p less 0 002 \) spontaneous \( r 0 61 p less 0 0002 \) gh levels inversely related bmi moreover , children precocious puberty group significantly elevated bmi 1 2 0 1 \( se \) sd units compared normal children age \( p less 0 0001 \) thus , increased body mass may explain high incidence subnormal gh levels patients , normative gh levels adjusted body mass needed concluded apparently subnormal gh levels lhrha treated children precocious puberty fact low
serum osteocalcin patients taking l thyroxine subclinical hyperthyroidism serum osteocalcin , index osteoblastic activity , increased hyperthyroidism serum osteocalcin levels negatively correlated bone density patients overt hyperthyroidism osteocalcin levels also elevated patients multinodular goiter subclinical hyperthyroidism therefore measured serum osteocalcin levels patients taking t4 determine correlated degree tsh suppression despite upward trend serum osteocalcin measurements decreasing tsh concentrations , significant difference serum osteocalcin among groups patients normal \( 0 5 5 0 mu l \) , mildly reduced \( 0 1 0 5 mu l \) , undetectable serum tsh \( less 0 01 mu l \) however , weak negative correlation seen serum tsh osteocalcin concentrations \( r 0 29 , slope 0 28 , p less 0 05 \) osteocalcin correlate either serum free t4 free t3 concentrations serum pth concentrations different among three patient groups data suggest osteocalcin useful clinical marker increased bone turnover patients subclinical hyperthyroidism due t4 therapy however , trend towards higher osteocalcin levels patients suppressed serum tsh values , weak negative correlation serum tsh osteocalcin consistent findings reduced bone density patients
accuracy portable blood glucose monitoring effect glucose level state glucose determined capillary venous blood samples adult diabetics three different glucoscan 2000 accu check ii portable glucose meters \( capillary \) 700 analyzer \( venous \) glucose meters correlated significantly results significant positive bias found glucoscan compared , found accu check ii accu check performed better glucoscan venous plasma glucose levels less 1 g l mean error glucoscan determinations significantly greater positive measurement performed within 4 hours eating , whereas effect seen accu check error multiple regression analysis revealed glucoscan measurement independently influenced venous plasma glucose state , whereas accu check ii measurement dependent either variable within run precision glucose meters comparable
differential expression basement membrane collagen chains diabetic nephropathy diabetic nephropathy characterized progressive expansion mesangial matrix thickening glomerular basement membrane \( gbm \) kidney tissues 13 patients insulin dependent diabetes mellitus studied immunohistochemical techniques distribution three recently described collagen peptides \( m28 , m28 good antigen , alport antigen \) various components classical type iv collagen alpha 1 \( iv \) \( nc \) globular domain , alpha 2 \( iv \) nc , , triple helix recently m28 m28 designated nc alpha 3 \( iv \) alpha 4 \( iv \) based limited amino acid sequencing course disease , distribution m28 chains alport peptide segregated completely classical type iv collagen diabetic kidneys , antibodies m28 alport peptides reacted intensely thickened gbm contrast , reactivity antibodies various components classical type iv collagen prominent within expanded mesangial matrix significant decrease reactivity peripheral capillary wall glomeruli , components classical type iv collagen virtually disappeared , whereas m28 alport peptides persisted gbm studies support view expansion mesangial matrix thickening gbm involve separate distinct collagen components differential expression m28 alport peptides compared classical type iv collagen may consequence differing sites synthesis \( classical type iv collagen endothelial mesangial cells m28 alport chains visceral epithelial cells \) , independent control mechanisms , differences degradation
role thyroid hormone development beta adrenergic control ornithine decarboxylase rat heart kidney role thyroid status ontogeny beta adrenergic receptor control ornithine decarboxylase \( odc \) activity assessed hearts kidneys neonatal rats hyperthyroidism induced administration postnatal days 1 5 caused reduction ability isoproterenol stimulate cardiac odc subsequently accelerated onset peak response latter effect even prominent administration given postnatal days 14 18 hypothyroidism induced propylthiouracil administration led persistent cardiac odc response beta receptor stimulation kidney odc , become subject beta receptor regulation weaning , resistant hyperthyroid induced changes reactivity , hypothyroidism still resulted long term response deficits results suggest thyroid hormone permissive normal development beta receptor odc link , euthyroid state provides optimal conditions maturation signal transduction mechanism relative resistance kidney odc responses alterations hyperthyroidism indicates effects excess hormone expressed receptor enzyme link already competent finally , thyroid status equivalent effects abilities vasopressin angiotensin stimulate odc , suggesting site thyroid hormone action transduction locus common several different receptor types
gonadotropin releasing hormones clinical applications gynecology since identification synthesis gonadotropin releasing hormones \( gnrh \) 19 years ago , 2 , 000 gnrh analogs synthesized evaluated treatment variety conditions requiring temporary , reversible suppression stimulation gonadotropin secretion effective stimulation gonads requires pulsatile administration gnrh agonist , preferably native gonadal suppression , proven highly effective intensive studies currently way promise new innovative clinical applications compounds
elevation thyroid stimulating hormone clinically euthyroid patient found normal serum thyroxine level elevated plasma thyrotropin \( tsh \) level measured thyroid hormone therapy failed suppress tsh level tsh level unresponsive thyrotropin releasing hormone \( trh \) administration , alpha subunits pituitary glycoproteins undetectable plasma , imaging pituitary hypothalamic region normal measurement tsh assay containing sheep antibody tsh failed reveal tsh patient 's plasma addition mouse igg tsh reduced patient 's tsh undetectable level observations consistent spurious elevation tsh due presence anti mouse antibody elevations tsh identified commonly , possibility considered tsh level inappropriate apparent state thyroid function
diabetes care rural primary health care district patient education given high priority metabolic evaluation present population based study comprises 84 known diabetics cared rural primary health care centre patient education given high priority integral part treatment provided specially trained nurse supervision general practitioners patients good metabolic control , reflected hba1 \( diet treated , n 119 , 7 3 1 3 oral agent treated , n 127 , 7 8 1 3 insulin treated , n 110 , 8 0 1 3 reference range 5 3 7 3 \) obvious reasons high hba1 values found
observer variation clinical assessment thyroid gland order evaluate reliability clinical assessment thyroid gland , two specialists two younger doctors independently examined 53 patients twice , assessed whether diffuse , multinodular , solitary nodule normal gland 30 patients four observers agreement , whereas 47 23 patients , two three different diagnoses given , respectively inter observer variation determined kappa values 0 04 0 54 found intra observer variation smaller , revealing kappa values 0 44 1 00 present study suggests clinical assessment thyroid gland may lead misclassification type thyroid disease , thereby less optimal choice therapy
postoperative computed tomographic evaluation patients large pituitary tumors treated operative decompression radiation therapy thirty consecutive patients underwent operative decompression radiation therapy large pituitary tumors \( greater equal 2 cm \) studied terms serial computed tomographic \( ct \) changes 23 men 7 women mean age 49 6 2 5 years , mean follow 45 3 3 9 months twenty eight 30 patients transsphenoidal surgery , 27 inactive tumors radiation therapy begun within 1 month surgery mean dose 70 cgy postoperative ct scans obtained within 1 month surgery 6 12 month intervals thereafter fourteen patients \( 45 \) tumor visualized either early postoperative ct scans subsequent scans eleven patients \( 35 \) persistent mass early postoperative period resolved serial ct evaluation mean time resolution 10 4 1 2 months six patients \( 20 \) persistent mass serial ct evaluation persistent postoperative mass subsequently resolved many patients thought caused gradual retraction postoperative packing hematoma , well effect radiation residual tumor
islet amyloid polypeptide significant factor pathogenesis pathophysiology diabetes \? islet amyloid polypeptide \( iapp \) amylin , recently discovered minor secretory peptide beta cell related calcitonin gene related peptide \( cgrp \) , constituent amyloid deposits islets many non insulin dependent \( type ii \) diabetic individuals elderly nondiabetic subjects iapp synthesized small precursor level approximately 1 insulin processed , , stored beta granules , released along insulin c peptide analysis gene \( located chromosome 12 \) supports evolutionary relationship calcitonin cgrp , peptides shares biological actions like cgrp , iapp action insulin mainly level muscle glycogen synthesis , levels required effect seem considerably higher reported circulating levels evidence overproduction iapp diabetic subjects found thus far , much work necessary define normal secretory rates clearance proposed actions iapp include serum calcium lowering effects smooth muscle relaxation latter effect might promote uptake insulin circulation within islets deposition amyloid species selective due structural differences within central part molecule may initiated type ii diabetes several mechanisms differences structure iapp precursor found individuals maturity onset diabetes young type ii diabetes
newly identified pancreatic protein islet amyloid polypeptide relationship diabetes \? islet amyloid polypeptide \( iapp \) amylin newly identified 37 amino acid terminal polypeptide major protein constituent amyloid deposits insulinomas amyloid deposits pancreatic islets non insulin dependent \( type ii \) diabetic humans adult diabetic cats iapp stored insulin beta cell secretory vesicles insulin response glucose several secretagogues iapp demonstrated normal pancreatic islets many species , iapp derived amyloid develops commonly islets species \( e g , humans cats \) , especially association age related diabetes iapp human cat inherently contains short sequence present species form islet amyloid studies animals indicate aberration synthesis processing iapp , leading local increase concentration iapp islet , also required facilitate conversion iapp amyloid formation islet amyloid may contribute development type ii diabetes causing disruption islet cells replacement islets also proposed abnormality iapp homeostasis underlies pathogenesis type ii diabetes significant causal relationship iapp type ii diabetes based reports iapp inhibits glucose stimulated insulin release beta cells iapp inhibits insulin stimulated rates glycogen synthesis glucose uptake skeletal muscle cells
increased incidence diabetes mellitus relation abdominal older women relationship body fat distribution , measured ratio waist hip \( whr \) , 2 year incidence diabetes mellitus examined cohort 41 , women aged 55 69 years women reported new onset diabetes significantly greater mean body mass index \( kg m2 \) whr non cases adjustment body mass index \( bmi \) , age education level using multivariate logistic regression , whr significant independent predictor diabetes dose response fashion cases 4 6 times \( 95 ci 3 8 , 5 6 \) likely non cases upper tertile whr 2 2 times \( 95 ci 1 8 , 2 7 \) likely middle tertile women highest whr bmi 14 4 fold \( 95 ci 9 5 , 21 9 \) higher risk diabetes women lowest results demonstrate increased abdominal significant independent risk factor development diabetes mellitus older women
insulins compare insulin preparations \? availability insulins , physicians diabetic patients wider choice therapeutic options preparation available united states consists 70 nph insulin 30 regular insulin major advantages insulins convenience improved accuracy suitable patients impaired mix insulin dose whose mixed dose ratio similar 70 30 preparation
portable blood glucose meters teaching patients correctly monitor diabetes self monitoring blood glucose important component treatment patients diabetes recent improvements glucose meters made patient self testing reliable less dependent user technique however , success process depends training , reassessment , support patient team
b cell differentiation following autologous , conventional , cell depleted bone marrow transplantation normal b cell ontogeny circulating lymphocytes 88 consecutive patients following autologous , conventional , cell depleted bone marrow transplantation serially analyzed b cell surface antigen expression function majority patients , except developed chronic graft versus host disease , number circulating cd20 b cell normalized fourth posttransplant month earliest detectable b cells normally expressed hla dr , , surface immunoglobulin \( \) , , leu 8 , lacked expression cd10 \( \) addition , circulating b cells expressed , cd38 , cd5 , cd23 first year following transplant , antigens normally expressed small percentage circulating b cells normal adults , highly expressed cord blood b cells similar cord blood b cells , patient b cells isolated first year following transplant , proliferated normally staphylococcus aureus cowan strain \( sac \) , produced igm , minimal igg stimulated pokeweed mitogen sac , unlike normal adult b cells produce similar phenotype function posttransplant cord blood b cells , similar rate decline patients normal children adds evidence support hypothesis b cell differentiation posttransplant normal b cell ontogeny
transmission htlv blood transfusion prevention passive immunization rabbits determine minimum volume blood required transmit human cell leukemia virus type \( htlv \) , heparinized blood collected virus infected female rabbit 10 , 5 , 1 , 0 5 , 0 1 , 0 01 ml transfused groups two male rabbits 10 rabbits transfused 10 0 1 ml 1 2 rabbits transfused 0 01 ml seroconverted htlv 2 4 weeks htlv producing lymphoid cell lines recipient origin established one seroconverted rabbit group determine ability passive immunization protect htlv infection , two groups three rabbits first transfused 5 ml blood virus infected rabbit infused 24 48 hours 10 ml htlv immune globulin \( 77 mg ml igg \) prepared seropositive healthy persons none 24 hour immunization group seroconverted htlv observation period six months however , 48 hour immunization group became seropositive 2 4 weeks results indicate htlv transmitted little 0 01 ml virus infected blood , passive immunization effective preventing cell cell infection htlv given within 24 hours transfusion virus infected blood
adrenaline nocturnal asthma objective determine whether nocturnal fall plasma adrenaline cause nocturnal asthma design double blind placebo controlled cross study first experiment nocturnal fall plasma adrenaline 4 corrected 10 asthmatic subjects infusion adrenaline parasympathetic blockade 30 micrograms kg intravenous atropine second experiment 11 asthmatic subjects showing similar variations peak expiratory flow rate nocturnal fall plasma adrenaline corrected infusion atropine given patients asthmatic subjects diurnal variation home peak expiratory flow rate greater 20 least 75 time two weeks study main outcome measures peak expiratory flow rate plasma adrenaline results correction nocturnal fall plasma adrenaline 4 resting 4 pm levels alter peak expiratory flow rate either parasympathetic blockade atropine conclusion nighttime fall plasma adrenaline cause nocturnal asthma
augmentation monocyte chemotaxis 1 alpha , 25 dihydroxyvitamin d3 stimulation defective migration aids patients preincubation 20 h 1 alpha , 25 dihydroxyvitamin d3 \( 1 , 25 \( oh \) 2d3 \) markedly augmented chemotactic responsiveness human blood monocytes classical chemoattractant , fmlp modest enhancement monocyte spontaneous locomotion absence chemoattractants also observed maximal increase monocyte migration observed pretreatment 10 \( 9 \) 1 , 25 \( oh \) 2d3 detectable fmlp concentrations ranging 10 \( 10 \) 10 \( 7 \) pretreatment 1 , 25 \( oh \) 2d3 augmented number monocyte high affinity fmlp receptors \( 1500 220 300 sites per cell untreated 1 , 25 \( oh \) 2d3 pretreated cells , respectively \) significant changes kd values \( 2 0 5 nm 4 1 nm , untreated 1 , 25 \( oh \) 2d3 pretreated monocytes \) enhanced chemotaxis restricted fmlp , 1 , 25 \( oh \) 2d3 treated monocytes showed enhanced migration also response activated c components chemotactic cytokines agreement previous observations , monocytes aids patients showed defective migration capacity vitro exposure 1 , 25 \( oh \) 2d3 stimulated monocyte migration 10 patients examined considerable quantitative differences among individuals regulating responsiveness mature monocytes chemo , 1 , 25 \( oh \) 2d3 , produced systemically situ immunocompetent cells , could play role regulation recruitment monocytes sites inflammation , cell mediated immunity , bone resorption potential 1 , 25 \( oh \) 2d3 restorative agent conditions defective phagocyte recruitment deserves exploration
vivo effects anti il 4 monoclonal antibody neonatal induction tolerance associated autoimmune syndrome role il 4 cellular interactions leading induction ctl tolerance h 2b alloantigens development lupus like autoimmune disease balb c mice neonatal injection \( c57bl 6 x balb c \) f1 cells investigated vivo using anti il 4 mab treatment f1 cell injected balb c mice 15 mg anti il 4 mab shown interfere tolerance induction , assessed high percentages h 2b target cell lysis low undetectable levels b cell chimerism markers observed mice treatment 4 5 mg anti il 4 mab tolerance induction one third f1 cell injected balb c mice , dose induces specific autoimmune manifestations mice , leading nearly complete prevention disease particular , production anti ssdna igg1 total igg1 ige antibodies seriously affected treatment , well proliferation membrane ia k expression f1 donor splenic cells thymic apc treatment f1 cell injected balb c mice 24 48 h life 0 5 mg anti il 4 mab interfere tolerance induction , similar effects autoimmune syndrome treatment 4 5 mg results suggest , f1 cell injection newborn mice , il 4 plays important role cellular interactions leading induction tolerance corresponding alloantigens development associated autoimmune syndrome
loss epidermal integrity cell mediated attack induces long term local resistance subsequent attack ii thymus dependency induction resistance previous study showed cutaneous graft vs host disease \( gvhd \) induced intradermal injection cells epidermal structures spontaneously recovered destruction became resistant subsequent attempts induce cutaneous gvhd resistance correlated well 30 fold increase number thy 1 epidermal cells \( thy 1 ec \) show resistance cutaneous gvhd never induced athymic nude mice adult thymectomy lethal radiation bone marrow reconstitution \( \) mice conditions , indicating induction resistance dependent presence thymus great increase number thy 1 ec similarly observed epidermis athymic nude mice spontaneously recovered cutaneous gvhd remained susceptible induction cutaneous gvhd however , results 1 1 b6 radiation clearly demonstrate vast majority increased thy 1 ec found susceptible epidermis mice donor bone marrow origin increase number host derived thy 1 ec , whereas resistant epidermis mice thy 1 ec populations equally increased overall results indicate expansion thy 1 ec mature thymus crucial induction resistance , although migration bone marrow derived thy 1 ec precursors epidermis occurs quite independently presence thymus
intact antigen receptor mediated generation inositol phosphates increased intracellular calcium cd4 cd8 lymphocytes mrl lpr mice predominant lymphocytes accumulate peripheral lymphoid tissues mice homozygous lpr gene bear phenotype cd3 cd4 cd8 certain functional criteria cells would appear impaired cd3 mediated signal transduction , respond produce little detectable il 2 lymphokines however , signal pathway appears adequate achieving cell functions , including induction high affinity il 2r , thymic deletion clarify basis discrepancy , examined transmembrane signal transduction cell subsets lpr lpr \( lpr \) mice , defined increased ca2 generation inositol phosphates \( \) stimulation lpr cd4 cd8 cells anti cd3 antibody produced prompt sustained increases concentration c2 similar responses occurred mature cells lpr mice , except somewhat slower kinetics increased ca2 marked distinction anti cd2 mediated response , con , even high doses , could stimulate increase ca2 lpr cd4 cd8 cells , modest increases mature cells , whether lpr origin , yielded normal increased ca2 con reason differences signal transduction anti cd3 con stimulation lpr cd4 cd8 cells may relate absence surface structures immature cells required activation con anti cd3 data demonstrate cd3 complex lpr cd4 cd8 cells phospholipase c activation properties lpr cd4 cd8 cells interesting functional parallels thymocytes time thymic selection , well tolerance induction mature lymphocytes
human severe combined immunodeficiency disease phenotypic functional characteristics peripheral b lymphocytes human severe combined immunodeficiency disease \( scid \) includes x chromosome linked type characterized complete absence mature cells , normal elevated number b cells , suggesting disease results block early cell differentiation shown b cells obligate carrier women disorder exhibit preferential use x chromosome active x \( shown cells \) , suggesting scid gene product direct effect b cells well cells examine question , analyzed phenotypic functional characteristics peripheral b cells nine infants scid found constant absence spontaneously expressed activation ag b cell membrane scid patients tested contrasts phenotypic pattern exhibited age matched infants cells bearing surface ig express ag lesser extent transferrin receptor concurrently , b cells scid patients profound impairment responses stimuli induce vitro b cell proliferation differentiation although ril 2 low mr b cell growth factor potent proliferation age matched b cells , poorly efficient inducing proliferation anti mu activated scid b cells impairment related resting b cell phenotype scid b cells shown comparison normal resting b cells furthermore , observed apparent block b cell differentiation inasmuch neither ril 2 ril 6 could support sac activated scid b cell differentiation , lymphokines efficient inducing sac activated age matched b cell purified resting b cell differentiation results suggest scid gene defect direct effect b cells required b cell maturation
surgeon 's risk aids model used estimate cumulative risk surgeons human immunodeficiency virus \( hiv \) recent data suggest probability infection following percutaneous inoculation 1 250 cases several studies suggest frequency percutaneous injury surgery least 1 40 cases , high 1 20 cases assuming average surgeon perform 350 operations per year practice 30 years , cumulative risk hiv infection depend prevalence hiv infection surgical population hiv prevalences 1 100 1 10 , cumulative risk per surgeon ranges 1 100 1 5 , respectively based risk estimates , crucial decrease frequency percutaneous injury case made substantial improvements barrier protection modification surgical technique
patterns food hypersensitivity sixteen years double blind , placebo controlled food challenges 16 years double blind , placebo controlled food challenge \( dbpcfc \) used national jewish center immunology respiratory medicine determine whether adverse reactions foods occur children objective studies explore reproducible adverse reactions characterize although skin testing performed subjects , history adverse reaction food subsequent dbpcfc criteria entry study 480 children studied , 185 \( 39 \) positive dbpcfc results 480 children , 245 \( 24 \) showed positive results egg , peanut , cow milk accounted 73 positive dbpcfc reactions , many foods produced reactions skin test results positive children positive dbpcfc reaction , large number patients asymptomatic hypersensitivity limited accuracy positive skin test result alone predictor clinical symptoms food ingestion evaluation results large number children prolonged period revealed reproducible patterns symptoms , timing , foods placebo reactions rare procedure safe twelve negative dbpcfc result subsequently positive reactions open challenges large amounts challenge food used cases reactions limited areas direct contact food could explained larger amount food ingested open challenge multiple food hypersensitivity rare finding dbpcfc gold standard research clinical diagnostic evaluations methods yet developed
ibuprofen suspension treatment juvenile rheumatoid arthritis pediatric rheumatology collaborative study group ninety two children juvenile rheumatoid arthritis randomly assigned treatment multicenter , double blind , 12 week trial designed compare efficacy safety liquid formulation ibuprofen dosage 30 40 mg kg day versus aspirin dosage 60 80 mg kg day significant intergroup differences response rates amount improvement articular indexes disease activity observed children treated aspirin discontinued treatment early adverse reactions trial , 84 additional patients juvenile rheumatoid arthritis entered 24 week , multidose \( 30 , 40 , 50 mg kg day \) , open trial ibuprofen suspension favorable response rates three groups similar , continued improvement observed throughout 24 week period dose response relationship observed respect adverse reactions upper gastrointestinal tract conclude ibuprofen suspension effective nonsteroidal antiinflammatory drug tolerability children acceptable
safety efficacy methotrexate therapy juvenile rheumatoid arthritis twenty nine children juvenile rheumatoid arthritis studied determine safety efficacy methotrexate therapy initial dose methotrexate averaged 7 1 mg m2 wk given single , oral weekly dose three divided doses , separated 12 hours current antiinflammatory medications continued 25 29 children lack efficacy , 8 29 toxic effects , one prior drugs intramuscularly orally administered gold , hydroxychloroquine , penicillamine corticosteroid dependency toxic effects present 18 29 cases methotrexate treated patients examined monthly minimum treatment duration required assess efficacy toxicity 6 months range treatment duration 8 39 months \( mean 18 5 months \) efficacy assessed comparing pretreatment versus posttreatment fever rash , swollen joint counts , articular indexes , duration morning stiffness , functional class , hemoglobin levels , platelet counts treatment methotrexate effectively controlled fever rash 83 children systemic juvenile rheumatoid arthritis , reduced morning stiffness 63 , eliminated joint restriction 48 , reduced numbers swollen joints swelling indexes 46 52 , respectively significant toxic effects observed juvenile rheumatoid arthritis long duration , major , likely refractory methotrexate therapy recommend earlier consideration methotrexate place slow acting antirheumatic drugs juvenile rheumatoid arthritis responding well usual therapy future studies address potential methotrexate toxic effects lungs reproductive system , well outcome discontinuation methotrexate treatment
use laboratory markers clinical endpoints evaluation treatment hiv infection strong ethical practical reasons decision making efficacy new treatments human immunodeficiency virus \( hiv \) infection one strategy use early markers disease progression , cd4 lymphocyte levels , ultimate clinical endpoints , development acquired immune deficiency syndrome \( aids \) death , evaluation new therapies used simple model transitions among three health states \( well alive adverse marker experienced definitive clinical endpoint \) examine extent treatment comparisons based surrogate endpoint predict ultimate clinical benefits parameters chosen model treatment hiv infection , computer clinical trials demonstrated substantial time savings use surrogate endpoint however , reliance surrogate led serious ultimate clinical benefit treatment delayed toxicity transient beneficial effects likewise , reliance surrogate led serious underestimates ultimate clinical benefit treatment effect transition well marker state reduce rates transition marker state ultimate clinical endpoint directly well state ultimate clinical endpoint
plasma perfusion patients systemic lupus erythematosus extracorporeal treatment acute systemic lupus erythematous \( sle \) plasmapheresis reported 10 years risks plasmapheresis include procedure , plasma perfusion im p column eight 10 patients evaluated improved 3 treatments 2 liter perfusion analysis proteins removed plasma perfusion showed im p column circulating immune complexes anti dsdna antibodies perfusion 2 liters plasma , substances reduced 35 40 , whereas whole protein lowered less 10 immunoglobulins 18 results severe sle indicate immunoadsorption advantage lowering side effects foreign protein substitution
prevalence concentration igm rheumatoid factor polyarticular onset disease compared systemic pauciarticular onset disease active juvenile rheumatoid arthritis measured elisa prevalence concentration igm rheumatoid factor \( rf \) children juvenile rheumatoid arthritis \( jra \) major disease onset groups remains uncertain study enzyme linked assay \( elisa \) 68 children active jra showed igm rf area 67 \( 16 24 \) polyarticular onset disease , 26 \( 7 27 \) systemic onset disease , 6 \( 1 17 \) pauciarticular onset disease median igm rf concentration 50 fold higher polyarticular disease compared systemic disease prevalence igm rf polyarticular disease greater severe disease \( functional classes 3 4 \) , 90 \( 9 10 \) seropositive agglutination assay , prevalence igm rf jra significantly less elisa , 33 polyarticular group positive igm rf , none systemic group positive , relatively low concentration igm rf similar seen systemic jra also found high prevalence area children non jra , systemic rheumatic disease \( n 8 \) summary , study shows elisa high concentrations igm rf found essentially sera children polyarticular onset jra especially severe disease
decreased number peripheral blood cd4 cd29 lymphocytes increased vitro spontaneous production anti dna antibodies patients active systemic lupus erythematosus flow cytometric 2 color analysis peripheral blood lymphocytes patients systemic lupus erythematosus \( sle \) showed reduction relative absolute number cd4 cd29 cells compared matched healthy individuals abnormality marked patients active active disease absolute number cd4 cd29 cells negatively correlated spontaneous anti dna ig production demonstrated laboratory index strongly correlated clinical disease activity score decrease percentage cd8 cd29 lymphocytes patients active disease also observed
adult still 's disease multicenter survey japanese patients comprehensive survey japanese patients adult still 's disease made questionnaire sent major institutions rheumatology units japan 146 cases 32 institutions , 90 judged definitely diagnosed adult still 's disease major clinical features 90 patients consisted high fever , , rash , increased erythrocyte sedimentation rate , negative autoantibodies , leukocytosis , liver dysfunction , incidence several features showed significant differences cases previous cases
growth differentiation b lymphocytes patients juvenile rheumatoid arthritis studied growth differentiation b lymphocytes patients juvenile rheumatoid arthritis \( jra \) using b cell enriched populations mitogen stimulation led similar increases proliferation immunoglobulin \( ig \) secretion cultures patient control lymphocytes increase proliferation , igg secretion increased absence mitogen activated ig synthesis could reduced replacing culture medium fresh medium 16 20 h culture partly reconstituted addition recombinant cytokines , interleukin \( il \) , il 2 , il 4 , il 6 results suggest may population b circulating b cells patients jra rheumatic diseases sufficiently mature differentiate secrete ig response cytokines alone
clonal analysis joint fluid lymphocytes patients juvenile rheumatoid arthritis synovial fluid \( sf \) lymphocytes 4 patients pauciarticular juvenile rheumatoid arthritis \( jra \) 4 patients polyarticular jra examined phenotypic functional characteristics 8 patients high proportion activated sf cells , together increased proportion cd2 cd3 presence cd3 cd4 cd8 lymphocytes functional analysis clonal level 5 patients \( clones \) showed relevant proportion cytotoxic cell clones , confined typically cytolytic phenotypes , also present among cd3 cd4 cd8 cultures compared pauciarticular jra , patients polyarticular disease significantly higher proportion cell clones cytotoxic activity although derived limited number patients , data suggest direct involvement cells pathogenetic mechanisms originate maintain articular damage , possibility different pronounced cell reactivities clinically diffuse jra types
european experience bone marrow transplantation severe combined immunodeficiency outcome bone marrow \( bmt \) carried 1968 march 1 , 1989 , 183 patients severe combined immunodeficiency \( scid \) analysed recipients hla identical \( 70 \) 76 probability survival \( median follow 73 months \) 32 treated since 1983 , 97 cured \( median follow 41 months \) good prognosis associated rapid development b cell function hla non identical , cell depleted , bmt \( n 100 \) gave significantly lower survival \( 52 median follow 47 months \) factors associated poor prognosis presence lung infection bmt , absence protected environment , use female donors male recipients use conditioning regimen significantly increased frequency sustained engraftment \( 86 vs 50 non conditioned bmt \) resulted frequent engraftment donor b lymphocytes myeloid cells donor b cell chimerism strongly associated development normal b cell function
measurement airborne mite antigen homes asthmatic children airborne concentration major house dust mite antigen der p1 measured low volume sampling \( 2 min \) homes 68 allergic , asthmatic children presence detectable airborne antigen strongly associated sensitivity mite , whereas significant relation sensitivity previously recommended threshold level 2 micrograms der p1 per g dust significant association lower threshold levels dust \( 0 5 microgram g \) level association strong air measurements concentrations airborne antigen higher synthetic hard , significant difference dust levels der p1 two types air sampling appropriate method assessing antigen exposure dust sampling asthmatic patients
aids pediatric neurology human immunodeficiency virus type 1 \( hiv 1 \) , etiologic agent aids , causes wide spectrum disease children owing selective tropism immune system , nervous system , perhaps organs 1991 , may many 10 , 000 15 , 000 children symptomatic hiv 1 infection united states article reviews current knowledge clinical , neuroradiologic , neuropathologic features hiv 1 related central nervous system involvement infants children symptomatic hiv infection
scid mutation mice causes general defect dna repair mice homozygous scid mutation chromosome 16 severe combined immune deficiency result inability correctly immunoglobulin cell receptor genes scid mice , precursors b lymphocytes reach stage development requiring expression surface receptors , defective system receptor gene segments greatly reducing efficiency producing functional receptors result , scid mice detectable b lymphocytes demonstrated scid defect specific lymphocyte development myeloid cells fibroblasts scid mice show marked increase sensitivity ionizing radiation , indicating scid mutation leads inability repair dna damage induced ionizing radiation well interfering rearrangement immunoglobulin cell receptor genes
multiple sclerosis sibling pairs clustered onset familial predisposition evaluated 48 relapsing multiple sclerosis \( r r ms \) sibling pairs derived 44 families age date onset ms symptoms , clinical course , family history ms age sex matched r r ms clinic patients provided statistical comparison group age onset tended cluster within multiplex families initial symptom ms occurred within 5 years age 30 48 sibling pairs compared 16 48 controls positive family history ms \( siblings \) present 43 multiplex families compared 20 among simplex controls 1st , 2nd , 3rd degree relatives lived age risk , 22 1 , 134 family members multiplex sibling pairs probable definite ms compared 10 1 , 215 control family members age onset clustering siblings concordant r r ms increased risk ms family members suggest factors influencing disease onset may part inherited kindreds
diffuse cns involvement systemic lupus erythematosus intrathecal synthesis 4th component complement systemic lupus erythematosus \( sle \) , complement system plays prominent pathogenic role , decreased serum concentration 4th component \( c4 \) reliable indicator systemic disease activity diffuse cns sle , however , pathogenic role complement less clear 12 patients active diffuse cns sle presenting delirium \( 4 \) , organic personality syndrome \( 3 \) , generalized seizures \( 5 \) , determined csf indexes complement components c3 , c4 , factor b , igg , iga , igm significant increase c4 index patients compared controls significantly higher csf c4 index patients increased igm index conclude intrathecal c4 produced diffuse cns sle
igg subclass concentrations absolute , partial transient iga deficiency childhood sixty seven children symptomatic iga deficiency studied two separate occasions eighteen aigad presentation , 49 pigad iga concentrations normal range age 22 2 children presenting aigad 77 6 presenting pigad restudied median interval 3 2 3 0 years , respectively igg subclass concentrations measured enzyme immunoassay serum samples collected enrollment 12 children aigad 22 children pigad igg2 igg4 concentrations 34 children 5th centile age sex frequently expected \( igg2 chi square 5 8 , p less 0 025 igg 4 chi square 18 4 , p less 0 0005 \) prevalence igg2 deficiency igg4 deficiency differ significantly aigad pigad igg2 concentrations remained 5th centile frequently expected 31 children whose pigad resolved \( chi square 4 6 , p less 0 05 \) children aigad presentation igg1 igg2 concentrations 95th centile frequently expected \( igg1 chi square 19 7 , p less 0 0005 igg2 chi square 13 5 , p less 0 001 \) seen igg3 igg4 concentrations children pigad elevated igg1 igg2 concentrations presentation high igg1 igg2 concentrations aigad may compensatory mechanism afford protection infection could part selective secondary response repeated episodes infection
nebulized albuterol acute childhood asthma comparison two doses thirty three children adolescents 5 17 years age moderate severe acute asthma given nebulized albuterol therapy either high \( 0 30 mg kg body weight \) standard \( 0 15 mg kg \) dose administered three hourly intervals randomized double blind study high dose hourly regimen resulted significantly greater improvement forced expiratory volume 1 second \( fev1 \) furthermore , patients receiving high dose showed steady improvement fev1 start end study , whereas fev1 second dose standard dose group although rise heart rate fall serum potassium level occurred , neither changes side effects different two groups high dose therapy resulted much higher serum albuterol levels standard dose correlation drug levels side effects initial subsequent fev1 concluded occasional hourly high dose albuterol therapy considered pediatric patients acute asthma moderate severity , especially relapse doses
reactions iodinated radiographic contrast agents identify manage patients risk systemic adverse reactions iodinated radiographic contrast material infrequent dramatic number patients experiencing reactions minimized selecting appropriate diagnostic study patient identifying patients increased risk pretreatment corticosteroids use low osmolality contrast materials minimize number severe reactions high risk patients
cell directed hepatocyte damage autoimmune chronic active hepatitis investigate function activated lymphocytes autoimmune chronic active hepatitis , 7 15 cell clones peripheral blood 8 patients studied clones showed specificity liver membrane antigen proliferation stimulated rabbit liver cell membranes 6 clones reacted liver specific lipoprotein complex , 1 clone \( 3 \) responded receptor \( \) , known targets immune attack autoimmune chronic active hepatitis 2 clones stimulated autologous b lymphocytes produce liver membrane specific autoantibodies antibody results suggest liver membrane specific activated lymphocytes peripheral blood may important autoimmune attack chronic active hepatitis
serological molecular survey htlv infection high risk middle eastern group define extent human cell leukaemia virus \( htlv \) infection among group jewish immigrants israel increased frequency adult cell leukaemia , various serological molecular screening methods , including enzyme linked immunosorbent assay \( elisa \) anti htlv , elisa antibody recombinant htlv protein , molecular detection infection polymerase chain reaction \( pcr \) amplification htlv proviral dna peripheral blood mononuclear cell dna , used htlv elisa overall rate infection 12 \( 24 208 \) among immigrants , htlv carriers detected among 111 unselected jewish immigrants parts unexplained clustering htlv infection within cohort 32 elderly women similar geographic origin home old people 14 seropositive elisa 19 29 positive pcr findings newly identified high risk population suggest addition elisa , screening techniques may required detect carriers high risk populations
bronchial hyperresponsiveness young students southern china relation respiratory symptoms , diagnosed asthma , risk factors cross sectional study carried determine prevalence bronchial hyperresponsiveness asthma students aged 11 17 years urban rural area \( \) , china methods used included self administered questionnaire , histamine bronchial provocation test , allergen tests bronchial hyperresponsiveness defined 20 fall fev1 peak expiratory flow dose histamine \( \) less 7 8 mumol two occasions four weeks apart response rate 98 0 99 2 two areas prevalence bronchial hyperresponsiveness 4 1 diagnosed asthma 2 4 total population significant differences prevalence urban rural area boys girls 11 12 year group higher prevalence bronchial hyperresponsiveness \( 7 6 \) older groups 125 bronchial hyperresponsiveness , 12 0 defined severe moderate \( less 0 8 mumol \) , 26 mild \( 0 9 3 2 mumol \) , 62 slight bronchial hyperresponsiveness \( 3 3 7 8 mumol \) severity bronchial hyperresponsiveness closely related diagnosed asthma , wheezing , cough , though half students bronchial hyperresponsiveness symptom free common allergens house dust house dust mite city , hay dust , pollen , rural area odds ratios respectively slight , mild moderate , severe bronchial hyperresponsiveness 5 9 , 21 0 , 30 4 atopy 1 9 , 1 9 , 7 3 early respiratory infection 3 1 , 2 5 , 5 6 history parental asthma
dietary alpha linolenic acid humans examined effect dietary alpha linolenic acid \( ala \) indices 10 healthy free living men \( age 21 37 \) consumed meals western human nutrition research center 126 stabilization period 14 start 10 subjects consumed basal diet \( bd \) two intervention periods 56 five subjects consumed basal diet five consumed seed oil diet \( fd \) intervention period feeding fd suppressed proliferation peripheral blood mononuclear cells cultured phytohemagglutinin p \( p 0 041 \) concanavalin \( p 0 \) delayed hypersensitivity response seven recall antigens \( ns \) concentrations immunoglobulins serum , c3 , c4 , salivary iga , numbers helper cells , suppressor cells , total b cells peripheral blood affected diets
rice pollen allergy taiwan panel tests including skin testing \( st \) , radioallergosorbent test \( rast \) , immunoblotting allergen induced done study rice pollen allergy asthmatic children characterize allergens 312 asthmatic patients skin tested , 29 \( 9 3 \) positive reactions \( wheal greater equal 6 mm \) rice pollen extract concentration 10 \( 5 \) g ml remaining 283 \( 90 7 \) negative eight \( 34 8 \) 23 st positive patients also rast positive , rast negative 34 st negative patients 20 normals immunoblotting revealed three major allergens , molecular weights 16 kd , 26 kd , 32 kd , respectively interestingly , rast positive patients showed ige responses allergens igg antibodies , normal controls stronger igg responses allergens , particularly 32 kd , none ige antibody preliminary results rice pollen protein induced informative thus , rice pollen proteins elicit specific response asthmatic children normals , pathogenic role bronchial asthma needs study
anaphylaxis pinon 21 year old white male developed life threatening systemic anaphylaxis within seconds ingesting small amount containing pinon skin testing , elisa , basophil histamine release studies demonstrated pinon specific ige electrophoresis pinon extract demonstrated 30 bands , three \( 66 68 , 000 range \) bound ige patient 's serum immunoblot ingestion challenge performed due severity patient 's reaction although used centuries certain cultures , pinon frequently american diet physicians aware potential anaphylactic reactions following ingestion food
bronchial challenge house dust induce immediate bronchoconstriction allergic asthmatic patients goal study evaluate whether natural exposure house dust could elicit immediate bronchoconstriction two groups asthmatic patients studied 12 asthmatics allergic house dust seven nonallergic asthmatics baseline fev1 similar two groups subject challenged nasal mask connected filled house dust patients randomly assigned dust high low group allergenic level allergic patients fev1 drop larger 20 baseline value drop maximal minute challenge fev1 remained unchanged nonallergic asthmatics allergic patients challenged high group allergenic house dust \( 8 4 micrograms g \) mean fev1 drop larger \( p less 01 \) challenged low group allergenic house dust \( 0 66 micrograms g \) late asthmatic reactions found two patients challenged high group allergenic house dust two patients immediate fev1 drops greater 50 baseline value occurrence symptoms test drop fev1 correlated \( r 3 p less 05 \) natural exposure house dust induce immediate bronchial allergic asthmatics dose dependent manner
bone marrow transplantation interleukin 2 activated bone marrow followed interleukin 2 therapy acute myeloid leukemia mice investigated approaches induce graft versus leukemia \( \) effect autologous bone marrow transplantation \( abmt \) without graft versus host disease improve survival cure leukemia present study shows bone marrow transplantation \( bmt \) using syngeneic bone marrow activated interleukin 2 \( \) 24 hours vitro , followed interleukin 2 \( il 2 \) therapy , superior bmt fresh , syngeneic bone marrow \( fbm \) terms survival cure mice acute myeloid leukemia \( p less 001 \) led normal hematopoietic reconstitution addition il 2 therapy bmt fbm improve results bmt fbm alone \( p 98 \) results suggest effect abmt enhanced using bmt followed il 2 therapy without compromising engraftment
direct relationship remission duration acute myeloid leukemia cell cycle kinetics leukemia intergroup study cell cycle characteristics including labeling indices \( li \) , duration phase \( ts \) , total cell cycle time \( tc \) determined 54 standard risk , newly diagnosed patients acute myeloid leukemia following infusion bromodeoxyuridine remission induction therapy consisting cytosine arabinoside administered patients , followed three courses consolidation achieved complete remissions \( cr \) older patients appeared rapidly cycling cells \( p 003 \) unique cell cycle characteristics identified patients achieved remission versus resistant disease however , cell cycle characteristics strong remission duration cr patients divided whose leukemic cell tc median \( \) median \( b \) among 14 b patients , median duration response 211 days , relapsed day 600 among 18 patients , median yet reached , nine patients continuous complete remission \( log rank p 007 , wilcoxon p 04 \) conclude cell cycle characteristics leukemic cells play role determining remission duration , perhaps leukemic cells former patients slowly courses chemotherapy
combined syngeneic bone marrow transplantation immunotherapy murine b cell lymphoma active immunization tumor derived idiotypic immunoglobulin recurrence underlying malignancy remains major cause treatment failure autologous bone marrow transplantation \( bmt \) patients lymphoma regard , developed immunotherapeutic approach designed induce resistance residual tumor cells persisting bmt previous studies model system , lethal b cell lymphoma c3h origin , shown active immunization purified tumor derived surface immunoglobulin \( id \) , tumor associated antigen , produces resistance tumor growth id immunization irradiated mice 3 5 weeks reconstitution syngeneic bone marrow resulted significantly prolonged survival tumor challenge compared immunized controls low levels idiotype specific antibody also demonstrated sera specifically immunized mice early time , functional studies literature syngeneic reconstitution might predicted incomplete recovery immunization mice lethal irradiation syngeneic marrow reconstitution also induced significant resistance tumor challenge , suggesting persistence established host antitumor immunity total body irradiation studies demonstrate feasibility id immunization conjunction bone marrow transplantation
lack relationship acetylator phenotype idiopathic systemic lupus erythematosus south east asian population study indians , chinese association idiopathic systemic lupus erythematosus \( isle \) genetically determined n acetylation polymorphism suspected previous studies , mainly caucasian populations approximate incidence 50 slow rapid present study incidence isle acetylator status mixed population results support association isle acetylator status frequencies slow isle patients chinese 13 38 respectively differ significantly respective healthy groups \( 20 29 \) small number indians survey allow valid comparison , figures suggest lack association isle acetylator status
quantitative analysis serum il 6 correlation increased levels serum il 2r hiv induced diseases devised elisa quantification il 6 sera cell culture supernatants , detection limit 100 ml test sample using elisa , low measurable levels il 6 \( 9 5 pg ml average \) found sera normal individuals serum levels il 6 elevated hiv seropositive asymptomatic carriers \( 55 5 pg ml average \) , il 6 levels correlated degree hiv induced disease progression \( aids related complex 106 8 pg ml average \( aids 283 pg ml \) il 6 immunoreactivity sera aids patients eluted 25 , 000 w major peak , biologically active heat stable , 500 , 000 w minor peak size exclusion hplc interestingly , significant correlation observed serum il 6 levels soluble il 2r levels vitro , hiv infection pha activated pbmc led enhanced release il 6 culture supernatants moreover , soluble il 2r release markedly increased adding exogenous il 6 , whereas decreased adding neutralizing anti il 6 mab cultures results demonstrate increased il 6 levels significantly associated sil 2r levels , suggest cause increased levels receptor patients hiv infection furthermore , serum il 6 serum il 2r levels hiv infection reflect stage hiv induced disease
evidence peptide mapping region cd4 \( 81 92 \) involved gp120 cd4 interaction leading hiv infection hiv induced formation peptide fragments cd4 molecule compared ability 1 \) inhibit cd4 dependent hiv induced cell fusion 2 \) inhibit cd4 dependent hiv infection vitro 3 \) block gp120 envelope glycoprotein binding cd4 peptides region cd4 \( 81 92 \) , although inactive , inhibitors cd4 dependent virus infection , cell fusion , cd4 gp120 binding via acetylation peptides identical chemical composition , altered sequence pattern blocked gp120 binding either cd4 positive cells solubilized cd4 , also blocked infection fusion similar block gp120 cd4 interaction also inactive hiv 1 infection cell fusion assays peptide fragments cd4 molecule inhibited fusion , infection , cd4 gp120 interaction peptide cd4 \( 23 56 \) , derived region cd4 implicated binding cd4 antibodies neutralize hiv infection cell fusion , effect cd4 dependent cell fusion , hiv 1 infection , cd4 gp120 binding , reverse anti leu 3a blockade gp120 binding cd4 data provide evidence 81 92 region cd4 directly involved gp120 binding leading cd4 dependent hiv infection formation previous observations structural mutants cd4 suggest homologous region cd4 also involved , either directly indirectly , binding gp120 cd4 like domains cd4 may contribute binding hiv envelope necessary hiv 1 infection hiv 1 induced cell fusion
immunodominance graft vs host disease cell response minor histocompatibility antigens immunodominance controls generation ctl c57bl \( b6 \) anti balb b h 2b matched strain combination despite potential responding numerous individual minor histocompatibility \( h \) ag balb b apc , focus ctl response largely specific limited number target ag minor h ag could distinguished differential expression panel target cells recombinant inbred strains , e , g , , j , k \( h 2b \) , express different original balb minor h ag hierarchy observed first order immunodominant ag present cxbg cells , whereas second order dominant ag found , , cells test whether immunodominance also plays role development lethal graft vs host disease \( gvhd \) directed multiple minor h ag , b6 cells transplanted along cell depleted bone marrow , irradiated \( rad \) recipients either balb b recombinant inbred strains results indicate hierarchy immunodominance exist gvhd , differs predicted vitro ctl studies gvhd observed balb b , , , recipients , cxbg recipients b6 donor mice cxbg splenocytes 3 wk transplant significantly increase overall gvhd potential corresponding cxbg recipients evidence second order immunodominance provided transfer cells irradiated cxbg balb b recipients resultant , potent gvhd
human murine anti dna antibodies induce production anti idiotypic antibodies autoantigen binding properties \( \) immune network interactions examine potential role immune network interactions production lupus autoantibodies , normal rabbit antibody responses analyzed immunization one following ig preparations human lupus serum anti dsdna antibodies , human lupus serum anti ssdna antibodies , mixture human lupus serum anti dsdna anti ssdna antibodies , mrl lpr lpr anti dsdna mab h241 , mrl lpr lpr anti ssdna mab four five rabbits produced ig typical lupus autoantibodies individual rabbit ig cross reacted multiple autoantigens including nucleic acids , , , glomerular extract , laminin , exogenous ag rabbit anti id human anti dsdna antibodies highly specific dsdna notably , serum autoantibody activity confined anti id ig fraction similar spontaneously occurring id anti id interaction also found anti ssdna anti dsdna antibodies isolated individual lupus patient results indicate lupus autoantibodies share ag binding properties pathogenic ig , including cross reactive anti dsdna antibodies , induce production ig similar autoantigen binding properties immune network interactions phenomenon , , could lead amplification pathogenic autoantibody production individuals systemic lupus
induction nf kb monocyte differentiation hiv type 1 infection production human immunodeficiency virus type 1 \( hiv 1 \) progeny followed u937 cell line stimulation either retinoic acid pma , purified human monocytes macrophages electrophoretic mobility shift assays southwestern blotting experiments used detect binding cellular factor nf kb double repeat kb enhancer sequence located long terminal repeat pma treatment , retinoic acid treatment u937 cells acts inducing nf kb expression nuclei nuclear extracts monocytes macrophages , induction nf kb occurred cells previously infected hiv 1 u937 cells infected hiv 1 , induction nf kb factor detected , whereas high level progeny produced , suggesting factor required viral replication results indicate monocytic cell lineage , hiv 1 could mimic differentiation activation stimuli allowing nuclear nf kb expression
b cell activation hiv 1 infection ii cell cell interactions cytokine requirement study examined mechanisms underlying intense activation hiv 1 specific b cells observed peripheral blood hiv 1 infected subjects spontaneous vitro synthesis anti hiv 1 antibodies , well total ig production , dramatically reduced accessory cell , cell removal fall addition ril 6 , cytokines , monocyte depleted cultures moreover , antisera il 6 suppressed spontaneous anti hiv 1 antibody synthesis dose dependent manner although il 6 apparently sustained hiv 1 specific b cell activation , increase serum il 6 levels observed pbmc seropositive subjects produce increased amounts il 6 vitro , compared seronegative controls , spontaneously presence lps stimulation finally , constitutive expression il 6 gene could documented freshly isolated pbmc findings indicate il 6 may play central role hiv 1 specific b cell activation seropositive patients , stress importance cytokine hiv 1 infection
ige dependent cytokine production human peripheral blood mononuclear phagocytes studies demonstrate ige dependent production il 1 beta tnf alpha circulating blood monocytes il 1 beta production demonstrated biologically stimulation proliferation cloned il 1 dependent murine cell line 1 presence concentration pha representative experiment , 3h thymidine uptake increased presence supernatants obtained unstimulated cells supernatants monocytes stimulated ige alpha ige immune complexes elisa , ige complexes increased il 1 beta production 0 54 0 06 ng \( per 10 \( 6 \) monocytes \) 2 60 0 62 ng \( p less 0 01 mean eight experiments \) tnf alpha production 0 17 0 10 ng 3 00 0 54 ng \( p less 0 01 mean four experiments \) il 1 alpha secretion observed rna hybridization analysis demonstrated il 1 beta production represented de novo synthesis cytokine stimulated rna production observed minimal 1 2 h incubation maximal 2 h ige dependent secretion pro inflammatory cytokines mononuclear phagocytic cells may contribute inflammation characteristic allergic responses
interferon treatment aids associated kaposi 's sarcoma american experience report intended summarize use interferon treatment kaposi 's sarcoma \( ks \) associated aids review focused trials united states , resulted food drug administration \( fda \) use recombinant interferon alpha treatment kaposi 's sarcoma
use new cd4 positive hela cell clone direct quantitation infectious human immunodeficiency virus blood cells aids patients new cd4 positive hela cell line \( clone \) increased sensitivity human immunodeficiency virus \( hiv \) isolates derived aids patients could titer infectivity hiv isolates level equal observed using normal human phytohemagglutinin \( pha \) stimulated lymphocyte cultures use clone focal immunoassay \( \) , peripheral blood mononuclear cells \( pbmc \) producing hiv detected 15 seropositive asymptomatic patients 23 aids patients frequency 1 2 x 10 \( 4 \) 3 x 10 \( 6 \) pbmc hiv detection primary correlated low cd4 positive cells counts hiv activation pha blasts resulted increasing numbers cells releasing hiv starting 3 4 days low incidence hiv detection direct compared high incidence hiv isolation pha blasts provided quantitative infectivity data suggesting hiv state latency low expression pbmc aids patients
iopamidol myelography morbidity patients previous intolerance iodine derivatives records patients underwent iopamidol myelography january september , 1988 , reviewed group , 50 patients histories suggestive untoward sequelae associated iodine intake , contact , administration charts patients carefully reviewed , none reactions sequelae suggestive toxicity allergic response iopamidol myelography concluded , even patients previous history suggestive intolerance iodine administration , iopamidol myelography generally safe procedure
controlled trial home ambulatory program asthmatic children care asthmatic children often episodic therapeutic preventive 2 year randomized , controlled trial involving 95 children measured impact comprehensive home ambulatory program pediatric asthma management using objective outcome measures interventions study group first year included 3 month clinic visits , education , home visits specially trained research nurse control subjects continued receive regular care family physician pediatrician eight nine subjects \( 93 \) completed study study subjects less school control subjects \( 10 7 vs 16 0 days , p 04 \) showed significantly better small airway function 1 year asthma severity improved 13 study subjects worsened 5 reverse true control subjects study subjects exhibited better metered aerosol technique control subjects \( p 0005 \) fewer days spent hospital study subjects admitted compared control subjects \( 3 67 vs 11 2 days , p 02 \) 1 year , study control families \( 72 1 vs 33 1 , p 006 \) reported asthmatic child took responsibility asthma management intervention failed reduce exposure smoke household significant differences medical visits , theophylline levels , records asthma symptoms one year discontinuing intervention , marked washout effect observed comprehensive ambulatory programs childhood asthma management improve objective measures illness severity must sustained
discordant expression antigens intraepidermal intradermal cells mycosis fungoides using immunohistochemical methods , authors studied expression pan majority cell antigens \( cd5 , cd2 , cd3 , tcr beta , cd7 \) cell subset antigens \( cd4 , cd8 \) cutaneous cells mycosis fungoides \( mf \) \( 177 biopsies 124 patients \) variety inflammatory lesions \( 45 biopsies 45 patients \) authors detected absence pan majority cell antigens , cell subset antigens , cells epidermis dermis 15 mf biopsies \( 8 \) 11 mf patients \( 9 \) , none inflammatory skin lesions opposite picture , characterized lack antigen expression dermal cells , seen mf inflammatory lesions absence antigen expression epidermal dermal cells , authors termed antigen discordance , prevalent cd5 , cd7 , tcr beta , discordant 6 7 mf cases patients tested among mf biopsies showing antigen discordance , 14 15 \( 93 \) 10 11 patients \( 91 \) discordant two antigens antigen discordance artifact treatment , none patients showing discordance receiving treatment time initial discordant biopsy discordance immunophenotypic abnormality detected 8 15 \( 53 \) discordant mf biopsies thus , antigen discordance important diagnostic feature allowed immunophenotypic distinction mf variety inflammatory skin lesions
hla antigens juvenile arthritis pauciarticular polyarticular juvenile arthritis distinct using dna techniques , investigated role hla dr , dq , dp alleles susceptibility juvenile arthritis \( ja \) studied 2 groups patients ja different disease prognosis course pauciarticular form usually benign , polyarticular disease frequently leads joint destruction disability persistent pauciarticular disease developed preferentially patients hla , antigens confer susceptibility patients whose disease converted polyarticular form hla 1 additional susceptibility factor patients ja pauciarticular onset polyarticular form ja , hla major factor susceptibility , giving relative risk 10 3 \( p less 0 0001 \) addition , found 1 increased , hla dr4 markedly decreased , patients pauciarticular polyarticular disease results indicate addition shared factors , distinct hla class ii alleles important pauciarticular polyarticular ja conclude typing oligonucleotide probes may useful predicting outcome children arthritis
restoration dna binding activity estrogen receptor mrl lpr lpr mice polyamine biosynthesis inhibitor diverse data link estrogen influences frequency severity systemic lupus erythematosus humans murine lupus fundamental mechanism action estrogen involves interaction hormone receptor protein , transformed dna binding form measured concentration uterine estrogen receptor dna binding normal balb c mice , lupus prone mrl lpr lpr mice , mrl lpr lpr mice treated 1 \( \) uterine estrogen receptor levels 20 week old mice 3 groups significantly different contrast , dna binding activity significantly higher balb c mice \( mean sd 100 mg dna \) untreated mrl lpr lpr mice \( 80 16 mg dna \) \( p less 0 001 \) treatment 1 associated increase uterine estrogen receptor dna binding \( 1 , 100 218 mg dna \) mrl lpr lpr mice \( p less 0 001 \) polyamine levels 2 6 fold higher uterine tissues untreated mrl lpr lpr mice compared balb c mice significantly reduced treatment results link uterine polyamine production dysfunction estrogen receptors mrl lpr lpr mice reduction polyamine level irreversible inhibition ornithine decarboxylase restores estrogen receptor function
antibody profile early htlv infection published erratum appears 1990 dec 22 29 336 \( \) define antibody profile early seroconversion infection human cell lymphotropic virus type \( htlv \) , consecutive serum samples 10 subjects presumed seroconverted basis particle agglutination test studied three enzyme immunoassays two confirmatory tests \( western blot \) 3 samples positive 1 sample indeterminate confirmatory tests reactive one enzyme immunoassay , used recombinant envelope antigen , two enzyme immunoassays 2 38 particle agglutination negative samples effect confirmatory tests identified 8 \( 7 women , 1 man \) serum samples used study antibody reactivity western blot assays htlv specific antigens \( three recombinant proteins spanning n terminal , middle , c terminal env glycoprotein gp46 recombinant transmembrane protein recombinant tax protein three gag proteins , p24 , \) 8 antibody reactivities c terminal region \( residues 229 308 \) gp46 gag p24 seroconversion detected
aids swedish people 1986 1989 order assess changes knowledge , attitudes behaviour related aids , annual mail surveys \( 1986 1989 \) sent random samples general public , aged 16 44 years total , 16 , 900 individuals sampled , average response rate 71 knowledge major routes infection generally good entire study period fear infection risks contact hiv infected people decreased period studied , still remained high 1989 entire period , respondents expressed strong fear concerning spread hiv population although increasing percentage respondents reported altered sexual habits result fear aids , overall sexual behaviour change sufficiently reduce risk spread sexually disease progress toward knowledge , attitudes , behaviour aimed prevention transmission infection unnecessary fear rapid middle study period public debate concerning aids peak knowledge attitudes change last year study , , respects , previous levels
complement mediated enhancement hiv 1 infection cell line u937 assess role complement complement receptors hiv 1 infection monocytes macrophages , studied infectivity hiv 1 , isolated peripheral blood patient subacute aids related encephalopathy , human cell line u937 hiv 1 hiv 1 infected cells capable activating complement system via classical alternative pathways , respectively low concentrations hiv 1 able infect u937 cells easily presence absence complement higher virus concentrations , infectivity longer facilitated presence complement infection u937 cells reduced presence monoclonal antibodies \( mabs \) , \( anti cd4 \) , \( anti cr3 \) , \( anti cr3 \) combination three mabs reduced infection even greater amount data indicate complement receptors may port entry complement coated hiv 1
immunological changes primary hiv 1 infection homosexual men symptomatic primary hiv 1 infection displayed pronounced significantly depressed numbers cd3 , cd4 cd8 cells b cells first week illness subsequently , cd8 cell counts rose parallel numbers cd3 cells , atypical lymphocytes activated \( cd38 hla dr \) cells attain maximal levels month following onset illness contrast cd4 b cell numbers remained low extended period time early signs host response included transient appearance interferon alpha blood raised levels neopterin beta 2 microglobulin \( beta 2 \) neither cd4 cd8 cell ratio beta 2 resumed completely normal values follow period 2 years findings shed light pathogenetic events early hiv 1 infection suggest infection , following acute symptomatic stage , usually stage chronic active rather latent infection
heterosexual transmission hiv 1 among employees spouses two large zaire better understand reasons 80 hiv 1 infections zaire , less 5 north america europe , acquired heterosexual transmission , assess impact hiv 1 infection large urban african , enrolled male employees , 416 female employees female spouses employees two large \( textile commercial bank \) prospective study hiv 1 infection hiv 1 seroprevalence rate higher male employees \( 5 8 \) spouses \( 5 7 \) bank among male employees \( 2 8 \) spouses \( 3 3 \) textile hiv 1 seroprevalence higher among employees positions \( 5 0 \) among workers lower level positions \( 3 0 p less 0 0001 \) multivariate analysis male employees , receipt transfusion , history genital ulcer disease , working bank , , separated independently associated hiv 1 infection 1987 1988 , aids common cause death among recently employed workers , accounting 20 24 deaths textile commercial bank , respectively hiv 1 seroprevalence rate higher among female workers \( 7 7 \) among spouses male workers \( 3 9 p 0 001 \) multivariate analysis wives workers , hiv 1 seropositive spouse , receipt blood transfusion , history genital ulcer disease independently associated hiv 1 infection
transition dynamics hiv disease cohort african prostitutes model approach progression hiv related disease infection death represented staged model transitions stages considered reversible model fitted data cohort african prostitutes means maximum likelihood appears progression symptomatic disease \( centers disease control stage iv \) population considerably rapid reported studies western countries
recreational drug use sexual behavior change cohort homosexual men multicenter aids cohort study \( \) relationship use recreational drugs high risk \( hiv \) homosexual behavior examined multicenter aids cohort study \( \) population among men completed baseline \( 1984 \) first 6 month follow evaluations sexually active 6 months prior enrollment , self reported use 10 classes recreational drugs conjunction sexual activity analyzed cross sectional prospective relationships pattern sexual behavior using four level sexual risk behavior index baseline , proportion men highest risk category \( unprotected anal exposures multiple partners \) increased 36 85 men using drugs men using three drugs plus volatile examined multivariate analyses , volatile nitrite use significantly associated failure maintain attain lower sexual risk levels controlling effects age , educational level numbers high risk partners results suggest volatile nitrite use may play important role association recreational drug use high risk sexual behavior among homosexual bisexual men
world health organization quality assessment programme hiv testing serum panel comprising 19 samples known \( five positives 14 negatives \) hiv 1 antibody content distributed 30 national reference laboratories hiv serology order simulate normal circumstances referral , participants asked test panel hiv 1 antibody status using normal procedures results testing returned 28 participants great variations number combinations tests used number used ranged one five assays per laboratory none 24 laboratories using two tests employed combination high average success rate 99 seen positive samples errors occurred negative samples , average 87 correct negative reports four 14 negative specimens reported negative participants
toxicity efficacy anti cell toxin chain murine model established graft versus host disease induced across major histocompatibility barrier graft versus host disease \( gvhd \) induced across murine major histocompatibility complex injecting c57bl 6 \( h 2b \) bone marrow splenocytes irradiated b10 br \( h \) murine recipients immunotoxin \( \) composed pan cell monoclonal antibody called anti \( murine homologue human anti cd5 \) conjugated toxin chain \( anti rta \) used treat recipient mice vitro , active free rta , bound selectively , inhibited cell proliferation even absence mice administered anti rta vivo ongoing gvhd , dose 10 micrograms 5 days , showed lower numbers splenic thy1 2 cells significantly improved survival compared mice given phosphate buffered saline \( \) irrelevant control rta protection transient gvhd weight loss occurred injections ceased survival could enhanced crosslinking , low oligosaccharide containing fraction purified rta treatment anti rta caused significant elevation neutrophils , higher doses associated mild hepatotoxicity contrast , infusion identical doses schedules another pan cell immunotoxin , anti thy1 2 rta , caused significant decrease lymphocytes , neutrophils increase weight decrease total plasma protein \( tpp \) increase pleural peritoneal effusions vascular leak syndrome \( \) although toxic effects anti thy1 2 rta severe show survival advantage gvhd model , histopathologic studies showed definite anti gvhd effect significant decline gvhd compared treated controls observed skin , lesser extent , liver lung investigate cause toxicity , anti thy1 2 rta administered intraperitoneally irradiated b10 br \( h \) recipients syngeneic bone marrow recipients showed weight gain , , observed gvhd model death occurred higher anti thy1 2 rta doses \( 30 50 micrograms daily injections administered days 8 12 posttransplant \) anti thy1 2 rta negligible effect renal function , histologic studies showed patchy dropout renal tubules treatment resulted pulmonary vascular congestion , pathologic evidence liver , brain , colon toxicity weight gain enhanced irradiation normal mice undergo weight increase \( abstract truncated 400 words \)
observations effect chimeric anti cd4 monoclonal antibody patients mycosis fungoides chimeric \( murine human \) anti cd4 monoclonal antibody infused seven patients mycosis fungoides successive patients received doses 10 , 20 , 40 , 80 mg antibody twice week 3 consecutive weeks patients clinical improvement , responses relatively short duration serum levels chimeric antibody varied function dose 80 mg dose level , antibody readily observed biopsied skin lesions although coating antibody cd4 positive cells blood , significant depletion cd4 positive cells low level antibody responses mouse ig variable region human ig constant region determinants observed several patients , none clinical significance two patients made primary antibody cell proliferative responses simultaneously administered foreign protein test antigen however , marked suppression mixed lymphocyte reaction conclude dose levels studied , chimeric anti cd4 monoclonal antibody \( 1 \) clinical efficacy mycosis fungoides \( 2 \) well tolerated \( 3 \) low level immunogenicity \( 4 \) immediate immunosuppressive effects \( 5 \) induce tolerance co injected antigen
evolving role etoposide management lymphomas hodgkin 's disease etoposide , derivative , one important new drugs introduced management malignant lymphomas past decade growing number specific protocols include useful agent management malignant lymphoma , time primary treatment relapse broad activity etoposide across several histologic subtypes malignant lymphoma hodgkin 's disease indicates potential fully used according optimal doses schedules , etoposide single agent activity earlier drugs agents doxorubicin functioning protein synthesis topoisomerase ii inhibitor , offers potential non cross resistant cytotoxicity brief single agent activity etoposide , report focus integration etoposide protocols used primary treatment malignant lymphoma hodgkin 's disease specific findings protocols prednisone , methotrexate , doxorubicin , cyclophosphamide , etoposide cytarabine , bleomycin , vincristine , methotrexate \( pro cytabom \) \( us national cancer institute nci \) etoposide , doxorubicin , cyclophosphamide , vincristine , prednisone , bleomycin \( b \) \( \) primary treatment malignant lymphoma , vinblastine , etoposide , cyclophosphamide , doxorubicin , bleomycin , vincristine , prednisone \( \) \( \) treatment previously untreated patients advanced hodgkin 's disease discussed
longitudinal study near fatal asthma effect careful follow treatment modification 45 patients admission nfa studied 24 45 , events recognized used 14 patients pre nfa mean follow days , deaths seven patients asthma six 45 patients attained normal fev1 blunted perception breathlessness , change vas ratio change fev1 , found first measured , normalized different asthmatic subjects airway responsiveness became milder co2 ventilatory responses differentiate individual nfa patients non nfa asthmatic normal subjects comparison nfa cohort 1985 asthma admission cohort showed asthma admission within last five years risk factor nfa episode
relationships aids patients clinical preventive aids , diseases , compelling aids epidemic seek therapeutic relationship , fundamental human possibility healing dying death us live advocate asking aids patients question , work \? generate facilitate relationships limits major source preventable ethical conflict major therapeutic possibilities doctor patient relationship durable power health care \( dpa \) helpful facilitating patients families successful preventive communication patient doctor possibilities hearing , understanding , expressing doctor parent , , , , may important roles appropriate given patient may experiencing disease variably infectious , , challenge , opportunity growth context communication real relationship includes , respect , humor , hope , genuine interest person lives
interleukin 1 released sites human cutaneous allergic reactions interleukin 1 \( il 1 \) promotes cell recruitment influences allergic mediator release analyzed histamine , prostaglandin d2 , il 1 , leukocytes accumulating hourly 12 hours skin chamber sites local ragweed challenge eight allergic subjects cutaneous late phase reactions ragweed induced peak histamine 1 hour \( p less 0 02 \) , diminished , steadily increased \( p less 0 02 \) prostaglandin d2 levels peaked second hour \( p less 0 02 \) decreased , approaching prechallenge levels 12 hours leukocyte infiltration \( predominantly neutrophils \) detectable 3 4 hours challenge , although selective enrichment mononuclear cells , eosinophils , basophils observed later hours \( p less 0 02 \) il 1 bioactivity detected fluids 10 12 hours challenge control sites \( p less 0 05 \) analysis il 1 beta levels ria revealed initial peak 1 hour 0 90 ng ml \( p less 0 02 \) second elevation 0 75 ng ml later hours \( p less 0 04 \) ragweed challenge three nonatopic subjects change levels mentioned mediators cells bioactivity chamber fluids antigen challenged sites atopic subjects significantly neutralized anti il 1 beta antiserum , although treatment anti il 1 alpha anti il 1 beta needed complete neutralization , il 1 released locally cutaneous allergic reactions may contribute ige dependent cutaneous inflammation
alpha beta adrenergic receptor systems bronchial asthma subjects without asthma reduced mononuclear cell beta receptors bronchial asthma assessed adrenergic receptor system individuals bronchial hyperreactivity , beta adrenergic receptors mononuclear cell membranes , alpha adrenergic receptors platelet membranes , camp response cell types different stimuli , including platelet activating factor \( paf \) , determined studies assessed 10 subjects mild asthma , six methacholine sensitive subjects without asthma , 10 normal subjects density affinity beta receptors alpha receptors determined scatchard analysis findings \( 1 \) subjects asthma significantly lower density beta receptors compared normal subjects , \( 2 \) subjects asthma significantly lower camp response isoproterenol stimulation compared two groups , \( 3 \) subjects without asthma paf decreased basal camp level significantly inhibited response isoproterenol stimulation , \( 4 \) difference density affinity platelet alpha receptors platelet camp responses stimulation alpha agonists among three groups , \( 5 \) neither camp response beta receptor density mononuclear cells significantly correlated pulmonary function tests \( fvc times 100 \) , sensitivity methacholine , cold air inhalation results suggest patients asthma may lower isoproterenol camp response decreased density beta adrenergic receptors mononuclear cells absence beta agonist therapy speculated release paf mediators secondary allergen exposure , even absence overt attacks asthma , may inhibit response endogenous exogenous beta adrenergic agonists
relationship early , late , reaction nasal challenge antigen observations role inflammatory mediators cells challenge 55 consecutive ragweed \( \) allergic patients hay fever graded increasing doses ragweed extract investigate frequency relationship early \( er \) , late \( lpr \) , reactions \( \) nasal challenge evaluated nasal response measuring levels histamine , esterase activity , kinins nasal lavage fluid grading symptoms fifty one subjects \( 92 7 \) er consisting dose dependent , increase mediators symptoms total amount esterase activity kinins generated er correlated significantly specific serum ige \( \) , intradermal skin test \( st \) sensitivity , basophil histamine release \( bhr \) antigen e \( p less 0 01 \) twenty four \( 47 \) subjects developed late increase mediators 23 \( 45 \) subjects symptoms none four subjects without er developed lpr levels late appearing mediators predicted st , , bhr significant weak association intensity er lpr , significant difference ige antibodies , st , bhr , intensity threshold er dual early number eosinophils neutrophils lpr increased prechallenge baseline , numbers correlated \( p less 0 05 \) er kinins \( r 0 46 , 0 37 , respectively \) , er esterase activity \( r 0 28 0 24 , respectively \) , case eosinophils , er histamine \( r 0 29 \)
1 , 25 dihydroxyvitamin d3 potentiates decreased response lymphocytes atopic subjects agents increase intracellular cyclic adenosine monophosphate inhibitory effect prostaglandin e2 , histamine , , 1 , 25 dihydroxyvitamin d3 \( 1 , 25 oh 2d3 \) mitogenic stimulation peripheral blood lymphocytes normal atopic subjects studied found lymphocytes atopic patients less susceptible inhibition three agents elevate intracellular cyclic adenosine monophosphate \( camp \) concentrations active metabolite vitamin \( inhibition 27 , 14 , 12 , 36 atopic patients compared 40 , 20 , 22 , 46 normal donors , four agents , respectively p less 0 02 \) inhibitory effect camp elevating agents potentiated addition 1 , 25 \( oh \) 2d3 lymphocyte cultures potentiation pronounced lymphocytes atopic donors , increasing responsiveness levels comparable levels lymphocytes normal donors synthetic corticosteroid , dexamethasone , similar potentiating effect inhibitory action prostaglandin e2 view beneficial action beta agonists , phosphodiesterase inhibitors , corticosteroids treatment allergy , potentiating effect 1 , 25 \( oh \) 2d3 action camp elevating agents may therapeutic interest
comparison effect loratadine airway skin responses histamine , methacholine , allergen subjects asthma loratadine highly selective , long acting , h1 receptor antagonist randomized , double blind , crossover study , evaluated effects loratadine , 10 20 mg , placebo administered daily 3 days skin wheal responses histamine , airway responses inhaled histamine methacholine , skin wheal airway responses allergen 12 subjects asthma evidence bronchodilator action 3 hours third oral dose airways , geometric mean provocative concentration histamine causing 20 fall fev1 placebo loratadine , 10 20 mg , 0 68 mg ml , 2 71 mg ml \( p , significant \) , 5 96 mg ml \( p less 0 05 \) , respectively concentration ratios \( value active treatment value placebo \) loratadine , 10 20 mg , 5 1 \( p less 0 05 \) 13 4 \( p less 0 05 \) neither dose loratadine significant effect methacholine dose response relationship skin , loratadine also displaced histamine log concentration response curves right concentration ratios 4 7 6 7 , respectively loratadine , 10 20 mg , protective effect early late phase bronchoconstrictor responses inhaled allergen skin , loratadine , 20 mg , significantly inhibited mean wheal area allergen thus , dose regimens studied , although loratadine moderately potent selective h1 antagonist skin airways , failed attenuate early late airway responses inhaled allergen
altered production histamine releasing factor \( hrf \) activity responsiveness hrf immunotherapy children asthma delineate working mechanisms immunotherapy \( \) \( \) , production , responsiveness , histamine releasing factor \( hrf \) studied four groups groups consisted 32 newly diagnosed children asthma , 40 good responders 18 poor responders \( older 2 years \) , 15 healthy subjects results demonstrated \( 1 \) peripheral blood mononuclear cells new patients produced much greater hrf activity , either spontaneously stimulation , normal subjects , \( 2 \) spontaneous hrf activity decreased significantly good responders , whereas poor responders increased , \( 3 \) allergen \( mite \) mitogen \( phytohemagglutinin pha \) stimulated hrf activity decreased , although decrease significant , good responders , activity changed poor responders , \( 4 \) granulocytes new patients responded hrf much granulocytes normal subjects responsiveness diminished significantly good poor responders , although magnitude decrease slightly greater former , \( 5 \) positive correlation pha mite stimulated hrf activity , mite stimulated hrf activity responsiveness hrf , plasma histamine level responsiveness hrf new patients , \( 6 \) inverse correlation pha stimulated hrf production responsiveness hrf good responders , correlation positive poor responders thus , able suppress hrf activity , particularly type spontaneous synthesis , responsiveness hrf clinically children asthma , effect may used explain , partly , efficacy proportion allergic patients
allergy different fish species cod allergic children vivo vitro studies presence positive clinical history skin test \( st \) results 17 fish species \( , , , , , , , , , red , , , sole , , , , \) investigated 20 children cod positive clinical history , st , rast , 40 children positive one foods different cod \( cow 's milk , chicken egg white , peanut , \) cod positive children , positive clinical history \( 60 \) st \( 85 \) fish species frequent cod negative children \( 7 5 10 respectively \) cod positive children , high frequency positive sts \( 85 \) , , sole , \( 55 \) observed positivity \( 10 \) least frequent rast inhibition experiments suggested presence cross reacting antigen \( \) cod , , , , sole , results study demonstrate cod allergy might , whole , reliable index fish allergy , cod positive children may perhaps tolerate species , tested possible inclusion diet
selective desensitization seminal plasma protein fractions immunotherapy anaphylaxis 24 year old white woman reported sexual intercourse related pruritus , , wheezing , dyspnea within 5 minutes ejaculation systemic reactions \( srs \) prevented use condoms prick testing confirmed sensitization five sephadex g 100 separated fractions husband 's seminal plasma intradermal end point threshold concentrations \( etc \) 10 \( 4 \) 10 \( 1 \) micrograms protein per milliliter fractions 2 3 , respectively leukocyte histamine release studies exhibited 100 release fraction 2 37 release fraction 3 2 day protocol rapid immunotherapy \( \) performed subcutaneous incremental doses human seminal plasma \( \) fractions 2 3 patient experienced sr receiving cumulative dose 38 55 micrograms fraction 2 day 1 day 2 , rapid fraction 2 administered patient experienced mild sr received cumulative dose 102 8 micrograms one increase intradermal etc fractions 2 3 end day 2 continued three times weekly 4 months patient tolerated 100 micrograms doses fractions 2 3 4 months , resumed without srs , stopped intradermal etc fractions 1 , 3 , 4 , 5 increased 6 months cessation injections , one log decrease etc fraction 2 experience demonstrated systemic tolerance achieved parenteral administration selected fractions partial immunologic desensitization patients anaphylactic sensitivity achieved
cetirizine antiallergic therapy beyond traditional h1 antihistamines three decades , traditional h1 antihistamines used treatment allergic diseases effective reducing histamine related symptoms , use agents limited sedation anticholinergic side effects adverse effects fewer recently introduced h1 antihistamines one , cetirizine , human metabolite hydroxyzine , characterized high selectivity h1 receptor site reliable consistent inhibition histamine induced allergic reactions also blocks eosinophil infiltration site allergen induced cutaneous reactions cetirizine proved effective treatment seasonal allergic rhinitis urticaria excreted primarily renal mechanisms well tolerated elderly patients cetirizine low rate penetration blood brain barrier , minimal central nervous system impairment furthermore , given day cetirizine 's low incidence sedation anticholinergic side effects contribute high profile safety article characteristics , pharmacology , pharmacokinetics , mode action cetirizine reviewed
aids family physicians' attitudes experiences study developed examine current experiences opinions national sample family physicians regard acquired immunodeficiency syndrome \( aids \) survey response rate 72 5 \( questionnaires returned sample \) approximately 47 respondents cared hiv infected patients percentage varied low 31 4 high 56 1 east coast thirty two percent family physicians practicing communities fewer 2500 illness , 60 communities greater 100 , 000 done seventy seven percent respondents willing provide care hiv infected individuals 62 9 believe physicians right care patient infected aids virus forty percent believe would lose patients known caring aids patient office finally , vast majority surveyed favor required partner notification would sexual partner hiv positive patient patient refused
p glycoprotein expression malignant lymphoma reversal clinical drug resistance chemotherapy plus high dose verapamil p glycoprotein transmembrane protein thought function efflux pump cells associated multidrug resistance laboratory systems recently found human tumors associated vitro clinical drug resistance used immunohistochemical method employing two monoclonal antibodies , 1 c 219 , detect expression p glycoprotein lymphoma patients one 42 newly diagnosed untreated lymphoma patients \( 2 \) seven 11 previously treated drug resistant patients \( 64 \) detectable levels p glycoprotein \( p less 001 \) based prior reports suggesting verapamil drug resistant cancer cells chemotherapy competitive inhibition p glycoprotein , tested efficacy verapamil 18 patients drug refractory disease patients previously failed relapsed within 3 months doxorubicin vincristine containing drug regimen patients received day 1 cyclophosphamide , 4 day continuous infusion doxorubicin vincristine oral dexamethasone \( \) combined 5 day continuous infusion verapamil given maximally tolerated dose overall , 13 18 patients \( 72 \) responded treatment including five complete remissions \( crs 28 \) median duration response 200 days median survival 242 days dose limiting toxicity verapamil infusion temporary cardiac dysfunction including hypotension , congestive heart failure , cardiac arrhythmia conclude p glycoprotein uncommonly expressed untreated lymphomas frequently expressed clinically drug resistant disease , chemotherapy using plus maximally tolerated doses verapamil results high response rate patients carefully selected clinical drug resistance
superiority promace cytabom promace mopp treatment advanced diffuse aggressive lymphoma results prospective randomized trial published erratum appears j clin 1991 apr 9 \( 4 \) one hundred ninety three patients stage ii , iii , iv follicular large cell , diffuse large cell , diffuse mixed , immunoblastic , diffuse small noncleaved cell \( non burkitt 's \) lymphoma randomized receive either cyclophosphamide mg m2 intravenously \( iv \) , doxorubicin 25 mg m2 iv , etoposide 120 mg m2 iv day 1 , 6 mg m2 iv , vincristine 1 4 mg m2 \( cap 2 mg total dose \) iv day 8 , prednisone 60 mg m2 orally daily days 1 14 , procarbazine 100 mg m2 orally daily days 8 14 , methotrexate 500 mg m2 iv day 15 leucovorin 50 mg m2 orally every 6 hours four doses beginning 24 hours methotrexate cycles repeated every 28 days \( promace mopp \) day 1 treatment promace mopp plus cytarabine 300 mg m2 iv , bleomycin 5 u m2 iv , vincristine 1 4 mg m2 \( cap 2 mg total dose \) iv , methotrexate 120 mg m2 iv day 8 , leucovorin 25 mg m2 orally every 6 hours four doses beginning 24 hours methotrexate , prednisone 60 mg m2 orally daily days 1 14 cycles repeated every 21 days \( promace cytabom \) co two double strength tablets orally twice daily throughout period treatment added promace cytabom regimen increased risk pneumocystis carinii pneumonia found first 35 patients receiving combination median follow 5 years among 99 patients treated promace mopp , 73 achieved complete remission \( cr \) \( 74 \) , 30 complete responders relapsed \( 41 \) , 45 patients died \( 45 \) , including two \( 2 \) treatment related causes among 94 patients treated promace cytabom , 81 achieved cr \( 86 \) , 22 complete responders relapsed \( 27 \) , 31 patients died \( 33 \) complete response rate \( p2 \) survival \( p2 046 \) significantly higher patients treated promace cytabom mortality promace cytabom treatment overall six 94 patients \( 6 4 \) treatment related mortality among patients treated prophylactic co \( n 59 \) promace cytabom combination chemotherapy co prophylaxis safe effective treatment patients aggressive histology malignant lymphoma superior promace mopp
care asthmatic oral maxillofacial surgery patient estimated asthma affects 6 9 million people united states nature disease makes special concern oral maxillofacial surgeon appropriate management asthmatic patient regard anesthesia surgical procedures oral maxillofacial region discussed
tuftsin deficiency aids tuftsin endogenous stimulates phagocytosis released fc fragment igg splenic tuftsin activity splenic function measured 21 patients aids , 7 patients aids related complex \( arc \) , 22 patients undergone splenectomy , 37 healthy volunteers significant inverse correlation tuftsin activity splenic function subjects tuftsin activity significantly lower patients aids , arc , undergone splenectomy compared healthy volunteers tuftsin deficiency may contribute risk bacterial infection symptomatic hiv positive individuals
absence highly homologous sequence htlv japanese multiple sclerosis tried detect htlv related sequences japanese patients multiple sclerosis highly sensitive method polymerase chain reaction \( pcr \) genomic dna followed southern blot hybridization analysis htlv sequences , used primers , pol , gag , env coding regions fourteen patients definite ms , 14 disease controls , 12 normal controls , 3 patients htlv associated myelopathy \( ham \) investigated results particle aggregation assay htlv antibodies negative serum subjects except 3 ham patients neither 14 ms patients 26 controls showed presence highly homologous sequences htlv observe faint signals gag , pol , env coding regions low stringent hybridization ms patients well normal controls nucleotide sequence analysis faint bands homologous major histocompatibility complex molecules htlv genome
beta 2 microglobulin concentrations pediatric human immunodeficiency virus infection serum concentrations beta 2 microglobulin \( b2 \) correlated disease outcome 40 children infected human immunodeficiency virus serum b2 serum concentrations 3 0 mg 100 ml decreasing concentrations indicative stable disease course also noted children 20 patients b2 concentrations 3 0 mg liter , 12 progressive disease course 8 remained stable latter 8 patients b2 values decreased time elevated b2 concentrations also noted infants younger 1 year age active human immunodeficiency virus infection b2 serum concentrations useful prognostic marker human immunodeficiency virus infected children
primary combined immunodeficiency resulting defective transcription multiple cell lymphokine genes circulating lymphocytes female child recurrent opportunistic infections normal number phenotype exhibited poor proliferation decreased synthesis cell growth factor interleukin \( il \) 2 response mitogens recombinant il 2 fully restored proliferative responses cells , suggesting poor immune function related il 2 deficiency northern blot analysis total cellular rna patient 's cells revealed markedly decreased levels il 2 mrna normal size addition , mrna levels lymphokines selectively expressed cells , include il 3 , il 4 , il 5 , either severely depressed absent levels interferon gamma mrna moderately decreased , granulocyte macrophage colony stimulating factor , lymphokine production restricted cells , unaffected decreased level lymphokine mrna patient 's lymphocytes enhanced catabolism resulted diminution transcription rate affected lymphokine genes normal transduction via cell receptor cd3 complex biochemical signals necessary initiation lymphokine gene transcription indicated defect distal membrane signal apparatus defect hypothesized involve cell specific trans acting regulatory factor required transcription affected lymphokine genes
autoimmune induced acetylcholinesterase antibodies systemic injection monoclonal antibodies neural acetylcholinesterase adult rats caused syndrome permanent , complement mediated destruction presynaptic fibers sympathetic ganglia adrenal medulla ptosis , hypotension , bradycardia , postural syncope ensued sympathetic ganglia , acetylcholinesterase activity disappeared nerve cell bodies choline acetyltransferase activity ultrastructurally defined synapses also lost electrical stimulation presynaptic fibers superior cervical ganglion ceased evoke end organ responses hand , direct ganglionic stimulation remained effective , adrenergic system appeared intact motor performance choline acetyltransferase content skeletal muscle preserved , parasympathetic \( vagal \) function model selective cholinergic autoimmunity represents another tool autonomic physiology may relevant pathogenesis human
evolution sequences encoding principal neutralization epitope human immunodeficiency virus 1 host dependent , rapid , continuous principal neutralization epitope human immunodeficiency virus 1 localized third variable \( v3 \) domain external envelope shown bind isolate specific antibodies therefore , extent variation within nucleic acid sequence encoding epitope studied dna directly obtained peripheral blood mononuclear cells six children plasma donor revealed species distribution sequences obtained cloning varied recipient recipient distance donor sequences increased time v3 nucleotide evolution rates averaged 9 5 x 10 \( 3 \) per site per year silent sites 11 4 x 10 \( 3 \) per site per year sites \( vs 9 7 9 8 x 10 \( 3 \) per site per year control region 5' adjacent v3 region \) , although individual differences observed , correlate serum antigen levels disease progression sequences epitope coding region \( v3 \) control region upstream diverted donor sequence among children progressing aids among children progressing aids evolution v3 sequences apparently host dependent , rapid , independent level antigen expression
aggressive non hodgkin 's lymphomas aids university colorado experience authors performed retrospective study investigate relationship non hodgkin 's lymphoma \( nhl \) acquired immunodeficiency syndrome \( aids \) january 1984 december 1987 cases aids nhl diagnosed university colorado affiliated hospitals identified submitted chart review twenty five patients fulfilled criteria diagnosis aids 24 biopsy proven nhl , additional patient met criteria diagnosis primary central nervous system lymphoma included analysis patients known risk factors development aids biopsy proven tumors , 23 categorized high grade patients \( 68 \) presented stage iv disease 92 extra nodal involvement median survival 5 months cause death often progressive lymphoma opportunistic infections data similar previously published series clinical trials evaluate effective treatment warranted
comparison median posterior tibial nerve somatosensory evoked potentials ambulatory patients definite multiple sclerosis somatosensory evoked potentials \( seps \) recorded stimulation median nerves posterior tibial nerves control subjects subjects multiple sclerosis \( ms \) several years' duration , ambulatory experiencing exacerbation documentation peripheral nerve conduction revealed abnormalities subjects centrally , abnormal responses median posterior tibial nerve stimulation found spinal level scalp nearly ms patients using latency initial scalp seps , posterior tibial seps abnormal significantly often median seps calculations suggested significant increase spinal conduction time high incidence abnormal seps support substantial physiological recovery group ms patients
lack evidence infection effect growth hematopoietic progenitor cells vivo vitro exposure human immunodeficiency virus pathogenesis hematologic abnormalities commonly observed patients acquired immunodeficiency syndrome \( aids \) incompletely understood report vitro growth myeloid \( cfu gm \) erythroid \( bfu e \) progenitor cells six patients aids significantly different normal human immunodeficiency virus \( hiv \) seronegative donors 25 3 5 cfu gm per 5 x 10 \( 4 \) low density marrow cells 33 5 5 bfu e observed aids patients versus 32 7 5 cfu gm 42 1 5 bfu e controls furthermore , hiv dna individual colonies \( cfu gm bfu e \) could detected using polymerase chain reaction \( pcr \) technique , although hiv 1 dna detected peripheral blood mononuclear cells patients similarly , normal bone marrow cells exposed vitro different isolates hiv recombinant purified hiv 1 envelope glycoprotein \( gp \) 120 exhibit difference growth cfu gm bfu e compared mock exposed bone marrow cells hiv 1 dna could detected pcr technique individual colonies derived hiv exposed marrow study suggests committed myeloid erythroid progenitors aids patients responsive hematopoietic growth factors vitro appear contain hiv 1 dna also , hiv envelope gp alter growth hematopoietic progenitor cells vitro evidence hiv infection progenitor cells could demonstrated impaired hematopoiesis patients aids may related direct effects hiv committed progenitor cells
retinoic acid receptors myeloid leukemia characterization receptors retinoic acid resistant k 562 cells although mrna retinoic acid receptor alpha \( alpha \) expressed many different myeloid leukemias , leukemia cells exhibit little phenotypic response exposed retinoic acid \( ra \) determine whether ra resistance related altered ra receptor structure function , performed detailed analysis nuclear ra receptors ra resistant k 562 cells cells exhibit ra receptors approximate molecular weight similar kd exhibited ra sensitive hl 60 leukemia cell line , number ra receptors ra resistant k 562 cells \( 80 per cell \) significantly lower exhibited ra sensitive hl 60 cells \( 550 per cell \) retroviral mediated transduction alpha cdna k 562 significantly increased number ra receptors 2 , 000 per cell alpha k 562 cells , incubated ra , exhibit diminished cell proliferation associated decreased c myc expression accumulation cells g0 g1 addition , ra treated cells exhibit downregulation surface antigen slight increase hemoglobin production manifest evidence significant erythroid , megakaryocytic , myeloid differentiation results indicate elevated number nuclear ra receptors involved altering proliferation necessarily differentiation certain ra treated myeloid leukemia cells
long term survival ki 1 lymphoma three patients histologic immunologic features ki 1 positive large cell lymphoma , experienced long term survival , presented three patients 2 , 28 , 49 years age adenopathy cases initially misdiagnosed metastatic carcinoma malignant histiocytosis subsequent review , diffuse growth large pleomorphic cells h2 \( ki 1 cd 30 \) positive one case marked cell lymphoma , one case expressed cell b cell markers , one case negative cell b cell markers patients received chemotherapy , two received local radiation one patient treated 9 years initial diagnosis two patients several recurrences , evidence lymphoma three patients 63 301 months overall survival time ranged 14 25 years cases longest reported survivors ki 1 lymphoma 5 years longest survival time previously reported also h2 lymphoid associated antigens appear preserved formalin fixed , paraffin embedded tissues prolonged periods may allow retrospective studies evaluate natural history ki 1 lymphomas , well spontaneous treatment induced regression
multiple sclerosis australia new zealand determinants genetic environmental \? prevalence multiple sclerosis \( ms \) recently reported nine regions australia new zealand marked variation prevalence ms seven times common southern new zealand tropical current evidence , suggested countries variation predominantly due environmental rather genetic factors
multiple sclerosis among united kingdom born children immigrants indian , africa west multiple sclerosis \( ms \) uncommon among ethnic indian , among resident new countries africa west also uncommon among migrated england countries contrast , children born united kingdom asian , african west indian immigrants , age groups available study , high prevalence ms similar order occurring general population england
use formal prior directives among patients hiv related diseases objective examine knowledge , counseling , use prior directives among patients hiv related disease design cross sectional survey personal interviews part evaluation multi site aids health services program setting outpatient clinics aids community based organizations patients participants eligible survey , subjects least 18 years age enrolled aids health services program least one month 1 , 031 clients interviewed nine communities measurements main results surveyed , 61 thought moderate great amount proxy health care decisions majority \( 68 \) patients knew prior directives , yet 35 counseled 28 prior directive counseled , physicians counseled 11 \( 38 359 \) gay bisexual men likely counseled executed prior directive others counseling associated obtained prior directive counseled subjects 3 5 times likely obtained prior directive counseled conclusions gap exists subjects' knowledge implementation prior directives help bridge gap , authors recommend physicians attend technical aspects patient care , also determine patient values concerning life sustaining therapy counsel patients prior directives
risk human immunodeficiency virus \( hiv \) transmission blood transfusions implementation hiv 1 antibody screening transfusion safety study group little information available regarding risk human immunodeficiency virus type 1 \( hiv 1 \) infection patients transfused routine anti hiv 1 screening blood donors instituted march 1985 model developed estimating proportion number transfusion recipients san francisco bay area infected hiv 1 7 years preceding routine donor screening anti hiv 1 model based analysis 1 \) donation histories hiv 1 infected donors identified regional blood center 2 \) hiv 1 seroprevalence estimates homosexual bisexual men san francisco 3 \) hiv 1 infection survival rates recipients traced transfusion safety study memorial blood look back program incidence transfusion associated hiv 1 infection estimated rapidly first occurrence 1978 peak late 1982 approximately 1 1 percent per transfused unit decrease 1982 coincided implementation high risk donor measures estimated , overall , approximately transfusion recipients infected hiv 1 san francisco region alone number suggests higher prevalence transfusion associated hiv 1 infection generally recognized indicates need continued tracing potentially exposed recipients data also strongly support effectiveness early donor education self exclusion measures emphasize importance continued research development area
association psychiatric manifestations antibodies ribosomal p proteins systemic lupus erythematosus purpose goal study determine whether elevated serum levels antibodies ribosomal p proteins \( anti p antibodies \) associated neuropsychiatric manifestations patients systemic lupus erythematosus \( sle \) additional experiments examined characteristics antibodies might associated patients methods large number serum samples collected patients sle , control subjects rheumatic diseases , normal individuals time serum samples obtained , patients sle categorized according presence psychosis , depression , manifestations central nervous system \( cns \) involvement serum anti p antibody activity quantitated enzyme linked immunosorbent assay utilizing synthetic peptide corresponding major p protein epitope results group 79 normal individuals , mean \( se \) igg anti p activity 0 01 0 003 individuals values greater 3 sd mean similar results obtained measuring igm anti p activity normal levels found sera 21 patients rheumatoid arthritis 119 patients demonstrating various patterns antinuclear antibody activity , elevated anti p levels found patients sle overall , 19 269 patients sle demonstrated elevated levels igg igm anti p antibodies , including 14 187 patients without 29 82 patients neuropsychiatric manifestations frequency positive test results varied greatly depending nature cns involvement frequency patients severe depression \( n 8 \) psychosis \( n 29 \) 88 45 , respectively , compared 9 patients nonpsychiatric neurologic disease \( n 45 \) entire sle group , odds ratio association anti p antibodies severe psychiatric manifestations 7 63 95 confidence interval 3 61 16 14 review 187 patients sle originally classified severe psychiatric disease , seven 10 patients treated antidepressant medications elevated levels anti p antibodies serial studies , serum level anti p antibodies appeared correlate activity psychiatric disease correlate activity manifestations sle anti p antibodies nearly patients igg directed primarily c terminal 11 amino acids p protein difference characteristics observed patients without psychiatric manifestations compared paired serum cerebrospinal fluid \( csf \) samples also obtained eight patients active neuropsychiatric disease even expressed fraction total igg present , anti p activity markedly lower csf serum conclusions elevated levels autoantibodies c terminal region ribosomal p proteins appear specific marker sle , associated severe depression psychosis disease assay easily reproducible may help distinguish sle induced psychiatric disease caused processes
effect inhaled corticosteroids maximal degree airway narrowing methacholine asthmatic subjects airway hyperresponsiveness asthma characterized increase sensitivity maximal response airway narrowing stimuli long term therapy inhaled corticosteroids known reduce airway hypersensitivity asthmatic patients investigate whether drugs also reduce maximal degree airway narrowing studied effects inhaled budesonide maximal response plateau dose response curve inhaled methacholine mildly asthmatic patients raised plateau could measured sixteen atopic patients mild asthma placed randomly two parallel treatment groups receive double blindly either budesonide \( 400 micrograms twice daily \) placebo , inhaled via , 4 wk treatment , 2 4 wk treatment , 2 4 wk wash , complete dose response curves methacholine obtained using standardized 2 min tidal breathing method response measured fev1 , expressed fall baseline plateau log dose response curve considered three data points fell within 5 response range maximal response obtained averaging values plateau \( \) , sensitivity calculated provocative concentration methacholine , causing 20 fall fev1 \( pc20 \) 4 wk budesonide treatment , mean decreased 41 6 33 7 fall \( p 0 0004 \) changes significantly different placebo budesonide \( p 0 03 \) geometric mean pc20 increased 3 4 6 3 mg ml \( p 0 02 \) , changes pc20 different two groups \( p 0 23 \)
morphometry airways late responses antigen challenge rat quantitate structural changes airways contribute late bronchial response \( \) antigen challenge killed six brown norway rats , sensitized \( oa \) challenged aerosol , compared dimensions airways six control animals lungs rapidly frozen liquid nitrogen fixed 's solution paraffin sections stained hematoxylin time \( 39 min oa challenge \) , rl increased baseline value \( 0 0 034 cm h2o ml 1 \) 0 107 0 03 cm h2o ml 1 \( p less 0 05 \) rl change significantly control rats lumen size wall area membranous airways measured corrected airway size dividing basement membrane length squared \( \) increase airway wall area oa challenged animals however , lumen large airways \( bm 2 0 2 99 mm \) significantly less oa challenged animals \( 0 0 mm2 \) control animals \( 0 0 mm2 p less 0 05 \) six additional rats , distribution mast cells \( mc \) bronchial tree determined tissues fixed 's solution stained modified may giemsa stain significantly mc large airways medial small airways conclude smooth muscle constriction large airways airway wall edema accounts rat distribution mast cells corresponds closely site bronchoconstriction
methotrexate induced asthma patient rheumatoid arthritis developed pulmonary symptoms function test abnormalities consistent asthma methotrexate therapy assessments airway responsiveness methacholine therapy revealed airway hyperreactivity normal methotrexate stopped extension methotrexate dosage interval 7 10 days resulted abolition asthma , remained remission despite return weekly cycle 3 month period 10 day cycles
prevalence mycobacterium complex respiratory specimens aids non aids patients san francisco hospital past several years large increase recovery mycobacterium complex \( mac \) isolates respiratory specimens submitted clinical laboratory san francisco general hospital \( \) increase mac recovery correlates increase number cases acquired immunodeficiency syndrome \( aids \) community although well known mac often isolated patients aids , isolation mac respiratory specimens often attributed contamination specimen mac organisms present environment determine whether increase mac isolates recovered due increase environmental contamination specimens increase aids patient population , conducted study prevalence mac respiratory specimens aids versus non aids patients results specimens submitted clinical laboratory culture reviewed 12 yr period , 1977 1988 prevalence mac respiratory specimens aids non aids patients determined 4 yr period pre aids year 1977 first year aids reported san francisco , 1981 1984 1987 1977 1981 prevalence mac respiratory specimens less equal 0 5 , mac isolates recovered non aids patients 1984 prevalence mac respiratory specimens aids non aids patients 6 5 0 3 , respectively , 1987 , 8 8 0 3 , respectively
delayed type hypersensitivity initiation early acting cells antigen mismatched mhc incompatible late acting , delayed type hypersensitivity effector cells elicitation delayed type hypersensitivity \( dth \) responses mice mediated sequential activities two different ag specific , thy 1 cells required early phase elicitation due dth initiating thy 1 cells cd3 produce ag specific factors act like ige antibodies tissues , local challenge ag release vasoactive amine serotonin released serotonin locally recruits activates cd4 th 1 classical dth effector cells secrete lymphokines activate nonspecific perivascular infiltrate circulating , bone marrow derived leukocytes current study used isolated subpopulations dth initiating dth effector cells determine whether two phases elicitation dth entirely separate contact sensitivity model dth used early acting dth initiating cells , late acting dth effector cells either \( \) immune chloride \( pcl \) immune cba balb c donors transferred cba balb c recipients results showed dth initiation could mediated polyclonal dth initiating cells ag mismatched mhc incompatible late acting dth effector cells fact dth initiating cells could ag mismatched mhc incompatible late acting cells addition , potential interactions different cell populations ruled showing dth initiation could mediated dth initiating clone ag mhc mismatched late acting dth effector cells thus , specific balb c clone could initiate dth pcl specific cba cells cba recipients recipients challenged pcl , challenged pcl alone suggest , least elicitation dth reactions mice , comprehensive description responses fact early late phase responses begin ag specificity end non specific humoral factors inasmuch two thy 1 cells dth different ag specificity , suggests forms delayed chronic inflammation , might initiated immediate hypersensitivity like immune reactivity one set ag , could prolonged delayed reactivity another set ag
ultraviolet b radiation converts langerhans cells immunogenic antigen presenting cells induction specific clonal cd4 helper 1 cells recently demonstrated single dose \( 200 j m2 \) uvb radiation capacity mouse epidermal langerhans cells \( lc \) splenic adherent cells \( sac \) present keyhole limpet \( klh \) ag specific , mhc restricted cd4 th1 cells present study determined whether th1 unresponsiveness represented long lasting immunologic tolerance address question , th1 klh pulsed uvb lc uvb sac , isolated unirradiated apc \( lc sac \) plus klh exogenous ril 2 absence apc preincubation klh uvb lc uvb sac rendered th1 unresponsive subsequent apc klh addition , th1 defective autocrine il 2 production , could respond normally exogenous ril 2 , indicating unresponsiveness due functional inactivation cell death th1 unresponsiveness ag specific , mhc restricted , long lasting \( greater 16 days \) addition , appears th1 unresponsiveness due release soluble suppressor factors uvb lc uvb sac supernatants cells effect th1 proliferation addition unirradiated allogeneic sac preincubation prevented induction unresponsiveness uvb lc uvb sac , suggesting uvb interferes capacity lc sac deliver signal \( \) provided allogeneic sac conclude uvb convert lc sac immunogenic apc
il 6 production human lymphocytes expression htlv 1 infected normal cells il 6 important regulator humoral cellular immunity although cytokine produced diverse cell types , known whether produced lymphocytes physiologic conditions agents induce cell expression il 6 analyzed production il 6 human peripheral blood cells , human thymocytes , human cell lines pure populations cells , stimulated different combinations various mitogens cytokines , il 6 activity could detected analysis purified alpha beta gamma delta cells showed neither cell subset produced il 6 similarly , il 6 mrna detected cell thymocyte populations 48 h stimulation use pcr assay , il 6 mrna cells found virtually negligible , change cell activation situ hybridization shown cells expressing il 6 mrna mitogen activation pbmc cell lineage analyze whether human cells express il 6 vivo , examined lymphoid tissues situ hybridization normal human thymus detectable signal il 6 showed positive cells within parenchyma , strong expression il 6 epithelial cells crypts contrast normal lymph node , contained rare cells positive il 6 , lymph node patient 's disease showed il 6 expression cells marginal sinus areas screening various human cell lines showed cell lines infected htlv 1 secrete il 6 activity express il 6 mrna addition , vitro infection peripheral blood cells htlv 1 induced de novo synthesis secretion il 6 furthermore , il 6 expression htlv 1 infected cells enhanced stimulation il 1 beta tnf alpha contrast , il 6 detectable non infected cell lines studies indicate il 6 may physiologic product human lymphocytes infection cells htlv 1 results aberrant expression cytokine
plasma adenosine marker human immunodeficiency virus infection plasma concentrations two isoenzymes adenosine deaminase \( , e c 3 5 4 4 \) , adenosine \( \) adenosine \( \) , measured cohort ambulatory patients infected human immunodeficiency virus \( hiv \) controls sensitive isoenzyme specific assay system developed studies among 22 hiv infected patients , plasma significantly elevated compared 16 control subjects \( p less 0 01 \) 6 uninfected subjects risk factor hiv infection \( p less 0 01 \) plasma associated stage disease defined clinical status \( p greater 0 05 \) helper \( cd4 \) lymphocyte count \( p greater 0 05 \) available evidence suggests elevated plasma could useful surrogate marker hiv infection occurs early disease process
costs aids los angeles article reports findings study medical non medical expenditures persons acquired immune deficiency syndrome \( aids \) los angeles 1987 1988 sociodemographic clinical data well information medical expenditures 36 persons aids obtained patient interviews review medical persons aids required mean 1 6 hospitalizations per year 17 days hospital care mean charges first 12 months diagnosis aids 22 , 272 inpatient medical care 22 , outpatient medical care overall , medical costs averaged 45 , 122 per patient per year almost one third costs devoted outpatient , azt aerosolized mean costs care volunteer services , , kind assistance 9 , results similar recently published estimates medical costs persons aids however , data support changing problems care increased use outpatient medical care decreased use hospital resources
epidemiology pediatric hiv infection perinatal transmission human immunodeficiency virus \( hiv \) continues increase 1989 alone , estimated infected children born united states although transmission spreading areas outside cities originally affected , cities continue bear greatest adolescents may particularly vulnerable hiv infection education counseling critical controlling epidemic age group
aids transfusion recipient summary , hiv virus transmitted approximately 90 recipients infectious blood blood products transfused prior donor product testing begun march 1985 self elimination risk donors several years prior testing donor blood helped reduce number infected donations virtually contaminated donors eliminated multiply transfused patient developed stimulated immune system due numerous antigens iron red cells plasma immune system resulted variable response added exposure hiv virus incubation period progression disease prolonged variable although small number patients progressed rapidly risk groups , many continue well without therapeutic intervention natural history disease needs continual monitoring determine ultimate outcome transfusion recipients
antiviral therapy human immunodeficiency virus infection children antiretroviral therapy children still early stage , although progress made slowly zidovudine administered 180 mg m2 dose every 6 hours current standard therapy symptomatic children low cd4 counts standard likely evolve testing optimal dosage different populations children need monitored closely \( least monthly \) hematologic side effects , common seriously ill children role newer , like ddc , likely licensed , yet established different toxicity profile thus may work well combination issue peripheral neuropathy lack easy test measure makes using ddc young , children , optimum dosage timing yet fixed ddc alone , even less available regimens combination therapy antiretroviral drugs less well developed , like high titer antiviral immunoglobulin , involve technology already available thus relatively easy study others , like antisense oligomers , new technology many overcome agents move laboratory clinic goal agents work sites reverse transcriptase reasonable one , work new categories drug difficult slow , children hiv symptomatically supported offered effective antiretroviral regimens available
psychosocial aspects aids children adolescents published erratum appears clin north 1991 jun 38 \( 3 \) viii first part article addresses neuropsychiatric aspects human immunodeficiency virus \( hiv \) infection children adolescents , including developmental delay , depression , dementia specific clinical issues diagnosis discussion death child examined second part presents aspects impact aids families , approaches hiv antibody testing , therapeutic interventions family
laboratory diagnosis hiv infection laboratory diagnosis human immunodeficiency virus \( hiv \) infection complicated absence data sensitivity , specificity predictive value various tests apply children presence maternal anti hiv passively transmitted across placenta also diagnosis authors review currently available data detection hiv , hiv genome , hiv gene products , well diagnostic value detecting serologic cellular responses hiv infants children
host defense abnormalities associated hiv infection infection human immunodeficiency virus \( hiv \) impairs immune function abnormalities host defense associated hiv infection due helper cell dysfunction studies defining abnormalities hiv infected patient largely done adults complete understanding immunodeficiency occurs infants young children infected hiv awaits study immune function effect virus developing immune system
orally administered immunoglobulin preparations food allergic children passive immunization oral administration immunoglobulin preparations derived bovine milk , chicken egg , human sera proposed method prevention treatment enteric diseases however , allergenic potential proteins may factor limiting widespread use disease prevention vitro study sera milk egg allergic children performed determine whether immunoglobulin preparations allergenic potential protein extracts milk , bovine immunoglobulin , egg white , human immune globulin , five egg yolk antiviral immunoglobulin preparations bound paper preparations probed specific ige binding sera milk egg allergic patients 22 milk hypersensitive patients , 16 specific ige binding bovine immunoglobulin preparation 28 egg allergic patients 15 specific ige binding one egg yolk derived antiviral chicken immunoglobulins control sera negative milk egg preparations western blot analysis confirmed milk egg allergic patients ige specific antibodies bovine chicken immunoglobulin molecules therefore , removal contaminating proteins milk egg antibody preparations would unlikely eliminate allergenic potential contrast , sera milk egg allergic patients displayed detectable ige binding human immunoglobulin preparations data indicate administration antibody preparations derived bovine chicken sources may lead severe allergic reactions milk egg sensitized patients sensitization nonallergic individuals
fatal reactions intravenous nonionic contrast material three cases fatality related use low osmolality contrast material \( \) presented definitely reduces side effects serious reactions , data currently insufficient determine whether death rate different associated high osmolality contrast agents present trend toward universal conversion continues , cost little , , benefit may incurred
prediction severe adverse reactions ionic nonionic contrast media japan evaluation report japanese committee safety contrast media nationwide prospective study adverse reactions intravenous contrast media \( cm \) , japanese committee safety contrast media compared high osmolar ionic cm low osmolar nonionic cm total , cases analyzed reliability intravenous injection small amount cm means predicting severe fatal reactions also evaluated predictive values pretest 1 2 ionic 0 0 nonionic cm , sensitivity values 3 7 0 0 , respectively low values render test predicting patients risk severe adverse reaction comparison incidence severe adverse reactions patients , well patients negative results , disclosed statistically significant differences also , beneficial effects premedication patients positive pretest proved authors therefore conclude intravenous injection small amount cm useful predicting severe reactions ionic nonionic cm
multiple sclerosis specificity mr diagnosis specificity magnetic resonance \( mr \) imaging diagnosis multiple sclerosis \( ms \) measured systematically conventional mr head images sagittal axial multiple echo sequences long repetition times obtained 92 patients clinically verified ms \( criteria \) , 100 healthy volunteers , 60 subjects hypertension , eight patients dementia two readers , without aid clinical demographic information , classified 260 studies ms ms readers classified studies supplied subjects' ages sex true negative true positive diagnoses ms tabulated specificity mr diagnosis ms \( true negative results proportion non ms studies \) 95 99 control groups included small risk incidental periventricular white matter foci plaques ms mr studies
aids related lymphoma histopathology , immunophenotype , association epstein barr virus demonstrated situ nucleic acid hybridization investigate range pathology shown acquired immune deficiency syndrome \( aids \) related lymphomas arising well defined group patients , cases lymphoma recognized danish human immunodeficiency virus \( hiv \) infected individuals end 1988 studied twenty seven cases \( 26 high grade non hodgkin 's lymphoma nhl , 1 hodgkin 's disease \) found , give cumulative incidence rate 8 among danish aids patients morphologically nhl patients classified two groups 1 \) high grade tumors predominant population , either monomorphic often polymorphic differentiation 2 \) burkitt type 26 , 22 b cell paraffin section immunophenotype 4 non b , non epstein barr virus \( ebv \) dna demonstrated tumor cells 12 24 cases \( 50 \) using situ nucleic acid hybridization 35s labeled probe paraffin sections epstein barr virus dna found 65 group 1 20 group 2 tumors study suggests existence two main groups aids related lymphoma different first rich lesions , usually associated ebv morphologically resemble lymphomas described immunosuppressed organ transplantation patients second burkitt type tumors ebv sequences less common may analogous sporadic burkitt 's lymphoma
fibroblast growth factor gene expression aids kaposi 's sarcoma detected situ hybridization biopsy samples five acquired immune deficiency syndrome \( aids \) kaposi 's sarcomas one non aids associated kaposi 's sarcoma assayed situ rna hybridization onto fixed , paraffin embedded skin sections presence two fibroblast growth factor gene transcripts , gene expression detected characteristic kaposi 's sarcoma spindle shaped cells five samples human immunodeficiency positive \( hiv \) patients transcripts detected kaposi 's sarcoma cells well epidermis hiv hiv patients results complement observations growth factor gene expression done kaposi 's sarcoma derived cell lines , thus appear representative vivo furthermore , demonstrate contrasting expression pattern genes , involved growth factor pathogenic cascade leading kaposi 's sarcoma
cyclic anaphylaxis associated menstruation middle aged woman developed recurrent episodes severe life threatening anaphylaxis episodes strikingly associated first day menstrual bleeding temporary relief achieved indomethacin therapy patient fully recovered following abdominal hysterectomy possible role sex hormones prostaglandin f2 alpha pathogenesis problem discussed
emergency room care asthmatics comparison auckland toronto compared emergency room visits treatment asthma two large teaching hospitals one auckland , new zealand one toronto , canada wished determine whether differences asthma mortality new zealand canada reflected different patterns emergency room use physician management emergency room use past decade enumerated hospitals , charts containing sole diagnosis asthma reviewed detail defined study period 1986 toronto auckland , number emergency visits asthma increased significantly past decade \( p less 015 rate rise significantly higher auckland \( p less 05 \) auckland , 27 asthmatics admitted whereas toronto significantly fewer \( 16 \) admitted \( p less 0005 \) objective measures pulmonary function documented frequently emergency room physicians new zealand canada \( 90 versus 48 p less 0005 \) pulmonary function measurement primarily peak flow meter auckland commonly toronto pulmonary function measurements could compared directly centers centers , however , admitted patients significantly lower pulmonary function indices discharged patients new zealand , mean peak flow 38 predicted value among asthmatics assessed toronto , mean fev1 47 predicted toronto , pulmonary function measurements likely missing among presumably discharged patients pulse rate , respiratory rate , documented consistently auckland toronto
hiv 1 infection cohort patients course hiv infection 53 patients aged 5 20 years evaluated clinical examination laboratory tests evaluation time \( median 30 months \) two patients died aids 32 patients \( 60 \) deteriorated assessed classification nineteen patients \( 37 \) decreased absolute helper cell counts \( less 500 cd4 positive cells microliters \) , 45 patients \( 87 \) reduced helper cell lymphocyte ratios \( less 0 35 \) hiv 1 isolated peripheral lymphocytes 29 46 patients disease progressed number positive viral cultures increased considerable progression hiv infection seen children adolescents median evaluation period 30 months transition hiv infection immunodeficiency easily recognised lowered ratio helper cells lymphocytes seems useful marker beginning deterioration immune system
long term outcome ventilated asthmatics 25 year period , 31 asthmatic children received artificial ventilation acute asthma children 's hospital 48 occasions altogether 47 episodes occurred 1971 89 , decline number episodes per year \( mean 2 5 \) period eight children died intermittent positive pressure ventilation \( \) , 23 survivors , three children subsequently died asthma seventeen children followed year sixteen still symptoms asthma half symptoms every day ten pulmonary function tests mean forced expiratory volume one second 83 predicted geometric mean provocative histamine concentration \( pc20 \) 2 1 mg ml since follow study fourth patient died asthma continues required small number asthmatic children year survivors remain high risk group significant continuing morbidity mortality
histopathologic features high grade non hodgkin 's lymphomas acquired immunodeficiency syndrome french study group pathology human immunodeficiency virus associated tumors high grade b cell non hodgkin 's lymphomas observed 5 10 patients acquired immunodeficiency syndrome describe histologic subtypes , group pathologists formed one hundred thirteen cases reviewed classified according working formulation , classification , recent description morphologic variants high grade b cell non hodgkin 's lymphoma three major types intermediate high grade lymphomas observed \( 1 \) large cell mainly polymorphic lymphomas component \( 35 cases \) \( 2 \) immunoblastic lymphomas features cases \( 33 cases \) \( 3 \) small non cleaved cell burkitt 's non burkitt 's lymphoma \( 41 cases \) , 15 cases fitting typical criteria burkitt 's lymphoma 26 heterogeneous cases size shape cells presence features varied frequent pathologic sites involvement presentation lymph nodes , gastrointestinal tract , bone marrow , brain , oral cavity , muscles comparison histologic type site involvement showed cases involving lymph nodes , bone marrow , muscles small noncleaved cell burkitt 's non burkitt 's lymphomas , affected gastrointestinal tract , brain , oral cavity immunoblastic lymphomas consistent differentiation 10 cases , previous persistent generalized lymphadenopathy syndrome present 13 cases , proliferation associated follicular diffuse hyperplasia seen lymph node biopsy specimen another lymph node
criteria western blot assay human immunodeficiency virus type 1 infection published erratum appears arch lab med 1991 115 \( 8 \) project designed evaluate different criteria used interpretation human immunodeficiency virus type 1 \( hiv 1 \) western blot assay group serum samples blinded examiner collected individuals attending three different public health departments central north carolina individual also completed anonymous linked questionnaire regarding risk factors blood borne infections western blot assays human immunodeficiency virus type 1 interpreted according criteria established university north carolina hospitals , , centers disease control , atlanta , ga , association association state , , public health laboratory directors , city , , american red cross , washington , , retrovirus serology standardization , , calif , food drug administration , washington , results obtained grouped positive , negative , indeterminate according organization 's criteria analyzed context associated risk factors results indicate institutions performing human immunodeficiency virus type 1 western blot confirmatory testing adopt criteria centers disease control state , , public health laboratory directors
enhancement immunoreactivity among lymphoid malignant neoplasms paraffin embedded tissues zinc sulfate formalin previously demonstrated improved detail obtained tissue blocks initially fixed 4 formaldehyde solution means run back procedure aqueous phase solution , allowing protein precipitating agent , zinc sulfate 4 formaldehyde solution anecdotal experience immunostaining tissues suggested improved results , performed prospective trial involving 13 cases compare intensity immunoreactivity 10 13 cases studied variety antibody reagents , noted definite improvement staining , preferentially among original immunoreactivity
evaluation peak flow symptoms self management plans control asthma general practice objective compare peak flow self management plan asthma symptoms plan design one self management plans follow year setting four partner , rural training practice subjects 115 patients \( 46 children 69 adults \) asthma prophylactic treatment asthma attending nurse run asthma clinic main outcome measures number doctor consultations , courses oral steroids , short term salbutamol treatments number patients required doctor consultations , courses oral steroids , short term salbutamol results self management plans produced significant reductions outcome measures significant differences degree improvement groups results similar children adults proportions patients requiring doctor consultation fell 98 \( 50 51 \) 66 \( 34 51 \) peak flow group 97 \( 62 64 \) 53 \( 34 64 \) symptoms group proportions requiring oral steroids 73 \( 34 46 \) 47 \( 21 46 \) 52 \( 31 60 \) 12 \( 7 60 \) median number doctor consultations reduced 8 0 2 0 peak flow group 4 5 1 0 symptoms group conclusions peak flow meter crucial improved illness two groups teaching patients importance symptoms appropriate action take asthma key effective management asthma simply prescribing peak flow meters without system self management regular review unlikely improve patient care
prominence slow acetylator phenotype among patients hypersensitivity reactions delayed hypersensitivity reactions among severe adverse effects sulfonamides current clinical use reactions appear occur differences metabolism detoxification reactive metabolites sulfonamides n acetylation major metabolic pathway sulfonamides slow acetylation phenotype might risk factor development reactions determined acetylation phenotype 21 patients suffered hypersensitivity reactions sulfonamides 11 females 10 males group , mean age 15 years \( age range , 1 8 50 years \) acetylator phenotype determined determining ratio urinary caffeine metabolites \( 1 5 amino 6 oral dose 50 mg caffeine \) nineteen \( 90 \) patients slow compared 55 incidence slow race matched control population \( p less 0 008 \) suggests slow acetylator phenotype risk factor development hypersensitivity reactions provides support role genetically determined pathways metabolism detoxification sulfonamides pathogenesis reactions
plasma histamine , epinephrine , cortisol , leukocyte beta adrenergic receptors nocturnal asthma plasma histamine , cortisol , epinephrine , cyclic adenosine monophosphate \( camp \) , leukocyte beta adrenergic receptors measured asthmatic patients \( n 7 \) without \( n 10 \) nocturnal asthma 4 pm 4 compared normal subjects \( n 10 \) twofold higher plasma histamine concentration observed 4 compared 4 pm groups , change plasma cortisol , epinephrine , camp concentrations 4 compared 4 pm , patients nocturnal asthma significant 33 decrease \( p less 0 05 \) mononuclear polymorphonuclear leukocyte beta adrenergic receptor density , difference binding affinity three groups polymorphonuclear leukocytes patients nocturnal asthma significantly impaired response isoproterenol 4 \( 17 7 3 sem increase camp p less 0 05 \) compared patients without nocturnal asthma \( 69 4 13 7 \) normal \( 80 2 21 3 \) subjects significant change beta adrenergic receptor density function occurs night patients nocturnal asthma
classifications acute myeloid leukemia detailed description various subtypes acute myeloid leukemias provided importance monoclonal antibodies discussed
immunophenotyping acute myeloid leukemia cells article expression myeloid cell associated antigens normal malignant myeloid cells progress use monoclonal antibodies myeloid cell surface antigens diagnosis , , treatment acute myeloid leukemia discussed results bone marrow purging monoclonal antibodies remove leukemia cells purpose autologous bone marrow transplantation promising
granulocytic sarcoma granulocytic sarcoma variant presentation acute leukemia , occurring locations uncommon , may occur site age , inclusion differential diagnosis undifferentiated tumors histology , touch imprint cytology , , immunocytochemistry , electron microscopy , molecular studies contribute diagnosis
growth regulation human mature b cell line , b104 , anti igm anti antibodies human b lymphoma cell line , b104 , established b104 cells express well igm surface , thought basic characteristic mature b cells growth b104 cells inhibited treatment panel anti igm antibodies cell cycle analyses revealed transition b104 cells g2 g0 g1 phase cell cycle markedly inhibited treatment anti igm antibodies progression b104 cells phase cell cycle found suppressed presence anti igm antibodies contrast , entrance g0 g1 phase cells phase progression phase cells g2 phase cell cycle seem inhibited significantly treatment anti igm antibodies results indicate mechanism inhibition growth b104 cells anti igm antibodies blockage transition g2 phase cell cycle contrast anti igm antibodies , anti antibodies could cause growth inhibition b104 cells b cell growth factors il 4 il 6 effect inhibition growth b104 cells anti igm antibody ifn alpha beta , b cell growth factor activity , increase number cells survived treatment anti igm antibodies b104 excellent experimental model study mechanism signal transduction well functional difference
cd20 hairy cells alteration low molecular weight b cell growth factor ifn alpha hairy cell leukemia \( hcl \) b cell tumor affecting pre plasma stage b cell differentiation hairy cells produce b cell growth factor \( bcgf \) related growth factor \( \) previously shown low mol wt \( \) bcgf induced proliferation hairy cells inhibited vitro vivo ifn alpha therefore suggested effect might contribute sensitivity hcl ifn alpha therapy elucidate mechanism involved therapeutic effect ifn alpha , analyzed pattern phosphorylated proteins hairy cells detected presence protein molecular mass 35 kda protein identified cd20 molecule \( b1 \) , structurally unique exclusively detected b cells expressed stages b cell development incubation hairy cells mitogenic concentrations bcgf induces additional increase cd20 protein phosphorylation contrast , preincubation cells ifn alpha , ifn gamma , decreases basal bcgf induced cd20 phosphorylation cd20 phosphorylation hairy cells also reduced vivo ifn alpha administration contrast , one case patient unresponsive ifn alpha therapy , cd20 phosphorylation altered vitro ifn alpha treatment , whereas bcgf still elicits cd20 phosphorylation stimulation results suggest ifn alpha may act hcl , least part , inhibiting leukemic cell proliferation via regulation phosphorylation , since cd20 phosphorylation thought associated cellular proliferation model involving dysregulation cd20 discussed
synergistic action monoclonal antibodies directed p55 p75 chains human il 2 receptor tu27 , mouse igg1 mab directed p75 chain human il 2r , analyzed ability interact il 2 binding isolated p75 chains \( cells \) high affinity p55 p75 receptors \( human cell clone 4as \) , inhibit il 2 induced proliferation \( 4as cells \) anti p55 chain mab \( 1 \) inhibiting il 2 binding proliferation tu27 il 2 bound isolated p75 chain expressed cells respective dissociation constants \( kd \) 1 3 1 nm cross inhibited binding inhibition constants \( ki \) agreement respective kd values nature interaction , however , purely competitive suggested epitopes two ligands p75 chain 4as cells , il 2 bound high affinity \( kd 50 pm \) tu27 affinity similar found cells binding tu27 il 2 also exclusive 4as cells however , mechanism interaction tu27 il 2 complex since inhibitory potency antibody depended temperature , antibody preincubation time assay data obtained 4 degrees c presence suboptimal , tracer like concentrations il 2 indicated intrinsic affinity tu27 high affinity configuration 15 fold lower isolated p75 chain argued favor affinity conversion model \( opposed preformed complex model \) p55 p75 dissociated absence il 2 37 degrees c , tu27 inhibited il 2 binding short time assays \( 6 min \) longer time \( 30 min \) il 2 binding resulted almost complete disappearance effect tu27 , suggesting internalization high affinity p55 p75 complex enables cells escape inhibitory effect tu27 presence 1 mab , interaction tu27 il 2 resembled one observed cells , suggesting 1 able inhibit il 2 induced association p55 p75 antibody found 4as cells , result cooperative mechanism 1 blocks formation high affinity complex hence allowing tu27 bind higher affinity , tu27 blocks il 2 binding p75 chain proliferation studies corroborated binding experiments \( abstract truncated 400 words \)
hla multiple sclerosis italy review literature hla antigens locus , c , b , dr dq typed 104 italian multiple sclerosis patients healthy controls results compared published italian literature italian studies reviewed regarding ethnic origin typed population corresponding prevalence disease data suggest lack association antigens italian multiple sclerosis relevance dr locus antigens \( mainly dr4 \) , addition dr2 , susceptibility disease
wernicke 's encephalopathy two patients acquired immunodeficiency syndrome two non alcoholic homosexual patients acquired immunodeficiency syndrome \( aids \) reported developed acute wernicke 's encephalopathy terminal stage illness first patient presented vascular congestion , minute , proliferation microglia vessel walls predilection sites wernicke process second patient bodies involved besides wernicke 's encephalopathy , primary cerebral cerebral toxoplasmosis found first patient , whereas second showed severe encephalitis numerous microglial multinucleated giant cells reacting positively anti hiv antibody development wernicke 's encephalopathy malignant diseases , catabolic trend metabolism immunodeficient patients consecutive thiamine deficiency must considered principal pathogenetic mechanism
prognostic factors aggressive malignant lymphomas description validation prognostic index could identify patients requiring intensive therapy des objectives study determine prognostic factors response treatment , freedom relapse \( ffr \) survival , overall survival aggressive malignant lymphoma patients treated doxorubicin , cyclophosphamide , , bleomycin , methylprednisolone , methotrexate leucovorin , ifosfamide , etoposide , , cytarabine \( 84 \) regimen construct prognostic index factors isolated multivariate analyses validate prognostic index another set patients complete response \( cr \) reached 75 84 patients , 30 relapsed median follow 36 months , median ffr survival median overall survival reached low serum albumin level , high tumoral mass , weight loss , bone marrow involvement , greater equal 2 extranodal sites , increased lactic dehydrogenase \( ldh \) level associated low response rate advanced stage , increased ldh level , cell histologic subtypes \( diffuse mixed , lymphoblastic , small non cleaved \) statistically associated high relapse rate short ffr survival increased ldh level , low serum albumin level , tumoral mass larger 10 cm , greater equal 2 extranodal sites , advanced stage , age older 65 years statistically associated short overall survival four parameters , namely , ldh level , stage , number extranodal sites , tumoral mass , put together construct prognostic index index 84 patients three subgroups good , intermediate , poor prognosis \( p less 00001 \) cr rates 93 , 83 , 61 relapse rates 12 , 25 , 45 3 year ffr survival 87 , 73 , 53 , 3 year survival 88 , 71 , 41 , respectively prognostic index applied test set patients 155 patients treated protocols lymphoma study group using index , patients 3 year ffr survival 70 , 40 , 22 \( p 0002 \) 3 year survival 79 , 52 , 31 \( p 005 \) patients aggressive lymphomas , simple prognostic index could distinguish patients requiring intensive treatment autologous bone marrow transplantation first complete remission could treated standard regimens
role dose intensity determining outcome intermediate grade non hodgkin 's lymphoma determine whether dose intensity chemotherapeutic regimens correlates complete remission rate adult patients advanced stage intermediate grade lymphoma , reports comparative trials therapy reviewed reports identified using medline , references review articles , review selected abstracts twenty two studies including 14 randomized eight cohort trials analyzed assess projected dose intensity four studies analyzed assess role received dose intensity dose intensities calculated using described methods correlated complete remission rates individual trials assessed using levels evidence randomized trials cross trial analysis comparative trials using weighted least linear regression performed using levels evidence , support obtained hypothesis dose intensity correlates remission rate two trials dose intensity indirectly tested studies directly test dose intensity , confounding variables , including arising assumptions made calculating dose intensity , cannot excluded showed relative probability achieving complete remission 1 34 \( 95 confidence interval , 1 13 1 58 \) favoring pooled arm high dose intensity cross trial analysis showed relatively weak association dose intensity remission rate \( r 49 , p 0001 \) two four reports retrospectively assessing received dose intensity suggested increased dose intensity associated superior remission rates analyses suggest dose intensity may correlate remission rate advanced stage intermediate grade lymphoma however , properly designed trials directly testing dose intensity performed needed confirm hypothesis
miller fisher syndrome systemic lupus erythematosus describe first case miller fisher syndrome , guillain barre variant , complicating systemic lupus erythematosus symptoms signs mimicked brainstem syndrome despite treatment high dose gamma globulin , patient worsened required mechanical ventilation plasma exchange , patient improved
effects vitro electrical stimulation enhancement suppression malignant lymphoma cell proliferation suppression enhancement proliferation mouse lymphoma cells varied significantly cells electrically stimulated within narrow range low level direct current use platinum electrodes , suppression characteristics observed narrow range , window , direct currents centered approximately 17 enhancement characteristics observed broad range low level direct currents \( approximately 0 1 10 \) results indicate proliferation certain eukaryotic cells may directly controlled stimulation low level direct current
common variable immunodeficiency disorder treatment case common variable immunodeficiency , relatively rare disorder , presented case complicated presence anti iga antibody patient 's serum history possible anaphylactic reaction prior intravenous infusion gamma globulin common variable immunodeficiency actually heterogeneous group demonstrable immunoglobulin deficiencies common low levels immunoglobulin isotypes , inability form antibodies antigen , absence gross defects cell mediated immunity , presence recurrent bacterial infections history immunoglobulin deficiency treatment reviewed although primary therapy common variable immunodeficiency gamma globulin replacement , ancillary measures early treatment infections antibiotics also important intravenous gamma globulin replacement therapy preferred intramuscular replacement therapy patients intramuscular doses must limited volume minimize local pain take 2 14 days achieve maximal blood levels , time situ degradation 50 administered dose occur five intravenous gamma globulin preparations currently available united states potential adverse effects intravenous gamma globulin infusion precautions currently taken ensure safety administration product discussed
broadly neutralizing antibodies elicited hypervariable neutralizing determinant hiv 1 published erratum appears science 1991 jan 4 251 \( \) 13 principal neutralizing determinant \( \) human immunodeficiency virus \( hiv \) 1 resides within v3 loop envelope protein antibodies elicited peptides region able neutralize diverse isolates serum one three animals immunized human cell lymphoma virus \( htlv \) peptide , , neutralized mn sequence divergent htlv iiib isolate serum one three animals immunized 13 amino acid iiib peptide \( \) also neutralized isolates characterization sera revealed cross neutralizing antibodies bound amino acid sequence \( \) present isolates sequence frequently found analyzed randomly selected hiv 1 isolates sera two rabbits immunized peptide containing residues neutralized divergent isolates , including iiib mn
clinical aspects multiple sclerosis north east scotland particular reference course prognosis prognosis course multiple sclerosis \( ms \) factors affect assessed group patients , representing unselected \( epidemiological \) sample observed north east \( region \) scotland period ranging 1 60 yrs 7 disease began age 20 yrs , 12 age 50 yrs , remainder onset ages 20 50 yrs male female ratio 1 1 8 mean disease duration observed death \( 216 patients \) 24 5 yrs , significant difference sexes prognosis assessed either interval onset death degree disability defined period time depending length follow , one quarter \( 26 \) one third \( 36 3 \) benign course 8 0 17 7 poor prognosis nearly third \( 32 8 \) relapsing cumulative \( 34 \) course 9 progressive course start several factors noted affect prognosis prognosis significantly better , independent sex , \( 1 \) early onset \( less 40 yrs age \) \( 2 \) brainstem lesion sensory symptoms alone onset \( 3 \) short duration initial symptoms \( less 6 months \) \( 4 \) long onset first relapse interval \( greater 1 yr \) \( 5 \) course beginning \( 6 \) lack family history ms factors predicted poor prognosis included \( 1 \) late onset \( greater 40 yrs age \) \( 2 \) progressive course start \( 3 \) multiple sites lesions initially , cerebellar spinal cord lesion onset \( 4 \) psychiatric persistent urinary symptoms onset within 10 yrs \( 5 \) persistent initial symptoms \( beyond 1 yr \) \( 6 \) early first relapse \( within 6 months \) \( 7 \) family history ms \( 8 \) social class status iv v \( 9 \) bilaterally prolonged visual evoked potential \( vep \) latency address childhood onset disease , changes csf ct brain scan predictive value
aids california family medicine changing experiences , knowledge , geographic distribution information regarding practice patterns specific acquired immunodeficiency syndrome \( aids \) obtained 1988 family physicians california using mail survey data analyzed across following county los angeles county , counties standard metropolitan statistical areas , counties outside standard metropolitan statistical areas comparisons made data telephone survey conducted 1986 differences time analyzed 1988 , percentage physicians treating referring patients possible aids doubled counties outside standard metropolitan statistical areas percentage physicians reporting one diagnosed cases aids tripled , finding suggests importance aids family medicine increasing rapid rate addition , survey results indicate majority surveyed still lack aids related knowledge competency necessary effectively deal aids
search retroviral sequences peripheral blood mononuclear cells brain tissue multiple sclerosis patients dnas peripheral blood mononuclear cells \( pbmcs \) 21 patients multiple sclerosis \( ms \) , 1 patient tropical spastic \( tsp \) well dnas brain spinal cord 5 ms cases 3 controls examined human cell lymphotropic virus \( htlv \) related sequences polymerase chain reaction primers used derived htlv gag , env tax genes amplified products separated gels , onto membranes hybridized specific oligonucleotides sensitivity amplification hybridization one copy target dna 10 \( 5 \) cellular genomes none specimens positive htlv sequences except tsp probe negative data significant brain material ms patients used studies studies thus fail support htlv involved aetiology multiple sclerosis
brain stem auditory evoked potentials multiple sclerosis relation vep , sep csf immunoglobulins one hundred patients multiple sclerosis \( ms \) analysed retrospectively respect investigations brain stem auditory evoked potentials \( baep \) , pattern reversal visual evoked potentials \( vep \) , somatosensory evoked potentials \( sep \) , cerebrospinal fluid immunoglobulins \( csf ig \) baep abnormal 42 normal vep sep examinations , 38 patients normal csf ig chance obtaining least one abnormal ep lower patients normal csf ig patients abnormal csf dispersion ratio included criteria baep abnormality , sensitivity increased compared conventional baep criteria recommend baep still included ep test battery patients suspected ms
vascularized bone marrow transplantation \( \) induction stable mixed cell chimerism transplantation tolerance unmodified recipients preliminary report , model across barrier consistently brings antigen specific host tolerance absence gvhd majority recipients immunologic radiologic intervention utilized results emphasized potentially important mechanism low level stable mixed lymphoid chimerism \( \) tolerance induction , independent immune suppressive effects due irradiation intervention
hiv risk behavior reduction following intervention key opinion population experimental analysis background purpose peer norms influence adoption behavior changes reduce risk hiv \( human immunodeficiency virus \) infection experimentally intervening community level modify risk behavior norms , may possible promote generalized reductions hiv risk practices within population methods trained persons reliably identified popular opinion among gay men small city serve behavior change peers opinion acquired social skills making talking frequently intervention , conducted surveys men gay intervention city two matched comparison cities results intervention city , proportion men engaged unprotected anal intercourse two month period decreased 36 9 percent 27 5 percent \( 25 percent baseline \) , reduction 27 1 percent 19 0 percent \( 30 percent baseline \) unprotected receptive anal intercourse relative baseline levels , 16 percent increase condom use anal intercourse 18 percent decrease proportion men one sexual partner little change observed among men comparison cities period time conclusions interventions employ peer change may produce accelerate population behavior changes lessen risk hiv infection
behavioral , health psychosocial factors risk hiv infection among sexually active homosexual men multicenter aids cohort study examined whether homosexual men engaged receptive anal intercourse particularly elevated risk seroconversion also possessed specific behavioral , health psychosocial vulnerability characteristics 11 potential factors examined , heavy drinking , moderate heavy drug use , younger age significantly related seroconversion variables also associated increased number sexual partners , anonymous sex , failure use condoms
sexual risk behaviors , aids knowledge , beliefs aids among sexual risk behaviors , knowledge acquired immunodeficiency syndrome \( aids \) , beliefs aids prevention examined among 126 previous 3 months , 65 percent sexually active among sexually active , males reported median 2 7 partners females reported 1 3 partners , 18 percent reported consistent condom use demonstrated moderately high aids knowledge beliefs aids prevention condom use abstinence directly related beliefs preventing aids
security measures aids hiv study describes measures taken aids surveillance across country ensure security information regarding patients aids hiv infection security measures evaluated according cumulative number aids cases reported , whether partner notification services provided , whether hiv seropositive reporting name also required study showed public health departments taken extra steps ensure security aids hiv data
anaphylactic anaesthetic reactions value paper radioallergosorbent tests ige antibodies muscle relaxants thiopentone three currently available paper radioallergosorbent tests \( , thiopentone \) evaluated radioallergosorbent test \( choline conjugated paper discs \) proved reliable detection allergy neuromuscular blockers , confirmed common cause anaphylactic reaction general anaesthesia thiopentone radioallergosorbent test may also useful , recommended conjunction radioallergosorbent test preliminary investigation reactions patients positive radioallergosorbent test usually require testing , including radioallergosorbent test , skin testing wide range drug concentrations leucocyte histamine release test
allergen induced asthmatic responses relationship increases airway responsiveness increases circulating eosinophils , basophils , progenitors inflammatory response allergen induced asthma assessed using serial measures peripheral blood eosinophils \( eo \) , basophils \( b \) , eo b progenitor cells \( eo b cfu \) group 14 stable asthmatic individuals \( beta 2 agonists needed \) inhalation provocation tests allergen \( 18 tests total \) serial blood samples taken 1 24 h tests cultures eo b cfu granulocyte macrophage \( gm cfu \) scored 14 days circulating eo , b , eo b cfu increased 24 h allergen inhalation resulted increased histamine airway responsiveness \( n 13 \) 5 subjects isolated early asthmatic responses eo , b , eo b cfu counts change change gm cfu allergen ratio change circulating eo b cfu negatively correlated baseline histamine airway responsiveness \( r 0 8 , p less 0 05 \) four subjects isolated early response blood changes one allergen developed increase histamine airway responsiveness increase eo , b , eo b progenitors inhalation second different allergen results indicate subjects allergen induced increase histamine airway responsiveness , inflammatory response occurs includes increase number eo b progenitors response , possibly mediated eo b growth differentiation factors , could lead accumulation cells airway contribute airways inflammation present asthma
asthma elderly comparison patients recently acquired long standing disease characterize asthma elderly , 25 consecutive nonsmoking pulmonary clinic patients age 70 met american thoracic society criteria asthma identified , 12 patients \( 48 \) developed asthma advanced age \( greater 65 yr \) group late onset asthma mean duration disease 5 1 2 5 yr remaining group early onset asthma mean duration illness 31 4 14 6 yr day evaluation patient underwent pulmonary function testing medication least 12 h two groups indistinguishable symptoms medication requirements immediate hypersensitivity skin testing 43 uniformly negative 25 patients histamine control always positive ige levels groups different elderly control subjects early onset asthma greater likelihood previous allergic disease \( p less 0 001 \) significantly greater degree airflow obstruction pre pulmonary function testing \( p less 0 05 \) study suggests long standing asthma may lead chronic persistent airflow obstruction thereby mimic chronic bronchitis emphysema \( copd \)
inhalation alkaline aerosol subjects mild asthma result bronchoconstriction although recognized inhalation acid aerosols subjects asthma cause bronchoconstriction , effects inhalation alkaline aerosol unknown supplemental restraints \( automobile air bags \) alkaline aerosol released aerosol composed particles sodium carbonate sodium bicarbonate sodium mass median diameter \( \) aerosol approximately 1 micron , ph aerosol 9 8 10 3 group 14 volunteer male subjects mild asthma inhaled increasing concentrations aerosol 20 min periods mouth tidal ventilation pulmonary function tests performed baseline \( preexposure \) , inhalation room air alone \( control \) , period inhalation aerosol total 5 subjects inhaled aerosols nominal concentrations 10 , 20 , 40 mg m3 , whereas 11 subjects inhaled aerosols concentrations approximately 30 , 60 , 120 mg m3 mean changes fev1 specific airways resistance \( \) 11 subjects inhaled higher concentrations \( average highest concentration 126 6 7 5 mg m3 , mean sem \) 1 4 1 9 17 5 8 5 , respectively neither change lung function clinically statistically significant conclude inhalation relatively high concentrations alkaline aerosol subjects mild asthma result bronchoconstriction
respiratory membrane permeability bronchial hyperreactivity patients stable asthma effects therapy inhaled steroids patients stable asthma , assayed plasma proteins bronchoalveolar lavage fluid obtain information plasma airways fourteen nonsmoking patients asthma stable period disease eight nonsmoking healthy volunteers studied ratios concentrations albumin , ceruloplasmin \( cp \) , alpha 2 \( \) blood epithelial lining fluid calculated \( , , \) increased patients \( u test , p less 0 05 \) 10 patients bronchial hyperreactivity assessed histamine provocation tests significant relationships , , one hand hand found \( 's rank correlation r 0 62 , p less 0 05 r 0 61 , p less 0 05 r 0 79 , p less 0 01 , respectively \) fourteen patients treated two inhalations 200 micrograms per day 3 month prospective study three excluded study intercurrent exacerbation asthmatic symptoms therapy 11 patients stable asthma , decreased treatment inhaled steroids \( wilcoxon 's matched pairs signed rank test , p less 0 03 \) results show patients stable asthma , increased plasma airways , likely caused increased respiratory membrane permeability plasma correlated bronchial hyperreactivity histamine , decreased corticosteroid therapy
abnormalities airway smooth muscle fatal asthma comparison trachea bronchus tracheal smooth muscle seven cases fatal asthma demonstrated increased contractile response histamine , acetylcholine , electrical stimulation intrinsic cholinergic nerves impaired relaxation isoproterenol , possibly theophylline , also evident \( 1 \) fourth generation bronchial patients also studied , results compared trachea normal bronchi \( n 5 \) contrast trachea , contractile responses asthmatic bronchi acetylcholine , histamine , cholinergic nerve stimulation similar control bronchi potency \( ic50 \) reduced 9 4 fold \( p less 0 003 \) , similar trachea \( 4 5 fold \) , whereas theophylline responses normal discrepant results obtained may reflect differences disease process , including rates postmortem change , two anatomic sites
lack evidence beta 2 receptor selectivity study metaproterenol , fenoterol , isoproterenol , epinephrine patients asthma order investigate pharmacodynamic selectivity number beta receptor agonists currently used asthma , compared pulmonary effects repeated inhalations epinephrine , fenoterol , isoproterenol , metaproterenol 12 patients asthma randomized double blind crossover study drugs administered metered dose 15 min intervals five doses \( total dose , 10 compound \) measurements heart rate , blood pressure , total systole \( measure inotropic response \) , qtc interval , plasma potassium , fev1 made 5 min dose 30 min final dose fenoterol metaproterenol significantly greater inotropic , electrocardiographic , chronotropic , hypokalemic effects isoproterenol epinephrine difference effect metaproterenol , fenoterol , isoproterenol although agents caused significantly greater increase fev1 epinephrine concept increasing beta 2 selectivity metaproterenol fenoterol compared isoproterenol supported clinical setting
ige mediated anaphylactic degranulation isolated human skin mast cells isolated human skin mast cells \( hsmc \) prepared cultured overnight functional electron microscopic studies mast cell suspensions examined stimulation anti ige produce anaphylactic degranulation examined buffer incubated controls histamine release measured replicate samples control , isolated hsmc studied electron microscopy well preserved fully although granule patterns reported human mast cells found , crystal granules prevalent , true hsmc situ individual mast cells containing crystal granules occurred lipid bodies rare , hsmc situ control , isolated mast cells express granule changes associated either degranulation recovery wound healing situ morphologic changes anaphylactic degranulation present spontaneous histamine release 0 control samples anaphylactic degranulation isolated hsmc accompanied 24 maximum histamine release characteristically showed extrusion altered , membrane free granules multiple plasma membrane cell morphologic aspects anaphylactic degranulation , expressed isolated human lung mast cells , also present events included granule swelling , fusion , alteration matrix contents , degranulation channel formation , pore formation , granules , membranes , surface processes ultrastructural morphology isolated hsmc ige mediated degranulation shows differences similar studies isolated human lung mast cells human lung gut mast cells biopsy samples differences include crystal granules predominant granule pattern , minor numbers lipid bodies , extrusion granules anaphylactic degranulation characteristic hsmc contrast , isolated human lung gut mast cells granules particle granules , respectively , lipid bodies isolated human lung mast cells , anaphylactic degranulation almost exclusively intracellular fusion event characterized formation complex degranulation channels within altered granule matrix materials addition morphologic differences mast cells skin , lung , gut origin , functional differences also reported among mast cells organs ultrastructural morphology isolated hsmc identical skin mast cells biopsy samples , thereby usefulness new source hsmc correlative functional morphologic studies
evidence graft versus lymphoma effect associated allogeneic bone marrow transplantation existence immunologic reaction associated allogeneic bone marrow transplantation \( bmt \) well established however , similar graft versus tumor effect lymphomas demonstrated analyzed results bmt 118 consecutive patients relapsed hodgkin 's disease aggressive non hodgkin 's lymphoma 38 patients less 50 years age hla matched donors marrow transplants , 80 patients received purged autologous grafts median age 26 years allogeneic autologous graft recipients patient 's response conventional salvage therapy transplant factor influenced event free survival bmt \( p less 001 \) patient 's response salvage therapy bmt \( p less 001 \) type graft \( p 02 \) significantly influenced probability relapse bmt actuarial probability relapse patients responded conventional salvage therapy bmt 18 bmt compared 46 autologous bmt however , actuarial probability event free survival 4 years , 47 versus 41 , patients responsive lymphomas received allogeneic autologous transplants , respectively \( p 8 \) beneficial antitumor effect allogeneic bmt offset higher transplant related mortality \( p 01 \) , largely resulting graft versus host disease allogeneic bmt appears induce clinically significant graft versus lymphoma effect magnitude effect similar reported leukemias
clinical assessment spondylitis study observer variation spinal measurements twenty two measurements repeated non sequentially 10 patients five observers undertaken determine reliability routine clinical use measurements without significant inter observer variation coefficient reliability greater 0 70 cervical rotation , cervical lateral flexion , wall distance , floor distance sagittal lateral flexion , c7 iliac crest line distraction modified index concluded many currently used measurements either statistically unreliable clinically mild moderate spondylitis clinically useful cervical rotation using , cervical lateral flexion using , thoracolumbar flexion c7 iliac crest line distraction , thoracolumbar lateral flexion floor distance modified index
, immunocytochemical , nucleic acid flow cytometric study 50 lymph nodes fine needle aspiration comparison results obtained subsequent excisional biopsy fifty patients clinically suspected previous diagnosis lymphoma underwent fine needle aspiration \( fna \) subsequent excisional biopsy lymph nodes results cytologic diagnosis made direct smears conjunction immunocytochemical study preparations nucleic acid flow cytometric study \( fcm \) compared results obtained histologic sections , cryostat immunohistochemical study , nucleic acid fcm performed resected lymph nodes study demonstrates \( 1 \) results immunocytochemical dna fcm analysis fna derived material comparable majority cases obtained surgical specimens , \( 2 \) immunostaining preparations immunoglobulin \( ig \) gives less background staining certain cases easier interpret performed frozen sections , \( 3 \) fna conjunction study 100 specific lymphoma , staining ig exclude hd , cell lymphoma , b cell malignancy focally involving lymph node
fludarabine therapy hairy cell leukemia study evaluated efficacy fludarabine , new adenine nucleoside analogue , typical variant forms hairy cell leukemia \( hcl \) two patients hcl one patient variant form hcl \( hcl variant \) resistant progressive disease prior treatments studied fludarabine \( 30 mg m2 \) administered intravenously 30 minutes daily 5 days every month two patients \( one hcl one hcl variant \) achieved partial responses third patient minor response first report encouraging activity fludarabine typical variant forms hcl experience fludarabine disorders indicated
human immunodeficiency virus infected macrophages produce soluble factors cause histological neurochemical alterations cultured human brains wanted establish vitro human model aids associated dementia hypothesis disease process may result soluble factors produced hiv infected macrophages human brain aggregates prepared nine different brain specimens , treated supernatants vitro hiv infected macrophages \( si \) , uninfected macrophages \( \) , infected cells , macrophage conditioned media four aids patients seven nine treated brains exposed si showed peripheral 1 wk incubation ultrastructural analysis showed cytoplasmic aggregates two three brain cultures treated si 3 wk became smaller , approximately 50 decrease size degree apparent toxicity brains exposed patient derived macrophage supernatants paralleled proportion macrophages found expressing hiv p24 ultrastructural abnormalities observed brains treated supernatants hiv infected cells , uninfected macrophages , lps activated macrophages levels five neurotransmitter amino acids decreased comparison structural amino acid leucine findings suggest hiv infected macrophages , infected vitro well derived aids patients' peripheral blood , produce factors cause reproducible histochemical , ultrastructural , functional abnormalities human brain aggregates
limited b cell repertoire severe combined immunodeficient mice peripheral blood mononuclear cells derived immunodeficient normal humans ability human pbmc fetal tissue immune cells severe combined immunodeficient \( scid \) mouse created need characterization systems application disease models demonstrate scid mice reconstituted pbmc support growth differentiation restricted set b cells human igg levels 1 2 mg ml \( 10 20 normal human serum levels \) routinely achieved spite serum half life 12 ig levels peaked around 50 ig production maintained greater 100 ig greater 85 igg though igm , iga , , even ige could detected however , human igg produced hu pbl scid mice clonal analyzed isoelectric focusing kappa lambda light chain usage using new polymerase chain reaction based analysis capable monitoring individual vh family utilization , found b cells showed skewed restricted human vh utilization parameters markedly variable among hu pbl scid mice reconstituted donor cell population early \( 21 50 \) late stages \( greater 100 \) hu pbl scid mice constructed cells patients common variable immunodeficiency vitro block terminal b cell differentiation produced human ig responses quantitatively produced hu pbl scid mice normal donors hu pbl scid system using pbmc appears lead growth ig production small number b cells results restricted b cell repertoire
effect thromboxane a2 receptor antagonist \( aa 2414 \) bronchial hyperresponsiveness methacholine subjects asthma bronchial hyperresponsiveness \( bhr \) various stimuli one major clinical features bronchial asthma study , effect thromboxane a2 \( txa2 \) receptor antagonist , aa 2414 , bhr methacholine evaluated 15 patients asthma methacholine inhalation test performed oral administration aa 2414 4 days \( 20 40 mg day \) provocative concentration methacholine producing 20 fall fev1 \( pc20 \) measured index bhr significant increase pc20 \( p less 0 01 \) 0 43 \( geometric sem , 1 42 \) mg ml 0 93 \( geometric sem , 1 43 \) mg ml 40 mg day aa 2414 , whereas baseline values fvc fev1 changed treatment twenty per day aa 2414 alter pc20 value parameter baseline pulmonary functions findings might support hypothesis concentration txa2 bronchial tissues , effect tone per se , may involved bhr asthma studies potent specific txa2 receptor antagonists needed confirm conclusion
secretion granule proteins eosinophils neutrophils increased asthma activity eosinophil neutrophil granulocytes respect secretion granule proteins studied 30 patients asthma varying severity disease granulocytes stimulated serum sephadex particles , released amount eosinophil cationic protein \( \) , eosinophil protein x \( \) , myeloperoxidase measured means specific radioimmunoassays eosinophils patients asthma released significantly \( p less 0 001 \) 20 minutes incubation cells control subjects without asthma release myeloperoxidase neutrophils also somewhat higher \( p less 0 03 \) serum concentrations also significantly increased \( p less 0 001 \) group asthma significant relationships found clinical variables secretory activity either eosinophils neutrophils conclude eosinophils , extent , neutrophils subjects asthma increased propensity release granule proteins , suggest consequence priming cells
food dependent , exercise induced anaphylaxis study 11 japanese cases eleven patients food dependent , exercise induced anaphylaxis studied seven patients experienced anaphylactic symptoms eating certain foods , , wheat , exercise remaining four patients , specific food could identified , act eating predisposed anaphylaxis anaphylactic symptoms clearly distinguished cholinergic urticaria history patients developed anaphylactic symptoms 20 years age \( n 7 \) atopic atopic first degree relatives six patients increased serum ige levels , ige antibodies causative food allergens detected skin prick test rast four cases contrast , patients developed symptoms 30 years age \( n 4 \) appeared less atopic background , ige levels within normal range except one case three four patients latter group developed symptoms ingesting food made wheat followed exercise patients sensitive wheat determined skin prick test six 11 patients , considerable rise plasma histamine concentration observed exercise challenge treadmill alone , food intake followed exercise induced increase one patient
modern haemophilia treatment medical improvements quality life adequate replacement therapy haemophilia available two decades led considerable improvements life expectancy physical status haemophilia patients study conducted investigate whether also led improvements quality life aim , information obtained dutch mailed questionnaires relationships , marriage , family life employment haemophilia patients less often married men general population \( 13 fewer \) lower total number children \( 30 lower , 17 married \) twenty two per cent patients employed received income disability severity haemophilia , joint damage age increased risk disability , noted home treatment associated 50 reduction risk remarkably , haemophilia patients differ general population view quality health results study show positive influence modern haemophilia treatment quality life present , aids feelings one may field however , results described demonstrate benefits achieved adequate replacement therapy , justify expectation improvements near future
mri guided brain biopsy neurologically symptomatic aids patients two patients aids related neurologic dysfunction evaluated computed tomographic \( ct \) brain scans magnetic resonance imaging \( mri \) ct scans essentially normal patients mri revealed focal lesions amenable brain biopsy using newly developed instrumentation , mri guided brain biopsy performed without complication benefits impact new technology care neurologically symptomatic aids patients discussed
multicenter proficiency trial gene amplification \( pcr \) detection hiv 1 sensitivity specificity polymerase chain reaction \( pcr \) detection hiv 1 proviral dna determined five laboratories extensive experience pcr testing five panels consisting 105 hiv 1 seronegative specimens regularly blood donors risk factors hiv infection 99 hiv 1 seropositive culture positive specimens cohort homosexual bisexual men sent code laboratory amplification procedures testing algorithms specimens judged positive , negative , indeterminate varied laboratories average sensitivity five laboratories 99 0 , two laboratories achieving 100 average specificity 94 7 , varying 90 5 100 overall false positive rate 1 8 , false negative rate 0 8 , indeterminate rate 1 9 1 , 005 determinations made five laboratories , 32 \( 3 2 \) classification errors occurred specimens uninfected individuals distributed among laboratories way indicate laboratory error rather inherent reactivity samples emphasizes need standardization pcr testing caution interpreting positive pcr reactions hiv 1 seronegative persons
serial cd4 lymphocyte counts development aids low cd4 lymphocyte counts associated increased risk progression aids human immunodeficiency virus \( hiv \) infection investigated extent timing progression aids explained solely terms decline cd4 lymphocyte count 111 followed 11 years since infection hiv median 10 cd4 lymphocyte counts made per patient applying simple linear model decline cd4 lymphocyte counts time , estimated date development aids 96 patients least 5 determinations 84 \( 81 96 \) patients correctly classified development aids jan 1 , 1990 \( p less 0 0001 \) , model results suggest differences time patients hiv progress aids largely explained differences rates decline cd4 lymphocyte counts
canadian cooperative trial cyclophosphamide plasma exchange progressive multiple sclerosis canadian cooperative multiple sclerosis study group find whether non specific immunosuppression beneficial multiple sclerosis \( ms \) randomised , placebo controlled , single masked trial carried nine university centres 168 patients clinically laboratory supported definite ms progressive phase \( deterioration least 1 0 expanded disability status scale edss previous year \) randomised receive intravenous cyclophosphamide oral prednisone \( n 55 \) daily oral cyclophosphamide , alternate day prednisone \( 22 weeks \) , weekly plasma exchange \( 20 weeks \) \( n 57 \) placebo medications sham plasma exchange \( n 56 \) patients followed least 12 months \( mean 30 4 months \) monitoring neurologist , aware treatment allocation , evaluating neurologist , primary analysis comparison rates treatment failure \( worsening evaluating neurologist 's assessment edss 1 0 two consecutive 6 monthly assessments \) significant differences among groups primary analysis \( 19 35 treatment failures cyclophosphamide 18 32 plasma exchange 16 29 placebo \) differences proportions improved , , worsened 6 month assessment mean change edss final assessment \( 0 81 cyclophosphamide 0 69 plasma exchange 0 69 placebo \) slight trend plasma exchange group 12 24 months follow sustained final assessment study fails confirm previous reports immunosuppressive treatments result improvement progressive ms
unusual amyloid polyneuropathy predominant lumbosacral nerve roots plexus involvement report 25 year old patient progressive asymmetric peripheral neuropathy distal lower limbs imaging studies showed enlargement lumbosacral roots , plexus , proximal sciatic nerve sacral plexus biopsy revealed amyloidosis associated edema immunohistochemistry anti , serum amyloid , immunoglobulin light chain antisera failed label amyloid
21 inhibits stimulated monocyte hydrogen peroxide chemiluminescence measurements ms patients controls monocytes recruited active sites multiple sclerosis \( ms \) demyelination may promote local tissue injury generating inflammatory response , mediated part production toxic oxygen metabolites corticosteroids frequently effectively used ameliorate ms exacerbations , despite inadequate knowledge mechanism assessed effects 21 , , new class steroid derivatives without glucocorticoid mineralocorticoid effects , production hydrogen peroxide \( h2o2 \) chemiluminescence stimulated monocytes harvested 8 stable ms patients age sex matched controls h2o2 measurements chemiluminescence significantly reduced groups results demonstrate 21 reduce production toxic oxygen metabolites monocytes thus inflammatory potential , suggesting agents may potentially effective safe treatment ms exacerbations
human immunodeficiency virus infected multinucleated histiocytes oropharyngeal lymphoid tissues two asymptomatic patients human immunodeficiency virus \( hiv \) infected multinucleated giant cells previously detected central nervous system hiv positive patients reported first cases infected cells observed outside central nervous system , oropharyngeal lymphoid tissues removed individually two asymptomatic homosexual men follicular hyperplasia many multinucleated giant cells often contact close proximity mucous membrane seen latter positive lysozyme , alpha 1 anti chymotrypsin , , 100 protein accordance origin situ hybridization hiv envelope specific rna probe demonstrated presence viral rna multinucleated giant cells findings support role peripheral histiocytes primary virus reservoir early disease also potential role oropharyngeal tissue primary target cases
early cellular events evolving cutaneous delayed hypersensitivity humans delayed type hypersensitivity reaction \( \) human skin many inflammatory dermatoses however cellular events precede gross lesion formation unknown study , inflammatory cell populations adhesion molecule expression early phases elicited 2 , 4 evaluated first event \( 1 hour \) mast cell degranulation , followed induction endothelial leukocyte adhesion molecule \( elam 1 \) expression dermal postcapillary venules 2 hours endothelial leukocyte adhesion molecule expression peaked 24 hours declined 48 hours contrast , endothelial expression intercellular adhesion molecule 1 \( icam 1 \) remained constitutive levels cell migration occurred independent icam 1 expression early 4 hours challenge mature , activated cd4 positive lymphocytes expressed helper inducer memory phenotype predominated early lesions results demonstrate vivo mast cell degranulation , elam 1 expression , memory cell follicular interactions key events subclinical evolutionary stages cutaneous
lack benefit methotrexate severe , steroid dependent asthma double blind , placebo controlled study objective determine effect low dose methotrexate asthmatic patients steroid use , asthma symptom scores , pulmonary function , airway reactivity , blood cellular components , immunoglobulin e levels design randomized , double blind , parallel , placebo controlled , 13 week clinical trial follow patients open trial methotrexate conclusion double blind study setting asthma care outpatient clinic patients february 1988 march 1990 , 19 patients severe , steroid dependent asthma enrolled study two patients excluded analysis interventions patients administered methotrexate placebo intramuscularly , assure complete absorption , weekly 13 week study results patients methotrexate placebo significantly decreased steroid dose 39 6 \( 95 ci , 25 1 54 1 , p 0 001 \) 40 2 \( ci , 17 9 67 4 , p 0 003 \) , respectively pulmonary function differ significantly methotrexate placebo groups addition , airway reactivity symptom scores unchanged methotrexate placebo significant toxicities seen course 13 week blinded study , one patient methotrexate prednisone follow period developed pneumocystis carinii pneumonia died despite continuing methotrexate 1 year , increasing methotrexate 30 mg weekly , significant benefit methotrexate asthma control could shown conclusion study support use methotrexate treatment severe asthma
treatment multiple sclerosis hyperbaric oxygen results national registry three hundred twelve patients entered long term study effects hyperbaric oxygen multiple sclerosis protocol called initial 20 treatments either chamber daily basis followed monthly booster treatments 2 years one hundred seventy neurologists 22 institutions provided data study control group , study based 's scientifically valid study test efficacy new therapy possible choosing patients diagnosed multiple sclerosis following 2 years imposed treatment overwhelming majority subjects failed get worse 2 year observation period , efficacy treatment would manifest expanded kurtzke disability status scale \( edss \) used assess severity disease state dropout rate high 76 \( 237 312 patients \) initial 20 treatments twenty two percent \( 69 312 \) 1 year booster therapy , 9 \( 28 312 \) completed 2 years monthly mean deterioration kurtzke edss score 0 93 almost full step beginning treatment last evaluation difference outcome shortest longest periods time onset symptoms hyperbaric oxygen treatment treatment pressure made difference outcome changes kurtzke edss score bore relationship use booster treatment patients reasonably well onset treatment initial kurtzke edss scores 1 2 \( n 21 \) deteriorated average 1 7 kurtzke points patients whose initial kurtzke edss scores greater 2 \( n 164 \) deteriorated average 0 82 points interest 19 5 \( 39 200 \) patients reported temporary improvement bladder function , improvement maintained 11 patients \( 5 5 \) 2 year follow fifteen patients \( 7 5 \) indicated long term worsening significant change working status patients following hyperbaric oxygen treatment although study treated patients accordance protocols reported produce benefit multiple sclerosis , unable substantiate useful long term effect hyperbaric oxygen therapy
prevalence hiv 1 infection region population based study population based survey carried region united republic 1987 determine magnitude hiv 1 infection study associated risk factors region divided one urban three rural zones multistage cluster sampling technique adopted antibodies hiv 1 determined enzyme linked immunosorbent assay confirmed western blot analysis total 2 , adults \( aged 15 54 years \) 1 , children \( aged 0 14 years \) studied overall prevalence hiv 1 infection among adults 9 6 , higher prevalence urban zone \( 24 2 \) three rural zones \( 10 0 , 4 5 0 4 , respectively \) corresponding figures children 1 3 overall 3 9 urban area rural areas 1 2 , 0 8 0 0 , respectively age specific seroprevalence adults highest age group 25 34 years age standardized sex specific prevalence higher among women men urban zone , rural zones change sexual partners among adults associated increased risk hiv 1 seropositivity outside region within country also found associated increased risk hiv 1 infection rural population
evolutionary dynamics hiv 1 development immunodeficiency disease paper presents theory explain development immunodeficiency disease long variable incubation period infection hiv 1 two assumptions central theory \( 1 \) mutation via reverse transcription viral replication generate viral strains resistant neutralization antibodies specific earlier mutants particular host \( 2 \) virus kill cd4 positive lymphocytes play role immunological attack directed virus theory examined via development mathematical model reveals increasing number antigenically distinct viral strains may immune system host viral diversity increases beyond certain level immune system unable suppress population growth strains simultaneously explanation pattern model behaviour lies assumption virus kill cd4 positive lymphocytes specific viral strains , lymphocyte immunological attack single viral strain
cohort study 89 hiv 1 infected adult patients contaminated blood products 1981 1989 du en \( \) published erratum appears aids 1991 mar 5 \( 3 \) 354 hospital based surveillance hiv infection implemented regional university hospital \( france \) reporting system , initiated du en , identified followed 89 adult patients transfusion associated hiv 1 infection \( 7 2 reported cases \) contamination occurred august 1981 june 1985 diagnosis made 1985 1989 30 june 1990 , 43 patients \( 48 3 \) full blown aids , 28 died mean follow period 66 months \( 16 months \) mean incubation period , e time interval contaminating transfusion development full blown aids , 62 months median 73 months 95 confidence interval \( ci \) 66 82 months five years contamination , cumulative probability reaching aids stage 34 2 \( 95 ci 20 3 49 3 \) , probability survival 81 7 \( 95 ci 72 5 90 0 \) surveillance system estimate south western france end 1989 cumulative incidence transfusion associated hiv 1 infection least 126 cases \( 45 6 per million \) although anticipate increase transfusion associated aids cases next 5 years , reports contamination 1 august 1985 , systematic screening hiv antibodies implemented french blood banks confirms efficacy screening countries like france risk contamination blood products minimal
recombinant human granulocyte macrophage colony stimulating factor combination standard induction chemotherapy de novo acute myeloid leukemia based vitro data suggesting recombinant human granulocyte macrophage colony stimulating factor \( rhgm csf \) capable stimulating acute myeloid leukemia \( aml \) blast cells become sensitive cell cycle specific drugs conducted phase ii study de novo aml patients \( pts \) rhgm csf \( 250 micrograms m2 , continuous intravenous infusion \) administered 18 pts suffering de novo aml combination standard induction chemotherapy \( 3 7 daunorubicin 45 mg m2 days 1 3 , cytosine arabinoside ara c 200 mg m2 continuous infusion days 1 7 \) gm csf started 48 24 hours chemotherapy \( \) 14 pts four pts high white blood cell counts \( wbc \) rhgm csf started chemotherapy induced cell reduction \( wbc less 30 , 000 mm3 \) gm csf induced increase neutrophil blast cell counts 13 14 10 14 pts , respectively vivo recruitment leukemic cells drug sensitive phases cell cycle could demonstrated cell cycle analyses peripheral blood \( n 7 \) bone marrow \( n 4 \) specimens day 14 , complete aplasia evident 17 18 pts gm csf administered recovery chemotherapy induced myelosuppression \( absolute neutrophil counts , greater 500 mm3 \) fifteen pts \( 83 \) achieved complete remission , 12 one cycle shorter duration neutropenia evident pts compared historical controls \( n 39 \) , \( greater 500 mm3 , day 22 5 3 4 v 25 2 3 7 , p less 05 \) three pts achieved complete remission second cycle \( combination rhgm csf 3 7 \) two pts died bone marrow aplasia invasive pulmonary aspergillosis clinical side effects possibly related gm csf , mainly fever , diarrhea , weight gain mild tolerable \( world health organization toxicity grade less equal 2 \) together , rhgm csf recruits aml cells vivo enter drug sensitive phases cell cycle promotes early myeloid recovery aplasia exposure standard induction chemotherapy aml
expression c fgr hck protein tyrosine kinases acute myeloid leukemic blasts associated early commitment differentiation events monocytic granulocytic lineages two members src proto oncogene family intracellular tyrosine kinases , c fgr hck , selectively expressed differentiated myeloid cells study expression genes acute myeloid leukemia \( aml \) determine specific myeloid lineages stages myeloid differentiation expression genes acquired , used series 79 cases de novo aml differentiation model levels c fgr , hck , c fms \( encoding colony stimulating factor 1 receptor \) mrna transcripts correlated presence specific cell surface antigens morphologic cytochemical features aml blasts relatively undifferentiated leukemic hla dr , cd34 , cd33 , cd13 cell surface immunophenotype \( french american british fab m1 m2 \) characterized lack c fms c fgr expression , low levels c fms c fgr could detected undifferentiated \( fab m1 m2 \) , also expressed cd14 low antigen density hck transcripts either undetectable cells expressed low levels contrast , hck mrna transcripts could identified blasts morphology \( fab m3 \) , c fms , c fgr , hck expressed high levels blasts differentiated myelomonocytic monocytic features \( fab m4 \) c fms , c fgr , hck transcripts evident leukemic cells erythroid lineage \( fab \) undifferentiated leukemic \( hla dr , cd34 , cd33 \) induced differentiate vitro cells monocytic characteristics , expression c fms , c fgr , cd14 cell surface antigen induced high levels , accompanied acquisition hck cd13 expression contrast , hla dr , cd34 , cd33 blasts induced differentiate vitro cells granulocytic characteristics , hck cd13 expression induced data suggest acquisition c fgr hck expression associated early commitment differentiation events distinct myeloid lineages assessment expression kinases may provide molecular tool lineage aml conjunction morphology , , cell surface antigen expression
macrophage colony stimulating factor \( csf 1 \) gene expression human lymphocyte clones macrophage colony stimulating factor \( csf 1 \) one several cytokines control differentiation , survival , proliferation monocytes macrophages set 11 human cell clones , chosen phenotypic diversity , tested ability express csf 1 mrna 5 hours stimulation phorbol myristate acetate \( pma \) calcium ionophore \( cal \) , cell clones expressed major 4 kb transcript , less abundant 2 kb transcript , several minor species pattern expression typical csf 1 mrnas furthermore , two cell clones analyzed , one showed definitive message csf 1 specific antigenic stimulation , delayed kinetics less efficiency conditions stimulation induced release csf 1 protein cells culture medium together , findings demonstrate first time normal cells able produce csf 1 , previous reports limited two cases tumoral cells cell lineage
loss interferon antibodies prolonged continuous interferon alpha 2a therapy hairy cell leukemia although highly active hairy cell leukemia \( hcl \) , interferons \( ifn \) curative disease current data indicate prolonged ifn therapy necessary control disease majority patients previously observed acquired ifn resistance association neutralizing ifn alpha 2a antibodies small numbers patients hcl finding suggests requisite long term therapy may compromised increasing incidence time neutralizing antibodies performed follow study ifn antibodies patients receiving continuous ifn therapy 16 patients previously antibody negative remained surprisingly , nine patients previously non neutralizing ifn antibodies became antibody negative median 14 5 months moreover , 3 10 patients neutralizing antibodies became antibody negative five non neutralizing antibodies median 10 months time neutralizing antibody first detected two patients persisting neutralizing antibodies inhibition neopterin synthesis , inhibition generation 2' , 5' synthetase activity , inability detect ifn serum subcutaneous injection ifn alpha 2a observed one patient tested neutralizing ifn antibodies confirming antibodies functional significance vivo conclude , although neutralizing ifn antibodies inhibit effectiveness ifn vivo , antibodies produced transiently long term therapy long term effectiveness drug likely affected patients neutralizing antibody
effect tamoxifen cell lines displaying multidrug resistant phenotype examined effect tamoxifen \( tmx \) , verapamil , daunorubicin \( dnr \) two cell lines displayed multidrug resistant \( \) phenotype used laser flow cytometry quantitate intracellular dnr content vinblastine resistant human lymphoblastic lymphoma cell line cem , simultaneous incubation dnr tmx 10 mumol l tmx 50 mumol l increased intracellular dnr fluorescence dose dependent manner demonstrated uptake pattern similar seen dnr verapamil similar results obtained vincristine resistant human myeloid leukemia cell line hl 60 rv cellular retention dnr also measured cell lines results suggested continuous exposure cells tmx resulted higher intracellular dnr content compared cells fresh medium effect tmx verapamil observed drug sensitive parent cell lines cem hl 60 clonogenic experiments performed determine whether tmx inhibitory cell growth whether tmx potentiated dnr cytotoxicity tmx 10 mumol l significantly inhibit either cem hl 60 rv cells 3 hour exposure followed culture tmx 50 mumol l significantly inhibitory cell lines however , cells incubated dnr tmx 10 mumol l demonstrated marked increment growth inhibition compared cells incubated dnr alone tmx 10 mumol l alone based data presented , suggest clinical testing tmx dnr pursued setting may play role
rapid simultaneous detection multiple retroviral dna sequences using polymerase chain reaction capillary dna chromatography polymerase chain reaction \( pcr \) technique powerful new tool target dna , thus allowing sensitive detection specific nucleic acid sequences one important potential use pcr involves screening donated blood supply transfusion transmitted viruses goal limited \( 1 \) requirement multiple , discrete pcr reactions detect target sequences one virus , \( 2 \) lack rapid , means specific detection one pcr amplified products report simultaneous amplification three distinct target sequences without loss sensitivity toward single target sequence also demonstrate rapid separation detection pcr amplified viral dna use automated capillary dna chromatography amplified dna peaks initially identified scanning capillary effluent ultraviolet wavelengths , discrimination human immunodeficiency virus type 1 human cell leukemic virus type pcr amplified dna accomplished use virus specific , labeled primers probes results indicate progress toward automated system screening blood supply nucleic acid sequences multiple pathogens
detection early human cell lymphotropic virus type antibody patterns seroconversion among transfusion recipients cohort human cell lymphotropic virus type \( htlv \) exposed transfusion recipients \( n 71 \) enrolled transfusion study , 11 selected detailed laboratory evaluation recipients followed monthly intervals 6 months bimonthly 1 year evidence htlv seroconversion without regard results screening assays , posttransfusion samples tested two licensed htlv 1 whole virus screening enzyme immunoassays \( \) , recombinant antibody tax \( \) envelope , standard whole virus western blot \( wb \) , wb enhanced recombinant , assay \( \) early period posttransfusion , antibody gag core protein predominant anti p24 generally appearing anti recombinant anti envelope protein , eia wb , frequently earliest envelope reactivity detected , anti gp46 wb anti 68 system appeared later anti tax antibodies appeared later time course seroconversion whole virus less sensitive confirmatory assays combination wb wb enhanced recombinant appeared equally effective confirming samples positive public health service two gene group confirmatory algorithm however , specificity assay approach could addressed study
reduction budesonide year increased use randomized controlled trial evaluate whether improvements airway responsiveness clinical asthma maintained demonstrated recently 1 year regular inhaled budesonide use produce substantial improvements airway responsiveness accompanied significant improvements clinical asthma severity present study designed evaluate whether improvements maintained dose budesonide reduced end original study , 28 subjects asthma , active treatment arm study randomized either continue taking dose budesonide taken original study dose reduced airway responsiveness methacholine , bronchodilator requirements , symptoms , spirometry assessed 6 weeks 3 months 3 months , subject experienced asthma exacerbation , evidence change airway responsiveness subjects steroids reduced \( provocative concentration causing 20 drop fev1 initial , 2 03 mg ml final , 1 91 mg ml \) , change different change subjects maintained higher dose \( initial , 3 02 mg ml final , 3 12 mg ml \) \( p 0 39 \) similarly , evidence change bronchodilator requirements \( p 0 89 \) however , 3 months reduced steroid use , small decline spirometry \( fev1 percent predicted initial , 84 4 final , 81 5 \) , change significantly different change subjects steroids reduced \( initial , 90 2 final , 90 2 \) \( p 0 002 \) 3 months , symptoms \( predominantly sputum production \) also beginning reduced budesonide group \( p 0 \)
environmental exposure cockroach allergens analysis monoclonal antibody based enzyme immunoassays quantitative two site monoclonal antibody \( mab \) based enzyme linked immunoassays two cockroach \( cr \) allergens , bla g bla g ii , developed used measure allergen levels house dust samples dust collected cr homes two patients asthma , va , demonstrated wide variation levels bla g , depending location dust collection dust contained 50 fold allergen \( mean , 10 , u gm dust \) dust \( mean , 204 u gm \) one hundred forty five dust samples collected living 22 children asthma 16 control subjects without asthma living atlanta , ga twenty seven 38 homes \( 17 22 children asthma 10 16 control subjects \) detectable bla g \( 4 u gm dust \) bla g ii levels assayed 40 , , living room samples homes , highest levels bla g ii detected floor dust \( 300 u gm dust \) additionally , approximately 20 homes visual evidence cr infestation significant levels bla g ii least one dust sample \( greater 4 u gm dust \) results demonstrate cr may occult allergen homes appears primary site cr allergen accumulation , significant cr allergen levels also found sites home mab based assays used quantitation environmental exposure cr allergens
bronchoalveolar lavage fluid mediator levels 5 minutes allergen challenge atopic subjects asthma relationship development late asthmatic responses inflammatory mediators implicated pathogenesis human asthma demonstrated increase bronchoalveolar lavage fluid time immediate asthmatic response \( \) allergen instillation lungs however , relationship mediators , measured early late asthmatic response \( lar \) , airway reactivity , clinical asthma , unknown present study , evaluated mediator levels bronchoalveolar lavage fluid 5 minutes allergen challenge three subject groups atopic subjects without asthma \( n 7 \) , atopic subjects asthma without lar \) lar \) \( n 6 \) , atopic subjects asthma lar \) lar \) \( n 6 \) subjects asthma differentiated subjects without based least 15 decrease fev1 3 8 hours inhalation mediators , prostaglandin d2 thromboxane b2 leukotriene c4 \( ltc4 \) , histamine , measured allergen instillation baseline prechallenge levels similar , except case ltc4 ltc4 detectable baseline significantly frequently atopic subjects asthma without lar subjects compared atopic subjects without asthma \( nine 12 detectable versus one seven detectable \) groups , significant increases mediator levels observed groups asthma challenge , compared atopic subjects without asthma atopic subjects asthma without lar significantly higher levels four mediators challenge atopic subjects asthma lar atopic subjects without asthma
airway effects inhaled bradykinin , substance p , sheep effects inhaled bradykinin \( bk \) , substance p \( sp \) , \( \) pulmonary resistance airway responsiveness carbachol studied conscious allergic sheep inhaled bk \( 20 breaths , 0 1 5 0 mg ml 1 \) caused dose dependent increases pulmonary resistance neither inhaled sp \( 20 breaths , 0 1 1 0 mg ml 1 \) produced significant bronchoconstriction allergic sheep however , response sp could enhanced \( p less 0 05 \) pretreatment neutral inhibitor , \( 40 breaths , 1 mg ml 1 \) sheep allergic antigen 5 9 times \( p less 0 05 \) sensitive effects bk nonallergic sheep bk induced bronchoconstriction blocked dose dependent fashion bk beta 2 receptor antagonist , \( arginine , bk \) atropine \( 0 2 mg kg 1 , intravenously \) sodium \( 1 mg kg 1 3 ml saline , aerosolized \) significantly inhibited bk induced bronchoconstriction 97 43 , respectively \( 2 mg kg 1 , intravenously \) effect caused transient increase airway responsiveness allergic sheep , producing mean 1 9 fold leftward shift dose response curves aerosolized carbachol \( p less 0 05 \) hyperresponsiveness evident 24 hours challenge neither sp bk changed airway responsiveness thus , allergic sheep , inhaled bk caused pronounced bronchoconstriction observed nonallergic sheep bronchoconstriction blocked bk receptor antagonist appeared partially mediated via cholinergic reflexes
comparison cockroach allergenic activity whole body fecal extracts previous studies established cockroach allergens important sensitizing agents induction exacerbation urban asthma present investigation compared saline extracts american cockroach \( \) whole bodies feces german cockroach \( \) whole bodies feces important sources allergens extracts tested gel filtration sephadex g 75 columns \( fraction 2 \) previously described skin test studies 69 subjects asthma extracts american german demonstrated significant correlation reactivity whole body fecal extracts species direct 13 sera cockroach skin test positive subjects generally greater german whole body extracts \( \) german fecal extracts \( \) compared american whole body fecal extracts good correlation rast reactivity rast inhibition demonstrated contained allergenic activity present studies demonstrate allergenic similarities cockroach whole body fecal extracts suggest cockroach feces important sensitizing agent atopic asthma
analyses microvascular permeability response mediators immediate hypersensitivity mediator induced changes microvascular permeability studied rodent skin monitor changes , 's blue dye , iodinated rat albumin igg , tritiated neutral dextran molecules different molecular used intradermal injections serotonin , histamine , bradykinin , degree radiolabeled tracer efflux determined measuring extent level radioactivity skin biopsy specimens although mediators varied potency molar basis \( serotonin greater bradykinin greater histamine \) , efflux resulting similar furthermore , kinetic studies revealed vasoactive agents caused marked transient increase permeability lasted less 30 minutes determine pore size created effect charge macromolecules interstitium , fractions neutral 3h known molecular size \( average , 12 4 4 nm , respectively \) infused either singly combination 125i labeled rat albumin igg intradermal injection serotonin , histamine , bradykinin , compound 48 80 regardless mediator used , differences could demonstrated efflux , indicated either molecular size charge tracer used thus , mediators immediate hypersensitivity reactions studied produce venular gaps greater 12 nm addition displaying similar characteristics
administration il 7 mice cyclophosphamide induced accelerates lymphocyte induced mice single injection cyclophosphamide il 7 control protein administered mice twice daily cellularity composition spleen , lymph node , bone marrow , thymus determined various time points thereafter comparison control cyclophosphamide treated mice , animals receiving cyclophosphamide il 7 accelerated regeneration splenic lymph node cellularity significant difference rate recovery bone marrow thymus control il 7 treated mice assessment pre b cell compartment revealed dramatic increase total pre b cell numbers spleen bone marrow il 7 treated mice measured flow pre b cell colony forming assay followed days significant increase surface igm b cell numbers levels normal values spleen lymph node il 7 administration cyclophosphamide treated mice also resulted accelerated recovery peripheral cd4 cd8 cell numbers spleen lymph node numbers cd8 cells increased twofold normal levels cyclophosphamide treated mice receiving il 7 myeloid recovery determined cyclophosphamide treated mice assessing numbers cfu granulocyte macrophage mac 1 cells significant difference myeloid recovery cyclophosphamide treated mice receiving il 7 control protein results suggest administration il 7 chemical induced may therapeutic benefits shortening period required achieve normal lymphoid cellularity
direct identification putative surface igm receptor associated molecule encoded murine b cell specific mb 1 gene b cell specific mb 1 gene recently reported encode putative surface glycoprotein cd3 like structural properties et al suggested presented evidence show mb 1 gene encodes 34 kda membrane glycoprotein \( igm alpha \) associated molecule identify mb 1 gene product directly b cells , affinity purified mb 1 specific antibody prepared immunization rabbits synthetic mb 1 immunoprecipitation combination two dimensional diagonal gel electrophoresis analysis revealed antibody detected b cell specific surface glycoprotein similar igm alpha \( \) protein described et al however , mb 1 protein exists usually monomeric form surface b cells , contrast igm alpha , detected dimeric \( igm alpha igm alpha igm alpha ig beta \) protein also found mb 1 protein already expressed pre b cell lymphoma , might suggest alternative functional role b cell specific mb 1 protein b cell differentiation molecular identity mb 1 protein igm alpha \( \) discussed
prevalence allergic bronchopulmonary aspergillosis patients asthma , determined serologic radiologic criteria patients risk allergic bronchopulmonary aspergillosis , hitherto uncommon potentially complication asthma , occurs unknown prevalence united states using modern serologic criteria complete history asthma radiologic findings , able make diagnosis allergic bronchopulmonary aspergillosis 28 100 consecutive patients asthma immediate cutaneous reactivity aspergillus fumigatus seen outpatient setting problems associated use less comprehensive criteria diagnosis discussed
major histocompatibility gene products human immunodeficiency virus infection present paper analyze role major histocompatibility gene products , human leukocyte antigens , pathophysiology acquired immunodeficiency syndrome association found human leukocyte antigen \( hla \) frequencies human immunodeficiency virus type 1 \( hiv 1 \) infection , whereas significant associations reported populations hla haplotypes appearance either opportunistic infections secondary cancers regard human leukocyte class antigens , role restriction elements presenting hiv 1 virus specific cytotoxic lymphocytes seems established increase serum levels soluble forms correlate disease stage also demonstrated circulating molecules could interfere immune response hiv 1 could contribute development immunodeficiency antigenic similarities detected human leukocyte class ii antigens hiv 1 envelope proteins could explain presence hiv positive sera anti hla class ii antibodies mediate lysis cd4 \( \) hla class ii cells false positive reaction hiv negative sera , contain anti hla class ii antibodies , tests hiv 1 antibodies reduced levels complement factors \( human leukocyte class iii antigens \) detected hiv infected subjects defects could play role progression disease affect clearance hiv 1 complement mediated antibody responses data reported review suggest hla antigens may involved several steps immune deficiency hiv infected subjects thus contribute pathophysiology acquired immunodeficiency syndrome
studies rp \( \) semisynthetic analogue taxol rp \( \) , new semisynthetic analogue taxol , potentially important chemotherapeutic agent treatment cancer report drug potent inhibitor cell replication , like taxol , promotes vitro assembly stable absence guanosine triphosphate induces bundle formation cells compared taxol , rp slightly active promoter tubulin polymerization inhibitor cell replication , rp 2 5 fold potent taxol 2 cells least 5 fold potent taxol resistant cells
aids adolescents help reduce risk \? aids adolescents \( 0 4 cases \) problem increasing importance united states infection human immunodeficiency virus \( hiv \) exists high schools university , presents real immediate threat americans engage drug abuse sexual activity appropriately targeted educational efforts needed limit hiv transmission among adolescents adolescents aware high risk activities may lead hiv transmission however , one third alter sexual behavior avoid aids important move beyond knowledge aids transmission move toward changing risky behavior strategies aids risk reduction adolescents implemented across country appropriate support intervention needed adolescents high risk
human immunodeficiency virus transmission child sexual abuse 1987 1989 , 14 \( 14 6 \) 96 children tested positive human immunodeficiency virus \( hiv \) followed duke university \( , nc \) pediatric acquired immunodeficiency syndrome team confirmed sexually abused every sexually abused child evaluated five modes hiv transmission , nine children pathway identified four study children acquired hiv child sexual abuse six , abuse possible source transmission child sexual abuse frequent proven modes acquisition hiv population proven modes acquisition vertical transmission \( n 3 \) hiv contaminated blood transfusion \( n 2 \) twelve males identified \( n 8 \) suspected \( n 4 \) three knew hiv time assault eight aware child hiv time assault indication child safe sex precautions observed children hiv infection multiple risk factors abuse neglect descriptors lives 14 abused children showed multiple known risk factors sexual abuse also known risk factors sequelae acquisition hiv infection included drug abuse alcoholism home , parent , lack , poverty , chronic illness child prevention efforts recognize children well adults risk sexually transmitted hiv infection
anaphylaxis annatto dye case report annatto dye orange yellow food extracted seeds tree commonly used , foods , beverages , cereals previously reported adverse reactions associated annatto dye included urticaria angioedema present patient developed urticaria , angioedema , severe hypotension within 20 minutes following ingestion milk fiber one cereal , contained annatto dye subsequent skin tests milk , wheat , corn negative patient strong positive skin test annatto dye , controls response fraction annatto dye sds page demonstrated two protein staining bands range 50 kd immunoblotting demonstrated patient ige specific one bands , controls showed binding annatto dye may contain contaminating residual seed proteins patient developed ige hypersensitivity annatto dye potential rare cause anaphylaxis
relationships skin prick test , radioallergosorbent test , assays allergic children results skin prick tests \( spt \) , radioallergosorbent tests \( rast \) , multiple tests \( cla \) grass mix , , , evaluated 43 allergic children cla tests valid positive negative control assays class 4 matched rast class 3 4 cla class 3 rast class 2 , , grass results obtained cla , rast , spt investigated principal components analysis showed good association different methods measuring results present study confirm cla effective vitro method detection ige allergen specific antibody
clustering fungal allergen specific ige antibody responses allergic subjects statistical analysis specific ige immune responses panel nine allergens 2 , 094 patients demonstrated significant clustering aspergillus fumigatus , , , explained elements may represent linked , high responder status fungal antigens allergic population
inhaled bronchodilator 's asthma low high dose \? studied effect regular inhalations low dose high dose fenoterol low dose high dose combinations fenoterol ipratropium bromide maintenance treatment 120 adults moderately severe asthma used double blind , randomized , parallel group design comparing 12 weeks treatment four regimens fenoterol , 100 micrograms dose fenoterol , 200 micrograms dose fenoterol , 50 micrograms ipratropium , 20 micrograms dose single inhaler \( \) fenoterol , 100 micrograms ipratropium , 40 micrograms dose single inhaler \( \) baseline active treatment period patients recorded pefr morning evening , symptoms use rescue inhaler changes twice daily peak expiratory flow rates asthma symptoms show significant differences among four treatment regimens 12 weeks compared baseline period use rescue inhaler differ among four groups active treatment patients' assessment efficacy active treatment favored low dose fenoterol low dose combination side effects recorded high dose combination group first 4 weeks compared groups conclude maintenance therapy chronic asthma high doses fenoterol alone combination ipratropium bromide offer clinical advantage low doses contrary , low dose fenoterol low dose combination better accepted tolerated patients
treatment career attitudes prehospital care providers associated potential exposure hiv aids career treatment attitudes related potential human immunodeficiency virus acquired immunodeficiency syndrome \( hiv aids \) exposure reported based survey 1 , 228 maryland career volunteer prehospital care providers trained provide basic \( bls \) advanced \( als \) life support sixty five percent stated potential exposure hiv aids major occupational stressor ninety two percent stated would treat hiv aids patients protected given choice , 38 would avoid providing treatment hiv aids patients eighteen percent considered emergency medical services \( ems \) work scale \( \) developed evaluate overall treatment career reactions respondents significantly higher \( negative reactions \) scores bls providers , men , paid providers , personnel 3 years field experience , working urban areas , personnel formal education beyond high school , stated hiv aids training inadequate implications findings quality care , career decision making , education discussed
identification functionally distinct domains human granulocyte macrophage colony stimulating factor using monoclonal antibodies granulocyte macrophage colony stimulating factor \( gm csf \) glycoprotein required survival , growth , differentiation hematopoietic progenitor cells although primary structure gm csf known cdna cloning , relationship structure function gm csf fully understood fifteen different monoclonal antibodies \( moabs \) human gm csf generated map immunologically distinct areas molecule moabs biotinylated shown enzyme linked immunosorbent assay bind recombinant gm csf solid phase 15 unconjugated moabs used biotinylated moab binding gm csf cross blocking studies identified eight distinct epitopes native gm csf seven epitopes also present denatured gm csf western blotting , four epitopes least partially conserved gm csf reduced beta moabs four eight epitopes neutralized recombinant \( glycosylated \) natural human gm csf gm colony forming unit \( cfu gm \) assay blocked gm csf induced activation neutrophils antibodies good correlation neutralizing activity capacity block binding 125i gm csf neutrophils blasts non neutralizing antibodies one epitope partially blocked binding 125i gm csf neutrophils none moabs neutralized interleukin 3 , g csf , csf locations seven epitopes could partially mapped regard amino acid structure determining reactivity gm csf synthetic peptides human mouse chimeric gm neutralizing antibodies found map amino acids 40 77 , 78 94 , 110 127 thus , moabs useful identify functional domains gm csf identifying regions likely involved receptor interaction
inhibition coenzyme reductase activity induces paradoxical increase dna synthesis myeloid leukemia cells effects competitive inhibition coenzyme \( hmg coa \) reductase compactin vitro proliferation peripheral blood myeloid leukemia cells studied using cells 45 patients acute myeloid leukemia chronic myelogenous leukemia blast phase cells 58 patients showed dose related inhibition dna synthesis incubated compactin unexpectedly , cells 18 patients resistant inhibitory effects compactin dna synthesis responded hmg coa reductase inhibition actual increase incorporation 14c labeled thymidine dna another 18 patients studied displayed inhibition stimulation dna synthesis biphasic response depending particular concentration compactin used maximum enhanced rates cellular dna synthesis observed lower compactin concentrations \( 5 x 10 \( 7 \) mol l \) required maximum inhibition dna synthesis \( 10 \( 5 \) mol l \) leukemia cells displaying stimulated response compactin significantly lower baseline dna synthetic rate cells showed inhibitory response dna synthesis compactin correlation varying dna synthetic response compactin measures baseline hmg coa reductase activity acetate conversion cholesterol whereas observation cellular dna synthesis stimulation hmg coa reductase inhibition observed mammalian cells seems paradoxical , explanations may emerge light growing knowledge concerning importance function certain cell regulatory proteins
epstein barr virus infection precedes clonal expansion burkitt 's acquired immunodeficiency syndrome associated lymphoma epstein barr virus \( ebv \) associated distinct forms human lymphoid malignancies , including endemic \( ebl \) sporadic forms burkitt 's lymphoma \( \) acquired immunodeficiency syndrome associated non hodgkin lymphoma \( aids nhl \) however , whether ebv pathogenetic role tumors passenger virus conclusively demonstrated one element distinguish two possibilities determine whether ebv infection preceded , thus , possibly contributed clonal expansion , whether infection occurred clonal expansion thus unlikely contribute pathogenesis toward end analyzed structure heterogeneous genomic ebv markers clonal infection panel ebl \( 11 cases \) , \( 9 cases \) , aids nhl \( 10 cases \) biopsies show ebv uniformly clonal , ebl , aids nhl , strongly suggesting ebv infection preceded , thus , likely contributed clonal expansion malignancies
stages ii diffuse large cell lymphomas prognostic factors long term results chop radiotherapy one hundred forty seven patients ann stages ii diffuse large cell lymphoma \( dlcl \) treated combination chemotherapy consisting cyclophosphamide , , prednisone , low dose bleomycin \( chop \) involved field radiation \( \) 1974 1984 complete remission \( cr \) attained 54 57 patients stage disease 78 90 patients stage ii disease thirty five patients relapsing disease occurred within 3 years 31 overall 10 year survival rate , counting deaths , patients stage 72 compared 43 patients stage ii \( p less 01 \) survival rates , eight unrelated deaths , similar overall survival rates 77 51 , respectively multivariate analysis identified three independent prognostic factors age , tumor extent , serum lactic dehydrogenase \( ldh \) level combined effect tumor extent ldh level taken consideration analysis , three risk groups survival identified best group , consists patients minimum tumor normal ldh levels , 10 year survival 79 patients extensive tumors elevated ldh levels poorest survival rate 44 intermediate risk group determinant survival 62 composed patients either extensive tumors elevated ldh levels differences demonstrate need develop different treatment strategies based risk factors survival patients apparently localized ann stages ii dlcl
individualized aerobic high intensity training asthmatic children exercise program training always helpful better adaptation exercise \? order define role individualized training intensity conditioning program asthmatic children , trained seven asthmatics \( age 11 4 1 8 years \) ventilatory threshold \( \) intensity level three month period \( aerobic training \) maximal intensity also three months \( high intensity training \) point nonlinear increase occurs another group seven asthmatics \( age 11 4 1 5 \) served control subjects cardiopulmonary fitness determined cycle ergometer training session study demonstrated aerobic training , correctly adapted child 's physical ability , induces following \( 1 \) rapid marked cardiovascular fitness increase \( 2 \) decrease given work range increased great importance hyperventilation major determinant exercise induced bronchospasm contrast , even high intensity training well tolerated indoor pool , long term effects unsuitable asthmatic children decrease involve increase hyperventilation , even exercise performed submaximal intensity
combined zidovudine interferon alpha treatment patients aids associated kaposi 's sarcoma effectiveness addition interferon alpha \( ifn alpha \) zidovudine patients aids associated kaposi 's sarcoma assessed non randomized , phase ii clinical trial twenty one patients treated oral zidovudine \( 600 mg daily \) ifn alpha increased 18 mu daily another 4 weeks one 20 evaluable patients achieved partial response 8 weeks , lasted 3 months despite ifn alpha dose escalation six patients , responses seen mild , fatigue dose limiting side effect prevented dose escalation seven eligible patients combined treatment result decrease hiv ag summary , results indicate addition ifn alpha zidovudine patients aids associated kaposi 's sarcoma efficacious treatment
scid mutation mice confers hypersensitivity ionizing radiation deficiency dna double strand break repair c b 17 severe combined immunodeficient \( scid \) mice carry scid mutation severely deficient cell b cell mediated immunity , apparently result defective v \( \) j joining immunoglobulin cell receptor gene elements present studies , defined tissue , cellular , molecular basis another characteristic mice hypersensitivity ionizing radiation bone marrow stem cells , intestinal crypt cells , epithelial skin cells scid mice 2 3 fold sensitive irradiated situ balb c c b 17 controls two independently isolated embryo fibroblastic scid mouse cell lines display similar gamma rays addition , cell lines sensitive cell killing bleomycin , also produces dna strand breaks , dna crosslinking agent c uv irradiation measurement gamma ray induced dna double strand breaks pulsed field gel electrophoresis indicates animals defective repair system suggests gamma ray sensitivity scid mouse fibroblasts could result reduced repair dna double strand breaks therefore , common factor may participate repair dna double strand breaks well v \( \) j lymphocyte development murine autosomal recessive mutation prove extremely useful fundamental studies radiation induced dna damage repair
long charge runs systemic lupus erythematosus associated autoantigens systemic lupus erythematosus chronic systemic autoimmune diseases associated circulating autoantibodies reactive limited set mostly nuclear proteins using rigorous statistical methods identified segments highly significant charge concentration majority characteristic nuclear cytoplasmic autoantigens extremely long runs charged residues , including sequences greater 20 consecutive charged residues \( purely acidic mixed basic acidic \) , occur third proteins , whereas equivalent runs found less 3 mammalian proteins sequences less extreme charge clusters , type location often conserved several otherwise antigens propose surfaces render targeted host proteins strongly immunogenic antinuclear antibody profiles might result chronic exposure intracellular contents , possibly conjunction viral products limited number potential systemic autoantigens may partly due rarity requisite charge properties
aids epidemiology inconsistencies human immunodeficiency virus infectious disease newly defined syndrome aids includes 25 unrelated parasitic , neoplastic , indicator diseases based epidemiological correlations , syndrome thought due new , sexually parenterally transmitted retrovirus termed human immunodeficiency virus \( hiv \) following epidemiological data conflict hypothesis \( \) exist hiv aids example , aids risks infected subjects vary greater 10 fold gender country abnormal health risks never controlled independent aids causes aids statistics , drug addiction hemophilia , correlate directly abnormal incidence aids diseases , aids diseases occur risk groups absence hiv \( ii \) american aids incompatible infectious disease , almost exclusively restricted males \( 91 \) , occurs , average 10 years transfusion hiv , specific aids diseases among different risk groups , unlike new infectious disease , aids spread exponentially since aids test established aids received current definition 1987 \( iii \) epidemiological evidence indicates hiv long established , transmitted retrovirus hiv acts marker american aids risks , rare horizontal contacts frequent transfusions , intravenous drugs , repeated sex concluded american aids infectious , suggested unidentified , mostly pathogens cause aids
frequency occupational exposures blood body fluids universal precautions training purpose annual periods universal precautions training , compared frequency health care self reported cutaneous exposures blood various body substances patient patients presumed infected human immunodeficiency virus type 1 \( hiv 1 \) subjects methods self reported cutaneous exposures blood , sputum , urine , feces , body substances evaluated separately 559 workers first survey 269 workers second results mean annual blood exposures decreased 35 8 18 1 , mean annual exposures substances decreased 77 8 40 0 \( p less 0 001 determinations \) two matched analyses subset 200 participants completed surveys similar results reported exposures blood , presumably infectious blood , sputum , presumably infectious sputum , urine significantly decreased participants tested antibodies hiv 1 participant reporting cutaneous exposures acquired hiv 1 infection upper bound 95 confidence interval risk hiv 1 infection associated single cutaneous exposure 0 04 blood presumed contain hiv 1 0 02 body substance presumed contain hiv 1 conclusions data suggest universal precautions training significantly decreased eliminate cutaneous exposures blood body substances results suggest risk hiv 1 infection associated cutaneous exposures substantially lower risk associated parenteral exposures
major differences dynamics primary secondary progressive multiple sclerosis patients primary secondary progressive multiple sclerosis \( ms \) , major differences pattern extent abnormality cerebral magnetic resonance imaging \( mri \) two groups recently demonstrated present study , 24 patients , matched age , sex , duration disease , disability , serial gadolinium acid enhanced mri 6 month period 12 patients secondary progressive group total 109 new lesions time \( 18 2 lesions per patient per year \) 87 enhanced enhancement also occurred within edge preexisting lesions contrast , 20 new lesions seen primary progressive group \( 3 3 lesions per patient per year \) one enhanced difference degree clinical deterioration two groups 6 month period findings may indicate difference dynamics disease activity two forms progressive ms , particularly relation inflammatory component lesions , important implications selection patients monitoring disease activity therapeutic trials
correlation phasic muscle strength conduction time multiple sclerosis central motor conduction times adductor pollicis muscle , twitch force muscle scalp magnetic motor cortex stimulation , maximum force phasic voluntary contraction muscle measured 15 patients multiple sclerosis two tests manual hand also studied test , maximal frequency movement thumb index finger patients normal strength minimal weakness intrinsic muscles hand clinical examination mean central motor conduction times adductor pollicis muscle patients longer normal , peak twitch force adductor pollicis muscle evoked cortical stimulation maximum force phasic voluntary contraction adductor pollicis muscle smaller normal strong correlations measures central motor conduction time patients inversely correlated voluntary phasic force twitch force cortical stimulation , longer central motor conduction time , weaker force prolonged central motor conduction time likely accompanied conduction block pathways correlation central motor conduction time voluntary phasic force twitch force likely reflects degree conduction block temporal dispersion rather delay conduction per se results indicate objective assessments phasic muscle strength may reveal correlations central motor conduction time evident conventional clinical examination assesses tonic muscle contraction strength
systemic lupus erythematosus 1975 1984 nationwide epidemiological study unselected population nationwide study 1982 revised ara criteria applied classification systemic lupus erythematosus \( sle \) unselected group patients included cases diagnosed managed hospitals , well outside hospitals 10 year period 1975 1984 seventy six new cases found , incidence 5 9 0 8 100 , 000 females males risk , respectively mean age diagnosis 46 6 years twenty five percent patients would missed study included hospital patients clinical pattern different previous studies found illustrated low incidence kidney disease nephritis found 20 patients comparison former study sle shows actual increase incidence period 10 years 5 year survival 84 10 year survival 78
juvenile systemic lupus erythematosus among children prospective analysis 30 children systemic lupus erythematosus \( sle \) conducted throughout 3 year period average followup period 13 months age onset ranged 8 14 years cases presented one classical features disease however , 23 3 presented primarily major organ involvement one case presenting cardiac tamponade reported series clinical laboratory manifestations disease presented , though complete studies required confirm possible differences disease manifestations compared found populations contrary frequently held view , results suggest childhood onset sle rare africa least parts continent
diagnosis aspirin sensitivity addition well recognized allergic responses individuals high mol wt substances , , , animal , susceptible asthmatics may also experience adverse reactions low mol wt substances , asa , nsaids diagnosis aspirin sensitivity made appropriately conducted provocative challenge every taken assure safety patients , since life threatening reactions occur better understanding mechanism mechanisms involved adverse reactions substances provide information better diagnose reaction , also improve understanding treatment asthma
using pulmonary function testing diagnosis treatment asthma asthmatics remarkable changes pulmonary function response numerous external stimuli internal controls serial pulmonary function testing office , hospital , home , work place allows objective measurement necessary diagnose treat patients patient physician understand use techniques monitoring degree airways obstruction , become key medical management decisions
human growth hormone variant biologically active somatogen lactogen human gh variant \( hgh v \) gene , member gh prl gene family , expressed placenta second third gestation secreted hgh v protein differs pituitary gh \( hgh n \) 13 amino acids previously demonstrated hgh v bind somatogen lactogen cell surface receptors vitro , ratio somatogen lactogen receptor binding affinities substantially higher hgh n characterize somatogen lactogen hgh v contrast bioactivity hgh n somatogen bioactivity assayed stimulation weight gain rats , lactogen bioactivity assayed mitogenic response lymphoma cell line average increase rat body weight response fixed concentration hormone comparable using either hgh v hgh n , mitotic response lactogen inducible cells significantly less hgh v comparable somatogen , lower lactogen , bioactivity hgh v relative hgh n parallels previously reported receptor binding profiles two hormones suggests hgh v potential perform unique role human gestation
sensitized liver represents rich source endogenous leukotrienes ability livers produce endogenous leukotrienes immunological stimulation tested organs rats guinea pigs passive sensitization rats vivo monoclonal murine ige antigen challenge isolated perfused liver system elicited rapid hepatic production biliary excretion leukotrienes judged radioimmunoassay separation individual leukotrienes high performance liquid chromatography within 10 min antigen infusion , mainly leukotriene c4 , also leukotriene n acetyl leukotriene e4 , appeared bile biliary excretion rate antigen induced cysteinyl leukotrienes rose less 2 pmol min 1 \( kg body mass \) 1 challenge 30 pmol min 1 \( kg body mass \) 1 20 min declined toward prechallenge level quantitatively similar hepatic production cysteinyl leukotrienes elicited isolated perfused guinea pig livers challenged active sensitization animals plus al \( oh \) 3 exclude extrahepatic contributions observed leukotriene production , passive sensitization anti ige subsequent antigen challenge performed isolated rat livers perfused blood free medium exclusively hepatic sensitization challenge also resulted massive production leukotrienes biliary excretion rate cysteinyl leukotrienes approximately 20 pmol min 1 \( kg body mass \) 1 10 20 min period antigen challenge compared less 1 pmol min 1 \( kg body mass \) 1 challenge
transforming growth factor beta suppression humoral immune responses hiv infection reported previously pbmc hiv patients spontaneously release increased levels tgf beta 1 , contributing defects cellular immune responses study defines implications tgf beta overexpression humoral immunity hiv infection found upon staphylococcus aureus cowan \( sac \) stimulation cells hiv donors , b lymphocyte proliferative responses decreased deficiency correlated closely \( r 0 7 , p less 0 001 \) increased tgf beta secretion pbmc hiv infected donors conditioned medium hiv pbmc purified tgf beta 1 similar inhibitory effects sac ebv induced b cell proliferation , b cells hiv infected donors sensitive inhibition tgf beta cells normal donors antibodies tgf beta 1 neutralized inhibitory effect hiv culture supernatants normal b cells increased low proliferative responses hiv cells using stimulus b cell differentiation , shown activated tgf beta hiv pbmc able significantly reduce induction immunoglobulins effect also abrogated anti tgf beta studies support concept hiv infection , tgf beta potent suppressor , cellular , humoral immune responses well
autocrine role urokinase phorbol ester mediated differentiation myeloid cell lines human myeloid cell line urokinase type plasminogen activator \( upa \) expresses receptor stimulated phorbol myristate acetate \( pma \) , secretion upa expression receptor regulated , cells differentiate adherent phenotype adhesive response markedly reduced presence upa antibodies pma response restored addition native upa , amino terminal fragment upa \( residues 1 143 \) devoid proteolytic activity , synthetic peptide \( residues 12 32 \) upa growth factor domain known mediate receptor binding contrast , addition active low molecular weight upa , missing growth factor domain , peptide catalytic domain \( residues 247 266 \) ineffective influence upa antibodies second marker macrophage differentiation , cysteine proteinase activity , also examined cysteine proteinase activity cells increased pma treated cells 24 h fails increase presence anti upa increase cathepsin b like activity also restored exogenous upa experiments indicate autocrine interaction growth factor domain upa receptor mediates essential step pma mediated myeloid cell differentiation
methods continuous outcomes parametric alternative often disease state disease defined continuous outcome variable example , diastolic blood pressure greater 90 mmhg used define hypertension classical method estimating risk \( prevalence \) defined disease states outcome variable according cutoff value standard statistical analysis risk disease methods developed specifically data , usually based distribution present method , based assumption \( normal \) distribution continuous outcome , specifically , estimation risk variance presented one two sample situations , latter focusing risk differences ratios , odds ratios approach applied data found less efficient proposed method 67 less latter found accurate , even small sample sizes , although rather sensitive substitutions underlying distribution tailed distributions canadian total cholesterol data used illustrate problem one sample case , approach illustrated using data study arterial oxygenation 20 patients one lung anesthesia thoracic surgery two sample case , data prognostic study renal function 87 lupus patients used
phase trial monoclonal antibody m195 acute myelogenous leukemia specific bone marrow targeting internalization radionuclide ten patients myeloid leukemias treated phase trial escalating doses mouse monoclonal antibody \( mab \) m195 , reactive cd33 , glycoprotein found myeloid leukemia blasts early hematopoietic progenitor cells normal stem cells m195 trace labeled iodine 131 \( 131i \) allow detailed pharmacokinetic studies serial sampling blood bone marrow whole body gamma camera imaging total doses 76 mg administered safely without immediate adverse effects absorption m195 onto targets vivo demonstrated biopsy , pharmacology , flow cytometry , imaging saturation available sites occurred doses greater equal 5 mg m2 entire bone marrow specifically clearly imaged beginning within hours injection optimal imaging occurred lowest dose bone marrow biopsies demonstrated significant dose related uptake m195 early 1 hour infusion patients , majority dose found marrow tumor observed estimated 0 33 1 0 rad mci 131i delivered whole body , 1 1 6 1 rad mci delivered plasma , 34 rad mci delivered red marrow compartment 131i m195 rapidly modulated , majority bound immunoglobulin g \( igg \) target cells vivo data indicate whole bone marrow ablative doses 131i m195 expected rapid , specific , quantitative delivery bone marrow efficient internalization m195 target cells vivo also suggest delivery isotopes alpha , , biologically important molecules either leukemia cells normal hematopoietic progenitor cells may feasible
program attitudes towards residents' care patients aids objective evaluate educational strategies experiences residency programs regarding training primary care providers care patients aids design cross sectional , self administered questionnaire survey setting survey conducted november 1988 april 1989 participants non military u internal medicine family medicine program directors surveyed 80 responded interventions none measurements main results 91 directors felt primary care aids patients important educational experience 94 reported programs usually aids inpatients , 16 reported majority trainees cared aids patients continuity clinics even programs typically six aids inpatients , 26 directors reported residents cared aids patient continuity clinics among 57 believe whether residents adequately trained aids ambulatory care , 38 reported improving resident education area high priority among 39 encourage residents' assumption primary care , 60 least one following concerns aids care stressful residents \( 24 \) , aids care complicated \( 31 \) , clinic faculty qualified residents' caring aids patients \( 39 \) conclusion although program directors view education aids ambulatory care important , believe residents adequately trained , many encourage residents' assumption primary care aids patients , residents usually provided care programs strategies augment residents' ambulatory experience aids care needed
pathogenesis recent therapeutic approaches graft versus host disease effective prophylaxis acute gvhd bring improved patient survival decreasing severe infections first 3 months transplantation reducing incidence chronic gvhd compromising quality hematopoietic engraftment increasing incidence leukemic relapse graft versus leukemia effect none current approaches prevention gvhd meeting expectations , although immunosuppressive therapy comes closest ideal technique cell depletion effective reducing incidence gvhd , conditioning programs must developed successful eliminating host immune malignant cells achieved systemic chemotherapy total body irradiation innovative approaches use monoclonal antibodies , either alone linked short lived radioactive isotopes short linear energy transfer , promise result less toxic efficient programs , providing better eradication malignant disease also ameliorating problem graft failure , however , never possible kill leukemic cells chemoradiotherapy form , graft versus leukemia effect may essential perhaps future possible distinguish lymphocytes causing graft versus leukemia effect causing gvhd , isolate , use attempts therapy , immunosuppressive drugs used frequently prevent treat gvhd , steadily improving survival statistics expected
effect therapeutic plasma concentrations theophylline behavior , cognitive processing , affect children asthma published erratum appears j 1991 jul 119 \( 1 pt 1 \) 164 double blind , randomized , crossover study assessed effects theophylline behavior , mood , efficiency cognitive processing thirty one children aged 8 12 years moderate asthma randomly assigned 10 day theophylline followed placebo placebo followed theophylline experimental conditions separated 2 day washout periods theophylline plasma concentrations pulmonary function tests performed throughout study cognitive functioning tests self report measures administered baseline medication phase behavior ratings obtained parents parents' ratings reflect theophylline effect attention activity level children 's self reports showed changes mood , statistically significant differences found measures cognitive processing large individual differences sensitivity theophylline effects present although children tolerated theophylline well , already attentional achievement problems appeared vulnerable adverse effects individual response differences focus future studies
travel eastern europe guidelines patients patients need medical preparation physician counseling eastern european countries addition baseline immunizations , measles booster , polio booster , vaccination , immune globulin prophylaxis hepatitis may indicated advice also given regarding air pollution , contaminated food water , , motor vehicle , country 's policy hiv screening level may poor , contact american british recommended emergency
circumcision \( \) amongst custom circumcision still people southern africa 45 consecutive required hospital admission mortality rate 9 complication seen years reviewed management discussed
recruitment mononuclear cells endothelial cell binding skin selective , time dependent process defined molecular interactions wound healing involves complex series interactions cells dermis epidermis , important relationships exist keratinocytes resident dermal cells monocytes lymphocytes secrete cytokines capable stimulating dermal repair influencing keratinocyte fibroblast migration proliferation , although mechanism mononuclear cells recruited wound unknown tested hypothesis skin specialized endothelial cells induced mediate peripheral blood mononuclear cell \( pbmc \) vasculature dermis purpose , partial thickness wounds made domestic pigs excised 0 9 , 12 , 15 , 21 wounding biopsies tested capacity adhere selectively pbmc results indicated pbmc onto sections wounds day 4 15 adhered selectively dermal endothelium , two distinct peaks adherence observed day 7 day 12 contrast , pbmc adhere tissue sections onto frozen sections normal skin 0 , 1 , 2 , 3 , 21 old skin additional studies binding properties pbmc subsets revealed monocytes adhered maximally day 7 , whereas cells adhered day 12 post wounding furthermore , adhesion process energy magnesium dependent calcium dependent involved surface protein carbohydrate moieties pbmc surface pre treatment pbmc monoclonal antibodies lfa 1 adhesive receptors inhibited binding greater 80 , suggesting lfa 1 adhesive receptors play important role binding process studies provide evidence recruitment monocytes lymphocytes wounds active , dynamic , regulated process mediated least part specific adhesive interactions mononuclear leukocytes dermal endothelial cells
comparison functional recovery nonsurgical surgical treatment condylar fractures article evaluates 16 cases condylar fracture treated surgically , comparing 20 cases treated , 2 year follow although severely displaced fractures involved surgical group rigid internal fixation , satisfactory postoperative function occlusion achieved level nonsurgical group , without severe complications
effects long term administration haloperidol electrophysiologic properties rat neurons haloperidol \( 1 5 1 7 mg kg day \) administered rats via drinking water periods either 4 weeks 13 14 months , animals withdrawn neuroleptic 1 2 weeks , respectively rats given haloperidol 13 14 months exhibited significantly controls single unit extracellular recordings obtained substantia nigra ventral area subjects anesthesia 1 month 1 year treatment , significant decrease mean firing rate substantia nigra pars reticulata neurons found subtle changes response pars reticulata neurons striatal stimulation seen extended haloperidol intake consistent effects haloperidol administration 4 weeks 13 14 months found either number spontaneously active dopamine neurons firing rates histopathologic assessment tissue , sectors striatum revealed significant effect long term haloperidol treatment neuronal cell counts results discussed reference neuroleptic induced tardive
progress characterizing anatomic injury three description anatomic injury presented anatomic profile \( ap \) components , b , c summarize serious injuries \( greater ais 2 \) head brain spinal cord thorax front neck remaining serious injuries relationships ap components survival rate seriousness head injury logistic function models relating ap components injury severity score \( iss \) survival probability based 20 , major trauma outcome study \( \) patients \( 9 2 mortality rate \) submitted 1986 model performance comparisons based 5 , patients \( 7 8 mortality rate \) submitted 1987 ap better discriminated survivors nonsurvivors provided 31 increase sensitivity compared iss neither iss ap alone reliably predict patient outcome predictive power methods estimating patient survival probability include physiologic indices profiles , patient age , anatomic profile compared current methods ap , based severity location serious injuries , provides rational basis comparing patient samples iss
injured drivers alcohol use , convictions , pre post crash driving history , crash related traffic convictions , pre post crash driving records group injured impaired \( blood alcohol level greater 80 mg dl \) drivers \( n 58 \) admitted level trauma center compared group admitted unimpaired drivers \( n 92 \) groups drivers 21 years age older , sustained moderate injuries \( defined injury brain , spinal column cord , extremity , pelvis injury score greater 2 \) , discharged home 140 crashes clearly defined , impaired drivers caused significantly greater percentage crashes \( 92 7 \) compared unimpaired \( 64 7 \) drivers \( p less 0 001 \) 55 unimpaired drivers considered causing crashes , 12 7 received traffic compared 39 2 51 impaired drivers mean number total pre crash traffic violations higher impaired drivers unimpaired drivers \( p less 0 01 \) mean number total post crash convictions unimpaired impaired significantly different , mean number pre post crash alcohol convictions significantly higher impaired drivers compared unimpaired drivers \( p less 0 02 \) data suggest injury protects legal alter impaired driving practices
effect prehospital fluids survival trauma patients effect prehospital intravenous fluids upon survival studied 6 , 855 trauma patients mean prehospital time 36 minutes group patients received fluids group volume fluid administered significantly different group survived compared died eighty five per cent patients injury severity score \( iss \) less 25 mortality rate 56 patients group received fluids similar patients receive fluids \( 0 7 vs 0 5 \) twelve per cent patients iss 25 50 sixty per cent patients received fluids mortality rates similar patients received fluids compared \( 23 vs 22 \) three per cent patients iss greater 50 mortality rate highest group influenced administration fluids \( 90 vs 86 \) comparison groups similar probability survival according triss methodology also failed show influence fluid administration survival mortality rate patients initial systolic blood pressure \( bp \) 90 torr greater compared rate patients admission bp less 90 torr although hypotension associated significantly higher mortality rate , administration fluids influence rate
blunt trauma adults children comparative analysis trauma remains major cause death children young adults adult pediatric patients differ significantly mechanism physiologic response injury reviewed records consecutive adult pediatric blunt trauma patients admitted major metropolitan trauma center 10 year period extensive computerized database maintained patients since 1977 comparative statistical analysis mechanism injury , specific organ injury , clinical outcome performed altogether , 1 , adults 289 children treated study period blunt trauma accounted 82 8 adult 94 3 pediatric injury \( p 0 \) , patients considered analysis diagnostic peritoneal lavage performed 249 children 1 , adults , respective accuracy 99 6 97 2 mechanism injury comparable groups , although children far likely injured falls , bicycle accidents , automobile comparative analysis specific injuries demonstrated significantly fewer pediatric chest \( p 0 001 \) , spine \( p 0 03 \) , pelvic \( p 0 003 \) injuries central nervous system \( cns \) injury children strong determinant outcome serious pediatric cns trauma associated increase mortality mortality children absence cns injury less 3 spinal injury also appeared predictor poor outcome pediatric population , associated mortality greater 50 overall , survival age independent \( 82 5 adults 85 8 children survivors
alcohol intoxication , injuries , dangerous behaviors emergency department suicides , , motor vehicle crashes , violent deaths injuries linked alcoholism association injury alcoholism particularly obvious emergency department \( ed \) physicians sought determine extent intoxicated patients ed properly diagnosed , , referred substance abuse care reviewed charts 153 consecutive patients seen teaching hospital ed blood alcohol levels 100 mg male \( 70 \) , white \( 62 \) , young \( mean age , 34 years \) severely intoxicated \( mean bal , 245 range , 109 mg \) forty six per cent visits trauma half patients victims violent intoxicated patients received extensive medical surgical management average five tests x rays performed per patient 75 received least one medication discharge 48 referred followup medical surgical clinics contrast , patients evaluated dangerous behaviors referred treatment alcoholism 19 patients \( 12 5 \) asked depression , suicide , homicide 15 advised stop drinking 13 received referral , mental health worker , alcohol rehabilitation facility forty seven per cent patients received intravenous thiamine \( although wernicke syndrome rare \) contrast , 16 received site psychiatric consultation \( although dangerous behaviors common alcoholics \) strong , statistically significant negative association occurrence injury decision initiate treatment referrals alcoholism
oxygen delivery consumption head injured multiple trauma patients critically ill patients often demonstrate whole body oxygen consumption \( vo2 \) dependent oxygen delivery \( do2 \) retrospective study , relationship vo2 do2 patients isolated head injury \( hi , n 18 \) compared patients multiple trauma \( mt , n 60 \) without serious head injury mean pulmonary capillary wedge pressure , central venous pressure , arterial pco2 , cardiac index , oxygen delivery significantly lower hi , oxygen consumption different groups groups , changes do2 \( delta do2 \) within patient significantly correlated changes vo2 \( delta vo2 \) patient relationship different hi patients , \( delta vo2 \( 0 20 0 02 \) delta do2 \) , mt patients \( delta vo2 \( 0 17 0 01 \) delta do2 \) groups divided high hematocrit \( greater 32 \) low hematocrit \( less 32 \) , hi patients low hematocrit demonstrated steeper regression slope , 26 3 do2 change reflected vo2 change significantly greater slope hi patients high hematocrit \( 13 3 \) mt patients high \( 19 2 \) low \( 16 2 \) hematocrits data show correlation changes oxygen delivery consumption similar head injury patients multiple trauma patients without serious head injury relationship greatest head injured patients low hematocrit relationship vo2 do2 groups suggests influence factors rather local tissue phenomena
skeletal treatment comminuted fractures distal end radius elderly ninety five patients \( 71 females 24 males \) , average age , 69 years \( 35 92 years \) , comminuted distal radial fractures treated wires \( wires \) bases ii v elbow cast two cases early infections four 's dystrophy \( 4 2 \) encountered followup studies lasted average 24 months \( 9 50 months \) could conducted 77 patients using 's ratings 27 patients fell good category , 44 , good , eight , fair , two , poor although cases comminuted intra articular fracture types , good results achieved simple quite straightforward method
serum phospholipase a2 patients multiple injuries catalytic phospholipase a2 activity \( ca pla2 \) concentration immunoreactive pancreatic pla2 \( ir pla2 \) measured serum samples 12 patients multiple injuries \( median injury severity score 41 \) ca pla2 increased patients positive correlations found extent increase ca pla2 , mortality , impairment pulmonary function ir pla2 values slightly increased serum nine patients multiple injuries nine patients , eight additional blunt abdominal trauma hand , relationship found ir pla2 ca pla2 values finding confirmed immunoadsorption experiments antiserum human pancreatic pla2 , demonstrated increased serum levels ir pla2 responsible increased ca pla2 values results suggest existence least two immunologically different phospholipase a2 enzymes sera patients multiple injuries
reassessment peritoneal lavage leukocyte count blunt abdominal trauma nine hundred three patients undergoing diagnostic peritoneal lavage \( dpl \) 6 year period retrospectively reviewed evaluate utility white blood cell \( wbc \) count lavage fluid eleven patients \( 1 2 \) dialysate wbc counts greater 500 mm3 , erythrocyte counts less 10 \( 5 \) mm3 nine patients within 4 hours injury intra abdominal pathology two patients , 4 hours , demonstrated intra abdominal injury two hundred twenty three patients \( 24 7 \) grossly clear dialysate sent laboratory analysis none patients required laparotomy conclude wbc count dpl fluid diagnostic value victims blunt abdominal trauma within 4 hours injury addition , laboratory analysis clear dialysate required patients
analysis 46 intra abdominal aortic injuries blunt trauma case reports literature review blunt trauma causing aortic injury infrequent primarily involves thoracic aorta abdominal aortic injury blunt trauma much less frequent varied presentation within 3 month period , trauma unit diagnosed treated two cases abdominal aortic injury secondary blunt trauma one belted passenger motor vehicle accident , one secondary crush injury addition two cases brings number found literature 46 reviewing cases emphasized need prompt recognition treatment vascular
reduced dependency arteriography penetrating extremity trauma influence wound location noninvasive vascular studies indications arteriography penetrating extremity trauma remain controversial reviewed clinical experience 454 patients \( extremities \) penetrating trauma admitted prior 3 1 2 year period injuries caused stab wounds 60 \( 11 7 \) extremities gunshot wounds 454 \( 88 3 \) extremities thirty three 60 stab wounds \( 55 \) required urgent exploration , 27 underwent arteriography arteriograms positive unsuspected arterial injury group forty two 454 gunshot wounds \( 9 3 \) underwent mandatory exploration arteriograms performed 412 extremities forty four arteriograms \( 10 7 \) demonstrated evidence unsuspected arterial injuries last year , randomly selected extremities \( n 23 \) studied b mode ultrasonography segmental doppler pressure measurements using subsequent arteriography gold standard , sensitivity 83 specificity 100 gunshot wounds categorized according location positive arteriograms injuries lateral thigh arm resulted positive arteriograms , positive studies observed 11 medial posterior arm , 14 fossa , 25 forearm , 7 5 medial posterior thigh , 8 popliteal fossa , 26 calf injuries recommend arteriography gunshot injuries identified high risk areas , clinical evaluation alone accurate stab wounds extremities gunshot wounds lateral thigh outer arm preliminary data suggest expanded use b mode ultrasonography may reduce dependency arteriography cases
impact volume outcome seriously injured trauma patients two years' experience chicago trauma system american college surgeons stated considering development trauma systems important ensure appropriate volume seriously injured patients seen trauma center order achieve acceptable mortality rates clinical data supporting recommendation lacking analysis performed 1 , seriously injured trauma patients determine relationship volume mortality rates three separate statistical methods used pearson correlation coefficients , mortality odds ratios , direct pairwise mortality comparisons addition , analysis introduced method analyze relationship volume mortality mortality rates adjusted confounding variable serious head injury pearson correlation coefficients volume vs adjusted mortality 0 65 mortality odds ratios comparing low volume \( less 140 pts \) trauma centers vs high volume \( greater 200 pts \) trauma centers 1 3 adjusted mortality rates \( 95 ci 1 01 1 66 p 0 04 \) categorical analysis showed significantly different mortality rates centers adjusting patient mix analysis showed relationship volume mortality significant , accounting 30 40 observed variation mortality rates addition , analysis allowed construction model predict mortality rates , given specific volumes patients data suggest inverse relationship exists volume mortality , support necessity trauma systems manner ensure designated trauma centers see high volume seriously injured patients
acute hospital costs trauma united states implications systems care part larger effort determine total direct indirect costs injury united states , national estimates numbers expenditures associated acute hospitalization due traumatic injury derived using data 1984 , 1985 , 1986 national hospital discharge surveys \( \) estimates numbers hospital episodes total expenditures reported paper subgroups patients defined age , sex , body region ais severity injuries sustained 1985 2 1 million individuals sustained traumatic injury resulted hospitalization hospital expenditures 11 4 inclusive professional adolescents young adults aged 15 44 years accounted nearly one half discharges total hospital costs elderly , represent 12 population , accounted additional one quarter total discharges hospital costs nearly three hospitalizations one half total expenditures minor \( icd ais 1 , 2 \) injuries moderate \( icd ais 3 \) severe \( icd ais 4 , 5 \) , injuries respectively accounted 23 3 total episodes 37 11 total expenditures 12 patients 25 trauma care dollars involved injuries sufficiently severe require treatment trauma center
geographic patterns urban trauma according mechanism severity injury purpose study investigate distribution various mechanisms injury relative severity injury cases throughout different geographic zones large urban area using computerized emergency medical services \( ems \) patient record database study city \( population , 2 million residents \) divided 156 geographic \( 4 5 3 \) incidence relative severity various injury mechanisms determined zone results one year \( 1988 \) , 115 , 000 separate ems incidents involving 150 , 000 patients , 26 , 000 transported injuries incurred 10 , motor vehicle accidents , 4 , falls , 4 , 015 lacerations , 1 , , 1 , 270 , auto accidents analysis 156 zones showed disproportionate number ems responses city center two accounting 25 responses call volume progressively diminished toward periphery city however , minor exceptions , relative incidence severity various injury mechanisms remained uniform within zone , regardless geographic location therefore , contrary popular , incidence associated severity given injury type generally necessarily predicted particular predilection , rather overall demand ems zone city
management complex perineal soft tissue injuries debridement , fecal diversion , rectal washout proposed primary therapy complex perineal lacerations , , series , survivors pelvic sepsis rate 40 80 retrospective study , six 18 patients sustaining severe perineal lacerations died within first hours injury due pelvic injuries remaining 12 patients underwent sigmoidoscopy , diversion fecal irrigation distal rectal stump , radical initial debridement necrotic soft tissue enteral access obtained two patients patients mandatory daily debridement pulsatile irrigation , pelvic sepsis occurred three patients without daily debridement , pelvic sepsis complicated recovery ability patients resume oral nutrition significantly delayed , necessitating total parenteral nutrition three patients conclude sigmoidoscopy , total diversion fecal irrigation distal rectal stump , enteral access feeding , radical initial debridement necrotic soft tissue , mandatory daily debridement pulsatile irrigation optimize recovery devastating injury
intra abdominal retroperitoneal organ injuries diagnosed dynamic computed tomograms obtained assessment renal trauma efficacy dynamic computed tomography assessment renal , intra abdominal , retroperitoneal organ injuries analyzed patients technique contributed valuable information toward diagnosis coexistent injuries patients sustained blunt trauma ct identified associated abdominal retroperitoneal organ injuries 85 patients \( 277 \) , clinical examination 26 ct proved invaluable assessment injury bowel mesentery , pancreas , retroperitoneal vascular structures , giving rise hematomas ct diagnosed injuries , clinical examination 0 \( pancreas \) 11 \( retroperitoneal hematomas \) patients penetrating injury , dynamic cts added valuable information status viability injured organs relatively high number false positive diagnoses resulted four unnecessary patients , diagnosis revealed repeat cts undertaken clinical course clinical findings initially suggested ct diagnosis time exploration undertaken correction confirmed injuries discovery associated intra retroperitoneal organ injuries , particularly patients sustained blunt trauma , resulted modification treatment prevented late sequelae complications thereby substantially reduced hospitalization time
rehabilitative techniques athletes reconstruction anterior cruciate ligament published erratum appears mayo clin proc 1991 jan 66 \( 1 \) 114 wide spectrum protocols available rehabilitation anterior cruciate ligament reconstruction , little agreement exists strengthening exercises sequence activities article , discuss current rehabilitative techniques used mayo clinic athletes undergone anterior cruciate ligament reconstruction techniques based established principles rehabilitation , clinical experience , new information related biomechanics knee case reflects benefits rehabilitation program , 1 year divided five stages early stages focus protected mobilization strengthening program emphasizes closed rather open kinetic chain exercises later , neuromuscular training sport specific training reaction time coordination necessary athletic competition high quality surgical care closely supervised rehabilitation program , based biomechanical factors anterior cruciate ligament , necessary successful outcome
specialist versus general practitioner treatment problem drinkers efficacy specialist versus general practitioner \( gp \) treatment problem drinkers assessed randomised controlled trial 40 problem drinkers referred consecutively specialist alcohol clinic gp , assessment , randomly allocated either gp specialist clinic treatment groups subjects received initial advice clinic drinking specialist clinic group received continued care clinic including , necessary , admission hospital patients gp group returned care gp contacted supported specialist 6 months follow , significant reductions alcohol consumption alcohol related problems groups significant difference found two groups respect main outcome measures differential treatment effect found severely dependent drinkers findings show initial detailed assessment advice session , treatment provided gps least effective specialist clinic respect improvements drinking behaviour alcohol related problems initial assessment advice , specialist clinics encourage gps become involved subsequent care problem drinkers practice based individual patient 's needs adequacy support offered gps
managing segmental facial nerve injuries surgical repair report describes experiences evolving regard managing segmental facial nerve injuries present results 13 facial nerve repairs traumatic injury segment facial nerve peripheral facial nerve branches contribute essential elements normal mimetic facial movement therefore , recommend early , appropriate repair nerve segment recommendation based principles established managing disruptions main trunk facial nerve offers patient chance complete recovery facial function
vaginal birth cesarean delivery results 5 year multicenter collaborative study cesarean delivery become frequently performed major operation united states widespread use vaginal birth previous cesarean delivery could potentially eliminate one third however , many physicians adopt policy without large studies conclusively demonstrating safety study evaluated maternal perinatal outcomes 5000 cases labor previous cesarean delivery multicenter study began 1984 initially included nine california hospitals first 2 years , trials labor resulting vaginal births january 1986 two additional hospitals collaborative project next 3 years , trials labor resulting vaginal births 11 participating hospitals entire study period , patients trial labor \( 75 \) delivered vaginally maternal deaths trial labor group , perinatal mortality significantly different general obstetric population results support findings numerous smaller studies concluded policy routine repeat cesarean delivery abandoned
tibial defects reconstruction using method alternative although used since , method recently employed north america manage bone defects seven cases patients tibial bone defects presented \( five deep infection \) treated gradual compression defect one two transported tibial segments filled tibial defect preserved regained original bone length six seven patients defect leg length maintained method minimally invasive , allows immediate weight bearing permits modifications strategy treating bone defects requires close attention detail steep learning curve
preoperative planning treatment nonunions correction malunions long bones detailed analysis steps preoperative planning employed clinic presented found techniques great value requirements must fulfilled correct obtain healing occur alone associated nonunion besides helping one malalignment best corrected anatomically match normal extremity , tracings aid allowing surgeon kinetics operative procedure , well define best methods stabilizing resulting correction
treatment tibial malunions nonunions intramedullary nails intramedullary nailing effective , relatively low risk technique management delayed union , nonunion , tibia closed technique used possible open , necessary , executed minimal dissection bone grafting rarely indicated use interlocking nails provides added degree security control rotation
treatment nonunions humeral shaft summary , one follows ao principles open reduction stable internal fixation nonunions humerus , mostly plate fixation supplemented , cement loose screws necessary , bone grafting defects atrophic nonunions , successful healing one operative procedure achieved 95 , almost full correction preoperative deformity return useful function range motion also achieved 75 90 early active exercises , physiotherapy , occasional continuous passive motion , supported braces cast braces postoperative period union occurs union achieved average 6 6 months operative procedure
intraarticular malunions nonunions principles intraarticular fracture care stable internal fixation , applied intra articular nonunions malunions , result restoration function joints seem almost totally either arthrodesis arthroplasty high degree success achieved almost cases illustrates human joints articular cartilage stability established together correction axial deformities mobilization joints
diagnosis treatment nonunions malunions acetabular fractures surgical treatment nonunions malunions acetabular fractures often challenge diagnosis nonunion rests clinical radiologic examination apart union involving one column , cases justify use approach
heat illness fluid electrolyte issues pediatric adolescent athletes primary mechanism maintaining normal body temperature physical exercise heat sweat , water loss far exceeds electrolyte loss rigorous exercise heat places athlete risk dysfunction dehydration children inherently less efficient adults , even greater risk heat illness three primary syndromes heat illness heat , heat exhaustion , heat stroke treatment heat illness based reduction body temperature rehydration heat stroke true medical emergency high mortality rate immediate reduction body temperature critical survival patients prevention heat illness based reducing known risk factors physical activity modified face high ambient temperature athlete begin exercise well frequent consumption cold water exercise decreases likelihood significant dehydration exercise , athlete continue drinking replace fluid losses skin exposed , greater available surface conditioning program , combined 8 14 day period , reduces risk heat injury although athletes engaged endurance sports may benefit drinking carbohydrate electrolyte containing solutions , majority young athletes , cold water remains preferred choice fluid replacement exercise relatively greater body surface area young athletes also places risk hypothermia special attention given athletes cold environmental conditions
review use prophylactic knee braces football review nine studies prophylactic knee braces worn players american football lends support use double braces high school level evidence use college level seems less caution exercised interpreting studies owing probable presence bias confounding variables difficulty results beyond study populations two studies assigned braces randomly found lower injury rates knees knee ligaments among high school high school size players conversely , large , study found significantly higher rate knee injuries among brace users , difference remained controlled position , skill , previous injury
strength training children adolescents strength ability exert muscular force resistance fundamental requirement daily physical activities children adults strength training use progressive resistance exercise methods specifically increase strength strength training children adolescents without risk proven medical concerns relate back , shoulder , joint injuries hypertension related diseases however , rate injury probably rather low , comparable many activities considered safe also , incidence severity injury probably minimized adherence guidelines presented children may expected become stronger appropriate training increased strength enhance performance athletic activities strength , power , speed required may reduce incidence severity overuse injury sport however , cannot reasonably expected protect serious , acute injury sport
substance abuse education pediatrics historically , physicians received little formal education related alcohol drug abuse dependence survey pediatric programs united states conducted assess current status alcohol drug education pediatrics medical student residency training levels , 44 40 programs , respectively , required formal instruction , 27 34 , respectively , offered elective medical students residents although respondents inclusion required elective alcohol drug education , programs include already future plan major identified time constraints \( 86 medical student level , 68 resident level \) lack qualified \( 55 medical student level , 50 resident level \) survey results suggest strong need development faculty structured alcohol drug abuse educational plans specific pediatrics
predictive value visible lesions \( , lips , \) suspected ingestion may endoscopy reasonably omitted completely negative pediatric patients \? relationship absence presence grossly visible lesions , lips , \( c l burns \) incidence , site , degree visceral burns evaluated children referred hospital suspected ingestion 10 year period children underwent gastro within 24 hours 156 children , 96 \( 61 6 \) showed visible signs contact substance however , 36 96 \( 37 5 \) , endoscopy revealed burns one visceral sites eight 36 children \( 22 2 \) sustained potentially dangerous lesions \( second third degree \) sixty 156 children \( 38 4 \) showed visible lesions 30 60 \( 50 \) , endoscopy revealed burns one visceral sites fourteen 30 patients \( 46 6 \) sustained potentially dangerous lesions \( second third degree \) total 50 esophageal burns recorded first degree \( e1 \) , 32 second degree \( e2 \) , 12 third degree \( e3 \) , 6 two 12 patients e2 lesions 6 6 e3 lesions developed esophageal stenosis one patient latter group died complications related tracheostomy total 31 gastric burns recorded g1 \( 22 \) , g2 \( 6 \) , g3 \( 3 \) one gastric perforation observed g3 group , whereas remaining two lesions healed residual asymptomatic scarring minimal scarring observed two six patients g2 burns total eight lesions recorded larynx l1 \( 3 \) , l3 \( 1 \) duodenum d1 \( 2 \) , d2 \( 2 \)
initial management trauma next 60 minutes hemodynamic stability achieved trauma patient , detailed physical examination appropriate diagnostic studies performed successful management trauma demands immediately life threatening problems receive top priority patients continuously reexamined problems conditions change finally , appropriate surgical evaluation treatment undertaken soon possible trauma patients allowed undergo extensive examination hospital lacking surgical specialists trained treat problems identified transfer another facility , whether specialized diagnostic tests evaluation treatment surgical specialists , accomplished quickly possible
skin coverage technique treatment severe injuries extremities torso 60 percent injury involving torso lower extremities 8 year old boy described successful management employed use new skin coverage technique flap still attached bed , 0 14 split thickness graft epithelium superficial dermis raised power driven dermatome harvest site , one level deeper , second layer consisting split thickness dermis \( 0 14 \) taken first second layers expanded remaining flap excised , sterile bench , produce third layer deep dermis case , third layer ultimately lost , functioned well temporary biologic dressing depending donor site morbidity , potential applications method \( e , major burn injuries \) may feasible
brachial plexus injury associated chest restraint seatbelt case report rapid deceleration wearing lap shoulder seatbelt may result traction injury brachial plexus side shoulder occult vascular injury considered patients injury pattern deficit recover type injury
biochemical analysis electroejaculates spinal cord injured men comparison normal ejaculates address consistent finding spinal cord injured men compared biochemical constituents antegrade fractions electroejaculates 6 patients manual ejaculates 6 volunteers semen samples group analyzed 19 biochemical parameters , ph osmolality organic components included triglycerides , glucose , fructose , uric acid , creatinine , urea , total protein , albumin cholesterol metabolic enzymes , including glutamic transaminase \( \) , glutamic transaminase , lactate dehydrogenase alkaline phosphatase , measured inorganic constituents included chloride , sodium , potassium , zinc although significant , higher levels blood urea nitrogen creatinine demonstrated electroejaculates suggesting urinary contamination antegrade specimens electroejaculates significantly lower levels \( p less 0 05 \) fructose , albumin , alkaline phosphatase well significantly higher levels \( p less 0 05 \) chloride noted significant difference osmolality ph found moreover , electroejaculates levels glucose , uric acid inorganic constituents approached corresponding levels serum conclude biochemical abnormalities seminal plasma may contribute seminal dysfunction spinal cord injured men may result neurological injury accessory sex glands procedure
population pedigree studies reveal lack association dopamine d2 receptor gene alcoholism using dopamine d2 receptor clone lambda , et al recently found d2 taq allele \( a1 \) present 69 35 deceased alcoholics 20 equal number controls assess association , evaluated d2 taq polymorphism single strand conformation polymorphism detected polymerase chain reaction gel electrophoresis \( pcr \) 3' region d2 receptor gene studied 40 unrelated white alcoholics , 127 matched controls , two white pedigrees schedule affective disorders schizophrenia lifetime version \( l \) clinical diagnostic interviews rated blindly two clinicians l interviews data used ascertain diagnoses according diagnostic statistical manual mental disorders , revised third \( dsm iii r \) criteria alcoholics according age onset , severity , presence antisocial personality , family history significant differences either d2 taq pcr allele frequencies observed alcoholics , subpopulations alcoholics , controls pcr polymorphism provided independent information linkage d2 receptor locus several recombinants d2 taq locus alcoholism observed two white families alcoholic parent possessed a1 allele study support widespread consistent association d2 receptor gene alcoholism
nicotine replacement therapy use transdermal nicotine patch randomized double blind placebo controlled trial rate smoking significantly reduced volunteer subjects providing effective nicotine replacement , self help material , weekly visits nurse 6 weeks nicotine replacement therapy transdermal nicotine patch \( \) almost doubled 6 week smoking cessation rate comparison placebo group \( 77 versus 39 p 0 002 \) among subjects smoking least 20 cigarettes per day baseline although subjects used active nicotine patches skin reactions , reactions primarily mild use active placebo patches , level patient compliance high among subjects continued smoke , use cigarettes decreased less 50 baseline smoking level 7 7 active nicotine patches 15 19 placebo patches outcomes beyond 6 weeks showed substantial relapse rate groups thus , nicotine replacement therapy provided , need exists concurrent behavioral intervention training prevention relapse , neither part protocol
composite free flaps staged microvascular transfer experimental clinical study feasibility free flaps inducing , process staged reconstruction , arteriovenous bundle surrounding fascia selected block tissue investigated experimentally clinically sixteen rat knee joints wrapped ipsilateral superficial inferior epigastric \( \) fascia 8 joints , composite flaps resected en bloc immediately replaced pedicled upon superficial inferior epigastric vessels remaining joints , resection orthotopic transfer performed 2 weeks later joints latter group , benefited staging period , found perfused long finger proximal interphalangeal joint child reconstructed staged microvascular transfer second toe proximal interphalangeal joint first stage , temporalis fascia flap wrapped around toe proximal interphalangeal joint pedis vessels six weeks later , joint temporalis fascia envelope dissected , joint flap transferred hand wrist vessels bony union progressed excellent recovery range motion conclude regardless indigenous vascular anatomy , array composite free flaps constructed transferred based induced large vascular pedicles
blunt trauma children significance peritoneal fluid seven hundred ninety consecutively seen children undergone peritoneal lavage underwent imaging computed tomography \( ct \) blunt trauma collections peritoneal fluid prospectively characterized small \( 51 children \) , moderate \( 32 children \) , large \( 40 children \) associated injuries included hepatic splenic injury 74 , isolated renal pancreatic injury 5 , isolated pelvic fracture 5 , isolated hollow injury 5 , combination 7 peritoneal fluid ct abnormality three children significant correlation found presence increasing size peritoneal fluid collections clinical signs hemodynamic instability lower trauma score \( p 0008 analysis variance \) , presence arterial hypotension \( p 0001 chi 2 test \) , hematocrit less 30 \( 0 30 \) \( p 0001 chi 2 test \) additionally , presence amount peritoneal fluid correlated need laparotomy mortality \( p 0001 chi 2 test \)
clinical efficacy triple injection wrist triple injection wrist demonstrated increase likelihood ligamentous perforations injured wrist diagnosed however , compared imaging single injection contrast material joint , triple injection increases patient expense also significantly increases time required patients obtain diagnosis goal decreasing number triple injections , author reviewed 50 consecutive triple injection wrist using technique based high volume injection contrast material achieve complete distention joint , author achieved false negative rate demonstration complete perforations injection alone 2 \( 10 partial perforations included \) none cases patient treatment altered additional information provided second third injections false negative rate significantly lower reported previously raises question whether circumstances easier less time consuming single injection might appropriate
accumulation erythrocyte nucleotides pattern lead workers nucleotides erythrocytes lead exposed subjects analyzed high performance liquid chromatography \( hplc \) pyrimidine levels correlated well blood lead concentrations \( pb b \) pyrimidine 5' nucleotidase \( \) activity highly significant correlations found pb b 5' diphosphate glucose \( \) , 5' triphosphate \( \) , choline \( \) levels compounds sharply elevated activity reduced levels less 7 h g hemoglobin \( hb \) , corresponded pb b 60 micrograms 100 g therefore , concentration nucleotides may provide useful index lead poisoning adenosine 5' \( atp \) concentrations correlated negatively pb b , whereas adenosine 5' monophosphate \( amp \) concentrations correlated positively pb b results suggest lead affects pyrimidine nucleotide metabolism also nucleotide metabolism \( energy production system \)
occult exposure asbestos steel workers revealed bronchoalveolar lavage investigate asbestos burden environment , counted asbestos bodies \( \) bronchoalveolar lavage fluid \( balf \) 65 steel workers previous 5 worked least 15 area plant \( blast \) maintenance production workers basis occupational , 28 occasional past professional exposure asbestos remaining 37 workers denied contact asbestos total 54 white collar workers occupational exposure asbestos included study controls increased prevalence concentration found balf steel workers electron microscopy analysis ab steel workers revealed core fibers mainly found balf maintenance workers production workers however , balf steel workers denied contact asbestos revealed increased ab burden v controls demonstrates steel workers may subject occult exposure environment
high mortality shortened life span patients itai itai disease subjects suspected disease follow study conducted 1967 1987 patients diagnosed itai itai disease , subjects suspected disease , controls ninety five subjects per category selected matching age , sex , residential area cumulative survival rate patients definite diagnosis itai itai disease significantly lower control group every period first 3 cumulative survival rate subjects suspected itai itai disease severe renal dysfunction due cadmium pollution significantly lower control group results demonstrate \( 1 \) negative influence itai itai disease prognosis \( 2 \) cadmium pollution induced renal disorder adversely affects health cadmium area
blunt traumatic cardiac rupture 5 year experience blunt traumatic cardiac rupture associated high rate mortality review computerized trauma registry \( 1983 1988 \) identified 32 patients injury \( ages 19 65 years mean age , 39 5 years 21 men 11 women \) twenty one patients \( 65 6 \) injured crashes , 3 \( 9 4 \) accidents , 3 \( 9 4 \) motorcycle accidents 3 \( 9 4 \) sustained crush injury 1 \( 3 1 \) injured fall 1 \( 3 1 \) chest anatomic injuries included right atrial rupture \( 13 40 6 \) , left atrial rupture \( 8 25 \) , right ventricular rupture \( 10 31 3 \) , left ventricular rupture \( 4 12 5 \) , rupture two cardiac chambers \( 3 9 4 \) diagnosis made thoracotomy 20 patients presenting cardiac arrest remaining 12 patients , diagnosis established seven emergency left anterolateral thoracotomy five pericardial window seven 12 patients \( 58 3 \) clinical cardiac tamponade significant upper torso mean injury severity score \( iss \) , trauma score \( ts \) , glasgow coma scale \( gcs \) score 33 8 , 13 2 , 14 3 , respectively , among survivors 51 5 , 8 3 , 7 0 nonsurvivors overall mortality rate 81 3 \( 26 32 patients \) , survivors presenting vital signs \( 6 12 patients 50 \) patients rupture two cardiac chambers ventricular rupture died mortality rate myocardial rupture high rapid prehospital transportation , high index suspicion , prompt surgical intervention contribute survival patients
role inhalation injury burn trauma canadian experience 1977 1987 , injured patients admitted burn center university hospitals thirteen hundred forty four male \( 78 8 \) female \( 21 2 \) , mean total burn surface area \( tbsa \) 15 1 \( sem 0 4 \) range 1 99 tbsa sixteen hundred thirty five patients survived discharged hospital , overall survival rate 95 9 one hundred twenty four burn patients \( 7 3 \) suffered concomitant inhalation injury diagnosed bronchoscopy patients inhalation injury suffered larger tbsa \( 39 7 2 8 versus 12 2 0 3 p less 0 01 \) without inhalation injury inhalation injury increased number deaths burn injury \( 34 7 versus 1 7 p less 0 01 \) independent age tbsa inhalation injury associated threefold prolongation hospital stay \( 23 7 0 7 versus 74 4 6 2 days p less 0 01 \) independent age tbsa multifactorial analysis performed inhalation injured burned patients allow tbsa age adjusted rates mortality burn population presented maximum detrimental effects inhalation injury burn patient outcome occurred moderate \( 15 29 tbsa \) large \( 30 69 tbsa \) thermal injuries data demonstrate inhalation injury important comorbid factor burn injury increases number deaths substantially importantly injuries also independently prolong duration hospitalization highly unpredictable fashion compared patients cutaneous burns data illustrate extreme importance inhalation injury comorbid factor following thermal injury reveal present limitations accurate quantification magnitude respiratory tract injury accompanying thermal trauma
antibody human retroviruses among drug users three east coast american cities , 1972 1976 1972 1976 , 585 persons attending methadone maintenance clinics east coast veterans hospitals enrolled survey hepatitis antibody prevalence sera tested human immunodeficiency virus \( hiv \) human lymphotropic virus \( htlv \) using htlv htlv ii immunoblots clinical death records also reviewed none sera hiv antibodies \( upper 95 confidence limit , 0 5 \) however , 103 \( 18 \) reactivity htlv profile reactivity suggested subjects exposed htlv ii rather htlv prevalence high early 1970s today correlated duration drug use rather age neither cancers , specific neurologic diseases , excess deaths cause \( overall 14 \) could ascribed seropositivity therefore , htlv \( probably htlv ii \) common infection drug users many years adverse outcomes following infection demonstrated
movement hemostatic ventricles lumbar spinal canal case report authors report patient operation left temporal arteriovenous malformation resulted dislocation multiple hemostatic several , including aneurysm clip , detected lumbar spinal canal clinical signs symptoms noted retrospectively , passage aneurysm clip could detected computerized tomography scans performed evaluate series epileptic seizures
conservative management duodenal trauma multicenter perspective experience eight trauma centers duodenal injuries analyzed identify trends operative management , sources duodenal related morbidity , causes mortality 5 year period december 1988 , 164 duodenal injuries identified patient ages ranged 5 78 years 38 class , 70 class ii , 48 class iii , four class iv , four class v injuries injury mechanism penetrating 102 \( 62 \) patients blunt 62 primary repair duodenal injury performed 117 \( 71 \) patients , including 27 patients also managed pyloric exclusion 12 tube duodenal resection primary anastomosis used six \( 4 \) patients necessary five \( 3 \) 30 \( 18 \) deaths cause death uncontrolled hemorrhage severe hepatic vascular injuries 22 \( 73 \) patients two \( 1 \) patients could death attributed duodenal injury result duodenal repair dehiscence subsequent sepsis duodenal related morbidity documented 29 \( 18 \) patients , including 22 patients intra abdominal abscess , six duodenal fistula , five frank duodenal dehiscence summary , analysis demonstrated 1 \) great majority duodenal injuries managed simple repair 2 \) tube mandatory component operative treatment 3 \) pyloric exclusion useful adjunct complex injuries 4 \) rarely necessary duodenal trauma 5 \) morbidity following duodenal trauma dependent associated intra abdominal injuries extent duodenal trauma 6 \) mortality following duodenal injuries primarily related associated vascular hepatic trauma
mortality trauma patients interaction host factors severity data host factors influencing mortality trauma patients sparse contradictory develop model health policy decisions , examined trauma admissions acute care hospitals state california year 1986 looked influence following host factors age , gender , medical conditions , mortality stratified injury severity study group \( n 199 , \) overall mortality rate 1 9 mortality increased starting age 40 years independently influenced gender , presence pre existing disease , body region injured patients minor injury , mortality rates became higher elderly age 65 however , patients injuries moderate severity , mortality increased middle age \( 40 64 \) elderly groups \( 65 \) male gender also risk factor , present elderly middle age groups presence pre existing medical disease injury head abdomen related increased mortality middle aged patients severity levels , neither accounted effect gender conclusion age gender influence mortality trauma patients effects explained documented pre existing disease region injury age gender serve observable markers subgroups patients impaired response injury middle aged males comprise previously unrecognized high risk subgroup impaired response
management large soft tissue defects following close range shotgun injury large soft tissue defects following close range shotgun blasts remain major technical challenge trauma surgeons period 1980 1988 , 43 patients survived greater 48 hours following injury managed center locations soft tissue defects extremity , 22 abdomen chest , 18 head neck , three patients underwent immediate surgical exploration wide debridement tissue along repair associated injuries management included mandatory frequent dressing changes , debridement , irrigation operating room , perioperative administration broad spectrum antibiotics four patients whose abdominal wall defects could initially closed temporary placement prevent overall , four patients underwent delayed primary closure , eight covered split thickness skin grafts , nine closure myocutaneous flaps , 19 closed secondary intent two patients , transferred us following initial management , developed wound sepsis due inadequate debridement eventually required amputation one patient developed early following lengthy arterial repair frequent operative dressing changes , adequate debridement , irrigation minimize sepsis following close range shotgun blasts treatment choice devastating injury techniques wound closure need individualized particular situation
nonoperative management blunt liver injuries adults need continued surveillance computed tomography \( ct \) scanning blunt abdominal trauma allowed nonoperative management selected patients liver injuries report describes 52 adult patients liver injuries treated without immediate surgery thirty four hepatic injuries relatively minor \( grade ii \) , 18 considered major \( grade iii v \) free intraperitoneal blood small large amounts evident ct 37 patients deaths series , major complications , known missed intra abdominal injuries , delayed hemorrhage liver injuries appear heal rapidly serial ct scans , small percentage patients residual liver defects persisting several months may risk future complications
dynamic computerized tomography axis complex trauma patients lateral mass asymmetry 23 month period , 25 patients aged 11 74 years presented level trauma center lateral mass asymmetry 2 5 mm properly centered ap open mouth x rays 32 patients asymptomatic , 68 cervical pain , 32 limited range motion patients cervical spine fractures dislocations fixed deformity excluded clinical significance asymmetry determined utilizing dynamic axial ct scanning \( \) , \( c1 \) axis \( c2 \) head neutral 15 degrees 30 degrees active rotation nineteen patients demonstrated greater 5 degrees relative motion c1 c2 bilaterally three patients less 5 degrees relative motion bilaterally three patients less 5 degrees relative motion left rotation patient formal treatment nearly normal cervical range motion clinical examination time hospital discharge finding asymmetric lateral mass properly centered open mouth ap x rays presence otherwise normal cervical spine x rays , conscious patients without fixed deformity , appears incidental requires evaluation treatment
complications evaluating abdominal trauma diagnostic peritoneal lavage versus computerized axial tomography reviewed experience 2 , dpl 's 1 , ct 's obtained resuscitative phase 3 year period trauma system determine significant complications associated modality 25 dpl complications eight false negatives , three false positives , 14 technical errors 46 ct complications including 25 false negative scans , three false positive scans , 18 delays operating room obtaining abdominal ct evaluation , two delays resulting preventable deaths although modalities low complication rates \( 0 9 dpl vs 3 4 ct \) , dpl associated less preventable mortality morbidity ct evaluation abdominal trauma
blunt carotid artery dissection incidence , associated injuries , screening , treatment blunt carotid dissection \( \) rare injury occurring less one 1 , 000 victims blunt injuries using 4 year experience trauma system 14 cases , performed matched blunt trauma patient case control analysis determine patterns injuries associated increased risk patients combinations head , facial , cervical spine injuries without extremity fractures proved significantly increased risk duplex scanning appears useful screening tool patients anticoagulation preferred treatment neurologic deficits present
unintentional injury death rates rural rural unintentional injury \( ui \) death rates higher rates urban regions trauma center serves 49 rural \( ap \) counties 120 county rural state investigated impact prehospital hospital resources ui death rates referral area age adjusted average age sex specific ui death rates 1979 1985 compared among 49 rural ap counties , 71 non \( nap \) counties , united states counties grouped comparisons level prehospital care \( advanced life support als vs basic life support bls \) presence \( h \) absence \( \) hospital death rates calculated using data 1980 population census , national center health statistics \( \) , state vital statistics within ap , 49 counties ambulance service 9 49 \( 18 \) als service 13 49 \( 26 \) hospital age specific ap rates higher nap us rates 25 44 45 64 year age groups ap death rates highest bls counties across age groups rural ui death rates region remain unacceptably high reason \( \) ap death rates exceed nap rates uncertain als service available hospital associated lower death rates propose educational epidemiologic programs better identify define additional problems
trauma centers improve outcome non trauma centers evaluation regional trauma care using discharge abstract data patient management categories development regional medical care systems treat patients sustain major accidental injuries \( trauma victims \) based autopsy studies demonstrate hospitals meet certain accepted criteria \( trauma centers \) prevent deaths trauma victims however , since autopsy data available non trauma centers , previously possible compare morbidity data trauma centers non trauma hospitals study examines discharge abstract data new patient classification system called patient management categories \( \) generated abstract data evaluate length stay \( los \) , complications , death compare morbidity mortality data trauma centers non trauma centers discharge abstracts 1 , patients femoral shaft fracture operation obtained hospitals western pennsylvania maryland 1 year data trauma centers identified compared non trauma centers using following criteria time \( less equal 2 days vs greater 2 days \) , age \( 0 12 , 13 55 , greater 55 years \) , associated injuries , development complications death patients treated trauma centers significantly fewer complications \( 21 vs 33 p less 0 001 \) lower mortality rates \( p less 0 05 \) treated non trauma centers associated injuries , age , complications , delay time significantly increased intensity length stay trauma non trauma centers significantly increased cost care provided patients types centers
management issues trauma patients alcohol estimated 20 25 patients treated emergency departments inpatients trauma drinking 0 10 gm dl \( 22 mmol l \) higher many problem drinkers alcoholics , smokers , also abuse drugs acute ingestion chronic abuse alcohol increase frequency severity injury , may complicate patient management mimicking head trauma , intra abdominal injury , causing circulatory collapse , reducing immune response , altering hepatic metabolism , causing delirium proper management trauma patient alcohol includes bac determination , careful history taking alcoholism referral evaluation treatment indicated , determination whether drugs also failure may put physician legal risk care patient exposing others injury patient crashes discharged emergency department still impaired alcohol
metabolism platelet activating factor \( paf \) paf polymorphonuclear granulocytes severely burned patients studied metabolism 3h platelet activating factor \( paf \) paf human polymorphonuclear granulocytes \( pmn \) severely burned patients \( n 6 \) days 1 , 5 , 9 , 15 , 25 post trauma patients suffered severe burn trauma 30 total body surface area stimulation pmn healthy donors \( n 10 \) ca ionophore resulted conversion 3h paf paf \( 18 2 total radioactivity \) acyl \( acyl , 50 6 \) burned patients significantly reduced formation 3h paf observed days 1 15 post trauma \( day 9 1 1 , p less 0 0001 \) pattern normalized patients \( n 5 \) survived trauma septic periods observed second week post trauma one patient injuries sustained inhibition paf formation observed death decreased formation paf correlated weakly appearance immature granulocytes within analyzed cell fraction \( ratio immature cells versus paf formation , r 0 55 , p 0 02 \)
management close range shotgun injuries chest diaphragmatic transposition case reports method chest wall following close range shotgun injuries described technique requires diaphragm peripherally suturing chest wall defect , resulting intact chest cavity abdominal wall defect latter problem addressed variety standard methods two patients presented excellent long term results diaphragmatic transposition , armamentarium surgeons deal trunk trauma
fractures process presentation seven cases review literature process fracture rare uncommon clinical entity seven cases base process presented fracture isolated one case , six cases combined injuries , either dislocation fracture superior glenoid cavity disorder one patients associated fractures clavicle process treatment conservative cases results satisfactory therefore nonoperative management advocated
gunshot wounds head prospective study previous retrospective studies cranial gunshot wounds failed determine whether aggressive field resuscitation , triage neurosurgical center , early surgical intervention improve assumed poor outcome severely injured patients therefore , studied 100 consecutive patients prospectively establish systematic approach treatment patient retained two neurological signs aggressive field resuscitation intubation , computed tomographic scan performed rapid surgical debridement done unless patient deteriorated clinical brain death glasgow coma scale \( gcs \) score resuscitation 3 5 58 patients , 6 8 8 patients , 9 12 12 patients , 13 15 22 patients seventy six computed tomographic scans 43 performed glasgow outcome scale scores showed 60 patients died , 2 vegetative , 6 severely disabled , 20 moderately disabled , 13 good outcomes 10 postoperative deaths patient gcs score 3 5 satisfactory outcome however , outcome progressively improved gcs score increased conclude cranial gunshot patients initially receive aggressive resuscitation patients stable vital signs examined computed tomographic scan patient 's gcs score resuscitation 3 5 operable hematomas present , therapy offered patients gcs score greater 5 receive aggressive surgical therapy
concepts soft tissue trauma repair proper evaluation treatment soft tissue trauma face extremely important psychologic , cosmetic , functional sequelae occur injuries facial trauma surgeon wide armamentarium techniques manage soft tissue facial trauma approach repair meticulous scientific fashion although best possible repair acute trauma goal , usually necessary perform later revision procedures scar high likelihood hypertrophic scarring inappropriate healing trauma scar
sagittal index management thoracolumbar burst fractures effort quantify risk late progression burst fractures , sagittal index \( si \) defined help assess segmental deformity level fracture si measurement segmental deformity corrected normal sagittal contour level deformed segment prospective study devised 1986 burst fracture treatment complete data available 35 patients \( 22 males , 13 females \) , average follow 27 months si greater 15 degrees first group , members treated surgically technique described si less 15 degrees third group , members treated conservatively second control group included patients si greater 15 degrees treated according authors protocol independent reasons results suggest si useful criteria assess deformity predict progression segmental
nonoperative observation clinically occult arterial injuries prospective evaluation forty seven patients 50 clinically occult injuries major arteries studied prospectively determine natural history lesions safety nonoperative management penetrating trauma predominant mechanism lower extremity arteries commonly involved morphology arterial injuries included 22 cases intimal flaps , 21 cases segmental arterial narrowing , 6 , 1 acute arteriovenous fistula one death result unrelated causes another three injuries operated immediately arteriographic diagnosis remaining 46 injuries followed nonoperatively serial arteriography \( 39 \) clinical examination \( 7 \) mean interval 3 1 months \( range , 3 days 27 months \) complete resolution documented 29 injuries \( 63 \) , whereas 3 improved , 9 remained unchanged , 5 worsened period follow worsened cases involved small occult subsequently enlarged underwent immediate surgical repair without subsequent morbidity 89 followed injuries never required surgery , nonoperative observation appears safe effective management option clinically occult arterial injuries
axis ii comorbidity substance abusers objective assess complex relationship substance abuse personality disorders , authors determined prevalence personality disorders group middle class substance abusers compared subjects personality disorders method subjects drawn patients consecutively admitted inpatient substance abuse program private psychiatric hospital first 100 agreed participate substance dependence diagnosed according dsm iii r , patients assessed structured clinical interview dsm iii r personality disorders , alcohol use inventory , , health daily living form , institute living scale , measures chemical use life satisfaction results 100 substance abusers , 57 personality disorders patients differed significantly 43 patients without personality disorders several ways greater involvement drugs , different patterns alcohol use , greater psychopathology , less satisfied lives , , isolated , depressed conclusions marked differences substance abusers without personality disorders , uniform approach substance abuse treatment may inadequate
psychiatric morbidity adult inpatients childhood histories sexual physical abuse objective extend knowledge long term effects childhood abuse psychiatric patients large sample , authors explored childhood sexual physical abuse adult inpatients 1 , consecutive admissions method patients admitted tertiary care military medical center patient interviewed , abuse history , dsm iii r diagnosis , characteristics recorded results prevalence reported childhood abuse 18 overall 9 sexual abuse \( without physical abuse \) , 10 physical abuse \( without sexual abuse \) , 3 combined abuse female male patients reported abuse alcohol use disorders common victims physical combined abuse sexually abused nonabused patients axis ii diagnoses , particularly borderline personality disorder , frequent abuse victims nonabused patients histories drug alcohol abuse common patients reporting physical combined abuse nonabused patients also frequent abused nonabused inpatients noted 79 patients histories combined abuse combined abuse women physical abuse men associated family history psychiatric illness , commonly alcoholism male relatives conclusions findings emphasize need greater attention family dynamics , aggressive diagnosis treatment alcoholism within family , , especially , determination patients' abuse histories , even repeated necessary
accidental firearm fatalities among new mexico children study hypothesis risk factors associated unintentional gunshot fatalities among children include gender race , type firearm used , whether loaded guns stored within home study population new mexico children 0 14 years old killed firearm 1984 1988 methods new mexico office medical investigator mortality reviewed retrospectively identify unintentional firearm fatalities occurring new mexico children five year period medical investigator , autopsy , police reports analyzed identify epidemiologic factors associated deaths chi square fisher 's exact tests used analyze data results twenty five unintentional firearm fatalities identified deaths occurred frequently among children playing loaded firearms found within home disproportionate number involved conclusions study results provide basis preventive strategies limit decrease lethality loaded firearms within home
reporting contaminated injuries emergency health care workers study hypothesis considerable reporting contaminated occupational sharp injuries among emergency health care workers population convenience sample emergency physicians , emergency nurses , emergency medical \( emts \) methods survey instrument eliciting demographic work related factors developed administered survey items included age , sex , occupation , years occupation , number procedures performed per week , number contaminated \( \) injuries recalled , number injuries formally reported previous five years visual analog scales used assess eight attitudes possibly associated analysis analysis variance multiple linear regression stepwise variable results two hundred fifty nine subjects recalled contaminated exposures five year study period , 228 \( 35 \) formally reported one injuries occurred 55 emts compared 72 nurses 80 physicians \( p less 05 \) physicians recalled mean 3 8 contaminated exposures , whereas nurses recalled 2 8 emts recalled 1 8 \( p less 05 \) physicians formally reported mean 0 26 exposures , whereas emts reported 0 85 nurses reported 1 25 \( p less 05 \) physicians formally reported one eighth injuries compared emts nurses , reported two thirds events \( p less 05 \) perception risk , occupation , years occupation , concern excessive powerful predictors low reporting rate \( p less 05 \) conclusions work related contaminated sharp injuries reported emergency health care workers , especially emergency physicians
's fracture 7 week old infant 's fracture infancy childhood bilateral avulsion pedicles c 2 vertebral body , frequently anterior dislocation c 2 c 3 present case youngest infant medical literature 's fracture discuss anatomy , kinematics injury , radiographic diagnosis , treatment
psychiatric disorders relatives probands opiate addiction previous research documented high rates major depression antisocial personality opiate addicts study designed investigate relationship dual diagnosis opiate probands family history psychiatric disorders substance use disorders biological relatives psychiatric disorders substance use disorders evaluated using direct interview family history sample first degree relatives 201 opiate addicts 360 relatives 82 normal controls results indicate \( 1 \) compared relatives normal subjects , opiate relatives substantially higher rates alcoholism , drug abuse , depression , antisocial personality \( 2 \) relatives depressed opiate probands elevated rates major depression anxiety disorders disorders , suggesting validity opiate addicts presence absence major depression \( 3 \) contrast , relatives antisocial opiate addicts rates disorders significantly different relatives opiate addicts without antisocial personality implications findings classification treatment substance abuse discussed
psychiatric diagnoses treatment seeking cocaine abusers sample 298 cocaine abusers seeking inpatient \( n 149 \) outpatient \( n 149 \) treatment , rates psychiatric disorders determined means schedule affective disorders research diagnostic criteria overall , 55 7 met current 73 5 met lifetime criteria psychiatric disorder substance use disorder common previous reports clinical samples cocaine abusers , overall rates largely accounted major depression , minor bipolar conditions \( eg , , personality \) , anxiety disorders , antisocial personality , history childhood attention deficit disorder affective disorders alcoholism usually followed onset drug abuse , anxiety disorders , antisocial personality , attention deficit disorder typically preceded drug abuse
symptoms tobacco withdrawal replication extension smokers \( n 315 \) wished quit randomly assigned double blind manner groups using either nicotine placebo self reported observed symptoms tobacco withdrawal collected cessation follow ups 1 2 weeks , 1 month , 6 months self reported observed , anxiety , craving , difficulty concentrating , , , prominent symptoms tobacco withdrawal symptoms returned levels 1 month except increased weight , , craving continued 6 months many smokers nicotine decreased symptoms , including craving weight smokers intense withdrawal likely relapse smokers gained weight less likely relapse
hyperactive boys almost grown v replication psychiatric status previously reported prospective follow study 101 young adult males whose conditions diagnosed hyperactivity childhood compared controls , probands significantly higher rates attention deficit , antisocial , drug use disorders follow \( mean age , 18 years \) present study attempt replicate findings independent sample 94 hyperactive boys seen clinic , compared 78 normal controls assessments made clinicians blind group membership information obtained 90 original cohort previous study , significantly probands controls given ongoing diagnoses attention deficit disorder \( 43 vs 4 \) , antisocial disorders \( 32 vs 8 \) , drug use disorders \( 10 vs 1 \) furthermore , absolute rates disorders comparable corresponding groups across studies , adjusted odds ratios differ significantly previously , increased risk affective disorders grown hyperactive children present study provides powerful replication nature young adult outcome childhood hyperactivity
outbreak pneumococcal pneumonia two men 's shelters report retrospective study 39 homeless men hospitalized acute pneumonia april 1988 march 1989 recently stayed one two shelters streptococcus pneumoniae serotype 1 , resistant , isolated 29 patients \( 74 percent \) blood cultures positive 24 \( 61 percent \) patients relatively young none 70 years old thirty five \( 90 percent \) heavy smokers 32 \( 82 percent \) alcoholics radiologic pattern atypical 14 cases \( 36 percent \) fatal case linked adult respiratory distress syndrome likely rate outbreaks pneumococcal pneumonia underestimated homeless high risk pneumococcal pneumonia addition , existing shelters occurrence outbreaks consequently , suggest shelter residents would benefit pneumococcal vaccination
reconstructions trace evidence paper reviews use trace evidence recovered spent bullets helping establish use information derived trace evidence combined techniques reconstruction data discussed five cases reviewed analysis trace materials bullets used help reconstruct event
application probability theory group breath alcohol blood alcohol data many per se driving intoxicated \( \) status expressed terms blood alcohol concentration \( bac \) standard \( grams per 100 ml equivalent \) since breath alcohol \( brac \) analysis typically employed determine bac , often challenge use assumed 1 conversion ratio concern may relevant light considerable data show low percentage cases brac greater bac , concern increases brac used predict bac context per se legislation probability theory provides basis estimating likelihood individual brac greater equal g 210 l corresponding bac less 0 10 g 100 ml actual field data state wisconsin \( n 404 \) evaluated determine probability occurrence probability occurrence involves law independent events computed probability data 0 018 actual number brac greater equal 0 10 g 210 l bac less 0 10 g 100 ml 5 , resulting probability 0 012 concern brac greater bac critical per se level low probability occurrence , thus supports per se legislation based upon blood alcohol standard determined breath alcohol analysis
usefulness lung surfactant phospholipids \( \) diagnosis drowning authors studied usefulness lung surfactant phospholipids \( \) isolated lung tissues markers drowning two different groups rabbits sacrificed drowning fresh salt water , phospholipid compositions compared non control series phospholipids studied lung \( phosphatidyl choline , phosphatidyl , phosphatidyl glycerol \) proportions differed control group group , fresh water salt water animals according results , lipids analyzed employed markers forensic autopsies , necessary differentiate death drowning postmortem immersion fresh water salt water drowning lung tissue , phosphatidyl choline phosphatidyl inositol showed differences results also confirm strongly affected drowning
death resulting poisoning fatalities due accidental exposure industrial setting infrequently reported deaths cases occurred within poorly ventilated , compartments areas case presented 16 year old male died result exposure working open pit chromatographic results tissue concentrations presented
tubular bullet unique projectile recently marketed \( pan metal corporation \) tubular hollow point uniquely constructed two part projectile composed tubular copper bullet teflon fatal gunshot wound described unique radiographic pattern results test firing also presented
use human skin bite mark template two case reports comparison suspected 's dental injury bite mark especially difficult bite occurs anatomic location small radius curvature complex compound curves authors present two case reports human skin used template bite one case victim 's skin used , skin anatomically similar person used use dental , photography , significantly reduced errors common analysis bite highly curved areas
combat related ptsd psychosocial adjustment problems among substance abusing veterans purpose study following \) determine prevalence combat related posttraumatic stress disorder \( ptsd \) symptoms among veterans seeking assistance veterans administration medical center substance abuse treatment facility , b \) examine relative contribution vietnam war zone variables ptsd symptom development , c \) study psychosocial adjustment problems associated vietnam combat exposure ptsd symptoms among help seeking substance abusing men male veterans presenting treatment , 10 7 significant vietnam combat related ptsd symptoms measured scale combat related ptsd clinically significant ptsd symptoms occurred among 46 subsample combat exposed vietnam veterans substance abuse problems degree combat exposure important military stressor distinguished vietnam veterans ptsd without ptsd , groups also differed age war zone duty , duration war zone duty , whether veterans served vietnam differ veterans war zone duty various parameters psychosocial adjustment however , subgroup vietnam veterans ptsd symptoms reported significantly greater psychosocial adjustment problems counterparts ptsd deleterious effects associated combat related ptsd appeared confined adjunctive psychiatric difficulties increase risk arrests antisocial conduct beyond found veterans without ptsd methodological clinical implications findings discussed
psychological absorption affect marijuana intoxication absorption \( trait capacity total attentional involvement \) reported increase episodes marijuana intoxication several subsets absorption scale items specifically characterized marijuana intoxication , groups users showed differential affective involvement experiences additionally , within drug using group , positive correlation frequency marijuana use affective ratings experiences found findings support hypothesis specific type alteration consciousness enhances capacity total attentional involvement \( absorption \) characterizes marijuana intoxication , enhancement may act , possibly influencing future use
lag screw fixation anterior mandibular fractures technique applying lag screws treating fractures anterior mandible presented review 41 patients lag screws placed treat fractures showed successful method providing rigid internal fixation advantages technique bone plate fixation discussed
method fractured analysis 105 cases prospective study analyzed 105 cases treated using temporal approach fractures 97 cases \( 92 \) sufficient eight cases required open reduction suggested method used frequently , associated minimal morbidity short duration general anesthesia
low dose caffeine physical dependence humans study investigated effects low dose levels caffeine \( 100 mg day \) 7 normal humans substitution placebo capsules caffeine capsules occurred double blind conditions subjects rated various dimensions mood behavior first phase study , substitution placebo 12 consecutive days resulted withdrawal syndrome 4 subjects peaked days 1 2 progressively decreased toward levels 1 week data remaining three subjects provided evidence withdrawal second phase study , withdrawal effect examined repeatedly placebo 100 mg day caffeine 1 day periods separated average 9 days despite differences within across subjects respect presence , nature magnitude symptoms , seven subjects demonstrated statistically significant withdrawal effect although phenomenon caffeine withdrawal described previously , present report documents incidence caffeine withdrawal higher \( 100 subjects \) , daily dose level withdrawal occurs lower \( roughly equivalent amount caffeine single cup strong coffee 3 caffeinated soft drink \) range symptoms experienced broader \( including headache , fatigue dysphoric mood changes , muscle pain stiffness , flu like feelings , nausea vomiting craving caffeine \) recognized
hyperbaric oxygen therapy acute smoke inhalation injuries hyperbaric oxygen therapy important adjunct management respiratory injuries secondary smoke inhalation , especially injury complicated inhalation toxic chemical carbon monoxide cyanide carbon monoxide poisoning , therapy become standard practice information becomes available concerning ability hyperbaric oxygen reduce reperfusion injuries , anticipate therapy become standard practice managing smoke inhalation injuries cyanide poisoning well
biomechanics fracture risk prediction hip spine quantitative computed tomography review , made use simple engineering concepts summarize current efforts relating qct measures bone density strength variety vitro experiments cadaveric vertebrae femora , evident apparent ash densities strong linear functions qct measures , coefficients determination ranging 0 49 0 90 relative errors 44 9 7 1 qct data also used \( somewhat less confidence \) determine compressive \( 0 36 0 68 , relative errors 45 0 35 5 \) compressive strength \( 0 58 0 70 , relative errors 56 5 39 9 \) trabecular bone proximal femur vertebral body cortical bone , material properties correlated weakly qct measures experiments designed relate qct data failure loads proximal femur vertebral body remarkably successful coefficients determination ranged 0 32 0 93 , relative errors 31 1 13 9 however , vitro failure loads determined experiments compared available estimates vivo loads spine hip , apparent , least elderly , vivo loads relatively close cause fracture vitro assess possibility developing qct based clinical predictors fracture risk individual patients , introduced concept factor risk often used engineering design account estimates service loads component strength factor risk particular loading condition defined ratio expected service loads known failure loads extend concept densitometric fracture risk prediction vivo , important recognize densitometric data must used predict ultimate load carrying capacity region interest , ultimate load must compared forces expected vivo comparable loading conditions one difficulty approach little known vivo forces associated age related fractures hip vertebrae even less forces applied hip spine traumatic events falls however , available estimates vivo loads bending lifting , apparent elderly , factors risk spine easily approach 1 \( abstract truncated 400 words \)
immediate closed reduction cervical spine dislocations using traction cervical facet dislocations may reduced rapidly effectively using axial traction weights applied traditional 45 limit fifty three sequential patients cervical facet dislocations reviewed thirty nine patients required 50 pounds traction achieve rapid reduction sixty eight percent entire series showed significant improvement neurologic function cases significant loss function cadaver study confirmed cranial could support 100 pounds traction careful application 100 pounds seems associated low risk neurologic compromise failure , results effective reduction dislocations
strategies trauma resuscitation victims penetrating trauma often trauma center within minutes sustaining injury nevertheless state deep circulatory shock patients require extensive resuscitative efforts particular , benefit rapid , massive normothermic fluid resuscitation initial one year period , 153 730 patients required immediate operation , , 33 required rapid infusion defined greater 5 liters per hour first hour survival rate operated upon 79 per cent encouraged data , rapid \( level 1 h 500 \) \( level 1 , technologies , inc \) modified increase normothermic fluid delivery 500 per minute eleven subsequent 205 patients required rapid infusion statistically significant improvement clinical flow rates , decrement resuscitation times unexpected survival particular , latter group \( nine survivors \) included four clinically dead field arrival trauma center , rapid infusion normothermic fluids may benefit penetrating trauma also generally management massive hemorrhage
increased intraocular pressure severely burned patients six eyes three patients severe body burns intraocular pressure ranging 37 2 81 7 mm hg extreme orbital congestion , lateral performed , caused abrupt decrease intraocular pressure \( range , 17 6 49 0 mm hg \) none patients history glaucoma , narrow angles , pupillary block mechanism two patients survived neither optic nerve damage increased intraocular pressure hospital discharge performed patients severe burns orbital congestion , especially patients receiving large amounts intravenous fluids lateral may benefit relieve potentially damaging high intraocular pressure
utility self administered alcoholism screening test \( saast \) schizophrenic patients utility self administered alcoholism screening test \( saast \) determining alcohol abuse alcoholism assessed preliminary study 21 schizophrenic patients hospitalization acute care psychiatric unit admission met dsm iii r criteria schizophrenia none detected alcohol related diagnosis saast scores ranged 2 26 mean score 10 8 forty eight percent \( 10 21 \) saast scores greater equal 10 , indicating probable alcoholism 62 \( 13 21 \) scored 8 higher every patient saast score 8 higher also met dsm iii r criteria alcohol abuse dependence basis patient interview , independent chart reviews , interviews significant others contrast , half \( 5 10 \) high saast would actually admit problem drinking extensive study interviews six saast items found highly predictive abuse alcoholism saast greater sensitivity interviews sixty two percent \( 8 13 \) schizophrenic patients met dsm iii r criteria alcohol abuse reported first degree relative alcohol related problem , contrast 25 nonalcoholic patients patterns alcoholic schizophrenic patients' responses different saast items revealed even greater denial lack insight alcoholic subjects
alcohol effects function familial alcoholism acute effects previous research demonstrated response differences following administration alcohol adult males positive \( fhp \) versus negative \( \) family history alcoholism response differences thought reflect differences vulnerability dependence alcohol thus , role positive family alcoholism history increasing risk addiction variety drug classes might studied determining whether fhp subjects show different responses drug classes alcohol done present study determining dose effect functions variety physiological \( heart rate , skin conductance , skin temperature \) , subjective \( analog mood drug effect , subjective high assessment scale \) , psychomotor measures \( hand tremor , body sway , digit substitution test , eye hand coordination , recall \) fhp college aged males \( 0 , 100 , 200 mg mouth \) ethanol \( 1 g kg \) fhp subjects matched light moderate drinking patterns , anthropometric dimensions , age , years , drug use equivalent blood alcohol levels family history positive subjects reported greater effects ethanol family history negative subjects almost subjective measures following high dose , fhp subjects showed elevated subjective effects effects substantially less evident fewer measures following ethanol contrast effects subjective measures , ethanol produced comparable impairment groups subjects psychomotor responses group differences obtained physiological measures
sons alcoholics report greater symptoms sons nonalcoholics pilot study investigated alcohol induced among college men high low risk alcoholism thirteen sons alcoholics reported significantly \( p less 0 001 \) greater symptoms past year 25 sons nonalcoholics two groups reported comparable quantity frequency recent drinking extent represents acute withdrawal syndrome alcohol , raises question whether sons alcoholics dependence prone
taste reactivity alcohol rats taste reactivity tests used examine orofacial responses alcohol \( p \) rats alcohol \( np \) rats taste alcohol initial exposure , naive rats tested reactivity five concentrations alcohol \( 5 , 10 , 20 , 30 , 40 v v \) , water , one solution sucrose quinine two bottle consumption test given 3 week period allow rats access 10 alcohol preference test , second taste reactivity test done using solutions initial reactivity test results indicated significant differences taste reactivity p rats np rats initial exposure , except np rats made significantly mouth movements two bottle tests , consumption alcohol p rats consistently higher np rats across test days second taste reactivity test , p rats showed increase number responses decrease number responses alcohol np taste reactivity alcohol remained unchanged exposure 1 exposure 2 p np responses sucrose quinine change exposure 1 exposure 2 concluded taste response differences p np rats alcohol following alcohol experience , p rats showed significant increase responses concomitant decrease responses taste alcohol
subject selection bias alcoholics treatment study baseline differences alcoholism problem severity compared alcoholics volunteer participate treatment effectiveness study positive relationship found self reports alcohol related problems degree research participation group differences also revealed rate treatment completion possible explanations solutions volunteer bias discussed
alcohol abuse among alcoholics preliminary findings drawing upon self reports family history alcoholism , present study compared level alcohol abuse among alcoholic maternal paternal although based small sample \( n 29 \) , results indicated significantly higher level alcohol abuse among maternal compared paternal
relationships neuropsychological test performance event related potentials alcoholic nonalcoholic samples event related potentials measured neuropsychological test performance correlated \? male female middle aged alcoholics peer controls administered event related potential \( erp \) task several hours later , battery neuropsychological \( np \) tests alcoholics performed significantly poorer controls np tests male alcoholics significantly altered erp responses \( , , p3 amplitudes \) female alcoholics differ erp variables controls number significant correlations erp np measures present consistent findings positive correlations perceptual motor \( pm \) tests p3 amplitude male female alcoholics male alcoholics , negative correlation pm tests p3 latency , findings similar seen parkinson patients significant correlations numerous family history positive alcoholics results lead two conclusions first , 's alcoholics may manifest intermediate duration organic mental disorder supported second , given lack erp differences females , erp measures considered causally related np performance
comparison self administered alcoholism screening test \( saast \) alcohol test \( \) results alcoholic population collaterals study examined reports patients collaterals drinking practices , measured summary scale alcohol test \( annual absolute alcohol intake , aaai \) alcohol related behavioral patterns , assessed self administered alcoholism screening test \( saast \) outpatients two area substance abuse treatment hospitals , number collaterals , participated study patients' responses aaai saast compared use paired test results indicated significant differences patients' self reports compared collateral reports , demonstrated direct relationship aaai \( two tailed p less 0 001 \) saast \( two tailed p less 0 001 \) self reports patients collaterals compared self reports patients volunteer collaterals also showed significant differences aaai saast , demonstrating consistency reporting whether patients believed reports would compared information provided collateral aaai saast corroborated diagnoses patients suffering alcoholism \( r 0 , p less 0 001 \) multivariate analysis revealed significant effect demographic variables either aaai saast study shows \( \) impressive concordance patient collateral reports \( 2 \) apparent memory , little evidence denial , measured instruments \( 3 \) efficacy measures aaai saast , two different scales measuring dimensions alcoholism
formation 37kd protein acetaldehyde adduct liver alcohol treatment dependent alcohol dehydrogenase activity protein acetaldehyde \( protein \) formed vivo chronic alcohol ingestion protein reported thus far include 37kd protein aa liver cytosol , 1 aa hepatic microsomes , hemoglobin aa , serum protein postulated acetaldehyde perhaps reactive acetaldehyde radical generated microsomal ethanol system \( cytp450iie1 \) explains formation cytp450iie1 aa source acetaldehyde responsible formation cytosolic 37kd protein aa determined report , examined effects \( inhibitor \) \( aldehyde dehydrogenase inhibitor \) formation 37kd liver protein aa vivo vitro found feeding rats alcohol containing liquid diet supplemented enhanced diet supplemented completely abolished formation 37kd liver protein aa liver rats fed supplemented alcohol containing diet showed significantly higher content cytp450iie1 rats fed diet containing alcohol alone hand , feeding supplemented alcohol containing liquid diet enhance content cytp450iie1 similarly , adding culture medium enhanced adding 4 inhibited production 37kd protein aa cultured hepatocytes even though combination alcohol 4 increased content cytp450iie1 2 fold control cells results demonstrate formation 37kd liver protein aa dependent
acute alcohol ingestion reduces fatty acid extraction heart , liver , small intestine ethanol may profound effects distribution perfusion substrate utilization liver heart due vasodilating properties generation high levels circulating acetate lactate since fatty acids highly extracted heart liver normal circumstances , changes relationship perfusion fatty acid uptake may sensitive indicator altered perfusion changes metabolic substrate availability test hypothesis , studies performed rats fed 3 1 , 6 2 , 9 3 g kg doses ethanol fatty acid uptake estimated 3 methyl substituted reagent chain length equivalent 17 methyl group three position prevented beta oxidation prolonged residence fatty acids tissue eighteen hours acute alcohol administration , fatty acid uptake reduced heart small intestine liver uptake increased unchanged acute ethanol administration also resulted increased perfusion , indicated enhanced uptake heart , liver , small intestine fatty acid extraction heart , liver , small intestine , defined concentration fatty acid divided concentration , markedly decreased alcohol ingestion alcohol effects dose dependent temporally related data suggest ethanol ingestion could potentially alter heart function exercise following prolonged fast , heart relies primarily upon fatty acids extracted circulation generated adenosine triphosphate \( atp \)
indications surgical debridement 125 human bites hand indications operative intervention following human bites hand determined based physical examination time elapsed since injury one hundred twenty four patients admitted hospital new , la , stratified according time elapsed injury treatment \( early , less 24 hours delayed , 1 7 days late , greater 7 days \) patients early group mainly treated conservative wound care , consisting local wound exploration irrigation emergency department , late group underwent surgical debridement patients delayed group either received conservative wound care underwent debridement operating room early late groups recovered excellent hand function results within delayed group variable improved results depending rapid surgical debridement drainage
effects granulocyte macrophage colony stimulating factor burn patients studied effects granulocyte macrophage colony stimulating factor burn patients serial measurements granulocyte oxidative function obtained treated patients group controls matched age total burn size administration granulocyte macrophage colony stimulating factor resulted 50 increase mean leukocyte counts groups showed significant baseline increases granulocytic cytosolic oxidative function treated patients showed normal stimulated cytosolic oxidative function , significantly depressed compared untreated patients myeloperoxidase activity increased treated patients first postburn week declined normal levels untreated patients significant increase myeloperoxidase activity first 3 weeks following injury untreated patients exhibited significant decrease superoxide activity second 3 weeks following injury treated patients demonstrated normal superoxide activity
universal precautions universally followed adherence universal blood body fluid precautions studied surgical patient care areas university hospital effort identify potentially hazardous health care personnel practices surgical teams 18 unit operating room , three surgical ward patient care teams , patient care personnel 16 bed surgical intensive care unit observed routine patient care activities \( study 1 \) \( study 2 \) specific educational programs held improve universal compliance overall , occurred 57 observed procedures study 1 58 observed procedures study 2 study 1 , occurred 75 operating room procedures , 30 surgical ward procedures , 75 surgical intensive care unit procedures study 2 procedure rates 81 , 32 , 40 , respectively surgical intensive care unit compliance significantly improved noncompliance universal precautions occurs frequently care patients undergone surgery , type specific varying according patient violations appear one time educational efforts substantial overall improvement may arise ongoing educational programs directed specific personnel care patients undergone surgery
seatbelt effectiveness cost noncompliance among drivers admitted trauma center seatbelt legislation maryland presented opportunity compare seatbelt compliance among seriously injured drivers admitted level trauma center establish levels severity , length stay , hospital cost differences among study population fifty five randomly selected drivers examined total surgical population seatbelt compliance rate 41 8 , reflecting rate community reduced total number injuries 34 , major injuries 57 , minor injuries 20 deaths occurred among belted group group mean injury severity score two times great belted group hospitalized 1 6 times longer double cost major injuries face , chest , pelvic regions prevented seatbelt among belted group , severe injuries occur head , neck , abdominal regions recommended air bags automatic devices required drivers trauma occurring daily eliminated acute hospital cost minimized
levodopa overdose 57 year old woman ingested 15 17 tablets levodopa 10 100 tablets \( 150 mg levodopa 1 , 500 mg \) along ibuprofen , , , acetaminophen patient developed movements persisted despite attempts naloxone , morphine , diazepam patient developed rising level creatine phosphokinase , treated ventilatory support pancuronium required paralysis 60 hours , resolved
three accident ems perspective three accident occurred august 7 , 1988 formula , 24 authors retrospectively examined prehospital based response multiple incident used emergency medical service \( ems \) physicians 32 paramedics water based triage 24 patients 32 minutes patients transported 5 hospitals including 4 level trauma centers accomplished 53 minutes ems response unique number respects prehospital based rescue entire triage stabilization phase accomplished river rescue units transported paramedic , ems physicians , trauma supplies 30 patients also significance proportion pediatric patients accounted 50 \( 12 24 \) cases successful medical care result planning based daily routine escalation existing treatment protocol adequate supplies , personnel transport adapted local patient population , including services ems , police , fire prehospital physician input ensure correct triage order patient disposition
measurement end expiratory pressure high frequency jet ventilation laryngoscopy anaesthetic technique using high frequency jet ventilation proposed direct laryngoscopy , may expose patients risk order assess risk , measured end expiratory airway pressure \( eep \) using two three way valves mounted series end insufflation first valve switched apparatus connected large exit port adjustable time \( decompression time \) second valve switched injection line connected transducer , allowing measurement eep accuracy measurement tested airway pressure measured directly trachea \( pt \) lung model provided decompression time long enough \( 70 ms \) apparatus small \( 6 ml \) , difference eep pt less 1 cm h2o frequencies 5 hz clinical evaluation performed 64 patients general anaesthesia laryngoscopy eep correlated end expiratory pulmonary volume frc inferred abdominal thoracic jet frequencies 5 hz , correlations two variables satisfactory \( r greater 0 88 \) , suggesting eep good indicator pulmonary
history classification knee braces great deal concern within orthopedic community regarding lack objective data available knee braces article fill void presenting overview history classification knee braces
choosing functional knee braces choosing functional brace knee injury complex issue complicated lack quantitative research subject increasing number braces currently market correct brace decision facilitated better understanding knee injury biomechanics thorough understanding choices available ultimate selection brace based sound mechanical criteria individualized patient brace must mechanically one patient , confidence , tolerate combination aggressive rehabilitation , functional brace make significant contribution returning individuals functional activity
functional analysis anterior cruciate ligament braces whether anterior cruciate ligament \( acl \) braces work subject debate research efforts undertaken understand braces divided two static functional analysis article explores issues surrounding functional analysis acl braces
use knee braces rehabilitation article use knee braces augmentation overall rehabilitation program following knee injury also outlined aspects rehabilitation , use continuous passive motion devices , forms exercises training , together bracing , may enhance patient recovery continuous passive motion devices used many different orthopedic problems good success understanding mechanics devices move knee forces applied knee helpful deciding use ligamentous reconstructions rehabilitation knee following surgery requires good understanding effects exercise knee reconstruction gradual progression exercises knee following knee ligament reconstruction healing tissues many different types knee braces exist , careful evaluation may enhance patient recovery
effect bracing collateral ligaments knee disruption ligamentous structures knee commonly seen competitive sports role prophylactic functional bracing controversial currently , prophylactic bracing shown , conclusively , protective functional braces appear capacity provide protective effect
clinical significance evaluation prophylactic knee brace studies football review nine studies prophylactic knee braces american football found support use double braces high school little support use level problems bias confounding make necessary caution exercised interpretation results studies , however , groups results might apply must also considered two studies assigned braces randomly found lower injury rates among high school high school sized players knee injuries knee ligament injuries conversely large , study found significantly higher rate knee injuries among brace users , difference remained controlled position , skill , previous injury
management smooth blunt gastric foreign bodies asymptomatic patients guidelines management asymptomatic patient smooth blunt gastric foreign body well established pediatric literature questionnaires sent pediatricians , family practitioners , pediatric pediatric surgeons response rate 62 2 agreement regard long one observe patients intervention correlation years clinical experience length observation recommended either review pre endoscopic literature revealed spontaneous evacuation 93 99 types foreign bodies pediatric patients observation period least eight weeks strongly considered asymptomatic patient smooth blunt gastric foreign body exceptions would include anatomic abnormality gastric outlet , previous gastric outlet surgery well possibly toxic
clinical value magnetic resonance imaging evaluation meniscal disorders prospective double blind study designed evaluate capability magnetic resonance imaging serve diagnostic tool patients clinically suspected disorder meniscus imaging studies provided diagnostic accuracy 72 per cent , sensitivity 88 per cent , specificity 57 per cent positive negative predictive values 66 83 per cent diagnostic sensitivity 94 per cent lesions medial meniscus value differed significantly 78 per cent lesions lateral meniscus \( p less 0 05 \) 37 per cent specificity lesions medial meniscus extremely low compared rate 69 per cent lesions lateral meniscus \( p less 0 01 \) intermediate part meniscus , diagnostic sensitivity 37 per cent medial side 23 per cent lateral side values significantly less average 74 per cent meniscal segments \( p less 0 001 \) imaging studies provided accuracy 67 per cent detection degeneration meniscus , 78 per cent identification meniscal tears , 82 per cent delineation postoperative lesions
accuracy diagnoses magnetic resonance imaging knee multi center analysis one thousand fourteen patients magnetic resonance images knee made patients , diagnosis subsequently confirmed accuracy diagnoses imaging 89 per cent medial meniscus , 88 per cent lateral meniscus , 93 per cent anterior cruciate ligament , 99 per cent posterior cruciate ligament magnetic resonance examinations done several centers , results varied substantially among centers accuracy ranged 64 95 per cent medial meniscus , 83 94 per cent lateral meniscus , 78 97 per cent anterior cruciate ligament results different magnetic resonance units also compared , findings suggested increased accuracy units stronger magnetic field magnetic resonance signal reported grade ii \( linear signal extending superior inferior meniscal surface \) , 17 per cent found arthroscopy
dislocations long term follow twenty patients dislocation one medial four joints followed average 6 5 years \( range , 1 5 20 5 years \) fifteen patients treated open reduction internal fixation first three weeks injury long term result excellent thirteen three four unsatisfactory results patients injuries normally rigid second third joints concomitant ulnar nerve injury
healing digital flexor tendons importance interval injury repair biomechanical , biochemical , morphological study dogs effect elapsed interval time injury operative repair flexor tendons investigated canine model flexor tendons repaired either immediately delay seven twenty one days biomechanical , biochemical , morphological characteristics compared three six weeks values angular rotation , linear excursion , ultimate load , linear slope determined concentrations collagen collagen cross links , index newly synthesized collagen , measured ultrastructural morphology tendons examined high voltage electron microscopy tendons repaired immediately , values angular rotation 9 4 3 2 13 0 3 7 degrees three six weeks repaired seven days , 4 1 1 3 2 5 1 4 degrees repaired twenty one days , 2 7 0 8 4 7 0 7 degrees significant effect delay repair angular rotation linear excursion three groups \( p less 0 005 \) tensile testing bone tendon complex revealed significant effect delay values ultimate load \( p greater 0 05 \) significant differences total concentration collagen sites repair levels base cross links \( indicators newly synthesized cross links \) tendons three groups
fat distribution steroid hormones women alcohol abuse anthropometric , hormonal liver function parameters examined 18 premenopausal women history early alcohol abuse , compared data randomly selected controls age alcoholic women showed slightly elevated levels transaminases , clinical laboratory signs advanced liver damage women characterized increased waist hip ratio , due enlarged waist circumference several endocrine abnormalities found , including irregular absent menses well low oestrogen , progesterone delta 4 levels concentration free testosterone high sex hormone binding globulin low data suggest abdominal distribution body fat , well alcoholic , premenopausal women postulated endocrine abnormalities might responsible abdominal fat distribution
association self reported injury alcohol consumption medical outpatients objective study designed examine association minor injury level alcohol consumption among adult outpatients design self administered survey alcohol use level injury prior month setting adult outpatients attending university based general internal medicine private practice patients participants four month period , 1 , 011 patients aged 18 65 years asked complete questionnaires waiting see physician completed forms appropriately included study intervention none measurements main results total number total number injuries reported preceding month calculated reported average 0 51 \( sd 1 18 \) injuries prior month drinkers , 0 92 \( sd 1 70 \) injuries minor injuries reported frequently heavier alcohol among younger patients \( rr 1 88 \) association reported injury alcohol consumption among patients 50 years age \( rr 0 90 \) conclusions minor injury associated heavier alcohol consumption younger patients attending general medical practice , among older patients research needed establish causal relationship alcohol drinking minor injury
massive transfusion outcome blunt trauma patients 54 month period 6 , 142 patients consecutively admitted level trauma center ninety two blunt trauma patients required massive transfusion \( mt \) 20 units packed red blood cells \( range , 20 126 \) eighty two per cent transfused blood given within 24 hours admission forty eight patients \( 52 \) long term survivors twenty six patients died \( 28 \) within 24 hours 21 eighteen patients died greater 24 hours nine \( 50 \) died multiple organ failure , nine \( 50 \) died severe closed head injury \( chi \) clinical predictors increased mortality shock admission , closed head injury , age forty three survivors followed mean 2 5 years \( range , 1 5 years \) patient died followup patients home 1 year four patients required continued medical assistance thirty two patients \( 74 \) returned work conclude 1 \) blunt penetrating trauma patients receiving mt similar survival rates 50 2 \) shock , closed head injury , age predict increased mortality preclude survival 3 \) long term outcome blunt patients requiring mt excellent post discharge death rare 3 4 survivors return work , high cost acute care
save fuel reduce injuries increased fuel reduced injuries incompatible goals , based false assumption vehicle weight determining factor predicts size velocity , weight , primary factors affecting crash forces , increased weight increased velocity fuel analysis fatal injury rates , injury costs , fuel use relation vehicle weight , vehicle size , confirms weight minimal importance injury severity compared two factors fuel use function weight injuries fuel use reduced reducing vehicle without changing vehicle size
high pressure injection injuries hand majority high pressure injection injuries produce serious damage hand nevertheless , injury may follow relatively benign course injected substance possesses less harmful nature treatment injuries requires immediate aggressive surgery circumstances , conservative treatment may justified certain instances 4 year period , eight cases high pressure injection injury encountered types injected material four , one grease , water , , hydraulic oil time important factor regarding results , types injected material modify clinical courses advisable etiology high pressure injection injury established initially , factor taken consideration choosing treatment options
traumatic rupture interventricular septum tricuspid valve case report cardiac injury following blunt trauma important cause morbidity mortality often unsuspected isolated chamber rupture valvular injury infrequent recognized consequences trauma report describes patient developed ventricular septal defect disruption septal leaflet tricuspid valve consequence blunt trauma diagnosis management traumatic ventricular septal rupture discussed
bullet fragment venous embolus heart case report report describes case bullet fragment embolus heart following small caliber gunshot wound mouth skull c spine films appeared account projectile however , chest x ray followed fluoroscopy two dimensional echocardiography demonstrated venous embolus right heart bullet , trapped right ventricle , easily
penetrating injury ureter case report genitourinary tract uncommon may source confusion early diagnosis ureteral trauma presence suspected present case delayed diagnosis penetrating injury ureter management
traumatic scapulothoracic dissociation case report 23 year old man suffered traumatic scapulothoracic dissociation \( tsd \) vs accident tsd devastating injury characterized brachial plexus damage , major upper extremity musculoskeletal disruption , hemorrhage patient survived hematocrit 7 prompt recognition aggressive management tsd 's multiple injuries crucial
improved outcome early fixation skeletally unstable pelvic fractures thirty seven consecutive patients unstable pelvic fractures divided two groups group 1 \( july 1981 december 1984 n 18 \) , early fixation routinely used , group 2 \( january 1985 march 1988 n 19 \) , early fixation performed unless contraindicated hospital stay decreased 37 8 group 2 \( p 0 04 \) group 1 patients , 60 disabled least 6 months versus 15 7 group 2 \( p 0 001 \) , 45 discharged rehabilitation facility versus 26 4 group 2 group 1 complications , 1 3 per patient , versus 1 0 patients group 2 \( undergoing early fixation \) required 27 2 fewer units blood group 1 fracture surgery delayed survival better group 2 , 100 versus 83 3 \( p 0 06 \) early pelvic fracture fixation reduces hospital stay , long term disability , may result fewer complications , decreased blood loss , better survival
early measurement systemic lipid peroxidation products plasma major blunt trauma patients sought evidence oxidant induced biological membrane damage 43 resuscitated blunt trauma patients \( average iss , 36 9 \) within 2 6 hours injury anaesthesia surgery plasma levels lipid peroxidation products \( conjugated dienes , 233 nm \) malondialdehyde \( mda , nmol ml \) oxidant inducing effect trauma plasma normal fmlp stimulated neutrophils compared control subjects differences observed plasma levels mda \( 1 73 2 15 vs 1 45 0 70 nmol ml \) \( 2 07 2 16 vs 1 28 0 60 \) , stimulated neutrophil superoxide production \( 26 4 6 9 vs 29 0 6 2 nmol o2 2 x 10 \( 6 \) pmns \) observations persisted patients analyzed based injury severity , presence long bone fractures , class shock presentation conclude evidence oxidant induced membrane damage manifested increased plasma levels mda within 2 6 hours blunt injury
spine trauma associated injuries longitudinal , prospectively gathered data base spine trauma developed review consecutive hospital admissions identified presence associated injuries 240 \( 47 \) individuals , frequently involving head \( 26 \) , chest \( 24 \) , long bones \( 23 \) twenty two per cent one associated injury , 15 two , 10 three spine fractures involved lower cervical \( 29 \) thoracolumbar junction \( 21 \) comparisons presence absence associated injuries spine fracture level showed significant differences \( p less 0 001 \) eighty two per cent thoracic fractures 72 lumbar fractures associated injuries compared 28 lower cervical spine fractures significant relationship type associated injury spine fracture level , associated injuries less likely neural deficit \( p less 0 05 \) hospital admission , seven deaths early assessment transport spine trauma victims must carried appropriate management associated injuries conversely , multiple trauma victims must due regard possible spine fracture value spinal units specially trained personnel emphasized
epidemiology seatbelt associated injuries study examined frequency spine abdominal injuries motor vehicle occupant crash victims , relationship two types injuries , association restraint use 303 motor vehicle occupants treated regional trauma center spine abdominal injuries 5 year period patients chance type fractures lumbar spine much likely seat passengers using lap belt patients types spinal injuries similarly , patients hollow injuries likely seat passengers lap belted patients injuries spleen , liver , pancreas , kidneys nearly two thirds lumbar chance type fractures associated hollow injuries , including six seven children increased risk chance type fractures hollow injuries associated increased use lap belt seat restraints population
fibrinogen degradation product , fibrinogen , serum change polymorphonuclear granulocyte activity possibly important post trauma \? severe trauma susceptibility patients infection shown proteins protein fragments responsible endogenous trauma coagulopathy accompanied increased serum levels fibrinogen degradation products \( \) often found therefore , examined whether influence activity polymorphonuclear neutrophils \( pmn \) pmn activation measured two different superoxide specific methods \( cytochrome c test , test \) methods found decrease pmn activity compared fibrinogen albumin , used control protein , influenced pmn activity high concentrations third method used quantify pmn activity chemiluminescence , method since developed oxygen radical species also activating lipoxygenase pathway contrast superoxide specific tests found inhibitory effect fibrinogen also serum compared using chemiluminescence
delayed union fibular fractures accompanying fractures tibial shaft among adult patients tibial shaft fracture accompanying fibular fracture eight cases radiographically 4 months injury , uneventful tibial union fractures severe soft tissue injuries excluded study 293 patients treatment method tibial fracture conservative , comprising closed reduction immobilization long cast 147 patients intramedullary nailing , eight cases delayed fibular union occurred among , frequency 5 4 typical accompanying fibular fracture develop delayed union comminuted one middle distal third bone followup examination 5 8 years original injury four eight fractures found ultimately spontaneously united , three showed radiographically nonunion one patient undergone segmental fibular persistent local pain remaining patients subjective symptoms negligible occurrence delayed fibular union association rigid intramedullary nailing concomitant tibial shaft fracture phenomenon trauma surgeons aware even natural course condition often seems benign
alcohol cocaine use among first year college students surveyed first year students university virginia , 1 month arrival campus , used alcohol time lives survey designed identify alcohol cocaine use , related psychosocial patterns men drank often women data suggest body weight considered defining drink heavily often define heavy five week men three four week women frequent heavy drinkers , cocaine users , students psychosocial problems appeared disproportionately among students planning although first year students used cocaine infrequently , users followed patterns frequent heavy drinkers believe efforts correct alcohol cocaine misuse college students directed , part , social organizations greek societies also , must attend psychosocial features predispose alcohol cocaine misuse
pharmacokinetic dosing phenobarbital treatment alcohol withdrawal syndrome used derived phenobarbital dosing protocol treat alcohol withdrawal syndrome patients admitted family medicine inpatient service describe protocol include two case reports documenting efficacy although benzodiazepine agents considered many primary agents choice , based upon experience ease administration , relative safety , therapeutic efficacy , lower cost , phenobarbital promising alternative comparative trials two therapeutic classes clarify roles treatment alcohol withdrawal syndrome
survey drinking patterns medical school several studies documented common use alcohol among medical students significant fraction students \( 7 17 \) show pattern alcohol abuse many authors implications physician impairment due alcoholism , presently estimated 10 surveyed 263 senior medical students , data support earlier surveys prevalence alcohol abuse indicate students tend drink less heavily less frequently entering medical school clinically proven cage questions used survey showed statistically significant associations heavy frequent drinking medical school , 4 2 respondents indicated school asked whether drinking drug abuse problem given findings , suggest routine administration screening instruments medical students , using education minimal intervention strategies individuals risk
comparison lung alveolar tissue cells silica induced inflammation dioxide mineral , \( crs \) induces inflammation involving alveolar cells connective tissue compartments study , compared lung cells recovered whole lung lavage digestion lung tissue rats varying times 8 days exposure aerosolized crs control exposed rats examined 2 36 wk exposure cells obtained bronchoalveolar lavage phosphate buffered saline lung wall cells prepared via collagenase digestion lung tissue slices cells lavage lung wall separated density centrifugation three upper fractions , containing mostly macrophages , cultured , conditioned medium assayed effect lung fibroblast growth activity lysosomal enzyme , n acetyl beta results demonstrated cells separated lung walls exhibited different reaction patterns compared cells recovered lavage lung wall cells exhibited progressive increase number macrophages lymphocytes compared steady state cells lung lavage increase macrophages apparently due low density cells , showed features silica exposure secretion fibroblast stimulating factor consistently high lung wall macrophages , whereas lung lavage macrophages showed inconsistent variations secretion nag increased lung lavage macrophages , decreased observation times lung wall macrophages differences found among cells different density fractions regarding fibroblast stimulation enzyme secretion
emergency center laboratory evaluation pediatric trauma victims emergency center \( er \) trauma evaluations often include leukocyte count \( lc \) , serum amylase \( sa \) , electrolytes \( el \) , urine analysis reviewed records 100 pediatric er patients determine utility tests management blunt injury sa evaluated 65 patients ranged 30 146 u l \( mean 50 6 u l \) 14 patients normal ct scans sa 30 68 u l \( mean 49 1 u l \) six patients intraabdominal retroperitoneal injuries sa 30 130 u l \( mean 64 0 u l \) , p ns lc determined 76 patients ranged 2 3 28 3 k ml \( mean 13 8 k ml \) patients normal abdominal ct \( 12 \) mean lc 14 8 k ml \( range 7 2 19 6 k ml \) eight patients injuries ct mean lc 14 4 k ml \( range 3 5 27 1 k ml \) er , sa , lc alter patient management thirty four patients serum sodium , 36 potassium , 33 chloride bicarbonate determinations sodium , potassium , chloride levels uniformly normal bicarbonate leukocyte counts uniformly abnormal initial evaluations changes expected response severe injury determinations alter patient care combined laboratory \( la \) urine \( da \) analysis hematuria sensitivity 75 0 per cent \( specificity 81 6 \) la predicted injury sensitivity 75 0 per cent \( specificity 81 6 \) da predicted injury sensitivity 60 0 per cent \( specificity 79 2 \) da accurately represented la results \( sensitivity 100 , specificity 94 5 \) da rapid effective replacement la evaluation trauma patients emergency center
real time digital contrast enhancement magnification assessment scaphoid wrist injuries study value commercially available top digital contrast enhancer \( detect system \) made series 550 patients presenting acute wrist injury four radiologists , varying experience , independently reviewed radiographs conventional later digitizer scaphoid series \( 350 cases \) , performance two experienced radiologists marginally better digitizer , whereas less experienced radiologists performed slightly worse overall digitizer improved confidence radiologists diagnosing correctly presence scaphoid fracture , less experienced radiologists , expense identifying wrist series \( 200 cases \) , use digitizer resulted minor increase true positive decrease false negative observations , offset concomitant minor increase false positive decrease true negative categories evaluation soft tissue planes around wrist joint showed limited value identification scaphoid fracture overall positive predictive value 0 26 correlation soft tissue changes presence absence scaphoid fracture slightly worse digitizer possible causes apparently poorer performance digitizer discussed , well relative merits potential value unit
prognostic significance radiologically detected knee joint effusions absence associated fracture significance radiologically detected knee joint effusion marker soft tissue injury following trauma uncertain study 100 patients presenting department following acute injury , effusions fracture , assessed available follow , 20 required investigation 11 surgery significant soft tissue injury concluded radiologically detected knee joint effusions useful marker underlying soft tissue injury
assessment efficacy activated charcoal treatment acute 2 toxin poisoning charcoal assessed efficacy decreasing lethality oral parenteral exposure 2 toxin , fungal metabolite cause death illness upon ingestion vitro binding studies , analyzed using adsorption , showed activated charcoal maximal binding capacity 0 48 mg toxin mg charcoal dissociation constant 0 mg charcoal l vivo , orally administered , activated charcoal assessed treatment acute oral parenteral exposure 2 toxin mice following oral toxin administration \( 5 mg kg \) , untreated mice showed 6 survival 72 hr charcoal treatment \( 7 g kg , po \) either immediately 1 hr toxin exposure resulted significant improvement survival values 100 75 , respectively following parenteral toxin exposure \( 2 8 mg kg , sc \) , untreated charcoal treated \( 7 g kg , po \) mice showed 50 90 survival , respectively , 72 hr ld50 value 2 toxin , determined 96 hr intoxication , increased significantly 2 mg kg untreated controls 4 5 mg kg activated charcoal treatment
occupational risk cytomegalovirus infection among day care providers prospectively studied day care providers six day care centers south eastern determine occupational risk primary cytomegalovirus infection define epidemiologic risk factors ninety six \( 38 \) day care providers seropositive cytomegalovirus latex agglutination entry study among 82 seronegative providers available follow , seven occurred two six participating centers , yielding seroconversion rate 7 9 median time seroconversion among providers 13 months using kaplan meier estimates risk , determined overall risk seroconversion among providers various centers ranged 0 22 12 months 0 40 16 months risk cytomegalovirus acquisition providers independent race , age , education , presence child home , caring children younger 2 3 years day care center however , risk seroconversion among day care providers appeared parallel rates cytomegalovirus excretion acquisition among children center
multiple alcohol related problems united states rise \? drinking problems rise u general population \? surveys drinking practices problems conducted united states 1967 , 1969 , 1979 1984 included numerous questions alcohol related problems identical nearly identical using data surveys , tested ordered increases time prevalence indicator multiple problems , considered current \( 1 year \) lifetime basis studied prevalence men women ages 22 59 four surveys prevalence multiple problem indicator rare , especially considered current basis however , relative increases prevalence ranging 53 200 found 1967 1984 multiple problem indicator men women , lifetime well current problems exception current problems women \( rare condition even 1984 survey \) , changes statistically significant showed trend toward significance respondents age , subgroups still showed increases since 1967 , although sample sizes decreased significance tests ordered increases time consistent
alcohol predictive cues enhance tolerance precipitate craving alcohol social drinkers study attempts show tolerance alcohol large part learned response , precipitated cues predictive drug effect also aims show cues integral environment dependent tolerance function increase motivational desire drink alcohol male students \( n 40 \) , drinking average 10 20 units alcohol per week , randomly assigned one four groups two groups ingested 1 kg alcohol one \( al \) cues typically associated alcohol use , \( al \) context normally associated alcohol third group \( placebo \) believed drinking alcohol , fact , consumed nonalcoholic beverage alcohol expected context fourth group drank juice alcohol unexpected context predicted , tolerance deleterious effects alcohol cognition motor performance , subjective desire consume alcohol , influenced alcohol predictive cues physiological index \( pulse rate \) also tended confirm cues elicited conditioned compensatory response alcohol implications findings tolerance motivation drink alcohol population discussed
boundary conditions effective use alcohol present research assessed conditions subjects consume alcohol consume placebo beverage , report consuming alcohol manipulation check question , equivalent respect subjective responses alcohol male subjects drinking alcohol consumed one four beverages alcoholic beer , nonalcoholic beer , tonic , tonic measures subjective intoxication , body sensations breath alcohol taken different times beverage consumption subjective intoxication ratings higher subjects received alcohol , compared subjects received placebo reported consuming alcohol , alcohol subjects achieved blood alcohol concentrations 04 two groups differ subjective intoxication ratings alcohol subjects achieved blood alcohol concentrations 04 data suggest orthogonal manipulation alcohol consumption expectancy effects problematic blood alcohol concentrations 04
diagnostic validity mast alcohol dependence scale assessment dsm iii alcohol disorders comparative validity michigan alcoholism screening test \( mast \) alcohol dependence scale \( ads \) screening current dsm iii alcohol abuse dependence disorders evaluated scales administered 501 patients presenting treatment alcohol drug problems dsm iii alcohol disorders diagnosed using diagnostic interview schedule receiver operating characteristic \( \) analysis used determine optimum threshold scores mast ads compare screening ability two instruments optimum cut points mast ads 12 13 8 9 , respectively overall accuracy classification instruments using threshold scores 88 areas curves 91 90 \( sd 02 \) significant differences mast ads ability screen alcohol abuse dependence population mast ads correlate highly \( 79 \) results reported study applicable revised dsm iii since field trial found high level agreement alcohol disorders diagnostic systems categorical versus dimensional approaches assessment alcoholism discussed
recent trends development alcohol drug treatment services ontario article summarizes major trends development alcohol drug treatment services ontario since 1979 trends contrasted objectives province wide addiction research foundation \( arf \) community development program designed establish expand addiction services within time period data obtained treatment services province surveys undertaken 1980 , 1983 1986 across period analysis , rapid increases number addiction programs , total cost total treatment specific changes quite consistent arf objectives stabilization use hospital beds addictions treatment , increase community based versus hospital based treatment resources , increase province wide capacity comprehensive assessment larger women addictions programs arf objectives yet achieved particular , major increase treatment alternatives increase proportion treated cases special populations elderly still required suggestions made concerning future program development
prediction drinking patterns drinking parents studies shown relationships adolescent parental drinking patterns , known parental influences maintained children adults removed early influences representative general population sample 6 , 364 adults living new york state interviewed regarding current drinking well family structure drinking patterns parents growing modeling analysis revealed natural father 's drinking growing , natural mother 's drinking growing , family structure \( father present \) sex significant predictors current heavy drinking adults even controlling variables model concluded early family influences may long term consequences drinking behaviors
drinking college consumption patterns , problems , sex differences legal drinking age data \( 75 8 \) undergraduate respondents drawn random sample \( n 800 \) university demonstrate , although fewer college students may drinking compared previous estimates , still large number heavy drinkers addition , traditional demographic variables continue predict alcohol consumption levels students also report similar variety drinking related problems previous college drinking studies women constitute half many heavy drinkers men , report equal amount alcohol related problems sample controlling race , appears white students continue drink , show heavy drinking rates comparable previous large college sample students live campus drink counterparts , drinking age little effect consumption levels total reported alcohol related problems , although alters context drinking somewhat findings generally compared previous well recent college drinking data sex differences similarities discussed , well findings concerning legal drinking status implications prevention efforts suggested
family background alcohol abuse relationship alcohol consumption among college students unexpected finding purpose study determine possible association positive family background alcohol abuse \( parent sometimes often drank much \) amount alcohol consumed per week among college students additionally determine possible differences students positive , compared students negative , family backgrounds alcohol abuse drinking patterns , using survey instrument indirectly measures family background alcohol abuse cross sectional study , sample college students four regions united states selected results revealed association family history mean amount alcohol consumed per week total sample \( r 007 \) , men \( r 04 \) women \( r 02 \) curve analysis indicated slightly positively skewed curve total group also male female students test chi square analysis found significant difference positive negative family backgrounds mean amount alcohol consumed drinking patterns among positive family backgrounds clustering scatter plot either heavy light amounts alcohol consumed results showed remarkable similarity alcohol consumption drinking patterns students classified positive , opposed negative , family background concluded positive family background heavy drinking associated either light heavy alcohol consumption among national sample college students
drinking styles adolescents young adults drinking among adolescents young adults received attention recent past , little research focused drinking styles might characterize younger people drinking behavior special relevance group , since adolescent years young adult years development drinking habits study used model applied normal drinking behaviors adults however , set drinking variables expanded cover wider range activities , second set behaviors , intended reflect potential problem drinking , derived national council alcoholism criteria diagnosis alcoholism set 55 normal drinking behaviors factor analyzed , yielding six factor structure first four factors quite similar previous work adult drinking styles , remaining two factors clearly related drinking younger people problem drinking variables yielded two factor structure , one set consisting serious uncommon experiences second set consisting less serious common experiences several normal drinking factors significant predictors problem drinking scores , suggesting certain styles drinking likely others lead later problems
low level lead exposure children 's cognitive function preschool years cohort 170 middle upper middle class children participating prospective study child development low level lead exposure , higher blood lead levels age 24 months associated lower scores age 57 months scales children 's abilities mean blood lead level age 24 months 6 8 micrograms dl \( sd 6 3 , , percentiles 8 8 , 13 7 , 23 6 , respectively \) 1 child less 25 micrograms dl , current definition elevated level adjustment confounding , scores general cognitive index decreased approximately 3 points \( se 1 4 \) natural log unit increase 24 month blood lead level inverse association lead level performance especially prominent visual spatial visual motor integration skills higher prenatal exposures associated lower scores 57 months except subgroup children high concurrent blood lead levels \( ie , greater equal 10 micrograms dl \) concentration lead shed teeth significantly associated children 's performance adjustment confounding
early asbestosis evaluation high resolution ct determine earliest stage lesions asbestosis diagnosed assess progression , 23 asbestos exposed patients minimal abnormalities plain radiography examined high resolution computed tomography \( \) twice , interval 12 37 months examinations 21 patients , parenchymal abnormalities found major parenchymal features seen ct included thickened lines , subpleural curvilinear lines , pleural based nodular , patches increased attenuation , small cystic spaces , small areas low attenuation paired serial ct , subpleural isolated branching structures connected peripheral branch pulmonary artery started appear lower subpleural zones became confluent create pleural based nodular ct pathologic correlation led conclusion confluence subpleural fibrosis subpleural fibrosis
splenic trauma ct grading systems enable prediction successful nonsurgical treatment \? capability computed tomographic \( ct \) grading systems enable prediction successful nonsurgical treatment splenic trauma children adults evaluated fifty six patients documented splenic injury examined ct use standard trauma protocols ct scan graded according two recently proposed grading systems charts patients reviewed , correlations ct grade clinical outcome determined grading system forty patients underwent successful nonsurgical treatment three patients \( 8 \) underwent delayed celiotomy splenic rupture failure nonsurgical treatment two three grades indicated nonsurgical treatment viable three patients , splenectomy necessary 16 patients underwent surgery , eight cases \( 50 \) ct grading errors documented surgery four cases , extent injury ct , another four cases injury still clear whether severity splenic injury defined ct correlates clinical outcome
bullet identification radiography authors provide simple radiographic method estimating bullet weight caliber deformed bullets enables accurate determination caliber bullet , known degrees confidence weight determination procedure based correlation bullet cross sectional area , derived three orthogonal radiographs , bullet weight , determined data base properties 48 bullets removed humans different equations developed bullets weighing 5 8 g less , 5 8 g relatively bullets additional method calculated caliber directly diameter bullet body radiographs methods enabled correct prediction weight caliber bullets one method could used , results reliable based results accepted local police case may meet requirements u cases involving
assessing nutritional needs critically ill patient critical illness often vigorous metabolic response permit repair injured tissues , nutritional considerations essential medical management critically ill patient individuals seemingly adequate endogenous nutritional may rapidly develop complications starvation nutritional supplementation essential however , critically ill patients may readily tolerate nutritional support calories may need patient able tolerate utilize nutritional support decision initiate nutritional support made , nutritional status , level stress , metabolic condition , vital organ function influence patient 's nutritional requirements assessment patient 's metabolic condition provides data useful determining need supplemental electrolytes data also provide information regarding vital organ function , necessary utilization fuel substrate aggressive monitoring judicious nutritional supplementation afford critically ill patient best chance recovery
familial alcoholism primary unipolar major depressive disorder objective studies suggested relationships depression probands alcoholism relatives studies , used inappropriate control groups failed divide probands sex method present study controlled sex probands used several comparison groups explore familial relationship depression alcoholism diagnoses directly interviewed relatives 326 probands primary unipolar depression compared diagnoses 469 control subjects chosen method resemble relatives affective disorder probands diagnoses relatives control depressed subjects used comparisons well results results indicated higher rates alcoholism families depressed women families depressed men conclusions familial association alcoholism depression may result either genetic environmental factors interaction two
effect financial management alcohol related hospitalization objective treatment unresponsive alcoholics new zealand unable care tend hospitalized lengthy periods time author examined effect adding financial management therapeutic management patients null hypothesis would effect duration alcohol related hospitalization method 61 alcoholic patients registered alcohol outpatient clinic received financial management period 6 years included study alcohol related disabilities severe resulted likely result lengthy frequent periods hospitalization financial management involved patient 's income account advisory saw patients' basic living requirements met expenditure alcohol detrimental effect participation voluntary voluntary patients involuntary committed patients durations patient 's alcohol related hospitalizations compared two equal periods time financial management instituted results null hypothesis supported duration alcohol related hospitalizations financial management instituted 86 less management conclusions patient face excessive drinking tasks daily living , including provision adequate shelter nutrition , benefits adding financial management therapeutic strategies considered
drug abuse schizophrenic patients clinical correlates reasons use objective study aimed 1 \) determine substance abuse prevalence preference diverse sample schizophrenic , , inpatients , 2 \) compare drug abusing non drug abusing patients demographic clinical variables acute stabilization phases hospital course , 3 \) obtain data patients reasons drug abuse acute state related changes periods intoxication method eighty three psychotic inpatients consecutively admitted new york city teaching hospital evaluated sixty eight schizophrenia , 12 disorder , three disorder diagnosed according structured clinical interview dsm iii r patient received ratings brief psychiatric rating scale , global assessment scale , scale assessment negative symptoms admission discharge , evaluation premorbid adjustment , extensive interview drug alcohol use results forty \( 48 \) patients received diagnoses drug alcohol abuse dependence drug abusing patients primarily used \( n 26 \) , alcohol \( n 21 \) , cocaine \( n 14 \) reported abused drugs get high , relieve depression , relax significantly fewer positive negative symptoms discharge , better sexual adjustment worse school performance adolescence , family histories drug abuse non drug abusing patients conclusions schizophrenic patients abuse drugs may represent subgroup patients better prognoses less severe clinical characteristics schizophrenia , drug abuse may adversely affect global outcome
x ray fluorescence measurements lead burden subjects low level community lead exposure k x ray fluorescence \( k \) instrument measure vivo bone lead low levels used population 34 adults known history excessive lead exposure questionnaire gathered information relevant occupational environmental lead exposure administered prior measurement 30 min measurement produced average estimated uncertainty 6 mcg lead g bone mineral taken mid tibial subject eighteen subjects bone lead levels measurement uncertainty remainder bone lead levels ranging 21 mcg lead g bone mineral bone lead levels greater among older subjects among young adult subjects , bone lead levels greater measurement uncertainty confined entirely subjects grown estimated build prior 1955 childhood environment high risk exposure biologically absorbable lead ingestion lead contaminated dust lead contaminated water conclude k technique potential distinguish low levels lead burden epidemiologic studies
clinical pathologic study four adult cases acute mercury inhalation toxicity report four cases fatal mercury vapor inhalation , rare occurrence mercury vapor released private home , one occupants silver dental amalgam containing unknown amount mercury within 24 hours incident , occupants began shortness breath necessitating hospital admission clinical courses briefly detailed however , included rapid deterioration respiratory failure chest roentgenograms four cases consistent adult respiratory distress syndrome patients treated , mercury chelator , died , survival varying 9 23 days autopsies performed four patients lungs cases heavy , firm , histologic examination revealed severe diffuse alveolar damage , variable amounts fibrosis , acute lung injury various stages organization additional postmortem findings included acute proximal renal tubular necrosis , vacuolar , spectrum central nervous system alterations including multifocal ischemic necrosis , gliosis , vasculitis
circadian variation heart rate affected environment study continuous electrocardiographic monitoring members twenty four hour ambulatory st segment monitoring performed 48 members \( 43 players five members management technical team \) british corporation \( \) without history cardiac disease period included final live performances \( radio \) royal hall \( n 36 \) centre \( n 21 \) period monitoring one person \( 2 \) transient st segment changes mean heart rates significantly higher live performances mean heart rates live performance significantly higher \( n 6 \) monitored occasions mean heart rates management technical team higher players recognised circadian pattern heart rate , peak morning hours , altered similarly concert days , primary peak occurring evening hours lesser peak morning management technical staff study showed environmental factors primary importance defining circadian pattern heart rate important implications identifying peak periods cardiovascular stress drug treatment patients angina pectoris
abuse elderly people carers objective assess prevalence abuse elderly people carers characteristics abusers abused design information abuse risk factors collected six months carers patients risk factors identified abused group compared non abused control group setting carers interviewed home patients examined wards geriatric hospitals , london subjects patients referred source care geriatric services six month period carers main outcome measures amount physical verbal abuse neglect quantification risk factors correlation presence absence abuse results 45 carers admitted form abuse patients admitted abuse significant risk factor physical abuse alcohol consumption \( p less 0 001 \) significant risk factors poor pre morbid relationship previous abuse many years abuse often associated social dysfunction many patients service delivery , care , level mental physical disability significantly associated abuse conclusion high level abuse found elderly patients care particularly associated alcohol abuse long term relationships poor quality , difficult change even increased provision services , care community may best solution people
intrapulmonary distribution bronchial blood flow moderate smoke inhalation systemic blood flow airways left lung determined radioactive microsphere technique 17 h smoke inhalation six conscious sheep \( smoke group \) six sheep insufflated air alone \( sham group \) smoke inhalation caused sixfold increase systemic blood flow lower trachea \( baseline 10 6 1 7 vs injury 60 9 16 1 ml min 1 100 g 1 \) 11 14 fold increase intrapulmonary central airways \( baseline range 9 5 1 9 13 5 3 7 ml min 1 100 g 1 vs injury 104 6 32 2 187 3 83 6 ml min 1 100 g 1 \) trend hyperemic response greater airway diameter decreased trachea 2 mm central airways airways smaller 2 mm , hyperemic response appeared diminish total systemic blood flow whole lung predominantly small peripheral airways showed significant increase baseline level 17 5 3 7 ml min 1 100 g 1 lung homogenate occlusion artery decreased central airway blood flow 60 80 peripheral airway blood flow 40 60 sham smoke groups
toxic epidermal necrolysis \( syndrome \) toxic epidermal necrolysis perhaps disease encountered uncommon rare , toxic epidermal necrolysis occurs 60 70 persons per year france remains disorder 34 years ago , described whether toxic epidermal necrolysis severe form erythema multiforme still subject discussion events lead rapidly extensive necrosis epidermis understood indirect evidence suggests hypersensitivity reaction , search potential immunologic mechanisms resulted little data support hypothesis accumulated clinical evidence points drugs important , , cause toxic epidermal necrolysis sulfonamides , especially long acting forms , anticonvulsants , nonsteroidal anti inflammatory agents , certain antibiotics associated cases toxic epidermal necrolysis many drugs implicated isolated case reports organs may involved either process destruction epithelium observed epidermis systemic consequences acute skin failure seen patients widespread burns sepsis important complication cause death approximately 20 30 patients toxic epidermal necrolysis die elderly patients patients extensive lesions higher mortality rate surviving patients completely heal 3 4 weeks , 50 residual , potentially disabling ocular lesions prognosis improved adequate therapy , provided burn units , , aggressive fluid replacement , nutritional support , antibacterial policy corticosteroids , advocated high doses hypersensitivity process , shown several studies detrimental avoided
protective behavior captopril hg \( \) induced toxicity kidney mitochondria vivo vitro experiments known induce morphological functional modifications kidney mitochondria work studied vitro vivo protective effect captopril deleterious effect hg \( \) induced nonspecific membrane permeability changes ca membrane de vivo administration captopril prevented toxic effects mercury poisoning membrane permeability , oxidative phosphorylation ca homeostasis moreover , captopril kidney tissue morphology hg \( \) induced damage protective effect captopril likely related existence sulfhydryl group drug
energy balance elderly patients surgery femoral neck fracture study energy protein elderly patients surgery , spontaneous energy protein intake resting energy expenditure \( ree \) measured 20 elderly female patients femoral neck fracture \( mean age 81 4 , sd , range 74 87 years weight 53 8 , range 42 68 kg \) 5 6 day period following surgery ree , measured 20 40 min indirect calorimetry using ventilated , averaged 0 98 0 15 kcal min day 3 decreased 0 93 0 15 kcal min day 8 9 \( p less 0 02 \) ree positively correlated body weight \( r 0 69 , p less 0 005 \) mean ree 24 hr \( 24 ree \) 194 kcal day mean daily food energy intake measured 5 day follow period 333 kcal day positively correlated 24 ree \( r 0 50 , p less 0 05 \) daily energy balance 235 kcal day day 3 \( p less 0 01 vs zero \) 13 392 kcal day day 8 9 \( ns vs zero \) mean study period 185 289 kcal day \( p less 0 01 vs zero \) extra 100 kcal day allowed energy cost physical activity , mean daily energy balance 5 day study period calculated 285 289 kcal day \( p less 0 01 vs zero \) measurements total 24 hr urinary nitrogen \( n \) excretion obtained subgroup 14 patients
use human growth hormone combined nutritional support critical care unit administration growth factors may potentially accelerate recovery critical illness reducing body protein catabolism , enhancing wound healing , improving skeletal muscle function purpose phase 1 study evaluate safety initial efficacy recombinant growth factor , human growth hormone \( gh \) , combined nutritional support critical care unit following initial control week , 11 individuals received gh \( 10 mg day \) daily 1 6 consecutive weeks near constant nutrient intake provided via parenteral enteral feedings throughout study period vital signs clinical parameters , blood values , nutrient excretion monitored daily gh administration associated clinically significant adverse effects first 2 weeks study , nitrogen excretion decreased 157 mmol day \( 19 0 2 2 g day \) control 107 mmol day \( 12 6 1 4 g day \) growth hormone \( p less 0 002 \) association markedly reduced urea generation significant reductions potassium excretion \( control 100 11 mmol day vs 69 6 gh p less 0 01 \) phosphorus excretion \( 31 5 mmol day vs 18 3 p less 0 025 \) also occurred gh protein conserving effects gh sustained several weeks treatment growth hormone enhanced efficiency administered protein facilitated nitrogen retention without clinically significant adverse effects small patient group controlled trials indicated determine whether use anabolic hormone reduces hospitalization time improves clinical outcomes severely injured patients combined appropriate nutritional support
factors contributing increased energy expenditure thermal injury review studies employing indirect calorimetry summary , remarkably close agreement exists mean mee measured 28 studies severe burn trauma especially surprising given variability sample sizes , measurement techniques , study designs , studied mean mee calculated data published reports listed final column table 450 cases , mee 85 kcal day studies prior 1980 , mean mee exceeds 3000 kcal day eight 14 reports vs two 14 published 1980 even , mean mee pre 1980 reports differs 200 kcal day \( 120 , n 14 \) accepted notion degree elevation mee proportion 60 useful general sense must applied caution recent studies , include proportionately burns exceeding 80 , suggest elevation mee cases nevertheless , physiologic plateau apparently exists slightly 2 x normal rmr peak mee magnitude mee response results undefined interaction among several factors examined others inflammatory mediators beginning receive study contributions reduction mee interventions control cardiac output peripheral cooling , core temperature , water \( heat \) loss , substrate cycling reviewed importance indirect calorimetry patient care highlighted large variability similarly injured individuals unexplained component regression analyses
biomechanics lumbar pedicle screw plate fixation trauma investigation conducted determine alterations biomechanical strength stiffness characteristics lumbar spine fixated instrumentation comparative studies parameters conducted using seven lumbar columns fresh human cadavers three runs conducted t12 l5 column control , injured , fixated specimens loaded compression flexion mode failure \( control run \) \( injury run \) failure deformation determined control run screw plates inserted one level proximal distal injury , specimens \( fixation run \) radiographs taken trial data deformation force histories gathered load deflection response injured fixated specimens two representative control failure loads higher injured \( p less 0 001 \) fixated \( p less 0 01 \) spine initial stiffness significantly higher fixated injured columns \( p less 0 001 \) , final similar increase initial stiffness fixated specimen compared injured specimen indicates strength added posterior region spine relatively smaller alteration final stiffness fixated injured columns , corresponding load shared anterior column , may suggest , critical strain level , anterior column higher portion external load posterior fixation may inadequate sole treatment trauma
free vascularized thin graft paper describes new thin graft harvested medial condylar areas femur based articular branch descending artery vein consists periosteum thin \( 0 5 1 0 mm \) layer outer cortical bone retaining cortex , layer preserved , thought better osteogenic capacity vascularized periosteal grafts graft used treat six patients fracture nonunion upper extremity conventional treatment failed uneventful bony union achieved patients within 10 weeks
simultaneous bilateral forearm revascularization successful simultaneous bilateral forearm revascularization performed 17 year old boy functional recovery evaluated 42 months injury patient use hands activities daily living far , employed significant psychological problems temporary intraluminal silicone shunts extremely helpful reducing ischemic damage injured limb sufficient skeletal shortening upper limb replantation important wounds must managed aggressive repeated debridement accurate primary nerve repair essential , early postoperative rehabilitation also important achieve satisfactory functional return functional upper extremity superior amputation prosthesis , especially cases bilateral upper extremity amputation
scientific foundation wound systemic rational approach used , coupled interest research wound 40 years , resulted clear elucidation principles form basic scientific foundation modern wound validity work proved repeatedly world century presently , ever , sound scientific revealed essential keep investigation within framework good judgment
nail gun suicide two cases reported young men committed suicide using nail gun one shot heart left lung shot head cases completed suicide nail gun previously reported english literature cases reported uncommon nature represent potentially fatal use relatively common industrial
suicides 's air guns report case 25 year old depressed woman committed suicide 's loaded cs tear gas gases contact shot entered chest left sixth intercostal space caused perforations pericardium apex heart autopsy reveal metallic foreign bodies might originated , , material injuries thus caused alone 0 5 mg l 1 cs degradation product cyanide detected cardiac blood also report case 54 year old man , suffering depressive psychosis , committed suicide air rifle lead bullet entered brain right large bone , traversed right temporal brain pole , damaged right middle cerebral artery right optic tract , finally left central ganglia extensive basal hemorrhage tamponade cerebral ventricles death attributed cerebral failure furthermore list another 26 cases suicide rarely used 1989
forensic photography ultraviolet imaging wounds skin use ultraviolet light \( \) study document injuries human skin opened new law article discusses techniques involved fluorescent documentation skin wounds via still photography dynamic video techniques , utilize various methods uv , covered techniques important presentation evidence gathered lacerations , , , bite presented case studies controlled experiments injuries common sequelae child abuse , , assault
suicide thiopentone infusion suicide intravenous thiopentone infusion described search literature revealed four cases , paucity possibly due reporting , suicides occur amongst medical personnel
homicide suicide rare kills someone afterward suicide scene report describes young killed young killed
wrist center case report review literature suicides occur rare thus require extensive forensic analysis asphyxia hanging common means suicide least 87 5 successful suicides committed way unique case suicide presented wrist lens evidence led suicide reviewed data compared known behavioral patterns world literature concerning suicide reviewed
suicide ingestion following self case suicide described combined elements psychotic self , chronic terminal , poisoning ingested illustrates need consider unusual methods investigating deaths people patterns behavior access unusual , fatal materials
dantrolene sodium treatment heatstroke study objective determine efficacy dantrolene sodium treatment heatstroke design randomized , double blind , placebo controlled trial setting heatstroke center , saudi patients fifty two adult patients heatstroke interventions patients assigned receive either dantrolene sodium \( 2 mg kg body weight iv \) placebo conventional cooling therapy initiated measurements main results significant difference mean cooling times treatment control groups \( 67 9 vs 69 min \) one death control group complications seen six \( 23 \) patients receiving dantrolene sodium seven \( 27 \) patients receiving placebo difference statistically significant significant difference mean number hospital days \( 4 7 2 0 vs 2 9 0 9 days \) conclusion treatment dantrolene sodium dose used , prove beneficial patients heatstroke
mandibular ramus anatomy relates medial osteotomy sagittal split ramus osteotomy sagittal split ramus osteotomy probably frequently used procedure correction mandibular skeletal deformities despite numerous improvements technique 30 years since procedure introduced , number troublesome complications still occur include unfavorable fracture surgery , , relapse purpose study determine fusion buccal lingual cortical plates occurs upper mandibular ramus , thought placement horizontal medial osteotomy point fusion \( without intervening medullary bone \) may lead unfavorable fracture forty nine human mandibles sectioned vertically three locations perpendicular surface ramus occlusal plane measurements made locate vertically point fusion buccal lingual cortical plates relative lingula depth sigmoid notch point fusion occurred 7 5 13 3 mm lingula 2 mandibles fusion level lingula anterior ramus , whereas posterior ramus , 6 1 mandibles fused level level halfway lingula sigmoid notch , 20 mandibles fused anterior ramus , whereas mid posterior ramus , incidence high 39 location medial horizontal osteotomy tip lingula higher level cut may associated increased difficulty incidence unfavorable fracture
cocaine metabolite detection homicide victims analyzed blood homicide victims presence cocaine 's major metabolite , benzoylecgonine 1989 county , georgia , 81 275 homicide victims tested benzoylecgonine 40 tested positive proportions blacks victims firearm injuries tested positive benzoylecgonine significantly larger respective proportions whites victims injuries involving firearms data show overall proportions benzoylecgonine positivity much larger previously reported literature relationships homicide , race , firearms , cocaine use deserve study
predictive value historical physical characteristics diagnosis child abuse child abuse may difficult recognize , especially since injuries often small historical physical findings elicited initial examination helpful initiating depth investigation injury inconsistent history given delay seeking medical treatment two frequent reports elicited suspicion isolated findings , however , low predictive value presence two 13 factors increased yield child abuse identification 60
childhood firearms fatalities metropolitan dade county experience reviewed cases childhood firearms fatalities files medical examiner department metropolitan dade county , , florida comparison cases 5 year period 1966 1970 5 year period 1984 1988 , basic epidemiologic parameters , showed death due firearms increasing among children aged 14 years younger
anterolateral ankle dislocation without fracture dislocation joint without associated fracture rare presented case open anterolateral ankle dislocation complete ligamentous disruption contrast reports internal fixation required maintain reduction joint dislocation , found dislocation grossly unstable , requiring screw pin stabilization
alcohol abuse adolescents alcohol abuse among teenagers increasing problem serious physical social consequences early diagnosis adolescent alcoholism may delayed two reasons physical indicators alcohol abuse seen adults often identifiable teenagers , alcoholism generally believed adult problem history taken carefully , respect , help family physician determine extent young person 's alcohol abuse begin process treatment adolescent patient family
left ventricular size , mass function relation duration quantity heavy drinking alcoholics left ventricular \( lv \) hypertrophy mild dysfunction frequently observed alcoholics little known relate duration severity alcohol abuse lv size , mass function studied using echocardiography systolic time intervals 78 middle aged male alcoholics also gave detailed accounts duration heavy drinking , quantity recent ethanol consumption duration abstinence compared 34 healthy nonalcoholics , alcoholics higher lv mass index \( 85 2 mean standard error vs 77 2 g m2 , p 0 001 \) , posterior wall \( 11 0 2 vs 10 0 2 mm , p 0 02 \) , longer end systolic diameter index \( 18 0 3 vs 17 0 3 mm m2 , p 0 02 \) , higher period ejection time ratio \( 0 36 0 01 vs 0 33 0 01 , p 0 002 \) multivariate linear regression models , abnormalities proved independent drinking history , except posterior wall thickness weakly related duration heavy drinking \( standardized correlation coefficient 0 36 , p 0 01 \) univariate analyses suggested lv mass index systolic time interval ratio , , curvilinear relation total duration heavy alcohol consumption concluded lv hypertrophy dysfunction found alcoholics poorly related duration severity self reported alcohol abuse together data , suggests simple linear dose injury relation long term cardiotoxicity ethanol factors modifying myocardial effects ethanol need studies future
motorcycle , , injury crash involvement interrelationships among motorcycle , , injury crash involvement investigated sample 2 , motorcycle drivers severely injured california 1985 86 crashes \( driver \) less likely valid random sample motorcycle crashes \( 42 vs 57 percent \) thirty three percent crash involved drivers valid motorcycle driver 's 39 percent operating \( driver \) driver less likely validly licensed driver \( 20 percent vs 44 percent \) rate crash involved driver 15 percent also rates valid lowest among youngest drivers virtually crash involved driver age 21 licensed cases also young
alcohol use abuse random samples physicians medical students background study sought resolve conflicting views whether physicians especially prone alcohol abuse methods using anonymous , mailed questionnaire substance use , surveyed 500 physicians , pharmacists , students physicians pharmacists selected randomly state society 's membership lists , students selected local school lists follow surveys sent nonresponders two week intervals results physicians medical students drink especially heavily vulnerable alcoholism counterparts physicians differed pharmacists style drinking \( greater frequency , smaller quantity \) , total amount alcohol consumed drinking habits among physicians associated medical specialty type practice , positively related gender \( males drank females \) age \( older doctors apt qualify heavy drinkers younger doctors \) conclusions physicians likely abuse substances professionals group alcohol use nearly universal risk abuse impairment cannot ignored
responsible alcohol service study , , environmental impact responsible alcohol service training program evaluated impact changing beliefs , knowledge , behavior 97 43 changing establishment policies encourage safer drinking training program significant impact changing beliefs knowledge observation 4 6 weeks training showed effects behavior , tendency toward establishment policies compared controls
spinal cord injury prognosis ambulation based sensory examination patients initially motor complete purpose retrospective study document patients motor complete injury , preserved pin appreciation , addition light touch , zone injury better prognoses regard ambulation patients light touch preserved medical records examined spinal cord injury \( sci \) patients admitted 1982 1988 twenty seven b patients upper motor neuron lesions admitted within 72 hours injury identified patients divided two groups \( b 1 b 2 \) group b 1 \( n 18 \) patients touch sensation pin appreciation zone injury group b 2 \( n 9 \) patients partial complete pin appreciation light touch zone injury charts examined patient 's ability walk independently using reciprocal gait least 200 feet data analyzed fisher exact test eight nine group b 2 patients compared two 18 group b 1 patients \( p less 0002 \) b sci patients touch preserved zone injury poor prognoses ambulation preserved pin appreciation zone injury excellent prognoses functional ambulation
chronologic age , time since injury , time measurement effect adjustment spinal cord injury people living longer spinal cord injury \( sci \) , yet limited research addressed issue aging adjustment sci purpose study use time sequential design identify relationship adjustment sci three facets aging chronologic age , time since injury , time measurement life situation questionnaires obtained one sample participants sci 1974 \( n 256 \) second sample 1985 \( n 193 \) participants grouped five cohorts based chronologic age , five cohorts based time since injury , two groups based time measurement \( 1974 , 1985 \) two two way 's performed , one chronologic age time measurement , time since injury time measurement results indicated chronologic age time since injury often worked directions aspects adjustment declined greater chronologic age , aspects improved increasing time since injury activity strongly related chronologic age , medical stability strongly related time since injury chronologic age time since injury correlated aspects life satisfaction comparisons two times measurement \( 1974 , 1985 \) indicated limited positive changes adjustment time results point complexity relationship aging adjustment need rehabilitation professionals consider multiple aging factors
post traumatic human retinal pigment epithelium light microscopy \( including fluorescence microscopy \) electron microscopy applied study photoreceptor retinal pigment epithelium \( rpe \) complex human eye severely nine months prior enucleation main feature interest massive accumulation retinal pigment epithelium posterior pole , quantitative fluorescence microscopy provided values three times obtained appropriate control tissue photoreceptor layer normal posterior pole became progressively atrophic towards periphery concentration proportional degree preservation retinal electron microscopy cells rpe seen packed mixture granules complexes , occasional photoreceptor found 's membrane normal attribute hitherto abnormality rpe trauma dysfunction consequent overload monolayer photoreceptor debris time trauma
administration interleukin 6 stimulates multilineage hematopoiesis accelerates recovery radiation induced hematopoietic depression hematopoietic depression subsequent susceptibility potentially lethal opportunistic infections well documented phenomena following radiotherapy methods therapeutically radiation induced myelosuppression could offer great clinical value vivo studies laboratory demonstrated interleukin 6 \( il 6 \) stimulates pluripotent hematopoietic stem cell \( cfu \) , granulocyte macrophage progenitor cell \( gm cfc \) , erythroid progenitor cell \( cfu e \) proliferation normal mice based results , ability il 6 stimulate hematopoietic regeneration following radiation induced hematopoietic injury also evaluated c3h female mice exposed 6 5 gy radiation subcutaneously administered either saline il 6 \( 1 , 000 micrograms kg \) days 1 3 1 6 days 7 , 10 , 14 , 17 , 22 , femoral splenic cfu , gm cfc , cfu e contents peripheral blood white cell , red cell , platelet counts determined compared saline treatment , 3 day 6 day il 6 treatments accelerated hematopoietic recovery 6 day treatment produced greater effects example , compared normal control values \( n \) , femoral splenic cfu numbers il 6 treated mice 17 days 27 n 136 n versus 2 n 10 n saline treated mice time , bone marrow splenic gm cfc values 58 n n versus 6 n 196 n saline treated mice bone marrow splenic cfu e numbers 91 n 250 n versus 31 n 130 n saline treated mice peripheral blood white cell , red cell , platelet values 210 n , 60 n , 24 n versus 18 n , 39 n , 7 n saline treated mice studies demonstrate therapeutically administered il 6 effectively accelerate multilineage hematopoietic recovery following radiation induced hematopoietic injury
bell broken bones objective determine incidence , , outcome injuries due bell ringing design retrospective review last six years' issues ringing world , ringing world , postal questionnaire sent 20 active ringing subjects regular bell results seventy nine injuries identified review ringing world incidence injury among 221 identified postal questionnaire 1 8 year conclusion although , bell ringing dangerous occasionally even fatal doctors aware dangers expose
occurrence repetition hospital admissions accidents preschool children objectives examine trends time rates admission hospital accidents preschool children study patterns repeated admissions accidents children design analysis linked , routine abstracts hospital inpatient records accidents setting six districts oxford regional health covered oxford record linkage study subjects records 19 , children aged 5 years time first recorded admission hospital main outcome measure number admissions hospital results records analysed three groups person based annual admission rates calculated year child 's first recorded admission 1976 85 identified , child 's record followed linkage one year admission child 's first recorded admission 1976 81 identified followed five years overall , 19 , children average annual resident population 163 , 000 children 1976 86 20 , 657 admissions accidents 6 years age admissions 13 , injuries , poisonings , burns admission rates declined 1976 poisoning , substantial changes time found admission rates injuries burns total 17 , children followed one year 10 , five years \( 2 6 \) children followed one year \( 8 5 \) followed five years least one admission accident followed one year 4 5 year old children least likely 1 1 year old likely admission accident number children one accident greater would expected accidents random poisoning first admission likely another poisoning injury burn burn first admission likely another burn conclusions hospital admissions accidents children common average 1 child 88 population admitted year multiple admissions uncommon none less occur often would expected chance
dose response relationships effects insulin glucose fat metabolism injured patients control subjects 1 twenty four patients studied around 7 days musculoskeletal injuries order define nature impairment sensitivity insulin insulin infused 6 , 35 , 200 1200 units min 1 2 2 h plasma glucose concentration 5 mmol l forearm \( uninjured \) glucose extraction blood flow measured , whole body substrate oxidation energy production rates assessed indirect calorimetry patients compared normal control subjects 2 plasma insulin concentrations infusion similar patients control subjects , showing similar metabolic clearance insulin infusion rate , rate glucose infusion needed maintain less patients control subjects dose response curve whole body glucose infusion rate plasma insulin concentration showed diminished sensitivity diminished maximal response patients similar pattern seen forearm glucose uptake , marked impairment sensitivity insulin maximal responsiveness 3 resting metabolic rate increased patients compared control subjects , failed respond insulin infusion , final metabolic rates similar patients control subjects higher insulin infusion rates , final rate whole body oxidation carbohydrate significantly less patients control subjects , fat significantly greater
percutaneous screw fixation fractures scaphoid describe percutaneous technique screw fixation types fractures scaphoid 15 year period 1984 , 280 cases treated method 198 returned evaluation 1986 comprise material report mean postoperative time 82 months , 89 recent fractures united well 81 8 delayed nonunion 42 8 sclerotic nonunion
fracture separation distal humeral epiphysis reviewed 12 cases fracture separation distal humeral epiphysis , three initially misdiagnosed fractures lateral condyle one elbow dislocation varus deformity common fracture separation following fracture , common children two years age closed reduction simple adequate older child , recommend two years age closed reduction followed percutaneous , carrying angle assessed immediately reduction elbow varus wires removed , reduction repeated treatment straight lateral traction used maintain valgus carrying angle
bone structure removal internal fixation plates used single photon absorptiometry assess forearm bones removal internal fixation plates 14 patients found convincing evidence cortical atrophy one patient , plates removed prematurely 16 months suggested plates retained least 21 months , allow bone density return level recommendations ao group supported
femoral head blood flow femoral neck fractures analysis using intra osseous pressure measurement studied 50 patients fractures femoral neck , 33 intracapsular 17 extracapsular intraosseous pressure measured transducer within bone quantify blood flow , intracapsular pressure needle introduced joint space mean intracapsular pressure lower extracapsular fractures , mean intraosseous pressure femoral head unchanged aspiration joint however intracapsular fractures aspiration produced significant decrease intra osseous pressure increase pulse pressure within femoral head results suggest aspiration intracapsular produced increase femoral head blood flow relieving tamponade
alcohol consumption synthesis ethyl esters fatty acids adipose tissue ethyl esters fatty acids \( eefa \) found formed ethanol metabolism human adipose tissue contains high concentrations free fatty acids , substrate eefa synthesis , might therefore tissue great potential eefa formation order explore potential usefulness markers alcohol abuse , eefa concentration activity eefa synthesizing enzyme therefore determined adipose tissue men belonging following categories , social drinkers , alcoholics treatment , established alcoholics found died result alcohol intoxication order estimate half life eefa synthase activity induction , alcoholics examined different time periods abstinence alcohol comparisons also made several established markers alcohol abuse eefa found , found low concentrations social drinkers eefa found several alcoholics , forensic cases high concentrations eefa synthesizing enzyme activity found subjects , increasing social drinkers , 2 fold higher alcoholics 5 fold higher dead alcoholics induction enzyme abstinence appeared half life order several weeks correlations found eefa synthase activity previously established markers alcohol abuse known remain long time period abstinence , mean erythrocyte corpuscular volume preliminary study suggests possibility eefa synthase induction adipose tissue might longer half life previously used markers alcohol abuse therefore suggested induction eefa synthase might potentially useful new marker alcohol abuse apparent proportionality alcohol intake prolonged time period , presumed specificity , long term elevation alcohol abstinence potential marker analysed
case asbestosis first published account disease attributed occupational asbestos exposure , died circumstances relating case described explanations given greater impact policy time case , starting , set context missed opportunities preventing major public health hazard effects hazard still witnessed today
related inner ear injuries related inner ear \( \) inner ear decompression sickness \( \) often result permanent severe deficits , unless immediate diagnosis reached correct treatment early nine cases sport induced inner ear injuries referred israeli hyperbaric institute october 1987 september 1989 presented regard evaluation , treatment , follow diagnosis five four carried remarkable results two patients , remaining three relieved bed rest alone three four patients according extended us navy table 6 good short term results role complete evaluation decision making process leading correct diagnosis treatment emphasized
three dimensional computerized tomography evaluation laryngeal injury comparison diagnostic information obtained physical examination , conventional two dimensional axial computerized tomography scanning \( 2 ct \) , three dimensional display computerized tomography \( 3 ct \) performed five patients sustaining laryngeal trauma four patients laryngeal fractures one patient incompletely thyroid cartilage \( normal variant \) simulating fracture 2 ct three dimensional display computerized tomography found superior conventional 2 ct assessing presence nature laryngeal injuries correctly identifying anatomic variant
secondary prevention low back pain clinical trial clinical trial , aimed secondary prevention low back pain , performed 142 hospital employees reporting least three annual episodes condition participants randomly assigned one three groups program \( cal \) 3 months sessions flexion exercises , back school program \( 5 sessions \) , control group effectiveness two intervention programs evaluated 1 year period baseline data evaluation end 3 months intervention additional 6 months collected monthly surveillance whole year showed mean 4 5 painful months cal group versus 7 3 7 4 months back school control groups , respectively \( p less 0 0001 \) superiority cal group achieved partly significant increase trunk forward flexion initial increment abdominal muscle strength increased trunk flexion associated rate participation cal sessions research needed answer question intensity versus type exercise comparing different intervention programs , similar intensity
effect 3 hydroxybutyrate posttraumatic metabolism man 20 patients suffering trauma , injury severity scores greater 20 , 11 patients received dl 3 hydroxybutyrate \( 3 ohb \) rate 25 mumol kg min 3 hours remaining nine patients received sodium dl lactate rate control subjects increased arterial concentrations ketone bodies , femoral arteriovenous difference \( arterial concentration minus venous concentration \) ketone bodies increased 3 ohb group \( r 0 , p less 0 001 \) venous concentrations free fatty acids , alanine , glycine , valine decreased significantly 3 ohb group compared control group concentration difference femoral vein artery \( venous concentration minus arterial concentration \) substrates also decreased , indicating decreased release extremity decrease venous concentration alanine difference femoral vein artery reached 102 3 69 3 mumol l 32 6 22 8 mumol l \( mean sd \) , respectively , 3 ohb infusion decreased alanine release muscle 3 ohb infusion patients suggests suppressive effect ketone body posttraumatic protein catabolism
use composite skin graft composed cultured human keratinocytes fibroblasts collagen gag matrix cover full thickness wounds athymic mice patients extensive full thickness burns , wound coverage may accelerated skin expanded produce skin replacement reproducibly supplies blood wound good structural addition , development skin replacements may benefit patients require reconstruction replacement large areas abnormal skin developed composite skin replacement composed cultured human keratinocytes \( \) fibroblasts cultured human fibroblasts seeded , cultured applied surface matrix composed type collagen glycosaminoglycan , defined physical structure reach confluence matrix surface , composite grafts placed full thickness wounds athymic mice graft acceptance , confirmed positive staining antibodies specific human hla antigens , approximately 90 defined skin structure present histologically day 10 grafting , differentiated epithelium layer densely fibroblasts capillaries without evidence inflammation fluorescent light microscopy identify laminin type iv collagen electron microscopy confirm presence basement membrane components 10 days grafting attachment graft wound similar without addition human basic fibroblast growth factor , potent angiogenic agent , skin replacement graft placement wounds
relation respiratory symptoms , type farming , lung function disorders farmers respiratory symptoms function examined random sample 181 farmers \( 124 pig farmers 57 farmers \) mean age 43 years wheezing shortness breath work animal house significantly associated pig farming \( odds ratio 11 4 \) , current smoking \( odds ratio 2 2 \) , bronchial hyperreactivity \( odds ratio 3 8 \) , low fev1 \( odds ratio 3 4 \) pig farmers slightly lower fev1 farmers \( 101 versus 104 predicted , ns \) symptomatic farmers significantly lower fev1 farmers \( 93 versus 106 predicted \) multiple linear regression analysis cross sectional values fev1 showed decline fev1 associated pig farming \( 12 ml year pig farming \) smoking \( 23 ml pack year \) addition age related decline 32 ml year multiple linear regression analysis pc20 histamine showed bronchial reactivity increased age , number pack years , number years pig farming work closed pig rearing units pulmonary health hazard causes decline lung function
characteristics 60 adult chronic hair objective study constructed detail demographic features chronic hair well assess psychiatric comorbidity sizable study group method subjects drawn outpatient population chronic hair referred trichotillomania clinic responded treatment study adults hair sixty adult chronic hair completed interview focused hair pulling behavior demographic characteristics incorporated screening questions dsm iii r axis disorders data tabulated derive comprehensive picture group results typical subject 34 year old woman pulled hair two sites 21 years subjects described either tension relief pulling hair primary site , 17 \( n 10 \) failed describe characteristics thus failed fulfill iii r criteria trichotillomania forty nine subjects \( 82 \) qualified past current axis diagnoses trichotillomania several characteristics study group suggested differences obsessive compulsive disorder trichotillomania conclusions adult trichotillomania chronic disorder , frequently involving multiple hair sites , associated high rates psychiatric comorbidity relation obsessive compulsive disorder requires clarification tension reduction requirement dsm iii r diagnosis trichotillomania may restrictive
transdermal nicotine smoking behavior psychiatric patients authors used double blind crossover design observe effect administered nicotine smoking behavior 13 psychiatric patients stop smoking patients smoked significantly fewer cigarettes receiving nicotine receiving placebo data suggest administered nicotine useful adjunct treating nicotine psychiatric patients non smoking environment
diagnostic peritoneal lavage limited indications due evolving concepts trauma care study undertaken determine appropriateness celiotomy 100 consecutive patients underwent celiotomy solely positive diagnostic peritoneal lavage \( dpl \) following blunt \( b \) stab \( \) abdominal trauma total 32 \( 32 \) patients positive dpl laboratory criteria blunt trauma greater rbc mm3 , greater 500 wbc mm3 stab trauma greater rbc mm3 , greater 250 wbc mm3 dpl 68 patients positive gross inspection 18 68 patients' dpl laboratory results returned surgery laboratory definition positive dpl 61 per cent underwent therapeutic celiotomy \( tc \) 39 per cent underwent celiotomy \( \) grade ii spleen liver injuries led 79 per cent positive dpl , determined gross inspection laboratory testing , poor accuracy rate evaluated light evolving beliefs promote nonoperative therapy grade ii liver spleen injuries positive dpl sole indication celiotomy patients blunt stab abdominal trauma , unacceptably large number performed dpl limited role evaluation patients abdominal trauma
splenic trauma choice management modern era splenic surgery injury began reported splenectomy 14 year old construction worker fell height presented abdominal pain , distension , tachycardia , report set stage routine splenectomy , performed splenic injury next two generations despite early reports splenectomy animals caused impaired infection , little challenge routine splenectomy made king reported syndrome overwhelming infection \( \) many studies since demonstrated importance spleen preventing infections , particularly encapsulated organisms overwhelming infection occurs 0 6 children 0 3 adults intraoperative splenic salvage become popular achieved safely patients delivering spleen pancreas incision , carefully repairing spleen direct vision , using many adjuncts suture repair , including hemostatic agents splenic wrapping intraoperative splenic salvage indicated patients actively bleeding organs presence alcoholic cirrhosis role splenic replantation patients requiring operative splenectomy needs study may provide significant long term splenic function although nonoperative splenic salvage first suggested 100 years ago , modality become popular children adults latter 1980s patients hematomas splenic fractures extend judged computed tomography usually observed successfully without operative intervention without blood transfusion nonoperative splenic salvage less likely fractures involve splenic severely spleen patients usually treated best early operative intervention following splenectomy injury , pneumococcal vaccine decreases likelihood used routinely role prophylactic penicillin uncertain use antibiotics minor infectious problems indicated splenectomy
increased gut permeability following burn trauma twenty female guinea pigs , weighing 350 400 g , given 30 full thickness burn injury gastrointestinal permeability assessed burn postburn days 1 3 , 7 , 14 administering 5 ml isotonic mixture 8 lactulose 1 15 l measuring urinary excretion next 7 hours normal guinea pigs , lactulose \( molecular weight , \) mostly absorbed route , whereas l \( molecular weight , 164 \) mostly absorbed route gut permeability l increase burn injury \( 211 micrograms burn vs 230 , 260 , 180 , 238 , 221 micrograms days 1 , 2 , 3 , 7 , 14 , respectively , burn \) contrast , gut permeability lactulose increased significantly greatest first 48 hours burn injury \( 60 micrograms burn vs 380 , 354 , 203 , 364 , 279 micrograms days 1 , 2 , 3 , 7 , 14 , respectively , burn \) gut permeability low molecular weight compounds increases immediately burn trauma , may rather mechanism
injecting drug use female working glasgow considerable difficulties associated calculating prevalence , activities paper outlines new methods developed calculating prevalence drug injecting non injecting glasgow data indicate glasgow much higher level injecting drug use reported among prostitutes british cities
downregulation platelet surface glycoprotein ib ix complex whole blood stimulated thrombin , adenosine diphosphate , vivo wound washed platelet systems , thrombin demonstrated platelet surface expression glycoprotein \( gp \) ib gpix present study , addressed question whether , physiologic milieu whole blood , downregulation platelet surface gpib gpix induced thrombin , adenosine diphosphate \( adp \) , vivo wound thrombin induced downregulation gpib gpix surface individual platelets whole blood demonstrated use flow cytometry , panel monoclonal antibodies \( moabs \) , inhibit fibrin polymerization , peptide l l l proline platelets identified whole blood specific moab exclusion monocytes light scattering properties flow cytometric analysis whole blood emerging standardized bleeding time wound established downregulation platelet surface gpib gpix occur vivo gpib ix complex specific antibody indicated gpib gpix remaining surface platelets activated vivo vitro fully simultaneous analysis individual platelets two demonstrated thrombin induced platelet surface exposure gmp 140 \( degranulation \) nearly complete time downregulation platelet surface gpib ix initiated however , degranulation prerequisite adp platelet surface gpib ix without exposing gmp 140 platelet surface inhibitory effects demonstrated activation induced downregulation gpix gpib dependent actin polymerization summary , downregulation platelet surface gpib ix complex occurs whole blood stimulated thrombin , adp , vivo wound , independent alpha granule secretion
superior humeral dislocation complication following decompression debridement rotator cuff tears large rotator cuff tears may surgically circumstances debridement edges cuff decompression may relieve pain paper , four cases described development superior migration humeral head following debridement decompression four patients attempts made repair rotator cuff case repair failed humeral head migrated two patients humeral head replaced fracture patients prosthesis displaced serious complication may follow debridement release bursa rotator cuff repair cannot achieved correction superior humeral migration , roof bursa carried two cases procedure appears effective may considered future cases
surgical treatment severe comminuted intraarticular fractures distal radius small ao external fixation device prospective three one half year follow study although fractures distal radius common , optimal treatment clearly delineated prospective study 40 patients , mainly young active adults , comminuted unstable intraarticular fractures distal radius end results closed reduction rigid fixation small ao external includes 36 patients \( 90 \) excellent good results roentgenograms 33 patients showed accurate alignment healed fractures four patients \( 10 \) fair functional result , partial restriction range movement , although roentgenograms demonstrated good alignment healed fractures small ao external useful convenient method reconstruction treatment comminuted intraarticular fractures distal radius
method articular fractures external fixation device allows limited motion wrist joint without disruption anatomic alignment used articular fractures study july 1985 april 1989 45 month period , 87 patients 90 articular fractures \( three cases bilateral involvement \) treated modified dynamic external skeletal device closed reduction full forearm excellent anatomic reduction near 91 sound wrist well satisfactory functional results around 90 5 sound wrist gained 24 month follow period forearm muscles exert compression forces distal radial fractures throughout healing period procedure device cannot provide constant action forearm muscles fracture healing result loss anatomic reduction adequate distraction counter force provided external fixation device superior conventional methods simple application , low rate complications , excellent anatomic functional results
diagnostic operative arthroscopy wrist evaluation diagnosis wrist disorders traditionally difficult problematic ligamentous wrist associated carpal , complex disruptions , cartilage injuries virtually impossible fully assess current diagnostic techniques arthroscopy wrist allows thorough evaluation soft tissue structures cartilaginous surfaces within joints selected cases , wrist arthroscopy employed surgically modify intraarticular lesions assist planning reconstructive operations
intercondylar notch measurements special reference anterior cruciate ligament surgery femoral intercondylar notch width measured 93 patients chronic anterior cruciate ligament \( acl \) insufficiency \( group 1 \) , 62 patients acute tear acl \( group 2 \) , 38 fresh anatomic specimen knees \( group 3 \) six specimen knees , anatomic studies intercondylar notch performed tissue removal average intercondylar distance 16 1 mm group 1 , 18 1 mm group 2 , 20 4 mm group 3 differences highly significant intercondylar notch wider posterior part crossing bony generally concave walls , provided functional acl insert lateral side significant formation stenosis anterior outlet intercondylar notch occur early acl deficient knee narrow anterior outlet intercondylar notch without also found knees acute acl rupture reconstruction acl , performed concomitantly
anterior cruciate insufficient knees treated physiotherapy three year follow study patients late diagnosis evaluate functional neuromuscular training program focusing strength , endurance , postural control , , 26 patients rupture anterior cruciate ligament \( acl \) diagnosed late examined starting training period followed three years study period , four patients acl reconstruction twenty two patients treated without surgery satisfied improvement knee function activity level three six months physiotherapy compliance rehabilitation program good improvement achieved completion training period maintained three years group recreational women quadriceps strength , functional knee score , activity level , functional performance improved training maintained follow period
dislocation knee results treatment vascular ligamentous injuries 17 patients suffered complete dislocation knee reviewed eight patients 23 associated injuries nine patients injuries popliteal artery arterial reconstruction saphenous vein bypass grafts , successful eight \( 89 \) intraoperative arteriography vascular repair showed anastomosis requiring revision two \( 22 \) nine patients distal thrombi requiring removal five \( 55 \) patients delay arterial repair responsible one failure eleven patients satisfactory results early open ligament repair results less favorable patients treated early ligament repair
varus ankle secondary calcaneus fracture case report varus displacement ankle secondary calcaneus fracture observed 33 year old man similar calcaneus fracture dislocation , mechanism involved inferior medial displacement body calcaneus patient 's ankle deformity corrected lateral ankle ligament reconstruction correction required distraction bone block fusion successful reconstruction calcaneus fractures requires careful analysis pathologic lesion unusual case , correction required restoration lost bone structure
blunt traumatic rupture heart pericardium ten year experience \( 1979 1989 \) blunt traumatic rupture heart pericardium , rarely diagnosed preoperatively , carries high mortality rate 1979 1989 , 20 , 000 patients admitted level trauma center retrospective review identified 59 patients requiring emergency surgery condition injuries resulted accidents \( 68 \) , motorcycle crashes \( 10 \) , \( 7 \) , falls \( 5 \) , \( 7 \) , \( 2 \) \( 2 \) seventeen patients \( 29 \) isolated rupture pericardium 37 \( 63 \) one cardiac chambers patients signs life scene transportation , 29 \( 49 \) vital signs admission 15 chamber injury , 12 pericardial rupture , two combined injuries diagnosis established emergency thoracotomy 30 patients arrived cardiac arrest remaining 29 patients , diagnosis made urgent thoracotomy \( 41 \) , subxiphoid pericardial window \( 34 \) , laparotomy \( 21 \) , chest radiography \( 3 \) overall mortality rate 76 \( 45 patients \) , 52 vital signs admission rapid transportation expeditious surgical treatment save many patients injuries
functional outcome pediatric trauma patients identified salvageable retrospective study 305 pediatric trauma patients seen 17 months undertaken evaluate functional outcome patients categorized non salvageable survivors \( \) functional outcome determined denver developmental screen tests \( \) children less 5 years age severity rating scale \( \) 5 years old older patient assigned injury scores \( ais \) injury severity score \( iss \) , glasgow coma scale \( gcs \) , trauma score \( ts \) total number patients classified severe 65 \( 21 \) , 13 classified non salvageable , seven non salvageable survivors six non preventable deaths study suggests current trauma scoring systems tend overestimate non salvageable population identified non salvageable survived high probability meaningful functional recovery current trauma scoring systems need revision better identify non salvageable survivors children make meaningful neurologic recovery
humeral mobility treatment hanging cast retrospective review 23 patients treatment humeral fractures hanging cast performed average followup time 8 59 years \( range , 1 0 15 5 years \) functional results good eight \( 34 8 \) excellent 15 patients \( 65 2 \) assess flexibility shoulder elbow joints 24 parameters measured body side using neutral zero method cumulative comparison parameter revealed decreased upper limb treatment hanging cast reduced abduction without moving shoulder blade \( 84 08 7 53 vs 77 34 11 38 p less 0 05 \) , reduced free abduction \( 166 09 14 4 vs 158 22 19 28 p less 0 01 \) , reduced \( 155 26 10 12 vs 149 35 3 22 p less 0 01 \) , reduced external rotation hanging arm \( 48 96 19 05 vs 41 18 16 75 p less 0 01 \) , increased flexion shoulder \( 25 65 10 37 vs 27 3 10 0 p less 0 05 \) reduced extension elbow \( 0 86 6 92 vs 2 68 9 63 p less 0 05 \) findings show deficiencies humeral mobility treatment hanging exist
results operative treatment intra articular fractures calcaneus since 1980 treatment displaced intra articular fractures consists open reduction , bone grafting , internal fixation thereby applied early postoperative movement possible precise preoperative planning ct scan required proper timing careful preoperative planning essential prevent soft tissue complications total 16 fractures good clinical radiologic results achieved 50 cases results satisfactory 25 poor 25 patients returned work average 5 months three patients \( 19 \) received disability , compares favorably nonoperative treatment believe majority comminuted intra articular fractures calcaneus profit open reduction internal fixation reliable functional results achieved conservative therapy
differential regulation b lymphocyte activation severely burned patients studied vitro expression regulation cd23 cd25 \( tac \) surface antigens peripheral blood lymphocytes \( pbl \) severely burned patients \( burn injuries ranging 25 72 tbsa \) order evaluate b lymphocyte activation processes thermal trauma spontaneous cytokine \( il 4 , il 2 \) induced expression cd23 represents b cell activation marker significantly reduced second fifth week postburn compared healthy donors contrast , cd25 , expressed activated cells , showed marked increase spontaneously , indicating vivo activation , stimulation il 2 pha concomitantly , cell proliferation induced pha con suppressed however , number b cells remained unchanged data demonstrate impairment early events lymphocyte program severely burned patients activation b cells , since become refractory external helper signals addition , cells highly activated fail proceed proliferation response mitogenic stimuli
sonographic screening mass abdominal renal injuries following 1988 value sonography acute trauma evaluation generally underestimated , opinions controversial sonography performed primary screening procedure 400 750 mass patients trauma admitted large hospital within first 72 hours 1988 two real time sector used area hospital , average time spent one patient 4 minutes 130 followup sonographic examinations required trauma associated pathology abdomen retroperitoneal space detected 12 8 patients , 1 false negatives false positives authors believe sonographic screening mass quick effective means detection abdominal retroperitoneal injuries sonography used purpose routinely gain experience maintain screening trauma cases mass situations
delayed diagnosis extremity injuries patients multiple injuries total 340 patients treated intensive care unit department university central hospital analyzed study 1 , fractures pelvis extremities , trauma surgeons radiologists duty initially missed 45 injuries , e , 4 2 taking account eventual late symptoms , severe delayed diagnoses injuries located around hip knee joints patients delayed diagnoses , average , severely ill needs primary blood transfusions assisted respiration resembled needs patients later died trauma complications common causes delay diagnosis radiographs done 60 patients , visible injury radiographs 31 inferior quality radiographs , reports , fracture visible corner radiograph , fracture hidden fractures , excessive obesity patient may also contribute delay study presents measures improving diagnostic strategies , would appear delayed diagnoses cannot totally eradicated
successful replantation legs child 5 year followup case report replantation lower extremities infrequent procedure , rarely indicated , due usual severity primary injury plus possibility good prosthetic substitution report case successful replantation legs 8 year old boy \( despite aspergillus septicemia \) followup 5 years case suggests leg replantation considered young patients appears second reported case successful replantation legs
spontaneous healing traumatic thoracic aortic tear case report patient deceleration trauma thoracic aorta causing significant intimal disruption described complete angiographic resolution documented period medical management review literature , along experience , suggests traumatic aortic disruption constitutes spectrum injury rather none phenomenon immediate surgery , especially multiply injured patients , may delayed even injury relatively limited
role computerized tomography diagnosis occult femoral neck fracture associated ipsilateral femoral shaft fracture case report report femoral neck head fracture diagnosed acutely ct scanning case illustrates potential benefits acute femoral neck head ct scan patients high energy femoral shaft fractures
bilateral fracture dislocation sacroiliac joint case report bilateral fracture dislocation sacroiliac joint displacement sacrum rare extremely severe injury treated patient bilateral fracture dislocation sacroiliac joint using nonoperative method obtained excellent functional result
traumatic renal avulsion chest case report case report patient survived blunt renal avulsion herniation kidney ruptured diaphragm symptoms mild considering severity injury prompt diagnosis unusual combination injuries aided contrast enhanced computed tomography \( ct \)
educational status drinking patterns representative college students \? using data large , nationally representative sample , multiple using sex , ethnicity , age educational status showed drinking patterns college students differed significantly dropouts , high school graduates former college students college students likely use alcohol tended drink less quantity per drinking day age sex differences smaller among college students among groups , especially proportions abstainers whites likely drink college , among blacks college students least likely drink age little association drinking conclusions based school samples may well populations tested , possible , using representative
associations alcohol cocaine use sample problem drinking employees increases cocaine use created new challenging cohort problem drinkers dual multiple addictions part randomized trial comparing alternative alcoholism treatments 10 , 000 industrial plant , interviewed 224 new alcoholic clients assistance program \( eap \) 40 used cocaine 6 months prior eap intake compared employees reporting recent cocaine use , cocaine users younger , less often married reported heavier drinking alcohol related problems , job even controlling demographic occupational factors , drinking indicators , cocaine users reported \( 24 hours \) , \( marginally significant , p 06 \) , unacceptable job performance alcoholic eap clients use cocaine appear engage drinking job report cocaine use , seems difference specifically attributable use cocaine
sex differences personality traits coping styles hospitalized alcoholics forty inpatients alcohol unit large hospital administered battery tests consisting coping styles scale , personality profile scale , depression scale brief mast comparable comparison group 40 outpatients attending medical screening clinic hospital also completed battery two groups differ terms age , education ratio men women significant differences coping styles personality characteristics alcoholics nonalcoholics , large extent , men women within alcoholic group significant differences found men two groups , female alcoholics differed greatly nonalcoholic women terms coping styles , personality variables also terms conflict findings indicate differences alcoholic nonalcoholics sample due largely patterns uniquely characterizing female alcoholic group results discussed terms cultural expectations
effectiveness alcoholism screening ambulatory care setting two hundred eighty subjects three ambulatory care clinics participated study designed assess psychometric properties using dsm iii criteria alcoholism diagnostic standard eighty two subjects \( 30 \) completed diagnostic interview schedule met dsm iii criteria alcohol abuse dependence sensitivity , using generally accepted weighted cut score five greater , 56 specificity 83 cut score two greater produced sensitivity 72 specificity 64 results study suggest , used screening ambulatory care clinic population , optimum balance sensitivity specificity achieved using cut score two greater addition , alcohol subscale diagnostic interview schedule easy considered use diagnostic standard clinical settings
factors associated alcohol use later adolescence relative influence number family individual characteristics frequency intensity alcohol use group older adolescents assessed sample consisted 8 , persons ranging age 20 21 years obtained high school beyond study logistic regression analyses performed frequency intensity alcohol use indicated white males higher socioeconomic backgrounds , living urban areas external locus control weak family orientation , tended drink frequently consume larger quantity alcohol per drinking episode results explained perspective
development measure examining children 's roles alcoholic families measure assessing roles played children alcoholic families presented study 1 , item pool generated targeting four distinct roles discussed alcohol literature , items reviewed panel experts children 's roles inventory \( cri \) administered 140 adult children alcoholics responses used measure observed levels internal consistency seemed adequate \( 's alpha ranged 89 95 \) replication effort \( study 2 \) , cri administered 142 adult children alcoholics internal consistency remained acceptable levels , ranging 90 95 study 3 examined cri 's discriminant validity sample 138 adult children alcoholics well sample 105 adults nonalcoholic families completed cri , measure self index one 's use social support reliability results studies 1 2 \( samples \) likewise , samples cri subscales differentially predictive self well size satisfaction one 's social support network
children alcoholic parents community relationship parental alcoholism risk offspring investigated community sample children parents met criteria dsm iii alcohol abuse dependence children parents met criteria ten diagnoses compared children normal parents data obtained data banks two major psychiatric epidemiology studies adult \( 17 64 \) child \( 4 16 \) population puerto rico results indicated parental alcoholism addition creating adverse family environment effect relative risk offspring \( measured scores child behavior checklist \) although previous studies reported higher levels behaviors children alcoholics , increased risk symptoms observed children studied similar findings obtained children parents psychiatric disorders suggesting effects parental alcoholism children ages 4 16 may different consequences parental mental illness per se
snare removal foreign bodies experimental study clinical evaluation authors describe use new right angle snare made nickel titanium \( \) retrieval foreign bodies placed devices snare loop right angles comes five sizes \( 5 , 10 , 15 , 25 , 35 mm \) radiographic visualization enhanced gold snare used wire catheter fragments introduced thoracic vasculature four dogs eleven 13 attempts successful three attempts intravascular foreign bodies successful two patients one patients , 10 mm snare used remove fractured end ventriculoatrial shunt tube left pulmonary artery three patients , four ureteral stents successfully removed fluoroscopic guidance retrievals performed vascular sheath standard techniques angiographic equipment complications seen patients dogs
tears cruciate ligaments evaluation cine mr imaging cine magnetic resonance \( mr \) imaging technique , involving acquisition kinematic sagittal images knee movement , used evaluate 52 symptomatic knee joints results compared obtained means static three dimensional \( \) mr imaging twenty seven 28 anterior cruciate ligament \( acl \) tears 22 24 normal ligaments correctly identified cine mr imaging sensitivity 96 specificity 92 static mr imaging yielded sensitivity 71 specificity 88 four posterior cruciate ligament tears identified cine mr imaging meniscal tears , cine mr imaging yielded sensitivity 48 specificity 96 sensitivity specificity mr imaging 71 96 , respectively cine mr imaging proved useful static mr imaging assessing cruciate ligaments , especially partially , assessing movement meniscal free fragments increased information obtained cine mr imaging may warrant continued investigation clinical application
injuries children second wave motivated number skateboard related injuries seen emergency department , undertook investigation injuries mid 1980s studied us product safety commission injury frequency estimates , indicated resurgence injuries 19 , 182 1984 37 , 180 1985 children 10 14 years old injured greatest frequency injuries common among children younger 5 years old , reflecting larger proportion head neck injuries boys sustained frequent severe skateboard related injuries observed injury patterns \( head neck injuries younger children , extremity injuries older children , severe head neck injuries older children \) probably reflect role psychomotor development risk exposure biomechanics likely prevention strategies include skateboard use children younger 5 years , , promotion use protective
predicting onset chronicity women 's problem drinking five year longitudinal analysis background longitudinal studies adult drinking typically excluded sampled small numbers problem drinking women , measured limited range influences women 's drinking behavior methods study development women 's problem drinking time , five year follow interviews conducted two groups respondents 1981 national survey women 's drinking 143 problem drinkers 157 drinkers regression analyses examined effects 1981 predictors six measures 1986 problem drinking , problem drinkers drinkers separately results among 1981 drinkers , predictors onset problem drinking indicators 1986 included younger age , , lifetime use drugs alcohol consistent predictor persistent \( chronic \) problem drinking sexual dysfunction predictor included employed part time never married , experiencing recent depression separation predicted lower levels subsequent alcohol among problem drinkers conclusions findings suggest different personal social factors predict onset problem drinking compared continuation , point life style , sexual dysfunction , role deprivation potentially important variables
importance planned health education prevention injury example planning health education aimed preventing sports injuries often incomplete stated instances , evaluation incomplete present theoretical framework planning evaluating health education , illustrating main points using example health education systematic planning consists analyzing magnitude problem behavioral risk factors , studying behavior determinants , designing optimal intervention , implementing intervention evaluation phase effects five levels \( implementation , intervention , determinants , behavior , incidence injury \) common pitfalls mentioned special attention given study determinants behavior design intervention importance health education material community approach sports participants health education , together regulations facilities , constitutes health promotion strategy prevention sports injuries sports , seems strong need research etiology determinants behavior effective prevention realized
meniscus repair anterior cruciate deficient knee 1979 1986 , isolated repair peripheral vascular zone meniscal tear performed 22 patients \( 23 \) acl insufficiency various reasons none patients underwent repair reconstruction acl meniscus repair done open 12 cases arthroscopic techniques 11 cases purpose study evaluate success rate meniscal repair anterior cruciate deficient knee average age patients time surgery 25 years average followup 56 months six patients \( 26 \) mild occasional pain requiring medication one patient moderate pain requiring pain medication eight patients \( 26 \) occasional giving way episodes one underwent acl reconstruction 5 years later frequent giving way one patient required postoperative manipulation inadequate range motion , neurovascular injuries infections three patients \( 13 \) failed repairs required subsequent subtotal none patients clinical symptoms signs meniscal tear significant differences results open arthroscopic repair even though failure rate meniscus repair may greater unstable knee , conclude meniscus repair contraindicated anterior cruciate deficient knee
conservative treatment anterior cruciate deficient knee seventy nine recreational athletes \( average age , 26 years \) complete acl tears treated arthroscopic surgery , monitored rehabilitation , functional bracing , activity modification average followup 52 months \( range , 36 102 months \) six \( 8 \) patients ultimately underwent ligament reconstruction considered failures treatment remaining 73 patients subject detailed analysis 9 \( 11 \) excellent , 25 \( 32 \) good , 17 \( 22 \) fair , 28 \( 35 \) poor results although 71 patients \( 97 \) satisfied knee activities daily living , 36 \( 49 \) satisfied knee sports twenty nine \( 40 \) significantly modified athletic activities age , sex , interval injury treatment , associated meniscal tears \( 49 67 \) , articular cartilage damage \( 21 29 \) apparent effect outcome poor results noted 29 \( 40 \) patients significant pivot shifts multiple repeat injuries , repeat arthroscopy , deficits , increased length followup also associated poor results
prevention common overuse injuries use shock prospective study sedentary individuals , particularly new military recruits , start physical training program substantial risk developing overuse injury lower limb study investigated effect incidence overuse injuries 9 weeks basic military training experimental group consisted 237 randomly selected new recruits , recruits control group given experimental group compliance monitored panel doctors documented classified injuries occurring 9 week period total 54 \( 22 8 \) 237 \( 31 9 \) injuries reported experimental control groups , respectively groups , majority injuries overuse \( experimental group , 90 7 control group , 86 4 \) mean weekly incidence total overuse injuries tibial stress syndrome significantly lower \( p less 0 05 \) experimental group mean incidence stress fractures lower experimental group significantly \( 0 05 less p less 0 1 \) study shows incidence total overuse injuries tibial stress syndrome 9 weeks basic military training reduced wearing
diagnostic capabilities magnetic resonance imaging computed tomography acute cervical spinal column injury present study conducted evaluate imaging capabilities magnetic resonance imaging \( mri \) evaluating acute cervical spinal column injury compare results computed tomographic \( ct \) imaging forty nine patients undergoing mri level regional spinal cord trauma center evaluate cervical spinal column injury studied seventy one injuries identified mri injuries classified osseous \( fracture dislocation \) \( n 21 \) , disc herniation \( n 29 \) , spinal cord injury \( edema contusion transection \) \( n 21 \) diagnostic imaging results 33 49 patients undergoing mri ct compared ct demonstrated 22 fracture dislocations compared 10 mri mri demonstrated 19 disc compared 7 ct additionally , mr imaged 13 cord injuries compared 0 ct mr imaging proved superior demonstrating spinal cord pathology intervertebral disc herniation ct superior mri demonstrating osseous injury ct mri may useful together determining presence extent spinal column injury
barium sulfate report complication barium sulfate subsequent retention barium sulfate years demonstrated three patients dilute suspension barium sulfate water used pathologic examination one patient showed barium sulfate within macrophages alveolar spaces walls perivascular interstitium since residual barium sulfate interferes imaging procedures lungs , represents event patients pulmonary disease high resolution computed tomography preferred method evaluating bronchiectasis performed , performed bronchoscopy using \( \)
1990 evans memorial lecture inhalation injury important question answered animal data whether significant difference existed two groups could observed resuscitation ringer 's lactate lead increased lymph flow total protein flow spite drop protein oncotic pressure plasma ringer 's lactate lower lymph plasma protein ratio , might significant negative difference could observed either pulmonary capillary wedge pressure pulmonary vessel resistance animals survived throughout experiment , experiments advantages regarding vital parameters could ascertained administration albumin however , several factors must borne mind inhalation injury heat source alone toxic substances involved inhalation trauma induced absence surface burn wound duration observation 36 hours thus caution must observed applying findings clinical situation evaluation clinical results , seen differences could established regard pulmonary capillary wedge pressure extravascular lung water ringer 's lactate albumin group spite 50 drop oncotic pressure , however , valid first 24 36 hours , one could assume protein drop coupled still raised hydrostatic filtration coefficient would lead interstitial edema
persistence fetal bovine serum proteins human keratinocytes cultured human keratinocytes used skin grafts , success limited late graft loss development antibody fetal bovine serum \( fbs \) protein used culture media vitro keratinocyte growth identified persistence fbs antigen skin grafts important induction immune response susceptibility keratinocytes immune mediated injury magnitude longevity fbs protein persistence human keratinocytes studied secondary passage human keratinocytes grown media supplemented 5 fbs media changed one supplemented pooled human ab serum , amount fbs protein incorporated tissue measured following 8 days elisa reaction directed fbs antigen incorporated fbs antigen decreased first 3 days 31 maximum significant decrease 5 days keratinocytes grown alternative serum supplements \( collaborative research inc , , mass serum plus research products inc , , \) , contain reduced amounts fbs , offered significant reduction fbs protein incorporation duration antigen persistence would make human keratinocytes susceptible cell destruction immune response fbs may contribute delayed loss human keratinocyte grafts
time course alterations lung lymph bronchial blood flows inhalation injury effects inhalation injury pulmonary microvascular fluid flux bronchial blood flow examined long term study sheep \( n 13 \) insufflated either 48 breaths cotton smoke \( n 8 \) air \( n 5 \) anesthetized halothane injury , anesthesia discontinued animals mechanically ventilated throughout experimental period \( 24 hours \) bronchial blood flow increased significantly time points recorded reached peak 20 minutes inhalation trauma \( 11 1 ml hr 106 18 ml hr p less 0 05 \) thereafter , bronchial blood flow decreased value six eight times baseline measurement remainder study period changes blood flow , concomitant increase lung lymph flow variable gradually increased baseline value \( 6 1 ml hr 44 8 ml hr \) 24 hours challenge smoke control animals showed little change cardiopulmonary function experimental period correlation increase bronchial blood flow lung lymph flow patterns cotton smoke inhalation injury
elevated serum aluminum levels severely burned patients receiving large quantities albumin aluminum various fluids used intravenous therapy , associated bone disease encephalopathy albumin highly contaminated aluminum , eliminated primarily renal excretion patients burns receive large quantities albumin impaired renal function , hypothetical risk aluminum loading assess risk aluminum loading analyzed sera 12 patients burns aluminum concentrations serum aluminum concentration elevated 8 12 patients , levels near toxicity 3 8 serum aluminum serum creatinine levels directly correlated , r 0 71 p less 0 005 relation found serum aluminum amount albumin received however , patients highest serum aluminum levels severely burned none survived thus patients burns receiving albumin risk aluminum loading impaired renal function contributes aluminum retention
observations stability contraction composite skin grafts xenodermis isograft overlay composite skin grafts xenodermis thin split thickness isograft overlay evaluated stability contraction male inbred lewis rats used recipients , rats serving allogeneic dermis donors cryopreserved human skin used xenodermis grafts two components composite graft , xenodermis isograft overlay , grafted one operation surgically created wound wounds observed 1 year composite skin grafts took fairly well , although loss isograft noted xenodermis remained grossly intact even 1 year grafting however , composite skin grafts animal model contracted sheet isografts alone
burns hot oil grease public health hazard examined incidence , etiology , morbidity burns due hot oil grease 10 year period 1976 1985 , patients hospitalized burns , 85 \( 4 7 \) injuries due hot grease oil mean age 20 years 34 patients less 8 years old mean total body surface areas second third degree burns 11 5 \( range 0 5 40 \) , average length hospital stay 19 6 days fifty eight percent patients required split thickness skin grafting \( n 49 \) , three required intubation , one required tracheostomy seventy eight percent oil burns occurred home common circumstances consisted children handle electric cord pan pulled hot oil onto \( nineteen 29 children less 8 years old \( 66 \) \) burns due oil grease associated considerable morbidity high point , high viscosity , potential oil increase potential soft tissue damage compared typical injuries hot water dangers children pulling , dangers hot oil , importance supervision children , importance knowledge management grease stressed public education needed potential seriousness burns
descriptive summary new 's 1985 burn population data obtained new state department health 1985 hospitalized patients burns data collected national burn victim foundation 's standard burn reporting form analyzed information epidemiology burns children \( 0 4 years age \) continue largest percentage 0 18 year old age group sustain burn injuries , 67 injuries sustained children age 5 males accounted 69 total burn population 58 admissions white 69 patients admitted partial thickness burns , 31 admitted full thickness burns largest primary third party 92 patients burns discharged home self care data also analyzed examination selected age groups determine individual needs specific groups analysis burn injuries reported national burn victim foundation confirmed previous reports home likely place burn injury occur injuries predominate injuries comprise 50 sustained burns gasoline accounted 54 burn injuries caused data supported efforts develop programs address needs urban child , 17 19 year old age groups , elderly information collected served objectives burn prevention programs
drugs femoral neck fracture case control study two hundred consecutive patients femoral neck fractures \( \) 200 controls matched age , sex , nursing home residency number admissions within last 2 years , interviewed recent drug use matching criteria chosen achieve case control groups comparable regard overall physical disability thus preliminary study shown strongly associated nursing home residency correlated number recent hospital admissions found negatively associated use coronary drugs \( 0 27 95 ci 0 11 0 70 \) positively associated drug use general \( 2 00 95 ci 1 04 3 05 \) various classes psychotropic drugs consistently greater 1 , although statistically significant inherent problem interpreting findings underlying disease may predispose subject drug use , thus creating non causal relationship
controlled drinking , treatment effectiveness , disease model addiction commentary despite long history claims followed , controlled drinking continue promote treatment goals procedures alcoholics recent claims favor controlled drinking examined critically context continuing debate concerning empirical studies treatment goals , treatment effectiveness , inpatient versus patient treatment alcoholism 's views concerning conventional disease based alcoholism treatment , controlled drinking , disease model shown based largely inadequate , literature , inappropriate comparisons , , man
universal precautions effective reducing number occupational exposures among health care workers \? prospective study physicians medical service using daily questionnaire , prospectively studied 277 physicians two hospital medical services incidents exposure blood body fluids barrier use implementation universal precautions found implementation significantly increased frequency barrier use exposure incidents 54 implementation 73 implementation universal precautions implementation led decrease number exposure incidents resulted direct contact blood body fluids \( actual exposures \) , 5 07 2 66 exposures per physician per patient care month , increase exposures direct contact prevented use barrier devices , 3 41 exposures per patient care month implementation 5 90 exposures per patient care month implementation implementation affected neither types body fluid procedures involved overall rate exposure incidents \( 8 5 per patient care month \) , increase barrier use , prevent direct contact blood body fluids thus converted would actual exposure one conclude universal precautions effective reducing risk occupational exposures among physicians medical service
catastrophic injuries fatalities high school college sports , fall 1982 spring 1988 direct indirect deaths catastrophic injuries , defined injury incurred participation high school college sport permanent severe functional neurological disability \( nonfatal \) transient permanent functional neurologic disability \( serious \) , presented sports period fall 1982 spring 1988 football contributed greatest numbers catastrophic injuries also largest number participants ice , , sports participants greatest risk catastrophic injury death mechanisms injury sport corrective actions identified discussed high school college catastrophic injuries may never totally eliminated , dramatically reduced reliable injury data collection analysis
use clinical toxicology resources emergency physicians impact control centers study objective need clinical toxicology resources emergency physicians unclear may implications future training resource availability study designed assess current emergency physician use available resources design prospective evaluation mail using 49 item questionnaire type participants 170 emergency physicians utah interventions none results response rate 75 3 \( 128 170 \) resources outside knowledge consulted occasionally frequently 98 3 used following resources occasionally frequently control center \( pcc \) \( 93 7 \) , toxicology \( 77 6 \) , expert \( 34 0 \) , house poisindex \( 23 9 \) often contacted pcc toxicity information \( 93 7 \) management recommendations \( 87 3 \) acute , symptomatic overdose cases \( 88 3 \) almost never contacted pcc adverse drug reactions \( 76 6 \) , pill identification \( 70 2 \) , consultation physician \( 68 1 \) , asymptomatic exposures \( 62 9 \) , chronic toxicity \( 50 4 \) , solely report case american association control centers data base \( 90 2 \) access house poisindex often pcc \( 82 6 \) house poisindex , 42 8 contacted pcc access providing access physician consultations thought important role pcc 86 7 , 32 physicians using option conclusion vast majority emergency physicians utah pcc acute , symptomatic view access physician consultation important role pcc seldom use availability house poisindex decreases likelihood pcc consultations emergency departments frequency emergency physician consultation pcc may decrease poisindex becomes available hospitals
flumazenil new benzodiazepine antagonist flumazenil recently discovered pharmacologic antagonist cns effects benzodiazepines acts binding cns benzodiazepine receptors competitively blocking benzodiazepine activation inhibitory synapses animal studies human studies appear demonstrate flumazenil weak intrinsic agonist activity hand , studies inconclusive demonstrating inverse agonist effects agent evidence available suggests flumazenil well tolerated human broad range doses given either orally parenterally produce serious adverse effects setting isolated benzodiazepine overdose , flumazenil capable completely reversing coma within one two minutes , effect lasting one five hours repeat doses given safely reverse recurrent effects longer acting benzodiazepines flumazenil undergoing evaluation food drug administration drug receive , likely used emergency departments well variety clinical settings first , could used effect rapid reversal benzodiazepine induced sedation administered facilitate medical , orthopedic , surgical procedures , particularly event respiratory depression second , flumazenil might therapeutic role management patients taken benzodiazepine although patients managed successfully supportive therapy alone , possible use flumazenil may obviate need intubation respiratory support patients eliminate possible adverse effects even short term endotracheal intubation finally , flumazenil could diagnostic therapeutic value patients acute alterations mental status unknown etiology , particularly possible drug overdose consideration flumazenil appears specific antagonism benzodiazepine induced respiratory cns depression , could used empirically confirm exclude role benzodiazepines generation mental status changes setting overdose coma unknown origin turn might obviate need expensive \( eg , computed tomography \) sometimes invasive \( eg , lumbar puncture \) diagnostic modalities might particularly useful nothing benzodiazepine induced coma clearly distinguishes causes coma thus , signs symptoms may reasonably allow benzodiazepine overdose confirmed eliminated clinical grounds studies continue define ultimate use new agent
risk factors manifestations digoxin toxicity elderly incidence digoxin toxicity increases age , largely two common conditions benefit use digoxin , congestive heart failure atrial fibrillation , markedly prevalent old age whether elderly sensitive effects digoxin age per se unclear however , several factors render elderly susceptible digoxin toxicity include age related decline renal function decrease volume digoxin distribution also increase number comorbid conditions , including cardiovascular chronic obstructive pulmonary disease , susceptibility digoxin toxicity moreover , treatment diseases interactive medications quinidine calcium channel blockers may increase serum level digoxin similarly , electrolyte hypokalemia hypomagnesemia occur frequently elderly result diuretic therapy however , recent data suggest manifestations digoxin toxicity among younger older patients differ similar incidences cardiac toxicity , gastrointestinal toxicity , altered mental status found patient populations treatment digitalis toxicity elderly younger patients response rates diminished elderly
results multicenter studies digoxin specific antibody fragments managing digitalis intoxication pediatric population digitalis toxicity continues problem pediatric patients undergoing therapy cardiac heart failure arrhythmias , well accidental article previous use digoxin specific antibody fab fragments treat digitalis overdose intoxication children reviewed case reports cited medical literature 57 pediatric cases gathered result multicenter clinical trial postmarketing surveillance study reported indicate digoxin specific antibody fab fragments effective ameliorating signs digitalis poisoning children fab fragments rapidly eradicate potentially life threatening arrhythmias conduction defects , also effective treating hyperkalemia noncardiac manifestations digitalis toxicity small samples patients studied date , complications minimal allergic reactions digoxin specific fab fragments observed recommendations management digitalis intoxication children outlined
recognition management digitalis intoxication implications emergency medicine digitalis intoxication among common serious adverse drug reactions clinical medicine recent development radioimmunoassay accurately measure serum concentrations digoxin assistance , digitalis intoxication remains difficult diagnosis make difficulty diagnosing digitalis intoxication arises associated signs symptoms common symptoms include fatigue , weakness , nausea , anorexia symptoms occur many illnesses digitalis intoxication similarly , electrocardiographic disturbances caused cardiac may nondiagnostic arrhythmias commonly associated digitalis toxicity often nonspecific reflection patient 's underlying heart disease measurement serum digoxin levels useful , studies demonstrated overlap levels groups without toxicity due modulation cardiac effects digitalis clinical variables underlying myocardial renal disease , electrolyte acid base , factors , correlation toxicity particular serum digoxin concentrations may vary inherent difficulties confirming diagnosis digitalis intoxication cases , digoxin specific fab antibodies may play role diagnostic tool certainly , digoxin specific fab antibodies play significant part treatment digitalis intoxication fab antibodies successfully used reverse effects digoxin , , poisoning antibodies useful treatment acute chronic digitalis intoxication age groups , including geriatric pediatric populations
changing patterns management fractures children advances radiographic greatly facilitated diagnosis treatment pediatric musculoskeletal injuries recent years , indications operative intervention treatment children 's fractures become clearly defined
influences protected passive mobilization interval flexor tendon healing prospective randomized clinical study prospective multicenter clinical study carried determine whether improved tendon could achieved greater durations daily passive motion rehabilitation flexor tendon repair fifty one patients placed randomly two controlled passive motion protocols group 1 patients received greater intervals passive motion rehabilitation using continuous passive motion device group 2 patients treated traditional early passive motion protocol tendon rehabilitation group 1 patients , mean interval controlled motion rehabilitation 75 hours week , mean number cycles 12 , 000 group 2 patients mean interval controlled passive motion four hours week , mean number cycles 1000 minimum follow time six months \( mean , 10 8 months \) using 's formula , mean active motion group 1 138 degrees 6 degrees mean motion tendons group 2 119 degrees 8 degrees difference groups 1 2 statistically significant effect number tendons injured per digit within group significant data experiment indicate duration daily controlled motion interval significant variable flexor tendon function concerned
fracture index metacarpal base subluxation joint case report 40 year old man fell arm suffered fracture index metacarpal base subluxation thumb basal joint small fracture fragment base index metacarpal attached base thumb metacarpal strong ligament , noted time surgery pattern injury , ligament reversed 's fracture , seems previously reported
pes interposition proximal tibial fracture case report ten year old girl suffered type ii fracture proximal tibia inspection revealed interposition pes \( pa \) within open , prevented reduction may first case report pa interposition
occurrence accessory immunologic cells bone induction differentiating tissues fracture healing demineralized bone powder induced \( dbp \) bone formation investigated monoclonal antibodies respect occurrence ia positive cells , macrophages , lymphocytes interleukin 2 receptors \( il 2 \) ia molecules cell surface belonging class ii major histocompatibility complex specific species individual types granulation tissues \( fracture healing following dbp implantation \) , mesenchymal cells surrounding musculature accompanied large numbers ia positive cells common macrophages occurrence il 2 receptors sparse fracture healing rich dbp induction , probably immunogenic properties , though weak day 7 , almost existing cells dbp induction ia positive , immunologic effector phase apparently directed remaining still passive bone powder periphery , central part inserted bone powder producing cartilaginous cells matrix presence accessory immunologic cells fracture healing perhaps due surveillance function \( standard response injury \) , cell differentiation might also dependent active mediators emitted ia positive cells macrophages investigation strengthens concept induced bone development occurs experimental fracture healing
stimulating effect growth hormone fracture healing dependent onset duration administration effect onset duration growth hormone administration biomechanical properties healing rat tibial fractures investigated 40 days healing biosynthetic human growth hormone , 2 7 mg kg body weight day , given two daily injections three groups rats \( 1 \) entire healing period \( 2 \) first 20 days \( 3 \) last 20 days healing three corresponding groups control rats injected saline group 1 , maximum load stiffness healing fractures increased 165 175 , respectively , compared control group group 2 , maximum load , stiffness , maximum stress , energy absorption maximum load increased 222 , 175 , 171 , 247 , respectively , compared control group group 3 , statistically detectable effects found results show growth hormone stimulates fracture healing given first part healing period given entire healing period
surgical treatment brachial plexus birth palsy brachial plexus birth palsy remains challenging condition 1000 infants followed 1977 1988 , functional results much improved obtained observation , surgical exploration repair performed clinical biceps function occurred three months age recovery slow , comprehensive follow study reconstructed conservatively managed children required prevent joint contractures children benefit palliative procedures tendon transfers must also identified
individualized care treatment alcoholism discussion several case , author emphasizes utilization individually tailored treatment approach working people experiencing problems related alcohol consumption patients may achieve abstinence without disease concept alcoholism , attending alcoholics anonymous need always part treatment furthermore , patients , controlled drinking may desirable outcome abstinence importance perspectives conducting clinical work patients discussed
staffing patterns american methadone maintenance programs methadone maintenance frequently utilized treatment addiction also represents one best aids prevention tools iv drug using population despite important roles , little reported methadone maintenance clinics surveys covering various aspects program operations , including staffing , sent clinics \( n \) listed 1984 national drug abuse alcohol treatment programs using anova , staffing patterns compared across programs function clinic size , city size , region country , funding resources differences found based city clinic size , staffing patterns varied function regional location well sources clinic 's funding
depression among alcoholics sample aim present study identify predictor variables depression among alcoholics mental hospital questionnaire depression inventory \( \) utilized collect data 71 male alcoholics stepwise multiple regression analysis scores demographic health related variables resulted identification marital problems physical problems due alcohol risk factors findings discussed within context findings western countries similarities
management auto psychotic state report 2 cases self penile amputations , offered differing surgical options contrasting surgical results due varying time delays 1 case repair done immediately , repair case delayed 3 days due psychotic state patient psychiatric backgrounds episodes discussed , well techniques repair reconstruction
evidence histamine causative toxin scombroid fish poisoning background highest morbidity worldwide fish poisoning results ingestion scombroid fish , , cause clear histamine could responsible , scombroid fish contain large quantities histamine whether histamine causative toxin , however , remained question address issue , investigated whether histamine homeostasis altered people methods urinary excretion histamine metabolite , n , measured three persons scombroid fish poisoning \( \) ingestion measured 9 alpha , 11 beta dihydroxy 15 oxo 2 , 3 , 18 , 19 5 1 , 20 acid \( \) , principal metabolite prostaglandin d2 , mast cell secretory product , assess whether mast cells activated release histamine results fish contained high levels histamine \( mumol per 100 g tissue \) symptoms flushing headache began 10 30 minutes ingestion fish urine samples collected one four hours fish ingestion , levels histamine n 9 20 times 15 20 times normal mean , respectively subsequent 24 hours , levels fell 4 15 times 4 11 times normal values levels normal 14 days later excretion increased time two persons treated prompt amelioration symptoms conclusions scombroid fish poisoning associated urinary excretion histamine quantities far exceeding required produce toxicity histamine likely derived fish results identify histamine toxin responsible scombroid fish poisoning
may significant think bb air rifle injury child 's head bb guns 20 years ago constructed generated relatively little force , projectile little threat serious injury today , coil spring construction replaced pump action pneumatic chambers allow generation velocities near 350 ft sec speeds 150 ft sec 200 ft sec required skin penetration bone penetration , respectively present seven year old boy suffered intracranial parenchymal injury air powered bb gun projectile playing discuss literature suggests severe , fatal , injury
early definitive bone soft tissue reconstruction major gunshot wounds face use craniofacial surgical techniques , extended open reduction , rigid fixation plates screws , replacement severely damaged missing bone immediate bone grafting treatment complex facial fractures applied management severe gunshot wounds face early definitive bone soft tissue reconstruction performed 37 patients one hundred seventy seven primary bone grafts utilized 33 patients orbital , nasal , , maxillary reconstruction twenty six patients required mandibular repair compression reconstruction plates soft tissue reconstruction provided combination flaps four patients extensive soft tissue loss replaced free vascularized omental flaps omentum provided circumferential coverage mandibular reconstruction reconstruction floor mouth circle middle upper face omentum reconstructed deficits hard palate upper buccal sulcus wrapped around , orbital , midfacial bone grafts used fill dead space maxillary , ethmoid , frontal sinuses omentum used provide contour bulk , cover bone grafts plates fill dead space carefully shaped bone grafts provide correct craniofacial early restoration midfacial bony prevention soft tissue contraction facilitate secondary reconstruction four late total nasal reconstructions tissue expanded forehead skin wrapped around bone grafts performed
healing facial bone fractures process secondary union mechanism healing facial bone fractures investigated rabbit model twelve new zealand white rabbits underwent surgically induced fractures right rim fracture \( 4 5 mm \) left rim animals sacrificed 2 , 4 , 8 weeks bone , including periosteum , obtained fracture fracture site divided longitudinally hematoxylin eosin staining , fluorescent microscopy , , sequential fluorochrome labels \( 30 mg kg \) , \( 30 mg kg \) , \( 20 mg kg \) , orange \( 90 mg kg \) administered 24 hours preoperatively 1 , 2 , 4 , 8 weeks fracture fracture sites demonstrated vascular ingrowth , mineralization , woven bone formation 2 4 weeks postoperatively , beginning cartilage precursor subsequently , woven bone replaced bone , resulting complete bony healing 8 weeks postoperatively steps microscopic , , radiologic examination specimens study demonstrates fractures facial bones rabbit model heal process new bone formation resembles secondary union bones
analysis soft tissue response components used breast implants rat animal model implant tissue response silicone gel mammary prosthesis requires thorough evaluation light recent concerns related human connective tissue diseases , contracture , infection , neoplasia silicone prosthesis homogeneous implant milieu various silicone chemistries silicone polymer precursors prosthesis components \( silicone , extracted low molecular weight components , silica free silicone , silicone oil , silica , silicone extract \) implanted subcutaneously using technique rats \( n 90 \) , two implants per rat , periods 7 , 14 , 28 , 56 , 90 days total 6 implants per material per time period histologic analysis performed specimens harvested soft tissue intensity cellular capsular response lowest silicone oil increased material 's molecular weight increased material compliance decreased silica elicited highly reactive cellular response study apparent polymer 's molecular weight influences migration , encapsulation , intensity cellular response , silicone extract elicited highly intense cellular response pronounced lymphocyte invasion human relevance work awaits correlation implant retrieval vivo performance
experience rehabilitation zone ii flexor tendon repair dynamic traction splinting review flexor tendon repairs man 's performed january 1985 june 1987 done evaluate efficacy method rehabilitation 60 fingers \( 57 patients \) complete laceration flexor digitorum flexor digitorum tendons zone ii fingers fractures , joint injuries , significant skin loss excluded follow ranged 12 48 months rehabilitation consisted 12 week protocol using u military combined regimen controlled motion features technique controlled active extension rubber band passive flexion well controlled passive extension passive flexion incorporated palmar modification 's dynamic traction splint utilized 's total active motion formula employed determine results results classified four categories excellent , good , fair , poor fifty two fingers \( 86 percent \) rated excellent , 4 fingers \( 7 percent \) rated good , 1 finger \( 2 percent \) rated fair , 3 fingers \( 5 percent \) rated poor
island flap supplied dorsal branch ulnar artery two cases reported island flap employed supplied artery method proposed becker original technique modified authors , produces better venous outflow vascular pedicle includes , besides ascending branch artery , one superficial veins together respective band technique also described provides optimal length vascular pedicle
strut fixation extensive chest indications preferred approaches operative stabilization posttraumatic chest wall instability uncertain suggest simple , rapid , effective approach surgical stabilization rod segment operation required
electrophysiologic investigation mandibular nerve injury isolated lesions mandibular branch trigeminal nerve rarely reported report occurrence isolated lesion mandibular nerve associated unilateral mandibular fracture , 65 year old man involved motor vehicle accident resulting multiple fractures , including unilateral mandibular fracture temporomandibular joint dislocation evidence intracranial pathology ct scan noted neurologic examination except dysfunction mandibular nerve ipsilateral fracture site bilateral facial nerve latency blink reflexes normal emg evaluation muscles facial expression demonstrated denervation confined muscles innervated mandibular branch trigeminal nerve patients complaining facial sensory dysfunction , , weakness muscles mandibular fracture , electrophysiologic examination assist evaluating cranial nerve integrity
operative exposure abdominal arteries trauma traumatic injuries abdominal arteries require operative exposures allow flexible repair dividing abdominal arterial tree four zones , based exposure , provides precise repair major abdominal arteries
surgeons prefer care trauma patients survey washington state american college surgeons undertaken document opinions surgeons trauma care issues thirty nine percent total sample surgeons responded would prefer treat trauma patients surgeons likely older , practice urban setting , feel trauma call negative impact elective practice , believe strongly reimbursement trauma patients equal patients also agreed strongly statements patients require greater time commitment pose increased medicolegal risk significant influence preference treat trauma patients exerted perception negative impact practice , older age , perception increased medicolegal risk reimbursement issues location practice less influential factors information used target concerns barriers active , willing participation trauma care system strategies deal effectively
serious childhood injuries caused air guns objective determine severity nonfatal injuries children caused air guns pellet guns design case series \( hospital chart review \) setting inpatient wards children 's hospital eastern ontario patients children 18 years age admitted hospital jan 1 , 1979 , dec 31 , 1989 , icd code , , , , suffered air gun injuries main outcome measures personal data , circumstances event clinical data results 43 children \( 37 boys \) median age 12 years circumstances accident known 20 cases 17 children playing 3 cleaning gun went four children thought gun unloaded five cases bullet eye nine injuries self injury extremities 21 \( 49 \) , eyes 15 \( 35 \) head neck 7 \( 16 \) median length hospital stay 4 days six children long term disabilities , result eye injuries two cataract surgery , four required enucleation eye conclusions air guns cause serious injury children needs least carefully regulated
adequate resuscitation burn patients may measured urine output vital signs objective compare vital sign urine output monitoring seriously burned patients invasive monitoring early resuscitation design retrospective review setting university hospital burn unit patients fourteen seriously burned patients pulmonary arterial monitoring monitoring data compared baseline fluid challenges results correlation derived physiologic variables vital signs urine output vital signs urine output changed little fluid challenge , variables invasive monitoring demonstrated significant change half patients , oxygen consumption increased fluid challenge vital signs urine output distinguish patients conclusions use urinary output vital signs guide initial burn resuscitation may lead suboptimal resuscitation invasive cardiorespiratory monitoring may necessary optimize resuscitation seriously burned patients
outcome following prolonged intensive care unit stay multiple trauma patients objective describe hospital course outcomes trauma patients requiring icu stays greater 30 days charges design retrospective case series analysis data collected patient charts trauma registry setting level regional trauma center part statewide trauma system patients 3 yr period , 87 patients \( 3 trauma icu admissions \) prolonged stays \( greater 30 days \) icu constitute study group blunt trauma responsible 90 injuries , mean injury severity score 34 16 sd results mechanical ventilation required 78 5 time spent icu mean time spent mechanical 47 23 days icu , 60 27 days hospital , 72 29 days infectious complications occurred 90 organ dysfunction seen 76 patients overall mortality rate 17 2 \( 31 patients greater 65 yr \) patients less 40 yr lower mortality rates despite significantly higher injury severity score lower glasgow coma scale score compared greater 65 yr patients greater 65 yr discharged chronic care facilities younger \( 23 vs 5 \) number patients followed 3 12 months discharge 74 54 , respectively , two deaths mean hospital professional charges patients 101 , 000 61 , 000 35 , 000 13 , 000 , respectively conclusion length icu stay closely associated need mechanical ventilation presence premorbid illness , age greater 65 yr , organ dysfunction associated increased mortality although trauma patients requiring prolonged icu stays utilize many resources , ultimate outcome may fairly good
unusual treatment rare dilemma \( oesophageal foreign body \) identification intramural oesophageal operation difficult case discussed attempted accurate radiological localization site pre operatively case far reported
motor vehicle crash injury patterns virginia seat belt law injuries front seat occupants away crashes , va , area compared 1 year 1 year virginia 's seat belt use law took effect vehicle occupant data combined examine crash injury patterns reported seat belt use crashes increased law , substantial decreases injuries front seat occupants less likely receive medical treatment following crash period reduction number injuries greater passengers right front seat drivers frontal crashes types crashes injury reduction effects occurred primarily reductions number head face injuries , particularly occur contact instrument panels
efficacy eyepad corneal healing corneal foreign body removal 30 patients corneal epithelial defect due removal corneal foreign bodies randomly allocated receive either chloramphenicol continuous application eyepad chloramphenicol without eyepad almost corneal defects healed 24 h , healed 48 h , statistically significant difference two groups discomfort 24 h greater eyepad group control group eyepad seems confer benefit healing
anterior cruciate ligament injuries evaluation , arthroscopic reconstruction , rehabilitation advantages arthroscopic reconstruction anterior cruciate ligament tear quite obvious reduced pain morbidity performing procedures outpatient basis physician choose several graft substitutes anterior cruciate ligament replacement autografts consisting band , , gracilis , meniscus used grafts common autograft bone patellar tendon bone , used since shown tensile strength near anterior cruciate ligament state art surgical alternatives anterior cruciate ligament tears arthroscopic reconstruction using patellar tendon treatment anterior cruciate ligament injuries requires prompt adequate evaluation laxity ligament well structures knee , appropriate treatment options offered patient complete descriptions knee function treatment option , comprehensive rehabilitation program patient compliance integral part success procedure nurse must include description injury , preoperative testing , surgical intervention , rehabilitation program patient successful postoperative anterior cruciate ligament rehabilitation program general , must specific guidelines applied physical therapist knowledge surgical procedure , principles ligament healing , ability program needed level athlete active person , must achievement goals per phase high performance level addition , must always objective measurements document progress physical therapist physician , perhaps importantly , patient restored
stress fractures athletes stress fractures preventable proper conditioning training essential selection appropriate age related sport must taken consideration adequate warm cool important prevent muscle injuries may contribute stress fractures later athlete aware fatigue contributing factor stress injury rate proper equipment necessary using basic methods prevention , along good , safe participation sport may anticipated demands expectations high performance athletes prevalent , education rehabilitation sports injured patient become ever important emergence sports medicine , injured athletes returned playing much rapidly newer protocols techniques must rapidly assess , diagnose , treat sports injuries however , must aware alert possibility injury wear tear making diagnosis prescribing treatment
common spinal injuries athletes special needs athletes spine injuries must considered planning treatment patients patients return competition safely rapidly nurses must understand patients' need put perspective respect diagnosis , treatment , degree disability support , , understanding knowledgeable health professional invaluable
pelvic fracture patient care past , implications future nursing care patients pelvic fractures changed dramatically past two decades fracture care necessitated long periods consequent complications influenced new classification systems , use external fixation , recent use internal fixation evolution pelvic fracture patient care greatly influenced nursing care patients
bone fusions fractures even though complete understanding electrical responses bone fully obtained , useful data toward end gathered development devices use known bone 's electrophysiologic properties impacted patient care many health care professionals remain effects electrical stimulation bone healing therefore , research needed help practitioner educated opinion form therapy
transdermal clonidine versus alcohol withdrawal randomized , controlled clinical trial prospective , double blind comparison , assessed efficacy transdermal clonidine treatment moderately severe acute alcohol withdrawal syndrome significant withdrawal symptoms , 50 hospitalized men randomly assigned receive either transdermal clonidine 4 day study period outcome evaluated daily , medically , using objective subjective measurements dependent variables patient either study group seizures progression delirium group receiving transdermal clonidine significant response signs symptoms alcohol withdrawal , measured alcohol withdrawal assessment scale also , clonidine effectively lowered elevated systolic diastolic blood pressure heart rate core target symptom , anxiety , decreased significantly patients receiving transdermal clonidine measured hamilton anxiety rating scale subscale somatic anxiety cognitive function responded equally study populations clonidine treated patients reported less diarrhea , dizziness , headache fatigue , treated patients reported less nausea vomiting conclude transdermal clonidine effective treatment acute alcohol withdrawal syndrome
pediatric injury surveillance use hospital discharge data base mortality data traditionally used describe epidemiology childhood injury fatal outcomes , however , represent less 1 injury events thus provide limited characterization problem future epidemiologic study resulting injury prevention depends upon development morbidity based injury surveillance systems e coded hospital discharge data bases \( used indicate external cause injury \) valuable source information monitoring controlling serious , nonfatal injuries e coded injury discharge data base developed evaluated children 's hospital alabama addition patient demographics , length stay , total charge , method payment , e code n code \( indicate anatomic site injury \) data collected 2 year study period , discharges hospital documented children serious injuries 15 years age adjusted discharge rate 78 0 per 10 , 000 child years injuries accounted 5 3 million total charges total days stay falls , unintentional poisonings , burns , bicycle , motor vehicle passenger , motor vehicle injuries six common causes injury closed head trauma accounted 55 4 motor vehicle passenger injuries , 67 6 bicycle injuries , 51 8 falls hot water caused 36 4 burns , clonidine ingestion accounted 22 1 unintentional poisonings
fatal incidents involving pickup trucks alabama death injury resulting crashes involving light trucks \( ie , pickup trucks \) significant problem data show fatal crashes occupant fatalities involving light trucks steadily increased since 1983 project describes vehicle crashes involving passengers riding beds pickup trucks actual crashes identified fatal accident reporting system \( \) national traffic safety administration 40 incidents studied involved 204 pickup truck passengers , 45 killed , 107 sustained visible injuries carried scene , 6 , 2 visible injury briefly documented complaint pain risk death among pickup truck passengers fully vehicle nearly six times passengers fully correspondingly , risk ejection truck 26 7 times greater among occupants riding bed occupants riding
isolated subclavian artery dissection blunt trauma present case report patient isolated dissection subclavian artery blunt trauma patient admitted center motor vehicle accident , complained chest neck pain physical findings diminished left extremity pulses arteriography showed occluded subclavian artery possibility dissection dissection confirmed surgery proximal extent originating distal origin vertebral artery distal extent dissection determined operative repair performed carotid subclavian artery bypass false lumen dissection running vascular anastomosis patient , discharged 5 days repair , normal extremity neurovascular function 4 months follow
platelet derived growth factor bb transforming growth factor beta 1 selectively modulate glycosaminoglycans , collagen , myofibroblasts excisional wounds recombinant platelet derived growth factor \( pdgf \) transforming growth factor beta 1 \( tgf beta 1 \) influence rate extracellular matrix formed treated incisional wounds incisional healing processes difficult quantify , full thickness excisional wound model rabbit ear developed permit detailed analyses growth factor mediated tissue repair present studies , quantitative qualitative differences acute inflammatory cell influx , glycosaminoglycan \( gag \) deposition , collagen formation , generation pdgf bb \( bb \) tgf beta 1 treated wounds detected analyzed ultrastructurally although growth factors significantly augmented extracellular matrix formation healing 10 day wounds compared controls \( p less 0 002 \) pdgf bb markedly increased macrophage influx gag deposition , whereas tgf beta 1 selectively induced significantly mature collagen bundles leading edge new granulation tissue \( p 0 007 \) transforming growth factor beta 1 treated wound fibroblasts demonstrated active collagen ultrastructural level myofibroblasts , phenotypically modified fibroblasts considered responsible wound contraction , observed control , absent early growth factor treated wounds results provide important insights mechanisms soft tissue repair indicate 1 \) pdgf bb induces inflammatory response matrix synthesis within wounds qualitatively similar quantitatively increased compared normal wounds 2 \) tgf beta 1 preferentially triggers synthesis rapid maturation collagen within early wounds 3 \) growth factors inhibit differentiation fibroblasts myofibroblasts , perhaps wound contraction required , due increased extracellular matrix synthesis
clinical utility position monitoring catheter pulmonary artery unsuspected distal migration tip pulmonary artery catheter may cause life threatening complications prospectively evaluated clinical utility pa catheter 25 patients cardiac surgery hourly measurements pulmonary artery \( distal lumen \) , right ventricular \( middle lumen \) , central venous \( proximal lumen \) pressures catheter considered proper position middle lumen port , located 10 cm tip , transmitted right ventricular pressure waveform satisfactory initial catheter placement obtained 24 25 patients 28 4 1 8 h postoperative monitoring , clinically unsuspected distal catheter migration , indicated presence pulmonary artery pressure waveform middle lumen port , occurred 12 25 patients \( 48 \) patients , 20 episodes occurred required catheter withdrawal distances 1 8 0 3 cm \( range 1 6 cm \) pa catheter proved useful indicator unsuspected distal catheter migration postoperative period pa catheter allows assessment catheter tip placement proximal pulmonary artery may decrease catheter induced complications
animal model human masseter muscle histochemical characterization mouse , rat , rabbit , cat , dog , pig , cow masseter muscle masseter muscle several animal species investigated use histochemical method demonstration acid stable stable myosin adenosine \( atpase \) following subdivisions fiber types used type fibers show weak atpase activity ph 9 4 , type im fibers react moderately , type ii fibers react strongly rat mouse masseter muscles contained type ii fibers , rabbit masseter muscles , whereas rabbit masseter muscles possessed equal amounts type ii fibers cat dog masseter muscles possessed type ii fibers , type ii cow masseter muscle consisted mainly type fibers , although cow masseter muscles contained small number type ii fibers pig masseter muscle type , ii , im fibers one characteristics human masseter muscle type im fibers , rarely seen muscles muscles therefore , pig masseter muscle might suitable animal model experimental studies , investigation distribution diameter fiber types muscles orthognathic surgery
collagen dystrophic hamster diaphragm collagen content diaphragm measured normal dystrophic hamsters aged 130 270 days diaphragm collagen content greater dystrophic hamsters control hamsters age effect greater older hamsters whether collagen content expressed terms percentage dry weight , relation surface area , total collagen increase apparently expense muscle tissue may major factor contributing respiratory muscle weakness dystrophy advances
cellular metabolic requirements induction macrophage procoagulant activity murine hepatitis virus strain 3 vitro cellular basis variation induction monocyte procoagulant activity \( pca \) murine hepatitis virus strain 3 \( mhv 3 \) examined using set recombinant inbred strains mice derived resistant \( j \) susceptible 6j \( b \) progenitors induction pca mhv 3 required live virus host protein rna synthesis absolute restriction induction pca observed level macrophage peritoneal macrophages resistant parental j ri strains \( \) could induced express pca stimulated mhv 3 alone presence lymphocytes susceptible h 2 compatible ri mice \( \) although respond endotoxin \( lps \) contrast , macrophages susceptible \( \) \( \) ri strains mice expressed similar increase pca stimulation mhv 3 absence lymphocytes levels pca expressed macrophages presence thy 1 2 lymphocytes correlated susceptibility disease thy 1 2 lymphocytes susceptible ri mice could induce levels pca macrophages ri mice equivalent seen cultures macrophages lymphocytes susceptible mice thy 1 2 cells demonstrated cells macrophages produce pca thy 1 2 cells mhv 3 immunized resistant mice , non immunized mice , able suppress induction pca suppressor cell activity could detected 4 days immunization , reaching maximal activity day 7 significant suppression even 28 days pca shown direct prothrombin activity \( \) elisa immunofluorescence staining using mab 3 results demonstrate induction unique pca \( \) restricted level macrophage define regulatory role lymphocytes induction
localization dystrophin postsynaptic regions central nervous system cortical neurons moderate non progressive cognitive impairment consistent feature duchenne muscular dystrophy \( dmd \) , although central nervous system \( cns \) abnormality identified recent studies elucidated molecular defect dmd , including absence protein dystrophin affected individuals normal brain tissue contains dystrophin messenger rna dystrophin present low abundance brain seems regulated tissue , least part , promoter differs muscle , antibodies immunocytochemical methods used demonstrate dystrophin plasma membrane mouse human muscle proven inadequate localize precisely dystrophin mammalian cns made antibody \( anti 6 10 \) much sensitive previously available dystrophin cns using antibody , found mouse , dystrophin particularly abundant neurons cerebral cerebellar , localized postsynaptic membrane dystrophin may different role neurons muscle , alteration synaptic level may basis cognitive impairment dmd
parental mhc molecule haplotype expression \( sjl j x swr \) f1 mice acute experimental allergic encephalomyelitis induced two different synthetic peptides myelin protein determine ag induces autoimmune disease influences parental mhc haplotype molecule expression situ mhc heterozygotes , acute experimental allergic encephalomyelitis \( eae \) induced different peptides \( sjl j x swr \) f1 mice mice sensitized either synthetic peptide corresponding mouse myelin protein \( plp \) residues 103 116 induces eae swr \( h \) , sjl j \( h \) mice synthetic peptide corresponding plp residues 139 151 sjl j swr mice mice killed 30 days sensitization twelve 18 f1 mice given plp peptide 103 116 12 17 mice given plp peptide 139 151 developed eae within 2 3 wk sensitization cryostat sections brain samples f1 parental mice panel mab identifying h h class ii mhc molecules brains controls , class mhc molecules expressed plexus , endothelial cells , microglia whereas class ii mhc molecules absent eae lesions , class ii mhc molecules present inflammatory parenchymal cells , degree parental haplotype molecule expression vary different peptide ag tested thus , \( sjl j x swr \) f1 mice , myelin plp peptides 103 116 139 151 co dominant ag respect clinical histologic disease parental haplotype mhc molecule expression propose hypothesis consistent results previous observations differential ia expression \( responder x non responder \) f1 guinea pigs suggest mhc molecules may bind locally derived peptide ag inflammatory sites interactions influence levels mhc haplotype molecules apc
dystrophin required normal thin filament membrane associations junctions dystrophin , deficient gene product duchenne muscular dystrophy , located muscle cell membrane junctions , well along entire muscle cell junctions sites thin filaments normally linked one another cell membrane , lateral end associations thin filaments membrane cell membrane sites normal muscle extensively dystrophic junctions display normal contacts ends thin filaments densities however dystrophic junctions deficient lateral associations thin filaments membrane display less membrane controls structural defects would result stress concentrations sites thin filament attachment membrane , cause membrane muscle activation , especially large diameter mature muscle cells deficiency dystrophic junction structure may contribute understanding previously aspects etiology duchenne muscular dystrophy
role influenza b virus hepatic mitochondrial abnormalities mouse model syndrome hepatic observed influenza b virus mouse model syndrome attributed infectious virus , alternately , decreased food intake virus treated mice virus preparation resolve issue , 4 6 wk old male balb c mice given , intravenous injection , 12 , 800 hemagglutination units influenza b 40 virus phosphate buffered saline 1 bovine serum albumin using virus prepared ultra centrifugation infected allantoic fluid , sucrose density gradient purification virus prepared ultracentrifugation infected allantoic fluid irradiation virus prepared ultracentrifugation infected allantoic fluid virus infectivity titer virus prepared ultracentrifugation infected allantoic fluid much higher sucrose density gradient purified virus prepared infected allantoic fluid 50 egg infectious dose virus prepared ultracentrifugation infected allantoic fluid 3 9 x 10 \( 4 \) hemagglutination unit vs 8 7 50 egg infectious dose hemagglutination unit sucrose density gradient purified virus prepared infected allantoic fluid control mice received phosphate buffered saline 1 bovine serum albumin uninfected allantoic fluid diluted phosphate buffered saline 1 bovine serum albumin mice fasted eliminate dietary variation , livers obtained 36 hr virus administration treatments , virus prepared ultracentrifugation infected allantoic fluid caused clinical illness increased hepatic triglycerides \( p less 0 02 \) compared controls hepatic triglycerides virus prepared ultracentrifugation infected allantoic fluid correlated histopathological scores \( r 0 p less 0 03 \)
x irradiation improves mdx mouse muscle model myofiber loss dmd mdx mouse , although genetic biochemical homologue human duchenne muscular dystrophy \( dmd \) , presents comparatively mild histopathological clinical phenotype differences partially attributable greater efficacy regeneration mdx mouse dmd muscle lessen disparity , used single dose x irradiation \( 16 gy \) inhibit regeneration one leg mdx mice result almost complete block muscle fiber regeneration leading progressive loss muscle fibers replacement loose connective tissue surviving fibers mainly peripherally , surprisingly , large diameter thus , x irradiation converts mdx muscle model system degenerative process studied isolation complicating effect myofiber regeneration system use testing methods alleviating myofiber degeneration common mdx dmd
low zinc intake affects maintenance pregnancy guinea pigs zinc deficiency pregnancy severe effects animals extent effects animals apply human pregnancy known pregnant guinea pig shares characteristics pregnant women make useful model , three experiments done guinea pigs zn intake reduced beginning gestation reduced zn intake two three experiments resulted abortion premature delivery zinc supplemented animals intake restricted zn deficient animals also aborted delivered prematurely zinc supplemented animals fed ad libitum access delivered living young term fetal neonatal liver zn concentration low guinea pigs compared reported animals affected lesser extent low zn intake zinc concentration neonatal plasma also less several species change activity angiotensin converting enzyme addition zn vitro greater plasma zn deficient guinea pigs zn adequate guinea pigs may useful indicator zn status
dystrophin expression myotubes formed fusion normal dystrophic myoblasts mdx mouse dystrophy characterized absence muscle cytoplasmic membrane high molecular weight protein called dystrophin possible treatment muscular dystrophies normal myoblasts dystrophic muscle form hybrid muscle fibers hybrid myotubes formed vitro fusion normal rat dystrophic mouse \( mdx \) myoblasts staining dye permitted clear distinction mouse rat nuclei immunostaining demonstrated dystrophin present entire membrane hybrid myotubes even nuclei ratio normal dystrophic low
menstrual state exercise determinants spinal trabecular bone density female athletes objective study effects intensive back exercise bone mineral density lumbar spine female athletes design cross sectional study comparing athletes rowers non rowers setting british medical centre , park hospital patients 46 female athletes comprising 19 rowers , 18 runners , nine , 25 21 main outcome measure trabecular bone mineral density lumbar spine measured computed tomography results mean trabecular bone mineral density 42 mg cm3 \( 95 confidence interval 22 62 mg cm3 \) lower athletes difference highly significant \( p 0 0002 \) mean trabecular bone mineral density 21 mg cm3 \( 1 41 mg cm3 \) lower non rowers rowers also significant \( p 0 05 \) interaction two effects \( p 0 28 \) conclusion effect intensive exercise lumbar spine partially adverse effect spinal trabecular bone density
nuclear techniques analysis urinary calculi sections urinary calculi prepared point point analyses along line scan carried using techniques proton induced x ray emission \( \) nuclear reaction analysis \( \) correlations several pairs elements \( including trace elements \) noted also clear composition stone varied markedly different stages development
single lumen ileum myectomy possible alternative pelvic reservoir restorative proctocolectomy alternative procedure construction pelvic ileal reservoir assessed avoids need pouch , providing adequate rectal substitute good continence thirty six female adult randomly undergo total \( \) ileo anal anastomosis alone , \( b \) ileo anal anastomosis two 15 cm , \( c \) ileo anal anastomosis myectomy ileo ileal valve , \( \) ileo anal anastomosis j pouch animals studied operation 4 weekly intervals 20 weeks operation mortality rates similar ileal compliance increased significantly myectomy 0 64 ml mmhg \( median , interquartile range 0 49 0 78 \) ileo anal anastomosis alone 1 65 mmhg \( 1 16 1 93 \) , p less 0 01 , increase maintained ileal capacity also increased myectomy j pouch ileo anal anastomosis 85 ml \( 75 100 ml \) , ileo anal anastomosis myectomy 139 ml \( 116 156 ml \) , ileo anal anastomosis myectomy ileo ileal valve 125 ml \( range 85 145 ml \) , ileo anal anastomosis j pouch 130 ml \( range 75 165 ml \) \( p less 0 01 \) bowel function three groups markedly superior ileo anal anastomosis alone mean transit time significantly less ileo anal anastomosis , 5 2 h \( 2 6 8 2 h \) ileo anal anastomosis myectomy , 10 5 h \( 9 6 13 9 h \) , p less 0 05 ileo anal anastomosis j pouch , 11 0 h \( 8 4 13 0 h \) , p less 0 05 , addition ileo ileal valve produce increase transit time , 12 9 h \( range 10 5 14 5 h \) , p n myectomy single lumen ileum may useful alternative pelvic ileal reservoir restorative proctocolectomy
evidence receptor operated event neutrophil mediates neutrophil accumulation vivo pretreatment 111in neutrophils pertussis toxin vitro inhibits accumulation vivo role neutrophil chemoattractant receptors neutrophil stimulation vitro well established , however , precise mechanisms underlying local neutrophil accumulation inflammatory sites vivo defined fundamental question remains open whether chemoattractants act endothelial cell neutrophil initiate process neutrophil migration vivo address question investigated whether neutrophil accumulation vivo occur chemoattractant receptor occupancy neutrophil stimulation purpose used pertussis toxin \( pt \) pharmacologic tool investigated effect vitro pretreatment rabbit neutrophils pt responses vitro accumulation vivo pretreatment rabbit neutrophils pt inhibited fmlp c5a , pma induced increases expression , neutrophil adherence , degranulation vitro pretreatment procedure pt inhibited accumulation radiolabeled neutrophils vivo response injected fmlp , c5a , c5a des arg , leukotriene b4 , il 8 , zymosan rabbit skin , contrast vitro results , pt inhibited pma induced 111in neutrophil accumulation vivo interestingly , pretreatment neutrophils pt also inhibited accumulation response injected il 1 , despite reports il 1 lacks neutrophil chemoattractant activity vitro although experimental techniques used cannot distinguish different stages neutrophil migration involved , results suggest accumulation neutrophils induced local extravascular chemoattractants vivo depends pertussis toxin sensitive receptor operated event neutrophil , pma il 1 may release secondary chemoattractants vivo
inhibition neutrophil migration tumor necrosis factor ex vivo vivo studies comparison vitro effect neutrophils tnf inhibited chemoattractant directed migration neutrophils enhanced migration chemotaxis chamber assess physiological significance differing vitro tnf effects , ex vivo vivo investigations performed using animal models neutrophils peripheral blood rabbits systemic tnf showed impaired ability migrate toward chemoattractants vitro addition , systemic tnf administration suppressed zymosan activated plasma induced local accumulation leukocytes mouse skin results indicate circulating tnf may act suppressor local inflammatory reaction
expression characterization tca3 murine inflammatory protein tca3 cdna originally isolated activated cells transcription gene shown correlate ag induced cellular activation cells mast cells based predicted amino acid sequence encoded cdna , previously proposed tca3 represents cytokine report used technology express tca3 two mammalian cell lines cases , tca3 expressed secreted molecule apparent molecular mass 16 kda digestion \( \) enzyme n revealed approximately 8 kda caused n linked glycosylation intradermal injection mouse resulted rapid swelling response sites injection characterized histologically local accumulation neutrophils findings discussed particular attention family related proteins , whose members also inflammatory properties
cytokine regulation il 1 beta gene expression human polymorphonuclear leukocyte although recently polymorphonuclear leukocytes \( pmn \) identified il 1 beta response lps granulocyte monocyte colony stimulating factor , little known regarding ability cytokines induce production il 1 beta pmn inasmuch il 1 tnf shown important priming agents , well agents induce migration pmn , investigated effect il 1 beta gene expression human peripheral blood pmn present study , demonstrate human peripheral blood pmn produce il 1 beta response il 1 alpha , il 1 beta , tnf alpha control \( unstimulated \) human pmn virtually undetectable levels il 1 beta mrna either il 1 beta tnf , induced pmn transiently express il 1 beta mrna peak expression 1 h , returning untreated levels 2 h dose response indicated little 0 05 ng ml il 1 beta tnf resulted il 1 beta induction , maximal effects 1 ng ml il 1 beta 5 ng ml tnf il 1 alpha il 1 beta exhibited similar dose responses il 1 beta mrna induction inasmuch cytokines shown synergistic effects cell function studies , induced pmn combination maximally effective doses tnf plus il 1 beta demonstrated cooperative effect il 1 beta gene expression , mrna levels sustained three hours il 1 beta ag expression , measured elisa , paralleled il 1 beta mrna expression cell associated peak levels 2 4 h il 1 beta ag levels pmn lysates supernatants correlated il 1 beta mrna levels , e , tnf il 1 greater tnf greater il 1 thus , studies represent first demonstration il 1 tnf induction il 1 beta gene expression pmn furthermore , time course induction unique pmn , peak induction mrna 1 h , consistent short lived nature cells inflammatory lesions
retroviral expression transforming growth factor alpha transform fibroblasts keratinocytes transforming growth factor alpha \( tgf alpha \) peptide named helps independent growth normal rat kidney \( \) cells vitro secreted many rodent human tumor cells directly investigate transforming properties factor , constructed replication defective murine retrovirus expresses human sequence coding tgf alpha infection nih 3t3 cells tgf alpha retrovirus led integration active overexpression biologically active tgf alpha , failed induce morphologic transformation similarly , tgf alpha retrovirus failed induce morphologic transformation five types rodent fibroblasts also investigated effect tgf alpha expression growth balb mk mouse keratinocytes , require epidermal growth factor \( egf \) proliferation show exogenously added tgf alpha extremely potent mitogen balb mk cells however , retroviral expression tgf alpha balb mk cells failed relieve dependence exogenously added egf \( tgf alpha \) cell growth results suggest overexpression tgf alpha , , transform rodent fibroblasts keratinocytes
dna sequence analysis three inhibitor positive hemophilia b patients without gross gene deletion identification four novel mutations factor ix gene three hemophilia b patients anti factor ix antibodies detectable gross deletion factor ix gene southern blotting analysis investigated molecular level eight exons , accompanied splicing junction sites presumptive promoter regions factor ix gene patients \( total 5 5 kb length \) amplified use polymerase chain reaction , followed complete nucleotide sequence analysis three different types novel single base substitutions 2 base pair nucleotide deletion identified patient hb 5 two point mutations factor ix gene one located promoter region nucleotide \( c transition \) found exon vi gene changing gln 191 stop codon patient hb 6 point mutation \( g \) splice site , interrupted normal splicing last intron g small two nucleotide deletion exon iii detected patient hb 7 yielded amino acids terminated stop codon suggest gross gene deletion factor ix gene also point mutations small nucleotide deletion may cause interruption coding mature protein synthesis predisposed development anti factor ix inhibitors patients hemophilia b
use determine red cell susceptibility oxidative stress define sensitive reliable method determine changes overall cellular characteristics erythrocytes oxidative damage , used method \( \) measure effect oxidative stress erythrocytes incubated presence hydrogen peroxide , butyl , phosphate buffer treatment resulted decreased cellular deformability intact erythrocytes addition , deformability fragility measurements erythrocyte membranes indicated increased membrane dynamic rigidity altered mechanical stability consequence oxidant stress changes observed onset hemolysis observed decrease deformability accompanied oxidation hemoglobin , alterations membrane proteins , lipid peroxidation continuously measure time course decrease deformability intact erythrocytes oxidative stress , new method developed erythrocytes challenged within constant osmolality shear stress change deformability monitored typical range defined erythrocytes normal individuals comparison erythrocytes patients sickle cell disease normal individuals demonstrated higher susceptibility sickle red cells toward oxidative stress
assessing clinical effectiveness preventive maneuvers analytic principles systematic methods reviewing evidence developing clinical practice recommendations report canadian task force periodic health examination paper examines process evaluating clinical effectiveness developing recommendations systematic methods used review evidence published clinical research reach sound conclusions appropriate medical policy methodology addresses four important components analytic process \( 1 \) criteria must satisfied clinical practice considered effective \( 2 \) proper methods reviewing evidence published clinical research determine whether clinical practice meets criteria \( including methods performing comprehensive literature reviews , quality individual studies , synthesizing pooling results multiple studies \) \( 3 \) theoretical practical concerns results scientific review sound clinical practice recommendations \( 4 \) importance documentation , guidelines , minimize effect reviewers consistency analytic methods
effects inflammation copper intake rat liver erythrocyte cu zn superoxide dismutase activity levels stress inflammation produces acute phase response includes elevated levels ceruloplasmin , main copper component plasma inflammatory effects cellular copper enzyme activity levels largely unknown cu zn superoxide dismutase \( sod \) activities liver , main site ceruloplasmin secretion , decreased induced inflammation \( 0 1 ml , intramuscular , leg \) rats fed three copper levels \( adequate 6 mg kg , marginal 2 5 mg kg deficient less 0 5 mg kg \) ceruloplasmin activities rose significantly inflammation adequate marginal groups deficient animals hepatic cu zn sod immunoreactive protein levels unaffected copper status inflammatory state erythrocyte cu zn sod activities influenced dietary copper inflammation additional group rats fed 15 mg copper kg show induced decrease liver cu zn activity levels inflammatory effects copper enzyme activities occur evidenced increases ceruloplasmin decreases serum extracellular sod conclusion , acute phase response rats increased amount dietary copper required maintain hepatic cu zn sod activity levels equal , copper adequate rats rat erythrocyte cu zn sod activities provided blood measurement copper intake without stress , values reflect decreases liver cu zn sod activities 3 inflammation
prospective evaluation effectiveness temporomandibular joint arthroscopy prospective study evaluate therapeutic arthroscopy internal derangement temporomandibular joint \( tmj \) fifty nine patients 76 abnormal joints evaluated preoperatively pain , noise , maximal opening \( \) , deviation opening preoperative postoperative magnetic resonance imaging \( mri \) scans obtained 29 joints patients treated superior joint arthroscopy , lysis adhesions , lavage , steroid injection , along preoperative postoperative splint physiotherapy pain , noise , motion evaluated three time periods 1 \) early \( 10 30 days \) 2 \) intermediate \( 1 6 months \) 3 \) late \( greater 6 months \) early , intermediate , late follow , increase statistically significant \( p less 05 \) noise return majority patients disc position , evaluated mri , appear change 25 29 joints correlate clinical outcome results study indicate tmj arthroscopy effective reducing pain increasing motion patients tmj internal derangement
improved technique development pectoralis major myocutaneous flap pectoralis major myocutaneous flap commonly employed muscle skin transfer used soft tissue reconstruction defects upper neck jaw region article presents conceptual technical changes development pectoralis major myocutaneous flap preserve greater vascular pedicle enhance flap 's arc rotation data 54 consecutive cases using modified approach show reduction complications , greater range use , consistent healing tissues without requiring sectioning removing clavicle causing significant chest deformities modifications produced predictable transfer compared reported techniques
importance routine surveillance distal bypass grafts duplex scanning study reversed vein grafts assess utility routine duplex surveillance , infrainguinal reversed vein grafts performed two independent teaching hospitals prospectively entered surveillance protocol march 1986 august 1989 average 3 2 postoperative duplex graft flow velocity \( \) measurements per graft obtained mean follow interval 21 1 2 months 2 1 280 grafts measurements greater 45 cm sec failed within 6 months normal surveillance examination measurements less 45 cm sec 99 grafts led arteriography 75 grafts , identifying 50 stenotic lesions 48 bypasses \( 12 6 series \) inflow lesions present 5 , outflow stenoses 2 , intrinsic graft stenoses 6 bypasses 29 grafts identified failing duplex scan associated reduction ankle brachial index greater 0 15 secondary reconstructions performed 48 grafts based detection reduced measurement reconstructions patent mean follow 5 months duplex surveillance reliable identification failing vein grafts determination ankle brachial index
surgical procedures management takayasu 's arteritis takayasu 's arteritis inflammatory often multiple large arteries variable results reported medical surgical management twenty female patients takayasu 's arteritis treated 1973 1989 eleven \( 55 \) patients hypertension upper lower extremity ischemia present 12 \( 60 \) patients cerebrovascular insufficiency seven \( 35 \) nine patients initially managed corticosteroids improvement signs symptoms arterial insufficiency eleven patients 16 vascular procedures following indications renovascular hypertension \( 6 \) , extremity ischemia \( 5 \) , cerebrovascular insufficiency \( 2 \) , dilation ascending aorta aortic insufficiency \( 1 \) , thoracic aortic aneurysm \( 1 \) , abdominal aortic aneurysm \( 1 \) procedures included bypass \( 5 \) , carotid subclavian , axillary , brachial bypass \( 4 \) , aorto carotid bypass \( 2 \) , aneurysm resection \( 2 \) , celiac aorto femoral bypass \( 1 \) , ascending aorta aortic valve replacement \( 1 \) , nephrectomy \( 1 \) clinical improvement occurred patients operative deaths alive mean follow 5 75 years \( 6 months 16 years \) revision initial reconstruction required recurrent renovascular hypertension one patient extremity ischemia another nine patients remain symptomatically improved symptomatic takayasu 's arteritis frequently requires arterial reconstruction symptomatic improvement excellent long term graft patency expected arterial reconstruction
prediction risk noncardiac operations cardiac operations determine preoperative variables affecting mortality rate development severe complications patients myocardial revascularization valve replacement undergo noncardiac operation , retrospectively studied data 120 patients 5 years 1982 1986 thirty six percent patients noncardiac operation first month cardiac operation mortality rate 11 , morbidity rate 56 statistical comparison predictive accuracy postoperative complications three simple , widely used classifications \( american society physical status , new york heart association classification , massachusetts general hospital cardiac risk index \) demonstrated superiority simplified three class cardiac risk index \( massachusetts general hospital cardiac risk index predictive accuracy 84 \) multivariate discriminant analysis 21 variables population , five variables \( myocardial infarction previous 6 months , s3 jugular vein distention , arrhythmia last preoperative electrocardiogram , emergency operation , delay cardiac noncardiac operation \) identified predictive postoperative complication variables used function \( \) obtained linear discriminant analysis , prediction accuracy postoperative complication reached 83 performance new models prospective validation population remained satisfactory \( 75 massachusetts general hospital cardiac risk index three class index 72 \) extensive statistical analysis data tested validation study provided simple predictive models based clinical variables easily available even emergency situations
location maxillary os importance endoscopic sinus surgeon functional endoscopic sinus surgery continues gain popularity support , necessity clear accurate understanding anatomy complex becomes essential clarify anatomy , serial cadaver dissections performed anatomy complex detailed three dimensions , emphasis precise localization internal os maxillary sinus relates orbit , natural canal , ethmoid infundibulum measurements position internal os relative position anterior posterior walls maxillary sinus position orbit taken dimensions configuration canal relationship infundibulum also detailed measurements relationships must understood endoscopic sinus surgeon locate natural without orbit
role facial nerve latency test prognosis bell 's palsy eighty patients idiopathic facial nerve palsy evaluated facial nerve latency test depending latency time , patients classified following four groups group patients normal latency times \( 3 25 msec \) group b patients slightly extended latency times \( 4 7 msec \) mean 5 6 msec group c patients extended latency times \( 10 14 msec \) mean 10 2 msec group patients displayed complete disappearance evoked compound muscle action potential \( responses \) therapeutic regimen , determined , latency time normal close normal , functional recovery nerve complete almost complete , recovery time short latency time extended response , functional recovery nerve either incomplete absent
non bone prostheses middle ear proposes use human cadaver non temporal bone middle ear reconstructive material bone obtained capsule histologically resembles bone body capsule , due proximity middle ear , harvested middle ear structures bone obtained , making easily accessible prostheses cost effective multiple prostheses one temporal bone core paper proposes use introduction non primary stapedectomy , well selected cases bypass stapes data provided grafts middle ear 5 years complications method harvesting , preservation , presented , well product relation natural one histological specimen presented basis audiologic results , well fact none resorbed , proposed non temporal bone place transplantation surgery
pediatric behavioral neurology update neurologic aspects depression , hyperactivity , learning disabilities published erratum appears clin 1991 feb 9 \( 1 \) viii high incidence poor social adjustment long term follow studies depressed children seems relate pharmacotherapy necessary sustain long lasting remission possibly repetitive inappropriate stresses insufficient antidepressant therapy resultant intermittent depression induced dysfunction functions performed right cerebral hemisphere would permit child develop appropriate interpersonal skills \( causing failure social situations \) , associated cognitive difficulties would complicate academic performance repeated school failure chronic social preclude development skills necessary successful independent living society thus , symptoms depression found , learning disabled disturbed child adolescent receive adequate antidepressant therapy ensure complete long term remission depression addition , learning disabled individuals , even without apparent depressive illness , must offered appropriate methods learning communication reduce stress appropriate educational strategies offered poor performance still \( continues \) , trial antidepressant therapy considered recognition depressive nature symptoms may possible treatment induced improvement occurred depression associated learning disability resolved improvement academic performance associated improved cognitive function treatment induced remission depressive episode dramatic , resolution apparent learning disability poor educational achievement associated chronic learning difficulties ultimately affects adult social functioning , untreated treated chronic depression may result development later personality disturbances therefore , school problems children untreatable conditions , depressive disorder must excluded , appropriate antidepressant therapy \( along removal apparent inappropriate stress , including inappropriate demands brain function \) provided children adolescents evidence depression
cortical tremor variant cortical reflex myoclonus two patients action tremor thought originate cerebral cortex showed fine like finger provoked mainly action posture surface emg showed relatively discharge rate 9 hz , resembled essential tremor however , electrophysiologic studies revealed giant somatosensory evoked potentials \( seps \) enhanced long loop reflex cortical spike locked averaging method treatment beta blocker showed effect , anticonvulsants , valproate , effective suppress tremor amplitude seps call involuntary movement cortical tremor , fact variant cortical reflex myoclonus
topographic mapping electrophysiologic measures patients analyzed electroencephalographic \( eeg \) activity spatial distribution pattern reversal visual evoked potential \( \) 20 patients unilateral lesions visual pathways focal abnormalities consistent lesion location present analyzed eeg vep 85 patients , compared 70 detection rate conventional analysis techniques quantitative analysis analyzed eeg revealed focal abnormality 7 patients whose conventional eeg interpreted either normal diffusely slow however , focal paroxysmal spikes present eeg 1 patient missed eeg mapping , false localization quantitative eeg abnormality contralateral lesion occurred 1 patient topographic analysis sensitive lesions conventional analysis 2 lateral occipital electrodes conclude topographic mapping valid technique detection localized cerebral lesions
control immediate postoperative pain topical bupivacaine hydrochloride laparoscopic ring tubal ligation conflicting reports exist literature effectiveness topical local anesthetic applied serosal surface fallopian tubes control immediate postoperative pain mechanical \( band clip \) tubal ligation sixty four patients studied prospectively outpatient laparoscopic ring tubal ligation using modified present pain intensity scale patients randomly assigned four groups received topical bupivacaine hydrochloride fallopian tubes , right tube , left tube , received none \( controls \) unique study design incorporated allowed untreated fallopian tube serve within subject control patient receiving unilateral treatment statistical analysis confirmed significant benefit fallopian tubes treated compared treatment \( p less 05 \) also consistent evidence decreased immediate postoperative pain perception treated side patients receiving unilateral treatment value topical bupivacaine demonstrated subjective patient response \( pain scale \) reduced need pain medication outpatient discharge data support value topical bupivacaine applied serosal surface fallopian tubes reduction postoperative pain outpatient laparoscopic mechanical \( band clip \) tubal ligation
quality assurance indicators short term outcome hysterectomy fifteen gynecologic quality assurance indicators recently published american college obstetricians gynecologists applied previously reported hysterectomy data base chart reviews performed recent cases data base , representing 18 month interval indicators divided two groups intended identify morbidity mortality intended screen appropriateness care rates actual morbidity cases failed meet published criteria sets hysterectomy determined chart review regardless presence quality assurance indicator total 135 indicators identified 114 \( 44 \) cases , including 64 patients \( 25 \) morbidity indicators 50 \( 19 \) appropriateness indicators actual morbidity correctly identified 64 cases morbidity indicators present three cases significant morbidity identified chart review identified indicators , yielding positive negative predictive values 100 98 , respectively , overall accuracy 99 morbidity indicators contrast , 14 50 cases appropriateness indicators present actually failed meet published criteria sets additional seven cases failing meet criteria sets identified chart review identified indicators , yielding positive predictive value 28 , negative predictive value 97 , overall accuracy 83 appropriateness indicators
primary mass closure midline incisions continuous absorbable suture mass closure midline incisions running large bore permanent polypropylene suture used general surgery gynecology patients reported small incidence fascial dehiscence late occurring wound sinus formation one problem reported use permanent suture material 22 month period , 285 patients midline incisions closed continuous , running 1 delayed absorbable suture closely spaced bites \( 1 5 cm apart \) taken placed 2 cm lateral fascial edge 60 patients surgery gynecologic cancer high risk factors included obesity 62 , diabetes 19 , previous irradiation chemotherapy 22 ovarian cancer staging procedure done 16 patients remaining patients , almost half extensive operative procedures ranged lymph node dissection wound complications noted nine patients \( 3 2 \) seven superficial infections , one , one developed ventral hernia wound sinuses occur closure technique safe tension equally continuous line additional advantage eventual absorption suture material , thereby avoiding wound sinus problems occasionally reported large bore permanent sutures
citrate stimulation adjunct ovarian tissue ovarian remnant syndrome ovarian remnant syndrome results residual ovarian tissue bilateral oophorectomy syndrome associated chronic pelvic pain suspected premenopausal levels lh present patient documented bilateral oophorectomy histologic demonstration ovarian tissue operation confirms diagnosis treated patient ovarian remnant syndrome 10 day course citrate , 100 mg daily , stimulate residual ovarian tissue facilitate localization preoperative ultrasound revealed 5 0 x 3 5 x 6 2 cm cystic mass right adnexal region exploratory laparotomy easily localized mass , removed intact histologic slides demonstrated normal ovarian tissue multiple follicles various stages development corpus luteum cyst citrate capable stimulating ovarian remnant , producing enlarged , cystic structure easily localized ultrasound increased size preoperative knowledge location facilitated surgical removal
umbilical cord hematoma following diagnostic funipuncture major complications associated funipuncture reported rare report diagnostic funipuncture performed 29 week fetus single umbilical artery multiple malformations immediately procedure , hematoma developed site needle insertion association severe fetal bradycardia fetal death confirmed within 5 minutes needle insertion hypothesized risk complications funipuncture may vary according clinical indication procedure may increased presence certain fetal malformations rapid evolution complications , occurred present case , importance clear plan management event discussing plan parents diagnostic funipuncture
dental patient reaction electrocardiogram screening ninety one patients receiving routine dental treatment university minnesota school dentistry participated electrocardiogram screening study purpose study evaluate patient reaction electrocardiogram screening dental school clinic vast majority patients indicated test easy dental patients reported test valuable service available dental office none patients indicated tests performed dental office patients expressed significant concern anxiety test either completed twenty six percent \( 24 91 \) patients found cardiac arrhythmia however , arrhythmias \( 18 24 \) would impact planned dental procedures six patients identified arrhythmias required medical referral dental treatment started
rapid sequence anesthesia induction emergency intubation emergency done variety reasons emergency department \( ed \) patients , rapid , controlled induction anesthesia useful facilitate intubation reduce complications intubation referred rapid sequence induction \( rsi \) anesthesia literature atropine , thiopental , fentanyl , diazepam , ketamine , vecuronium , succinylcholine , drugs applications rsi described purpose article describe use rsi airway management ed patients nineteen pediatric patients requiring emergency intubation intubated using rsi vecuronium thiopental actual intubation difficulty using rsi significantly less anticipated intubation difficulty without rsi complications caused intubation rsi significant impact patient outcome feel sedative combination vecuronium represents optimal means achieving rsi ed setting although induction general anesthesia best done , emergency physicians often experienced physicians immediately available manage airway critical emergency objective protocol described make easier emergency physicians perform procedure needed
bell 's palsy ensuring best possible outcome bell 's palsy thought idiopathic must distinguished disorders cause facial weakness cases , differentiation accomplished basis history , physical examination , clinical course routine follow care recovery occurring testing often helps assess prognosis eye care corticosteroid therapy recommended
infant reddish infant reddish presents diagnostic challenge primary care physician described dr , cause may benign , ominous disorders must ruled
regulation calmodulin related gene transformation human mammary epithelial cells human cdna library obtained cultured normal mammary epithelial cells \( \) hybridization genes whose decrease expression might relevant epithelial transformation one clone identified procedure corresponded 1 4 kilobase mrna , designated nb 1 , whose expression decreased greater 50 fold transformed vitro exposure sarcoma virus sequence analysis nb 1 cdna revealed open reading frame high degree homology calmodulin nb 1 expression could demonstrated polymerase chain reaction amplification normal breast , prostate , cervix , epidermal tissues presence nb 1 transcripts variable primary breast carcinoma tissues undetectable tumor derived cell lines breast , prostate , origins nb 1 mrna expression could regulated cultured exposure reconstituted extracellular matrix material , exposure transforming growth factor type beta increased relative abundance protein encoded nb 1 may ca2 binding properties perform functions similar calmodulin possible roles differentiation suppression tumorigenicity epithelial tissues remain examined
tumorigenic 3t3 cells maintain alkaline intracellular ph physiological conditions one earliest events response mammalian cells mitogens activation na h exchange , increases intracellular ph \( phin \) absence hco3 external ph values 7 2 proliferative response blocked preventing phin increase yet , proliferative response cannot stimulated artificially raising phin weak bases high medium ph observations support hypothesis optimal phin necessary , sufficient , component proliferative response sequence hypothesis recently challenged observation transfection nih 3t3 cells yeast h \( \) atpase renders tumorigenic although previous measurements indicated transfected cells maintain higher phin absence hco3 , whether h \( \) atpase transfection raised phin physiologically relevant conditions known current report shows transfected cells maintain higher phin control cells presence hco3 , supporting possibility elevated phin proliferative trigger situ also show cells serum independent growth much rapidly phenotypically normal cells
simian virus 40 small tumor antigen amino terminal domain large tumor antigen share common transforming function 82 residue amino terminal sequences simian virus 40 large tumor antigen \( tag \) small tumor antigen \( tag \) identical genetic analysis tag lacking amino acids 1 82 revealed transformation defective , revealed agar growth assay , except introduced presence tag since latter , alone , lacks overt transforming activity , would appear function sequence common tag tag necessary , sufficient , tag transforming activity tag provide function equivalent trans thus , tag may , part , viewed portable copy tag functional domain
identification characterization regulated promoter element epidermal growth factor receptor gene identified 36 base pair proximal element \( 112 77 relative translation initiation codon \) epidermal growth factor receptor 5' region functions promoter mediates inductive responses epidermal growth factor , phorbol 12 myristate 13 acetate , cyclic amp acts orientation independent manner region functions enhancer transferred heterologous promoter containing tata box mutations within 36 base pair region alter function assayed reporter gene expression recipient cells protein identified demonstrates appropriate binding specificity mutant dna sequences correlates promoter activity observed vivo basis dna binding characteristics size , identified protein appears distinct several previously identified transcription factors known bind g c rich regions
identification preliminary characterization protein cysteine ras proteins must conserved cysteine residue near carboxyl terminus \( cys 186 mammalian ras p21 proteins \) order exert biological activity previous studies indicate intermediate mevalonate pathway , likely pyrophosphate , donor group inhibition mevalonate synthesis abnormal phenotypes induced mutant 19 gene saccharomyces cerevisiae blocks maturation xenopus oocytes induced oncogenic ras p21 protein human origin results raised possibility using inhibitors mevalonate pathway block transforming properties ras oncogenes unfortunately , mevalonate precursor various end products essential mammalian cells , , , , cholesterol study , describe enzymatic activity \( \) capable ras p21 proteins vitro correct \( cys 186 \) residue activity heat labile , requires mg2 ions , linear time enzyme concentration , present mammalian cell lines tissues tested gel filtration analysis partially purified preparation protein revealed two peaks activity 250 350 kda 80 130 kda availability vitro protein assay useful screening potential inhibitors ras oncogene function interfere aspects mevalonate pathway
u1 small nuclear rna plays direct role formation rev regulated human immunodeficiency virus env mrna remains rev regulated expression hiv 1 envelope proteins simian virus 40 late replacement vector found dependent presence 5' splice site env mrna spite fact mrna remains 5' splice site upstream env open reading frame deleted mutated , expression envelope protein lost rna analysis cells transfected 5' splice site mutants showed dramatic reduction steady state levels env mrna whether rev present envelope expression could restored one 5' splice site mutants plasmid expressing suppressor u1 small nuclear rna containing compensatory mutation experiments show u1 small nuclear rna plays direct essential role formation rna subject regulation rev
identification three related human gro genes encoding cytokine functions product human gro gene cytokine inflammatory growth regulatory properties gro also called melanoma growth stimulatory activity identified two additional genes , gro beta gro gamma , share 90 86 identity deduced amino acid level original gro alpha isolate one amino acid substitution proline gro alpha leucine gro beta gro gamma leads large predicted change protein conformation significant differences also exist 3' untranslated region , including different numbers repeats associated mrna instability 122 base pair region 3' region conserved among three gro genes , part also conserved chinese hamster genome , suggesting role regulation dna hybridization oligonucleotide probes partial sequence analysis genomic clones confirm three forms derived related different genes one chromosomal locus identified , , using gro alpha cdna clone hybridized three genes expression studies reveal tissue specific regulation well regulation specific inducing agents , including interleukin 1 , tumor necrosis factor , phorbol 12 myristate 13 acetate , lipopolysaccharide
retro orbicularis fat \( roof \) resection aesthetic 6 year study 63 patients sixty three patients undergone resection retro orbicularis fat \( roof \) conjunction aesthetic patients , consistent useful ability lateral upper orbital region seen two patients developed postoperative hematoma , two different patients transient dry eye symptoms following twenty percent patients transient degree numbness lateral nerve region , patients noted transient numbness lateral upper region patient demonstrated significant paralysis orbicularis muscle experience , retro orbicularis fat resection would appear useful adjunct standard techniques selected patients
augmentation means route new operative technique developed augmentation incision , anterior rectus sheath entered , pocket dissected entirely submuscular plane performed procedure 112 patients date complications capsular contracture rate 90 patients followed greater 1 year 7 percent lowered using technique , making unnecessary patients moderate ptosis
comparison lymphatic venous autografts experimental canine lymphatics mongrel dogs , 56 autologous lymphatic vein grafts bridge defect femoral collecting lymphatics one group , 26 lymphatic autografts good results obstruction observed 6 months another group , 20 venous autografts irrigation heparinized saline another 10 autografts without irrigation 1 week , four grafts partially occluded red thrombus 6 months , grafts totally occluded third group , 15 anastomoses silicone sheet provoke prolonged none vessels patent anastomotic patency vivo postoperatively specimens studied light microscopy scanning transmission electron microscopy prolonged damaged endothelial cells results show lymphatic vessel autograft best choice bridge defect lymphatic vessels
intracerebral hematoma complicating split calvarial bone graft harvesting case reported intracerebral hematoma following harvest split calvarial bone full recovery patient occurred complications following calvarial bone graft harvest reviewed potential devastating complications warrant serious consideration alternative sources bone , especially purely elective surgical candidate
new treatment frontal sinus hypertrophy new treatment frontal sinus hypertrophy described anterior wall removed , inverted , attached resulting depression filled bone dust details discussed , case presented
angiographic technique three dimensional determination arterial supply patterns cadaver soft tissue method arterial tree mapping used cadaver soft tissue presented situ angiograms photographs supplemented profile angiograms relatively narrow bands tissue removed specimen described method better suited mapping course supply patterns soft tissue arterial network either situ angiograms dissection practical problems encountered solutions used providing structural support vessels , pure barium sulfate found suitable filled vascular tree capillary level without leakage excision specimen
syndrome complication implantable subclavian venous access devices implantable central venous access devices placed via subclavian vein may become obstructed thrombosis , impingement vein wall , compression clavicle first rib latter termed syndrome \( \) eleven patients studied , including one whose catheter fractured one whose catheter fragmented compared 22 matched control patients 100 consecutive routine clinic patients catheter graded 0 normal , 1 abrupt change course luminal narrowing , 2 luminal narrowing , 3 complete catheter fracture present \( eight 11 \) cases within 3 weeks placement grade 1 catheter common \( 33 \) among control subjects , grades 2 3 uncommon \( 1 \) catheter fracture fragmentation seen two five cases long term \( greater 3 weeks \) \( grade 2 catheter \) following conclusions reached grade 2 represents significant catheter compression potential serious complications grade 1 uncertain clinical significance , due high prevalence control subjects
mitral valve prolapse comparison diagnosis physical examination echocardiography determine well physical examination findings suggestive mitral valve prolapse \( mvp \) correlate echocardiographic evidence mvp , retrospectively reviewed charts 104 patients referred air force cardiology clinic echocardiography rule mvp case , referring physician 's specialty findings cardiac physical examination recorded patients mode echocardiography , half patients two dimensional echocardiography sensitivities , specificities , likelihood ratios physical examination calculated using echocardiography comparison standard combination systolic systolic murmur physical examination finding predictive echocardiographic mvp , positive likelihood ratio 2 43 combinations physical findings yielded likelihood ratios close 1 differences found based specialty examining physician conclude practicing physicians find systolic murmur , mvp likely present echocardiography , though one third patients normal echocardiograms combinations physical findings little help predicting echocardiographic mvp
selected measures health status mexican american , mainland puerto rican , cuban american children 1987 national vital statistics system hispanic health nutrition examination survey \( 1982 1984 \) used assess health status mexican american , mainland puerto rican , cuban american children examining prevalences pregnancy outcomes chronic medical conditions low birth weight rate among hispanics \( 7 0 \) compared favorably non hispanic whites \( 7 1 \) despite greater poverty lower levels education among hispanics examined hispanic subgroup , however , significant differences present , mainland puerto ricans highest prevalences low birth weight infants premature births common among three hispanic subgroups among non hispanic whites mexican american cuban american children similar prevalence \( 3 9 2 5 , respectively \) chronic medical conditions compared non hispanic white children puerto rican children higher prevalence chronic medical conditions \( 6 2 \) assessed health status indicators , hispanic children seem health status similar non hispanic white children however , mainland puerto rican children seem greater risk poor health , reflecting us hispanic population 's heterogeneity health programs targeted us hispanics appropriately consider group differences
strategy reduce infant mortality using maternal mortality reviews historic model , fetal infant mortality reviews proposed reduce infant mortality united states national program three elements 1 \) guidelines direction national multidisciplinary panel staff , 2 \) technical advisory capacity guidelines work local regional review , 3 \) local review special emphasis , lacking limited efforts previous infant mortality reviews , would given fetal mortality plan proposes broad classification potential contributing causes mortality , related strictly medical care , health system , individual patient factors allow different effective targeted responses factors identified locally critical gained american college obstetricians gynecologists leading effort private medical sector national , state , local public health agencies national medical societies
poloxamer 407 intraperitoneal barrier material prevention adhesion formation rodent models reproductive surgery adhesion prevention regimens infertility surgery emphasize use barrier materials effect physical separation injured surfaces poloxamer 407 polymer displays reverse thermal gelation characteristics , material exists liquid room temperature solid body temperature properties make ideal material use laparoscopic surgery properties poloxamer 407 evaluated two models first experiment , golden hamsters subjected standardized adhesion producing lesion left uterine horn poloxamer solutions concentrations ranging 15 35 applied injured horn location , thickness , extent adhesion formation assessed 14 days later significant reduction post traumatic adhesion formation observed following treatment 30 35 solutions second experiment designed paradigm typical situation encountered infertility surgery prevention adhesion lysis established adhesions new zealand white rabbits subjected three laparotomies 14 day intervals placement adhesion producing lesion , evaluation \( \) surgical lysis induced adhesions , subsequent evaluation adhesion \( post score \) effect applying poloxamer 407 compared controls \( treatment \) adhesion \( post score \) markedly reduced poloxamer 407 treatment trials material clinical setting indicated
effects topical glaucoma drugs rabbit conjunctiva conjunctival fibroblastic proliferation contracting scar formation implicated possible cause glaucoma filtering surgery failure effects glaucoma medications bulbar conjunctiva evaluated eyes 20 pigmented rabbits , 5 rabbits per group receiving topically applied daily doses either 0 5 timolol , 1 epinephrine , 4 , artificial tears masked fashion 4 months posterior lip performed 16 rabbits 4 treatment group remaining four rabbits served nonsurgical controls four additional rabbits , received eye drops , included control group , one rabbit serving nonsurgical control immunostaining performed identify presence myofibroblasts conjunctiva treated surgical eyes , regardless medication , higher cell proliferation treated nonsurgical eyes among eyes , medications increased cell proliferation , eliciting dramatic increase compared groups
increase skin flap survival vasoactive drug effect protect skin tissue ischemia necrosis studied random cutaneous flaps measurements performed microscopy level capillary perfusion flap model hairless mouse 30 hairless mice , single pedicle flaps measuring 6 x 16 mm raised perpendicular spine animal flap develops reliable amount necrosis distal edge period 7 days group 10 mice received intravenous injections doses 3 mg kg per day diluted 0 1 ml normal saline beginning 4 hours flap elevation 6 consecutive days postoperatively addition , 10 animals received treatment except started 5 minutes flap elevation 10 mice serving controls , normal saline equal volumes experimental groups applied means microscopy , functional vessel density \( \) determined 2 5 mm increments flap 's base distal edge 1 , 6 , 24 hours elevation skin flap survival quantified measuring necrotic area day 7 means digital functional vessel density preserved distal flap animals pretreated , revealing higher functional vessel density 10 0 mm \( p less 0 01 \) , 12 5 mm \( p less 0 05 \) , 15 0 mm \( p less 0 001 \) flap 's base compared controls
abdominal wall reconstruction \( chop flap \) reconstruction full thickness abdominal wall defects difficult surgical challenge may especially use prosthetic mesh significant , use pedicled myocutaneous flaps advantageous present 15 consecutive cases demonstrating highly successful reconstructions massive abdominal wall defects using myocutaneous flaps without prosthetic mesh extended rectus femoris flap , chop flap , capable resurfacing , described complications minimal , use units , particularly rectus femoris , considered technique choice reconstruction major abdominal wall deficits
analysis brain cerebrospinal fluid volumes mr imaging impact pet data correction atrophy part ii aging alzheimer dementia new , computerized technique , magnetic resonance \( mr \) imaging produces accurate volumetric measurements brain cerebrospinal fluid \( csf \) without limitations computed tomography , used retrospective analysis digitized t2 weighted mr images 16 healthy elderly control subjects 16 patients alzheimer dementia ventricular csf quantified , effects aging studied groups , atrophy measurement used correct metabolic values obtained positron emission tomography patients alzheimer dementia higher total csf , total ventricular , third ventricular csf volumes \( 49 , 37 , 99 , 74 , respectively \) 7 lower brain volumes control group patients also showed marked decline brain volumes greater increase csf volumes advancing age control group 25 0 increase corrected whole brain metabolic rates control group 15 8 increase use technique may provide basis studies aging dementia , including regional volume analysis
disruption human scl locus v \( \) j activity fusion complementary dna cell line 2 provocative mechanism disruption putative hematopoietic transcription factor scl fusion cdna results interstitial deletion previously unknown locus , sil \( scl locus \) , 5' untranslated region scl similar 1 14 , deletion scl 5' regulatory region event probably mediated v \( \) j activity , although neither locus immunoglobulin cell receptor two cell lines , cem , essentially identical deletions thus , lymphocytes , growth affecting genes immune receptors risk rearrangements
interpleural analgesia thoracotomy examined effects following variables interpleural analgesia thoracotomy addition epinephrine local anesthetic , thoracostomy drainage , two catheter placement , location catheter tips twenty patients randomized one catheter \( paravertebral tip location \) two catheters \( paravertebral lateral thoracic wall tip locations \) interpleural catheters sutured parietal pleura surgeon time wound closure patients randomly assigned receive 20 ml 0 5 bupivacaine 1 200 , 000 epinephrine single catheter 10 ml 0 5 bupivacaine without 1 200 , 000 epinephrine two catheters supine bupivacaine concentrations whole blood thoracostomy drainage fluid assayed gas chromatography actual content bupivacaine drainage fluid calculated degree analgesia assessed verbal numerical pain scores first 4 h opioid demand thereafter addition epinephrine bupivacaine influence degree analgesia approximately 30 40 administered dose bupivacaine lost via thoracostomy tube 4 h period correlation true initial dose \( 100 mg minus thoracostomy drainage \) use two catheters resulted significantly less opioid requirements initial 8 h period failure achieve adequate interpleural analgesia postthoracotomy patients may related loss anesthetic via thoracostomy drainage , presence blood tissue fluid pleural space , possibly sequestration flow local anesthetic restricted motion operated lung
blinded comparison noninvasive , vivo phosphorus nuclear magnetic resonance spectroscopy vitro halothane caffeine contracture test evaluation malignant hyperthermia susceptibility malignant hyperthermia \( mh \) potentially fatal , anesthetic induced syndrome currently , accurate means diagnosing susceptibility syndrome testing biopsied skeletal muscle contracture response halothane caffeine less invasive means diagnosis needed authors previously reported mh susceptible patients studied vivo phosphorus nuclear magnetic resonance \( 31p nmr \) spectroscopy demonstrated higher resting inorganic phosphate \( pi \) phosphocreatine \( pcr \) ratio skeletal muscle , well slower postexercise recovery pcr pi , compared normal controls present blinded study , authors compared vivo 31p nmr determination resting pi pcr recovery rate pcr pi forearm muscles vitro halothane caffeine contracture test results 42 patients forty three control subjects studied establish normal nmr values resting pi pcr recovery rate pcr pi findings compared 27 patients shown mh susceptible 15 patients mh negative contracture testing mh susceptible group significantly \( p less 0 005 \) higher resting pi pcr value \( 0 202 0 044 \) either mh negative \( 0 152 0 \) control \( 0 141 0 026 \) group mh susceptible group also significantly \( p less 0 02 \) slower postexercise recovery rate pcr pi \( 1 50 0 pcr pi 1 min 1 \) either mh negative \( 2 11 1 07 pcr pi 1 min 1 \) control \( 2 25 0 pcr pi 1 min 1 \) group twenty six 27 mh susceptible patients demonstrated abnormal nmr test results \( resting pi pcr greater equal 0 18 recovery rate less 1 0 pcr pi 1 min 1 \) , 13 15 mh negative patients normal nmr results although neither nmr parameter alone reliable , nmr test utilizing parameters quite accurate nmr test contracture test demonstrated overall agreement 93 96 87 sensitivity specificity nmr test estimated 98 8 11 8 95 3 20 3 , respectively role 31p nmr diagnosis mh susceptibility possible mechanisms underlying observations discussed
effective doses epidural morphine relief postcholecystectomy pain previously established effective dose intrathecal morphine relief postcholecystectomy pain , determined study effective dose epidural morphine relief postcholecystectomy pain 154 patients given epidural injections placebo \( group 1 , n 49 \) , 2 mg morphine \( group 2 , n 54 \) , 4 mg morphine \( group 3 , n 51 \) intraoperatively mixed 1 5 lidocaine percentage patients request analgesic , 30 mg im , relief pain first 24 postoperative hours significantly greater groups 2 3 group 1 patients need 30 mg im postoperatively , number times administered also significantly greater group 1 groups 2 3 percentage patients developing respiratory depression vomiting first 48 postoperative hours similar three groups based present data previously reported intrathecal morphine , conclude epidural morphine dose 2 4 mg intrathecal morphine dose 0 06 0 12 mg relief postcholecystectomy pain
caffeine cardiac arrhythmias purpose review evidence supporting belief caffeine causes cardiac arrhythmias data sources studies published since 1982 identified computerized medline , , chemical abstracts review bibliographies relevant articles subject caffeine cardiac arrhythmias study selection clinical studies examining caffeine cause cardiac arrhythmias selection basic science experiments illustrate caffeine 's effects vitro data extraction study quality assessed available clinical data pertaining caffeine cause arrhythmias summarized results data analysis one electrophysiologic study , caffeine associated increased susceptibility provoked cardiac arrhythmias five placebo controlled trials , caffeine doses 500 mg daily \( equivalent 5 6 cups coffee \) increase frequency severity ventricular arrhythmias one large epidemiologic study reported increase frequency ventricular persons consuming 9 cups coffee daily conclusion moderate ingestion caffeine increase frequency severity cardiac arrhythmias normal persons , patients ischemic heart disease , pre existing serious ventricular ectopy
reperfusion inhibits elevated splanchnic production hemorrhagic shock published erratum appears ann 1991 feb 213 \( 2 \) 91 effect reperfusion following hemorrhagic shock splanchnic release studied anesthetized male rats bled mean arterial blood pressure 30 mmhg 30 minutes either killed treated shed blood 60 minutes killed superior mesenteric arterial bed cannulated perfused vitro oxygenated krebs collected venous effluent \( 180 minutes \) analyzed 6 keto pgf1 alpha \( pgi2 metabolite \) , pge2 , pgf2 alpha , thromboxane b2 radioimmunoassay shock , shock plus reperfusion , sham groups major released 6 keto pgf1 alpha three times higher shock group compared sham group \( p less 0 05 \) reperfusion shed blood abolished increase 6 keto pgf1 alpha found shock group \( p less 0 05 \) data show attempt rat splanchnic bed compensate hemorrhagic shock increasing release pgi2 \( potent vasodilator \) abolished reperfusion blood
camp mediates il 1 induced lymphocyte penetration endothelial monolayers endothelial cell incubated il 1 shown adhere lymphocytes endothelial cells demonstrate il 1 also increase lymphocyte penetration endothelial monolayers vitro il 1 induced transient increase number lymphocytes endothelial monolayer filter time dose dependent manner effect could mimicked increasing cytosolic camp levels endothelial cells either forskolin camp concomitantly able show il 1 increased cytosolic camp levels endothelial cells inhibitor adenylate cyclase , , decreased il 1 induced camp elevation lymphocyte penetration protein kinase inhibitor ha could inhibit il 1 induced lymphocyte penetration , protein kinase c \( n \( 2 ethyl \) 5 \) calcium calmodulin \( n \( 6 \) 5 1 \) inhibitors effect adding calcium ionophore endothelial cells could mimic il 1 induced penetration finally il 1 induce pkc translocation endothelial cells data support view il 1 acts via camp second messenger regard lymphocyte penetration endothelial cells data demonstrate il 1 induced lymphocyte penetration endothelial cells il 1 induced signal via camp endothelial cells
interferons collagen production immunoregulatory , antiviral , antiproliferative agents known interferons profound effects collagen synthesis interferons alpha , beta , gamma suppress collagen synthesis dermal fibroblasts addition , interferon gamma \( ifn gamma \) inhibits constitutively increased collagen synthesis characteristic fibroblasts derived lesions patients scleroderma ifn gamma also inhibits collagen synthesis myofibroblasts synovial fibroblast like cells inhibition collagen synthesis ifn gamma associated inhibition transcription types iii collagen addition , ifn gamma suppresses levels procollagen mrna type ii collagen synthesis human articular chondrocytes vivo studies mice demonstrated ifn gamma inhibits collagen synthesis associated fibrotic response implanted foreign body , bleomycin induced pulmonary fibrosis , healing response cutaneous thermal burns latter case , collagen content wound scar decreased , hyaluronic acid increased mice receiving ifn gamma compared controls vitro studies showing , interferons alpha beta decrease production glycosaminoglycans , ifn gamma increases production glycosaminoglycans interest , acute inflammation sites thermal injury , elicited proinflammatory agents separate experiments , also suppressed mice treated ifn gamma means ifn gamma inhibits collagen synthesis involves transcriptional regulation single report interferon alpha decrease size recent onset human patient interferons inhibit collagen synthesis vivo , studies may warranted evaluate usefulness agents treatment disease states characterized abnormal fibrotic responses well potential altering healing response associated particular therapeutic interventions
long term outcome following anterior cerebral artery ligation ruptured anterior communicating artery aneurysms long term prognosis \( 15 years \) determined 17 patients undergone anterior cerebral artery \( aca \) ligation sole treatment anterior communicating artery aneurysm number early late lower expected previously ruptured aneurysms late ischemia major complication late postoperative epilepsy occurred 19 survivors review previously published series , aca ligation appears significantly reduced rates early late study helps define late results conservative operations ruptured aneurysms
treatment severe intraventricular hemorrhage intraventricular infusion urokinase six patients severe intraventricular hemorrhage treated direct intraventricular infusion urokinase case , hemorrhage extended ventricular chambers , cast formation expansion third fourth ventricles found immediately therapy started \( within 7 days onset symptoms \) , reduction intraventricular hematoma volume observed computerized tomography average , third fourth ventricles became clear third day hemorrhage one exception , case ruptured aneurysm five six patients showed excellent good outcome , although two developed delayed hydrocephalus infection observed outcome retrospectively studied group five patients treated urokinase also reported authors conclude relatively easy method treatment greatly improve prognosis severe intraventricular hemorrhage
continuous arteriovenous rewarming experimental results model simulation treatment hypothermia evaluated technique treating hypothermia uses extracorporeal circulation require heparin pump assistance hypothermia 29 5 degrees c induced eight anesthetized dogs , placed pulmonary artery , liver , bladder , esophagus , rectum , muscle , skin four experimental animals creating fistula connected arterial venous femoral lines counter current heat external rewarming used four controls bleeding time \( \) , coagulation profile \( pt , , tt \) , cardiac output \( co \) measured rewarming core temperature \( \) rose significantly faster \( 0 00001 \) average time rewarming 45 min , vs 4 controls , platelet , fibrinogen , fibrin split product levels unaffected continuous arteriovenous rewarming \( \) improved , co , , coagulation profile faster method yet reported requiring heparin cardiac bypass application post traumatic hypothermia warrants investigation
morbidity financial impact colostomy closure trauma patients 10 year period , 87 patients undergone elective colostomy closure hospital retrospectively reviewed order evaluate morbidity colostomy closure traumatic injury financial impact sixty two per cent left colon 38 right sided interval original injury colostomy varied 20 days , mean 144 days mean postoperative hospital stay entire group 15 13 days cost 13 , 995 deaths anastomotic leaks entire series , morbidity rate 25 ensued small bowel obstruction frequent significant complication , occurring ten patients \( 11 5 \) resulting prolongation hospital stay 7 days additional cost 6 , 500 per patient one additional patient developed abscess required operative drainage , necessitating additional 24 days hospital increased cost 22 , 200 complications prolong hospital stay included eight superficial wound infections , one transient respiratory failure , two patients returned later date incisional hernias stoma site 25 morbidity encountered series suggests colostomy closure low morbidity procedure considered important factor favoring primary repair coupled significant financial impact colostomy formation , justification exists greater efforts avoiding colostomy formation whenever feasible
facial nerve stimulator 25 year update percutaneous nerve excitability testing using facial nerve stimulator introduced 25 years ago test reliable , easy use , inexpensive continues frequently used method predicting prognosis facial nerve disorders 1966 1974 , recorded 10 , 243 nerve excitability tests patients mean 3 29 tests peripheral branch 3 43 trunk using multiple regression model , determined effect nerve stimulation values age , sex , race , diabetes , hypertension , partial complete clinical paralysis , diagnosis herpes zoster , year testing , eventual facial paralysis recovery profile discuss statistical reliability , provide table results , offer tips invaluable practitioner prospective study 25 patients residual facial paralysis evaluated two separate determine reliability
gene human major histocompatibility complex class ii region controlling class antigen presentation pathway major histocompatibility complex \( mhc \) class molecules peptides cell surface surveillance cytotoxic lymphocytes intracellular peptide binding critical proper assembly transport class molecules mechanism impaired result non functional peptide supply factor gene \( \) several human mutant cell lines genomic lesions mhc identified mhc class ii region deletion mapping mutants chromosome walking homologous mammalian bacterial atp dependent transport proteins , suggesting intracellular transport peptides
median nerve somatosensory evoked potentials glasgow coma scale predictors outcome comatose patients head injuries median nerve somatosensory evoked potential \( ssep \) grades glasgow coma scale \( \) scores obtained 51 patients head injuries within 1 week injury determine relationship scores , individually combined , outcome scores obtained 6 months injury ssep grading based presence absence cortical evoked potential , amplitude early generated wave form , conduction time brain \( p n13 n20 interpeak latency \) ssep responses sides brain combined graded 1 6 gcs graded without verbal component \( maximum score , 10 \) , patients intubated patients unresponsive median ssep grades correlated better glasgow outcome scale barthel index scores \( r 0 57 0 64 , respectively p less 0 00001 \) gcs scores \( r 0 35 0 37 , respectively , p less 0 00001 \) , combining ssep grades gcs scores improve predictive power model \( r 0 57 0 64 , respectively p less 0 00001 \) ssep grade 1 patients \( n 13 \) either died remained vegetative state contrast , ssep grade 6 patients \( n 7 \) moderate disability good recovery study demonstrates prognostic value early quantitative median nerve ssep grading patients head injuries unresponsive within 1 week injury
persistent primitive trigeminal artery cavernous sinus fistulas report two cases two cases persistent primitive trigeminal artery cavernous sinus fistulas presented one case , fistula treated using two balloon tandem technique method accomplished introducing , , silicone balloon trigeminal artery , thus preserving carotid basilar blood flow unusual case similar fistula contralateral exophthalmos also reported relationship type fistula presence aneurysms persistent primitive trigeminal artery relationship traumatic events discussed
quantification leakage pressures repairs canine study undertaken investigate relative strengths dural repair using standard suture techniques , suture supplemented tissue adhesive , tissue adhesive alone uniform 2 mm dural defects created adult , repaired , subjected testing defects repaired suture alone initially within range physiologic , supplemented tissue adhesive repaired tissue adhesive alone failed higher levels histologic sections obtained dura treated fibrin adhesive sealant demonstrated minimal inflammatory response significantly different sections examined sites repaired suture alone new substance , fibrin adhesive sealant , appears useful dural repair due ability pressures greater obtained suture alone
capillary leakage inflammation study vascular labeling local injection pure inflammatory mediators induces venular leakage test effect endogenous mediators dying tissue vascular leakage , authors devised experimental model simulating infarct , whereby living vessels would exposed fragments organs undergoing aseptic necrosis tissues donor rats implanted sac control rats implanted materials deemed close possible tissues spheres teflon glass different points rats injected intravenously carbon black killed hour later whole showed vascular labeling strictly venular 8 hours , mixed capillary labeling 12 24 hours , mainly exclusively capillary 48 hours histology showed acute inflammatory infiltrate labeled areas similar weaker labeling pattern accompanied milder inflammation seen controls results indicate vascular leakage aseptic inflammation biphasic , first venular , capillary capillary phase induced inflammatory reaction , possibly form diffuse angiogenesis
childhood outline overview childhood trauma appears crucial etiological factor development number serious disorders childhood adulthood like childhood rheumatic fever , trauma sets number different problems motion , may lead definable mental condition author suggests four characteristics related childhood trauma appear last long periods life , matter diagnosis patient eventually receives visualized otherwise repeatedly perceived memories traumatic event , repetitive behaviors , trauma specific , changed attitudes people , life , future childhood trauma two basic types defines findings used characterize types type trauma includes full , detailed memories , , type ii trauma includes denial , self dissociation , crossover conditions often occur sudden , deaths accidents leave children handicapped instances , characteristics type type ii childhood exist side side may considerable finding childhood trauma discussed author illustrated one two case examples
cognitive behavioral effects coadministration haloperidol schizophrenia objective authors sought determine acute dose might positive effects affect cognition schizophrenic patients maintained regimen haloperidol , , variables might predict improvements method twenty one patients chronic schizophrenia hospitalized research ward received single oral dose \( 0 25 mg kg \) double blind , placebo controlled , crossover study patients receiving 0 4 mg kg per day haloperidol cognitive tests , motor tests , global ratings , mood ratings , videotape ratings used determine effect coadministration drugs ventricle brain ratios derived ct scans used predict response coadministration drugs results amphetamine improved performance measure concept formation wisconsin test result changes performance tests memory attention group , patients active performed psychomotor tests quickly receiving amphetamine six patients judged clinical improved terms affect , cooperation , environment improvement associated enlarged cerebral ventricles increases blink rate placebo active drug condition patient unequivocally worsened conclusions results may consistent theory coadministration amphetamine haloperidol produces relatively selective enhancement cortical dopaminergic activity however , acute nature trial specialized research environment conducted , authors advocate amphetamine routine clinical treatment schizophrenia
prospective analysis intramuscular meperidine , , chlorpromazine pediatric emergency department patients study objective examine physiologic responses efficacy 2 , 1 , 1 mg kg im meperidine , , chlorpromazine \( \) , respectively , children design prospective , trial setting university community emergency department patients sixty three hemodynamically neurologically stable children intervention single dose im measurements main results serial , heart rate , arterial systolic blood pressure , oxygen saturation , glasgow coma scale measured 30 minute intervals effectiveness assessed two independent observers using separate visual analog scales cooperation sedation times sleep \( 27 24 minutes \) , sitting upright \( 103 87 minutes \) , ed discharge \( 4 7 2 4 hours \) , eating \( 11 7 9 hours \) , normal behavior \( 19 15 hours \) acceptable minor , statistically significant , changes respiration rate \( 1 9 0 4 \) , heart rate \( 4 5 1 8 \) , oxygen saturation \( 0 7 0 3 \) , glasgow coma scale \( 2 5 0 6 \) occurred 120 minutes serious complications resuscitation required mean visual analog scale scores 5 0 10 4 71 cases , interobserver agreement good \( cooperation , r 79 effectiveness , r 80 \) twenty nine percent children judged sedated conclusion im safe generally effective agent ed procedures selected children
comparison rectal , axillary , tympanic membrane temperatures infants young children study objective evaluate reliability tympanic membrane detecting fever young children presenting emergency department setting pediatric emergency department urban teaching hospital , design measurement participants temperature measurements obtained sequentially three body sites children less 3 years old presenting pediatric ed axillary rectal temperatures obtained electronic probe \( 500 \) , tympanic membrane temperatures obtained , infrared sensing device \( first \) patients stratified age , ear canal patency , presence otitis media , rectal temperature results 224 patients enrolled , 87 \( 39 \) febrile overall correlation axillary tympanic membrane measurements rectal 75 \( p 001 \) 81 \( p 001 \) , respectively sensitivity detecting fever axillary tympanic membrane sites 48 55 , respectively otitis media ear patency influence correlation tympanic membrane measurements low tympanic membrane temperature sensitivity may result probe configuration conclusion tympanic membrane axillary temperatures viewed caution children less 3 years old neither detect fever reliably
core temperature measurement hypovolemic resuscitation study objectives accurate core temperature measurement severely hypovolemic patients difficult achieve used dog model determine convenient method measuring core temperature relative accuracy multiple sites design prospective laboratory \( animal model \) study setting operating animal care department participants eight adult , anesthetized dogs interventions continuous temperature monitoring placed brain , central vein , tympanic membrane , bladder , rectum , esophagus , subcutaneous tissue hemorrhage 65 initial intravascular volume autologous transfusion cooled blood , serial temperature measurements recorded measurements main results readings analyzed pearson 's correlation coefficient brain temperature correlated well tympanic membrane temperature throughout course \( r , p less 0005 \) rectum , bladder , esophagus also correlated well brain central venous temperature , however , correlated poorly temperatures sites , reflecting marked intravascular temperature caused cold transfusion wide variations sites best correlation central venous temperature brain bladder , although tympanic membrane correlation fair conclusions intravascular hypothermia appears source arrhythmias hemostatic abnormalities often seen early resuscitation hypovolemic patients , results suggest bladder tympanic membrane initial temperature site initial resuscitation , end organ \( eg , brain \) temperature important accurately reflected tympanic membrane temperature
code 9 systematic approach responding medical emergencies occurring around hospital members public expect receive efficient appropriate medical care become acutely ill injured around hospital institution became aware need organized system respond emergencies involving patients , visitors , local community residents , hospital employees , inside hospital grounds surrounding building search literature provide information regarding response survey surrounding hospitals revealed plan effect institutions therefore designed plan superimposed onto existing system responding house cardiac respiratory arrests \( codes \) results one one half years appear encouraging recommend establishment emergency response system health care institutions
comparison neurological , metabolic , structural , genetic evaluations persons risk huntington 's disease compared four diagnostic data sets assessment individuals risk huntington 's disease fifty four free persons evaluated neurological examination , positron emission tomography measurement glucose metabolism , radiographic computerized tomographic measurement caudate size , genetic testing polymorphic dna loci , , twelve \( 22 \) persons abnormal caudate metabolism , 6 \( 11 \) subtle abnormalities motor control , 7 \( 13 \) computed tomographic evidence caudate atrophy , compared expected gene frequency 34 population 20 persons unambiguous genetic test results subsequent phenotypic expression huntington 's disease \( \) , greater sensitivity positron emission tomographic measurement caudate metabolism \( 75 \) relative computed tomography \( 33 \) clinical examination \( 17 \) determination subpopulation probable huntington 's disease gene carriers , gyrus also associated high probability carrying huntington 's disease gene findings support hypothesis abnormalities cerebral metabolism precede clinical structural \( computed tomographic \) abnormalities gene positive individuals risk huntington 's disease
quadriceps myopathy becker muscular dystrophy examined dystrophin , protein product duchenne muscular dystrophy gene , muscle biopsy specimens 4 male patients quadriceps myopathy , showed mild slowly progressive myopathy confined quadriceps muscles 4 patients clear abnormalities dystrophin , diagnosed becker muscular dystrophy immunofluorescence immunoblot examinations , dystrophin abnormal molecular mass visualized muscle patchy discontinuous immunostaining surface membrane muscle fibers one patient brother showed widespread myopathic changes consistent typical becker muscular dystrophy conclude syndrome called quadriceps myopathy includes group becker muscular dystrophy
dystrophin analysis duchenne becker muscular dystrophy carriers correlation intracellular calcium albumin immunocytochemical localization immunoblot analysis dystrophin muscle fibers 11 obligate probable , 7 possible carriers duchenne becker muscular dystrophy revealed abnormal expression protein 3 localization calcium albumin , endogenous markers extracellular fluid penetration , showed presence molecules inside fibers lacking dystrophin morphological studies show initial stages leading fiber necrosis duchenne muscular dystrophy present carriers comparison dystrophin studies restriction fragment length polymorphism analysis creatine kinase levels showed neither immunocytochemical immunoblot techniques dystrophin sensitive enough provide basis genetic counseling
suicide twins suicide appears cluster families , suggesting genetic factors may play role behavior studied 176 twin pairs one twins committed suicide seven 62 monozygotic twin pairs concordant suicide compared two 114 twin pairs \( 11 3 vs 1 8 \) presence psychiatric disorder twins families examined subsample 11 twin pairs , two concordant suicide eleven 13 twin suicide victims treated psychiatric disorder , eight nine surviving addition , twins 10 pairs first second degree relatives treated psychiatric disorder thus , twin data suggest genetic factors related suicide may largely represent genetic predisposition psychiatric disorders associated suicide however , leave open question whether may independent genetic component suicide
valproate treatment acute mania placebo controlled study conducted placebo controlled , double blind study valproate , drug originally developed antiepileptic , 36 patients acute episodes previously failed respond tolerate lithium carbonate treatment duration 7 21 days , psychotropic medications permitted except 4 mg first 10 days treatment serum valproate concentrations measured three times weekly investigator adjusted dosage produce serum concentrations 50 100 mg l valproate proved superior placebo alleviating symptoms 17 patients randomized active drug demonstrated median 54 decrease scores young mania rating scale compared median 5 0 decrease among 19 patients receiving placebo 100 point global assessment scale overall psychiatric functioning , patients receiving valproate improved median 20 points compared zero point change placebo significant differences also emerged brief psychiatric rating scale number supplemental doses required patients group substantial effects appeared within 1 4 days achieving therapeutic serum valproate concentrations adverse effects infrequent , adverse effect appearing significantly frequently valproate placebo conclude valproate represents useful new drug treatment patients
carbamazepine maintenance treatment outpatient double blind crossover trial used evaluate carbamazepine sole maintenance treatment chronic , schizophrenic outpatients whose conditions stabilized use neuroleptics prior study criteria treatment effectiveness included number patients relapsing time relapse 95 day neuroleptic free period either carbamazepine placebo administered relapse determined concordance psychiatric ratings independent clinical indicating significant worsening results 27 patients \( 13 receiving carbamazepine 14 receiving placebo \) involved first phase treatment comparison descriptive findings second phase available 14 patients evidence supporting existence treatment relevant subgroup defined episodic phenomena
reactions first year medical students initial encounter cadaver dissecting room study reports results 1986 questionnaire survey 100 first year medical students regarding preparation reactions first encounter human cadaver dissecting room students aware psychological physical reactions experience , although felt adequately prepared prior class , expressed desire greater preparation afterwards , particularly discussion experience anatomy staff surprising number students \( 62 \) prior exposure dead human body , significant influence upon reactions results study suggest need improving preparation coping dissection follow opportunities dealing professional emotional issues raised human dissection
hemoglobin montreal new variant extended beta chain due deletion asp , gly , leu positions 73 , 74 , 75 , insertion ala , arg , cys , gln location unstable hemoglobin montreal deletion three amino acid residues \( asp , gly , leu \) positions 73 , 74 , 75 beta chain insertion four residues \( ala , arg , cys , gln \) location observed 7 year old canadian boy suffering moderate hemolytic anemia introduction extra amino acid residue changes group located likely cause instability hemoglobin variant listed changes detected analyses tryptic peptides beta montreal chain , sequencing amplified dna , hybridization amplified dna appropriate , 32p labeled , oligonucleotide probes suggested involving sequences codons 66 67 codons 72 73 normal beta gene caused repetition 16 bp segment , deletion 10 nucleotides due recombination slippage followed second short deletion dna repair resulted modified sequence beta montreal gene
somatosensory evoked potential monitored total hip arthroplasty one hundred consecutive patients monitored using somatosensory evoked potential \( sep \) monitoring detect intraoperative sciatic nerve compromise total hip arthroplasty peroneal nerve stimulated using contralateral extremity rule systemic influences sep tracings loss amplitude increase latency greater 10 considered significant 18 patients exhibited changes met criteria , 16 female two patients loss amplitude tracings time closure , patients exhibited postoperative sciatic nerve palsies false negatives femoral reduction surgical events commonly associated nerve reactions patients prior hip procedures appear higher risk correlation intraoperative sep changes age , weight , surgical approach , leg lengthening compared patients , reduction incidence sciatic palsy
effects smoking signal averaged electrocardiogram normal subjects tobacco smoking increases risk sudden cardiac death , possibly altering substrate propagation ventricular tachyarrhythmias test hypothesis , 15 long term smokers without known coronary artery disease tobacco smoking 12 h , underwent saecg , 15 min 30 min smoking two cigarettes minor lengthening filtered qrs duration , significant change time domain saecg parameters noted conclude late potentials produced cigarette smoking ventricular arrhythmia substrate measured saecg variables worsened long term smokers without evidence coronary artery disease
\( \) daytime regular heavy snorers fifteen men , mean \( means \) age 44 years , investigated means body mass index 21 9 kg m2 , respiratory disturbance index 5 good nocturnal oxygen saturation subjects monitored several nights without following devices tight fitting facial mask , , esophageal balloon also monitored without nasal continuous positive airway pressure multiple sleep latency test administered three experimental nights \( baseline nights second nasal cpap night \) determination short eeg arousals nocturnal sleep , lasted 2 10 , performed relationship short eeg arousals , esophageal pressure nadir , airflow decrease investigated also determined relationship clinical reporting decrease daytime results , relationship results frequency eeg arousals monitoring indicated heavy snorers may present significant increase pes nadir abrupt decrease flow leading eeg arousals frequency eeg arousals occur impact scores nasal cpap improves scores eliminates respiration related eeg arousals heavy snorers without obstructive sleep apnea syndrome may risk decrease daytime
pharyngeal volume asymptomatic snorers compared volunteers study objective determine asymptomatic snorers smaller pharyngeal volumes age height matched design recruited asymptomatic heavy snorers study matched age \( 3 years \) height \( 2 \) required near ideal body weight volunteers underwent overnight polysomnography , pulmonary function testing , magnetic resonance imaging pharynx awake volume pharynx determined computer data input instrument setting veterans administration hospital university florida teaching hospital participants nine volunteers recruited groups participant paid 50 interventions measurements results differences sleep variables two groups also significant difference pharyngeal volumes two groups conclusions volume pharynx asymptomatic snorers similar volume age height matched
ornithine decarboxylase repair duodenal mucosa stress rats investigation shows whether ornithine decarboxylase role duodenal mucosal repair following stress induced microscopic damage rats fasted 22 hours , placed restraint , water process 6 hours animals killed either immediately period stress 2 hour intervals 24 hours thereafter duodenal mucosa examined histologically , ornithine decarboxylase polyamine levels measured ornithine decarboxylase activity increased significantly 6 hours following stress , peaking 4 hours level 10 times control 8 hours , enzyme activity returned near normal increases mucosal , , content paralleled changes ornithine decarboxylase activity peaked 4 hours stress stress resulted microscopic damage evidenced nearly complete absence villi significant macroscopic lesions present following stress mucosal repair evident 12 hours stress almost complete 24 hours , although villi short blunted decreases mucosal dna , rna , protein content caused stress restored reached near normal levels 12 hours period stress animals given specific inhibitor ornithine decarboxylase , alpha , increases duodenal mucosal ornithine decarboxylase activity polyamine levels inhibited mucosal repair almost completely prevented following stress alpha also prevented recovery dna , rna , protein content duodenal mucosa results indicate duodenal mucosal damage following stress repaired rapidly repair process accompanied significant increases ornithine decarboxylase activity polyamine levels increases ornithine decarboxylase absolutely required normal repair mucosa
respiratory input impedance anesthetized paralyzed patients respiratory impedance \( \) measured 0 25 32 hz seven anesthetized paralyzed patients applying forced oscillation low amplitude inlet endotracheal tube effective respiratory resistance \( rrs cmh2o l 1 \) fell sharply 6 2 2 1 \( sd \) 0 25 hz 2 3 0 6 2 hz , rrs decreased slightly frequency 1 5 0 5 32 hz respiratory \( cmh2o l 1 \) 22 2 5 9 0 25 hz reached zero approximately 14 hz 2 3 0 8 32 hz effective respiratory elastance \( ers x frequency x cmh2o 1 \) 34 8 9 2 0 25 hz increased markedly frequency 44 2 8 6 2 hz interpreted data terms network mechanical model represented proximal branch central airway resistance shunt pathway accounted bronchial distensibility alveolar gas distal branch included resistance component tissues peripheral airways component tissues component represented body model et al \( j 61 , 1986 \) , good fit obtained entire frequency range , reasonable values parameters estimated strong frequency dependence rrs ers observed 2 hz anesthetized paralyzed patients could mainly interpreted terms tissue nevertheless , high ers found low volume suggests tissues also exhibit properties
theophylline minimally alters contractile properties canine diaphragm vitro examined effects theophylline contractile properties high frequency fatigue canine diaphragm vitro eighteen diaphragm muscle bundles obtained 10 anesthetized dogs oxygenated krebs solution 100 , 200 , 300 mg l theophylline bundles compared 18 matched control bundles contralateral statistically significant differences twitch tension , tetanic tension , twitch tetanus ratio , time peak tension , half relaxation time observed concentrations 300 mg l theophylline , however , significantly \( p less 0 05 \) increased force production 10 hz 32 similar tendency present lower concentrations exhibited clear dose response behavior high frequency fatigue similar control theophylline treated bundles conclude vitro concentrations theophylline increase maximal tetanic tension protect muscle fatigue potentiate relative force production low stimulation frequencies relatively small effect cannot explained poor diffusion drug muscle bundle , theophylline concentrations muscle bath muscle bundle virtually identical moreover , remains unclear whether potentially beneficial effect achieved vivo serum concentrations
ventilatory effect acute pulmonary hypothermia isolated effect cooling pulmonary circulation ventilation quantified nine anesthetized dogs right pulmonary artery \( rpa \) cannulated within pericardium , systemic blood pumped left atrium rpa , , periods cooling cooled blood boluses injected rpa conditions either bolus temperature \( 5 35 degrees c \) volume \( 0 1 5 ml kg body wt \) varied inspiratory time \( ti \) , expiratory time \( te \) , breath duration \( tt \) , peak integrated activity \( peak \) determined diaphragm emg results five postinjection breaths converted percent values five breaths linear relationship bolus temperature ti r 0 61 , slope \( x \) 0 59 degrees c , p less 0 001 \) , te \( r 0 73 , x 1 43 degrees c , p less 0 001 well tt \( r 0 74 , x 1 10 degrees c , p less 0 001 \) , whereas peak unaffected \( n 9 \) injection temperature 5 degrees c , inverse linear relationship existed bolus volume ti \( r 0 75 , x 15 2 ml 1 kg 1 , p less 0 001 \) te \( r 0 78 , x 23 4 ml 1 kg 1 , p less 0 001 \) \( n 4 \) two dogs tested effect bolus injection minimal residual volume progressively increased lung volume effect cold bolus injection eliminated right vagotomy three dogs results indicate cooling vagal receptor lung increases breathing frequency primarily shortening te
validity canine platelet aggregometry predicting vascular graft patency several laboratories found canine platelet aggregometry predictive thrombotic potential vascular grafts adenosine diphosphate \( adp \) frequently used agonist , often unspecified differing concentrations study designed evaluate predictive value adp induced platelet aggregometry validity methodology platelet aggregometry response 2 x 10 \( 5 \) adp assayed 70 dogs twenty six percent , 51 non , 20 dogs treated aspirin dipyridamole vascular prostheses implanted bilaterally \( aorto iliac \) anti platelet therapy continued two weeks dose response adp studied three concentrations 20 dogs 2 x 10 \( 5 \) 1 20 aggregated , 4 x 10 \( 5 \) 3 19 aggregated 2 x 10 \( 4 \) 15 20 aggregated time samples study evaluated 11 dogs , 2 11 changing non two three hours daily reproducibility studied 70 dogs , 14 changed aggregation status days patency 58 68 \( 85 \) non , 23 34 \( 68 \) \( p 0 038 \) platelet aggregometry significant predictive value graft patency methodology must specified standardized
ultrastructural evidence effects shear stress variation intimal thickening dogs transplanted autologous vein grafts based findings changes wall shear stress , rate blood flow , main hemodynamic factor related intimal hyperplasia autologous vein grafts , investigated effect wall shear stress variation sequential ultrastructural changes intimal hyperplasia transplanted grafts , using canine models noted , wall shear stress variation \( tau variation \) could defined variation wall shear stress within cardiac cycle , using flow waveform analyzer group , high flow rate 78 4 4 6 ml min low tau variation 36 1 2 2 dynes cm2 , intimal hyperplasia significant ultrastructurally , marked transformation intimal smooth muscle cells secretory cells 2 4 weeks implantation surface intima lined modified smooth muscle cells 2 weeks implantation group ii , low flow rate 5 6 2 2 ml min normal tau variation value \( 174 6 13 0 dynes cm2 \) , intimal hyperplasia minimal , several layers contractile type smooth muscle cells , characteristic surface intima lined endothelial cells 2 weeks implantation findings suggest , regions low wall shear stress variation , intimal smooth muscle cells grafts may well become secretory cells , enhanced platelet adherence could occur early intimal repair , causing intimal hyperplasia develop
clip repair peripheral side side arteriovenous fistulas evaluation method dogs preliminary results humans simple technique repair peripheral arteriovenous fistula clip application presented procedure rapid effective , minimizes extent dissection , eliminates need application vascular clamps vessels anticoagulation safety procedure confirmed dog experiments clinically applied successfully four patients suitable simple , uncomplicated side side fistulas amenable procedure
spherical connective tissue inclusions epithelial hyperplasia breast \( collagenous \) partial myoepithelial differentiation common simple epithelial hyperplasia \( \) breast functional myoepithelial differentiation basement membrane production exceedingly rare peculiar change hyaline within benign epithelial hyperplasia recognised collagenous type iv collagen shown immunohistochemistry another seven cases described show presence laminin collagens iv iii within proliferation electron microscopy examination two cases using material retrieved block showed varying degrees myoepithelial differentiation cells immediately surrounding basal lamina material , including mature collagen fibrils one case degree myoepithelial differentiation cells surrounding seemed correlate differing types amounts extracellular matrix aware rare change may misinterpreted situ carcinoma
determination activity postmortem blood samples assay using 3 \( p \) acid \( \) conducted determine activity \( \) enzyme commission \( ec \) 3 1 1 8 postmortem blood samples test poisoning enzymatic reaction , substrate , , produces choline , oxidized choline oxidase generate hydrogen peroxide oxidized hydrogen peroxide peroxidase become dimer whose concentration measured excitation emission wavelength 320 nm elimination emission wavelength 404 nm selectivity sensitivity present method found superior conventional ph methods
brain markers suicide relationship found \? recent work suggests persons suicide altered brains remains unclear many reported abnormalities reliably present whether reflect specific psychiatric disorder disposition violent number technical problems must clarified , postmortem test indicating subject high risk suicide may eventually emerge approach would useful suicide , since altered likely involved every case
sudden cardiac death exercise weight using anabolic androgenic steroids pathological findings 21 year old , previously healthy weight bench press taken anabolic androgenic steroids parenterally previous several months pertinent autopsy findings included marked cardiac renal hypertrophy hepatosplenomegaly , regional myocardial fibrosis focal myocardial necrosis \( 19 testosterone \) metabolites identified postmortem urine possible etiologies cardiac findings discussed
adrenal hormones anorectic response adaptation rats amino acid imbalance role adrenal function anorectic response adaptation rats diet \( ile \) imbalance investigated first four experiments , rats fed mildly ile imbalanced diet treatment metyrapone , inhibitor glucocorticoid synthesis two separate experiments , rats presented either mildly severely ile imbalanced diet \( 4 93 9 86 imbalanced amino acid mixture , respectively \) bilateral adrenalectomy finally , effects ics 205 , serotonin 3 receptor antagonist , intake mildly ile imbalanced diet tested adrenalectomized animals experiment 2 x 2 design used neither metyrapone adrenalectomy altered initial depression intake imbalanced diet adaptation phase response adrenalectomized rats fed mildly ile imbalanced diet different controls , adrenalectomized rats fed severely ile imbalanced diets unable adapt adrenalectomy alter anti activity ics 205 model results suggest adrenal hormones necessary initial response adaptation rats ile imbalanced diet , implicated anti anorectic effect serotonin 3 blockade
pharmacological characterization ly233053 structurally novel substituted competitive n methyl aspartic acid antagonist short duration action study reports activity structurally novel excitatory amino acid receptor antagonist , ly233053 cis \( \) 4 \( 5 \) methyl 2 acid , first containing competitive n methyl aspartic acid \( nmda \) antagonist ly233053 inhibited nmda receptor binding rat brain membranes shown vitro displacement 3h \( ic50 107 7 nm \) appreciable affinity 3h alpha amino 3 hydroxy 5 4 acid \( \) 3h binding assays observed \( ic50 values greater 10 , 000 nm \) vitro nmda receptor antagonist activity demonstrated selective inhibition nmda induced depolarization cortical \( ic50 4 2 0 4 microm vs 40 microm nmda \) ly233053 effective vivo systemic administration number animal models neonatal rats , ly233053 selectively blocked nmda induced convulsions \( ed50 14 5 mg kg p \) relatively short duration action \( 2 4 hr \) pigeons , ly233053 antagonized \( ed50 1 3 mg kg \) behavioral effects 10 mg kg nmda however , dose 160 mg kg , , required produce like catalepsy pigeons mice , ly233053 protected maximal induced seizures lower doses \( ed50 19 9 mg kg p \) impaired horizontal screen performance \( ed50 40 9 mg kg p \) cholinergic neuronal striatal infusion nmda prevented single multiple p doses ly233053 summary , antagonist activity ly233053 systemic administration demonstrates potential therapeutic value conditions neuronal cell loss due nmda receptor relatively short duration action ly233053 may make compound particularly advantageous agent treatment acute conditions cerebral ischemia
new biological properties quinone related compounds inhibition chemiluminescence , lipid peroxidation rat paw edema quinone \( pqq \) inhibited chemiluminescence \( cl \) mouse peritoneal cells initiated zymosan , n phenylalanine cl generated xanthine xanthine oxidase reaction lipid peroxidation rat brain homogenate inhibitory activity pqq potent , alpha tocopherol ascorbic acid three assay systems xanthine xanthine oxidase reaction , pqq effect formation uric acid concentration cl inhibition results suggest pqq might radical scavenger like activity structure activity relationship pqq six related compounds showed 7 9 carboxyl groups pqq well structure responsible radical scavenger like activity addition , group ring pqq seemed essential activity rat brain homogenate administered p , pqq inhibited development 0 1 induced paw edema rats results suggest pqq might therapeutic effects various diseases , development exacerbation known associated radical
application pulsed continuous wave 1 32 1 06 microns wavelengths nd yag laser canine tracheobronchial tree comparative study previous investigations shown good clinical potential use 1 32 microns wavelength nd yag laser soft tissue absorption better 1 06 microns wavelength nd yag laser 1 32 microns wavelength nd yag laser absorption coefficient water 10 times higher 1 06 microns wavelength nd yag laser comparative vivo study laser soft tissue effects performed using 1 32 microns wavelength 1 06 microns wavelength nd yag lasers pulsed wave \( \) mode continuous wave \( \) mode using non contact endoscopic delivery system standard 5 mm mucosal lesion made canine tracheobronchial tree level perichondrium soft tissue cartilage effects examined light scanning electron microscopy , acutely , 1 week 2 weeks operation , comparison made different laser modalities create similar lesions , higher energy required using 1 06 microns wavelength nd yag laser soft tissue injury greater 1 06 microns wavelength mode , cartilage damage occurred mode soft tissue cartilage repair 1 2 weeks better 1 32 microns wavelength laser comparison , co2 laser contact nd yag laser proved precise cutting tools 1 32 microns wavelength 1 06 microns wavelength nd yag lasers nd yag laser wavelengths useful coagulation tissues blood vessels studies needed determine effect new 1 32 microns wavelengths endotracheal tumors
trans scleral application semiconductor diode laser used diode laser output power 1 w fiberoptic light \( 200 microns diameter \) deliver laser energy pigmented rabbits ciliary body destruction occurred energy levels 300 400 mw exposure time 0 5 sec retinal photocoagulation achieved energy levels 200 500 mw 0 5 sec histologic examination acute lesions demonstrated thermal destruction ciliary body processes retina scar formation observed clinically histologically within 2 3 weeks data indicate transscleral diode laser may used destruction ciliary body processes peripheral retinal coagulation pigmented eyes
co2 welded venous anastomosis enhancement weld strength heterologous fibrin glue co2 laser used perform end end anastomoses canine jugular veins high disruption rate \( 50 \) laser welded veins \( n 10 \) fibrin glue \( n 17 \) , formed human fresh frozen plasma , enhanced weld strength decreasing disruption rate \( 18 \) , resulting 82 patency nearly contralateral sutured vein patency \( 93 \) bursting strength improved fibrin glue transmural necrosis present initially groups extended longer distance vessel wall laser welded anastomoses sutured anastomoses exhibited greater inflammatory response laser welded anastomoses endothelial cells confluent sutured anastomoses six weeks carbon dioxide laser welded end end vein anastomoses appear disrupt easily however , addition heterologous fibrin glue weld results reasonably strong anastomosis histologic properties may beneficial vein bypass grafts
decreased osmotic stability dystrophin less muscle cells mdx mouse human x linked duchenne becker muscular dystrophies due defects dystrophin , product large gene although dystrophin characterized spectrin like cytoskeletal protein , experimental evidence function structural maintenance muscle current hypotheses attribute necrosis dystrophin less fibres situ mechanical outer membrane , excessive influx ca2 ions , combination two mechanism , possibly mediated stretch sensitive ion channels using osmotic shock determine stress resistance mouse model \( mdx \) human disease , show functional dystrophin contributes stability cultured myotubes isolated mature muscle fibres
mouse insulin like growth factor type 2 receptor closely linked tme locus associated maternal effect \( tme \) known maternal effect mutation mouse defect nuclear encoded embryos deletion tme locus mother die day 15 gestation many regions known mouse genome far genes cloned tme locus absent two chromosome 17 deletion mutants , , position localized using deletions 1 cm region report genes insulin like growth factor type 2 receptor \( \) mitochondrial superoxide dismutase 2 \( sod 2 \) absent deletions probes genes plasminogen \( \) complex peptide 1 \( 1 \) used pulsed field gel mapping show tme must lie within region 800 1 , 100 kb also demonstrate embryos express maternal chromosome , 1 , sod 2 expressed chromosomes therefore closely linked identical tme
quantification magnetic resonance scans hippocampal parahippocampal atrophy alzheimer 's disease brains patients alzheimer 's disease \( ad \) invariably exhibit hippocampus cortex examined postmortem magnetic resonance imaging \( mri \) offers noninvasive , high resolution method quantifying volumetric changes ad brain eight patients diagnosed probable ad 7 age matched controls mri scans tested battery cognitive olfactory tests hippocampus cortex \( parahippocampal gyrus \) showed significant atrophy , 40 reduction size areas brain highly involved degenerative state ad , striatum , show significant volumetric changes hippocampal parahippocampal gyrus volumes highest correlation scores mini mental state examination \( r 0 89 \) , lower correlations smell identification test \( r 0 65 \) , odor match sample test \( r 0 72 \) , visual match sample test \( r 0 26 \)
recurrent peripheral facial nerve palsy dental procedures peripheral facial palsy uncommon complication dental procedures cases begin immediately dental anesthesia resolve within 12 hours report recurrent facial palsy dental manipulations previously described report patient two episodes peripheral facial palsy , 2 years apart , developing within 24 hours dental procedures third episode contralateral facial weakness developed 3 years second event event related dental manipulations although exact mechanism known , dental manipulations may rarely result precipitation recurrent bell 's palsy
physiological induction reversal focus formation tumorigenicity nih 3t3 cells published erratum appears proc natl acad sci u 1991 apr 15 88 \( 8 \) nih 3t3 cells undergo morphological transformation response conditions growth , occur low serum concentrations confluence transformation expressed small fraction cells appearance discrete foci cells confluent monolayer quiescent cells isolated expanded cell populations three dense three light foci cells populations efficiently reproduced foci grown background nontransformed nih 3t3 cells using cultures derived one dense foci \( subline 2 \) , found number focus forming units stable cells remained tumorigenic subjected repeated weekly passage 2 calf serum however , equivalent passage 10 calf serum eventually rendered cells focus production tumor formation results show capacity produce tumors well morphological transformation produced response physiological constraints growth metabolism absence carcinogens properties reversed lifting constraints behavior typical response , taken together supporting evidence , shows tumorigenesis require conventional genetic alteration
cation dependent mannose 6 phosphate receptor contains two internalization signals cytoplasmic domain published erratum appears proc natl acad sci u 1991 feb 15 88 \( 4 \) signals required rapid internalization bovine cation dependent mannose 6 phosphate receptor localized two distinct regions 67 amino acid cytoplasmic domain one signal includes phenylalanine 13 phenylalanine 18 , involves tyrosine 45 former signal potent latter , must present maximal rate receptor internalization signal shares similarities known internalization signals receptors
long terminal repeat containing hybrid dysgenesis drosophila hybrid dysgenesis syndrome similar described drosophila occurs drosophila laboratory crossed wild strain collected region georgia \( u r \) mutations various loci obtained crosses presumably induced insertion dna sequences cloned induced white mutation characterized insertion sequence responsible mutant phenotype sequence 10 6 kilobase \( kb \) element named element flanked unusually large 2 1 kb long terminal repeats also contains characteristic family , trna binding site adjacent 5' long terminal repeat open reading frames encoding putative products homology reverse transcriptase , protease , domains typical proteins encoded retroviruses mutations obtained contain copy element mutant locus , suggesting different element may responsible mutation therefore , may primary cause entire syndrome , mobilization may result activation independent mobile element
repair o6 dna protects rat cells tumorigenic conversion n ethyl n nitrosourea o6 \( o6 \) one different products formed dna cells exposed n carcinogen n ethyl n nitrosourea \( \) evaluated selectively relative capacity cells specific enzymatic repair o6 determinant probability malignant conversion eleven o6 repair \( r \) variant isolated o6 repair deficient \( r \) clonal rat fibroblast line selection resistance 1 , 3 bis \( 2 \) 1 nitrosourea \( frequency , approximately equal 10 \( 5 \) contrary wild type cells , variants expressed o6 dna methyltransferase activity , kinds cells deficient repair dna products o2 exposure \( less equal 500 micrograms ml 20 min \) , cells analyzed formation foci monolayer culture independent colonies agar medium depending concentration , frequencies foci agar colonies , respectively , r variants low 1 1 r wild type contrasting cells r variant derived agar colonies , cells \( r \) agar colonies gave rise highly malignant tumors implanted subcutaneously syngeneic rats significant differences frequencies foci found wild type variant cells exposure major reactive metabolite , \( \) 7 beta , 8 alpha dihydroxy 9 , 10 alpha epoxy 7 , 8 , 9 , 10 alpha , stable binding guanine o6 cellular dna observed relative capacity cells repair o6 , therefore , critical determinant risk malignant conversion n carcinogens
ligamentous laxity across c1 c2 complex axial torque rotation characteristics failure axial torque failure ligamentous axial complex \( c1 c2 \) subjected axial angular rotation \( theta \) characterized using system special permitted right axial rotation specimen failure without additional constraints designed obtain data average values axial rotation torque point maximum resistance , respectively , 68 1 degrees 13 6 n specimens offered minimal resistance \( approximately 0 5 n \) , average axial rotation 21 degrees across complex torque angular rotation \( theta \) curve divided four regions regions least steadily increasing resistances , transition zone two regions , increasing resistance region point maximum resistance regions least steadily increasing resistances may represented two straight lines average slopes 0 028 0 383 n degree , respectively post test dissection specimens disclosed following point maximum resistance corresponded roughly value axial rotation complete bilateral rotary dislocation c1 c2 facets occurred types injuries observed related magnitude axial rotation imposed specimen testing soft tissue injuries alone \( like stretch rupture capsular ligaments , subluxation c1 c2 facets , etc \) confined specimens close point maximum resistance specimens subjected point maximum resistance curve spontaneously reduced completely removal testing apparatus spontaneous reduction possible specimens tested slightly beyond points maximum resistance
perinatal parents experience following perinatal loss devastating loss older one pattern anticipated interventions implemented proper help , parents pass catastrophic time lives minimum scars physician , , , supports parents , dramatic effect lives parents manner started paper , close another parent suffered loss daughters may die , \? even daughters ca n't live half heart three days n't much life long enough thin blue lips , , breaths cause pain long enough never held felt counted n't even know color eyes dead hands quite covered go home smell one small tears see , hold hand occasion sheet paper filled statistics , , girl , know feel ca n't know n't feel yet
study genesis double potential recorded high right atrium atrial flutter role reentry circuit atrial flutter investigate genesis double potential \( dp \) , two separate waves , role reentry circuit atrial flutter \( af \) , performed pacing \( \) high right atrium \( \) six cases spontaneous af dp recorded four six cases , dp designated d1 d2 , d1 d2 showed progressive fusion addition , d1 return cycle , immediately termination , corresponded af cycle , d2 return cycle corresponded pacing cycle may indicate dp caused collision two waves furthermore , suggested plays important role preventing possible reentry waves stabilizing reentry circuit af
diagnosis dural carotid cavernous sinus fistulas used standardized ophthalmic identify specific abnormalities four patients low pressure , low flow dural arteriovenous malformations patients , b scan ultrasonography showed ipsilateral vertical vein scan ultrasonography imaged rapid blood flow superior ophthalmic vein enlargement ocular muscles patients restrictive ophthalmopathy 30 degree test distinguished venous optic nerve sheath apical compression optic nerve enlarged ocular muscles
leukotriene synthesis inhibition receptor blockade inhibit hypoxic pulmonary vasoconstriction sheep several lines evidence suggest leukotrienes may mediators hypoxic pulmonary vasoconstriction \( hpv \) however , effect leukotriene inhibition hpv remains controversial present study investigated effect leukotriene synthesis inhibition receptor blockade hpv halothane anesthetized sheep initial baseline measurements , pulmonary pressor response 15 min global hypoxia \( fio2 0 13 \) measured second set baseline measurements obtained sheep received combined cyclooxygenase lipoxygenase inhibitor , selective lipoxygenase inhibitor , leukotriene receptor antagonist hemodynamic measurements obtained drug administration subsequent hypoxic challenge \( fio2 0 13 \) initial hypoxic challenge increased pulmonary artery pressure 68 increased pulmonary vascular resistance 104 pulmonary hemodynamics recovery hypoxia similar initial baseline values drug administration significant hemodynamic effect hypoxic challenge drug administration resulted pulmonary pressor response identical initial hypoxic challenge leukotriene synthesis inhibition receptor blockade alter response hypoxia , conclude leukotrienes obligatory mediators hpv critical review literature supports rather obligatory role leukotrienes hpv
effects neuroleptic agents rat skeletal muscle contracture vitro purpose investigation examine compare effects vivo pretreatment vitro treatment neuroleptic agents droperidol , haloperidol , trifluoperazine skeletal muscle contracture using vitro model strips normal rat diaphragm challenged succinylcholine halothane \( halothane 1 3 \) subsequent either vitro administration \( 10 100 microm \) vivo pretreatment \( 0 35 2 80 mg kg \) droperidol , haloperidol , trifluoperazine , maximum increases tension recorded mean data analyzed analysis variance \( p less 0 05 \) either droperidol trifluoperazine administered vivo , contracture values exposure succinylcholine halothane significantly decreased vivo pretreatment haloperidol vitro administration droperidol , succinylcholine induced contractures significantly reduced contractures subsequently induced halothane significantly differ controls vitro treatment haloperidol trifluoperazine , however , produced significant increases tension muscles exposed succinylcholine halothane study provides evidence droperidol may considered safe anesthetic adjunct malignant hyperthermia susceptible patients , , additionally , caution exercised interpreting results studies contracture testing performed muscle patients treated neuroleptic agents
simultaneous superior oblique inferior oblique congenital brown 's syndrome since brown , 1950 , described superior oblique tendon sheath syndrome , numerous surgical techniques explored treat condition superior oblique , alone combination procedure inferior oblique , technique advocated however , good functional results rarely achieved single procedure , delayed complications frequent taking advantage improved dissection reduced trauma afforded use surgical microscope , one techniques first recommended later abandoned brown technique consists dissection sheath attachments superior oblique , preserving tendon , combined inferior oblique typical severe atypical congenital case , according classification brown , treated fashion full correction achieved
effects hyaluronic acid fractions rabbit eye two fractions hyaluronic acid different molecular weight \( , molecular weight 500 , 000 730 , 000 , molecular weight 750 , 000 \) injected rabbit eye although fraction higher molecular weight caused increase intraocular pressure , change parameter found administration fraction lower molecular weight furthermore , various inflammatory reactions ocular tissues observed slit lamp administration inflammatory reaction found instillation compounds
pleural anesthetics given epidural catheter inside chest tube pain management thoracic surgical procedures difficult clinical problem variety pain management methods used variable efficacy paper presents effective method pleural anesthetic administration using pleural catheter inserted chest tube
intraoperative coronary angiography using fluorescein intraoperative coronary angiography using fluorescein applied evaluate patency saphenous vein grafts completion distal anastomosis technique , area myocardium well estimated real time intraoperative direct vision examination gives us timely precise information coronary artery bypass grafting
delayed chest wall pain due sternal wire sutures report describes 18 patients disabling chest wall pain due one sternal wire sutures pain occurred 2 84 months median sternotomy pain described either sharp deep seated involved wires exaggerated fibrous tissue reaction surrounding portion adjacent wires minimal reaction last 7 patients , serial sections fibrous tissue revealed entrapment one sensory nerve fibers 6 7 electrical potentials measured found elevated , indicating wire damage tests confirmed collection iron ions point result removal involved wires fibrous tissue surrounding point relieved symptoms pain tenderness resulting sensory nerves
might free arterial grafts fail due spasm \? rat femoral artery used free graft studied 2 , 7 , 14 , 30 , 60 days patency grafts 100 \( 2 days , n 6 \) , 78 \( 7 days , n 9 \) , 63 \( 14 days , n 8 \) , 33 \( 30 days , n 12 \) , 18 \( 60 days , n 11 \) histology showed intimal thickening 14 days media , controls consisted eight ten layers myocytes , reduced six eight cell layers first 2 weeks graft segments impaired contraction exposed krebs solution 124 mmol l k , whereas 1 month later graft segments approached controls even higher contractile force thromboxane mimic u 46619 elicited full contractile force times whereas potency significantly lower first 14 days noradrenaline unable induce contraction graft segments first 14 days , 30 60 days regained full contractile force significantly potent \( approximately 60 times \) graft segments compared controls study suggests intimal thickening might problem free muscular arterial grafts
primary care patients specialized mental health services charts 65 patients completed mental health care referrals compared 65 patients failed complete referrals year referral , noncompliant patients made 37 medical visits compliant patients compared compliant patients , significantly greater proportion noncompliant patients' medical visits difficult explain somatic symptoms mental health referrals physicians much successful referrals physicians attending patients' pattern health care utilization , primary care physicians may able identify patients high risk noncompliance mental health referrals
suicide attempts old old attempted suicide elderly major psychiatric problem ninety five patients 60 90 years age evaluated psychiatric consultation service suicide attempt characteristics group included \( 1 \) high degree , \( 2 \) tendency toward firearm use wounds head , \( 3 \) male sex , \( 4 \) coexisting medical problems , \( 5 \) serious intent increased decade , \( 6 \) solitary living arrangements , \( 7 \) presence history major psychiatric illness , \( 8 \) ill health reported major depression common psychiatric diagnosis , congestive heart failure chronic obstructive pulmonary disease frequently noted physical elderly population resembled older persons actually completed suicide differed significantly persons aged 16 59 years attempted suicide heightened investigation depressive features , treatment alcohol abuse , early referral psychiatric care , limited access firearms , strategies aimed decreasing social isolation recommended decrease likelihood completed suicide elderly
relationship medical illness forty one diagnostic statistical manual mental disorders iii revised primary care practice seventy five control subjects selected random among remainder patients clinic subjects completed structured diagnostic interview standardized self report questionnaires medical morbidity assessed medical record audit primary physicians' ratings comparison samples differ aggregate medical morbidity , although sample undiagnosed complaints nonspecific findings medical records within comparison sample , higher levels medical morbidity associated higher levels symptoms occurred primarily serious medical disorders associated , disease , within sample , correlation found degree extent medical morbidity
preoperative aspirin therapy reoperation bleeding coronary artery bypass surgery performed case control study estimate relative risk reoperation bleeding coronary artery bypass graft patients taken aspirin within 7 days preceding surgery comparison 90 cases reoperation 180 matched control subjects gave estimated odds ratio reoperation 1 82 \( 95 confidence interval , 1 23 3 32 \) although preoperative coagulation values similar , cases used significantly whole blood \( cases , 9 5 5 2 units control subjects , 3 0 2 0 units median interquartile range \) , packed red blood cells \( cases , 2 1 4 0 units control subjects , 0 9 2 0 units \) , platelets \( cases , 12 2 12 0 units control subjects , 2 9 4 0 units \) control subjects cases intensive care unit stays 4 7 5 7 days \( mean sd \) vs 2 1 1 9 days control subjects postoperative hospitalizations 10 9 8 2 days vs 7 0 3 2 days control subjects conclude aspirin exposure within 7 days coronary bypass surgery associated increased rate reoperation bleeding reoperation associated large increases transfusion requirements intensive care unit hospital stays
use calcium agonist bay k 8644 vitro diagnosis susceptibility malignant hyperthermia studied effects calcium agonist bay k 8644 vitro halothane test 10 malignant hyperthermia susceptible \( mhs \) , 12 mh equivocal halothane \( \) , 30 mh non susceptible \( \) 10 control patients bay k 8644 potentiated halothane induced contracture muscle strips mhs patients drug produced obvious difference contracture responses group compared control groups
regulatory control terminal complement proteins surface human endothelial cells neutralization c5b 9 inhibitor antibody cd59 functionally inhibitory antibody plasma membrane complement inhibitor cd59 used investigate control terminal complement proteins endothelial cell surface antibodies purified human erythrocyte cd59 \( polyclonal anti cd59 monoclonal antibodies moabs \) found bind specifically monolayers cultured human umbilical vein endothelial cells , western blotting recognize 18 21 kd endothelial protein bound endothelial monolayer , anti cd59 \( immunoglobulin g fab fragment \) potentiated membrane pore formation induced upon c9 binding c5b 8 , augmented c5b 9 induced cellular responses , including stimulated secretion von willebrand factor expression catalytic surface enzyme complex although potentiating endothelial responses terminal complement proteins , anti cd59 effect response cells stimulation histamine taken together , data suggest human endothelial cells express cd59 cell surface inhibitor terminal complement proteins , serves protect cells pore forming cell stimulatory effects c5b 9 complex data also suggest inactivation deletion cell surface regulatory molecule would increase likelihood procoagulant changes endothelium exposed complement activation plasma
regulatory elements erythropoietin gene human hepatoma cell line produces erythropoietin \( epo \) regulated fashion , used investigate cis acting regulatory elements epo gene comparison primate mouse sequences shows strong homology coding sequence also within 5' flanking region , first intron , 3' flanking region portions epo gene inserted 5' 3' reporter gene , human growth hormone \( gh \) 1 , 192 base pair \( bp \) fragment extends bp 5' cap site first intron obviate problem false initiation translation epo start codon , site changed tag site directed mutagenesis 3a 255 bp fragment extends 67 bp upstream epo termination codon 3' region homology plasmid dnas transfected cells internal standard correct transfection efficiency one cells exposed 50 mumol l 1 o2 end incubations , gh epo measured cell media cell pellet assayed cat production gh stimulated 1 7 fold cobalt hypoxia furthermore , addition 3a gh gene , irrespective orientation , stimulated gh production 2 6 fold 2 3 fold hypoxia stable cell lines produced , along marker two clones , exposure hypoxia resulted much marked \( 16 fold \) induction gh stimulus gh epo production hypoxia partially abrogated carbon monoxide results demonstrate presence promoter enhancer elements within human epo gene appropriately responsive hypoxia cobalt
reduce haemorrhage transurethral prostatectomy \? double blind , randomised trial 44 consecutive patients undergoing transurethral prostatectomy demonstrated \( \) reduce blood loss either operative post operative periods
acceleration luteinizing hormone pulse frequency functional hypothalamic amenorrhea dopaminergic blockade neuroendocrine secretory aberrations , including reduced lh pulse frequency prl concentrations , documented women functional hypothalamic amenorrhea \( fha \) pituitary function preserved , aberrations attributed alteration hypothalamic investigate participation dopaminergic system genesis reduced lh pulse frequency suppressed prl levels fha , studied six women fha six cyclic women early follicular phase obtaining blood samples 15 min intervals 48 h sequential 24 h infusions saline dopamine receptor blocker , metoclopramide \( mcp \) hypothalamic vs pituitary site action inferred pulsatility characteristics mcp consistently elicited increase lh pulse frequency women fha 7 3 1 2 \( se \) 10 5 1 3 pulses 24 h p less 0 005 contrast , eumenorrheic women show significant change lh pulse frequency response mcp \( 15 2 1 0 14 3 0 9 pulses 24 h \) prl concentrations significantly lower fha group infusion saline \( p less 0 001 \) mcp \( p less 0 005 \) , relative increases prl mcp similar groups acceleration lh pulse frequency blockade dopamine receptors implies increased hypothalamic dopaminergic inhibition gnrh pulse frequency women fha
simple stress test evaluation hypothalamic pituitary adrenal axis first 6 months life 33 normal infants , divided 3 age groups \( less 1 month , 1 3 months , 3 6 months \) plasma cortisol measured , , h baseline plasma cortisol h , expected , low infants , mean sem values 41 5 , 72 14 , 97 17 nmol l group , respectively thirty 60 min painful stimulus venipuncture , plasma cortisol increased significantly \( p less 0 0005 \) , reaching maximum increase 50 , 392 66 , 97 nmol l age group , respectively conclude infants hypothalamic pituitary adrenal axis functionally intact responded painful stimulus venipuncture significant increase plasma cortisol test may used simple procedure evaluation integrity hypothalamic pituitary adrenal axis without administration pharmacological agents usefulness , however , validated patients disorder system
stressful retirement \? findings normative aging study retirement transitional event experienced past year life stage investigated transitional stress assessed using life events approach , stage stress using hassles approach respondents 1 , male participants normative aging study , 45 among past year , spouse 's retirement rated least stressful list 31 possible events 30 found retirement stressful retirement hassles also less frequently reported rated less stressful work hassles men still labor force consistent predictors transitional stage retirement stress poor health family personality predict retirement stress
living arrangements sources study examined prevalence different types \( terms relation individual \) , whether living someone important relation individual examined terms emotional support analyses conducted using three separate random samples married living spouse , live alone , live others , manitoba , canada results confirm previous research pointing married people tend receive assistance spouse among , children named frequently primary children , however , live alone tend receive assistance , live others receive assistance siblings data document importance structural characteristic living someone , rather marital status , assistance
social networks , health , emotional well among oldest old london survey health social circumstances 662 people aged 85 , living home inner london , conducted 1987 primary aim analyze structure social support networks sample relation emotional well met needs practical help conceptual methodological framework applied study derived theory social networks confirmation common assumption people aged 85 different younger elderly people , survivors , high levels social support help given respondents although associations found social network variables provision help , multifactorial analysis showed health status explained variation emotional well
induced gastrointestinal hemorrhage associated ileal duplication 31 year old man recurrent gastrointestinal hemorrhage aortic valve replacement initiation anticoagulation therapy radionuclide bleeding scan subsequent contrast angiogram demonstrated site hemorrhage distal ileum , surgery 1 8 cm spherical duplication found histologic examination , duplication lined normal ileal mucosa , near mouth duplication inflammatory ulceration proved site hemorrhage young patient anticoagulation associated gastrointestinal hemorrhage , tract duplication considered
large telangiectatic focal nodular hyperplasia presenting normal radionuclide studies case report 9 cm lesion telangiectatic focal nodular hyperplasia identified 31 yr old female despite typical appearance x ray computed tomography ultrasonography , scintigraphy technetium 99m \( 99mtc \) colloid , 99mtc acid , 99mtc labeled red cells failed demonstrate abnormalities findings felt reflect relative lack architectural disruption histologically characterizes particular lesion present report described imaging characteristics telangiectatic form focal nodular hyperplasia
techniques emergency ventilation model evaluate tidal volume , airway pressure , gastric insufflation designed model evaluate effectiveness various noninvasive methods ventilation upper airway simulated head attached test lung esophagus stomach simulated drain connected seal via peep valve fifteen paramedic volunteers ventilated model utilizing mouth mouth , mouth mask , bag valve mask , portable field ventilator \( impact \) recording tidal volume , gastric volume , proximal distal airway pressure completed three different levels compliance normal compliance , methods except met exceeded american heart association standards compliance decreased , tidal volume fell gastric insufflation increased compliance 0 02 l cm h2o methods failed meet aha standards gastric insufflation volume delivered tidal volumes mouth mouth mouth mask techniques mouth mouth mouth mask techniques generated largest tidal volumes also created largest volume gastric insufflation impact ventilator provided acceptable tidal volume minimal gastric insufflation results suggest mouth mask ventilation supplemental oxygen enrichment efficient technique non invasive airway management
prostaglandin f1 alpha levels neonatal extracorporeal membrane oxygenation infants receiving extracorporeal membrane oxygenation therapy undergo long term cardiopulmonary bypass , systemically heparinized , frequently receive platelet transfusions prostacyclin powerful inhibitor platelet aggregation well potent vasodilator levels stable metabolite prostaglandin f1 alpha increase significantly children undergoing cardiopulmonary bypass heart operations decrease preoperative levels bypass determine effect long term bypass prostacyclin levels , multiple plasma samples analyzed 10 human neonates extracorporeal membrane oxygenation therapy within 24 hours extracorporeal membrane oxygenation prostaglandin f1 alpha , stable metabolite prostacyclin , quantitated radioimmunoassay per milliliter prostaglandin f1 alpha levels elevated patients received extracorporeal membrane oxygenation therapy decreased duration extracorporeal membrane oxygenation infants , prostaglandin f1 alpha levels rose weaning extracorporeal membrane oxygenation remained elevated 24 hours extracorporeal membrane oxygenation extracorporeal membrane oxygenation course influenced circulating prostaglandin f1 alpha levels prostaglandin f1 alpha levels clinical significance management vasomotor tone platelet function , common problems care prevention hemorrhage critically ill infants
reevaluation heparin requirements cardiopulmonary bypass wished determine reduction standard heparin administration cardiopulmonary bypass could accomplished safely use membrane experimental study designed evaluate two different heparin administration protocols cardiopulmonary bypass hollow fiber membrane two groups six pigs submitted hypothermic cardiopulmonary bypass \( 28 degrees c \) 3 hours , , , 1 hour group \( control \) heparin administered maintain activated clotting time excess 450 seconds group ii activated clotting time maintained 250 300 seconds mean total heparin administered 41 , 000 units group 25 , 000 units group ii concentration coagulation factors ii , v , viii , fibrinogen , platelet count determined , , 1 hour bypass significant difference coagulation parameters observed groups performance similar groups , evidence thrombosis thus reduced heparin administration , enough keep activated clotting time 250 300 seconds , related either major coagulation factors platelet consumption derangements oxygenator 's performance
analysis medtronic intact bioprosthetic valve effects zero pressure fixation long term performance current design porcine xenograft valves satisfactory valves generally fixed low pressures 3 5 mm hg medtronic intact \( medtronic , inc , , \) valve fixed zero pressure proposed better alternative existing xenograft valves mechanical analysis valve carried determine intact valve differs significantly low pressure fixed xenograft twelve circumferential strips tissue 5 mm wide cut leaflets four clinical grade intact valves stress strain , stress relaxation , behavior examined mechanically histologically intact valve low pressure fixed xenograft \( 22 versus 12 strain , p less 0 001 \) , relaxed faster \( p less 0 001 \) , pliable xenograft \( p less 0 05 \) , however , buckle less low pressure fixed xenograft bending , significantly fresh porcine aortic valve tissue \( p less 0 001 \) intact valve also relaxed significantly slowly fresh tissue \( p less 0 05 \) bending stiffness stronger dependence leaflet thickness bending thickness fresh tissue \( p less 0 001 \) weaker dependence bending thickness low pressure fixed xenograft material \( p less 0 001 \) intact valve demonstrated large variability , bending stiffness , buckling behavior , little correlation parameters valves appeared leaflets others likely fixed different pressures shrinkage leaflet material low fixation pressures likely important , since modify elastic behavior valve overall , intact valve natural elastic behavior low pressure fixed xenograft , therefore experience lower stresses normal valve function concluded zero pressure fixation preserve many desirable stress reducing properties aortic valve tissue
neutrophil influx inflammatory site inhibited soluble homing receptor igg neutrophil mediated inflammation involved number human clinical manifestations , including adult respiratory distress syndrome , multi organ failure reperfusion injury one way inhibiting type inflammatory response would block competitively adhesive interactions neutrophils endothelium adjacent inflamed region lectin containing murine adhesion molecule , homing receptor , found cells , including neutrophils 14 , monoclonal antibody directed adhesion molecule , blocks lymphocyte traffic lymph nodes extravasation neutrophils blood inflammatory sites show administration mice soluble immunoglobulin containing murine homing receptor extracellular domain significantly decreases number neutrophils migrate peritoneum response inflammatory irritant results indicate soluble forms single type adhesion molecule , homing receptor , could clinically effective compounds inhibition neutrophil mediated inflammation
ams \( altered mrna stability \) protein e encoded structural gene escherichia coli vitro vivo analysis e deficient \( \) altered mrna stability protein deficient \( ams \) strains escherichia coli demonstrated carry mutations structural gene strains encoding either thermolabile e \( \) ams protein \( ams 1 \) defective processing mrna turnover immediately shift temperature , chemical decay rate bulk mrna slowed 2 3 fold , within 70 min , precursors begin accumulate addition , phenotypes associated either ams 1 alleles complemented recombinant plasmid carrying ams taken together previous genetic studies , results suggest role e mrna turnover involves proposed \( u \) consensus sequence
nerve growth factor binding domain nerve growth factor receptor structural analysis rat low affinity nerve growth factor \( ngf \) receptor undertaken define ngf binding domain mutant ngf receptor dna expressed mouse fibroblasts cells , ability mutant receptor bind ngf assayed first mutant , 16 amino acid residues intracellular domain receptor removed receptor bound ngf kd comparable wild type receptor second mutant contained four cysteine rich sequences extracellular portion protein mutant expressed cells resultant protein secreted soluble form receptor able bind ngf two n terminal deletions , either first cysteine rich sequence first part second cysteine rich sequences removed , bound ngf however , mutant lacking four cysteine rich sequences unable bind ngf results show four cysteine rich sequences ngf receptor contain ngf binding domain
molecular evolution drosophila amylase gene region amylase region third chromosome drosophila cloned localized cytological band contained within series highly polymorphic serves convenient tool molecular evolutionary analysis inverted gene arrangements amylase family three genes , chromosomes deletions one two two overlapping clones covering 26 kilobases isolated used probes survey dna restriction map polymorphism among 28 lines , representing five major inversion types found natural populations , well single chromosomes closely related species drosophila drosophila restriction site differences considerably greater among various gene arrangements among chromosomes gene arrangement clustering restriction map haplotypes yielded concordant generated independently cytogenetic considerations inversion polymorphism estimated 2 million years old
platelet derived growth factor receptor alpha subunit gene \( pdgfra \) deleted mouse patch \( ph \) mutation platelet derived growth factor receptors composed two subunits \( alpha beta \) associate one another form three functionally active dimeric receptor species two subunits encoded separate loci humans species study , used conventional interspecific backcross mapping analysis mutation establish close linkage alpha subunit gene \( pdgfra \) dominant \( w \) locus mouse chromosome 5 , analyzing restriction fragment length polymorphisms interspecific f1 , able demonstrate closely associated patch \( ph \) locus carries deletion pdgfra observation confirmed dna rna analysis 10 5 day fetuses produced crosses ph heterozygotes 16 fetuses analyzed , pdgfra genomic sequences absent mrna receptor detected 6 fetuses abnormal \( presumptive ph homozygotes \) also determined deletion associated ph mutation extend coding sequences adjacent kit gene , analysis genomic dna interspecific f1 presumptive ph homozygotes absence pdgfra genomic sequences lack detectable message associated ph mutation make mutant valuable understanding role receptor alpha subunit mammalian development
role iliolumbar ligament lumbosacral junction biomechanical function iliolumbar ligament human lumbosacral junction investigated analyzing three dimensional movements whole lumbar sacral specimens experiment repeated following three conditions 1 \) intact iliolumbar ligament , 2 \) right iliolumbar ligament , 3 \) bilateral iliolumbar ligaments representative values increased motions , compared intact , transection bilateral iliolumbar ligaments 1 7 degrees \( 23 \) flexion , 1 1 degrees \( 20 \) extension , 0 3 degrees \( 18 \) axial rotation , 1 2 degrees \( 29 \) lateral bending restricted motion iliolumbar ligament lumbosacral junction lateral bending bilateral iliolumbar ligament specimen could restrict flexion extension lumbosacral junction , unilateral iliolumbar ligament preparation alone could restrict motions iliolumbar ligament also function restricting rotational movement lumbosacral junction
biomechanical evaluation lumbar spinal stability graded facetectomies vitro experiment using fresh human lumbar functional spinal units , effects division posterior ligaments \( consisting ligaments \) graded facetectomies investigated graded facetectomies consisted unilateral bilateral medial facetectomies , unilateral bilateral total facetectomies six kinds applied ranges motion \( rom \) neutral zones \( \) determined three methods range motion affected division ligaments load modes flexion , rom increased slightly unilateral medial facetectomy right axial rotation , rom increased left unilateral total facetectomy range motion affected , even bilateral total facetectomies , extension lateral study suggested medial facetectomy affect lumbar spinal stability , conversely , total facetectomy , even created , makes lumbar spine unstable
red cell antibodies arising solid organ transplants rbc antibodies arising transplanted organs directed recipient rbcs represent well established complication solid organ transplantation abo organs , frequency severity graft antibodies hemolysis generally increase size \( lymphoid content \) organ , kidney liver heart lung transplants cases reviewed , frequency hemolysis increased cyclosporine treated kidney transplant recipients liver transplant recipients decreased group ab liver transplant recipients kidney transplant recipients receiving azathioprine low dose postoperative graft irradiation available data cannot otherwise distinguish cyclosporine treated recipients abo kidneys livers \( 30 40 total \) develop graft antibody conclusive effect date age , race , gender donor recipient , cadaver versus living kidney donors , patients' a2 status cases living donor kidney grafts , donor patient 's mother exposed recipient 's rbc antigens via pregnancy abo antibodies typically igg , appear 7 10 days transplantation , last month immediate spin done routinely , recommended testing abo transplants changes immunosuppressive regimen , change cyclosporine therapy , affected duration antibodies patients require transfusions self limited process , six cases hemolysis induced acute renal failure reported , one death attributed complications hemolysis rbc plasma exchange performed fulminant cases rbcs donor 's blood type given antibody appears workers recommend transfusion prophylaxis time surgery , although liver transplants , plasma accompanying large amount group rbcs given perioperatively might problematic several centers , abo liver transplants equivalent overall graft survivals , pittsburgh adult patients hemolysis reduced early graft survival cases reviewed , nine igg rh antibodies kidney grafts directed recipient rbcs observed , usually beginning 2 3 weeks cyclosporine treated transplant , lasting 2 6 months operation , causing mild hemolysis one case represented primary immune response previously donor \( abstract truncated 400 words \)
association hypothermia mortality rate premature infants revisited incidence hypothermia \( axillary temperature less 35 degrees c \) admission infant neonatal intensive care unit retrospectively analyzed 559 low birth weight \( less 1500 gm \) newborn infants smaller infants greater risk hypothermia larger neonates mortality related hypothermia , suggests known association bears little cause effect relationship
myocardial epinephrine sensitization subanesthetic concentrations halothane dogs authors investigated myocardial epinephrine sensitization subanesthetic concentrations halothane dose response relationship action halothane examined etomidate plus varying subanesthetic concentrations halothane dogs arrhythmogenic threshold epinephrine decreased dose dependent manner end tidal concentrations halothane 0 1 0 3 end tidal halothane greater 0 3 , reduction arrhythmogenic threshold epinephrine occurred plasma concentrations epinephrine producing four premature ventricular contractions 15 201 3 34 3 , 98 1 13 9 , 60 3 8 63 , 57 9 12 8 , 54 5 8 61 , 53 9 4 86 ng ml \( mean sem \) , 0 , 0 1 , 0 3 , 0 5 , 1 0 , 1 5 halothane end tidal concentrations , respectively results suggest presence etomidate , halothane produces myocardial sensitization epinephrine subanesthetic concentrations low 0 1 increasing halothane 0 3 produces reduction arrhythmogenic dose epinephrine
endothelium derived relaxing factor inhibits hypoxic pulmonary vasoconstriction rats hypothesis endothelium derived relaxing factor \( edrf \) modulates hypoxic pulmonary vasoconstriction \( hpv \) tested isolated , blood perfused rat lungs ventilated gas mixtures 21 o2 5 co2 74 n2 \( \) 3 o2 5 co2 92 n2 \( hypoxia \) 30 microm ng l arginine \( l \) , inhibitor edrf production , caused reduction endothelium dependent relaxant response acetylcholine \( ach \) 62 7 , 88 4 , 100 4 26 8 , 49 12 , 75 7 ach concentrations 1 , 10 , 100 microm , respectively \( p less 0 05 concentrations \) , indicating l acts via inhibition edrf production l induced concentration related augmentation hpv 20 5 , 32 8 , 34 8 concentrations 30 , 300 , 1 , 000 microm \( p less 0 05 , compared vehicle control group concentrations \) pressor response dose angiotensin ii \( ii \) , produced increase pulmonary artery pressure induced hypoxia , also significantly augmented \( 2 0 6 \) , lesser extent augmentation hpv 30 microm l completely reversed 1 mm l arginine \( precursor edrf \) , arginine \( isomer l arginine \) one 6 mm l arginine , 6 mm arginine caused significant inhibition hpv 20 2 47 12 \( p less 0 05 , compared vehicle control group \) small significant reduction ii mediated contraction
neural substrate memory impairment demonstrated intracarotid amobarbital procedure intracarotid amobarbital sodium \( \) procedure \( iap \) performed 46 patients temporal lobe epilepsy \( 21 left seizure foci 25 right seizure foci \) anteromedial temporal lobectomy , neuronal densities established hippocampal ca1 , ca2 , ca3 dentate granule cell layer intracarotid amobarbital procedure memory results related ca3 neuronal loss patients demonstrate memory injection contralateral seizure focus significantly fewer cells ca3 patients additionally , significant correlation observed intracarotid amobarbital procedure memory examination raw score injection contralateral seizure focus ca3 cell density using chi 2 analysis , significant differences documented frequency memory demonstrated injection contralateral seizure focus groups patients classified degree ca3 neuronal loss finding supports prior research showing specificity memory processes
memory complaints older adults fact \? complaints poor memory patients may early symptom pathologic process like alzheimer 's disease therefore important determine patients' complaints memory impairments accurate reflection real memory disturbance relationship memory complaints \( \) objective memory performance , mood , age , verbal intelligence , sex examined group 199 healthy , community adults \( 39 89 years old \) memory complaints demonstrated stronger association depressed mood performance memory tests increasing reports depressive symptoms associated overall memory complaints verbal intelligence , age , sex also contributed memory complaints patients higher verbal intelligence reported fewer complaints placed less emphasis older individuals reported greater frequency greater frequency using memory techniques specific types memory complaints , seriousness , types memory aids employed also described results showed self rating memory disturbance older adults may related depressed mood poor performance memory tests
clinical choices circulatory assist devices approximately 1 0 open heart surgery patients become cardiac bypass surgical procedure addition , nearly 20 patients accepted cardiac transplantation die waiting donor heart pulsatile pneumatic ventricular assist devices \( \) provide realistic solution dilemmas currently , five manufacturers major market share clinical use devices novacor , , , , competitive vad systems one system optimal patients , limitations , similarities , strengths system known enhance patient 's outcome using devices successful use vad systems , either bridge transplantation ventricular recovery , best approached adherence strict patient selection instituted , vad management centers detailed attention anticoagulation prompt diagnosis treatment various complications
deoxyribonucleic acid regions involved hormonal regulation thyroglobulin gene expression transcription thyroglobulin \( tg \) gene stimulated tsh via camp characterized sequence elements responsible hormone dependent expression tg gene rat thyroid frtl 5 cells using internal deletion scanning mutants minimal tg promoter \( 170 \) fused bacterial chloramphenicol acetyltransferase reporter gene tg gene regulated least two regions located 165 140 bp \( tg iii \) 95 65 bp \( tg \) transcription initiation site intervening region deleted without significant effect promoter activity either two regions alone promote hormone dependent transcription dnase assay showed tg tg iii principal protein binding sites proteins interacting two regions induced tsh camp results suggest hormone dependent expression tg gene may achieved cooperative interaction proteins bound tg tg iii
effect surgical stress vitro metabolism thyroxine rat liver , kidney , brain man , acute stress , like extensive surgery , leads rapid prolonged decrease serum t3 concentrations present study carried investigate mechanisms abrupt decrease t3 occurs response acute surgical stress male sprague dawley rats , surgically , treated 1 2 micrograms t4 100 g bw day , underwent wide vertical horizontal incisions extending abdominal cavity receiving light ether anesthesia different dietary manipulations performed investigate superimposed influence reduced carbohydrate caloric intake t3 metabolism 125i t4 labeled outer \( \) ring investigated liver , kidney , brain homogenates animals killed 48 h surgery liver , values proportion t4 degraded percent generation t3 iodide unaffected laparotomy percent t3 generation experiments 25 nm t4 concentration 3 7 1 24 \( mean sd \) fed control animals given free access 5 glucose , 3 4 0 67 unoperated controls given restricted amount chow 5 glucose , 3 8 0 67 operated animals given free access chow 5 glucose expected , t3 livers unoperated animals significantly reduced rats fasted 48 h reduction similar rats fasted 48 h surgery liver , effect laparotomy t4 metabolism kidney brain homogenates observed finally , serum total t4 t3 concentrations affected surgery concluded acute surgical stress t4 replaced rats influence t4 metabolism liver , kidney , brain homogenates affect serum t4 t3 concentrations since thyroid secretion t4 \( t3 \) eliminated careful attention paid caloric intake rat model , previously reported abnormalities serum thyroid hormone concentrations t3 various states illness man rat , including surgery , probably contributed thyroid secretion t4 \( t3 \) caloric deprivation , especially carbohydrate
rat glucagon gene regulated protein kinase dependent pathway pancreatic islet cells camp response element \( cre \) identified proximal 5' flanking region rat glucagon gene , activation camp dependent pathway fetal rat intestinal cells leads increase levels glucagon mrna transcripts contrast , human glucagon gene contain similar cre , results studies using immortalized rat hamster islet cell lines suggested glucagon gene expression may regulated camp observations , studied control glucagon gene expression incubation primary rat islet cell cultures forskolin presence low \( 0 5 g liter \) high \( 2 0 g l \) glucose resulted 2 3 fold increase levels glucagon mrna transcripts forskolin also stimulated secretion synthesis immunoreactive glucagon importance protein kinase dependent pathway regulation glucagon gene expression also examined hamster islet cells glucagon chloramphenicol acetyltransferase \( cat \) fusion gene containing glucagon cre cdna encoding catalytic subunit protein kinase resulted stimulation glucagon cat activity hamster islet cells catalytic subunit also activated somatostatin cat , activation detected results experiments suggest rat glucagon gene regulated protein kinase dependent pathway endocrine pancreas
sympathetic neural adjustments stress physically trained untrained humans purpose study determine state physical training influences sympathetic neural activation acute stress humans recorded muscle sympathetic nerve activity \( peroneal nerve \) , arterial blood pressure , heart rate 12 highly trained , endurance athletes \( 25 1 years , mean sem \) 12 untrained subjects \( 27 1 years \) \( supine rest control \) 1 \) lower body negative pressure 5 , 10 , 15 , 20 mm hg \( orthostatic stress \) 2 \) isometric handgrip 30 maximum \( exercise stress \) 3 \) hand immersion ice water , , cold pressor test \( thermal stress \) body weight different two groups , athletes lower body fat content \( 8 9 1 3 versus 16 1 2 0 , p less 0 05 \) supine rest , muscle sympathetic nerve burst frequency \( 24 3 versus 24 2 bursts min , athletes versus untrained subjects \) burst incidence \( 36 3 versus 44 4 bursts 100 heart beats \) arterial blood pressure different two groups , heart rate lower athletes \( 54 2 versus 67 3 beats min , p less 0 05 \)
electrophysiologic findings fontan repair functional single ventricle cardiac arrhythmias well recognized sequelae fontan operation complex congenital anomalies study electrophysiologic effects fontan procedure evaluated 30 patients underwent cardiac catheterization electrophysiologic study 1 9 1 3 years \( mean sd \) modified fontan repair functional single ventricle abnormalities sinus node ectopic pacemaker automaticity detected 50 \( 15 patients \) determination prolonged corrected sinus node pacemaker recovery time total conduction time prolonged 50 patients normal sinus rhythm sinus node ectopic atrial pacemaker function entirely normal 43 patients predominant atrial rhythm normal sinus 70 ectopic atrial junctional 30 abnormalities atrial effective functional refractory periods noted 43 patients pronounced faster paced cycle lengths atrial endocardial catheter mapping revealed intraatrial conduction delays adjacent sites 76 patients tested eight nine patients inducible intraatrial reentry programmed atrial stimulation induced nonsustained supraventricular arrhythmias 10 30 patients sustained arrhythmias 27 intraatrial reentry common inducible arrhythmia present seven eight patients sustained two three patients nonsustained atrial arrhythmias atrioventricular conduction abnormalities noted 10 \( three patients \) patient inducible ventricular arrhythmias programmed ventricular stimulation electrophysiologic findings fontan repair include abnormal sinus node function , prolonged atrial refractoriness , delayed intraatrial conduction inducible atrial arrhythmias
patients persistent vegetative state attitudes reactions family members patients persistent vegetative state \( pvs \) constituted approximately 3 population four nursing homes order understand family attitudes reactions toward patients , 33 \( 92 \) 36 family members patients pvs contacted studied age patients ranged 19 95 mean age 73 4 17 2 years , family ages ranged 41 89 mean age 61 8 3 3 years etiology pvs varied dementia cerebral trauma mean duration pvs 54 8 4 months \( range 12 204 \) family members reported visited patients 260 times first year following onset pvs still rate 209 visits yearly time interview significant correlation frequency family members visits duration pvs , patient 's family member 's age , family member 's relationship patient ninety percent patients considered family members awareness pain , light darkness , environment , taste , verbal , family member 's presence family members thought understood patient 's medical condition , majority expect patient improve nevertheless , majority family members wanted patient undergo therapeutic interventions , including transfer acute hospital surgery
separation characterization saponins adjuvant activity cortex saponins purified silica reverse phase chromatography resulting purified saponins tested adjuvant activity mice several distinct saponins , designated qs 7 , qs 17 , qs 18 , qs 21 , demonstrated boost antibody levels 100 fold used mouse immunizations ag bsa beef liver cytochrome purified saponins increased titers major igg subclasses determine optimal dose mice adjuvant response , qs 7 qs 21 tested dose response study intradermal immunization bsa mice purified saponins , adjuvant response \( determined stimulation elisa titers bsa \) maximum doses 5 micrograms shown plateau highest dose tested , 80 micrograms purified saponins vary considerably toxicity , assessed lethality mice main component , qs 18 , toxic saponins qs 7 qs 21 showed low toxicity mice , respectively none saponins stimulated production antibodies composition saponins showed similar distinct compositions four containing fucose , xylose , acid predominant differences observed quantities , , glucose monomer w \( determined size exclusion hplc \) determined range 1800
effects site specific mutations biologic activities recombinant human il 6 examine structure activity relationships human il 6 , determined effects specific mutations biologic activity human ril 6 expressed bacteria three types mutants examined 1 \) variant contains place four naturally occurring 2 \) series cysteine containing deletion mutants , single internal 20 amino acid deletion 3 \) cysteine free variant containing single 20 amino acid deletion mutants second type constitute set , adjacent deletions spanning amino acids 4 183 184 amino acids natural human il 6 mutants expressed , along full length , cysteine containing analogue , escherichia coli fusion proteins , beta collagen system allows microgram quantities ril 6 variants partially purified small bacterial cultures without chromatographic steps ril 6 variants released beta fusion protein collagenase , recovered ril 6 quantitated laser densitometry stained , sds polyacrylamide gels sp ac ril 6 variants determined using four assays induction igm secretion ebv transformed human b cell line , induction fibrinogen secretion human hepatoma cell line , induction fibrinogen secretion rat hepatoma cell line , induction proliferation murine hybridoma cell line replacement reduced activity relative cysteine containing ril 6 20 rat hepatoma assay 3 mouse hybridoma assay , whereas activity human cell lines reduced less 0 1 data suggest murine rat cell lines less selective human cell lines requirements recognition biologically active il 6 deletions , except amino acids 4 23 , resulted loss activity four assays results suggest information necessary activity contained within one portion il 6 molecule , rather multiple segments protein required biologic activities tested
chronic hypomagnesemia caused cisplatin effect calcitriol group six patients hypomagnesemia \( serum magnesium less equal 0 5 mmol l \) , previously given treatment cisplatin ovarian testicular cancer , received calcitriol dose 0 5 1 0 microgram day period 4 weeks determine whether treatment vitamin metabolite could improve hypomagnesemia response treatment , serum magnesium concentration fell progressively association rise serum urinary calcium levels decrease parathyroid hormone level single previous report , active vitamin metabolites markedly improved renal magnesium however , present study , increases serum urinary calcium levels suppression parathyroid hormone , factors known decrease magnesium reabsorption , presumably direct effect calcitriol may enhance magnesium reabsorption , net effect marked exacerbation renal magnesium
antiplatelet drugs femoropopliteal vein bypasses multicenter trial evaluate influence antiplatelet drugs patency femoropopliteal vein bypasses , 48 vascular surgeons recruited patients randomized double blind trial aspirin \( 300 mg \) dipyridamole \( 150 mg \) placebo twice daily starting 2 days surgery continuing graft occlusion measured objectively independent cardiovascular events \( myocardial infarction stroke \) studied , expressed life table , analyzed statistically log rank confidence intervals \( 95 ci \) randomization achieved comparable groups 60 grafts inserted rest pain operative complications aspirin plus dipyridamole included 18 reoperations bleeding 12 hematomas compared 9 14 , respectively , placebo \( ns \) 172 graft failures occurred early failure rates 43 1000 patient months first 3 months , reducing 17 1000 6 12 months , 10 1000 subsequent years cumulative graft patency placebo 72 , 62 , 60 1 , 2 , 3 years , respectively , compared 78 , 70 , 61 aspirin plus dipyridamole difference patency 6 1 \( 95 ci , 3 15 5 \) 1 year 8 0 \( 95 ci , 5 21 \) 2 years failed achieve significance \( p 0 43 \) mean follow 34 months , 53 \( 132 1000 patient years \) cardiovascular events \( myocardial infarction cerebrovascular accident \) occurred patients placebo compared 35 \( 73 1000 \) aspirin plus dipyridamole , significant difference 59 1000 \( p 0 004 \) antiplatelet therapy little influence femoropopliteal vein patency , subsequent myocardial infarction stroke reduced patients peripheral vascular disease
prospective , randomized comparison ringed polytetrafluoroethylene femoropopliteal bypass grafts preliminary report compression knee flexion thought one cause failure knee polytetrafluoroethylene femoropopliteal bypass prevent problem polytetrafluoroethylene grafts supported rigid rings developed present randomized , prospective study compared ringed polytetrafluoroethylene grafts 122 patients underwent femoropopliteal bypass severe limb ischemia patients well matched surgical indications risk factors significant difference 3 year graft patency rate ringed versus polytetrafluoroethylene femoropopliteal bypasses \( 74 vs 68 , p 0 5 \) similarly , significant differences found 3 year graft patency rates ringed versus non ringed knee \( 82 vs 74 , p 0 5 \) knee polytetrafluoroethylene femoropopliteal bypasses \( 68 vs 59 , p 0 5 \) 3 year graft patency rate knee polytetrafluoroethylene femoropopliteal bypasses slightly greater knee polytetrafluoroethylene femoropopliteal bypasses \( 76 vs 62 \) , difference statistically significant \( p 0 25 \) 3 year limb salvage rate ringed polytetrafluoroethylene grafts 92 compared 79 polytetrafluoroethylene grafts , difference statistically significant \( p 0 25 \) data date study fail support recommendation ringed polytetrafluoroethylene grafts used preferentially conventional polytetrafluoroethylene grafts patients require femoropopliteal bypass synthetic graft
glucose induced exertional fatigue muscle phosphofructokinase deficiency background exercise capacity patients muscle phosphofructokinase deficiency low day day basis variable exercise tolerance unknown , patients disorder report fatigue active muscles rapid high carbohydrate meal methods results determine effect carbohydrate exercise performance , asked four patients muscle phosphofructokinase deficiency perform cycle exercise conditions differing availability substrate e , overnight fast , infusion glucose triglyceride \( 10 u heparin per kilogram body weight \) overnight fast compared fasting infusion triglyceride heparin , glucose infusion lowered plasma levels free fatty acids , reduced maximal work capacity 60 70 percent , lowered maximal oxygen consumption 30 40 percent glucose also increased relative intensity submaximal exercise , indicated higher heart rate given workload exercise maximal cardiac output \( e , oxygen delivery \) affected varying substrate availability , maximal systemic arteriovenous oxygen difference significantly lower glucose infusion \( mean se , 5 5 0 3 ml per \) fasting \( 7 6 0 4 ml per , p less 0 05 \) infusion triglyceride heparin \( 8 9 1 3 ml per , p less 0 05 \) conclusions muscle phosphofructokinase deficiency , oxidative capacity muscle capacity aerobic exercise vary according availability blood borne believe glucose infusion lowers exercise tolerance inhibiting lipolysis thus muscle oxidative substrate \( plasma free fatty acids \) impairs capacity working muscle extract oxygen lowers maximal oxygen consumption
incidence adverse events negligence hospitalized patients results medical practice study background part interdisciplinary study medical injury litigation , estimated incidence adverse events , defined injuries caused medical management , subgroup injuries resulted care methods reviewed 30 , 121 randomly selected records 51 randomly selected acute care , nonpsychiatric hospitals new york state 1984 developed population estimates injuries computed rates according age sex patients well specialties physicians results adverse events occurred 3 7 percent hospitalizations \( 95 percent confidence interval , 3 2 4 2 \) , 27 6 percent adverse events due negligence \( 95 percent confidence interval , 22 5 32 6 \) although 70 5 percent adverse events gave rise disability lasting less six months , 2 6 percent caused permanently disabling injuries 13 6 percent led death percentage adverse events attributable negligence increased categories severe injuries \( test chi 2 21 04 , p less 0 0001 \) using weighted , estimated among 2 , , patients discharged new york hospitals 1984 98 , adverse events 27 , 179 adverse events involving negligence rates adverse events rose age \( p less 0 0001 \) percentage adverse events due negligence markedly higher among elderly \( p less 0 01 \) significant differences rates adverse events among categories clinical specialties \( p less 0 0001 \) , differences percentage due negligence conclusions substantial amount injury patients medical management , many injuries result care
psychometric descriptive perspectives illness impact life span article describes development instrument illness course life sample comprised 308 women , aged 50 70 , 's program nursing submitted information concerning illness experienced decade life time period rated \( duration , discomfort , interference , threat life \) reflect impact various conditions means decade \( decade impact \) computed general , first two decades , magnitude ratings increased age , indicating greater disease impact reliability internal consistency reliability scale high evidence construct validity included substantial differences without specific illness conditions , well correlations hospitalization history health self ratings cluster analysis patterns across decades , five distinct patterns emerged subjects grouped
benign biliary strictures treatment percutaneous cholangioplasty results percutaneous balloon cholangioplasty 17 patients 28 benign biliary strictures compared published radiologic surgical series determine whether stricture location related therapeutic success whether patient undergo percutaneous surgical therapy treatment considered successful anatomic evidence recurrent stricture need surgery \( mean follow , 32 months \) treatment successful nine \( 100 \) intrahepatic \( zone 1 \) strictures , 11 12 \( 92 \) extrahepatic \( zone 2 \) strictures , one three \( 33 \) intrapancreatic \( zone 3 \) strictures , three four \( 75 \) anastomotic \( zone 4 \) strictures restenosis occurred five patients cholangioplasty ultimately successful two patients stent placement basis results published radiologic surgical series , authors believe cholangioplasty treatment choice zone 1 strictures effective surgery zone 2 4 strictures patients zone 2 4 strictures concomitant portal hypertension history multiple previous biliary surgical procedures considered good candidates cholangioplasty zone 3 strictures may better treated surgically percutaneously
dominant negative regulation mouse alpha fetoprotein gene adult liver transcription mouse alpha fetoprotein gene activated developing fetal liver gut tissues shortly birth transformation mice , cis acting element identified upstream transcription initiation site alpha fetoprotein gene responsible gene adult liver negative element acts position dependent manner
hot spots growth hormone gene deletions homologous regions outside repeats familial growth hormone deficiency type 1a autosomal recessive disease caused deletion growth hormone 1 \( gh1 \) alleles ten patients heterogeneous geographic origins showed differences restriction fragment length polymorphism haplotypes regions flanked gh1 , suggesting deletions arose independent recombination events deoxyribonucleic acid \( dna \) samples nine ten patients showed occurred within 99 homologous , base pair \( bp \) segments flanked gh1 dna sample one patient indicated crossover occurred within 454 bp segments flanked gh1 contained bp repeats 98 homologous although repeats , frequent sites recombination , adjacent gh1 , involved recombination events studied results suggest length degree dna sequence homology important defining recombination sites resulted gh1 deletions
sensitive sequence specific dna binding c myc basic region function c myc role cell growth control unclear basic region c myc structurally related basic helix loop helix \( \) leucine proteins , provide sequence specific dna binding function c myc basic region tested ability bind dna dimerization interface enhancer binding factor dimers chimeric protein , termed e6 , specifically bound e box element \( \) recognized proteins manner dependent integrity c myc basic motif core e box recognition site specifically inhibited binding e6 , two proteins expression e6 \( e6 dna binding mutant \) suppressed ability c myc h ras rat embryo fibroblast transformation assay , suggesting dna recognition specificity e6 related c myc vivo
death functional outcome spontaneous intracerebral hemorrhage prospective study 166 cases using multivariate analysis using death functional status end points , prospectively analyzed outcome 6 months spontaneous intracerebral hemorrhage 166 patients admitted acute care stroke unit first day stroke seventy one patients \( 43 \) died , 69 \( 42 \) satisfactory outcome , 26 \( 16 \) poor functional outcome early \( 30 day \) survival correlated morphologic parameters initial computed \( hemorrhage size , midline shift , intraventricular spread hemorrhage \) , later \( 6 month \) survival correlated age using logistic regression , found five independent predictors satisfactory outcome 6 months age , hemorrhage size , intraventricular spread hemorrhage , limb paresis , communication disorders , age important predictor far
mild hypothermic intervention graded ischemic stress rats investigated effect mild \( 34 degrees c \) postischemic hypothermia hippocampal neuronal damage 43 rats function duration forebrain ischemia two temperatures two durations investigated two normothermic groups ischemia lasted 8 \( n 15 \) 12 \( n 10 \) minutes , respectively two hypothermic groups ischemia lasted 8 \( n 9 \) 12 \( n 9 \) minutes , respectively , followed immediately lowering maintenance rectal temperature 34 degrees c 2 hours seven days ischemic insult , rats sacrificed brains prepared histologic analysis percentage necrotic neurons among total neuronal population selected ca1 2 sectors hippocampus determined significant decrease percentage necrotic neurons central \( 77 5 versus 55 5 , p 0 006 \) lateral \( 62 5 versus 38 9 , p 0 005 \) areas overall ca1 2 sector hippocampus \( 71 8 versus 52 2 , p 0 008 \) 8 minute hypothermic group compared 8 minute normothermic group contrast , differences detected area hippocampus 12 minute normothermic 12 minute hypothermic groups \( p 0 29 0 49 \) data indicate mild postischemic whole body hypothermia neuronal survival ischemia 8 minutes 12 minutes
increased microvascular permeability vivo response intradermal injection neutrophil activating protein \( nap 2 \) rabbit skin neutrophil activating protein 2 \( nap 2 \) , nh2 terminally processed form platelet release product beta \( beta tg \) , purified homogeneity stimulated human blood leukocytes presence vasodilator substance \( pge2 , cgrp \) \( pmol l \) amounts nap 2 induced neutrophil accumulation plasma leakage intradermal injection rabbit skin , whereas longer forms , beta tg connective tissue activating peptide iii \( iii \) , effect nap 2 induced increased microvascular permeability neutrophil dependent fast onset , half life 65 75 minutes , comparable previously reported structural related neutrophil activating protein 1 interleukin 8 \( nap 1 il 8 \) however nap 2 showed lower potency protein needed provoke skin reactivity nevertheless finding platelet release product elicit neutrophil mediated inflammation gap thrombotic events inflammatory disorders
somatostatin analogue treatment inhibits post resectional adaptation small bowel rats post resectional hyperplasia phenomenon residual small bowel increases size capacity segmental experiment studied effect somatostatin analogue therapy development two structural parameters post resectional hyperplasia rats subjected 40 proximal small bowel resection octreotide acetate treated rats failed develop increased villus height \( 50 microns \) relative saline treated rats \( 1 , 103 98 microns \) augmentation residual intestinal weight also significantly impaired analogue treated rats \( 92 3 versus 118 5 mg cm \) conclude somatostatin analogue treatment early postoperative period impair growth residual bowel rats findings raise concern regarding use drug postoperative patients undergone massive small bowel resection process post resectional adaptation may critical allow enteral nutrition
prospective , randomized trial anastomosis ring bar investigational group randomized trial undertaken compare anastomotic ring \( bar \) conventional intraperitoneal colorectal anastomotic techniques patients randomized one two schemes bar versus sutured bar versus stapled anastomosis patients entered study 283 patients \( 36 \) sutured anastomosis , 104 patients \( 13 \) stapled anastomosis , 395 \( 51 \) bar comparison bar combined suture stapled controls revealed significant differences wound complication , abscess rate , bleeding , anastomotic leaks , ileus , obstruction , deaths differences return bowel function , return normal diet , hospital stay intraoperative difficulties occurred 46 bar patients \( 17 \) , significantly higher \( p less 0 001 \) sutured \( 3 \) stapled anastomoses \( 11 \) occurrence problems adversely effect outcome data suggest bar safe , satisfactory alternative sutured stapled colorectal anastomoses
laparoscopic guided cholecystectomy cholecystectomy remains effective form therapy patients symptomatic cholelithiasis alternative method gallbladder removal , laparoscopic guided cholecystectomy , attempted 100 patients five patients required conversion laparoscopic procedure open laparotomy following reasons discovery pancreatic malignancy one patient , extensive adhesions one , presence aberrant accessory right hepatic duct one , common hepatic duct injury one , avulsion cystic duct one ductal injuries occurred early phase clinical program patients undergoing laparoscopic cholecystectomy , 93 discharged within 24 hours surgery 94 returned normal activity within 1 week laparoscopic guided cholecystectomy appears offer number advantages patient care well significant reduction health care gallbladder disease appropriate training laparoscopic surgery necessary order avoid operative complications
27 year experience splenectomy gaucher 's disease gaucher 's disease inherited metabolic disorder caused defective activity acid beta glucosidase resultant accumulation macrophages liver , bone , spleen splenectomy preferred treatment patients gaucher 's disease develop massive splenomegaly accompanying mechanical pressure symptoms charts 48 patients gaucher 's disease undergoing splenectomy institution january december 1989 analyzed determine short long term results procedure thirty five \( 73 \) patients total splenectomy , whereas 13 \( 27 \) patients partial splenectomy one postoperative death \( total splenectomy \) , 13 patients \( 27 \) postoperative complications eleven patients \( 23 \) presented accelerated bone disease total splenectomy \( mean follow 96 months \) patients partial splenectomy \( mean follow 25 months \) developed progressive bone disease eight patients died since surgery four deaths due malignant disease occurred patients total splenectomy results largest ever reported series splenectomy gaucher 's disease confirm either total partial splenectomy performed minimal morbidity mortality , total splenectomy accompanied aggressive bone disease predisposition malignancy prospective , randomized trials needed substantiate whether partial splenectomy indeed treatment choice splenomegaly associated gaucher 's disease
growth velocity sudden infant death weight velocities 136 infants died sudden infant death syndrome \( \) compared 136 controls matched sex , birth weight , type feeding found infants gained weight slowly overall differences significantly different infants breast fed last two weeks possible estimate growth velocity breast fed infants periods growth centile expected differences unlikely useful prediction babies likely die frequent episodes poor growth infants die
measurements height made health visitors sufficiently accurate routine screening growth \? find whether measurements height made health visitors sufficiently accurate use routine screening children carried interobserver intraobserver reliability study height measurements made group 10 children aged 3 years old 10 aged 4 5 years old two sets four health visitors used wall chart measurements compared made trained single assessment height pieces equipment gave reasonably accurate results child aged 3 years , height measured 100 cm , true height could expected 95 probability lie 99 2 cm 101 8 cm age 4 5 years , measurement 110 cm , child 's true height could expected lie 108 9 cm 111 9 cm confidence interval growth rate 3 4 5 years achieved , taking mean three measurements conclude measurements made health visitors sufficiently accurate routine screening height , use measurements calculation height velocity could improved structured training
nocturnal faecal soiling anal two cases late onset faecal soiling result anal children neither mentally handicapped psychotic studied role soiling young person family avoid separating highlighted suggest association anal resistant nocturnal soiling may
systemic idiopathic fibrosis cell receptor gene rearrangement case systemic idiopathic fibrosis analyzed southern blotting probes immunoglobulin heavy chain cell receptor genes 45 year old man presented bilateral neck swelling later developed lower back pain , findings computed tomographic scan consistent idiopathic retroperitoneal fibrosis biopsy specimen neck lesion showed morphologic characteristics typical idiopathic fibrosing immunophenotyping lesion revealed polymorphic lymphoid population molecular analysis use probes immunoglobulin cell receptor genes disclosed dna pattern immunoglobulin gene rearranged pattern cell receptor gene
persistence chronic constipation children biofeedback treatment investigated efficacy biofeedback treatment evaluated anorectal factors might responsible persistence chronic constipation without group 38 children abnormal contraction pelvic floor straining persistence chronic constipation conventional treatment nine children unsuccessful learning relax pelvic floor straining biofeedback treatment , one patient contraction pelvic floor follow despite successful biofeedback treatment none recovered twenty eight children able relax pelvic floor follow 14 recovered 14 recover chronic constipation patients learned relax pelvic floor significantly decreased rectal anal responsiveness rectal distension compared recovered patients initial follow anorectal manometric study psychological factors social competence behavior problems appear responsible recovery chronic constipation
clinical physiological study anal sphincter ileal j pouch closure 6 12 months closure loop ileostomy spontaneous evolution pouch anal function , absorption features assessed 15 patients underwent proctocolectomy j ileal pouch anastomosis without conservation rectal muscular cuff patients studied closure six 12 months closure protection loop ileostomy stool frequency identical six 12 months \( mean sem 5 0 0 4 5 3 0 5 day , respectively \) sixty six percent patients six months 40 patients 12 months need least one time night stool weight well decreased significantly six months closure loop ileostomy \( p less 0 05 \) mean resting anal pressure remained unchanged six 12 months closure loop ileostomy \( 41 6 45 5 cm h2o , respectively \) maximum squeeze anal pressures increased significantly six \( p less 0 05 \) 12 months \( p less 0 05 \) inhibitory reflex always absent period maximum pouch capacity increased significantly first six months \( p less 0 01 \) 142 17 279 27 ml maximum infused volume saline continence test significantly different six 12 months percentage evacuation reservoir volume first ileal contraction appeared reservoir increased significantly \( p less 0 05 \) six 12 months conclusion , patients ileoanal anastomosis pouch reservoir , closure loop ileostomy associated spontaneous modifications anal pouch parameters
kupffer cell activation endothelial cell damage storage rat livers effects reperfusion reperfusion injury characterized loss endothelial cell viability occurs cold ischemic storage livers transplantation surgery , ultrastructural changes stored rat livers examined scanning transmission electron microscopy increasing times storage solution \( 4 24 hr \) followed 15 min reperfusion 37 degrees c , sequence structural alterations observed involving endothelial kupffer cells widening endothelial occurred 4 hr progressed 8 24 hr retraction cellular processes , ball like , sinusoidal denudation ultrastructural derangements consistent loss cell viability kupffer cells exhibited progressive , cell surface , , appearance densities , degranulation similar time course contrast , structures parenchymal fat storing cells relatively cold storage reperfusion alterations endothelial kupffer cells also studied function time reperfusion 24 hr storage , endothelial cells showed retraction cytoplasm reperfusion progressed quickly loss viability denudation reperfusion kupffer cell activation \( , degranulation \) reperfusion slower occurred deterioration endothelial cells livers stored solution also compared livers stored university wisconsin cold storage solution , improved preservation medium transplantation university wisconsin solution provided better preservation endothelial structure markedly reduced parenchymal cell swelling reperfusion university wisconsin solution also reduced kupffer cell activation release lysosomal enzymes conclusion , endothelial cell deterioration followed kupffer cell activation occurred increasing times cold ischemic storage reperfusion rat livers changes may contribute pathophysiology graft failure caused reperfusion mediated storage injury
interpleural analgesia published erratum appears heart lung 1991 jul 20 \( 4 \) 413 postoperative pain relief necessary patient comfort , also facilitate ventilation ambulation use opioid analgesia , either intravenously , intramuscularly , , may ineffective cause respiratory depression administration local anesthetics pleural space technique providing analgesia rapid onset long duration analgesia accomplished without causing respiratory depression sedation associated use opioids innovative analgesic methods often selected critically ill patients presenting surgery intensive care setting , critical care nurses may encounter patients receiving local anesthetics administered via interpleural catheter
development special care unit chronically critically ill patients intensive care units \( icus \) recognized one expensive services provided hospitals within icus growing population patients whose stays extensively prolonged complications underlying chronic health conditions exacerbated critical illness patients described chronically critically ill hospitals terms actual dollars terms burden care nurses physicians article describes creation special care unit \( \) designed specifically meet needs chronically critically ill patients environment composed physical design limited technology care aimed family involvement rehabilitation , case management practice model , shared management model structure contrast traditional icu , include physical allow high technology close monitoring patients , primary nursing delivery system , management model research project compare effects effects traditional icus nurse patient outcomes described
treatment strategies shock use oxygen transport measurements shock traditionally categorized according cause shock result hemorrhage , primary cardiac failure , central nervous system failure , trauma , sepsis therapeutic principles developed etiologic type end points therapy included optimization pulmonary capillary wedge pressure , cardiac output , blood pressure , urine output recent investigators agree common shock syndromes reduction amount oxygen consumed cell logical therapeutic approach would increase oxygen delivery support increased metabolic demand cells end point resuscitation optimization oxygen delivery oxygen consumption variables easily calculated using data obtained pulmonary artery catheter laboratory measurements physician nurse caring critical ill patients thorough understanding rationale use oxygen transport calculations methods oxygen delivery simple explanation principles including importance hemoglobin , cardiac index , percent saturation hemoglobin suggested treatment strategies presented
flow volume characteristics pulmonary circulation isolated ferret canine lungs used validate method assessing determinants vascular volume pulmonary circulation left atrial pressure \( \) constant 5 mmhg , flow \( q \) raised steps physiological range changes vascular volume \( delta v \) increment q determined opposite changes perfusion system reservoir weight increase lung weight level q , pulmonary arterial left atrial simultaneously occluded , allowing vascular pressures static pressure \( ps \) , equal compliance weighted average pressure circulation occlusion hypoxia \( inspired po2 25 torr \) ferret lungs , causes intense constriction arterial extra alveolar vessels , effect slope ps q relationship , interpreted represent resistance downstream compliance \( control 0 025 0 006 mmhg ml 1 min , hypoxia 0 0 013 \) ps axis intercept increased 8 94 0 50 13 43 1 52 mmhg , indicating modest increase effective back pressure flow downstream compliant regions compliance circulation , obtained slope relationship delta v ps , unaffected hypoxia \( control 0 52 0 08 ml mmhg , hypoxia 0 56 0 08 \) contrast , histamine canine lungs , causes constriction veins , caused slope ps q relationship increase 0 013 0 007 0 0 006 mmhg ml 1 min \( p less 0 05 \) compliance decrease 3 51 0 56 1 68 0 37 ml mmhg \( p less 0 05 \)
regional h2o2 concentration rat brain convulsions o2 toxicity central nervous system \( cns \) may result enhanced generation reactive o2 species superoxide h2o2 high po2 study , measured h2o2 production six regions rat brain convulsions induced hyperbaric hyperoxia \( \) h2o2 concentration determined ex vivo using method based h2o2 dependent decline catalase activity presence irreversible inhibitor compound , 3 amino 1 , 2 , 4 triazole regional catalase activity brain ranged 0 0 004 0 0 004 mumol o2 min 1 micrograms dna 1 cerebellum medulla pons , respectively presence , catalase activity declined induced convulsions 26 45 normoxic values rates inactivation catalase used predict average steady state values h2o2 concentration different brain structures estimated h2o2 concentrations varied 31 51 pm cerebellum posterior represented increases 2 2 7 3 times normoxic values findings suggest h2o2 important mediator selective neuronal vulnerability cns o2 toxicity
transfection stable transformation adult mouse schwann cells sv 40 large antigen gene cultured schwann cells derived adult mouse dorsal root ganglia peripheral nerves transfected plasmid containing sv 40 large antigen gene , 25 colonies stable obtained , one expanded transfected cell line , designated , expressed sv 40 large antigen showed continuous cell growth doubling time 27 hours cells distinct schwann cell phenotypes 100 protein , laminin , 2' , 3' cyclic nucleotide 3' phosphodiesterase p0 protein , shown immunofluorescence microscopy cells exposed cyclic adenosine 3' , 5' monophosphate \( amp \) , extended long bipolar processes two ten fold longer untreated cells frequently formed like similar patterns observed human results suggest transformed schwann cells useful model analyzing regulatory mechanisms schwann cells , neuron schwann cell interactions experimental schwann cell neoplasms vitro
acute experimental allergic encephalomyelitis sjl j mice induced synthetic peptide myelin protein clinical , histologic , ultrastructural characteristics acute experimental allergic encephalomyelitis \( eae \) induced sensitization synthetic peptide corresponding mouse myelin protein \( plp \) residues 139 151 studied sjl j mice groups mice immunized 20 , 50 , 100 nmol peptide killed seven 28 days sensitization beginning day 9 , mice showed signs eae disease progressed rapidly paralysis central nervous system \( cns \) inflammation , edema , gliosis , demyelination found mice killed days 10 28 white matter lesion areas correlated clinical score time mice killed peripheral nerve roots cauda equina lesions within range studied , severity clinical histologic disease regardless plp peptide dose two ten mice immunized 100 nmol none 14 mice given smaller doses synthetic peptide mouse myelin basic protein \( mbp \) showed clinical eae mice small numbers cns lesions indistinguishable plp peptide sensitized mice findings demonstrate immunization sjl j mice plp peptide 139 151 produces disease clinical morphologic features cns tissue , whole plp , whole mbp , mbp peptide induced acute eae thus , plp major immune reactions epitopes different myelin proteins may induce identical patterns injury cns
reliability clinical electromyographic examination tendon reflexes reliability clinical examination tendon reflexes examined studying inter observer agreement twenty patients examined three neurologists tendon reflexes arms legs scored nine point scale 28 160 examined reflexes observations 2 scale units disagreement presence asymmetry occurred 45 80 reflex pairs 15 one observer judged reflex pair symmetrical another observer found asymmetry least 2 scale units second experiment clinical observation apparently quadriceps reflexes compared measurement surface electromyography significant , semi relationship found clinical scores measured reflex amplitudes measured reflex asymmetry always agreed clinical asymmetry , right left amplitude differences correlated magnitude clinically observed asymmetry bedside examination tendon reflexes subject considerable inter observer disagreement
treatment advanced stage massive mediastinal hodgkin 's disease case combined modality treatment initial series 198 patients treated national cancer institute \( nci \) , vincristine , procarbazine , prednisone \( mopp \) chemotherapy hodgkin 's disease , review presenting chest radiographs available 192 patients showed 49 patients mediastinal masses greater one third greatest chest diameter five patients stage iib disease , 44 stage iii iv disease thirty five \( 71 \) patients achieved complete remission mopp chemotherapy fourteen \( 40 \) complete responders relapsed , four achieved durable remissions response subsequent therapy thirty \( 61 \) patients died \( 14 induction failures , nine relapsed patients , seven complete responders remission \) thus , median follow 20 years \( range , 15 23 \) , overall survival group 39 , disease free survival complete responders 60 subset 10 patients received radiation therapy maximal response mopp one patients failed achieve complete remission , among nine complete responders one relapsed contrast , 13 26 \( 50 \) patients achieving complete response mopp alone relapsed \( p2 \) although mopp alone prospectively compared mopp plus radiation therapy treatment advanced stage massive mediastinal hodgkin 's disease series , retrospective analysis shows nearly significant difference disease free survival favoring combined modality treatment difference tumor mortality mopp treated \( 44 \) combined modality treated patients \( 80 \) also nearly significant \( p2 \) however , overall survival differences patients treated mopp alone treated combined modality therapy significantly different \( p2 0 23 \) mortality related late complications combined modality treatment
variant arteriovenous fistulas within wall dural sinuses results combined surgical endovascular therapy dural arteriovenous \( av \) fistulas thought acquired lesions form area thrombosis within sinus sinus remains completely thrombosed , venous drainage lesions occurs cortical veins , , sinus open , venous drainage usually involved sinus among 105 patients dural av fistulas evaluated past 5 years , seven unique type dural av fistula superior sagittal , transverse , straight sinus cortical venous drainage occurred despite patent involved sinus fistula located within wall patent dural sinus , outflow involved sinus variant dural av fistulas patient serious risk hemorrhage neurological dysfunction caused venous hypertension three patients presented hemorrhage , one progressive neurological dysfunction , one seizures , two headaches combination surgical endovascular techniques used close fistula preserving flow sinus
management hemorrhagic complications preoperative embolization arteriovenous malformations endovascular embolization procedures undergone dramatic evolution improvement recent years despite advances , controversy remains regarding optimal role procedures treating cerebral arteriovenous malformations \( avm 's \) whether purpose adjunct primary therapy controversy risks fragmentation broader efforts improve management cerebrovascular disorders authors report seven cases life threatening occurred staged invasive therapy avm 's illustrate value team approach optimize patient care patient underwent least one embolization procedure using alcohol particles , followed two cases occlusion proximal feeding vessels platinum one case attempted detachment endovascular balloon three patients , catheter penetration subarachnoid space resulted subarachnoid hemorrhage one patient suffered rupture large feeding vessel balloon inflation final three patients sustained intracranial hemorrhage 2 hours , 8 hours , 5 days , respectively , following embolization two patients underwent emergency craniotomy time complication cases advantages interdisciplinary management optimizing decision making providing expeditious care life threatening complications develop
dorsal root ganglionectomy failed back surgery syndrome 5 year follow study dorsal root ganglionectomy suggested method treatment chronic intractable radicular pain , theoretical advantages dorsal rhizotomy , ventral root afferents indications procedures patients persistent pain following lumbosacral spine surgery well established long term results reported infrequently , published series mean follow period 30 months authors reviewed experience series 13 patients failed back surgery syndrome , dorsal root ganglionectomy performed patients selected basis clinical presentation diagnostic root blocks suggesting pain syndrome follow data obtained mean 5 5 years following dorsal root ganglionectomy follow interviews assess outcome conducted third party treatment success \( least 50 sustained relief pain patient satisfaction result \) recorded two patients 2 years surgery none 5 5 years equivocal success \( least 50 relief , without patient satisfaction \) recorded one patient 2 5 5 years postoperatively improvements activities daily living recorded minority patients loss sensory motor function reported frequently patients minority patients reduced eliminated analgesic intake results suggest dorsal root ganglionectomy limited role management failed back surgery syndrome , methods select patients receive procedure refined alternative approaches considered
intraoperative monitoring facial nerve surgery hemifacial spasm 11 consecutive patients , intraoperative electromyographic \( emg \) recordings made facial muscles microvascular decompression hemifacial spasm one patient , recordings could obtained technical reasons , two patients abnormality remaining eight patients , abnormal response resolved decompression two , resolved immediately time decompression five , failed resolve one patients relieved hemifacial spasm five patients whose abnormalities resolved time decompression , precise intraoperative correlation decompression nerve disappearance abnormal emg response three cases , useful guide need one vessel results confirm findings , support use technique intraoperative monitoring facial nerve decompression procedures , provide strong evidence vascular cross compression important etiological factor hemifacial spasm
refined method delivering vas deferens developed used china since 1974 method eliminates , results fewer hematomas infections , smaller wound conventional techniques extracutaneous fixation ring clamp firmly vas without penetrating skin sharp curved scrotal skin vas sheath vas delivered , occluded surgeon 's preferred technique contralateral vas delivered opening puncture wound 2 mm , visible man requires sutures closure reported incidence hematoma 179 , men followed china 0 09 hematomas infections identified first 273 procedures performed surgeon united states operating time china last 50 united states procedures ranged 5 11 minutes disadvantage technique hand training number cases necessary gain proficiency however , advantages surgeons patients enhance popularity
elevation petrous bone caused hyperplasia occipital bone presenting hemifacial spasm diagnostic values magnetic resonance imaging three dimensional computed tomographic images bone anomaly case elevation petrous bone due hyperplasia occipital bone presenting hemifacial spasm reported 44 year old man sought treatment buccal muscles right side progressed rapidly severity within 2 weeks onset anatomical details petrous occipital bones delineated clearly computed tomographic scans bone window level details brain stem shown magnetic resonance images bone anomaly displayed three dimensional computed tomographic reconstructions structures radiological studies mandatory , prepare surgical planning complicated bone anomaly
aneurysms distal anterior cerebral artery report series 42 consecutive patients aneurysms distal anterior cerebral artery \( aca \) , 36 patients one aneurysm , 5 two aneurysms , one three aneurysms thirty patients ruptured distal aca aneurysm among patients , size aneurysm less 5 mm diameter 20 , 6 10 mm 7 , larger 11 mm 3 eighteen patients \( 42 9 \) multiple aneurysms , distal aca aneurysms responsible subarachnoid hemorrhage 10 thirty four patients underwent direct surgery , 30 excellent outcomes 3 months surgery treatment patients distal aca aneurysms often technically difficult , broad neck configuration coexistence aneurysms nevertheless , present study emphasizes distal aca aneurysms tend , irrespective size , excellent outcomes obtainable direct surgery
peritoneal closure non closure cesarean value peritoneal closure time cesarean birth evaluated prospectively two hundred forty eight women undergoing low transverse cesarean skin incision assigned one two groups peritoneum open \( n 127 \) peritoneum closed \( n 121 \) mean \( sem \) surgical time open group \( 48 1 1 2 minutes \) significantly less closed group \( 53 2 1 4 minutes \) \( p less 005 \) postoperative differences groups incidence wound infection , dehiscence , , ileus , length hospital stay study suggests leaving parietal peritoneum acceptable way manage patients cesarean delivery
deletions central helix functionally replace native protein yeast cells deletion glu 84 , glu 83 glu 84 , ser glu glu glu \( residues 81 84 \) central helix mammalian calmodulin known result 5 7 times decrease apparent vitro affinities three calmodulin dependent enzymes however , based vitro experiments , difficult estimate deletions might affect vivo cellular function yeast saccharomyces cerevisiae , requires calmodulin growth , provides excellent system evaluate deletion proteins vivo based ability restore normal growth characteristics yeast cells , mammalian calmodulin functionally identical yeast protein herein evaluate effect residues 84 , 83 84 , 81 84 central helix sequences encoding deletion proteins unaltered control sequence introduced means yeast vector expressed control yeast calmodulin promoter deletion control produced levels similar observed yeast protein , completely restore normal growth characteristics result suggests regions deleted central helix critical activation yeast calmodulin target normally required cell growth division likely shortening motions associated deletions central helix alter significantly spatial relationship two lobes calmodulin abilities deletion restore completely normal growth characteristics yeast cells suggest lobes deletion proteins still appropriately positioned calmodulin target complexes consistent hypothesis central helix calmodulin analogous flexible tether rather rigid two lobes molecule
src homology region 2 segment abl tyrosine kinase binds tyrosine phosphorylated cellular proteins high affinity several proteins implicated regulation cell proliferation contain common domain , src homology region 2 \( sh2 \) used expressed sh2 domain abl protein tyrosine kinase evaluate ability domain bind cellular proteins specifically bound number tyrosine phosphorylated proteins cells transformed tyrosine kinase oncogenes filter binding assay subset proteins solution sh2 probe bound almost exclusively tyrosine phosphorylated proteins , binding eliminated cell proteins free phosphotyrosine could partially disrupt sh2 binding , suggesting phosphotyrosine directly involved binding interaction results demonstrate sh2 domain sufficient confer direct , high affinity phosphotyrosine dependent binding proteins suggest general role sh2 domains cellular signaling pathways
nasal augmentation split calvarial grafts study reports experience autogenous split calvarial grafts nasal augmentation 62 78 percent patients , procedure performed local anesthesia outpatient setting total operating time harvesting split calvarial grafts ranged 20 55 minutes , mean 32 minutes patients ranged age 16 48 years , mean 27 years follow 6 months 8 years , average 3 1 years intraoperative discomfort uniformly low well tolerated local anesthesia used complication rate 8 0 percent , three cases minor hematoma formation bone graft donor site treated aspiration two recipient site complications , one case complete bone resorption occurred densely fibrotic nose preexisting septal perforation case successfully 1 year later easy beneath scalp , split calvarial grafts nose useful various types nasal augmentation , technique offered practical alternative use materials
donor seropositivity prednisolone therapy risk factors cytomegalovirus infection disease cyclosporin treated renal allograft recipients attempted assess importance blood transfusion , donor seropositivity , prednisolone therapy risk factors cytomegalovirus infection cyclosporin treated renal allograft recipients primary infection diagnosed 27 86 patients \( 31 per cent \) recurrent infection 27 79 patients \( 34 per cent \) receipt blood unselected donors transplantation increase incidence primary infection transfused patients kidney donor seropositivity maintenance prednisolone addition cyclosporin associated increases incidence primary recurrent infection , respectively cytomegalovirus infection clinically mild presumed bacterial pneumonias occurred three patients recurrent cytomegalovirus infection absence severe cytomegalovirus disease probably reflected minimal use prednisolone matching seronegative donors seronegative recipients seemed cyclosporin treated renal transplant patients
abdominal wall considerations complications reoperative surgery abdominal wall source significant problems patients undergoing multiple abdominal operations orientation sequential incisions must carefully considered avoid compromise abdominal wall blood supply , may result either acute \( dehiscence \) delayed \( ventral hernia \) complications infections serious problems multiply operated abdominal wall complications may range simple wound infection necrotizing management may require simple drainage infection may extensive debridement necrotizing processes regardless cause , multiply operated abdominal wall may require reconstruction lost fascia polypropylene mesh employed safely effectively purpose
reoperation biliary strictures benign bile duct strictures often follow intraoperative injury recognized later ideal reconstruction mucosa mucosa anastomosis without tension , usually stent tube maintain patency immediate postoperative period mortality rate reoperation bile duct reconstruction patients cirrhotic approximately 2 , success rates average 85 prevention operative injuries use cholangiography , careful dissection , removal gallbladder fundus downward best treatment
reoperation intra abdominal abscess reoperative procedures patients abscess septic complications remain among difficult management problems general surgery diagnosis intra abdominal septic complications greatly enhanced within last 10 years remains requires clinical judgment objective methods surgical drainage remains care patients postoperative intraabdominal abscess
performance cesarean section using absorbable staples although stapling techniques gained wide acceptance general surgery , still commonly used obstetrics u surgical corporation introduced stapling device suitable use cesarean sections staples \( acids \) maintain tensile strength healing occurs without producing granulation tissue benefits include minimal trauma tissue reduced operating time , blood loss postoperative morbidity july 1988 february 1989 , patients undergoing low transverse cervical cesarean sections randomized either group 1 uterine incision performed routine manner group 2 uterine incision cut stapled using preoperative management , intraoperative technique postoperative surveillance similar groups uterine incision assessed pelvic sonography postpartum period statistical analysis performed using fisher 's exact test chi square analysis groups comparable age , race , parity , gestational age primary diagnosis length operative procedure significantly shorter \( p less 0 05 \) stapled group patients also statistically significantly decreased incidence uterine incisions lacerations parameters significantly different two groups stapled uterine incisions visible ultrasonography patients stapled group throughout postpartum period sutured group thus , stapling uterine incision acceptable alternative traditional suturing techniques possible visualize clearly incisions postpartum period
correlation apache ii score , drainage technique outcome postoperative intra abdominal abscess apache ii score used stratify retrospectively severity illness 91 patients postoperatively undergoing drainage intra abdominal abscesses method initial abscess drainage \( percutaneous operative \) selected attending physician two groups patients , whose initial drainage performed percutaneously versus operatively similar respect age , sex , abscess location , importantly , severity illness assessed apache ii score calculated day abscess drainage , mortality rate 29 per cent \( 26 91 patients \) 1 7 per cent patients apache ii score less 15 died compared 78 per cent apache ii equal 15 \( p less 0 0001 \) 8 per cent patients apache ii equal 15 undergoing percutaneous drainage survived compared 30 per cent patients underwent surgical drainage procedures chi square analysis demonstrated independence outcome drainage technique , outcome dependent upon severity illness \( p less 0 0005 \) paradoxically , despite percutaneous technique abscess drainage ill patients , series , better , although statistically improved , chance survival noted surgical treatment recommend objective severity scoring system used whenever assessing results treatment intraabdominal infection surgical treatment avoided patient considered ill
death investigation case report provides details extensive death investigation , results led certification manner death means , without additional assistance persons mechanical devices death chronically mentally ill person currently approved professional treatment major investigative aspects case death scene observations body , elimination possibility homicide , study analysis subject 's psychiatric illness reasons reported deaths category discussed
death notification family notification sudden , unexpected , violent death major responsibility law , medical examiner , report reviews discusses process procedures utilized death notification provides suggestions accomplish difficult task effectively
long term results ionescu shiley valve tricuspid position retrospective analysis long term results using ionescu shiley pericardial bioprosthesis tricuspid position carried 73 patients \( 8 men , 65 women \) procedures , ten tricuspid valve replacement alone remainder combination valve procedures mean follow 9 6 years \( range , 4 18 years \) mean age patients 53 years \( range , 27 78 years \) seventy one patients suffered tricuspid valve dysfunction rheumatic heart disease 13 postoperative deaths \( within 30 days \) , giving mortality rate 17 8 actuarial survival 10 years 71 4 2 survivors , 49 \( 79 6 \) functional class ii primary tissue valve failure tricuspid position occurred 1 patient 12 years implantation required reoperation another patient bioprosthetic tricuspid valve endocarditis developed incidence thromboembolic complications conclude ionescu shiley pericardial bioprosthesis satisfactory prosthesis tricuspid position patients acquired valvar dysfunction
dosage haloperidol schizophrenia eighty seven newly admitted inpatients schizophrenia randomized receive 10 , 30 , 80 mg oral haloperidol treated double blind conditions 6 weeks , less acute symptoms sooner survival analysis showed differences among three treatments side effects minimal three treatment groups , differences side effects among groups results suggest dosages higher 10 mg haloperidol patients additional beneficial effect treatment acute exacerbated schizophrenia
disordered colorectal motility intractable constipation following hysterectomy colorectal anal sphincter motility electrophysiology investigated 14 women profound constipation following hysterectomy compared asymptomatic group control subjects twelve patients complained significant urinary symptoms differences motor function anal sphincters detectable latency reflex unchanged hysterectomy demonstrated significantly increased rectal volumes compliance hysterectomy group together deficits rectal sensory function basal state significant proximal distal sigmoid colon motility gradient existed control group following stimulation , gradient enhanced control group paradoxically reversed patients , thus functional obstruction denervation demonstrable two patients tested carbachol provocation control subjects findings suggest dysfunction autonomic innervation patients undergone hysterectomy , resulting severe constipation
saphenous vein graft stenting acute occlusion percutaneous transluminal coronary angioplasty report describes initial use united states emergency intravascular stenting treatment acute coronary occlusion complicating elective saphenous vein graft angioplasty case adds support role balloon expandable stent effective device failed angioplasty
alternative oxygen delivery system infants children post anaesthesia care unit randomized controlled trial compared compliance oxygen method standard face mask children recovering anaesthesia rate face mask rejected applied infants children pacu compared proposed hose method efficacy hose method oxygen supplementation children low high risk developing postoperative hypoxaemia also compared face mask using n 200 pulse oximeter , 66 infants children \( mean age 2 3 yr , range 2 mo 6 yr \) continuously monitored 30 min upon arrival pacu patients randomized receive oxygen supplementation either face mask proposed hose method results showed greater 80 per cent rejection face mask contrast 100 per cent compliance hose method sao2 measurements following 5 , 15 30 min o2 supplementation hose significantly higher sao2 measurements obtained room air upon arrival pacu patients pre existing cardiopulmonary disease 20 per cent incidence arterial oxygen desaturation upon arrival pacu versus 2 1 per cent patients pre existing disease concluded hose associated high patient compliance effective pacu increasing sao2 children low high risk developing postoperative hypoxaemia
oxygen debt metabolic acidemia quantitative predictors mortality severity ischemic insult hemorrhagic shock background methods experimental canine model hemorrhagic , hypovolemic shock described uses oxygen debt metabolic consequences lactic acidemia metabolic base deficit independent variables prediction probability death results lactic acidemia metabolic base deficit compared conventional hemodynamic variables bp cardiac output \( qt \) predictors outcome shown superior using modified kaplan meier probability statistic ld50 oxygen debt shown 113 5 ml kg , 12 9 mmol l lactate , 18 8 mmol l base excess \( \) comparison made ability qt , bp , shed blood , , lactate predict oxygen debt conclusions single variable predictors , shows highest explained variability however , combined prediction lactate appears superior use either alone using regression oxygen debt , possible estimate accurately actual level oxygen debt lactate values obtained hemorrhagic serial determinations time increase biochemical variables oxygen debt baseline , possible estimate rate oxygen debt accumulation time remaining ld50 reached indicators severity total body ischemia resulting hemorrhagic shock
long term postthoracotomy pain used pain questionnaire evaluate prevalence functional significance long term postthoracotomy pain data 56 patients least 2 months analyzed thirty patients \( 54 percent \) median follow 19 5 months persistent pain 26 others pain free median 30 5 months postthoracotomy pain reported 24 44 patients \( 55 percent \) one year surgery , 13 29 patients \( 45 percent \) two years , six 16 \( 38 percent \) three years , three ten patients \( 30 percent \) greater four years postthoracotomy pain intensity low , 13 patients stated pain slightly moderately lives five 56 patients sufficiently severe chronic pain require either daily analgesic use , nerve blocks , relaxation therapy , acupuncture , referral pain clinic conclude long term chest wall pain common postthoracotomy generally severe , small proportion patients may experience persistent , moderately disabling pain
stress induced secretion diurnal responses decreases stress evening dependent corticosterone test whether diurnal rhythm stress responsiveness dependent corticosterone \( b \) mediated negative feedback , responses intact \( sham \) adrenalectomized \( adx \) rats restraint 3 90 minutes ip injection saline morning \( \) evening \( pm \) compared sham adx rats , acth responses restraint stress larger intact rats , could resulted fast negative feedback , due rate rise b stress pm , delayed negative feedback , due high basal concentrations b stress pm however , diurnal pattern stress responsiveness dependent b , relative responses restraint ip injection found adx rats determine whether lack response adx rats pm stress due loss sensitivity endogenous secretagogues , adx rats given crf arginine vasopressin \( avp \) anesthetized ether 30 min restraint pm , able respond exogenous secretagogues second novel finding pm , , plasma acth concentrations adx rats decreased substantially period restraint , despite lack b mediated negative feedback pm , adx rats 30 min stressed ether 6 min acth concentrations different ether , suggesting , although adx rats able respond exogenous crf avp stress , additional stress ether exposure longer stimulates endogenous crf avp release 30 min restraint either time day 90 min restraint pm , relationship acth b positive , negative , providing evidence ongoing b mediated negative feedback sham rats therefore , mechanism responsible decrease acth secretion adx rats may occur sham rats well results , conclude diurnal rhythm stress responsiveness , pm adx rats , decrease plasma acth stress , largely independent b
military family syndrome revisited numbers concerns raised high levels psychopathology military children , authors used standardized psychopathology rating scales survey 213 six twelve year old children military parents parents results children 's symptom self reports , well ratings children , indicated children 's symptom levels levels consistent national norms contrast , parents' \( especially \) ratings children significantly higher national norms , parents' ratings symptoms also , parents' symptom reports showed somewhat stronger relationships life stressors presumably affecting child children 's reports results suggest parents' reports children 's symptoms may mediated effects military life stressors parents , stressors necessarily result higher symptoms children overall results support notion levels psychopathology greatly increased children military parents studies military families address effects rank socioeconomic status , , current impact life stressors parents well children order avoid drawing conclusions parts military community
outpatient orthognathic surgery criteria review cases 9 year period , 87 orthognathic procedures performed outpatient environment procedures performed included horizontal mandibular osteotomies , rapid palatal , bilateral sagittal split osteotomies , posterior anterior maxillary osteotomies , le osteotomies fourteen patients subsequently admitted hospital either observation full inpatient care rates admission varied procedures , length anesthesia statistically related frequency admission patient selection criteria facilities used reviewed
mechanisms vein graft atherosclerosis ldl metabolism endothelial actin explored effect arterial hemodynamics endothelial cell morphology low density lipoprotein metabolism human saphenous vein segments harvested tissue donors arterial pulsatile perfusion system used physiologic pressures flows 20 hours saphenous vein \( control \) femoral artery segments venous perfusion apparatus also employed perfusion second \( control \) saphenous vein segment period time calculations fluid shearing wall tensile stresses performed related induced changes endothelial cell geometry cytoskeletal actin organization incorporation , degradation , localization intact low density lipoprotein within vessel wall results indicate , compared native arteries veins , 20 hour exposure test saphenous veins arterial hemodynamics induced \( 1 \) significant increase endothelial cell luminal surface area perimeter independent alignment flow , \( 2 \) dense peripheral band actin concomitant assembly stress fibers , \( 3 \) two fourfold elevation low density lipoprotein content , localized primarily within subendothelial intima although exact mechanisms underlying results uncertain , focal accumulation intramural low density lipoprotein may related loss normal barrier function endothelial cell enlargement , accompanied transient cytoskeletal adaptation arterial flow
senescence nickel transformed cells x chromosome possible control transfer normal chinese hamster x chromosome \( carried mouse donor cell line \) nickel transformed chinese hamster cell line chromosome deletion resulted previously cells early passages cx donor cells , hamster x chromosome highly active , inducing senescence 100 colonies obtained transfer nickel transformed cells however , senescence reduced 50 chinese hamster x chromosomes transferred later passage cells full activity intact hamster x chromosome restored treatment donor mouse cells 5 , induced dna results suggest senescence gene genes , may located chinese hamster x chromosome , regulated dna , escape senescence possibly loss tumor suppressor gene activity occur mechanisms
laparoscopic cholecystectomy report 82 cases initial experience 82 patients , laparoscopic cholecystectomy shown numerous advantages open cholecystectomy intraoperative blood loss postoperative need pain medication minimal patients discharged within 24 36 hours resumed normal activities within 3 5 days aesthetic aspect also obvious advantage , since laparoscopic procedure avoids abdominal scars previous abdominal surgery contraindication attempting procedure based experience , laparoscopic cholecystectomy done safely patients candidates open cholecystectomy , including elderly , obese , acute cholecystitis
study influence left bundle branch block signal averaged electrocardiogram qualitative quantitative analysis study influence left bundle branch block \( lbbb \) signal averaged electrocardiogram \( saecg \) , quantitative qualitative analyses saecg parameters undertaken 48 patients electrocardiographic evidence intrinsic lbbb 39 patients normal surface qrs duration \( less 120 msec \) underwent right ventricular pacing induced lbbb assumed pacing right ventricular apex suitable model conduction defect sustained monomorphic ventricular tachycardia \( \) inducible 16 48 patients intrinsic lbbb 23 39 patients pacing induced lbbb utilizing filter setting 25 250 hz , late potentials defined total filtered qrs duration greater equal 120 msec , root mean square voltage terminal 40 msec \( rms 40 \) less equal 25 microv , duration signals less 40 microv \( las 40 \) greater equal 38 msec rms 40 las 40 criteria used patients lbbb prolongation las 40 fragmentation signals terminal portion filtered qrs characteristic patients lbbb aberration patients intrinsic lbbb , mean total filtered qrs duration , rms 40 , las 40 inducible patients significantly different \( 170 28 , 16 10 , 55 24 , 153 18 msec , 25 10 microv , 33 16 9 msec p 0 04 , 0 009 , 0 007 , respectively \) patients normal qrs duration demonstrated 60 decrement mean rms 40 value pacing induced lbbb changes resulted 59 false positive incidence late potentials pacing induced lbbb correlated similarly low mean rms 40 value patients intrinsic lbbb inducible , hence giving rise false positive incidence late potentials 63 since standard rms 40 las 40 criteria resulted low specificity positive predictive value , new parameters selected analyzed combination rms 40 less equal 17 microv plus las 40 greater equal 55 msec yielded best overall statistical result , sensitivity , specificity , total predictive accuracy 69 , 81 , 77 , respectively conclusion \( 1 \) reduction rms 40 , prolongation las 40 , fragmentation signals terminal portion filtered qrs characteristics lbbb \( abstract truncated 400 words \)
short term variability ventricular arrhythmia rapid assessment drug efficacy statistical criteria suppression ventricular arrhythmia defined means 50 short term drug tests performed 24 patients patient 's spontaneous variability \( sv \) evaluated linear regression analysis hour hour changes ectopy 24 48 hour holter monitoring response single oral dose , 300 mg , , 200 mg , propafenone , 450 mg , measured trial lasting 4 hours lidocaine administered intravenously incremental doses 4 mg min evaluated 3 hours threshold values ventricular arrhythmia corresponding 95 confidence limits calculated baseline recordings used ascertain likelihood true drug effect minimum decrease hourly ectopy indicating arrhythmia suppression averaged 90 9 , increase least required effect efficacy criteria applied , 16 50 short term tests revealed drug effect contrast , 70 threshold derived studies daily variability employed , 7 50 trials negative thus individual determination hourly arrhythmia variability yields stringent criteria extrapolation day day spontaneous variation
prosthetic valves children adolescents purpose paper present short long term results prosthetic valve replacement children 7 year period ended april 1985 , 186 children , ages 1 20 years , underwent valve replacement 55 \( 30 \) aortic valve replacements , 95 \( 51 \) mitral valve replacements , 36 \( 19 \) multiple valve replacements ninety four percent lesions rheumatic origin , 4 congenital , 2 infectious 223 valves replaced , 175 \( 78 \) mechanical valves 48 \( 22 \) latter mitral position three patients surgical mortality rates 3 6 , 4 2 , 19 4 respectively aortic valve , mitral valve , multiple valve replacements five year actuarial survival 91 aortic valve replacement , 82 mitral valve replacement 60 multiple valve replacement major events included reoperation 34 \( three deaths \) , progressive myocardial failure led death 10 , sudden unexpected death two , thromboembolic complications 19 \( death five \) , subacute bacterial endocarditis five \( two deaths \) , bleeding required transfusion two patients five year complication free actuarial survival rates 83 aortic valve replacement , 63 mitral valve replacement , 57 multiple valve replacement respective five year complication free survival rates 83 , 48 , 43 significant morbidity mortality rates associated valve replacement therefore every effort made preserve native valve plastic reparative procedures prosthetic replacement mitral valve , data would suggest inserted children 15 years age younger , although may used children 15 years age expectation valve survival comparable mechanical valves complications associated anticoagulant therapy reviewed , platelet inhibiting drugs seem quite satisfactory patients aortic valve replacement patients mitral valve replacement seem require warfarin therapy , warfarin must used patients multiple valve replacement reduce risk thromboembolic complications
improved molecular diagnostics ornithine transcarbamylase deficiency since cloning cdna x linked ornithine transcarbamylase \( otc \) 1984 , diagnostic accuracy otc deficiency prenatal carrier detection greatly improved use linkage analysis however , use rflp based diagnosis limited new mutation diseases report use direct mutation detection new pcr based techniques experience linkage based diagnosis 18 families previously reported use chemical cleavage detect mutations first amplified mrna genomic dna patients technique utilized prenatal diagnosis primers specific amplification otc exons 1 , 3 , 5 , 9 , 10 developed employed map deletions otc gene two families primers also used detect alterations sites found exons 1 , 3 , 5 , 9 four novel mutations otc gene leading abolition site otc cdna discovered one mutations exon 1 two lie exon 3 one exon 9 addition , used pcr products probes identify exon specific bands seen southern blots map polymorphic sites , commonly used linkage analysis information facilitate interpretation altered band patterns seen deletion cases cases point mutations affecting restriction sites utilization appropriate combination molecular techniques permitted accurate diagnostic evaluations 17 18 families
new approaches diagnosis , prevention , treatment cytomegalovirus infection transplantation infection occurring solid organ transplantation continues exert considerable detrimental effect upon patient allograft survival search better targeted immunosuppressive regimens continues , must seek improve ability diagnose treat infections occur transplantation viral infections general , cytomegalovirus \( cmv \) infections particular , represent area substantial progress made improvement diagnostic modalities allowed rapid precise identification cmv infection disease , use antiviral agents possess activity cmv allowed prophylaxis treatment frequently life threatening disease prophylactic use presently available agents combination development less toxic , potent anti cmv agents serve lessen impact cmv disease upon field solid organ transplantation
bacterial overgrowth intestinal atrophy etiology gut barrier failure rat bacterial translocation occurs animal models shock , trauma , sepsis , parenteral elemental enteral bowel atrophy cecal bacterial overgrowth implicated pathophysiology bacterial translocation many models define etiology bacterial translocation resulting dietary manipulations , rats fed elemental defined formula diet \( \) 2 weeks ad libitum randomized either intestinal decontamination nonabsorbable antibiotic \( neomycin \) antibiotic treatment neomycin treatment significantly \( p less 0 01 \) reduced incidence bacterial translocation , association significant reduction number cecal gram negative bacteria neither loss bowel mass bowel composition affected oral neomycin bacterial translocation would thus appear result cecal bacterial overgrowth rather loss physical intestinal barrier due atrophy
arterial oxygen saturation induction anaesthesia three groups 10 asa 1 patients studied determine incidence hypoxaemia \( oxygen saturation less equal 90 \) using pulse oximetry induction anaesthesia , whether simple oxygenation techniques could prevent occurrence also surveyed three major hospitals ascertain techniques method anaesthesia anaesthesia induced patients thiopentone maintained nitrous oxide isoflurane first group received 33 oxygen nitrous oxide carrier gases , second group normal breaths 100 oxygen thiopentone administration followed 33 oxygen nitrous oxide , third group received 100 oxygen loss reflex spontaneous breathing established patient received positive pressure ventilation spontaneous breathing established six 10 patients first group became compared none second group , three patients became third group thirty seven percent responded survey either apply positive pressure ventilation establishment spontaneous breathing , prolonged one anaesthetist fully pre oxygenated patients lungs conclude avoid likely occurrence hypoxaemia induction mask anaesthesia , minimum breaths pre oxygenation necessary
randomised double blind study interpleural analgesia cholecystectomy continuous interpleural analgesia provided 4 hourly injections 20 ml bupivacaine 0 5 adrenaline 5 micrograms ml compared placebo randomised , double blind study cholecystectomy patients self administered intravenous morphine using patient controlled analgesia device highly significant difference mean morphine consumption groups \( 72 mg compared 22 mg \) visual analogue pain scores tended lower bupivacaine group throughout significant 2 hours respiratory function measurements significantly different groups mean peak venous plasma bupivacaine concentration sixth dose 3 03 micrograms ml symptoms suggestive local anaesthetic toxicity occurred concluded regimen provide effective continuous analgesia cholecystectomy combined administration interpleural bupivacaine systemic morphine effective morphine alone immediate postoperative period doses bupivacaine required optimal use technique lead significant total plasma bupivacaine concentrations within 24 hours
patients' expectations patient controlled analgesia patient controlled analgesia increasingly popular method postoperative pain relief however , patients often new therapies eighty asa 1 2 patients aged 18 65 years asked list advantages disadvantages using patient controlled analgesia important advantage perceived patients reduced time spent nurses giving medication , concern direct personal contact would also preservation self control , autonomy , rapid onset analgesia , ability analgesia lack injections seen advantage addiction machine seen minimal problems preservation patient nurse contact great importance ensure success postoperative analgesia
patient controlled analgesia children report experience introducing patient controlled analgesia royal hospital sick children , glasgow twenty five children used technique orthopaedic general surgery using system pump loaded 1 mg kg morphine sulphate 50 ml bolus dose 0 02 mg kg \( 1 ml \) interval 10 minutes initial settings dose used , pain sedation scores , respiratory rate arterial oxygen saturation recorded ages ranged 5 15 years \( mean 9 6 \) method used mean 48 hours operation morphine requirements averaged 26 \( micrograms kg \) hour \( sd 10 6 \) pain control good sedation minimal adverse effects minor education patients , parents nurses essential success safety technique effective safe means providing good quality analgesia school age children
clinical efficacy oral transdermal clonidine combinations perioperative period attempt maintain stable levels alpha 2 adrenergic agonist throughout perioperative period , two different oral transdermal clonidine dosage regimens administered according randomized , double blind , placebo controlled study patients undergoing abdominal surgery determined clinical efficacy high low dose clonidine regimen sedation , hemodynamic parameters , anesthesia , analgesia low dose clonidine group patients \( n 14 \) received 7 cm2 clonidine transdermal patch \( 2 \) , supplemented oral doses clonidine approximately 3 micrograms kg 1 evening prior surgery morning surgery high dose clonidine group \( n 14 \) received 10 5 cm2 clonidine transdermal patch \( 3 \) oral clonidine approximately 4 5 micrograms kg 1 bedtime 6 0 micrograms kg 1 morning surgery placebo treated \( control \) patients received occlusive patch without active oral placebo tablets bedtime morning surgery medication included midazolam 50 micrograms kg 1 intramuscularly \( im \) anesthesia induced alfentanil 30 micrograms kg 1 intravenously \( iv \) , thiopental 3 mg kg 1 iv , vecuronium 0 1 mg kg 1 iv , maintained 70 nitrous oxide oxygen continuous infusion alfentanil 0 5 microgram kg 1 min 1 isoflurane added blood pressure exceeded 110 patient 's value pain relief postoperatively , patients received morphine , 1 2 mg iv boluses , via patient controlled analgesia pump low dose clonidine patient group mean plasma clonidine concentrations varied 1 47 ng ml 1 \( preoperative \) 1 32 ng ml 1 \( postoperative day 2 \)
beneficial effect upper thoracic epidural anesthesia experimental hemorrhagic shock dogs influence circulating catecholamines question whether reduction plasma catecholamine concentration contributes beneficial effects upper thoracic epidural anesthesia survival hemorrhagic shock examined twenty six dogs anesthetized halothane nitrous oxide , blood withdrawn reduce mean arterial blood pressure \( map \) 40 mmhg 12 dogs group received upper thoracic epidural anesthesia hemorrhage intravenous infusion epinephrine \( 450 ng kg 1 min 1 \) norepinephrine \( 150 ng kg 1 min 1 \) hemorrhage 14 dogs group b received none 20 min start bleeding , plasma catecholamine concentrations increased groups ten fold significant intergroup differences respect concentrations point experimental period 100 min period hemorrhage , 1 12 animals group 10 14 group b died significant difference survival seen two groups 100 min hypotensive period \( p less 0 01 generalized wilcoxon test \) results suggest survival benefit upper thoracic epidural anesthesia cannot explained simply differences level catecholamines plasma , perhaps differences level catecholamines nerve factors may important
memory retraining support educational memory retraining package specifically designed facilitate head injured patients educational environment described two adolescent patients severe head injuries administered memory retraining package approximately three months postinjury single case study multiple baseline design used evaluate efficacy memory retraining program results suggested promising improving memory functioning facilitating educational , moderate rather severe memory deficits involved studies involving groups patients collection data required confirm usefulness
interleukin 6 receptor expressed human megakaryocytes vitro effects proliferation interleukin 6 \( il 6 \) cytokine plays important role megakaryocytic differentiation recently , observed il 6 synthesized several human cell lines megakaryocytic features study , investigated whether similar phenomenon occurs normal megakaryocytic differentiation human megakaryocytes \( mk \) obtained culturing normal marrow liquid culture aplastic plasma \( ap \) first , il 6 secretion bone marrow culture enriched mk well purified mk populations demonstrated biologic assay second , il 6 mrna detected purified population mk polymerase chain reaction dot blot analysis il 6 mrna protein undetectable platelets third , situ hybridization procedure demonstrated presence il 6 mrna individual immature mk fourth , il 6 protein detected mk level phosphatase technique using monoclonal antibody il 6 furthermore , presence il 6 receptor \( il 6 r \) mk demonstrated situ hybridization using il 6 r probe situ autoradiography binding 125i labeled recombinant il 6 il 6 endogenously produced liquid cultures containing normal human plasma ap subsequently neutralized resulted 50 decrease mk growth minor shift ploidy distribution toward lower values cultures addition anti il 6 antibodies led 42 decrease colony number cultures stimulated il 3 conditions culture results suggest normal human megakaryocytopoiesis might regulated part il 6 autocrine loop
molecular characterization erythrocyte glycophorin c variants human erythrocyte glycophorin c plays functionally important role maintaining erythrocyte shape regulating membrane mechanical stability immunochemical serologic studies identified number glycophorin c variants include , , phenotypes report molecular characterization variants amplification glycophorin c mrna phenotype , using two oligonucleotide primers span coding domain , generated 338 bp fragment compared 395 bp fragment generated amplification normal glycophorin c mrna sequencing mutant 338 bp fragment identified 57 bp deletion corresponds exon 2 glycophorin c gene similar analysis showed deletion 84 bp exon 3 phenotype contrast generation shorter normal dna fragments mrna amplification phenotypes , amplification mrna phenotype generated normal sized fragment sequencing dna fragment showed g substitution nucleotide 23 coding sequence , resulting substitution asparagine serine modification accounts altered glycosylation glycophorin c seen phenotype results enabled us characterize glycophorin c variants three different phenotypes involve deletions exons 2 3 glycophorin c gene , well point mutation exon 1 results altered glycosylation protein
metastatic tumors unknown origin clinical appearance metastatic lesions without obvious primary source tumor common event tumor registry figures epidemiologic data grossly actual frequency unknown , primary sites often assigned patients best basis without positive proof tumor 's origin majority patients whose primary tumors continued detection , extensive use diagnostic imaging studies fails produce information alters patients' clinical course rare exceptions cited , exceptions prove general rule imaging studies therefore targeted selected patients disseminated malignancies identification primary tumors could benefit quality life length survival
conditioning biphasic defibrillator waveforms enhances refractoriness fibrillation mechanism biphasic waveform defibrillation threshold reduction unknown tested hypothesis , refractory period stimulation , first pulse biphasic waveforms facilitates excitation channel recovery , enhances graded responses produced second pulse prolongs cellular refractoriness fibrillation compared monophasic stimulus monophasic \( 10 msec , wave \) symmetrical biphasic \( 10 msec , pulse \) current injection s2 stimuli 1 5 two times s1 threshold used scan s1 action potential refractory period \( s1 cycle length , 600 msec \) myocardial cell aggregates s2 waveforms delivered normal reversed test action biphasic waveforms responses s3 stimulus , simulated potential fibrillation wavefront , also determined results showed biphasic s2 waveforms produced longer graded responses immediately s1 refractory period corresponding monophasic s2 waveforms maximum difference response duration produced biphasic monophasic waveforms 58 6 10 0 msec \( p less 0 001 \) maximum difference occurred 10 msec end s1 refractory period longer response durations produced biphasic s2 also produced longer refractoriness s3 stimulus maximum difference total refractoriness s3 51 8 2 8 msec \( p less 0 002 \) occurred coupling interval maximum difference s2 response duration prolonged refractoriness may protect ventricular cells act cellular basis greater biphasic waveform defibrillation efficacy
endothelium dependent responses long term human coronary artery bypass grafts present study , responses long term human coronary artery bypass grafts \( cabgs \) known endothelium dependent vasodilators , acetylcholine , calcium ionophore a23187 , thrombin , histamine , well nitric oxide , putative endothelium derived relaxing factor , studied sixteen isolated within 1 2 hours hearts 14 patients receiving cardiac transplant total 109 ring segments prepared cabgs studied vitro duration cabgs ranged 7 months 12 years addition acetylcholine \( 0 01 10 microm \) , calcium ionophore a23187 \( 0 01 1 0 microm \) , thrombin \( 0 01 1 0 unit ml \) , histamine \( 0 01 1 0 microm \) consistently produced dose endothelium dependent relaxation , reaching maximum 35 3 3 3 , 45 3 5 5 , 26 9 4 8 , 17 8 2 5 \( mean sem \) , respectively significant difference observed among cabgs different duration transplantation , whereas relaxant responses different segments along entire length cabg markedly different latter differences endothelium dependent responses appear correlate inversely development intimal proliferative lesions cabgs addition nitric oxide \( 0 01 10 microm \) produced potent dose endothelium independent relaxation , also slightly depressed cabgs severe intimal proliferation results demonstrate long term transplanted human saphenous vein grafts retain endothelium dependent responses development severe intimal proliferative lesions , rather duration grafts , result marked alterations reactivity transplanted cabgs
oral clofilium produces sustained lowering defibrillation energy requirements canine model effect long term oral administration antiarrhythmic drugs defibrillation energy requirements well understood examined effect clofilium , drug prolongs cardiac action potential duration without slowing cardiac conduction , defibrillation energy requirements ventricular effective refractory periods canine model 3 week period epicardial patch electrodes implanted 12 dogs , baseline testing conducted fentanyl anesthesia day 7 oral clofilium \( 100 mg day \) regimen started day 8 six clofilium treated six control dogs underwent repeated testing days 14 , 21 , 28 surgery truncated shocks given repeatedly various stored random order delivered current impedance measured delivered energy calculated energy current 50 success defibrillation \( , respectively \) determined control animals , increased mean 34 78 , 60 83 , 69 122 compared baseline \( day 7 \) days 14 , 21 , 28 , respectively contrast , clofilium treated dogs decreased 39 62 , 24 33 , 32 15 days 14 , 21 , 28 , respectively mean current requirements \( \) remained relatively stable compared baseline control animals \( 7 39 , 25 36 , 40 75 days 14 , 21 , 28 , respectively \) clofilium administration decreased 36 22 , 32 17 , 33 17 days 14 , 21 , 28 , respectively
life table analysis intravenously gonadotropin releasing hormone treated patients amenorrhea success pulsatile intravenous \( iv \) gonadotropin releasing hormone \( gnrh \) treatment patients amenorrhea studied retrospectively using life table analysis two hundred forty four ovulatory cycles 48 patients evaluated cumulative conception rate 12 cycles 93 , mean conception rate 22 5 per cycle comparing cycles 1 6 cycles 7 12 , significant difference conception rate observed subdivisions made relative presence additional infertility factors , history weight loss , actual weight , status , primary versus secondary amenorrhea life table curves patients either without infertility factors significantly different statistically significant differences found subdivisions concluded iv gnrh therapy highly successful patients amenorrhea , especially infertility factors present
response plasma , corticotropin , cortisol , luteinizing hormone corticotropin releasing hormone stimulation test eumenorrheic amenorrheic athletes compared pituitary response corticotropin releasing hormone \( crh \) test 9 eumenorrheic 10 amenorrheic endurance athletes maximal oxygen capacity \( vo2max \) , determined using exercise test bicycle ergometer , larger amenorrheic \( 62 7 1 0 se ml min per kg \) eumenorrheic \( 54 7 2 3 ml min per kg \) athletes 100 micrograms bolus human crh administered intravenously , blood samples collected 15 , 0 , 30 , 60 , 90 , 120 minutes mean basal concentrations , hormone \( acth \) , cortisol show significant differences groups cumulative response acth crh test larger eumenorrheic \( 7 7 1 3 pmol l \) amenorrheic \( 3 6 0 6 pmol l \) athletes , response cortisol differ groups negative correlation found vo2max acth response crh test total group athletes findings indicated changes function hypothalamic pituitary adrenal axis amenorrheic athletes attributed intensive training
evaluation therapy breakthrough bleeding women using oral contraceptive study designed investigate incidence pattern breakthrough bleeding \( btb \) 1 , 259 women prescribed first time oral contraceptive \( oc , 7 7 7 \) evaluate hypothesis management btb persisting three cycles new users compared control group women used various least 6 months incidence btb control group 16 8 new users 24 9 , 17 5 , 15 3 first 3 months , respectively breakthrough bleeding occurred late 7 7 7 package 58 early package 17 25 , respectively hypothesized late package btb would improve patient switched monophasic pill similar relatively formulation beginning package vice versa early btb seventy women btb 3 months randomly given 0 5 35 1 35 3 months breakthrough bleeding likely \( p less 0 05 \) improve women switched 1 35 compared 0 5 35 regardless package btb occurred
steroid hormone abnormalities women severe idiopathic constipation patients severe idiopathic constipation almost exclusively women reproductive age investigate possibility sex hormone abnormality condition , compared range sex hormones follicular luteal phases menstrual cycle 23 healthy women \( mean age 33 years \) 26 patients severe idiopathic constipation \( mean age 32 years , spontaneous bowel frequency less one per week \) patients reduction follicular phase progesterone \( 4 5 v 4 nmol l , p 0 006 , median value , controls v patients \) , 17 \( 9 7 v 5 8 nmol l , p 0 01 \) , cortisol \( 387 v 245 nmol l , p 0 008 \) , testosterone \( 2 3 v 1 8 nmol l , p less 0 001 \) , \( 10 3 v 8 4 nmol l , p 0 02 \) , dehydroepiandrosterone sulphate \( 5 1 v 3 0 mumol l , p 0 03 \) luteal phase reduction oestradiol \( v 350 pmol l , p 0 015 \) , cortisol \( v 242 nmol l , p 0 \) , testosterone \( 2 4 v 1 7 nmol l , p 0 003 \) concentrations sex hormone binding globulin , prolactin , hormone , follicle stimulating hormone significantly different either phase cycle women severe idiopathic constipation consistent reduction steroid hormones
fatigue failure noncemented porous coated implants retrieval study causes mechanical failure five noncemented porous coated components studied two cobalt chromium alloy three titanium alloy implants fractured 12 48 months implants included one acetabular component , one femoral condylar , one patellar two tibial components examination fractured surfaces revealed fatigue mechanism failure cases porous coating processes required resulted reduction substrate thickness additional factors stress concentration due limited , bone ingrowth , features design implants
cemented uncemented femoral components evaluated initial stability cemented uncemented femoral components within femoral canals cadaver simulated single limb stance stair climbing types stable simulated single limb stance \( maximum 42 microns cemented 30 microns uncemented components \) however , simulated stair climbing , cemented components much stable uncemented components \( 76 microns 280 microns \) also greater variation stability uncemented components simulated stair climbing , two seven components moving 200 microns future implant designs aim improve initial stability cementless femoral components loads improve chances bony ingrowth
repair cartilage lesions using biological implants comparative histological biomechanical study goats report experimental use three different biological implants restore articular surface defects glutaraldehyde fixed bovine meniscal xenograft , glutaraldehyde fixed bovine cartilage xenograft , viable allografts grafts implanted knees 19 goats allowed free field activity studied one year natural articular surfaces meniscal provided excellent articular surfaces times equally good articular surfaces restored host tissue growth covering cartilage grafts six months , 12 months surface degenerated majority allografts survived integrated host six months , many showed signs failure 12 months three seven defects healed completely six months healed surfaces 12 months
successful treatment severe premenstrual syndrome combined use gonadotropin releasing hormone agonist estrogen progestin although ovarian use long acting gnrh agonist \( gnrh \) provides effective treatment premenstrual syndrome \( pms \) , use limited resultant study effects estrogen progestin replacement symptomatic improvement afforded gnrh evaluated eight women severe pms 8 month study design included 2 months control , 2 months gnrh alone , 4 months exogenous steroids replaced randomized , double blind , placebo controlled cross fashion using 1 month 1 \) conjugated estrogen \( cee \) days 1 25 , 2 \) 10 mg medroxyprogesterone acetate \( mpa \) days 16 25 , 3 \) cee \( days 1 25 \) plus mpa \( days 16 25 \) , 4 \) placebo alone mood physical symptoms measured daily valid reliable instrument , premenstrual experiences expected , administration gnrh alone resulted 75 improvement luteal phase symptom scores \( 17 8 4 8 vs 4 2 1 6 p less 0 01 \) combined sequential administration cee mpa addition gnrh effective maintaining reduced symptom scores seen gnrh alone superior addition cee alone , mpa alone , placebo combination cee mpa resulted 60 improvement \( p less 0 05 \) compared luteal phase control months behavioral \( 14 1 3 9 vs 4 2 0 8 \) total \( 17 8 4 8 vs 6 5 1 8 \) symptoms conclude undesirable consequence ovarian steroid deficiency treatment pms gnrh overcome addition sequential estrogen replacements without significantly reducing effectiveness gnrh disorder
intranasal administration neostigmine potentiates intravenous intranasal growth hormone \( gh \) releasing hormone induced gh release short children administration cholinergic agonists increases basal gh releasing hormone \( ghrh \) induced gh secretion , probably acting via inhibition endogenous somatostatin release aim study verify two groups children idiopathic short stature effect intranasal administration neostigmine \( inns 3 mg \) , cholinesterase inhibitor , basal gh levels well response ghrh peptide administered either iv \( ivghrh 1 microgram kg \) \( inghrh 10 micrograms kg \) group \( n 6 age , 10 6 16 0 yr \) inns induced significant gh increase inns vs saline , area curve \( auc mean sem \) , 263 7 60 2 vs 73 8 3 1 micrograms l h p less 0 03 potentiated response ivghrh \( inns ivghrh vs ivghrh , 183 0 vs 9 154 5 micrograms l h p less 0 03 \) group b \( n 6 age , 11 5 15 9 yr \) ivghrh induced gh rise clearly higher induced inghrh \( 2 154 3 vs 137 1 28 2 micrograms l h p less 0 03 \) administration inns induced gh rise similar occurring inghrh \( auc , 239 2 69 5 micrograms l h \) markedly increased inghrh induced gh response \( 4 103 6 micrograms l h p less 0 05 0 03 vs inns inghrh , respectively \) , induced ivghrh alone conclusion , cholinergic agonists neostigmine able increase basal ghrh induced gh secretion short children even given combined intranasal administration neostigmine ghrh \( 10 micrograms kg \) able induce gh rise similar induced ivghrh alone \( 1 microgram kg \) , suggesting potential usefulness combination cocktail route administration treatment short stature
screening nineteen unrelated families generalized resistance thyroid hormone known point mutations thyroid hormone receptor beta gene detection new mutation generalized resistance thyroid hormone \( grth \) syndrome characterized impaired tissue responsiveness thyroid hormone two distinct point mutations hormone binding domain thyroid hormone receptor \( tr \) beta recently identified two unrelated families grth one , mf , involves replacement normal glycine 345 arginine exon 7 another , mh , normal proline histidine exon 8 probe presence mf mh defect 19 unrelated families grth , applied separate polymerase chain reactions using allele specific oligonucleotide primers containing normal two mutant nucleotides 3' position total 24 affected subjects 13 normal family members studied mode inheritance dominant 13 families , unknown 5 families , clearly recessive 1 family consanguineous subjects affected primers containing substitutions specific mf mh amplified exons 7 8 , respectively , affected members two index families primers containing normal sequences amplified exons 7 8 tr beta gene subjects except affected members one family family inherited grth , neither exon could amplified using combinations primers dna blot revealed absence coding exons results indicate major deletion tr beta gene , including dna hormone binding domains since heterozygous members family affected , presence single normal allele sufficient normal function tr beta data also support hypothesis dominant mode grth inheritance presence abnormal tr beta interferes function normal tr beta distinct mutations probably responsible grth unrelated families
murine mast cells synthesize basement membrane components potential role early fibrosis mast cells resident tissues , particularly association endothelial epithelial cell basement membranes , increase sites inflammation , injury , fibrosis although mast cells known release generate proinflammatory molecules response inflammatory stimuli , little known normal biologic function demonstrate il 3 dependent mouse mast cells , mouse bone marrow derived mast cells , rat basophilic leukemia cells express large amounts mrna collagen iv , laminin , heparan sulfate proteoglycan western blot analysis confirmed mast cells synthesize secrete significant amounts collagen iv laminin b1 b2 chains data suggest mast cells may contribute normal tissue repair early overproduction basement membrane components seen variety fibrotic conditions
nursing home patients transferred ambulance va emergency department nursing home residents frequently transferred hospital emergency departments delayed transfer may lead poor outcomes however , inappropriate transfer elderly may cause social financial problems prospectively evaluated 221 consecutive ambulance transfers community nursing homes va emergency department objectives study describe process outcomes transferred patients determine alternative interventions feasible results indicate problems nearly half study group could treated nursing home physician minimal medical equipment admitted hospital \( 52 \) seriously ill , prolonged lengths stay \( 23 6 days \) , high mortality rate \( 11 \) complex issues physician reimbursement , nursing home , day day appear involved decisions transport patients ambulance va emergency departments
endothelial cell human lymphocytes inhibited transforming growth factor beta 1 recombinant human transforming growth factor beta \( tgf beta \) found inhibit adhesive phenotype human umbilical vein endothelial cells human pbl , purified lymphocytes , pha activated tgf beta inhibited lymphocyte attachment resting human umbilical vein endothelial cells also endothelial monolayers stimulated pro inflammatory cytokines tnf alpha il 1 beta investigations also show ability endothelial cells respond tgf beta altering lost prolonged culture cells however , loss selective tgf beta inhibits cell proliferation early late passage endothelial cells results suggest vivo tgf beta may inhibit adhesive phenotype endothelial cells also may limit immunologic response occurring endothelial cell barrier
cytokine release syndrome induced 145 2c11 anti cd3 monoclonal antibody mice prevention high doses methylprednisolone hamster mab 145 2c11 specific cd3 complex murine lymphocytes shares many properties okt3 , including induction cell activation vivo , injection 145 2c11 variety pathologic changes relation systemic release cytokines tested effects cytokine release syndrome different doses methylprednisolone \( \) given various intervals time 145 2c11 mab administration high doses \( 50 mg kg \) 2 3 h mab resulted almost complete inhibition systemic release tnf alpha , il 2 , il 6 far pathologic changes concerned , hypothermia , acute renal tubular necrosis , fatty infiltration liver completely prevented whereas hypoglycemia partially attenuated protective effect toxicity 145 2c11 confirmed reduction mortality rate among sensitized mice inhibition release cytokines affect immunosuppression triggered 145 2c11 assessed ctl activity alloantigens measured 48 h injection mab conclude administration high doses glucocorticoids 2 3 h 145 2c11 prevents release cytokines attenuates acute toxicity mab similar protocols could allow cytokine release syndrome induced okt3 mab man
lovastatin treated rodent new model barrier disruption epidermal hyperplasia recent studies linked epidermal cholesterol synthesis maintenance permeability barrier assess directly importance cholesterol synthesis , applied lovastatin , potent inhibitor cholesterol synthesis , hairless mouse skin transepidermal water loss \( tewl \) began increase four six daily applications co application cholesterol blocked expected increase tewl , demonstrating importance cholesterol development lesion histology lovastatin treated skin revealed epidermal hyperplasia , accompanied accelerated dna synthesis whereas cholesterol synthesis initially reduced lovastatin treated epidermis , treatment cholesterol synthesis normalized , fatty acid synthesis accelerated greatly although total free sterol content lovastatin treated epidermis remained normal , fatty acid content increased coincident barrier disruption finally , morphologic abnormalities body structure deposited , intercellular contents occurred coincident emerging biochemical abnormalities thus , abnormal barrier function model ascribed initial inhibition epidermal sterol synthesis followed alteration cholesterol fatty acid synthesis , leading imbalance stratum corneum lipid composition abnormal membrane structure
secretion unique collagen spontaneously transformed murine keratinocytes \( cells \) vitro spontaneously transformed murine keratinocyte cell line \( cell \) found secrete two linked collagenous polypeptides apparent molecular weight \( mw \) 190 kd 120 kd pulse experiments indicated 190 kd polypeptide secreted culture medium 2 h processed 120 kd collagen component within 4 h process inhibited edta 120 kd polypeptide sensitive pepsin , 50 kd fragment produced mild pepsin treatment 4 degrees c bromide peptide map 120 kd polypeptide distinct types , ii , iii , iv , v collagens properties indicate similarities type viii related collagen produced human astrocytoma cells secretion collagen rapidly reached maximum level first day culture subsequently declined cell proliferation accelerated processing 120 kd polypeptide observed culture conditions high cell density similar collagens also found produced normal human keratinocytes results indicate 120 kd polypeptide potentially functional protein may participate formation extracellular matrix keratinocytes
olfactory mucosa following injury olfactory bulb removal olfactory bulb performed rats attempt elucidate processes olfactory dysfunction following head injury degeneration regeneration olfactory mucosa examined , histopathologically immunohistochemically used antisera olfactory marker protein \( \) neuron specific enolase \( nse \) marker mature olfactory receptor neurons following rapid degeneration , olfactory receptor neurons regenerated nse containing cells appeared 49 days later however , cell population numbers observed non operated , even three months later lack connection regenerated axons olfactory bulb may result immature neuronal replacement reduce number olfactory receptor neurons
enlarged adenoid adenoidectomy adults endoscopic approach histopathological study adenoid enlargement uncommon adults examination nasopharynx indirect posterior inadequate , many cases enlarged adenoid adults misdiagnosed accordingly study conducted 35 cases enlarged adenoid aged 20 42 years nasal endoscope utilized identify adenoid mass adenoidectomy endoscopic control performed excised material sent histopathological examination adenoidectomy resulted marked improvement 94 per cent cases without major complications histopathological examination revealed non specific inflammatory reaction 15 cases \( 43 per cent \) , pure reactive changes , predominantly follicular hyperplasia , two cases \( 6 per cent \) mixed pattern 18 cases \( 51 per cent \) endoscopic follow average 17 months identified recurrence two patients concluded enlarged adenoid tissue adults histopathological differences children adenoidectomy endoscopic control safe reliable
delayed positive gastrointestinal bleeding studies technetium 99m red blood cells utility second injection two patients studied technetium 99m labeled red blood cells \( rbcs \) gastrointestinal bleeding positive findings 24 hr delayed images , time site bleeding could ascertained instance , additional delayed images suggested active bleeding occurring , second rbcs labeled injected sites active hemorrhage identified following imaging patients delayed gi bleeding images positive , views obtained ascertain pattern intraluminal activity changes renewed active hemorrhage suspected , reinjection second dose labeled rbcs may identify bleeding site
warm heart surgery hypothermia widely fundamental component myocardial protection cardiac operations although prolongs period ischemic arrest reducing oxygen demands , hypothermia associated number major disadvantages , including detrimental effects enzymatic function , energy generation , cellular integrity hypothesized ideal protected state heart would arrested perfused blood , , aerobic arrest conditions fundamental need hypothermia becomes questionable developed novel approach myocardial protection cardiac operations based concepts , chemically arrested heart perfused continuously blood maintained 37 degrees c 121 consecutive coronary bypass procedures compared approach historical cohort 133 consecutive patients treated hypothermic cardioplegia perioperative myocardial infarction significantly less prevalent \( 1 7 versus 6 8 p less 0 05 \) warm cardioplegic group , use intraaortic balloon pump \( 0 9 versus 9 0 p less 0 005 \) prevalence low output syndrome \( 13 5 versus 3 3 p less 0 005 \) cardiac output immediately bypass significantly higher bypass \( 3 1 0 9 versus 4 9 1 0 l min p less 0 001 \) warm cardioplegia group furthermore , 99 2 patients treated continuous warm cardioplegia converted normal sinus rhythm spontaneously removal aortic compared 10 5 hypothermic group time removal aortic discontinuation cardiopulmonary bypass \( e , reperfusion time \) significantly shorter warm cardioplegia group \( 11 4 3 versus 27 5 6 minutes p less 0 001 \) results suggest continuous normothermic blood cardioplegia safe effective , represents new approach problem maintaining excellent myocardial preservation cardiac operations
studies controlled reperfusion ischemia reperfusate composition detrimental effects initial asanguineous cardioplegic washout acute coronary occlusion study tests whether initial asanguineous washout potentially toxic substances accumulate ischemia improves recovery produced blood cardioplegic reperfusion evaluates role plasma versus whole blood cardioplegia methods twenty four dogs underwent 2 hours occlusion left anterior descending coronary artery 20 minutes blood cardioplegic reperfusion total vented bypass 13 dogs , 5 minute infusion either crystalloid \( n 7 \) plasma \( n 6 \) cardioplegic solution \( containing ph , calcium potassium , blood cardioplegia \) given immediately reoxygenation blood cardioplegia regional oxygen uptake coronary vascular resistance measured controlled reperfusion , segmental shortening \( ultrasonic crystals \) , tissue water content , histochemical damage \( triphenyltetrazolium chloride stain \) assessed 1 hour bypass discontinued results asanguineous cardioplegic washout reoxygenation blood cardioplegic solution resulted progressive \( 42 \) increase coronary vascular resistances \( 123 176 units , p less 0 05 \) low oxygen utilization 20 minutes blood cardioplegic reperfusion \( 29 ml 100 gm , p less 0 05 \) coronary vascular resistance remained low throughout blood cardioplegic reperfusion without washout \( 109 98 units \) , oxygen utilization 54 ml 100 gm \( p less 0 05 \) neither plasma crystalloid washout restored substantial regional systolic shortening \( 3 systolic shortening versus 73 systolic shortening blood cardioplegia \) , asanguineous washout caused myocardial edema \( 81 1 80 9 versus 79 5 water content , p less 0 05 \) produced extensive transmural triphenyltetrazolium chloride damage \( 48 41 versus 8 area risk , p less 0 05 \) initial blood cardioplegic reperfusion conclusion asanguineous cardioplegic washout blood cardioplegic reperfusion limits oxygen utilization subsequent controlled reperfusion , early recovery systolic shortening , allows myocardial edema , produces extensive histochemical damage , may avoided initial reoxygenation blood cardioplegia red blood cells appear important plasma components blood cardioplegia
studies controlled reperfusion ischemia reperfusate composition effects leukocyte depletion blood blood cardioplegic acute coronary occlusion objectives study evaluates role leukocyte depletion initial reoxygenation normal blood blood cardioplegic limiting reperfusion damage methods twenty eight dogs underwent 2 hours ligation left anterior descending coronary artery initial reperfusate \( 37 degrees c \) delivered total vented bypass left anterior descending artery calibrated pump via internal mammary artery graft 50 mm hg 20 minutes eight dogs received normal \( , \) blood reperfusion \( leukocyte count mm3 \) six reperfused leukocyte depleted normal blood \( leukocyte count less 100 mm3 \) 14 dogs reperfused substrate enriched \( \) blood cardioplegic solution , six received cardioplegic solution leukocyte count less 100 mm3 results leukocyte depletion normal blood reduced reperfusion induced arrhythmias 63 17 \( p less 0 05 \) coronary vascular resistance initial reperfusion low remained low substrate enriched blood cardioplegic reperfusion normal reduced leukocyte counts contrast , coronary vascular resistance rose 63 normal blood reperfusion , increase avoided leukocyte depletion \( 2 6 versus 4 0 mm hg x ml min , p less 0 05 \) coronary vascular resistance 20 minutes , however , higher blood cardioplegia normal decreased leukocyte counts negligible functional recovery followed reperfusion normal blood leukocyte depleted blood \( 12 6 control systolic shortening \) contrast , substantial segmental recovery followed blood cardioplegic reperfusion \( 73 systolic shortening , p less 0 05 \) improved \( 81 systolic shortening \) leukocyte depletion normal blood reperfusate reduced histochemical damage 53 38 \( p less 0 05 \) , least histochemical damage followed blood cardioplegic reperfusion normal reduced leukocyte count \( 8 11 , p less 0 05 \) conclusions findings suggest important role leukocytes reperfusion damage , reperfusate leukocyte filtration alone inferior blood cardioplegic reperfusion leukocyte depletion blood cardioplegic solutions seems unnecessary 2 hours ischemia
long term suppression tremor chronic stimulation ventral intermediate thalamic nucleus usefulness high frequency stimulation ventral intermediate nucleus \( vim \) first neurosurgical procedure disabling tremor assessed 26 patients parkinson 's disease 6 essential tremor 7 patients already undergone contralateral stimulated side , 11 others bilateral vim stimulation time chronic stimulating electrodes connected pulse generator implanted vim tremor amplitude rest , posture holding , action assessed means 43 stimulated , 27 showed complete relief tremor 11 major improvement \( 88 \) improvement maintained 29 months \( mean follow 13 sd 9 months \) adverse effects mild could eradicated reduction cessation stimulation reversibility adaptability , allowing control side effects , make thalamic stimulation preferable , especially treatment sides brain needed
diaphragmatic fatigue produced constant modulated electric currents anesthetized rabbits efficiency phrenic nerve stimulation electric current studied either ventilation entirely bilateral nerve stimulation \( ventilation \) unilateral nerve stimulation animals ventilated pump open chest electric pulses \( \) constant amplitude frequency waves , amplitude frequency modulated controlled computer \( \) , used animal closely reproduced physiological shape pressure waves diaphragm fatigue , determined decrease maximal relaxation rate twitches , occurred 20 minutes bilateral unilateral nerve stimulation , 60 min \( unilateral stimulation \) 98 min \( bilateral stimulation \) data show importance motor signal pattern long lasting nerve stimulation
raf 1 protein kinase required growth induced nih 3t3 cells many growth factors regulate cytoplasmic raf 1 protein kinase , consistent central role transduction growth signals kinase expressed promote proliferation , presumably manner dependent growth factor receptors membrane associated oncogenes examined dependence serum tpa \( 12 tetradecanoylphorbol 13 acetate \) regulated nih 3t3 cell growth raf 1 kinase determine whether raf 1 essential receptor inhibited raf 1 function expressing c raf 1 antisense rna kinase defective c raf 1 mutants antisense rna c raf 1 interferes proliferation normal nih 3t3 cells raf transformed cells cells , dna replication induced serum tpa eliminated reduced proportionately reduction raf protein levels expression kinase defective raf 1 mutant \( \) regulatory domain fragment \( \) inhibited serum induced nih 3t3 cell proliferation raf transformation even efficiently inhibition antisense rna blocked proliferation transformation ki ha ras oncogenes conclude raf functions essential signal transducer downstream serum growth factor receptors , protein kinase c ras
effect flunarizine essential tremor investigated effect flunarizine treatment \( 10 mg \) 17 subjects essential tremor double blind placebo controlled design tremor assessed clinical scoring , recordings , subjective rating subjects 15 subjects completed study , 13 showed improvement conclude flunarizine effective treatment essential tremor
case diffuse sclerosis adult report case rapidly progressive cerebral demyelinating disease previously healthy 40 year old woman case diagnostic criteria diffuse sclerosis \( mds \) , unusual age onset 1st case mds adult full documentation clinical , biochemical , radiographic , pathologic features
full thickness skin graft treatment stenotic vagina vaginal stenosis following surgery radiation therapy lead report concerns successful use full thickness skin grafts taken flank overlying iliac crest treat vaginal stenosis operation consists involved area creating space become recipient site piece full thickness skin harvested area overlying iliac crest cleared underlying fat , fit recipient site , sutured place vaginal packing used keep graft recipient bed ten patients treated successfully technique , without significant complications sequelae follow 6 weeks 42 months showed excellent vaginal capacity patients similarly , excellent functional results achieved eight patients , distinct improvement remaining two procedure useful addition gynecologic surgeon 's armamentarium
activating protein interactions viral cellular src kinases activating protein \( gap \) , regulates activities ras proteins , implicated mitogenic signal transduction growth factor receptors tyrosine kinase activity oncogenic viral src \( src \) encoded sarcoma virus possesses elevated tyrosine kinase activity compared normal , cellular src \( p60c src \) examine molecular interactions gap two src kinases , immunoprecipitates src gap prepared cell resolved gel electrophoresis analyzed immunoblot procedure antibodies gap src used probes results suggest p60c src associated complex containing gap immunoprecipitates lysates normal rat chicken cells however , gap phosphorylated p60c src immunoprecipitates subjected vitro kinase reactions contrast , gap undergoes phosphorylation vitro immunoprecipitates src prepared transformed cell lysates incubated atp findings suggest src p60c src associate complexes containing gap provide biochemical link kinases gap ras signal transduction pathways results consistent hypothesis gap role mediating normal functions p60c src well oncogenic activities src
molecular basis activation tumorigenic potential gag insulin receptor previous study showed human insulin receptor \( ir \) could activated insertion 3' portion cdna encoding beta subunit retrovirus genome form gag ir fusion protein capable transforming cells culture , ir cdna containing virus , called uir , able induce tumors animals subsequently , isolated spontaneous variant called parental uir cloned , sequenced , found harbor two mutations 44 amino acid deletion immediately upstream transmembrane domain gag ir fusion protein removes extracellular sequence ir remaining original uir construct addition , single nucleotide deletion 3' end results truncation replacement carboxyl terminal 12 amino acids 4 new amino acids specific kinase activity 4 5 fold higher parental uir however , new cellular substrates detected transformed cells compared uir cells viruses containing either 5' 3' deletion mutation constructed assessed biological function data indicate 5' deletion alone sufficient confer tumorigenic ability conclude sequence immediately upstream transmembrane domain negative effect transforming tumorigenic potential gag ir fusion protein
transcriptional human virus maps bel 1 genomic region human virus \( hfv \) genome possesses three open reading frames \( bel 1 , 2 , 3 \) located env 3' long terminal repeat analogy human retroviruses region selected likely candidate encode viral results presented confirmed showed deletion introduced bel 1 open reading frame plasmid derived infectious molecular clone hfv abolished contrast , deletions bel 2 bel 3 minor effects ability role bel 1 genomic region investigated eukaryotic expression genome fragment hfv spanning bel 1 open reading frame construct expressing bel 1 control heterologous promoter found hfv long terminal repeat dose dependent fashion furthermore , shown region hfv long terminal repeat sufficient respond hfv
transgenic mice susceptible poliovirus poliovirus sensitive transgenic mice produced introducing human gene encoding cellular receptors poliovirus mouse genome expression receptor mrnas tissues transgenic mice analyzed using rna blot hybridization polymerase chain reaction human gene expressed many tissues transgenic mice tissues humans transgenic mice susceptible three poliovirus serotypes , mice inoculated poliovirus show clinical symptoms similar observed humans monkeys rabbit serum detects antigens mainly motor neurons anterior horn spinal cord nerve cells medulla pons paralyzed transgenic mice therefore , cell types sensitive poliovirus central nervous system transgenic mice appear identical humans monkeys furthermore , many doses oral poliovirus vaccine strains virulent strains required cause paralysis transgenic mice may reflect observation virulent strain efficiently central nervous system attenuated strain thus , transgenic mice may become excellent new animal model study molecular mechanisms pathogenesis poliovirus assess oral poliovirus vaccines
ability c product associate tubulin proto oncogene product , pp39mos , protein kinase cytostatic factor \( csf \) , activity eggs thought responsible arrest metaphase ii biochemical properties potential substrates pp39mos examined eggs transformed cells order study protein functions csf transformation pp39mos protein associated polymers conditions favor tubulin present approximately 500 kilodalton core complex conditions favor beta tubulin preferentially pp39mos immunoprecipitates major phosphorylated product pp39mos dependent immune complex kinase assay immunofluorescence analysis nih 3t3 cells transformed xenopus c showed pp39mos tubulin spindle metaphase disruption affected tubulin pp39mos organization way therefore appears pp39mos tubulin associated protein kinase may thus participate modification contribute formation spindle activity expressed somatic cells may responsible transforming activity pp39mos
cauda equina anatomy intrathecal nerve root organization three dimensional organization human cauda equina described previously partly due difficulties dissecting individual , nerve roots use newly developed situ fixation embedding technique 15 fresh human cadavers , cross sectional anatomy cauda equina defined l2 l3 l5 s1 highly consistent cross sectional pattern observed specimens lower sacral \( s2 \) roots located dorsal aspect thecal sac , whereas lumbar first sacral roots exhibited oblique , pattern motor bundle anteromedial respective sensory bundle within layer , held nerve roots fixed relationship one another previously undescribed three dimensional anatomy within thecal sac may aid understanding treatment trauma , syndromes , tumors cauda equina
1990 basic science cauda equina anatomy ii nerve roots dorsal root ganglia inconsistent data exist regarding anatomy spinal nerve roots lateral thecal sac newly developed situ technique used precisely define anatomic parameters 20 fresh human cadavers take angle nerve roots thecal sac decreases mean approximately 40 degrees l1 l5 22 degrees s1 motor bundles directly ventral sensory fibers within individual roots dorsal root ganglia size varies vertebral level majority ganglia lie directly beneath vertebral pedicles one third portion lateral intervertebral disc previously undescribed relationships may aid understanding lumbosacral disorders important note pedicle screw insertion , posterolateral decompression spinal trauma , paravertebral approaches lateral disc
prospective study patients sciatica comparison conservatively treated patients patients undergone operation , part patient characteristics differences groups based prospective study sciatica patients examined rhizography , aim determine factors others rhizography finding grade duration symptoms related selection patients undergo operation compared surgically treated patients , conservatively treated patients undergo operation pathologic rhizography findings attitudes possible surgery , often expressed desire , considered work physically stressful women group older lower pain indices women underwent operation conservatively treated patients negative rhizography severe occupational , minor expectations possible surgery , physically strenuous requiring difficult physical positions , lower indices pain adl operated patients social background problems emphasized sciatica patients conservatively treated rhizography
prospective study patients sciatica comparison conservatively treated patients patients undergone operation , part ii results one year follow prospective study included 122 sciatica patients undergone operation \( \) 220 sciatica patients undergone operation \( \) examined rhizography follow study done 110 \( 90 \) 212 \( 96 \) divided two groups 30 patients pathologic rhizography \( pr \) 80 patients negative rhizography \( \) pain , adl , occupation handicap indices showed 1 year follow op group best result group lowest result pr group nearly good result op group thus , sciatica patients candidates conservative therapy , even though pathologic findings rhizography , symptoms mild improve therapeutic outcome , accurate diagnostic tools needed develop specific therapy especially sciatica patients negative rhizography
preliminary study dye enhanced laser laser ablation veins injection wavelength specific enhance localize energy absorption could provide useful adjunct current treatment options enhance absorption diode laser energy nm , ear veins 41 rabbits infused 2 3 ml indocyanine green dye \( maximum absorption , nm \) exposed 2 20 seconds animals killed 0 28 days operation discrete time intervals laser exposure exist various sized vessels ablated without significant thermal injury overlying tissue small vessels \( 0 2 mm diameter \) 2 3 seconds exposure , whereas medium sized vessels \( 2 mm diameter \) require 8 10 seconds vessels ablated power density low 11 1 w cm2 specimens taken immediately laser exposure show vessel wall thinning effect , created laser energy initially absorbed dye seventh day operation , brisk inflammatory response overlying epidermal layer develop lumen partially filled thrombus cellular invasion postoperative day 28 , epidermal thickening inflammatory reaction resolved vessel walls fibrotic use low power , air cooled diode lasers , conjunction wavelength specific , may provide simple , viable , alternative treatment superficial varicosities extremities
treatment solitary arteriovenous fistulas four patients solitary arteriovenous fistula treated transvascular balloon embolization technique , resulted complete fistula closure three patients partial closure one two vertebral arteriovenous fistulas , one peroneal arteriovenous fistula , one radial arteriovenous fistula first two fistulas spontaneous , two traumatic partial occlusion peroneal fistula , opinion , due technical failure , balloon inflated slightly proximal instead complications , morbidity opinion transvascular balloon embolization technique treatment choice solitary arteriovenous fistulas
munchausen syndrome proxy documented discrepant blood typing authors describe case munchausen syndrome proxy , form child abuse , documented use routine blood bank serologic procedures testing used legal resolve issues investigate instances acts , authors believe first documented application clinical disorder
analysis erythrocyte morphologic characteristics urine using hematologic flow microscopic methods three methods examination erythrocyte morphology urine described phase contrast microscopy , microscopy stained preparations , erythrocyte analysis h1 analysis h1 described methods used discriminate erythrocytes red cell distribution width best h1 parameter discrimination authors found good correlation microscopic methods clinical impact three methods studied urine samples patients confirmed diagnosis discrimination renal hematuria similar phase contrast microscopy preparations use h1 discrimination recommended
small bowel intraoperative obscure gastrointestinal bleeding intraoperative endoscopy \( \) accepted ultimate diagnostic procedure completely evaluating small bowel patients obscure gastrointestinal \( gi \) bleeding small bowel \( sbe \) reported useful nonsurgical evaluation small intestine patients , findings may limited incomplete small bowel intubation lack tip deflection twenty three patients underwent 25 sbe subsequently 25 surgical exploration continued bleeding patients' bleeding histories averaged 2 yr , average transfusion requirement 27 units findings sbe 17 22 \( 77 \) examinations conclude sbe comparable depth insertion ability detect small vascular procedures missed pathology due limited nature long term success bleeding combined techniques expected 55 patients sbe precede surgery , since finding diffuse precludes benefit operative intervention
endoscopic management postoperative biliary leaks review 77 cases report two cases formation biliary leaks uncommon complications abdominal surgery left untreated , may result significant morbidity mortality traditional treatment surgical , several authors reported successful endoscopic management review 77 cases endoscopically managed postoperative biliary leaks reported literature past 15 yr endoscopic treatment technically successful 95 cases , resulted biliary leak healing 82 cystic stump leaks better prognosis healing compared common bile duct hepatic duct leaks also present two additional cases postoperative biliary leaks formation successfully treated endoscopic stent placement experience lends additional support endoscopic management preferred approach postoperative biliary leaks
heparin skin necrosis delayed occurrence patient hemodialysis case skin necrosis patient receiving intravenous \( iv \) heparin routine intermittent hemodialysis reported multiple erythematous , tender lesions developed abdomen thighs rapidly became necrotic biopsies showed fibrin thrombi dermal venules capillaries , cellular infiltrate patient third month regular hemodialysis skin necrosis associated use heparin usually occurs within 2 weeks beginning heparin therapy reported patients receiving heparin hemodialysis possible mechanisms , including acquired antithrombin iii deficiency leading heparin induced skin necrosis , discussed
toxicities rats free versus liposomal encapsulated cisplatin wistar rats \( five group \) given either 1 mg kg free cisplatin , 1 2 mg kg liposomal encapsulated cisplatin , saline solution intraperitoneally 15 injections rats free drug group showed significantly less weight gain two rats died study necropsy , free cisplatin treated rats showed gross microscopic evidence peritoneal fibrosis detected remaining groups free cisplatin treated rats showed serum histologic evidence renal damage five rats moderate severe acute tubular necrosis renal abnormalities detected rats received 1 mg kg , focal mild changes found rats received 2 mg kg liposomal preparation neurotoxicity , determined nerve conduction plane studies , developed rats treated free liposomal cisplatin results encouraging warrant investigation
acetazolamide treatment abnormal response treated seven patients vertigo elicited walking store driving results neurologic , neuro ophthalmic , neuroradiologic examinations normal episodic vertigo secondary abnormal response diagnosed patient given trial 250 500 mg acetazolamide daily symptoms resolved completely four patients , two patients near resolution symptoms , one patient relief carbonic anhydrase activity demonstrated inner ear , acetazolamide shown affect ion balance inner ear fluids
genetics psychiatry window environment two recent reviews american journal psychiatry british journal psychiatry reported progress understanding genetics psychiatric disorder reviews focused progress psychiatric diagnostics therapeutics based molecular biology neither review recognized data behavioral genetics support environmental causes abnormal development psychopathology much support genetic causes moreover , genetic data point clearly type environmental cause central importance environment specific unique sibling family
treatment depressed cardiac transplant recipients safety tricyclic antidepressants cardiac transplant recipients established author used treat major depressive episodes eight cardiac transplant recipients therapy associated increased qrs interval heart rate significantly affect hemodynamic ecg variables cyclosporine dose requirements appears may used safely depressed cardiac transplant patients
splenectomy enlarged spleen experience national cancer institute 1955 1988 46 cases splenectomy massive splenomegaly \( greater equal 1 , 500 grams \) reviewed assess indications , pathology , operative , postoperative course procedure median age 51 years thirty one \( 67 4 \) performed malignancy \( chronic lymphocytic leukemia , 11 chronic myelogenous leukemia , 10 lymphoma , 9 hairy cell leukemia , 1 \) , 11 myeloid metaplasia , four nonmalignant conditions indications splenectomy included \( 32 patients \) , symptoms \( 6 \) , diagnosis \( 3 \) , splenic rupture \( 3 \) midline incision \( 30 patients \) commonly used median operative time 2 hours , 50 minutes median operative blood loss 1 , 300 ml \( range , 100 ml 60 units \) splenic artery ligated initially 16 patients \( 34 8 \) correlate blood loss operating time median splenic weight 2 , grams \( range , 1500 gm \) postoperative complication rate 39 1 per cent \( 21 complications 18 patients \) included infection 10 patients , bleeding six patients six patients required reoperation \( bleeding , 4 abscess , 1 small bowel obstruction , 1 patient \) 30 day operative mortality 19 6 per cent \( 9 patients \) excluding operative deaths , 35 patients available follow evaluation twenty nine patients improvement parameters splenectomy indicated six patients change course splenectomy findings indicate many patients massive splenomegaly benefit splenectomy , however , procedure associated high risk postoperative morbidity mortality
erythrocyte sedimentation rate predicts early relapse survival early stage hodgkin disease lymphoma cooperative group objective assess value elevated \( greater 30 mm h \) erythrocyte sedimentation rate \( esr \) predicting early relapse survival therapy patients clinical stage ii hodgkin disease interventions studied patients early stage hodgkin disease participated two separate multicenter clinical trials trials used modern field radiotherapy , patients , multi agent chemotherapy main results esr patterns based post therapy assessments pattern 1 , always normal \( n 261 \) pattern 2 , elevated therapy normal immediately therapy \( n 121 \) pattern 3 , elevated therapy normal within 3 months therapy \( n 89 \) pattern 4 , always elevated \( n 48 \) pattern 5 , normal therapy normal elevated therapy \( n 150 \) pattern 6 , elevated therapy normal elevated therapy \( n 130 \) multivariate analysis , independent whether patients received chemotherapy initial therapy protocol , esr patterns 4 , 5 , 6 shown best predictors early relapse survival patients stratified according type chemotherapy received number involved nodal areas patients esr pattern 4 relative risk death seven times patients patterns 1 , 2 , 3 early relapse second important factor predicting death , irrespective esr patients early relapse esr patterns 1 , 2 , 3 relative risk death 4 5 , early relapse esr patterns 4 , 5 , 6 relative risk death 15 whether chemotherapy given initially change relative risk , shows esr , initial therapy , predictor early relapse death due hodgkin disease conclusion unexplained elevated esr therapy , especially modern radiotherapy , independent factors , strongly suggest presence aggressive resistant hodgkin disease elevated esr predictive early relapse poor prognosis presence early aggressive therapy
surgical complications cochlear multiple channel implant experience melbourne surgical complications first 153 multiple channel cochlear implant operations carried first 100 operations university melbourne clinic , royal eye ear hospital , presented experience major complications wound breakdown , wound infection , electrode erosion external auditory canal , electrode slippage , persistent increase , facial nerve stimulation incidence wound breakdown requiring removal package 0 6 1 0 melbourne complications operation clinics acceptable levels considered wound breakdown requiring implant removal could kept minimum making incision suturing flap without tension
role calcium ions calcium channel entry blockers experimental ischemia reperfusion induced liver injury verapamil administered treatment , treatment , beneficial effect 90 minute warm ischemia reperfusion rat liver injury model possible activation proteases converting xanthine dehydrogenase xanthine oxidase , significant mitochondrial calcium loading ischemic period , potentiation calcium oxygen derived free radicals promote injury mitochondria mechanisms supported study , based histologic observations pattern enzyme leak acute ischemic event
deleterious effects women 's health medical utilization long term consequences physical health examined among 390 adult women \( 74 victims crime \) data included health status self ratings objective service utilization findings indicated severely women , compared , reported distress less well , made physician visits twice frequently index year , outpatient costs 2 5 times greater severity powerful predictor physician visits outpatient costs utilization data across 5 years preceding following crime obtained 15 victims , 26 physical assault victims , 27 crime victims compared five continuous years utilization among 26 physician visits increased 15 24 year crime compared less 2 change among conclude long term deleterious effects suggest women 's needs medical treatment traditional focus emergency care forensic evaluation
reference ranges lymphocyte subsets comparison standard vs rapid whole blood lysis techniques reference ranges lymphocyte subsets may vary processing techniques , monoclonal reagents , analytic methods compared reference ranges obtained b lymphocyte subsets means standard manual whole blood lysis wash step vs rapid , wash whole blood lysis system techniques demonstrated reference ranges similar previous literature reports ranges established standard rapid lysis similar antibodies directed cluster designation used although slight statistical differences relative percentages cd2 cd3 lymphocytes observed , differences probably clinically significant data indicate rapid technique provides standardized method b lymphocytes peripheral blood
anatomic , metabolic , neuropsychological , molecular genetic studies three pairs identical twins discordant dementia alzheimer 's type three pairs twins , proved , shown discordant dementia alzheimer 's type remained discordant periods 8 11 years dementia alzheimer 's type demonstrated history serial clinical examinations serial measurements cerebral glucose utilization using positron emission tomography cerebral ventricular volumes rates change volumes using quantitative computed tomography serial neuropsychological tests results measures showed evidence clinical abnormality unaffected twin dna markers proximal long arm chromosome 21 distinguish affected unaffected member pair identical twins family pedigrees negative alzheimer 's disease results suggest environmental nongenetic factors contribute alzheimer 's disease discordant monozygotic twins , cases arise somatic mutation
anterior femoral cutaneous nerve injury following femoral artery reconstructive surgery two cases presented exhibiting symptoms signs bilateral anterior femoral cutaneous nerve injury , clinically sparing femoral nerve branches saphenous nerve quadriceps muscles occurred following surgical dissection femoral associated femoral artery reconstructive surgery anterior femoral cutaneous nerve injury considered anterior medial thigh pain numbness occur following bypass graft surgery types femoral artery reconstructive surgery
perinatal mortality rates isolated general practitioner maternity units objective determine perinatal mortality rate among normally formed , singleton babies birth weights greater equal 2500 g bath health district based intended place delivery time onset labour time diagnosis intrauterine death design numbers live births collected monthly returns maternity units concerned deaths infants aged less equal 1 week collected returns intended place delivery confirmed monthly perinatal mortality meeting , maternal fetal factors discussed setting rural health district 400 , 000 population one third deliveries occurred seven isolated general practitioner maternity units , 8 integrated general practitioner unit , remainder consultant unit subjects babies women whose deliveries district onset labour diagnosis intrauterine death , excluding twins , babies lethal congenital malformations , less 2500 g main outcome measures outcome deliveries parity mothers results 14 , deliveries analysed perinatal mortality rate 2 8 1000 births consultant unit \( deliveries \) , 4 8 isolated general practitioner units \( deliveries \) , zero integrated general practitioner unit \( deliveries \) perinatal deaths attributable asphyxia common isolated general practitioner units \( 1 5 per 1000 \) consultant unit \( 0 6 per 1000 \) perinatal mortality rate among babies born nulliparous women 3 2 1000 births consultant unit 5 7 isolated general practitioner units born women 2 4 4 2 respectively conclusions outcome delivery influenced parity antenatal intrapartum care responsible higher perinatal mortality rate isolated general practitioner units integrated unit , shared staff consultant unit , seemed work well analysis intended place delivery time onset labour diagnosis intrauterine death suggested care given isolated units needs improved , perhaps better training general practitioners consultant supervision antenatal care
role fistulography fistula report five cases retrospective review 27 patients undergoing anal fistulography presented etiology 27 fistulas studied follows infection 18 , ibd 7 \( crohn 's 6 , 1 \) , iatrogenic 1 , foreign body perforation 1 twenty six revealed either direct communication rectum , abscess cavities tracts , two revealed radiographic evidence fistula \( one patient two \) 13 27 patients \( 48 percent \) information obtained revealed either unexpected pathology \( n 7 \) directly altered surgical management \( n 6 \) conclude anal fistulography properly selected patients may add useful information definitive management fistula
chronic care needs higher priority although acute care remains focus u health care delivery system , shift taking place toward chronic illness mortality developing effective chronic disease management processes context today 's acute care orientation , according f , strategy , st , mn
revision total knee arthroplasty failed replacement results nineteen patients \( twenty one knees \) failed knee replacement followed revision total knee arthroplasty evaluated twelve excellent , four good , one fair , two poor results interval replacement revision total knee arthroplasty ranged eight months eight years time revision , major osseous defect found sixteen knees \( 76 per cent \) duration follow revision ranged two ten years recent follow examination , radiographs revealed least one radiolucent line thirteen knees \( 62 per cent \) technical difficulties associated revision operation evidence arthroplasty conservative procedure allows total knee arthroplasty done easily later results also support argument revision performed failure arthroplasty less technically demanding one performed failed primary total knee arthroplasty
cross linked hemoglobin solution resuscitative fluid hemorrhage rat \( alpha alpha \) cross linked hemoglobin reported oxygen transport properties similar whole blood present study evaluated efficacy alpha alpha cross linked hemoglobin solution resuscitation fluid , heart rate , mean arterial pressure , transcutaneous oxygen tension study parameters rats bled approximately one third total blood volume \( 20 ml kg \) removed anesthetized resuscitated 14 hemoglobin solution animals received either 10 mg kg \( n 10 \) 20 mg kg \( n 10 \) hemoglobin solution responded quickly positively infusions mean arterial pressure \( dropped less 40 levels \) returned baseline within 2 minutes initiating infusion 4 minutes , mean arterial pressures hemoglobin infused groups significantly higher \( p less equal 0 05 \) autologous shed blood \( n 8 \) ringer 's \( n 10 \) groups heart rate transcutaneous oxygen tension responses half volume full volume replacement hemoglobin groups matched response autologous shed blood throughout hour observation favorable hemodynamic response infusion cross linked hemoglobin solution hemorrhage suggests material comparable autologous shed blood superior ringer 's solution resuscitative fluid assessed model
slowly progressive aphasia three cases language , memory , ct pet data three cases slowly progressive speech language disturbance studied various points post onset \( three , five 15 years respectively \) language , neuropsychological brain imaging \( computer tomography positron emission tomography \) evaluations completed three patients data suggest syndrome progressive aphasia 1 \) involve uniform symptom complex 2 \) necessarily develop full blown dementia syndrome 3 \) varies greatly rate progression case case 4 \) associated normal brain structure \( computer tomography \) 5 \) associated abnormal left temporal lobe metabolism measured fluorodeoxyglucose \( fdg \) positron emission tomography \( pet \) one patient histological findings consistent alzheimer 's disease necropsy
vitro pharmacological characterization m1 , m2 m3 muscarinic receptors vivo effects urinary bladder contraction , mydriasis salivary secretion guinea pigs major side effects \( oxy \) , used treatment urinary incontinence dry mouth \( \) vision \( mydriasis \) highly purified oxy \( r \) oxy , \( \) oxy compared vitro functional studies vivo guinea pigs evaluate pharmacological action relative adverse effects affinity \( r \) oxy \( \) oxy different muscarinic receptor subtypes determined using field stimulated rabbit vas deferens \( m1 \) guinea pig atria \( m2 \) bladder \( m3 \) strips effects \( r \) oxy greater equal \( r \) oxy much greater \( \) oxy evident three receptor subtypes ratio \( \) oxy \( r \) oxy ranged 12 88 \( r \) oxy \( r \) oxy slightly selective \( 2 4 fold , p less 01 \) m1 m3 relative m2 muscarinic receptors also evident vivo volume induced urinary bladder contractions measured parameters \( \) oxy \( r \) oxy approximately 21 , mydriasis \( \) oxy \( r \) oxy approximately 136 salivary gland secretory responses \( \) oxy \( r \) oxy approximately 30 absolute \( r \) oxy \( r \) oxy mydriasis similar inhibition intravesical bladder pressure also , \( r \) oxy \( r \) oxy antagonized cholinergic mediated cns effects mice collectively , data suggest activity \( r \) oxy resides predominantly \( r \) however , appears \( r \) oxy may offer significant pharmacological advantage \( r \) oxy terms principal therapeutic side effect profile
evidence intraluminal ca regulatory site defect sarcoplasmic reticulum malignant hyperthermia pig muscle malignant hyperthermia \( mh \) disease humans various animal species life threatening , anesthetic agent induced syndrome mh thought consequence abnormal , sustained increases ca sarcoplasmic reticulum \( sr \) membranes mh muscle shown ca release channel defect present study tested hypothesis abnormal ca release mechanism mh expressed ca loaded presence pyrophosphate sr membrane vesicles isolated normal mh pig muscle loaded ca presence absence pyrophosphate ca \( \) induced ca release occurred circumstances threshold amount ca loaded ca release occurred lower sr mh pig skeletal muscle difference amount ca preload explained results obtained comparing rates ca uptake , number binding sites amounts among sr vesicles mh normal muscle conclude study use pyrophosphate ca loading ablate abnormal ca release sr mh muscle , suggesting study done small amounts sr biopsied human muscle data also suggest abnormality intraluminal , low affinity ca binding site regulating ca release occurs sr membrane mh pig muscle
absorbable mesh severe splenic injuries functional studies animal model additional patient series acid mesh introduced method controlling hemorrhage severely damaged spleens study examines effect splenic wrapping immune function spleen , also ability control splenic bleeding trauma patients thirty dogs divided three groups subjected sham operation \( group 1 \) , splenectomy \( group 2 \) , splenic \( group 3 \) immunologic studies showed difference wrapped group \( group 3 \) spleens intact \( group 1 \) induction specific antibody producing lymphocytes splenic tissue injection attenuated splenic injuries treated county hospital january 1985 may 1988 retrospectively analyzed 60 patients splenic injuries , 14 underwent mesh without mortality serious complications study demonstrates immune function spleen preserved following mesh , technique used clinical setting safe efficacious results
lumbar spinal nerves neural foramen mr appearance appearance proximal lumbar spinal nerves magnetic resonance \( mr \) imaging , authors' knowledge , described mr images corresponding sections obtained four cadavers means correlated characterize mr appearance proximal spinal nerves junction dorsal ventral dorsal ventral roots consists group six 15 fascicles measuring 2 6 mm length fascicles appear mr images obtained short repetition times small foci lower signal intensity surrounding fat proximal spinal nerve relationship intervertebral disk osseous margins neural foramen demonstrated effectively mr imaging
dutch experience percutaneous transluminal angioplasty saphenous veins used aortocoronary arterial bypass 19 , percutaneous transluminal coronary angioplasty procedures performed netherlands april 1980 january 1989 , long term follow 454 patients underwent angioplasty greater equal 1 saphenous vein bypass graft reviewed 46 patients single graft angioplasty attempted , 54 patients sequential graft angioplasty attempted clinical primary success rate 90 hospital mortality 0 7 , 2 8 patients sustained procedural myocardial infarction , 1 3 patients underwent emergency bypass surgery follow period 5 years , 74 patients alive , 26 alive event free \( myocardial infarction , repeat bypass surgery repeat angioplasty \) patients initial angioplasty attempt unsuccessful , 3 event free 5 years , versus 27 successfully dilated patients time interval angioplasty attempt previous surgery significant predictor 5 year event free survival event free survival rates patients bypass surgery 1 year , 1 5 years , 5 years angioplasty , 45 , 25 19 , respectively less one third patients previous bypass surgery angioplasty graft remained event free 5 years patients angioplasty within 1 year bypass surgery , better long term results achieved
intraosseous infusion dobutamine isoproterenol intraosseous infusion advocated emergency route sick infants children intravenous access readily obtainable dobutamine hydrochloride isoproterenol hydrochloride useful emergency drugs studied administered bone marrow swine model , compared physiologic responses \( heart rate , arterial pressure , cardiac output \) dobutamine isoproterenol infusions delivered intravenously 20 minute intervals observed statistically significant effects dobutamine isoproterenol delivered intraosseous route addition , effects resulting intraosseous infusion statistically similar resulting intravenous administration drugs conclude intraosseous infusion dobutamine isoproterenol effective useful method emergency administration medications
effectiveness growth promoting therapies comparison among growth hormone , clonidine , levodopa ability growth hormone , clonidine , levodopa stimulate growth compared short slowly growing children randomly assigned different treatment regimens 6 months 10 children group , 10 additional subjects served controls growth hormone improved mean height velocity , height velocity sd score , height sd score mean height velocity height velocity sd score significantly increased clonidine , levodopa enhanced mean height velocity sd score treated children moreover , nine patients \( 90 \) receiving growth hormone , two \( 20 \) receiving clonidine , one \( 10 \) receiving levodopa , height velocity raised 2 cm increments height velocity height sd score greatest growth hormone group clonidine induced increase height velocity significantly different control children control group , significant reduction height sd score time
unsuspected cocaine exposure young children objective determine prevalence cocaine exposure among preschool children clinically unsuspected signs symptoms design prevalence study setting pediatric emergency department inner city hospital participants 250 children aged 2 weeks 5 years underwent urine assays cocaine prior discharge emergency department interventions none measurements main results six \( 2 4 \) 250 urine assays \( 95 confidence interval , 0 5 4 3 \) positive benzoylecgonine , major urinary cocaine metabolite four positive urine assays children younger 1 year children positive urine assays younger 24 months none children presented complaint identified clinical problems currently associated childhood exposure cocaine possible exposure routes include , intentional administration , accidental ingestion cocaine cocaine contaminated household dust via normal hand mouth activity , passive inhalation conclusion among inner city children served hospital , significant numbers infants young children exposed cocaine , exposure occurs clinically unsuspected population
role experience response simulated critical incidents eight experienced \( faculty private practitioners \) presented simulated critical incidents previously presented 19 anesthesia trainees detection correction times incidents measured , compliance advanced cardiac life support \( \) guidelines cardiac arrest , occurrence incidents experienced personnel tended react rapidly trainees , differences second year anesthesia residents \( ca2 \) experienced statistically significant high variability performance incidents within group errors management still occurred experience subjects response incidents anesthesia complex process involves multiple levels cognitive activity vulnerable error regardless experience trainees seemed acquire adequate response end ca2 year formal reasoning appeared play minor role responding intraoperative events , exact nature 's cognition remains investigated
low dose bupivacaine improve postoperative epidural fentanyl analgesia orthopedic patients published erratum appears 1991 may 72 \( 5 \) epidural infusions 10 micrograms ml fentanyl combined low dose bupivacaine \( 0 1 \) compared epidural infusions fentanyl alone postoperative analgesia total knee joint replacement detectable differences two groups analgesia \( visual analogue scale ranging 15 40 mm \) , infusion rates \( averaged 7 9 ml h \) , serum fentanyl levels \( reached 1 2 ng ml \) incidence side effects , including nausea , vomiting , pruritus , also similar patients receiving fentanyl low dose bupivacaine , one developed transient unilateral motor sensory loss , one developed significant hypotension respiratory depression addition low dose bupivacaine improve epidural fentanyl infusion analgesia knee surgery may increase morbidity
patient flow emergency department chest pain patient prompt treatment chest pain patient emergency department \( ed \) crucial ensure prompt treatment , identification factors delay flow patients department essential identify factors delay patient flow ed , authors conducted prospective study chest pain patients , using time flow analysis eighty eight \( 36 \) 245 patients required critical unit admissions average department stay 3 1 2 hours flow differences seen critical care patients three primary sources delay identified critical unit bed availability , registration process , role unit resident additional findings confirmed efficacy role triage nurse patient flow nursing medical education staffing needs addressed use community 's emergency medical services examined analyzing disposition patients ed ambulance
immune functions treatment growth hormone deficient children biosynthetic human growth hormone immune functions , including cell surface markers , interleukin 2 receptor levels responses lymphocytes mitogenic stimulation evaluated seven growth hormone deficient children ages 4 15 years , treatment derived human growth hormone treatment resulted decrease b cells total cells also decreases individual patients' mitogen responses interleukin 2 receptor levels changes noted transient similar previously demonstrated pituitary derived human growth hormone treatment although resulting overt clinical manifestations patients , think potential interactions growth hormone immune functions need considered physicians treating children growth hormone
oxygen desaturation fiberoptic bronchoscopy pediatric patients study objective pulse oximetry used measure arterial oxygen saturation extent hypoxemia pediatric patients undergoing fb design arterial oxygen saturation measured \( 1 \) prior procedure provide baseline value , \( 2 \) bronchoscope positioned nasopharynx , \( 3 \) bronchoscope positioned mid trachea setting fiberoptic bronchoscopy performed pediatric special care unit pediatric pulmonary laboratory using fiberoptic bronchoscope 3 5 mm outer diameter patients participants thirty six children underwent diagnostic therapeutic bronchoscopy variety reasons evaluated ranged age 6 142 months 20 male 16 female interventions interventions measurements results 36 patients , 29 experienced fall sao2 levels exceeding 5 percent baseline values youngest age group , 6 12 months , showed greatest drop saturation compared groups desaturation significantly increased fb conclusions decline arterial oxygen saturation may substantial infants children undergoing fb examination frequently noted , especially smaller infants bronchoscope positioned mid trachea supplemental oxygen brisk procedure time minimize risk dangerous hypoxia
patterns resource consumption medical intensive care intensive care major factor increasing health care costs examined 404 consecutive admissions medical icus university medical center study patterns consumption icu resources proportion resources used patients admitted monitoring found skewed distribution icu resource consumption , high cost 8 percent using many icu resources low cost 92 percent forty one percent admissions receive acute icu treatments , admissions consumed less 10 percent icu resources reducing number patients admitted monitoring relatively small impact hospital charges since 70 percent high cost patients died , improved understanding prognosis better physician patient communication may substantially reduce proportion critical care resources treatment
active vs passive rhythms explanation rhythm similar p waves describe criteria differential diagnosis 3 2 block atrial due ectopic focus sinus zone 3 2 block rr interval basic rhythm similar short r r interval paired rhythm atrial , r r interval basic rhythm similar long r r interval paired rhythm
immunoglobulins , g , cytomegalovirus recurrent infection recipients allogeneic bone marrow transplantation occurrence significance specific iga igm cytomegalovirus \( cmv \) recurrent cmv infection evaluated 21 allogeneic lymphocyte depleted bone marrow transplantation \( bmt \) recipients previously cmv seropositive 17 patients cmv infection , detected 94 , cmv specific iga 88 igm 76 , fourfold rise igg 65 median time bmt detection 69 days , iga 70 , igm 62 , igg 88 days igm iga responses lasted 14 30 days \( median time \) , whereas high igg titers persisted twelve patients developed cmv disease appearance , iga , igm preceded rise igg \( p less 02 \) cmv specific iga igm valuable diagnostic tools bmt recipients recurrent cmv infection
operation ii ventilatory adaptation gradual decompression extreme altitude assess ventilatory adaptation gradual extreme altitude , studied seven healthy males part 40 simulated mt chamber measured resting ventilation \( , l min 1 \) , arterial oxygen saturation \( sao2 \) , ventilatory response oxygen breathing , hypoxic ventilatory response \( \) , ventilatory response \( \) sea level prior \( 760 torr \) , 14 , 000 feet \( torr \) , 24 , 000 feet \( 305 torr \) , within 24 h descent \( torr \) increased 9 3 1 1 l min 1 760 torr 23 4 1 3 l min 1 305 torr remained elevated 14 7 0 7 l min 1 descent oxygen breathing decreased 9 6 1 3 l min 1 305 torr \( expressed positive slope sao2 , l min 1 sao2 \( 1 \) increased 0 18 0 07 760 torr 0 34 0 11 0 38 0 5 torr 305 torr \( p less 0 05 \) respectively elevated upon return sea level \( 0 8 0 09 , p less 0 05 \) \( , l min 1 torr 1 \) increased sea level \( 4 4 0 09 \) 305 torr \( 18 7 3 5 , p less 0 01 \) remained elevated upon return sea level \( 10 7 4 6 , p less 0 001 \) study first investigate ventilatory response extreme altitude soon descent shows hypoxic responses increase prolonged progressive hypoxic exposure remain significantly elevated pre levels immediately upon descent
communication blind major somatosensory mechanism adaptive evolution communication , low frequency substrate borne generated head , travel long distances , important communication mole rats \( 52 , 54 , 58 , 60 \) israel importance adaptation , behavioral , anatomic findings study suggest mechanism long distance communication somatosensory independent auditory mechanism communication thus appears channel communication important evolution mammals display major adaptation life
clustered trna genes dna sequence repeats centromere associated b dna sequence repeats chromosomes ii found contain clusters trna genes centromere ii region \( \) includes least 22 trna genes distributed among five copies b sequence repeat containing genes trna \( ile \) , trna \( ala \) , trna \( val \) individual b repeats associated trna genes , including trna \( \) , trna \( arg \) , trna \( \) centromere region \( \) contains least six trna genes two copies repeated element , including genes trna \( ile \) , trna \( ala \) , trna \( \) multiple arranged clusters trna genes presumably conserved due restricted recombination frequencies centromere regions
quantification midline shift predictor poor outcome following head injury retrospective study patient outcome , based admission computed tomography , carried 75 consecutive patients head injury computed tomography data collected included type extent intracranial hemorrhage , extent midline shift , ratio midline shift compared extent intracranial hemorrhage midline shift considered proportion intracranial hemorrhage midline shift septum exceeded extent hemorrhage measured inner table skull computed tomography data analyzed logistic regression , significant predictive factors poor outcome intracranial hemorrhage \( 34 \) , intracranial hemorrhage midline shift \( 61 \) , midline shift proportion extent intracranial hemorrhage \( 88 \) patient outcome mortality rates considered , study indicates midline shift proportion extent intracranial hemorrhage highly useful predictor poor patient outcome following head injury
ketamine analgesic total intravenous anaesthesia propofol prospective study 18 patients underwent noncardiac surgery performed study use ketamine analgesic total intravenous anaesthesia propofol comparison made combination propofol fentanyl propofol ketamine combination resulted stable anaesthesia without need additional analgesics postoperative behaviour normal patients none patients reported operation propofol seems effective eliminating side effects dose ketamine humans recommend propofol ketamine combination total intravenous anaesthesia surgery stable required
awareness caesarean section 1982 1989 3000 patients questioned recall general anaesthesia caesarean section 28 \( 0 9 \) patients able recall operation 189 \( 6 1 \) reported dreams uniform adherence rigid anaesthetic protocol including 1985 , much incident reported stimulated relaxation regimen consequently incidence awareness decreased 1 3 0 4 , incidence also reduced surgery confined manipulations , none patients complained pain time interview , although one since initial protocol approach informed consent discussed
national institute mental health longitudinal study chronic schizophrenia prognosis predictors outcome published erratum appears arch psychiatry 1991 jul 48 \( 7 \) performed longitudinal study chronic schizophrenic patients hospitalized research purposes national institute mental health \( \) intramural program 1970s early 1980s assessed present course , outcome predictor data initial cohort 58 young chronic schizophrenic patients followed 2 12 years following index hospitalization follow , sample showed substantial functional impairment levels symptoms 20 sample demonstrating good outcome addition , strong noted among symptom functioning indexes follow moreover , neuropsychologic tests frontal cortical functioning significantly correlated outcome levels negative symptoms social functioning levels positive symptoms period index hospitalization follow assessment , 78 sample suffered relapse , 38 attempted suicide 24 episodes major affective illness furthermore , levels positive negative symptoms ascertained patients received optimal neuroleptic treatment index hospitalization significantly predicted outcome levels symptoms functioning time spent hospitalized follow period contrast , levels index positive negative symptoms ascertained drug free state predict outcome symptoms functioning data suggest treatment response critical predictor variable examined implication data course illness
course outcome schizophrenia study early course schizophrenia , assessed 79 early phase , young , dsm iii schizophrenic patients two successive follow ups , 2 5 5 0 years index hospitalization 50 sample poor overall outcome , either severe impairment functioning symptoms , suicide , follow period rates decreased significantly course two assessments , despite sample showing persisting psychosis small group schizophrenic patients showed complete remission 10 first follow 17 second follow , patients excluded consideration progressive deterioration common schizophrenia , relatively negative findings challenge conclusions longitudinal studies implications data schizophrenic course discussed
plasma concentrations bupivacaine two metabolites continuous brachial plexus block brachial plexus block performed via catheter 20 28 ml 0 75 bupivacaine plus adrenaline surgery shoulder region 12 patients constant infusion 0 25 bupivacaine 0 25 mg kg 1 h 1 continued 24 h surgery light general anaesthesia , without analgesics , maintained plasma concentrations total unbound \( free fraction \) bupivacaine , \( \) , 4 \( 4 ohb \) alpha 1 acid glycoprotein \( \) measured predetermined intervals continuous block greatest mean plasma concentrations bupivacaine measured 30 min \( 1 63 \( sd 0 55 \) micrograms ml 1 \) 60 min \( 1 38 \( 0 48 \) micrograms ml 1 \) small statistically significant increase plasma concentration bupivacaine 12 24 h infusion mean unbound concentration bupivacaine plasma decreased 0 044 \( 0 015 \) microgram ml 1 \( 3 6 \( 1 1 \) total bupivacaine concentration \) 3 h 0 \( 0 011 \) micrograms ml 1 \( 2 1 \( 1 0 \) \) 24 h concentration plasma increased 38 24 h metabolites 4 ohb detectable plasma 30 min , gradual increase infusion 24 h mean concentrations 4 ohb 0 33 \( 0 22 \) micrograms ml 1 0 13 \( 0 04 \) micrograms ml 1 , respectively toxic reactions blocks
pharmacokinetics clinical experience 20 h infusions methohexitone intensive care patients postoperative studied pharmacokinetics 20 h infusions methohexitone young patients postoperative fever undergoing artificial ventilation lungs infusion rate adjusted patients unresponsive vocal stimulation reacted tracheal suction mean steady state concentration methohexitone required 2 6 mg litre 1 \( unbound 0 53 mg litre 1 \) mean \( sd \) total clearance methohexitone 16 3 \( 4 2 \) ml min 1 kg 1 , greater volunteers normal surgical patients unbound clearance correlated positively body temperature infusion \( r 0 , p 0 017 \) terminal half life methohexitone 6 3 \( 3 8 \) h 4' hydroxy metabolite 5 8 \( 2 1 \) h marked haemodynamic effects infusion , excessive sedation infusion however , clearance methohexitone high variable , possibly direct effect postoperative fever consequently , need individual titration rate infusion emphasized
sciatic nerve monitoring revision total hip arthroplasty study presents simple method intraoperative sciatic nerve monitoring revision total hip arthroplasty \( tha \) , utilizing intraoperative , somatosensory evoked potentials using method , sciatic nerve protected surgical correction shortened limb length necessary revision tha twenty three revision thas performed using intraoperative sciatic nerve monitoring postoperative peripheral nerve complications occurred , average increase 18 mm leg length , ranging 6 mm 43 mm
importance general practice relationship general health questionnaire \( \) score complaints presented general practitioners office examined , showed correlation high might expected many patients present psychosocial problems gp appear low score many patients high score exclusively present somatic complaints , also assessed gp purely somatic implications results discussed
morphological features blood access stenosis results noninvasive angioplasty investigated connection results noninvasive angioplasty blood access stenosis morphological features 37 dialysis cases 3 cases presenting stenosis original artery , area could dilated noninvasive techniques 4 cases stenosis vein downstream needle insertion points extracorporeal circulation , 3 showed long term dilatation procedures 30 cases stenosis upstream points , 16 showed long term dilatation unsuccessful cases , angle formed stenosed portion normal vessel 39 degrees , distance anastomosis stenosed portion less 11 mm
reliability stimulated spontaneous growth hormone \( gh \) levels identifying child low gh secretion reliability stimulated spontaneous gh levels identifying child low gh secretion subject debate compared ability gh concentrations pharmacological stimulation levodopa clonidine spontaneous peak 12 h pooled gh concentrations sleep single night estimate maximum spontaneous gh secretion 2 nights 55 children , aged 5 16 yr , heights 3rd percentile height velocities percentile age , two consecutive overnight gh secretory profiles maximum stimulated gh concentrations correctly categorized 80 children maximum spontaneous gh concentrations 4 micrograms l using double monoclonal immunoradiometric assay gh \( tandem r hgh , \) remaining 20 children stimulated gh concentrations spontaneous gh concentrations 4 micrograms l using cut , maximum gh concentrations first second nights correctly categorized 98 95 children , respectively night night variation gh secretion low children low spontaneous gh secretion \( maximum spontaneous peak pool gh concentrations , less 4 less equal 0 7 micrograms l , respectively \) , pooled gh concentrations 2 nights concordant 98 cases conclude uncommon stimulated gh concentrations underestimate spontaneous gh secretion even without hospital setting , measurement spontaneous gh secretion single night reliable identifying child low endogenous gh secretion gh stimulation testing alone
quality life elderly , chronically ill outpatients quality life \( ql \) elderly outpatients poorly characterized interviewed 258 elderly outpatients three health care settings identify attributes events affect self assessment ql outpatients rated ql acceptable , medical care , health , interpersonal relationships , financial status , functional status affecting ql overall ql ratings strongly associated objective indicators demographic characteristics use health care services subjective indicators , including patient perceptions health , memory , financial concerns , correlated independently global ql \( sigma r2 35 \) conclude older , chronically ill patients generally consider ql acceptable affected variety factors , including perceptions emotional , socioeconomic , intellectual , physical functioning furthermore , ql poorly associated objective indicators thus , assessing ql elderly , chronically ill outpatients , physicians elicit information regarding perceptions
value combined assessment physical health functional status community aged prospective study , italy survey health social conditions representative sample persons aged 60 years older city , italy , undertaken 1980 1987 , follow survey cohort performed documented deaths , 408 survivors , 168 individuals could located functional ability baseline assessed using world health organization 14 item scale indicators physical health status included chronic disease status , number drugs , physician visits , days hospitalization adjustment age sex , functional ability indicators physical health status found independent , statistically significant predictors mortality results study support view functional assessment necessary comprehensive evaluation older population
decision criteria pure tone detection used two age groups normal hearing hearing impaired response criteria yes task detection thresholds two test procedures measured four groups adults younger normal hearing , older normal hearing , younger hearing impaired , older hearing impaired two test procedures procedure \( control response bias \) adaptive procedure \( control bias \) signal 500 hz tone presented four groups showed equally conservative response bias yes task addition , neither age hearing loss affected difference \( 6 5 db \) two threshold measures
effects rate , sequencing , memory auditory processing elderly auditory sequencing , rate , memory evaluated three age groups series require identification \( repetition test , 1973 \) older elderly group \( age 80 \) , younger elderly group \( age 70 \) , performed significantly \( p less 05 \) poorer young adult group \( age 25 \) auditory memory 4 5 required interval decreased performance related hearing sensitivity , thus suggesting changes auditory mechanism occur age may loss hearing sensitivity moreover , performance repetition test correlate memory , indicates relationship auditory processing higher cortical functions
religious participation among elderly black adults study investigated rates participation religious activities elderly black adults four indicators participation examined reading religious materials , religious programs , , requests demographic , religious , health disability factors influenced participation behaviors findings discussed implications development multidimensional
health perceptions survival global evaluations health status really predict mortality \? self evaluations health status shown predict mortality , beyond contribution prediction made indices based presence health problems , physical disability , biological life style risk factors several possible reasons association discussed \( \) methodological shortcomings previous studies render association spurious \( b \) psychosocial influences mortality involved explain association \( c \) self evaluations health status direct independent effect four year follow mortality data health aging project \( n \) used explore possibilities analysis controls contribution numerous indicators health problems , disability risk factors , also makes adjustments standard errors complex sample design findings favor third possibility , independent effect , extent particular set psychosocial factors examined explain basic association , extent control variables adequately comprehensive set
population aging patterns expansion mortality used hypothesis mortality compression framework examine patterns mortality 1962 1984 data national vital statistics records used analysis changing age death percentiles population data social security administration u census used calculate force mortality mean age death percentiles , including oldest groups , interval examination coefficient variation mean age death suggests relative increase variability age death among oldest old available data fit hypothetical sequence normal density distributions increasing mean declining standard deviation force mortality 85 years appears decreasing pattern similar 85 years current mortality patterns suggest expansion , rather compression , mortality oldest ages refinement observations , improved data mortality among oldest old , helpful mortality patterns
stressful events life satisfaction among elderly men women purpose study examine interrelationships among stressful events , domain specific assessments life satisfaction , global evaluations life satisfaction research guided two theoretical formulations according bottom theory , older adults first assess feelings satisfaction within specific life domains based part experiences \( e , stressors \) encounter areas domain specific views subsequently synthesized form overall sense satisfaction life whole contrast , top theory suggests person 's ongoing sense satisfaction life whole assess satisfaction specific domains ways initial sense global life satisfaction analysis data provided older participants nationwide survey tends support bottom perspective
resting metabolic rate energy balance amenorrheic eumenorrheic runners study investigated metabolic nutritional factors association athletic menstrual dysfunction \( \) three groups women studied amenorrheic runners \( amenorrheic \) , eumenorrheic runners \( eumenorrheic \) , eumenorrheic sedentary controls \( sedentary \) amenorrheic eumenorrheic similar age , weight , percent body fat , training pace , best 10 km race time , years running , maximal oxygen consumption adjusted body weight fat free mass analysis covariance , rmr significantly lower amenorrheic eumenorrheic sedentary daily caloric intakes groups differ significantly , amenorrheic scored significantly higher eumenorrheic sedentary scale aberrant eating patterns amenorrheic high runners seem less adequate diet eumenorrheic runners appear maintain energy balance stable weight reduction rmr
menstrual function eating behavior female recreational weight competitive body group 103 female weight \( wl \) 92 control \( c \) women answered survey concerning eating behavior attitudes \( including eating disorder inventory \) menstrual function incidence menstrual dysfunction , defined plus amenorrhea , significantly higher wl \( 30 \) c \( 13 \) contraceptive pills 2 women amenorrhea incidence dysfunction highest subset 12 wl least one body building competition \( \) 86 birth control pills menstrual dysfunction \( p less 0 05 \) wl c reported missing least one menstrual period last year \( p 0 06 \) wl scored significantly higher c drive subscale eating disorder inventory \( \) fifteen percent wl 9 c achieved criteria subscale weight \( p greater 0 05 \) significantly wl c responded becoming fat \( wl 56 , c 38 \) , food \( wl 47 , c 30 \) , used weight control \( wl 14 , c 1 \) , claimed past \( wl 17 , c 5 \) examination answers revealed several items significantly different remainder wl example , 42 used , 67 becoming fat , 50 experienced
skeletal muscle following tonic overload functional structural analysis functional skeletal muscle induces compensatory hypertrophy adaptive response increased functional demand overload extensor digitorum longus \( \) muscle \( 129 strain male mouse \) induced unilateral surgical removal synergistic muscle , anterior \( ta \) response overload 7 , 21 , 42 analyzed changes 1 \) muscle weight , 2 \) myofiber type distribution , 3 \) myofiber cross sectional area fiber type , 4 \) speed contraction relaxation muscle , 5 \) force contraction , 6 \) myofiber morphologic integrity weight significantly increased overload caused impairment muscle contractility significant effect isometric twitch contraction time peak tension time one half relaxation twitch overloaded muscles demonstrated transient shift fiber type profile preferential hypertrophy type iia fibers occurred early phase overload type iib fibers recruited 42 significant increase myofiber number overloaded muscles occurred morphologic changes loaded muscles parallel found patients neurogenic muscular disorders however , overloaded muscle exhibit significant occurrence fiber branching controls region muscle
oxygen uptake heart rate responses hypoxic exercise children adults control ventilation heart rate exercise appears undergo maturation , aerobic metabolism \( vo2 \) may since previously found hypoxia exercise produced different ventilatory responses children \( c \) compared adults \( \) , hypothesized vo2 heart rate kinetics exercise would show similar responses hypoxia test hypothesis , examined responses progressive \( \) constant work rate tests children adults breathing either room air hypoxic gas \( fio2 0 15 \) corrected body weight , children adults similar values lactic acidosis threshold \( \) \( c 29 1 5 0 ml min 1 kg 1 27 9 4 3 \) vo2max \( c 40 7 8 6 ml min 1 kg 1 45 2 6 7 \) hypoxia significantly lowered \( c 27 5 5 4 ml min 1 kg 1 23 2 3 8 p less 0 05 \) vo2max \( c 37 7 8 3 ml min 1 kg 1 40 1 5 3 p less 0 05 \) children adults metabolic efficiency \( delta vo2 delta work rate \) vo2 heart rate relationship \( delta vo2 delta hr kg \) similar two groups unaffected hypoxia constant work rate exercise , vo2 kinetics \( time constant phase 2 response \( pi 1 \) o2 deficit \) similar children adults significantly slowed hypoxia , consistent current understanding control oxidative metabolism finally , heart rate increased rest exercise hypoxia , time reach 75 end exercise response delayed significantly , groups
video display risk spontaneous abortion background relation spontaneous abortion use video display \( vdts \) great public health concern previous investigators issue reported inconsistent findings methods determine whether electromagnetic fields emitted vdts associated increased risk spontaneous abortion , cohort female telephone operators used vdts work compared cohort operators use vdts obtain reliable estimates exposure , determined number hours use per week company records measured electromagnetic fields , purposes comparison , without vdts operators used vdts higher abdominal exposure low frequency \( 15 khz \) electromagnetic fields \( without vdts low frequency energy \) abdominal exposure extremely low frequency fields \( 45 60 hz \) similar operators used vdts among women interviewed , pregnancies met criteria inclusion study results found excess risk spontaneous abortion among women used vdts first trimester pregnancy \( odds ratio 0 93 95 percent confidence interval , 0 63 1 38 \) , dose response relation apparent examined women 's hours use per week \( odds ratio 1 25 hours per week 1 04 95 percent confidence interval , 0 61 1 79 odds ratio greater 25 hours per week 1 00 95 percent confidence interval , 0 61 1 64 \) continued risk associated use vdts accounted multiple pregnancies , conducted separate analyses early abortion , late abortion , fetal losses , limited analyses spontaneous abortions physician consulted conclusions use vdts exposure accompanying electromagnetic fields associated increased risk spontaneous abortion study
comparison three formulations tac \( tetracaine , , cocaine \) anesthesia minor lacerations children randomized , prospective , double blind study comparing three formulations topical anesthetic solution tac laceration repair undertaken 250 children children 's wounds anesthetized either tac \( original formulation 0 5 tetracaine , 1 2000 , 11 8 cocaine \) , tac ii \( 1 0 tetracaine , 1 , 7 0 cocaine \) , tac iii \( 1 0 tetracaine , 1 , 4 0 cocaine \) prior repair solutions compared respect efficacy , acceptability , wound complications , side effects found comparable efficacy three formulations , similar efficacy 1 lidocaine infiltration facial scalp wounds anesthesia extremity wounds adequate 39 9 cases , regardless tac strength wound complications side effects within expected acceptable limits findings support use tac face scalp lacerations change less concentrated tac preparation , tac iii , presumably safer widespread use
experience 50 free tram flap breast reconstructions data first 50 patients undergoing free tram flap breast reconstruction two units examined average patient age 42 years , average weight 62 kg forty percent patients chronic smokers , 26 percent low abdominal scars twelve percent exercised abdominal muscles regularly eighteen percent undergone radical mastectomy , whereas 76 percent undergone modified radical mastectomy 6 percent undergone subcutaneous mastectomy postoperative radiotherapy given 16 percent patients , 54 percent received postoperative chemotherapy average time mastectomy 32 months , whereas six breasts reconstructed immediately average operating time 5 6 hours , average blood loss 2 4 units average hospital stay 11 2 days complications included three total flap losses \( 6 percent \) two partial flap losses \( 4 percent \) abdominal hernia occurred two patients \( 4 percent \)
methyl prednisolone double lumen gel saline submuscular mammary prostheses double blind , prospective , controlled clinical trial time immediate breast reconstruction submuscular implants , 76 consecutive patients \( 89 breasts \) randomized two groups one received gel saline , double lumen implant 40 cc saline added outer lumen , received implant plus 40 cc saline 16 mg methyl prednisolone \( 40 mg \) patients followed minimum 3 years groups , matched patient age implant size , evaluated 3 , 12 , 24 , 36 months capsular contracture , steroid atrophy , complications completion double blind study , patients submuscular gel saline implants saline added overall capsular contracture rate 38 percent 3 months , 38 percent 12 months , 44 percent 24 36 months methyl prednisolone overall capsular contracture rate 14 percent 3 months , remained unchanged end study rates complications comparable methyl prednisolone dose 16 mg 40 cc saline \( concentration 40 mg \) , used outer lumen double lumen gel saline implant submuscular pocket , safe efficacious reducing risk capsular contracture minimum 3 years patients undergoing immediate breast reconstruction submuscular mammary implants
radiographic manifestations congenital anomalies spine although review embryologic development congenital anomalies spine infants children necessarily brief , commonly encountered abnormalities reviewed , possible , attempt made stage embryologic development various abnormalities originate noted , congenital abnormalities spine relatively uncommon may profound clinical significance past decade , significant developments diagnosis treatment abnormalities ultrasonography , ct scanning , mr imaging neonate , spinal cord neural outflow evaluated ultrasonography osseous elements begin fuse thereafter , mr imaging procedure choice permits evaluation spine spinal cord planes imaging provides detailed evaluation effect osseous abnormalities neural structures finally , plain radiographs spine evaluation neonates spectrum sacral rarely helpful , presence significant cutaneous subcutaneous abnormalities , ultrasonography preferred modality evaluation
characteristics accessory pathways exhibiting decremental conduction prevalence , electrophysiologic characteristics functional significance decremental conduction accessory pathway examined retrospective study patients accessory pathway demonstrated electrophysiologic study decremental conduction identified 50 patients \( 7 6 \) 15 patients anterograde decremental conduction , accessory pathway right parietal septal 14 patients left parietal 1 patient 40 patients retrograde decrement , accessory pathway left parietal 19 , 13 , right parietal 2 right 6 patients anterograde conduction accessory pathway absent 11 40 patients retrograde decrement retrograde conduction accessory pathway absent 9 patients anterograde decrement significant difference accessory pathway effective refractory period , shortest cycle length 1 1 conduction accessory pathway anterograde retrograde directions shortest rr interval atrial fibrillation 2 qrs complexes longer patients anterograde decremental conduction control group patients anterograde conducting accessory pathways without decremental properties data demonstrate decremental conduction accessory pathways uncommon anterograde decremental conduction usually occurs right sided septal pathways often conduct retrograde direction
usefulness , sotalol suppression chronic ventricular arrhythmias sotalol unique beta blocking drug , possessing significant class iii antiarrhythmic activity efficacy safety 2 doses sotalol \( 320 640 mg day , divided 2 doses \) compared placebo 6 week randomized , double blind , multicenter study 114 patients chronic ventricular premature complexes \( \) frequencies greater equal 30 hour sotalol significantly reduced patients receiving low \( n 38 \) high \( n 39 \) doses , compared patients \( n 37 \) receiving placebo \( 75 88 , respectively , vs 10 p less 0 001 , sotalol vs placebo p less 0 05 , high vs low dose \) individual efficacy criterion \( greater equal 75 reduction \) achieved 34 low dose 71 high dose sotalol versus 6 placebo treated patients \( p less 0 003 , sotalol vs placebo p 0 007 , high vs low dose \) repetitive beats suppressed 25 placebo \( difference significant \) , 80 low dose \( p less 0 003 \) 78 high dose sotalol \( p less 0 005 \) sotalol decreased heart rate \( 24 25 , p less 0 001 \) increased pr \( 4 6 , p less 0 001 \) corrected intervals \( 12 13 , p less 0 001 \) , change ejection fraction \( nonfatal \) occurred 3 sotalol 2 placebo patients nine discontinued therapy adverse effects \( 1 low dose 8 high dose , p less 0 02 \) summary , sotalol efficacious antiarrhythmic drug suppression lower doses , somewhat less effective better tolerated
perception life events daily stress nonulcer dyspepsia previous studies association nonulcer dyspepsia major life events performed without emphasis perception events , yielded conflicting results present study examined perception life events , addition , role daily hassles \( stressful events \) patients nonulcer dyspepsia thirty three dyspeptic patients defined normal endoscopy 33 controls comparable sex , age , social class recruited study groups asked select 56 major life events experienced give rating perceived asked select similarly 117 items daily stress rate severity item results demonstrated number positive negative events positive score similar dyspeptic patients controls , dyspeptic patients higher perceived magnitude negative events higher score total life change given magnitude positive negative events \( p less 0 05 \) hassles scores significantly different dyspeptic patients controls analysis individual life events revealed dyspeptic patients significantly \( p less 0 05 \) higher scores controls items minor law violations , major change family members , major personal illness injury conclude patients nonulcer dyspepsia higher negative perception major life events , indicates psychological factors may play role pathogenesis nonulcer dyspepsia
clinical molecular diagnosis miller syndrome report results clinical , cytogenetic , molecular studies 27 patients miller syndrome \( mds \) 25 families severe type grossly normal cerebellum distinctive facial appearance consisting prominent forehead , , short nose nares , upper lip , thin border , small jaw several abnormalities , especially growth deficiency , frequent constant chromosome analysis showed deletion band 14 25 mds probands rflp somatic cell hybrid studies using probes 3 region including \( \) , \( \) , \( \) detected deletions 19 25 probands tested including seven chromosome analysis normal cytogenetic molecular data combined , deletions detected 21 25 probands parental origin de novo deletions determined 11 patients paternal origin occurred seven maternal origin four demonstration cytogenetic molecular deletions 21 25 mds probands deletion critical region comprising two genetic loci within band 3 cause mds phenotype suspect remaining patients smaller deletions involving proposed critical region detected currently available probes
blockade prostaglandin production increases cachectin synthesis prevents depression macrophage functions hemorrhagic shock although hemorrhage severely macrophage functions , known whether increased tnf alpha pge2 production responsible study c3h mice bled mean blood pressure 35 mmhg 60 minutes , resuscitated , treated either ibuprofen \( 1 0 mg kg body weight \) vehicle \( saline \) hemorrhage increased plasma prostaglandin e2 \( pge2 \) levels 151 7 40 0 \( p less 0 05 \) significantly decreased peritoneal macrophage \( pm phi \) antigen presentation \( ap \) 60 5 7 3 , ia expression 52 3 7 6 , interleukin 1 \( il 1 \) synthesis 60 5 12 3 compared however ibuprofen treatment reduced pge2 plasma levels 61 3 12 1 significantly increased ap \( 237 0 95 3 \) , ia expression \( 72 8 27 5 \) , il 1 synthesis \( 235 7 134 7 \) , cachectin synthesis \( 8 209 0 \) compared vehicle treated animals results indicate prostaglandins cachectin involved suppression pm phi functions following hemorrhage blockade prostaglandin synthesis improved depressed macrophage functions despite enhanced cachectin synthesis
site action continuous extrapleural intercostal nerve block continuous extrapleural intercostal nerve block shown randomized , controlled study effective reducing postoperative pain thoracotomy restoring pulmonary mechanics assess extent spread bupivacaine infused placed cannula inserted thoracotomy , iohexol \( \) infused 5 days postoperatively 5 patients computed tomography performed contrast medium confined paravertebral space covering average six intercostal spaces study demonstrated anatomically , site action bupivacaine infused extrapleural cannula primarily paravertebral space
simplified hepatic resection use prolonged vascular inflow occlusion ten consecutive patients scheduled undergo liver resection studied prospectively use standard protocol , included routine vascular inflow occlusion reduce blood loss blood transfusion requirements fibrin sealant raw liver surface , abdominal drainage performed deaths occurred , postoperative course remarkably smooth normothermic liver ischemic times 30 122 minutes \( mean , 73 minutes \) well tolerated amount blood transfused reduced mean 2 u \( range , 0 4 u \) occurrence infected intraabdominal bile collections two patients preexisting biliary tract infection suggested abdominal drainage performed patients vascular inflow occlusion recommended liver resections
babies born arrival hospital objective establish prevalence babies born arrival two local hospitals identify women risk giving birth arrival , morbidity mortality associated births design case control study baby born arrival mother compared next born hospital \( random control \) , one matched gestation birthweight , together mothers setting two maternity units serving east subjects babies \( mothers \) born arrival hospitals january 1983 december 1987 main outcome measures perinatal mortality rates , patterns perinatal morbidity , demographic , social obstetric features mothers results 137 \( 0 44 \) 31 , 140 consecutive births arrival hospital \( group \) perinatal mortality rate group 58 4 1000 \( 8 deaths \) compared 10 1 1000 inborn babies \( relative risk 5 8 , 95 confidence interval 2 9 11 4 \) group mean birthweight g 212 g \( 95 ci 50 g \) less random control group mean gestation 266 days 10 days less \( 95 ci 5 9 14 1 days \) random control group hypothermia commonest morbidity women delivered arrival tended either inner city living long way hospital unmarried younger white conclusions high perinatal mortality related immaturity low birthweight , rather birth arrival although groups mothers risk delivery arrival identified information needed establish whether additional antenatal care would beneficial women babies
role phenytoin healing large abscess cavities promotion healing large abscess cavities attained topical phenytoin evaluated controlled studies clinical experimental wounds clinical abscess cavities , phenytoin application 20 patients compared conventional treatment 20 patients resulted earlier separation , decrease oedema , control pain overall enhanced healing mean \( \) rate reduction wound area 2 02 \( 0 48 \) cm2 day phenytoin group versus 1 58 \( 0 51 \) cm2 day controls \( p less 0 05 \) day 10 , 1 8 \( 0 32 \) cm2 day versus 1 19 \( 0 21 \) cm2 day \( p less 0 01 \) day 20 mean volume reduction rates 10th day 0 48 \( 0 01 \) cm3 day phenytoin versus 0 32 \( 0 04 \) cm3 day controls \( p less 0 005 \) day 20 , 17 patients treated phenytoin rated healed completely , compared one controls standardized guinea pig model clinical abscess cavity , included inoculation wound bacillus pneumoniae , enhanced healing rate also observed \( 7 days 0 40 \( 0 05 \) cm2 day phenytoin versus 0 21 \( 0 08 \) cm2 day controls p less 0 005 \) eight animals treated phenytoin healed day 21 , compared one eight controls biopsies wounds treated phenytoin showed less inflammation , necrosis , enhanced neovascularization , collagen deposition fibroblast proliferation compared controls bacterial colonies also decreased rapidly use phenytoin
effect fibrin sealant healing colonic anastomosis rat fibrin advocated protective seal colonic anastomosis prevent leakage order assess effect fibrin glue sealing compared healing sutured colonic anastomosis rat \( group 1 \) addition human derived fibrin sealant \( group 2 \) control possible reaction foreign protein , group 3 sutured anastomosis sealed specially prepared rat fibrin adhesive days 2 , 4 7 , ten animals group killed adhesion formation scored situ bursting pressure measured collagen concentration degradation estimated measuring hydroxyproline adhesion formation significantly increased groups 2 3 compared control group days 2 7 bursting pressure different groups day 4 bursting pressure groups 2 3 significantly lower group 1 \( p less 0 001 \) findings correspond results collagen measurements day 4 concentration hydroxyproline significantly reduced groups 2 3 histological examination showed infiltration neutrophilic granulocytes sealant days 2 4 day 7 sealant results concluded fibrin sealing colonic anastomosis rat improve healing , demonstrated bursting pressure hydroxyproline concentration contrary , seems negative influence
mechanism spastic muscle variation reflex gain time course spasticity electromyographic \( emg \) response initially passive biceps brachii muscle imposed extension applied elbow studied 19 12 normal subjects relaxed normal subjects , biceps muscle found respond displacement velocities 175 , single early burst activity biceps emg contrast , subjects , addition early emg activity , also showed considerable late activity , persisted even stretch velocities low 35 late activity stretch reflex , present fully arms seen spastic subjects tone biceps clinically assessed raised , never observed subjects normal muscle tone mean level emg response highly correlated displacement velocity duration duration applied displacement suggested reflex emg activity major factor genesis spastic arm arises reduction threshold stretch reflexes muscle , pathological increase stretch reflex gain shown activity high level first third months onset spasticity reflex gain significantly reduced spasticity established year concluded , changes passive mechanical properties may play role spasticity established year , major cause spastic muscle pathological increase stretch reflex activity
alterations left ventricular diastolic twist mechanics acute human cardiac allograft rejection background contraction oriented left ventricular \( lv \) fibers results motion left ventricle purpose study assess effects acute human cardiac allograft rejection lv twist pattern twist volume relation methods results markers implanted lv 15 transplant recipients measure time varying , three dimensional chamber twist using computer assisted analysis biplane images twist defined mean longitudinal gradient circumferential rotation lv long axis plotted normalized percent ejection fraction \( ef \) , resulting twist normalized ef relation could divided three phases systole , lv twist linearly related ejection blood contrast , diastolic characterized early rapid recoil little change lv volume , followed gradual bulk diastolic filling occurred 10 acute rejection episodes 10 patients , maximum twist , peak systolic twist rate , slope systolic twist normalized ef relation change contrast , slope early \( first 15 filling \) diastolic twist normalized ef relation \( \( early \) \) decreased significantly \( 0 194 0 versus 0 103 0 rad cm rejection , p 0 0003 \) , resulting prolonged tau 1 2 \( time required 50 20 5 versus 28 5 diastole , p 0 0003 \) decrease percent 15 diastolic lv filling \( 62 11 versus 36 13 , p 0 0003 \) therefore , greater proportion lv occurred later diastole rejection , reflected increase slope \( \( mid \) \) middle late \( 15 90 filling \) diastolic twist normalized ef relation \( 0 018 0 009 versus 0 0 rad cm , p 0 \) peak rate affected resolution rejection , \( early \) percent early diastole returned baseline levels \( p ns versus baseline \) also trend \( mid \) return toward values \( p ns versus baseline \) , change reach statistical significance compared rejection values conclusion acute cardiac allograft rejection associated altered diastolic twist mechanics absence systolic abnormalities rejection , myocardial edema factors may result intrinsic changes elastic properties myocardium , thereby leading modification recoil forces responsible early , rapid deformed ventricle
small volume resuscitation hemorrhagic shock dogs effects systemic hemodynamics systemic blood flow background methods study compared canine systemic hemodynamics organ blood flow \( radioactive microsphere technique \) resuscitation 0 8 saline \( na 137 meq l \) , 7 2 hypertonic saline \( na meq l \) , 20 hydroxyethyl starch 0 8 saline , 20 hydroxyethyl starch 7 2 saline , volume 15 shed blood volume twenty four intubated mongrel dogs \( 18 24 kg \) underwent 30 min period hemorrhagic shock , time 0 30 min shock period , followed fluid resuscitation data collected baseline , 15 min shock period , immediately fluid infusion , 5 min beginning resuscitation , 60 min intervals 2 hr , \( 65 min beginning resuscitation , 125 min beginning resuscitation \) animals received one four randomly assigned iv resuscitation fluids saline \( 54 ml kg \) , hypertonic saline \( 6 0 ml kg \) , starch \( 6 0 ml kg \) hypertonic saline hydroxyethyl starch \( 6 0 ml kg \) results mean arterial pressure increased groups resuscitation cardiac output increased resuscitation groups , exceeding baseline saline hypertonic saline hydroxyethyl starch groups \( p less 05 compared hypertonic saline hydroxyethyl starch \) sixty five minutes beginning resuscitation , cardiac output significantly \( p less 05 \) greater either two colloid containing groups hypertonic saline group resuscitation , hypertonic saline hydroxyethyl starch produced minimal improvements hepatic arterial flow , hypertonic saline hydroxyethyl starch increased hepatic arterial flow near baseline levels , saline markedly increased hepatic arterial flow levels exceeding baseline \( p less 05 , saline vs hydroxyethyl starch \) one hundred twenty five minutes beginning resuscitation , hepatic arterial flow decreased groups hepatic arterial flow hypertonic saline group decreased levels comparable shock myocardial , renal , brain blood flow significantly different groups conclusions small volume resuscitation combination hypertonic saline hydroxyethyl starch comparable much larger volumes 0 8 saline , equal hypertonic saline hydroxyethyl starch ability restore sustain bp improve organ blood flow resuscitation hemorrhagic shock
corticotropin releasing factor modulates immune response stress rat examined role crf , key mediator endocrine response stress , modulating immunosuppression subacute stress intermittent electrical shock 1 h administration shock intact rats resulted 74 decrement lymphocyte proliferation 59 decrease natural killer cytotoxicity similar suppression two parameters immune function response shock noted adrenalectomized rats well immunosuppressive effects shock significantly blunted intact adrenalectomized animals pretreated 1 \) iv either highly potent polyclonal crf antibody specific crf antagonist 2 \) intracerebroventricularly either high affinity monoclonal antibody crf specific crf antagonist immunomodulatory role crf supported findings administration exogenous crf , either iv \( 10 micrograms animal \) intracerebroventricularly \( 1 microgram animal \) , resulted significant decrements lymphocyte proliferation natural killer cytotoxicity , similar seen stress paradigm observations indicate crf plays significant role modulating immune response subacute stress , largely adrenal independent mechanisms
pituitary adrenocortical system neonatal rats responsive stress throughout development time dependent stressor specific fashion responsiveness neonatal hypothalamus pituitary adrenal \( hpa \) axis stress thought impaired diminished first 2 weeks life although previously found full responsiveness hypothalamus pituitary unit adrenalectomy young rats days \( \) 5 10 , failed measure significant increase acth 10 min ether administration age studies , therefore , designed test functional activation hpa axis single repeated exposures stress qualitative \( time course , stressor specific , circadian \) quantitative changes acth corticosterone \( b \) responses various stressors tested first 10 days life exposure 3 min ether vapor increased acth b secretion \( p less 0 05 0 01 \) 1 , 5 , 10 old rats , increasing amplitude acth b responses function age peak secretion acth occurred 5 min onset stress \( 122 3 8 359 54 pg ml d1 10 \) , time maximal b increased function age stressors , maternal separation \( 12 h \) , cold \( 4 c 60 min \) , histamine injection \( 4 mg kg bw , ip \) , provoked significant stressor specific acth b responses 10 old rats histamine administration increased acth secretion vehicle injected rats , peak secretion 15 min drug injection \( 272 29 vs 127 8 pg ml p less 0 01 \) histamine induced b secretion peaked 60 min \( 3 7 0 5 micrograms dl \) contrast early responses observed ether , separation , histamine stress , cold stress 10 old caused large acth b release 4 h onset cold compared deprived acth cold , 457 61 pg ml separated , 150 14 \( p less 0 01 \) b cold , 3 3 0 4 micrograms dl separated , 1 8 0 2 \( p less 0 05 \) detect morning evening \( pm \) differences either pattern magnitude acth b response maternal separation cold stress suppression cold induced acth release b injection \( 1 mg kg bw \) 2 h stress observed 4 h stress pm , whereas given cold , b less effective pm preventing rise acth levels observed 4 h \( abstract truncated 400 words \)
managing geriatric arrhythmias , general considerations cardiac arrhythmias become increasingly common people age , always clinically significant sinus node dysfunction , av conduction disturbances , ventricular supraventricular arrhythmias found always symptomatic treatment asymptomatic arrhythmias controversial probably indicated , symptomatic elderly , therapy indicated , since even elderly found benefit much younger patients specific guidelines , however , apply age group based susceptibility side effects
risk factors emphysema cigarette smoking associated reduction association rate constant lung alpha 1 antitrypsin neutrophil elastase increased risk developing emphysema among individuals smoke cigarettes normal levels alpha 1 antitrypsin \( alpha 1at \) hypothesized result decrease elastase capacity lower respiratory tract alpha 1at smokers compared nonsmokers evaluate hypothesis compared time dependent kinetics inhibition neutrophil elastase lung alpha 1at healthy , young cigarette smokers \( n 8 \) nonsmokers \( n 12 \) alpha 1 antitrypsin purified lavage fluid using affinity molecular chromatography , association rate constant \( k \) neutrophil elastase quantified k smoker plasma alpha 1at \( 9 5 0 5 x 10 \( 6 \) 1 \) similar nonsmoker plasma \( 9 3 0 7 x 10 \( 6 \) 1 , p greater 0 5 \) marked contrast , k smoker lower respiratory tract alpha 1at significantly lower nonsmoker alpha 1at \( 6 5 0 4 x 10 \( 6 \) 1 vs 8 1 0 5 x 10 \( 6 \) 1 , p less 0 01 \) furthermore , smoker lower respiratory tract alpha 1at k significantly less autologous plasma \( p less 0 01 \) considered context concentration alpha 1at lower respiratory tract epithelial lining fluid , inhibition time neutrophil elastase smoker lung alpha 1at twofold greater nonsmoker lung alpha 1at \( smoker 0 34 0 05 vs nonsmoker 0 17 0 05 , p less 0 01 \) consequently , concentrations alpha 1at lower respiratory tract takes twice long equivalent amount neutrophil elastase inhibited smoker 's lung compared nonsmoker 's lung observations support concept cigarette smoking associated decrease lower respiratory tract neutrophil elastase inhibitory capacity , thus increasing vulnerability lung destruction thereby increasing risk development emphysema
hypoxia induces specific set stress proteins cultured endothelial cells vascular endothelial cells \( ec \) initial cells within vascular wall exposed decreases blood ambient oxygen concentration mechanisms tolerate low levels oxygen unknown , may parallel response cellular stresses , heat shock 4 8 h hypoxia , found decrease total protein synthesis cultured bovine aortic pulmonary arterial ec sds page autoradiographic analysis 35s methionine labeled proteins demonstrated concomitant induction specific set proteins \( mr 34 , 36 , 47 , 56 kd \) cell types hypoxia associated proteins \( haps \) cell associated regulated time oxygen concentration dependent manner comparison proteins heat shock proteins \( \) demonstrated haps distinct ec maintained chronically 3 o2 continued synthesize elevated levels haps , yet regulated proteins exposed 0 o2 presence five times normal media glucose concentration alter appearance haps hypoxia sensitive renal tubular epithelial cells regulated proteins corresponding haps irreversibly damaged within 8 h exposure 0 o2 vitro translation experiments demonstrated steady state level several mrnas higher ec normoxic ec encoded proteins mr 32 , 35 , 37 , 40 , 48 kd different proteins encoded hsp mrnas induction haps acute hypoxia continued synthesis chronic hypoxia suggest haps may important maintenance endothelial cell integrity conditions decreased ambient oxygen
acute biologic response excimer versus thermal laser angioplasty experimental atherosclerosis vascular injury platelet accumulation balloon angioplasty two potentially important triggers process restenosis may minimized use laser energy ablate atherosclerotic plaque type laser suitable achieve goals remains unknown accordingly , angiographic histologic studies quantitative platelet deposition analysis performed 27 atherosclerotic rabbit iliac arteries randomized treatment excimer laser thermal laser angioplasty excimer laser angioplasty achieved 35 40 mm2 308 nm chloride irradiation delivered 4 5f catheter made 13 arranged 200 microns fiber , repetition rate 25 30 hz pulse duration 135 ns thermal laser angioplasty achieved 1 7 mm metal probe 10 w continuous wave argon laser energy baseline post laser luminal diameters excimer laser treated vessels \( 0 92 0 28 1 56 0 48 mm , respectively \) similar observed thermal laser treated vessels \( 1 05 0 44 1 61 0 41 mm , respectively \) perforation occurred 4 \( 29 \) 14 thermal laser treated arteries 0 13 excimer laser treated arteries \( p 0 04 \) spasm observed 1 thermal laser treated vessel basis quantitative histologic grading scheme \( damage scores 0 4 \) , greater degrees injury measured thermal versus excimer laser treated vessels \( 2 4 1 0 versus 1 3 0 4 , p 0 009 \)
differential impairment semantic episodic memory alzheimer 's huntington 's diseases controlled prospective study controlled prospective study compared performance 14 patients dementia alzheimer type \( dat \) 14 patients huntington 's disease \( hd \) , matched overall level dementia , battery semantic episodic memory tests dat patients significantly impaired measures delayed verbal episodic memory , addition showed rapid rate decline tests depend upon integrity semantic knowledge \( , number information , similarities category \) contrast , hd patients significantly worse , showed rapid decline test , task especially sensitive deficiencies retrieval hd patients also impaired dat patients test geometric figures observed double offer compelling evidence distinct forms dementing illness result different patterns cognitive impairment
skin reflectance pulse oximetry vivo measurements forearm calf study describes results series human experiments demonstrating ability measure arterial hemoglobin oxygen saturation \( sao2 \) forearm calf using reflectance pulse oximeter sensor special optical reflectance sensor includes heating element interfaced temperature commercial data scope pulse oximeter adapted study perform reflectance pulse oximeter reflectance pulse oximeter sensor evaluated group 10 healthy adult volunteers steady state hypoxia hypoxia induced gradually lowering inspired fraction oxygen breathing gas mixture 100 12 simultaneous sao2 measurements obtained forearm calf two identical reflectance pulse oximeters compared sao2 values measured finger sensor interfaced standard pulse oximeter equations best fitted linear regression lines percent reflectance , spo2 \( r \) , , spo2 \( \) , values range 73 100 spo2 \( r \) 7 06 1 09 spo2 \( \) forearm \( n 91 , r 0 95 \) spo2 \( r \) 7 78 0 93 spo2 \( \) calf \( n 93 , r 0 88 \) regression analysis forearm data revealed mean sd error 2 47 1 66 \( sao2 90 100 \) , 2 35 2 45 \( sao2 80 89 \) , 2 42 1 20 \( sao2 70 79 \) corresponding regression analysis calf data revealed mean sd error 3 36 3 06 \( sao2 90 100 \) , 3 45 4 12 \( sao2 80 89 \) , 2 97 2 75 \( sao2 70 79 \)
patient controlled analgesia children adolescents randomized , prospective comparison intramuscular administration morphine postoperative analgesia randomized , prospective trial patient controlled analgesia \( pca \) , , method analgesia administration involving computer driven pump activated patients receive small doses within defined limits performed 82 children adolescents major orthopedic surgery compare \( 1 \) intramuscularly administered morphine , \( 2 \) pca morphine \( 3 \) pca morphine low dose continuous morphine infusion \( pca plus \) patients receiving pca pca plus lower pain scores greater satisfaction patients receiving intramuscularly administered morphine three groups used equal amounts morphine measures recovery identical groups particular , pca pca plus increase incidence opioid related complications , patients receiving pca plus less sedated patients receiving intramuscular therapy conclude pca pca plus safe effective methods pain relief children adolescents orthopedic surgery , better accepted intramuscular injections , increase perioperative morbidity
cells derived omental fat tissue used seeding vascular prostheses endothelial origin study origin cells derived omentum use microvascular endothelial cells derived omental tissue advocated seed vascular grafts autologous endothelial cells high density purpose study evaluate precise origin cells therefore compared cellular characteristics cells endothelial cells isolated collagenase treatment human umbilical veins omental cells isolated omental tissue four different patients incubation collagenase solution part material processed density gradient centrifugation attempt isolates cellular characteristics types cells determined studying morphologic features cells determining presence von willebrand factor , antigens en 4 e specific endothelial cells , cytokeratins 8 18 , vimentin desmin , uptake dii low density lipoprotein cells omental tissue , isolated collagenase treatment either purified density gradient centrifugation , differed human umbilical vein endothelial cells respect presence surface microvilli , expression von willebrand factor , en 4 e , presence cytokeratins 8 18 desmin von willebrand factor \( granular staining pattern \) presence en 4 e detected human umbilical vein endothelial cells vimentin present cell types , whereas cytokeratins 8 18 desmin present cells derived omentum data conclude called microvascular endothelial cells omentum endothelial mesothelial nature
subclavian artery vein fistula insertion hemodialysis catheter insertion hemodialysis catheters temporary use preferentially performed percutaneous subclavian vein catheterization method involves passage stiff dilator away sheath guide wire , usually carried without fluoroscopy part proved valuable safe approach however , small incidence major complications occurs , needs emphasized sixteen cases arteriovenous fistulas subclavian artery branches subclavian vein reported far literature date one case subclavian artery vein fistula reported report second case complication suggest possible preventive measures
diagnosis popliteal artery entrapment syndrome role duplex scanning authors present new diagnostic procedure quickly noninvasively diagnose popliteal artery entrapment syndrome large personal experience surgical treatment disease \( 29 cases 22 patients \) allowed us focus optimal diagnostic procedure useful detect problem early stage technique based continuous wave doppler duplex scanning studies done resting state active contraction calf muscles compression popliteal artery occurs contraction calf muscles , detected decrease flow finding also direct radiologist obtain films maneuver repeated makes unlikely diagnosis missed since july 1988 total patients evaluated continuous wave doppler suspected chronic ischemia group 41 patients selected studied combined continuous wave doppler duplex scanning method possible popliteal artery entrapment syndrome two cases discovered verified dynamic angiography guided continuous wave doppler treated surgically
follow status patients angiographically normal coronary arteries panic disorder cardiology patients normal coronary angiography demonstrate continuing substantial social , health , work disability hypothesized diagnosis panic disorder would mark continuing disability likely interviewed 72 patients time normal angiogram , average 38 months later panic disorder \( n 36 \) demonstrated significantly disability follow study patients conclude patients normal angiograms panic disorder disabled panic disorder panic disorder psychiatric samples shown highly treatable therefore , early identification treatment panic disorder group likely minimize suffering associated condition
effect muscle sparing versus standard posterolateral thoracotomy pulmonary function , muscle strength , postoperative pain increased interest alternative approaches thoracotomy developed considerable morbidity associated standard posterolateral technique conducted prospective , randomized , blinded study 50 consecutive patients compare postoperative pain , pulmonary function , shoulder strength , range shoulder motion standard posterolateral muscle sparing thoracotomy techniques pulmonary function \( forced expiratory volume 1 second forced vital capacity \) , shoulder strength , range motion measured preoperatively 1 week 1 month postoperatively pain quantitated postoperative requirements , visual analogue scale , pain questionnaire morbidity , mortality , hospital stay compared standard posterolateral muscle sparing techniques differences postoperative pulmonary function , shoulder range motion , extent lung resection , surgical approach time , mortality , hospital stay significantly less postoperative pain muscle sparing group requirement less first 24 hours \( p 0 \) , visual analogue scale scores significantly lower \( p less 0 05 \) throughout first postoperative week shoulder girdle strength decreased 1 week standard incision group whereas strength preserved muscle sparing approach muscle strength returned preoperative levels 1 month groups morbidity identical two groups exception postoperative prevalence 23 muscle sparing group 0 standard incision group \( p 0 \) demonstrated muscle sparing incision may reasonable alternative standard posterolateral approach
hospital management voluntary total fasting among 1989 20 , held without trial 32 months , admitted , , hospital , south africa held regulations state emergency \( since \) 5 held section 29 internal security act \( still force \) guidelines ethical management based , included understanding constituted mental conditions hospital complicated police interference medical nursing care , beds doctors unique position treatment , use
cerebrospinal fluid fistula endoscopic sinus surgery seven cases cerebrospinal fluid fistulae occurring result endoscopic sinus surgery total 800 discussed , along 1 case referred consultation one cerebrospinal fluid fistula , 4 posterior ethmoid base skull , 2 anterior ethmoid , 1 ethmoid cribriform six 8 fistulae closed endoscopically sinus cerebrospinal fluid fistula closed successfully fibrin glue five cerebrospinal fluid fistulae closed successfully using fascia , muscle , gel foam two cerebrospinal fluid fistulae treated conservatively , 1 stopped anatomic technical aspects related occurrence cerebrospinal fluid fistulae discussed management treatment cerebrospinal fluid fistulae occurring endoscopic sinus surgery emphasized identified intraoperatively delayed , cerebrospinal fluid fistulae managed successfully endoscopic technique
synchronous positive negative myoclonus due pontine hemorrhage report case synchronous positive negative myoclonus following pontine hemorrhage constant synchronous eyes , tongue , face , mandible , larynx , pharynx , persisted sleep limb muscles occurred activities , rest inability sustain glottic adduction contributed severe dysarthria electromyography \( emg \) revealed positive myoclonus musculature synchronous negative myoclonus generalized distribution treatment trazodone reduced ocular myoclonus worsened dysphagia suggest single neural rhythm generator may produce positive negative myoclonus
4 gene member family elegans genes induce neuronal degeneration three dominant mutations 4 , gene needed , cause touch receptor neurons elegans 1 , another c elegans gene induce neuronal degeneration similar sequence , 4 defines new gene family cross hybridizing sequences detectable species , raising possibility degenerative conditions organisms may caused mutations similar genes three dominant 4 mutations affect amino acid effects amino acid substitutions position suggest may induce degenerative state
protein synthesis required anchor mutant p53 protein temperature sensitive nuclear transport p53 protein rendered temperature sensitive point mutation rat cells transformed mutant p53 activated ras oncogene grow well 37 degrees c dna synthesis cell division shifted 32 degrees c immunostaining demonstrates mutant p53 protein nucleus arrested cells 32 degrees c cytoplasm growing cells 37 degrees c first example protein temperature sensitive nuclear transport translocation cytoplasm nucleus vice versa occurs 6 h temperature shift coincident inhibition dna synthesis transport cytoplasm nucleus require protein synthesis remarkably , inhibition protein synthesis 37 degrees c also results rapid appearance mutant p53 cell nucleus results suggest presence short lived protein responsible holding p53 cytoplasm 37 degrees c 32 degrees c analysis non temperature sensitive mutant p53 protein shows cytoplasmic location sensitive protein synthesis inhibitors temperature
hypoxanthine levels vitreous humor evidence hypoxia infants died sudden infant death syndrome postmortem changes hypoxanthine vitreous humor humans investigated hypoxanthine formed hypoxic degradation adenosine monophosphate repeated sampling performed 13 deceased adults keeping bodies 6 degrees c , increase hypoxanthine levels estimated 3 5 mumol l per hour sampling started 12 hours death \( range 2 8 5 6 mumol l per hour \) results hypoxanthine measurements vitreous humor 73 infants sudden infant death syndrome , 17 infants children died sudden violent deaths , 6 neonates died suddenly without hypoxemia prior death corrected according expected postmortem hypoxanthine increase time death autopsy similar three groups studied corrected median hypoxanthine level group sudden infant death syndrome 227 mumol l , significantly higher groups 22 mumol l group violent deaths \( p less 01 \) , 0 mumol l neonate group \( p less 01 \) findings seem confirm sudden infant death preceded relatively long period tissue hypoxia cases
esophageal gastric endoscopy critically ill patients help \? bleeding upper gastrointestinal tract critically ill patient diagnostic situation endoscopy help physicians determine cause bleeding also provide several therapeutic options authors discuss applications current technology
emergency resuscitation children role intraosseous infusion intraosseous infusion temporary procedure use pediatric emergencies intravenous access difficult multiple drugs fluids safely administered intraosseous route dosage rate infusion essentially intravenous infusion
patients anorexia bulimia \? understanding first step helping anorexia nervosa bulimia nervosa , recent years , become disorders major concern young women particularly prone eating disorders , substantial numbers involved practices identify problems understanding behind disorders helpful recognizing developing treatment approach effective medication bulimia reported date fluoxetine hydrochloride \( \) concurrent participation physician , , family therapist care patients ideal
interaction v rel protein nf kappa b dna binding site avian virus contains within genome oncogene rel expression gene responsible induction lymphoid tumors birds recently , rel gene shown related dna binding subunit transcription factor complex nf kappa b binding sites nf kappa b complex found enhancer regions number genes , including immunoglobulin kappa gene human immunodeficiency virus long terminal repeat communication identify activity avian virus transformed avian lymphoid cells binds electrophoretic mobility shift assay nf kappa b binding site kappa enhancer activity contains proteins immunologically related rel , detected polyclonal monoclonal antibodies directed v rel dna affinity precipitation assay using nf kappa b site human immunodeficiency virus long terminal repeat , v rel several proteins identified data suggest oncogenic transformation v rel result altered pattern gene expression
nerve growth factor corrects developmental impairments basal forebrain cholinergic neurons trisomy 16 mouse trisomy 16 \( ts16 \) mouse , shares genetic phenotypic syndrome , exhibits impaired development basal forebrain cholinergic system basal obtained ts16 euploid fetuses 15 days gestation dissociated cultured completely defined medium , cholinergic neurons identified choline acetyltransferase \( chat \) immunoreactivity ts16 cultures exhibited fewer chat immunoreactive neurons , smaller emitted shorter , , simplified euploid littermates whereas addition beta nerve growth factor \( 100 ng ml \) augmented specific activity chat extension ts16 euploid cholinergic neurons , ts16 cultures exhibited increase number size chat immunoreactive neurons furthermore , ts16 chat immunoreactive formed varicosities presence beta nerve growth factor
stage transitions b lymphocyte differentiation correlate limited variations nuclear proteins total nuclear proteins extracted cell lines representing various stages differentiation mouse b lymphocytes studied computer analysis two dimensional gels spots present gels , 55 varied significantly intensity differentiation variations occurred often steps correlating defined b cell differentiation seventeen spots detectable least one stages \( qualitative variations \) could represent switching genes coding nuclear proteins detailed analysis 55 variable spots showed fall small sets characterized similar expression profiles , , control mechanism gene expression addition , analysis expression nuclear proteins resolved gels clearly differentiated b lineage cells myeloid cells suggested important transition b cell differentiation occurs resting b cell stages
potency mrnas encoding receptors voltage activated channels postmortem rat brain stability integrity mrnas encoding neurotransmitter receptors voltage activated channels postmortem rat brain investigated poly \( \) mrna , injecting xenopus oocytes , examining expression functional neurotransmitter receptors voltage activated channels oocyte membrane electrophysiological recording approach also used assess stability mrnas brains incubated oxygenated mammalian ringer 's solution various lengths time brains freshly frozen thawed room temperature oocytes injected mrna 21 hr postmortem brains gave large agonist voltage activated responses , indicating mrnas encoding neurotransmitter receptors voltage activated channels relatively stable postmortem brain tissue contrast , oocytes injected mrna brains incubated ringer 's solution exhibited smaller responses , oocytes injected mrna tissue frozen thawed displayed small undetectable responses northern blot analysis using nucleic acid probe rat brain na \( \) channel mrna indicated size na currents injected oocytes reflected levels mrna na channels different mrna preparations thus , potency mrnas encoding neurotransmitter receptors voltage activated channels quite stable postmortem brains situ , reduced brains kept oxygenated saline , tissue results rapid degeneration mrna
long chain \( \) bases inhibit multistage carcinogenesis mouse c3h 2 cells treated radiation phorbol 12 myristate 13 acetate sphingosine long chain \( \) bases inhibit protein kinase c , putative cellular receptor tumor promoter phorbol 12 myristate 13 acetate \( pma \) , exert potent effects diverse cell functions tested ability long chain bases modulate multistage carcinogenesis mouse c3h 2 cells exposed gamma rays pma sphingosine completely blocked enhancement radiation induced transformation pma \( promotion \) partially suppressed transformation radiation alone n , analog , inhibit transformation sphingosine rapidly taken cells metabolized hence , long chain bases added daily achieve prolonged inhibition long chain bases inhibited protein kinase c activity c3h 2 cells suppressed regulation enzyme pma results establish long chain bases highly effective inhibitors carcinogenesis model results also indicate suppressive effects may mediated , part , inhibition protein kinase c data suggest sphingosine long chain bases derived complex may act cancer agents
open heart surgery 's 7 year period , 11 adult members religious 's underwent cardiac surgery extracorporeal circulation homologous blood transfusions given blood conserving procedures employed , initial collection autologous blood , processing \( cell \) blood collected extracorporeal circulation reinfusion shed mediastinal blood total perioperative blood loss averaged ml \( 15 ml kg body weight \) , 19 total body blood volume mean haemoglobin discharge hospital 11 0 g 100 ml perioperative mortality postoperative pulmonary function good serious morbidity 's serious , surgery necessitating heart disease offered operation comprising recognized blood conserving procedures
effect dipyridamole \( \) blood flow patency aortocoronary vein bypass grafts effect dipyridamole investigated 360 patients undergoing coronary bypass surgery randomly allocated receive dipyridamole \( 100 mg orally q 2 days preoperatively , 5 mg kg body weight 24 h v 100 mg orally q 1 year postoperatively \) placebo withdrawn study 48 patients dipyridamole 57 placebo cardiovascular cerebrovascular events need anticoagulant treatment reasons withdrawal 22 \( 13 \) dipyridamole , 34 \( 18 \) placebo group logistic regression analysis risk factors influencing graft patency showed significant relation measured coronary blood flow positive trend treatment observed \( p 0 08 \) vein graft blood flow measured bypass surgery \( 245 patients \) significantly greater dipyridamole group \( p less 0 01 \) occlusion rate lower vessels blood flow greater 30 ml min \( vein marginal p less 0 01 , vein p less 0 05 , vein diagonal 0 05 less p less 0 1 \) dipyridamole increases coronary blood flow graft patency following coronary bypass surgery
factitious cyclic new variant factitious disorder central goal patients factitious disorders receive medical care unnecessary diagnostic procedures recurrent hospitalizations often saw 39 year old man novel variation disorder factitious cyclic , simulation recurrent episodes excessive sleep case highlights observations patients whose illnesses simulated may diverse symptoms , syndrome immune factitious , attempts treatment , though exceedingly challenging , always contingent upon appropriate recognition
value routine preoperative laboratory testing predicting postoperative complications multivariate analysis purpose study evaluate ability preoperative laboratory testing predict postoperative complications five hundred twenty patients undergoing elective surgery american society classification , index , electrolyte values , glucose levels , blood urea nitrogen creatinine values , complete blood counts , coagulation studies , total protein albumin lymphocyte count , electrocardiogram , chest radiograph , urinalysis , pulmonary function tests , type anesthesia , type operation recorded preoperatively patients followed prospectively surgery development complications data analyzed univariate multivariate methods postoperative complications strongly associated american society classification , type anesthesia , type operation however , laboratory tests , electrocardiogram , chest radiograph , nutritional status , associated postoperative complications therefore , general , preoperative laboratory testing undertaken specific indications recommendations routine tests made depending age patient
bacteriologic quality intraoperative autotransfusion controversies remain bacteriologic aspects intraoperative blood salvage despite widespread use technique prospective study , intraoperative salvaged blood cultured 401 patients , according direct technique bacterial growth detected 12 7 cases results compared obtained control studies sterile water blood bank units culture conditions microorganisms negative staphylococci , followed skin environmental contaminants quantitative estimates showed low counts colony forming units \( cfu ml \) 82 positive cultures yielded 1 2 cfu ml 6 5 20 cfu ml patients followed minimum 3 months detect septic complications statistically significant correlation could found bacteriologic results blood infectious complications study suggests bacteriologic monitoring patients undergone autotransfusion may help detecting surgical field contamination also confirms intraoperative autotransfusion adds little septic risk cardiac surgery
predisposing factors bladder calculi review 100 cases one hundred patients , aged twenty ninety two years , underwent 111 procedures removal bladder calculi patients \( 88 \) type bladder outlet obstruction two types stones identified apparently formed upper tract trapped bladder \( 17 cases \) appeared formed bladder presence various types outlet obstruction stone analysis revealed uric acid stones 50 percent , calcium oxalate stones 19 percent , stones mixed composition 31 percent five patients metabolic abnormalities predisposing stone formation 2 cases , abnormalities discovered evaluation stone disease treatment depended stone characteristics , associated pathology , general health patient review literature regard morbidity mortality combining treatment vesical calculi bladder outlet obstruction secondary prostatic obstruction included
application microwave tissue coagulation partial nephrectomy microwave tissue coagulation used partial nephrectomy 10 mongrel dogs , without clamping renal artery major complications , retroperitoneal hematoma , abscess formation , macroscopic infarction kidney tissue related new procedure advantages microwave coagulation reduced blood loss , shorter operative time , minimal risk vascular injury
effect nisoldipine hemodynamic responses defibrillation sequences ventricular fibrillation defibrillation cause transient hypertension hypothesized adrenergic overshoot might blunted functional effect calcium channel blocking drug nisoldipine , potentially beneficial reduction myocardial oxygen requirements however , calcium channel blocking drugs shown reduce shock success defibrillation , deleterious effect thus purposes study assess effect nisoldipine hemodynamic responses sequences ventricular fibrillation defibrillation , effect energy requirements defibrillation 16 dogs administered intravenous nisoldipine \( 1 microgram kg bolus followed infusion 0 075 0 50 microgram kg min \) lower mean blood pressure 10 20 baseline ventricular fibrillation induced electrically , shocks varying energy levels \( 30 , 50 , 100 joules \) administered determine defibrillation energy requirements heart rates blood pressures recorded 3 minutes shock determine hemodynamic responses measurements made nisoldipine administration two levels drug induced blood pressure decline found usual systolic blood pressure overshoot defibrillation \( typically maximum 15 30 seconds shocks \) significantly blunted nisoldipine administration \( p less 0 05 \) heart rate slowing defibrillation \( cholinergic response \) affected nisoldipine alter shock success rates , varied 12 7 se 30 joules 68 12 100 joules thus nisoldipine blunted adrenergic overshoot systolic blood pressure following defibrillation , potentially beneficial effect , without altering energy requirements transthoracic defibrillation
isotonic high sodium oral rehydration solution increasing sodium absorption patients short bowel syndrome compared effect standard oral rehydration solution high sodium polymeric glucose solution sodium absorption short bowel syndrome six patients high tested random order standard solution solution containing \( 18 g 12 l \) enriched 2 5 g nacl l solutions administered via nasogastric tube rate 2 ml min jejunal effluent collected 8 h period net 8 h fluid absorption significantly different two periods glucose absorption greater 90 administered amount solutions net sodium absorption greater solution standard solution \( 56 12 vs 24 20 mmol , p less 0 05 \) conclude replacement glucose addition sodium standard oral rehydration solution results improved sodium absorption short bowel syndrome
hairless skin novel model studies cutaneous biology reported structural immunohistochemical similarities hairless \( hmp \) skin humans hairless skin surface composed complex created geometric patterns remarkably similar human skin surface dermal epidermal interface consisted dermal papillae hairless epidermis contained two morphologically distinct populations basal keratinocytes \( \) similar heterogeneity seen human epidermis primate palmar epidermis immunohistochemistry revealed hmp epidermis reactive monoclonal polyclonal antisera keratin proteins melanocytes reactive antisera 100 protein , human skin , also observed hmp epidermis organization dermal extracellular matrix , including collagen elastic fibers , organization reactivity microvasculature antisera factor viii , consistent human skin induced atrophy subsequent rebound phenomenon withdrawal steroid observed hmp skin similar observed humans concluded hmp skin human skin significantly precisely existing species excellent model studies cutaneous physiology pharmacology
induction inflammatory cell infiltration necrosis normal mouse skin combined treatment tumor necrosis factor lithium chloride previously reported lithium chloride \( licl \) potentiates tumor necrosis factor \( tnf \) mediated cytotoxicity vitro vivo , using murine normal skin model , shown subcutaneous injection tnf plus licl induces acute dermal subcutaneous inflammation necrosis histology showed marked initial dermal subcutaneous neutrophil infiltrate approximately 2 hours , followed predominantly mononuclear infiltrate 24 hours , remained present several days tumor necrosis factor licl alone induced negligible inflammation , 6 hours furthermore never necrosis ulceration overlying skin case single agent application vitro studies showed combination tnf licl , either agent alone , directly cytotoxic fibroblastic cells murine skin inflammatory infiltration visible tumors treated tnf plus licl , although latter treatment resulted perilesional leukocyte infiltration furthermore combination tnf licl effect macrophage cytotoxicity tumors
cultured human atherosclerotic plaque smooth muscle cells retain transforming potential display enhanced expression myc protooncogene proliferation vascular smooth muscle cells \( smc \) critical atherosclerotic plaque formation monoclonal hypothesis proposes stimulus smc proliferation mutational event describe procedure growing human plaque smooth muscle cells \( p smc \) culture show p smcs derived two patients differ smc cultured normal vascular tissue expression protooncogene myc one p smc strain extensively characterized diploid , normal cells finite life span culture ultrastructural examination revealed two populations , one classic contractile smc appearance , , modulated synthetic state northern blotting showed 2 6 fold 6 11 fold enhanced expression myc p smc , compared smc derived healthy human aorta \( ha smc \) saphenous vein \( hv smc \) , respectively contrast , p smc hv smc expressed similar levels message genes n myc , l myc , ha ras , fos , sis , myb , ldl receptor , egf receptor , igf receptor , igf ii , hmg coa reductase finally , although p smcs tumorigenic , dna isolated cells positive transfection nude mouse tumor assay myc , however , appear transforming gene newly introduced human myc gene detected p smc associated nude mouse tumor thus human atherosclerotic p smcs possess activated myc gene transforming gene retained throughout many cell passages
traditional versus laparoscopic cholecystectomy laparoscopic cholecystectomy minimally invasive procedure whereby gallbladder removed using laparoscopic techniques indications similar elective traditional cholecystectomy , selection patients important success contraindications currently evolving patients advanced cholecystitis , abdominal sepsis , ileus , bleeding disorders , pregnancy , morbid obesity undergo procedure procedure requires good traditional surgical skills , well additional laparoscopic \( laser \) skills operative time slightly longer traditional cholecystectomy , decreases experience morbidity low , concern bile duct injuries mortality low \( 0 \) comparable traditional cholecystectomy \( 0 4 \) major advantages laparoscopic cholecystectomy short hospital stay \( average 2 days \) early return normal activity \( 7 days \) results reduction hospital costs adequate training important processes good patient outcomes
european experience laparoscopic cholecystectomy retrospective survey 7 european centers involving 20 surgeons undertook 1 , 236 laparoscopic cholecystectomies performed procedure completed 1 , 191 patients conversion open cholecystectomy necessary 45 patients \( 3 6 \) either technical difficulty \( n 33 \) , onset complications \( n 11 \) , instrument failure \( n 1 \) deaths reported , total postoperative complication rate 20 1 , 203 \( 1 6 \) , 9 serious complications requiring laparotomy total incidence bile duct damage 4 1 , 203 median hospital stay 3 days \( range 1 27 days \) median time return full activity discharge 11 days \( range 7 42 days \)
complications laparoscopic cholecystectomy emergence laparoscopic cholecystectomy viable alternative traditional cholecystectomy enthusiasm surgical community new technique without complications , potential real complications associated diagnostic laparoscopy well documented , associated traditional cholecystectomy may also seen laparoscopic cholecystectomy incidence occurrence , however , may vary remains early evaluate complication rates new procedure , reports large series beginning emerge early reports encouraging caution bile duct injury , hemorrhage , even death may occur early enthusiasm new method must care practice complication rates maintained acceptable level procedure permanent place armamentarium surgeon
interruption professional home activity laparoscopic cholecystectomy among french american patients laparoscopic approach , patients undergo cholecystectomy shorter hospitalization , minimal pain , recovery demonstrated , however , patients actually return work laparoscopic cholecystectomy faster traditional 4 6 week absence work standard open procedure survey 104 french 84 american patients undergoing laparoscopic cholecystectomy revealed postoperative discomfort completely resolved 2 weeks 73 french 93 american patients 11 french 5 american patients back normal home activities 2 weeks operation 35 american 40 french patients professional activity outside home , 63 25 , respectively , returned work within 14 days five \( 14 \) american patients 12 \( 30 \) french patients returned work 4 weeks operation amount physical activity job correlated period work , , interestingly , least six patients hard physical activity work \( including construction workers \) able return full work activity within 1 week data suggest early return work possible pain quickly laparoscopic cholecystectomy economic benefit patients back job quickly , however , may less expected cultural norms change regard leave absence major surgery
enhanced mobilization intracellular ca2 induced halothane hepatocytes isolated swine susceptible malignant hyperthermia halothane , dose dependent manner , induced release intracellular ca2 hepatocytes prepared swine magnitude release induced halothane greater hepatocytes prepared animals susceptible malignant hyperthermia \( mh \) normal swine two different methods used ascertain release ca2 induced halothane 1 \) release 45ca2 stores permeabilized hepatocytes measured 2 \) changes intact hepatocytes loaded ca2 \( \) sensitive recorded also observed , although 1 , 4 , 5 inositol \( ip3 \) , guanosine 5 triphosphate , arachidonic acid induced significant release 45ca2 permeabilized swine hepatocytes , quantities 45ca2 released ip3 significantly greater hepatocytes prepared animals susceptible mh data indicate abnormal ca2 homeostasis hepatocytes isolated swine susceptible mh , supports hypothesis membrane systems multiple organs may affected genetic disorder
superficial cultures neonatal sepsis evaluations impact antibiotic decision making authors performed retrospective analysis neonatal superficial cultures effect antimicrobial decision making nine month period general hospital obtained reviewed charts infants \( n 66 \) paired superficial \( skin gastric aspirate \) deep \( blood cerebrospinal fluid \) cultures evaluation early onset sepsis superficial cultures positive pathogens \( streptococcus enteric gram negative \) 15 \( 10 66 \) cases antimicrobial decision making affected one cases , seemingly inappropriate manner summary , evidence review superficial cultures used sepsis evaluation influenced physician antimicrobial decision making one case may led unnecessary antibiotic exposure
catheter related sepsis prospective , randomized study three methods long term catheter maintenance studied infectious risk different methods managing vascular catheters long term use consecutive surgical icu patients requiring triple lumen catheters , pulmonary artery catheters , arterial catheters greater 7 days prospectively randomized one three management groups \) percutaneous \( \) puncture every 7 day catheter change new site , b \) weekly change \( \) new site changed , c \) guidewire exchange \( \) every 7 day catheter change site groups , catheter change mandatory positive blood culture , skin site infection , sepsis without likely source cultures obtained clinically indicated time every catheter change catheter related sepsis \( crs \) defined positive blood culture catheter culture organism total 112 patients met evaluation criteria intergroup differences age , primary diagnosis , severity injury illness , number study days , number protocol violations , route catheterization , number catheters present patient day , catheter sepsis rate , bacteremia rate group demonstrated increased number days catheter , fewer catheter subcutaneous tract segment cultures patient , reduced incidence catheter tip colonization results occurred setting number crs episodes patient 0 17 , 0 22 , 0 16 conclude difference infectious risk three methods long term catheter management method least complications expense used
effect blood transfusion oxygen consumption pediatric septic shock treatment plans pediatric septic shock advocate increasing oxygen consumption \( vo2 \) recent studies septic shock indicate improving oxygen delivery \( do2 \) increasing blood flow increase vo2 prospectively examined effect vo2 improving do2 increasing oxygen content \( co2 \) blood transfusion eight hemodynamically stable septic shock patients transfusion consisted 8 10 ml kg packed rbc 1 2 h hemodynamic oxygen transport measurements obtained blood transfusion transfusion significantly \( p less 05 \) increased hct 10 2 0 8 g dl 30 2 13 2 1 4 g dl 39 4 , respectively \( mean sd \) do2 significantly \( p less 05 \) increased transfusion \( 65 189 ml min m2 \) , vo2 change \( 166 68 176 74 ml min m2 ns \) pediatric septic shock patients , increasing co2 blood transfusion may increase vo2
effects epinephrine hemodynamics oxygen metabolism dopamine resistant septic shock hemodynamic effects epinephrine prospectively studied 13 patients septic shock remained hypotensive fluid loading dopamine hemodynamic measurements performed one hour start epinephrine infusion systolic , diastolic , mean arterial pressure increased patients \( p less 0 01 \) cardiac index systemic vascular resistance increased 34 32 percent , respectively \( p less 0 05 \) , heart rate pulmonary vascular resistance remained unchanged concomitant increase oxygen delivery \( p less 0 01 \) oxygen consumption \( p less 0 05 \) , magnitude latter related baseline \( p less 0 01 \) view generally recognized physiologic goals septic shock management , conclude epinephrine could appropriate alternative fluid loading dopamine failed
denatured muscle grafts nerve repair experimental model nerve damage leprosy 20 patients leprosy develop granulomatous lesions peripheral nerves report experiments guinea pigs thawed autogenous muscle grafts used treatment mycobacterial granulomas granulomas induced guinea pig tibial nerves animals left 7 100 days order assess maximal damage local area nerve damage excised gap filled denatured muscle grafts clinical assessment periods 150 days showed good sensory motor recovery correlated well histological findings muscle graft technique may value treatment chronic nerve lesions selected cases leprosy
selection antibiotic coverage vascular patients undergoing cystoscopy bacteremic seeding prosthetic vascular grafts represents cause graft infection transurethral procedures account one source bacteremia therefore , prospective study 200 patients undergoing cystoscopy conducted identify incidence factors associated , organisms involved antibiotic sensitivities positive cultures found 21 incidence 64 patients 8 patients positive cultures found 12 patients received antibiotics 29 four percent showed signs bacteremia cultures identified gram positive negative organisms multiple organisms grew 22 gram negative organisms common patients candida grew 8 gram positive organisms sensitive ampicillin \( 92 \) , \( 75 \) cefazolin \( 60 \) gram negative aminoglycosides \( 100 \) cefazolin \( 92 \) view unpredictable multiple organisms , recommended pre cystoscopy cultures performed specific antibiotic coverage based sensitivities
possible role bacterial inflammation iron bound pseudomonas function hydroxyl radical tissue injury linked neutrophil associated hydroxyl radical \( oh \) generation , process requires exogenous transition metal iron vivo iron bound form obtain iron required growth , many bacteria secrete iron \( \) since pseudomonas aeruginosa infections associated considerable tissue destruction , examined whether iron bound pseudomonas \( pch \) \( pvd \) could act oh purified pch pvd iron loaded \( fe pch , fe pvd \) added hypoxanthine xanthine oxidase superoxide \( o2 \) hydrogen peroxide \( h2o2 \) generating system evidence oh generation sought using two different spin trapping agents \( 5 5 dimethyl 1 oxide n butyl alpha \) , well oxidation assay regardless methodology , oh generation detected presence fe pch fe pvd inhibition process catalase sod suggested oh formation fe pch occurred via reaction similar results obtained stimulated neutrophils used source o2 h2o2 addition fe pch fe pvd stimulated neutrophils yielded oh detected assay systems since pch pvd bind \( \) \( \) iron , oh fe pch would likely involve o2 \( \) mediated reduction subsequent release free confirmed measuring formation \( \) complex exposure fe pch , fe pvd , enzymatically generated o2 data show fe pch , fe pvd , capable generation oh process could represent yet another mechanism tissue injury sites infection p aeruginosa
treatment fungal skin infections state art number cases infections increasing , presenting physicians today challenge handling treatment prophylactic control disorders increase disorders due many factors , longer life span , organ transplantation , acquired immunodeficiency syndrome pharmaceutical industry providing physicians newer , potent drugs manage overview current practice use topical oral agents , especially ketoconazole , given following specific tinea capitis , , dermatitis , infections , vaginal candidiasis , efficacy ketoconazole various dosage schedules traditional agents griseofulvin discussed relation
itraconazole tinea review itraconazole , new orally active triazole antifungal , tested patients number studies shown itraconazole effective mild fungal skin disease total dose required effective treatment 1000 mg , given 200 mg 5 days 7 days organisms slowly skin , even dead , results assessed clinically mycologically around 3 4 weeks treatment numerous studies shown itraconazole superior placebo effective selenium , clotrimazole , also better tolerated patients selenium
itraconazole common infections skin fixed treatment schedules itraconazole effective medication common shown active griseofulvin ketoconazole ease use , affinity tissues , lack toxicity , continued activity discontinuation , possibility using fixed schedules advantages itraconazole fixed schedules indicated pharmacokinetics clinical studies one 100 mg capsule daily 15 days cases tinea tinea cruris dosage 30 days cases tinea pedis tinea fixed treatments limitations , recommended treating tinea capitis tinea drug well tolerated
treatment oral candidosis itraconazole review oral candidosis common infection infants , elderly persons , patients receiving immunosuppressive therapy , patients acquired immunodeficiency syndrome \( aids \) orally active antifungal agent itraconazole evaluated number different patient populations oral oropharyngeal candidosis initial studies shown itraconazole , 100 200 mg day 14 days , active placebo treating oral candidosis comparative study itraconazole capsules \( 200 mg daily \) clotrimazole \( 10 mg five times daily \) showed equivalent results end therapy significantly faster response itraconazole faster relapse rate clotrimazole study aids patients oropharyngeal candidosis demonstrated itraconazole , 200 mg day , ketoconazole , 400 mg day , 4 weeks give equivalent clinical cure rates similar relapse rates pilot study oral solution itraconazole given impressive 100 clinical response rate within 1 week treatment conclusion , itraconazole capsule solution form may constitute major addition armamentarium drugs oropharyngeal candidosis
treatment vaginal candidiasis clinicians vast array effective treatment vaginal candidiasis multiple topical formulations available , yet little evidence suggest formulation per se influences outcome growing number highly effective oral systemic agents provide practitioner additional options treatment regimens also changed introduction shorter , often single day single dose courses therapy therapeutic agents activity vaginal fungal pathogens topical tend active differences patient characteristics , however , important differences agents therapeutic regimens determining selection appropriate patients vaginal candidiasis vary regard duration severity symptoms past frequency attacks , distribution inflammation , pregnancy status clinician consider variables selecting appropriate agent route administration planning duration therapy individualized therapy offers additional benefits patients , may maximum advantages available
itraconazole treatment nineteen patients treated itraconazole , 17 assessable clinical outcome , two received prior therapy , five failed amphotericin b therapy , four failed ketoconazole therapy , five failed amphotericin b therapy one patient received prior surgical intervention fungi seven different caused disease skin nine patients , soft tissue nine , sinuses eight , bone five , joints two , lungs two itraconazole given dosages ranging 50 600 mg day 1 48 months clinical improvement remission occurred nine patients two patients stabilization disease six patients failed treatment , one relapse initially successful treatment itraconazole appears highly effective patients , including patients refractory antifungal agents
clostridium difficile invasion toxin circulation fatal pediatric pseudomembranous colitis direct involvement clostridium difficile lesional tissue pseudomembranous colitis demonstrated organism 's effects assumed strictly toxin mediated c difficile cytotoxin may found intestinal asymptomatic infants , role organism variety pediatric intestinal diseases uncertain authors studied seven cases fatal pediatric pseudomembranous colitis presence c difficile uniformly demonstrable lesional tissues use intestinal stain specific patients either underlying hirschsprung 's disease hematologic malignancy striking pathologic features peculiar patients altered mucosal mucin immunologic barriers former group neutropenia latter two patients demonstrable circulating cytotoxin serum ascitic fluid , c difficile identified colonic mucosa submucosa phenomena occur control pediatric patients multiple intestinal lesions altered host factors may responsible intestinal invasion c difficile systemic toxin circulation cases fatal pediatric pseudomembranous colitis
cerebrospinal fluid changes 48 hours effective therapy influenzae type b meningitis interval cerebrospinal fluid \( csf \) analysis often performed assess efficacy treatment bacterial meningitis authors reviewed 101 cases pediatric bacterial meningitis resulting influenzae type b analysis csf occurred admission 48 72 hours initiation parenteral antibiotic therapy , one patient positive repeat csf culture 100 cases sterile csf repeat culture , instance infection hospitalization following characterized interval changes csf profile group 100 \( 100 \) persistence 14 \( 14 \) differential cell count conversion polymorphonuclear neutrophil leukocyte \( pmn \) predominance relative lymphocytosis 96 98 \( 98 \) initial positive gram stained smear negative results organisms 53 75 \( 71 \) normalization initial 10 94 \( 11 \) normalization initial abnormally elevated protein levels differences mean values csf total white blood cell counts , percentage pmns , glucose protein concentrations presentation 48 72 hours therapy highly significant \( p less 0 0001 \) 48 hours effective antibiotic therapy h influenzae type b meningitis , csf abnormally elevated protein concentration usually preserved , whereas usually uncommon differential cell count convert pmn predominance relative lymphocytosis significant alteration csf parameters associated h influenzae type b meningitis occur 48 hours effective parenteral antibiotic therapy
streptococcus mitis sepsis bone marrow transplant patients receiving oral antimicrobial prophylaxis purpose streptococcal infection increasingly become problem patients report outbreak streptococcus mitis sepsis six bone marrow transplant patients receiving oral antimicrobial prophylaxis patients methods performed epidemiologic study patients bone marrow transplant program 1986 1988 hospital microbiology records patients reviewed bone marrow patients treated according specified protocols , including oral prophylactic antimicrobial regimen changed late 1987 vancomycin tobramycin norfloxacin identification , susceptibility testing , whole cell protein analysis streptococcal isolates performed reference antimicrobial investigations laboratories centers disease control results detected six cases mitis sepsis among 21 patients undergoing bone marrow transplantation concurrent pathogen isolated patient time mitis bacteremia bacteremia developed within 72 hours transplant five six patients associated severe mucositis four patients environmental study failed reveal common source outbreak , whole cell protein analysis six mitis isolates revealed distinct 12 patients receiving oral vancomycin tobramycin , one developed mitis bacteremia , versus five nine patients receiving norfloxacin \( p less 0 03 \) conclusion believe mitis bacteremia potential complication bone marrow transplantation associated antimicrobial prophylaxis norfloxacin , especially setting mucositis
infection early phase second trimester total 157 consecutive patients studied effort examine prospectively incidence asymptomatic infection early phase second trimester patients referred amniotic fluid addition , amniotic fluids examined gram stain directly cultured blood agar agar well broth found positive amniotic fluid cultures eight cases \( 5 09 \) however , results gram stain examinations negative amniotic fluid samples data indicate correlation white blood cells amniotic fluid positive amniotic fluid culture results one pregnancy positive amniotic fluid culture resulted septic abortion therefore suggest infection exist early pregnancy , even intact membranes , cases without clinical symptoms
hemofiltration reverses left ventricular dysfunction sepsis dogs depressed left ventricular \( lv \) contractility sepsis ascribed presence circulating substance \( factor sepsis \) however , finding controversial authors hypothesized decrease lv contractility indeed occurred due circulating depressant substance , removal substance hemofiltration would reverse dysfunction study , lv mechanics examined hemofiltration anesthetized dogs continuous intravenous infusion live escherichia coli left ventricular anterior posterior apex base dimensions measured subendocardial ultrasonic crystal transducers implanted 4 weeks experiments left ventricular contractility determined end systolic pressure dimension relationship slope relationship \( emax \) index contractility 4 h sepsis , emax reduced one half hemofiltration resulted return emax control values activity plasma also assessed percent reduction isometric contraction electrically stimulated , isolated right ventricular trabeculae obtained nonseptic dogs activity reached peak 4 h sepsis reduced 2 h hemofiltration results show experimental sepsis , circulating substance less 30 , 000 produces decrease lv contractility lv dysfunction may improved hemofiltration
ceftazidime clindamycin versus tobramycin clindamycin treatment intra abdominal infections order assess efficacy toxicity ceftazidime substitute aminoglycosides treatment intra abdominal sepsis , prospective randomized trial conducted ninety four patients \( 49 trauma \) randomized receive ceftazidime clindamycin \( caz c \) \( n 47 \) tobramycin clindamycin \( c \) \( n 47 \) caz \( 2 0 gm \) c \( 0 9 gm \) administered intravenously every 8 hours dosage adjusted maintain peak \( 5 8 mg l \) trough \( less 2 mg l \) concentrations age , sex , baseline serum creatinine , etiology infection comparable two groups clinical cure similar culture positive culture negative patients received caz c \( 94 vs 88 \) clinical cure rate however significantly lower c culture positive \( 73 \) culture negative patients \( 100 \) \( p 0 016 \) pathogenic organisms eradicated 100 \( 30 30 \) 76 \( 13 17 \) caz c c patients , respectively \( p 0 0006 \) nephrotoxicity nephrotoxicity observed none caz c patients one two c patients , respectively caz c effectively eradicated bacteria isolated patients significant difference clinical response observed culture positive patients findings plus lack toxicity suggest caz c effective alternative treatment
effects method hemostasis wound infection rate adequate hemostasis important preventing postoperative wound infection study compared four methods hemostasis specific vessel electrocautery \( spc \) , specific vessel ligation 4 0 \( \) , nonspecific electrocautery vessel plus excessive surrounding tissue \( \) , nonspecific ligation vessel excessive surrounding tissue 4 0 \( \) , rate wound infection rabbits contaminated 10 \( 6 \) staphylococcus aureus statistical significant increase rate wound sepsis electrocautery used fashion producing minimal tissue compared specific vessel ligation electrocautery use specific vessel hemostasis result higher wound infection rate contaminated wounds
congenital insensitivity pain keratitis congenital insensitivity pain well defined entity group sensory deficiency syndromes best knowledge , unilateral keratitis associated congenital insensitivity pain reported report case alert clinicians potentially problem
vitro evaluation nicotinamide riboside analogs haemophilus influenzae exogenous nad , nicotinamide , nicotinamide riboside required growth haemophilus influenzae compounds defined v factor growth requirement previously shown internalization nicotinamide riboside energy dependent carrier mediated saturation kinetics riboside , 3 riboside , 3 riboside , 3 aminopyridine riboside prepared corresponding nad analogs compounds several nicotinamide riboside analogs evaluated ability support growth h influenzae ability block uptake 14c nicotinamide riboside h influenzae 3 aminopyridine riboside blocked uptake 14c nicotinamide riboside inhibited growth h influenzae nad , nicotinamide , nicotinamide riboside served v factor antibacterial activity 3 aminopyridine riboside found specific h influenzae effect growth staphylococcus aureus escherichia coli additional experiments reversed phase high performance liquid chromatography , determined whole cells h influenzae degrade 3 aminopyridine adenine dinucleotide 3 aminopyridine riboside , inside cell , 3 aminopyridine riboside ability interfere growth h influenzae undetermined mechanism
beta lactamase production susceptibilities amoxicillin , amoxicillin clavulanate , ticarcillin , ticarcillin clavulanate , cefoxitin , imipenem , metronidazole 320 non bacteroides bacteroides isolates 129 fusobacteria 28 u centers beta lactamase production \( disk method \) agar dilution susceptibility amoxicillin , amoxicillin clavulanate , ticarcillin , ticarcillin clavulanate , cefoxitin , imipenem , metronidazole determined 320 bacteroides species \( bacteroides group \) 129 fusobacteria 28 u centers overall , 64 7 bacteroides species 41 1 fusobacteria beta lactamase positive among bacteroides species , positivity rates highest b \( 85 0 \) , followed b \( 83 3 \) , b \( 77 8 \) , b \( 77 1 \) 54 5 black pigmented bacteroides species beta lactamase positive among fusobacteria , showed highest rate beta lactamase positivity \( 76 9 \) amoxicillin \( 128 micrograms ml \) ticarcillin \( 64 micrograms ml \) 90 beta lactamase positive strains reduced 4 2 micrograms ml , respectively , addition clavulanate amoxicillin ticarcillin 90 beta lactamase negative strains 1 4 micrograms ml , respectively , greater equal 98 4 strains susceptible beta tested beta lactamase producing strains , 45 9 susceptible amoxicillin less equal 4 micrograms ml 93 4 susceptible ticarcillin less equal 64 micrograms ml addition clavulanate raised rates 90 4 100 , respectively strains susceptible cefoxitin , imipenem , metronidazole activity amoxicillin 29 beta lactamase producing strains \( 10 bacteroides species 19 fusobacteria \) enhanced addition clavulanate however , 82 7 strains susceptible amoxicillin , susceptible ticarcillin
activity compound g2 isolated roots experimental infection compound g2 isolated roots applied topically skin lesions guinea pigs experimentally infected 12 15 applications , 80 infected lesions cured , judged clinical microbial criteria , compared 20 untreated lesions healed spontaneously \( p less 0 01 \)
vitro susceptibility \( pseudomonas \) maltophilia newer antimicrobial agents susceptibilities 45 clinical 3 environmental isolates maltophilia 14 antimicrobial agents determined broth newer quinolones , , , , , active agents tested , 70 99 isolates susceptible agents isolates resistant new aminoglycosides active 12 1 isolates , respectively
comparison amphotericin b therapy murine candidiasis compared efficacies amphotericin b treatment murine model disseminated candidiasis three different dosages drug plus controls evaluated statistically improved survival noted among mice treated 1 mg amphotericin b per kg body weight \( p less 0 05 \) amphotericin b regimens two lower dosage regimens significantly reduced yeast cell counts kidneys compared controls , amphotericin b treated mice significantly higher percentage sterile kidneys following therapy compared treated \( p 0 0001 \)
emergence ciprofloxacin resistance nosocomial methicillin resistant staphylococcus aureus isolates resistance ciprofloxacin plus rifampin therapy methicillin resistant aureus colonization initiated randomized , single blinded trial ciprofloxacin plus rifampin vs sulfamethoxazole trimethoprim plus rifampin therapy patients underwent colonization methicillin resistant staphylococcus aureus \( mrsa \) patients mrsa received 2 weeks either regimen study terminated enrollment 21 subjects due recognition ciprofloxacin resistance 10 21 new mrsa isolates last 2 months study five 10 patients ciprofloxacin resistant mrsa isolates never received ciprofloxacin long term \( 6 month \) eradication achieved three 11 ciprofloxacin plus rifampin four 10 sulfamethoxazole trimethoprim plus rifampin recipients use new eradication mrsa colonization usually effective may risk development ciprofloxacin resistance mrsa within hospital environment
buccal cellulitis buccal cellulitis \( bc \) appearing infection cheek found children high incidence concomitant bacteremia typically , child younger 12 months 2 8 hour fever developing cellulitis cheek region highly suggestive influenzae bacteremia differential diagnosis reviewed complete blood count , blood culture , cellulitis aspirate culture , obtained patients bc meningitis may present despite lack meningeal signs lumbar puncture performed children risk bacteremic bc vast majority children bacteremic require parenteral antibiotics typical case bc presented management reviewed
intraocular pressure changes postural changes intraocular pressure experimentally induced hansen 's disease rhesus , , african green monkeys long term evaluation patients hansen 's disease frequently found reduction intraocular pressure furthermore , noted changes intraocular pressure change posture determine changes significance measured intraocular pressures 24 experimentally infected 39 control monkeys sitting positions found significant reduction intraocular pressure 66 7 compared controls sitting position , significant increase intraocular pressure 79 checked first sitting position offer possible pathophysiological explanation changes occur
seven day administration recombinant human granulocyte colony stimulating factor newborn rats modulation neonatal neutrophilia , , group b streptococcus sepsis single pulse administration rhg colony stimulating factor \( csf \) neonatal rats previously demonstrated induce peripheral neutrophilia modulate bone marrow \( bm \) neutrophil storage proliferative pools \( \) study , investigated prolonged effects 7 days rhg csf therapy \( 5 micrograms kg per day \) sprague dawley newborn rats \( less equal 24 hours \) injected intraperitoneally \( ip \) \( daily 7 days \) rhg csf phosphate buffered saline human serum albumin \( hsa \) rhg csf induced significant early late peripheral neutrophilia 6 , 1 , 625 \( day 1 \) 9 , 223 microl \( day 7 \) v 1 , 275 90 microl \( p less equal 0001 \) addition , 7 days rhg csf resulted significant increase bm 3 , 247 190 microl v 1 , 339 microl \( p less equal 001 \) , however , depletion significant change bm seven days rhg csf also induced mild increase bm cfu gm colony formation \( p less equal 01 \) , however , significant change liver spleen cfu gm colonies cfu gm proliferative rate either bm liver spleen cultures finally , 7 days prophylactic rhg csf therapy resulted synergistic response antibiotic therapy significantly modulated mortality rate experimental group b streptococcal sepsis \( gbs \) \( 100 v 50 \) \( \) \( p less equal 001 \) pulse rhg csf administered 6 hours 18 hours gbs inoculation , however , failed act synergistically antibiotics improve survival prevent peripheral neutropenia study suggests 7 days prophylactic rhg csf therapy induces peripheral neutrophilia , myeloid maturation , increases neutrophil bm also may provide immunologic enhancement neonatal host defense experimental gbs term neonatal rats
ringer 's acetate dextran 70 without hypertonic saline endotoxin induced shock pigs effects ringer 's acetate , 6 dextran 70 , 7 5 nacl , combination 7 5 nacl dextran 70 tested resuscitation endotoxin shock induced continuous iv infusion escherichia coli endotoxin pigs 3 h , reproducible shock state achieved treatment started , left atrial pressure hypertonic solutions \( 7 5 nacl 7 5 nacl dextran 70 \) show overall advantages isotonic solutions \( ringer 's acetate dextran 70 \) transient beneficial hemodynamic effects lasting less 30 min infusion seen dextran 70 administered , cardiovascular function markedly improved oxygen delivery \( do2 \) survival significantly higher compared crystalloid groups \( ringer 's acetate 7 5 nacl \) administration large amounts ringer 's acetate resulted immediate deterioration pulmonary function difficult elevate left atrial pressure even keep baseline level , cardiac index transiently increased overall result deterioration do2 poor survival compared dextran 70 treated pigs conclude dextran 70 superior ringer 's acetate resuscitation endotoxin induced shock pigs furthermore , found role use hypertonic saline , alone combination dextran , treatment type prolonged endotoxin shock
infection control nursing home physician 's role infection control nursing home long term care facility increasingly complex activity high rates \( approximately 15 \) special risks \( group activities , \) nosocomial infection demand special attention attending physicians specific include recognition infection knowledge use basic infection control principles appropriate antibiotic use review immunizations facilitation among office , hospital , long term care facility involvement infection control program \( \)
use latex agglutination technique detecting \( serogroup 1 \) antibodies following outbreak disease 1985 , 500 serum samples submitted indirect immunofluorescence antibody test latex agglutination latex agglutination using disrupted antigens coupled latex particles , proved rapid , simple method detecting circulating antibodies l one minute slide latex agglutination test good correlation indirect immunofluorescence antibody test \( \) , specificity sensitivity respect diagnostic result 98 3 97 6 , respectively , using series well sera latex agglutination test seems well suited screening test presumptive cases disease latex reagent easy prepare seems remain stable 4 degrees c six months
history two three decades ago , drugs available treatment fungal infections status antifungal therapy changed dramatically late introduction newer broader spectrum agents , iodinated , acted disruption fungal cell membrane recently developed broad spectrum antifungal drugs include terconazole , itraconazole , fluconazole represent one classes compounds shown effective management fungal disorders two members unique chemical class studied clinically , terbinafine , effective wide spectrum fungal organisms terbinafine added advantage topical oral activity
clinical trial topical terbinafine \( new antifungal \) treatment tinea pedis twenty three patients enrolled randomized , double blind trial terbinafine 1 cream compared placebo vehicle treatment tinea pedis 20 patients evaluated efficacy , 10 received terbinafine 10 received placebo except terbinafine treated patients average 11 years older patients receiving placebo median duration disease 6 weeks longer placebo group , two groups clinically similar results mycologic tests clinical findings showed terbinafine significantly effective placebo treatment tinea pedis significantly terbinafine treated patients placebo treated patients showed conversion negative culture microscopy end therapy significant reduction scored signs symptoms overall efficacy follow \( combined mycologic clinical findings \) also significantly greater terbinafine group \( 78 \) placebo group \( zero \) \( p less 0 001 \) unexplained elevation liver function test results noted three placebo treated patients one terbinafine treated patient , changes considered clinically relevant drug related
efficacy tolerability topical terbinafine treatment tinea cruris thirty men clinical mycologic evidence tinea cruris enrolled controlled , randomized , double blind trial comparing terbinafine 1 cream cream vehicle placebo patients applied test medications affected area twice daily 2 weeks therapeutic response evaluable 18 patients week treatment follow visit 2 weeks therapy ended visit , terbinafine found effective cream vehicle reduction signs symptoms infection conversion culture microscopy findings negative normal end treatment , therapy effective 67 nine terbinafine treated patients compared 11 nine placebo treated patients follow examination , efficacy rates 78 terbinafine treatment group 33 placebo group difference borderline statistical significance \( p 0 \) possible reasons result may include higher incidence chronic disease terbinafine group large number patients classified delayed negative initial culture side effects significant alterations laboratory hematologic tests observed either treatment group
treatment tinea cruris topical terbinafine twenty three patients enrolled randomized , double blind trial terbinafine 1 cream versus vehicle \( placebo \) treatment tinea cruris one patient negative initial culture excluded , two patients dropouts , one poor study compliance \( terbinafine \) one adverse event \( placebo \) twenty patients examined efficacy treatment \( 9 terbinafine treated , 11 placebo treated \) groups similar age , sex , duration disease , prior therapy , size location lesion , organism , predisposing factors terbinafine 1 cream effective vehicle cream reduction signs symptoms tinea cruris addition , higher conversion rate negative culture normal microscopy findings terbinafine treated group clinical results combined evaluation mycologic tests end therapy showed terbinafine rapid significantly effective treatment tinea cruris placebo \( 78 vs 18 cure rate , respectively \) follow cure rates confirmed findings \( 89 18 , respectively \) significant adverse events occurred terbinafine treatment
oral terbinafine versus griseofulvin treatment type tinea pedis safety effectiveness oral terbinafine , 125 mg twice daily , griseofulvin , 250 mg twice daily , patients type tinea pedis examined double blind randomized trial end 6 week treatment period , clinical mycologic cure mycologic cure minimal signs infection noted 12 \( 75 \) 16 terbinafine treated patients compared 3 \( 27 \) 12 patients treated griseofulvin overall response rate 2 weeks completion treatment 88 terbinafine treated group 45 griseofulvin treated group contacted 6 15 months completion study , 94 terbinafine treated patients reported sustained clearing tinea pedis , 88 nail involvement time treatment reported improvement contrast , tinea pedis remained cured 30 patients received griseofulvin , improved 14
involvement peripheral nerves absence skin lesions case report literature review absence clinically apparent cutaneous lesions , primarily neural leprosy uncommon primarily neural leprosy presents clinically peripheral neuropathy frequently affects motor nerves occasionally involves sensory nerves well long incubation period leprosy occurrence outside endemic areas often lead delayed diagnosis present case glove , weakness flexor muscle right great toe , palpable thickening right popliteal nerve , normal appearing areas back , developed lived canada 16 years skin biopsy specimen obtained normal area back demonstrated acid fast bacteria small dermal nerves , smooth muscle , rare perivascular histiocytes , associated sparse mixed inflammatory cell infiltrate patient responded well therapy dapsone , rifampin , classification review primarily neural leprosy presented patient represents first reported case primarily neural borderline lepromatous leprosy canada
prevalence health effects indoor environment assessing role residence related symptoms involves \( 1 \) determining symptoms related residence medical examination careful , \( 2 \) connecting reported symptoms known hypothesized effects , \( 3 \) examining residence risk factors poor ventilation , inappropriate outdoor air , dampness standing water , \( 4 \) finally , obvious risk factors present , air sampling air sampling always last use reliable volumetric method particulate , personal trap , inexpensive alternatives viable particle provide data organisms implicated hypersensitivity diseases interpretation residential sample data requires qualitative quantitative comparison adjacent outdoor air examination aerosol changes related domestic activities recommendations lead decrease indoor include use air conditioning allow limitation outdoor aerosols , prevention dampness , use devices assessment workplace often complex symptomatic subjects charge environment , situations often lead difficult management relations occasionally litigation essential step workplace assessment best possible methods used approach similar approach used , larger scale symptom assessment must include stress factors air sampling , necessary , must usually extensive controls ventilation rates , occupancy , spatial variation
monoclonal antibody mouse lipopolysaccharide receptor protects mice lethal effects endotoxin specific endotoxic lipopolysaccharide \( lps \) binding sites cell membranes murine lymphocytes macrophages may serve functional receptors lps recently identified using cross linking lps derivatives monoclonal antibody \( mab 5d3 \) specificity 80 kda protein also generated characterized capacity mab 5d3 protect mice lethal effects endotoxin investigated pretreatment mice little 15 micrograms mab 5d3 provided virtually complete protection dose endotoxin 10 fold greater required kill mice untreated control group using sensitization model significant protection also afforded normal mice given mab 5d3 relative saline several lines evidence suggest mab 5d3 mediated protection due agonist properties antibody rather receptor blockade mechanism
platelet activating factor platelet activating factor antagonist decreases tumor necrosis factor alpha plasma mice treated endotoxin l platelet activating factor \( paf \) \( paf antagonist \) administered lipopolysaccharide \( lps \) treated mice , level plasma tumor necrosis factor \( tnf alpha \) determined either elisa cytotoxic assay using cells significantly lowered inactive , paf , effective lowering plasma tnf alpha levels lps treated mice decrease plasma tnf alpha induced l paf partly reversed indomethacin despite decrease plasma tnf alpha , l paf caused increase amount tnf alpha mrna present kidneys livers lps treated mice , suggesting event leading synthesis release tnf alpha inhibited agents
protective effects polyclonal sera monoclonal antibodies active salmonella minnesota re595 lipopolysaccharide experimental endotoxemia mice passively immunized sera blood donors active rough \( lps \) , \( rc \) mutant escherichia coli b4 , re595 \( \) mutant salmonella minnesota protected mice lethal challenge smooth e coli lps , e coli salmonella rough mutant lps , free lipid epitopes recognized monoclonal antibodies \( mabs \) reacting lps minnesota re595 lipid localized 2 keto 3 deoxy acid \( \) region lipid core reactive mabs reacted homologous lps free lipid one , , cross reacted alone mabs , , l 4 , l 6 , l 8 protected actinomycin sensitized mice lethal effects lps e coli , salmonella , e coli , minnesota re595 , free lipid antibody also protective injected lps challenge results indicate antibodies directed core glycolipid minnesota re595 lps may useful additive form therapy may enable decreased mortality gram negative bacterial sepsis
antimicrobial resistance shigella isolates usa importance international travelers nationwide sample shigella isolates collected tested resistance 12 antimicrobial agents assess prevalence epidemiologic correlates antimicrobial resistance shigella isolates , 32 resistant ampicillin , 7 trimethoprim sulfamethoxazole , 0 4 acid fifty \( 20 \) isolates associated foreign travel best predictor clinically important resistance history foreign travel 20 isolates foreign travelers showed trimethoprim sulfamethoxazole resistance , compared 4 isolates without history quinolone resistance identified travel related isolates , quinolones may appropriate initial therapy travel related trimethoprim sulfamethoxazole
cefuroxime treatment failure haemophilus influenzae meningitis associated alteration penicillin binding proteins 10 year old boy presented rigidity cerebrospinal fluid \( csf \) leukocytosis initially day 6 intravenous cefuroxime therapy \( 200 mg kg day \) csf specimens yielded beta lactamase negative haemophilus influenzae susceptible disk tests relatively resistant cefuroxime \( mic , 8 16 fold greater control isolates \) define mechanism resistance , cefuroxime resistance marker transformed susceptible h influenzae recipient inactivation permeability beta lactam substrate tested penicillin binding protein \( \) profiles examined inactivation beta lactam substrate detected reduced permeability found however , reduced beta lactam binding 4 5 observed 18 27 fold penicillin 2 5 4 fold cefuroxime required block 50 binding sites , respectively thus , reduced affinity 4 5 beta lactam substrate appears mechanism cefuroxime resistance strain reduced affinity targets appears contributed bacteriologic clinical failure patient
restriction endonuclease analysis total cellular dna aspergillus fumigatus isolates geographically diverse origin typing system exists aspergillus fumigatus , though isolates distinguishable phenotypic characteristics dna prepared lysis , followed , extraction , dialysis dna prepared uniform size exceeded 60 kb digestion , dna , stained , differences 10 50 kb bands distinguished isolates reproducibility shown repeated preparations animal passage use proposed system describing restriction fragment length polymorphism patterns , 31 characterized isolates three revealed 24 patterns \( dna types \) three dna types represented 3 isolates 1 dna type 2 isolates 20 types unique two groups 3 isolates dna type stanford university hospital one patient isolate stanford dna type isolate new another stanford isolate german isolate observations indicate widespread clones restricted others paired isolates airway fluids three patients two dna types restriction endonuclease typing shows promise investigating epidemiology fumigatus
detection interleukin 3 serum mice infected mycobacterium lepraemurium infection mice mycobacterium lepraemurium accompanied ablation erythropoiesis bone marrow gross enlargement spleen , together increased earlier demonstration macrophage colony stimulating factor serum infected mice , suggested activity additional cytokines eight weeks infection mice lepraemurium , interleukin 3 \( il 3 \) activity demonstrated serum \( titer , 1 \) serum titer il 3 activity maximal 13 weeks \( greater 1 \) slightly reduced 18 weeks \( 1 \) il 3 activity detected serum lepraemurium infected mice reflected presence il 3 confirmed neutralization assay using anti murine il 3 antibodies il 3 activity serum mice 13 weeks infection completely abolished anti il 3 antibodies finally , 1 kb signal il 3 rna detected spleens lepraemurium infected mice 13 weeks infection
large outbreak antibiotic resistant mass gathering july 1987 , large outbreak occurred among mass gathering national , annual family gathering poor , allowing widespread transmission disease , probably food , water , person person spread attack rate may greater 50 among estimated 12 , 700 outbreak caused shigella , resistant ampicillin , tetracycline , trimethoprim sulfamethoxazole organism type 9 contained 90 kilobase plasmid found non outbreak related strains group resulted nationwide dissemination organism , outbreaks three states linked transmission gathering outbreak demonstrates potential rapid dissemination disease setting necessity careful planning mass
prevalence diagnosis pneumonia 3 year prospective study emphasis application urinary antigen detection 3 year period frequency hospitalized patients community acquired nosocomial pneumonias 3 4 \( 23 cases \) 5 9 \( 33 559 \) , respectively diagnostic tests evaluated , detection serogroup 1 antigen urine highest sensitivity , 86 culture proven cases positive sensitivities serologic tests examination respiratory secretions \( culture direct immunofluorescence \) 36 26 , respectively diagnostic value serology examination respiratory secretions low specimens obtained processed typical conditions hospitalization urinary antigen detection represents important diagnostic addition , examination postmortem lung tissue fatal cases pneumonia important adjunct estimating prevalence assessing effectiveness diagnostic tests
tumor necrosis factor alpha plays role host defense capsulatum tumor necrosis factor alpha detected supernatants collected balb c mouse peritoneal macrophages incubated continuously capsulatum levels tnf alpha measured actinomycin bioassay peaked within hours exposure greatly declined 24 h tnf alpha also measured bronchoalveolar lavage fluid balb c mice challenged h capsulatum lavage fluid tnf alpha levels exhibited pattern vitro supernatants peaked within hours challenge lower levels detected 24 h treatment mice anti tnf alpha antibody accelerated mortality response systemic infection significantly increased tissue colony counts liver spleen murine model , tnf alpha produced response h capsulatum appears play role host defense infection
occurrence secondary attenuating mutations salmonella typhimurium vaccine strains attenuating delta aroa554 mutation salmonella typhimurium strain complemented vitro selecting recombinant dna clones containing cloned genes require exogenous phenylalanine , , , p acid , acid growth defined media cloned genes restore wild type , however , murine model delta aroa554 mutation typhimurium strain sr 11 , mouse virulent strain recently mice sr 11 delta aroa554 mutant highly attenuated mice challenged parenterally cloned genes isolated restored sr 11 delta aroa554 mutant wild type sr 11 results suggest delta aroa554 allele remains effective reducing typhimurium , laboratory passage attenuated vaccine strains may lead accumulation additional attenuating defects
nasal carriage staphylococcus aureus correlation hormonal status women view recent observations hormone interactions , study staphylococcus aureus nasal carriage relation sex hormone status undertaken prospectively women attending clinic , hormonal status assessed determining index \( ki \) smears stained papanicolaou method rates aureus nasal carriage 29 3 premenopausal women 21 9 postmenopausal women \( p significant \) carriage rates significantly higher \( p 026 , chi 2 7 32 \) women high \( 40 7 \) intermediate low \( 27 03 25 1 , respectively \) aureus nasal carriage also correlated independently significantly previous antibiotic use presence insulin treated diabetes mellitus preliminary observation confirms association levels sex hormones reflected ki aureus nasal carriage rates
positive lyme serology subacute bacterial endocarditis study four patients lyme borreliosis multisystem inflammatory disorder caused borne borrelia burgdorferi clinical manifestations , involving skin , joints , peripheral central nervous systems , heart however , presentation lyme disease often conditions describe four patients region endemic lyme disease elevated levels antibodies reactive b burgdorferi whose signs symptoms initially attributed lyme borreliosis whose subsequent blood cultures established diagnosis subacute bacterial endocarditis although immunoblots serum samples three four patients consistent prior infection b burgdorferi , positive immunoblot establish active infection similarly , seropositivity b burgdorferi indicates possible exposure organism occurrence positive b burgdorferi presence diseases lead diagnostic confusion
changing epidemiology group streptococcal infection usa see whether changes epidemiology group streptococcal disease usa accompanied corresponding change serotype distribution , epidemiological typing typing data strains sent centers disease control , atlanta , 1972 1988 analysed proportions types 1 , 3 , 18 increased significantly study period types likely invasive , cause fatal infection , occur cluster infections types contrast , proportions types 4 12 decreased less invasive less likely found clusters types data suggest changes epidemiology group streptococcal disease may related changes distribution types causing infection
randomized , prospective field trial conjugate vaccine protection infants young children invasive haemophilus influenzae type b disease background haemophilus influenzae type b leading cause invasive bacterial disease young children capsular polysaccharide vaccine protect children greatest risk \( age 18 months \) , polysaccharide protein conjugate vaccine proved immunogenic age group methods enrolled 114 , 000 infants finland open , prospective , randomized trial h influenzae type b capsular polysaccharide diphtheria toxoid conjugate vaccine \( phosphate diphtheria toxoid prp \) children born days vaccinated ages 3 , 4 , 6 , 14 18 months born even days formed control group received vaccine age 24 months results three doses vaccine 4 cases verified bacteremic h influenzae type b disease group receiving early vaccination , compared 64 cases control group , ages approximately 7 24 months protective efficacy vaccine thus 94 percent \( 95 percent confidence interval , 83 98 \) serious adverse effects reported immune response conjugate vaccine characteristic cell dependent response studied cohort 120 infants primary immunization series resulted geometric mean concentration antibody 0 53 micrograms per milliliter age seven months , fourth dose evoked response , mean antibody concentration 45 22 micrograms per milliliter conclusions new conjugate vaccine consisting capsular polysaccharide h influenzae type b covalently linked protein carrier \( prp \) , administered infants beginning age 3 months , highly effective protecting young finnish children \( 7 24 months old \) invasive h influenzae type b infections
limited efficacy haemophilus influenzae type b conjugate vaccine alaska native infants alaska h influenzae vaccine study group background prevention invasive haemophilus influenzae type b disease requires vaccine effective administered first six months life infants alaska particularly high risk invasive h influenzae type b disease methods evaluate protective efficacy h influenzae type b polysaccharide diphtheria toxoid conjugate vaccine \( phosphate diphtheria toxoid prp \) , enrolled alaska native infants randomized , double blind , placebo controlled trial either vaccine saline placebo administered approximately two , four , six months age results subject years follow 32 episodes h influenzae type b disease , overall incidence invasive disease reduced significantly vaccinated subjects \( 6 0 cases per 1000 patient years \) , compared placebo controls \( 9 6 \) alaska native infants \( 6 0 \) one , two , three doses significant protective efficacy vaccine three doses efficacy 35 percent \( 95 percent confidence interval , 57 73 \) lack efficacy related age onset disease , age immunization , type disease , degree alaska native , time immunization , year study levels h influenzae type b antibody recipients vaccine became significantly higher levels received placebo second third doses even third dose , 48 percent vaccinated infants antibody levels 0 1 microgram per milliliter \( geometric mean titer , 0 18 \) antibody responses vary level acquired antibody , degree alaska native , age time first second immunizations , increased increasing age time third dose \( p less 0 001 \) conclusions found evidence prp vaccine provides significant protection , least alaska native infants , invasive diseases caused h influenzae type b vaccine paralleled limited immunogenicity
use prophylactic control nosocomial epidemic multiply resistant salmonella typhimurium pediatric wards nosocomial spread enteric pathogens often difficult control pediatric wards 1983 1984 , despite patients hand washing , 200 cases nosocomial multiply resistant salmonella typhimurium type r 9 observed two adjacent pediatric wards cases occurred summer months 19 new cases detected early summer 1985 , oral administration throughout entire hospital stay \( 2 5 mg kg twice daily \) recommended subsequently hospitalized infants among 114 \( 65 \) infants appropriately treated , one additional case \( 1 \) detected contrast 11 \( 19 \) cases occurred among 59 infants inappropriately treated 5 35 \( 14 \) treated 6 24 \( 25 \) treatment delayed greater 24 hours \( p less 0 001 appropriately inappropriately treated groups \) pediatric wards infection control measures cannot applied , prophylactic administration may helpful preventing spread enteric pathogens
safety evaluation prp haemophilus influenzae type b conjugate vaccine children immunized 18 months age older follow study 30 , 000 children evaluated safety prp conjugate hib vaccine \( , \) 29 , 309 children vaccinated 18 60 months age southern california medical clinics period april 1 , 1988 , july 31 , 1989 surveillance potential reactions involved questionnaires , telephone surveys , reports staff review hospitalizations covered two periods following immunization \( 1 \) first 48 hours \( 2 \) days 2 30 surveillance invasive hib disease involved methods addition systematic reviews laboratory hospital records january 31 , 1990 rates local systemic reactions within 48 hours vaccination prp alone low \( less equal 2 fever greater 102 degrees f , local swelling \) similar previously reported vaccination prp hospitalization seizures \( 0 15 0 09 vaccinated children , respectively \) occurring within 1 month immunization appeared unrelated vaccination one 29 month old child onset fatal episode hib sepsis meningitis within 48 hours vaccination also , 30 month old child developed hib meningitis 10 months prp vaccination conclude prp safe given alone combination childhood vaccines 18 60 months age
immunogenicity haemophilus b conjugate vaccine \( meningococcal protein conjugate \) children prior invasive haemophilus influenzae type b disease children younger 2 years age previous invasive haemophilus influenzae \( hib \) type b disease may develop protective antibodies antigens hib may risk developing second episode hib disease twenty three children prior hib disease immunized haemophilus b conjugate vaccine \( meningococcal protein conjugate \) children 12 24 months age given one dose vaccine children younger 12 months age given 2 doses 2 months apart antibody polysaccharide capsule hib \( prp \) measured radioimmunoassay eighteen children serum antibody concentrations less 0 150 micrograms ml 18 children responded greater 0 150 micrograms ml antibody single dose vaccine 1 23 children serum antibody concentration greater 1 000 micrograms ml seventeen children ultimately responded greater 1 000 micrograms ml antibody \( p less 0 0001 \) , concentrations antibody thought correlate protection haemophilus b conjugate vaccine \( meningococcal protein conjugate \) immunogenic children invasive hib disease children younger 2 years age invasive hib disease subsequently immunized hib conjugate vaccine
pneumonia atypical presentations \? presentations pneumonia varied sometimes complicated atypical nature illness , opposed clear pattern findings classic bacterial pneumonias , leads physician diagnosis appropriate therapy allows quick improvement rule , sequelae
early postoperative care cardiac transplantation patient routine considerations immunosuppressive therapy authors attempted outline current state art respect early postoperative management cardiac transplant recipient special attention immunosuppressive therapies commonly used agents , well successful combination regimens , described along current levels expectation regarding rates rejection infection much learned regarding management problems much remains learned decrease incidence postoperative infection rejection , equally importantly , studies investigate etiology transplant coronary artery disease need undertaken measures delay prevent occurrence arrest progression instituted
comparison species distribution antimicrobial susceptibility aerobic clinical specimens compare species distribution antimicrobial susceptibility aerobic , evaluated isolates referred centers disease control october 1985 february 1988 used conventional biochemical tests identify various species four species accounted 191 \( 52 \) aerobic isolates \( 98 isolates \) , \( 42 isolates \) , \( 28 isolates \) , \( 23 isolates \) sputum wounds common sources isolate resistant , n isolate resistant sulfamethoxazole trimethoprim sulfamethoxazole , isolate resistant ceftriaxone imipenem summary , findings show unusual species aerobic cause infection , colonization , antimicrobial resistance varies markedly species
enterobacter bacteremia pediatric patients enterobacter emerged important human pathogen , particularly sick , hospitalized patients previous reports enterobacter bacteremia focused adult patients report , epidemiologic factors , clinical characteristics , treatment , outcome 33 patients enterobacter bacteremia large children 's hospital 5 year period reviewed ratio males females 1 2 1 patients' ages ranged 2 days 24 years , 18 patients less 18 months old twenty two cases acquired six nature significantly underlying conditions present 32 patients biliary tract central venous catheters common sources bacteremia two thirds patients preceding antibiotic therapy overall mortality 24 mortality attributable enterobacter bacteremia 18 statistically significant differences mortality associated age less 18 months \( p 031 \) thrombocytopenia \( p 017 \) presence fever borderline significance \( p \) enterobacter bacteremia important cause morbidity mortality pediatric patients
quinolone antibiotics treatment salmonella infections 4 new class antimicrobial agents possess broad vitro antibacterial activity , including efficacy enteric pathogens salmonella , shigella , campylobacter , yersinia , species drugs clinically effective drug sensitive strains salmonella salmonella cause enteric fever salmonella enterocolitis , quinolones unlike older antimicrobial agents may little impact duration symptomatic illness fact prolong fecal carriage actually shorten course clinical disease excretion organisms stool similarly , chronic carriers salmonella strains , quinolones effective eradicating biliary fecal infection immunosuppressed persons , aids , may benefit short term treatment prolonged prophylaxis quinolone antibiotic optimal agent , dose , duration quinolone therapy salmonella syndromes remain determined larger controlled trials
infectious diseases canadian subspecialty , projections year 2000 infectious diseases relatively new subspecialty canada past decade , however , important advances made include formation canadian infectious diseases society development first royal college physicians surgeons examinations subspecialty infectious diseases majority training practice field infectious diseases enrolled programs canada despite predictions united states excess physicians infectious diseases , situation occurred canada physicians training infectious diseases required canada next decade fill positions patient care , microbiology \( individuals clinical laboratory training \) , research , epidemiology infection control , programs related human immunodeficiency virus infections , geographic international medicine , pharmaceutical industry , education administration canada , extent infectious diseases physicians involved areas varies united states review suggests continued need physicians appropriate training infectious diseases
protection mice lyme disease agent recombinant ospa lyme borreliosis borne illness caused borrelia burgdorferi gene outer surface protein \( ospa \) b burgdorferi strain cloned expression vector expressed escherichia coli c3h mice actively immunized live transformed e coli purified recombinant ospa protein produced antibodies ospa protected challenge several strains b burgdorferi recombinant ospa candidate vaccine lyme borreliosis
giant basilar aneurysm course subacute bacterial endocarditis describe man aged 42 years mitral valve regurgitation suffered subacute bacterial endocarditis caused streptococcus clinical picture began toxic syndrome five months later , patient embolic episode right rostral pontine stroke , followed days later focal seizure right despite antibiotic treatment , suffered complete third nerve palsy arteriography , magnetic resonance imaging , computed tomography brain showed giant aneurysm rostral end basilar artery aneurysm clipped discuss clinical features , radiology , characteristics aneurysm unique case giant bacterial aneurysm vertebrobasilar system
percutaneous central venous catheterization three years' experience neonatal intensive care unit prolonged venous access desirable low birth weight infants infants feedings contraindicated prospectively evaluated small diameter venous catheters placed percutaneously patients 3 years catheters , 241 \( 50 \) placed infants weighing 1 kg less mean catheter stay 13 days \( range , less 1 77 days \) almost half \( 49 \) central thoracic catheters \( 91 \) removed 43 due problems leaking clotting 6 suspicion sepsis venous occlusion 23 episodes possible sepsis catheter stays , six \( 1 3 \) confirmed catheter related sepsis 12 \( 2 5 \) confirmed alternate locus sepsis three factors specific percutaneous central venous catheter related sepsis prolonged catheter stay \( 3 5 weeks \) , staphylococcus epidermidis , weight less equal 1 kg four factors specific alternate locus sepsis presence alternate infection site , earlier infection \( 1 2 weeks \) , extremely low birth weight , prolonged clinical instability percutaneous central venous reduced need stress repeated venipuncture , resulting lower complication rates reported surgically placed central venous catheters , leading identification risk factors specific catheter sepsis alternate locus sepsis
epidemiology lyme disease virginia prior january 1986 , one case lyme disease reported virginia 1986 87 , however , virginia department health observed increase reports suspected lyme disease physicians , despite fact highly prevalent virginia population twenty eight cases lyme disease identified virginia , eight cases occurred 1986 20 1987 lyme disease appears increasing frequency virginia moving along eastern
epidemiologic differences chlamydia gonorrhea assess prevalence , demographics , transmission patterns genital chlamydia infection , screened 3 , patients , compared identified cases \( n \) gonorrhea cases \( n \) diagnosed setting chlamydia cases younger likely white gonorrhea counterparts chlamydia cases distributed diffusely geographic overlap two diseases 40 percent gonococcal noted less 10 percent patients chlamydia nearly half men chlamydia four women asymptomatic cases identified screening contact tracing populations high risk chlamydia seemingly different gonorrhea differences may due control interventions \( active gonorrhea , passive chlamydia \) chlamydia case reporting control initiatives recommended
day care characteristics associated haemophilus influenzae disease haemophilus influenzae study group identify characteristics day care facilities associated h influenzae disease , compared 92 licensed facilities case h influenzae disease occurred randomly selected facilities cases occurred matched univariate analysis showed personnel facilities h influenzae disease occurred likely control facilities use children 's , admit children trained diarrhea \( fecal policy \) , age range , likely control facilities profit less likely use volunteers multivariate model adjusted age range , profit status fecal policy , use \( 5 5 , 95 ci 1 1 , 30 \) variable independently associated case facilities first association specific day care practice h influenzae disease
evidence gonococcal transmission within system study examine sexually disease occurring within large system sexual activity , 27 male acquired culture proven gonorrhea sexual activity three month period results provide evidence encourage education acquired immunodeficiency syndrome \( aids \) support condom distribution programs facilities
recombinant capsular antigen \( fraction 1 \) yersinia pestis induces protective antibody response balb c mice yersinia pestis produces glycoprotein capsule , biosynthesis appears temperature dependent fraction \( f1 \) component capsule specific pestis detection f1 antibodies basis several serological tests report cloning f1 gene expression escherichia coli using vector lambda f1 specific monoclonal antibody recombinant f1 antigen molecular weight 17 kda , proved identical f1 antigen produced pestis recombinant cells produced f1 antigen 37 degrees c minimal amounts 27 degrees c , suggesting genetic features affected temperature pestis may operating e coli clone known similar molecular weights reflect glycosylated nature proteins f1 antigen purified e coli recombinant induced protective immune response balb c mice challenged 10 \( 5 \) virulent pestis resistance immunized mice infection correlated high titers f1 antibody cloned gene expresses competent f1 antigen suitable use vaccine development
tetanus immunization status immunologic response booster emergency department geriatric population study objectives although effective procedures prevention tetanus long available , done since 1977 demonstrate 49 66 elderly population lacks protective antitoxin level \( 0 01 iu ml \) study undertaken assess tetanus immunization status patients presenting emergency department evaluate immunologic response tetanus booster setting study conducted tertiary care ed type participants patients enrolled 65 years old breaks skin barriers design patient 's initial presentation , pertinent demographic data tetanus immunization history recorded patient followed 21 days interventions patient 's antitoxin titer determined serum sample elisa , , required advisory committee immunization practices criteria , booster administered first visit measurements main results serum antitoxin assays repeated days 7 , 14 , 21 initial visit seroconversion \( titer 0 01 iu ml \) forty four patients \( 55 \) protective levels initial presentation , 36 \( 45 \) levels protective age sex predictive protection past military service definite history three previous immunizations good predictors protection 34 patients followed serially inadequate initial titers , 19 \( 56 \) seroconverted day 14 patients likely older \( p less 05 \) conclusions study demonstrated significant number elderly patients lacked initial protective level tetanus antitoxin , 44 failed within 14 days carried potential risk developing tetanus
inactivation antithrombin iii serum elastase patients surgical infections relationship serum elastase antithrombin iii determined septic surgical patients possible mechanism intravascular thrombosis sepsis eighteen patients surgical infections elevated white blood cell counts blood assayed daily white blood cell count , serum elastase , antithrombin iii , patient 's white blood cell count returned normal antithrombin iii significantly lower \( 0 87 \) elastase normal range \( greater 14 2 micrograms ml \) elastase significantly higher \( 30 6 micrograms ml \) , antithrombin iii less normal data indicate elevated serum elastase associated significant reduction circulating antithrombin iii stimuli increase serum elastase , e surgery , trauma , sepsis may promote intravascular thrombosis inhibition antithrombin iii blood endothelial cell interface
air contamination open heart surgery disposable , gowns , effect polypropylene coverall , replacing , combined sterile gowns compared cotton system studied regard dispersion bacteria particles conventionally ventilated operating operations carried open heart procedures 30 adult patients blood agar sedimentation plates placed operative , anesthesia , perfusion areas mean sedimentation values 1 hour start operation follows group 63 colony forming units \( cfu \) m2 operative area 77 cfu m2 anesthesia area 143 cfu m2 perfusion area corresponding figures cotton group 350 cfu m2 , 364 cfu m2 , cfu m2 , respectively \( p less 0 0002 \) beginning operation , mean values noted colony forming units air operative site 8 0 cfu m3 group 31 cfu m3 cotton group one hour later , values 10 cfu m3 22 cfu m3 , respectively \( p less 0 0002 \) end operation , number particles 5 microns larger air operative site 278 m3 group m3 cotton group concluded use polypropylene coverall gowns significantly reduces particle bacterial contamination air bacterial sedimentation cardiac operations
antimicrobial prophylaxis open heart operations 1986 1988 , 450 adults undergoing coronary artery bypass , cardiac valve replacement , enrolled prospective , randomized , comparative trial versus perioperative prophylaxis assessed hospitalization 6 weeks 6 months discharge postoperative infectious complications eleven patients major postoperative infections including 5 sternal wound infections \( three bacteremic \) , 6 bacteremia , 1 prosthetic valve endocarditis , 3 severe venous donor graft site infections eight major infections occurred patients receiving prophylaxis three patients receiving , five sternal wound infections occurring group postoperative pathogens responsible major infections included gram negative 5 patients , staphylococcus aureus 4 , staphylococcus epidermidis 2 preoperative staphylococcal isolates predictive postoperative staphylococcal pathogens although statistically significant difference rate major postoperative infectious complications using either prophylaxis , trend favor gram negative becoming increasingly important pathogens setting
seroprevalence helicobacter pylori seventh day groups maryland lack association diet evaluate possible role diet transmission helicobacter pylori , compared h pylori seroprevalence among seventh day \( vegetarian alcohol , caffeine , meat n 94 \) two non seventh day control groups \( n 168 \) use enzyme linked immunosorbent assay h pylori antigen prepared french pressure cell , found difference seroprevalence among groups however , seropositivity strongly correlated age black race
survival depend amount splenic tissue \? susceptibility streptococcus pneumoniae infection studied 11 groups rats allocated sham operation , splenectomy , splenic autotransplantation 10 , 20 , 30 , 40 , 50 , 60 , 70 , 80 , 90 removed spleen three months later , rats exposed intravenously type 1 streptococcus pneumoniae \( median lethal dose , ld50 , control group \) survivors killed 13 days bacterial challenge autopsy showed splenic tissue recovered rats received less 50 splenic tissue compared received 50 survivors found among sham operated rats \( 47 5 95 confidence intervals , 32 68 \) rats 40 splenic tissue implanted \( 35 confidence interval , 20 54 \) found regenerated 40 splenic tissue conclude 40 spleen protect rat infection splenectomy
immunogenicity animals polysaccharide protein conjugate vaccine type iii group b streptococcus native capsular polysaccharide type iii group b streptococcus elicits specific antibody response 60 nonimmune human subjects enhance immunogenicity polysaccharide , coupled type iii polysaccharide tetanus toxoid prior coupling , aldehyde groups introduced polysaccharide controlled oxidation , resulting conversion 25 sialic acid residues polysaccharide residues 8 carbon analogue sialic acid , 5 3 , 5 acid tetanus toxoid conjugated polysaccharide , via free aldehyde groups present partially oxidized sialic acid residues rabbits vaccinated conjugate vaccine produced igg antibodies reacted native type iii group b streptococcal polysaccharide \( 3 3 rabbits \) , rabbits immunized unconjugated type iii polysaccharide failed respond \( 0 3 rabbits \) sera animals receiving conjugate vaccine type iii group b streptococci phagocytic killing human peripheral blood leukocytes , protected mice lethal challenge live type iii group b streptococci results suggest method carrier protein may useful strategy improve immunogenicity type iii group b streptococcus polysaccharide human subjects
national immunization program netherlands brief explanation immunization policy netherlands , national immunization program described , special attention given coupling population records computerized database individual immunization records provincial level dutch program achieves coverage rates greater 90 routine immunizations participation program free charge every child living country age 13 years , requirement immunized program also discussed
postneonatal infectious disease mortality french situation mortality caused infectious parasitic diseases represents limited part postneonatal deaths france , stable past decade component careful analysis least partially preventable statistics presented interpreted , discussion disorders included assessing impact infection morbidity mortality figures international change according definition chosen need epidemiologic statistical research make comparisons mortality clear morbidity also important high incidence , frequent hospitalization , heavy social cost policy services france relate control treatment infection described , shortcomings call efforts
postneonatal mortality norway study recent trends comparison mortality rates norwegian children postneonatal mortality norway decreased rapidly 1956 1980 subsequently remained stable recent years postneonatal death rate appears increasing , primarily due greater numbers deaths attributed sudden infant death syndrome period , mortality among older children also decreased , decline evident leading causes among people aged 15 19 years recent trends less encouraging , number fatal traffic accidents particular remaining stable increasing although room continued improvement , widely held belief health status norwegian children good supported trends mortality
botulism among alaska role changing food preparation consumption practices alaska one highest rates food borne botulism worldwide outbreaks associated consumption native foods , recent years outbreaks occurred previously unaffected areas involved new food items five botulism outbreaks occurred 1975 1985 area southwestern alaska without previous confirmed outbreaks among one ethnic group , 5 outbreaks , 3 associated tail , native food recently introduced region preparation techniques vary widely within villages among ethnic groups traditional fermentation techniques changed past 50 years current preparation methods used families ethnic groups may favorable clostridium botulinum growth prevention efforts targeted high risk subgroups alaska appear modified traditional practices increased risk food borne botulism
impetigo current etiology comparison penicillin , erythromycin , therapies attempted determine causative bacterial pathogens impetigo children area , compare effectiveness three frequently used oral antimicrobial treatment regimens , correlate antimicrobial sensitivity bacterial isolates clinical responses treatment seventy three children impetigo randomly assigned receive penicillin v potassium monohydrate , administered dosages 40 50 mg kg per day , erythromycin administered dosage 30 40 mg kg per day drugs given three divided doses 10 days treatment failure defined persistence lesions 8 10 days initiation drug therapy determined blinded treatment therapies forty five \( 62 \) cultures showed staphylococcus aureus , 14 \( 19 \) showed aureus group beta hemolytic streptococci , six \( 8 \) showed group beta hemolytic streptococci , eight \( 11 \) showed growth organisms treatment failure occurred six \( 24 \) 25 patients treated penicillin v , one \( 4 \) 25 patients treated erythromycin , patients treated conclude aureus common cause impetigo children study population , effective treatment , erythromycin nearly equally effective may preferred cost effectiveness basis , penicillin v inadequate treatment infection
lung function children following empyema spirometry performed response exercise measured 15 children following recovery empyema evaluate impact pleural infection subsequent lung function seven children underwent chest tube drainage eight two groups similar age \( mean sd , 6 5 years \) , sex distribution , bacterial pathogen producing empyema , age follow evaluation \( 12 5 years \) one child reported recurrent respiratory symptoms child restrictive spirometric changes \( total lung capacity , less 80 vital capacity , less 80 predicted \) seven 15 reduced forced expiratory volume 1 second \( less 80 predicted \) forced expiratory flow middle half vital capacity \( less 75 predicted \) , suggesting mild airway obstruction child demonstrated reduced exercise tolerance due restrictive ventilatory limitations mild obstructive abnormalities lung function identified equal frequency children treated without chest tube drainage
group b streptococcus endocarditis following second trimester abortion 18 year old woman underwent elective second trimester abortion developed streptococcus \( group b streptococcus \) endocarditis characterized large , involving previously normal tricuspid valve symptoms , well multiple pulmonary emboli , experienced , cure followed course treatment using intravenous penicillin g potassium combined gentamicin sulfate endocarditis caused pathogen usually occurs among individuals compromised underlying chronic disorders , today , rare pregnancy abortion planning therapy , consideration given possibility tolerance among clinical isolates need operative intervention selected patients
initial evaluation human monoclonal anti lipid antibody \( ha 1a \) patients sepsis syndrome ha 1a , human monoclonal immunoglobulin antibody binds specifically lipid domain endotoxin , administered septic patients evaluate safety , pharmacokinetics , immunogenicity antibody thirty four patients received single infusion either 25 mg , 100 mg , 250 mg , followed clinically 14 21 days treatment ha 1a serum levels measured infusion frequently infusion assay one compartment pharmacokinetic model fit measured serum levels , accurately described changes ha 1a level time dose group \( r2 99 \) mean sem apparent volume distribution ha 1a 48 5 4 5 ml kg , mean serum clearance 2 8 0 4 ml kg h mean serum half life ha 1a 15 9 1 5 h mean serum level one hour 100 mg dose 33 2 2 4 micrograms ml , mean concentration 24 h later 9 1 1 6 micrograms ml dose administered presence gram negative bacterial infection significantly influence volume distribution serum clearance adverse reactions ha 1a observed , antibodies ha 1a detected patient data indicate pharmacokinetics ha 1a well described one compartment pharmacokinetic model , ha 1a safe patients sepsis
dependence oxygen consumption oxygen delivery children hyperdynamic septic shock low oxygen extraction studied effect increasing systemic oxygen delivery \( do2 \) packed rbc \( \) transfusion oxygen consumption \( vo2 \) children hyperdynamic septic shock routine resuscitation volume loading pharmacologic support , patients studied significant derangements oxygen transport variables defined baseline vo2 less 180 ml min m2 oxygen extraction \( o2 \) less 24 eight studies performed transfusion increased do2 167 266 ml min m2 \( p less 01 \) without increasing cardiac index \( 5 2 1 3 vs 5 0 1 4 l min m2 \) vo2 increased 112 36 157 60 ml min m2 \( p less 01 \) o2 unchanged \( 18 3 vs 19 6 \) despite initial low o2 , vo2 increased pediatric septic shock increase do2 since vo2 correlates survival , one consider enhancing do2 despite initial low o2 high do2 effects morbidity mortality require study
accuracy early prediction prognosis patients septic shock analysis simple indices prospective study 26 consecutive septic shock patients , analyzed clinical , hemodynamic , metabolic data volume infusion test circulatory reserve response fluid repletion patients investigated identify early variables could predict outcome 15 survivors \( group \) 11 nonsurvivors \( group b \) mean , group patients hemodynamically evaluated 2 3 h onset sepsis syndrome , whereas group b patients underwent cardiac catheterization 12 h interval initial evaluation , groups demonstrated similarly decreased mean arterial pressure , mean heart rate , mean cardiac filling pressure group patients evidenced elevated cardiac index \( ci \) \( greater 4 l min m2 \) associated low systemic vascular resistance index \( less dyne sec cm5 m2 \) , generally recognized hyperdynamic cardiac state however , none initial cardiovascular variables could serve predictor survival fluid challenge increased left ventricular preload 6 12 4 7 8 12 7 mm hg group group b , respectively increases associated significant increases ci 4 4 6 9 3 3 8 l min m2 however , end fluid challenge , group patients exhibited normal cardiac response , evidenced change left ventricular stroke work index \( \) given increase pulmonary capillary wedge pressure \( wp \) referred left cardiac preload
pseudomonas aeruginosa compared escherichia coli produces less endotoxemia cardiovascular dysfunction mortality canine model septic shock investigated effects two different gram negative bacteria radiation induced leukopenia endotoxemia , cardiovascular abnormalities , mortality canine model septic shock serial hemodynamics measured conscious dogs using radionuclide heart scans thermodilution cardiac output catheters plasma endotoxin concentrations determined lysate assay viable pseudomonas aeruginosa escherichia coli implanted intraperitoneally produced concordant hemodynamic patterns septic shock \( p less 0 01 \) endotoxin concentrations lower dogs infected p aeruginosa compared e coli \( p less 0 0001 \) despite lower endotoxin levels , p aeruginosa infected dogs higher mortality \( p less 0 01 \) , severe hypotension \( p less 0 05 \) , greater depression left ventricular ejection fraction \( p less 0 05 \) dogs e coli sepsis e coli challenge combined leukopenia \( induced dose radiation \) resulted mortality 60 percent \( p less 0 01 \) without greater cardiovascular dysfunction higher endotoxin concentrations findings suggest bacterial products endotoxin host related factors may important toxicity , cardiovascular instability , mortality gram negative septic shock quantitative determinations plasma endotoxin unlikely correlate clinical severity septicemia heterogeneous patient populations infected different gram negative organisms
reduction contamination total hip replacement special working assessed wound , air operative field contamination 50 total hip operations , performed zonal ventilation system staff either specially designed polypropylene non woven coverall conventional cotton surgeons partially impermeable operating gowns polypropylene coverall associated significantly lower air wound counts coverall cotton judged acceptable combined use zonal ventilation coverall achieved ultra air conditions
lack association medication use presence absence bacteriuria elderly women study undertaken determine association medication use presence absence bacteriuria elderly ambulatory women 198 women participated three urine culture surveys \( every 6 months \) 18 month study period , 66 \( 34 4 \) bacteriuria least one survey univariate multivariate analyses demographics , age , place residence , medication use \( drug class \) revealed place residence significant association presence absence bacteriuria regard , subjects commonly resided nursing home less commonly lived house complex compared subjects \( p less 05 \) therefore , study demonstrates elderly ambulatory women , medication use appear associated presence absence bacteriuria
absence significant bacteremia urinary catheter manipulation patients chronic indwelling catheters objective study quantify microorganisms present blood urinary catheter removal patients chronic indwelling urinary catheters prospective study 4 month period university affiliated geriatric medical center subjects 33 patients chronic indwelling urinary catheters positive urinary cultures urinary catheter usually changed month peripheral vein line used blood withdrawal urinary cultures quantitative blood cultures \( \) performed shortly urinary catheter removal insertion patients significant bacteriuria \( greater 10 \( 5 \) cfu ml \) average 2 3 microorganisms among 46 sequential quantitative blood cultures performed , two patients bacteremia urinary source low concentration one patient 0 13 cfu ml blood 5 minutes removal urinary catheter , 0 1 cfu ml 5 minutes new urinary catheter none patients subjective objective clinical problem 36 hours urinary manipulation clinical symptoms bacteremia rare events , prophylactic antibiotics appear necessary urinary catheter removal elderly institutionalized patients studies necessary identify risk factors rare instances patients bacteremia
mycobacterium leprae specific cells leprosy patient suppress hla dr3 restricted cell responses immunodominant epitope 65 kda hsp polar type \( tt \) leprosy , characterized high cell reactivity mycobacterium leprae , associated hla dr3 surprisingly , dr3 restricted low cell responsiveness leprae found hla dr3 positive tt leprosy patients low responsiveness specifically induced leprae tuberculosis seen patients healthy controls studied patient specific , leprae induced , dr3 restricted low cell responsiveness depth one representative hla dr3 positive tt leprosy patient using cell clones patient two types cell clones obtained one type cross reactive tuberculosis recognized immunodominant epitope \( amino acids 3 13 \) 65 kda heat shock protein \( hsp \) type leprae specific reacted protein 65 kda one examine whether leprae specific cell clones responsible dr3 restricted low responsiveness leprae , tested ability suppress proliferation dr3 restricted , 65 kda , hsp reactive clones dr3 restricted , leprae specific cells completely suppressed proliferative responses dr3 restricted , cross reactive cell clones 65 kda hsp patient well individuals also , dr3 restricted responses irrelevant ag suppressed leprae specific cell clones however , suppression non dr3 restricted cell responses seen although mechanism must still elucidated , leprae induced , dr3 restricted immunosuppression may least partly explain observed dr3 associated low cell responsiveness tt leprosy patients
general model sexually transmitted disease epidemiology implications control achieving control may possible activities discussed previously research provide additional empiric data sex behavior , develop innovative strategies access risk std \( e , core group members \) , biologic study std pathogens goal vaccine development new strategies identify core group members currently used std status would help targeting educational efforts , laboratory screening , vaccines achieving complete control may possible recent advances understanding epidemiology transmission dynamics translated effective new interventional strategies
syphilis adults article reviews clinical manifestations syphilis , diagnostic tests might help diagnose accurately disease , current recommendations therapy association syphilis human immunodeficiency virus infection raises additional questions related transmission , diagnosis , therapy diseases
amoxycillin plus versus doxycycline treatment erythema borreliosis 72 adults erythema \( early lyme borreliosis \) enrolled randomised prospective trial comparing amoxycillin 500 mg plus 500 mg three times day doxycycline 100 mg twice day 21 days antibiotic regimens chosen known vitro sensitivity borrelia burgdorferi , antibiotic tissue penetration , pharmacokinetics drugs , organism early course infection 72 patients evaluable \( 35 doxycycline group 37 amoxycillin group \) two regimens equally effective treatment erythema mild fatigue post treatment complaints , resolved within 6 months none patients needed antibiotic treatment lyme borreliosis
bird attack milk bottles possible mode transmission campylobacter jejuni man case control study carried test hypothesis rise rate campylobacter jejuni infection area south wales may due consumption handling milk bottles birds 32 36 cases meeting case definition interviewed , along 2 controls per case , matched age , sex , area residence strong associations campylobacter infection delivery milk bottles , history milk bottle attack birds , milk bottle attack birds week illness , consumption milk bottles week illness strong dose response relation frequency bird attack illness controls history milk bottle attack birds likely cases taken preventive measures bird attack consumption contaminated milk although people witnessed attacks , likely \( \) \( \)
interleukin 1 receptor antagonist reduces mortality endotoxin shock five 1 , 000 patients admitted hospital develop bacterial sepsis leading shock , mortality rate high despite antibiotic therapy infection results hypotension poor tissue perfusion , eventually leads failure several organ systems bacterial endotoxin thought direct cause shock gram negative sepsis , cause shock animals , antibodies endotoxin prevent gram negative shock animals humans , symptoms septic shock result actions host cytokines induced endotoxin cytokine interleukin 1 implicated important mediator septic shock induce tachycardia hypotension act synergistically tumour necrosis factor cause tissue damage death report specific interleukin 1 receptor antagonist reduces lethality endotoxin induced shock rabbits , indicating interleukin 1 indeed play important part endotoxin shock
calcitonin gene related peptide levels elevated patients sepsis calcitonin gene related peptide \( cgrp \) , endogenous vasoactive peptide encoded calcitonin gene nerve cells , distributed throughout cardiovascular system potent vasodilator plasma levels cgrp elevated animal models sepsis study designed determine whether plasma cgrp levels elevated patients sepsis perhaps contribute hyperdynamic cardiovascular state sepsis plasma cgrp levels obtained normal healthy volunteers patients sepsis volunteers normal pulse blood pressure patients sepsis selected according following criteria \( 1 \) temperature higher 38 5 degrees c , \( 2 \) white blood count greater 14 , 000 ml , \( 3 \) positive blood culture bacterial organisms , \( 4 \) hemodynamic parameters consistent hyperdynamic sepsis , \( 5 \) negative history thyroid endocrine abnormalities cgrp extracted assayed radioimmunoassay iodine 125 labeled human cgrp patients sepsis , cardiac index 5 4 0 5 l min m2 \( normal , 3 0 \) systemic vascular resistance 7 1 0 5 mm hg l min \( normal , 16 \) oxygen delivery 137 ml min \( normal , 1000 \) plasma cgrp levels significantly elevated patients sepsis , 14 9 3 2 pg ml , compared plasma cgrp levels control volunteers , 2 0 0 3 pg ml \( p less 0 0005 \) elevated levels cgrp may contribute decreased vascular resistance increased cardiac output hyperdynamic septic state
thoracic empyema causes , diagnosis , treatment thoracic empyema disease recognized centuries principles management stated remain less unchanged diagnosis masked underlying cause , antibiotic treatment , frequently associated diseases specific investigation , main diagnostic test remains diagnostic empyema encountered , objectives save life eliminate empyema , complications , chronicity return pulmonary mechanics normal reduce duration hospital stay introduction antibiotics dramatically influenced spectrum disease encountered original infection adequately treated , empyema rarely occurs penicillin removed major cause empyema , developments antibiotics mean majority occur patients disabled disease processes malnutrition , remains delay medical attention patients often less able prolongation infective processes sometimes encountered staged approach treatment developments operative postoperative care meant patients best treated aggressive definitive surgical management
results outbreak , texas recent \( continuing \) epidemic included morphologic variation disease , including called dwarf , classic , giant , transient , follicular , , types cases clearly acquired unprotected sexual local prostitutes strain haemophilus responsible outbreak relatively easily cultured routine media unexpected sensitivity strain vancomycin rendered recommended selective growth medium much less optimal isolation therapeutic success uniformly followed use intramuscular ceftriaxone sodium one case responded oral ciprofloxacin hydrochloride
resurgence acute rheumatic fever mid south children 's hospital resurgence acute rheumatic fever \( arf \) reported many areas united states recent years retrospectively reviewed medical records inpatients new diagnosis arf 1982 1988 children 's hospital serves six state referral area mid south thirty patients identified , 21 seen 1987 \( 13 \) 1988 \( 8 \) rate new cases arf per 1000 hospital discharges \( 0 7 \) significantly greater 1987 1988 \( 0 15 \) 1982 1986 patients recently diagnosed arf predominantly areas , common recent major manifestation reasons resurgence arf us , including mid south , unclear , experience serves support recently published guidelines diagnosis management streptococcal light resurgence arf
drug therapy helicobacter pylori infection problems pitfalls antibacterial chemotherapy helicobacter pylori currently assessed open randomized controlled clinical studies efficacy eradicating stomach patients gastritis gastroduodenal ulcer whereas presently optimal agent treatment scheme , combination antibiotics \( metronidazole , , amoxicillin \) salts definitely superior vivo either agents administered alone several reasons proposed , explain clinical failure treatment insufficient concentration active drugs gastric mucus , instability agents acidic ph , inappropriate formulation drug , insufficient duration treatment , variable compliance patients recently , appeared several clinical trials h pylori may rapidly acquire resistance antibiotics , event might also account clinical failure critical review literature h pylori treatment indicates association antibiotics antibiotics alone may efficiently reduce risk emergence resistance improve therapeutic outcome guidelines treatment suggested order avoid future misuse antibiotics would increase selection antibiotic resistant h pylori negatively affect gastric likewise , accurate definition subset patients h pylori really require treatment needs rapidly established
risk factors staphylococcus aureus nosocomial pneumonia critically ill patients staphylococcus aureus nosocomial pneumonia become important infection apparently increasing incidence also high mortality rate total 50 episodes nosocomial pneumonia critically ill patients etiologic diagnosis well established prospectively followed medical surgical intensive care unit \( icu \) aureus isolated total 13 episodes univariate analysis variables significantly associated aureus nosocomial pneumonia 25 yr age , coma , corticosteroids , antecedent trauma step forward logistic regression analysis defined coma significantly influencing risk developing aureus nosocomial pneumonia suggest antimicrobial drugs active aureus must included initial empirical antimicrobial regimen treating nosocomial pneumonia patients coma identification factors influencing etiology possibility earlier effective antimicrobial treatment may represent step control nosocomial pneumonia critically ill patients improving prognosis
tuberculous meningitis short course chemotherapy march 1986 , began 6 month short course trial therapy tuberculous meningitis , 28 patients analyzed diagnosis based following cerebrospinal fluid test results 53 5 cases , mycobacterium tuberculosis identified direct smear 57 , culture medium positive 83 3 , detection anti calmette guerin \( bcg \) antibodies enzyme linked immunosorbent assay positive 74 , adenosine deaminase activity positive addition , 21 4 cases , diagnosis established means autopsy findings moreover , diagnosis supported analyses another tissue body fluids despite administration therapy , 32 4 patients died decreased reached last stage disease beginning treatment sixteen percent patients survived 18 months follow therapy ended suffered neurological sequelae 6 month therapeutic regimen , morbidity mortality similar found longer course therapies latter regimen therefore thought good acceptable therapeutic option treatment tuberculous meningitis
patterns bacterial infection calves implanted artificial hearts device related infection one serious potential consequences total artificial heart \( tah \) implantation complication must addressed full potential benefit devices , especially fully implantable devices , realized review research reports clinical data conducted ascertain similarities existed patterns infection reported human tah recipients seen experimental animal models infection reported approximately 57 human tah recipients approximately 47 implanted animals implant periods ranged 1 days humans , 32 days animals spectrum organisms isolated groups similar , high proportion infections caused pseudomonas aeruginosa staphylococcus epidermidis addition , numerous isolates enterobacter obtained animals positive blood cultures often observed animals within 2 4 weeks following implantation devices similarities noted review suggest calf may appropriate animal model study pathogenesis tah related infection
prevention infection porous tracheal prosthesis omental wrapping ideal tracheal prosthesis permit complete incorporation epithelialization luminal surface possible currently available impermeable solid silicone tube authors developed reinforced , porous polyurethane tubular prosthesis potential complete incorporation however , prostheses implanted area airway , become infected order prevent infection , authors evaluated effect omental wrapping guinea pigs authors' tubular prosthesis implanted subcutaneously abdominal area ends open air ten prostheses wrapped omentum 10 prostheses 4 weeks , control prostheses infected wrapped prostheses remained place macroscopically infected microscopically , wrapped prostheses well vascularized incorporated granulation tissue , occur prostheses control group results authors conclude omental wrapping would effective way prevent infection porous tracheal prostheses open air situation , allow rapid tissue ingrowth incorporation host
parents' vs physicians' \( values \) clinical outcomes potentially bacteremic children previous analyses decision strategies children 3 24 months acute onset fever greater equal 39 degrees c evident bacterial focus infection indicated risks routine blood cultures \( unnecessary hospitalization treatment children clear bacteremia spontaneously \) benefits \( prevention cases major infectious sequelae \) analyses based parents' values beneficial adverse clinical outcomes , wished examine whether values differed physicians , , whether differences sufficient change results decision analysis using pre tested linear analog utility \( value \) scale , evaluated eight potential clinical outcomes potentially bacteremic children 121 parents healthy 3 24 month old children attending private pediatric group practice 57 attending physicians tertiary care children 's hospital emergency room based 0 1 normalization , 0 utility worst outcome \( meningitis major bacterial infection , plus venipuncture \) , 1 utility best outcome \( complete recovery without venipuncture hospitalization \) , analyzed using recently developed statistical model utility majority parents physicians combined components outcomes \( disease , pain venipuncture , stress hospitalization \) nonlinear fashion parents assigned substantially lower utility \( e greater \) venipuncture , minor infection , hospitalization physicians , even lower parents children home
low gastric acid risk factor cholera transmission application new non invasive gastric acid field test although gastric acid thought important host defense certain enteric infections , field studies role gastric acid preventing enteric infections hampered lack suitable non invasive test low gastric acid output \( \) established risk factor cholera , assessed validation , whether new non invasive test estimates measuring breath hydrogen excess ingestion magnesium gastric acid secretion , could discriminate persons high low risk developing cholera fifteen age matched pairs , participants field trial two oral cholera vaccines rural , tested pair case person recovered severe cholera least 6 months testing control person resided home cholera patient remained uninfected stimulated breath hydrogen higher controls \( median hydrogen excess 369 mumol 80 min \) cases \( median hydrogen excess 150 mumol 80 min \) \( p less 0 05 \) higher controls 12 15 pairs results , consistent past invasive assessments association cholera , suggest non invasive test may useful evaluating epidemiological field studies
tampon absorbency , composition oxygen content risk toxic shock syndrome tampon use identified major risk factor toxic shock syndrome , although etiologic role clearly understood two epidemiologic studies conducted date reported association tampon absorbency risk toxic shock syndrome finding corroborated laboratory studies , however , suggested absorbency may marker characteristics create environment conductive elaboration toxic shock syndrome toxin 1 used data previously reported state study estimate simultaneously effects tampon oxygen content , absorbency chemical composition although data sparse , oxygen content strongly associated risk toxic shock syndrome either absorbency chemical composition results suggest may possible develop highly tampon associated high risk toxic shock syndrome
development potential use antibody directed lipopolysaccharide treatment gram negative bacterial sepsis gram negative bacterial sepsis remains major cause lethality hospitalized patients , despite routine therapy consisting antimicrobial agents , hemodynamic monitoring fluid resuscitation , metabolic support large body evidence supports concept gram negative bacterial lipopolysaccharide \( endotoxin , lps \) responsible many direct host mediator induced deleterious effects , recent work centered development use anti lps antibody preparations order ameliorate lethality polyclonal monoclonal antibody preparations directed common deep core lipid region lps cross reactive vitro cross protective vivo wide range challenge organisms lps , preliminary clinical trials indicate reduction lethality may possible precise endotoxin epitope antibody directed order maximize protection , however , established modality probably become standard form adjunctive therapy within next several years treatment gram negative bacterial sepsis
altered ca2 homeostasis functional correlates hepatocytes adipocytes endotoxemia sepsis decreased cytosolic ca2 impaired ca2 release response ip3 challenge among perturbations hepatocyte ca2 homeostasis associated endotoxemia sepsis changes consistent accompanying alterations appropriate physiologic functions , e g , activation glycogen , mediated ca2 c defective phosphorylation relevant enzymes attenuation ip3 binding subcellular fractions targets ip3 decrease size ip3 sensitive pool ca2 underlying components mechanism reduced ca2 release upon ip3 stimulation metabolic sequelae et treatment leads significant increase ca2 associated cell surface compartment adipocytes , reduction 45ca2 uptake endoplasmic reticulum higher cytosolic ca2 basal conditions upon acth stimulation observed cells control rats reduced 45ca2 uptake also manifest adipocytes septic rats alterations adipocyte metabolism induced et include increased oxidation glucose co2 \( insulin like effect \) increased lipolysis upon ne acth stimulation
suppression herpes simplex virus type 1 reactivation latency \( \) 9 \( \( z \) 2 \( \) methyl \) guanine \( l , 180 \) vitro latent herpes simplex virus type 1 \( hsv 1 \) infection induced human embryonic lung cells vitro using combination viral replication inhibitors elevated temperature conditions \( human cytomegalovirus temperature manipulation \) , thymidine kinase inhibitor \( l , 180 \) found suppress delay reactivation hsv 1 infected human embryonic lung cells l , 180 alone combination interferon ineffective primary acute viral replication inhibitor unable induce latent hsv 1 infection cell culture data suggest initial acute virus replication replication resulting reactivation latency separate events
treatment adult oral acyclovir thirty one late adolescents adults varicella studied patients identified within 72 hours varicella offered open treatment acyclovir \( 4 g \) , patients identified 72 hours followed treated twenty two patients treated acyclovir nine patients treated severe complications occurred 31 patients minor complications , including prolonged fever , localized secondary infections , persistent cough , prolonged fatigue frequent untreated group acyclovir therapy begun within first 24 hours varicella , rash clinical illness dramatically treatment oral acyclovir considered varicella adults identified within first 24 hours
infection mice lactate dehydrogenase elevating virus subpopulation kupffer cells involved receptor mediated endocytosis lactate dehydrogenase enzymes previous experiments rats , shown rapid plasma clearance number clinically important enzymes due receptor mediated endocytosis kupffer cells resident macrophages others shown infection mice lactate dehydrogenase elevating virus , virus macrophages , leads reduced plasma elimination enzymes paper two sets experiments plasma elimination intravenously injected , labeled lactate dehydrogenase m4 mitochondrial dehydrogenase mice shown caused part uptake liver , spleen bone uptake lactate dehydrogenase m4 tissues , large extent , two competitively inhibited 's clearance results suggest , also mice , enzymes partly cleared plasma endocytosis way common receptor cells \( probably macrophages \) liver , spleen bone marrow data showed normal mouse liver contains 23 x 10 \( 6 \) kupffer cells cm3 number reduced 30 controls 24 hr infection mice lactate dehydrogenase elevating virus returned normal within next 9 days component uptake lactate dehydrogenase m4 liver , spleen bone disappeared 24 hr infection virus , return kupffer cell population recovered findings suggest lactate dehydrogenase m4 , large extent , removed circulation way receptor subpopulation macrophages permissive replication lactate dehydrogenase elevating virus
chronic encephalitis caused mentioned previously , ms pml demyelinating conditions cns pose diagnostic difficulties differentiation similarities clinical findings however , certain features unique diseases helpful clinical diagnosis ms , unlike pml , disease unknown cause influences combination exposure environmental agent immune mediated factors may operative pathogenesis ms age onset peaks third fourth decades predominance women , contrasted pml , peaks fifth sixth decades non aids associated cases slight predominance men ms prevalent areas north america , europe , australia , new zealand common initial symptoms seen ms include bilateral limb weakness \( legs affected twice often arms \) , , spasticity , optic , , incoordination , paresthesias \( paresthesias typically found lower limbs symmetric pattern , may follow obvious anatomic distribution often correspond distribution sensory symptoms vibration position sense frequently disturbed pain temperature \) intellectual impairment mental deterioration uncommon early ms , whereas frequent initial presentation pml addition , presence speech impairment hemiparesis suggestive pml brain stem involvement infrequent
situ hybridisation labelled dna probes detection viral genomes applicability recently developed non radioactive dna labelling detection method , uses \( \) enzyme linked immunosorbent assay \( elisa \) system , detection viral infections pathology specimens situ hybridisation , examined efficacy compared biotin labelling methods three cases progressive multifocal , two vulgaris , seven cases laryngeal studied sensitivity labelled probe almost 35s labelled probe dot blot hybridisation test using situ hybridisation 35s labelled labelled probes , levels signals detected similar biotin labelled probe less sensitive , particularly cases laryngeal labelling detection method highly sensitive applicable detection viral infection , preferable probe , especially situ hybridisation done pathology laboratory
immunocytochemical analysis lymph node aspirates patients human immunodeficiency virus infection thirty four patients positive human immunodeficiency virus \( hiv \) lymphadenopathy investigated using fine needle aspiration cytological analysis included immunocytochemical investigation alkaline phosphatase phosphatase \( \) method patients confirmation cytological diagnosis lymph node biopsy fifteen aspirates follicular hyperplasia evaluated eleven patients showed b cell predominance b cell population show light chain restriction ten patients b cell non hodgkin 's lymphoma \( five burkitt 's lymphoma five b cell immunoblastic lymphoma \) investigated nine 10 cases monoclonal respect light chain determinants one case burkitt 's lymphoma partial lymph node metastasis show light chain restriction cytological diagnosis included two mycobacterial infections four cystic lesions histological investigation necessary diagnose extent lymph node disease caused kaposi 's sarcoma findings indicate investigation lymph node aspirates useful evaluating lymphadenopathy hiv positive patients
measles antibody reevaluation protective titers school blood drive measles outbreak permitted correlation preexposure measles antibody titers clinical protection using plaque reduction neutralization \( prn \) test eia 9 donors detectable preexposure prn titer less equal 120 , 8 met clinical criteria measles \( 7 \) compared none 71 preexposure prn titers greater 120 \( p less 0001 \) seven 11 donors preexposure prn titers 216 greater equal 4 fold rise antibody titer \( mean , 43 fold \) compared none 7 preexposure prn titer greater equal \( p less 02 \) 37 preexposure prn titer less , 26 \( 70 \) reported one symptoms compared 11 \( 31 \) 35 donors preexposure prn titers greater equal \( p less 002 \) eia , case detectable preexposure antibody preexposure geometric mean titer asymptomatic donors \( 220 \) significantly higher symptomatic donors meet clinical criteria measles \( 153 \) \( p 10 \) study suggests prn titers less equal 120 protective measles disease illness without rash due measles may occur persons prn titers level
measles incidence , vaccine efficacy , mortality two urban african areas high vaccination coverage measles incidence , vaccine efficacy , mortality examined prospectively two districts vaccine coverage children aged 12 23 months 81 \( bandim 1 \) 61 \( bandim 2 \) little difference cumulative measles incidence 9 months age \( 6 1 7 6 , respectively \) 9 months 2 years age , however , 6 1 contracted measles bandim 1 13 7 bandim 2 even adjusting vaccination status , incidence significantly higher bandim 2 \( relative risk 1 6 , p 04 \) even though 95 children measles antibodies vaccination , vaccine efficacy 68 \( 95 confidence interval ci 39 84 \) unrelated age vaccination children mortality hazard ratio 3 0 compared vaccinated children \( p 002 \) , indicating protective efficacy death 66 \( ci 32 83 \) measles vaccination data suggest necessary age 9 months control measles urban african areas
occurrence groups b respiratory syncytial virus 15 years associated epidemiologic clinical characteristics hospitalized ambulatory children 15 years respiratory syncytial virus \( rsv \) isolates hospitalized ambulatory children examined strain group subset subgroup determine associated epidemiologic clinical characteristics three patterns yearly outbreaks existed \( 1 \) strong predominance group strains \( 9 years 83 100 strains \) , \( 2 \) relatively equal proportions group b strains \( 4 years \) , \( 3 \) strong predominance group b strains \( 78 85 \) 2 years , separated decade first pattern highly dominant strains occurred cycles 1 2 consecutive years single intervening year b strains greater equal 40 isolates subgroups a1 a2 predominated , b2 , 3 , 4 occurred almost equally greater clinical severity group strains suggested children group infections requiring intensive care significantly often \( 15 4 vs 8 3 , p 008 \) , strongly dominant strain years associated higher proportions rsv admissions requiring intensive care \( 16 6 vs 5 5 , p less 01 \) strains subgroups a2 b4 frequently found hospitalized patients a1 outpatients , 2 years highest rates intensive care admissions subgroup a2
effect vaccination serotype specific antibody responses infants administered wc3 bovine rotavirus natural rotavirus infection evaluation wc3 bovine rotavirus \( serotype 6 \) vaccine infants , subjects experienced natural serotype 1 rotavirus infection vaccination others therefore , effects wc3 natural rotavirus strains either primary serotype specific neutralizing antibody responses could determined primary natural infection \( symptomatic asymptomatic \) , neutralizing antibody titers highest serotype 1 consistently high serotype 3 , low titers \( greater equal 20 \) serotypes 2 4 often detected previous vaccination wc3 little effect magnitude responses contrast , subjects infected serotype 1 strains vaccination experienced large \( average , 12 fold \) rises neutralizing antibody human serotypes 1 4 vaccinated wc3 thus , although wc3 natural strains distinct serotypes , epitopes sufficiently similar wc3 could boost neutralizing antibody titers human serotypes subjects primed previous natural infection
cytomegalovirus 's encephalitis situ hybridisation biotinylated cytomegalovirus \( cmv \) dna probe done brain biopsy specimens 10 patients 's encephalitis \( \) 46 age matched control patients neurological diseases 10 patients intractable epilepsy focal neurological deficits , perivascular , microglial nodules , , neuronal loss cmv genomic material demonstrated 7 10 patients \( neurons , astrocytes , , endothelial cells \) 2 46 control patients probes herpes simplex virus hepatitis b virus negative patients fibroblast controls results suggest cmv likely cause 's encephalitis
use single fiber emg macro emg study reinnervation use single fiber emg macro emg studies reinnervation discussed gives information changes motor unit function transmission terminal nerve , motor muscle fiber dynamics reinnervation may studied technique amount reinnervation obtained macro emg studies capacity reinnervation discussed conditions well factors limit reinnervation process
measles israel , west bank , continuing incidence case new eradication strategy measles continues occur epidemic waves israel , , west bank , causing morbidity mortality israel , immunization infants measles began 1967 , 90 immunized mid 1980s west bank , immunization infants measles began 1973 1976 , respectively , immunization rate reached 75 late 1970s increased greater 90 1980s measles epidemics , previously occurred 5 7 year cycles , occurred every 2 4 years 1980s affected individuals older affected previous years israel 's commitment eradicating measles require substantially expanded immunization program comparison traditional program requires immunization infants alone benefits several alternative immunization strategies considerably exceed costs new , two dose immunization needed minimal strategy , administering booster doses school aged children may required well achieve control eradication measles measles serious preventable public health problem appropriate strategies must devised national international public health control disease developing developed countries
impact cytomegalovirus infection organ transplant recipients cytomegalovirus \( cmv \) single important infectious agent affecting recipients organ transplants , least two thirds patients cmv infection 1 4 months transplantation infected allografts major exogenous source cmv infection transplant recipients , although leukocyte containing blood products also transmit virus three patterns cmv infection recognized primary infection , reactivation infection , primary infection greatest clinical impact clinical effects cmv infection include infectious disease syndromes pneumonia immunosuppressed state potentially lethal opportunistic infection initiation process result allograft injury progress made controlling cmv infection anti cmv globulin certain antiviral drugs appear promising prophylaxis , combination ganciclovir appears promising therapy
american blood donors seropositive human lymphotropic virus types ii exhibit normal lymphocyte subsets recent reports demonstrated lymphocyte subsets abnormal japanese blood donors seropositive human lymphotropic virus type \( htlv \) determine similar changes characterize american blood donors seropositive htlv ii , lymphocyte subsets measured 42 htlv seropositive 42 htlv seronegative blood donors seronegative individuals matched age , race , gender seropositive individuals peripheral blood mononuclear cells treated panel 12 monoclonal antibody pairs analyzed two color flow cytometry significant differences observed seropositive seronegative groups respect absolute number circulating lymphocytes percentages lymphocytes belonging subsets assessed subsets included b , , cd4 , cd8 cells subpopulations cd4 cd8 cells defined coexpression markers appear \( cd25 , hla dr , cd38 \) \( leu 8 , cd45ra \) activation findings indicate htlv seropositive persons american blood donor pool exhibit lymphocyte subset alterations reported htlv seropositive blood donors japan
measles update incidence measles united states dramatically increased 1980s , low 1 , 497 cases 1983 17 , 000 cases 1989 family physicians help reverse trend following revised immunization schedule , includes measles \( \) booster preschool age children new guidelines also recommend either two dose schedule serologic evidence immunity required persons entering college employed medical field immunization policies physician 's ensure office staff acquired measles immunity triage policy separating patients rash illnesses utilized mild upper respiratory illness , history seizures , egg allergy asymptomatic human immunodeficiency virus infection contraindications measles vaccine cases measles reported local health department
hiv seroconversion two homosexual men receptive oral intercourse ejaculation implications counseling concerning safe sexual practices seroconversion hiv antibody occurred two homosexual men reported anal intercourse greater equal 5 years multiple episodes receptive oral intercourse ejaculation neither man reported intravenous drug use receipt blood products last antibody negative specimen also negative polymerase chain reaction p24 antigen assays sexually active persons clearly receptive oral intercourse ejaculation carries potential risk hiv transmission
stressful life events risk factors herpes zoster \? determine stressful life events risk factors herpes zoster , conducted case control study zoster self reported recent negative life events major changes relationships subjects 101 healthy community cases zoster 101 healthy controls matched age , sex , race generated random digit geriatric scale recent life events administered case control subjects , additional questions asked regarding perception life event results showed case subjects experienced negative life events significantly often subjects control groups 2 months zoster onset analysis discordant pairs \( 26 versus 10 , odds ratio 2 60 , 95 confidence interval ci 1 13 , 6 27 , p 012 \) , 3 months \( 29 versus 11 , odds ratio 2 64 , 95 ci 1 20 , 6 04 , p 007 \) , 6 months \( 35 versus 16 , odds ratio 2 00 , 95 ci 1 04 , 3 93 , p 012 \) mean number total life events significantly higher cases 6 months zoster \( case means 2 64 , control means 1 82 , p 008 \) , significant differences 2 , 3 , 12 months significant differences case subjects control subjects events , given single life event conclusion , found whereas patients herpes zoster experienced kinds life events year preceding illness control subjects , recent events perceived stressful significantly common among patients zoster
human immunodeficiency virus primary care physician scope size human immunodeficiency virus \( hiv \) epidemic , primary care physician need assume greater role knowledge hiv risk factors ability perform pretest counseling hiv testing essential counseling patients hiv risk reduction part hiv risk interview understanding benefits contraindications testing , well respect impact testing , important hiv seropositive individuals undergo complete history review symptoms soon test results known judicious use laboratory testing , including monitoring cd4 cell counts , recommended pneumocystis carinii prophylaxis zidovudine therapy offered patients appropriately low cd4 counts
isolation human cell lymphotropic virus type 2 indians human lymphotropic virus type \( htlv \) associated adult cell leukemia lymphoma chronic degenerative myelopathy however , another major type htlv , htlv ii , isolated , little known disease associations , transmission routes , risk factors htlv ii infection recent studies indicate high percentage certain groups v drug users blood donors infected htlv ii studies found elevated rate htlv among indians province , identify cause among unique population used htlv ii specific polymerase chain reaction techniques detect htlv genetic sequences blood leukocytes three seropositive indians htlv ii primer amplified polymerase chain reaction products two subjects partially sequenced matched published htlv ii nucleotide sequences p24 gag \( 94 107 bases \) pol \( 98 112 bases \) regions cd4 lymphocyte line established one subjects produced htlv ii specific proteins tested antigen capture immunoblot assays , well mature htlv particles demonstration htlv ii infection geographically isolated central american indian population without typical risk factors htlv infection suggests htlv ii infection endemic population provides important potential natural reservoir virus
immunological studies basis simian immunodeficiency virus african green monkeys potential reasons lack simian immunodeficiency virus sivagm natural host , african green monkey \( , \) , investigated respect immunological mechanisms functional immune response monkeys infection similar \( though identical \) humans infection human immunodeficiency virus type 1 \( hiv 1 \) sera infected animals , neutralizing antibodies found low absent , particular neutralization various isolates homologous sera detectable antibody complement cytotoxicity , though sera able initiate antibody dependent cellular infected cells presence healthy effector peripheral blood lymphocytes human hiv system , macrophages readily infected sivagm two possibly important differences sivagm system human hiv system \( \) low immune response core protein sivagm \( ii \) significantly lower inhibitory effect sivagm proteins proliferation lymphocytes
increasing incidence varicella hospitalizations united states navy personnel today 's teenagers susceptible \? recruits vaccinated \? hospital records 10 , united states navy adult varicella \( \) admissions reviewed annual hospital admission rates varicella increased fourfold active duty 1980 1988 18 fold among active duty navy personnel 1975 1988 fifty seven percent varicella admissions occurred military members , aged 17 20 half total varicella admissions occurred personnel less year military service multivariate analysis navy data confirmed increasing time related trends risk , suggesting national temporal trend increased varicella susceptibility us teenagers young adults administering safe effective varicella vaccine navy recruits could prevent hospital bed days first year use
routine tool detection assessment epidemics influenza like syndromes france regression model level influenza like syndrome estimated 55 , 200 cases collected october 1984 august 1988 using french diseases computer network start major epidemic 1988 89 detected early size epidemic , entire country , estimated approximately 4 3 million cases excess cost sick leave , among working age , estimated 86 million
hiv 1 hiv 2 cross reactive cytotoxic cell epitope hla restricted hiv gag cytotoxic lymphocyte \( ctl \) epitope , 265 279 , highly conserved amongst hiv 1 isolates , one , hiv , single amino acid substitution region hiv 2 differs five amino acids broadly cross protective aids vaccine protect infection isolates hiv 1 hiv 2 , tested ctl specific hiv 1 265 279 epitope peptide analogues hiv , hiv 2 two simian immunodeficiency virus \( \) isolates , recombinant vaccinia viruses expressing respective gag genes , determine whether cross reactivity ctl epitope ctl hiv 1 infected donor could recognize hiv peptide , hiv 2 peptide recombinant vaccinia virus infected target one two peptide treated targets epitopes exhibit cross reactivity may valuable vaccine design
cd4 monocyte counts persons hiv 1 infection early increase followed progressive decline study , asked whether difference number cd4 cd4 peripheral blood monocytes cd4 cells decrease hiv mediated immunodeficiency monocytes cells 90 hiv positive 43 hiv negative persons analyzed flow cytometry 90 hiv positive patients represented entire spectrum cd4 cell counts report cd4 cells decrease , number cd4 monocytes decrease parallel moreover , significantly higher cd4 monocyte counts observed persons early stage hiv disease , e , greater 800 cd4 cells mm3 , hiv negative persons greater 800 cd4 cells mm3 potential implications findings discussed
impact mass treatment onchocerciasis ivermectin transmission infection onchocerciasis major disease , recently , essentially untreatable ivermectin safe effective drug mass treatment onchocerciasis used individual basis , reduces ability treated person transmit onchocerca volvulus infection present study , effect community based ivermectin treatment degree transmission within community assessed determining incidence new infection children ivermectin distributed annually three occasions eligible members population approximately 14 , 000 people living rubber area endemic onchocerciasis 2 years , prevalence infection 5 year old children decreased 21 annual incidence uninfected cohort children decreased 35 , age specific adjustment , reduction incidence 7 12 year old children 45 thus , community based distribution ivermectin led significant reduction incidence new infection findings suggest ivermectin important reducing transmission onchocerciasis
common infect humans infection occurs contaminated containing mature eggs clinically , infection ranges asymptomatic carrier state life threatening pulmonary disease intestinal obstruction diagnosis frequently established identification eggs stool specimens treatment drugs effective preventing serious complications eradicating parasite members household
humoral cell mediated immune responses plasmodium falciparum antigens resa cs protein seasonal variations population recently endemic malaria resurgence falciparum malaria occurred central 1980s disease currently determined humoral cellular responses synthetic peptides repeat sequences 2 major plasmodium falciparum antigens resa \( cs \) protein blood samples 83 subjects living rural community near obtained beginning end transmission season enrollment , 40 subjects presenting 43 without blood parasites similar cell proliferative response antibody level antigens tested however , p falciparum infected individuals exhibited decrease absolute number lymphocytes , due diminished number cd8 natural killer lymphocytes number cd4 cells similar groups overall population , 45 subjects cell response least 1 resa peptide \( 29 35 responding given peptide \) 35 cs protein peptide thirty two percent donors presented resa antibodies 23 cs protein antibodies 20 weeks , end transmission season , cellular proliferative responses antigens markedly decreased evidenced decrease number responders mean stimulation indexes humoral response resa , detected erythrocyte membrane immunofluorescence \( number responders mean antibody titers \) markedly increased humoral responses cs protein resa peptides similar
vitro growth inhibition plasmodium falciparum sera different regions philippines sera different malaria endemic regions republic philippines compared ability inhibit growth plasmodium falciparum vitro dialyzed serum added synchronous cultures containing either total 48 hr test period last 24 hr order analyze effects erythrocytic invasion growth , respectively reduction 3h hypoxanthine uptake used determine percent inhibition compared nonimmune serum one hundred seventy sera south , centrally located island , north , tested 4 p falciparum strains philippines 1 africa indirect fluorescent antibody titers predictive inhibition inhibition invasion rather parasite growth suggested study generally , sera inhibitory parasite strains geographical area remote areas
comparison active passive case detection cutaneous leishmaniasis guatemala estimate degree passive case detection underestimates true incidence cutaneous leishmaniasis guatemala , compared data passive surveillance system health cross sectional population based survey cutaneous leishmaniasis guatemala 2 , persons interviewed , 143 \( 5 \) reported cutaneous leishmaniasis time past , 37 \( 1 3 \) reported onset infection 12 months survey , 31 \( 1 1 \) active infections , 16 \( 0 5 \) confirmed infections calculated basis reports estimated population endemic area , total number new cases leishmaniasis endemic area 12 months survey approximately 2 , 12 month period , health data based passive surveillance listed 64 cases cutaneous leishmaniasis guatemala , incidence estimates based passive surveillance may underestimate occurrence cutaneous leishmaniasis much factor 40
diffuse cutaneous leishmaniasis acquired case diffuse cutaneous leishmaniasis \( \) acquired described causative agent leishmania mexicana determined isoenzyme analysis species specific monoclonal antibody binding characteristics histological examination biopsy material showed large number intracellular extracellular lymphocytes treatment meglumine \( \) administered iv dosage 20 mg antimony kg body weight day 60 days resulted visible improvement lesions , clinical cure
transmission indices , longitudinal survey vectors conducted area \( region \) september 1987 august 1989 principal site palm grove 3 km village densities measured standardized lasting 11 hr carried twice month vector densities also assessed villages fields populations palm grove examined 6 times month infection infective stage silacea predominate vector except beginning season , c dimidiata prevailing species throughout season , october june host seeking activity c silacea greatest middle season \( february \) , occurred sooner \( october \) c dimidiata following variables associated transmission calculated observations palm grove \( first figure corresponds first year study figure corresponds second year \) calculated 2 \( 2 185 \) c silacea 1 412 \( 1 182 \) c dimidiata could bite person palm grove per year , including average 14 4 \( 12 7 \) infective c silacea 9 8 \( 7 2 \) infective c dimidiata percentage dissected third stage larvae head mean number larvae head infective 0 57 10 1 6 8 c silacea 0 66 11 2 6 5 c dimidiata , respectively estimated annual transmission potentials 171 1 \( 102 9 \) c silacea 116 1 \( 73 8 \) c dimidiata palm grove , transmission 2 effective vectors season \( october may \) although annual rate species twice low village , data suggest effective transmission occurs also
vivo assessment antimicrobial agents toxoplasma quantification parasites blood , lungs , brain infected mice vivo effects antimicrobial agents toxoplasma evaluated mice infected intraperitoneally 10 \( 4 \) rh strain determination survival rates study kinetics growth infected mice various intervals infection , serial dilutions blood , lung , brain homogenates performed fibroblast tissue cultures determination parasitic loads pyrimethamine \( 18 5 mg kg per day \) , sulfadiazine \( mg kg per day \) , clindamycin \( 300 mg kg per day \) administered 10 days day 1 day 4 infection untreated control mice died within 9 days showed early predominant lung involvement mice treated sulfadiazine administered day 1 survived apparently healthy parasitic loads decreased early treatment , relapse observed 5 days cessation therapy pyrimethamine administered day 1 , 7 11 mice died within 25 days determination parasitic loads , effect pyrimethamine demonstrable day 6 , relapse constantly observed cessation therapy pyrimethamine sulfadiazine administered combination , 100 mice survived therapy started day 1 , parasites remained undetectable mice treated day 4 , parasites eradicated day 8 infection relapsed 8 days cessation therapy mice treated clindamycin day 1 day 4 died within 10 days , parasitemia always undetectable
diagnosis intestinal using salivary iga antibody detection investigation sought determine whether detection salivary iga antibodies histolytica could identify intestinal infections among 223 school children four groups children identified examination e histolytica parasites \( 20 \) parasite free \( 25 \) diagnostic accuracy salivary iga antibodies e histolytica membrane extract 91 5 \( sensitivity , 85 specificity , 98 \) , maintaining high predictive value different prevalences also , positive correlation \( r , p less 001 \) observed fecal e histolytica membrane antigen levels salivary iga antibody activity measurement iga antibodies saliva may useful diagnosing intestinal infections e histolytica within wide range prevalences moreover , sampling saliva may useful non invasive test surveys
effects albendazole echinococcus infection albendazole chemotherapy larval echinococcus studied administration medicated various concentrations durations effects evaluated comparison treated control groups terms host mortality , larval metastases lungs , final weight histologic appearance larval tissue viability larval tissue necropsy animal tested inoculation two albendazole medicated \( 0 05 0 10 \) significantly inhibited larval growth effects drug included larval degeneration necrosis , inhibition formation , decreased pulmonary metastases , reduced mortality hosts adverse effects parasite correlated significantly serum albendazole metabolite levels duration therapy however , serum albendazole levels equal exceeding concentrations achieved humans receiving daily doses 10 mg kg body weight kill parasite
variations malaria transmission rates related survivorship per feeding cycle survivorship , capacity , mosquito infection probability estimates mosquito infection rates determined 4 times 1 year papua new guinea village estimates survivorship length extrinsic incubation period differed significantly year however , survivorship per feeding cycle , individual mosquito capacity , mosquito infection probability vary significantly estimates parameters compared estimates survivorship , individual capacity , mosquito infection probability mosquito populations villages study area since survivorship per feeding cycle vary significantly among mosquito populations villages , changes malaria transmission potential better estimates survivorship length extrinsic incubation period however , measurements relative inoculation rates easier perform related parasite prevalences children area , estimates inoculation rates preferred option estimating malaria transmission area papua new guinea
geographical distribution plasmodium falciparum erythrocyte rosetting frequency rosetting antibodies human sera uninfected erythrocytes bind spontaneously infected certain strains plasmodium falciparum known spontaneous erythrocyte rosetting studied occurrence frequency rosetting 75 fresh patient isolates identified rosetting strains africa , south america , asia rosetting present 49 isolates tested frequency rosetting red blood cells \( rbc \) individual isolates 0 75 scored first cycle vitro growth rosetting antibodies found 15 73 \( 21 \) sera measured disruption rosettes vitro however , antibodies able inhibit dependent p falciparum infected rbc detected sera erythrocyte rosetting geographically widespread phenomenon rosetting antibodies seem induced natural infection molecular mechanism formation seems distinct endothelial
studies monkeys leading development synthetic vaccine asexual blood stages plasmodium falciparum development synthetic vaccine human use asexual blood stages plasmodium falciparum , monkey trials performed assess safety , immunogenicity , determined minimal infective dose p falciparum strain , kinetics immune response induced vaccination synthetic peptide mixture \( s12 \) synthetic hybrid polymeric protein , induction protective immunity experimental challenge 2 p falciparum strains clear effect observed , determined increased antibody titers synthetic peptides , s12 , , , improvement protective immune response challenge studies suggest either peptide mixture synthetic hybrid polymeric protein excellent choices development vaccine p falciparum
immunization monkeys combination plasmodium falciparum asexual blood stage synthetic peptide antigens mixture 3 synthetic peptides \( 35 1 , 55 1 , 83 1 \) corresponding portions 35 kda , 55 kda , 83 kda proteins asexual blood stages plasmodium falciparum polymer peptide incorporating 3 individual peptides \( \) tested candidate malaria vaccine antigens monkeys immunized combinations 3 peptides 2 separate sources \( centers disease control cdc , atlanta , ga \) synthetic polymer animals immunized combination 3 peptides cdc higher antibody titers 35 1 55 1 peptides 83 1 peptide monkeys immunized combination 3 peptides produced developed higher levels antibody 55 1 83 1 35 1 peptides animals immunized polymer produced detectable antibodies 55 1 peptide alone following challenge p falciparum , differences observed 3 vaccine groups 2 control groups respect number animals greater equal 10 serologic response 3 peptides animals contrasted previous trials performed monkeys developed high antibody titers 3 peptides protected experimental infection
investigations onchocerciasis efficiency ultrasonography \( us \) diagnosis clinical characterization onchocerciasis evaluated us performed 120 probands ninety two patients generalized onchocerciasis , 21 patients suffered chronic form onchocerciasis \( \) , 7 probands served controls patients examined us linear \( 7 5 mhz 5 mhz \) sector \( 3 5 mhz \) us results evaluated examination nodules us structure nodules revealed typical pattern consisting homogeneous small particles lateral acoustic , differentiation lymph nodes , lipoma , achieved within , calcifications fluid identified regarding estimation burden , important note 24 patients , additional nodules previously found us also , number centers palpable nodules determined us palpation 4 16 patients , impalpable nodules found us 13 patients positive microfilaria counts , nodules could detected highly characteristic pattern may serve basis us investigations onchocerciasis
quantitative vitro drug potency drug susceptibility evaluation leishmania patients unresponsive antimony therapy quantitative vitro drug sensitivity 32 leishmania isolates \( 16 patients failing antimony therapy \) determined using \( \) 30 isolates histories , 22 \( 73 \) tests agreed patient history remaining 8 \( 27 \) difference drug sensitivity clinical correlation 15 isolates tested blindly 15 known clinical history \( 4 agree clinical history \) test sensitivity appeared limited sensitivity leishmania could detected 2 micrograms ml \( 10 serum drug level \) isolate patient untreated self healing cutaneous disease drug resistant using , parasite drug sensitivity quantified apart patient physiologic immunologic variables intrinsic clinical data potency differed maximum 100 \( weight weight \) among drug also potency changes drug based content test test variability offers rapid method evaluating drug sensitivity patient isolates determining activity candidate anti prior initiation therapy
parasite antigenemia untreated treated lymphatic filarial infections evaluate merit antigen detection assays tool monitor efficacy chemotherapy lymphatic filariasis , serially measured antigen levels sera infected humans filariasis antigenemia detected animals proven infection present occult filariasis antigen levels correlated , progressively declined drug cured animals treatment diethylcarbamazine \( dec \) triggered transient increase serum levels filarial antigens bearing epitope recognized monoclonal antibody hc 11 patients filariasis became within one week dec treatment antigenemia levels slowly declined period several months one treated individual forty two months treatment , progressively rising antigen levels present 10 patients six remain 4 , elevated antigenemia levels preceded detected time recurrent parasitemia periodic monitoring antigenemia levels treatment patients lymphatic filariasis used identify individuals likely develop recurrent parasites become detectable blood samples , thereby allowing timely
echinococcus infestation biceps brachii case report echinococcus endemic certain parts world found rarely united states extremely unusual case intramuscular infestation involving extremity occurred 41 year old man since infestation closely resembled soft tissue tumor clinical roentgenographic examination , patient treated incisional biopsy mass , consisted cystic cavity filled clear fluid diagnosis echinococcus cyst made permanent section analysis revealed numerous within cyst lining patient asymptomatic six months cyst excision still remains risk recurrence infestation present report serves alert rare potentially fatal condition preoperative diagnosis avoid rupture cyst , releases viable systemic circulation may precipitate anaphylactic reaction
b cell responses paramyosin analysis epitope mapping filarial paramyosin patients onchocerciasis examine fine specificity human immune response filarial paramyosin , antigenicity expressed \( 2 55 kb \) paramyosin detailed elisa using sera patients infected onchocerca volvulus , analyzed entire paramyosin molecule six fragments igg , igg subclasses , ige responses patients guatemala \( 64 positive \) \( 100 positive \) reacted paramyosin specific igg levels normal controls although anti paramyosin subclass restriction common patients , igg3 response significantly greater \( p less 0 001 \) ige anti paramyosin responses showed positive correlations igg2 \( p less 0 001 \) , igg4 \( p less 0 002 \) , igg1 \( p less 0 04 \) responses epitope mapping using igg response six demonstrated preferential recognition amino terminal end molecule \( nucleotides 1 360 \) igg2 reactivity clearly localized amino terminal 120 amino acids , igg4 antibodies recognized amino acids immediately adjacent fragment studies examining fine specificity anti filarial immune reactions provide method understanding parasites either induce host immune responses
visceral leishmaniasis scottish child scottish girl acquired visceral leishmaniasis \( \) presented infection , six months later , scotland disease degree unnecessary investigations carried resulting delay treatment
activated eosinophils increase vascular permeability resistance isolated perfused rat lungs effects eosinophils activated phorbol myristate acetate \( pma \) isolated perfused rat lungs examined eosinophils obtained lungs rats infected canis bronchoalveolar lavage , incubated pma , administered isolated perfused rat lung preparation vascular endothelial permeability assessed measuring capillary filtration coefficient \( kf , c \) perfused lungs lungs receiving either eosinophils \( control \) eosinophils , changes pulmonary hemodynamics kf , c however , lungs receiving 2 x 10 \( 6 \) eosinophils activated pma , transient 4 8 fold increase pulmonary vascular resistance peaked 30 min , primarily due constriction small arteries veins initial pressor response , kf , c increased 7 5 times control 130 min resulted marked lung edema , increased wet dry weight ratios , edema histologic examination pulmonary arterial pressure kf , c responses dose related eosinophil numbers 1 x 10 \( 6 \) 4 x 10 \( 6 \) cells peak airway pressure \( paw \) constant tidal volume ventilation also increased lungs receiving activated eosinophils compared control eosinophil groups findings indicate activated eosinophils potent effector cells cause pulmonary vasoconstriction , bronchoconstriction , vascular endothelial injury without widespread capillaries aggregated eosinophils
cisplatin fluorouracil interaction squamous cell carcinoma xenograft patients squamous cell carcinoma head neck treated cisplatin fluorouracil according schedule based findings clinical studies similar schedule showed additive effect treatment human squamous cell carcinoma head neck sought ascertain whether schedule optimal single intraperitoneal injection cisplatin \( 7 5 mg kg \) combined three injections fluorouracil given 24 hour period \( total dose , 150 80 mg kg \) , , cisplatin administration combined effect cisplatin fluorouracil tumor growth toxic effects schedule dependent consideration toxic effects tumor growth inhibition , assessed reduction area growth curve , optimal administration interval found fluorouracil given 3 days cisplatin administration
hla class class ii antigen expression squamous cell carcinoma head neck compared human major histocompatibility \( hla \) class class ii antigen expression squamous cell carcinoma head neck normal mucosa frozen sections consecutive series 30 squamous cell carcinomas stained monoclonal antibodies 32 \( class \) anti dr \( class ii \) using immunoperoxidase technique normal mucosa showed class class ii expression basal layers class expression tumors diffuse 87 , patchy 10 , scattered 3 class ii expression tumors diffuse 20 , patchy 53 , scattered 20 , absent 7 patterns expression correlate significantly clinical parameters , including survival , except class ii diffuse patchy patterns found correlate poorly differentiated tumors
computed tomography metastatic cervical lymph nodes clinical , computed tomographic , pathologic correlative study retrospective comparative study 63 neck dissections undertaken evaluate accuracy high resolution computed tomography \( ct \) detection nodal metastases , previous studies indicated trend toward superiority ct scanning palpation respective values neck examination , ct scanning , histopathologic examination assessed 51 patients head neck cancer underwent total 63 neck dissections overall agreement clinical examination findings histopathologic findings 92 vs 81 ct scanning retrospective analysis ct findings failed reveal greater accuracy found nodes measuring 10 mm central low density always malignant ct scanning seems offer little advantage palpation neck , regarded essential tool staging nodal disease radiation therapy , neck dissection performed clinical radiologic suspicion , ct scanning importance
invasive migration epidemic kaposi 's sarcoma cells vitro kaposi 's sarcoma \( ks \) low grade malignant neoplasm shows invasive growth often occurs immunosuppressed patients acquired immune deficiency syndrome \( aids epidemic ks \) also found elderly men usually limited skin \( classic ks \) present study investigated chemotaxis invasive migration epidemic ks cells vitro compared cells grown classic ks lesions fibroblasts epidemic ks cells demonstrated invasive migration reconstituted basement membrane \( matrigel \) well interstitial connective tissue \( collagen \) early passages , whereas fibroblasts either barrier epidemic ks cells late passages show invasive migration following pretreatment tumour necrosis factor alpha \( tnf alpha \) enhanced migration matrigel collagen epidemic ks cells , whereas classic ks cells showed increased migration type collagen barrier
distinct characteristics lymphokine activated killer \( lak \) cells derived patients b cell chronic lymphocytic leukemia \( b cll \) factor b cll serum promotes natural killer cell like lak cell growth show lymphokine activated killer \( lak \) cell precursors derived patients b cell chronic lymphocytic leukemia \( b cll \) cultured presence recombinant interleukin 2 normal human serum \( nhs \) , develop primarily nk cell like \( cd 57 \) lak cells , whereas prepared lak cell precursors normal subjects develop mainly cell like \( cd 3 , cd 8 \) lak cells b cll lak cells exhibited greater proliferative capacity normal lak cells normal lak cells grown b cll serum instead nhs , proliferation increased nk cell levels also increased found b cll lak cells , suggesting b cll serum contains factor promotes nk cell like growth , lak cells derived normal b cll patients demonstrated similar lytic activity toward k562 cells growth b cll serum reduce lytic potential thus , altered phenotype growth exhibited b cll lak cells normal lak cells grown b cll serum lead abnormalities cytolytic functions propose instead predominance nk like cells b cll lak cell populations presence nk cell like growth factor b cll serum reflect abnormalities related nk cell mediated b cell regulation ie , either inhibition normal b cell growth growth stimulation leukemic clone b cll
genotypic characterization centrocytic lymphoma frequent rearrangement chromosome 11 bcl 1 locus centrocytic lymphomas defined classification b cell lymphomas composed exclusively cells resembling cleaved follicular center cells \( fcc \) lymphomas shown histologically , , clinically distinct cleaved fcc lymphomas dna 18 centrocytic lymphomas \( 14 patients \) analyzed using southern blotting probes immunoglobulin heavy \( \) kappa light chain \( jk \) joining gene , cell receptor beta chain constant gene \( cb \) , bcl 1 , bcl 2 , c myc gene rearrangements lymphomas jk rearrangements , confirming b cell origin none specimens detectable cb , bcl 2 , c myc rearrangements however , 4 14 patients \( 28 6 \) rearrangement chromosome 11 bcl 1 locus therefore , centrocytic lymphomas distinguishable majority small cleaved fcc lymphomas lack demonstrable bcl 2 rearrangements supports distinct nature centrocytic lymphomas suggests lack importance putative oncogene bcl 2 cases furthermore , frequent rearrangement bcl 1 suggests possible role locus pathogenesis least centrocytic lymphomas
pharmacokinetics plasminogen activator inhibitor 1 rabbit pharmacokinetics activated latent forms plasminogen activator inhibitor 1 \( pai 1 \) isolated fibrosarcoma cells \( pai 1 \) form human pai 1 isolated yeast expression system \( rpai 1 \) followed rabbit assessed immunologic assay specific human pai 1 , guanidine activated pai 1 rpai 1 entered total plasma volume following intravenous bolus administration exhibited biphasic clearance pattern t1 pai 1 initial beta phases 6 0 24 8 minutes , respectively t1 rpai 1 initial beta phases 8 8 34 0 minutes , respectively similar results obtained measuring pai 1 activity plasma trace amounts 125i rpai 1 , suggesting pharmacokinetic behavior could also apply endogenous pai 1 liver main site rpai 1 clearance , latent pai 1 exhibited different pharmacokinetic profile 80 latent rpai 1 cleared circulation within 10 minutes \( t1 2 1 7 minutes \) difference clearance behavior activated latent pai 1 may related ability activated pai 1 , latent pai 1 , rapidly form high molecular weight complexes plasma binding factors observed vitro vivo pai 1 could potentially tilt fibrinolytic balance toward state , rapid clearance may represent important control mechanism governing circulating levels key component fibrinolytic pathway
cancer mortality higher income black population new york state comparison rates united states whole 1980 census median family income among blacks suffolk county , new york \( e , 19 , \) much higher american blacks whole \( e , 12 , \) 94 1 american whites \( e , 20 , \) , proportion poverty level still higher suffolk county blacks american whites observed numbers deaths 1979 1985 total cancers cancer sites suffolk county black men women lower expected basis age specific gender specific death rates blacks us although numbers deaths cervical cancer prostate cancer slightly lower expected suffolk county blacks versus american blacks , numbers still significantly greater expected basis death rates among american whites age specific death rates age groups 25 44 years 55 64 years tended lower suffolk county lung cancers black men breast cancer black women specific cancer sites , differ direction association incidence socioeconomic status , age , gender must considered comparisons cancer mortality race socioeconomic level implications comparisons discussed regard goal reducing racial differences cancer death rates
immunocytochemical estrogen progestin receptor assays breast cancer monoclonal antibodies histopathologic , demographic , biochemical correlations relationship endocrine response survival breast cancer specimens 600 women assayed estrogen receptors \( er \) using immunocytochemical assay \( ica \) employing monoclonal antibody sp gamma results showed significant correlation biochemical er determinations well tumor grade menopausal status 449 cases , results progesterone receptor assay ica using monoclonal anti pgr antibody kd 68 , also correlated significantly biochemical pgr measurements positivity significantly frequent postmenopausal white women colloid carcinomas likely positive positive whereas medullary carcinomas often negative 47 patients advanced mammary carcinoma , results closely related endocrine response er pgr dextran coated charcoal assay \( dcc \) 339 women stage stage ii breast cancer , significantly associated disease free survival analysis cox 's proportional hazard model , however , showed best predictor survival disease free survival 197 women stages disease data indicate ica predictive prognosis biochemical er pgr ease ica performance coupled results indicate method acceptable substitute dcc analyzing breast cancers er pgr
teniposide \( vm 26 \) continuous infusion cytosine arabinoside initial induction failure childhood acute lymphoblastic leukemia pediatric oncology group pilot study twenty six evaluable children newly diagnosed acute lymphoblastic leukemia \( \) failed achieve initial remission receiving two seven drugs least 4 week period given teniposide \( vm 26 \) continuous infusion cytosine arabinoside \( ara c \) twenty two received 150 mg m2 vm 26 days 1 2 100 mg 2 ara c continuous infusion days 1 5 second shortened course given day 14 eight patients evidence effect clinically judged able tolerate second course last four patients received three daily doses vm 26 7 day infusion ara c daily dosages twelve \( 48 \) achieved complete remission \( cr \) trend toward decreasing response rates increasing number drugs used initial induction regimen , e , five cr among seven patients prior two drug induction attempt , six cr among 14 patients prior three four drug induction attempt , one cr among four patients prior five seven drug induction attempt \( p 0 14 \) ten 17 non cell patients two nine cell patients achieved remission \( p 0 10 \) median time required achieve complete remission initiation treatment 26 days \( range , 14 72 days \) period shorter required one course compared required two induction courses , e , 25 days median vs 44 days median toxicity significant due mainly marrow aplasia infection one patient severe prolonged vm 26 induced hypotension 12 patients entering remission , two removed marrow transplant one removed due parental request remaining nine patients , median remission duration 2 months \( range , 1 18 months \) nine patients relapsed marrow among entire group 26 patients , one patient alive long term event free survivor \( allogeneic marrow transplant \) due current use aggressive initial induction regimens extremely poor prognosis children fail achieve initial remission , intensive regimens continuation therapy alternative therapies , bone marrow transplant , considered
association disease free survival percent ideal dose adjuvant breast chemotherapy relationship percent ideal dose disease free survival examined 256 stage ii iii patients participated 2 year breast adjuvant chemotherapy trial consisting cyclophosphamide , methotrexate , 5 fluorouracil \( cmf \) given postoperatively analyzed previous work , results confirmed dose response relationship , appeared improved disease free survival patients receiving higher doses adjuvant chemotherapy major analysis bias bias addressed considering patients still receiving therapy 6 , 12 , 24 months , dose response relationship longer seen although cannot inferred , apparent differences disease free survival among dose groups attributed recurrences first 2 years among patients receiving lower doses chemotherapy
doxorubicin unresectable hepatocellular carcinoma prospective study addition verapamil prospective study conducted assess safety efficacy addition oral verapamil intravenous adriamycin \( doxorubicin \) management patients unresectable hepatocellular carcinoma \( hcc \) 28 patients studied histologically verified disease , cirrhosis present 20 21 patients adequate tissue sampling overall median survival 57 days chemotherapy terminated seven patients one course treatment partial response complete response noted four patients \( 19 \) one patient \( 4 8 \) , respectively , among 21 patients evaluated side effects related chemotherapy present patients studied death fulminating sepsis occurred three 13 patients leukopenia symptomatic myocardial dysfunction developed one patient addition verapamil apparently potentiate effect systemic adriamycin hcc probably increase complications
phase trial cisplatin hypertonic saline escalating doses 5 fluorouracil continuous intravenous infusion patients advanced malignancies thirty four patients incurable solid tumors treated phase trial fixed dose high dose cisplatin \( cddp \) administered hypertonic saline escalating doses 5 fluorouracil \( 5 fu \) five treatment levels 5 fu , ranging 500 900 mg m2 day 5 days , studied leukopenia , thrombocytopenia , oral mucositis dose limiting toxicities encountered nephrotoxicity minimal peripheral neuropathies rare mild patient group , patients received small number treatment cycles diarrhea dose limiting two complete responses \( one non small cell lung cancer one sweat gland carcinoma \) observed major responses noted dose cddp set 35 mg m2 day 5 consecutive days , maximum tolerated dose \( mtd \) concurrent 5 day 5 fu infusion found 900 mg m2 day recommended dosages phase ii trials 35 mg m2 day cddp 800 mg m2 day 5 fu 5 consecutive days cancers lung , breast , gastrointestinal tract , genitourinary tract would reasonable targets phase ii studies
treatment advanced squamous cell carcinoma skin cisplatin , 5 fluorouracil , bleomycin authors treated 14 patients advanced squamous cell carcinoma \( scc \) skin lip one four cycles combination chemotherapy consisting cisplatin bolus injection , 5 fluorouracil \( 5 fu \) bleomycin continuous 5 day infusion objective responses seen 11 13 evaluable patients \( 84 \) four patients complete remission \( 30 \) seven patients , partial remission \( 54 \) local control definitive complementary radiation surgical treatment achieved seven patients toxic side effects acceptable consisted nausea vomiting patients , transient skin changes , hematologic \( grade 3 4 \) abnormalities four patients , pulmonary fibrosis one elderly patient results show chemotherapy combination could play role reducing tumor mass facilitating definitive treatment obtain better functional cosmetic results advanced scc skin
effect intraarterial versus intravenous cisplatin addition systemic doxorubicin , high dose methotrexate , ifosfamide histologic tumor response osteosarcoma \( study 86 \) osteosarcoma , intraarterial \( ia \) administration systemic treatment advocated improve local tumor response , even , definitive surgery data literature unequivocally support local superiority ia infusion , comparative study started 1986 preoperative chemotherapy consisted 45 mg m2 doxorubicin days 1 2 12 g m2 high dose methotrexate days 15 22 3 g m2 ifosfamide days 29 , 30 , 50 , 51 followed days 31 52 intravenous \( iv \) versus ia tourniquet infusion cisplatin \( ddp \) strict randomization patients feasible balanced distribution risk factors appropriate patients centrally infusion time prolonged 1 5 hours iv group , ddp dose reduced 150 120 mg m2 arms became apparent multivariate analysis performed exclude bias response rates risk factor distribution modifications ddp infusion time dosage overall fraction histologic good responders \( greater 90 necrosis \) found different ia versus iv treatment \( 34 50 68 vs 41 59 69 \) intraarterial instead iv use ddp within aggressive systemic treatment seem improve local tumor response
long term follow 24 patients undergoing radical resection ampullary carcinoma , 1953 1988 potentially curative radical pancreaticoduodenectomy ampullary adenocarcinoma performed 24 patients 35 year period overall operative mortality 12 5 actuarial survival rate 5 years 61 13 4 standard error mean \( sem \) subsequently remained unchanged time period , 21 patients underwent potentially curative radical pancreaticoduodenectomy tumors pancreatic origin similar analysis showed overall operative mortality 23 8 survival rate 5 years 27 12 5 sem results radical pancreaticoduodenectomy ampullary carcinoma recent years \( 1976 1988 \) compared former years \( 1953 1975 \) statistically significant differences 5 year survival rate however , operative mortality decreased 25 former period 6 3 recent period survival dependent nodal status 5 year survival rate 78 11 5 sem absence nodal metastasis versus 50 25 sem presence regional nodal metastasis findings support concept radical pancreaticoduodenectomy offers realistic probability cure selected group patients carcinomas ampulla
expression ki 1 antigen \( cd30 \) mesenchymal tumors expression cd30 \( ki 1 \) antigen long considered restricted activated lymphocytes related tumors however , expression antigen also detected embryonal carcinomas , carcinomas , malignant melanomas , even myeloid cell lines macrophages late stages differentiation study , using monoclonal antibody ki 1 , expression cd30 antigen immunohistochemically examined frozen sections 28 benign 63 malignant mesenchymal tumors authors found cd30 expressed two four , seven 11 , one six rhabdomyosarcomas , two two aggressive , one three , two four synovial sarcomas , one giant cell tumors tendon sheaths , five malignant fibrous , three , one three ewing 's sarcomas , tumor cell subpopulation two ten malignant , schwann cell compartment one two tested furthermore , cd30 consistently expressed myoepithelial compartment 13 fibroadenomas however , five , seven , three neuroblastomas , , , tumors origin tested consistently cd30 negative findings indicate , outside lymphatic system , cd30 antigen restricted epithelial neoplasms may also present tumors mesenchymal origin authors conclude cd30 antigen , although limited utility differential diagnosis tumors questionable , may eventually define relevant subgroups within main tumor categories
classical b cell chronic lymphocytic leukemia correlation normal cellular counterpart clinical findings study evaluates expression series membrane antigens , normally expressed b lymphocytes lymphocytic marginal zone , 90 selected cases classical \( mouse red blood cell receptor , cd20 , cd5 , surface immunoglobulin \) b chronic lymphocytic leukemia \( b cll \) aim contributing toward identifying normal counterpart b cll correlations surface antigen pattern certain clinical characteristics clustered \( cd23 , 25 , 39 , 40 , 27 , 1c , \) \( , 7f7 , kib3 \) monoclonal antibodies \( moab \) tested almost cases showed high reactivity cd23 , 27 , , 39 , 40 , expression low 7f7 , kib3 , cd25 variable reactivity 7f7 kib3 strictly correlated , correlated individually cd25 results show frequent b cll phenotype \( , 5 , 23 , 27 , 39 , , kib3 , 7f7 , cd25 \) corresponds one cellular subsets zone correlation found moab expression , surface immunoglobulin \( \) class type , clinical stage , disease activity , age diagnosis difference \( statistically borderline \) expression 7f7 kib3 \( young versus old patients \) suggests expression surface antigens affect clinical behavior disease
prognostic implication 5' nucleotidase activity acute lymphoblastic leukemia 5' nucleotidase \( 5' n \) activity determined 191 patients \( 71 children 120 adults \) acute leukemia elevated values 5' n registered common acute lymphoblastic leukemia \( \) , blast cells cell \( \) common antigen negative non low enzyme activity comparable values acute non lymphocytic leukemia dependence remission duration 5' n activity analyzed 74 adults , treated similarly prospective multicenter trial remission curves patients 5' n activity lower 10 nmol h x 10 \( 6 \) cells substantially significantly better patients high activity \( greater 10 nmol h x 10 \( 6 \) cells \) difference also evident immunologic subclass common statistical evaluation showed interaction immunologic subtype blast cells 5' n activity prognostic significance remission duration addition independent factor , initial age , interaction also prognostic survival
lewis system alterations gastric carcinogenesis alterations expression type 1 blood group related antigens \( lewis b \) examined immunohistochemically 371 gastric biopsy 80 surgical specimens patients gastric carcinoma abh lewis phenotype status patients correlated histologic findings anomalous expression lewis antigen found 88 249 gastric biopsy specimens lewis \( b \) phenotype patients prevalence anomaly increased evolution premalignant process , agreement commonly accepted model gastric carcinogenesis thus , anomalous lewis antigen appeared 66 6 gastric dysplasia cases , 64 6 intestinal metaplasia , 15 4 atrophic gastritis , 7 4 superficial gastritis alterations found subjects normal gastric mucosa forty seven 49 lewis \( b \) phenotype gastric carcinoma patients showed antigenic alterations tumor cells \( anomalous lewis antigen 36 loss lewis antigens 11 \) 26 gastric specimens anomalous lewis antigen present areas intestinal metaplasia dysplasia away area neoplastic transformation expression lewis antigen lewis \( b \) phenotype patients frequent phenomenon gastric neoplastic cells could result blocked synthesis lewis b antigen accumulation precursors findings suggest , gastric carcinogenesis , antigenic alterations may precede neoplastic transformation anomalous lewis antigen could constitute significant index severity histologic lesion contribute identifying high risk individuals
comparison dna content gastric cancer cells primary lesions lymph node metastases dna contents tumor cells primary lesions corresponding metastatic lymph nodes compared 61 cases gastric cancer determine whether dna content remains stable lymph node metastasis dna distribution patterns grouped three types , according proportion aneuploid cell population changes dna patterns primary metastatic lesions evident 36 61 patients \( 59 0 \) remaining 25 \( 41 0 \) , dna distribution patterns noted lesions 33 36 , dna pattern primary carcinoma transformed scattered one metastatic lesion lymph node mean values frequency cells tetraploid \( \) \( \) significantly higher primary lesion compared findings metastatic lesions reduction dna content metastatic lesions frequent occurrence differentiated \( 18 23 \) undifferentiated adenocarcinoma \( 15 35 \) \( p less 0 01 \) therefore , primary lesions widely scattered dna ploidy , tumor cells smaller dna ploidy frequently metastasized lymph nodes , particularly cases differentiated carcinoma observations may pertinent future designing treatment protocols
mucinous adenocarcinoma submandibular gland rare tumor easily among published histologic categories salivary gland tumors reported neoplasm developed within submandibular gland 78 year old woman invasion mandible metastasis regional lymph nodes histopathologically , cells possessing clear cytoplasm displaced round nuclei proliferated exhibited adenomatous pattern many cystic spaces tumor cell seen , mucus substance filled cystic spaces , tumor cells seemed mucus secreting , neither epidermoid cells papillary appearance could observed , numerous mucous droplets low electron density prominent cytoplasm , tumor cells sparse irregular microvilli luminal surface mucin histochemistry , including paradoxical concanavalin staining , revealed tumor cells contained neutral acid mucins , identified class ii iii neoplastic lesion , except recurrent metastatic neck nodes , detected 6 years first examination , seems tumor rare primary mucinous adenocarcinoma submandibular gland
use flow cytometry prognosis stage ii adjuvant treated breast cancer patients characterization breast cancer cells histology , flow cytometry , steroid receptors performed 197 stage ii breast node positive cancer patients given adjuvant chemotherapy , plus tamoxifen patients positive hormone receptors histologic steroid receptor assays performed using standard techniques flow cytometric analysis performed paraffin embedded blocks obtained primary tumor quality control studies reproducibility , tissue heterogeneity , analysis procedures included 197 patients studied , aneuploidy found 102 \( 52 \) median value 8 range 0 4 38 results demonstrated number positive nodes , receptor status , grade prognostic value cell cycle kinetic data independent prognostic value series however , ploidy could differentiate prognosis receptor negative subgroup patients receptor negative tumors significantly better overall survival tumor diploid nature cell kinetics significantly prognostic either receptor subgroup , although patients higher tended better relapse free overall survival disagreement studies may demonstrate treatment results diminished ability flow cytometry data help predict outcome
comparison conventional method lymph node staging comprehensive fat clearing method gastric adenocarcinoma discrepant results long term survival united states japanese patients resectable gastric adenocarcinoma may result accurate staging japanese series authors compared comprehensive fat clearing method conventional pathology method lymph node sampling 11 patients undergoing curative gastrectomy extended lymphadenectomy institution comprehensive fat clearing doubled total lymph node counts \( p less 0 01 \) , identified smaller lymph nodes \( p less 0 001 \) , identified histologically involved nodes significantly smaller size \( p less 0 001 \) comprehensive fat clearing pathologically 29 authors' eligible specimens accurate pathologic staging necessary comparing japanese united states survival data resectable gastric adenocarcinomas
neuropeptide neuron specific enolase levels benign malignant pheochromocytomas neuron specific enolase \( nse \) isoform enolase , enzyme found neuroendocrine system neuropeptide \( npy \) peptide recently discovered peripheral central nervous systems serum nse plasma npy levels reported increased patients pheochromocytoma authors evaluated whether measurement molecules could help discriminate benign malignant forms pheochromocytoma nse levels normal patients benign pheochromocytoma \( n 13 \) elevated one half malignant pheochromocytoma \( n 13 \) plasma npy levels average significantly higher malignant \( 177 1 38 9 pmol l , n 16 \) benign forms disease \( 15 7 pmol l , n 24 \) however , difference percentage patients elevated npy levels results show determination serum nse may useful distinguishing malignant benign pheochromocytoma measurement plasma npy useful differentiating two kinds tumors
newly established human osteosarcoma cell line osteoblastic properties human osteosarcoma cell line , , established tumor athymic nude mice antiserum nude mouse spleen cells added early passage cultures eliminate host fibroblastic cells cell line retained high activity liver bone kidney type alkaline phosphatase \( alp \) secreted osteocalcin , e , bone gamma acid containing protein \( bgp \) , medium addition 1 , 25 dihydroxyvitamin d3 \( 1 , 25 \( oh \) 2d3 \) increased alp activity well level bgp secreted medium alp 1 , 25 \( oh \) 2d3 treated cells inhibition characteristics heat amino acids untreated cells synthetic human parathyroid hormone stimulated production intracellular adenosine 3' , 5' cyclic monophosphate \( camp \) approximately 100 fold within five minutes however , stimulation observed synthetic human cells transplanted back nude mouse , tumor abundant osteoid formation mineralization produced results indicate cell line expresses well differentiated osteoblastic phenotypes first established human cell line produce bgp , provides useful model studies regulatory mechanisms bgp production
glomus tumor trachea variant glomus tumor trachea occurred 47 year old woman experienced intermittent cough hemoptysis three years bronchoscopy chest ct scan showed small reddish polypoid tumor lower end trachea biopsy carefully done diagnosed wedge resection tumor done tumor cells characterized strongly eosinophilic granular cytoplasm light microscopy numerous closely packed round mitochondria prominent tubular electron microscopy arranged sheet around small vessels , result biopsy diagnosis changed glomus tumor knowledge , first report glomus tumor arising trachea
endobronchial granular cell granular cell \( \) rare benign neoplasm involving tracheobronchial tree believed arise schwann cell four cases tracheobronchial , , presented conservative therapeutic approach suggested
lymph nodes vitro vivo evaluation one hundred thirteen patients carcinoma rectum evaluated lymph node metastases ultrasound use 7 5 mhz based different echo patterns , two main groups lymph nodes differentiated hypoechoic hyperechoic lymph nodes compared pathologic findings , hypoechoic lymph nodes represent metastases , whereas hyperechoic lymph nodes visualized due inflammation lymph node metastases predicted sensitivity 72 percent inflammatory lymph nodes specificity 83 percent physical basis differentiation lymph nodes assessed vitro determination ultrasound parameters \( speed sound , acoustic impedance , attenuation , amplitude \) attenuation coefficient benign lymph nodes 2 5 db \( mhz x cm \) significantly higher mean value lymph node metastases 1 3 db \( mhz x cm \) results demonstrate involved nodes principally differentiated involved nodes micrometastases , mixed lymph nodes , changing echo patterns within inflammatory nodes explain accuracy rate 78 percent
characterization significance sulfonylurea receptors study describes characterizes putative sulfonylurea receptor radioligand used 3h glipizide \( 9 ci mmol \) beta cell plasma membranes derived transplantable rat insulinoma generated subcutaneous injection cells purified ultracentrifugation 15 55 sucrose gradient specific binding 3h glipizide purified beta cell plasma membranes determined maximal temperatures 4 23 degrees c , ph 7 3 , incubation 2 h scatchard analysis indicated single binding site kd 7 nm sulfonylurea binding 0 93 pmol mg membrane protein displacement 3h glipizide purified beta cell plasma membranes various sulfonylureas analogues correlated well known hypoglycemic insulin releasing activities various agents , including nutrients , agents affecting ca2 flux , gastrointestinal hormones , pancreatic hormones , effect 3h glipizide binding beta cell plasma membranes putative sulfonylurea receptors beta cell brain cell plasma membranes reported several groups investigators sulfonylurea binding beta cell hypothesized close atp sensitive k channel , leads depolarization membrane activation voltage dependent ca2 channel
effect metoclopramide ovarian responsiveness gonadotropin administration patients severe polycystic ovarian syndrome six patients poor ovarian response pretreatment gonadotropin releasing hormone analog exhibited improved ovarian responsiveness metoclopramide added days 3 , 5 , 7 cycle evidenced higher number leading follicles \( 4 4 versus 0 6 \) , higher mean maximal serum 17 beta estradiol levels \( 560 versus 178 pg ml \) , shorter duration treatment \( 7 versus 11 days \) , fewer used \( 20 versus 37 cycle \) metoclopramide treated cycles compared control cycles , respectively serum prolactin levels reached maximum 172 ng ml within 1 hour metoclopramide administration declined normal range within 6 hours results suggest intermittent increased prolactin secretion may augment ovarian response gonadotropins
aromatase activity human granulosa cells patients polycystic ovaries treated dexamethasone effect dexamethasone \( dex \) \( 9 alpha 16 alpha methyl prednisolone \) secretion steroids human granulosa luteinized cells studied culturing cells mature follicles women polycystic ovarian disease treated infertility vitro fertilization program patients treated dex 0 5 mg day human chorionic gonadotropin administration cells cultured 24 hours presence \( 10 \( 7 \) \) incubating 24 hours , medium replaced cells incubated additional 24 hours medium harvested assayed estradiol \( e2 \) progesterone \( p \) results compared control group treated dex estradiol production cells significantly lower study group treated dex progesterone production influenced dex follicular fluid levels , e2 , androgens vary dex treatment , whereas cortisol levels markedly decreased p levels increased treatment findings suggest directly influence granulosa luteinized cell function
endoscopic ultrasonography evaluation smooth muscle tumors upper gastrointestinal tract experience 42 cases surgery , 12 patients suspected leiomyoma 12 patients suspected leiomyosarcoma studied endoscopic ultrasonography \( eus \) , computed tomography \( ct \) , endoscopy , barium results correlated surgery histology ten , one benign gastric ulcer , one carcinoid metastasis , eight , two , one mucus secreting adenocarcinoma , one bronchial carcinoma diagnosed eighteen additional patients suspected benign submucosal lesions endoscopy barium meal treated non surgically , studied eus ct eus superior imaging techniques detection , staging , follow submucosal smooth muscle tumors clear imaging intramural abnormality adjacent lymph nodes
growth group human liver cell line recent observations children rotavirus infant mice given rotavirus vaccine oral administration suggest well known gastrointestinal pathogen may infect liver examine possibility , susceptibility hep g2 cells infection variety rotavirus strains tested cells used considered well differentiated exhibit many liver specific functions hep g2 cells supported growth simian strain rhesus rotavirus \( \) , strain currently used vaccine , support growth human strain \( , , price \) rhesus rotavirus infection cytopathic resulted release lactate dehydrogenase rhesus rotavirus growth hep g2 cells displayed trypsin enhanced infectivity inhibited pretreatment cells clostridium hep g2 cells also permissive another simian strain \( \) , bovine strain \( uk \) single gene substitution containing \( major outer neutralization protein \) human rotavirus strain remaining 10 genes either rhesus rotavirus uk general , uk produced lower levels antigen rhesus rotavirus hep g2 cells hepatic cell lines may prove useful tools explore potential wild type candidate vaccine strains
hbv dna sequences tumor nontumor tissue patient variant hepatocellular carcinoma one patient variant hepatocellular carcinoma found seropositive hbsag anti dna tumor nontumor areas liver examined molecular hybridization hepatitis b virus dna sequences dna tumor gave high molecular weight smear , restriction enzyme analysis indicated single instance integration nontumor liver tissue analyzed three separate areas hepatitis b virus dna detected two restriction enzyme digestion suggested contained different sites viral integration typical hepatitis b virus related hepatocellular carcinoma , analysis hepatitis b virus dna liver yielded different pattern high molecular weight bands , indicating virus genome integrated different chromosomal locations seen tumor finding integrated hepatitis b virus dna , especially also liver , would consistent oncogenic role hepatitis b virus certain instances tumors typical hepatitis b virus related hepatocellular carcinoma
prognostic factors hepatocellular carcinoma west multivariate analysis 206 patients investigate prognostic factors western patients hepatocellular carcinoma , 206 patients confirmed diagnoses hepatocellular carcinoma studied terms survival patients diagnosed 1983 1987 multivariate survival analysis \( cox regression model \) using clinical , biochemical , pathological data obtained diagnosis disclosed bilirubin \( p 0 0001 \) , ascites \( p 0 0001 \) , toxic syndrome \( defined presence weight loss greater 10 premorbid weight , anorexia \) \( p 0 009 \) , blood urea nitrogen \( p 0 025 \) , tumor size \( p 0 001 \) , gamma \( p 0 0006 \) , age \( p 0 0005 \) , serum sodium \( p 0 003 \) presence metastases \( p 0 002 \) independent predictors survival according contribution factors final model , prognostic index constructed allowing division patients different groups according relative risk death \( age x 0 03 ascites x 0 bun x 0 serum sodium x \( 0 \) gamma x 0 bilirubin x 0 tumor size x 0 33 toxic syndrome x 0 metastases x 0 55 \) results facilitate stratification hepatocellular carcinoma patients design evaluate future controlled trials
left ventricular echocardiographic diagnosis successful surgical excision three cases management three patients left ventricular outlined asymptomatic children routine chest radiography suggested cardiac masses mode two dimensional echocardiography valuable adjuncts conventional angiography assessing children electrocardiographic changes , present cases , shown regress postoperatively stress importance noninvasive aids initial investigation outline operative methods reconstruction
upper gastrointestinal pathology familial adenomatous polyposis results prospective study 102 patients multiple gastric duodenal biopsy specimens 102 asymptomatic patients familial adenomatous polyposis , taken prospective endoscopic screening programme examined one hundred patients microscopic gastroduodenal pathology , often absence macroscopic lesions adenomas found 94 patients duodenum , second third parts hyperplasia villous crypt epithelium also seen , sometimes absence adenomas may precursor neoplastic change stomach fundic gland polyps commonest abnormality , seen microscopically 44 patients chronic antral gastritis common patients without fundic polyps gastric adenomas present six patients , also duodenal adenomas duodenal adenomas familial adenomatous polyposis similar malignant potential colorectum sequential endoscopy biopsy necessary detect cancer patients
activation inducer subset phenotype lymphocytic infiltrate around derived tumors situ analysis mononuclear cell infiltrate found association range benign , premalignant , malignant epidermal tumors described predominant cell phenotype recently described immunoregulatory helper inducer lymphocyte large number lymphocytes expressed antigens associated cellular activation , suggesting ongoing immunologic response host tumor , although evidence situ proliferation cells lacking findings suggest infiltrate found association cutaneous tumors represent passive accumulation lymphocytes circulation rather active antitumor response
benign studied eight cases acquired lymphatic endothelial lesion propose name benign lesions developed solitary , slowly extending , erythematous plaques , usually occurring extremities adolescents adults characteristic histopathologic feature permeation dermal collagen flattened , endothelium lined channels spaces hemorrhage , iron deposition , inflammation part lesion ulex europaeus agglutinin labeled lesional endothelial cells consistently , factor viii related antigen labeling negative histologic pattern special studies suggested lymphatic lesion surgical excision , performed six patients , followed recurrence
cutaneous surgery pregnant patient cutaneous surgery 34 pregnant women described main indication surgery diagnosis treatment malignancy surgery period \( 15 56 days \) avoided possible patients positioned left side procedure avoid supine hypotensive syndrome monitoring fetal desirable local anesthetics , penicillin , erythromycin safe used carefully acetaminophen analgesic choice exposure sun avoided perioperative period
comparison methods surgical margins surgical margins cutaneous neoplasm evaluated various combinations three major types sections vertical \( perpendicular \) , horizontal \( parallel \) , oblique \( mohs method \) vertical sections may run tumor \( method \) , longitudinally tumor \( cross method \) , peripheral tumor peripheral \( perimeter \) sectioning methods methods evaluate almost 100 margin , disadvantage showing relationship tumor margin , seen clearly vertical transverse sections seven methods surgical margins compared contrasted none judged perfect best
years potential life lost another indicator impact cutaneous malignant melanoma society years potential life lost \( ypll \) indicator premature mortality complements traditional incidence mortality rates facilitates comparisons among different cancers calculated ypll cutaneous melanoma 11 cancers routinely recorded surveillance , epidemiology end results \( \) ypll cutaneous melanoma ranked eighth persons younger 65 years age fourth 20 49 years age average 17 1 ypll per death due melanoma , one highest rates adult onset cancers results study , first apply ypll cutaneous melanoma , emphasize disproportionate impact cancer young middle aged adults importance cancer public health priority
trends basal cell carcinoma , squamous cell carcinoma , melanoma skin 1973 1987 major increases occurred incidence basal cell carcinoma squamous cell carcinoma skin , well cutaneous malignant melanoma period 1973 1987 british columbia greatest increases basal squamous cell carcinomas head neck indicates exposure sunlight major causative factor greatest increase melanoma trunk men lower limbs women dramatic increases nonmelanoma skin cancers british columbia , relatively low sunlight area , suggest major prevention programs needed areas considered
effect gastric mucus uptake carcinogen gastric mucosal dna prostaglandin e2 \( pge2 \) , , indomethacin administered rats , incorporation n methyl 3h n \( methyl 3h \) gastric mucosal dna measured quantitatively liquid counting intragastric instillation methyl 3h amount incorporation 25 4 5 9 pmol mg dna control rats , 11 7 3 8 pmol mg dna pge2 administered rats , 6 2 5 6 pmol mg dna administered rats , 42 9 14 4 pmol mg dna indomethacin administered rats pge2 significantly decreased incorporation compared control group contrast , indomethacin increased incorporation addition , gastric mucosa drug treated rats studied pge2 increased secretion gastric mucus whereas indomethacin decreased possible gastric mucus protective effect agents also carcinogens considered gastric mucus plays important role defense mechanism carcinogenesis
campylobacter pylori interactions gastric cell tissue culture many investigators reported gastric mucosal biopsies patients chronic gastritis peptic ulcer disease show presence campylobacter pylori large majority cases histologic examinations tissues indicate close c pylori gastric surface epithelial cells recent report described adherence cell invasion gastric cells c pylori using transmission electron microscope , examined interaction c pylori , c jejuni , e coli vitro gastric cancer cell line , iii results indicate marked toxicity e coli moderate toxicity c jejuni iii cells c pylori minor effect tissue culture viability c pylori found strong association iii cell membranes evidence occasional cell invasion c jejuni e coli showed attachment association iii cells interpret findings indicating c pylori may specific adhesion gastric cells
rectal carcinoma ct staging water contrast medium computed tomography \( ct \) used study 42 patients rectal carcinoma water used contrast medium studying local extent tumor patients scans read prospectively without knowledge histologic staging compared pathologic specimens ct depicted tumor patients comparison ct histologic results \( following dukes classification \) showed disease correctly staged three four patients , b eight 12 , c 15 17 , nine nine overall , carcinoma correctly staged ct 35 42 patients \( diagnostic accuracy , 83 3 \) accuracy assessment local invasion 97 6 \( 41 42 \) detection lymph node involvement , accuracy 78 6 \( sensitivity , 88 specificity , 64 7 \) ct recommended preoperative staging rectal carcinoma aid choosing appropriate therapy use water enema complete distention rectum reliable techniques improving accuracy ct assessment local invasion cancer
effect somatostatin analogue \( octreotide \) blood flow endocrine tumors metastatic liver angiographic evaluation effect analogue somatostatin , octreotide , tumor blood flow evaluated angiography eight patients hepatic endocrine tumors one patient primary intrahepatic gastrinoma , two patients hepatic metastases gastrinomas , two patients \( vasoactive intestinal polypeptide secreting tumor \) , three patients carcinoid tumors octreotide caused marked decrease tumor blood flow two patients gastrinomas two one patient could evaluated due lack tumor control angiogram patients carcinoid tumors , octreotide caused slight reduction blood flow tumors two patients , change one patient octreotide markedly decreased gastrin gastric acid secretion two three patients gastrinomas , lowered vip stopped diarrhea patients , controlled symptoms two three patients carcinoid tumors vasoactive effect octreotide hepatic endocrine tumors may direct action tumor blood supply secondary inhibition endocrine tumor cell secretion consequent decreased blood flow
direct interaction ligand erbb2 oncogene product egf receptor p185erbb2 erbb2 oncogene encodes 185 kilodalton transmembrane protein whose sequence similar epidermal growth factor receptor \( egfr \) 30 kilodalton factor \( gp30 \) secreted mda mb 231 human breast cancer cells shown ligand p185erbb2 antibody egfr abolished tyrosine phosphorylation induced egf transforming growth factor alpha \( tgf alpha \) partially blocked produced gp30 sk br 3 breast cancer cells two cell lines erbb2 egfr \( mda mb breast cancer cells chinese hamster ovary cell line transfected erbb2 \) , phosphorylation p185erbb2 induced gp30 gp30 specifically inhibited growth cells overexpressed p185erbb2 antibody egfr effect inhibition sk br 3 cell colony formation obtained gp30 thus , appeared gp30 directly egfr erbb2 direct binding gp30 p185erbb2 confirmed binding competition experiments , gp30 found p185erbb2 binding specific antibody p185erbb2 evidence described suggests gp30 ligand p185erbb2
carcinoma male breast review 41 cases reviewed cases 41 consecutive men treated breast carcinoma 1950 1987 university affiliated hospitals examine controversies methods therapy disease twenty two patients \( 52 \) stage ii lesions potentially curable operative therapy overall 5 year survival rates 100 stage , 65 stage ii , 56 stage iii , 0 stage iv radical mastectomy offered advantage modified radical mastectomy terms survival rate recurrence diagnosis early clinical stage finding disease axillary lymph nodes important factors survival series patients tumors evaluated hormone receptors positive although experience limited , encouraging results obtained use tamoxifen citrate adjuvant well palliative roles exception predominance centrally located lesions uniquely high frequency positive hormone receptor status , carcinoma male breast appears biologically similar disease women , treatment guided similar principles
malignant melanoma pigmented lesions diagnostic management dilemma document two cases malignancy occurring site partially removed benign nevi difficulty clinical diagnosis uncertainty behavior , propose recurring melanocytic nevus expanding beyond original surgical scar excised specimen carefully analyzed ensure complete removal
results conservative surgery radiation therapy breast cancer stage ii breast cancer , conservative surgery radiation therapy effective modified radical radical mastectomy cases , cosmetic considerations availability therapy primary concerns extent surgical resection less mastectomy subject randomized trial controversial appears removal quadrant breast small lesions safe excessive using histologic findings biopsy guide , may possible limit breast resection gross tumor removal patients using wider resections patients extensive intraductal component invasive lobular carcinoma also appears excluding patients breast conservation basis positive margins first attempt tumor excision may restrictive although patients extensive intraductal component invasive lobular carcinoma negative margins , appears patient predominantly invasive ductal carcinoma treated without excision gross tumor resected reason suspect extensive microscopic disease patients indeterminate margins excision axillary dissection provides prognostic information prevents progression disease within axilla axillary dissections limited level accurately identify substantial number patients pathologically positive clinically negative nodes combined radiation therapy axilla , level dissection results limited number patients progressive axillary disease patients pathologically positive patients particularly high risk systemic disease extent axillary node involvement identified dissections levels ii radiation therapy avoided safely patients pathologically negative level ii dissection appears advantage routine dissection level iii lymph nodes arm breast increases extensive dissections radiation therapy
role mastectomy breast cancer surgical management breast cancer continues evolve attempt define ideal line therapeutic efficacy morbidity clear breast cancer biologically heterogeneous group diseases , single hypothesis explains behavior surgical options proposed individual patient must experience retrospective clinical studies prospective randomized trials attempt optimize treatment plan patients without distant disease eligible consider mastectomy , accomplish excellent local control significantly improve survival earlier stages disease however , breast conservation remains appropriate alternative carefully defined subset patients today , early stage disease , patient need leave operating room without breast recent advances reconstructive surgery make mastectomy immediate reconstruction limited resection plus axillary dissection postoperative radiation therapy two principal treatment choices available future studies focus integration treatment modalities clinical research use preoperative chemotherapy disease permit less extensive surgery interest recent application molecular biologic techniques oncogene analysis , cytogenetic studies , proliferative indices , highly sensitive detection distant micrometastases using monoclonal antibodies may assist design innovative approaches surgery , radiation therapy , systemic drug treatment advances show great promise improving quality life cure rate patients breast cancer today , surgical treatment options evolved fulfill objectives outlined dr ewing memorial hospital 50 years ago concerns breast cancer remain relevant today half century ago drawn impression dealing mammary cancer , surgery meets peculiar difficulties almost form disease anatomical types numerous , variations clinical course wide , dissemination free diverse , difficulties determining actual conditions complex , sacrifice tissues great , render impossible majority cases reasonably accurate adjustment means end
selection breast preservation therapy primary invasive breast carcinoma breast preservation treatment primary breast cancer used women women frequently excluded consideration treatment choose may elderly concerned cosmetic appearance live distance 6 weeks daily radiotherapy would even impossible also , expertise facilities available , breast preservation program difficult massachusetts , full course cgy \( cgy whole breast 1600 cgy local boost \) costs roughly thus , breast preservation expensive mastectomy even reconstruction , patients still frequently require hospital admission general anesthesia axillary dissection although insurance policies cover , patients insurance inadequate coverage may find extra expense breast preservation technique impossible women small breast proportionately large cancer may unsatisfactory cosmetic outcome appropriate cosmetic result patients frequently cannot predicted fact adds emphasis need two step process evaluation cosmetic outcome well pathologic features decisions regarding breast preservation finally , women may strikingly different attitudes toward breast preservation expected surgeon women , preserve breast strong accept virtually risk achieve option , whereas women , constant anxiety recurrence undergoing radiation therapy traumatic enough readily accept mastectomy referral surgical oncology practice , roughly 60 patients currently treated breast preservation techniques remainder undergo mastectomy , immediate reconstruction approximately three cases proportion patients breast preservation depends greatly local medical attitudes skills available women 's attitudes , frequently dependent local press publicity surgeon 's interest enthusiasm program appropriate proportion patients treated breast preservation techniques , clearly , proportion patients treated increases experience , acceptability , publicity , availability thus , selection breast preserving therapy individual patients result array factors need considered patient \( abstract truncated 400 words \)
selection therapy stage iii breast cancer locally advanced breast cancer heterogenous group including operable inoperable lesions local surgery radiation alone produces poor survival rates , indicating micrometastases diagnosis systemic chemotherapy part multimodality regimens increased length rate disease free survival
adjuvant chemotherapy breast cancer many women cured breast cancer even best early detection surgical techniques micrometastases present diagnosis adjuvant therapy extended disease free interval patients overall survival many combination chemotherapy become standard form adjuvant treatment premenopausal women breast cancer positive lymph nodes primary therapy minimal toxicity , disease free overall survival improved results less impressive less clear cut postmenopausal women woman negative lymph nodes long term toxicities adjuvant chemotherapy may include second malignancies cardiac dysfunction although complications probably rare , must considered seriously weighing chemotherapy patients benefits may slight likely become standard adjuvant therapy decision making include risk assessment new prognostic indicators \( growth fraction , oncogene expression \) investigation dose intensification using bone marrow growth factors autologous stem cell support
adjuvant therapy breast cancer past , present , future laboratory investigations using animal models breast cancer growth indicated compound tamoxifen agent therefore effective suppressing , rather , breast tumor use adjuvant breast cancer management successful , proportion women long periods tamoxifen treatment initial studies recruited postmenopausal women , tamoxifen proposed treatment premenopausal women extended time naturally , many aspects toxicology tamoxifen consider however , careful monitoring clinical trials determine safety drug general patient population
management local regional recurrence mastectomy breast conserving treatment locoregional failures primary treatment breast cancer include diverse group lesions represent different categories failures various prognoses although patients chest wall recurrences regional nodal failures traditional radical surgery poor prognosis , many patients still achieve significant degree palliation even long term survival cure carefully multimodal treatment patients breast failures breast conservation surgery radiation , long term salvage cure achieved majority prompt detection appropriate treatment , , like treatment primary breast cancer , includes consideration local control also risk subsequent systemic failure need treatment
reconstruction mastectomy advances materials techniques , especially involving transposition muscle skin flaps , made breast reconstruction possible women undergo mastectomy breast cancer availability option alleviate breast chest wall deformity results virtually local treatment breast cancer essential reconstruction surgeon part breast cancer management team beginning treatment planning surgeon work closely general surgeon , medical , radiation therapist well adjunctive treatment team members patient 's clinical status type local treatment significant determinants reconstructive options women stage breast cancer , decisions may based largely 's local adjunctive therapy procedures woman 's desire proceed delay women systemic disease , members breast management team may need agree timing reconstruction central numerous decisions described paper regarding timing , type , extent breast reconstruction primary goal entire team best possible management breast cancer promise attractive , symmetric , natural appearing breasts , complete symmetric nipple complex , somewhat self threat accompany loss breast lowering fear , widely recognized availability breast reconstruction may encourage women monitor breasts seek diagnosis changes may influence selection type local treatment cancer detected psychological cultural significance breast , reconstructive surgeon must particularly sensitive psychological aesthetic expectations patient even patients metastases limited life expectancy , breast reconstruction enhance quality life
bilateral breast cancer second primary breast cancer opposite breast either synchronous metachronous majority metachronous woman breast cancer fivefold increase risk second breast cancer additional risk factors include multifocal cancer , lobular carcinoma situ , original cancer early age long survival lobular carcinoma situ predominantly marker subsequent development second primary breast cancer incidence synchronous bilateral cancer approximately 1 2 metachronous cancer 5 6 cancer invasive noninvasive mammography increased number synchronous cancers found overall incidence incidence invasive cancer detected random biopsy opposite breast high enough justify routine adoption procedure remaining breast must followed remainder patient 's life physical examination annual mammography treatment secondary primary breast cancer appropriate stage disease prognosis woman second primary breast cancer quite favorable dependent stage first second cancer
breast cancer pregnancy lactation breast cancer frequently seen cancer pregnancy lactation , incidence low , disease seen approximately 0 03 pregnancies 1 2 breast cancer overall diagnosed pregnancy lactation evidence implicate pregnancy lactation either etiology progression breast cancer careful breast examination early pregnancy important find solid masses require biopsy breast therapeutic options vary , depending stage disease stage pregnancy operable disease first 6 7 months pregnancy treated mastectomy , irradiation contraindicated late pregnancy , axillary dissection done , irradiation delayed delivery general anesthesia safe usual precautions taken compensate physiologic changes induced pregnancy unfortunately , delay diagnosis common , 70 89 patients operable primary lesions positive axillary lymph nodes late stage appears reason generally worse prognosis patients , stage stage , course similar nonpregnant patients adjuvant chemotherapy considered late pregnancy usually delayed delivery patients locally advanced metastatic cancer diagnosed early pregnancy , chemotherapy radiation therapy would normally recommended , consideration must given termination pregnancy evidence termination pregnancy improves patients , permit standard aggressive therapy advanced disease
male breast cancer male breast cancer uncommon important diagnosis easily made breast biopsy , patients presenting earlier course disease past despite , patients often first seen tumors metastasized axillary nodes , markedly decreases survival rate therapy localized disease includes simple excision , modified radical mastectomy , radical mastectomy , consensus operation appropriate radiation therapy strongly considered patients metastases axillary nodes , role adjuvant hormonal therapy chemotherapy unclear treatment disseminated disease , tamoxifen seems replacing orchiectomy favorable response rate , especially patients estrogen receptor positive tumors , lack side effects , high level patient acceptability make attractive therapeutic choice
clinical problems follow patients conservative surgery radiotherapy patients treated conservative surgery radiotherapy early stage breast carcinoma risk developing ipsilateral breast recurrence long period fortunately , patients present inoperable recurrence simultaneous distant metastases salvage rates high may improved early detection although usually unambiguous , physical examination treated breast may reveal changes attributable surgery radiotherapy mimic recurrent cancer also substantial overlap radiologic appearance benign malignant lesions may necessary perform biopsy question recurrence careful life long follow patients thus critical part care
trends primary breast cancer management going \? treatment cancer period based clinician therapeutic consequences dominant biologic model disease , dominant model breast cancer disease spread along anatomic pathways , time determinant prognosis alternative model , biologic , outcomes treatment determined extent microscopic dissemination occurred tumor became detectable model , , , author suggests time paradigm shift breast cancer exhibits heterogeneity phenotypes resulting one perhaps two mutations multiple prognostic variables may , expressing different degrees amplification limited domain genome
prognostic indicators invasive breast cancer tumor size axillary lymph node involvement primary determinants clinical course patients receptors estrogen progesterone important additional prognostic factors disease free survival , overall survival , survival time initial disease recurrence , likelihood response hormonal therapy histologic grading merit prognostic factor , although poor reproducibility limits broad application promising data emerging use flow cytometry analyze dna content proliferative rate patients aneuploid tumors likely shorter survival time patients diploid tumors high phase fraction also identifies subset patients increased risk early relapse combined index ploidy phase may useful guide together , low phase identify subgroup node negative patients low risk disease recurrence number oncogenes identified breast cancer amplification 2 neu gene overexpression gene product may important prognostic indicator node positive patients
carcinoma thyroglossal duct review 39 instances excision cyst thyroglossal duct performed st medical center , , texas , revealed two patients carcinoma thyroglossal duct review english literature yielded 146 instances uncommon tumor eighty four per cent papillary adenocarcinoma thyroid type 5 per cent squamous cell carcinoma patients six 81 years old 2 1 female male ratio metastatic disease lymph nodes noted 11 per cent invasion overlying muscles found 4 per cent carcinoma thyroid gland occurred 14 per cent preoperative diagnosis rare procedure recommended initial surgical therapy surgical adjuvant therapy dependent associated clinical findings prognosis carcinoma thyroglossal duct thyroid type parallels carcinoma thyroid gland
unusual epidural , vascular spinal lipoma 3 year old child case report review literature epidural usually benign tumors affecting spinal cord report unusual presentation spinal lipoma associated cervical young boy diagnostic options using magnetic resonance imaging gadolinium acid discussed pathway early diagnosis occult spinal lesions
neonatal intracranial two neonates intracranial presented cranial weeks birth cases underwent surgery one died intraoperatively longest known survivor , alive 7 years 9 months subtotal excision mature teratoma left previous operations relatively nearly unsuccessful size favorable location may important prognostic features regardless histologic classification mature immature one cases demonstrates even subtotal excision mature teratoma result long term survival
prospective evaluation clinical pathologic detection axillary metastases patients carcinoma breast complete axillary dissection performed patients undergoing modified radical mastectomy 1984 1987 identify patterns axillary node metastases , well discontinuous axillary node \( \) metastases positive pathologic findings compared preoperative clinical examinations 266 patients showed 60 cases \( 22 6 \) clinically suspicious tumor , contrast 131 \( 45 6 \) pathologically confirmed positive lymph nodes axillary contents classified level , ii , iii based relationship pectoralis minor muscle average 24 2 nodes resected per patient \( level , 10 level ii , 8 1 level iii , 5 3 \) tumors ranged size 0 5 12 0 cm \( mean , 2 6 cm \) , increasing tumor size associated increased likelihood positive nodes data 204 patients complete clinical pathologic data show 119 patients negative level nodes limited axillary dissection \( level \) would fail identify 6 positive level ii 2 positive level iii nodes , whereas 85 patients positive level nodes limited axillary dissection would fail identify 17 positive level ii nodes , 7 positive level iii nodes , 27 positive levels ii iii nodes complete axillary dissection \( levels , ii , iii \) performed stage patients accurately , well remove tumor involved nodes diminish local axillary recurrences clinical examination axilla appears poor means identifying axillary metastatic cancer
short term tamoxifen plus chemotherapy superior results node positive breast cancer three hundred eleven patients node positive breast cancer randomized one three adjuvant treatments cyclophosphamide \( \) , methotrexate , 5 fluorouracil tamoxifen citrate tamoxifen bacillus calmette guerin vaccination local therapy patients modified radical mastectomy estrogen receptors measured primary tumors patients stratified number positive nodes \( one three nodes three nodes \) estrogen receptor value \( less 3 mg greater equal 3 mg \) follow available , mean 9 1 maximum 14 2 years study efficacy short term tamoxifen apparent alone continues significant prolonged follow addition tamoxifen significantly prolonged disease free survival among patients estrogen receptor positive tumors postmenopausal , larger tumors \( greater 3 cm \) , extensive axillary node involvement \( three nodes \) tamoxifen improved overall survival patients estrogen receptor positive tumors larger 3 cm addition bacillus calmette guerin , methotrexate , 5 fluorouracil , tamoxifen significantly alter disease free overall survival
dna ploidy prognostic significance stage cutaneous melanoma \? recent studies suggested presence dna aneuploidy stage cutaneous melanoma carries poor prognosis see experience correlated reports , used dna analysis flow cytometry iodide stained nuclei formalin fixed paraffin embedded tissue biopsy specimens retrospectively study 55 patients cutaneous stage melanomas patients treated 1977 1987 mean follow 5 4 years thirty nine \( 71 \) 55 histograms diploid , 16 \( 29 \) histograms aneuploid dna content significantly associated conventional prognostic factors , including growth pattern , ulceration , pathologic stage , tumor thickness , 's level dna aneuploidy significantly related disease free survival predicted poorer prognosis \( p less 0 05 \) , stratified tumor thickness lost significance multivariate discriminant function analysis 12 factors melanoma showed six factors independently significant determining prognosis dna content \( p 0 034 \) ranked fifth importance behind growth pattern \( p less 0 001 \) , ulceration \( p less 0 001 \) , thickness \( p 0 001 \) , pathologic stage \( p less 0 005 \) dna content , although significantly associated conventional prognostic factors disease free survival , best indicator biologic behavior melanomas study investigation usefulness necessary dna content become routine diagnostic modality work stage cutaneous melanomas
local recurrence curative resection colorectal adenocarcinoma total patients colorectal adenocarcinomas operated institution 1965 1981 complete follow information obtained six patients \( 99 4 \) , available histologic slides reviewed determine pathologic stage characteristics six hundred fifty one patients \( 76 3 \) underwent potentially curative procedure , operative mortality rate 2 8 patients available analysis , 50 \( 8 \) local recurrence median time local recurrence 18 months , 16 local recurrences diagnosed 5 years original resection median survival patients local recurrence 3 1 2 years original resection , 16 patients \( 32 \) survived 5 years longer multivariate logistic regression analysis conducted examine influence several clinical pathologic characteristics local recurrence among dukes' stages b c adenocarcinomas \( n 539 \) exclusion patients synchronous tumors \( n 8 \) , postoperative deaths \( n 18 \) , loss follow \( n 6 \) , incomplete data \( n 11 \) analysis revealed local recurrence rate significantly related depth invasion \( b1 c1 0 b2 c1 10 p less 0 01 \) , site origin \( right plus transverse colon 6 left plus colon 10 rectum 12 p less 0 05 \) , lymphatic capillary microinvasion \( absent , 6 present , 14 p less 0 05 \) analysis attempts identify patients high risk development local recurrent disease select candidates postoperative adjuvant therapy
effective ultraviolet irradiation platelet teflon bags several plastic materials used blood storage evaluated ability transmit ultraviolet b \( uvb \) light plastic bag teflon efficiently \( 78 86 \) transmitted uvb light employed subsequent functional studies lymphocytes platelets exposed uvb light contained bags vitro experiments showed uvb dose dependent lymphocyte responder stimulator functions , concurrent preservation platelet aggregation responses phase pilot study , uvb treated platelet administered four bone marrow transplant recipients adverse effects attributable transfusions observed , patients showed clinically effective transfusion responses patient developed hla platelet antibodies studies suggest platelets effectively irradiated uvb light closed system however , numerous variables , including material , volume composition contents , steady exposure versus agitation , exact uv wavelength , must considered
squamous cell carcinoma antigen \( ta 4 \) penile carcinoma ta 4 antigen , originally isolated women squamous cell carcinoma cervix , elevated sera patients squamous cell carcinomas several sites , including esophagus , lungs , head neck study , compared serum levels ta 4 normal volunteers , patients resected penile squamous cell carcinoma , patients metastatic penile squamous cell carcinoma ta 4 values elevated 5 11 patients \( 45 \) metastatic disease 2 , ta 4 normal first time metastasis clinically detected rose disease progressed moreover , 3 patients serial determinations made , serum ta 4 values correlated well disease progression response treatment conclude ta 4 values elevated patients metastatic squamous cell carcinoma may become useful marker monitoring response therapy
uneventful delivery following series successive treatments cushing syndrome due adrenocortical carcinoma twenty one year old woman cushing syndrome due huge adrenocortical carcinoma treated \( 3 beta dehydrogenase inhibitor \) , subsequent adrenalectomy , postoperative cis platinum clinical biochemical abnormalities peculiar cushing syndrome gradually , three one half years adrenal surgery , patient delivered normal female infant study points clinical biochemical responses treatment
selenium nutritional , toxicologic , clinical aspects despite recent findings environmental contamination , selenium humans exceedingly rare united states , known cases resulting industrial accidents episode involving ingestion selenium supplements chronic essentially country typical diversity american diet nonetheless , growing public interest selenium dietary supplement occurrence environmental selenium contamination , medical practitioners familiar nutritional , toxicologic , clinical aspects trace element
mammary carcinoma clinicopathologic study 72 cases carcinoma \( ac \) uncommon , poorly characterized type breast tumor review , 55 patients intraductal \( id \) ac 17 patients infiltrating \( \) ac analyzed retrospectively define histologic features clinical course neoplasm recurrences breast occurred 3 20 id ac patients treated biopsy alone , 2 patients received local radiation therapy biopsy one patient id ac axillary metastases time treatment mastectomy died disease five years later remaining patients id ac treated mastectomy remained disease free one three patients ac treated biopsy alone died disease , one two patients ac treated biopsy radiotherapy alive carcinoma twelve patients ac treated mastectomy ten recurrence free time last observation one third cases id ac ac detected mammography alone survival analysis ac cases compared duct carcinoma cases matched stage revealed statistical difference estimated recurrence free survival estimated survival probability ac distinct morphologic entity natural history similar ductal carcinoma
bcr abl recombinant dna analysis versus karyotype diagnosis therapeutic monitoring chronic myeloid leukemia karyotype bcr abl recombinant dna analyses two means detecting chromosomal aberration chronic myeloid leukemia authors compared two methods retrospective study 36 patients cml found bcr abl dna recombinant event 100 \( 29 29 \) patients philadelphia chromosome achieve sensitivity , battery two bcr probes three restriction enzymes necessary authors propose sequential algorithm efficient use probes enzymes 76 patients , bcr abl rearrangement detected ii digest 3' commercial probe additional 21 patients detected second assay membrane 3' 5' combination bcr probe one patient \( 3 \) required additional restriction enzyme digest detect recombinant event 3' probe karyotype analysis used determine cytogenetic remission patients cml therapy authors studied use dna analysis southern blot technique detect decrease relative number leukemic cells dilution studies densitometric scanning , authors able detect 15 decrease relative number cells bcr abl recombinant event authors report preliminary results three patients compared karyotype recombinant dna analysis multiple time points clinical course conclusion , bcr abl recombinant dna analysis superior karyotype diagnosis cml used monitoring treated patients
use molecular probes distinguish new primary tumors recurrent tumors gynecologic malignancies first report using dna molecular probe technology distinguish recurrent tumor second primary malignancy patient tumor dna extracted squamous cell carcinoma cervix time radical hysterectomy eighteen months later squamous cell cancer found vaginal apex biopsy dna extracted tumor dna lesions subjected restriction enzyme digestion dna molecular hybridization human papillomavirus \( hpv \) probes although lesions positive hpv 16 , respective restriction enzyme patterns different hpv genetic arrangements , thereby demonstrating
thyroid carcinoma mixed tall cell cell features tall cell cell carcinomas regarded aggressive variants papillary thyroid carcinoma present case report authors describe composite tumor forms differentiation , transitional changes occurring within single follicular structures finding indicates two variants closely related local recurrences , one feature appeared separate lesions lung metastases developed , patient died 5 1 2 years diagnosis primary treatment
diagnostic expert system colonic lesions diagnostic expert system colonic lesions \( \) designed discriminate colonic adenoma adenocarcinoma normal colonic tissue although originally developed use conjunction machine vision analytic system , evolved teaching tool model conceptual machine learning expert system table driven consists knowledge base latter comprises series architectural cytologic observations quantitative estimate diagnostic importance relating observations diagnostic outcome validation study 100 colonic lesions , expert system achieved success rate 98 flexibility allow individual pathologists knowledge base diagnostic criteria
estimation pr er immunocytochemistry breast cancer comparison radioligand binding methods immunocytochemical assays progesterone receptor \( pr \) using monoclonal pr antibodies \( pr ica \) estrogen receptor \( er \) \( er ica \) compared radioligand binding \( dextran coated charcoal dcc \) methods receptor determination patients breast cancer immunocytochemical staining pr exclusively nuclear localization regard , pr staining similar previous findings er pr ica showed sensitivity 89 specificity 100 er ica also 89 sensitive similarly specific good correlation degree intensity staining quantitative binding radioligand receptor positive tumors , however , show considerable variation immunocytochemical staining , suggesting heterogeneity cellular pr content availability immunocytochemical assay pr increases discriminatory potential methods receptor determination
clinical significance colonic fermentation recent evidence potential benefits short chain fatty acids prompted renewed interest area human colonic fermentation paper reviews clinical metabolic consequences colonic fermentation
endoscopic ultrasonography staging rectal cancer endoscopic ultrasonography \( eus \) used stage rectal cancer assessing depth invasion bowel wall layers involvement lymph nodes eus findings correlated histopathologic findings usefulness modality predicting patients could candidates procedures avoidance abdominoperineal resection m3 endoscopic ultrasound system used assess depth penetration rectal wall layers identify lymph nodes comparison eus findings histopathologic findings possible 13 patients eus agreed histopathology 9 13 cases \( 69 3 \) \( p 0 07 , kappa statistic \) eus agreed histopathology presence absence lymph nodes 9 13 cases \( 69 3 \) \( p 0 07 \) however , presence lymph nodes could necessarily predict metastatic involvement nodes one patient , invasion vaginal cuff correctly predicted nine cases , computed tomographic analysis \( ct \) available comparison eus detection penetration beyond bowel wall ct agreed histopathology 3 9 \( 33 \) , whereas eus agreed histopathology 7 9 \( 78 \)
equal parental origin chromosome 22 losses human sporadic meningioma evidence genomic inactivation tumor suppressor genes occur either mutation gene locus loss part chromosome region containing gene latter frequently detected dna markers loss heterozygosity tumor tissue several reports , paternal homologue preferentially retained embryonal tumors associated loss particular chromosomal regions , suggesting genomic corresponding tumor suppressor loci explore findings possible role genomic adult tumors nervous system , determined parental origin chromosome 22 loss sporadic meningioma nine cases studied , five tumors retained derived chromosome 22 homologue four retained derived chromosome 22 thus , contrast embryonal tumors , meningioma locus chromosome 22 inactivated random mutation sporadic adult meningiomas
prognostic significance ca 125 half life patients ovarian cancer received primary chemotherapy surgical cytoreduction fifty four patients advanced epithelial ovarian cancer monitored serial serum ca 125 levels surgical cytoreduction multi agent chemotherapy cisplatin containing regimens ca 125 half life less 20 days associated prolonged overall survival \( p less 0 015 \) patients eventually found disease free surgical surveillance procedures , normalization serum ca 125 levels less 35 u ml within 65 days primary operation also suggested improved survival \( p less 0 059 \)
suppression serum insulin level diazoxide alter serum testosterone sex hormone binding globulin levels healthy , nonobese women suppression serum insulin levels diazoxide associated decrease serum testosterone increase serum sex hormone binding globulin obese women polycystic ovary syndrome determine whether physiologic insulin levels play regulatory role androgen status nonobese women normal menses , androgen status five nonobese normal women assessed two occasions control study 10 days oral diazoxide \( 100 mg , three times daily \) administration insulin release response 100 gm oral glucose administration decreased 108 0 28 2 49 3 5 2 nmol min l \( p 0 05 \) diazoxide administration however , despite suppression insulin release , diazoxide administration affect serum total testosterone \( diazoxide , 0 73 0 10 control , 0 69 0 11 nmol l p ns \) sex hormone binding globulin \( diazoxide , 79 7 16 6 control , 70 2 12 6 nmol l p ns \) concentrations observations suggest physiologic insulin levels nonobese healthy women regulate testosterone metabolism diazoxide exert direct independent effect serum testosterone sex hormone binding globulin levels
autologous antibodies eluted membrane fragments human ovarian epithelial neoplastic effusions iii cytotoxic potential vitro characterization antigen \( \) cyst ascites fluids patients ovarian epithelial neoplasms contain immunoglobulins antitumor activity autologous antibodies bound cellular membrane fragments obtained human ovarian neoplastic effusions react cell surface antigens different human ovarian cell lines , surgical specimens human ovarian adenocarcinoma , human ovarian tumors grown athymic balb c mice antibodies react tissue preparations normal human ovaries , normal neoplastic tissues , human cell lines studies indicate antibodies capable complement mediated lysis human ovarian tumor cell lines vitro preliminary characterization autologous ovarian tumor associated antigen \( \) indicates may composed three large molecular weight proteins 182 , 000 , 164 , 000 , 122 , 000
oral contraceptives breast cancer among women general risk breast cancer 59 years age appear affected appreciably use oral contraceptives nonetheless , concern continues expressed effects early age first use , long term duration use , formulation , variety factors thought influence breast cancer risk presence oral contraception number recent studies restricted young women suggest long term use may increase risk disease occurring early , present lack consistent findings well conducted epidemiologic studies prevents certain conclusion regard cause effect however , increased risk indeed present , interpretation long term oral contraception promotes earlier clinical manifestation breast cancer women net impact lifetime risk disease
limbal autograft reconstruction conjunctival squamous cell carcinoma two patients squamous cell carcinoma extensive limbal corneal involvement treated surgery cryotherapy rarely large areas cornea involved tumor visual prognosis patients poor two patients , autologous limbal transplants effective restoring excellent corneal surface good visual function technique may useful reconstruction eyes extensive neoplastic involvement corneoscleral limbus cornea
immunohistochemical study pi class glutathione transferase expression normal human tissue glutathione \( \) , family isoenzymes play important role protecting cells cytotoxic carcinogenic agents , separated biochemical immunologic characteristics three distinct classes named alpha , mu , pi previous studies indicated marked heterogeneity expression different gst isoenzymes different normal malignant tissues better understand regulation human pi class glutathione transferase isoenzyme \( gst pi \) , tissue distribution protein studied immunohistochemical technique using anti gst pi polyclonal antibody normal paraffin embedded human tissues studies indicate broad distribution gst pi normal human tissues establish precise localization within different organs studied gst pi expressed predominantly normal epithelial cells urinary , digestive , respiratory tracts , suggesting possible role gst pi elimination toxic substances previous studies indicated gst pi putative drug efflux pump p glycoprotein overexpressed multidrug resistant human breast cancer cells resistant rat hyperplastic liver nodules results study indicate also similarities normal tissue distribution gst pi previously reported mammalian p glycoprotein , particularly secretory epithelia finding suggests two gene products , implicated development resistance cytotoxic drugs , may normal malignant cells
decreased expression integrin adhesive protein receptors adenocarcinoma breast integrin represents major class receptors mediating cell substrate adhesion recent study tissue distribution alpha 2 beta 1 integrin , cell surface collagen receptor , revealed high levels receptor expression associated , regulated epithelial cell proliferation observations prompted present investigation alpha 2 beta 1 integrins adenocarcinoma breast alpha 2 beta 1 integrin highly expressed epithelium ducts ductules normal breast tissue normal nearly normal levels receptor expressed fibroadenomas contrast , markedly decreased undetectable alpha 2 beta 1 expression typical poorly differentiated adenocarcinomas well differentiated lesions exhibited intermediate levels expression similar , less extensive , decreases expression observed alpha 5 beta 1 \( fibronectin receptor \) alpha v beta 3 \( vitronectin receptor \) significant expression beta 1 subunit even poorly differentiated tumors suggests expression undefined members beta 1 family reduced low level alpha 2 beta 1 alpha 5 beta 1 expression alpha 2 beta 1 integrin highly correlated estrogen receptor expression decreased expression alpha 2 beta 1 integrin adhesive protein receptors probably contributes altered adhesive properties tumor cells characteristic malignant phenotype
lymph node metastasis papillary follicular thyroid carcinoma young patients total 117 patients 20 years age papillary follicular thyroid cancer presented anderson cancer center 1987 common presenting symptom cervical mass twenty percent patients history prior irradiation sixty percent initially palpable lymph nodes , 26 clinically negative examinations pathologically positive lymph nodes recurrence highest regional lymph nodes 24 , 4 recurrence rate primary site 3 recurrence rate distant sites deaths due thyroid cancer maintain low rate recurrence , near total thyroidectomy neck dissection followed iodine 131 treatment considered young patients
survival differentiated thyroid cancer since 1975 , american cancer society , illinois division , published end results major cancer sites drawn patient data contributed hospital cancer registries throughout state current study undertaken , part , information regarding areas management patients differentiated \( papillary follicular \) thyroid cancer total 2 , 282 patients either papillary follicular carcinoma thyroid 76 different illinois hospitals providing 10 years follow information \( life table analysis \) retrospectively analyzed demographic , disease , treatment related predictors survival multivariate analysis using cox proportional hazards method made stage , age , race , sex , morphology , history radiation exposure , presence positive lymph nodes , initial surgical treatment , postoperative iodine 131 therapy , replacement suppressive thyroid hormone treatment statistically significant \( p less equal 0 05 \) predictors favorable survival thyroid cancer low stage \( ii \) , young age \( less 50 years \) , white race , female sex , administration , postoperatively , either thyroid hormone radioactive iodine factors influence survival lymph node status , choice initial surgical treatment , history prior irradiation suggest prospective clinical trial , retrospective analysis large detailed database , available hospital based tumor registries , may yet provide useful insights solutions cancer management problems
soft tissue sarcomas head neck adults reviewed clinical records pathologic material 176 adults primary soft tissue sarcomas treated memorial sloan kettering cancer center 1950 1985 seventy two patients \( 41 \) low grade sarcomas 104 \( 59 \) high grade sarcomas 18 patients underwent form excision initial therapy adjuvant radiotherapy chemotherapy combined surgical excision showed significant effect significantly increased risk treatment failure associated large tumor size , positive surgical margins , bone involvement , local recurrence , metastatic spread , high histologic grade except recurrence , p value univariate analysis log rank test comparison survival according clinical pathologic characteristics p less 0 0001 although overall survival 75 2 years , 55 5 years , 46 10 years , 20 patients high grade sarcomas alive 10 years treatment patients rhabdomyosarcoma , high grade peripheral nerve tumor , high grade fibrous histiocytoma patients high grade died disease less 5 years diagnosis new therapeutic strategies needed improve survival adult patients high grade soft tissue sarcomas head neck
multimodality preoperative treatment advanced stage iv \( mo \) cancer head neck sixty three patients advanced unresectable squamous cell carcinoma head neck treated combination chemotherapy , radiation , surgery observed 75 response neoadjuvant chemotherapy 5 year survival rate 63 patients 20 , 3 patients alive 8 years 5 year survival rate patients completed treatment plan received chemotherapy , radiation , surgery 43 compared 20 chemotherapy radiation refused surgery development second primary cancer cause death 62 patients survived 24 months
significance positive margins oral cavity squamous carcinoma three hundred ninety eight consecutive , previously untreated patients undergoing surgery epidermoid carcinoma oral cavity 1979 1983 reviewed one hundred twenty nine patients classified positive surgical margins , 83 patients tumor within 0 5 mm surgical margin , 9 premalignant changes margin , 9 situ carcinoma margin , 28 invasive cancer margin remaining 269 patients uninvolved margins significance positive margins relating survival , subsequent clinical course , local recurrence , patterns treatment failure examined , along impact adjuvant postoperative radiotherapy positive margins percentage patients positive margins progressively increased increasing stage 21 t1 versus 55 t4 primary cancer overall 5 year survival patients negative margins 60 patients positive margins , 5 year survival 52 difference statistically significant incidence local recurrence patients positive surgical margins twice much negative margins \( 36 versus 18 \) metastasis rates neck distant sites significantly influenced status surgical margin 129 patients positive margins , 49 received postoperative radiotherapy patients treated , trend toward lower recurrence rates noted differences statistically significant retrospective review confirms importance adequate resection primary tumor well relative adjuvant postoperative radiotherapy improvement local control patients positive surgical margins
flow cytometric evaluation head neck tumors patients head neck squamous carcinoma , clinical response induction chemotherapy correlated survival advantage similarly , patients diploid tumors displayed survival advantage compared patients aneuploid tumors study examined dna content 33 patients undergone induction chemotherapy part two clinical protocols determine correlation patients diploid tumors patients clinical response chemotherapy although patients stage iii tumors longer disease free survival stage iv patients \( p less 0 0002 \) , addition dna content information improve ability predict response specifically , correlation dna content response chemotherapy addition , group patients , diploid dna content correlated survival advantage conclude dna content information add significantly prediction clinical outcome patients received induction chemotherapy
serologic determinants survival patients squamous cell carcinoma head neck specific circulating serum proteins may reflect unique properties governing growth progression head neck cancers one hundred three previously untreated patients squamous cell carcinoma head neck prospectively evaluated serum iga , igg , igm c1q binding macromolecules immunoglobulins assessed technique c1q binding macromolecules \( c1qbm \) measured utilizing iodine 125 assay et al \( j 1976 116 232 5 \) neither level serum immunoglobulins c1qbm values correlated primary site , \( american joint committee cancer \) stage disease , size primary lesion likewise , comparison serum iga c1qbm values demonstrated laboratory parameters independent variables \( r 0 15 pearson linear regression \) univariate statistical analysis , utilizing cox proportional hazard model , showed serum iga c1qbm values contribute significantly ability predict survival patients advanced squamous cell carcinoma head neck \( p 0 01 0 003 , respectively \) furthermore , multivariate analysis reveals c1qbm serum iga levels contribute significantly hazards model beyond staging predicting survival \( p less 0 001 \) predictive results apparent patients stage iv disease related probability regional distant metastatic recurrences conversely , serologic analysis provided information patients staged early results support pretreatment serologic analysis patients squamous cell carcinoma head neck
delayed reconstruction following mohs' skin cancers head neck case records 52 patients 55 cutaneous neoplasms treated mohs' subsequently reconstructed plastic surgeons reviewed determine delay resection reconstruction adversely affected outcome reconstruction reconstruction performed 5 61 days mohs' 45 basal cell carcinomas 10 cutaneous neoplasms complications interval resection reconstruction following reconstruction , minor wound complications occurred 6 patients major complications microscopic examination excised wound revealed residual disease 2 45 cases basal cell carcinoma 0 10 cutaneous malignancies patients residual basal cell carcinomas \( e , false negative margins mohs' surgery \) presented mohs' surgeon recurrent tumors follow period 3 months 3 years complete resection , recurrent tumor developed 2 45 cases basal cell carcinoma 3 8 cases squamous cell carcinoma delayed reconstruction , usually 5 20 days mohs' , performed without significant morbidity excision mohs' wound pathologic examination detect residual disease may especially indicated large recurrent wounds
effect doxycycline associated agents burnetii cells consistently reliable treatment endocarditis resulting chronic burnetii infection , causative agent q fever although certain antibiotics recommended basis vitro activities , results therapy antibiotics often disappointing evaluate whether currently recommended antibiotic susceptibility tests c burnetii give misleading results continued division uninfected cells , thereby resulting dilution infected cells , hence , false picture antibiotic efficacy , blocked cell division antibiotic susceptibility testing cycloheximide using new method , found currently recommended antibiotics treatment q fever , doxycycline , , rifampin , reduce ratio infected cells \( either \) 9 days test hypothesis lack antibacterial activity due antibiotic inactivation low ph c burnetii found , used agents \( chloroquine \) concurrently doxycycline resulted c burnetii infection cells finding seems confirm suspicion acidic conditions c burnetii located inhibit antibiotic activity inhibition reversed vitro agents used
histopathologic spectrum clinically atypical melanocytic nevi ii studies melanoma published erratum appears arch 1990 dec 126 \( 12 \) studied clinically atypical pigmented lesion removed 142 patients newly diagnosed sporadic melanoma specimens categorized type nevus , ie , junctional compound , presence congenital features , degree nuclear presence nuclear enlargement , nuclear , , prominent nucleoli intraepidermal frequency nuclear abnormality graded 1 \( rare cells \) , 2 \( 10 50 cells \) , 3 \( greater 50 cells \) nuclear parameter among lesions , 42 \( 29 6 \) junctional nevi , 74 \( 52 1 \) compound nevi , 14 \( 9 9 \) dermal nevi eighteen percent total either dysplastic nevi \( 23 cases \) malignant melanoma situ \( three cases \) fourteen nevi \( 9 9 \) congenital features 12 junctional 39 compound nevi one dermal nevus exhibited nuclear abnormality , four junctional nevi compared 19 compound nevi sufficient atypia designation dysplastic nevus two nevi congenital features demonstrated nuclear abnormality , clearly thus , among nevi surgically removed clinically atypical lesion study , compound nevi much likely demonstrate nuclear atypia \( dysplasia \) nevi , ie , junctional dermal nevi , nevi congenital features
compound blue nevus variant blue nevus additional junctional dendritic component clinical , histopathologic , immunohistochemical study six cases studied six cases heavily pigmented melanocytic lesions features blue nevi within dermis , additional junctional dendritic component compound variant blue nevus uncommon lesion previously identified distinct histologic entity immunoperoxidase staining protein b distinguished presence melanocytes among numerous within dermis compound variant blue nevus distinguished histologically combined blue nevus , pigmented spindle cell nevus , malignant melanoma , due regressed malignant melanoma six lesions three men three women whose ages ranged 11 51 years \( mean , 31 years \) three lesions located trunk , two extremities , one head mean follow period 47 months \( range , 38 58 months \) , evidence recurrence
surgical treatment cardiac myxomas long term results 1965 1988 , 22 patients underwent 24 operations cardiac myxomas two patients complex myxoma syndrome mitral valve replacement required initial operation 2 patients one patient died perioperatively , 5 others died subsequently 16 surviving patients recently underwent evaluation mean duration 9 years operation ten asymptomatic 6 new york heart association class ii symptoms nine patients continue employed eleven sinus rhythm , 3 permanent pacemakers , 2 chronic atrial arrhythmias echocardiography showed atrioventricular valve insufficiency 3 patients reduced contractility 4 , new tumor recurrences long term prognosis relatively large group patients cardiac myxomas good patients without complex myxoma syndrome recurrence , whereas 2 patients require reoperation mitral valve replacement long term disability chronic arrhythmias infrequent , functional status patients good
left superior vena cava computed tomographic diagnosis surgical implications report 2 cases computed tomography mediastinum demonstrated abnormality originally misinterpreted lymphadenopathy subsequently shown represent left superior vena cava misinterpretation may result errors optimum treatment may complicate surgical exploration mediastinum 2 cases presented radiologists surgeons possibility unusual anatomy
analyzer chronic lymphocytic leukemia b cell leukemias automatic assessment large cells separation chronic lymphocytic leukemia b cell origin chronic b cell leukemias subjective , largely based morphologic features lymphoid cells peripheral blood percentage large cells determined analyzer \( automated blood cell differential analyzer , instruments corp , , ny \) used cell volume variable investigation 70 cases chronic lymphocytic leukemia b cell origin chronic b cell leukemias significant degree correlation percentage large cells diagnosis , although obtained relatively small number cases , suggests method cell volume analysis used improve diagnostic reproducibility chronic b cell leukemia
persistence mucosal gastric carcinomas 8 6 years two patients small gastric carcinoma detected man , refused surgery eight years later , check , partial gastrectomy performed pathologic examination revealed well differentiated adenocarcinoma restricted within mucosa another man , shaped , grossly depressed lesion indicating malignancy present gastric angle , 6 years later agreed partial gastrectomy lesion proved well differentiated adenocarcinoma confined mucosa retrospective examination original biopsy specimen revealed small area adenocarcinoma , presumably overlooked initial examination thus , gastric carcinomas well differentiated type grow extremely slow rate , without extensive spread invasion findings cases contribute knowledge biological behavior gastric carcinomas
tumor atrioventricular nodal region clinical immunohistochemical study autopsy specimens 17 tumors atrioventricular nodal region studied sudden death occurred 14 children adults seven patients history atrioventricular block syncope three tumors incidental findings infants congenital anomalies diaphragmatic agenesis , pulmonary hypoplasia , 's one patient mitral atresia one congenital hydrocephalus , ventricular septal defect , patent ductus arteriosus , coarctation aorta , patent duct third immunohistochemical stains demonstrated strong positivity carcinoembryonic antigen 13 13 cases , b72 3 antigen 5 7 cases , cytokeratin 11 11 cases twenty control cases mesothelial hyperplasia negative b72 3 one showed focal carcinoembryonic antigen staining ultrastructural analysis one case demonstrated short microvilli characteristic mesothelial cells conclude called atrioventricular nodal region mesothelial origin , strong carcinoembryonic antigen positivity occasional positivity b72 3 , antibodies react glycoproteins found derived tissue generally mesothelial tissue conduction system tumors likely congenital rests endodermal origin , associated congenital anomalies , often cause symptoms heart block sudden death
signet ring cell carcinoma ampulla describe variant carcinoma ampulla , , knowledge , previously described classic signet ring cells represented predominant cell type , admixed poorly differentiated tumor cells chromogranin positive findings raise possibility tumor ampulla
impact microinvasion axillary node metastases survival patients intraductal breast cancer rational approach local treatment intraductal breast cancer continues generate considerable debate however , finding invasive component intraductal breast cancer widely regarded appropriate indication axillary node dissection part local treatment staging disease despite view , natural history patients intraductal breast cancer foci microinvasion poorly defined 1965 1988 , 41 patients pathologic finding intraductal carcinoma foci microinvasion seen medical center twenty three patients presented mammographic abnormalities , 17 patients presented palpable mass one patient presented paget 's disease nipple thirty three patients underwent axillary node dissection part local treatment lymph node metastases identified median follow 37 patients 47 months local recurrences deaths recurrent breast cancer intraductal breast cancer associated microinvasion appears extremely favorable lesion minimal risk nodal metastases
autologous bone marrow transplantation high risk remission lineage acute lymphoblastic leukemia using plus 4 marrow purging fourteen patients high risk lineage acute lymphoblastic leukemia \( \) complete remission underwent autologous bone marrow transplantation \( bmt \) attempt eradicate residual disease burden combined protocol using cocktail two directed cd5 cd7 lineage differentiation antigens combination vitro active cyclophosphamide 4 cyclophosphamide \( 4 hc \) used autografts despite high dose pretransplant effective purging autografts , 9 14 patients relapsed median 2 5 months \( range , 1 2 16 8 months \) post bmt two patients remain alive disease free 26 28 months post bmt used novel quantitative minimal residual disease \( \) detection assay , combines fluorescence activated flow cytometry cell leukemic progenitor cell \( lpc \) assays , analyze remission bone marrow \( bm \) samples lineage patients presence residual notably , high numbers residual lpc detected remission bm bmt constituted poor prognostic indicator , providing first evidence biologic significance clinical value vitro lineage lpc assays median value residual leukemia burden bmt , approximately 8 6 x 10 \( 3 \) lpc 10 \( 8 \) mononuclear cells \( \) \( approximately 0 lpc \) patients residual leukemia burden less median value appeared better remaining free relapse autologous bmt patients greater leukemia burden \( 53 25 v 14 13 , p 006 , mantel cox \) comparison , log kill efficacy purging , remaining numbers lpc purged autografts , estimated numbers lpc , correlate probability disease free survival \( \) results indicate primary reason recurrence leukemia inefficient pretransplant rather inefficient purging autografts
human basophils express interleukin 4 receptors interleukin 4 \( il 4 \) , lymphokine play important role regulation immune responses , variety hemopoietic target cells specific cell surface membrane receptors present study designed investigate whether human basophils express il 4 binding sites purpose , basophils enriched homogeneity \( 93 98 , respectively \) peripheral blood two chronic granulocytic leukemia \( \) donors using cocktail monoclonal antibodies \( moabs \) complement purified basophils bound 125i radiolabeled recombinant human \( rh \) il 4 specific manner quantitative binding studies scatchard plot analysis revealed presence single class high affinity il 4 binding sites \( 280 40 sites per cell donor 1 640 45 sites per cell donor 2 \) apparent dissociation constant , kd , 7 12 x 10 \( 11 \) 2 29 x 10 \( 11 \) 9 55 3 5 x 10 \( 11 \) mol l , respectively f , human basophil precursor cell line , found express single class 810 1 , 500 high affinity il 4 binding sites kd 2 63 5 54 x 10 \( 10 \) mol l change numbers binding constants il 4 receptors found exposure f cells rhil 3 \( potent activator basophils \) 60 minutes effect rhil 4 3h thymidine uptake , release synthesis histamine , expression basophil differentiation antigens \( 1 , , cd25 , , \) primary human basophils f cells observed
developmental regulation granulocytic cell binding \( hn \) , component bone marrow \( bm \) extracellular matrix promotes adhesion cells granulocytic lineage , purified near homogeneity tested ability mediate attachment normal leukemic cells granulocytic lineage purified hn immobilized plastic substrates promoted serum free attachment normal granulocyte macrophage progenitor cells \( cfc gm \) , using situ attachment assay cell attachment inhibited specific polyclonal antisera unfractionated bm cells allowed purified hn stained situ , hn preferentially bound cells earlier stages granulocytic differentiation observations confirmed using cells hl 60 cell line differentiation stage specific binding hn hn promoted attachment 60 hl 60 cells arrested stage , whereas 15 hl 60 cells attached plastic 4 attached plastic coated equal microgram quantities bovine serum albumin \( bsa \) hl 60 cells induced differentiate along granulocytic pathway incubation \( dmso \) , attachment reduced thus , primary bm granulocytic cells granulocytic cell line show preferential attachment cells earlier stages differentiation regulated binding suggests mechanism release bm peripheral circulation
human macrophage colony stimulating factor induces macrophage colonies l phenylalanine treatment human marrow macrophage colony stimulating factor \( csf \) well known effects murine bone marrow , colony stimulating activity human bone marrow controversial treatment human bone marrow l phenylalanine \( pme \) , macrophage colonies \( cfu \) induced csf dose dependent fashion optimal concentration recombinant human macrophage colony stimulating factor \( rhm csf \) 1 , 000 u ml purified human urine csf colony stimulating activity similar rhm csf studies performed determine factors responsible enhanced cfu formation pme treated marrow compared iron monocyte depletion methods , pme eliminated significantly monocytes myeloid cells observation suggested cells may release hematopoietic inhibitory factors cfu low concentrations \( 1 \) normal \( 10 \) concentrations blood monocytes inhibitory \( mean inhibition , 48 \) cfu high concentrations monocytes \( 50 \) augmented cfu colonies hl 60 conditioned media used simulate secretory products early myeloid cells hl 60 conditioned media \( 1 \) inhibited cfu formation granulocyte macrophage granulocyte colonies conclude csf colony stimulating activity human marrow recognized removal inhibitory cells pme treatment
new type bcr abl junction philadelphia chromosome positive chronic myelogenous leukemia new rare type bcr abl junction exon c3 3' portion bcr gene abl exon 2 identified leukemic cells two ph1 positive chronic myelogenous leukemia patients chronic phase fourth type bcr abl junction far identified ph1 positive hematologic malignancies consequence unusual breakpoint position chromosome 22 falls approximately 20 kb downstream major breakpoint cluster region \( bcr \) bcr gene new hybrid mrna 540 base pairs \( bp \) longer expressed k562 cell line could bcr abl protein carrying 180 additional respect larger protein far identified hematologic phenotype expressed two patients carrying unusual type bcr abl rearrangement significantly differ commonly seen chronic myelogenous leukemia
autologous bone marrow transplantation multiple myeloma identification prognostic factors multiple myeloma remains universally fatal malignancy median survival time exceeding 3 years clinical trial undertaken determine feasibility efficacy marrow ablative chemoradiotherapy supported autologous bone marrow \( abmt \) define prognostic variables total body irradiation either melphalan administered 55 patients \( median age 53 years range 20 66 years \) group 21 patients resistance standard melphalan prednisone continuous infusions vincristine adriamycin high dose dexamethasone \( vad \) included 7 primary unresponsive disease 14 resistant relapse among 34 patients achieving remission vad regimen , 14 first 20 subsequent remission marked cytoreduction greater equal 75 observed among 21 patients refractory myeloma , whereas cytoreduction magnitude noted 56 34 patients already remission vad five 6 early deaths among 55 patients occurred 14 patients resistant relapse , none achieved complete remission , group , median durations relapse free overall survival 8 7 months , respectively among 41 remaining patients , one early death , 27 achieved complete remission including 36 incidence among 14 patients treated first remission projected 4 year survival rate 82 regardless disease status \( first later remission primary resistance \) information sensitivity prior therapy , presence abmt high beta 2 microglobulin levels \( greater 3 mg l \) non igg helped identify 9 among 55 patients poor prognosis 8 responders relapsed within 9 months , 8 patients died within 15 months contrast , 4 year projected survival rate 70 patients \( 80 series \) investigation novel treatment approach comparison standard dose regimens results indicate marrow ablative therapy cannot recommended myeloma patients resistant relapse combination risk factors \( advanced tumor burden , absence igg \) apparent lack adverse effect even marked autografts \( 30 \) emphasizes need better cytoreduction rather bone marrow purging
induction donor type chimerism murine recipients bone marrow allografts different radiation regimens currently used treatment leukemia patients three radiation protocols currently used treatment leukemia patients bone marrow transplantation \( bmt \) investigated murine model \( c57bl 6 c3h \) bm allograft rejection include \( \) single dose total body irradiation \( 8 5 gy tbi delivered dose rate 0 2 gy min \) , \( b \) fractionated tbi \( 12 gy administered six fractions , 2 gy twice day 3 days , delivered dose rate 0 1 gy min , \( c \) hyperfractionated tbi \( 14 4 gy administered 12 fractions , 1 2 gy three times day 3 days , delivered dose rate 0 1 gy min \) donor type chimerism 6 8 weeks bmt hematologic reconstitution day 12 bmt found groups compared results obtained mice conditioned 8 gy tbi delivered dose rate 0 67 gy min , routinely used murine model results parameters showed marked advantage single dose 8 5 gy tbi treatments advantage found equivalent three fourfold increment bm inoculum compared hyperfractionated radiation , afforded least favorable conditions development donor type chimerism fractionated radiation protocol equivalent efficacy results obtained mice irradiated single dose 8 gy tbi , afforded smaller significant advantage hyperfractionated protocol model also used test effect radiation dose rate development donor type chimerism significant enhancement found increase dose rate 0 1 0 7 gy min enhancement could achieved dose rate increased 1 3 gy min , survival high dose rate reduced results demonstrated indirectly dose rate affects expression host type pluripotent stem cells , progeny appear 3 6 weeks treatment 8 gy tbi delivered dose rate 0 1 gy min , eradicated radiation delivered dose rate 1 3 gy min
contamination peripheral blood stem cell harvests circulating neuroblastoma cells peripheral blood stem cells \( \) used one alternative autologous marrow rescue patients neuroblastoma solid malignancies physicians prefer use less risk tumor contamination believed exist hypothesis evaluated analysis blood samples concurrently drawn bone marrow \( bm \) samples harvests obtained 31 patients disseminated neuroblastoma found circulating neoplastic cells 75 specimens analyzed diagnosis , 36 therapy , 14 harvests tumor cells blood obtained therapy appear 3 months time diagnosis clearance circulating neuroblastoma cells documented two courses induction chemotherapy six 13 patients minimal bm disease positive blood specimens conclude substantial risk tumor contamination pb harvests exists recommend induction chemotherapy administered hematopoietic progenitor cells collected blood
metabolic changes human breast carcinogenesis malignant breast tissue characterized morphological metabolic changes compared normal breast tissue study , cytochemical measurement glucose 6 phosphate dehydrogenase \( g6pd \) activity used detect abnormal metabolism breast tissue determine whether abnormal metabolic activity precedes morphological change human breast carcinogenesis normal benign breast tissue , morphologically normal tissue cancer containing breasts , malignant breast tissue studied malignant tissue , mean \( e \) g6pd activity significantly increased compared normal benign tissue \( 9 69 \( 2 3 \) versus 27 02 \( 1 7 \) mean integrated \( \) x 100 , p less 0 01 \) g6pd activity increased morphologically normal tissue cancer containing breasts compared normal benign breast tissue breasts known cancer \( 27 02 \( 1 7 \) versus 18 42 \( 2 6 \) x 100 , p less 0 05 \) findings suggest metabolic abnormalities precede morphological changes breast carcinogenesis abnormal metabolism detected widely within cancer containing breast detection abnormality may prove helpful identifying patients high risk developing breast cancer
endoscopic screening early esophageal cancer dye method patients head neck cancers poor prognosis esophageal cancer could improved lesions detected early stage detect early esophageal cancer , endoscopic screening esophagus dye method performed patients head neck cancers asymptomatic regarded high risk synchronous metachronous esophageal cancer 178 patients screened , 9 esophageal cancer \( 5 1 \) eight patients \( 89 \) early stages lymph node metastasis lesions \( 9 13 lesions \) detectable barium studies ordinary endoscopic study epidemiologic statistical analysis patients confirmed significantly high observed expected number \( e \) ratio \( 39 7 p less 0 001 \) results demonstrate value endoscopic screening esophagus dye method patients head neck cancers imply endoscopic screening dye method may useful detecting early esophageal cancer individuals risk causes
surgical treatment brain metastases malignant melanoma authors report results retrospective review 13 patients underwent 19 resection metastatic malignant melanoma university colorado \( denver , co \) 1983 1989 preoperative evidence extracranial disease 11 patients eight patients one intracranial metastasis operation intraoperative ultrasound used 18 19 minimize surgical trauma brain 30 day mortality zero 30 day morbidity minimal patient acquired new neurologic deficit result surgery patients regained least preoperative level functioning six patients living time review followed 4 25 months \( median , 7 5 months \) seven patients dead time review survived 4 18 months \( median , 10 months \) results compare favorably survival untreated patients metastatic melanoma brain \( median , 1 month \) , patients treated radiation therapy alone \( median , 2 4 months \) , treated chemotherapy alone \( median , 2 4 months \) excision metastatic melanoma brain , although curative , may increase survival patients problem little morbidity mortality even presence metastases
loss expression blood group antigen h associated cellular invasion spread oral squamous cell carcinomas membrane bound carbohydrates may influence metastatic behavior cancer cells forty two squamous cell carcinomas \( scc \) buccal maxillary alveolar mucosa studied retrospectively using monoclonal antibody \( \) reacts blood group h \( type 2 chain \) structure immunoperoxidase \( avidin biotin peroxidase complex \) staining technique h antigen staining within entire tumor correlate stage tumor , e , tumor spread however , loss staining within invasive sites tumors correlated significantly stage tumor development histologic grade malignancy findings support view features regarding cells deeper parts carcinomas important clinical behavior tumors loss h antigen expression related stage tumor invasion carcinoma cells
occurrence beta breast cancer patients residues \( \) neutral compounds breast fat 44 breast cancer patients 33 women free cancer determined statistically significant differences appeared two comparison groups regard occurrence compounds neutral compounds , residues beta \( \) found frequently breast cancer patients adjusting age parity stepwise logistic regression , beta remained significant risk factor breast cancer using cutoff point residue level beta breast adipose tissue 0 1 mg kg fat , odds ratio 10 51 \( 95 ci , 2 00 55 26 \)
cell lineage markers human pancreatic cancer normal pancreas consists three major cell types lineages share common embryologic origin pluripotent endodermal precursors type cell undergoes neoplastic transformation form pancreatic carcinoma controversial may influence phenotype biologic behavior tumor study , immunohistologic techniques used determine cell lineage differentiation expressed 29 primary exocrine pancreatic adenocarcinomas , five metastatic exocrine pancreatic adenocarcinomas , five islet cell specimens normal pancreas chronic pancreatitis used comparison cell lineage markers consisted monoclonal polyclonal antibodies trypsin lipase \( acinar cells \) secretory component , carbonic anhydrase ii , pancreatic cancer mucin span 1 \( ductal cells \) chromogranin somatostatin \( islet cells \) expression carcinoembryonic antigen \( cea \) lysozyme also determined collection markers allowed differentiation acinar , ductal , islet cells normal pancreas chronic pancreatitis specimens expression cell lineage markers islet cell tumors homogeneous restricted chromogranin contrast , expression markers primary metastatic exocrine pancreatic adenocarcinomas variable reactivity monoclonal anti cea absent normal pancreas , present 83 chronic pancreatitis specimens well 90 exocrine pancreatic adenocarcinomas addition , lysozyme reactivity absent normal pancreas however , lysozyme expressed one case chronic pancreatitis , 17 cases primary carcinoma , three cases metastatic carcinoma findings support concept original transformed cell type many pancreatic exocrine carcinomas resemble endodermal stem cells retain capability differentiation along one cell lineage pathway
expression pancreatic secretory trypsin inhibitor gene human colorectal tumor expression pancreatic secretory trypsin inhibitor \( psti \) gene examined northern blotting analyses 31 human colorectal tumors included two benign adenomas 26 adenocarcinomas among total 28 cases proved adequate mrna analyses , one showed expression psti various levels contrast , psti expression detected two malignant lymphomas rectum level psti expression correlated patient 's age , sex , tumor location size , stage differentiation , lymph node metastasis , progression stage colorectal adenocarcinomas also shown express genes human cdna probe though tumors , protease \( \) inhibitor produced simultaneously part cellular self defense mechanism
physical state human papillomavirus 16 dna cervical carcinoma cervical intraepithelial neoplasia cervical carcinomas cervical intraepithelial \( cin \) analyzed presence human papillomavirus \( hpv \) dna using southern blot hybridization five hpv types examined \( hpv types 6 , 11 , 16 , 18 , 33 \) , hpv 16 dna detected frequently hpv 16 positive carcinomas examined , hpv 16 dna present integrated state cellular dna without coexistence species one case , however , species detected among seven cases hpv 16 positive cin , four contained hpv 16 dna state rest contained hpv 16 dna integrated state , coexistence states found results suggest integration hpv 16 dna necessary cells become malignant , although frequently associated malignant cells
distribution immunoglobulins secretory component gastric cancer aged secretory immune system plays important role local humoral immunity gastrointestinal tract order evaluate humoral immunity gastric cancer , distribution immunoglobulins \( ig \) secretory component immunohistochemically studied 74 early 15 advanced primary gastric cancers non cancerous gastric mucosa , iga igm , secretory component mainly identified cytoplasm intestinal metaplasia early gastric cancer well differentiated type , localization iga igm , secretory component similar intestinal metaplasia advanced gastric cancer , observed showed low positivity number ig containing cells infiltrating cancerous stroma enumerated immunoglobulin containing cells dominant stroma early gastric cancer hand , ig containing cells stroma advanced gastric cancer , number iga containing igm containing cells also decreased results suggest local humoral immunity suppressed gastric cancer , especially advanced gastric cancer
giant cell tumor bone clinicopathologic dna flow cytometric analysis flow cytometric dna analysis performed 60 cases giant cell tumor bone results correlated clinicopathologic features tumors studied 31 men 29 women whose ages ranged 18 62 years \( median , 29 years \) common sites distal end femur proximal end tibia , accounting 75 lesions treatment consisted resection 29 patients \( 48 \) , curettage bone packing 15 patients \( 25 \) , curettage cement packing 16 patients \( 27 \) ten patients \( 17 \) local relapse within 1 3 years , two lung metastases forty two patients \( 70 \) exhibited tumors diploid dna content , 16 aneuploid \( 27 \) , two tetraploid \( 3 \) six \( 37 5 \) aneuploid patients relapses one treated resection tumor five curettage remaining ten \( 62 5 \) aneuploid patients , nine treated resection tumor one curettage four 42 diploid patients \( 9 5 \) relapses treated curettage tumor two tetraploid tumors treated resection none relapsed histologic parameters correlate relapse rate dna pattern although relapse common among aneuploid tumors , study shows appears influenced treatment modality rather ploidy status based study dna analysis giant cell tumor bone limited utility predicting tumor 's biologic behavior
hyperthermia alone treatment recurrences malignant tumors experience 60 lesions localized hyperthermia alone used treatment cancer recurrences previous conventional therapies failed since 1983 1988 , 57 patients 60 lesions means microwave radiofrequency system treatment protocol provided 45 minutes heating temperature least 42 degrees c , twice week , total number six , eight , ten heating sessions invasive performed lesions complete response \( cr \) obtained ten cases \( 16 6 \) partial response \( pr \) 14 \( 23 4 \) higher rates cr observed chest wall \( 38 5 \) compared head neck area \( 11 4 \) , trunk \( 10 \) , limbs \( none \) adenocarcinoma responsive histologic type \( 40 \) squamous cells carcinoma 7 7 cr case undifferentiated carcinoma showed cr none five sarcomas long term local control \( 24 months \) approximately 7 multivariate analysis showed statistical significance histologic variety \( adenocarcinoma versus others , p less 0 0001 \) side effects complications treatment minimal
clear cell adenocarcinoma lower genital tract correlation mother 's recall diethylstilbestrol history obstetrical records written obstetric records maternal exposure diethylstilbestrol \( des \) used criterion standard compared des exposure history recalled mothers women vaginal , cervical , vaginal clear cell adenocarcinoma among cervical cases , sensitivity maternal recall 50 \( n 2 \) , specificity 100 among vaginal vaginal cases , sensitivity 72 specificity 60 majority mothers said take des des positive written records thus investigators avoid using maternal recall alone measure des exposure among subjects written maternal obstetric records available , 88 vaginal cases 46 cervical cases des positive authors conclude cases vaginal clear cell adenocarcinoma occur young women cohort women exposed utero des continues age , whereas cases cervical origin may continue occur
multiple spinal metastases isolated vertebral body metastases exceedingly rare reported occur presence active primary tumor neck , local recurrence , widespread metastases unique case carotid body tumor \( \) reported following features \( 1 \) multiple vertebral body metastases \( c6 , , l3 \) presenting spinal cord compression , evidence local recurrence metastatic disease \( 2 \) absence mitoses original specimen metastatic \( 3 \) prolonged interval \( 9 years \) development symptomatic metastases
cancer families children soft tissue sarcoma cancer experience among first degree relatives \( mothers , fathers , siblings \) population based series 177 children soft tissue sarcoma reported current study represents extension earlier work authors found excess breast cancer mothers 143 children 40 cancers among first degree relatives , compared 24 82 expected \( relative risk rr 1 61 , p 0 006 \) excess fathers , excess borderline significance seen mothers \( rr 1 67 , p 0 \) , significant excess siblings \( rr 4 55 , p 0 0002 \) , mainly due carcinoma breast pediatric tumors results step forward cox multivariate analysis identified three variables index child independently associated high cancer risk relatives , follows age younger 24 months diagnosis histologic type , embryonal rhabdomyosarcoma unspecified soft tissue sarcoma male sex possible , therefore , identify subgroup children whose relatives high risk early onset cancer \( rr group 10 14 \) pattern cancers consistent li fraumeni syndrome authors conclude marked proportion childhood soft tissue sarcoma genetic basis
cholecystectomy right colon cancer puerto rico case control study undertaken evaluate possible relationship cholecystectomy right colon cancer two hundred patients adenocarcinoma ascending colon \( diagnosed 1984 1989 \) compared 200 matched controls cholecystectomy history obtained interviews using structured questionnaires subsequently validated hospital records statistically significant association \( odds ratio 2 14 \) found right colon cancer history prior cholecystectomy altered bile metabolism occurs removal gallbladder may carcinogenic effect right colon dietary habits colon cancer patients study consistent prior reports literature , showing group lower intake vegetables cereal fiber control population
concomitant cisplatin chemotherapy radiotherapy advanced mucosal squamous cell carcinoma head neck long term results radiation therapy oncology group study 81 17 one hundred twenty four eligible patients advanced mucosal squamous cell carcinoma head neck entered pilot study concomitant cisplatin \( 100 mg m2 given every 3 weeks three doses \) standard irradiation initial complete response \( cr \) 71 additional two cases salvaged surgery overall 73 cr keratin identified histologic specimen \( 41 patients \) cr 90 nasopharynx showed best cr \( 89 \) among sites 4 years treatment , estimated locoregional tumor control rate 43 survival , 34 keratin present specimen , estimated locoregional control tumor superior \( 56 versus 38 keratin identified , p 0 02 \) estimated survival also superior \( 48 versus 26 , p 0 008 \) acute treatment related toxicities included one death due renal damage two patients life threatening renal damage delivery radiotherapy altered late toxicity included necrosis 3 , fibrosis 4 , one fistula results study justify randomized trial comparison combination cisplatin radiotherapy versus radiotherapy alone advanced mucosal carcinomas head neck
final report french multicenter phase ii study nitrosourea 153 evaluable patients disseminated malignant melanoma including patients cerebral metastases one hundred sixty nine patients histologic evidence disseminated malignant melanoma , including patients cerebral metastases , entered phase ii study nitrosourea treatment regimen consisted 100 mg m2 1 hour iv infusion every week 3 consecutive weeks , followed 4 5 week rest period \( induction therapy \) responding stabilized patients , maintenance therapy consisted 100 mg m2 every 3 weeks disease progressed one hundred fifty three patients evaluable response three complete responses 34 partial responses observed \( according world health organization criteria \) , leading objective response rate 24 2 \( 95 confidence interval 17 4 31 0 \) responses also documented cerebral \( 25 0 \) , visceral \( 19 2 \) , \( 31 8 \) metastatic sites median duration response 22 weeks \( range , 7 80 weeks \) objective response rate previously untreated patients 30 7 \( 19 62 patients \) main toxicity hematologic delayed reversible leukopenia objective response rate observed \( especially untreated patients \) , activity cerebral metastases , small amount extra hematologic toxicity encountered suggest effective drug disseminated malignant melanoma
treatment advanced neuroblastoma emphasis intensive induction chemotherapy report study group japan one hundred nine newly treated patients advanced neuroblastoma entered study january 1985 may 1989 eligible patients included infants younger 12 months age stage disease \( bone cortex , distant lymph node , remote organ metastases \) patients aged 12 months older stage iii iv disease \( plus tumor crossing mid line metastases confined bone marrow , liver , skin \) patients first received six cyclic course intensive chemotherapy \( regimen a1 \) , consisting cyclophosphamide \( 1200 mg m2 \) , vincristine \( 1 5 mg m2 \) , adriamycin \( 40 mg m2 \) , cisplatin \( 90 mg m2 \) original tumors regional lymph node metastases removed time first six cycles chemotherapy patients divided three groups patients course 1 received alternating treatment regimen b \( cyclophosphamide \) intensified regimen a1 , course 2 treated alternating administration regimen c \( cyclophosphamide \) intensified a1 patients course 3 treated bone marrow transplantation \( bmt \) preceded high dose preconditioning chemotherapy survival rates 77 stage iii 54 stage iv 2 years , 70 stage iii 45 stage iv 3 years major toxicities encountered bone marrow suppression leukocyte counts 100 mm3 , mild cystitis , hearing impairment 2 year survival rate 78 21 patients underwent bmt complete remission achieved concluded intensive induction chemotherapy significant value increasing rate complete response , widening indications achieving improved results treatment bmt
impaired production tumor necrosis factor breast cancer spontaneous lipopolysaccharide \( lps \) induced production tumor necrosis factor \( tnf \) peripheral blood macrophages investigated breast cancer whereas spontaneous tnf production macrophages derived patients breast cancer comparable one found healthy controls \( p greater 0 1 \) , lps stimulated macrophages derived patients disease free interval well metastatic breast cancer found produce significantly lower amounts tnf , compared macrophages derived healthy control individuals \( p less 0 0005 \) however , production tnf significantly differ two patient populations \( p greater 0 05 \) impairment lps induced tnf production depend upon characteristics primary tumor size , axillary lymph node estrogen receptor status , upon fact administration adjuvant chemotherapy , patients metastatic disease , hormone treatment investigate cytokine production macrophages , spontaneous lps induced interleukin 1 \( il 1 \) production investigated also however , difference found patients controls concerning il 1 generation authors thus conclude lps induced tnf production impaired breast cancer independent presence detectable metastatic disease , whereas il 1 production remained unimpaired
medroxyprogesterone acetate lowers plasma corticotropin cortisol suppress anterior pituitary responsiveness human corticotropin releasing factor endocrine action medroxyprogesterone acetate \( mpa \) claimed glucocorticoid like nature upon clinical observation , mpa shown improve life quality overall well patients advanced breast cancer , renal carcinoma , prostatic carcinoma , uterine adenocarcinoma authors evaluated mpa endocrine action administration human corticotropin releasing factor \( \) 90 minute assay 15 patients advanced breast cancer renal cell carcinoma , initiation oral high dose mpa treatment \( 1000 mg mpa \) well least 10 days therapy curves corticotropin , beta endorphin , cortisol responses tumor patients tested initiation mpa treatment parallel curves healthy control group probands tested equal conditions , although significantly higher respective hormone levels patients malignant disorders assayed mpa administration , basal peak hormone levels found comparable values obtained healthy controls conclusion , mpa appeared act level since pituitary responsiveness preserved mpa treatment moreover , appeared mpa brought hormonal stress state found patients malignant tumors back normal
sialosyl tn novel mucin antigen associated prognosis colorectal cancer patients colon cancers typically produce mucin however , known whether tumor mucin plays biological role cancer cell behavior address issue , expression mucin associated antigen , sialosyl tn , examined immunohistochemical study 128 primary colorectal carcinoma specimens 137 patients underwent curative surgical resection antigen expression correlated disease free overall 5 year survival sialosyl tn antigen expression occurred 112 \( 87 5 \) tumors , independent age , gender , tumor location , dukes' stage , depth invasion , degree differentiation , ploidy status survival 5 years patients sialosyl tn negative versus sialosyl tn positive tumors 100 versus 73 \( p less 0 05 \) disease free survival 94 versus 73 , respectively \( p 0 12 \) although advanced dukes' stage , deeper invasion , aneuploidy associated poorer overall 5 year survival , antigen negative tumors within groups much better prognoses antigen positive tumors multivariate regression analysis revealed tumor ploidy \( p less 0 001 \) sialosyl tn expression \( p less 0 05 \) two variables importance predicting disease free overall survival authors conclude sialosyl tn expression independent predictor poor prognosis colon cancer , therefore suggest qualitative mucin alterations may reflect important differences biological behavior neoplasms
increased expression multidrug resistance gene undifferentiated sarcoma analyzed multidrug resistance gene \( mdr1 gene \) expression patient undifferentiated sarcoma liver using cloned cdna mdr1 gene tissue samples available time initial diagnosis two intracranial relapses chemotherapy regimen including doxorubicin teniposide level mdr1 gene expression increased intracranial tumor time first relapse 11 fold second relapse case may example acquired multidrug resistance associated overexpression mdr1 gene
intraoperative pathologic diagnosis thyroid neoplasms report experience 504 specimens intraoperative pathologic examination frozen section \( fs \) performed 504 specimens thyroid tissue obtained 457 patients period 9 years examination permanent sections \( ps \) malignant neoplasm diagnosed 57 specimens \( 11 3 \) 50 \( 87 \) primary thyroid carcinoma , four \( 8 \) metastatic carcinoma , three \( 5 \) malignant lymphoma fs diagnosis benign \( 88 9 \) , malignant \( 30 \) 5 9 , deferred 26 \( 5 2 \) sensitivity fs diagnosis malignancy 53 specificity positive predictive value 100 negative predictive value 97 8 overall accuracy 97 9 ps disclosed malignant neoplasm 62 specimens fs diagnosis deferred sixty eight percent papillary carcinomas , 87 undifferentiated carcinomas , single case medullary carcinoma diagnosed fs examination fs diagnosis malignancy made ten specimens containing follicular carcinoma ten neoplasms well differentiated eight encapsulated minimally invasive inability diagnose follicular carcinoma intraoperatively fs significant factor accounting relatively low sensitivity fs diagnosis malignant thyroid neoplasms
cerebral tumor staging patients bronchial carcinoma computed tomography computerized tomographic \( ct \) scans 271 patients histologically proven bronchial carcinoma accomplished initial tumor staging retrospectively evaluated signs cerebral metastasis results histologic subtypes quite different 13 8 patients small cell carcinoma limited disease authors found signs brain metastasis however , routine cerebral staging patients seem useful lack therapeutic consequences hand , patient non small cell carcinoma \( n scc \) tumor stage ii brain metastases patients brain metastasis n scc classified tumor stage iii cerebral imaging among patients , however , authors found brain metastasis 17 5 without known distant metastatic disease \( iii \) , especially large cell carcinoma adenocarcinoma stage iii patients undergo routine cerebral imaging tumor surgically resectable thoracotomy planned
infiltration dendritic cells relation tumor invasion lymph node metastasis human gastric cancer infiltration dendritic cells determined 210 patients gastric carcinoma investigated standpoint tumor invasion , lymph node metastasis , prognosis dendritic cell infiltration graded slight marked 39 frequency marked infiltration group mucosal stage change proportion invasion deeper layers 5 year survival rate 60 4 patients marked infiltration 38 8 slight infiltration , statistically different \( p less 0 01 \) difference survival rates statistically significant cancer emerging serosa \( p less 0 001 \) similar incidence lymph node metastasis marked slight infiltration groups grade tumor invasion however , marked infiltration dendritic cells prevented widespread nodal involvement beyond primary node cases advanced carcinoma \( p less 0 05 \) findings indicate infiltrating dendritic cells prevent spread tumor invasion prevent nodal involvement therefore , patients gastric cancer emerging serosa , prognosis good
familial occurrence gastric cancer 2 year experience population based registry authors studied familial occurrence tumors 154 individuals gastric cancer reviewing clinical data tree patients registered 1986 1987 local health care district , italy , cancer stomach crude age adjusted \( world population \) incidence rates gastric cancer 34 0 21 4 new cases 100 , 000 year , respectively , men , 24 5 10 9 women , respectively among first degree relatives registered patients 30 cases gastric carcinoma versus 15 cases control group matched age sex \( mantel odds ratio h 3 14 , p less 0 01 \) excess gastric neoplasms observed siblings \( 17 versus 7 , h 4 33 , p less 0 02 \) parents \( 13 versus 8 , significant \) besides gastric cancer , significant excess type tumors case families familial occurrence gastric cancer tended frequent patients diffuse carcinoma \( 52 \) subjects intestinal cancer \( 33 \) , although difference statistically significant conclusion , current investigation suggests family history gastric neoplasms usually observed approximately 10 15 registered cases already described common malignancies , therefore , familial occurrence gastric carcinoma suggests existence genetic susceptibility cancer stomach , least fraction patients
complications associated limb salvage extremity sarcomas management retrospective clinical review 100 consecutive patients extremity sarcomas managed limb salvage operations performed evaluate local tumor control morbidity mean follow period 45 1 months overall survival 86 local recurrences 3 patients , 26 complications 22 patients wound necrosis frequent complication failure allogeneic bone graft operations occurred 25 patients complications salvageable without loss limb limb salvage acceptable surgical treatment extremity sarcomas based adequate local control minimal morbidity
leiomyoma digital artery benign , soft tissue masses hand common vascular leiomyoma unusual tumor smooth muscle origin 62 year old man , tumor arose within digital artery persistent symptoms prompted excisional biopsy , requiring resection portion artery adequate collateral circulation need vascular graft vascular repair grafting may necessary collateral circulation adequate
survival patients large bowel cancer population based investigation melbourne colorectal cancer study five year survival data obtained 97 percent new patients histologically confirmed colorectal adenocarcinoma 12 month period 1981 1982 , part large comprehensive population based study colorectal cancer incidence , etiology , survival , melbourne colorectal cancer study fifteen percent patients dukes' stage , 32 percent dukes' b , 25 percent dukes' c , 29 percent dukes' five years diagnosis , observed survival rate 36 percent adjusted rate 42 percent dukes' staging highly discriminating factor survival \( p less 0 001 \) survival rates better women men better patients colon cancer patients rectal cancer survival dukes' staging affected colon subsite tumor first single tumor , metachronous tumor , synchronous tumor survival younger patients better dukes' stages , b , c , worse dukes' survival worse presence bowel perforation dukes' c stages within dukes' \( incurable cases \) , survival best absence hepatic metastases , slightly worse hepatic metastases present , poorest presence hepatic extrahepatic metastases statistical modeling survival determinants staging indicated cell differentiation largest effect \( survival decreasing poor cell differentiation \) , followed site \( survival worse rectal cancer colon cancer \) , age \( survival better younger patients \) , bowel perforation smallest effect survival
early gastric cancer endoscopic diagnosis depth invasion order treatment strategy gastric cancers , accurate preoperative evaluation depth cancer invasion essential preoperative endoscopic diagnosis depth invasion compared pathological results resected specimen 206 early gastric cancers 32 early like advanced gastric cancers endoscopic distinction early early like advanced cancers correctly made 83 6 cases among early gastric cancers , mucosal submucosal invasion correctly presumed 71 9 cases tumor elevated type , located antrum , endoscopic diagnosis tended deeper true depth size tumor contributed little depth diagnosis changes tips folds important diagnosing depth
cholecystokinin stimulates growth human pancreatic adenocarcinoma sw 1990 effect synthetic analogue cck \( , 9 \) growth sw 1990 human pancreatic cancer examined two experimental models nude mice bearing sw 1990 pancreatic cancer xenografts injected cck \( 5 , 15 , 25 micrograms kg \) vehicle twice daily 20 days animals sacrificed tumor volume , weight , protein , deoxyribonucleic acid \( dna \) content evaluated sw 1990 cells grown vitro effects cck , secretin , vasoactive intestinal peptide \( vip \) , proglumide \( cck receptor antagonist \) cell number dna synthesis determined highest dose cck , 25 micrograms kg , significantly increased tumor weight , protein content , dna content \( p less 0 005 \) vitro , cck caused significant increases cell counts 47 six days 66 12 days compared control graded concentrations cck biphasic effect dna synthesis significant increases 65 \( p less 0 005 \) cck induced cell proliferation inhibited proglumide secretin slightly increased cancer cell growth , although cck , vip secretin combination cck show potentiation results indicate growth human pancreatic cancers may influenced gastrointestinal peptides , cck potent
prospective study alcohol intake large bowel cancer alcohol intake cohort japanese men directly significantly related risk developing rectal cancer , whether assessed basis amount consumed percent total calories wine directly related rectal cancer , beer alcoholic beverage displays statistically significant dose response \( p 0 008 \) colon cancer risk also related directly alcohol intake , association statistically significant measured percent energy intake suggests alcohol might cancer inhibitors diet calcium , vitamin c , dietary fiber inversely related colon cancer risk cohort , displays statistically significant negative correlation alcohol intake possible positive association alcohol lung cancer ruled adjusting cigarette smoking cancers prostate stomach unrelated alcohol intake , risk acquiring cancer sites combined strongly related alcohol intake
diagnosis metastatic lesions stomach salvage cytology report three cases secondary neoplasms stomach rare often clinical diagnostic problems three patients bleeding like ulcers diagnosed combined endoscopic salvage cytology surgical biopsy metastatic submucosal lesions hematologic spread combination endoscopic appearance , clinical findings , tissue cytologic examination lead correct diagnosis results cases support utility cytologic technique combination biopsy clinical setting
primary non hodgkin 's cell lymphoma esophagus case peculiar endoscopic ultrasonographic pattern report case primary esophageal non hodgkin 's cell lymphoma young white female admission , endoscopy revealed large , shaped , esophageal ulcerations imposed candidiasis endoscopic ultrasonography assess submucosal alterations involvement revealed diffuse thickening \( 5 mm \) esophageal wall , pattern consistent infiltration definitive diagnosis made aid histology immunohistochemistry
complex carbohydrate units human thyroglobulin human thyroglobulin \( htg \) contains sulfate chondroitin 6 sulfate chains complex carbohydrates study sulfate containing complex carbohydrates characterized number sulfate sialic acid residues contain samples normal nodular thyroid tissue incubated 16 h 35s sulfate containing medium , htg purified tissues media complex carbohydrates enzymatically removed htg subsequent analysis hplc anion exchange column ph 2 2 separated carbohydrate units according number negative charges sulfate containing peaks monitored radioactivity , sialic acid containing peaks identified shift lower charge treatment peaks corresponding sialic acid free carbohydrate units one four identified also , carbohydrate units two three negative charges containing sulfate sialic acid present nodular tissue one patient sulfated units higher charge , especially units containing sialic acid patient proportion sulfated units sialic acid 22 4 normal 64 6 nodular tissue difference composition charged units tissues corresponding media seen , making unlikely sulfate containing carbohydrates play role htg release concluded htg contains complex carbohydrate units four sulfate groups units sulfate sialic acid patients , sulfate containing carbohydrate units htg normal nodular thyroid tissue different
detection duodenal gastrinomas operative endoscopic transillumination prospective study ability operative endoscopic transillumination bowel wall detect duodenal gastrinoma evaluated prospectively 26 patients zollinger ellison syndrome results assessed exploratory laparotomy compared results localization techniques twelve duodenal gastrinomas resected 10 patients operative endoscopic transillumination detected 10 12 gastrinomas , sensitivity 83 , significantly greater \( p less 0 05 \) either preoperative imaging \( 25 \) intraoperative ultrasonography palpation \( 42 \) sensitivity operative endoscopic transillumination result ability detect focal areas serosal side duodenum , mucosal appearances seen endoscope , helpful operative endoscopic transillumination detected gastrinomas less 1 cm diameter throughout duodenum patients study , 39 duodenal gastrinomas , greater frequency previously reported results indicate operative endoscopic transillumination sensitive technique yet described detecting duodenal gastrinomas performed routinely patients zollinger ellison syndrome undergo exploratory laparotomy cure
liver fatty acid binding protein marker studying cellular differentiation gut epithelial neoplasms human liver fatty acid binding protein 127 residue cytoplasmic protein synthesized liver intestinal epithelium previous studies normal transgenic mice indicated liver fatty acid binding protein gene sensitive marker differentiation study shows use immunohistochemical methods examine liver fatty acid binding protein gene expression normal human colonic epithelium , colonic adenomas , mucinous adenocarcinomas , several types epithelial neoplasms cells containing liver fatty acid binding protein found normal colonic epithelium , two thirds colorectal adenomas adenocarcinomas , one third mucinous adenocarcinomas , carcinomas liver fatty acid binding protein positive colonic adenomas adenocarcinomas contained patches immunoreactive cells distributed among histologically identical patches cells without liver fatty acid binding protein immunoreactivity also found metastases liver fatty acid binding protein positive colonic adenocarcinomas immunostaining liver fatty acid binding protein positive tissues carcinoembryonic antigen show mosaic cellular pattern expression data suggest within given neoplasm , differences exist differentiation programs derived , malignant colonic epithelial cells liver fatty acid binding protein useful marker defining subpopulations liver fatty acid binding protein also potentially useful diagnostic marker colorectal hepatic carcinomas
performing screening flexible sigmoidoscopy using experience 500 subjects still controversy regarding optimal length flexible performed screening distal colon examinations using 168 cm 500 asymptomatic subjects sigmoidoscopy preparation mean depth penetration 66 cm similar persons examination discontinued poor preparation versus discomfort polyps detected 87 patients , 5 subjects polyps detected 60 cm conclude group subjects scheduled flexible sigmoidoscopy sigmoidoscopy , use instruments longer 60 cm gives little additional yield
insulin like growth factor ii possible local growth factor pheochromocytoma pheochromocytomas , neural crest tumors , express abundance insulin like growth factor ii \( igf ii \) assess potential igf ii play autocrine role tumors , measured 1 \) igf ii content 7 pheochromocytomas peripheral blood patients , 2 \) igf ii receptors western analysis , 3 \) characterized tumor binding proteins ligand blot studies igf ii levels tumors varied 2 8 41 micrograms g chromatography revealed 60 peptide eluted large mol wt form igf ii \( 8 7 10 kda \) remainder mature peptide \( 7 5 kda \) contrast igf ii levels normal adrenal tissue \( 0 225 0 005 micrograms g \) another neural crest derived tumor , medullary carcinoma thyroid \( 0 63 0 02 micrograms g \) serum igf ii levels 7 patients pheochromocytoma \( 71 ng ml \) similar 35 normal controls \( 69 ng ml \) radiolabeled igf ii \( 9 1 \) igf \( 20 2 \) bound specifically pheochromocytoma membranes western analysis membranes using specific antiserum directed type ii receptor demonstrated band 210 kda affinity cross linking studies 125i igf demonstrated specific band 140 kda ligand blot analysis performed void volume pools sephadex g 75 column demonstrated bands 30 25 kda conclusion , data 1 \) confirm pheochromocytomas increased levels igf ii 2 \) demonstrate despite high igf ii concentrations tumors , peripheral levels elevated , suggesting little tumoral igf ii released circulation , unlike catecholamines 3 \) demonstrate presence igf ii igf receptors 4 \) describe binding protein species similar present tissues thus , presence high levels igf ii type type ii receptors suggests igf ii may act receptors alter tumor growth
receptors human astrocytoma cells \( ttr \) , transport protein t4 retinol binding protein , principal t4 binding protein cerebrospinal fluid function regard delivery ligands respects unclear binding 125i ttr cultured human astrocytoma cells studied determine whether cells carry receptors ttr scatchard analysis consistent single class binding sites kd 3 nm significant cross reactivity transferrin serum albumin observed internalization ttr temperature dependent proportional receptor occupancy dilutions cerebrospinal fluid displaced 125i ttr proportion content ttr parallel purified ttr uptake internalization ttr increased presence high t4 t3 concentrations results demonstrate ttr binds specific high affinity receptors human astrocytoma cells receptor binding ttr provides potential mechanism delivery ligands within central nervous system
growth cultured human cerebral meningiomas inhibited dopaminergic agents presence high affinity dopamine d1 receptors found microm concentrations dopamine agonist significantly decrease proliferation rate human meningioma cells culture \( 25 56 inhibition \) effect also seen direct application dopamine , well dopamine d1 agonist \( \) \( applied microm concentrations \) meningioma cell cultures receptor studies dopamine d1 ligand \( 125i \) \( dopamine d1 antagonist \) indicated dopamine d1 binding sites present membranes meningioma tissue mean dissociation constant \( kd \) 325 \( 74 5 sem \) pm receptor density \( \) 25 4 \( 1 5 sem \) fmol mg pellet protein 5 human meningiomas pharmacological specificity proven \( \) , \( \( \) inactive isomers \( \) \( \) 1000 fold excess results provide evidence human meningiomas possess high affinity dopamine d1 receptors dopamine agonists antiproliferative effect tumors culture conclude proliferation cerebral meningiomas may dopaminergic control dopamine agonists may role medical treatment patients meningiomas
endothelin like immunoreactivity human breast cyst fluid immunoreactive endothelin detected 21 43 samples breast cyst fluid \( 21 cases 3 5 0 6 pmol l , mean sem 22 cases detectable , less 0 5 pmol l \) fast protein liquid chromatographic analysis immunoreactive endothelin pooled breast cyst fluid showed two immunoreactive peaks one void volume position endothelin 1 probable endothelin 1 produced epithelial cells lining breast cysts , significance presence endothelin 1 breast cyst fluid remains elucidated
tissue preparation simultaneous flow cytometric quantitation tumour associated antigens dna solid tumours flow cytometric assay simultaneous study tumour associated antigens \( taa \) dna fresh solid tumours devised cell suspensions prepared solid tumour samples mechanically steel mesh indirect immunofluorescence used identify taa , dna stained iodide cell morphology well preserved , cell negligible , high quality indirect immunofluorescence quality indirect immunofluorescence dna staining obtained technique simple , rapid , reproducible assays developed study prognostic indicators membrane , receptors , multidrug resistance solid tumours suitable panel antibodies technique might become aid differential diagnosis biochemical diagnosis solid tumours
cutaneous manifestations cell malignancies description five clinicopathologic subtypes study undertaken identify cutaneous manifestations among different prognostic subgroups cell malignancies cutaneous involvement demonstrated 43 88 cases recognized five clinicopathologic subtypes type , classical cutaneous cell lymphoma \( ctcl \) mycosis fungoides , six cases type ii , primary large cell type ctcl , ki 1 antigen \( ki 1 ki 1 \) , seven cases type iii , primary cell lymphoma , three cases type iv , human lymphotropic virus type \( htlv \) adult cell leukemia lymphoma \( atl \) , eight cases type v , secondary cutaneous involvement peripheral cell lymphoma \( \) , 19 cases primary ctcl atl tend involve papillary dermis without , whereas cell lymphoma predominantly affect skin , vessels , cutaneous lesions type v heterogeneous may confused , vasculitis , eruption classic ctcl , ki 1 lymphoma , cell lymphoma chronic course , whereas atl , ki 1 large cell lymphoma , clinically aggressive
giant eccrine four cases large eccrine \( three benign , one malignant \) reported benign tumors involved lower extremities two women one man \( 73 89 years age \) duration lesions ranged 10 20 years malignant tumor involved left side chest 60 year old man occurrence lesion present 40 years suggested malignant transformation pre existing benign eccrine tumor showed little cellular atypia mitotic rates \( mitotic figures per 10 high power fields \) varied within lesions average mitotic rates differentiate benign malignant tumors important distinguishing features large benign eccrine relative , lack cellular atypia , absence stromal , , invasion
tumor carcinoma tumor anogenital tumor characteristic clinical histologic pattern best considered low grade , well differentiated squamous cell carcinoma remarkable neoplasm features reviewed detail , salient advances understanding
cutaneous melanoma bilateral retinoblastoma report case otherwise healthy 37 year old man bilateral enucleation early childhood bilateral , addition two cutaneous melanomas \( first appearing age 27 years \) also dysplastic melanocytic nevi history cutaneous melanoma mother retinoblastoma may aggregate families associated dna abnormalities chromosome 13 recent reports emphasized appearance second malignancies retinoblastoma survivors second malignancies include osteosarcoma , soft tissue sarcoma , cutaneous melanoma cutaneous melanoma also may aggregate families , usually setting dysplastic melanocytic nevi features case similar reported cases suggest may greater expected association retinoblastoma cutaneous melanoma
oncogenes suppressor genes involvement colon cancer editorial abnormalities oncogenes , broadly classified viral cellular oncogenes , suppressor genes appear critical development colon cancer cellular oncogenes contribute malignant transformation become activated point mutation , translocation , amplification , loss regulator sequences properties , proteins encoded oncogenes essential carcinogenesis , unclear suppressor genes normally suppress tumorigenic phenotype keeping growth cells check inactivation contributes malignant transformation development colon cancer appears take place stepwise accumulation multiple genetic alterations progression normal colon adenoma carcinoma activation ras , early event sequence , found 50 colon cancers overexpression c myc found approximately 80 inactivation suppressor genes , occurs later stages , noted greater 70 tumors current model colonic tumorigenesis presented
liver transplant metastatic neuroendocrine tumor generally , results liver transplantation metastatic liver disease favorable one exception unique group neuroendocrine tumors , slow growth allows liver transplantation effectively control symptoms report two cases \( \) 51 year old man underwent orthotopic liver transplantation resection pancreatic primary tumor malignant neuroendocrine tumor features carcinoid islet cell remains symptom free without evidence tumor recurrence 13 months follow \( b \) 47 year old man underwent orthotopic liver transplantation resection metastatic islet cell tumor head pancreas fully recovered 5 months follow
insulinoma streptozotocin therapy metastatic gastrinoma natural history iatrogenic complication \? islet cell carcinoma frequently produces one chemical product , although clinical expression usually restricted single hormone describe unusual patient presented full blown gastrinoma treated cimetidine five years streptozotocin therapy , resulted regression fall serum gastrin levels following one year 's therapy streptozotocin , admitted hyperinsulinemic hypoglycemic appears first reported case shift clinical gastrinoma insulinoma possibly related prolonged streptozotocin therapy
insulin like growth factor supports proliferation autocrine thymic lymphoma cells pre cell phenotype studied phenotypic characteristics growth properties murine lymphoma cell lines derived primary x ray induced thymic lymphomas earliest stage detected , well spreading organs occurred cell lines serve model systems earliest events cell lymphoma induction , tumor cell progression spreading organs find primary x ray induced cell lymphoma lines phenotypic characteristics thymic pre cells show proliferative response il tested hematopoietic growth factors however , response insulin like growth factor \( igf \) small autocrine peptide distinct igf , term lymphoma growth factor one earliest lesions cell lymphoma induction may therefore inhibition differentiation one several specific points early stages , lymphoma cell growth may restricted environment local concentrations specific growth factors igf lymphoma growth factor sufficiently high
regional systemic distribution anti tumor x anti cd3 antibodies cultured human peripheral blood lymphocytes human colon cancer xenograft anti tumor antibody \( 317g5 \) covalently coupled anti cd3 antibody \( okt3 \) produces \( ha \) antibody target pbl lyse tumor cells expressing appropriate tumor ag v p distribution radiolabeled ha antibody 317g5 x okt3 radiolabeled cultured human pbl studied athymic nude mice bearing solid intraperitoneal tumor established human colon tumor line , mice injected 125i labeled ha antibody , 125i labeled anti tumor mab , 111in labeled pbl , designated tissues harvested measured radioactivity 125i 317g5 x okt3 localized specifically tumor sites tumor radioactivity levels \( percent injected dose gram \) lower 125i 317g5 x okt3 ha antibody 125i 317g5 anti tumor mab , similar levels reported anti tumor mab major difference radioactivity levels observed v p administration 125i 317g5 x okt3 increase hepatic radioactivity v ha antibody administration ha antibodies produced f \( ab' \) 2 fragments , exhibit decreased w decreased fc receptor mediated binding , demonstrated improved tumor tissue ratios compared intact antibody ha 125i 317g5 f \( ab' \) 2 x okt3 f \( ab' \) 2 antibody levels equivalent intact ha antibody levels tumor , lower intact ha antibody levels blood , bowel , liver tumor bowel ratios \( 20 1 48 h \) highest 317g5 f \( ab' \) 2 x okt3 f \( ab' \) 2 injected p autoradiography confirmed anti tumor x anti cd3 ha antibodies localized specifically intraperitoneal tumor p administered ha antibodies tumor directly v administered ha antibodies distributed along tumor vasculature cultured human pbl distributed moderate concentrations intraperitoneal tumor administered p , administered v poor localization v injected pbl tumor may reflect species disparity homing receptors endothelial ligands , problem may overcome syngeneic model results suggest regional therapy ha antibodies pbl may offer advantages systemic therapy initial clinical trials
lymphokine activated killer \( lak \) cells v 8 il 2 sparing agent lak generation guanine , substituted position either group , recently shown regulate several immunologic responses previously shown 8 \( 8mg \) replace requirement cytokines generation mhc restricted ctl paper , examined ability 8mg induce mhc killer cells found 8mg induce significant lytic activity normal resting lymphocytes however , 8mg able minimal amounts il 2 inducing lytic activity similar lymphokine activated \( lak \) nk sensitive nk resistant tumor cells killed precursors 8mg lak activity similar nk cells cd4 cd8 gm1 1 similar il 2 induced lak , 8mg lak 8mg appeared stage precursor lymphocytes become responsive il 2 optimal induction 8mg lak required preincubation 8mg addition il 2 staging appeared due release second signal since readily inhibited cyclosporine anti ifn alpha beta efficient cyclosporine inhibiting 8mg lak generation , whereas anti ifn gamma anti il 1 exhibit significant inhibition findings suggest 8mg possible utility il 2 sparing agent lak generation nk cells
excision repair pyrimidine dimers induced simulated solar radiation skin patients basal cell carcinoma one prominent lesion induced dna ultraviolet \( uv \) radiation pyrimidine dimer formed adjacent dna strand investigated whether people developed basal cell carcinoma sun exposed skin altered ability repair uv induced pyrimidine dimers dna twenty two patients least one basal cell carcinoma , aged 31 84 years , 19 healthy volunteers , aged 25 61 years , took part study groups given one minimal erythema dose \( med \) simulated solar radiation lower back dna extracted irradiated skin 0 6 h later , number uv induced pyrimidine dimers determined using dimer specific endonuclease time 0 , average number dimers per unit dna similar two groups 6 h , average 22 4 dimers removed group basal cell carcinoma compared 33 4 cancer free group basal cell carcinoma group , 23 patients repaired 30 dimers 6 h , compared 53 cancer free subjects \( p less 0 05 \) conclude patients develop basal cell carcinoma sun exposed skin may decreased ability repair pyrimidine dimers induced skin exposed simulated solar radiation
premalignant lesions cancers skin general population evaluation role human papillomaviruses evaluate role human papillomaviruses \( hpv \) development premalignant lesions cancers skin general population , biopsies obtained 227 patients benign neoplasms , premalignant lesions , cancers skin 25 patients squamous cell carcinoma lip analyzed southern blot hybridization dna probes specific various cutaneous genital hpv types used hybridizations conducted stringent conditions hpv dna sequences detected eight specimens obtained six patients hpv 34 one case 's disease , hpv 36 yet hpv two cases keratosis , hpv 20 one case basal cell carcinoma , yet unrecognized hpv one case squamous cell carcinoma , hpv 16 one case squamous cell carcinoma lip none specimens cutaneous horn contained detectable hpv dna contrast , hpv dna sequences , mostly hpv 16 , detected 13 23 cases anogenital 's disease invasive 's carcinoma hpv dna sequences detected 90 cutaneous samples analyzed polymerase chain reaction technique , using amplification primers contain conserved sequences among genomes hpv results strongly suggest known hpv types play minor role , , skin carcinogenesis general population
cytomegalovirus brain vitro infection human brain derived cells models human cytomegalovirus \( \) brain infection developed variety brain derived cells factors governing virus infectivity might studied vitro studies initiated brain endothelial cells , likely portal entry virus central nervous system primary cultures brain endothelial cells , derived homogenates healthy human brain , supported complete viral gene expression cytopathic effect \( \) endothelial cells appear barrier passage central nervous system lines \( primary tumor derived \) varied ability support replication \( t98g \) supported incomplete \( immediate early \) gene expression others \( 172 \) support detectable gene expression lines \( hs \) supported extensive virus replication minimal viral neuronal cell lines \( sk n mc \) fully permissive differentiated glial lines \( astrocytoma \) fully permissive infection however , less differentiated glial lines \( glioblastoma \) partly
alternating vac ineffective end stage squamous cell carcinoma head neck sixteen patients end stage squamous cell carcinoma head neck admitted phase ii study alternating courses \( 100 mg m2 \) vac \( vincristine 1 4 mg m2 , adriamycin 50 mg m2 , cyclophosphamide 750 mg m2 \) given three weekly intervals two patients achieved response \( 12 per cent \) median survival time 62 days much similar group patients received chemotherapy previous trial \( 70 days \)
head neck cancer retrospective study 438 patients evaluate whether age 70 years represents prognostic factor head neck cancer , reviewed cases observed 1981 1984 four hundred thirty eight \( 438 \) patients considered relation three age groups \( less equal 59 , 60 69 , greater equal 70 years , defined non elderly , mid elderly elderly respectively \) main parameters analyzed included histological diagnosis \( difference emerged among three age groups \) anatomical site \( carcinoma frequent non elderly patients \) tnm stage \( higher incidence early stages seen elderly \) performance status \( better non elderly \) previous illnesses \( life style related diseases frequent non elderly \) contraindications surgery \( frequent elderly \) surgical treatment \( resections often employed non elderly \) post operative complications local control \( difference three groups \) multiple primary malignancies \( head neck , oesophagus lung frequent non elderly patients \) survival \( difference \) although age affects several features head neck cancer patients , appear present study independent prognostic factor local control survival regard survival , stage appeared important prognostic factor
prognostic value c myc proto oncogene overexpression early invasive carcinoma cervix prognostic effect c myc oncogene overexpression assessed multivariate analysis 93 patients invasive carcinoma cervix , stage ib , iia , iib proximal treatment based association brachytherapy lymphadenectomy analysis c myc gene expression done using northern slot blot hybridization techniques overexpression c myc \( ie , levels least three times mean observed normal tissues \) present 33 tumors proportion carcinomas c myc overexpression significantly increased size primary tumor \( p 04 \) relationship found c myc overexpression clinical histologic parameters , including nodal status relative risk relapse \( overall , pelvic failure , distant metastases \) analyzed cox 's proportional hazards model three factors significantly related risk overall relapse multivariate analysis performed , namely , tumor size , nodal status , c myc expression combination c myc expression nodal status provided accurate indication risk relapse indeed , patients negative nodes 3 year disease free survival rate 93 \( 95 confidence interval cl , 79 98 \) c myc expressed normal level , whereas rate 51 \( 95 cl , 26 63 \) c myc overexpressed \( log rank test , p 02 \) addition , subgroup patients positive nodes , rate 44 \( 95 cl , 25 77 \) 15 \( 95 cl , 4 49 \) c myc gene expressed normal level , overexpressed , respectively finally , c myc gene overexpression , multivariate analysis , first factor selected model regarding risk distant metastases
human tumor fluorouracil trapping clinical correlations vivo nuclear magnetic resonance spectroscopy pharmacokinetics previously reported fluorouracil \( 5fu \) accumulation metabolism human livers tumors studied vivo nuclear magnetic resonance spectroscopy \( nmrs \) extended observations evaluating pharmacokinetics 5fu tumors 11 patients carcinoma breast , colon , endometrium , cervix , kidney , using nmrs 1 5 \( medical systems , , ca \) magnetic resonance imaging unit \( mri \) nmrs measurements detected long lived tumor pool 5fu six 11 tumors patients including carcinomas pelvis , breast , lung , liver half life \( t1 2 \) tumor pool trapped 5fu 0 33 1 3 hours \( 20 78 minutes \) , much longer t1 2 5fu blood \( 5 15 minutes \) neither 5fu \( , nucleotides , 5fu rna , 5fu synthase \) \( eg , \) detectable nmrs patient response chemotherapy appeared correlate extent trapping free 5fu human tumors seven patients receiving 5fu , 5fu fudr plus leucovorin , four four patients whose tumors trapped 5fu responded pyrimidine chemotherapy , whereas three patients failure detect tumor trapping resistant 5fu conclude nmrs clinically feasible , enables investigators study 5fu pharmacokinetics metabolism tumors vivo nmrs 5fu allows vivo evaluation 5fu metabolic modulation might able guide therapeutic decisions
changes clearance total unbound etoposide patients liver dysfunction disposition total non protein bound etoposide investigated 21 cancer patients receiving etoposide cisplatin combination chemotherapy etoposide plasma concentrations determined using specific high performance liquid chromatography \( hplc \) method , etoposide plasma protein binding determined equilibrium dialysis patients wide range renal function \( creatinine clearance , 32 159 ml min m2 \) hepatic function \( total bilirubin range , 0 3 21 5 mg dl aspartate aminotransferase range , 14 iu l serum albumin range , 2 7 4 1 g dl \) mean etoposide total systemic clearance different 15 patients total bilirubin less 1 0 mg dl versus six patients total bilirubin 1 1 21 5 mg dl \( 18 7 5 9 ml min m2 v 26 4 10 7 ml min m2 test p 06 \) , trend toward higher total clearance patients abnormal bilirubin values however , mean clearance unbound etoposide significantly lower patients increased total bilirubin \( 220 90 ml min m2 v 135 61 ml min m2 test p 027 \) fraction etoposide unbound \( fu \) plasma significantly higher patients increased bilirubin \( 9 3 v 27 15 test p 002 \) , explaining trend toward higher total clearance patients etoposide clearance \( total unbound \) 14 patients measurable hepatic metastases different clearance seven patients without hepatic metastases study provides explanation patients increased bilirubin lower total systemic clearance etoposide , indicates patients higher exposure unbound etoposide results ongoing pharmacodynamic studies total unbound etoposide patients increased bilirubin determine clinical relevance altered etoposide protein binding
clinical evaluation side entry access port novel dual lumen venous access device initial clinical experience low profile side entry access \( sea \) dual lumen implantable venous access port cancer chemotherapy administration summarized report catheter material polyurethane overall experience 35 patients study total 6 , 224 patient days , mean 178 days per patient variety chemotherapeutic agents , biologic response modifiers , antibiotics administered 26 patients , device chambers simultaneous use treatment period 6 incidence clinical subclavian vein thrombosis noted infectious complications inconsistencies blood withdrawal temporary catheter dysfunction comparable access ports clinical use novel design side entry port catheter material low thrombogenicity make device good option patients requiring low profile system dual access nursing staff made aware side entry design service training septum required centers devices routinely used
prospective , randomized evaluation treatment colorectal cancer metastatic liver 4 year period \( 1982 1986 \) , 91 patients solitary multiple metastases colorectal cancer stratified , based findings laparotomy , one three groups prospectively randomized one two treatment arms within group group patients solitary resectable metastases , group b patients multiple , resectable metastases , group c patients multiple , unresectable metastases patients randomized one two treatment arms within group group arm a1 resection , arm a2 resection continuous hepatic artery infusion \( chai \) \( fudr \) group b arm b1 resection chai , arm b2 chai group c arm c1 chai , arm c2 systemic fluorouracil followed chai median time failure \( \) 31 8 , 11 1 , 8 8 months groups , b , c , respectively arm a2 improved compared arm a1 \( p 03 \) median survival correlated extent disease 37 3 , 22 4 , 13 8 months groups , b , c , respectively survival changed treatment variation \( arms \) within group two 5 year cumulative survivals groups , b , c 72 7 45 4 45 8 16 7 31 7 3 2 , respectively patients multiple metastases \( groups b c \) , patients whose original tumor dukes' b significantly improved survival patients whose tumor dukes' c \( p less equal 02 \)
unique aspects acute promyelocytic leukemia acute promyelocytic leukemia \( \) accounts approximately 10 cases acute myeloid leukemia \( aml \) distinctive features disorder time diagnosis include leukopenia coexisting marrow replaced dysplastic promyelocytes , disseminated intravascular coagulopathy , lack ia \( hla dr \) antigen expression , translocation long arms chromosomes 15 17 \( 15 17 \) heparin widely universally used interfere coagulopathy initial phases treatment serial bone marrow examinations induction period demonstrate achievement remission despite persistence malignant appearing promyelocytes patients generally younger subtypes aml , 70 80 likelihood entering remission , thought favorable prognosis individuals aml remission may achieved conventional cytarabine combination , alone , , apparently , trans retinoic acid genes potentially important myeloid differentiation granulocyte colony stimulating factor \( g csf \) myeloperoxidase located close breakpoint \( 15 17 \) conclusively shown rearranged translocation better understanding unique aspects may well shed light pathogenetic processes aml
intraperitoneal yttrium 90 labeled monoclonal antibody ovarian cancer march 1987 march 1988 , phase ii study carried 25 patients ovarian cancer received escalating doses intraperitoneally \( ip \) administered yttrium 90 \( 90 \) labeled monoclonal antibody , , tumor cell surface antigen myelosuppression prevented escalation administered 90 activity 25 mci 90 labeled antibody absorbed peritoneal cavity circulation maximum blood 90 activity observed 40 hours ip injection mean 21 injected activity \( range , 14 2 26 4 \) circulation radiation dose bone marrow received circulating 90 labeled antibody \( blood radiation dose \) calculated applying medical internal radiation dose \( \) formulation measured 90 activity patients blood myelosuppression occurred following calculated blood radiation doses bone marrow 10 30 cgy excessive myelosuppression following modest radiation doses circulating 90 labeled antibody could explained uptake 90 bone attempt reduce bone absorption 90 , seven patients received intravenous \( iv \) infusion edta \( , , united kingdom \) increased urinary excretion 90 mean 11 1 32 3 injected activity \( p 0001 \) fourteen patients assessable tumor laparoscopy tumor regression observed one patient , palliation ascites patient
pediatric osteosarcoma therapeutic strategies , results , prognostic factors derived 10 year experience ninety eight pediatric patients treated three separate protocols \( treatment investigation osteosarcoma tios , ii , iii \) 47 developed recurrent disease \( metastases local recurrence \) actuarial overall disease free survival \( designated survival \) 43 90 patients treated initially preoperative intraarterial cisplatin \( \) postoperative chemotherapeutic regimens comprised high dose methotrexate leucovorin rescue \( mtx cf \) , adriamycin \( adr doxorubicin laboratories , , oh \) , cyclophosphamide primary definitive treatment comprised amputation limb salvage \( tios tios iii \) patients treated preoperative surgery \( tios iii \) 62 survival patients tios ii refused surgical treated exclusively chemotherapy 23 survival survival patients treated amputation 55 limb salvage 58 prognostic factors considered significant relation development pulmonary metastases comprised tumor burden \( p 04 \) percentage tumor necrosis induced preoperative chemotherapy \( p 01 \) histopathologic subtype marginally significant favorable opposed osteoblastic \( p 05 \) findings compared results prognostic factors published literature
phase ii study fluorouracil recombinant interferon alfa 2a previously untreated advanced colorectal carcinoma conducted phase ii clinical trial fluorouracil \( 5fu \) recombinant interferon alfa 2a \( rifn alpha 2a \) 52 previously untreated patients measurable metastatic colorectal cancer week 1 , 5fu administered continuous intravenous infusion , 750 mg m2 5 consecutive days intravenous bolus administration 5fu 750 mg m2 given weekly 7 weeks starting day 12 rifn alpha 2a \( , , \) , 9 x 10 \( 6 \) u , administered subcutaneously three times weekly weeks 1 8 patients evaluated response week 9 52 patients enrolled study , 51 assessable toxicity , 45 assessable response fifteen patients experienced partial response , one patient achieved clinical complete response overall response rate 35 \( 95 confidence interval ci , 22 , 50 \) median duration response 7 5 months \( range , 4 11 months \) seventy percent patients entered study alive median follow duration 7 months twenty five percent patients developed grade 4 toxicity , 82 developed grade 3 toxicity one drug related death presence sepsis reported , two treatment related seizures occurred experience schedule produced lower response rate greater toxicity previously reported current randomized trials comparing schedule 5fu rifn alpha 2a 5fu plus folinic acid \( leucovorin \) single agent 5fu may determine role treatment advanced colorectal carcinomas
adjuvant cyclophosphamide , methotrexate , fluorouracil patients axillary node positive breast cancer update 's trial 1976 1985 , patients \( 202 premenopausal , 189 postmenopausal \) operable breast cancer positive axillary lymph nodes randomized total mastectomy axillary clearance receive cyclophosphamide , methotrexate , fluorouracil \( cmf \) \( n 193 \) adjuvant therapy \( n 198 \) median follow 8 years , relapse free survival \( rfs \) survival \( \) significantly prolonged premenopausal patients receiving cmf \( rfs , p less 001 , p 003 \) treatment cmf resulted significant improvement rfs premenopausal patients steroid receptor positive steroid receptor negative tumors also subgroups premenopausal patients defined number axillary nodes involved premenopausal patients developed permanent amenorrhea following cmf significantly better rfs continued induction amenorrhea following cmf related age , almost patients 40 years becoming amenorrheic patients less equal 40 years , development amenorrhea following cmf influence outcome difference detected control cmf groups \( rfs , p 9 , p 9 \) postmenopausal patients subgroup patients results trial efficacy cmf improving rfs longer follow
node negative breast cancer prognostic subgroups defined tumor size flow cytometry adjuvant systemic therapy women node negative breast cancer easily justified patients highest risk relapse examined impact tumor size , histologic grade , estrogen receptor \( er \) status , tumor ploidy , phase fraction \( spf \) relapse free survival \( rfs \) 169 patients node negative breast cancer order identify groups patients high low risk relapse patients small tumors \( less equal 1 0 cm \) significantly better rfs larger tumors \( p 005 \) , 96 remaining relapse free 5 years patients tumors less equal 1 0 cm thus excluded analysis attempting define group poor prognosis within group patients tumors greater 1 0 cm , tumor ploidy \( p 63 \) , er status \( p 3 \) , progesterone receptor \( pgr \) status \( p 24 \) predict rfs patients grade 1 2 infiltrating ductal tumors significantly better prognosis grade 3 tumors \( p 04 \) prognostic factor gave separation subgroups , however , spf patients whose tumors greater 1 0 cm spf less equal 10 5 year rfs 78 compared 5 year rfs 52 spf greater 10 \( p 006 \) combined tumor size spf identify three prognostic groups \( 1 \) tumor less equal 1 0 cm , 5 year rfs 96 \( 2 \) tumor greater 1 0 cm plus spf less equal 10 , 5 year rfs 78 3 \) tumor greater 1 0 cm plus spf greater 10 , 5 year rfs 52 prognostic may help identify patients suitable adjuvant therapy
drug induced dna damage tumor chemosensitivity cytotoxic drugs act principally damaging tumor cell dna quantitative analysis interaction provides basis understanding biology therapeutic cell kill well rational strategy optimizing predicting tumor response recent advances made possible correlate assayed dna lesions cytotoxicity tumor cell lines , animal models , patients malignant disease addition , many complex interrelationships dna damage , dna repair , alterations gene expression response dna damage defined techniques modulating dna damage cytotoxicity using schedule specific cytotoxic combinations , dna repair inhibitors , cell cycle manipulations , adjunctive drug therapy developed , critical therapeutic targets identified within tumor cell subpopulations genomic dna alike importantly , methods predicting clinical response cytotoxic therapy using vitro markers tumor cell sensitivity vivo measurements drug induced dna damage becoming advances expected provide strong foundation development innovative cytotoxic drug strategies next decade
motility factor produced malignant glioma cells role tumor invasion better understand cellular mechanism tumor invasion , production cell motility stimulating factor malignant glioma cells studied vitro serum free conditioned media cultures rat c6 human t98g cell lines contained factor stimulated locomotion cells factor termed glioma derived motility factor glioma derived motility factor heat labile protein molecular weight greater 10 kd relative stability acid factor showed chemotactic activity also \( stimulated random locomotion \) activity two types glioma cells studied although glioma derived motility factors conditioned media obtained two different cell origins likely , migration t98g cells conditioned medium much stronger c6 cells cells cytochalasin b , assembly cellular actin , almost completely inhibited cell migration stimulated glioma derived motility factor cytochalasin b also induced marked alterations cell morphology , including cell retraction , drug affect cell attachment culture results indicate glioma cells produce motility factor may play role particularly tumor cells detached migrate away original tumor mass , thus promoting tumor invasion also , glioma cell migration stimulated motility factor requires normal organization actin
antigen related cell proliferation malignant gliomas recognized human monoclonal antibody human monoclonal antibody \( cln igg \) produced human human hybridoma derived lymphocytes patient cervical carcinoma reactivities antibody various human glioma tissues cultured glioma cells characterization antigen recognized cln igg malignant glioma cells analyzed reported cln igg reacted various human glioma cells glioma tissues , especially glioblastoma , react normal brain tissues fetal brain tissues large amount antigen recognized cln igg expressed cell membranes undifferentiated glioma cells glioma cells g2 tumor growth phase cycling cells antigen recognized cln igg detected one seven samples cyst fluid , detected 27 serum samples 18 samples cerebrospinal fluid glioma patients cln igg exhibited antibody dependent cell cytotoxicity u 25 1 mg glioma cells primary cultured cells glioblastomas anaplastic astrocytomas data suggest antigen recognized cln igg might related cell proliferation malignant gliomas thus , cln igg might useful immunotherapy malignant gliomas
ovarian cancer indium 111 labeled tl 3 f \( ab' \) 2 monoclonal antibody safety diagnostic accuracy indium 111 labeled monoclonal antibody tl 3 f \( ab' \) 2 \( 111in tl 3 f \( ab' \) 2 \) diagnosis follow ovarian cancer prospectively studied 31 patients planar spect scintigraphy performed 4 days v injection 140 mbq 111in tl 3 f \( ab' \) 2 surgical evaluation possible 22 31 patients imaging results compared x ray computed tomography , ultrasound , ca 125 serum level using histologically confirmed surgical findings gold standard apart transient rash observed two patients , immediate delayed adverse reactions observed within surgically evaluated group , ovarian cancer lesions detected 16 17 patients \( 94 \) 45 distinct tumor deposits found operation , 67 detected localized x ray computed tomography ultrasound visualized 53 23 , respectively
potential 2 deoxy 2 18f fluoro glucose \( fdg \) detection tumor involvement lymph nodes assess potential fdg pet imaging nodal tumor metastases , evaluated uptake normal lymph nodes , tumor involved lymph nodes , subcutaneous tumor xenografts normal lymph nodes mice rats accumulate fdg moderately , developing node blood ratios 1 3 11 9 1 2 hr following v injection contrast , fdg given subcutaneously healthy sprague dawley rats developed high normal draining lymph node blood ratios \( 272 1 \) versus 7 7 1 v injection nude mice , subcutaneous human ovarian cancer xenografts 1 27 fold uptake relative blood normal popliteal lymph nodes subcutaneous tumor xenografts rat breast cancer developed tumor normal node uptake ratios 4 91 0 43 1 tumor blood ratios 6 6 0 9 2 hr postinjection mouse nodes involved murine b cell lymphoma mean node blood ratios 42 9 6 7 1 node normal lymph node uptake 6 3 1 thus , fdg given intravenously \( due high normal nodal uptake \) potential agent detection metastatic tumors regional lymph nodes using pet scanning
using iodine 131 anti cea monoclonal antibodies thallium 201 scintigraphy medullary thyroid carcinoma case report case report demonstrates use thallium 201 \( 201tl \) scans versus iodine 131 \( \) anti cea f \( ab' \) 2 scans patient high serum cea levels due metastases medullary thyroid carcinoma region region scintigraphy using monoclonal antibodies directed cea showed higher tumor uptake \( 0 26 dose 0 64 dose , respectively \) thallium scan believed promising future applications
treatment planning internal radionuclide therapy three dimensional distributed radionuclides approach described provides spatially varying radiation absorbed dose , presented contours superimposed ct images , irregular activity distributions ct images read magnetic displayed high resolution color display monitor source tissue defined series contiguous ct images automatically \( edge detection algorithm \) \( using \) , thereby obtaining three dimensional various source volumes activity dose calculations performed using radionuclide specific absorbed dose point form table method described yields spatially varying dose delivered tumor normal tissue volumes patient specific activity distribution clinically manner level accuracy determining normal tissue tumor doses may prove valuable evaluation implementation radionuclides radiolabeled compounds therapeutic purposes
implementation cancer prevention guidelines clinical practice data several sources , including surveys , physician surveys , medical record , indicate receive cancer screening tests recommended national cancer institute , american cancer society , u preventive services task force performance rates consistently published standards tests except pap tests major reasons physicians perform recommended tests include physician , disagreement recommendations , lack time , patient refusal physicians also tend overestimate performance rates barriers screening test performance categorized patient factors , physician factors , test factors , health care delivery system factors interventions , computerized reminder systems , physician feedback , patient education reminders , effective promoting performance screening interventions target physician patient may particularly effective
breast cancer screening included \? recommendations u preventive services task force reviewed regard screening breast cancer issued national organizations , screening breast cancer using mammography ages 40 49 recommended concluded scientific evidence insufficient present recommend mammography screening women aged 40 49 recommendations task force women age 40 receive annual breast examination women mammography every one two years beginning age 50 approximately age 75 unless disease detected may prudent begin mammography earlier age women high risk breast cancer recommendations appropriate light available evidence though present evidence clinical examination breasts age reduces breast cancer mortality upper age beyond breast cancer screening longer significant effect reducing breast cancer mortality unknown evidence women high risk breast cancer benefit different degree screening women high risk
colorectal cancer identified effective screening strategy \? three currently used screening methods aimed detecting colorectal cancer asymptomatic curable , detecting polyps removed progress cancer digital rectal examinations relatively easy detect small fraction large bowel cancers sigmoidoscopy sensitive , low acceptability patients partially introduction 35 cm flexible instrument fecal occult blood testing limited sensitivity blood cancers polyps neither continuously shed uniformly distributed feces specificity positive predictive value also low sources blood stool prudent judgment suggests screening tests may prevent death colorectal cancer patients however , none proven effective general use well controlled studies case control studies provide timely valuable new evidence regard authors' investigations progress described current lack strong evidence support screening tests interpreted evidence use
impact u preventive services task force guidelines cancer screening perspective national cancer institute u preventive services task force evaluated medical literature , utilizing strict criteria merits experimental trials designed show benefit screening cancer individuals normal risk , task force able make recommendations screening colorectal , prostate , skin , oral , testicular cancers one physical examination cancer screening procedure ever tested randomized trial past 27 years , national cancer institute \( nci \) six randomized screening trials thus far , one shown decrease mortality recognizing limitations trials , nci published working guidelines early cancer detection designed practicing physician , guidelines based upon best available evidence judgment representatives medical professional organizations
squamous cell carcinoma antigen detection squamous cell mucoepidermoid carcinoma primary treatment preliminary report study evaluated efficacy using periodic measurement serum level squamous cell carcinoma antigen \( scc antigen \) determining local recurrence metastasis squamous cell mucoepidermoid carcinomas primary treatment found time clinical recognition recurrence , scc antigen level normal , metastasis regional lymph nodes remote organs generally accompanied increase scc antigen changes scc antigen level mucoepidermoid carcinoma seemed less sensitive squamous cell carcinoma
interaction trimethoprim sulfamethoxazole methotrexate children leukemia trimethoprim sulfamethoxazole \( tmp smx \) causes neutropenia children leukemia , investigated possibility pharmacokinetic interaction methotrexate \( mtx \) tmp smx causes accumulation agent studied pharmacokinetics mtx given intravenously orally nine children acute lymphoblastic leukemia , without tmp smx increase free mtx fraction tmp smx therapy patients , \( mean sd \) 37 4 11 without tmp smx 52 2 6 4 tmp smx \( p less 0 01 \) plasma clearance total mtx change significantly , whereas clearance free mtx decreased significantly \( 12 5 4 7 6 1 5 ml kg min p less 0 05 \) consistent decrease renal clearance free mtx \( 12 1 6 8 5 6 2 4 ml kg min p less 0 05 \) elimination half life mtx affected significantly tmp smx significant correlation serum concentrations tmp smx percentage decrease renal clearance free mtx \( r 0 91 p less 0 05 \) changes protein binding tubular clearance mtx , caused competition tmp smx , result mean 66 increase systemic exposure mtx may explain often observed coadministration two drugs
laparoscopic management ovarian cysts one hundred two women ovarian cysts managed laparoscopically 13 year period thirteen treated laparoscopic inspection followed laparotomy , 6 laparoscopic fine needle aspiration followed laparotomy 83 laparoscopic biopsy , without coagulation removal cyst lining satisfactory results noted patients treated completely laparoscopy 1 56 functional , simple cysts recurred study period two 18 ovarian treated coagulation removal lining recurred , whereas 8 9 lesions recurred treated alone surgical complications
expression mdr1 gene human gastric colorectal carcinomas measured expression mdr1 gene \( also known gene \) human gastrointestinal tract mdr1 messenger rna \( mrna \) levels elevated 13 15 colorectal carcinoma specimens six 13 gastric carcinoma specimens well differentiated colorectal carcinomas contained significantly higher concentrations mdr1 mrna moderately differentiated colorectal carcinomas similarly , moderately differentiated gastric carcinomas contained higher concentrations mdr1 mrna poorly differentiated gastric carcinomas mdr1 gene expression normal colorectal gastric tissues adjacent carcinomas similar carcinomas mdr1 gene expression xenografts colorectal gastric carcinomas nude mice also investigated elevated expression mdr1 gene seen four 18 xenografts colorectal carcinoma seen xenografts gastric carcinoma p glycoprotein distributed luminal surface colorectal carcinoma results imply higher levels mdr1 mrna found well differentiated carcinomas derived colorectal tissues results increased expression mdr1 gene luminal surface cells level expression mdr1 gene colorectal gastric carcinomas appears correlate degree differentiation also appears affected transplantation nude mice
race , nutritional status , survival breast cancer effects nutritional status differences survival black white women breast cancer studied cohort 1 , georgia women diagnosed 1975 1979 data adjusted stage disease , socioeconomic status , prognostic factors , poorer survival rates shown black women within stage classification , lower levels serum albumin hemoglobin higher relative body weight common among blacks independently associated poorer survival among women stage 3 disease , adjustment variables substantially reduced excess mortality rate among blacks , suggesting racial differences survival may partly explained differences nutritional status extent disease within stage
effect tamoxifen serum insulinlike growth factor levels stage breast cancer patients insulinlike growth factor \( igf \) shown potent mitogen breast cancer cells vitro , igf receptors demonstrated human primary breast neoplasms randomized , placebo controlled study , document administration tamoxifen patients breast cancer associated statistically significant \( p 002 \) reduction serum level igf mean igf level 1 4 u ml placebo treated group 0 9 u ml tamoxifen treated group serum igf level growth hormone \( gh \) dependent data suggest pubertal surge gh igf levels sex steroid dependent , speculate mechanism underlying observation may involve blockade tamoxifen estrogen action hypothalamic pituitary axis conclude tamoxifen treatment reduces igf levels reduction may contribute therapeutic effect drug
reduction membrane fluidity human breast cancer cells tamoxifen 17 beta estradiol intracellular steady state levels methotrexate previously shown reduced estrogen receptor \( er \) negative human breast cancer mda mb 436 cells er positive human breast cancer cells following treatment pharmacologically relevant concentrations 17 beta estradiol \( e2 \) report e2 tamoxifen \( tmx \) significantly decreased fluidity mda mb 436 cellular membranes e2 tmx concentrations greater 1 microm , perturbations membrane fluidity accompanied apparently non er mediated cytotoxicity alterations membrane structure may contributed cytotoxicity high dose endocrine therapy ability e2 inhibit methotrexate transport cytotoxicity human breast cancer cells
antitumor activity encapsulated doxorubicin advanced breast cancer phase ii study previous studies animals demonstrated encapsulated doxorubicin \( led \) substantially less cardiac toxicity free doxorubicin retains antitumor activity phase clinical study led , maximum tolerated dose 90 mg m2 dose limiting toxicity considered reached produced used led treat 20 patients advanced , measurable breast cancer led given doses 60 75 mg m2 every 3 weeks intravenous infusion regression disease objectively measured nine patients five patients , complete regression index lesion occurred mean duration responses 7 months hematologic toxicity consisted grade 1 2 leukopenia patients gastrointestinal toxicity mucositis generally mild tolerable alopecia occurred patients usually complete twelve patients received cumulative doses led greater 400 mg m2 evaluated radionuclide eight patients , cumulative dose greater 500 mg m2 , five endomyocardial biopsies four biopsy results grade 0 , one \( cumulative led dose , 750 mg m2 \) showed grade 1 changes mild loss dilatation sarcoplasmic reticulum involving less 5 cardiac myocytes two patients decreases left ventricular ejection fraction one patients received total dose led mg m2 decline 13 left ventricular ejection fraction , clinical evidence congestive heart failure grade 0 endomyocardial biopsy
oral zidovudine , continuous infusion fluorouracil , oral leucovorin calcium phase study phase clinical , pharmacologic , biochemical evaluation escalating oral zidovudine \( azt \) given 2 days fixed dose continuous infusion fluorouracil \( 800 mg m2 per day x 3 days \) oral leucovorin calcium performed eighteen patients treated doses azt ranging 1 0 9 0 g m2 per day nausea vomiting dose limiting , maximally tolerated dose 7 5 g m2 per day rash mucositis occurred dose limiting dose related increase peak plasma levels azt observed , alpha half life azt plasma \( 75 min \) unaffected high doses doses 4 0 g m2 per day , trough levels significantly increased , perhaps reflecting prolonged absorption gut responses observed however , significant increase dna single strand breaks observed peripheral blood cells threshold dose 4 0 g m2 per day , confirming biological effect azt regimen trials intravenous formulation capable maintaining plasma levels dose limiting toxicity warranted
validation intermediate end points cancer research investigations using intermediate end points cancer , smaller , less expensive studies use malignancy end point present strategy determining whether given valid intermediate end point exposure incidence cancer candidate intermediate end points may selected case series , studies , animal experiments prospective cohort sometimes case control studies may used quantify intermediate end point cancer association appropriate measure association attributable proportion intermediate end point valid cancer surrogate attributable proportion close 1 0 , close 0 usually , attributable proportion close neither 1 0 0 case , valid requires intermediate end point mediate established exposure cancer relation would turn imply exposure effect would adjusted intermediate end point discuss relative advantages intervention observational studies validation intermediate end points validation strategy also may applied intermediate end points adverse reproductive outcomes chronic diseases cancer
anti idiotype monoclonal antibody carrying internal image gm3 murine anti idiotype monoclonal antibodies generated human igm monoclonal antibody \( l612 \) recognizes gm3 human melanoma secreting antibodies bound specifically l612 selected enzyme linked immunosorbent assay using l612 three negative control human , including monoclonal anti anti antibodies , well purified serum igm , antigen sources gm3 binding inhibition cell binding inhibition assays used identify seven anti idiotype monoclonal antibodies recognized determinants located within antigen combining sites l612 determine whether anti idiotype monoclonal antibodies possessed internal image original antigen , immunized syngeneic balb c mice one anti idiotype monoclonal antibodies , , coupled keyhole limpet sera immunized mice reacted strongly antigen positive melanoma cell line purified gm3 l612 detects kills melanoma tumor cells vitro vivo presence complement without affecting normal tissues , anti idiotype monoclonal antibodies carrying internal image gm3 may effective tool active specific immunotherapy patients melanoma
sensitivity patients head neck cancers biologic marker risk multiple primary malignancies eighty four patients head neck cancers evaluated vitro sensitivity followed longitudinally development multiple primary malignancies assessed sensitivity exposing lymphocytes bleomycin vitro bleomycin induced chromosomal breaks per cell hypersensitive patients , ie , expressed greater 1 0 break per cell , significantly likely develop multiple primary cancers patients less sensitive \( less equal 1 0 break per cell \) \( relative risk 4 4 95 confidence limits 1 2 , 15 8 \) relationship independent age , sex , site , treatment first primary cancer tobacco alcohol exposures sensitivity bleomycin induced chromosomal damage serves indicator genetic susceptibility multiple primary malignancies patients head neck cancers
total pelvic exenteration simultaneous bowel urinary reconstruction technique total pelvic exenteration simultaneous bowel urinary reconstruction described surgical option management pelvic sarcoma adults highly selected patients types advanced pelvic malignancy surgical technique presented detail performed 43 year old man presented extensive primitive pelvic sarcoma believe approach may provide benefits operation without undesirable psychosocial sequelae permanent colostomy external urinary diversion
prospective study estrogen replacement therapy risk breast cancer postmenopausal women published erratum appears 1991 apr 10 265 \( 14 \) prospectively examined use estrogen replacement therapy relation breast cancer incidence cohort women 30 55 years age 1976 187 person years follow among postmenopausal women , incident cases breast cancer documented overall , past users replacement estrogen increased risk \( relative risk , 0 98 95 confidence interval , 0 81 1 18 \) , including even 10 years since last corrected use \( relative risk adjustment established risk factors , 0 70 95 confidence interval , 0 45 1 10 \) however , risk breast cancer significantly elevated among current users \( relative risk , 1 36 95 confidence interval , 1 11 1 67 \) among current users , stronger relationship observed increasing age increasing duration use data suggest long term past use estrogen replacement therapy related risk breast cancer current use may modestly increase risk
preoperative cell mediated immune function prognosis patients gastric carcinoma cell mediated immune function 83 patients gastric carcinoma assessed preoperatively results compared 52 patients benign lesions data subjected analysis order evaluate prognostic significance abilities induce allogeneic cytotoxicity produce interleukin 2 \( \) patients stage iv carcinoma significantly depressed , compared patients benign lesions , whereas natural killer \( nk \) cell activity significantly impaired significant correlation among immune functions patients stratified two groups , high \( greater mean value patients benign lesions \) low \( less value \) values immune reactivities , survival patients high nk activity \( greater equal 43 \) significantly better , compared patients low cytotoxicity \( less 43 \) however , correlation survival allogeneic cytotoxicity patients high ability produce \( greater equal 1 3 u ml \) correlated better survival patients , group patients underwent curative resection
neoadjuvant cis ddp esophageal cancers experience regional cancer centre , india results 80 patients underwent surgery 1983 84 esophageal cancer forty patients received pre operative single agent cis ddp grouped 40 patients went surgery directly grouped b twenty two patients \( 55 \) group showed tumor necrosis groups underwent resection hand esophagus 10 post operative deaths among 80 resected cases , 9 leak cis ddp induced negligible side effects comparatively high survival rate early years patients responded cis ddp suggests neoadjuvant chemotherapy might value
vivo selection characterization murine mammary tumor subline high potential spontaneous lymph node metastasis transplantable mammary adenocarcinoma , grown balb c mice , marked enhancement draining lymph node metastatic ability \( \) , obtained vivo procedure variant tumor moderately metastatic lymph nodes \( mm3 \) mm3 presented similar latency tumor growth rate reached tumor mean diameter death tumor bearing mice exhibited larger mean survival time new variant showed 2 5 fold higher incidence tumor draining lymph node metastases mm3 line , differences incidence lung metastases morphology well cytogenetic vitro adhesion properties studied order characterize new subline murine tumor model potential application study metastatic process lymphoid tissue
ampullary carcinoma patients 50 years age poor prognosis clinicopathologic features 145 japanese patients ampullary carcinoma compared among three age groups 145 patients divided three groups patient 's age time operation 24 patients group \( younger \) aged less equal 50 years , 99 group ii \( ordinary \) aged 51 69 , 22 group iii \( elderly \) aged greater equal 70 three groups showed significant difference sex , , duration , size tumor , year operation , macroscopic type , histopathologic type , tumor margin , lymphatic permeation , venous invasion , pancreatic invasion survival curve group worse groups ii iii multivariate regression analysis using 11 prognostic variables failed reveal age patient time operation independent factor younger patients aged less equal 50 worse elderly patients aged greater equal 70 , group tumors included significantly greater number advanced ampullary carcinoma frequent invasion group iii tumors
paraneoplastic cerebellar degeneration clinical comparison patients without purkinje cell cytoplasmic antibodies review 32 patients paraneoplastic cerebellar degeneration \( pcd \) , 16 \( women \) purkinje cell cytoplasmic antibodies \( \) 16 \( 8 women \) patients \( 15 16 seropositive 12 16 seronegative patients \) active cancer time neurologic diagnosis gynecologic breast cancers found 14 16 seropositive 2 8 seronegative female patients lung cancer diagnosed 7 16 seronegative patients seropositive patient seropositive patients , onset syndrome often abrupt abnormalities affect , , ocular motility , cerebrospinal fluid igg index common seronegative patients additional paraneoplastic neurologic syndromes present five seronegative patients seropositive patient clinical impairment equivalent groups approximately 75 patients confined bed last follow four 16 seropositive patients died \( 4 18 months onset pcd \) , 7 16 seronegative patients died \( 7 120 months onset pcd \) thus , seem marker clinical subset female patients gynecologic breast cancer high frequency autoimmune paraneoplastic syndromes patients seronegative pcd suggests pcd seropositive seronegative patients may common pathogenic basis involves yet unidentified autoimmune mechanism
1990 memorial lecture dilemmas head neck cancer neither dilemma defined concept practical management head neck cancer although important implications , particularly regard ethnic social factors , play relatively minor role determining management policy little knowledge intrinsic causes cancer treatment strategy limited radiotherapy surgery , desire cure must concern avoid increase patient , based upon care patients almost 30 years , reflects difficulties applying concept nothing may cause harm , offering patient opportunity long term cure
carcinoma external auditory canal update review continuation series 35 cases carcinoma external auditory canal originally reported senior author colleagues eighteen additional cases evaluated treated since 1976 preoperative high resolution computed tomographic scanning replaced , improved surgical skull base approaches allowed extended resections advanced lesions revised classification local extensive lesions presented prognosis localized tumors treated en bloc resection remains excellent , whereas prognosis extensive lesions might dependent histologic type grade tumor
relation meat , fat , fiber intake risk colon cancer prospective study among women background rates colon cancer various countries strongly correlated per consumption red meat animal fat , lesser degree , inversely associated consumption fiber methods conducted prospective study among 88 , women 34 59 years old without history cancer , inflammatory bowel disease , familial polyposis completed dietary questionnaire 1980 1986 , , person years follow , 150 incident cases colon cancer documented results adjustment total energy intake , animal fat positively associated risk colon cancer \( p trend 0 01 \) relative risk highest compared lowest 1 89 \( 95 percent confidence interval , 1 13 3 15 \) association found vegetable fat relative risk colon cancer women beef , , main every day 2 49 \( 95 percent confidence interval , 1 24 5 03 \) , compared reporting consumption less month processed liver also significantly associated increased risk , whereas fish chicken without skin related decreased risk ratio intake red meat intake chicken fish particularly strongly associated increased incidence colon cancer \( p trend 0 0005 \) relative risk women highest ratio compared lowest 2 49 \( 95 percent confidence interval , 1 50 4 13 \) low intake fiber fruits appeared contribute risk colon cancer , relation statistically independent meat intake conclusions prospective data provide evidence hypothesis high intake animal fat increases risk colon cancer , support existing recommendations substitute fish chicken high fat
overall mortality cancer mortality around french nuclear sites higher expected mortality leukaemia observed population age 25 living around , nuclear plants united kingdom report results similar study population residing around nuclear sites france number leukaemia deaths 58 , comparable 62 control areas , slightly less 67 expected national mortality statistics twelve deaths due hodgkin 's disease observed around nuclear sites twice number hodgkin 's deaths observed control areas twice number expected national mortality statistics observation must , however , interpreted light fact several causes deaths studied , increasing play chance
downstream initiation element required efficient tata box binding vitro function tfiid gene encodes glial acidic protein , intermediate filament protein expressed glial cells vitro transcription analysis shown human promoter contains two initiation elements independently transcription one elements tata box 25 base pairs \( bp \) upstream transcription located 10 50 bp downstream transcription initiation site shown transfection elements required efficient transcription cultured cells partially purified natural human tata box binding factor \( tfiid \) hela cells gave extended upstream tata box downstream deletion downstream inhibited tfiid binding tata box transcription vitro contrast natural human tfiid , clone human yeast expressed bacteria gave covering tata box region , although hypersensitive sites observed downstream region cloned also showed less dependence natural human tfiid downstream tata box binding vitro transcription results suggest natural human tfiid contains additional component \( \) contribute \( \) stable tfiid binding effective transcription interacting downstream
inhibition tumor growth glioma model treated boron neutron capture therapy investigation attempts determine whether increased survival time seen glioma model treated boron neutron capture therapy \( bnct \) result inhibition tumor growth caused radiation induced alterations endothelial cells normal tissue components indirect effect radiation called tumor bed effect series tumor bearing rats studied , using standardized investigational bnct protocol consisting 50 mg kg injected intravenously 14 17 hours neutron irradiation 4 x 10 \( 12 \) n cm2 ten rats , serving controls , received treatment either tumor implantation second group 10 rats treated bnct 4 days tumor implantation animals received treatment remaining group 10 rats received pretreatment treated bnct 10 days implantation histological ultrastructural analyses performed 2 animals group 17 days implantation survival times untreated control animals \( mean , 25 8 days \) differ statistically survival times rats pretreated group \( mean , 25 5 days \) rats treated bnct implantation survived significantly longer \( p less 0 02 mean , 33 2 days \) controls animals tumor size indices calculated measurements taken time death similar groups results indicate , tumor model , bnct cause tumor bed effect cerebral tissue therapeutic gains observed bnct result direct effects tumor cells
multiple intracranial tumors different cell types multiple intracranial tumors different cell types rare report nine patients multiple intracranial tumors , history trauma , irradiation , clinical , radiological , histopathological findings well indications operations patients asymptomatic second tumors discussed
brain stem spinal metastases supratentorial glioblastoma multiforme clinical series although spread supratentorial glioblastoma multiforme brain stem spine extensively described published autopsy series , information diagnosis , treatment , subsequent clinical course patients symptoms dissemination remains scant report series 11 patients signs symptoms dissemination supratentorial glioblastoma multiforme patients radiographic documentation metastases either contrast enhanced myelograms enhanced magnetic resonance imaging scans ten presented spinal involvement , whereas one presented lower cranial neuropathies secondary diffuse involvement basal mean age patients 38 5 years , mean time interval diagnosis intracranial disease diagnosis metastases 14 1 months diagnosis tumor spread , subsequent mean survival time 2 8 months patients received additional radiotherapy areas metastasis , clinical response radiotherapy quite poor study confirms previous reports literature suggesting metastases occur younger patients patients extended survival findings suggest relatively infrequent clinical incidence symptomatic spread glioblastoma multiforme , compared frequent incidental discovery spread autopsy , may result limited survival affected patients , due biology tumor
ultrastructural evidence differentiation human glioblastoma cell line treated inhibitors eicosanoid metabolism human glioblastoma cells incubated presence inhibitors eicosanoid biosynthesis show decreased cellular proliferation without cytotoxicity studied ultrastructural morphology human glioblastoma cell line cultured acid \( \) , lipoxygenase inhibitor , 5 , 8 , 11 , 14 acid , cyclooxygenase lipoxygenase inhibitor glioblastoma cells treated 3 days antiproliferative concentrations either agent , shared many morphological characteristics , including evidence increased astrocytic differentiation limited signs toxicity inhibited glioma cells demonstrated increase number length astrocytic processes containing greater numbers glial filaments , treated cells also demonstrated extensive lateral formation along processes glioblastoma cell shape also became elongated , usual nuclear nuclear inclusions , especially treated cells many cytoplasmic organelles packed cytosol inhibited glioma cells , including prominent golgi apparatus , dilated smooth endoplasmic reticulum evolving dilated vesicles , cytoplasmic vacuoles , numerous concentric limited evidence toxicity , however , mitochondria pleomorphic mitochondrial distention disruption along increase cytoplasmic conclude inhibitors eicosanoid biosynthesis , 5 , 8 , 11 , 14 acid , suppress glioblastoma cell proliferation , also induce increased astrocytic differentiation
procarbazine chemotherapy treatment recurrent malignant astrocytomas radiation nitrosourea failure brain tumor study group shown procarbazine \( pcb \) effective adjuvant treatment 1 , 3 bis \( 2 \) 1 nitrosourea \( bcnu \) treated 35 patients recurrent malignant astrocytomas radiation nitrosourea failure successive courses pcb 150 mg m2 28 days every 8 weeks 2 courses , 2 patients complete responses , 7 partial responses , 11 stable disease , 15 progression significantly patients receiving pcb complete partial responses stable disease similar group patients previous trial received intra arterial \( ia \) cisplatin \( ddp \) significant advantage time disease progression receiving pcb compared receiving ia \( \) results suggest pcb effective 2nd agent ia ddp following radiation nitrosourea failure
basement membrane cervical adenocarcinoma immunoperoxidase study laminin type iv collagen basement membrane components type iv collagen laminin examined immunohistochemically 14 cases adenocarcinoma cervix patterns staining adenocarcinoma situ , invasive adenocarcinoma , early invasive adenocarcinoma compared see whether characteristic patterns could delineated adenocarcinoma situ uniform intact basement membrane , whereas basement membrane invasive adenocarcinoma fragmented irregular cases early stromal invasion showed early gland defective basement membrane staining degree histologic differentiation tumor clearly related amount basement membrane component staining concept early stromal invasion cervical adenocarcinoma , supported immunohistochemical studies , discussed relates possible pathogenic mechanism early invasion infiltration adenocarcinoma cervix
treatment fallopian tube carcinoma cisplatin , doxorubicin , cyclophosphamide primary carcinoma fallopian tube uncommon often treated using regimens active ovarian carcinoma evidence scant therapies benefit patients fallopian tube carcinoma december 1979 july 1988 , treated 18 patients adenocarcinoma fallopian tube combination cisplatin \( 50 mg m2 \) , doxorubicin \( 50 mg m2 \) , cyclophosphamide \( 500 mg m2 \) administered intravenously 1 day every 28 days histologic confirmation fallopian tube carcinoma obtained entry study three patients stage disease , five stage ii , nine stage iii , one stage iv sixteen patients received combination therapy first line treatment surgery , two patients received recurrent carcinoma seven patients clinically measurable disease start therapy two patients complete clinical response , two stable disease , three progressive disease eight 15 patients stages ii iv disease underwent second look laparotomy four complete response therapy four partial response , making overall response rate 53 toxicity regimen moderate median survival 81 months patients stages ii iv disease median survival 43 9 months progression free survival 22 5 months regimen appears active fallopian tube carcinoma result response rates comparable reported epithelial ovarian cancer
debulking pelvic para aortic lymph node metastases ovarian cancer ultrasonic surgical six patients metastatic ovarian cancer extensive involvement pelvic para aortic lymph nodes underwent surgical debulking ultrasonic surgical intraoperative postoperative morbidity minimal suggested technique may used surgery combination standard surgical techniques
epidemiology ophthalmic malignancies new york state epidemiologic characteristics primary eye cancers \( icd 9 , site 190 \) diagnosed among new york state \( nys \) residents 1975 1986 described among nys male residents , average annual age adjusted incidence rate 7 5 per 1 , 000 , 000 , among nys female residents , rate 5 4 per 1 , 000 , 000 \( male female rate ratio , 1 39 \) majority ophthalmic malignancies included within three histologic melanomas \( 70 4 \) , \( 9 8 \) , squamous cell carcinomas \( 9 2 \) average annual incidence retinoblastoma among persons nys less 5 years age 9 5 per 1 , 000 , 000 boys 8 7 per 1 , 000 , 000 girls \( male female rate ratio , 1 09 \) average annual incidence \( age adjusted \) ocular melanomas 4 9 per 1 , 000 , 000 among men 3 7 per 1 , 000 , 000 among women nys \( male female rate ratio , 1 32 \) expanded knowledge epidemiology ophthalmic cancers help develop foundation monitor disease patterns serve stimulate etiologic research involving rare malignancies
screening neuroblastoma 3 weeks age methods preliminary results quebec neuroblastoma screening project large neuroblastoma screening study recently started province quebec , canada project , quebec network genetic medicine university minnesota , studying impact screening infants preclinical detection neuroblastoma population based mortality caused tumor infants born quebec 5 year period screened twice , 3 weeks 6 months urinary homovanillic acid acid determination filter paper samples used screening initial qualitative screening done means thin layer chromatography confirmatory quantitative screening gas chromatography mass spectrometry \( gc ms \) initial 6 months 3 week screening , 41 , neonates \( 92 compliance rate \) screened 10 6 tested also gc ms nine neonates positive results two gc ms tests referred evaluation rule presence neuroblastoma four tumor , 1 calcified adrenal gland , 4 tumor detected three additional neonates clinical diagnosis neuroblastoma reached screening age 3 weeks neuroblastoma secrete homovanillic acid acid diagnosed clinically 1 additional patient tested negative screening
expression murine renin genes subcutaneous connective tissue renin promoter large tumor antigen \( antigen \) fusion gene constructed provide reporter function renin expression transgenic mice transgenic mice gave rise tumors subcutaneous soft tissue , attributed expression site immunohistochemical analysis transgenic fetuses several independent lines revealed scattered antigen containing mesenchymal cells fibroblasts subcutaneous layer skin muscle skin skeletal muscle body wall localization consistent location overt tumorigenesis adult mice pattern specific renin antigen fusion gene immunohistochemical staining observed transgenic fetuses containing heterologous promoter antigen fusion gene northern blot analysis tumor rna indicated tumors expressed antigen endogenous renin gene 1c addition , multiple renin genes introduced crossing transgenic mice dba mice , contain another allele 1 locus well locus 2 , resultant tumors expressed 2 gene northern blots used analyze renin expression subcutaneous tissue normal mice fully processed renin mrna detected 15 5 day fetal newborn newborn skin data indicate renin expressing cell population fetal newborn subcutaneous tissue
e1a dependent expression adenovirus genes otf963 embryonal carcinoma cells role e1a induced differentiation undifferentiated f9 embryonal carcinoma cells allow adenovirus genes expressed independently e1a oncogene normally required activation attributed cellular equivalent e1a f9 cells however , transcription early genes low undifferentiated otf963 embryonic carcinoma cells first 48 hr infection adenovirus type 5 \( \) transcription increased level seen 16 hr infection cells induced differentiate retinoic acid \( ra \) \( referred ra cells \) , increase occur cells infected e1a deletion mutant addition e1a trans , ra , immediate effect viral transcription otf963 cells , viral transcription increased 48 hr induced transcription several differentiation specific genes otf963 cells kinetics induction ra genes ra cells camp infection adenovirus suggest small amount e1a produced early infection otf963 cells activates cellular genes , differentiation specific required efficient transcription viral genes , e1a induces induced differentiation simple hypothesis cellular equivalent e1a adequately explain complex interactions viral cellular genes otf963 embryonic carcinoma cells
human immunodeficiency virus type 2 vpr gene essential infection human macrophages human immunodeficiency virus \( hiv \) genetic determinant \( \) responsible tropism human cells macrophages well defined studied role hiv type 2 \( hiv 2 \) nef vpr genes viral tropism hiv 2 mutants , lacking either vpr nef genes , vpr nef , obtained site specific mutagenesis biologically active hiv 2 proviral clone \( hiv \) , infectious human cells macrophages viral progeny carrying mutations nef , vpr , nef vpr genes efficiently parental virus primary human peripheral blood cells human 78 cell line contrast , hiv 2 nef mutant infected human macrophages efficiently parental virus , whereas viruses lacking vpr gene either alone conjunction lack nef gene replicate macrophages thus , lack nef hiv 2 enhances viral replication cells interfere viral replication primary macrophages , whereas vpr essential replication hiv 2 human macrophages parental hiv cloned virus also rhesus macaques , use animal studies hiv 2 mutants differences cell tropism rates replication highly useful understanding mechanism viral infectivity possibly vivo
human colorectal cancers display abnormal fourier transform infrared spectra fourier transform infrared spectroscopy \( ft ir \) applied study tissue sections human colorectal cancer pairs tissue samples colorectal cancer histologically normal mucosa 5 10 cm away tumor obtained 11 patients underwent partial cancer specimens displayed abnormal spectra compared corresponding normal tissues changes involved phosphate c stretching bands , stretch region , pressure dependence bending c stretching modes findings indicate colonic malignant tissue , changes degree hydrogen bonding \( \) oxygen nucleic acids \( increased \) \( ii \) oh groups serine , tyrosine , threonine residues \( \) cell proteins \( decreased \) \( iii \) c groups acyl chains membrane lipids \( increased \) addition , indicate changes structure proteins membrane lipids \( judged changes ratio methyl methylene groups \) packing conformational structure methylene chains membrane lipids cell \( \) malignant colon tissues responsible spectral abnormalities unknown cultured colon adenocarcinoma cell lines displayed similarly abnormal ft ir spectra diagnostic potential observed changes discussed
transfer secretory proteins endoplasmic reticulum golgi apparatus discrimination homologous heterologous transfer intact examine aspects transfer secretory proteins endoplasmic reticulum golgi apparatus situ , formed hep g2 human hepatoma cells 38 human fibroblasts cells appropriately treated cycloheximide fusion , respective secretory proteins , serum albumin hep g2 cells procollagen 38 cells fusion complete , cycloheximide washed , protein synthesis resumed , rates serum albumin procollagen two separated golgi within followed immunofluorescence microscopy serum albumin found always first golgi apparatus contributed hep g2 half , procollagen golgi apparatus 38 half results suggest endoplasmic reticulum golgi apparatus transfer situ simply process either spatially restricted exhibits cell type specificity
adult cell leukemia derived factor , produced human lymphotropic virus type epstein barr virus transformed lymphocytes , acts autocrine growth factor interleukin 1 interleukin 2 interleukin 1 \( il 1 \) obtained epstein barr virus infected b lymphoblastoid cell line 3b6 shown involved autocrine growth 3b6 b cells independently , adult cell leukemia derived factor \( adf \) purified human lymphotropic virus infected leukemic cell line \( atl 2 \) reported interleukin 2 \( il 2 \) receptor inducing factor previously reported molecular mass , pi , nh2 terminal amino acid sequence 3b6 derived il 1 adf cdna cloning adf demonstrated high homology disulfide reducing enzyme show adf 3b6 derived il 1 identical rna blot , 3b6 atl 2 cells shown contain high levels 0 6 kilobase mrna corresponding adf message detected resting peripheral blood lymphocytes could weakly induced lymphocyte activation antibodies raised synthetic peptides corresponding nh2 terminus terminus adf immunoblotting sequential immunoprecipitation antibodies revealed 13 kda protein 3b6 atl 2 cells recombinant adf could sustain growth 3b6 atl 2 cells low cellular concentration without fetal calf serum adf , thus , appears involved autocrine growth similarly , recombinant adf could enhance growth b cell lines , including epstein barr virus negative burkitt lymphoma line lymphoblastoid cell lines , , finally , recombinant adf exhibits marked synergism cytokines , il 1 il 2 , allowing infected lymphocytes respond suboptimal amounts variety growth factors
recombinant immunotoxin anti tac \( fv \) pseudomonas 40 cytotoxic toward peripheral blood malignant cells patients adult cell leukemia anti tac \( fv \) pe40 recombinant single chain immunotoxin containing heavy light variable regions anti tac monoclonal antibody fused mutant form pseudomonas \( pe \) anti tac binds p55 subunit human interleukin 2 \( il 2 \) receptor , anti tac \( fv \) pe40 kills human monkey cell lines contain either intact il 2 receptor p55 subunit alone assess usefulness anti tac \( fv \) pe40 treatment il 2 receptor positive leukemia , tested peripheral blood mononuclear cells six patients adult cell leukemia six patients , anti tac \( fv \) pe40 extremely cytotoxic malignant cells metabolic activity sensitivity fresh cells improved small amount il 2 \( 10 units per ml \) present incubation toxin concentration necessary inhibit protein synthesis 50 16 hr incubation cells immunotoxin varied 1 6 16 ng ml \( 2 5 25 x 10 \( 11 \) \) every case , binding means tac antigen anti tac \( fv \) pe40 cytotoxicity prevented adding excess anti tac antibody moreover , anti tac alone inactive mutant anti tac \( fv \) pe40 without adp activity little cytotoxic activity peripheral blood mononuclear cells normal controls , patient tac negative leukemia , adult cell leukemia patients without significant peripheral blood involvement sensitive anti tac \( fv \) pe40 results indicate anti tac \( fv \) pe40 potent cytotoxin adult cell leukemia cells vitro warrants clinical testing
170 kda membrane bound protease associated expression invasiveness human malignant melanoma cells malignant spreading cancer cells requires cell surface proteases collagenous matrix connective tissues correlating morphologically defined invasiveness tumor cells presence specific membrane associated proteases , identified malignant human melanoma cell line , lox , gelatin films vitro contains uniquely neutral 170 kda gelatinase cell membrane similar gelatinase found membranes recovered culture media conditioned lox 170 kda gelatinase wheat germ agglutinin binding protein proteolytic activity maximal neutral ph , enhanced edta , inhibited cysteine protease inhibitors n , , fluoride , bind , suggesting neutral sulfhydryl sensitive protease 170 kda gelatinase lox cells found control melanoma cell line , sk , 32 tumor cell lines show extracellular gelatin degradation thus , identified large membrane bound protease may specific marker molecule melanoma cell invasiveness
introduction nerve growth factor \( ngf \) receptors medulloblastoma cell line results expression high low affinity ngf receptors ngf mediated differentiation expression cloned human nerve growth factor receptor \( ngfr \) cdna cell lines generate high low affinity binding sites since inability respond appropriately differentiation factors ngf may contribute determining malignant phenotype neuroblastomas , sought determine whether true generate human central nervous system neuronal cell line would respond ngf , infected medulloblastoma cell line med defective retrovirus carrying cdna coding human ngfr resultant cells \( med ngfr \) expressed abundant low high affinity , ngf treatment induced rapid transient increase c fos mrna ngfr expressing cells parent line cells infected virus lacking cdna insert however , med ngfr cells ngfr high efficiency , differentiate response ngf three important conclusions emerge study \( \) internalization necessary early rapid transcriptional effects ngf \( ii \) unknown factor \( \) cloned ngfr allowing high affinity ngf binding found primitive central nervous system cell line \( iii \) introduced expressed med \( e , med ngfr \) cells partially functional unable induce differentiation primitive neuron like tumor cells , implying high efficiency receptor mediated endocytosis ngf receptor may necessary step cascade events leading ngf mediated differentiation
dioxin inducible , ah receptor dependent transcription vitro developed homologous vitro transcription system requires \( \) 2 , 3 , 7 , 8 p dioxin \( called tcdd dioxin \) , \( ii \) ah receptor , \( iii \) dioxin responsive enhancer activity unfractionated nuclear extracts mouse hepatoma cells contain inhibitor fail direct transcription vitro however , following chromatography reconstitution , fractionated nuclear extract accurate transcription vitro , using template promoter enhancer region mouse cytochrome p1 450 gene \( \) linked g free \( generates transcript guanosine residues \) extracts tcdd treated cells exhibit higher activity extracts untreated cells template containing promoter enhancer template containing promoter alone extracts ah receptor defective cells fail direct vitro transcription tcdd inducible fashion regulatory element contains two binding sites ah receptor plus truncated promoter direct tcdd inducible , ah receptor dependent transcription vitro inducible , receptor dependent , enhancer dependent properties system make appropriate analyzing vitro mechanism dioxin action function ah receptor
molecular structure major insulin mitogen activated 70 kda s6 protein kinase molecular structure rat hepatoma 70 kda insulin mitogen stimulated s6 protein kinase , obtained molecular cloning , compared rat 85 kda xenopus s6 protein kinase alpha kinases cloned hepatoma cdna 70 kda s6 kinase \( calculated molecular mass 59 , 186 da \) exhibits single catalytic domain closely related amino acid sequence \( 56 identity \) amino terminal , kinase c like domain rat s6 kinase \( calculated molecular mass 82 , da \) strong similarity extends 67 residues carboxyl terminal catalytic domain \( 40 identity \) , corresponding region also conserved among kinase c family outside segment approximately 330 amino acids , structures p70 s6 kinases substantially p70 s6 kinase known activated serine threonine phosphorylation unidentified insulin mitogen activated protein kinases model regulation p70 s6 protein kinase activity proposed low activity enzyme results binding basic , inhibitory site \( located carboxyl terminal extended catalytic domain \) acidic substrate binding region \( located amino terminal catalytic domain \) substrate binding thereby prevented s6 kinase activation requires displacement inhibitory segment , proposed occur consequent multiple phosphorylation putative segment contains several serine threonine residues , followed directly proline residue motif may prevent permit two serine residues reside maturation promoting factor \( \) cdc 2 consensus motif thus , hormonal regulation s6 kinase may involve action cdc 2 protein kinases related substrate specificity
identical splicing aberrant epidermal growth factor receptor transcripts amplified rearranged genes human glioblastomas epidermal growth factor receptor gene found amplified rearranged human glioblastomas vivo present sequence across splice junction aberrant epidermal growth factor receptor transcripts derived corresponding uniquely rearranged genes coexpressed non rearranged epidermal growth factor receptor genes six primary human glioblastomas six tumors contains aberrant transcripts derived identical splicing exon 1 exon 8 consequence deletion rearrangement amplified gene , extent variable among tumors spite variability , rearrangement results loss 801 coding bases \( exons 2 7 \) creation new codon novel splice site corresponding transcripts rearrangements , however , affect mrna sequence signal peptide , first five codons , reading frame downstream rearrangement
prospective clinical evaluation autogenous vein grafts used nerve conduit distal sensory nerve defects 3 cm less purpose study determine efficacy autogenous vein grafts nerve grafts \( \) bridging small peripheral sensory nerve gaps compared direct repair conventional nerve grafting techniques \( ang \) patients painful neuroma segmental nerve injury 3 cm chosen test group amenable direct repair classified controls 1982 1988 , total 22 patients enrolled study total 34 nerves repaired , 15 venous nerve conduit , 4 sural nerve graft , 15 direct repair significant symptom relief satisfactory sensory function return uniformly observed two point discrimination measurements indicated superiority direct repair probably conventional nerve grafting however , universally favorable patient acceptance return measurable two point discrimination indicates effectiveness autogenous vein grafts nerve conduits selectively applied bridge small nerve gap \( less equal 3 cm \) peripheral sensory nerves
dacron fabric hydroxyapatite prosthesis sternal tumor defect autopsy report 38 year old solitary plasmacytoma underwent subtotal treated resection lesion reported followed replacement dacron fabric hydroxyapatite prosthesis dacron fabric sutured surrounding tissues , clavicle passed shaped dacron fabric form joint capsule patient returned daily life 3 months operation daily living , without dislocation joints displacement artificial autopsy examination 1 year operation showed dacron fabric artificial became stronger time joint also stably fixed , dacron fabric fulfilled function artificial articular capsule biologic fixation surrounding supporting tissues
interventional radiology biliary tract intraductal radiation one palliative method treating patients high duct cholangiocarcinoma use wire placed tumor , previously intubated , high local dose radiation mean survival time 30 patients treated intraductal radiation 16 8 months , improvement compared surgical bypass endoscopic radiologic drainage procedures
regulation gene expression double phosphorothioate oligonucleotides alteration gene transcription inhibition specific transcriptional regulatory proteins necessary determining factors participate cellular differentiation functions proteins antagonized several methods , specific limitations inhibition sequence specific dna binding proteins achieved double \( ds \) phosphorothioate oligonucleotides contained octamer kappa b consensus sequences phosphorothioate oligonucleotides specifically bound either octamer transcription factor nuclear factor \( nf \) kappa b modified oligonucleotides accumulated cells effectively standard ds oligonucleotides modulated gene expression specific manner octamer dependent activation reporter plasmid nf kappa b dependent activation human immunodeficiency virus \( hiv \) enhancer inhibited appropriate phosphorothioate oligonucleotide added transiently transfected b cell line addition phosphorothioate oligonucleotides contained octamer consensus leukemia cells inhibited interleukin 2 \( il 2 \) secretion degree similar observed mutated octamer site il 2 enhancer ds phosphorothioate oligonucleotides probably binding specific transcription factors may provide anti viral , immunosuppressive , therapeutic effects
survey alabama physicians' use mammography , 1989 early 1989 surveyed questionnaire alabama primary care physicians \( n 1800 \) concerning attitudes toward use mammography respondents \( 37 8 \) majority \( 83 \) recommend mammograms patients according american cancer society guidelines obtain baseline studies asymptomatic women ages 35 40 years appears cost mammograms decreasing alabama screening study available 50 less 34 responding physicians almost one half \( 48 \) physician respondents believe 50 patients least one mammogram
trabecular merkel 's cell carcinoma two cases trabecular cell carcinoma skin presented clinical presentation behavior , histologic findings , tumor described surgical excision primary lesion regional lymph node dissection , indicated , treatment choice distant metastasis treated local irradiation
time recurrence varies inversely thickness clinical stage 1 cutaneous melanoma thickness tumor identified principal prognostic factor cutaneous malignant melanoma however , time recurrence conclusively related thickness retrospective study 216 patients primary cutaneous malignant melanoma recurred conducted clarify relationship investigate possible independent relationships age diagnosis sex patients time recurrence results analysis linear regression revealed inverse linear relationship thickness time recurrence \( p less 0 001 \) patients 50 years age time diagnosis shown relapse sooner less 50 years age \( p 0 014 \) sex significant factor predicting time recurrence \( p greater 0 10 \) results suggest thickness tumor provides indication time recurrence patients recur stress need long term surveillance patients history malignant melanoma possibility late relapse even thin lesions
justification surgical treatment metastatic melanoma gastrointestinal tract fifty six patients symptomatic metastatic melanoma gastrointestinal tract \( \) treated surgically melanoma unit 1974 1989 reviewed majority patients presented abdominal pain symptoms anemia small intestine site metastasis 80 per cent mean survival time 11 7 months \( range one 60 months \) surgical treatment first metastasis 3 6 months \( range zero 12 months \) postoperatively second metastasis forty four patients reported complete relief symptoms postoperatively results suggest aggressive approach symptomatic metastases malignant melanoma justified relieve distressing symptoms prolong life
silicone rubber advanced hepatocellular carcinoma preliminary report new treatment method , collaterals silicone rubber sheet , applied three patients advanced hepatocellular carcinoma arterial assessed ineffective developed collateral feeding arteries procedure followed arterial infusion chemotherapy follow celiac angiography confirmed long term achieved shielding liver silicone rubber technique resulted partial responses without serious complications patients including two responses procedure response durations 5 , 21 , 27 , months , respectively one patient died gastrointestinal bleeding 7 months two patients still alive , survivals procedure 28 30 months , respectively therapy considered promising may choosing adjuvant treatment advanced hepatic malignancies uncontrolled arterial chemotherapy
constitutional symptoms patients germ cell neoplasms patient mediastinal germ cell neoplasm evidenced fever , weight loss , pruritus , painful adenopathy ingestion alcohol retrospective review revealed 9 percent 104 patients advanced germ cell neoplasm evidence constitutional symptoms presentation
natural history cardiac rhabdomyoma infancy childhood although spontaneous regression cardiac rhabdomyoma reported , prognosis still considered poor surgery continues indicated experience rhabdomyoma diagnosed live infants 20 year period reviewed diagnosis angiography echocardiography accepted multiple tumors present tuberous sclerosis also diagnosed nine patients \( 3 diagnosed prenatally remaining 6 age less 8 months \) identified total 24 tumors measurements 2 planes demonstrated least evidence regression 24 patients \( 100 \) , 20 24 complete resolution one patient required delayed surgery excision subaortic ridge appeared site resolved tumor findings suggest pediatric cardiac rhabdomyoma often benign condition spontaneous regression rule surgery recommended patients refractory severe hemodynamic compromise
diet female sex hormone concentrations intervention study type fat consumed possible mechanism dietary fat may influence development breast cancer influencing concentration female sex hormones study investigated effect alteration type fat consumed concentrations female sex hormones serum female volunteers randomly assigned continue usual meat eating diet , change vegetarian diet , change diet predominantly vegetarian fish consumed least three times per week change vegetarian fish diet little effect diet total hormone concentrations however , amount estradiol significantly decreased vegetarian group nutrient consumption correlated hormone concentrations , prolactin directly associate fat consumption , sex hormone binding globulin inversely associated fat consumption \( particularly cholesterol consumption \) , proportion nonprotein bound estradiol directly associated complex carbohydrate consumption
dietary fat risk breast cancer relationship dietary fat subsequent risk breast cancer studied initially cancer free finnish women aged 20 69 follow period 20 , 54 breast cancer cases diagnosed risk breast cancer significantly inversely related energy intake inversely related absolute fat intake positive association energy adjusted total fat intake occurrence breast cancer also observed relative risk highest tertile compared lowest tertile 1 7 \( 95 confidence limits 0 6 4 8 \) corresponding relative risks 1 4 \( 0 5 3 7 \) saturated fatty acids , 2 7 \( 1 0 7 4 \) fatty acids , 1 2 \( 0 6 2 8 \) polyunsaturated fatty acids , 2 2 \( 1 0 5 0 \) cholesterol intake adjustment different potential confounding factors alter results present data suggest breast cancer associated inversely energy intake weakly positively energy adjusted fat intake
breast cancer dietary plasma concentrations carotenoids vitamin case control study breast cancer conducted participants completed food frequency questionnaire donated fasting blood sample definitive workup breast masses dietary plasma concentrations carotenoids retinol 83 women found breast cancer compared 113 women found free breast cancer \( control subjects \) case control differences dietary estimates vitamin intake plasma alpha carotene however , subjects breast cancer lower concentrations plasma beta carotene control subjects \( p 0 02 \) overall association plasma retinol breast cancer positive relationship observed retinol breast cancer subgroup low beta carotene values results suggest low plasma beta carotene associated increased risk breast cancer studies need determine whether low carotene concentrations subtle effect disease might causally related breast cancer
demonstration lipiodol paraffin sections using modified silver technique demonstrate lipiodol \( lip \) hepatocellular carcinoma \( hcc \) paraffin sections , direct formalin fixed tissue blocks silver nitrate \( \) followed routine processing lip appeared black sinusoids ninety four tissue blocks 13 lip hccs 69 8 non lip hccs 4 fatty livers studied seventy two 73 negative controls positive blocks seen soft tissue radiographs \( \) correctly coded \( specificity 98 6 , sensitivity 100 \) twenty six 44 lip negative areas lip cases contained less 10 microns diameter fatty change gave positive readings thus , modified simple , accurate means detecting lip high quality paraffin sections suitable tumor diagnosis , applied lip , guided liver biopsy , verify biopsy reached suspected tumor focus
immunophenotypic adult acute lymphoblastic leukemia recent reports indicate high frequency immunophenotypic acute lymphoblastic leukemia \( \) investigate issue regard adult , authors reviewed immunophenotyping data 39 cases analyzed clinical laboratory flow cytometric analysis peripheral blood bone marrow performed use panel 21 b cell , cell , myeloid monoclonal antibodies \( moabs \) surface antigen profiles leukemic cells compared normal bone marrow thymic counterparts , defined current models twenty six cases b precursor , 8 , 3 b \( burkitt 's leukemia \) two cases coexpressed lymphoid myeloid antigens contrast , quite common 13 26 b precursor cases normal b lineage marrow cells defined recent classification cases also heterogeneous high incidence aberrant antigen expression adult suggests also involves aberrant differentiation rather purely process arrest
malignant rhabdoid tumor liver distinct clinicopathologic entity malignant rhabdoid tumor occurring primary hepatic neoplasm six month old white infant reported treated attempt total resection involving right hepatic lobectomy chemotherapy cis platinum , vp 16 , adriamycin despite , recurrence tumor resulted girl 's death within three months neoplasm showed typical light microscopic features malignant rhabdoid tumor well filamentous cytoplasmic inclusions electron microscopic examination staining cytokeratin vimentin immunohistochemistry classic clinicopathologic features tumor support concept malignant rhabdoid tumors similar kidney may occur extrarenal sites
primary malignant melanoma lower respiratory tract report case literature review authors report case primary bronchial malignant melanoma , occurring 34 year old woman presenting persistent cough examination , polypoid mass found occlude left bronchus biopsies showed malignant epithelioid tumor resembling atypical carcinoid histochemistry , electron microscopic study , immunohistochemistry confirmed diagnosis melanoma physical examination additional clinical history exclude possible primary sites negative patient underwent thoracotomy left pneumonectomy nineteen months resection found histologically similar tumor involving left adrenal gland review literature shows melanoma lower respiratory tract reported adults tendency present central polypoid growth may responsive surgical resection
granular cell tumor esophagus endoscopic ultrasonographic demonstration endoscopic removal 35 yr old japanese man granular cell tumor esophagus removed endoscopic polypectomy presented radiography endoscopy showed 20 x 12 mm distal esophagus endoscopic ultrasonography demonstrated hypoechoic mass submucosa without continuity propria lesion successfully treated endoscopic polypectomy without complications cross sections resected specimen quite agreement ultrasonographic findings endoscopic ultrasonography valuable assess exact location extent tumor , determine indication endoscopic polypectomy
chance cut chance cure \? fifty seven patients underwent local excision invasive distal rectal cancer initial operative procedure curative intent five year survival 82 5 , rectal cancer specific mortality rate 10 5 level wall invasion , vascular permeation , tumor ulceration , mobility , differentiation criteria studied prognosis poor prognostic factors included mucinous cell differentiation full thickness invasion , cases , abdominoperineal resection recommended none 27 patients without adverse prognostic factors died rectal cancer factors appear influence outcome , local excision distal rectal cancer would treatment choice selected patients
increase beta 1 6 branched oligosaccharides human esophageal carcinomas invasive surrounding tissue vivo vitro beta 1 \( beta 1 6 \) branched n oligosaccharides expressed tumor cells found contribute malignant metastatic potential experimental tumor models vulgaris \( l pha \) requires beta 1 6 linked high affinity binding used characterize distribution sugar structures human esophageal squamous cell carcinomas 42 patients reactive carcinoma cells invasive tumors distributed predominantly outer surface tumor adjacent surrounding tissue furthermore , te 1 cells , human esophageal squamous cell carcinoma line , cultured collagen gel matrix obtain colonies three dimensional form , colonies exhibited high affinity l pha binding outer cell layer facing collagen matrix , unrelated cell growth cycle findings suggest increase beta 1 6 branched oligosaccharides esophageal carcinomas important trait tumor invasion surrounding tissue
coexpression patterns vimentin glial filament protein cytokeratins normal , hyperplastic , neoplastic breast authors studied immunohistochemistry intermediate filament \( \) protein profile 66 frozen samples breast tissue , including normal parenchyma , variants disease \( fcd \) , fibroadenomas , , ductal lobular carcinomas monoclonal antibodies \( mabs \) cytokeratins included mab 1 , binds polypeptide 5 complex polypeptide 14 recognizes preferentially myoepithelial cells mab , binds polypeptides 14 , 15 , 16 19 individual mabs polypeptides 7 , 13 , 16 , 17 , 18 , 19 , mab mixture authors also applied three mabs vimentin \( vim \) , three mabs glial filament protein \( gfp \) selected samples studied double label immunofluorescence microscopy staining sequential sections said mabs , mab alpha smooth muscle actin , well characterized polyclonal antibodies possible coexpression diverse types cytoskeletal proteins gel electrophoresis immunoblot analysis also performed samples reacted cytokeratins mabs , although reaction involve cells monoclonal antibody stained preferentially luminal secretory cells normal breast fcd , whereas stained vast majority cells carcinomas monoclonal antibody stained preferentially basal myoepithelial cells normal breast fcd staining tumor cell subpopulations 4 31 carcinomas vimentin positive cells found 8 12 normal breasts 12 20 fcd cases , vim reactive cells appeared myoepithelial , occasional luminal cells also stained variable subpopulations vim positive cells noted 9 20 ductal 1 7 lobular carcinomas glial filament protein reactive cells found normal breast ducts 15 20 cases fcd rare exceptions , gfp reactivity restricted located , myoepithelial appearing cells occasional gfp reactive cells found 3 31 carcinomas evaluation sequential sections double label immunofluorescence microscopy showed coexpression certain cytokeratins \( possibly including polypeptides 14 17 \) vimentin alpha smooth muscle actin together gfp myoepithelial cells presence gfp myoepithelial cells confirmed gel electrophoresis immunoblotting results indicate coexpression cytokeratin vimentin gfp comparatively frequent normal basal myoepithelial cells breast \( abstract truncated 400 words \)
expression n \( cd13 \) mesenchymal tumors long time , cd13 molecules considered restricted myeloid cells related neoplasms , however , expression cd13 also detected hepatocellular , gallbladder , renal , lung carcinomas , even malignant melanomas study , expression cd13 antigen immunohistochemically examined non neoplastic mesenchymal cells , along 33 benign 83 malignant mesenchymal tumors \( met \) using cd13 monoclonal antibodies \( mab \) , , wm 15 , non neoplastic mesenchymal cells , expression cd13 restricted perivascular blasts , tissue histiocytes , osteoclasts , peripheral nerve trunks neoplastic conditions , cd13 detectable tumors smooth muscle , fibrous , , synovial , osteogenic , peripheral nerve sheath origin , even tumors adipose tissue tumors muscle origin , autonomic ganglia , cartilage forming tissues cd13 negative throughout thus tumors studied pattern expression cd13 situation found cells origin findings data expression leukocyte differentiation antigens extra hematopoietic tissues expression cd13 , known identical n , important peptide enzyme , met might reflect special functional state neoplasms
immunocytochemical localization progesterone receptors endocrine cells human pancreas progesterone receptors \( pgr \) localized nuclei several \( 40 75 \) endocrine cells human pancreas variable number neoplastic cells 7 18 endocrine pancreatic tumors conversely exocrine epithelial cells pancreas exhibit pgr immunoreactivity normal well different pathologic conditions , including pancreatic adenocarcinomas estrogen receptors detected pancreatic samples investigated double immunocytochemical experiments documented pgr immunoreactivity normal langerhans islets consistent feature \( 75 \) glucagon producing cells , approximately 5 20 insulin producing b cells , variable percentage pancreatic polypeptide \( pp \) producing cells , ranging 5 70 figures affected sex , age , underlying disease patients reported findings previous clinical experimental evidence indicating sex steroid hormones may regulatory effects functional activity endocrine pancreas
immediate versus delayed shoulder exercises axillary lymph node dissection total 144 evaluable patients breast cancer enrolled multicenter , randomized , prospective study establish role delayed shoulder exercises wound drainage shoulder function axillary lymph node dissection patients group 1 \( n 78 \) started active shoulder exercises 1 day postoperatively patients group 2 \( n 66 \) started eight postoperative day , following 1 week immobilization arm patients group 2 14 less wound drainage volume group 1 \( 600 436 ml versus 398 ml \) difference , however , significant also , differences could established two groups duration volume wound drainage , number volume , wound complication rates , shoulder function compared 6 months surgery
variations sensitivity sectioning intercostobrachial nerve authors present prospective study variations sensitivity appear arm intercostobrachial nerve sectioned modified radical mastectomy total 208 patients studied 1978 1987 , intercostobrachial nerve sectioned 139 patients , whereas 30 remained intact 39 patients peripheral branches nerve sectioned patients examined regular postoperative intervals order evaluate sensitivity touch pain axilla arm four hundred thirty three examinations carried 3 operative groups assessed accordingly nerve sectioned , increasing anesthesia face arm , patients intercostobrachial nerve remained intact , alterations less intense long lasting significant statistical differences two groups also exist absence axillary lymphatic ganglia infiltrated tumor , conservation intercostobrachial nerve recommended
anesthesia craniotomy double blind comparison alfentanil , fentanyl , sufentanil using prospective , randomized , double blind study design , alfentanil \( n 15 \) , fentanyl \( n 14 \) , sufentanil \( n 16 \) , combination n2o , administered patients undergoing craniotomy supratentorial tumor resection physicians given two , one labeled load initial loading dose maintenance continuous infusion concentration drug syringe adjusted permit administration milliliter per kilogram basis target loading doses alfentanil , fentanyl , sufentanil 75 , 10 , 1 microgram kg , respectively , initial infusion rates 33 5 , 2 0 , 0 3 microgram kg 1 h 1 , respectively additional supplementary boluses changes maintenance infusion rate made according predetermined guidelines isoflurane , increasing 0 2 inspired increments , used maximum allowed opioid dose given \( e , supplementary bolus doses equal 75 calculated loading dose supplementary bolus doses equal 50 calculated loading dose combined 50 increase maintenance infusion rate \) opioid infusions stopped time bone flap replacement antihypertensive medications naloxone subsequently given group demographics different total volumes drug similar among groups indicating preparations administration isoflurane , antihypertensive medications , naloxone different among groups although decreases blood pressure seen induction similar among groups , alfentanil treated patients received frequently intubation thirty minutes entry recovery area , respiratory rate ph lowest sufentanil treated patients
single breath nitrogen test , mortality , cancer relationship indices single breath nitrogen test mortality , overall cancer incidence , respiratory cancer incidence examined cohort men , 46 69 yr age , examined 1974 followed june 1985 closing volume , closing capacity , slope phase iii related mortality cancer contrast , fev1 related mortality , estimated relative mortality risk 1 37 \( 95 confidence interval , 1 11 1 70 \) per liter expected fev1 , given height , age , smoking , fev1 related cancer inability perform acceptable single breath nitrogen test tracings related mortality relative mortality risk 2 03 \( 1 45 2 85 \) , cancer conclude indices single breath nitrogen test predictive value concerning overall mortality cancer incidence
colorectal cancer evidence distinct genetic categories based proximal distal tumor location purpose examine studies normal colon colorectal cancer evidence location primary tumor proximal distal splenic colon may determine distinct genetic categories disease data identification studies identified manual search , medline , review bibliographies identified articles study selection approximately 300 articles examined 150 articles excluded tumor location reported reported way permit correlation results conclusions data extraction articles selected either presentation data permitted correlation results anatomic regions colon relevant inherited colorectal cancer results analysis differences noted biologic properties proximal distal segments normal fetal adult colonic epithelium epidemiologic , pathologic , cytogenetic , molecular features proximal distal colorectal cancer differences correlated features inherited colorectal cancer \( proximal , distal , polyposis forms \) conclusions developmental biologic differences proximal distal colon may reflect differing susceptibilities neoplastic transformation differences proximal distal colorectal cancer suggest may arise different pathogenetic mechanisms proximal tumors appear represent genetically stable form disease may arise mechanisms underlie inherited colon cancer distal tumors show evidence greater genetic instability may develop mechanisms underlie polyposis associated colorectal cancer syndromes
localization peptide content endocrine pancreatic tumors endocrine pancreatic tumors contain frequently neurohormonal peptides phenomenon used diagnostic classifying tool study analyzes 31 patients operated endocrine pancreatic tumor , including diagnostic procedures localization methods 15 insulinoma cases 6 patients positive arteriography , 11 selective pancreatic vein positive immunoreactivity showed , besides insulin , tumors also contained peptides four gastrinoma cases arteriography positive three , selective vein sampling localized tumor tumor 's content peptides showed mixed patterns four , arteriography positive venous sampling performed three cases also positive five pancreatic polypeptide containing tumors \( pp \) arteriography positive four sampling performed two positive pp peptide pattern showed tumors frequently contain several peptides used selective pancreatic vein sampling 21 cases positive result cases arteriography negative , sampling results helped surgeon find tumor peptide pattern tumors varied greatly tumors
localization surgical treatment occult insulinomas management patients biochemical evidence insulinoma negative preoperative imaging studies \( occult \) tumors controversial , varying primarily medical management aggressive , blind nearly total pancreatectomy tumor since 1982 , 12 consecutive patients occult insulinoma underwent preoperative portal venous sampling \( pvs \) insulin followed surgical exploration intraoperative ultrasound \( ious \) eleven twelve patients \( 92 \) insulinoma removed cured portal venous sampling correctly predicted location insulinoma 9 patients \( 75 \) tumor would found another patient fourfold insulin gradient pancreatic tail one patient correctly predicted distal pancreatectomy would remove insulinoma despite fact neither palpation ious identified tumor intraoperative ultrasound single best method identify occult tumors correctly identified 10 11 insulinomas found , including five pancreatic head tumors palpable palpation identified five insulinomas 10 tumors identified operation palpation ultrasound , ious identified significantly \( 100 versus 50 , p 0 03 \) guided successful enucleation results support strategy preoperative pvs operation ious localize remove insulinoma patients occult tumors tumors \( 75 \) correctly localized specific pancreatic region preoperative pvs identified ious \( 83 \) , allowing simple enucleation biochemical correction hypoglycemia morbid blind pancreatic resections longer indicated long term medical management hypoglycemia reserved occasional patient \( 8 \) fails preoperative pvs operation guided ious
successful fontan type operation right ventricular tumor large intracavitary right ventricular tumor 24 year old patient considered involved interventricular septum , free ventricular walls , tricuspid valve surgical palliation consisted closure tricuspid pulmonary valves , right atrium anastomosed pulmonary artery bifurcation patient asymptomatic 7 years operation , neoplasm \( rhabdomyoma \) increased size
mediastinal , rare tumor uncommon soft tissue tumor derived remnants fetal brown fat review world medical literature revealed 90 cases , 6 intrathoracic present seventh case intrathoracic case , within mediastinum without direct invasion structures
systemic therapy metastatic colorectal cancer fluorouracil based chemotherapy regimens utilized metastatic colorectal cancer 30 years early attempts defining optimal treatment schedule use combination drugs failed significantly improve results contrast , clinical effectiveness fluorouracil improved continuous infusion administration modulation folinic acid approaches increased response rate compared results achieved traditional bolus schedules effect survival less significant unfortunately , expense , instances , toxicity also increased , overall usefulness clinical studies evaluate fluorouracil chemotherapy combination biological response modifiers ongoing areas intense research next years
needle localized mammographic lesions results evolving treatment strategy january 1981 december 1987 , needle localization breast biopsies performed institution mammographically detected abnormalities reviewed needle localization breast biopsy procedures performed two periods \( january 1981 june 1984 , n january august 1987 , n 220 \) compare results treatment patterns , determine prevalence missed lesions mammographic abnormalities detected routine screening accounted larger proportion needle localization breast biopsies later series \( 94 30 vs 94 43 220 \) however , rate carcinoma identified remained constant 29 percentage cancers invasive \( 46 vs 51 \) overall , rate malignant diagnoses needle localization breast biopsy lowest asymptomatic women undergoing routine screening mammography \( 44 24 188 \) significantly higher women undergoing mammographic follow contralateral breast treatment breast cancer \( 28 43 65 \) seven missed lesions needle localization breast biopsies , necessitating second procedure six interval mammograms one
hepatic vein reconstruction preserving remnant liver function hepatic malignancies often infiltrate major hepatic vein recently , performed hepatic resection combined hepatic vein reconstruction preserving remnant liver function three patients one patient saphenous vein graft postoperative liver function patients underwent hepatic vein reconstruction compared eight patients underwent hepatic resection segments vii viii right hepatic vein four resected remaining four preserved using ultrasonic although four patients right hepatic vein resection showed severe lowering liver function surgery , postoperative course patients preservation reconstruction right hepatic vein maintained good liver function liver regeneration three patients hepatic vein reconstruction good computed tomography besides report , knowledge , report hepatic vein reconstruction preserving remnant liver function problems hepatic resection combined hepatic vein reconstruction discussed conclude hepatic vein reconstruction one means extending indication malignant tumor resection liver
papillary cystic neoplasm pancreas increasingly recognized clinicopathologic entity clinical course papillary cystic neoplasm pancreas contrasted pancreatic ductal adenocarcinoma former occurs predominantly young women , low malignant potential , highly curable surgical treatment three cases reported illustrate typical clinical features nature tumor one case discovered blunt abdominal trauma resulted rupture tumor cases treated pancreatic resection preservation spleen , important consideration younger patients patients free disease long term follow increasing awareness tumor resulted several tumors lead better recognition surgeons caring patients pancreatic diseases
molecular phenotype pediatric small round cell tumor molecular probes used characterize unusual small round cell abdominal tumor arising fallopian tube 15 year old girl dna rna extracted tumor adjacent normal tissue subjected southern northern blot analysis using variety different probes n myc oncogene rna greatly expressed tumor , expressed normal tissue amplified chromosomal dna insulin like growth factor ii rna similarly overexpressed neoplasm , normal tissue histopathologic studies could distinguish neuroectodermal neoplasm wilms' tumor , electron microscopy pattern gene expression consistent wilms' tumor
decrease cerebral metabolic rate glucose high dose methotrexate childhood acute lymphocytic leukemia measured changes regional cerebral metabolic rate glucose \( rcmrglu \) using 18f fluorodeoxyglucose positron emission tomography assessment neurotoxicity childhood acute lymphocytic leukemia treated high dose methotrexate \( hd mtx \) therapy studied 8 children acute lymphocytic leukemia \( mean age 9 6 years \) treated hd mtx \( 200 mg kg 2 , 000 mg m2 \) therapy cmrglu hd mtx therapy reduced \( 40 \) patient central nervous system leukemia treated largest total doses intrathecal mtx \( mtx \) hd mtx cmrglu whole brain hd mtx therapy reduced average 21 \( p less 0 05 \) reductions cmrglu 8 patients correlated total doses mtx \( r 0 p less 0 05 \) systemic hd mtx \( r 0 p less 0 05 \) cmrglu cerebral cortex , especially frontal occipital cortex , reduced basal ganglia white matter suggest measurement changes rcmrglu hd mtx therapy useful detecting accumulated mtx neurotoxicity
photodynamic therapy treatment squamous cell carcinoma head neck photodynamic therapy experimental modality tumor treatment based combined action tumor agent , ie , derivative , red light 1985 1989 , 26 patients treated using derived drugs nm light delivered dye laser patients biopsy proved squamous cell carcinoma head neck , either failed traditional treatment modalities refused conventional therapies histological complete responses achieved 20 \( 77 \) 26 patients partial responses 5 \( 19 \) 26 patients periods 48 months minimal toxic reaction noted group guide treatment planning patient group large tumors , used optical model based tissue rate complete responses treatment 8 \( 73 \) 11 data indicate photodynamic therapy capable inducing significant clinical histological responses majority treated , patients prolonged response produced certain select head neck malignancies , photodynamic therapy important role treatment modality
improving diagnostic accuracy cervical metastases computed tomography magnetic resonance imaging elective neck dissection patients head neck cancer continues controversial management patients would greatly facilitated improvements predicting cervical metastases recent investigations suggested computed tomography magnetic resonance imaging sensitive detecting cervical metastases physical examination department otolaryngology state university hospitals , , undertook prospective study compare preoperative sensitivities physical examination , computed tomography , magnetic resonance imaging pathologic findings 27 patients undergoing neck dissections head neck cancer results indicate computed tomography magnetic resonance imaging sensitive \( 84 92 , respectively \) physical examination \( 75 \) , although results achieve statistical significance sensitivity combined computed tomography magnetic resonance imaging 90
reliability colposcopy directed punch biopsy group 118 women underwent laser cone biopsy data collected routinely case notes entered computerized database histology cone biopsies compared previous , directed punch biopsies , cytology smears taken clinic diagnosis punch biopsy 54 false negative rate neither two microinvasive carcinomas biopsied way detected biopsy ten 24 women negative punch biopsies cin iii cone punch biopsy showed cin ii worse , cone biopsy confirmed presence cin 86 evidence false negative cone biopsies data suggest management based solely upon punch biopsy result include consideration cytology colposcopy findings excisional methods treatment likely reveal early invasion adenocarcinoma situ
lipiodol computerized tomography sensitive specific technique diagnosis hepatocellular carcinoma \? computerized tomography \( ct \) following intra arterial injection lipiodol \( lipiodol ct \) performed 60 patients suspected hepatocellular carcinoma \( hcc \) four main patterns uptake lipiodol within liver seen ct 14 well circumscribed lesions dense homogeneous uptake lipiodol , 13 confirmed hccs 25 lesions dense patchy uptake lipiodol periphery centre , 19 confirmed hccs 18 patients , ill defined faint patchy uptake lipiodol present liver , hepatic uptake present , one patient found later hcc three lesions liver lipiodol uptake , one found necrotic hcc , one cholangiocarcinoma one regenerative nodule diagnosis hcc , lipiodol ct overall sensitivity 97 1 , accuracy 88 3 specificity 76 9 34 patients hcc , 23 solitary diagnosis size hccs ranged 0 8 cm 11 cm diameter median size 2 2 cm eleven 34 hccs \( 32 3 \) resectable conclude , part screening programme high risk patients lipiodol ct useful early detection hccs technique also plays important role determining whether tumour resected managed chemotherapy detecting hccs still small , resectability rate also improved
clinical management port wine stain infants young children using flashlamp pulsed dye laser flashlamp pulsed dye laser \( \) 585 nm , wavelength well absorbed , causes highly selective vascular injury addition , 450 pulse duration produced laser thermal relaxation time dermal blood vessels thereby energy target new laser effects excellent lightening port wine stain \( \) infants young children without adverse complications hypertrophic scarring , permanent pigmentation abnormality , changes , complications often seen conventional laser systems permits treatment patient population expected gain benefit early laser therapy much safer manner , psychological complications marked person develop purpose report \( 1 \) describe theoretical considerations behind achieving selective removal understood used oriented practitioner \( 2 \) describe practical application device used clinical management infants young children
erythrocyte acid desaturation patients colorectal carcinoma erythrocyte oleic acid ratio \( saturation index \) investigated means differentiating control subjects \( n 146 \) patients benign \( n 48 \) malignant \( n 117 \) colorectal disease patients undergoing postoperative follow curative resection \( n 49 \) erythrocyte fatty acid profiles determined gas liquid chromatography neither age , sex , dukes' stage , degree differentiation tumors significant effect erythrocyte saturation index erythrocyte saturation index lower patients primary recurrent colorectal cancer compared control subjects patients inflammatory bowel disease benign colonic polyps \( p less 0 0001 \) erythrocyte saturation index found useful postoperative follow patients using saturation index age means differentiating patients primary colorectal cancer control subjects gave sensitivity 67 percent specificity 81 percent
characterization vitro human tumor necrosis factor binding protein soluble form tumor necrosis factor receptor tumor necrosis factor \( tnf \) mediator inflammatory responses cysteine rich , highly glycosylated 30 kd tnf binding protein \( tnf bp \) purified urine may role regulation protects vitro biological effects tnf cytotoxic effect tnf fibrosarcoma cell line 164 inhibited 50 10 fold excess tnf bp binding tnf receptor partially reversed addition tnf bp results biosynthetic labeling cells 35s cysteine followed immunoprecipitation anti tnf bp indicated tnf bp formed released cell surface cleavage corresponding cellular polypeptide observed cellular 60 kd polypeptide , immunoprecipitated anti tnf bp , may correspond transmembrane tnf receptor molecule precursor tnf bp thus , tnf bp appears soluble form transmembrane tnf receptor moreover results demonstrate production tnf bp increased tnf receptor cells treatment tnf activation protein kinase c phorbol esters tnf bp may important agent blocks harmful effects tnf , , therefore , useful clinical applications
potent toxicity 2 toward human monocytes vitro vivo novel approach immunosuppressive therapy lymphoid cells thought uniquely susceptible excess 2' \( dado \) , exposed inhibitors adenosine deaminase \( \) however , find human monocytes sensitive lymphocytes dado resistant 2 2' \( cldado \) monocytes exposed vitro cldado , dado plus rapidly developed dna strand breaks dna damage toxicity cldado dado toward monocytes blocked , inhibitors poly \( adp \) polymerase partial decrease rna synthesis gradual decline cellular nad early biochemical events associated monocyte dna damage low cldado concentrations \( 5 20 nm \) inhibited monocyte phagocytosis reduced release interleukin 6 higher cldado concentrations led dose time dependent loss monocyte viability circulating monocytes disappeared within 1 wk patients cutaneous cell lymphoma rheumatoid arthritis continuous cldado infusion marked sensitivity human monocyte function survival cldado vitro , together monocyte depletion patients receiving cldado chemotherapy , suggests cldado dado analogues offer novel therapeutic strategy chronic inflammatory autoimmune diseases characterized inappropriate monocyte function
elevated insulin receptor content human breast cancer growth breast cancer cells regulation hormones , growth factors , receptors present study , employed new , sensitive , specific radioimmunoassay direct measurement insulin receptors surgical specimens breast cancers 159 specimens insulin receptor content 6 15 3 69 ng 0 1 mg protein value sixfold higher mean value found 27 normal breast tissues obtained total mastectomy \( 0 95 0 68 , p less 0 001 \) six normal specimens obtained reduction \( 0 84 0 78 , p less 0 001 \) insulin receptor content breast cancer tissues also higher normal tissue investigated including liver \( , v , v , v , , p , k , j , b , r , , 1989 j 457 \) insulin receptor breast cancer retained ability bind insulin undergo insulin induced tyrosine kinase activation immunostaining specimens revealed insulin receptor present malignant epithelial cells , detected stromal inflammatory cells analysis revealed insulin receptor content tumors correlated positively tumor size \( p 0 014 \) , histological grading \( p 0 \) , estrogen receptor content \( p 0 \) significant correlations insulin receptor content age , body weight , menopausal status , nodal involvement patients studies indicate , therefore , insulin receptor content increased breast cancers raise possibility insulin receptor may role biology tumors
epidermal growth factor regulates vitro sensitivity human ovarian carcinoma cells cisplatin cisplatin \( ddp \) effective drug treatment human ovarian cancer , mechanisms determine sensitivity cytotoxic action ddp well understood treatment two human ovarian carcinoma cell lines epidermal growth factor \( egf \) simultaneously increased sensitivity ddp caused persistent change morphology absence mitogenic effect sensitization ddp shown dependent egf concentration egf receptor number mouse fibroblasts expressing human egf receptor transfection plasmid construct containing human egf receptor gene control transferrin receptor 3' inducible regulator sensitization human ovarian carcinoma cells ddp blocked inhibition protein synthesis egf enhance sensitivity ddp alter morphology ddp resistant human ovarian carcinoma cells despite presence functional egf receptors cells results showed elements signal transduction pathway activated egf determined cellular sensitivity ddp , ddp resistant phenotype associated defect signal transduction pathway
phosphatase activity present peripheral blood myeloid cells chronic myelogenous leukemia patients normal individuals alters nuclear protein binding transcriptional interferon inducible genes cytoplasmic protein peripheral blood myeloid cells chronic myelogenous leukemia \( cml \) patients altered electrophoretic mobility complexes formed nuclear proteins interferon inducible transcriptional immature myeloid marrow cells \( blasts promyelocytes \) higher level activity mature myeloid marrow cells \( bands \) activity , detectable peripheral blood cells normal individuals , least 50 fold higher cml marrow blasts promyelocytes found marrow blasts promyelocytes normal individuals activity inhibited vivo incubation immature myeloid cells phosphatase inhibitor , sodium \( 0 2 mm \) , adding \( 20 mm \) directly cytoplasmic proteins myeloid cells interferon alpha \( 1 , 000 u ml \) reduced effects cml myeloid cell cytoplasmic protein electrophoretic mobility nuclear protein dna complexes data suggest unique phosphatase may involved abnormalities cml modulated interferon alpha
quality control practices tumor registries north america survey quality control practices mailed 73 central registries u canada response rate 88 , respondents representing wide range registry characteristics reporting strategies registries expressed different priorities data use , 80 respondents felt quality control data important identification problems common method quality control acceptance sampling \( used 97 respondents \) , took form visual review , computer based almost universally used \( 95 \) process control methods used 22 respondents less 4 registries reporting formal quantitative criteria sixty one percent respondents reported conducting one designed studies \( e g studies \) 20 made results public greater emphasis placed development quantitative process controls , experimental design quality control studies , formal analyses reporting study results
chondrosarcoma head neck chondrosarcoma malignancy rarely encountered head neck attempt define tumor 's characteristics response therapy , cases chondrosarcoma treated university michigan past 25 years retrospectively studied fourteen cases originating nose paranasal sinuses , mandible , temporal bone , larynx reviewed aggressive surgical resection treatment , resulted overall survival 70 , average follow 3 5 years survival highest primary temporal bone lesions , lowest paranasal sinus lesions unresectable lesions cured modalities study , therefore , continued support crucial role wide surgical resection treatment head neck chondrosarcoma , conservative resection , needed preserve important structures , resulted long term survival
melanoma paper reviewed interesting biological aspects melanocytes relationship nevus melanoma also proposed rationale adequate surgery management melanoma according level , depth , margins , trends treatment derived analysis 995 cases melanoma head neck
cancer prevention reminder system cancer prevention reminder system computer based system designed increase delivery periodic health maintenance procedures program provides reminders identify patients' procedures , summary reports percentage patients eligible procedure , labels patients performed randomized , controlled trial effects computer based reminders compared two interventions among residents university based group practice
585 nm treatment port wine stains although flashlamp pulsed dye laser successfully used treatment port wine stains \( \) 577 nm , number adult patients incomplete clearance treatment modality residual vessels beyond 0 75 mm penetration depth 577 nm irradiation fifteen adult patients , nine previously treated limited success 577 nm \( group \) , six untreated patients \( group b \) included study group patients , treatment 585 nm produced successful clearance six patients group b , parallel treatment different sites lesion coupled skin biopsies histologic examination revealed change wavelength 577 585 nm allowed laser light dermis subcutaneous fat explained clearance achieved 585 nm 577 nm
reasons mastectomy patients breast reconstruction breast reconstruction mastectomy valuable , yet small percentage eligible patients ever reconstruction little done determine patients proceed reconstructive surgery homogeneous population mastectomy patients , underwent breast reconstruction others , surveyed regarding attitudes breast reconstruction total 245 women surveyed one hundred fifty eight \( 64 percent \) responded , 71 reconstructed 87 comparison responses two groups suggests factors play role determining whether mastectomy patient accept decline option breast reconstruction considerations made less likely woman would reconstruction included advanced age time mastectomy , concern complications surgery , uncertainty outcome , fear effect reconstruction future problems breast cancer marital status , receiving chemotherapy , patient result reconstruction affect decision awareness understanding factors may helpful physicians counseling patients increasing number women benefits breast reconstruction
mammographic measurements augmentation thirty five augmented women underwent mammography using standard implant compression technique , possible , implant displacement technique film screen mammography available evaluation area mammographically visualized breast tissue augmentation measured using grid patients implants mean decrease 49 percent measurable tissue area compression mammography 39 percent decrease displacement mammography patients submuscular implants 28 percent decrease measurable tissue area compression mammography 9 percent decrease displacement mammography anterior breast tissue seen better displacement mammography posterior breast tissue , compression mammography patients degree parenchymal scarring lower image quality augmentation state art mammography possible patients augmented silicone gel filled implants
combined musculocutaneous flap musculocutaneous flap repair wide defects lower leg musculocutaneous flap great advantages reconstruction abdominal wall , medial border territory limited thigh order expand territory , combined musculocutaneous flap musculocutaneous flap devised flap successfully used large defect lower leg distally based musculocutaneous flap advantages flap extremely large territory , fact total necrosis flap cannot occur , proximally distally pedicled flap suitable large defects abdominal wall , lower leg , region
metabolism human gliomas assessment h 1 mr spectroscopy f 18 fluorodeoxyglucose pet localized hydrogen 1 magnetic resonance \( mr \) spectroscopy fluorine 18 fluorodeoxyglucose \( fdg \) positron emission tomography \( pet \) employed obtain metabolic information intracranial gliomas advantages difficulties associated comparison results two modalities realized forty patients studied h 1 mr spectroscopy mr signal intensities lactate , n \( naa \) , choline , creatine volume interest containing tumor contralateral volume obtained evaluated naa signal intensities generally decreased tumor spectra , choline signal intensities elevated h 1 mr spectroscopy unsuccessful eight patients , fdg pet scans obtained four patients successful mr spectroscopic examinations lactate signal intensity detected 10 28 patients successful h 1 mr spectroscopic fdg pet studies lactate signal intensities observed lesions shown fdg pet hypermetabolic , well lesions found
chemical shift imaging human brain axial , sagittal , coronal p 31 metabolite images magnetic resonance \( mr \) spectroscopy novel data analysis techniques developed obtain high quality phosphorus 31 metabolite images human brain overlay metabolite distribution directly onto corresponding hydrogen 1 mr images p 31 mr spectroscopic data acquired means three dimensional chemical shift imaging \( phase encoding three spatial dimensions \) 1 5 clinical instrument equipped specially designed p 31 coil constructed authors' laboratory axial , sagittal , coronal metabolite images based area one five peak regions \( phosphocreatine gamma , alpha , beta adenosine triphosphate \) generated 8 x 8 x 8 12 x 12 x 8 sizes 27 cm3 12 cm3 , respectively positions images aligned anatomic features means shifting capability fourier transform direct metabolite images corresponding proton images demonstrated excellent correlation anatomy , factors indicating utility technique p 31 metabolite levels areas brain simultaneously
rhabdomyosarcomas head neck mr imaging evaluation determine typical magnetic resonance \( mr \) signal intensity characteristics rhabdomyosarcomas , short repetition time \( tr \) short echo time \( te \) \( t1 weighted \) long tr \( proton density t2 weighted \) images 13 patients rhabdomyosarcomas head neck retrospectively reviewed seven patients received gadopentetate dimeglumine injections common mr appearance homogeneous mass , muscle fat long tr long te images minimally muscle short tr short te images lesions patients received gadopentetate dimeglumine enhanced markedly two lesions intratumoral hemorrhage , six markedly heterogeneous signal intensity similar mr signal intensity patterns described lymphomas nasopharyngeal carcinomas mr imaging lies ability delineate precisely extent rhabdomyosarcoma
colorectal tumors vitro study high resolution mr imaging study potential utility magnetic resonance \( mr \) imaging staging colorectal tumors , 15 resected colonic segments containing 17 elevated lesions examined 1 5 1 9 mr system whole intestinal wall apparent three five layers images obtained short repetition time \( tr \) short echo time \( te \) six eight distinct layers , including intestinal wall proper well adherent mucus layer outer layer fat , long tr te images cases colonic carcinoma , mr images correlated well pathologic findings , including macroscopic growth pattern , depth mural invasion , presence foci tumor necrosis pools extracellular mucin \( colloid \) features suggest mr imaging may valuable clinical evaluation colorectal tumors
hepatic tumors signal enhancement doppler us intravenous injection contrast agent experiments carried detect establish origin doppler echo signal enhancement small vessels systemic circulation tumors intravenous injection contrast agent eight \( \) studied naturally occurring hepatocellular carcinoma injections 0 1 4 0 ml air filled human serum albumin microspheres administered hind limb jugular vein ultrasound \( us \) examination included duplex scanning , color doppler imaging , placement doppler transducer exposed tumor , surgical implantation pulsed doppler cuffs doppler signals assessed recording color doppler images results spectral analysis subjective echo level unaffected within tumors , dramatic doppler signal enhancement recorded normal tumor vessels optimum dose levels , signal gain approximately 10 db recorded tumor analysis showed echo enhancement due presence contrast agent branches hepatic artery results suggest tumor detection may enhanced intravenous administration us contrast agent
receptor imaging application mr imaging liver cancer new contrast agent magnetic resonance \( mr \) imaging , directed \( asg \) receptors hepatocytes , used detection liver cancer rats \( mean size , 12 nm \) particles iron oxide \( \) targeted asg receptors coating particles \( ag \) liver t2 relaxation times decreased effectively single intravenous administration ag uspio equal dose conventional liver mr contrast agent \( ami 25 mean size , 72 nm \) receptor affinity studies demonstrated receptor mediated attachment subsequent cellular endocytosis occur primary malignant \( hepatocellular carcinoma \) metastatic \( adenocarcinoma \) tumors , surface asg receptors lost malignant vitro relaxation vivo mr imaging experiments liver tumors show targeting uspio hepatocytes rather mononuclear phagocytic system allows considerable dose reduction , increases tumor liver contrast , potentially allows distinction asg positive \( benign hepatocellular \) asg negative \( malignant hepatocellular \) tumors
invasive papillary carcinoma breast mammographic appearance mammographic findings 18 patients invasive papillary carcinoma studied retrospectively mammograms 10 patients showed multinodular pattern , seven patients solitary nodules one patient irregular , ill defined mass region two patients found carcinoma contralateral breast , two patients intraductal carcinoma adjacent invasive papillary carcinoma varied mammographic features may occur rare breast malignancy discussed
retroviral recombination reverse transcription recombination occurs high rate retroviral replication , observation requires containing two different rna molecules \( particles \) analysis retroviral recombinants formed single round replication revealed \( \) nonselected markers changed frequently expected rate recombination selected markers \( ii \) transfer initially synthesized minus strand strong stop dna either \( iii \) transfer first synthesized plus strand strong stop dna always \( iv \) strong correlation type transfer minus strand strong stop dna number template observed data suggest retroviral recombination ordered occurs synthesis minus plus strand dna
germ line p53 mutations familial syndrome breast cancer , sarcomas , neoplasms familial cancer syndromes helped define role tumor suppressor genes development cancer dominantly inherited li fraumeni syndrome \( lfs \) particular interest diversity childhood adult tumors occur affected individuals rarity high mortality lfs formal linkage analysis alternative approach select candidate gene tumor suppressor gene , p53 , studied previous indications gene inactivated sporadic \( \) forms cancers associated lfs germ line p53 mutations detected five lfs families analyzed mutations produce amounts mutant p53 protein expected exert trans dominant loss function effect wild type p53 protein frequency germ line p53 mutations examined additional families lfs , cancer patients families clinical features might attributed mutation
biopsy breast mammographically detected lesions prospectively studied women underwent biopsy breast suspicious , mammographically detected mammary lesions attempt identify key clinical risk factors , well roentgenographic characteristics associated appearance early carcinoma breast patients benign outcome average age 55 years versus 63 years patients carcinoma breast seventy six per cent patients previous history mammary problems , 20 per cent positive family history carcinoma breast , 58 per cent premenopausal 21 per cent used birth control pills except age \( p less 0 001 \) , distribution clinical risk factors equal among patients benign malignant outcomes suspicious mammographic findings included mass lesions \( 53 per cent \) , calcifications \( 36 per cent \) association \( 11 per cent \) predominant pattern mammography p1 \( 36 per cent \) relationship observed pattern malignant conditions group patients , mammography poorly specific however , positive predictive value increased age related age specific prevalence carcinoma breast eight hundred twenty five lesions removed twenty five per cent \( n 203 \) specimens taken biopsy contained carcinoma stellate mass lesions highly suggestive malignant growth \( p less 0 0001 \) relationship size suspicious mammographic mass malignant lesion observed marked correlation \( chi square test 's correction \) observed malignant tumor lesions linear branching pattern , 15 calcifications , small sized calcifications presence mass calcifications associated carcinoma 34 per cent incidence invasive carcinoma much higher mass lesions \( 81 per cent \) suspicious calcifications \( 56 per cent \) \( p less 0 0001 \)
trends conserving treatment invasive carcinoma breast females population based study presents trends treatment node negative invasive carcinoma breast females 1980s metropolitan area done determine whether significant shift toward conservation breast 1980 1987 trend analyses surgical treatment , tumor size , node status , year diagnosis , age race performed 13 , 217 patients drawn metropolitan cancer surveillance system significant increase use conserving breast observed , younger women receiving treatment option often older women implications continuing shift biologic findings treatment carcinoma breast discussed
correlation clinical effect carcinoma esophagus correlation evaluated vitro succinate dehydrogenase inhibition \( \) test histopathologic effects \( therapy \) investigated 43 patients carcinoma esophagus succinate dehydrogenase \( sd \) activity tissue fragments taken biopsy assayed exposure heat \( 43 degrees c \) radiation \( 6 \) done sensitivity radiation plus heat treatment estimated percentage sd activity treated cells , compared control cells 43 patients divided three groups according degree sd activity exposure radiation plus heat treatment sd activity less 50 per cent group 1 \( highly sensitive \) , 50 70 per cent group 2 \( moderately sensitive \) , 70 per cent group 3 \( less sensitive \) eighteen 20 group 1 , 11 17 group 2 two six group 3 classified histopathologically effective therapy two year survival rate groups 1 , 2 3 55 5 , 34 9 zero per cent , respectively , statistical differences regard prognostic factors data suggest vitro activities sd correlate well clinical effectiveness therapy therefore , recommended sd inhibition test included among guidelines clinical management
therapeutic dilemmas associated detected ovarian cysts fifteen instances ovarian cysts detected reported seven cysts 5 centimeters diameter treated surgically clinical signs , palpable abdominal mass , vomiting abdominal distension seven cysts less 5 centimeters diameter , one cyst 5 centimeters diameter began regress spontaneously within six months birth pathophysiologic nature neonatal ovarian cysts elucidated borderline physiologic pathologic factors still unclear , propose conservative approach management neonatal ovarian cysts avoid unnecessary operations
magnetic resonance imaging vertebral report two cases two patients vertebral evaluated computed tomography magnetic resonance imaging presented literature review revealed cases originating within vertebral body exceedingly rare
computed tomography bronchoscopy chest radiographically occult main stem neoplasm diagnosis nd yag laser treatment 8 patients studied 8 adult patients variable symptoms cough , dyspnea , , wheezing , hemoptysis fiberoptic bronchoscopy showed complete nearly complete endobronchial obstruction main stem bronchus neoplasm mean bronchial diameter 1 9 mm 1 6 mm \( mean standard deviation \) 4 patients , lobar bronchus also completely obstructed mass visible chest radiographs patient however , computed tomography showed main stem endobronchial obstruction , lobar obstruction \( 4 instances 3 patients \) , 6 patients hypoperfusion involved lung computed tomographic scan showed additional abnormalities unsuspected chest radiographs bronchoscopy , including mediastinal adenopathy 3 patients tumor component 4 therapy nd yag laser , main stem airway diameter increased mean 9 6 mm 1 0 mm \( p less 05 \) pulmonary functions improved results suggest complementary role computed tomography fiberoptic bronchoscopy detection laser treatment planning chest radiographically occult severe neoplastic obstruction main stem bronchus
correlation free phenytoin serum albumin cancer patients objectives study compare total free phenytoin serum concentrations cancer patients hypoalbuminemia cancer patients normal serum albumin correlate percentage free phenytoin albumin concentration total 22 patients studied , 13 normal albumin concentration 9 low albumin mean free phenytoin normal albumin group 9 9 \( 1 3 \) percent 17 6 \( 4 6 \) percent low albumin group groups combined , mean free phenytoin 13 1 percent \( range 8 3 22 2 \) albumin range 20 45 g l significant negative correlation \( r 0 9 , p less 0 001 \) percentage free phenytoin measured serum albumin cancer patients , serum albumin concentration appears key factor determines percentage free phenytoin cancer patients low serum albumin concentration , total free phenytoin concentration measured adequate assessment phenytoin therapy
fine needle aspiration cytology flow cytometry papillary carcinoma breast define criteria cytologic diagnosis papillary carcinoma \( \) , authors retrospectively reviewed fine needle aspiration \( fna \) cytologic specimens eight cases histologically proven breast patients five black three white women , 56 87 years age fna specimen cyst fluid four cases \( three , clear one \) aspirates showed cellular smears small large clusters cells papillary cribriform numerous single epithelial cells cells minimal atypia suggested fna case , patients underwent surgical excision mastectomy flow cytometry , performed fresh fna specimen one case paraffin embedded surgical tissue eight cases , showed seven tumors aneuploid one diploid authors breast distinct features recognized fna may present cyst fluid , either clear , breast cyst fluids postmenopausal women examined flow cytometric demonstration aneuploid population may assist confirming malignancy lesion
immunocytochemical profile benign effusions practical approach difficult diagnosis one great challenges effusions distinction reactive histiocytes cancer cells notably true patients undergone radiation chemotherapy establish whether monoclonal antibodies \( moabs \) could used reliable diagnostic , authors retrospectively blindly studied 60 cases diagnosed standard cytologic criteria \( malignant , benign , equivocal \) , panel seven readily available moabs \( cytokeratins , vimentin , ema , b72 3 , alpha cea , 2 , leu m1 \) lectin ulex europaeus 18 \( 100 \) malignant cases showed reactivity ema , whereas 17 \( 95 \) 11 \( 61 \) reacted b72 3 alpha cea , respectively combinations \( 1 \) ema b72 3 , \( 2 \) ema alpha cea , \( 3 \) ema alpha cea b72 3 displayed positivity 17 \( 95 \) , 11 \( 61 \) , 10 \( 56 \) malignant cases , respectively 18 benign cases , 7 reacted 2 ema b72 3 one case \( 5 5 \) reacted ema b72 3 based results , 24 equivocal cases 14 malignant 10 benign cases follow effusions obtained within ensuing three months patients allowed authors unequivocally confirm diagnosis five combination ema b72 3 moabs detected malignant cells 95 cases , 3 5 incidence false positive cases study panel ema , b72 3 , alpha cea moabs prove useful simple approach correct diagnosis questionable effusions potential pitfalls discussed
association selected cancers service us military vietnam ii soft tissue sarcomas selected cancers cooperative study group part series investigations health vietnam veterans , conducted population based , case control study soft tissue sarcomas 1984 1988 men born 1953 diagnosed area covered eight cancer registries considered eligible controls selected random digit analyses men pathologically confirmed sarcoma controls showed vietnam veterans relative risk 1 0 sarcoma comparison men serve vietnam \( 95 confidence interval , 0 6 1 6 \) restriction analysis 254 men soft tissue sarcoma yielded relative risk 0 9 \( 95 confidence interval , 0 5 1 6 \) several attributes military service vietnam \( eg , branch , duration service , military region , characteristics may associated use agent orange \) examined , none associated increased risk development sarcoma furthermore , morphologic type sarcoma among vietnam veterans results unchanged vietnam veterans compared \( 1 \) veterans \( 2 \) men never served military study , 97 power detect relative risk 2 0 sarcomas , provides evidence risk development soft tissue sarcomas increased among veterans 15 25 years following service vietnam
generation human monoclonal antibodies colon cancer lymphocytes regional lymph nodes patients colon cancer fused human lymphoblastoid cell line without vitro immunization efficacy two protocols generation human monoclonal antibodies colon cancer investigated hyperplastic lymph nodes adjacent tumor best source b lymphocytes fusion frequency number tumor reactive clones markedly increased vitro immunization protocol applied prior fusion vitro immunization , supernatant pokeweed mitogen stimulated lymphocytes superior supernatant mixed lymphocytes culture carcinoembryonic antigen 20 micrograms l seemed optimal dose vitro immunization reactivities human monoclonal antibodies thus generated measured enzyme linked immunosorbent assay confirmed immunoperoxidase staining combining vitro immunization lymphocytes cancer patients may lead successful production clinically useful human monoclonal antibodies
detection primary colorectal cancer indium 111 monoclonal antibody b72 3 b72 3 murine monoclonal antibody immunoglobulin subclass igg1 directed tag 72 , cell surface antigen present colorectal carcinoma cells investigated utility scanning indium 111 labeled b72 3 16 patients high clinical suspicion biopsy proven primary colorectal cancer patient received 1 2 mg b72 3 monoclonal antibody labeled 152 mbq indium 111 patients underwent scanning 2 3 days 7 days infusion planar emission computed tomography nineteen lesions confirmed 12 patients three patients benign polyps true negative monoclonal antibody scans indium 111 labeled imaging b72 3 detected nine 19 lesions unsuspected tumor sites identified monoclonal antibody scan three patients detection additional abdominal disease extra abdominal spread , indium 111 labeled scanning b72 3 directly affected treatment 18 patients
oral contraceptives breast cancer review meta analysis evaluate relation use oral contraceptives incidence breast cancer , authors reviewed epidemiologic literature used quantitative methods summarize data study results use oral contraceptives pooled using model accounted variability authors also explored variability modeled duration effect relation oral contraceptive use breast cancer case control follow studies considered separately overall , authors observed increase risk breast cancer women ever used oral contraceptives , even long duration use results consistent across study design however , data combined case control studies revealed statistically significant positive trend \( p 0 001 \) risk premenopausal breast cancer women exposed oral contraceptives longer duration risk predominant among women used oral contraceptives least 4 years first term pregnancy \( relative risk 1 72 95 confidence interval 1 36 2 19 \) additional study required determine whether finding subgroup exposed women confirmed whether risk remains increased advancing age
predictive value tumor estrogen progesterone receptor levels postmenopausal women advanced breast cancer treated predictive value estrogen receptor \( er \) concentrations evaluated group 113 postmenopausal patients estrogen receptor positive \( er greater 7 fmol mg protein \) advanced breast cancer 103 patients , tumors also sampled progesterone receptor \( pgr \) determination patients treated , novel , 60 mg daily median er 51 responders 78 fmol mg protein , 62 nonresponders , 51 fmol mg protein median pgr levels 40 37 fmol mg protein , respectively response rate patients er less 50 fmol mg protein 38 , 51 group er greater 50 fmol mg protein \( significant ns \) response rate patients pgr less 10 fmol mg protein 42 , patients greater 10 fmol mg protein , 44 duration response patients er greater 50 fmol mg protein significantly longer lower er levels \( p 0 002 \) pgr associated duration response cox 's multiple regression analysis , er independent prognostic factor \( p 0 005 \) response duration thus , er concentration tumor tissue predicts duration response response rate patients advanced breast cancer pgr status predict response rate duration response
low dose preoperative radiation recurrences operable rectal cancer results randomized multicenter trial western norway randomized , multicenter clinical trial conducted western norway study effectiveness preoperative radiation therapy operable rectal cancer , given dosage cgy 18 fractions , 2 3 weeks radical surgery three hundred nine patients entered trial may 1976 december 1985 radiation tumor seen 4 5 patients increased morbidity mortality surgery 5 year survival evaluable patients 57 5 control group 56 7 radiotherapy group patients operated cure 5 year survival 60 9 64 2 control group radiotherapy group , respectively radiation significantly delayed local distant recurrences patients radiation group curative resection 13 3 months controls 27 1 months local recurrence rate corresponding groups 21 1 13 7 , respectively conclude higher preoperative radiation doses used new trials higher dosage may transform observed positive effects survival benefit
comparison computed tomography scanning evaluating abdominal disease stages iii iv hodgkin 's disease southwest oncology group study authors reviewed records 139 patients laparotomy plus computed tomography \( ct \) \( lag \) part staging workup hodgkin 's disease , accordance southwest oncology group \( \) protocol evaluated relative ability ct lag detect disease abdomen two regions abdomen designated , upper lower , examine capabilities ct lag lower abdomen ct upper abdomen lag sensitive \( p less 0 05 \) ct detecting positive lower abdominal nodes upper abdomen , ct scan low sensitivity detecting positive nodes , liver , spleen study suggests lag lower abdomen provided information ct , therefore abandoned valid method detecting nodal disease
diffuse sclerosing variant papillary carcinoma thyroid clinical importance , surgical treatment , follow study diffuse sclerosing variant rare among papillary carcinomas thyroid patients female younger 30 years age variant characterized diffuse involvement one thyroid lobes , dense sclerosis , patchy lymphocytic infiltration , abundant bodies controversy still exists concerning prognosis reviewed experience 14 patients treated 1988 patients young females , age 10 28 years mean 19 6 's thyroiditis suspected nine patients came clinic diagnosis cancer possible entity mind detect abundant bodies either ultrasonography soft tissue neck total thyroidectomy modified neck dissection carried eight patients , subtotal thyroidectomy neck dissection five , lobectomy neck dissection one alive well without distant metastasis mean follow 16 years patients variant papillary carcinoma young women prognosis favorable , complete resection without causing later recurrence , also cosmetic complication free surgery , considered
internal mammary chain treatment decrease risk death patients medial breast cancers positive axillary lymph nodes \? effect internal mammary chain treatment type malignant death related event analyzed patients operable breast cancer histologically involved axillary lymph nodes group 135 patients internal mammary chain treatment compared control group patients treated surgery postoperative radiation therapy multivariate analysis taking account age , clinical size tumor , grading , number positive axillary lymph nodes , quantitative interaction tests used determine whether effects internal mammary chain treatment type malignant event significantly different patients lateral tumor compared medial tumor authors found effects treatment risks distant metastases secondary breast cancer patients medial tumor lateral tumor untreated patients medial tumor , risks distant metastases second breast cancer , respectively , 1 6 \( p 0 02 \) 2 9 \( p 0 02 \) , compared treated patients conversely , women lateral tumor , difference two treatment groups observed thus , internal mammary chain treatment may improve long term survival rate patients medial tumor positive axillary lymph nodes essentially decreasing risk development distant metastases \( mainly brain , distant lymph nodes , multiple simultaneous metastases \) secondary breast cancer
concept locally advanced gastric cancer effect treatment outcome gastrointestinal tumor study group previous gastrointestinal tumor study group \( \) reports , gastric cancer patients locally unresectable disease , treated combined radiation chemotherapy shorter median survival \( 40 weeks \) remained alive 4 years \( 18 \) compared randomized receive chemotherapy alone \( 76 weeks 6 , respectively \) test concept combined modality therapy might increase number long term survivors , second protocol designed , three major modifications course chemotherapy would precede 5 fluorouracil potentiated radiation therapy doxorubicin would added 5 fluorouracil plus methyl ccnu combination radiation therapy would given single course cgy , 5 fluorouracil given daily 3 days beginning end course median survival 46 patients treated chemotherapy alone 59 weeks , 11 alive 3 years following combined modality therapy , median survival 62 weeks , 7 lived 3 years although problem early deaths combined modality group resolved , long term survival combination therapy demonstrated study
lack relationship perioperative blood transfusion survival time curative resection gastric cancer better relationship perioperative blood transfusion survival time curative gastrectomy advanced gastric cancer , authors reviewed retrospectively data patients treated clinics 1965 1983 , 195 \( 34 3 \) required blood transfusion \( 65 7 \) required transfusions within perioperative period univariate analysis indicated survival time transfusion recipients significantly less patients transfusions \( p less 0 01 \) subgroups authors' patients stratified adjust stage disease , , however , significant difference survival rates subsequently , multivariate analysis , using cox regression analysis , adjusted sex , age , covariates , indicated perioperative blood transfusion useful factor predicting survival time multivariate analysis suggested tumor size \( p less 0 01 \) , degree invasion gastric wall \( p less 0 01 \) status lymph node metastasis \( p less 0 01 \) important covariates curative gastrectomy advanced gastric cancer authors' findings revealed lack relationship perioperative blood transfusion survival time patients underwent curative resection advanced gastric cancer
effect dietary omega 3 fatty acids \( fish oil \) induced focal areas dysplasia colon tumor incidence \( \) , fish oil high omega 3 fatty acids , combined various levels corn oil \( co \) , rich omega 6 fatty acids , fed female mice three fish oil co two co levels diets studied follows 16 0 co 4 4 \( diet 1 \) 10 2 co 10 2 \( diet 2 \) 4 4 co 16 0 \( diet 3 \) 20 4 co \( diet 4 \) 4 4 co \( diet 5 \) diets provided 2 weeks weekly subcutaneous injection saline \( aom \) studies epithelial cell proliferation incidence focal areas dysplasia \( \) involved six weekly aom injections one week last aom injection 1 hour killing , mice injected tritiated thymidine \( \) differences proliferative parameters found among five groups saline treated mice among aom treated animals , fed diet 3 showed significantly fewer cells per crypt significantly fewer labeled cells gland co diets 4 5 additionally , distribution phase cells crypts aom treated mice fed diet 3 closely resembled saline controls greatest alteration distribution proliferative cells observed high co diet \( diet 4 \) lowest level \( diet 1 \) mice fed diets 2 3 significantly fewer 500 microns distal colonic serial sections fed high co diet \( diet 4 \) mice involved chronic tumor incidence studies received three weekly injections dose aom regardless diet , approximately 88 tumors arose distal colon significantly larger tumor bearing population observed high co diet 4 lowest \( \) diet \( diet 1 \) compared incidence diets 2 3 low co diet 5 diet ratio omega 6 omega 3 fatty acids approximately 1 0 apparently prevented development adenoma type proliferative pattern thereby reducing numbers subsequent tumor incidence
comparative study cutaneous cell lymphoma adult cell leukemia lymphoma clinical , histopathologic , immunohistochemical analyses important disease entity distinct cutaneous cell lymphoma \( ctcl \) japan adult cell leukemia lymphoma \( atl \) , usually shows phenotype ctcl , e , helper inducer cell phenotype \( cd4 cd8 \) , usually involves skin clinically , ctcl atl heterogeneous nature study , demonstrated differences ctcl atl terms clinical immunopathologic cell surface features patients atl , predominant clinical findings peripheral lymph node involvement , skin lesions , hepatosplenomegaly , leukemic manifestations , aggressive course patients ctcl , contrast , skin lesions predominated onset disease relatively good prognosis demonstrated phenotypic heterogeneity atl skin , e , cd4 cd8 , cd4 cd8 , cd4 cd8 , demonstrated expression , cd7 \( \) , cd45ra \( \) high skin infiltrating atl cells peripheral blood lymph node atl cells compared skin infiltrating ctcl cells expression cd25 \( il 2r \) , \( \) , hla dr , hla dq higher skin infiltrating atl cells ctcl cells expression cd29 \( \) high , cd45ra \( \) low skin infiltrating atl ctcl cells compared peripheral blood lymph node atl cells expression \( 1 \) significantly high skin infiltrating ctcl cells compared atl cells significant phenotypic difference atl cells ctcl cells expression \( lymph node homing receptor \) , cd7 cd25 antigens cell surface , main phenotypic difference skin infiltrating atl ctcl cells peripheral blood lymph node atl cells expression cd29 cd45ra findings confirm difference antigen expression cell surface might reflect clinical features atl ctcl , suggest predominant phenotype peripheral blood lymph node atl cells naive , relatively immature activated cells , ctcl cells previously activated \( memory \) cells words , ctcl cells share origin atl cells observations support concept atl disease distinct ctcl
von willebrand factor head neck cancer laboratory abnormalities blood coagulation factors common patients cancer significance unknown twenty eight patients head neck cancer studied time diagnosis twenty five advanced stage \( iii iv \) patients levels clotting factors , antithrombin iii , plasminogen normal levels von willebrand factor \( vwf \) , antigenic functional \( ristocetin cofactor \) , elevated group patients followed minimum 41 months \( median , 48 months \) fifteen patients died within follow period von willebrand factor levels significantly higher 15 13 survivors extreme elevation ristocetin cofactor \( greater 300 u dl \) seen six 15 patients died none survivors plasma vwf elevated head neck cancer level measured time diagnosis may prognostic potentially therapeutic implications
abnormal vitamin b6 status childhood leukemia vitamin b6 involved many biological processes potential relevance carcinogenesis tumor growth , including dna synthesis maintenance , yet little information exists b6 nutritional status childhood leukemia using assay , authors measured plasma 5' phosphate \( plp \) , biologically active form b6 , 11 newly diagnosed untreated children leukemia 11 age matched controls children leukemia significantly lower plp levels controls 26 additional leukemia patients 26 additional controls , high performance liquid chromatography assay also demonstrated lower plasma plp levels childhood leukemia compared controls differences significant acute lymphoblastic leukemia \( \) acute leukemia \( anll \) plp values correlate indices leukemia cell burden , correlate reported b6 intake , suggesting illness related diet changes least partially responsible low plp levels chemotherapy , overall nutritional status suboptimal 53 cases 57 anll cases newly diagnosed children leukemia suboptimal overall nutrition well suboptimal vitamin b6 status
melanoma soft tissue sarcoma seven patients seven patients melanoma sarcoma seen cancer institute \( , \) 4 year period three additional malignant neoplasms one patients also hereditary cutaneous malignant melanoma , dysplastic nevus syndrome observations suggest possibility biologic relationship melanoma sarcoma , nature remains unknown
epidemiology cancer among hispanic women experience florida explore cancer incidence among hispanic women living dade county , florida , data analyzed statewide cancer registry three sites , hispanics lower rates 15 prevalent cancers non hispanics however , higher rates cancer among hispanics noted cancers gallbladder , liver , heart soft tissue subgroups women significantly higher rates cervical cancer thyroid cancer lower rates among hispanics observed cancers esophagus , vagina , breast , colon , buccal cavity pharynx , malignant melanoma data suggest cancer sites traditionally higher among us women higher among dade hispanics , sites common among non hispanics yet shown increased incidence among hispanic women dade county
increasing incidence cecal sigmoid carcinoma data connecticut tumor registry studied distribution incidence colorectal cancer using connecticut tumor registry , oldest tumor registry united states time period 1973 1985 , left sided colon cancers accounted 63 cancers , right sided cancers 33 , cancers unspecified sites 4 indeed , pattern distribution remained constant 25 years period 1985 , calculated sex specific , age adjusted \( normalized 1970 u census \) incidence age adjusted incidence rectal cancer remained stable 50 years men , 22 8 cases 100 , 000 year , women , 13 9 cases 100 , 000 year 50 years , age adjusted incidence cecal carcinoma men increased 3 6 16 7 cases 100 , 000 year , women , increased 4 9 14 2 cases 100 , 000 year sigmoid carcinoma men increased 8 8 18 7 cases 100 , 000 year , women , increased 7 7 12 8 cases 100 , 000 year incidence colon cancer site continues increasing constant rate age adjusted incidence colorectal cancers increased 35 2 70 2 cases 100 , 000 year men 32 1 49 2 cases 100 , 000 year women thus , distribution colorectal cancers site connecticut remained stable 25 years importantly , however , age adjusted incidence colon cancer continued increase 50 years , whereas rectal cancer remained relatively stable
bronchogenic carcinoma situ eradicated endobronchial biopsy squamous cell carcinoma situ bronchus rare disorder isolated clinical setting present case carcinoma situ located excisional biopsy via fiberoptic bronchoscope recurrence five years knowledge , represents case carcinoma situ treated solely excisional biopsy case emphasizes importance biopsy specimens mucosal abnormalities raises possibility limited excision sole therapy carcinoma situ
clinical application ras gene mutation diagnosis pancreatic adenocarcinoma pancreatic adenocarcinomas known ras gene \( oncogene \) mutations site mutations localized codon 12 k ras gene high incidence localization ras gene mutations observed human malignancies polymerase chain reaction direct sequencing method enabled us analyze dna sequence around codon 12 k ras gene small quantities specimens obtained needle biopsies aspirate samples pathological diagnosis materials obtained 12 patients pancreatic adenocarcinoma showed mutations , whereas obtained 6 patients chronic pancreatitis showed mutations several cases using mutations k ras gene marker , analysis supplemented conventional pathology cytology making diagnosis pancreatic adenocarcinoma analysis ras gene mutations useful clinical diagnosis pancreatic adenocarcinoma
modified van nes rotationplasty osteosarcoma proximal tibia children knee amputation traditional treatment osteosarcoma proximal tibia recent advances chemotherapy encouraged development limb salvage techniques van nes rotationplasty malignant lesions distal femur increased popularity reconstructive technique , similar procedure described lesions proximal tibia developed modified rotationplasty lesion performed four children surgical technique , postoperative management results procedure described two patients delayed wound healing complications developed patients disease free follow , appearance leg well accepted patients parents procedure useful addition armamentarium tumour surgeon treatment malignant lesions proximal tibia
osteosarcoma treatment wide resection prosthetic replacement reviewed 20 cases osteosarcoma treated wide local resection prosthetic replacement followed six 17 years limb function excellent 85 one patient grade iii histological disease developed pulmonary metastases four patients local recurrences , related repeated preliminary biopsies , inappropriate biopsy vascular tumour mode treatment , outcome related medullary invasion tumour
embryologic fusion planes spread cutaneous carcinoma review reassessment long held embryologic fusion planes influence spread skin cancer embryologic fusion planes implicated depth invasion , horizontal spread , recurrence cutaneous carcinoma however , structures never studied detail review surgical literature reveals considerable confusion regarding exact nature , location , tumor interactions fusion planes review gross microscopic development sites embryologic fusion examine histologic sections fusion sites normally developed adult fetal fresh cadaver specimens studies , supported review developmental anatomy , indicate fusion planes persist identifiable anatomic structures would influence tumor spread
use mohs micrographic surgery establish quantitative proof heightened tumor spread basal cell carcinoma recurrent following radiotherapy compared 27 basal cell carcinomas \( \) recurrent following radiotherapy subsequently excised mohs micrographic surgery control group recurrent following treatment modalities similarly excised mohs technique permitted precise , quantitative tumor assessment , obtained via novel method utilizing three parameters number surgical stages required complete excision , percentage increase clinical preoperative tumor area final postoperative defect area , presence deep subcutaneous tissue invasion figures group larger three categories , latter two revealing statistically significant differences versus group study gives strong , direct quantitative support clinical impression bcc recurrent following radiotherapy uniquely aggressive , invasive subset recurrent bcc
growth factor dependent differentiation along myeloid lymphoid lineages immature acute lymphocytic leukemia bone marrow cells child immature \( cd2 , cd5 , cd7 \) acute lymphocytic leukemia \( \) cultured presence absence human ril 2 , il 3 , granulocyte macrophage \( gm \) csf cells cultured without growth factors failed divide initiated presence il 2 gm csf underwent maturation terminal lymphoid myelomonocytic differentiation , respectively contrast , permanent growth factor dependent cell line , designated tall 103 3 , established upon culture il 3 tall 103 3 cells gradually lost cell specific markers acquired myeloid phenotype \( , cd33 \) switching il 3 dependent cells early passage medium containing human ril 2 resulted establishment subline , named tall 103 2 , lymphoid phenotype \( cd3 , cd8 , tcr gamma delta , cd7 \) tall 103 2 cells strictly require il 2 growth , irreversibly committed lymphoid lineage , cannot survive presence hemopoietic growth factor tested far contrast , il 3 dependent tall 103 3 cells could adapted grow synthetic \( serum free \) medium also presence either gm csf il 5 , retain myeloid phenotype interestingly , 18 mo culture il 3 , tall 103 3 cells still phenotypically converted lymphoid lineage upon addition il 2 , thus maintaining despite marked phenotypic differences , tall 103 2 tall 103 3 cell lines show multiple abnormalities present primary malignant clone identical rearrangements tcr gamma delta loci , thus confirming common precursor cell together , findings indicate phenotype immature cells drastically modified presence specific hemopoietic growth factors environment , leading either lymphoid myeloid lineage commitment leaving karyotype genotype intact
antigen induced cross linking ige receptor leads association detergent insoluble membrane skeleton rat basophilic leukemia \( \) cells cross linking ige receptor surface rat basophilic leukemia cells ag \( bsa \) causes rapid conversion detergent insoluble form concurrent increase amount filamentous actin associated plasma membrane degree receptor detergent insolubility rise f actin content rapid half maximal response less 1 min rapidly reversed addition ag \( lysine \) two early steps triggering rat basophilic leukemia cells dissociated pretreatment cells either cytochalasin sodium reagents block increase f actin effect receptor detergent insolubility indicates responsible detergent insolubility receptor may membrane skeleton interacting complex confirmed finding cross linking ige receptors surface purified plasma membranes also leads detergent insolubility receptor therefore , components necessary detergent insolubility receptor present plasma membrane , cytoplasmic components needed results suggest detergent insolubility cross linked receptors caused interaction membrane skeleton actin filaments may interact receptor membrane skeletal complexes order produce large scale clustering membrane skeleton may therefore acting intermediate structure cell surface receptors
mapping site interaction murine ige high affinity receptor chimeric ig investigated interaction mouse \( \) ige fc epsilon ri rat basophilic leukemia cells using set chimeric ig constructed homologous h chain c domains human \( hu \) igg1 mige binding affinities examined equilibrium kinetic measurements , found epsilon c gamma 3 \( mige c epsilon 4 replaced c gamma 3 \) indistinguishable mige chimeric ig , contain c epsilon 2 c epsilon 3 , bind rat basophilic leukemia cells \( less 10 \( 6 \) 1 \) ability chimeric ig stimulate cellular response \( degranulation \) presence ag also tested epsilon c gamma 3 indistinguishable mige eliciting high level degranulation , whereas chimeric ig stimulated response even enhance binding results demonstrate c epsilon 4 may replaced c gamma 3 without affecting binding cell activating properties mige lack binding chimeric ig indicates c epsilon 2 c epsilon 3 necessary binding interaction
ige receptor mediated phosphatidylinositol hydrolysis exocytosis rat basophilic leukemia cells independent extracellular ca2 hypotonic buffer containing high concentration k isotonic buffer , ige receptor mediated exocytosis rat basophilic leukemia cells dependent extracellular ca2 , half maximal degranulation requiring 0 4 mm ca2 significant exocytosis occurs absence extracellular ca2 absolute requirement ca2 eliminated cells hypotonic buffer containing 60 80 mm k na cannot substitute k optimal ca2 \( \) independent exocytosis occurs buffer containing 20 mm , ph 7 1 , 40 mm kcl , 5 mm glucose , 7 mm mg acetate , 0 1 bsa , 1 mm egta cells maintain ca2 \( \) independent exocytosis even 1 mm egta 40 min 37 degrees c triggering exocytosis eliminated approached adding sucrose , nacl , kcl , potassium glutamate buffer 2 fluorescence measurements reveal small rise ca2 cells triggered hypotonic buffer absence extracellular ca2 presence 1 mm egta isotonic buffer , degranulation occur conditions lead small rise ca2 sustained ige receptor mediated phosphatidylinositol hydrolysis , also ca2 dependent isotonic buffer , becomes independent ca2 hypotonic buffer fact , rate phosphatidylinositol hydrolysis hypotonic buffer absence ca2 \( presence 1 mm egta \) twice observed isotonic buffer presence 1 mm ca2 data show hypotonic buffer , requirement ige receptor mediated pi hydrolysis extracellular ca2 eliminated , degranulation ca2 0 1 microm , baseline level ca2 found resting cells results consistent hypothesis , isotonic buffer , ca2 requirement mast cell degranulation generation second via hydrolysis membrane
technetium 99m \( v \) dimercaptosuccinic acid planar scintigraphy head neck cancer clinical , scintigraphic radiological study technetium 99m \( tc99m \) \( v \) dimercaptosuccinic acid \( dmsa \) imaging agent proposed scintigraphic marker head neck squamous cell carcinoma fifty four patients studied 51 head neck tumour patients examined imaged using tc99m \( v \) dmsa scintigraphy computerized tomography scintigraphy less sensitive clinical examination detection patients cancer , patients primary tumours patients metastatic neck disease ct sensitive accurate clinical examination sensitive tc99m \( v \) dmsa detecting patients cancer primary tumours ct sensitive accurate clinical examination tc99m \( v \) dmsa scintigraphy predicting patients metastatic neck disease although tc99m \( v \) dmsa accumulated squamous cell carcinoma , inability detect low volume disease apparent low specificity means role play management patients head neck squamous cell carcinoma
late development squamous carcinoma reconstructed pharynx report case squamous cell carcinoma found arisen skin flap used pharyngeal reconstruction flap forming pharynx 24 years signs recurrent disease developed period raises possibility tumour induction heterotopic skin used oropharyngeal reconstruction
maxillary antrum extremely rare head neck histological diagnosis often difficult present case maxillary antrum 33 year old male histological diagnosis subsequent management discussed
laser therapy vaginal intraepithelial neoplasia hysterectomy recent years marked increase number reported cases vaginal intraepithelial neoplasia \( \) hysterectomy 10 years ago radiation surgery therapeutic modality mostly used disease recently , topical drugs , bleomycin 5 fluorouracil cream , used , often ineffective poorly tolerated last 14 years used co2 laser treatment treated total 143 patients use combination wire sutures vaginal mucosa introduction fluids underlying submucosal areas allows retraction scars permits us place vaginal mucosa right angles laser beam allow complete treatment
cytobrush evaluating routine endocervical smears conventional cotton tipped applicator remained method obtaining papanicolaou smears clinicians university california los angeles , student health service \( \) adopted cytobrush sole method obtaining cervical samples late 1986 study done define changes adequacy sampling detection rate squamous glandular epithelial abnormalities cytobrush accomplish goal , 1 , 000 cytobrush 244 conventionally obtained smears analyzed prospectively , 3 , samples obtained 1986 prior change method reviewed retrospectively compared cervical samples obtained conventional methods , cytobrush smears contained significantly endocervical cells fewer artifacts methods obtained equivalent squamous samples similar final class distributions case endocervical adenocarcinoma carcinoma situ invasive adenocarcinoma detected patients initial endocervical cells samples whose repeat sample contain endocervical cells retained class 75 cases study confirmed cytobrush technique produces papanicolaou smears improved sampling junction questioned whether results increased detection rate cervical pathology
human recombinant gm csf allogeneic bone marrow transplantation leukaemia double blind , placebo controlled trial randomised , double blind trial 20 patients leukaemia received human recombinant granulocyte macrophage colony stimulating factor \( gm csf \) 20 received placebo , 14 days allogeneic , matched sibling , bone marrow transplantation neutrophil count recovered 0 5 x 10 \( 9 \) l 3 days earlier gm csf group placebo group \( significant \) , median neutrophil count 14 days significantly higher gm csf group \( 1 90 vs 0 46 x 10 \( 9 \) l \) lymphocyte count significantly higher gm csf placebo group days 10 15 transplantation , difference associated higher incidence graft versus host disease evidence gm csf associated greater incidence relapse gm csf group lower haemoglobin concentrations platelet counts higher plasma urea , creatinine , bilirubin placebo group duration hospital stay patient groups studies indicated assess overall effect gm csf outcome allogeneic bone marrow transplantation
synthetic analogues inhibit angiogenesis suppress tumour growth neovascularization critical growth tumours dominant feature variety angiogenic diseases diabetic retinopathy , , arthritis psoriasis recognition potential therapeutic benefit controlling capillary growth led search safe effective angiogenesis inhibitors report synthesis family novel inhibitors analogues , naturally secreted antibiotic aspergillus fumigatus first isolated fungus contaminated culture capillary endothelial cells purified inhibited endothelial cell proliferation vitro tumour induced angiogenesis vivo also inhibited tumour growth mice , prolonged administration limited caused severe weight loss synthesis analogues yielded potent angiogenesis inhibitors \( \) suppress growth wide variety tumours relatively side effects
purification characterization inhibitor \( soluble tumor necrosis factor receptor \) tumor necrosis factor obtained serum human cancer patients serum \( \) human patients different types cancer contain blocking factor \( bf \) inhibits cytolytic activity human tumor necrosis factor alpha \( tnf alpha \) vitro bf protein molecular mass 28 kda reducing sodium dodecyl sulfate polyacrylamide gel electrophoresis \( sds page \) active material purified homogeneity combination affinity chromatography , page , high pressure liquid chromatography amino acid sequence analysis revealed bf derived membrane tnf receptor purified bf blocks lytic activity recombinant human mouse tnf alpha recombinant human murine cells vitro however , bf inhibits lytic activity tnf alpha effectively bf also inhibits necrotizing activity recombinant human tnf alpha established cutaneous meth tumors balb c mice bf may important role \( \) regulation control tnf alpha activity cancer patients , \( ii \) interaction tumor host antitumor mechanisms , \( iii \) use systemically administered tnf alpha clinical trials human cancer patients
cholangiocarcinoma diagnosis cholangiocarcinoma made greater rapidity accuracy clinical setting obstructive jaundice , ct scan may suggest cholangiocarcinoma dilated intrahepatic ducts seen extrahepatic biliary tree diagnosis confirmed cholangiography , tumor staged combination cholangiography angiography tumor extensively involves lobes liver involves main portal vein hepatic artery , lesion considered unresectable patients best nonoperatively , still attempt tissue diagnosis , various lesions cholangiocarcinoma comparison , tumor confined distal hepatic duct bifurcation , extends one lobe liver , involves right left portal vein hepatic artery , lesion may resectable , exploration indicated many half patients explored curative intent successful resection various surgical options appropriate patients undergoing tumor resection , depending site extent lesion similarly , several surgical options possible palliation patients unresectable cholangiocarcinoma role radiotherapy management cholangiocarcinoma uncertain results , like many retrospective analyses , suggest radiotherapy prolongs survival curative resection well palliative stenting however , data randomized studies necessary support impression studies adjuvant chemotherapy hormonal therapy also necessary improve patient survival
effects tamoxifen somatostatin analogue growth human medullary , follicular , papillary thyroid carcinoma cell lines tissue culture nude mouse xenograft studies knowledge \( 1 \) normal thyroid contains somatostatin , \( 2 \) polypeptide growth factors influence thyroid cell function , \( 3 \) thyroid cells contain steroid hormone receptors prompted us add somatostatin analogue 201 995 \( sms \) \( 5 ng ml \) tamoxifen citrate \( tam \) \( 5 mumol l \) 7 day monolayer cultures \( 50 , 000 cells well \) three separate human thyroid carcinoma cell lines \( medullary \) , \( follicular \) , \( papillary \) results , tabulated cell numbers well \( \( 5 \) day 7 , revealed tam inhibited growth medullary follicular cells tam plus sms inhibited growth papillary cells vivo studies subcutaneous tumor cell xenografts nude mice documented tam \( 5 mg subcutaneous pellet \) significantly inhibits growth medullary implants flow cytometric dna studies medullary cell cultures demonstrated reduced g2 phase tam treatment papillary cell implants , tam plus sms \( 5 micrograms subcutaneously , twice daily \) suppress tumor growth three cell lines negative estrogen receptor addition estradiol \( 5 ng ml \) medullary cell cultures neither stimulated replication reversed inhibitory effects tam vitro conclude \( 1 \) tam slowed growth cell line human medullary carcinoma , vitro vivo \( 2 \) effect reversed estradiol \( 3 \) tam plus sms inhibited replication papillary carcinoma cell line vitro , vivo \( 4 \) tam alone tam plus sms inhibited replication cultures human follicular thyroid carcinoma cell line tam sms may useful treatment human thyroid carcinomas
time recovery hypothalamic pituitary adrenal axis curative resection adrenal tumors patients cushing 's syndrome recovery time hypothalamic pituitary adrenal \( hpa \) axis curative resection adrenal tumors patients cushing 's syndrome poorly documented eight consecutive patients treated standardized hydrocortisone replacement strategy curative resection cortisol secreting tumor time recovery hpa axis determined documented elevated 24 hour urinary free cortisol levels cure documented undetectable postoperative morning serum cortisol levels patient received replacement hydrocortisone surgery every 3 6 months hormone \( acth \) stimulation test patient also monitored carefully symptoms signs adrenal insufficiency , defined symptoms consistent diagnosis responded increases hydrocortisone levels surgical resection , patient cured subsequently , despite replacement hydrocortisone , patient symptoms , four eight patients dose hydrocortisone increased relieve symptoms patients required median time 15 months \( range , 9 22 months \) recover normal acth stimulation test 19 months \( range , 12 24 months \) allow discontinuation replacement doses hydrocortisone results suggest surgical resection cortisol secreting adrenal tumor result rapid cure , complete recovery hpa axis discontinuation replacement steroids require 1 2 years normal adrenal function , assessed cortisol response acth , returns despite replacement doses hydrocortisone , replacement doses hydrocortisone tapered rapidly discontinued normal acth stimulation test
posttranslational gastrin processing depends tumor morphology extracellular recently demonstrated alter cell morphology culture altered cell morphology associated changes gene transcription translation , known whether also affects posttranslational processing using tyrosine sulfation marker processing , studied effects various substrates biologically active gastrin \( irg \) production sulfation gastrin containing tumor cells \( gt cells \) dispersed gt cells onto different substrates incubated culture media days 4 , 7 , 28 assayed specific antibodies recognize total irg irg cells cultured plastic films laminin , collagen , matrigel \( collaborative research inc , , mass \) flattened formed monolayers gt cells cells cultured porous membrane gels collagen matrigel formed spheroids gt cells monolayer cultures showed increase sulfation time decrease irg production cultures maintained constant level sulfation time , exception matrigel \( gel \) , also showed decrease irg production results indicate level sulfation unchanged original tumor cells grown spheroids increased cultured monolayers appears alteration cellular milieu alters colony morphology , turn alters gastrin processing
retroperitoneal paragangliomas natural history response treatment retroperitoneal paragangliomas \( rp \) uncommon tumors rarity , little known natural history response treatment reviewed 22 patients rp seen center 1990 distribution male female patients nearly equal , mean age 42 patients admitted pain mass , eight 22 tumors functional significant difference noted duration symptoms , size tumor , survival functional tumors eleven 22 \( 50 \) rp metastasized therefore classified malignant five year 10 year disease free survival rates 19 19 tumors resected 75 45 completely resected metastases occurred , 5 year survival rate 36 , patient survived beyond 76 months predictors survival included complete resection tumor size functional status although patients received chemotherapy radiotherapy clinical responses , survival benefit could shown rp high rate malignant behavior treated operation late metastases uncommon , prolonged follow necessary metastases occurred , patients may prolonged survival
effect somatostatin 5 hydroxytryptamine release carcinoid tumor one major manifestations carcinoid syndrome secretory diarrhea thought due overproduction 5 hydroxytryptamine \( 5 ht \) synthetic somatostatin analogues proved clinically effective controlling diarrhea established continuous cell line human pancreatic carcinoid tumor 5 ht examined ability somatostatin analogue , sms 201 995 , inhibit 5 ht release vitro tumor cells exposed sms 201 995 \( 10 \( 6 \) mol l \) , pentagastrin \( 10 \( 9 \) mol l \) , acetylcholine \( 10 \( 5 \) mol l \) , isoproterenol \( 10 \( 5 \) mol l \) alone combination 5 ht release assayed high pressure liquid chromatography found pentagastrin \( 6 43 0 64 ng ml \) , isoproterenol \( 20 24 2 17 ng ml \) , acetylcholine \( 12 39 1 10 ng ml \) stimulated release 5 ht compared control values \( 4 38 0 42 ng ml \) sms 201 995 significantly reduced release 5 ht response isoproterenol acetylcholine inhibit effect data suggest different agents act pathway stimulate 5 ht release human pancreatic carcinoid cells
intraatrial extension thyroid cancer technique results radical surgical approach occlusion superior vena cava tumor thrombus extending right atrium diagnosed three patients follicular thyroid cancer patients showed typical clinical picture superior vena cava syndrome right thoracotomy performed preparation major vessels superior vena cava opened entire intravascular tumor thrombus removed closed directly two patients third patient left brachiocephalic trunk resected reconstructed vascular \( polytetrafluoroethylene \) graft patient bone brain metastases occlusion graft 3 months surgery anticoagulation stopped two patients clinically symptom free without local recurrence 13 50 months surgery aggressive surgical approach justified grossly invasive thyroid cancer decrease local recurrence death rates , correct clinical symptoms superior vena caval occlusion , prevent tumor embolism development distant metastases reducing tumor mass , even better basis radioiodine treatment prepared
intraoperative decision making thyroid surgery based results preoperative needle biopsy frozen section prognostic factors well differentiated thyroid cancer age patient grade , size , distant metastasis , extracapsular spread disease however , surgeon often pathologic diagnosis thyroid nodules accuracy preoperative studies , ultrasonography thyroid scanning , limited cost effective test fine needle aspiration , accuracy exceeds 80 series however , large group nodules exist aspiration cytologic studies considered either suspicious indeterminate decision extent thyroidectomy may difficult patients intraoperative frozen section may help surgeon distinguish benign malignant lesions , fine needle aspiration , major problem distinction follicular adenoma follicular carcinoma frozen section diagnosis follicular adenoma changed follicular carcinoma one third cases \( 13 38 cases \) decision extent thyroidectomy patients follicular adenomas based prognostic factors , age sex patient size nodule accuracy frozen section diagnosis 95 experience suggests decisions regarding extent thyroidectomy best made preoperative fine needle aspiration confirmation frozen section diagnosis equivocal cases
prognostic significance nondiploid dna determined flow cytometry sporadic familial medullary thyroid carcinoma clarify role dna measurements predicting outcome surgical treatment medullary thyroid carcinoma \( mtc \) , performed flow cytometric analysis nuclear suspensions 119 mtc tumors 119 patients , 63 \( 53 \) patients sporadic tumors 56 \( 47 \) patients familial tumors survivors followed mean 13 years dna content normal 92 \( 77 \) patients abnormal \( nondiploid \) 27 \( 23 \) patients ten year cause specific mortality rates 12 , 42 , 49 diploid , tetraploid , aneuploid tumors \( p 0 \) greater nondiploid tumors sporadic \( p 0 012 \) multiple endocrine neoplasia \( familial \) cases \( p 0 114 \) none 27 patients tnm stage disease died mtc patients tnm stages ii , iii , iv disease , dna nondiploid tumors associated increased deaths mtc cox proportional hazards model involving 119 patients adjusted disease stage inheritance pattern , nondiploid dna independently associated increased deaths mtc \( p 0 008 \) identical cox model restricted 92 dna diploid tumors , phase fraction 15 0 remained significant variable \( p 0 034 \) adjustment stage inheritance pattern therefore conclude dna measurements role play predicting outcome surgical treatment mtc
actin architecture cultured human thyroid cancer cells predictor differentiation \? actin cytoskeleton important cell structure motility disordered actin architecture correlated high metastatic potential melanoma , fibrosarcoma , colon cancer models thyrotropin known induce growth differentiation cultured thyroid cells , whereas carcinogenic phorbol ester 12 tetradecanoylphorbol 13 acetate \( tpa \) causes malignant transformation many cell lines therefore assessed effect thyrotropin tpa actin architecture 133 human follicular thyroid cancer cells continuous culture staining filamentous actin showed 1 mu ml 30 mu ml thyrotropin induced actin polymerization detectable 1 hour notable 24 hours similarly tpa \( 0 008 10 mumol l \) caused rapid actin fiber disruption redistribution cell periphery secondary antibody staining alpha , protein binds actin , prominent treatment thyrotropin decreased tpa findings indicate actin cytoskeleton dynamic response trophic factors thyrotropin promoted actin polymerization , tpa caused effects may correlate cellular alpha levels actin architecture may therefore reflect state differentiation thyroid tumor cells
posterior mediastinal teratoma abdominal extension posterior mediastinal benign uncommon neoplasms infancy nine cases reported far one month old baby found benign posterior mediastinal teratoma infiltrating lower oesophagus level oesophageal upper abdomen partial provided successful outcome
parental age sporadic hereditary retinoblastoma 104 children sporadic hereditary retinoblastoma born 1970 , studied age parents birth compared age mean age parents birth children period netherlands mean age fathers birth children sporadic hereditary retinoblastoma \( 33 7 years \) significantly higher mean age fathers birth children general population \( 32 5 years \) \( p less 05 , one sided \) similarly , mean age mothers birth children sporadic hereditary retinoblastoma \( 31 2 years \) significantly higher mean age mothers birth children general population \( 29 5 years \) \( p less 05 , one sided \) analyzed parental age factor measuring relative risk age groups comparing incidence sporadic hereditary retinoblastoma various parental age groups incidence sporadic hereditary retinoblastoma total population mothers 35 years age older relative risk 1 7 child sporadic hereditary retinoblastoma compared mothers population general \( p 006 , one sided \) similarly , fathers 50 years age older relative risk 5 0 child sporadic hereditary retinoblastoma compared fathers population general \( p 04 , one sided \) parental age effect found children retinoblastoma conclude high paternal high maternal age significant risk factors sporadic hereditary retinoblastoma
carotid body tumors surgical management carotid body tumors requires identification preservation neural vascular structures without compromising resection neoplasm fifteen patients examined treated carotid body tumors \( \) clinic foundation 1979 1987 diagnosis bilateral carotid angiography neural structures free tumor , meticulous dissection facilitates preservation large tumor size increases risk arterial resection necessitating reconstruction use vascular shunt minimizes risk cerebral ischemia postoperative intravenous digital subtraction angiography allows evaluation arterial repair retrospective review 15 carotid body tumor resections performed 14 patients revealed evidence tumor recurrence , mortality associated surgical intervention , postoperative cerebrovascular accident , limited morbidity associated sacrifice neural elements
oncogene amplification squamous cell carcinoma head neck cellular oncogenes appear involved control normal cell growth differentiation abnormal activation genes naturally occurring experimentally induced cancers may important role expression malignant phenotype cancer cells mechanisms activation genes include chromosomal translocation , point mutation , dna amplification amplification specific oncogenes correlates clinical prognosis several human malignancies , including breast cancer neuroblastoma examined 21 fresh frozen human squamous cell carcinomas tract amplification 10 known cellular oncogenes \( c myc , n myc , l myc , n ras , h ras , k ras , erb b , erb b2 , raf , 2 \) , using southern blotting techniques eleven 21 tumors demonstrated two fold 11 fold amplification 2 oncogene , one member family genes related basic fibroblast growth factor amplification c myc , gene codes dna binding protein involved regulation cell growth , seen two tumors none eight genes studied amplified tumor specimens
intraoperative radiation canine carotid artery , internal jugular vein , vagus nerve therapeutic applications management advanced head neck cancers step application intraoperative radiotherapy \( iort \) treating advanced head neck cancers , preliminary information obtained radiation tolerance canine common carotid artery , internal jugular vein , vagus nerve single , high dose electron beam sides neck eight mongrel dogs operated expose 8 cm segment common carotid artery , internal jugular vein , vagus nerve one side neck irradiated , using escalating doses 2500 , , , cgy contralateral side neck served unirradiated control 3 6 months iort , one dog dose level killed none dogs developed carotid bleeding time iort light microscopic investigations using hematoxylin eosin staining common carotid artery internal jugular vein showed consistent changes suggested radiation damage however , stain hydroxyproline concentration irradiated common carotid artery indicated increase collagen content tunica media marked changes irradiated vagus nerve seen , indicating severe demyelination loss nerve fibers , appeared radiation dose dependent four patients advanced recurrent head neck cancer treated surgical resection iort without acute subacute complications role iort supplement surgery , external beam irradiation , chemotherapy selected patients advanced head neck cancer needs exploration
use levator muscle flap head neck reconstruction numerous techniques available reconstruction defects following composite resection oral cavity oropharyngeal tumors single technique applicable situations levator muscle flap well known application carotid protection little attention paid usefulness aspects head neck reconstruction using levator muscle flap variety reconstructive problems flap useful intraoral suture lines , closing intraoral defects , providing soft tissue fill dead spaces bulk lateral anterior oral defects levator flap found easy elevate , safe , reliable minimum wound complications review 18 patients , representative case studies , discussion surgical technique relevant anatomy blood supply presented
patterns care outcome study cancer uterine cervix results second national practice survey report summarizes outcome results patterns care study \( pcs \) cancer uterine cervix patients treated 1978 5 year survival evidence disease stage , 74 stage ii , 56 stage iii , 33 5 year local field failure rate stage , 12 , stage ii , 27 stage iii , 51 extent parametrial involvement , unilateral versus bilateral , may important determining survival local failure four year actuarial survival 58 unilateral involvement versus 47 bilateral \( p 0 06 \) , local failure rate 32 unilateral versus 45 bilateral \( p less 0 05 \) analyzed stage , patients stage iib disease unilateral parametrial involvement showed trend toward improved survival decreased local failure compared bilateral stage iib cancers \( p 0 1 \) use intracavitary irradiation significantly improved survival reduced local failures furthermore , number intracavitary applications important two intracavitary applications used compared one application , local field failure significantly reduced , 29 versus 17 4 years \( p less 0 001 \) , four year survival improved , 60 versus 73 \( p 0 01 \) four year actuarial rate major complications depended stage stage , 8 stage ii , 15 stage iii , 13 statistically significant increase major complications patients undergoing laparotomy staging versus laparotomy 23 versus 11 4 years \( p less equal 0 01 \) trend toward increased major complications patients thin prior abdominal surgery study confirmed stage dependent outcome treatment cancer uterine cervix radiation indicated division stage iib indicate prognostic significance unilateral bilateral parametrial involvement may warranted study also confirmed importance intracavitary radiation optimizing control established 1973 pcs suggests possible , two intracavitary insertions may yield better results one insertion
carboplatin childhood brain tumors children 's cancer study group phase ii trial october 1985 march 1988 , children 's cancer study group institutions entered 95 patients recurrent brain tumors phase ii trial carboplatin 560 mg m2 every 4 weeks complete partial responses observed one 19 evaluable children brainstem glioma , two 14 , six 19 medulloblastoma central nervous system primitive neuroectodermal tumor \( pnet \) , none 15 high grade astrocytoma 33 children medulloblastoma , , central nervous system pnet , five 12 prior cisplatin exposure responses , two 21 prior cisplatin exposure responses \( p 0 03 \) thirty four percent patients absolute neutrophil count less 500 microliters , 37 platelet count less 25 , 000 microliters sixteen percent moderate severe , 10 nausea vomiting , none nephrotoxicity
interferon alpha 2a 5 fluorouracil advanced colorectal carcinoma assessment activity toxicity preclinical data showed cytotoxic effects 5 fluorouracil \( 5 fu \) augmented interferon \( ifn \) small study , 13 17 patients advanced colorectal cancer responded regimen 5 fu ifn using dose schedule pilot study , 38 previously untreated patients metastatic colorectal carcinoma treated continuous intravenous \( iv \) infusion 5 fu 750 mg m2 daily 5 days , followed weekly bolus 5 fu 750 mg m2 subcutaneous ifn 9 million units three times per week 35 evaluable patients , nine \( 26 \) partial response \( 95 confidence limit , 11 41 \) , median response duration 7 5 months \( range , 4 4 greater 11 7 months \) seven patients \( 20 \) minor response , ten \( 28 \) stable disease common toxicities observed stomatitis \( 52 \) diarrhea \( 43 \) neurotoxicity seen 34 patients consisted gait disturbance , dizziness , confusion , memory loss , dementia toxicity , 84 patients required reduction ifn dose least 50 , 63 required reduction 5 fu dose least 25 although combination 5 fu ifn patients advanced colorectal carcinoma activity , regimen toxic , observed response rate \( 26 \) substantially superior alternative 5 fu programs
conservative surgery radiation therapy soft tissue sarcoma wrist , hand , ankle , foot seventy eight patients soft tissue sarcoma \( sts \) arising distal extremities wrist , hand , finger , ankle , foot , toe treated conservation surgery radiation therapy studied retrospectively respect survival , local recurrence , functional limb preservation , complications , distant metastasis median follow 7 9 years , actuarial 5 year 10 year survival rates 80 69 , respectively , disease free rates 61 51 times actuarial local control rates 80 74 5 10 years , respectively fifteen patients \( 19 \) local recurrence , 12 salvaged ultimately , 53 patients \( 68 \) retained normal fairly normal extremity , six \( 8 \) needed amputation complications , 13 \( 17 \) needed amputation control recurrent disease functional outcome significantly better patients upper extremity lesions lower extremity tumors even latter , treatment strategy preferable amputation incidence metastases distal extremity sarcomas depends size primary tumor concluded conservation surgery radiation therapy \( \) acceptable treatment strategy sts arising distal extremities yielded high rate disease control functional limb preservation
standard dose radiation microscopic disease appropriate elective irradiation sites potential occult tumor spread often part patient 's radiation therapy program required radiation dose \( \) depends probability occult disease exists \( p \( \) \) , number sites risk \( \) , number tumor present \( ni \) , radiation sensitivity , desired control rate exponential model cell survival used quantify importance factors control probability 1 x \( 1 e ni x \( \) 2 \) surviving fraction 2 gy implications clinical radiation therapy include 1 since number occult site may vary 10 degrees 10 \( 8 \) , ni major determinant required dose intrinsic radiation sensitivity \( \) also extremely important determining dose factors less influential since vary less 2 variability ni \( 8 logs \) larger variation cell number seen gross disease \( 1 cm3 versus 1000 cm3 , 3 logs \) ni approximately 10 \( 8 \) , required dose approaches needed small volume gross disease \( 10 \( 9 \) cells , 1 cm3 \) 3 dose prescribed elective sites reflect risk occult disease based primary tumor site , stage , grade 4 regions evaluation difficult \( e g , pelvis obese neck \) require higher doses macroscopic tumor deposits may exist 5 relatively low doses \( 10 30 gy \) often thought inadequate microscopic tumor however , similar doses reported microscopic tumor ovarian , rectal , bladder , breast , head neck carcinomas relatively low doses since may useful select cases normal tissue previous irradiation treatment limit radiation dose
local distant control cure cervical cancer 1978 1986 , 183 women cervical cancer received definitive radiation therapy surgical staging relapse free rates strong functions pelvic lymph node metastases cervical size recurrence distribution consisted 4 isolated local , 13 isolated distant , 17 combined local distant failures assumption independent local distant failure probabilities , et al 's method extended assess potential improvement cure perfect local distant control , yielding local \( lsa \) distant \( dsa \) survival advantages 17 28 various subsets clinical stage , cervical size , pelvic node metastases , metastases , peritoneal metastases lsa 12 27 dsa 12 71 prognostic group , lsa never exceeded dsa , showing effective systemic therapy would greater impact improving survival would advances local regional tumor control therapeutic implications limitations extended lsa dsa model discussed form analysis used guide intensity local distant treatment maximize cure patient cancer
role elective lymph node dissection management patients thick cutaneous melanoma retrospective search patients seen duke melanoma clinic 1970 1986 identified 308 clinically stage patients , 4 0 10 0 mm cutaneous melanomas five year ten year survival 56 43 , respectively elective lymph node dissection \( elnd \) done 116 patients \( 37 7 \) difference disease free interval \( \) survival patients versus patients treated wide excision \( p 0 9 \) thirty two patients \( 27 6 \) pathologically positive nodes elnd patients shorter \( p 0 05 \) survival \( p 0 03 \) compared patients negative node dissections divided 's thickness , difference persisted patients 4 0 6 0 mm lesions \( p 0 01 \) however , lesions \( greater 6 0 mm \) , difference survival node negative node positive groups \( p 0 9 \) mean follow 7 1 years elective lymph node dissection done 192 patients 78 recurred first regional nodes 78 patients compared 32 patients pathologically positive nodes elnd see patient survival improved early removal nodal disease difference \( p 0 5 \) survival \( p 0 3 \) two groups concluded elnd may provide prognostic information patients thick cutaneous melanomas however , change ultimate survival patients followed , nodes removed clinically positive authors recommend elnd patients thick melanomas risk distant metastases benefit regional node dissection
endoscopic radiographic evaluation murine colon endoscopic radiographic techniques widely applicable evaluation chemically induced murine colon cancer authors investigated methods rat colon refined endoscopic radiographic techniques compared total colonoscopy \( tc \) air contrast \( \) single contrast barium enema \( \) findings obtained necropsy rats 1 , 2 \( \) induced colon cancer showed complete evacuation solid feces sprague dawley rats treated underwent tc \( 5 0 mm bronchoscope \) either colonoscopy equally sensitive \( 81 5 76 3 , respectively \) , although significantly insensitive identifying lesions \( p less 0 001 \) study demonstrates \( 1 \) mechanical rat colon feasible , \( 2 \) tc barium radiology done routinely mechanical , \( 3 \) tc double contrast sensitive identifying colon lesions techniques provide means manipulation murine tumors vivo surveillance
immunohistochemical differentiation basal cell cutaneous using monoclonal anti glycoprotein antibody tnkh1 application mohs' micrographic surgery tnkh1 , primarily developed detect differentiated melanocytic tumor cells , found recognize basal keratinocytes hair follicle basal keratinocytes human epidermis thus , tnkh1 basal cells following structures epidermis \( 39 54 , part specimen opes \) , upper hair follicle \( one 24 , opes \) , lower hair follicle \( 21 21 , high rate specimen \) , duct \( 14 15 , \) , gland \( ten 14 , cells near duct \) , eccrine duct \( three 19 , opes \) epithelial tumors , considered derived differentiating toward hair follicle \( one one , \) basal cell \( \) \( 32 32 , \) labeled peripheral cells hand , epidermal tumors , keratosis \( ten 11 , opes \) , keratosis \( two three , opes \) , squamous cell carcinoma \( one two , opes \) , showed irregular peripheral basal cell staining normal epidermis sweat apparatus eccrine secretory portion negative eccrine ductal tumors \( two tested \) , eccrine \( one \) , eccrine carcinoma \( two \) tnkh1 negative taking advantage total labeling versus peripheral labeling hair follicle , authors could distinguish tissue structures clearly among structures upper hair follicle eccrine duct excluded easily negative staining tnkh1 lower hair follicle tnkh1 positive outer basal layer , whereas tnkh1 positive entire cells result indicated tnkh1 useful antibody mohs' micrographic surgery
immunohistochemical demonstration placental form glutathione transferase , enzyme human gliomas expression human placental form transferase \( gst pi \) human gliomas investigated immunohistochemical methods , result compared normal human glial cells gliomas study composed five benign astrocytomas \( grade 2 \) , ten anaplastic astrocytomas \( grade 3 \) , 16 glioblastomas \( grade 4 \) normal human glial cells showed weak immunostaining response gst pi cytoplasm nuclear membranes benign astrocytomas diffusely weak gst pi immunostaining , resembling normal glial cells increasing grade , gliomas showed strongly positive reaction gst pi positive reactions remarkable especially giant cells high grade gliomas results suggest cells gliomas function expression enzyme , gst pi , related degree malignancy gliomas
expression placental alkaline phosphatase gastric colorectal cancers immunohistochemical study using prepared monoclonal antibody authors developed monoclonal antibodies \( moab \) human placental alkaline phosphatase \( plap \) four specific moab reacting plap two nonspecific moab reacting equally alkaline phosphatase \( hepatic , intestinal , placental \) obtained immunohistochemical staining specific moab showed cell membrane cytoplasm cancer cells stained gastric colorectal carcinoma incidence plap positivity 23 \( 25 107 \) gastric carcinomas among gastric carcinomas , 42 \( 13 31 \) positivity highly differentiated carcinoma \( papillary adenocarcinoma well differentiated tubular adenocarcinoma \) significantly higher rate found poorly differentiated carcinoma \( poorly differentiated adenocarcinoma signet ring cell carcinoma , five 41 , 12 \) incidence plap positivity 11 \( four 35 \) colorectal carcinoma contrast , gastric adenoma , intestinal metaplasia , tissue adjacent cancer show staining results indicated expression plap apt occur highly differentiated gastric carcinoma highly specific carcinoma gastrointestinal tract , although incidence high
cancer antigen 125 , carcinoembryonic antigen , carbohydrate determinant 19 9 ovarian tumors authors studied data combination assays tumor markers , simultaneous elevation different types tumor markers serum interpreted phenomena regarding cancer antigen 125 , carcinoembryonic antigen , carbohydrate determinant 19 9 ovarian tumors tissue expression antigens compared preoperative serum levels several different factors found cause simultaneous elevation two three markers serum furthermore , even levels tumor markers raised serum , ovarian tumor always produce marker study indicates immunohistochemical identification marker tumor tissue prerequisite use marker serum monitor disease status
cartilage containing benign soft tissue clinical pathologic features four cases benign mature cartilage represented predominant component reported distinctive histologic feature four cases lobular proliferation cartilaginous tissue exhibiting spectrum hyaline cartilage , , myxoid cartilage , cartilage ossification even bone marrow formation , associated mature adipose tissue vascular elements localization tumors proximity bone , attached periosteum continuity joint lesions may mistaken cartilaginous neoplasms soft tissue , recognition entity potentially important diagnostic therapeutic implications surgery may avoided
fallopian tube cancer park experience sixty four patients primary fallopian tube cancer treated park memorial institute 1964 1987 underwent retrospective clinicopathologic review 40 patients fallopian tube cancer primary , 24 patients primary fallopian tube cancer part multifocal upper genital tract malignancy 40 patients fallopian disease , median survival 28 months 15 patients alive disease free follow ranging 22 141 months \( median , 90 5 months \) survival associated stage disease , tumor histology , grade , depth invasion series fourteen patients received cisplatin based chemotherapy evaluable response three patients \( 21 \) responded two complete one partial twelve patients without clinical evidence disease underwent second look procedures , ten laparotomy two laparoscopy four ten second look laparotomies negative secondary debulking done three four patients gross disease , one negative third look laparotomy negative laparotomy , second look third look , associated improved survival \( p 0 016 \) one two negative , patient recurred remaining 24 patients cancer fallopian tube part multifocal upper genital tract malignancy 12 patients tubal disease invasive , 12 , situ separate occurred ovaries \( n 20 \) uterus \( n 7 \) cervix \( n 2 \) represents 1 3 ovarian malignancies treated park memorial institute study period fallopian tube cancer seems virulent ovarian cancer long term survivors frequently associated sites upper genital tract malignancy second look laparotomy important predictor survival second look laparoscopy may useful positive
extrahepatic metabolism morphine occurs humans pharmacokinetics morphine studied six patients radiologic localization insulinoma performed general anesthesia sampling done peripheral artery , mesenteric vein five six patients , hepatic vein , peripheral vein , well urine hepatic blood flow estimated indocyanine green infusion technique end radiologic procedure morphine terminal half life 92 9 minutes , total body clearance ml min 1 , hepatic extraction ratio 0 65 0 11 concentration gradient observed artery superior mesenteric vein , showing gut wall metabolism morphine occurred total body clearance exceeded hepatic clearance 38 concluded extrahepatic clearance morphine probably occurred kidney
insulin like growth factor binding protein secretion breast carcinoma cell lines correlation estrogen receptor status breast tumor cell lines shown secrete several distinct polypeptide growth factors , although conflicting results exist insulin like growth factors \( igfs \) contrast limited number breast tumor cell lines definitely shown secrete high affinity igf binding proteins \( \) modify igf actions characterize types secreted breast tumor cell lines , conditioned medium collected seven separate tumor cell lines , three estrogen receptor \( er \) negative , four er positive three er negative cell lines , mda 231 , mda 330 , , secreted binding proteins 49 , 000 43 , 000 mr \( igfbp 3 \) well 29 , 000 \( igfbp 1 \) 24 , 000 mr contrast , four er positive cell lines secreted 34 , 000 \( igfbp 2 \) 24 , 000 mr forms , none secreted 49 , 000 43 , 000 29 , 000 mr forms 20 , cell line positive er messenger rna \( mrna \) negative er protein , secreted predominantly 34 , 000 mr protein amount total igfbp activity released 24 h ranged 0 4 5 6 nm equivalents igfbp 1 , significant difference er positive negative cell lines mcf 7 cells produced predominantly 34 , 000 24 , 000 mr forms showed 1 8 fold increase igfbp secretion estrogen stimulation immunoblotting specific ria igfbp 1 showed er negative lines mda 330 , mda 231 , secreted form northern blotting analysis mrna encoding protein showed mda 330 mda 231 contained single 1 6 kilobase mrna species hybridized igfbp 1 complementary dna \( cdna \) probe immunoblotting analysis cell lines showed 34 , 000 mr form secreted er positive cell lines reacted igfbp 2 antisera exposure conditioned media three er negative cell lines n revealed 49 , 000 43 , 000 mr forms igfbp glycosylated therefore probably represent igfbp 3 conclude er negative cell lines secrete three forms , igfbp 1 , igfbp 3 , 24 , 000 mr form contrast , er positive cell lines secrete predominantly igfbp 2 24 , 000 mr form secrete igfbp 3 1 \( abstract truncated 400 words \)
alterations opioid parameters hypothalamus rats estradiol induced polycystic ovarian disease distribution density selectively labeled mu , delta , kappa opioid binding sites examined vitro hypothalamus normal , estradiol valerate \( ev \) injected , estradiol \( e2 \) implanted female rats hypothalamic beta endorphin concentration also examined ria three groups animals quantitative analysis film demonstrated selective increase mu opioid binding medial preoptic area ev treated , e2 implanted rats however , groups exhibited reduction density delta opioid binding nucleus statistically significant changes either groups observed kappa opioid binding results hypothalamic concentration beta endorphin indicated marked reduction ev injected animals respect controls contrast , e2 implanted animals exhibited beta endorphin concentrations similar controls present results confirm increase opioid receptor binding previously reported hypothalamus ev treated rats demonstrate increase confined medial preoptic area exclusively concerns mu opioid receptors concomitant reduction beta endorphin levels observed group animals suggests observed increase mu opioid binding could reflect chronic regulation receptor response compromised beta endorphin input given restriction effect site origin lhrh neurons demonstrated inhibitory role opioids lhrh release , postulate regulation could lead suppression plasma lh pattern characterizes polycystic ovarian disease ev treated rat
rapid inactivation phosphorylation pyroglutamyl peptidase ii 79 human retinoblastoma cells exposure phorbol ester pyroglutamyl peptidase ii \( ec 3 4 19 \) , membrane bound metalloproteinase , highly specific trh degrading enzyme exposure 79 human retinoblastoma cells 12 0 phorbol 13 acetate \( tpa \) decreased activity enzyme time concentration dependent manner \( ic50 5 x 10 \( 9 \) \) 15 min tpa treatment , 10 pyroglutamyl peptidase ii activity remained tpa treatment affect activity cytosolic enzyme pyroglutamyl peptidase \( ec 3 4 19 3 \) membrane bound enzyme peptidase iv \( ec 3 4 19 3 \) pretreatment cells protein kinase c inhibitors h 7 sphingosine prevented inactivation pyroglutamyl peptidase ii tpa time course tpa mediated effect paralleled time course translocation activation protein kinase c cell line immunoblot analysis demonstrated inactivation pyroglutamyl peptidase ii due dissociation internalization enzyme molecule incubation tpa activated 79 cell membranes gamma 32p atp followed immunoprecipitation revealed time dependent phosphorylation 48 kilodalton subunit pyroglutamyl peptidase ii studies indicate phorbol ester effect mediated protein kinase c , reveal mechanism potentiation action trh target sites
ability circular dna molecules carry amplified mycn proto oncogenes human neuroblastomas vivo amplification proto oncogene mycn \( also known n myc \) neuroblastomas shown correlate disease stage prognosis , yet little known dna structures carry amplified mycn genes neuroblastomas vivo used dna irradiation pulsed field gel electrophoresis analyze mycn amplification structures eight neuroblastomas separate patients \( four primary tumors four metastatic lesions exhibiting mycn amplification \) six eight neuroblastomas \( three primary tumors three metastatic lesions \) exhibited mycn dna irradiation profiles consistent presence circular dna amplification structures five neuroblastomas possessed amplification structures within size range double minute chromosomes , one contained smaller dna two neuroblastomas exhibited mycn dna irradiation patterns consistent larger \( presumably chromosomal \) amplification structures multiple sizes dna observed neuroblastomas four different patients , implying vivo amplification structures presence circular mycn amplification structures six eight neuroblastomas examined suggests circular dna molecules important structures vivo gene amplification
segregation analysis breast cancer cancer steroid hormone study histologic subtypes segregation pattern breast cancer white families cancer steroid hormone study investigated families categorized four groups based histologic type breast cancer probands ductal cancer , lobular cancer , adenocarcinoma , medullary cancer ductal cancer sample split premenopausal proband postmenopausal proband subset results six complex segregation analyses presented findings suggest heterogeneity transmission breast cancer analyses , evidence multifactorial component mixed model , ie , major locus plus transmission , genetic cultural interpretation medullary cancer , adenocarcinoma , lobular cancer analyses permit discrimination among major locus models segregation breast cancer entire ductal sample consistent autosomal recessive transmission ductal , recessive gene sufficient explain breast cancer distribution proband postmenopausal breast cancer contrast , proband premenopausal breast cancer , transmission model consistent dominant major gene , sporadic cases disease
results stereotactic brachytherapy used initial management patients glioblastoma recent studies shown survival benefit patients recurrent glioblastomas treated stereotactic brachytherapy basis encouraging results , began prospective study 1987 evaluate use brachytherapy patients newly diagnosed glioblastoma patients considered eligible study met following criteria karnofsky performance status 70 greater tumor size greater 5 cm dimension radiographically well delineated , supratentorial lesion involving surfaces pathologically confirmed glioblastoma treated 35 patients 1987 1990 stereotactic brachytherapy part initial therapy treatment protocol involved surgery , partial brain external beam radiotherapy \( 59 4 gy 33 fractions \) , stereotactic brachytherapy temporary high activity iodine 125 sources giving additional 50 gy tumor bed chemotherapy used initial management 35 patients compare results obtained matched control group , identified 40 patients glioblastoma treated surgery external radiotherapy , without chemotherapy , 1977 1986 institution patients clinical radiographic characteristics would made eligible brachytherapy protocol survival rates 1 2 years diagnosis 87 57 , respectively , patients receiving brachytherapy versus 40 12 5 , respectively , controls \( p less 001 \) conclude stereotactic brachytherapy improves survival patients glioblastoma incorporated initial treatment approach unfortunately , one four patients glioblastoma suitable candidates brachytherapy time initial presentation
effects fudr primary cultured colon carcinomas metastatic liver hepatic arterial infusion \( fudr \) demonstrated efficacy treatment metastatic colorectal carcinoma liver study , direct cytotoxic effect fudr measured ten metastatic two primary site colorectal carcinomas primary culture assay system overall , clinically concentrations fudr \( 0 4 4 microm \) induced partial cell kill 75 tumors , including greater 50 reduction viable tumor cell number two tumors less 50 remaining seven total cell kill observed tumor three tumors resistant fudr concentrations tumor sensitivity correlated size tumor growth fraction increasing exposure time fudr 3 7 days approximately doubled magnitude response 5 cisplatin , clinically concentrations , toxic metastatic tumor cells fudr limited chemosensitivity metastatic colorectal tumor cells fudr vitro , postulate mechanisms besides direct cytotoxicity contribute clinical efficacy fudr vivo
handle resection metastatic liver tumors resection metastatic liver tumors difficult risky procedure using handle greatly facilitate resection providing surface transection improving visualization ductal vascular structures addition , technique may decrease risk contaminating surrounding tissues cancer cells , may inhibit tumor recurrence within margins resection
extended neck dissection time described radical neck dissection , surgical procedure became popular management metastatic cancer neck past two decades , modified neck dissection effectively utilized conservation function cosmesis achieving oncologic goals however , several instances standard procedures adequate resection malignant tumors although definite trend toward conservation procedures , extended neck dissection often necessary especially patients n2 disease apart standard structures removed radical neck dissection , structures removed extended neck dissection include skin , muscle , nerve , vagus nerve , sympathetic chain , ramus , carotid artery , esophageal nodes , etc past seven years , performed 40 extended neck dissections patients n2 disease neck nine patients unknown thirteen patients primary tumors oral cavity 11 five patients primary tumor salivary glands two patients metastatic melanoma patients underwent extensive skin excision pectoralis myocutaneous flap reconstruction patients received postoperative radiation therapy one patient died cardiac problems 4 weeks operation local control achieved 70 difficult region local control disease behind process , difficult problems patients involvement lymphatics data suggests definite situations extended neck dissection indicated satisfactory local control nodal disease
gamma detecting probe autoradiographic studies radiolabeled antibody b72 3 cx 1 colon xenografts nude mice bearing cx 1 colon tumors injected 50 microci 125i labeled monoclonal antibody \( mab \) b72 3 radioactivity tumors studied gamma detecting probe \( \) days 1 , 3 , 7 , 10 mab injection day , two mice sacrificed sections examined autoradiography \( arg \) , immunoperoxidase methods \( imp \) , routine stains mean probe counts showed increasing tumor background ratios arg demonstrated progressive increase radionuclide tumors distribution 125i primarily around vascular spaces day 1 , day 3 progressively appeared tumor gland necrotic areas regional correlation shown radionuclide vascular spaces sequestration tumor elements
long survival prognostic factors hepatocellular carcinoma studied survival prognostic factors cases hepatocellular carcinoma seen midwestern teaching hospital 1986 70 cases , 56 diagnosed life 14 autopsy 47 males 23 females age diagnosis ranging 14 88 median survival 56 patients diagnosed life 106 days 11 patients lived longer one year two patients long survivors presumed cured , one living 27 years diagnosis surgical treatment 19 years cox regression model showed young age diagnosis low stage disease diagnosis significant predictors long survival white patients survived nearly twice long black patients difference significant gender year diagnosis appear important determinants survival pathologic material still available one two long survivors histology carcinoma young adults
community lifestyle characteristics risk acute lymphoblastic leukaemia children high rates leukaemia children young people associated features community isolation population growth incidence data collected two specialist registries used compare incidence rates ward level relevant ward characteristics derived routine census survey data england wales excess risk childhood acute lymphoblastic leukaemia \( \) found wards large urban centres excess greatest wards higher socioeconomic status children aged 1 7 years \( childhood peak \) , two fold excess seen findings general support hypothesis childhood leukaemia infectious aetiology
method pattern separation medical diagnosis applied breast cytology pattern separation mathematical method distinguishing elements two pattern sets element pattern sets comprised various observations paper , use diagnosis breast cytology demonstrate applicability method medical diagnosis decision making 11 cytological characteristics breast fine needle aspirates reported differ benign malignant samples graded 1 10 time sample collection nine characteristics found differ significantly benign malignant samples mathematically , values sample represented point nine dimensional space real variables benign points separated malignant ones planes determined linear programming correct separation accomplished 369 370 samples \( 201 benign 169 malignant \) one malignant case , fine needle aspirate cytology definitely benign cytology excised cancer definitely malignant believe tumor missed aspiration mathematical method applicable medical diagnostic decision making problems
embryonic stem cell virus , recombinant murine retrovirus expression embryonic stem cells expression murine leukemia virus vectors derived restricted undifferentiated mouse embryonal carcinoma embryonal stem \( es \) cells developed retroviral vector , murine embryonic stem cell virus \( \) , active embryonal carcinoma es cells derived retroviral mutant cell myeloproliferative sarcoma virus \( pcmv \) expressed embryonal carcinoma cells es cells enhancer region pcmv shown functional cell types , sequences within 5' untranslated region pcmv found restrict viral expression es cells replacement region related sequences obtained dl retrovirus results , modified pcmv virus confers resistance fibroblasts es cells similar expression es cells mediated transcriptional regulatory elements within 5' long terminal repeat viral genome
glucocorticoids locally disrupt array positioned rat tyrosine aminotransferase promoter hepatoma cells transcriptional activation steroid hormones often associated appearance dnase hypersensitive site resulting local alteration structure promoter mouse mammary tumor virus long terminal repeat , viral promoter glucocorticoid control , model proposed appearance dnase hypersensitive site reflects displacement single precisely positioned associated glucocorticoid responsive elements determine mechanism general relevance transcriptional activation steroid hormones , investigated organization rat tyrosine aminotransferase promoter 1 kilobase region contains glucocorticoid regulatory target region displays dnase hypersensitive site absence hormone , nuclease digestion nuclei demonstrates presence positioned , cutting sites centered around positions , , , , , treatment cells dexamethasone induces disruption chromatin structure relatively short stretch dna \( approximately positions \) two observations suggest strong similarity role chromatin structure glucocorticoid dependent transcriptional activation mouse mammary tumor virus tyrosine aminotransferase
vaccination tumor cells expressing breast cancer epithelial tumor antigen ninety one percent breast tumors express epithelial tumor antigen \( eta \) identified monoclonal antibody vaccinia virus recombinants expressing tumor antigens considerable promise active immunotherapy cancer , evaluated potential vaccinia recombinants expressing secreted \( \) cell associated \( transmembrane , \) forms eta elicit immunity tumor cells expressing eta tumorigenic ras transformed fischer rat fibroblast lines fr fr , expressing form eta , respectively , constructed use challenge experiments expression eta lines confirmed western blotting immunofluorescence challenged subcutaneous seeding tumor cells , 97 \( fr \) 91 \( fr \) syngeneic fischer rats rapidly developed tumors failed regress vaccination recombinant vaccinia virus expressing eta prior challenge prevented tumor development 82 animals seeded fr cells 61 animals seeded fr vaccinia recombinant expressing form less effective , vaccination protected 29 30 animals developing tumors upon challenge either fr cells increased immunogenicity recombinant expressing eta reflected elevated levels eta reactive antibody vaccinated animals , confirming secreted antigens expressed vaccinia virus less effective membrane associated counterparts
recognition elam 1 sialyl lex determinant myeloid tumor cells endothelial leukocyte adhesion molecule 1 \( elam 1 \) endothelial cell adhesion molecule allows myeloid cells walls blood vessels adjacent sites inflammation elam 1 recognizes sialyl lewis x \( sialyl lex \) determinant , alpha 2 beta 1 4 \( alpha 1 3 \) , granulocyte carbohydrate also found surface tumor cell lines binding myeloid cells soluble elam 1 inhibited monoclonal antibody recognizing sialyl lex proteins bearing sialyl lex , may participate humoral regulation myeloid cell adhesion stimulated granulocytes also release inhibitor elam 1 binding selectively monoclonal antibody sialyl lex
head neck paragangliomas clinicopathologic study dna flow cytometric analysis total 11 head neck paragangliomas subject pathologic study , including histologic , immunohistochemical , dna flow cytometric analyses cannot absolutely predict aggressive clinical behavior using histologic parameters alone , use parameters patients low risk high risk groups several trends observed current study tumors higher phase fractions , g2 fractions , aneuploid cell populations tended behave presence sustentacular cells primary tumors cannot used absolute indicator tumor metastatic potential , two metastatic paragangliomas study contained sustentacular cells primary metastatic lesions dna ploidy status cannot used absolute prognostic parameter two metastatic tumors composed diploid primary metastatic lesions three tumors aneuploid cell populations showed aggressive histologic clinical features , length follow period cases limited conclusions although absolute criteria used present gauge , close follow patients essential , especially pathologic findings suggest aggressive course \( ie , malignant histology , higher phase fractions , g2 fractions , aneuploid cell populations , decreased sustentacular cell density \)
breast cancer military 's experience hall medical center reviewed experience breast cancer hall medical center years 1978 1988 total cases identified hall tumor registry overall 5 year 10 year survivals 63 39 , respectively infiltrating ductal carcinoma represented principal histologic category predominant variants included invasive lobular carcinoma , lobular carcinoma situ , ductal carcinoma situ recently , patients \( 90 \) modified radical mastectomy definitive surgical therapy , chemotherapy reserved primarily patients advanced disease
giant lipoma esophagus patient giant lipoma esophagus presented progressive dysphagia , fever , recurrent two years previously , symptoms less pronounced , misdiagnosed achalasia surgical removal lipoma , patient became symptom free
primary leiomyoma liver 30 yr old woman right upper quadrant abdominal pain found hepatic leiomyoma youngest patient rare tumor found diagnostic approach toward gastrointestinal emphasized , including role immunohistochemistry
role attitudes , beliefs , personal characteristics italian physicians surgical treatment early breast cancer influence italian physicians' attitudes , beliefs , personal characteristics medical decision making examined case surgical treatment early breast cancer responses mail survey 657 physicians different specialties analyzed comparing doctors radical procedure \( 9 \) conservative procedure younger patients \( 25 \) , considering conservative surgery treatment choice regardless patients' age \( 66 \) findings suggest likelihood physicians' conservative procedure influenced specialty extent feel patient role treatment decision differences beliefs treatment outcomes preferences small group indicating radical surgery sole treatment accounted results recent trials findings suggest scientific factors guide many doctors decision making may help explain diffusion research results clinical practice often slow
characteristics duodenal wall gastrinomas fifteen patients duodenal wall gastrinomas \( dwgs \) zollinger ellison syndrome treated since 1960 6 11 patients , dwgs recognized operation totally excised four patients , tumor subsequently found proximal duodenum surgical specimens 12 patients , dwgs single lymph node metastases present 8 three patients , dwgs multiple lymph node metastases present two dwgs submucosal located first second portions duodenum except one found fourth portion tumor size ranged 1 15 mm , nine less 5 mm 12 patients single dwgs , 9 remained resection \( mean follow 5 5 years \) none patients multiple dwgs became surgery dwgs characteristically single , small microscopic , submucosal , located proximal duodenum , rarely liver , usually curable surgical resection
selective nonoperative management patients referred abnormal mammograms screening mammography provides means detecting clinically occult breast carcinoma , question whether abnormal mammograms require biopsy remains unanswered retrospectively reviewed records 214 women referred 8 year period abnormal mammograms selectively assigned biopsy mammographic follow based specific mammographic criteria 114 women initially observed mammographically , 2 later found biopsy carcinoma initial assignment mammographic observation delayed recommendation biopsy 3 12 months , respectively , patients , effect outcome documented benign lesions clinical mammographic criteria , 102 women \( 53 \) spared biopsy continue monitored closely believe data support use selective approach biopsy based specific mammographic criteria
multimodal therapy locally advanced breast carcinoma among patients treated breast cancer 1975 1984 , advanced disease found 125 \( 14 \) subgroup 34 \( 4 \) presented untreated locally advanced disease without demonstrable distant metastases time diagnosis \( stage iiib , nx 2 , mo \) first 5 years \( 1975 1979 \) , 17 patients treated primarily sequential radiotherapy chemotherapy \( group \) 1980 1984 \( group b \) , management consisted four courses induction multi drug chemotherapy followed primarily mastectomy additional chemotherapy mean follow recent group \( group b \) 48 months follow complete local disease control rate groups \( 76 \) , survival remarkably different group patients experienced median survival 15 months , one survived 5 years group b , median survival 56 months nine patients \( 53 \) alive 40 76 months , seven \( 41 \) 5 year survivors overall mortality patients inflammatory breast cancer greater groups compared group noninflammatory disease , survival patients group b better group inflammatory noninflammatory cancers \( p less 0 01 \) estrogen receptor , nodal , menopausal status influence survival data suggest neoadjuvant chemotherapy improves survival patients stage iiib breast carcinoma delays establishment progression distant metastases mastectomy important component treatment disease
tyrosine kinase control cell proliferation usefulness phosphotyrosine antibodies detection physiologically regulated tyrosine kinases discussed report rather rare enzymatic activity shared receptors polypeptide growth factors products class 1 oncogenes antibodies able detect proteins phosphorylated tyrosine fibroblasts stimulated growth factors egf pdgf major phosphorylated protein species receptors , undergo phosphorylation addition exogenous factor transiently phosphotyrosine antibodies able detect products retroviral class 1 oncogenes , tyrosine kinase activity fact , cases constitutive phosphorylation relevant proteins observed , occurred continuously independently presence lack exogenous ligands tyrosine kinase constitutively activated human gastric carcinoma cells detected p tyr antibodies molecule characterized molecular level , mechanisms responsible enzymatic activation investigated question whether tyrosine kinase identified responsible induction maintenance transformed phenotype gastric carcinomas remains answered reasonable suggest might case analogy situations class 1 oncogenes activated transduction retroviruses , abnormal expression egf receptors , activity c abl encoded proteins chronic myelogenous leukemia acute lymphoblastic leukemia thus , search kinases means phosphotyrosine antibodies seems useful identifying new activated oncogenes clinical oncology
internists' practices health promotion disease prevention survey objective estimate internists' use disease prevention health promotion activities , explore demographic , professional , behavioral , psychological , cognitive , factors associated use practices design mail survey setting subjects sample members american college physicians \( \) participated study engaged patient care activities 20 hours per week stratified gender region lived four geographic areas united states \( , southeast , central , west \) , comprising 21 regions measurements questionnaire background information well information personal health record keeping use immunizations \( pneumococcal , influenza , tetanus , hepatitis b \) use screening tests procedures detecting cancer \( breast examination , papanicolaou smear , stool occult blood test \) diseases \( electrocardiograms , cholesterol level tests , chest radiographs \) behavioral counseling promote health \( areas smoking , exercise , alcohol seat belt use \) main results internists used effective preventive interventions less frequently ineffective practices frequently experts recommend internists' use health promotion disease prevention activities associated habit , , lack adequate knowledge younger physician age , general internal medicine practice , personal health promotion disease prevention practices strongly associated appropriate use recommended practices \( p less 0 01 \) conclusions internists' use disease prevention health promotion activities falls short expert recommendations programs improve delivery preventive services might aimed improving physicians' personal health practices , might directed toward patients , might include development effective systems physicians
enhanced expression c myc h ras oncogenes disease sequential study using situ hybridization tissues two patients disseminated histiocytosis x \( disease \) histiocytosis x cells exhibited histologic cytologic features malignancy evaluated situ hybridization use biotinylated nucleic acid probes c myc h ras oncogenes enhanced expression oncogenes observed multinucleated cells histiocytosis x terminal proliferative phase early quiescent phase disease patients findings indicate c myc h ras histiocytosis x late events likely confer selective growth advantage histiocytosis x cells
bilateral familial carotid body paragangliomas report case dna flow cytometric cytogenetic analyses case study bilateral familial carotid body paragangliomas dna flow cytometric cytogenetic analyses presented analysis tumor cell nuclear dna content flow cytometry revealed aneuploid cell populations tumors standard cytogenetic analysis \( giemsa banding technique used \) right carotid body showed evidence numerical structural abnormalities describe parameters currently used predict biological behavior tumors
soft tissue tumor abnormal collagen fibers electron microscopic examination solitary soft tissue tumor face demonstrated large areas abnormal collagen fibers neoplasm lesion classified benign neoplasm myofibroblasts named significance collagen fibers unknown normal native collagen fibers found parts neoplasm
shear stress induces platelet aggregation also platelet tumor cell interaction investigate interaction platelets tumor cells well defined flow conditions , effect tumor cells platelet aggregation induced shear stress studied using cone plate adapted measuring transmitted light intensity aggregation markedly enhanced hmv 1 cells cell number dependent fashion shear stress 12 dyne cm2 enhancement observed high shear stress 108 dyne cm2 monoclonal antibody gpiib iiia , completely abolished enhancement aggregation hmv 1 similar inhibitory effects scanning showed direct contacts platelets hmv 1 cells could demonstrated platelet platelet interaction inhibited results may indicate , shear stress 12 dyne cm2 , direct contacts platelets hmv 1 cells may trigger enhancement platelet aggregation
basic studies new material inducing antitumor immune cells recently , adoptive immunotherapy cancer lymphokine activated killer \( lak \) cells widely used experimentally therapy several problems , including difficulty handling , , time consumption problems , new materials able induce antitumor immune cells investigated pokeweed mitogen \( \) conjugated materials \( 1 \) could induce strong killer cells short term stimulation human peripheral blood lymphocytes \( pbl \) induced killer cells showed wide killing spectrum vitro human tumor cell lines \( 1 , , 2 , , h 1 , hela , kb , hmv 1 , pc 10 , c 1 \) human pbl stimulated short time 1 also showed effect tumor bearing \( 1 , 45 \) nude mice results suggest 1 may problems currently used lak therapy may provide easily applicable extracorporeal immunotherapy cancer
fine needle aspiration biopsy diagnosis management breast cytological histological biopsies obtained 75 breast clinically diagnosed fibroadenomas , 95 per cent lesions benign 51 \( 68 per cent \) confirmed fibroadenomas histologically , cytology benign 78 per cent , inadequate diagnosis 16 per cent remaining 24 lesions included three breast cancers one lymph node hodgkin 's disease group cytology inadequate diagnosis 54 per cent , including one breast cancer lesion benign cytology subsequently shown malignant study supports view clinical diagnosis cytology accurate diagnosis benign breast disease type breast cancer may rarely present clinical features lesions studied assess fully performance cytological biopsy detecting small mobile lesions non excisional policy therefore include prolonged follow repeat biopsy
regional chemotherapy colorectal liver metastases phase ii evaluation targeted hepatic arterial 5 fluorouracil colorectal liver metastases results systemic chemotherapy patients liver metastases colorectal cancer remain regional chemotherapy advocated method improving delivery cytotoxic drugs tumour , minimizing systemic toxicity use vasoactive agents arterial blood flow towards tumour , microspheres slow tumour blood flow , also suggested methods improving tumour exposure drug present 21 patients received intrahepatic arterial chemotherapy colorectal liver metastases combined treatment \( angiotensin ii , albumin microspheres 5 fluorouracil \) administered 4 6 weekly , bolus 5 fluorouracil given intervening weeks toxicity minimal responses seen seven patients fewer half deaths liver metastases quarter patients died non cancer related causes survival prolonged treated group compared historical controls results suggest regimen activity patients colorectal liver metastases
hepatic metastases colorectal carcinoma impact surgical resection natural history 1960 1987 , patients colorectal liver metastases recorded , followed 1 january 1990 242 cases diagnosis based external imaging , whereas patients operative confirmation staging liver disease three groups patients analysed group 1 involved cases , deemed non resectable whereas 19 could unequivocally classified 21 patients lived longer 3 years , seven survived 4 years , 5 year survivors group 2 comprised 62 highly selected patients laparotomy demonstrated resectable metastatic spread confined liver , treated mainly different therapeutic approach patients significantly longer median survival time \( 14 2 versus 6 9 months \) , also failed achieve 5 year survival patients forming group 3 underwent hepatic resection intent cure nine minimal macroscopic disease left , 34 gross tumour removed positive margins survival patients 43 eventually non radical resections followed identical course group 2 \( median survival 13 3 months , maximum 42 months \) 183 patients potentially curative resection ten died surgery \( 5 5 per cent \) actuarial 5 10 year survival rates remaining 173 patients 40 27 per cent 25 seven patients alive respective periods time 1 january 1990 , 64 patients remained free recurrent disease 24 years three patients tumour status death unclear 106 patients developed definite cancer relapse nevertheless demonstrated prolongation survival time median 1 year compared 43 non radically resected patients 62 untreated patients resectable liver metastases , accomplished maximum survival time 8 years radical excision colorectal liver therefore offers effective palliation , small number chance cure
association extent colonic mucosal sialomucin change subsequent local recurrence curative excision primary colorectal cancer two interrelated studies carried determine whether extent sialomucin change adjacent primary colorectal carcinoma predicted local tumour invasiveness risk local recurrence first , depth tumour penetration correlated length sialomucin band adjacent 72 primary colorectal cancers significant \( p less 0 05 \) increase sialomucin band length adjacent tumours adjacent structures compared \( u test \) , although overall correlation depth penetration , duke 's classification degree differentiation \( test \) sialomucin band greater 3 cm associated 70 per cent probability adjacent structure \( t4 \) invasion observations tested prospectively second study involving 256 patients determine whether presence greater 3 cm sialomucin band could predict local recurrence presence greater 3 cm sialomucin band significant \( 7 12 , f 1 , p less 0 001 \) independent predictor local distant recurrence addition interval local recurrence survival significantly shorter greater 3 cm sialomucin band present however accuracy greater 3 cm sialomucin band predictive test local recurrence 70 per cent extent sialomucin adjacent primary colorectal cancer provide crude assessment tumour invasiveness risk local recurrence
importance calcium regulation toxic cell injury studies utilizing technology digital imaging fluorescence microscopy regulation ions within cell critical importance acute chronic toxicology recently , new methods developed measuring changes living cells correlating studies structure , function , biochemistry major occurred linkage computer light microscope , resulted use digital imaging fluorescence microscopy video intensification microscopy coupled image analysis methods already yielded much additional information anticipated application pathologists continue important role ion toxic cell injury
role ultrasound guided fine needle aspiration biopsy diagnosis hepatocellular carcinoma 170 cases hepatocellular carcinoma , ultrasound showed high sensitivity identifying focal liver lesions fine needle aspiration biopsy guided ultrasound yielded pathological diagnosis majority cases advantages technique , high diagnostic yield low cost , render older technique blind percutaneous biopsy using needle laparoscopy retains essential role selected cases complementary use fine needle aspiration biopsy ultrasound guidance laparoscopy highest rate diagnostic accuracy hepatocellular carcinoma confirm poor sensitivity alpha fetoprotein
function amputation , arthrodesis , arthroplasty tumors knee studied function twenty two patients malignant skeletal tumor adjacent knee knee amputation done seven resection arthrodesis , nine replacement arthroplasty , six patients similar speed \( sixty one sixty six meters per minute \) , slower normal \( eighty meters per minute \) comparable efficiency three velocities mean consumption oxygen 0 210 milliliter per kilogram body weight per meter free velocity , 0 215 milliliter per kilogram body weight per meter 25 per cent faster , 0 211 0 240 milliliter per kilogram body weight per meter 50 per cent faster three groups patients normal control group consumed oxygen similar rates patients amputation active , least damaging affected limb , difficulty walking steep , rough , surfaces patients arthrodesis stable limb performed demanding physical work recreational activities , difficulty sitting patients arthroplasty led sedentary lives protective limb , least self conscious limb
van nes tibial rotationplasty functionally viable reconstructive procedure children tumor distal end femur twelve patients malignant tumor distal end femur treated van nes tibial rotationplasty survival rates comparable knee patients endoprosthetic replacement results functional testing showed patients performed well endoprosthetic replacement better knee amputation rotationplasty therefore favorable alternative amputation endoprosthetic replacement , either primary salvage procedure
active specific immunotherapy patients melanoma clinical trial mouse antiidiotypic monoclonal antibodies elicited syngeneic anti high molecular weight melanoma associated antigen monoclonal antibodies published erratum appears j clin invest 1991 feb 87 \( 2 \) two clinical trials mouse antiidiotypic monoclonal antibody \( mab \) 30 , bears internal image human high molecular weight melanoma associated antigen \( \) administered subcutaneous route without patients stage iv malignant melanoma day 0 , 7 , 28 additional injections administered anti antiidiotypic antibodies found titer decreased first phase trial 16 patients initial dose 0 5 mg per injection 4 mg per injection neither toxicity allergic reactions observed despite development anti mouse ig antibodies minor responses observed three patients second clinical trial mab 30 administered 21 patients dose 2 mg per injection , since dose shown initial study effective inducing anti antiidiotypic antibodies two patients remaining 19 patients , average duration treatment 34 wk trial well , neither toxicity allergic reactions observed 17 19 immunized patients increased levels anti mouse ig antibodies 16 developed antibodies inhibit binding antiidiotypic mab 30 anti mab 225 28 one patient increased level anti antibodies one patient achieved complete remission disappearance multiple abdominal lymph nodes duration 95 wk minor responses observed three patients results suggest mouse antiidiotypic mab bear internal image may useful reagents active specific immunotherapy patients melanoma
polypoid melanoma virulent variant nodular melanoma report three cases literature review report cases three patients polypoid melanoma case microscopic evidence melanoma cell invasion papillary dermis polypoid variant nodular melanoma , melanoma cells accumulate large volume skin 's surface increase tumor volume dislodgment melanoma cells carried superficial lymphatic vessels without reticular dermis feature polypoid melanoma nodular variant although polypoid melanoma considered malignant form melanoma , findings , albeit limited three cases , suggest early diagnosis prompt surgical excision may provide favorable 5 year survival rate
photopheresis treatment cutaneous cell lymphoma investigated use extracorporeal chemotherapy \( photopheresis \) eight patients cutaneous cell lymphoma initially described et al treatment cutaneous cell lymphoma , expanded treatment include patients extensive patch plaque disease well tumor stage disease four five patients stage disease either complete partial clinical remission photopheresis alone one patient extensive patch plaque disease continued partial clinical remission 7 months' duration photopheresis alone two patients tumor stage disease , one remained without evidence clinical disease 10 months photopheresis alone , whereas second patient partial clinical remission 5 months combination local radiation therapy followed monthly photopheresis skin biopsy specimen obtained patient tumor stage disease complete clinical remission show cutaneous cell lymphoma conclude photopheresis effective modality alone combination adjunctive therapy , extensive patch plaque disease , tumor stage disease
corrective osteotomy slipped capital femoral epiphysis long term follow study 26 patients results corrective osteotomy series 26 hips moderate severe chronic slipped capital femoral epiphysis reported follow studies 1976 1986 hips slippage less 40 degrees \( ten hips \) , present one hip remaining 16 cases slippage exceeded 40 degrees , osteoarthrosis present 15 , even though correction adequate observations concluded corrective osteotomy prevent degeneration cases severe basis present observations treated untreated cases , authors advocate treatment fixation without , deformity moderate severe chronic rotational osteotomy may considered event hip joint contracture
influence joint line position knee stability condylar knee arthroplasty using special knee testing device , ten knees obtained autopsy subjected varus valgus , anterior posterior , flexion rotation analysis intact state total knee arthroplasty ten knees showed significant change stability knee replacement joint line maintained natural position femoral component 5 mm proximally 5 mm anteriorly , significant increase laxity occurred joint line shifted 5 mm distal 5 mm posterior anatomic location , significant occurred motion coupled rotation tibia knee flexion decreased surgery knees specific relationship joint line position coupled rotation varus valgus testing , however , remained within normal range first 30 degrees flexion joint line restored normal anatomic position stability condylar knee arthroplasty part dependent position joint line surgical techniques rely restoring flexion extension gap without regard joint line position may result alteration varus valgus anterior posterior displacement flexion
pediatric spondyloarthropathies seronegative spondyloarthropathies childhood often misdiagnosed juvenile rheumatoid arthritis , recognition distinct clinical manifestations unique underlying aid making proper diagnosis spondylitis , 's syndrome , psoriatic arthritis , arthritis associated inflammatory bowel disease often found young adults , may also present children manifestations include inflammation eyes , skin , gastrointestinal tract , genitourinary tract associated inflammation proper diagnosis allow treatment regimens differ usually used juvenile rheumatoid arthritis early diagnosis treatment often lead early recovery return normal daily activities
influence growth hormone reversibility articular cartilage degeneration rabbits growth hormone affects normal well damaged articular cartilage study , influence growth hormone investigated early degenerative changes articular cartilage 72 new zealand white rabbits cartilage lesions created femoral condyles using immobilization model cartilage damage assessed using biochemical , histologic , biomechanical criteria growth hormone influence prevention immobilization abnormalities significant affect healing established lesions
biomechanical comparison single double pin fixation acute slipped capital femoral epiphysis biomechanics pin fixation acute slipped capital femoral epiphysis \( scfe \) studied vitro immature canine model acute scfe created 24 paired paired specimens either one two loaded failure strength stiffness paired limbs expressed percentages loads necessary create initial scfe intact specimen strength stiffness equivalent statistically intact fractured fixed two single 83 strong 78 stiff intact plate double pin fixation recommended single pin fixation acute scfe data , however , clinical situation fixation chronic scfe
mechanism pivot shift mechanism pivot shift investigated movements valgus torque 29 fresh cadaveric knees movements measured three dimensions , using photography , ligaments intact , ligaments sequentially divided anterior cruciate ligament sectioned , pivot shift occurred seven 20 knees examined 13 , though pivot shift observed , abnormal internal rotation occurred 10 degrees 50 degrees flexion division tract addition division anterior cruciate ligament stopped pivot shift , tibia remained throughout range flexion axis rotation pivot shift located medial collateral ligament , kept tight applied valgus torque sudden movement pivot shift caused complex interaction geometry knee valgus torque applied
healing non vascularised diaphyseal bone transplants experimental study four different experiments performed study healing large , non vascularised , diaphyseal , bone segment adult cats first experiment , 4 cm segment tibia periosteum excised replaced bed experiments similar , except second , periosteum segment removed , third medullary canal blocked silastic rod , last group segment isolated muscle bed silastic sheet reparative processes quantified estimating resorption index , cortical new bone formation index , index , count bone resorption occurred segment even periosteum absent medullary canal blocked , osseous union ends eight 12 weeks , provided segment isolated muscle bed thus , muscle bed played significant role reparative processes
open biopsy vertebral body describe method obtaining biopsy body vertebra open route danger contamination tissue planes spaces
radiographic appearances lumbar disc prolapse pre operative lumbar spine radiographs 200 consecutive patients undergone discectomy intervertebral disc reviewed prolapse recognized bulging sequestration disc consequent root compromise measurement lumbar level line shown correlate level disc prolapse incidence transitional vertebrae lumbosacral junction significantly higher normal pathological value lumbosacral angle could identified
restorative surgical technique full maxillary implant edentulous atrophic maxilla represents one challenging implant restorative opportunities prescribed within appropriate diagnostic range performed highly skilled experienced practitioner , full maxillary implant predictable solution patient edentulous atrophic maxilla
dermatomyositis correlative mr imaging p 31 mr spectroscopy quantitative characterization inflammatory disease magnetic resonance \( mr \) imaging phosphorus 31 mr spectroscopy used examine four patients dermatomyositis five control subjects t2 weighted images thigh muscles patients showed increased signal intensity , focal involvement predominantly vastus lateralis secondarily vastus vastus t1 t2 values vastus lateralis patients significantly higher control subjects t1 values rectus femoris biceps femoris generalized inflammation moderately elevated still significantly higher control subjects p 31 mr spectra quadriceps muscles obtained rest , exercise two graded levels , recovery concentrations adenosine triphosphate phosphocreatine \( pcr \) diseased muscles 30 normal values , inorganic phosphate pcr ratios increased patients' muscles rest throughout exercise t1 t2 values well p 31 metabolite data correlated symptoms clinical assessment
sagittal plane analysis idiopathic scoliosis patients treated cotrel dubousset instrumentation one hundred sixty patients idiopathic scoliosis treated cotrel dubousset instrumentation \( \) underwent preoperative postoperative sagittal plane analysis thoracic spine , thoracolumbar junction , lumbar spine data suggest mild moderate improvements thoracic possible crossing thoracolumbar junction , reversal rod bend reversal rod appear provide physiologic sagittal contour cotrel dubousset instrumentation mid distal lumbar spine preserve , times , enhance lumbar lordosis
long scoliosis fusion sacrum adults scoliosis improved method first 17 adults scoliosis long fusion sacrum treated galveston technique reviewed 3 men 14 women average age time surgery 47 years mean follow period 42 months neurologic complications patient developed significant loss lumbar lordosis fusion occurred 88 patients two patients developed pseudarthrosis , neither anterior fusion level pseudarthrosis best results occurred patients two stage procedures , initial anterior lumbar fusion sacrum without instrumentation followed posterior segmental instrumentation galveston technique fixation pelvis
high levels inflammatory phospholipase a2 activity lumbar disc inflammation neural elements frequently mentioned clinically association lumbar mechanical embarrassment neural elements definable structural abnormalities inadequate sole explanation nerve injury condition purpose study demonstrate whether enzymatic marker inflammation \( phospholipase a2 \) could identified human disc samples removed surgery due lumbar disc disease samples assayed phospholipase a2 activity level activity disc samples compared values obtained human tissues using assay specific activity \( percent hydrolysis substrate \) ranged 238 1 , 014 5 nmol min mg mean activity human disc material 7 nmol min mg , compared 0 006 nmol min mg human pmn , 12 1 nmol min mg inflammatory human synovial effusion ph cation related activity identical demonstrated phospholipase a2 inflammatory conditions human lumbar disc phospholipase a2 activity 20 100 , 000 fold active phospholipase a2 described enzyme responsible arachidonic acid cell membranes , phospholipase a2 rate limiting step production prostaglandins leukotrienes data establish biochemical evidence inflammation site lumbar disc
high lumbar disc degeneration incidence etiology three hundred seventy nine consecutive magnetic resonance images \( \) dual echo images entire lumbar spine reviewed authors patients presented back pain leg pain interviewed examined pain completed 42 patients \( 11 1 \) disc pathologies involving t12 l1 , l1 2 , l2 3 levels six patients \( 1 6 \) isolated disc degeneration limited high lumbar segments remaining 36 patients degenerative changes higher discs variable involvement lower lumbar discs 12 l5 s1 , 7 high disc pathologies one levels presenting lesions severe high disc lesions noted grade ii isolated high disc degeneration often associated pre existing abnormalities end plate defects , 's disease , limbus vertebra , forth , stressful cumulative work activities construction workers , mechanics , forth high disc degeneration noted previous fractures high disc involvement diffuse changes lower lumbar spine commonly found ascending fashion older age groups , patients previous lower lumbar spine surgeries , prior fusions particular findings suggest altered mechanics associated high lumbar disc pathologies
lumbar discography followed computed tomography diagnosis low back pain two hundred fifty patients low back pain underwent lumbar discography followed computed tomography \( ct \) subject prospective study 93 patients , combined imaging techniques provided additional useful diagnostic information affected patient management selection treatment alternatives lumbar discography followed ct proved valuable determining significance equivocal multiple level abnormalities , determining type disc herniation , defining surgical options , evaluating previously operated spine 94 patients surgery , ct discography correctly predicted type disc herniation , , , disrupted computed tomography discography may sensitive magnetic resonance imaging \( mri \) early stages disc degeneration 18 177 discs normal t2 weighted image abnormal ct revealed annular tears radial fissuring radiographic morphology normal herniated degenerative lumbar discs shown ct discography gives unique insight pathogenesis disc degeneration complications followed 750 one case urticaria one disc space infection even availability high resolution ct mri , lumbar discography remains pain provocation challenge lumbar disc
multicenter analysis percutaneous discectomy study performed evaluate group patients undergoing percutaneous discectomy patients single level unilateral l4 5 l5 s1 disc herniation documented either computer tomographic \( ct \) scan , , magnetic resonance imaging \( mri \) average follow percutaneous discectomy 16 8 months \( range , 2 46 months \) average hospitalization time 1 7 days \( range , 1 5 days \) 21 patients \( 55 \) able return work procedure thirteen patients ultimately underwent surgical discectomy continued symptoms procedure additional 4 patients undergo surgical discectomy never returned work 25 percutaneous discectomy patients undergo surgical discectomy , significantly pain , residual weakness , numbness compared patients undergoing surgical discectomy results study clearly indicate percutaneous discectomy appear predictable successful treatment modality surgical discectomy
relationship glucocorticoid dosage serum bone gla protein concentration patients rheumatologic disorders serum bone gla protein \( bgp \) measurements 50 rheumatic disease patients receiving long term prednisone therapy revealed inverse relationship \( r 0 71 , p less 0 001 \) serum bgp levels prednisone dosage multiple regression analysis demonstrated significant relationships \( r2 0 72 , p less 0 001 \) serum 2 prednisone dosage , , serum creatinine , age , age creatinine interaction model predicts suppression serum bgp low dosages steroids 50 suppression dosages 20 25 mg day
effect local deep microwave hyperthermia experimental zymosan induced arthritis rabbits effect local deep microwave hyperthermia \( ldmwh \) normal zymosan induced arthritis evaluated 12 rabbits \( 24 joints \) ldmwh , four treatments joint \( twice weekly period 2 wk \) , generated operating mhz 60 min , reaching intraarticular temperature 42 5 0 5 degrees c surface cooling system used microwave apparatus two weeks last treatment , animals sacrificed application ldmwh normal joints induced limited proliferation synovial lining cells minimal perivascular infiltration mononuclear neutrophil cells however , histologic damage skin , muscles , bone , cartilage bone marrow adjacent joints could noted induction zymosan arthritis \( 2 wk ldmwh \) characterized formation granulomatous reaction accompanied deposits disseminated necrotic foci synovial intima ldmwh treatment examined arthritic joints brought reduction degree granulomatous reaction concomitant appearance fine collagen fibrils findings suggest ldmwh safely applied , even repeatedly , without morphologic evidence damage normal mesenchymal tissue moreover , reduces inflammatory process experimentally induced
clinical epidemiological study low back pain description two clinical syndromes 100 patients mainly chronic low back pain \( \) signs symptoms evaluated prospectively without expectation particular findings two clinical syndromes distinguished , characterized local associated specific clinical features syndromes , described previously literature receiving scant attention , named greater pain syndrome \( bursitis \) iliac crest pain syndrome \( iliolumbar syndrome \) , occurred 35 43 patients , respectively recognition syndromes may enable us study aetiology , prognosis , therapy homogeneous groups patients
bone loss distal anterior femur total knee arthroplasty bone loss distal anterior femur asymptomatic total knee arthroplasty \( tka \) patients noted roentgenographically revision surgery retrospective roentgenographic review 147 tka cases carried document bone loss influence mode fixation \( porous coated cemented \) implant design bone loss examined time onset progression bone loss studied bone loss occurred distal anterior femur majority cases reviewed \( 68 \) prevalence bone loss independent mode fixation implant design qualitative observation , roentgenographically detectable bone loss occurred within first postoperative year progress previously three dimensional finite element analysis demonstrated replacement bearing surface femur stiff metallic implant reduces stress distal anterior femur least one order magnitude therefore speculated observed bone loss results stress shielding apparent lack progression may reflect development new remodeling equilibrium altered stress conditions bone loss distal anterior femur described implicated source failure however , since bone strength femoral region compromised becomes , bone failure may occur longer periods cyclic loading furthermore , result bone loss , revision arthroplasty may difficult
sequential three step lateral release correcting fixed valgus knee deformities total knee arthroplasty approach mild , moderate , severe fixed valgus deformities knee described sequential approach soft tissue releases fixed valgus knee allows surgeon neutral alignment valgus deformities 90 degrees additional benefit approach spontaneous correction fixed external tibial rotation deformities using approach , early late stability allows use knee implants , including mobile bearing elements
giant cell reparative granuloma hand foot bones giant cell reparative granuloma \( \) uncommon benign reactive intraosseous lesion occurs skull , jaw , hand , foot , facial bones rarely skeletal sites solitary , lytic , expanded lesion infrequently may extend surrounding soft tissue histologically , composed fibrous stroma spindle shaped fibroblasts , multinucleated giant cells , inflammatory mononuclear cells areas hemorrhage uniformly present may difficult distinguish entity aneurysmal bone cyst , giant cell tumor , brown tumor hyperparathyroidism roentgenographic histologic similarities accurate diagnosis essential appropriate treatment serum calcium , phosphorus , parathyroid hormone levels measured curettage bone graft effective treatments primary lesions recurrences second recurrences rare
pointing knee unrecognized problem external rotational malalignment twelve patients pointing knees chronic knee pain disability suggestive patellofemoral subluxation none responded well conservative measures surgical correction level soft tissues pattern limb alignment studied roentgenographically found differ significantly control group 49 healthy young adults deformities primarily related tibia external tibial torsion , excess varus tibial plateau , varus knees femoral condyles normal femoral appear contribute significantly deformity surgery seven cases \( nine knees \) valgus osteotomy tibia lateral release outcome assessments three year follow period \( five knees \) excellent early results remaining cases satisfactory
studies porcine intestinal calcitriol receptor pseudo vitamin deficiency rickets type 1 calcitriol \( 1 , 25 dihydroxyvitamin d3 \) concentrations plasma humans pigs pseudo vitamin deficiency rickets type \( \) reported significantly lower normal subjects animals sometimes , however , calcitriol concentrations relatively high subjects animals \( 50 80 pmol l \) nevertheless clinical symptoms rickets develop studied whether development lesions piglets due altered binding properties intestinal calcitriol receptor addition defective renal production calcitriol piglets clinical biochemical symptoms rickets \( , increased activity alkaline phosphatase \) calcitriol concentrations plasma 83 7 4 2 pmol l \( n 7 \) used compared unaffected piglets normal calcitriol concentrations \( 178 0 17 7 pmol l , n 9 \) 2 equilibrium dissociation constant \( kd \) receptor piglets \( 0 31 0 05 nmol l \) control piglets \( 0 33 0 05 nmol l \) maximum binding capacity \( \) \( 103 122 fmol mg protein , respectively \) different \( n 9 \) 3 association rate constant \( \) 4 degrees c 0 15 x 10 \( 7 \) 0 24 x 10 \( 7 \) \( mol l \) 1 min 1 dissociation rate constant \( \) \( 0 40 x 10 \( 3 \) 0 48 x 10 \( 3 \) min 1 half life dissociation 24 1 28 9 h , respectively \) also different diseased control piglets
macrophage colony stimulating factor restores vivo bone resorption op op mouse op op variant murine recessive mutation characterized impaired bone resorption due lack osteoclasts cultured fibroblasts mutant secrete csf activity resident macrophages absent bone marrow failure related mutation within csf coding region report administration recombinant human csf \( rhm csf \) corrects vivo impaired bone resorption animal treatment restores bone marrow cavity virtually absent op op animal induces appearance osteoclasts resident bone marrow macrophages deficiency csf cause op op bone disorder cytokine directly indirectly necessary physiological , resulting bone resorption establishment bone marrow
soft tissue upper extremities diagnosis management upper extremity tendinitis bursitis usually result repetitive , probably resulting disruption fibers focus inflammation often occurs , producing pain , spasm , disability careful history physical exam , diagnosis made , distinguishing soft tissue arthritis treatment consists rest , heat ice , frequently , use non steroidal anti inflammatory drugs injections control inflammatory response protection repeated trauma may beneficial preventing recurrence
evaluation knees anterior cruciate ligament used kt 1000 test knees 107 patients acute tear anterior cruciate ligament , 153 patients chronic tear , 141 control subjects , total 401 individuals three testing parameters extent anterior translation eighty nine force maximum manual force , compliance index differences involved uninvolved knees calculated eighty nine , one control subjects anterior translation ten millimeters less , compared 58 per cent patients chronic tear maximum manual force , two control subjects translation ten millimeters less , compared 20 per cent patients acute chronic tear analysis variance showed clinical diagnosis correlated well results tests \( p less 0 001 \) however , uninjured knees patients acute chronic tear compared knees control subjects , significant differences noted \( p less 0 001 0 006 \) patients chronic tear , relationship time injury operation extent anterior translation test maximum manual force strongest discriminant differentiated normal abnormal knees \( p less 0 001 \) high sensitivity \( 92 per cent \) , high specificity \( 95 per cent \) , high positive predictive accuracy cut point eleven millimeters less
evaluation electrogoniometric instrument measurement laxity knee eight lower extremities tested anterior posterior laxity two positions transection anterior cruciate ligament critical points tests , electrogoniometric radiographic measurements translation compared direct measurement , determined accuracy radiographic method 0 4 \( 95 per cent \) measuring anterior posterior tibia respect femur estimated displacement tibia respect femur anterior drawer test 3 5 8 2 millimeters 90 degrees flexion knee 11 1 16 1 millimeters 30 degrees flexion direct comparison measurements obtained means radiographic technique showed tended , average , overestimate tibial translation amount overestimation 0 7 intact knees 1 9 millimeters sacrifice anterior cruciate ligament despite small average error measurement tibial translation , difference individual electrogoniometric radiographic measurements varied greatly , 95 per cent confidence limit 5 5 millimeters error electrogoniometric measurements varied angle flexion knee testing , accuracy reliability electrogoniometric measurements greatly diminished 30 degrees flexion electrogoniometric method also tended overestimate tibial internal rotation \( average 10 5 degrees \) external rotation \( average 9 3 degrees \) reliability measurements 6 9 degrees
arthrodesis ankle cancellous bone screws fibular strut graft biomechanical analysis stability arthrodesis two cancellous bone screws across ankle joint evaluated eighteen fresh frozen motion recorded response following loading modes medial lateral moment , flexion moment , internal external tibial torque series loading tests performed two cancellous bone screws tibia lateral fibular strut graft fixed proximal distal screw tests repeated strut graft removed , amount motion site arthrodesis greatest tibial torque least medial lateral bending true specimens without fibular strut graft removal strut graft allowed increased motion modes loading increases motion far greater specimens poor bone quality
spondyloepiphyseal dysplasia cases four patients unusual clinical entity disproportionately short stature , referred spondyloepiphyseal dysplasia , described patients syndrome , abnormalities confined musculoskeletal system patients corneal opacities increased excretion mode transmission appears autosomal dominant present anterior tongue like deformities vertebral bodies presence spondyloepiphyseal dysplasia normal intelligence , lack abnormalities birth , entity seems mimic syndrome however , unlike syndrome , disorder involves biochemical abnormalities thus , entity may classified new
musculoskeletal impairments physical among aged article summarizes results longitudinal investigation progression , hearing , musculoskeletal impairments association change physical disability , 10 among members massachusetts health care panel study findings confirm widely held clinical beliefs specific types musculoskeletal decrement important cause physical disability among older persons decrement hand function significant musculoskeletal impairment influencing limitations basic adl , progression instrumental adl dysfunction influenced progression lower extremity impairments progression hearing impairments associated change physical disability musculoskeletal impairments , one prevalent symptomatic chronic complaints middle old age , deserve increased attention , disability researchers , clinicians seeking ways prevent among aged
monosodium urate crystals stimulate phospholipase a2 enzyme activities synthesis phospholipase a2 activating protein eicosanoids important mediators inflammatory response monosodium urate crystals \( msuc \) results gout phospholipase enzymes fatty acids membrane phospholipids , thought rate limiting step eicosanoid production understand better mechanism eicosanoid production disease , stimulated human peripheral blood neutrophils monocytes msuc measured phospholipase enzyme activities msuc stimulated intracellular secretory phospholipase a2 enzyme activities time concentration dependent manner specificity observed , phospholipase c activities affected pretreatment colchicine , aspirin , indomethacin , allopurinol , islet activating protein , abrogated enhanced phospholipase a2 activities recently isolated characterized phospholipase a2 activating protein termed plap synovial fluid patients rheumatoid arthritis , murine bovine cell lines plap detected gouty synovial fluid blotting elisa assays expressed characteristics plap identified sources examine role plap msuc induced phospholipase a2 stimulation , treated cells msuc observed increase immunoreactive plap response also could blunted colchicine , drugs phospholipase a2 plap induced production human monocytes pge2 leukotriene b4 neutrophils findings suggest phospholipase a2 activation response msuc requires intact structure , phospholipase a2 plap may important least portion gouty inflammatory response
limited precision lumbar spine dual photon absorptiometry variations soft tissue background estimation error due variations soft tissue baseline lumbar bone mineral content \( bmc \) measured dual photon absorptiometry \( dpa \) calculated new method automatic baseline subtraction water phantom measurements , soft tissue \( st \) baseline matched closely \( r 0 98 \) random error , calculated using 44 100 count rates directly determined baseline variations 21 volunteers 70 patients osteoporosis , st variations larger expected random error , revealing source error related soft tissue estimation error bmc caused st variations 0 7 healthy subjects \( mean bmc 40 5 \) 1 5 patients \( mean bmc 26 4 \) results indicate st related errors important limit precision lumbar dpa measurements
evaluation anterior maxillary alveolar ridge resorption opposed implant fifteen edentulous patients complaints regarding comfort function treated implant patients restored conventional maxillary opposed implant supported prostheses two 4 years surgery , patients evaluated vertical horizontal maxillary bone loss radiographic analysis developed authors technique , attention focused vertical alveolar ridge resorption anterior maxilla although sample size small , findings study indicate vertical bone loss anterior maxilla occur maxillary opposed implant supported comparison results previous study evaluated anterior maxillary resorption complete maxillary opposed natural mandibular anterior teeth distal extension partial demonstrated statistically significant difference
polymyositis case history approach differential diagnosis treatment wide range conditions mimic polymyositis thus , diagnosing condition challenge although single criterion diagnostic polymyositis , following criteria proposed widely used \( 1 \) symmetric proximal muscle weakness \( 2 \) characteristic rash hands , , knees \( 3 \) increased muscle enzymes serum \( 4 \) characteristic electromyographic findings \( activity , fibrillation potentials , motor unit potentials increased frequency decreased duration , normal conduction velocity nerves \) \( 5 \) muscle biopsy specimen characteristic inflammatory myopathic changes although polymyositis primarily involves muscle , 20 patients may problems main treatment polymyositis high dose corticosteroids corticosteroid resistant patients , methotrexate often effective report , case histories presented highlight usefulness limitations common diagnostic criteria polymyositis
electrophysiological spectrum inclusion body present data 30 patients inclusion body \( \) order better delineate electrophysiological features comprehensive electromyography \( emg \) nerve conduction studies \( \) performed cases twelve patients single fiber electromyography \( \) emg showed abundant short small motor unit potentials \( mup \) positive sharp waves 56 6 patients , mixed pattern large small mup 36 7 6 7 , neurogenic features seen slow 33 3 revealed mildly abnormal slightly increased fiber density demonstrates heterogeneous emg profile pattern large small mup highly suggestive seen one third cases
quantitative electromyography polymyositis reappraisal manual analysis motor unit action potentials \( muaps \) performed 33 patients polymyositis 16 studied acute stage 17 chronic stage contrary common description myopathic potentials low amplitude , short duration , shape , quantitated study revealed difference amplitude short duration muaps patients normal subjects though short duration short duration potentials 4 3 times , respectively , common patients controls although mean duration muaps usually significantly shorter polymyositis controls , average scatter muaps duration 2 groups average incidence muaps 4 times higher patients controls , incidence long duration avoid misinterpretation emg findings due excess muaps , greater number individual potentials usually recommended collected allowing valid estimate mean duration muaps simple configuration
little women growth hormone receptor deficiency inbred population southern background methods laron type dwarfism , characterized clinical appearance isolated growth hormone deficiency elevated serum levels growth hormone decreased serum levels insulin like growth factor \( igf \) , described approximately 50 patients condition caused deficiency cellular receptor growth hormone , transmitted autosomal recessive trait , indicated equal sex distribution high rate affected families studied 20 patients \( 19 females 1 male , 2 49 years age \) , inbred population southern , clinical features laron type dwarfism results seventeen patients members two large pedigrees among 13 affected , 19 affected 24 unaffected female siblings 1 affected 21 unaffected male siblings patients' heights ranged 10 0 6 7 sd normal mean height age united states addition previously described features , 15 patients limited elbow , blue , affected adults relatively short extremities , four affected women 30 years age hip degeneration basal serum concentrations growth hormone elevated affected children \( 30 160 micrograms per liter \) normal moderately elevated adults serum level growth hormone binding protein ranged 1 30 percent normal igf concentrations low less equal 7 micrograms per liter children less equal 66 micrograms per liter adults \( normal women , 98 238 \) serum levels igf ii growth hormone dependent igf binding protein 3 also low conclusions describe inbred population high incidence growth hormone receptor deficiency resulting clinical picture resembling laron type dwarfism differing principally showing marked predominance affected females population , mediterranean origin , may genetically related reported populations laron type dwarfism , genetic defect linked trait resulting early fetal death affected males
radical osteoclastic craniectomy sagittal synostosis report experience surgical treatment sagittal synostosis using radical osteoclastic craniectomy 60 consecutive patients surgery children aged 6 months younger \( group \) , usually started 2 weeks postoperatively complete within 6 months , resulting optimal skull contour children aged 7 12 months \( group ii \) , prolonged lasted 12 months longer skull contour normalized biparietal width improved sagittal diameter , remaining , however , slightly abnormal children older 12 months \( group iii \) , skull contour partly improved biparietal diameter change sagittal direction incomplete persistent enlarged frontal subarachnoid spaces reversible improved patients independent age time surgery encountered complications series opinion , radical osteoclastic craniectomy , efficient , physiologically sound method treatment sagittal synostosis patients 6 months age procedure allows rapidly growing brain form skull , thus providing optimal cosmetic results older children , procedures treatment choice
psoriatic arthropathy temporomandibular joint case psoriatic arthritis temporomandibular joints described brief review literature discussion management condition date , psoriatic arthritis successfully treated conservative means case reported , surgical replacement condyles became necessary eliminate pain restore function
quantitative evaluation digital dental radiograph imaging systems two digital imaging systems , video camera analog digital , charge coupled device linear array slide scanner , tested suitability quantitative studies periodontal disease information content original films estimated , digital systems assessed according requirements geometric performance criteria digital systems estimated measurements observations scanner based image acquisition \( \) system detectable noise modulation transfer function curve superior video based system scanner based system equivalent video based system recording radiographic film densities geometric distortion video based system comparison demonstrated superiority charge coupled device linear array system quantification periodontal disease extent activity
cross sectional radiography implant site assessment accurate tomographic technique described acquisition optimal cross sectional images implant sites implant surgery described technique applicable tomographic systems equipped head cross sectional tomographic technique performed series patients images first 20 patients subsequently evaluated cross sectional images allowed characterization alveolar crest visualization anatomic structures dimension providing accurate estimation available vertical space crest
dysplasia gene maps distal long arm chromosome 5 used polymorphic dna markers map gene clinically well characterized form , dysplasia \( dd \) , autosomal recessive disorder unknown pathogenesis linkage analyzed 13 families two three affected comprising total 84 individuals positive two point odds \( lod \) scores obtained dd locus three polymorphic markers chromosome 5 highest pairwise lod score estimate 7 37 zero recombination locus suggests tight linkage evidence heterogeneity linkage analysis published order three loci gave result centromere \( dd , \) terminus four point lod score 9 11 present findings place dd locus distal gene adenomatous polyposis coli distal part long arm chromosome 5 results provide basis map position dd locus followed physical localization , isolation , characterization gene
fructose induced aberration metabolism familial gout identified 31p magnetic resonance spectroscopy responsible development gouty arthritis results wide range environmental factors underlying genetically determined aberrations metabolism 31p magnetic resonance spectroscopy studies children hereditary fructose intolerance revealed readily detectable rise marked fall inorganic phosphate liver vivo rise serum urate response low doses oral fructose parents family members heterozygous enzyme deficiency showed similar pattern given substantially larger dose fructose three nine heterozygotes thus identified also clinical gout , suggesting possibility defect fairly common cause gout present study noninvasive technology used identify spectral pattern 2 11 families studied hereditary gout one family , index patient 's three brothers mother showed fructose induced abnormality metabolism , agreement maternal inheritance gout family group test dose fructose used produced significantly larger increment concentration serum urate patients showing changes 31p magnetic resonance spectra patients familial gout members , thus suggesting simpler method initial screening defect
use contour yet another application suction equipment presented remove pathologic tissue owing variations consistency material condition , technique may successful patients , certainly recommended indicated
estrogen therapy menopause treatment osteoporosis estrogen remains single effective agent treatment menopausal symptoms prevention bone loss article focuses use estrogen therapy menopause pharmacotherapy osteoporosis risks benefits hormonal therapy regimen selection menopausal women discussed second section article focuses current treatment strategies osteoporosis
1990 experimental studies anulus tears intervertebral disc degeneration experimental study using animal model animal model developed test hypothesis discrete peripheral tears within anulus lead secondary degenerative changes disc components 21 adult sheep , cut made left anterolateral anulus three randomly selected lumbar discs cut parallel adjacent inferior end plate , controlled depth 5 mm left inner third anulus nucleus intact closely reproduced rim lesion described animals randomly allocated different groups relation length time interval operation death , varying 1 18 months death , lumbar spine cut individual joint units disc sectioned six observation dissecting microscope , two six , one containing anulus lesion contralateral , processed histology results study suggest , despite great care taken operation ensure inner anulus left intact , progressive failure inner anulus seen sheep occurred majority discs 4 12 months operation although anulus showed ability heal , defect induced cut led initially deformation bulging collagen bundles , eventually inner extension tear complete failure findings suggest discrete tears outer anulus may role formation concentric clefts accelerating development clefts peripheral tears anulus therefore may play important role degeneration intervertebral joint complex
computer assisted tomography scoliosis operated without harrington 's rod biomechanics aspects fusion forty eight cases posterior vertebral arthrodesis scoliosis , performed without instrumentation , examined using computed tomography \( ct \) scanning study evolving fusion mass authors observed fusion mass area cases performed without instrumentation ones performed instrumentation , 2 years fusion bone mass shows already considerable increase cases operated harrington 's technique , increase fusion mass slow becomes considerable 5 years operation series , section fusion masses apex curve asymmetric \( prevalence concave side \) , area central resorption shows structure long bone \( box section \)
factors influencing result posterior spinal fusion treatment adolescent idiopathic scoliosis sixty six consecutive patients adolescent idiopathic scoliosis treated posterior spinal fusion using harrington distraction compression instrumentation followed minimum 3 years initial surgical correction satisfactory , follow period , mean 4 4 years \( 3 5 years \) , loss correction several factors \( age , sex , number vertebrae fusions , use cross wires \) important influences correction method assessing balance posterior spinal fusion described useful assessing radiographs
operative treatment progressive early onset scoliosis preliminary report thirteen patients progressive early onset scoliosis managed operatively attempt achieve correction without bracing allow spine grow posterior segmental spinal instrumentation \( \) without fusion 9 13 anterior apical growth arrest separate additional procedure 2 year follow , curve correction averaged 46 patients anterior apical growth arrest without fusion less curve deterioration alone new methods described 1 \) measuring growth instrumented segment spine 2 \) calculating predicted growth instrumented segment eight 13 50 predicted growth , three 30 50 predicted growth , two less 30 predicted growth operative treatment successful short term malignant form infantile idiopathic scoliosis
analysis effect operation shaped curves idiopathic scoliosis follow study revealing skeletal soft tissue factors involved curve progression article analyzes fate shaped idiopathic spinal curves follow 18 patients operation spinal radiographs evaluated cobb angle , end vertebra angles \( \) , vertebral rotation , new method using tilt surgically fused spinal block frontal plane spinal growth measured using conventional criterion cobb angle progression , 83 lower curves 50 upper curves progress use shows progression occurs mainly middle \( thoracolumbar \) segment spine curve progression occurs frontal plane without significant change vertebral rotation progression upper curve cobb angle related progression cobb angle lower curve related 1 \) tilt spinal block , 2 \) growth spine block 3 \) overall linear spinal growth \( t1 s1 \) progression upper upper curve associated skeletal immaturity key features leading curve progression operation appear spinal asymmetry frontal plane , linear spinal growth , concave lumbar muscle tether \( contracture \) surgical implications findings outlined
effects rib elongation spine distortion vertebral alignment rabbit elongation one rib right side 1 cm achieved two groups adult rabbits different age , osteotomy application metallic procedure resulted immediate deviation spine frontal sagittal planes , moderate scoliosis , left , significant decrease normal lordosis thoracolumbar moreover , computed tomography \( ct \) scanning demonstrated rotation vertebra longitudinal axis relative anterior midline body , deviation spinous process toward , left side , deformity rib developed right side elongated rib changes , occurred simultaneously three planes , less pronounced group older animals two weeks operation , distorted configuration spine remained unchanged observed changes alignment vertebrae changes , except direction horizontal plane , resembled associated idiopathic scoliosis man support earlier proposed link early stage development condition asymmetry rib growth
effects rib elongation spine ii correction scoliosis rabbit three intercostal nerves right side growing rabbits resected partially 1 3 months later , moderate left thoracic scoliosis rotation vertebrae developed , sagittal spine diminished one group animals , mechanically produced increase 1 cm length one rib side resulted immediate correction deformity , improvement still evident 3 weeks operation two groups rabbits , resection three intercostal nerves , time left side , 1 2 months first operation , resulted regression scoliosis progression results support new concept precipitating factor development scoliosis ascribed asymmetric longitudinal growth also suggest regulation rib length could promising approach effective correction progressive scoliosis early stage man
estrogen prophylaxis u preventive services task force recommendation although routine postmenopausal estrogen replacement recommended , estrogen therapy considered asymptomatic women increased risk osteoporosis , lack known contraindications received adequate counseling potential benefits risks
mother daughter pairs spinal femoral bone densities dietary intakes bone mineral density \( bmd \) lumbar spine \( l1 l4 \) femur \( femoral neck , ward 's triangle , trochanter \) measured 37 healthy , white mother daughter pairs dual photon absorptiometry mothers daughters aged 52 7 25 4 \( mean sd \) , respectively three day dietary intakes evaluated significant correlations mother daughter pairs bmd lumbar femoral areas except l2 \( r 0 26 , p 0 \) indicated familial bone mineralization total calcium intake significantly correlated three bmd values daughters \( l2 , femoral neck , trochanter \) mothers mothers classified pre \( n 20 \) postmenopausal \( n 17 \) , correlation coefficients bmd higher premenopausal mothers daughters lower postmenopausal mothers daughters , except trochanter results suggest nature inheritance bone mass women may least two components , one influencing level peak bone mass one related bone loss menopause
controlled trial intravenous immunoglobulin g chronic fatigue syndrome purpose currently , established therapy chronic fatigue syndrome \( cfs \) , recently defined illness associated variety immunologic abnormalities based hypothesis chronic viral infection immunoregulatory defect involved pathogenesis cfs , therapeutic benefit intravenous immunoglobulin g \( iv igg \) evaluated group patients cfs additionally , serum immunoglobulin concentrations peripheral blood lymphocyte subset numbers measured study , effect iv igg therapy igg subclass levels determined patients methods thirty patients cfs enrolled double blind , placebo controlled trial iv igg treatment regimen consisted iv igg \( 1 g kg \) intravenous placebo \( 1 albumin solution \) administered every 30 days 6 months participants completed self assessment form prior six treatments , used measure severity symptoms , functional status , health perceptions patients also asked report adverse experiences defined worsening symptoms occurring within 48 hours treatment results twenty eight patients completed trial baseline , 28 patients complained moderate severe fatigue , measures social functioning health perceptions showed marked impairment low levels igg1 found 12 \( 42 9 \) , 18 \( 64 3 \) low levels igg3 end study , significant therapeutic benefit could detected terms symptom amelioration improvement functional status , despite restoration igg1 levels normal range major adverse experiences observed 20 iv igg placebo groups conclusion results study indicate iv igg unlikely clinical benefit cfs addition ongoing need placebo controlled trials candidate therapies cfs , expanded research effort needed define etiology pathogenesis disorder
gallium nitrate advanced paget disease bone effectiveness dose response analysis objective evaluate whether brief course treatment gallium nitrate reduce biochemical parameters accelerated bone turnover patients advanced paget disease design trial , decreasing dose schedules gallium nitrate setting university hospital primary orthopedic metabolic bone disease specialty patients ten patients advanced paget disease previously received conventional therapy consisting calcitonin , , interventions five patients entered three dose schedules 2 5 mg kg body weight per day continuous intravenous infusion 7 days 0 5 mg kg per day 14 days subcutaneous injection 0 25 mg kg per day 14 days subcutaneous injection several patients treated different dose schedules patients followed relapse results fifteen courses treatment administered ten patients reductions serum alkaline phosphatase urinary hydroxyproline excretion observed treatment dose schedule treatment high , intermediate , low doses , median maximum decreases serum alkaline phosphatase activity 49 , 39 , 18 , respectively median maximum decreases urinary hydroxyproline excretion 50 , 52 , 16 , respectively maximum decrease urinary hydroxyproline excretion occurred within median 2 weeks start treatment , whereas maximum decrease serum alkaline phosphatase activity occurred substantially later median 6 weeks treatment schedules well tolerated response duration highly variable \( range , 6 42 weeks \) conclusions short term treatment gallium nitrate reduce biochemical parameters disease activity patients advanced paget disease bone larger trials using low dose intermittent treatment schedules required evaluate safety effectiveness therapy
granulation cerebrospinal fluid case report review temporal bone \( tb \) collection department otolaryngology health science center demonstrated occurrence \( ags \) posterior fossa surface tb role cerebrospinal fluid \( csf \) large ag responsible csf 64 year old man excised soft tissue repair dural defect sixteen 188 \( 8 5 \) collection contained 24 ags ranging size 0 07 80 65 mm3 nine ags \( 37 \) small \( less 1 mm3 \) demonstrate enlargement twelve \( 50 \) intermediate size \( 2 50 9 32 mm3 \) , three \( 13 \) large \( 49 82 80 65 mm3 \) intermediate large ags associated bone erosion high incidence communication complex \( serous otitis media meningitis \) findings suggest ags sufficient size produce bone erosion primary responsible lesions adult onset spontaneous csf
american college rheumatology criteria classification reporting osteoarthritis hand clinical criteria classification symptomatic idiopathic \( primary \) osteoarthritis \( oa \) hands developed data collected multicenter study patients oa compared group patients hand symptoms causes , rheumatoid arthritis variables medical history , physical examination , laboratory tests , radiographs analyzed patients pain , , stiffness hands patients classified clinical oa examination hard tissue enlargement involving least 2 10 selected joints , swelling fewer 3 joints , hard tissue enlargement least 2 distal interphalangeal \( \) joints patient fewer 2 enlarged joints , deformity least 1 10 selected joints necessary order classify symptoms due oa 10 selected joints second third , second third proximal interphalangeal , \( base thumb \) joints hands criteria derived using classification tree method 92 sensitive 98 specific traditional classification method required least 3 4 criteria present classify patient oa hand latter sensitivity 94 specificity 87 radiography less value clinical examination classification symptomatic oa hands
type collagen degrading activity human osteoarthritic cartilage homogenates 6 samples human osteoarthritic cartilage shown degrade exogenous type collagen sodium dodecyl sulfate polyacrylamide gel electrophoresis , cleavage products generated homogenate similar , identical obtained cleavage substrate purified gelatinase enzyme activity , inhibited edta , greater extracts osteoarthritic cartilage extracts grossly normal cartilage joint extracts cartilage joints activation enhanced digestion , breakdown apparent extracts osteoarthritic cartilage even without enzymatic degradation type collagen could play significant role turnover articular cartilage health disease states
treatment psoriatic arthritis oral 1 , 25 dihydroxyvitamin d3 pilot study conducted 6 month open label trial 10 patients active psoriatic arthritis received 2 micrograms oral 1 , 25 dihydroxyvitamin d3 daily statistically significant improvement noted tender joint count physician global impression 10 patients , 4 substantial \( greater equal 50 \) improvement , 3 moderate \( greater equal 25 \) improvement tender joint count two patients unable receive therapeutic doses high dose vitamin may useful therapeutic agent psoriatic arthritis
effect early fronto orbital advancement frontal sinus development forehead frontal sinuses make important contribution normal forehead contour study designed test clinical impression early fronto orbital \( frontal bone \) advancement could adverse effect frontal sinus development consequently forehead retrospective study conducted 11 patients undergone fronto orbital advancement also long period follow institute reconstructive plastic surgery new york university longitudinal data compared unoperated controls one exception , patient underwent bilateral fronto orbital advancement developed frontal sinus , patients flattened contour compared unoperated patients , 82 percent developed least one frontal sinus three patients underwent unilateral fronto orbital advancement \( flattened forehead \) , two developed frontal sinus unoperated side one developed bilateral frontal sinuses two patients unilateral frontal sinus development particularly obvious deformity resulting normal projection unoperated side flattened contour operated side fronto orbital advancement affects forehead performed infant patients moderate severe deformities patients whose deformity sufficiently severe warrant surgery preferably undergo bilateral fronto orbital advancement \( technique described \) rather unilateral advancement order avoid asymmetry results unilateral frontal sinus development
arthritis roles radiography imaging techniques evaluation imaging studies performed patients arthritis variety reasons determine whether arthritic condition present establish specific diagnosis determine extent disease assess activity disease detect complications disease evaluate progression disease efficacy drug treatment help selection surgical candidates aid choice surgical procedures size , design , prostheses identify complications surgery conventional radiography still examinations arthritic patients best applied evaluate complications disease surgery , although may useful disease detection determining specific diagnosis nuclear medicine studies best used identify complications surgery may also useful assess disease activity extent ultrasound useful detect dissecting synovial cysts deep venous thrombosis valuable role computed tomography design prostheses evaluating complex anatomy involved joints magnetic resonance imaging may useful early detection articular cartilage damage may assist determination specific diagnosis enhancement contrast material may aid assessment disease activity
focal dysplasia associated tibia focal dysplasia tibia insertion pes \( expanded insertion gracilis , , muscles \) rare unilateral lesion characteristic deformity proximal tibial associated unilateral tibia three cases entity described , radiologic features presented recognition disease important response conservative therapy excellent
magnetic resonance imaging nonoperative treatment spinal epidural abscess report describes three patients spinal epidural abscess diagnosed magnetic resonance imaging treated nonoperatively prior treatment , one patient neurologically intact , one patient demonstrated moderate neurological deficit , one patient severely loss bladder bowel control following identification pathogenic organism , antibiotic therapy continued patients demonstrated clinical improvement radiological resolution abscess patients remained stable improved neurologically analysis 33 previously reported patients treated antibiotics suggests nonoperative treatment may reasonable alternative therapy certain clinical conditions include \( 1 \) identification pathogenic organism , \( 2 \) stable neurological condition , \( 3 \) access magnetic resonance imaging computed tomography potentially rapid reevaluation , \( 4 \) appropriate neurosurgical consultation nursing care nonoperative treatment may also considered reasonable alternative patients severe concurrent medical illness
flurbiprofen versus diclofenac treatment osteoarthritis knee seventy four patients enrolled double blind , randomized single center study evaluate therapeutic effectiveness 50 mg regimens flurbiprofen diclofenac sodium patients osteoarthritis knee chance , flurbiprofen patients significantly advanced disease status baseline diclofenac treated counterparts however , subsequent follow evaluations , treatment groups experienced significant reduction disease severity regardless baseline differences serious safety problems associated either investigational therapy frequency reported medical events distributed equally flurbiprofen diclofenac groups although imbalance disease severity treatment groups made rigorous statistical interpretation results difficult , data clinical trial tend support 50 mg regimens flurbiprofen versus diclofenac treating osteoarthritis knee
determinants vertebral mineral density patients receiving long term glucocorticoid therapy study addresses impact clinical biochemical factors bone density patients receiving glucocorticoid therapy vertebral mineral density measured quantitative computed tomography 35 patients aged 17 77 years received therapeutic glucocorticoid drugs 0 1 22 years mean \( sem \) vertebral mineral density z score subjects 1 7 0 2 z score unrelated underlying diagnosis , sex , age significantly related duration previous steroid therapy \( r 38 \) total cumulative glucocorticoid dose \( r 50 \) rate change bone density 16 subjects followed period 12 months 8 9 significantly greater subjects taking 12 5 mg prednisone per day bone loss influenced sex , age , duration previous steroid treatment , diagnosis predictable biochemical measures calcium metabolism
coupling adjunctive treatment avascular necrosis purpose study determine effectiveness coupling , noninvasive method applying electrical stimulation biologic tissues , used adjunct decompression grafting treatment avascular necrosis \( avn \) femoral head also compared results core decompression grafting nonoperative management forty patients stages iii avn femoral head treated core decompression grafting coupling units electrodes placed femoral head continuously six months one half units active one half inactive patients followed two four years results determined preoperative postoperative ratings , quantitative roentgenographic measurements , number hips required total hip arthroplasty \( tha \) evaluations completed , patients divided stimulated groups patients groups similar regarding gender , etiology , roentgenographic stage involvement results also compared 55 hips previously treated symptomatically , without surgery electrical stimulation fractures , infections , significant complications hips operated hips treated decompression grafting , without electrical stimulation , satisfactory hips treated symptomatically regard roentgenographic progression need tha , however , indication addition coupling gave better results decompression grafting alone
making core decompression work meaningful assessment treatment modality \( \) must take account number factors \( 1 \) accurate diagnosis , \( 2 \) consistent staging disease process , \( 3 \) understanding variability disease , \( 4 \) consistent application treatment modality \( surgical technique \) , \( 5 \) clear understanding goal treatment used article reviews important steps diagnostic algorithm used accurately diagnose stage disease process consistent surgical technique clearly defined goals also outlined results two clinical studies based diagnostic therapeutic assess role core decompression treatment reviewed first study compared core decompression conservative management prospective randomized study 55 hips decompression provided predictable pain relief changed indications surgical intervention consistently conservative management second study represents preliminary review ten year study decompression procedure showed core decompression particularly useful stage stage ii roentgenographic stabilization predictable stage hips core decompression safe , effective , predictable procedure treatment stage stage ii
effect stem stiffness femoral bone resorption canine porous coated total hip arthroplasty bilateral noncemented total hip arthroplasty \( tha \) produced dogs determine effect stem stiffness stress related bone resorption two porous coated femoral implants substantially different designed direct comparison one cobalt chromium \( \) alloy , titanium alloy titanium stem wall thickness 1 mm reduce stiffness cumulative stiffness differences 5 4 fold 3 6 fold bending torsion staged bilateral tha performed eight dogs dog received stiff stem one side flexible titanium stem death , femora removed processed thin section histology bone ingrowth remodeling quantified computer aided image analysis compared stem designs femoral specimens showed bone ingrowth fixation stiff flexible stems along implant length tetracycline labeling indicated active bone turnover femoral cortex regions ingrowth however , gross differences femoral bone remodeling observed roentgenographically histologically femora flexible stems consistently showed much less bone resorption stiff stems quantitative analysis paired cross sections indicated average 25 35 cortical bone area femora flexible stems severe resorption cortex region occurred three femora stiff stems none flexible stems stem stiffness strongly influences bone remodeling flexible stem results uniform load transfer less stress shielding
bipolar versus total hip arthroplasty avascular necrosis femoral head comparison relatively small series cases results bipolar prostheses avascular necrosis inferior total hip arthroplasty \( tha \) femoral loosening rates reduced using bipolar prostheses tha produced inferior results avascular necrosis degenerative joint disease early results noncemented tha avascular necrosis good also must test time fixed noncemented acetabular component preferable bipolar prosthesis avascular necrosis femoral head
histologic , biochemical , ion analysis tissue fluids retrieved total hip arthroplasty large amounts metal polyethylene debris high ion readings found capsule fibrous membranes loose titanium cobalt chromium stems prostaglandin e2 , interleukin 1 , collagenase levels elevated compared control values collagenase highest consistent elevations synovial fluid blood ion readings elevated loose cemented cementless stems made materials blood ion readings elevated fixed stems fixed stems much less particulate debris soft tissues data showed failure metal hip stems initially due mechanical cause , high debris ion counts occurring secondarily capsule fibrous membranes particulate debris high ion readings primarily focal problem contained fibrous connective tissue encapsulation within femoral canal joint capsules systemic problems manifest patients examined followed study
intra osseous pressure oxygen tension avascular necrosis osteoarthritis hip intra osseous pressure , po2 , pco2 measured 32 hips \( 21 patients \) painful showed severe degenerative changes pre operative scintigraphy radiography performed patients thirteen hips showed early osteoarthritis , eight early , 11 changes core biopsies performed bone examined histologically graded necrosis histologically , necrosis present 27 specimens scintigraphic findings correlate histological results closely related radiographic findings intra osseous pressure hips histological necrosis \( mean 47 mmhg \) significantly higher hips without necrosis \( mean 26 mmhg \) po2 lower bone histological necrosis \( mean 44 mmhg \) bone without \( mean 71 mmhg \) po2 increased intra osseous pressure decreased decompression results confirm ischaemia plays central role development necrotic changes bone histological necrosis found hips radiographic signs osteoarthritis radiography , scintigraphy shown insensitive methods differentiating disorders
effects 2 lignocaine somatosensory evoked potentials recorded extradural space studied effects extradural administration 2 lignocaine l3 4 somatosensory evoked potentials recorded cervical extradural space corrective surgery idiopathic adolescent scoliosis eight patients equivalent volume 0 9 sodium chloride solution administered lumbar extradural space acted control group lignocaine 2 resulted decrease overall amplitude , main effect significant decrease amplitude second third peaks , suggesting action dorsal columns spinal cord significant increase latency found lignocaine sodium chloride groups conclude use extradural 2 lignocaine patients undergoing scoliosis surgery may interfere intraoperative monitoring somatosensory evoked potentials
effects parathyroid hormone \( pth \) pth related peptide osteoclast resorption bone slices vitro analysis pit size resorption focus mechanism whereby pth , potent stimulator bone resorption , may certain circumstances exert anabolic effects bone known , possible involves reduction size osteoclast resorption therefore made detailed vitro study effects pth pth related peptide \( pthrp \) resorption neonatal rat osteoclasts particular attention plan area resorption pits order distinguish increased resorption particular site increased numbers sites , used define focus resorption , namely area 1 bone , may contain either one several pits addition studied relationship number pits resorption focus total area bone resorbed focus found pth pthrp , doses 2 x 10 \( 10 \) 2 x 10 \( 8 \) , significant stimulatory effects bone resorption , caused reduction median plan area pits increase number resorption foci primary stimulatory effect pth pthrp , occurring within 6 h case pth however , plan area bone resorbed focus showed significant increase , despite increase number pits per focus , pits formed focus , pits smaller , thus partially stimulatory effect pth resorption results consistent activation new remodeling sites pth vivo furthermore , formation smaller pits resorptive influence pth may , together maintenance coupling formation resorption , play role preservation cancellous bone recorded cases primary hyperparathyroidism anabolic effect exogenous pth
biomechanics mammalian locomotion mammalian experience peak locomotor stresses \( force per area \) 25 50 failure strength , indicating safety factor two four mechanism animals achieve constant safety factor varies depending size animal much size \( 0 1 300 \) , larger mammals maintain uniform skeletal stress primarily upright posture , decreases mass specific muscle force increasing muscle mechanical advantage greater sizes , increased skeletal decreased locomotor performance likely maintain stresses constant smaller sizes , skeletal stiffness may critical strength decrease mass specific muscle force mammals weighing 0 1 300 kilogram indicates peak muscle stresses also constant correlates decrease mass specific energy cost locomotion consistent pattern locomotor stresses developed long bones different speeds within species may important implications bones changes stress
eosinophilic granuloma cervical spine case report review literature report case eosinophilic granuloma involving second cervical vertebra 33 year old woman 32 case reports literature describing eosinophilic granuloma presenting cervical spine disease due relation central nervous system , opportunity neurological sequelae neurosurgical intervention common cervical eosinophilic granuloma report brief history eosinophilic granuloma reviewed case histories literature cervical spine involvement summarized therapeutic options described recommended protocol management outlined
incidence cervical spinal stenosis professional football players sagittal canal vertebral body ratios measured cervical spine lateral radiographs 124 professional football players 100 football players total levels measured 224 players thirty two percent \( 40 \) 124 professional football players , 34 100 ratio less 0 80 one levels c3 c6 0 80 ratio considered indicative cervical spinal stenosis first time incidence spinal stenosis , determined 's ratio , demonstrated population professional football players one third population cervical spinal stenosis determined ratio , factors considered evaluation transient quadriplegic episode making continued play decisions
effect pulsing electromagnetic field metabolically derived osteoporosis rats pilot study literature suggests electromagnetic field \( \) effective bone loss disuse osteoporosis study conducted evaluate effects metabolically derived osteoporosis rats sixteen 5 month old female sprague dawley rats divided three groups \( g 1 , 2 , 3 \) g 1 given normal diet exposure g 2 , 3 fed low calcium diet 8 months g 3 also exposed 24 hr day generated applying 15 hz , 5 6 peak peak square wave \( 64 cm , 200 coil \) rats sacrificed 4 , 6 , 8 months skeletal changes analyzed measurements acid extracted bone calcium bone mineral content \( bmc \) using single photon absorptiometry \( spa \) although animals started approximately weight \( mean 290 0 g \) , g 2 showed progressive increase mean weight 8 months g 1 350 0 g , 5 g g 3 , g 2 400 0 g calcium content femur g 2 g 3 8 months lower g 1 , significant differences among three groups
alternative classic randomization effects recruitment controlled trial arthroscopy osteoarthrosis knee possibly greatest threat success randomized clinical trial inability adequate number subjects concern randomized clinical trial adversely affect physician patient relationship common reason physicians' patients trials report modification design , first described , implemented randomized clinical trial arthroscopy patients osteoarthrosis knee method associated sixfold increase rate patients compared use classic randomization trial propose design potential solution problem recruitment subjects , particularly clinical studies
molecular basis hereditary 1 , 25 dihydroxyvitamin d3 resistant rickets seven related families hereditary 1 , 25 dihydroxyvitamin d3 1 , 25 \( oh \) 2d3 resistant rickets \( \) autosomal recessive disease caused target organ resistance action 1 , 25 \( oh \) 2d3 , active form hormone defect target cells heterogenous commonly appears mutation gene encoding vitamin receptor \( vdr \) studied cultured skin fibroblasts epstein barr virus transformed seven family branches extended kindred eight children affected previously shown cells three affected children group contain mutation coding premature stop codon exon 7 within steroid binding domain vdr gene current studies , found cells affected children failed bind 3h 1 , 25 \( oh \) 2d3 undetectable levels vdr determined immunoblots using anti vdr monoclonal antibody measurement vdr mrna hybridization human vdr cdna probe showed undetectable decreased abundance steady state vdr mrna parents , expected obligate heterozygotes , showed approximately half normal levels 3h 1 , 25 \( oh \) 2d3 binding , vdr protein , mrna mutation nucleotide \( counting mrna cap site \) results conversion , eliminates rsa restriction enzyme site facilitates identification mutation found polymerase chain reaction \( pcr \) amplification exons 7 8 family members subsequent rsa digestion allows detection specific genotype individuals rsa pcr amplified dna subjected polyacrylamide gel electrophoresis , children exhibit homozygous banding pattern loss rsa site parents exhibit dna pattern detection normal mutant alleles summary , data show genetic abnormality point mutation within steroid binding domain vdr seven related families analysis restriction fragment length polymorphism locus pcr amplified dna fragments used diagnose mutation affected children parents carrying disease
joint inflammation provoked local synovial allergic reaction antibody stimulated animals administering protein antigens vaccine b pertussis adjuvant titers allergic antibody responses judged passive cutaneous anaphylaxis reactions sera globulin fractions containing high titers antibody activity injected knee joints experimental animals sufficient delay proteins cleared knee joints , animals challenged intravenously corresponding antigen resultant local reaction swelling \( passive synovial anaphylaxis \) judged visually scanning procedures histological studies showed evidence mast cell degranulation concurrent synovial reaction
evaluation women possible appendicitis using technetium 99m leukocyte scan authors evaluated use technetium 99m albumin colloid white blood cell \( tac wbc \) scan women possible appendicitis one hundred nine women underwent 110 tac wbc scans one woman second scan separate admission considered two individual patients analysis twenty six women appendicitis , 10 perforated surgery tac wbc scan indeterminate \( abnormal nondiagnostic appendicitis \) 52 women \( 47 \) , nine appendicitis fifty eight scans read positive negative pathology 16 true positives , 5 false positives , 36 true negatives , 1 false negative predictive value positive scan 76 , predictive value negative scan 97 tac wbc scan positive 62 patients appendicitis negative 43 patients without appendicitis resulting overall accuracy 47 109 women main value tac wbc scan women possible appendicitis high negative predictive value main problem tac wbc scan high indeterminate rate
intermittent obstruction hiatal hernia total thoracic stomach case intermittent obstruction sliding hiatal hernia presented obstruction occurred patient 's stomach totally diaphragm anatomy sliding hiatal hernias discussed , well presenting signs symptoms obstruction sliding hiatal hernias
prospective trial comparing combination ph probe nasogastric tube aspirated gastric ph intensive care unit patients upper gi bleeding related stress ulcer syndrome estimated affect much 15 patients icu since occurrence bleeding icu admission may associated increased morbidity mortality , many efforts directed defining optimal therapy stress ulcer prophylaxis titration intragastric ph antacids iv doses h2 receptor antagonists may prevent stress ulcer bleeding high risk icu patients evaluated recently developed ph probe incorporated ng tube compared aspiration gastric contents using ph paper means monitor ph 22 surgical icu patients regression analysis comparing intragastric probe ph values aspirated ph values showed good correlation two methods \( r 71 \) new technique intragastric ph measurement appears technically simple clinically applicable use patients risk stress ulcer bleeding may accurate ph paper patients receiving antacids
absorption motility human ileum authors assessed absorption motility human ileum prolonged period disuse eight patients ulcerative colitis , manometric catheter assembly placed via ileostomy portion distal ileum two months ileal pouch anal anastomosis temporary loop ileostomy distal ileum perfused 5 ml min solution either sodium chloride ileal diluted sodium chloride three hours three hours meal two consecutive days absorption measured , single clustered pressure waves identified quantitated aid computer program , motility index calculated mean absorption e perfusates poor day 1 \( 10 2 ml 25 cm x 30 min \) , meal induced ileal motor response day 2 , however , absorption perfusates much improved \( 1 2 ml 25 cm x 30 min p less 0 05 \) , number discrete clustered contractions motility index clearly increased meal \( 2 6 0 6 vs 7 2 1 0 clustered waves hr 7 5 0 5 vs 9 7 0 2 motility units 30 min p less 0 05 \) conclusion absorption motility human ileum impaired two months disuse , ileal absorption motility improved one day introduction ileal perfusates
sign endoscopic feature mucosal spots , , surrounding orifice endoscopic feature clusters 1 2 mm round oval slightly raised spots , center erythematous border correlate microscopically subepithelial submucosal lymphoid follicles pattern , identified one third , seen best identified commonly patients systemic illness recognition mucosal around orifice helps identify may useful evaluation cecal pathology
effects milk , prostaglandin , antacid experimentally induced duodenitis rat use myeloperoxidase index inflammation duodenal mucosa frequently involves inflammatory reaction infiltration leukocytes measurement neutrophil myeloperoxidase activity might thus sensitive indicator damage , visible lesions occur test possibility , rat model duodenal injury used fasted animals treated indomethacin histamine twenty four hours indomethacin treatment , duodenal tissues collected histochemical staining biochemical assay myeloperoxidase activity indomethacin histamine challenged rats significantly elevated myeloperoxidase activity compared controls \( p less 0 05 \) histochemistry biochemistry also significant correlation two parameters \( r 0 68 , p less 0 001 \) duodenal injury model used test effectiveness known gastric protective agents results indicated milk protect duodenal injury , antacid prostaglandin significantly protect inflammation \( p less 0 02 \) concluded measurement myeloperoxidase activity sensitive potentially useful estimate duodenal injury valuable assessing healing
sterol dependence gastric protective activity unsaturated phospholipids major aim study investigate gastric protective effect unsaturated phospholipids determine ability neutral lipids enhance activity found although liposomal suspension unsaturated phosphatidylcholine \( pc \) administered failed protect rats acid induced gastric ulcer formation , addition cholesterol unsaturated pc induced dose dependent protective response maximally effective dose , reducing lesion score greater 70 effect also seen plant sterol , beta \( reducing lesion score 81 6 36 \) blocked cholesterol esterified fatty acids varying chain length addition liposomes saturated , contrast , attenuated gastric protective action saturated pc appears protective mechanism elicited unsaturated pc mediated alterations gastric emptying rate prostaglandin biosynthesis , although maintenance surface may involved results suggest sterol may promote packing adjacent unsaturated phospholipid molecules either cell membrane putative extracellular hydrophobic lining gastric epithelium provide mucosa protection luminal acid
gastric lesions secondary long distance running gastrointestinal disorders reported long distance running purpose study evaluate effects prolonged exercise upper digestive tract seven subjects submitted standard endoscopic examination upper digestive tract long distance running \( range 18 50 km \) mucosal biopsy specimens taken running , runners histologically pathological features stomach vascular lesions present six subjects running , intensity lesions ranging congestion hemorrhage postexercise histological examination also showed decrease mucosal secretion lesions secondary prolonged exercise indicate presence hemodynamic perturbations upper digestive tract
outpatient health care utilization patients inflammatory bowel disease basis normal life expectancy inflammatory bowel disease patients , early onset disease , variety symptoms , inflammatory bowel disease patients anticipated frequent users outpatients services study assesses \( 1 \) characteristics , \( 2 \) outpatient health care utilization , \( 3 \) degree satisfaction health care inflammatory bowel disease patients compared patients gastrointestinal disease study method secondary analysis data collected 395 patients attending university gastroenterology outpatient clinic 1988 inflammatory bowel disease patients significantly younger \( p less 0 001 \) better educated \( p less 0 05 \) patients past year inflammatory bowel disease patients consulted significantly often \( p less 0 001 \) spent time hospital \( p less 0 05 \) patients inflammatory bowel disease patients also consulted frequently , inflammatory bowel disease patients satisfied health care received patients results provide information useful health care well dealing directly inflammatory bowel disease patients
investigation mode action biofeedback treatment fecal incontinence study carried 25 incontinent patients evaluate factors thought responsible success retraining fecal incontinence subjects initially allocated one two groups one group trained small rectal volumes \( active retraining \) , group carried maneuvers given information instruction active sensory retraining reduced sensory threshold 32 8 7 2 ml \( p less 0 001 \) , corrected sensory delay present \( p less 0 004 \) , reduced frequency incontinence 5 1 1 1 episodes per week \( p less 0 01 \) sham retraining caused modest reduction sensory threshold \( 29 9 20 8 p less 0 05 \) significantly reduce frequency incontinence subsequent strength coordination training significantly improve continence , although end study , 50 patients incontinent episodes 76 patients reduced frequency incontinence episodes 75 improvement continence associated change sphincter pressures continence infused saline associated significant improvements rectal sensation functional improvement sustained period two years 16 22 patients available follow conclusion , results support use retraining management fecal incontinence suggest retraining may work enhancing rectal sensitivity confidence
phospholipids rat , human , canine gastric mucosa composition metabolism molecular classes phosphatidylcholine validate recent phospholipid lining high content may protect gastric mucosa luminal acid , study composition metabolism phospholipids gastric mucosa phospholipids analyzed rat , human , dog gastric mucosal surface tissue methanol lavage rat canine stomach phosphatidylcholine main components saturated fatty acids almost exclusively esterified sn 1 position glycerol moiety phosphatidylcholine , unsaturated fatty acids mainly sn 2 position class phosphatidylcholine comprised 2 6 total phosphatidylcholine precursors phosphatidylcholine , e , 32p methyl 14c choline , preferentially incorporated molecular class 0 5 6 hours iv administration speculated phosphatidylcholine , although quantitatively minor component , specifically triggered mucosal processes
alpha 1 antitrypsin excretion stool normal subjects patients gastrointestinal disorders fecal clearance plasma alpha 1 antitrypsin used measure protein leakage intestinal tract study , alpha 1 antitrypsin concentration stool plasma clearance alpha 1 antitrypsin normal subjects consecutive series patients chronic diarrhea , malabsorption , unexplained hypoalbuminemia determined normal subjects studied usual state also diarrhea secondary ingestion lactulose , sorbitol , sodium sulfate , study first concluded induced diarrhea cause increase alpha 1 antitrypsin clearance considered establishing normal values , may excess protein leakage patients diarrhea second , highly significant statistical correlation \( p less 0 001 \) alpha 1 antitrypsin clearance serum albumin concentration average , serum albumin falls 3 0 g dl \( 30 g l \) alpha 1 antitrypsin clearance exceeds 180 ml day , value threefold higher upper limit normal third , three nine patients microscopic collagenous colitis elevated clearance alpha 1 antitrypsin contrast , abnormal alpha 1 antitrypsin clearance found 23 patients idiopathic secretory diarrhea fourth , fecal alpha 1 antitrypsin concentration reliable index abnormal alpha 1 antitrypsin clearance
piezoelectric lithotripsy stone disintegration follow results patients symptomatic gallbladder stones one hundred symptomatic patients radiolucent gallbladder stones treated new piezoelectric lithotripter oral agents stone disintegration achieved 99 patients \( 99 \) mean \( sd \) maximum fragment size 5 1 4 1 mm significant differences found mean \( sd \) fragment sizes single stones less equal 20 mm \( 4 2 2 5 mm \) compared single stones greater 20 mm \( 5 8 3 4 mm p less 0 05 \) multiple stones \( 6 2 3 8 mm p less 0 05 \) , respectively none patients required anesthesia , analgesics , treatment stone free rates patients followed 4 12 months \( mean sd , 10 7 2 9 months \) 18 \( 1 month \) , 25 \( 2 months \) , 38 \( 4 months \) , 52 \( 8 months \) , 67 \( 12 months \) partly significant differences obtained stone free rates single stones \( less equal 20 mm \) compared larger stones \( greater 20 mm \) multiple stones \( p less 0 05 \) , respectively serious adverse reactions \( e , cholestasis pancreatitis \) observed 3 patients \( 3 \) conditions induced fragment common bile duct 2 patients , endoscopic retrograde endoscopic sphincterotomy required concluded generated shock waves suitable effective safe disintegration gallbladder stones humans anesthesia free analgesia free shock wave application possibility perform biliary lithotripsy outpatient procedure stone free rate achieved combination oral bile acids promising single stones \( less equal 20 mm \)
effects synthetic human secretin calcium carbonate solubility human bile study sought determine effects synthetic human secretin ionized calcium carbonate concentrations human hepatic bile five patients drain right hepatic duct studied three basal samples bile collected , 15 minute period synthetic human secretin infused iv 0 05 micrograms kg 1 h 1 45 minutes followed 0 5 micrograms kg 1 h 1 45 minutes bile sampled 15 minute periods document return baseline conditions , two samples bile obtained 15 minute periods 2 hours infusion terminated bile acid concentration determined enzymatic method ph pco2 measured automated analyzer total calcium determined coupled plasma emission spectrometry ionized calcium ion specific electrode bicarbonate carbonate concentrations calculated using 's law equation fraction bile sampled catheter determined green recovery end experiment secretin caused increase bile flow bicarbonate output bicarbonate concentrations increased 26 3 mmol l 41 3 mmol l \( p less 0 05 \) , chloride concentrations decreased mean bile acid concentrations declined significantly 14 6 2 mmol l 4 7 1 mmol l \( p less 0 05 \) ionized calcium concentrations decreased 0 7 0 005 mmol l 0 5 0 02 mmol l \( p less 0 05 \) ph increased significantly 7 44 0 06 7 6 0 04 \( p less 0 05 \) carbonate concentrations increased significantly 0 15 0 02 mmol l 0 26 0 03 mmol l , ion product calcium carbonate increased significantly 0 0 002 \( mmol l \) 2 0 135 0 015 \( mmol l \) 2 \( p less 0 05 \) synthetic human secretin augments ion product calcium carbonate human hepatic bile , increasing tendency calcium carbonate precipitation
bile duct emptying response fat validation study fatty meal sonography suggested assess patients biliary pain cholecystectomy , effects gallbladder removal biliary dynamics studied prospectively elective cholecystectomy , 25 patients common hepatic diameter measured ultrasonography fat stimulus 23 , tests repeated 1 month , 1 year , 5 years surgery preoperative studies , 5 patients showed dilatation fat 2 stones common bile duct however , another 4 patients stones sludge duct show dilatation , response fat poor indicator patients requiring common bile duct exploration patient major symptoms surgery 1 month 12 months , response fat variable half tested showing decrease duct size consistent pattern emerged 5 years , 14 18 patients tested showed decrease common hepatic duct fat 3 unchanged 1 increased 1 mm response fat less consistent difficult measure common bile duct , even 5 years operation concluded patients indications exploration common bile duct operative cholangiography show dilatation response fat preoperative testing also , fatty meal sonography used caution response fat asymptomatic patients soon operation unpredictable , occasional patients showing dilation without apparent obstruction measurement common hepatic duct preferred common bile duct increases diameter 1 mm probably significant
associated hepatic injury among 100 cases hepatic injury attributed administration , 43 sufficient accompanying information permit analysis two patients less 20 years old , 80 less 12 years old males predominated study injury appeared early 1 week late greater 1 year taking drug injury uniformly hepatocellular judged high values death massive necrosis one patient mechanism judged , probably metabolic rather immunologic
mechanical lithotripsy common duct stones past 8 years utilized various types mechanical crush common bile duct stones procedure performed 93 patients overall success rate 94 however , many developmental stage , entrapment stones always possible first attempt , procedure repeated patients second third time interim , awaiting another attempt lithotripsy , cholangitis prevented leaving prosthesis place variety lithotriptor models different manufacturers proven effective recommend use devices bile duct retained stones
role ercp children adolescents diagnostic therapeutic role ercp 42 patients ranging 1 19 years age discussed ercp provided useful additional information 15 patients biliary tract disease , 15 patients pancreatic disease , 9 patients abdominal pain appropriate duct cannulated 95 cases mild pancreatitis occurred two patients ercp endoscopic successful five patients ercp plays important part investigation unexplained biliary tract pancreatic disease rarely demonstrates abnormal pathology patients otherwise unexplained abdominal pain
clinicians accurately assess esophageal dilation without fluoroscopy \? study questioned whether clinicians could determine success esophageal dilation accurately without aid fluoroscopy twenty patients enrolled diagnosis distal esophageal stenosis , including benign peptic stricture \( 17 \) , 's ring \( 2 \) , squamous cell carcinoma esophagus \( 1 \) dilation attempts using dilators monitored principle investigator , physician patient unaware findings physicians predicted whether dilations successful , examined various features determine usefulness predicting successful dilation able predict successful dilation accurately 97 cases studied however , predictions unsuccessful dilation correct 60 time features helpful predicting passage included easy passage dilator \( 98 \) patient feeling dilator stomach \( 95 \) excessive resistance suggesting unsuccessful passage unreliable feature often due dilator stomach dilators used simple distal strictures , physician predicts successful passage , reliably accurate without use fluoroscopy however , unsuccessful passage suspected , fluoroscopy must used confirmation
endoscopic appearance significance functional lymphangiectasia duodenal mucosa intestinal lymphangiectasia found wide variety pathologic conditions functional lymphangiectasia well characterized report 20 patients followed 9 55 months \( mean 30 months \) incidental detection endoscopy lymphangiectasia study indicates functional lymphangiectasia pathologic warrant repeat endoscopy absence clinical indications
circulating antibodies human colonic extract enriched 40 kda protein patients ulcerative colitis previously described 40 kda colonic protein \( \) specifically recognised tissue bound immunoglobulin g obtained colon patients ulcerative colitis report presence circulating antibodies antigen using enzyme linked immunosorbent assay highly enriched preparation 40 kda protein normal colon extracts serum collected 79 patients ulcerative colitis , 36 crohn 's disease , 16 specific syndromes , 19 normal subjects twenty nine 79 patients ulcerative colitis , 21 36 crohn 's disease , patients diarrhoea symptomatic collection sera difference optical density values patients symptomatic ulcerative colitis groups , including patients ulcerative colitis remission , highly significant \( p less 0 01 \) seventy nine per cent patients symptomatic ulcerative colitis optical density values means groups fifty five per cent sera patients symptomatic ulcerative colitis optical densities beyond two sds values groups two 71 sera non ulcerative colitis patients \( one crohn 's disease one normal subject \) values range results show presence anti colon antibodies 40 kda protein \( \) sera many patients symptomatic ulcerative colitis
effect ulcerative colitis smoking rectal blood flow rectal blood flow measured laser doppler flowmetry 60 minutes eight patients colitis remission eight healthy male non smokers ten smokers also examined two occasions , one included smoking cigarette plasma nicotine concentrations measured smokers subjects showed pronounced fall rectal blood flow first 30 minutes patients colitis significantly higher values compared smokers \( p less 0 002 p less 0 04 \) non smokers \( p less 0 007 p less 0 002 \) first second 30 minutes respectively values smokers non smokers similar , smoking cigarette associated significant fall blood flow \( p less 0 04 \) change inversely related rise plasma nicotine concentration \( r 0 63 p less 0 05 \) findings may relevant association colitis smoking history
inhibition cell mediated cytotoxicity sulphasalazine effect vivo treatment 5 aminosalicylic acid sulphasalazine vitro natural killer cell activity decreased cell mediated cytotoxicity occurs frequently inflammatory bowel disease , particularly patients active disease clear , however , whether decrease caused disease consequence medical treatment study evaluated effect vivo treatment 5 aminosalicylic acid sulphasalazine vitro natural killer cell activity five patients inflammatory bowel disease remission four healthy control subjects double blind randomised crossover trial preceded separated four weeks treatment placebo natural killer cell activity significantly impaired 67 \( six nine subjects \) four weeks' sulphasalazine treatment tended related subjects slow acetylator phenotype contrast , 5 aminosalicylic acid treatment caused marginal reaction natural killer cell activity 22 \( two nine subjects \) inhibitory effects found reversible since decreased natural killer cell activity completely restored placebo treatment subjects conclusion , vivo treatment sulphasalazine inhibits vitro natural killer cell activity seems mediated moiety phenomenon may contribute low natural killer cell activity found patients active inflammatory bowel disease
soluble interleukin 2 receptor crohn 's disease relation serum concentrations disease activity serum concentrations soluble interleukin 2 receptor \( sil 2r \) measured marker immune activation group 30 patients crohn 's disease sil 2r concentrations determined enzyme linked immunosorbent assay periods active inactive disease correlated standard parameters disease activity serum concentrations sil 2r significantly raised patients active crohn 's disease compared patients inactive disease \( p less 0 001 \) control subjects significant correlation serum sil 2r concentrations disease activity assessed index \( r 0 42 , p less 0 01 \) , platelet numbers \( r 0 49 , p less 0 01 \) , \( r 0 47 , p less 0 01 \) , alpha 1 antitrypsin \( r 0 44 , p less 0 01 \) , c reactive protein concentrations \( r 0 48 , p less 0 001 \) erythrocyte sedimentation rate measurement serum sil 2r concentration simple useful laboratory means assessing disease activity raised concentrations patients active crohn 's disease evidence vivo immune activation occurring disease
use anal reflex treatment neurogenic faecal incontinence electrical stimulator devised treat neurogenic faecal incontinence caused nerve neuropathy basis repeated stimulation anal reflex arc although conduction anal reflex arc may prolonged , neurogenic faecal incontinence , must shown present method used stimulation results immediate rise pressure anal canal significant increase electromyographic activity external anal sphincter maintenance stimulus two month period raised mean resting pressure significantly anal canal increased reflex voluntary responses external anal sphincter coughing squeezing actions respectively length sphincter affected widening mean motor unit potential duration , though significant resting electromyogram enhanced course treatment , indicating greater spontaneous activity external sphincter changes led seven eight patients studied becoming continent end treatment
relation rectal sensation anal function normal subjects patients faecal incontinence relation sensory perception rapid balloon distension rectum motor responses rectum external internal anal sphincters 27 normal subjects 16 patients faecal incontinence impaired rectal sensation normal sphincter pressures studied patients normal subjects , onset duration rectal sensation correlated closely external anal sphincter electrical activity \( r 0 8 , p less 0 0001 \) rectal contraction \( r 0 51 , p less 0 001 \) , internal sphincter relaxation normal subjects perceived rectal sensation within one second rapid inflation rectal balloon volumes 20 ml less air six patients rectal sensation 60 ml introduced , remaining nine patients sensation delayed least two seconds internal sphincter relaxation occurred sensation perceived three 27 normal subjects 11 16 patients \( p less 0 001 \) , could associated anal leakage , stopped soon sensation perceived lowest rectal volumes required induce anal relaxation , cause sustained relaxation , elicit sensations desire pain similar patients normal subjects conclusion , results show close association rectal sensation external anal sphincter contraction , show faecal incontinence may occur result delayed absent external anal sphincter contraction internal anal sphincter relaxed
inter variation pressure volume relations rectum normal subjects patients irritable bowel syndrome relation volume pressure increasing rectal distension latex balloon studied repeated occasions 10 healthy adult volunteers define variations within individuals wide variation maximum tolerable volume \( 58 ml \) pressure \( 12 2 108 8 cm h2o \) end point seen , two values correlated \( r 0 78 \) variation maximum tolerable volume also occurred related study order progressively reduced repeated study 26 unselected patients pain predominant irritable bowel syndrome similar variation noted virtually patients data fell within calculated 95 confidence limits normal individuals differentiation patients normal subjects possible knowledge rectal responses noticeable inter variations rectal responses distension need considered whenever similar techniques proposed use study rectal disease rectal response treatment
pancreatic function crohn 's disease investigated exocrine pancreatic function population patients crohn 's disease order correlate pancreatic function clinical laboratory variables total 143 patients affected crohn 's disease 115 control subjects studied meal test group patients crohn 's disease significantly decreased activity amylase \( p less 0 02 \) lipase \( p less 0 001 \) duodenal aspirates patients crohn 's disease enzyme activities correlated duration disease extent previous bowel resection lowest enzyme values found patients extensive bowel involvement , significantly lower \( p less 0 05 \) patients disease confined terminal ileum differences enzyme values subgroups patients significant patient group whole correlation found disease activity enzyme values , uniform group patients , terminal , pancreatic function significantly lower \( p less 0 05 \) patients moderate severe disease compared patients mild disease thus least two factors seem responsible impaired pancreatic function crohn 's disease disease activity extent disease
loss duodenal folds allows diagnosis unsuspected coeliac disease report three patients coeliac disease presented without classic features malabsorption underwent biopsy diagnosed endoscopic finding disappearance 's folds descending duodenum sign constitutes new valid aid identification patients otherwise unsuspected coeliac disease
comparison omeprazole cimetidine reflux symptomatic , endoscopic , histological evaluations symptomatic patients endoscopically verified reflux randomised double blind trial received either omeprazole \( 20 mg daily \) cimetidine \( 400 mg four times daily \) four , necessary , eight weeks analysis , found healed four weeks 77 137 \( 56 \) omeprazole group 34 133 \( 26 \) cimetidine group \( p less 0 001 \) eight weeks values 71 35 respectively p less 0 001 histological assessments available 73 patients entry , 63 \( 66 104 \) omeprazole group 60 \( 56 94 \) cimetidine group \( ns \) abnormal histology study , proportions patients initially abnormal histology progressed normal 67 \( 44 66 omeprazole \) 48 \( 27 56 cimetidine \) respectively \( p less 0 001 \) patients reflux symptoms entry four weeks , 46 omeprazole group 22 \( p less 0 001 \) cimetidine group asymptomatic diary cards completed first two weeks showed patients treated omeprazole experienced fewer reflux symptoms day night used fewer antacids omeprazole , 20 mg day four eight weeks , healed greater proportion patients reflux cimetidine , 1 6 g per day , assessed endoscopically histologically , relieved patients' symptoms
towards true prevalence peptic ulcer gastrointestinal disorder study study , designed overcome methodological problems inherent earlier prevalence studies peptic ulcer , carried northern norway included total population , aged 20 69 years , comprised questionnaire search previously diagnosed peptic ulcers local medical records subjects , additional endoscopy subjects dyspepsia matched healthy controls \( n \) overall prevalence 10 5 men 9 5 women , sex ratio close one higher duodenal gastric ratio previously reported region substantial 1 prevalence asymptomatic ulcers also observed
duodenal ulcer refined carbohydrate intake case control study assessing dietary fibre refined sugar intake association duodenal ulceration low fibre intake high refined carbohydrate diet reported therefore compared current diet , smoking habits , social class , possible risk factors 78 patients duodenal ulcer community control group matched age sex logistic regression matched sets used calculate relative risks successive dietary fibre sugar intake adjustment total calorie intake possible confounding effect known risk factors relative risks differ consistently total dietary fibre cereal moiety whether adjusted calorie intake contrast , relative risks tended reduced high vegetable fibre intake low refined sugar intake controlling smoking social class , associated ulcer disease , relative weight \( 's index \) , relation ulcer disease low refined sugar intake persisted , high vegetable fibre intake reduced results study indicate lack cereal total fibre intake plays part duodenal ulcer development low refined sugar intake may protective factor
duodenal ulcer associated low dietary linoleic acid intake suggested falling incidence duodenal ulcer related increased dietary polyunsaturated essential fatty acid intake adipose fatty acid profile , closely reflects dietary intake , measured 35 men chronic duodenal ulcer 35 matched control men mean percentage linoleic acid adipose tissue significantly lower ulcer group \( 10 0 \( 0 7 \) v 12 3 \( 0 7 \) , p less 0 01 \) difference found smokers non smokers finding suggests diets duodenal ulcer patients deficient linoleic acid could importance
biliary cholesterol transport precipitation introduction overview conference cholesterol secreted bile cholesterol phospholipid vesicles cholesterol phospholipid subsequently exposed bile salts contained bile , leads process two situations may arise depending whether enough bile salt proportion cholesterol complete maturation process cholesterol saturation low , equilibrium bile salts completely vesicles hand , bile saturated cholesterol , process incomplete vesicles present equilibrium residual vesicle latter situation may higher cholesterol phospholipid ratio greater propensity phospholipid situation may result cholesterol nucleation mechanism nucleation vesicles possible role proteins process discussed
bile sampling , processing analysis clinical studies obtaining proper bile sample investigative purposes importance obtain valid results bile collected direct aspiration gallbladder , duodenal intubation tube drainage optimal method collection depends investigative question , well resources available investigator procedures obtaining , processing analyzing human bile \( gallbladder hepatic \) summarized , pointing disadvantages pitfalls may occur
gallbladder mucin agent cholesterol monohydrate crystals bile mucin densely glycosylated secreted gallbladder epithelium principal constituent gallbladder mucus hypersecretion gallbladder mucus occurs response diet experimental animals , mucus viscous gel within gallbladder lumen gallstone formation animals man , initial stage cholesterol gallstone formation , nucleation cholesterol monohydrate crystals , occurs within mucus gel inhibition mucus secretion aspirin prevents gallstone formation cholesterol fed dog , indicating importance mucus gallstone formation mucin contains domains bind cholesterol lecithin transported vesicles supersaturated bile furthermore , mucin accelerates nucleation cholesterol crystals supersaturated model native binding cholesterol enriched vesicles hydrophobic domains mucin protein core appears critical acceleration cholesterol crystal nucleation mucin study structure function gallbladder mucin help elucidate pathogenesis cholesterol cholelithiasis
glycoproteins agents cholesterol promoting factors probably play important role pathogenesis gallstone disease isolated one factors involved using lectin affinity chromatography potent promoting activity binds concanavalin sepharose activity heat labile sensitive digestion remarkably insensitive proteases concanavalin binding affects cholesterol model bile two ways induces shift cholesterol phospholipid vesicular phase also directly cholesterol phospholipid vesicles concanavalin binding protein fraction contains least two different promoting factors gel permeation molecular weights 150 kd 5 kd , respectively higher molecular weight activity could assigned protein apparent molecular weight 130 kd concanavalin binding promoting activity present bile patients without stones , indicating normal constituent bile however , activity strongly increased bile patients multiple cholesterol gallstones , suggesting could play key role gallstone formation patients
pathogenesis biliary sludge increasing application ultrasonography biliary tract disease led frequent recognition old disorder biliary sludge sludge detected ultrasound low amplitude without acoustic layers dependent part gallbladder shifts positioning particulate matter bile , cholesterol monohydrate crystals , shown crystals high mucus content accounts layering characteristic appearance movement sludge alteration patient position within gallbladder , stability vesicular form cholesterol protein lipid interactions important determinants cholesterol precipitation mixed pigment gallstones , equilibrium ionized calcium hydrolysis conjugated bilirubin also important factors although risk factors contributing formation gallbladder sludge critically examined , known instances sludge produce biliary pain associated cholecystitis , recurrent pancreatitis , ultimately , formation gallstones better appreciation pathogenesis sludge formation help understanding genesis gallstones also perhaps understanding documented poorly understood biliary pancreatic disorders
unconjugated bilirubin cholesterol gallstone formation cholesterol gallstones usually small amounts pigment centers often diffuse pigmentation pigmented layers alternating cholesterol layers pigmented associated calcium carbonate \( calcification \) primarily monomeric calcium salts unconjugated bilirubin anions insoluble , black , network polymer bilirubin presumably precipitate bile supersaturated calcium among various vitro model systems , aqueous values unconjugated bilirubin differ greatly therefore known whether normal bile saturated unconjugated bilirubin however , systems indicate unconjugated bilirubin solubilized binding bile salt oligomers , well marked metastable unconjugated bilirubin occur presence bile salt , values unconjugated bilirubin greater 6 0 , probably internal hydrogen bonding groups lecithin decreases equilibrium unconjugated bilirubin crystals enhances metastable unconjugated bilirubin calcium ions form insoluble salts unconjugated bilirubin soluble complexes bilirubin conjugates solubility products calcium bilirubinate salts suggest normal hepatic bile saturated ca \( hb \) 2 gallbladder bile may supersaturated ca \( hb \) 2
current concepts cholesterol transport crystal formation human bile presence vesicles human bile probably accounts almost entirely frequently observed , hitherto unexplained , phenomenon metastable cholesterol , turn , largely explains prolonged stability cholesterol solubilized supersaturated human bile certain overall conditions supersaturated native bile , vesicular phase contribution total cholesterol transport also becomes supersaturated cholesterol , vesicles also become unstable , leading formation cholesterol crystals simple common example one factor affecting composition way concentration total solutes , especially biliary lipids conversely , dilution bile \( e g , hepatic bile \) markedly reduces cholesterol saturation level biliary vesicles result vesicles become much stable conditions , cholesterol crystal formation becomes unlikely rarely , ever , occurs
fluorescence assays monitor membrane fusion potential application biliary lipid secretion vesicle interactions membrane fusion constitutes essential , intermediate step numerous cell biological processes , occurring example endocytosis , membrane exocytosis also less desirable events infection cells animal viruses mediated membrane fusion viral envelope cellular membrane , causing expulsion viral cytoplasm cell initial step virus replication much current knowledge concerning mechanism membrane fusion derived studies using simple artificial membranes , liposomes phospholipid vesicles , model systems essential feature studies development membrane fusion assays register sensitive continuous fashion mixing membranes aqueous volumes initially membranes assays allow one readily detect quantify fusion , also provide possibility relate kinetics fusion rate certain molecular changes membranes take place obviously , insight relevance understanding mechanism membrane fusion principles applications representative assays rely use fluorescence spectroscopy discussed assays monitor membrane mixing commonly based detection changes resonance energy transfer efficiency relief fluorescence self appropriate fluorescent lipid analogs contents mixing assays rely either formation \( aqueous soluble \) fluorescent complex , encapsulated one vesicle population , suitable , second population
relative frequencies portosystemic pathways renal shunt formation posterior gastric vein study 460 patients percutaneous transhepatic carried 460 patients portal hypertension study various collateral routes besides left gastric vein , frequent collateral route esophageal varices , distinct vein located left gastric vein short gastric vein constituted major collateral route 191 patients \( 42 \) terms frequency , vein significant short gastric \( 34 \) vein \( 24 \) collateral route propose previously anonymous vein called posterior gastric vein runs posterior stomach vein also formed renal shunt , common cause encephalopathy , 43 \( 23 \) 191 patients relative frequency renal shunt formation vein significantly greater left gastric vein \( 12 \) short gastric vein \( 18 \)
albumin absorption protein secretion gallbladder man pig study albumin absorption gallbladder man , vitro model first established pig compared vivo function species water electrolyte transport 125i albumin absorption protein secretion vivo vitro compared similar vitro studies performed human gallbladders obtained surgery vivo study pig performed without gallbladder except cannula cystic duct end vitro model identical pig human gallbladders gallbladders excised using technique causing minimal injury oxygenated mucosal serosal surfaces temperature controlled environment luminal external bath test solutions consisted modified bicarbonate added glucose luminal solutions also contained 125i albumin different species , depending study active absorption sodium water occurred types studies pig vivo absorption rates considerably greater vitro rates albumin absorption vivo substantial although present vitro , absorption albumin diminished relatively electrolyte transport rates protein secretion rates gallbladder similar vitro vivo results studies human gallbladders vitro similar pig , except albumin absorption greater human gallbladders obtained control patients patients cholesterol gallstones significant differences two groups variables studied however , numbers small control gallbladders normal gallbladders
immunohistochemical detection abnormal cell proliferation colonic mucosa subjects polyps previous studies shown presence increased proliferation large bowel epithelium high risk developing colon cancer vitro technique labelling large bowel mucosa thymidine analogue bromodeoxyuridine \( brdu \) therefore developed ability distinguish differences mucosal proliferation subjects colorectal adenomas normal controls assessed sigmoid biopsy specimens 15 subjects polyps 15 age sex matched controls labelled incorporated brdu immunohistochemical technique mean labelling index \( li \) significantly higher polyps controls differences pattern labelling colonic crypts compared generation cumulative labelling distributions analysis showed significant expansion proliferative compartment colon crypts polyps concluded vitro labelling brdu provides useful method assessment mucosal proliferation subjects high risk developing colon cancer
generation ammonia mucosal lesion formation following hydrolysis urea urease rat stomach examined morphological changes gastric mucosa generation ammonia exposure rat stomach urea presence urease , attempts investigate pathophysiological role urea , urease , ammonia system gastric ulcer diseases exposure stomach 20 min 2 ml urea \( 0 025 0 2 \) together urease \( 100 iu \) induced histological damages concentration related manner either urea urease alone induce histological change mucosa instillation urea stomach generated ammonia presence urease amount ammonia increased depending concentration urea , closely associated severity histological damage exposure stomach ammonia \( 0 01 0 1 \) also produced histological damages gastric mucosa concentration related manner characteristics injury induced 0 5 1 0 ammonia stasis microcirculation , disruption surface epithelial cells , necrosis mucosa results demonstrated ammonia generated hydrolysis urea urease stomach causes damages gastric mucosa
healed experimental gastric ulcers remain histologically ultrastructurally abnormal present study designed assess histologic ultrastructural features gastric mucosa areas grossly healed ulcers \( acetic acid induced gastric ulcers \) rats specific question studied whether structure cellular composition gastric mucosa area grossly healed ulcer fully restored eighty sprague dawley rats underwent laparotomy 100 acetic acid applied lower gastric corpus serosa 30 abdomen closed 2 weeks 2 , 3 , 4 months standardized gastric wall specimens area grossly healed ulcers obtained , processed , evaluated light microscopy transmission electron microscopy gastric mucosa grossly healed ulcers demonstrated epithelialization study time mucosa beneath surface epithelium displayed prominent histologic ultrastructural abnormalities two different patterns scar could distinguished \( \) mucosa area healed ulcer \( 25 45 reduction vs normal \) , increased connective tissue poor differentiation degenerative changes glandular cells \( b \) mucosa displayed dilatation gastric glands , reduction microvascular network , poor differentiation glandular cells conclude \( \) subepithelial mucosa grossly healed gastric ulcer displays restoration glandular vascular structures remains histologically ultrastructurally abnormal \( ii \) abnormalities may interfere oxygenation , nutrient supply , mucosal resistance defense , therefore could basis ulcer recurrence
vascular microvascular changes key factors development acetic acid induced gastric ulcers rats present study examined time sequence histologic ultrastructural features formation evolution experimental , acetic acid induced gastric ulcerations rats one hundred percent acetic acid applied gastric serosa 140 fasted male sprague dawley rats polyethylene tube 30 gastric mucosal changes evaluated 1 , 5 , 15 , 30 min , 1 3 h , 1 , 2 , 3 , 5 , 8 , 11 days acetic acid application visual inspection , quantitative qualitative light microscopy , transmission electron microscopy following exposure acetic acid , earliest morphologic changes occurred 1 min consisted dilatation large submucosal veins arteries mucosal collecting venules five 15 minutes injury , thrombi developed submucosal veins collecting venules , leading microvascular stasis mucosal necrosis 3 h , necrotic masses started 24 48 h , necrotic changes submucosa 72 h , ulcers underwent transition chronic stage characterized histologically presence granulation tissue bottom , appearance transitional healing zone margins 5 days , increased amount granulation tissue observed gastric glands transitional zones ulcer margin displayed cystic dilatation based study , conclude key feature acetic acid induced ulcer formation early vascular microvascular injury , precedes glandular cell necrosis
study mucosal repair sofalcone experimental gastritis effect sofalcone glandular structure cell proliferation gastric mucosa rats gastritis induced administration sodium taurocholate \( tca \) 6 months examined analysis 3h thymidine autoradiography morphometric observation revealed , tca treatment , mucosal thickness , parietal cell mass , ratios length glandular portion total length gastric gland decreased fundic pyloric glands inflammatory cell infiltration collagenous fiber proliferation present gastric mucosa following tca indicated presence atrophic gastritis atrophic changes inflammatory cell infiltration reversed 3 week administration sofalcone cellular proliferative activity assessed labeling indices gastric mucosa increased tca induced gastritis rats administration sofalcone rats tca induced gastritis significantly increased labeling indices , particularly pyloric glands results , appears sofalcone stimulates compensatory increase proliferative activity cells , may become available heal gastritis
effect epidermal growth factor combination sucralfate omeprazole healing chronic gastric ulcers rat epidermal growth factor \( egf \) shown enhance healing experimental gastric ulcers given subcutaneously orally drinking water effect egf occurs without reducing gastric acid secretion hand , egf excreted rapidly gastric lumen administered intragastric bolus suggests stimulation ulcer healing may expected egf given acid suppressive agent agent allowing egf remain rat gastric lumen high concentrations present study , egf administered gastric intubation dose 10 micrograms kg , three times smaller reported previous studies , evaluated effect acetic acid induced rat gastric ulcers combination sucralfate omeprazole sucralfate well known selectively bind proteins covering ulcer base , omeprazole potent acid suppressive agent prior study combined egf sucralfate , oral sucralfate confirmed allow endogenous gastric egf mouse egf given exogenously remain high concentrations gastric contents tissues egf sucralfate \( 2 g kg day \) given alone failed stimulate ulcer healing rats \( smr rat \) whose endogenous gastric egf depleted however , combination drugs administered doses significantly accelerated ulcer healing smr rat omeprazole \( 200 mg kg day \) significantly enhanced ulcer healing regardless removal submandibular glands combination egf omeprazole stimulated ulcer healing smr rat
fibronectin related substance located chief cells human rat gastric mucosa novel substance located chief cells human rat gastric mucosa , detected immunologically either polyclonal monoclonal antihuman fibronectin \( fn \) antibodies , reported three polyclonal antihuman fn antibodies used study reacted immunohistologically exclusively chief cells monoclonal antibody c terminal peptide cell binding peptide reacted clearly human chief cells , monoclonal antibodies fn n terminal failed react cells western blot analysis rat gastric mucosal extract polyclonal antihuman fn antibody showed substance molecular weight 70 , 000 da therefore , substance appears fragment containing c terminal peptide whole molecule fn thus present study named fn related substance \( \) study ethanol induced ulcer model rat , physiological significance examined decreased remarkably , dose dependent manner , fundic mucosa rats ingested ethanol appeared associated development mucosal damage repair , subsequently playing , part , important role gastric mucosal protection mechanism
biliary lithotripsy vitro analysis gallstone fragmentation equivalent stone volumes relationship gallstone fragmentation extracorporeal shock wave lithotripsy \( eswl \) gallstone volume poorly understood clinical results eswl show highest stone free rate 6 months occurs radiolucent single gallstones 20 mm less diameter vitro study , individual gallstones cholecystectomy specimens divided size composition nine single nine multiple stone groups stones paired basis similar volume eswl performed phantom size largest fragment measured 500 , 1 , 000 , 1 , 500 shock waves 1 , 500 shock waves , particles present six nine single stones versus two nine multiple stone groups mean size largest fragment 1 , 500 shock waves 2 1 mm \( single \) 4 4 mm \( multiple \) diameter corrected volume , authors' data suggest single stones easily broken fragments smaller 5 mm diameter multiple gallstones implication , especially gap technology used , shock wave energy \( ie , increased number shock waves higher \) necessary achieve results treating patients multiple stones versus single gallstone similar stone volume
early results combined electrohydraulic shock wave lithotripsy oral therapy gallbladder stones university one hundred thirty three patients entered randomized , double blind , placebo controlled trial extracorporeal shock wave lithotripsy symptomatic gallstones versus extracorporeal shock wave lithotripsy plus adjuvant therapy ursodeoxycholic acid \( udca \) six months lithotripsy , patients receiving placebo crossed udca therapy without study one hundred sixteen patients completed 6 months follow five patients dropped study nine percent required cholecystectomy \( 11 patients biliary 1 acute cholecystitis \) ninety one patients solitary stone \( 64 patients stones less equal 20 mm 27 patients stones greater 20 mm diameter \) , 25 patients two three stones fifty percent cumulative stone free rates 6 , 12 , 18 months 26 , 39 , 41 , respectively 6 months significant advantage patients treated udca versus placebo \( 36 vs 17 stone free \) disappeared 12 months \( placebo treated patients received 6 months udca \) patients solitary stones equal less 20 mm diameter treated udca stone free rates 6 , 12 , 18 months 58 , 58 , 62 , respectively , versus 27 , 56 , 50 difference significant 6 month follow stone free rates patients large solitary stones multiple stones low extracorporeal shock wave lithotripsy safe effective therapy treatment symptomatic gallstones patients solitary stone equal less 20 mm diameter udca markedly improves efficiency procedure results stone free gallbladder sooner
circadian esophageal motor function patients gastroesophageal reflux disease effective esophageal major determinant esophageal clearance function may contribute development complications gastroesophageal reflux disease using 24 hour ambulatory esophageal manometry , compared circadian esophageal motor activity normal volunteers patients increased esophageal exposure gastric juice various grades mucosal injury \( mucosal injury , esophagitis , stricture , 's esophagus \) prevalence mechanically defective lower esophageal sphincter , esophageal acid exposure time , frequency esophageal contractions supine , upright , meal periods increased increasing severity mucosal injury median amplitude esophageal contractions compromised patients mechanically defective sphincter particularly patients stricture 's esophagus associated increased frequency ineffective contractions \( less 30 mm hg \) data show esophageal motor function increasing severity mucosal injury appears caused persistent reflux gastric juice across mechanically defective lower esophageal sphincter need surgical correction mechanically defective sphincter loss esophageal body function implicated
day care center ubiquitous lamblia recognized worldwide public health problem seroprevalence data developing developed world show high rates carriage populations risk fecal oral transmission , children day care centers outbreak investigation expanded understanding lamblia routes transmission various host factors associated infection pathogenesis infections elucidated , particular role lectin activation producing disease three standard chemotherapeutic agents available united states institution community wide prevention measures equally important current areas investigation including antigenic composition enzymatic variants result effective forms immunotherapy , effective forms could assist eradicating pathogen institutional settings
prospective randomized comparison brown balloon dilators treatment achalasia report results randomized prospective study comparing standard rubber balloon dilator brown \( \) newer polyethylene dilator passed guide wire \( mvr \) twenty achalasia patients \( , 5f , mean age 45 4 yr \) considered candidates either dilator randomized symptom assessment , body weight , upright radionuclide solid esophageal emptying study measured 6 months pneumatic dilatation performed one three experienced fluoroscopic guidance overall success occurred 10 10 7 10 mvr one patient improved mvr myotomy two successfully treated complications occurred either dilator
healing amelioration esophagitis result increased lower esophageal sphincter esophageal contractile pressure published erratum appears j 1991 feb 86 \( 2 \) 253 conflicting evidence regarding whether lower esophageal sphincter esophageal contractile pressures affected changes severity gastroesophageal reflux disease compared manometric endoscopic findings 30 patients treatment esophagitis treatment , grade esophagitis \( iii \) significantly correlated \( r 0 37 p less 0 05 \) lower esophageal sphincter pressure , esophageal contractile pressure treatment , grade esophagitis change became worse 15 patients , became better 15 patients , seven healed group showed endoscopic improvement demonstrated change lower esophageal sphincter esophageal contractile pressures group show endoscopic improvement also demonstrated increase lower esophageal sphincter esophageal contractile pressures , particularly evident whose esophagitis healed data suggest healing esophagitis result improvement esophageal motor function
sucralfate used adjunctive therapy patients severe erosive peptic esophagitis resulting gastroesophageal reflux total 36 patients grade 2 greater erosive esophagitis abnormal 24 h ph monitor study , treated randomized , double blind fashion assess efficacy sucralfate suspension adjunctive therapy cimetidine severe esophagitis secondary gastroesophageal reflux treatment consisted cimetidine , 300 mg either sucralfate suspension \( 1 g 10 ml \) identical placebo suspension , 10 ml meals 20 ml hs patients treated 12 wk unless endoscopic healing occurred earlier initial evaluation monthly follow consisted symptom monitoring , endoscopic evaluation pre post therapy esophageal manometry , test , 24 h ph monitoring combination cimetidine sucralfate suspension superior cimetidine alone improving daytime heartburn symptoms \( p less 0 05 \) nighttime heartburn , dysphagia , regurgitation sucralfate plus cimetidine improved overall endoscopic outcome esophagitis cimetidine alone \( p less 0 05 \) patients exhibited endoscopic healing adjunctive sucralfate group cimetidine group endoscopic healing , however , statistically different groups conclude sucralfate used adjunctive therapy cimetidine resulted improvement symptoms reflux , probably increases likelihood complete healing esophagitis , compared cimetidine alone
exacerbation chronic active hepatitis type b short term corticosteroid therapy resulting fatal liver failure case 36 yr old male chronic active type b hepatitis 4 wk prednisone therapy resulted prolonged fatal exacerbation liver disease described thus , short term corticosteroid therapy may patients effects course chronic active hepatitis b
update epidemiology anorexia nervosa defined region follow investigation , authors studied women developed anorexia nervosa ages 12 25 years hospitalized first time diagnosis 1983 1985 data compared earlier study , focused periods 1956 , 1965 , 1973 1975 incidence anorexia nervosa increase significantly 1983 1985 compared 1973 1975 , contrast constant increase found 1956 1975 however , frequent use vomiting abuse 1983 1985 may indicate increase cases mixed features anorexia nervosa bulimia
management acute abdomen complicating oral anticoagulation therapy acute abdominal pain patient receiving oral anticoagulants poses difficult diagnostic therapeutic challenge describe two cases peritonitis requiring laparotomy anticoagulated patients , review 49 similar case reports world literature patients usually explored signs bowel obstruction operation , intestine often appeared infarcted , pathologic examination commonly revealed intramural contrast , present microscopic evidence hemorrhagic cecal infarction complicating oral anticoagulation therapy one patient intramural intestinal hemorrhage common cause acute abdominal pain anticoagulated patient undergoes laparotomy addition intramural hemorrhage , 14 per cent patients coexistent volvulus , appendicitis , intestinal wall disruption intestinal infarction conclude anticoagulated patients suspected intramural intestinal hemorrhage may severe intraabdominal pathology requiring operation therefore , operation mandatory patients fail improve short course management
nonoperative management small bowel obstruction endoscopic long intestinal tube placement intestinal obstruction remains major cause morbidity mortality surgical patients reviewed records 77 patients mechanical small bowel obstruction treated endoscopically placed long intestinal tube decompression patients \( 59 \) failed trial nasogastric tube miller tube decompression overall , 29 per cent patients able resolve obstruction tube decompression alone subdivision patients basis etiology obstruction demonstrated much higher rate success tube decompression adhesive obstruction \( 37 \) versus malignant obstruction \( 12 \) inflammatory obstruction \( successes \) patients radiographic clinical evidence complete intestinal obstruction significantly less likely respond long intestinal tube treatment \( 13 \) long intestinal tube easily passed patients complications intubation procedure series , incidence tube related complications four per cent conclude initial period long intestinal tube decompression allows significant percentage patients mechanical small bowel obstruction treated nonoperatively , particularly partial obstruction postoperative adhesions present patients failed trial nasogastric tube decompression poor operative risks also considered long intestinal tube placement
influence sclerotherapy gastric mucosal blood flow distribution hemodynamic events structural vascular changes gastric mucosa cirrhotics attention investigators recent past , yet known whether therapeutic interruption variceal blood flow gastroesophageal level alters portal hypertensive mucosal features newly developed endoscopic laser doppler technique used assess whether variceal eradication means endoscopic sclerotherapy influences gastric mucosal congestion portal hypertension patients gastric mucosal blood flow determined ten defined sites stomach , first session sclerotherapy complete variceal eradication achieved 15 patients statistically significant decrease \( p less 0 01 0 05 \) microcirculation found gastric antrum corpus , increase \( p less 0 05 \) , change fundic area important question following findings consequences gastric congestion integrity gastric mucosa \?
ct diagnosis acquired small bowel volvulus small bowel volvulus uncommon important cause small bowel obstruction often results ischemia infarction clinical examination plain film radiography may nondiagnostic , leading delay surgical intervention subsequent increase morbidity mortality present two patients diagnosis small bowel volvulus made computed tomography \( ct \) , allowing rapid surgical correction potentially life threatening condition
surgical aspects sclerosing cholangitis results 178 patients 178 patients sclerosing cholangitis treated since 1950 , 88 patients associated inflammatory bowel disease , 72 history , 18 iatrogenic injury stone disease total 233 biliary operations performed , 75 rate temporary improvement initial operation subsequent operations resulted lower success rate higher mortality rate radiologic findings included predominant extrahepatic , intrahepatic , diffuse disease 29 , 28 , 43 patients , respectively survival differences noted seventy five one hundred three deaths \( 73 \) related liver failure , bleeding , sepsis 14 patients undergoing portosystemic shunt , 13 died surgical complications related disease orthotopic liver transplantation performed 16 patients resulted eight deaths , mainly patients previously undergone extensive surgical treatment survival differences seen patients inflammatory bowel disease , without condition , surgical treatment patients sclerosing cholangitis minimized orthotopic liver transplantation offered treatment choice patients portal hypertension , refractory cholangitis , advanced cirrhosis , progressive liver failure
cholecystitis associated interleukin 2 lymphokine activated killer cell therapy case unusual cholecystitis developed completion interleukin 2 lymphokine activated killer cell therapy described 62 year old man treated interleukin 2 lymphokine activated killer cells disseminated renal cell carcinoma course immunotherapy , serum alkaline phosphatase level increased , peripheral eosinophil count \( 0 31 \) subsequently , clinical radiologic evidence acute cholecystitis noted removed gallbladder showed cholecystitis extensive diffuse infiltrates numerous eosinophils lymphocytes , sparse polymorphonuclear leukocytes authors name unusual cholecystitis cholecystitis believe associated interleukin 2 lymphokine activated killer cell therapy pathogenic relationship discussed
pharmacokinetics propofol infusions patients cirrhosis compared pharmacokinetics propofol infusion 10 control 10 patients cirrhosis anaesthesia induced within 3 4 min administration infusion propofol 21 mg kg 1 h 1 5 min , infusion decreased stepwise manner 12 mg kg 1 h 1 subsequently 6 mg kg 1 h 1 mean recovery time discontinuation infusion significantly longer cirrhotic group however , patients opened eyes , blood concentrations propofol similar groups \( 1 micrograms ml 1 \) pharmacokinetic analysis performed beginning infusion 8 h termination total body clearance reduced significantly cirrhotic \( 1 56 \( sd 0 48 \) litre min 1 \) compared control \( 1 75 \( 0 32 \) litre min 1 \) patients volume distribution steady state significantly greater patients cirrhosis control patients \( 202 \( 82 \) litre vs 121 \( 49 \) litre \) however , difference change terminal elimination half life pharmacokinetics propofol given infusion maintain general anaesthesia affected markedly moderate cirrhosis
computed tomography patients esophageal perforation contrast diagnostic procedure choice patients clinically suspected perforation esophagus patients usual clinical signs symptoms unrecognized diagnosis obscure , diagnosis perforated esophagus may suggested finding mediastinal fluid air ct three patients reviewed perforations included one spontaneous , one erosion esophageal carcinoma , one iatrogenic two three patients , diagnosis perforated esophagus made initially one patient initial interpreted normal computed tomography chest patient led suspected diagnosis perforated esophagus prompt appropriate surgical intervention followed findings mediastinal fluid importantly mediastinal air ct chest strongly suggestive esophageal perforation
systemic hemodynamic cardiac function changes patients undergoing orthotopic liver transplantation objective study determine changes systemic hemodynamics \( systemic vascular resistance svr , cardiac output co , systemic blood pressure sbp \) cardiac function \( pulmonary artery pressure pap pulmonary wedge pressure \) 96 hours following orthotopic liver transplantation \( \) correlate changes hepatic renal function patient outcome study took place 12 bed medical respiratory intensive care unit large teaching hospital twenty one patients performed 21 5 month period \( january 1988 october 15 , 1989 \) end stage liver disease \( \) variety causes flow directed right heart catheter indwelling arterial cannula inserted hemodynamic monitoring 96 hour postoperative period liver renal function studies , total serum calcium , serum albumin , fluid balance determined daily svr increased significantly 12 8 0 6 u 48 hours compared immediate \( less 8 hours \) postoperative levels \( p less 0 05 \) remained elevated 96 hours co fell progressively significantly lower baseline values 64 96 hours significant inverse correlation increase svr fall co \( r 85 , p less 0 01 \) sbp stable except small , significant fall 16 24 hours postoperatively increased significantly baseline value 12 5 0 9 mm hg 15 0 9 mm hg 32 hours remained elevated 96 hours \( p less 0 05 \) serum bilirubin level fell progressively postoperatively prothrombin time partial thromboplastin time \( \) shortened significantly bile flow increased progressively 107 120 ml 24 hours end first 24 hours 188 125 ml 24 hours 96 hours postoperatively five patients died nine 43 days postoperatively patients' hemodynamic parameters significantly different patients survived successful associated rapid increase svr fall co without changes sbp findings tend parallel improvement found results liver function tests however , correlation improvement hemodynamic state long term survival
peptide response construction pelvic reservoir humans results investigation plasma levels gastrointestinal hormones patients construction pelvic reservoir reported \( eg \) peptide tyrosine tyrosine \( \) , two hormones believed play relevant role adaptive response bowel resection , investigated using specific radioimmunoassay basal conditions standard meal pouch patients showed statistically significant increase basal levels compared control subjects \( p less 0 02 p less 0 001 , respectively \) response food ingestion , evaluated means total integrated response , similar patients controls conversely , response significantly increased pouch patients compared control cases \( p less 0 02 \) results investigation suggest gut hormones may involved mediating adaptive response intestine pouch construction changes gut peptides may explain , least part , functional results observed pouch construction
effect race upon organ donation recipient survival liver transplantation effect race donor organ donation outcome clinical liver transplantation addressed previously aims study determine \( 1 \) number organs donated major racial groups united states , \( 2 \) outcome transplantation organs across racial groups , \( 3 \) pattern liver disease required transplantation racial groups significantly higher proportion organs donated white non hispanic americans either black hispanic americans significant difference survival organ transplanted black white americans vice versa cirrhosis variety causes common indicator affecting black white recipients , primary biliary cirrhosis primary sclerosing cholangitis uncommon black population number organs donated blacks low , , however , proportional number black recipients study reasons low rate donation black white hispanic population discussed concluded race criteria used selection donors liver transplantation educational programs addressing issues organ donation transplantation directed towards black hispanic populations recommended
cirrhosis liver risk factor development cholelithiasis males ultrasonographic study prevalence cholelithiasis performed 410 cirrhotic patients controls matched age sex gallstone disease found often cirrhotic patients \( 31 9 \) controls \( 20 7 \) \( p less 0 001 \) female male ratio gallstones prevalence cirrhotic patients approached 1 1 gallstone disease cirrhotic patients vs controls significantly higher \( 30 2 vs 16 5 \) \( p less 0 001 \) males difference found , gallstone disease prevalence cirrhosis different etiology prevalence cholelithiasis increased child 's child 's c significant trend \( p less 0 001 \) difference significant males \( 12 3 vs 40 5 \) \( p less 0 001 \) females study shows cirrhosis represents risk factor development cholelithiasis males suggest high levels estrogens could play role patients , impairment gallbladder emptying similar observed pregnant women
corticosteroid treatment reduces mast cell numbers inflammatory bowel disease mast cell degranulation gut causes mucus secretion , mucosal edema , increased gut permeability may responsible symptoms signs inflammatory bowel disease used novel monoclonal antibody \( aai \) tryptase expressed exclusively granules mast cells mast cells rectal biopsies order study effect inflammatory bowel disease drug treatment upon rectal mast cell numbers rectal mast cell numbers significantly reduced inflammatory bowel disease patients taking corticosteroids \( mean 4 95 cells mm2 \) compared control patients \( 10 1 , p less 0 001 \) inflammatory bowel disease patients taking corticosteroids \( 9 7 , p less 0 001 wilcoxon rank sum test \) reduction mast cell counts independent degree inflammation architectural distortion negative correlation dose corticosteroids mast cell count \( r 0 53 , p less 0 05 rank correlation \) , mast cell count reduced within days treatment remained low throughout steroid therapy mucosal mast cell depletion may important mechanism action corticosteroids inflammatory bowel disease
pancreatitis pancreatitis common rather poorly understood entity often associated alcohol abuse biliary tract disease despite availability variety diagnostic tests imaging techniques , diagnosis pancreatitis continues primarily clinical one major concern emergency physician distinguishing pancreatitis , potentially lethal , causes abdominal pain , identifying patients severe pancreatitis risk complicated course secondary remote systemic effects disease
alcoholic liver disease alcoholic liver disease presents wide spectrum clinical manifestations ranging mild asymptomatic fatty liver alcoholic hepatitis severe life threatening liver failure ascites , esophageal varices , encephalopathy although still poorly understood , mechanism injury probably result numerous direct toxic metabolic effects alcohol hepatocyte therapy consists primarily abstinence supportive care however , several newer treatments actively studied include prednisolone , anabolic steroids , glucagon insulin , propylthiouracil , colchicine promising agent inhibit fibrosis complications cirrhosis , including ascites variceal hemorrhage , result end stage disease return old techniques ascitic fluid management suggests therapeutic large volume albumin infusion safe effective form therapy variceal hemorrhage best treated sclerotherapy , , balloon tamponade little done alter ultimately prognosis long term survival alcoholic liver disease
24 hour intragastric acidity plasma gastrin omeprazole treatment proximal gastric vagotomy duodenal ulcer patients relationship suppressed gastric acidity increase plasma gastrin levels pharmacological surgical treatment peptic ulcer disease compared study eight patients chronic duodenal ulcer referred proximal gastric vagotomy studied 24 hour intragastric acidity plasma gastrin levels investigated patients three consecutive occasions without treatment 4 weeks administration 20 mg omeprazole daily , 4 6 months proximal gastric vagotomy intragastric acidity slightly reduced omeprazole \( 94 \) proximal gastric vagotomy \( 78 \) , difference found day night either plasma gastrin levels increased slightly proximal gastric vagotomy 284 \( median , pmol h l range , pmol h l \) omeprazole administration 186 \( median , pmol h l range , pmol h l \) strong evidence increased plasma gastrin concentration following omeprazole treatment caused reduced intragastric acidity slight increase plasma gastrin concentration following proximal gastric vagotomy despite lesser reduction intragastric acidity may result additional effects gastrin release vagotomy treatments resulted modest increase plasma levels gastrin far gastrin levels observed patients , e g , patients anemia
glucose disposal , beta cell secretion , hepatic insulin extraction cirrhosis minimal model assessment factors controlling glucose metabolism iv load studied nine patients compensated cirrhosis six age matched controls time courses glucose , insulin , c peptide analyzed means minimal model technique cirrhosis , insulin sensitivity reduced approximately 70 glucose dependent glucose uptake \( glucose effectiveness \) 45 decreased glucose effectiveness explained 65 variance glucose disappearance correlated ratio urinary creatinine height , independent measure muscle mass \( r 0 \) beta cell responsiveness glucose , measured c peptide kinetics , variable increased average 170 107 \( first phase second phase , respectively \) total amount insulin secreted beta cells course study nearly doubled , whereas basal insulin secretion rate normal range time courses hepatic extraction insulin differ groups , basal extraction average 58 controls 56 patients cirrhosis reduced 30 single patient severe hepatocellular failure large spontaneous portosystemic shunting conclude alterations glucose metabolism cirrhosis include decreased insulin sensitivity , reduced glucose effectiveness , increased pancreatic responsiveness glucose , leading hyperinsulinemia hepatic extraction insulin reduced advanced stages disease , possibly large reserve capacity hepatic parenchyma
pathogenesis ceftriaxone associated biliary sludge vitro studies calcium ceftriaxone binding solubility ceftriaxone , semisynthetic third generation cephalosporin , recently associated biliary sludge formation analysis biliary induced agent shows calcium salt ceftriaxone present vitro studies undertaken provide insight pathogenesis ceftriaxone associated biliary sludge formation evaluating possible interactions may exist calcium , bile salts , ceftriaxone ceftriaxone possessed high calcium binding affinity formation constant calcium ceftriaxone salt 37 degrees c 157 3 l mol salt 1 1 , e , calcium ceftriaxone calcium binding property ceftriaxone observed additive taurocholate mixed taurocholate ceftriaxone solutions although solubility product constant calcium ceftriaxone 1 62 x 10 \( 6 \) mol l2 , marked observed neither visible microscopic precipitates developed ca2 x ceftriaxone ion product exceeded solubility product constant factor 10 4 calcium ceftriaxone salt also observed human gallbladder bile vitro estimates human biliary calcium ceftriaxone solubility vivo calculated previously reported values biliary ca2 , ceftriaxone , solubility product constant defined study calculated saturation indices calcium ceftriaxone human bile generally increased \( corresponding decrease solubility \) increasing ceftriaxone dose doses less equal 1 g , saturation index well within metastable range calcium salt however , doses greater equal 2 g , saturation index metastable limit conditions , precipitation ceftriaxone could occur concluded development ceftriaxone induced biliary sludge solubility problem occurs patients receiving high dose treatment \( greater equal 2 g \) study proposes risk developing ceftriaxone associated biliary increases increasing ceftriaxone dose patients impaired gallbladder emptying
gallbladder motility cholesterol gallstone disease effect ursodeoxycholic acid administration gallstone dissolution gallbladder motility evaluated ultrasonography 75 cholesterol gallstone patients 77 matched control subjects 75 gallstone patients candidates oral bile acid therapy \( radiolucent gallstones , less 2 cm diameter , well gallbladder \) , 38 also studied ursodeoxycholic acid administration additional 20 gallstone patients studied 1 year confirmed gallstone dissolution oral bile acids gallstone patients showed significantly greater fasting residual volumes , decreased percent gallbladder emptying , similar absolute emptying emptying rate compared control subjects greater fasting volumes reduced gallbladder emptying also found gallstone free patients achieved complete dissolution oral bile acids ursodeoxycholic acid administration , fasting gallbladder volumes greater , gallbladder emptying decreased untreated gallstone patients conclusion , greater fasting volumes , reduced gallbladder contractility , account defective gallbladder function radiolucent \( cholesterol rich \) gallstone patients condition likely precede , possibly promote , gallstone formation persists gallstone dissolution ursodeoxycholic acid administration defect observed gallstone patients finding also suggests , although indirectly , expected normalization cholesterol saturation oral bile acid administration paralleled improvement gallbladder function
primary biliary cirrhosis quantitation autoantibodies purified mitochondrial enzymes correlation disease progression primary biliary cirrhosis characterized presence antibodies recently , six autoantigens identified components 2 oxo acid dehydrogenase complexes located within mammalian mitochondria immunoblotting studies shown two components , namely e2 protein x pyruvate dehydrogenase complex , major antigenic polypeptides recognized autoantibodies study shows development enzyme linked immunosorbent assay detect quantitate antibodies two purified antigens coded serum samples 166 patients primary biliary cirrhosis , 140 patients liver autoimmune disease , 52 normal women analyzed reactivity using immunoassay results indicate rapid , simple method 93 sensitivity 96 specificity diagnosis primary biliary cirrhosis titer immunoglobulin g autoantibodies correlated antibody titer measured indirect immunofluorescence \( p less 0 0001 \) also histological stage disease \( p less 0 04 \) prognostic biochemical variables higher serum bilirubin lower serum albumin levels \( p 0 038 0 028 , respectively \) significant correlation titer autoantibodies serum globulin immunoglobulin g levels , indicating positive correlation disease progression secondary
long term outcome surgery biliary atresia study 40 patients surviving 10 years define long term prognosis children underwent surgery biliary atresia , retrospective study undertaken 122 children underwent one procedures 1968 1977 forty 122 children \( 32 7 \) alive 10 years firm present 31 splenomegaly 29 children serum bilirubin liver function tests normal 21 11 children , respectively survival rate decreased age operation , significant difference observed rate children surviving normal serum bilirubin whether underwent surgery age 2 months 2 3 months twenty four esophageal varices 15 experienced gastrointestinal bleeding normal liver function tests absence portal hypertension observed 11 122 children results indicate 's procedures helpful significant proportion children biliary atresia underwent surgery period however , 80 children initially underwent surgery 's procedures eventually undergo liver transplantation
microprocessor assisted solvent transfer system gallstone dissolution vitro vivo validation improve efficacy , safety , convenience contact dissolution gallbladder stones , microprocessor assisted solvent transfer system developed system 's two pumps simultaneously aspirate solvent gallbladder high flow rate catheter microprocessor controls pumps using closed feedback loop control algorithm regulate pressure prevent solvent escape duodenum turbulent solvent flow catheter end gallbladder designed induce rapid stone dissolution insoluble residue , thus promoting aspiration system 's response gallbladder emptying capacity 160 fold faster natural gallbladder emptying rate rate gallstones dissolved methyl tert butyl ether using system compared achieved syringe pump 6 11 pairs stones totally dissolved , mean dissolution time system 10 6 minutes compared 112 81 minutes syringe pump 5 11 stone pairs dissolved incompletely , insoluble residue completely eliminated system 21 9 minutes syringe pump even 360 minutes system used gallstone patients , solvent recovery 99 1 , concentration nonabsorbable marker change , confirming lack appreciable absorption methyl tert butyl ether studies suggest microprocessor assisted solvent transfer system device capable safe , complete , fully automatic contact dissolution cholesterol gallbladder stones using methyl tert butyl ether similar
endoscopic retrograde cannulation gallbladder direct dissolution gallstones percutaneous transhepatic catheterization gallbladder dissolution cholesterol stones instillation methyl tert butyl ether \( mtbe \) invasive therapeutic procedure non invasive alternative available , endoscopic retrograde cannulation cystic duct , difficult cystic duct 's tortuosity spiral valves therefore developed catheter system , using conventional routine endoscopic retrograde cholangiography \( \) procedure , permits reliable safe catheterization gallbladder without need endoscopic sphincterotomy 18 22 patients \( 82 \) able place nasal catheter , 14 patients mtbe dissolution therapy performed eight patients \( 57 \) completely free stones treatment six \( 43 \) residual debris 4 22 patients \( 18 \) cannulation attempts failed , 3 patients due cystic duct blockage calculus endoscopic retrograde cannulation gallbladder \( \) represents promising alternative invasive percutaneous transhepatic catheterization procedure
sphincter manometry decreased risk clinical pancreatitis use modified catheter study undertaken determine whether routine use modified triple lumen five french sphincter manometry catheter would reduce frequency severity post manometry pancreatitis pancreatic enzyme elevation seventy six patients alternately assigned undergo sphincter manometry \( \) standard perfusion \( infused group \) catheter newly developed aspiration \( aspirated group \) catheter , significantly patients infused group amylase lipase values elevated least two times upper limits normal 2 \( p less 0 001 \) , 6 \( p 0 01 \) , 18 hours \( p 0 03 \) procedure compared standard perfusion system , aspiration catheter associated decreased frequency clinical pancreatitis \( 23 5 vs 3 , p 0 01 \) reduced hospital stay \( 5 1 83 days , mean se , versus 1 day p 0 03 \) milder pancreatitis aspiration manometry catheter considered standard use , particularly pancreatic duct sphincter evaluated
schatzki 's ring long term results following dilation purpose study report long term results 61 patients schatzki 's ring dilated relief dysphagia severity schatzki 's ring mild 28 patients \( 46 \) , moderate 26 \( 43 \) , severe 5 \( 8 \) , indeterminate 2 \( 3 \) follow information available 56 61 patients \( mean , 75 months \) follow , 35 patients \( 63 \) developed recurrent dysphagia required repeated dilations 19 patients \( 34 \) one two dilations , 9 patients \( 16 \) three seven dilations , 6 patients \( 11 \) seven dilations 1 patient underwent surgery resection schatzki 's ring \( 2 \) mean \( range \) dilation free interval 50 1 months \( 11 8 100 months \) mild cases , 44 5 months \( 8 9 82 months \) moderate cases , 28 6 months \( 9 76 months \) severe cases significant correlation severity schatzki 's ring initial presentation subsequent dilation free interval data indicate recurrent dysphagia common among patients schatzki 's ring successful dilation , severity schatzki 's ring good prognostic indicator need subsequent dilation
witzel pneumatic dilation achalasia safety long term efficacy dilation lower esophageal sphincter considered primary therapy achalasia witzel pneumatic balloon dilator , unlike placed dilators , placed standard allowing positioning dilation direct vision report experience witzel dilator 45 patients achalasia 5 year period patients least one major symptom score 8 10 dysphagia regurgitation dilation witzel dilation , symptomatic response graded excellent \( score 0 2 \) , good \( score 3 5 \) , fair \( score 6 8 \) , poor \( improvement \) symptom response assessed 1 week , 1 month , 6 month , 1 year , present mean period follow 25 months \( range , 3 85 months \) passage balloon across gastroesophageal junction technically unsuccessful three patients esophageal perforation occurred two patients \( 4 \) transient chest pain greater 2 days three patients \( 7 \) bleeding death symptomatic long term improvement excellent 25 patients \( 63 \) , good 6 patients \( 15 \) , fair 4 patients \( 10 \) , poor 5 patients \( 12 \) repeat witzel dilation performed five patients resulted good excellent improvement one patient conclude pneumatic dilation witzel balloon safe , effective procedure achalasia
selective intestinal decontamination increases serum ascitic fluid c3 levels cirrhosis selective intestinal decontamination 7 days norfloxacin performed 14 cirrhotic patients ascites low ascitic fluid total protein variations serum ascitic fluid c3 c4 ascitic fluid total protein therapy compared control group 14 untreated patients similar characteristics oral norfloxacin administration , saw significant increase c3 serum \( p less 0 05 \) ascitic fluid \( p 0 01 \) significant increase also observed ascitic fluid total protein \( p less 0 05 \) serum ascitic fluid c4 changes serum c3 , ascitic fluid c3 , ascitic fluid c4 ascitic fluid total protein group 2 data demonstrate selective intestinal decontamination increases serum ascitic fluid c3 levels , therefore , might useful preventing spontaneous infections cirrhotic patients high risk infection
left retroperitoneal exposure distal mesenteric artery repair distal disease mesenteric arteries usually repaired since believed proximal centimeter vessel accessible treated five patients chronic visceral ischemia lesions extending beyond orifice using retroperitoneal approach exposure obtained left flank incision tenth left diaphragm divided order control aorta mesenteric vessels identified dissected entrance peritoneum difficulties exposing superior mesenteric artery \( sma \) pancreas duodenum approximate length 5 10 cm uncinate process pancreas limiting factor exposure sma region distal exposure could obtained peritoneum celiac artery splenic artery accessible exposure however , first centimeter hepatic gastric branches could reached revascularization performed endarterectomy \( 2 patients \) bypass \( 3 patients \) bowel viability assessed conclusion procedure peritoneum complications exposure patient required reoperation ischemic bowel conclude left retroperitoneal approach acceptable orifice lesions also applicable distal disease
crypt cell proliferation hla dr expression pelvic ileal pouches investigate nature morphological changes occur ileal pouches , 26 biopsy specimens patients functioning ileo anal pouches \( eight pouchitis \) studied normal ileum \( n 10 \) used control mucosal morphometry \( using linear measurements \) , crypt cell proliferation \( ccp \) \( using monoclonal antibody \) , epithelial hla dr expression \( monoclonal antibody cr3 43 \) assessed ccp \( expressed percentage positive nuclei crypt \) significantly higher pouches pouchitis , compared without , pouches without pouchitis compared normal ileum ccp values pouches without pouchitis approached values found pouchitis ccp related inversely villous height index villous atrophy \( vh \) , directly crypt depth presence pouchitis intense epithelial hla dr expression extended crypts pouches high ccp values , without clinically important inflammation , surface epithelial hla dr expression weak patchy concluded villous atrophy crypt hyperplasia ileal pouches associated high ccp values may increased even absence active inflammation , increase may occur response new luminal environment
crohn 's disease pancreas \? editorial crohn 's disease \( cd \) accepted systemic illness importance manifestations fact complications prominent even difficult control intestinal disease , evidence accidental association pancreatitis exocrine pancreatic insufficiency cd growing might significant impact treatment abdominal pain diarrhea cd , symptoms far attributed exclusively intestinal rather manifestations disease
stasis syndromes following gastric surgery clinical motility features 60 symptomatic patients retrospectively reviewed records 60 patients referred gastrointestinal manometry stasis gastric surgery nausea , vomiting , bloating , abdominal pain , weight loss common symptoms two thirds patients well documented history peptic ulcer initial operations others , surgery performed reasons , obesity \( 5 \) reflux esophagitis \( 8 \) twelve patients undergone vagotomy drainage operation 48 received partial gastrectomy \( n 8 \) , ii \( n 11 \) , roux en \( n 29 \) patients recordings gastrointestinal manometry 16 also scintigraphic measurement gastric emptying measurements compared data healthy controls gastric manometry , could assessed group intact antrum , characterized antral \( p less 0 05 \) gastric emptying studies showed rapid early emptying delayed emptying \( p less 0 05 \) whole group , fasting jejunal motility characterized absence phase ii 13 , presence bursts phasic activity 18 , abnormal propagation phase iii 8 significantly increased frequency phase iii noted patients ii roux en operations , 19 patients failed develop fed pattern
rosacea ulcerative colitis possible association although rosacea believed associated gastrointestinal , one longer significant association rosacea intestinal tract describe four patients combination ulcerative colitis rosacea four , ulcerative colitis preceded onset severe rosacea , therefore feel severity rosacea could due associated bowel disorder one , severity poor initial response rosacea treatment clearly related activity ulcerative colitis , rosacea improved proctocolectomy possible association , report cases hope others may seen combination diseases , knowledge previously
limitations evaluation therapy inflammatory bowel disease suggestions future research current treatment inflammatory bowel disease \( ibd \) , though improved earlier therapies , remains variable rather consistent supportive rather curative similar management ulcerative colitis \( uc \) crohn 's disease \( cd \) , thought differing though related disorders , suggests therapy nonspecific variation therapeutic practices results fact etiologies diseases obscure , limited knowledge biological pharmacological actions drugs commonly prescribed \( sulfasalazine , 5 asa compounds , steroids , 6 mp azathioprine \) , inadequate understanding genetic differences influencing drug metabolism , insufficient awareness factors influencing drug efficiency \( concurrent use drugs , cigarette smoking , food combinations \) , variability patient groups studied \( extent severity disease \) , incomplete documentation clinical status patients time therapeutic trial future advances treatment depend new information nature ibd drug pharmacology bioavailability , derived collaborative studies clinicians , clinical investigators , basic scientists important areas ibd research include biology intestinal epithelium , nature ibd inflammatory reaction gut mucosal immune regulation \( via application new \) representative experimental animal models multicenter therapeutic studies require agreement definitions ulcerative colitis crohn 's disease , accurate characterization patient groups , acceptable objective criteria ibd severity activity , reliable indicators therapeutic response
frequency recovery hominis clinical practice examined frequency isolation hominis stools patients seen care teaching hospital 2 year period , 2 , stool specimens examined prospectively b hominis found 262 stools \( 9 5 stool specimens 53 5 positive specimens \) clinical data obtained 80 patients stools positive b hominis b hominis parasite isolated 39 47 \( 83 \) adults , compared 17 33 \( 52 \) children \( p 0 006 \) 2 52 patients without concomitant parasitic infection bacterial pathogens stool gastrointestinal symptoms \( 41 abdominal pain , 26 diarrhea , 5 vomiting \) , association seen fever , peripheral leukocytosis , stool occult blood , fecal leukocytes , endoscopic radiologic evidence colitis therefore , b hominis frequently recovered stools examined hospital clinical laboratory clinical presentations patients series suggest b hominis invasive patients b hominis probably require treatment since either spontaneous resolution symptoms found alternative explanation problem
clinical significance cholelithiasis patients cirrhosis general agreement prevalence gallstones cirrhotics high \( least twice general population \) , pathogenetic link cirrhosis cholelithiasis still uncertain influence cholelithiasis survival cirrhotics also unknown 8 year period , observed 90 patients affected cirrhosis 36 \( 40 \) turned ultrasonographic examination cholelithiasis able demonstrate correlation cholelithiasis sex , age patients , etiology cirrhosis , severity illness , degree portal hypertension , previous gastrointestinal bleeding , number pregnancies , levels serum cholesterol , bilirubin , triglycerides follow observation , \( range , 1 91 months \) , 30 patients died survival curves analyzed log rank test show difference patients without gallstones therefore confirm cirrhosis condition , able explain reasons close relationship cholelithiasis cirrhosis gallstones , however , affect survival patients
gallstone disease north india clinical ultrasound profile referral hospital studied prevalence gallstones patients upper abdominal pain , , discomfort ultrasound examination gallbladder actual ultrasound examination performed clinical blinded symptoms 1 , consecutive dyspeptic patients , 500 \( 29 8 \) gallstones gallbladder contracted 450 \( 91 2 \) , normal size 36 \( 7 2 \) , distended 8 \( 1 6 \) biliary frequently presenting complaint patients contracted gallbladder normal size gallbladder \( p less 0 001 \) dyspepsia frequent presence normal size gallbladder contracted one \( p less 0 001 \) conclude ultrasonography gallbladder clinician high diagnostic yield , symptom complex excellent correlation sonographic appearance
mallory syndrome cardiopulmonary resuscitation report mallory tears successful cardiopulmonary resuscitation \( cpr \) computer search english language literature disclosed 3 similar cases , review complication cpr may occur frequently recognized prevented careful technique
morphological study cholesterol hepatolithiasis report three cases three cases pure cholesterol intrahepatic stones compared morphologically calcium bilirubinate stones cholesterol stones found intrahepatic bile duct left lateral lobe two cases left lateral right posterior lobe one although chronic inflammatory reaction fibrous thickening bile duct wall similar types hepatolithiasis , proliferation intrahepatic glands production mucin rather mild , compared containing calcium bilirubinate stones multiple intramural cholesterol calculi granulomas \( crystals foreign body giant cells \) found within dilated small bile duct branches conduits glands calculi granulomas characteristic cholesterol hepatolithiasis findings suggest formation cholesterol stones differs calcium bilirubinate stones perturbation factors influencing cholesterol nucleation hepatic bile may related changed microenvironment intrahepatic bile ducts , followed formation cholesterol stones
cellular immune response hepatitis b virus encoded antigens acute chronic hepatitis b virus infection proliferative response pbmc hepatitis b virus \( hbv \) envelope , core , e ag analyzed prospectively 21 patients acute self limited hbv infection compared response patients chronic hbv infection different levels hbv replication \( e , hepatitis e ag \( hbeag \) anti positive \) liver damage \( e , chronic active hepatitis chronic asymptomatic carriers \) results indicate 1 \) hbv infected subjects develop self limited acute hepatitis show vigorous pbmc response hepatitis b core ag hbeag , expression cell activation 2 \) appearance detectable lymphocyte response hbv ag temporally associated clearance hbv envelope ag 3 \) patients chronic hbv infection level cell responsiveness hepatitis b core ag hbeag significantly lower observed acute infection 4 \) cell sensitization hbv envelope ag acute chronic hbv infection usually undetectable measurable expressed transiently low levels results may reflect immune events pathogenetic relevance respect evolution disease viral clearance
phase clinical pharmacologic study intraperitoneal cisplatin fluorouracil patients advanced intraabdominal cancer fluorouracil \( 5 fu \) cisplatin display marked therapeutic synergy preclinical models effective treatment number solid tumors combined administered intravenously \( iv \) drug also administered intraperitoneally \( ip \) displays favorable pharmacologic profile acceptable clinical toxicity therefore undertook phase study determine feasibility toxicity combination ip chemotherapy agents thirty one patients histologically documented malignancy confined peritoneal space treated cisplatin 90 mg m2 mixed 5 fu 2 l ringer 's solution given ip 4 hours every 28 days cohorts least three patients received starting 5 fu concentrations ranging 5 mmol l \( 1 , 300 mg 2 l \) 20 mmol l dose limiting toxicity neutropenia median granulocyte nadir 156 cells per microliter occurring 5 fu dose 20 mmol l escalation 5 fu dose permitted 15 cycles chemotherapy delivered 5 fu concentrations greater 20 mmol l , highest concentration 30 7 mmol l \( 8 g 5 fu \) toxicities included mild moderate nausea cycles therapy , vomiting 54 cycles , diarrhea 15 cycles abdominal pain , renal dysfunction , peripheral neuropathy , oral mucositis occurred infrequently related 5 fu dose peritoneal fluid plasma 5 fu concentrations measured high performance liquid chromatography \( hplc \) selected patients mean peak plasma 5 fu concentrations ranged 6 19 mumol l greater 60 mumol l , peritoneal fluid plasma 5 fu area curve \( auc \) ratios ranged 85 1 , 150 nine 15 patients disease resolution malignant ascites least 50 reduction peritoneal tumor repeat laparotomy conclude combination ip chemotherapy cisplatin 5 fu technically feasible acceptable clinical toxicity favorable pharmacologic profile recommended starting 5 fu dose phase ii trials 3 , 900 mg mixed 90 mg m2 cisplatin 2 l isotonic fluid
azathioprine treatment children inflammatory bowel disease 6 year period , treated 21 patients azathioprine , 2 mg kg day , adjunct regimen nine patients ulcerative colitis 12 patients crohn disease patients' ages ranged 3 17 years median duration disease start azathioprine therapy 2 years , median follow 2 years sixteen patients seemed respond azathioprine therapy six patients disease group complete responses four patients \( one ulcerative colitis three crohn disease \) partial responses two patients ulcerative colitis three patients crohn disease respond median time patients responded less 3 months patients ulcerative colitis 4 months crohn disease reduction corticosteroid dose possible patients responded azathioprine therapy minimal side effects attributable drug conclude azathioprine effective adjunctive agent treatment inflammatory bowel disease childhood , questions remain regarding long term safety , use reserved children refractory disease severe unacceptable side effects corticosteroids
assessment functional gastrointestinal disease bowel disease questionnaire need exists self report questionnaire reliably accurately measures symptoms distinguishes patients functional gastrointestinal disease conditions developed instrument , bowel disease questionnaire , herein describe details discriminatory validity data subjects analyzed patients gastrointestinal symptoms ultimately diagnosed functional gastrointestinal disease \( 82 irritable bowel syndrome 33 functional dyspepsia \) organic gastrointestinal disease \( n 101 \) 145 healthy control subjects 38 patients psychiatric disease , disorder \( includes diagnosis , pain , conversion disorder \) subjects completed questionnaire undergoing independent diagnostic assessment experienced physicians functional gastrointestinal disease could distinguished organic disease , disorder , health using models derived logistic discriminant analysis use models , estimated probability functional gastrointestinal disease calculated descriptive symptom scores less value scores derived data sets logistic discriminant analysis age significantly affect responses questionnaire items conclude , population studied , bowel disease questionnaire valid measure symptoms functional gastrointestinal disease , instrument may clinical research applications
preliminary report antegrade continence enema principles antegrade colonic washout non channel combined produce continent colonic stoma antegrade delivered route would produce complete colonic emptying thereby prevent soiling procedure successfully carried five patients intractable faecal incontinence
increased cholecystectomy rates saudi gallstones become increasingly prevalent saudi , cholecystectomy one commonest major abdominal operations people underwent cholecystectomy 14 hospitals country 's eastern province years 1977 1986 period overall frequency cholecystectomy increased , finding explained 67 increase population 87 increase operations simultaneously , average daily individual consumption total calories , fat , sugar increased 81 , 197 , 164 , respectively , consumption high fibre fell 75 striking increase frequency cholecystectomy , presumably reflects incidence gallstones , cannot explained demographic changes seems closely linked concomitant changes dietary habits
binding human jejunum serum iga antibody children coeliac disease jejunal histology presence serum iga antibodies \( jab \) binding human jejunum vitro studied 139 children severe symptoms among 33 children confirmed coeliac disease \( criteria \) , 13 \( 93 \) 14 sampled starting gluten free diet jab , none 21 sampled jab gluten free diet long duration , 90 30 sampled gluten challenge jab 53 children severe jejunal villous atrophy \( probable coeliac disease \) 71 younger 2 years 94 aged 2 18 years jab gluten intake jab could detected 53 disease control patients \( normal jejunal histology \) 3 coeliac disease patients selective iga deficiency simultaneous determination antigliadin \( \) \( ema \) levels , tissue absorption studies , showed jab different , whereas jab ema probably identical iga jab could target organ related autoantibodies coeliac disease
cyclic pelvic pain cyclic pelvic pain common gynecologic problem caused relatively diseases , usually diagnosed quickly complaints reflect normal physiologic aspects menstrual cycle \( , menstrual awareness \) premenstrual syndrome diagnosed , effective convenient treatment lacking commonest source cyclic pain , diagnosed characteristic history rapid relief administration agents endometriosis diagnosed surgically best treated either surgically , medically danazol gnrh agonists contrast , adenomyosis problem commonly encountered later life , hysterectomy usually needed definitive diagnosis treatment
advanced assessment abdomen gastrointestinal problems many unique physical assessment findings associated specific gastrointestinal disorders detection findings enables nurse manage gastrointestinal emergencies patient unit timely fashion , preventing deterioration maintaining safety patient skills build well traditional , detailed , comprehensive assessments nurse makes using nursing process specific abdominal assessments include detection signs associated appendicitis rebound tenderness 's , 's , 's signs nurse must always alert possibility peritonitis urgency early detection treatment patient cirrhosis liver presents distinct clinical picture need subtle evaluation mental status detect early signs hepatic coma another extra abdominal assessment complication finally , assessment patient enhanced nurse able help identify location bleeding improving abdominal gastrointestinal system assessment leads early detection nursing problems appropriate interventions
diarrhea diarrhea one manifestation gi disturbance symptoms may acute caused things infections , drug reactions , alterations diet , heavy metal poisoning , fecal chronic diarrhea symptom gi diseases irritable bowel syndrome , deficiency , cancer colon , inflammatory bowel disease , malabsorption diseases chronic diarrhea may also associated gi surgery , radiation therapy , abuse , alcohol abuse , chemotherapeutic agents interventions required deal diarrhea , may include things alteration tube feeding products methods administration , fluid replacement oral rehydration procedures , rapid return feeding , education aimed health information clients need prevent control symptom diarrhea
colonoscopy critically ill patients conditions call \? indications colonoscopy intensive care unit include acute lower intestinal bleeding , sigmoid volvulus , pseudo obstruction colon , suspicion pseudomembranous colitis although incidence cardiorespiratory complications may higher critically ill patients , procedure done safely proper attention detail colonic dilatation , endoscopy often done without bowel preparation
interventional radiology biliary tract intervention diagnostic therapeutic biliary intervention percutaneous access gallbladder important new area interventional radiology anatomy gallbladder , biliary tree , surrounding reviewed article preliminary discussion diagnostic techniques aspiration , cholangiography , biopsy , therapeutic techniques gallbladder drainage recently proliferation procedures aimed removal , fragmentation , dissolution gallbladder stones several discussed article removal common bile duct stones percutaneous also discussed
interventional gallbladder procedures interventional radiologic procedures gallbladder influencing diagnosis therapy many gallbladder disorders current diagnostic therapeutic percutaneous techniques offer important alternatives management article highlights spectrum interventional radiologic techniques available gallbladder diseases
intracorporeal biliary lithotripsy bile duct calculi removed standard percutaneous endoscopic techniques large stones common cause failure intracorporeal lithotripsy , particular , used safely either biliary tree gallbladder fragment large stones allow percutaneous removal passage intracorporeal requires direct vision prevent damage bile duct mucosa intracorporeal laser lithotripsy may offer safety advantages , laser requires much expensive equipment intracorporeal additional studies needed determine technique better
technical aspects biliary extracorporeal shock wave lithotripsy radiologic imaging procedures play major role evaluation potential patient biliary extracorporeal shock wave lithotripsy , procedure follow evaluation treating physician must thorough knowledge ultrasonography techniques lithotripsy requires continual monitoring frequent reassessment optimize targeting fragmentation gallstones maintaining patient comfort
ablation cystic duct gallbladder experimental basis initial clinical observations bipolar radiofrequency cystic duct catheter performed safely reproducibly using fluoroscopic control induces scar formation scar within cystic duct forms reliable barrier gallbladder biliary system avoids recanalization cystic duct later date sclerotherapy isolated gallbladder 95 ethanol 3 sts performed without toxic otherwise adverse effects suitable ablate porcine gallbladder initial clinical trials new technique small number patients promising demonstrated protocol applied safely humans technique catheter appears suitable ablate human cystic duct follow evaluation first patients way must determine whether regimen appropriate ablate human gallbladder long term basis development new approach may eventually enable definitive nonoperative treatment selected patients
combined radiologic retrograde endoscopic biliary interventions methods treating complex biliary duct problems team composed interventional radiologist described procedures two types manipulations performed endoscope antegrade transhepatic retrograde endoscopic approach combined
esophageal reflux isolated myotomy achalasia four patients achalasia underwent 24 hour esophageal ph measurements ambulatory patients limited myotomy without fundoplication resting lower esophageal sphincter pressure reduced 24 3 1 3 mm hg 7 5 4 3 mm hg significant differences \( p greater 0 05 \) found operation total 24 hour ph data distribution \( ph 6 24 0 84 vs 5 75 1 03 \) , fraction time ph 4 0 \( 4 8 5 3 vs 8 0 6 9 \) , mean duration reflux episodes greater 5 minutes \( 22 8 18 8 minutes vs 23 0 10 minutes \) , sd effective relief esophageal obstruction achalasia feasible isolated limited myotomy without producing gastroesophageal reflux
effect omeprazole high doses ranitidine gastric acidity gastroesophageal reflux patients moderate severe esophagitis thirty fifty percent patients reflux esophagitis fail heal treatment conventional doses h2 receptor antagonists , whereas omeprazole administration induces 90 healing investigate effect omeprazole higher presently recommended doses h2 blockers , evaluated gastric acidity gastroesophageal reflux 17 patients severe moderate esophagitis treatment 300 mg ranitidine twice daily 20 mg omeprazole daily three ph studies performed , cross design , 8 days treatment omeprazole ranitidine drugs significantly reduced intragastric acidity \( p less 0 001 \) night day hours median hourly 24 h intragastric ph 1 8 basal study , 2 9 ranitidine , 3 4 omeprazole intragastric acidity fell 84 0 mmol l basal study 14 2 mmol l \( 79 inhibition \) ranitidine 9 3 mmol l \( 84 inhibition \) omeprazole patients esophagitis significantly exposed acid healthy subjects , supine upright position \( p less 0 01 \) time esophageal ph less 4 dropped 23 9 basal study 8 5 ranitidine 7 2 omeprazole \( p less 0 001 \) drugs significantly reduced esophageal exposure acid supine upright positions \( p less 0 001 \) , whereas neither effect esophageal acid clearance
esophageal 24 h ph monitoring prior manometry necessary correct positioning electrode \? 24 h esophageal ph monitoring , electrode usually positioned 5 cm localized esophagogastric junction order replace esophageal manometry purpose , tested whether esophagogastric junction identified correctly fluoroscopy determination ph step stomach esophagus , compared esophageal manometry distance nares esophagogastric junction determined three times three methods 46 patients 14 volunteers fluoroscopy assumed esophagogastric junction 1 23 0 23 cm \( mean se \) lower peak pressure point determined manometry , ph step 0 45 0 16 cm ph step , one subject difference 3 cm defined esophagogastric junction , whether gastroesophageal reflux disease \( proven ph monitoring \) present conclude esophagogastric junction usually identified sufficient accuracy measurement ph step stomach esophagus fluoroscopy far less accurate ph step , used
oral dissolution therapy cholelithiasis mix match authors conducted prospective , randomized trial chenodeoxycholic ursodeoxycholic acid versus ursodeoxycholic acid alone patients cholelithiasis determine efficacy dissolution gallstones one hundred twenty patients radiolucent gallstones , less equal 15 mm functioning gallbladder enrolled patients divided two groups based diameter largest stones seventy patients stones larger 5 mm less 15 mm , whereas 50 patients stones measured 5 mm less patients randomly assigned treatment chenodeoxycholic acid plus ursodeoxycholic acid \( 5 mm kg \) ursodeoxycholic acid \( 10 mm kg \) alone oral cholecystography , plain abdominal x rays , ultrasonography gallbladder done 6 , 12 , 24 months dissolution deemed complete stones visualized two examinations partial dissolution defined 50 reduction stone size number stones detected cholecystography still detected ultrasonography considered partially dissolved plasma triglycerides , serum cholesterol , hdl , serologic liver function tests determined 1 , 3 , 6 , 12 , 18 , 24 months select group patients , bile rich duodenal aspirates aspirated analyzed biliary lipid contents group small stones , defined less equal 5 mm , complete stone dissolution occurred significantly often utilizing combination therapy 6 months \( 52 vs 24 \) , trend persisted , although longer significant , 12 24 months combination therapy also achieved improved rate dissolution large stones within 6 months however , persist 12 24 months although statistically significant , stone calcification occurred less often combined therapy treatment regimens well tolerated , minor changes bowel habits mild elevations serum transaminase levels serum lipid levels change either therapy authors concluded combination chenodeoxycholic acid ursodeoxycholic acid preferred therapy gallstone dissolution , stones rapidly , lower incidence stone calcifications , thus might reduce long term cost treatment
outpatient laparoscopic laser cholecystectomy laparoscopic laser cholecystectomy performed clinically united states since 1988 refinement technique , procedure offered outpatient basis eighty three patients underwent laparoscopic laser cholecystectomy study period thirty seven \( 45 \) procedure outpatient younger patients suited outpatient procedure without previous surgery likely procedure done outpatient weight , operating time , gallbladder pathology similar , although patients acute inflammation gallbladder likely require hospitalization primary reason patient admission patient preference
rectal prolapse infants children rectal prolapse intractable usual medical therapy successfully managed without significant complications 10 patients simple subcutaneous heavy nonabsorbable suture , place suture removed 4 6 months four patients required two sutures one needed third insertion since procedure simple , serious complications , controls rectal prolapse , recommended preferred initial surgical treatment condition
prevention pancreatic fistula modified anastomosis major cause morbidity leakage anastomosis prevent complication , employed mucosal stripping proximal jejunum prior end end anastomosis 19 patients good results
sexual physical abuse women functional organic gastrointestinal disorders study objectives determine prevalence history sexual physical abuse women seen referral based gastroenterology practice , determine whether patients functional gastrointestinal disorders report greater frequencies abuse patients organic gastrointestinal diseases , determine whether history abuse associated symptom reporting health care utilization design consecutive sample women seen university based gastroenterology practice 2 month period asked complete brief questionnaire measurements self administered questionnaire requested information demographics , symptoms , health care utilization , history abuse physicians indicated primary diagnosis patient whether ever discussed sexually physically abused results 206 patients , 89 \( 44 \) reported history sexual physical abuse childhood later life 1 physically abused patients sexually abused almost one third abused patients never discussed experiences 17 informed doctors patients functional disorders likely organic disease diagnoses report history forced intercourse \( odds ratio , 2 08 95 ci , 1 03 4 21 \) frequent physical abuse \( odds ratio , 11 39 ci , 2 22 58 48 \) , chronic recurrent abdominal pain \( odds ratio , 2 06 ci , 1 03 4 12 \) , lifetime surgeries \( 2 7 compared 2 0 surgeries p less 0 03 \) abused patients likely nonabused patients report pelvic pain \( odds ratio , 4 05 ci , 1 41 11 69 \) , multiple somatic symptoms \( 7 1 compared 5 8 symptoms p less 0 001 \) , lifetime surgeries \( 2 8 compared 2 0 surgeries p less 0 01 \) conclusions found history sexual physical abuse frequent , yet hidden , experience women seen referral based gastroenterology practice particularly common functional gastrointestinal disorders history abuse , regardless diagnosis , associated greater risk symptom reporting lifetime surgeries
preoperative congenital diaphragmatic hernia january 1983 november 1986 , 26 newborn infants congenital diaphragmatic hernia treated early operation mean 7 hours age 23 infants admitted december 1986 december 1989 mean period 40 hours operation significant difference survival two groups delayed operation detrimental infants congenital diaphragmatic hernia
origin evolution j published innovative operation treating difficult problem hiatal hernia , esophagitis , stricture design operation based relatively primitive understanding hiatal hernia newly emerging concept reflux esophagitis variety operations different surgeons emerged years follow original subsequently modified addition partial complete fundoplication procedures place modified fundoplication operations today 's approach problems hiatal hernia gastroesophageal reflux disease remains
combined electromyographic investigation patients defecation disorders records 20 patients electromyography performed simultaneously defecation disorders analyzed according electromyographic investigation , patients could divided three main groups 1 \) normal sphincter reaction 2 \) paradoxical sphincter reaction 3 \) combined reaction group characterized marked reduction muscular activity emptying pronounced closing reflex emptying followed return normal tonic activity patients group b relaxation sphincters emptying pronounced increased activity external sphincter muscle also severe emptying difficulties closing reflex seen group c electrical activity sphincters increased moderate straining emptying complete clear closing reflex seen study , dynamic visualization defecation together registration electromyographic activity anal sphincters performed shown patients paradoxical sphincter reaction lacking closing reflex emptying complete reported previously important evidence paradoxical defecation pattern also shown patients paradoxical sphincter reaction
extracellular matrix gene expression increases preferentially rat lipocytes sinusoidal endothelial cells hepatic fibrosis vivo whether parenchymal nonparenchymal liver cells play predominant role pathophysiology hepatic fibrosis firmly established vivo addressed question relative abundance specific mrnas collagen types , iii , iv , laminin purified populations hepatocytes , sinusoidal endothelial cells , lipocytes normal fibrotic rat liver normal liver , type collagen gene expression minimal cell types mrna types iii iv collagen apparent endothelial cells lipocytes , hepatocytes laminin mrna present cell types induction fibrogenesis either bile duct ligation carbon administration associated substantial increase mrna types iii collagen nonparenchymal cells lipocytes fibrotic animals exhibited greater 30 fold increase type collagen mrna relative normal lipocytes , greater 40 fold relative hepatocytes type iii collagen mrna reached 5 times normal lipocytes greater 120 times hepatocytes endothelial cells exhibited isolated increase type collagen mrna , reaching five times normal liver type iv collagen laminin gene expression significantly increased nonparenchymal cells fibrogenesis fact , mrna type iv collagen laminin decreased 50 endothelial cells despite pronounced changes occurred matrix gene expression nonparenchymal cells fibrogenesis , change noted hepatocytes conclude nonparenchymal liver cells , particularly lipocytes , important hepatic fibrosis vivo
pharmacology pravadoline new analgesic agent pravadoline new chemical entity analgesic activity humans report describes pharmacology pravadoline compares activity pravadoline two major classes analgesics , opioids nonsteroidal anti inflammatory drugs \( nsaids \) like nsaids , pravadoline inhibited synthesis prostaglandins \( \) mouse brain vitro \( ic50 , 4 9 microm \) ex vivo \( ed50 , 20 mg kg p \) displayed antinociceptive activity subjected variety chemical , thermal mechanical nociceptive stimuli administration pravadoline prevented response induced p administration acetylcholine \( ed50 , 41 mg kg p \) pge2 \( ed50 , 24 mg kg p \) prolonged response latency induced tail immersion hot water temperature 55 degrees c \( minimum effective dose , 100 mg kg c \) rat , treatment pravadoline prevented acetic acid induced \( ed50 , 15 mg kg p \) , 's yeast induced \( test \) \( minimum effective dose , 1 mg kg p \) , nociceptive response induced paw flexion adjuvant arthritic rat \( ed50 , 41 mg kg p \) bradykinin induced head flexion \( ed50 , 78 mg kg , p \) antinociceptive activity pravadoline cannot explained opioid mechanism , pravadoline induced antinociception antagonized naloxone \( 1 mg kg c \) pravadoline bind opioid receptors concentrations 10 microm however , like opioid analgesics , pravadoline diminished electrically induced twitch response mouse vas deferens preparations , , contrast opioids , action pravadoline attenuated naloxone possibility discussed effect pravadoline upon isolated tissues may contribute antinociceptive activity contrast nsaids , pravadoline potent ex vivo inhibitor formation brain vs stomach addition , pravadoline failed produce gastrointestinal lesions administered p rats mice , possess significant anti inflammatory activity antinociceptive doses also unlike nsaids , pravadoline inhibited rat gastrointestinal transit administered doses similar antinociceptive overall pharmacologic profile pravadoline suggests compound may capable managing diverse severe pain achieved anti inflammatory analgesics , without producing side effects commonly associated either opioid analgesics
effect leukotriene b4 receptor antagonist sc 41930 colonic inflammation rat , guinea pig rabbit inflammatory bowel disease chronic inflammatory disorder gastrointestinal tract includes ulcerative colitis crohn 's disease leukotriene b4 thought prominent proinflammatory mediator diseases , leukotriene b4 levels increased colonic mucosa inflammatory bowel disease patients increased polymorphonuclear leukocyte infiltration tissues evaluated efficacy 7 3 \( 4 acetyl 3 methoxy 2 \) 3 , 4 8 1 2 acid \( sc 41930 \) , potent , orally active leukotriene b4 receptor antagonist , model inflammatory bowel disease colonic mucosal inflammation induced rats , guinea pig rabbits rectal instillation dilute solution acetic acid twenty four hours later , mucosal levels myeloperoxidase \( marker enzyme neutrophil infiltration \) extravasation v administered evans blue dye \( marker vascular disruption increased permeability \) measured tissues also evaluated histologically animals received either sc 41930 vehicle , , 30 min 1 hr 1 hr acetic acid given 30 min acetic acid instillation sc 41930 prevented rise myeloperoxidase dye extravasation observed acetic acid tissue sc 41930 treated tissues less fewer neutrophils within subepithelial space median effective dose \( ed50 \) values vascular protection approximately 20 mg kg rat guinea pig ed50 values inhibition granulocyte accumulation 20 mg kg rat , 24 mg kg guinea pig 30 mg kg rabbit data indicate sc 41930 effective locally prevent acute colonic inflammation
feasibility digital imaging evaluation patients acute right upper quadrant abdominal pain assess utility commercially available digital system evaluating patients acute pain right upper quadrant , hard copy images 100 examinations \( 50 hepatobiliary 50 sonograms right upper quadrant \) digitized , transmitted via standard telephone lines , viewed video monitor video hard copy interpretations compared degree concordance scintigraphic studies , hard copy video images equal demonstrating gallbladder bile duct activity video images failed presence bowel activity one case gallstones depicted equally well hard copy video sonographic images video overestimated presence abnormal hepatic parenchyma overlooked one case right hydronephrosis video interpretations sonograms showed overall error rate 4 , comparable rate obtained radiographs interpreted digital systems
extracorporeal without oral one hundred thirty six patients completed extracorporeal biliary lithotripsy \( ebl \) symptomatic sonographic evidence complete clearance stone fragments criterion treatment success , occurred 32 71 patients \( 45 \) followed 24 weeks 36 59 patients \( 61 \) followed 52 weeks authors' protocol varied protocols researchers primarily adjuvant used however , number treatment sessions total number shock waves \( maximum 4 , 000 shock waves per treatment session , 12 , 000 shock waves patient demonstrating significant fragmentation , 20 , 000 shock waves patient whose stones responded well fragmentation \) higher reports results treatment complication rates study comparable centers using shock wave lithotripsy chemotherapy authors conclude ebl developing important alternative surgery , patients complete clearance fragments gallbladder
azygos vein cannulation cirrhotic patients mistaken cannulation mammary vein azygos venous flow measured thermodilution catheter patients cirrhosis useful technique since azygos flow thought reflect superior portosystemic collateral flow patients authors report 3 cases mistaken internal mammary vein cannulation mimicked azygos vein cannulation supine fluoroscopic view lateral fluoroscopic view confirmed internal mammary cannulation suggest azygos arch flow measurements unexpectedly low patients portal hypertension due cirrhosis , lateral view performed rule internal mammary vein cannulation
calcium calcium binding human gallstone disease precipitation calcium salts bile important pigment gallstone formation may serve cholesterol precipitation compared gallbladder bile patients symptomatic gallstone disease \( 40 cholesterol gallstones 12 pigment gallstones \) bile 10 patients undergoing surgery non biliary tract disease bile patients gallstone disease less concentrated , decreased sodium , bile salt , phospholipid concentrations , elevated biliary calcium concentrations observed relationship free ionized calcium total calcium similar groups , indicating difference calcium binding gallstone containing bile cannot exclude elevated biliary calcium level factor gallstone pathogenesis , could transient event importance calcium precipitation supported finding half samples saturated supersaturated least one calcium salt , calcium carbonate
geographic variation inflammatory bowel disease within united states one approach learn possible environmental risks inflammatory bowel disease relates studying geographic pattern occurrence geographic variation inflammatory bowel disease within united states analyzed using accumulated 17 5 million hospital discharges u medicare beneficiaries two consecutive years validate geographic pattern shown medicare data , hospitalization compared mortality inflammatory bowel disease among different states mortality hospitalization statistics suggested occurrence inflammatory bowel disease determined environmental factors marked geographic variation within united states crohn 's disease ulcerative colitis appeared frequent northern parts united states southern urban rural parts trends observed men women blacks whites alike similar geographic patterns crohn 's disease ulcerative colitis suggested influence one identical risk factors diseases
expression leukocyte adhesion molecules mucosal mononuclear phagocytes inflammatory bowel disease leukocyte adhesion molecules important cell cell interactions immune system lymphocyte function associated antigen 1 \( cluster designation \) mediates interactions cells mononuclear phagocytes ligand , intercellular adhesion molecule 1 \( \) , whereas complement receptors 3 \( cd \) 4 \( \) involved complement mediated phagocytosis expression molecules intercellular adhesion molecule 1 studied colonic biopsy specimens 20 patients inflammatory bowel disease 10 normal controls normal colon , mononuclear phagocytes expressed lymphocyte function associated antigen 1 intercellular adhesion molecule 1 high densities major adhesion molecule thus , largest population normal colonic mononuclear phagocytes represented quiescent , resident macrophages likely phagocytic function inflammatory bowel disease , mononuclear phagocytes showed slight increase expression significant change expression contrast , percentage mononuclear phagocytes expressing intercellular adhesion molecule 1 increased 6 9 3 9 controls 69 2 12 8 ulcerative colitis \( p less 0 001 \) 45 7 22 8 crohn 's disease \( p less 0 01 \) , showing close relationship histological activity increased expression intercellular adhesion molecule 1 inflammatory bowel disease indicates state immunological activation induced local release inflammatory cytokines induction intercellular adhesion molecule 1 mononuclear phagocytes may important maintenance chronic inflammation facilitating interactions cells cell antigen recognition
effects short term pancreatic duct obstruction rats short term effects rat pancreatic duct obstruction evaluated compared recently reported follow obstruction rabbit pancreatic duct species pancreatic edema noted , lysosomal cathepsin b enriched granule enriched subcellular fraction theoretically , redistribution phenomenon might lead digestive enzyme activation cathepsin b known capable activating pancreatic edema \( cathepsin b redistribution \) follow rat pancreatic duct obstruction increased infusion stimulating dose cholecystokinin analogue administration cholecystokinin receptor antagonist l 364 , reduced alter pancreatic edema cathepsin b redistribution observations indicate cholecystokinin may modulate effects duct obstruction secretin administration increased degree pancreatic edema demonstrable protective effect rat duct obstruction model described report may prove particularly useful future studies designed clarify early events underlying development acute pancreatitis
physicochemical determinants vitro shock wave biliary lithotripsy human gallstones studied visual inspection , computerized tomographic imaging , chemical analysis assess physicochemical characteristics may determine outcome vitro shock wave fragmentation eighty five stones \( mean diameter 13 2 5 mm \) collected different patients fifty five \( 65 \) calculi angular 30 \( 35 \) round oval shaped three easily obtained measures derived stone 's optimal computerized tomographic image including mean stone density , measure corresponding standard deviation mean stone density value termed stone density distribution index may reflect physicochemical heterogeneity given gallstone , well density range administration 2500 shock waves using electrohydraulic generator , fragmentation noted 68 calculi \( 80 \) satisfactory 27 \( 32 \) \( largest resulting fragment diameters less equal 5 mm \) strong determinants satisfactory fragmentation multivariate analysis included stone diameter less equal 15 mm , presence angular stone shape , stone density distribution index greater equal 60 units parameters independently determine satisfactory fragmentation prospective clinical trials needed assess whether findings result better prediction success extracorporeal biliary lithotripsy indications
intrahepatic cholesterol stones rationale dissolution therapy case primary cholesterol hepatolithiasis reported stone composition documented infrared spectroscopy , presence cholesterol saturated bile demonstrated using standard biochemical techniques patient treated operative stone extraction , , biliary enteric anastomosis , oral dissolution therapy administration oral dissolution agents altered composition patient 's bile may prevent stone formation advocate use stone biliary biochemical analysis patients primary hepatolithiasis facilitate optimal therapy
insulin resistance idiopathic portal hypertension explore pathogenesis glucose intolerance insulin resistance observed patients cirrhosis portal hypertension , studied 35 year old woman portal hypertension without cirrhosis due nodular regenerative hyperplasia liver oral glucose ingestion , glucose tolerance remained normal however , occurred expense markedly hyperinsulinemic plasma response , suggesting presence insulin resistance examine question directly , performed stepwise euglycemic insulin clamp study combination infusion 6 3h glucose 1 14c palmitate indirect calorimetry ability insulin promote total body \( primarily muscle \) glucose uptake markedly impaired , whereas effect suppress hepatic glucose production normal compared results obtained nine healthy subjects moreover , insulin failed normally suppress plasma free fatty acid turnover oxidation patient informative case demonstrates portal hypertension alone , without hepatic dysfunction cirrhosis , associated impaired insulin mediated glucose plasma free fatty acid metabolism may also play predominant role development insulin resistance many cirrhotic patients
airway responsiveness inhaled methacholine patients irritable bowel syndrome examined whether patients irritable bowel syndrome increased airway responsiveness measuring forced expiratory volumes 1 second \( fev1 \) inhalation increasing concentrations methacholine responses obtained 11 ibs patients compared obtained 11 normal subjects 11 subjects organic disease gut related organs subjects selected factors might contribute increased airway responsiveness excluded methacholine concentration caused 20 fall fev1 \( pc20 \) , well reduction fev1 induced methacholine concentration , used assess airway responsiveness geometric mean pc20 197 6 mg ml \( sem , 1 15 \) normal subjects , 83 9 mg ml \( sem , 1 51 \) subjects organic bowel disease \( p 0 012 \) , 12 8 mg ml \( sem , 1 74 \) ibs patients \( p less 0 0001 \) 22 5 2 5 decrease fev1 induced 64 mg ml methacholine ibs patients significantly greater 12 3 1 5 observed healthy subjects \( p 0 003 \) contrast , 15 7 2 0 decrease fev1 observed patients organic disease different seen normal subjects \( p 0 189 \) conclude ibs associated increased airway responsiveness following challenge methacholine
pathogenesis therapy peptic ulcer disease epithelial cells stomach duodenum normally protected damaging effects acid pepsin mechanism mucosal resistance imbalance occurs , peptic ulcer may result traditional teaching emphasized importance acid \( pepsin \) cause imbalance however , clear acid pepsin important factors pathogenesis peptic ulcer recent investigative efforts directed constitutes mucosal resistance disrupted produce , presence gastric acid , peptic ulcer depletion endogenous prostaglandins helicobacter pylori gastritis emerged prominent theories evidence exists support theories humans , definitive conclusions cannot made time acute management peptic ulcer disease directed relieving pain , accelerating ulcer healing , preventing complications peptic ulcers healed antisecretory agents \( e , h2 receptor antagonists , omeprazole \) , antacids , prostaglandins , sucralfate effective , safe , convenient , h2 receptor antagonists widely used agents management peptic ulcer disease h2 receptor antagonist agents equally effective indicated uses equally safe based scientifically valid data , selection based primarily cost omeprazole antisecretory agent single morning dose 20 mg suppresses acid secretion 24 h agent offers little advantage h2 receptor antagonists majority patients peptic ulcer
nsaid induced gastrointestinal damage critical review prophylaxis therapy nonsteroidal anti inflammatory drugs \( nsaids \) cause acute diffuse injury gastroduodenal mucosa , also cause chronic focal ulcers may without warning symptoms acute chronic lesions distinct , different , respond differently drugs , require different management strategies principal rationale antiulcer therapy nsaid users prevent reduce potentially fatal outcomes date evaluated drug meets criterion efficacy antacids h2 receptor antagonists , based open uncontrolled studies , appear heal gastric duodenal ulcers , maintain healed continued nsaid use larger gastric ulcers show delayed healing conventional doses h2 receptor antagonists nsaid therapy delay occurs omeprazole therapy suggests nsaid associated gastric ulcers treated h2 receptor antagonists , larger doses given longer periods patients pre existing ulcer disease , h2 receptor antagonists given prophylactically prevent duodenal gastric ulcers sucralfate individuals without peptic ulcer disease taking nsaids , , given prophylaxis , reduces development gastric ulcers beneficial effects ulcer healing symptoms continued nsaid therapy , ability prevent duodenal ulcers ulcer complications , established diarrhea , 400 micrograms day dosage recommended , especially elderly
gastroesophageal reflux disease update management gastroesophageal reflux humans experience many patients , gastroesophageal reflux disease \( gerd \) condition others , gerd progress severe symptoms , inflammation , disruption mucosal lining effective therapy calls clear understanding pathogenesis gerd final common gerd lower esophageal sphincter mechanism allows gastroesophageal reflux occur key factors associated gerd \( \) gastric content , \( b \) potency , \( c \) esophageal clearance , \( \) tissue resistance , \( e \) disruption anatomic gerd generally chronic condition characterized recurrent symptoms treatment goals gerd patient need defined therapy directed toward eliminating symptoms therapy designed eliminate gastroesophageal reflux \? unfortunately , effective therapy gerd usually affect mechanism \( \) underlying problem broad goals therapy gerd decrease gastroesophageal reflux neutralize , enhance esophageal clearance , protect esophageal mucosa therapeutic modalities related situations numerous overlap , treatment strategies managing gerd patient used clinical stages clinical situation h2 receptor antagonist therapy become management gerd unfortunately , gerd patients respond conventional h2 receptor antagonist dosage treatment high dose h2 receptor antagonist therapy recently demonstrated effective greater number gerd patients severe esophagitis
safety concerns available ulcer treatment influence drug selection \? identification parietal cell receptors gastric acid secretion coupled introduction cimetidine 1977 , treatment acid peptic diseases transformed empiric therapy approach based understanding human physiology today , physicians array antiulcer agents differ within drug class \( e g , h2 receptor antagonists \) well mechanisms action \( e g , neutralize acid , alter mucosal factors , suppress acid secretion \) minor exceptions , clinical efficacy available antiulcer drugs regarded comparable thus , safety profile becomes next consideration choosing among similarly effective drug products available antiulcer agents , h2 receptor antagonists class excellent safety profile , indicated 25 years cumulative clinical experience postmarketing surveillance important safety issues currently available antiulcer drugs , e , h2 receptor antagonists , sucralfate , prostaglandin e analogues , antiulcer agent , omeprazole , reviewed place perspective clinician
clinical importance drug interactions antiulcer therapy overall safety given drug determined toxicity , side effects , drug drug interactions thus , clarification mechanisms , importance , clinical implications drug drug interaction antiulcer therapy critical use antiulcer medications drug drug interactions may occur result changes absorption , metabolism , distribution , excretion fortunately , drug distribution protein binding unchanged antiulcer therapy antiulcer drugs may affect absorption several mechanisms ionized medications may bind antacids sucralfate result poorly absorbed complexes reduced gastric acid may decrease absorption medications weak bases enhancing absorption weak acids drug absorption may impaired delayed gastric emptying several h2 receptor antagonists , including cimetidine lesser extent ranitidine , proton pump inhibitor , omeprazole , may reduce hepatic degradation drugs metabolized cytochrome system degree agents alter drug metabolism determined patient 's age , genetics , duration therapy , degree cytochrome binding , regimen clinical importance interaction cannot always predicted , caution recommended whenever drugs metabolized system used concurrently development understanding ways drug metabolism interactions occur may lead effective safe use medications
requirement endogenous tumor necrosis factor cachectin recovery experimental peritonitis immunization raised rat mab \( mab v1q , kappa \) potent neutralizing activity natural mouse tnf \( 1 microgram ml mab v1q 100 u ml tnf \) mab v1q used study role endogenous tnf experimental peritonitis induced sublethal cecal ligation puncture mab v1q persisted 5 days serum mice injected 100 micrograms antibody , therefore , proved useful vivo experiments little 20 micrograms mab v1q mouse prevented lethal shock animals 400 micrograms lps mouse sublethal cecal ligation puncture p injection mab v1q directly 8 h induction experimental peritonitis lead death animals within 1 3 days lethal effect mab v1q compensated injection recombinant mouse tnf similar mab v1q effects immunocompetent mice shown severe combined immune deficiency mice deficient mature functional b cells taken together , data suggest early phase peritonitis endogenous tnf may stimulate cells granulocytes , macrophages , platelets , fibroblasts bacteria localize inflammation , respectively beneficial effects tnf may determine survival thus , data may implications therapeutic management beginning peritonitis
pathogenesis gallstones many developments nonoperative methods treatment gallstone disease importance understanding pathogenesis stones elucidation factors responsible nucleation crystals mechanism occurs would appear challenge define cascade events results gallstone formation
gallstone dissolution many methods available gallstone dissolution , including oral bile salts cholesterol methyl tert butyl either calcium pigment edta approaches appropriate individual patient depends type stones whether gallbladder bile ducts whether access biliary tree available patient 's age general medical condition availability necessary expertise us , available expensive appears produce fewer side effects may efficacious agents effective thin women small floating , radiolucent cholesterol stones functioning gallbladder half small subset patients experience partial complete dissolution stones within year stone recurrence potential toxicity long term therapy problems approach therefore , patients , cholecystectomy , either traditional fashion using laparoscopic approach \( see article later issue et al \) , cost effective perhaps option instillation methyl tert butyl ether probably applicable small subset patients , treatment likely followed high recurrence rate patients retained common duct cholesterol stones access biliary tree , therapy advantageous initiated soon cholangiography demonstrates extravasation properly selected patients , 90 success rate technique expected within 7 days
extracorporeal shock wave lithotripsy biliary stones extracorporeal shock wave lithotripsy noninvasive technique treatment patients gallbladder bile duct stones selected patients gallbladder stones treated outpatient basis without general anesthesia may return full activity within 1 2 days stone free rates 40 60 6 months achieved reported series minimal morbidity bile duct stone lithotripsy achieved stone clearance 80 patients conventional methods unsuccessful therefore constitutes valuable second line treatment patients
nonoperative management bile duct stones treatment choice retained bile duct stones nonoperative means tube place , percutaneous techniques via tract indicated percutaneous access via puncture roux en loop also practical absence tube , retrograde endoscopic techniques used techniques effective safe stones intrahepatic extrahepatic ducts also treated nonoperatively endoscopic sphincterotomy role treatment selected patients gallstone pancreatitis , acute cholangitis , situ gallbladders difficult cases , endoscopic percutaneous techniques employed combination
surgical management bile duct stones biliary surgeon 1990s must familiar available techniques treatment bile duct stones experience judgment important successful management individual patient intrahepatic extrahepatic stones knowledge nonsurgical methods stone removal important decision making process however , biliary surgeon must resist less thorough removal stones operation patient subjected additional procedures , carry risks morbidity death goal clear stones biliary system fewest procedures offering lowest morbidity mortality risks patient
primary sclerosing cholangitis primary sclerosing cholangitis rare disease unknown etiology sclerosis bile ducts may actually final result multiple factors autoimmune , bacterial , congenital , drug , viral injury commonly associated diseases ulcerative colitis chronic pancreatitis except earliest stages disease , liver histologic findings specific patients present jaundice , pain , pruritus , although increasing number asymptomatic patients inflammatory bowel disease abnormal liver function identified cholangiography key diagnosis usually except unusual case primary sclerosing cholangitis confused cholangiocarcinoma many forms medical therapy tried , including antibiotics , azathioprine , cholestyramine , colchicine , cyclosporine , penicillamine , steroids , ursodeoxycholic acid date , none medications proved alter course disease recent reports ursodeoxycholic acid trials encouraging , long term results ongoing randomized trials yet published recent years , balloon dilatation biliary strictures accomplished via endoscopic percutaneous transhepatic approaches however , patients primary sclerosing cholangitis , nonoperative manipulations must done repeatedly , may multiple general anesthetics , difficult perform believe direct surgical approach biliary tree long term transhepatic stenting indicated selected patients severe extrahepatic , persistent jaundice recurrent cholangitis , evidence cirrhosis hepatic transplantation reserved patients primary sclerosing cholangitis well established cirrhosis responded therapeutic measures
carcinoma gallbladder gallbladder cancer remains difficult diagnose preoperatively however , recent work suggests ultrasound may effective gallbladder cancer remains highly lethal despite aggressive therapy extension disease beyond mucosa predicts poor chance long term survival
normal small bowel biopsy followed coeliac disease report four patients \( two children , one adolescent , one adult \) normal small bowel mucosa shown biopsy specimen taken initial diagnosis coeliac disease made first biopsy undertaken two cases suspected malabsorption , third suspected dermatitis herpetiformis , fourth part coeliac disease family study 2 6 9 years diet containing gluten , small bowel villous atrophy crypt hyperplasia compatible coeliac disease found second biopsy specimen hla type patients typical coeliac disease dr3 positive within families three patients coeliac disease diagnosed , two earlier one time first biopsy undertaken four hla dr3 positive first degree relatives found biopsies four normal small bowel villous architecture , one increased intraepithelial cell count , another positive reticulin antibodies coeliac disease may exist latent patients normal mucosa eating normal diet containing gluten
reproducibility 24 hour oesophageal ph studies infants thirteen infants undergone 24 hour oesophageal ph monitoring diagnose gastro oesophageal reflux second study carried see results reproducible studies done without restricting activities appreciable differences found , percentage total time ph less 4 varying 3 7 fold two tests differences largely result biological rather technical variability results estimates made reliability single diagnostic study size changes would necessary show effect treatment findings considerable impact diagnosis abnormal gastro oesophageal reflux response treatment whether using 24 hour ph monitoring method measurement
serial prothrombin time prognostic indicator paracetamol induced fulminant hepatic failure objective find whether changes daily prothrombin time prognostic importance patients paracetamol induced fulminant hepatic failure design retrospective study setting liver unit , king 's college hospital , london patients 150 consecutive patients paracetamol induced fulminant hepatic failure admitted october 1986 february 1989 main outcome measure death results 150 patients , 72 \( 48 \) died , 34 37 \( 92 \) patients peak prothrombin time greater equal 180 seconds died 20 41 \( 49 \) time 130 179 seconds , nine 25 \( 36 \) time 90 129 seconds , nine 47 \( 19 \) time less 90 seconds 42 patients continuing rise prothrombin time days 3 4 overdose , 39 died \( 93 \) compared 21 96 \( 22 \) prothrombin time fell conclusions data indicate continued increase prothrombin time day 4 overdose peak prothrombin time greater equal 180 seconds identify early stage patients less 8 chance survival liver transplantation considered patients meeting either criteria
disposition liver cirrhosis pharmacokinetics type diuretic studied patients liver cirrhosis ascites compared healthy control subjects oral administration 40 mg , diuretic rapidly distributed blood ascites ratio area concentration time curve \( auc \) plasma ascitic fluid 7 2 , protein content respective compartments auc plasma cirrhotic patients significantly greater control subjects \( p less 0 001 \) striking finding increase amount \( ae \) parent drug main metabolite excreted urine \( p less 0 001 \) renal clearance moderately reduced patients liver cirrhosis auc ae positively correlated plasma concentration direct bilirubin patients \( p less 0 05 \) concluded drug clearance patients liver cirrhosis reduced result blockade hepatobiliary excretion cholestatic conditions
esophageal motility adult congenital h type tracheoesophageal fistula congenital h type tracheoesophageal fistulas \( \) rare long standing respiratory symptoms common presenting complaints patients fistulas congenital esophageal motor abnormality characterized , low amplitude esophageal body low normal lower esophageal sphincter pressures described findings persist despite fistula repair case history adult patient congenital presented literature reviewed patient unusual esophageal symptoms \( dysphagia \) prominent usual respiratory symptoms
motility changes primary achalasia following pneumatic dilatation changes esophageal motility pneumatic dilatation evaluated prospectively 51 patients achalasia patients evaluated median 14 months pneumatic dilatation led clinical improvement 41 patients manometric evaluation , significant decrease lower esophageal sphincter pressure observed \( 28 4 14 9 mmhg vs 13 5 7 2 mmhg p 0 001 \) resting pressure esophageal body dropped 4 8 4 2 mmhg gastric baseline 0 1 3 9 mmhg gastric baseline therapy , peristaltic activity present 10 51 \( 20 \) patients 1 case , complete relaxation lower esophageal sphincter recorded treatment induced motility changes could predicted clinical history lower esophageal sphincter pressure therapy however , resting pressure esophageal body therapy significantly lower patients recurred therapy patients unchanged motility pattern peristaltic activity pneumatic dilatation unrelated lower esophageal sphincter pressure conclusion , motility disturbances esophageal body patients achalasia simply reflect functional obstruction lower esophageal sphincter findings support hypothesis achalasia distinct motility disturbance regarded part broad spectrum different interrelated esophageal motility disorders
breast feeding morbidity study used unique longitudinal survey 3000 mother infant pairs observed pregnancy infancy sample representative infants region philippines sequencing breast feeding morbidity events carefully examined longitudinal analysis allowed examination age specific effects feeding patterns work controlled wide range environmental causes diarrhea , results generalized populations confidence addition breast milk diet even water , , doubled tripled likelihood diarrhea supplementation breast feeding additional foods increased significantly risk diarrhea benefits breast feeding alone combination foods became small second half infancy benefits breast feeding slightly greater urban
high fat semielemental diet treatment protracted diarrhea infancy capacity greater fat absorption relative carbohydrate absorption protracted diarrhea infancy studied developed developing country \( , ny , , \) fifty patients protracted diarrhea first year life \( defined liquid stools 20 ml kg per day 14 day duration \) randomly assigned receive either standard semielemental diet \( \) high fat semielemental diet contained 40 fat increased fat largely form medium chain triglycerides , new diet providing 60 fat medium chain triglycerides compared 40 standard diet tolerance diets good studies groups showed adequate weight gain improvement anthropometric biochemical parameters patients receiving high fat diet showed initial weight loss , however , weight gain initiated earlier cumulative weight gain also higher group receiving high fat semielemental diet fecal fat analyses performed 1 week therapy difference observed coefficient fat absorption groups receiving two formulas , indicating infants protracted diarrhea may able tolerate higher fat intake normally provided carbohydrate intolerance known complicating factor using semielemental enteral infants protracted diarrhea , higher fat semielemental diet may appropriate way provide adequate caloric intake
incidence prevalence ulcerative colitis upper , northern israel , 1967 1986 epidemiological study ulcerative colitis performed upper , israel , 20 yr period \( 1967 1986 \) average annual incidence ulcerative colitis 2 23 per 100 , 000 population , prevalence december 31 , 1986 , 44 58 per 100 , 000 considering fact strict steps taken include definite cases , figures probably increase average annual incidence 0 88 period 1967 1976 3 79 1977 1986 found data stratified according ethnic groups , highest average annual incidence highest point prevalence found israeli born jews \( 6 9 138 2 per 100 , 000 population , respectively \) jewish residence patterns compared , highest average annual incidence point prevalence found among members \( 5 52 110 39 , respectively \) , lowest \( 1 94 38 76 \) among 10 arab patients average annual incidence 0 96 point prevalence 19 27 25 women 28 men \( female male ratio 0 89 \) among jews , female male ratio 1 04 peak incidence found 25 34 yr old range second peak noticed anemia demonstrated 66 6 women 27 5 men study suggest increase uc incidence prevalence israeli asia africa born upper points toward environmental factors etiology disease
failure hepatitis b immunization liver transplant recipients results prospective trial twenty patients advanced liver disease , need transplantation , given three injections 20 micrograms three injections 40 micrograms hepatitis b vaccine see antibody response could obtained 20 patients developed measurable anti one failed develop anti developed chronic hepatitis b exposure infected sexual partner type liver disease native liver , age , sex , sexual preference , timing immunization \( transplantation \) , dosage hepatitis b vaccine seem explain lack immunologic response hepatitis b vaccine presumed immunosuppression , underlying disease immunosuppressive medications , best explains findings liver transplantation patients infrequently benefit hepatitis b vaccine possible vaccines given prevent viral bacterial illness may also fail elicit immunologic response patients
increasing prevalence gallstones male veterans alcoholic cirrhosis cases alcoholic cirrhosis identified necropsy studied prevalence type gallstones , compared age race matched autopsy controls data examined 1970 1977 1980 1987 early sample 460 cirrhotic patients , 33 gallstone disease , contrasted 12 controls 1980s , among patients , 46 gallstone disease , whereas present 13 controls prevalence stones significantly greater patients controls time periods , among patients , significantly greater 1980s 1970s \( p less 0 05 \) comparison cirrhotic patients without gallstones indicated significantly higher incidence ascites patients gallstones gallstones cirrhotics frequently pigmented controls time periods 100 living patients advanced cirrhosis studied sonography 1987 1989 , prevalence gallstones 43 , almost autopsy sample 1980 1987 cirrhotics , ascites , encephalopathy , varices prevalent patients stones without conclude pigmented gallstones increasing cirrhosis liver related severity liver disease
plasma fatty acid profile advanced cirrhosis deficit lipid fractions fatty acid \( fa \) profile plasma total lipids , phospholipids \( pl \) , cholesteryl esters \( ce \) , triglycerides \( tg \) measured 101 patients advanced liver cirrhosis 44 age sex matched healthy controls plasma levels phosphorus , esterified cholesterol , tg also measured , index \( ui \) calculated fraction total plasma concentrations saturated fa , , polyunsaturated fa \( pufa \) lower cirrhotics controls profile also found plasma levels pl ce associated fa detectable amounts found cirrhotic patients percent fa distribution lipid fractions showed lower percentage pufa higher relative amount saturated fa cirrhotics controls consequence , ui pl ce diminished liver cirrhosis pufa deficiency marked ce pl , shown number patients values 5th percentile control group , suggesting attempt maintain pl important component cell membranes hepatic failure , poor essential fa intake , malnutrition possible etiologic factors pufa deficiency cirrhosis relative contribution plasma fa abnormalities , well clinical pathophysiological consequences pufa deficit cirrhotic patients , requires investigation
hemodynamic changes splenic blood flow distal splenorenal shunt purpose study examine hemodynamic changes spleen subsequent influence numbers blood cells 1 month distal splenorenal shunt \( \) 20 patients portal hypertension intraoperative splenic blood flow , measured electromagnetic , significantly increased shunt insertion mean percentage increases within splenic vein artery 60 \( p less 0 01 \) 37 \( p less 0 05 \) , respectively splenic venous blood flow , measured pulsed doppler , changed significantly 1 month postoperatively \( 501 540 306 ml min \) wbc platelet counts significantly \( p less 0 05 p less 0 01 , respectively \) increased 1 month postoperatively , whereas small , significant \( p less 0 05 \) , decrease rbc count concluded splenic blood flow increases immediately , increase may short term influence postoperative hemodynamic changes blood cell count uncertain
antibiotic use among children urban risk factor diarrhea \? published erratum appears j public health 1991 apr 81 \( 4 \) among cohort children poor urban setting brazil , relative risk occurrence new episode diarrhea two weeks following antibiotic use vs weeks 1 44 \( 95 confidence interval \( ci \) 1 33 , 2 45 \) among children ever corrected exposed antibiotics , odds ratio 1 34 \( 95 ci 0 84 , 2 16 \) individual child controlling previous diarrhea research needed confirm whether antibiotics risk factor diarrhea settings
free radical inhibition serial chemiluminescence evolving experimental pancreatitis oxygen free radical activity inhibition examined experimental pancreatitis twenty five rats randomized five groups controls received intravenous saline , simulate pancreatitis one group received intravenous caerulein \( 5 micrograms kg 1 h 1 \) , three groups received sodium taurocholate via pancreatic duct \( 0 2 ml , 5 per cent \) , either alone , following allopurinol immediately superoxide dismutase chemiluminescence \( phenomenon based emission light chemical reactions dependent oxygen free radical activity \) used index oxygen free radical activity measured tissue samples 5 min intervals following induction pancreatitis control mean \( e \) serum amylase level 1 h induction pancreatitis \( 13 \) units significantly elevated caerulein induced pancreatitis , \( 118 \) units \( p less 0 05 \) exceeded 3000 units taurocholate infused animals mean \( e \) chemiluminescence ranged 44 \( 8 \) mv 100 mg 1 time zero 404 \( 113 \) mv 100 mg 1 1 h controls caerulein induced pancreatitis mean \( e \) chemiluminescence peaked 20 min \( \( 239 \) mv 100 mg 1 , p less 0 02 \) taurocholate induced pancreatitis 15 min \( \( 95 \) mv 100 mg 1 , p less 0 004 \) superoxide dismutase significantly reduced chemiluminescence taurocholate groups increasing oxygen free radical activity paralleled evolving pancreatitis superoxide dismutase may therapeutic role pancreatitis
gallstone clearance randomized study extracorporeal shock wave lithotripsy chemical dissolution following extracorporeal shock wave lithotripsy known whether gallstone fragments cleared gallbladder without use oral dissolution therapy assess efficacy lithotripsy dissolution therapy , alone combination , 35 patients randomized one three treatment groups lithotripsy alone , dissolution therapy alone combined lithotripsy dissolution therapy patients symptomatic gallstones , functioning gallbladders comparable stone profiles lithotripsy administered using piezoelectric lithotripter dissolution therapy consisted combined bile acid clearance assessed 6 months using ultrasound oral cholecystography patients less 50 per cent stone clearance end 6 months considered failures number patients total partial clearance combined group \( 7 10 \) significantly greater lithotripsy alone group \( 0 10 , p less 0 002 \) gallstone clearance following lithotripsy appears dependent upon dissolution therapy
antimony glass ph electrodes used 24 hour studies gastric acidity antimony glass ph electrodes show almost identical experimental errors continuously measuring buffer solutions constant temperature 24 hr errors lower nominal error instruments properly described 24 hr determination addition food particles solutions induce severe reading artifacts longer response time reported vitro antimony electrodes moving ph 1 ph 7 \( 3 4 sec vs 0 8 sec glass electrodes \) irrelevant vivo ph studies , found greatest absolute difference raw fast acquired \( 4 6 sec \) consecutive ph readings two commonly used devices 0 7 ph units circadian profiles obtained 413 subjects various clinical conditions vivo studies , gastric acidity monitored continuously two side side , combined \( antimony glass , g antimony antimony a1 a2 glass glass , g1 g2 \) applied groups 27 subjects matched clinical condition 24 hr ph means 24 hr h means calculated acidity profiles obtained three electrode combinations , lie identity line group using technique assessing measurement agreement , differences 24 hr ph means 24 hr h means obtained three combined systems similar \( p p 0 , respectively \) 95 confidence limits comprised within range \( \) reading error measuring systems \( namely , 0 3 ph units 12 mmol liter terms h \)
cigarette smoking , gastric acidity peptic ulceration relationships \? influence cigarette smoking intragastric acidity assessed duodenal ulcer patients symptomatic remission healthy volunteers retrospective study continuous 24 hr ph recordings 150 nonsmokers 174 smokers receiving placebo treatment compared daytime intragastric acidity higher smokers median ph \( interquartile range \) 1 56 \( 1 34 1 80 \) nonsmokers , median ph 1 70 \( 1 45 1 97 \) \( p less 0 001 \) difference 24 hr nighttime median ph two groups small difference daytime intragastric acidity smokers nonsmokers unlikely account increased prevalence peptic ulcer disease smokers analysis smoking status duodenal ulcer patients healthy controls males females supports general trend towards higher daytime acidity smokers , differences ph 24 hr night period found groups epidemiological clinical correlation smoking duodenal ulcer disease adequately explained increased intragastric acidity
relation helicobacter pylori human gastric mucosa chronic gastritis antrum spatial relations bacteria affected tissues indicate pathogenic mechanisms study undertaken define spatial relation helicobacter pylori human gastric mucosa antibodies gastric mucus red used glycoprotein structure mucus antral biopsy specimens eight patients infected h pylori location organisms ultrastructural features assessed using systematic scanning transmission electron microscopy 92 \( 2 \) \( mean \( se h pylori pit mucus , 7 \( 3 \) surface mucus 60 \( 12 \) h pylori close epithelial cells , 5 \( 2 \) located near epithelial intercellular junctions fine filamentous extended organisms epithelial cells , organisms membrane membrane contact h pylori observed , beneath , within cells gastric mucosa preferred location h pylori gastric antrum within pit mucus close epithelial cell surface , evidence direct toxic effect mucosa
paf acether synthesis helicobacter pylori clinical studies suggest helicobacter pylori may play role pathogenesis gastroduodenal ulcers man direct evidence mucosal injury still lacking paf acether \( paf \) causes number disorders including ischaemic bowel necrosis gastroduodenal ulceration since paf produced escherichia coli , investigated whether could h pylori five h pylori isolates collected antral biopsy specimens patients gastritis duodenal ulcer cultured selective antibiotics colonies obtained blood agar brucella broth medium used paf determined platelet aggregation assay extraction subsequent purification high performance liquid chromatography paf detected h pylori blood agar plates \( \( 390 \) pg paf 1 x 10 \( 6 \) organisms \) bacteria cultured brucella broth medium supplementation latter medium paf acetyl coa , two paf precursors present high amounts mammalian intestine , induced paf production three five isolates platelet material extracted h pylori exhibited biological characteristics identical paf released eukaryotic cells findings suggest h pylori may add local production paf inflamed gastric mucosa
crohn 's disease city , 1951 85 epidemiological survey crohn 's disease city showed incidence condition increased 0 7 10 \( 5 \) per year 1951 1955 6 67 10 \( 5 \) per year 1981 1985 seemed reach plateau 1976 1985 large bowel crohn 's disease common patients presenting aged 60 79 years aged 20 39 years increase incidence solely due detection milder disease evidence asian \( indian \) population resistant development crohn 's disease
disposition 5 aminosalicylic acid olsalazine three preparations patients ulcerative colitis comparison intraluminal colonic concentrations , serum values , urinary excretion compare disposition 5 aminosalicylic acid \( 5 asa \) metabolite treatment olsalazine , 14 patients inactive ulcerative colitis randomly assigned olsalazine \( 1 g twice daily \) , \( 800 400 800 mg daily \) , \( 750 500 750 mg daily \) , \( 750 500 750 mg daily \) crossover design trial received drug seven days intraluminal colonic concentrations 5 asa estimated five days method equilibrium vivo dialysis serum sample 24 hour urine collection obtained day seven 5 asa acetyl 5 aminosalicylic acid \( ac 5 asa \) values determined high performance liquid chromatography olsalazine almost doubled colonic concentrations \( mean 23 7 \( sem \) \( 1 9 \) mmol l \) therapeutically active \( 5 asa \) compared equimolar doses \( 12 6 \( 2 2 \) mmol l p less 0 0003 \) \( 15 0 \( 2 0 \) mmol l p less 0 003 \) time , olsalazine treatment associated lower serum concentrations urinary excretions \( p less 0 05 \) 5 asa ac 5 asa compared preparations low systemic load 5 asa provided olsalazine reduces potential risk nephrotoxicity long term treatment
lipid peroxidation hepatic antioxidants alcoholic liver disease generation hepatic liver peroxidation free radicals proposed mechanism ethanol induced hepatotoxicity investigate hypothesis , lipid extracts hepatic needle biopsy specimens alcoholic subjects examined evidence lipid peroxidation measuring total conjugated dienes derivative spectroscopy , hydrolysis hepatic lipid extract reverse phase high performance liquid chromatography , molar ratio conjugated linoleic acid isomer \( 18 2 \( 9 , 11 \) \) parent linoleic acid isomer \( 18 2 \( 9 , 12 \) \) changes related hepatic histology , iron deposition , glutathione vitamin e values derivative spectroscopy suggestive identified 233 242 nm correlated weakly , suggesting two may represent different classes lipid dienes weak relation inflammatory histological changes biopsy specimen correlation hepatic iron grade , glutathione , vitamin e lipid ratio proportion 18 2 \( 9 , 11 \) linoleic acid hepatic lipids correlated significantly inflammatory histological features inversely hepatic glutathione furthermore , hepatic glutathione lower biopsy specimens greater iron staining ratio vitamin e lipid related histological group , inflammation , iron grade findings suggest excess alcohol consumption leads hepatic inflammation lipid peroxidation
monitoring enzyme replacement treatment exocrine pancreatic insufficiency using cholesteryl breath test cholesteryl 14c breath test used monitor intraluminal enzymatic activity preparations six patients severe pancreatic insufficiency conventional enzyme replacement , cimetidine adjunct , compared supplementation enteric coated microspheres healthy control subjects , 14co2 excretion rose rapidly peaked 90 120 minutes mean \( sd \) cumulative recovery four hours 51 \( 8 \) patients pancreatic insufficiency treatment mean \( sd \) cumulative recovery 6 \( 4 \) , previous administration cimetidine , increased 27 \( 11 \) time course resembling controls 2 mm enteric coated microspheres , 14co2 excretion rise significantly 120 minutes cumulative recovery four hours 15 \( 11 \) control study , 2 mm radio microspheres empty stomach two hours ingestion results suggest cholesteryl breath test successfully used monitor intraluminal enzymatic activity treatment different forms enzyme replacement pancreatic insufficiency contrast treatment conventional cimetidine adjunct , 2 mm enteric coated microspheres show vivo enzymatic activity two hours administration
salivary gland cancer case control investigation risk factors unlike upper tract cancers , salivary gland cancers relatively infrequent , characterized diversity histologic subtypes , never associated tobacco exposure present results case control study risk factors cancers , risk estimates derived self administered comprehensive risk factor questionnaires distributed patients university texas anderson cancer center , cases 64 patients histologically confirmed salivary gland cancer control subjects , randomly selected patient population excluding patients cancer head neck nonmelanoma skin cancer , frequency matched cases age , sex , ethnicity achieve 2 1 control subjects cases ratio multivariate analysis , prior radiotherapy significant risk factor men \( odds ratio 2 1 \) women \( 2 3 \) among women , higher educational attainment \( 2 4 \) , alcohol use \( 2 0 \) , use \( 2 5 \) also significantly associated risk significant differences cases control subjects respect tobacco exposure specific occupational leisure time exposures biological associations use alcohol exposure
diagnosing periodontal diseases present , diagnosis periodontal disease requires clinical evaluation patient including visual findings , use periodontal probe , radiographs test available evaluate disease activity specific cases , adjunctive procedures may also useful identification pathogenic microorganisms may aid evaluating periodontal status special patients however , required adequate diagnosis common adult form chronic periodontitis
reviewing nonsurgical periodontal therapy selection appropriate case clinical competency treatment modalities results success nonsurgical periodontal therapy patient early periodontitis significant local factors form accessible plaque calculus receptive nonsurgical periodontal treatment clinician must make decisions around important question , patient , moreover , therapist delivering debridement , gain access microbial plaque frequent basis host defense threshold respective patient \? answer yes , nonsurgical periodontal therapy answer , modalities periodontal surgery must instituted
surgical pocket reduction possible within scope paper describe detail aforementioned procedures found various clinical instead , objectives treatment , spectrum techniques available , rationale use described periodontal surgery performed certain conditions patient must physically mentally competent undergo type surgery , understand agree procedure postoperative management finally , periodontal surgery considered nonsurgical therapy accomplish desired result periodontal surgery pocket elimination performed selected defects properly evaluated debridement healing period , executed technical competence proper postoperative care , preserve dentition affected periodontal disease
using periodontal plastic surgery techniques 1980s , surgery evolved periodontal plastic surgery various techniques designed produce root coverage areas marginal tissue recession , augment deficient , cases excessive gingival display periodontal plastic surgery enables reconstruct also lost tissues
maintaining periodontal treatment dental maintenance , supportive periodontal treatment \( spt \) , keep peri implant tissues healthy active therapy patients comply suggested spt better keep teeth longer data gathered examinations , talking patients , reviewing personal oral sub gingival deposits removed average spt visit last 1 hour scheduled every 3 months supportive periodontal treatment patients advanced periodontal peri implant destruction responsibility
dental implants used periodontal patients performing implant treatment , continued research reports long term successful results essential evaluating validity implants , especially variables design surface treatment introduced dental profession clinical results implant treatment benefits patient however , patients undergo periodontal restorative treatment must continue regular long term routine maintenance therapy ensure dental health , must patients receive dental implants places implants prosthetic replacement must work deliver healthy restoration function many years
fractured maxillary first molar multidisciplinary treatment diagnosis treatment fractured maxillary first molar described case report 28 year old male successful treatment retained palatal root fractured molar , referred , ensued integration endodontic , , , fixed care
approach vertical root extrusion patient anterior open bite report case previous attempt locate root canal system maxillary left central created root defect level alveolar crest patient received root canal therapy next , vertical root extrusion chosen expose sound tooth structure apical defect could constructed anterior open bite , natural left intact possible position anchor bar lingual position , maintaining patient stabilization phases treatment
needle aspiration biopsy salivary gland lesions value needle aspiration biopsy evaluation management salivary gland pathology controversial major reasons controversy difficulty cytologic evaluation fact extent surgery easily defined based clinical judgement however , preoperative diagnosis helpful patients regarding extent type surgery apart fact needle biopsy distinguish benign malignant conditions , also useful distinguishing salivary pathology past 7 1 2 years , performed 160 needle parotid , submandibular , submucosal lesions adequate specimens cytologic evaluation obtained 155 patients \( 97 \) total 84 parotid lesions , 70 submandibular , 6 submucosal abnormalities detected cytologic diagnosis benign pathology made 120 patients twelve patients lymphoma diagnosis suspected based needle aspiration 10 patients tuberculosis 30 patients hyperplastic lymph nodes benign disease parotid three false positive two false negative reports complications hematoma , nerve injury , infection developed major difficulty distinguishing malignancy obstructive submandibular region needle aspiration helpful evaluating lesions tail parotid submandibular area cytologic distinction salivary pathology useful planning appropriate surgery extent surgical resection clinical standpoint , distinction benign malignant salivary pathology helpful preoperative diagnosis 's tumor , lymphoma , benign disease essential correct management patients
whole organ sectioning mixed parotid tumors pathologic study involving 15 standard formal specimens carried using whole organ sectioning technique histopathologic characteristics noted included presence exposed capsule , breaks capsule , capsular , tumor ingrowth thickness , cellularity , lymphocytic infiltration tracings histopathology slides used reconstruct three dimensional configuration tumor viewed different angles tumor smooth surface extreme , two tumor connected narrow waist separated tumors seen one specimen lymph node contain additional tumor form tumors showed exposed capsule area degree affected mainly position tumor capsular damage occasionally seen usually minor capsular tumor ingrowth make global capsular dissection concluded formal remains operation choice pleomorphic adenoma parotid gland , although capsular dissection \( otherwise termed enucleation \) cannot entirely avoided procedure
long term fate vascularized iliac crest bone graft mandibular reconstruction vascularized bone grafts , iliac crest , become major tool mandibular reconstruction due growing trend toward immediate bone replacement followed implant dental rehabilitation , understanding long term characteristics grafts essential early postoperative bone scans demonstrate increased activity within vascularized graft relative surrounding bone study addressed use bone spect \( single photon emission computed tomography \) scintigraphy long term method evaluating integrity vascularized bone grafts
repair salivary fistulae laryngectomy new surgical technique described repair salivary fistulae used three patients fistulae occurred laryngectomy unsuccessfully treated local regional flaps principle technique use jejunal patch free microvascular transfer one patch used reconstruction pharynx mucosa skin defect closed patch mucosa excised expose muscle create recipient site split skin graft
dental service requirements supplies epidemiologic demographic evidence negative interpretations recent trends , article presents positive picture dentistry 1990s century reported trends show large increases older dentate adults retaining natural dentition , new diagnosis treatment technologies , increased incidence dental older adults , increased awareness periodontal diseases , greater interest dentistry , generally higher expectations health fitness society factors point greater need adult dental services therefore , next 30 years , dental profession prepared provide increased amounts diagnostic , preventive , adult operative , fixed , endodontic services declines need expected children 's operative dentistry , , complete
prevalence periodontitis military treatment population group 1 , males females \( age range 13 84 \) military dental clinic given oral examinations full mouth circumferential periodontal diagnoses made individual entire mouth using clearly defined diagnostic criteria results showed 37 subjects , 33 early periodontitis , 14 moderate periodontitis , 15 advanced periodontitis , 0 5 juvenile periodontitis , 0 5 necrotizing prevalence periodontitis increased age peak 45 50 year age group proportion periodontitis affected , although initially behind overall case diagnoses , also increased age
general practice professional plaque control traditionally primary emphasis preventive daily patient performed plaque control recent studies indicate frequent professional mandatory treatment prevention recurrent periodontitis pathogenic bacterial complexes disrupted frequent cleaning require time disease progression prevented recall interval exceed time required pathogenic plaque , patients acquired duty comply prescribed recall interval patient practitioner benefit preventive program includes frequent professional
epithelial function replantation splinting necessary replantation \? problem resorption replantation relationship epithelial rests lack splinting studied ten mongrel dogs used two dogs served control subjects , eight mandibular incisors studied histologically observed rests present see resorption , lack splinting result resorption loss teeth appears stain epithelial rests immunofluorescent antibodies use technique study tissue
improved primary surgical dental treatment clefts improved combination surgical dental primary treatment clefts presented consistent principles fact , staged design correction classic clefts lip palate , based biological principles , facilitates failed embryonic toward normal end point positioning alveolar segments , dissection cleft , union across alveolar anterior hard palate cleft make possible create periosteal tunnel across bony gap set condition bone formation eventual tooth eruption cleft area lip closure adhesion reduces tension primary lip closure allows arch occurs thus complete cleft rendered incomplete cleft balanced , stabilized maxillary , definitive lip nose carried completion early \( 2 4 years age \) planned actions bypass persistent cleft , fistulas , raw areas , alveolar segments , probably necessity later bone grafting question totally answered effect approach final growth although reports seem indicate growth proceed within normal limits , another 10 years careful follow indicated , fact , progress
primary repair bilateral cleft lip nose 15 year review new treatment plan 15 years flap used reconstruction primary repair bilateral cleft lip nose adolescent growth , three unfavorable features become apparent \( 1 \) may grow long large , \( 2 \) often nasal tip remains broad , \( 3 \) base lip angle scar procedure therefore discontinued new treatment plan presented reconstructed tissues nasal tip
secondary correction unilateral cleft lip nose using composite graft secondary deformity unilateral cleft lip nose many components one dorsal dislocation lateral alar cartilage used composite graft positioned aperture lateral upper lateral cartilage correct dislocation nine patients believe graft effective lateral alar cartilage depressed aperture technique simple perform , easy achieve nasal results quite satisfactory , recurrence dorsal dislocation donor site covered subcutaneous pedicled flap sulcus , leaving deformity
activation cell subsets peripheral blood patients sjogren 's syndrome flow cytometric analysis using 3 color flow cytometry , determined proportions activated cells \( dr \) , including cd4 cells , cd8 cells , subsets , peripheral blood 17 patients sjogren 's syndrome \( ss \) activated cells significantly increased cd4 cells , cd8 cells , suppressor inducer \( cd4 , leu 8 \) , helper \( cd4 , leu 8 \) , cytotoxic \( cd8 , \) subsets , suppressor natural killer subset \( cd8 , \) , patients ss compared controls furthermore , proportions activated cells cd4 , leu 8 subset , cd8 subset , cd8 , subset showed positive correlation serum gamma globulin levels ss patients findings suggest certain immunoregulatory balance helper suppressor activities maintained ss patients , although balance seems occur highly activated levels , quantitative changes lymphocyte subsets important factors maintaining balance discuss possibility cd4 , leu 8 cells peripheral lymph nodes , cd4 , leu 8 cells migrate inflammatory tissues salivary glands , since leu 8 antigen reported homing receptor peripheral lymph nodes process might accelerated ss , cell subset may participate immunologic activation lymph nodes target tissues
parotid gland plain gadolinium enhanced mr imaging purpose study show typical appearance lesions parotid gland plain mr imaging mr imaging enhanced gadopentetate dimeglumine seventeen patients inflammatory changes 43 benign malignant tumors studied examinations carried plain t1 weighted sequences repetition time \( tr \) 500 msec echo time \( te \) 25 msec \( tr te 500 25 \) , t2 weighted sequences \( 1 , 600 90 \) , gadolinium enhanced t1 weighted sequences axial , coronal , sagittal identifying normal anatomic structures facial nerve main duct , administration gadopentetate dimeglumine helpful inflammatory changes , gadolinium enhanced images showed diagnostic advantages gadopentetate dimeglumine proved helpful lesions differentiating benign malignant lesions however , exact differentiation different histologic types possible post operative fibrosis could differentiated recurrent tumors administration gadolinium question regarding infiltration definition boundaries lesion cannot answered non enhanced mr imaging , gadopentetate dimeglumine administration advised however , routine imaging parotid gland , use recommended
histopathologic grading salivary gland neoplasms iii adenoid cystic carcinomas histopathologic grading adenoid cystic carcinomas provide valuable prognostic information , particularly presence absence solid growth architecture noted growth patterns , cribriform differentiation , associated protracted biologic course less rapid mortality three grading system based three growth patterns carcinoma presented
histologic study eustachian tube cartilage without congenital anomalies preliminary study investigated histopathologically development eustachian tube \( et \) cartilage cellular level individuals without congenital anomalies fourteen specimens obtained 14 individuals ranging age 24 weeks' gestation 3 years cleft palate trisomy 21 \( \) syndrome 49 specimens \( control \) group 49 individuals ranging 26 weeks' gestation 85 years age temporal bone specimens included et accessory structures , processed stained hematoxylin eosin histologic study routine manner number cartilage cells portion et determined light microscopy groups , cartilage cell density et decreased increasing age however , cell density tended higher ages individuals cleft palate versus controls , tended lower ages individuals syndrome
role herpes simplex virus development oral mucositis bone marrow transplant recipients herpes simplex virus \( hsv \) implicated major etiologic factor development ulcerative mucositis bone marrow transplant \( bmt \) recipients study , 60 patients received evaluated least 30 days post transplant ulcerative mucositis presence hsv fifty nine patients received prophylactic acyclovir forty six patients developed ulcerative lesions 45 culture negative hsv neither source transplant \( autologous versus \) hsv antibody status patient affected frequency mucositis conditioning regimen appeared significant factor contributing severity ulcerative mucositis majority ulcers occurred mucosa bmt recipients , usual sites reactivation intraoral hsv , mucosa conclude hsv probably major etiologic agent mucositis bmt recipients acyclovir effective agent preventing hsv reactivation
mapping epitopes la \( ss b \) autoantigen primary sjogren 's syndrome identification cross reactive epitope ribonucleoprotein la \( ss b \) identified using recombinant la \( ss b \) polypeptides sera 166 patients antinuclear autoantibody anti la \( ss b \) la \( ss b \) polypeptides encoded polymerase chain reaction derived overlapping fragments la \( ss b \) gene , encodes protein 408 amino acids \( aa \) 166 sera tested , 99 reacted fusion protein comprising first 107 n terminal aa \( \) 91 reacted fusion protein comprising aa 111 242 \( \) , 91 reacted fusion protein comprising aa 408 \( 3 \) c terminus la \( ss b \) order immunodominance assessed number sera reacting epitope strength reactivity \( aa 1 107 \) greater \( aa \) 111 242 \) much greater 3 \( aa 408 \) cross reactivity observed antibodies eluted \( aa 111 242 \) 3 \( aa 408 \) , significant primary sequence homology two regions region contained least two epitopes , one encompassing putative rna binding motif \( aa 112 187 \) recognized 83 patient sera serial serum samples three patients showed antibody response la \( ss b \) initially directed n terminus \( , aa 1 107 \) , period time three major epitopes , including encompassing putative rna binding motif , recognized result suggests primary immune response la \( ss b \) restricted immunodominant epitope specificity autoantibody response , includes rna binding motif , may important implications expression disease
detection human type retroviral particle antigenically related hiv sjogren 's syndrome autoimmune disease characterized mouth eyes loss salivary lacrimal gland function accompanied lymphocytic infiltration similar symptoms glandular pathology observed certain persons infected human immunodeficiency virus \( hiv \) , search initiated possible retroviral etiology syndrome human type retroviral particle antigenically related hiv detected lymphoblastoid cells exposed homogenates salivary tissue patients sjogren 's syndrome comparison retroviral particle hiv indicates distinguishable several ultrastructural , physical , enzymatic criteria
basis defective proliferation peripheral blood cells anti cd2 antibodies primary sjogren 's syndrome anti cd2 induced cell proliferation analyzed peripheral blood samples 31 primary 8 secondary untreated sjogren 's syndrome patients anti cd2 stimulated pbmc proliferation low one third primary sjogren 's syndrome samples , despite number cd2 cells similar primary secondary sjogren 's syndrome normal pbmc samples depressed response anti cd2 mainly found anti la patients experiments purified cells demonstrated defect cell level responsible anti cd2 unresponsiveness cell proliferation failure associated poor il 2 il 2 receptor mrna expression , consequently , il 2 il 2 receptor synthesis since defective anti cd2 induced mitogenesis could reversed phorbol myristate acetate , calcium ionophore a23187 , probably correlated impaired protein kinase c activation comparison anti cd2 triggered pbmc proliferation treated untreated patients long term study nine patients showed defect stable characteristic primary sjogren 's syndrome patients , reversed pharmacological immunosuppression
case studies review three cases presented , representative acute chronic presentations problem evaluation treatment salivary gland duct stones outlined primary , treat gland , stone , essential aspects emergency medical management antibiotics , , warm , mechanical stimulation , appropriate referral
pulmonary edema induced neutrophils protective effect monoclonal antibody phagocyte integrin studied changes pulmonary hemodynamics lung wet weight induced zymosan \( oz \) isolated guinea pig lungs perfused ringer albumin solution containing neutrophils \( pmns \) addition oz pmn perfused lungs caused pulmonary vasoconstriction weight gain neither oz pmns added individually perfusate altered pulmonary vasomotor tone wet weight steady gain lung weight 1 , mg 45 minute study period associated pulmonary capillary hypertension increase capillary filtration coefficient , indicative increased lung vascular permeability responses may due generation oxygen radicals , alterations pulmonary hemodynamics lung weight reduced addition superoxide dismutase , catalase , superoxide dismutase plus catalase examined basis pmn mediated effects layering pmns bovine pulmonary artery endothelial monolayers challenge oz resulted increased endothelial permeability 125i albumin monoclonal antibody \( directed , common beta subunit structurally related adhesion receptors phagocytes , lfa 1 , mac 1 , , 95 \) prevented oz mediated increase pmn adherence endothelial cells increase endothelial permeability 125i albumin also inhibited lung weight gain mediated oz stimulated pmns intact lungs protective effect could ascribed neither inhibition uptake oz pmns inhibition release oxygen radicals , myeloperoxidase , elastase
flow volume dependence respiratory system mechanics constant flow ventilation normal subjects adult respiratory distress syndrome seven control subjects seven patients adult respiratory distress syndrome \( ards \) artificially ventilated flow , volume , tracheal pressure monitored respiratory system resistance \( rrs , max \) homogeneous \( rrs , min \) \( rrs , u \) components respiratory system elastance \( ers \) also measured groups ers vary different inspiratory flows volumes , significantly higher ards increasing volume \( maneuvers \) , rrs , max rrs , u increased rrs , min remained unaltered ards control patients , however , resistances vary rrs , max rrs , u smaller rrs , min corresponding values ards hence , stress relaxation seems increased ards maneuvers rrs , max rrs , u decreased increasing flows \( groups \) , although significantly higher ards rrs , min modified different flows similar groups thus , also increased ards conclusion , mechanical profile ards characterized increased ers rrs , max , latter secondary augmented mechanical within system
confluence pulmonary veins simulating pulmonary mass confluence pulmonary veins commonly appears frontal view chest generally easily recognized plain film tomography , computerized tomography , pulmonary angiography , anatomy convergence pulmonary veins prior common entry left atrium clearly displayed report , attention called occasional appearance confluence pulmonary veins lateral view chest clearly circumscribed round opacity mimicking lung mediastinal mass
cytomegalovirus pneumonia allogeneic bone marrow transplantation immunopathologic process \? recent literature suggests cmv pneumonia immunopathologic process case report summarizes clinical course patient supports hypothesis patient recipient allogeneic bmt recovered episode cmv pneumonia occurred two months transplant despite recovery viral infection , follow revealed persistent lymphocytosis apparent asymptomatic patient subsequently developed four months initial cmv infection observations suggest viral infection may resulted activation host 's cell mediated response provides evidence support hypothesis cmv pneumonia immune mediated process
diagnostic value percutaneous lung needle aspiration patients pneumonia forty one patients \( mean sd age 51 19 years range , 11 88 years seven female 34 male \) clinical signs symptoms pneumonia , performed percutaneous lung needle \( 22 \) aspiration \( plna \) investigate diagnostic yield technique patients receiving antibiotics time study , plna performed either lack response empiric antibiotic treatment severity pneumonia underlying condition patient eight patients mechanically ventilated \( mv \) due acute respiratory failure plna performed bedside without fluoroscopic guidance twenty two microorganisms identified means stains cultures plna samples sensitivity plna 43 percent \( 18 41 \) detected three false positive cultures probably due contamination skin area eight mv patients studied , sensitivity plna 37 5 percent , findings turned crucial outcome patients pneumothorax developed three patients \( 7 percent \) plna none three patients developed pleural infection two required thoracostomy drainage none mv patients presented complications results showed plna technique moderately good sensitivity low rate false positive cultures \( 8 percent \) diagnose pulmonary infections patients unresponsiveness empiric antibiotic treatment severe pneumonia evaluation diagnostic value complications mv patients needed , although preliminary results suggest plna alternative technique methods diagnosing pulmonary infections patients receiving artificial ventilatory support
acute pulmonary effects aerosolized randomized controlled study toronto aerosolized study \( \) group june 1988 february 1989 , enrolled 36 patients human immunodeficiency virus randomized double blind placebo controlled trial assessing efficacy toxicity aerosolized \( ap \) secondary prophylaxis pneumocystis carinii pneumonia patient underwent spirometric evaluations aerosolized treatment significant difference results baseline pulmonary function tests two groups eleven patients \( 65 percent \) ap group developed cough four demonstrated significant reduction forced expiratory flow rates ap four patients \( 21 percent \) placebo group developed cough , significant change expiratory flow rates noted episodes self limited symptomatically responded inhaled albuterol \( salbutamol \) treatment conclude ap treatment frequently associated coughing attacks \( 65 percent \) , actual incidence bronchospasm spirometry much lower \( 24 percent \) generally quite mild
neutrophilia bronchoalveolar lavage fluid diffuse clinical pathologic features diffuse \( dpb \) well reported date , although pathogenesis remains unknown present study , performed bronchoalveolar lavage \( bal \) three patients biopsy specimen proven dpb eight patients highly probable dpb \( six women five men one smoker ten nonsmokers \) , nine patients chronic bronchitis \( men , five smokers four nonsmokers \) , nine normal control subjects \( six women three men , nonsmokers \) clarify cell populations lower respiratory tract neutrophils comprised 55 3 24 4 percent recovered cells bal dpb patients 6 6 6 4 percent chronic bronchitis patients , 1 8 1 5 percent normal control subjects \( p less 0 001 , comparisons \) dpb patients also exhibited decreased percentage alveolar macrophages \( 34 9 23 5 percent \) compared chronic bronchitis patients normal control subjects \( p less 0 001 , comparisons \) percentage lymphocytes recovered lavage cells dpb patients differ chronic bronchitis patients normal control subjects results indicate neutrophils play important role pathogenesis dpb also suggest neutrophilia bal recovered fluid common finding diseases associated bronchiolar inflammation despite clinical pathophysiologic differences
pulmonary lipid peroxidation cigarette smokers lung cancer patients lipid peroxidation \( \) studied lung tissues patients lung cancer \( lc , n 37 \) cancer \( nlc , n 13 \) relationships smoking habits degree airway obstruction investigated specimens peripheral lung parenchyma , free tumor tissue , taken malondialdehyde \( mda \) content measured 12 fractions airway obstruction assessed flow volume curves , data expressed percentage predicted values cigarettes smoked expressed pack years patients lc nlc differ mda content , age , number pack years contrary , 85 significantly lower lc nlc patients \( p less 0 05 \) mda content inversely correlated number days patients smoking \( r 0 66 , p less 0 001 \) mda content higher recent smokers \( ie , people smoking last 30 days surgery \) patients \( 0 136 0 007 vs 0 116 0 007 mumol g tissue , p less 0 05 \) , considering recent smokers , mda content higher lc patients \( 0 144 0 008 mumol g tissue \) nlc patients \( 0 113 0 014 mmol g tissue , p 0 059 \) patients divided high mda low mda groups , much lower high mda group \( 35 1 3 4 percent \) low mda group \( 55 1 8 1 percent \) \( p less 0 01 \) results suggest following \( 1 \) enhanced level state lungs associated recent cigarette smoking \( 2 \) lc patients may prone respective nlc patients oxidative stress \( 3 \) mda level degree small airway obstruction associated differed lc nlc patients even though groups differ percentage recent smokers \( 4 \) common free radical mediated pathway may active lc small airway obstruction
lactate levels predictors relationship oxygen delivery consumption ards reviewed changes do2 vo2 58 patients ards interventions included fluid loading , blood transfusion , peep significant change do2 , patients lactic acidosis \( lactate level greater 2 4 mmol l \) exhibited significant corresponding changes vo2 \( p less 0 001 \) however , change vo2 observed patients without lactic acidosis \( 1 beta greater 0 8 \) conclude biphasic pattern oxygen utilization patients ards subsets patients without lactic acidosis compared lactic acidosis , marker anaerobic metabolism , may characteristic patients ards exhibit changes vo2 dependent changes do2
mechanical disruption pulmonary emboli dogs flexible rotating tip catheter \( kensey catheter \) pulmonary embolism induced 11 dogs injection three four day old allogeneic blood clots clots made contrast material resulting clots firm , 3 4 cm long , 1 cm diameter injection clots external jugular vein consistently produced occlusion least one lobar pulmonary arteries every instance tip catheter could positioned clot embolus \( six dogs \) , clots readily fragmented number 8 french \( 2 67 mm od \) flexible rotating tip catheter \( kensey catheter \) activated 80 , 000 overall perfusion shown posttreatment angiograms markedly improved studies show catheter tip fragmentation pulmonary emboli kensey catheter excellent potential therapeutic application patients pulmonary embolism
pneumonia syndromes clinical approach elderly important pathogenesis pneumonia elderly patient chronic diseases , including diabetes mellitus , coronary artery disease , congestive heart failure , chronic obstructive pulmonary disease , cerebrovascular disease also vital changes take place immune system clearance mechanisms lung clinician aware risk factors , especially since mortality rate lower respiratory infections approaches 40 elderly patients treatment guidelines included
changes self concept pulmonary rehabilitation , part 1 purpose two part study describe changes self concept formal pulmonary rehabilitation program 20 item semantic meaning differential scale administered 37 patients severe chronic obstructive pulmonary disease participating multidisciplinary pulmonary rehabilitation program patients asked evaluate past , present , future program admission , program discharge , 2 6 months home discharge mean total self concept score present self significantly increased program admission home discharge 3 weeks later \( mean change 31 32 22 04 , p less 0 0001 \) significant declines self concept found 2 6 months home discharge \( p 0 39 \) men showed significantly higher change total self concept score women 3 week program \( p 0 03 \) however , men 's change score dropped significantly home discharge \( p 0 02 \) , suggesting need intensive follow care women self concept tool study provided easy way monitor subjective changes psychologic status
changes self concept pulmonary rehabilitation , part 2 two part study describes changes self concept pulmonary rehabilitation 20 item semantic meaning differential scale administered 37 patients severe chronic obstructive pulmonary disease participating multidisciplinary pulmonary rehabilitation program patients asked evaluate past , present , future self concepts program admission , program discharge , 2 6 months home discharge part study item level quantitative data well qualitative data counseling session program discharge reported quantitative data documented detailed changes self concept various stages pulmonary rehabilitation counseling session results indicated patient involvement item level analysis greatly facilitates psychosocial intervention findings study establish clinical indications use self concept evaluation tool adult patients chronic obstructive pulmonary disease use tool recommended early rehabilitation process
platelet derived growth factor idiopathic pulmonary fibrosis fibrosis complex process involving inflammatory reaction , fibroblast proliferation , abnormal accumulation interstitial collagens mononuclear cells usually present lung fibrosis activated monocytes macrophages culture shown produce several growth factors including platelet derived growth factor \( pdgf \) pdgf potent mitogen chemoattractant fibroblasts smooth muscle cells stimulator collagen synthesis studied expression c sis pdgf 2 mrna lung tissues derived five patients idiopathic pulmonary fibrosis \( ipf \) four control individuals without ipf northern blot analysis specimens obtained four patients ipf revealed expression c sis pdgf 2 protooncogene control lung tissue without ipf express c sis protooncogene situ hybridization extended studies demonstrating expression c sis mrna five specimens ipf four control specimens without ipf expression c sis mrna localized primarily epithelial cells alveolar macrophages also expressed c sis mrna expression c sis mrna accompanied expression pdgf like proteins lung specimens ipf control lung specimens findings demonstrate vivo expression c sis pdgf 2 protooncogene production pdgf like proteins epithelial cells macrophages fibrotic tissue localized sustained production pdgf like mitogen may constitute important contributing factor abnormal fibroblast proliferation collagen production , events associated pulmonary fibrosis
mr imaging bird 's filter appearance bird 's inferior vena cava filter magnetic resonance \( mr \) images 11 patients described complication symptomatic filter displacement encountered result mr imaging performed 1 5 filters created significant local artifact distortion mr images however , diagnostic mr images pelvis , spine , brain may still obtained
trends lung cancer , chronic obstructive lung disease , emphysema death rates england wales 85 relation trends cigarette smoking trends smoking associated respiratory diseases england wales 85 studied , careful attention problems caused changes classification cause death three diseases selected analysis lung cancer , emphysema , chronic obstructive lung disease 1971 85 deaths would previously certified chronic bronchitis increasingly tended classified chronic airways obstruction definition chronic obstructive lung disease used includes terms avoid artificial decline caused consideration chronic bronchitis isolation age specific rates three diseases show pronounced cohort \( period birth \) pattern , rates men rising rates born shortly turn century declining , rates women peaking cohort born 20 25 years later chronic obstructive lung disease , lung cancer emphysema , cohort peak superimposed sharply declining downward trend sexes cohort patterns cumulative cigarette consumption peak time broadly similar seen three diseases trends cigarette consumption , however , cannot explain underlying declining rate chronic obstructive lung disease fully explain declining trends lung cancer emphysema rates younger men women
use biological glue control pulmonary air leaks biological glue natural adhesive generated interaction fibrinogen \( pre glue \) thrombin produce fibrin pre glue prepared single donor \( avoid problems pooled plasma \) stored used thawed , dissolved saline , activated adhesive addition topical thrombin biological glue used prophylactically prevent air leaks bronchial suture lines raw lung surfaces pulmonary resections six patients addition two new methods using biological glue developed control persisting air leaks selective tamponade glue instilled bronchial tree flexible bronchoscope , therapeutic instilled pleural cavity chest drainage tube air leaks resolved cases seven procedures using selective tamponade carried six patients four immediately successful three required interventions therapeutic alone successfully carried one patient adjunct selective tamponade two occasions thoracotomy eventually needed one seven patients
appropriate inappropriate neuroendocrine products pulmonary tumourlets pulmonary tumourlets focal aggregates neuroendocrine cells occur periphery lung may associated chronic inflammation scarring six lesions seen five lungs series 35 pairs lungs studied necropsy immunoreactive specific enolase , protein gene product 9 5 , range neuroendocrine products peptides found neuroendocrine cells normal human lungs , gastrin releasing peptide present tumourlets calcitonin one none contained series peptide protein hormones present neuroendocrine cells healthy human lungs , growth hormone present six tumourlets two identical patterns peptide expression displayed neuroendocrine cells airway associated tumourlets two cases cells increased number abnormally clustered aberrant expression peptides might accompany morphological changes pulmonary neuroendocrine cells seen diseased lungs , florid focal proliferation occasionally resulting formation
plasma cross linked fibrin degradation products pulmonary embolism plasma concentrations cross linked fibrin degradation products , marker intravascular thrombosis fibrinolysis , measured patients suspected pulmonary embolism referred ventilation perfusion lung scanning determine whether concentrations increased pulmonary embolism potential use diagnosis lung scans described normal \( n 66 \) showing low \( n 292 \) , indeterminate \( n 58 \) , high probability \( n 79 \) pulmonary embolism difference mean levels cross linked fibrin degradation products scan category normal scans , 142 ng ml low probability scans , ng ml indeterminate probability scans , ng ml high probability scans , ng ml \( p less 0 001 \) patients high probability scans , 96 raised concentrations explanations discrepant low results include incorrect scan diagnosis , delay blood sampling , anticoagulation patients low indeterminate probability pulmonary embolism , 43 increased concentrations cross linked fibrin degradation products could attributed cases another illness owing wide range values lung scan diagnostic category , raised concentrations fibrin degradation products cannot used without reference patient 's clinical state discriminatory test pulmonary embolism evaluation significance normal concentrations excluding diagnosis pulmonary embolism appears warranted
external detection pulmonary accumulation indium labelled transferrin guinea pig accumulation labelled transferrin lungs guinea pigs determined external detection system method based intravascular extravascular distribution indium labelled transferrin compared intravascular distribution technetium 99m labelled red blood cells guinea pigs given iloprost , prostacyclin analogue potent pulmonary vasodilator , noradrenaline , pulmonary vasoconstrictor , attempt increase decrease respectively blood volume lungs neither agent altered transferrin accumulation lung comparison saline infusion iloprost infused oleic acid infusion reduced macro molecular leakage compared oleic acid alone data suggest double isotope method distinguish hydrostatic injury induced pulmonary oedema
prostaglandin f2 alpha enhancement capsaicin induced cough man modulation beta 2 adrenergic anticholinergic drugs effect inhaled prostaglandin \( pg \) f2 alpha response inhaled agent capsaicin investigated normal subjects seven subjects inhaled three breaths four doses capsaicin \( 0 3 , 0 6 , 1 2 , 2 4 nmol \) immediately pgf2 alpha \( 0 1 mumol \) placebo \( 0 nacl \) separate days numbers capsaicin induced coughs greater pgf2 alpha \( mean 42 3 coughs \) 0 sodium chloride \( 30 1 \) visual analogue scores \( 0 10 10 cm continuous scale \) showed capsaicin irritant pgf2 alpha saline total respiratory resistance \( rrs \) , measured forced oscillation technique , unaltered throughout study double blind , placebo controlled study effects inhaled salbutamol \( 200 micrograms , 0 6 mumol \) ipratropium bromide \( 40 micrograms , 0 1 mumol \) cough induced capsaicin \( 2 4 nmol \) pgf2 alpha \( 0 1 mumol \) pgf2 alpha augmented , capsaicin induced coughing performed seven subjects neither drug effect capsaicin induced coughing salbutamol reduced coughing due pgf2 alpha \( mean 7 7 coughs salbutamol , 9 3 placebo \) ipratropium bromide \( mean 6 9 coughs ipratropium bromide , 6 6 placebo \) salbutamol also inhibited augmentation capsaicin induced cough followed inhalation pgf2 alpha \( mean augmentation 1 9 coughs salbutamol , 4 1 placebo \) , whereas ipratropium bromide \( augmentation 1 7 coughs ipratropium bromide , 2 7 placebo \) changes rrs seen pgf2 alpha either drug thus salbutamol reduces pgf2 alpha induced cough augmentation capsaicin induced cough follows pgf2 alpha
use fenestrated silicone drain stent malignant tracheobronchial stenosis innovative use fenestrated silicone drainage tube endobronchial stent reported patient respiratory obstruction due tumour laser failed restore airway patency
inhaler spacer use obstructive airway diseases role inhaled aerosols treatment obstructive airway diseases increasing immediate prophylactic anti inflammatory effects inhaled aerosol agents available metered dose inhaler forms maximum therapeutic benefit metered dose correct inhaler technique used spacer devices may helpful patients
additive effect albuterol ipratropium bromide treatment bronchospasm children inhaled albuterol \( \) \( salbutamol \) alone albuterol plus ipratropium bromide \( ib \) administered 12 asthmatic children following administration alone combination ib , significant increase fev1 significant statistical difference favor association plus ib observed 120 240 minutes fev1 period 120 , 180 , 240 minutes additive effect present large small airways short lived additive effect plus ib suggests opportunity increase frequency drug administration patients severe bronchial obstruction
effects albuterol procaterol exercise induced asthma procaterol albuterol , beta agonists , studied using placebo controlled , repeated exercise challenge design order assess duration effectiveness modifying exercise induced asthma \( eia \) fifty three subjects aged 12 50 years least 20 drop fev1 screening exercise tolerance test entered subjects took two inhalations procaterol \( 10 micrograms inhalation \) , albuterol \( 90 micrograms inhalation \) , placebo thirty minutes later exercised treadmill workload sufficient induce greater equal 80 aerobic o2 consumption six minutes pulmonary function measured serially 30 minutes exercise exercise challenge repeated three , six , nine hours drug administration procaterol albuterol modified eia 30 minutes three hours , mean drops fev1 8 2 9 7 respectively 30 minutes 16 8 16 3 three hours compared placebo falls 30 26 six hours subjects' response similar procaterol albuterol , fewer subjects 20 fall fev1 placebo , although protection afforded beta agonists substantially less three hours drugs tolerated well
exercise induced biphasic responses methacholine reactivity asthma biphasic \( early late \) asthmatic responses exercise occurred seven 43 children reproducible exercise induced asthma biphasic allergen induced asthma associated prolonged increase nonspecific bronchial hyperreactivity , effect sought 43 asthmatic children significant change methacholine fev1 exercise challenge , either children early , early late , exercise responses late reactions allergen exposure likely considerable clinical significance relation enhancement bronchial responsiveness case exercise challenge , would major implications relation recommendations asthmatics participate normal activities even training programs furthermore , suggests differences pathophysiology asthma induced exercise produced allergens
selective igg subclass deficiencies antibody responses pneumococcal capsular polysaccharide antigen adult community acquired pneumonia measured serum concentrations igg subclasses healthy subjects \( n 26 \) patients community acquired pneumonia \( cap \) admission \( n 38 \) , recovery \( n 21 \) , 9 months admission \( n 19 \) , 8 control subjects 15 patients , measured igg subclasses mean serum antibody concentrations pneumococcal capsular 3 wk immunization pneumococcal vaccine compared control subjects , serum concentration igg2 subclass lower admission patients cap bacterial unknown cause \( p less 0 005 \) concentrations igg subclasses patients differ admission recovery , admission 9 months later vaccination , control subjects patients , increase concentrations igg2 subclasses \( p 0 01 \) antibodies \( p less 10 \( 4 \) \) show serum igg2 concentration patients cap bacterial unknown cause lower healthy subjects remains lower several months immunization pneumococcal vaccine , increase serum concentrations igg subclasses antibodies patients differ control subjects
differential roles opioid receptors respiration , respiratory disease , opiate induced respiratory depression summary , findings indicate importance designing future experiments delineate opioid forms respiratory disease dysfunction , need identify means diagnosing order achieve successful recovery apparently great diversity animal species terms contributions endogenous opioids tonic control ventilation , future work identify species appropriate model human ventilatory control disease certain opioid receptor types appear linked independent respiratory functions instance , mu receptors brain stem produce strong inhibitory actions respiratory parameters , including rr , vt , , co2 sensitivity effects observed vivo electrophysiologic recordings vitro delta receptors may also exert inhibitory effect respiration , especially nts cns , ventral surfaces medulla pons , especially nts na , seem important sites opioid induced inhibition respiration , whereas spinal cord probably involved opioid mediated ventilatory depression kappa receptors appear devoid respiratory depressant activity , whereas sigma receptors may stimulate ventilatory parameters morphine similar pure mu agonists , fentanyl , probably produce analgesic respiratory depressant effects stimulation mu receptors mixed agonists antagonists mu antagonist \( partial agonist \) activity plus kappa agonist sigma agonist activity show effect respiratory depression future tests need determine opioid receptor may responsible effect addition , effects mu , delta , kappa , sigma selective agonists hypoxic drive also determined , drug stimulates hypoxic sensitivity face depression may produce less overall respiratory depression due effects future , clinically optimal opiates specificity action available may achieved creating drugs selective single receptors creating drugs desirable combinations receptor combinations mixed agonists antagonists pure mu agonists currently use today promising , provide analgesia reduced respiratory depression early days opiate research development , combination drug regimens tested determine ideal ratios would retain analgesic properties undesirable effects respiratory depression \( 196 \) \( abstract truncated 400 words \)
tumor necrosis factor alpha mediates acid aspiration induced systemic organ injury acid aspiration induced systemic organ injury mediated sequestration activated neutrophils \( pmn \) settings cytokines shown increase neutrophil endothelial adhesion , requisite injury study tests whether systemic leukosequestration permeability following localized aspiration mediated tumor necrosis factor \( tnf \) alpha induced synthesis adhesion protein anesthetized rats underwent tracheostomy insertion fine bore cannula anterior segment left lung followed instillation either 0 1 ml 0 1 n \( n 18 \) 0 1 ml saline control rats \( n 18 \) localized aspiration induced generalized pulmonary leukosequestration 95 pmn 10 high power fields \( \) aspirated lung 46 pmn 10 lung , higher control values 7 pmn 10 5 pmn 10 saline aspirated sides , respectively \( p less 0 05 \) leukosequestration associated permeability edema shown increased protein concentrations bronchoalveolar lavage \( bal \) micrograms ml aspirated micrograms ml side , higher saline micrograms ml micrograms ml , respectively \( p less 0 05 \) generalized pulmonary edema following aspiration measured increase wet dry weight ratios \( w \) 6 6 aspirated 5 1 lung , higher control values 3 5 3 4 , respectively \( p less 0 05 \) localized aspiration led systemic leukosequestration documented increases myeloperoxidase activity \( units g tissue \) 2 2 1 7 heart kidney , higher control values 0 3 0 4 , respectively \( p less 0 05 \) event associated edema organs w ratios 4 6 4 3 , relative control values 3 0 3 4 \( p less 0 05 \) treatment animals \( n 18 \) 20 minutes aspiration anti tnf alpha antiserum \( rabbit anti murine \) normal rabbit serum \( n 18 \) reduced lung leukosequestration aspirated segments \( 61 32 pmn \) , bal protein concentration \( micrograms ml \) , w ratio \( 4 3 3 7 \) \( p less 0 05 \) heart kidney reductions myeloperoxidase activity \( 0 7 0 6 \) w ratio \( 3 5 3 6 \) \( p less 0 05 \) treatment rabbits \( n 18 \) protein synthesis inhibitor cycloheximide , 0 2 mg kg hr effective tnf alpha antiserum modifying aspiration injury \( abstract truncated 400 words \)
results 104 patients undergoing procedures bronchial lesions procedures used 104 patients various bronchial disorders ten benign lesions 94 , malignant tumors principal operative procedures sleeve lobectomy sleeve pneumonectomy bronchogenic carcinoma , 11 limited bronchial resections performed patients benign lesions , minute bronchogenic carcinomas , low grade malignant tumors 94 patients malignant tumors , 79 underwent procedure without resection \( sleeve lobectomy 75 limited bronchial resection 4 \) , one operative death \( 1 3 \) overall 5 year survival rate patients bronchogenic carcinoma group 45 patients undergoing curative resection , 57 \( survival patients stages , ii , iiia 79 , 55 , 30 , respectively \) procedure resection performed 15 patients twelve group underwent sleeve pneumonectomy two operative deaths , 1 patient survived longer 4 years two patients low grade malignant tumors underwent resection without lung resection still alive believe safe valuable procedure limited bronchial resection appears procedure choice localized bronchial lesions
selection factors resulting improved survival surgical resection tumors metastatic lungs 1973 1987 , total 140 patients underwent 184 operations removal metastatic tumors lungs number lesions removed ranged form one 30 patients , 44 solitary lesions overall 3 year survival 62 6 , 5 year survival 48 2 primary tumors except melanoma breast cancer , 3 year survival greater 50 5 year survival greater 40 rare exceptions , operation choice unilateral lesions ipsilateral thoracotomy , bilateral lesions median sternotomy adequate conservative resection rule three , 25 , 71 single wedge resections , 38 multiple unilateral wedge resections , 47 bilateral wedge resections postoperative hospital deaths cox analysis demonstrated improved survival patients whose largest lesion less 1 5 cm diameter disease free interval longer 1 year , survival related number lesions age patient aggressive surgical approach justified patients primary tumors limited number lung metastases less 1 5 cm diameter resection metastases melanoma breast cancer accomplished sites metastatic disease ruled stringent criteria
effect different rates infusion propofol induction anaesthesia elderly patients effect changing rate infusion propofol induction anaesthesia studied 60 elderly patients propofol administered 300 , 600 1200 ml h 1 loss consciousness \( judged loss verbal contact patient \) achieved duration induction significantly longer \( p less 0 001 \) slower infusion rates \( 104 , 68 51 \) , total dose used significantly less \( p less 0 001 \) patients \( 1 2 , 1 6 2 5 mg kg 1 , respectively \) decrease systolic diastolic arterial pressure significantly less 300 ml h 1 group end induction immediately induction \( p less 0 01 \) incidence also significantly less slower infusion group
foam tracheal tubes clinical laboratory assessment efficiency foam tracheal tube studied protecting pulmonary tree aspiration oropharyngeal gastric contents following instillation methylene blue dye cuff , subsequent fibreoptic bronchoscopy revealed instance dye staining tracheal mucosa bench study undertaken subsequently estimate likely pressure cuff would exert tracheal mucosa result elastic recoil properties foam results suggested , normal clinical conditions , pressure likely exceed value impairment mucosal blood supply would occur
variations urethral bladder pressure stress episodes healthy women pressure variations urethra bladder stress episodes time investigated 30 healthy female volunteers pressure measured means double transducer catheter distal sensor bladder proximal sensor bladder neck , mid urethra distal urethra advance pressure spike cough pressure rise demonstrated bladder 3 sites measurement urethra urethral pressure increments preceding following pressure spike statistically significantly higher mid urethra corresponding bladder pressures active urethral pressure generation mid urethra distal urethra initiated 200 ms bladder pressure began rise pressure urethral high pressure zone higher bladder pressure cases passive pressure transmission urethral high pressure zone take place due continuous higher pressure inside urethra bladder due location high pressure zone abdominal cavity concluded urethral pressure rise high pressure zone stress episodes mainly generated actively intra peri urethral structures
heterogenous amplification myc family oncogenes small cell lung carcinoma one hundred forty two foci small cell lung carcinoma \( sclc \) 47 patients examined amplification myc family oncogenes \( c myc , n myc , l myc \) , dot blot hybridization using formalin fixed paraffin embedded materials resected surgically obtained autopsy selected patients also examined situ hybridization amplification myc family genes detected 11 patients \( 23 4 \) \( c myc one , n myc five , l myc five \) two 11 patients \( one n myc one l myc \) amplified clones patient n myc amplification , amplification detected metastatic tumors pancreas , lung , pleura , liver lymph node metastases primary tumor , areas without n myc amplification seen patient l myc amplification , although amplification detected surgically resected primary lesion , mediastinal lymph node metastatic lesions obtained autopsy showed l myc gene amplification two cases , together previously reported evidence , suggest myc gene amplification plays important role malignant progression , rather development , sclc stage iii iv groups , patients ten fold myc gene amplification suggested survive shorter time patients without amplification \( p 0 06 \)
identification somatostatin receptors human small cell lung carcinoma biopsy specimens obtained eight patients lung cancer tested content somatostatin receptors autoradiography somatostatin receptors detected two three patients small cell lung cancer \( sclc \) none five patients non small cell lung cancer \( nsclc \) including adenocarcinoma \( two \) , squamous cell carcinoma \( two \) , bronchoalveolar carcinoma \( one \) sclc , specific somatostatin receptor binding evidenced tumor foci surrounding stroma normal lung parenchyma tissue characterization immunoperoxidase staining monoclonal antibody , mab 5 , revealed labeling nsclc none sclc specimen selective immunoreactivity detected sclc nsclc specimen chromogranin neuron specific enolase \( nse \) whereas none specimen detectable immunostaining somatostatin , bombesin , serotonin , hormone , , calcitonin , synaptophysin identification somatostatin receptors primary human lung cancer may bearing biology disease perhaps clinical application somatostatin analogues patients sclc
peak flow nasal patency indices self assessment septoplasty present study evaluates results septoplasty monitored objective peak flow nasal patency indices subjective patient self assessment scores nasal obstruction mini peak flow meters used peak flow nasal patency index defined ratio nasal oral peak flow rates bi lateral , well ex , indices calculated peak ex flow nasal patency indices significantly increased 1 6 months post operatively , indicating improved nasal patency marked post operative increase nasal patency indices seen preoperatively worst airway total airway weak significant positive correlation found peak flow nasal patency indices patient mean self assessment scores bi lateral nasal obstruction change peak flow nasal patency indices measured 6 months post operatively correlated well patient overall assessment operative changes total nasal patency method found quick easy handle monitoring effect functional septoplasty recommended alternative
trimming inferior turbinates prospective long term study aim study determine whether initial benefits radical trimming anterior trimming inferior turbinates nasal airflow persisted long term radical trimming significantly reduced nasal resistance 2 months following operation \( n 12 \) \( p less 0 005 \) significant change nasal resistance next 20 months symptom scores nasal obstruction also showed significant reduction \( n 16 \) \( p less 0 005 \) , 2 months , change significantly next 20 months radical trimming inferior turbinates highly effective operation patients hypertrophy inferior turbinates initial complications however , analysis data revealed 20 patients lose initial subjective benefit relief nasal obstruction within 2 years follow late onset occurs patients though directly attributable increase nasal airflow study also concludes anterior trimming inferior turbinates cannot recommended form treatment
community acquired pneumonia evidence functional inactivation alpha 1 proteinase inhibitor quantitative qualitative elastase inhibitory capacity \( \) alpha 1 proteinase inhibitor \( alpha 1 pi \) measured pulmonary arterial systemic arterial blood patients community acquired pneumonia \( cap \) eleven patients uncomplicated cap compared 16 patients fulminating pneumonia requiring intensive care management appropriate increase quantitative alpha 1 pi demonstrated patients significant functional inactivation alpha 1 pi demonstrated icu treated patients apparent uncomplicated cap patients \( p less 01 \) low returned normal 4 wk hospital discharge survivors significant \( p less 02 \) difference pulmonary arterial systemic arterial blood found nonsurvivors admission , suggests alpha 1 pi inactivated lungs patients fulminating cap present data demonstrate alpha 1 pi functionally inactivated patients fulminating cap low serum functional alpha 1 pi may result proteolytic lung damage unfavorable outcome
tracheostomy children guillain barre syndrome 10 yr period beginning january 1979 , 59 infants children guillain barre syndrome \( gbs \) admitted hospital performed 15 patients records reviewed fourteen patients recalled assessment pulmonary function respiratory muscle strength \( rms \) median duration assisted ventilation \( including endotracheal et intubation \) 21 days median duration tracheostomy 39 days two patients discharged tracheostomy situ patients successfully first attempt tracheostomy related complications symptoms reported apart two patients review , lung volumes maximal inspiratory expiratory flows normal evidence tracheal stenosis significant rms tests normal hospital , tracheostomy safe , well tolerated procedure management infants children gbs need long term ventilation deaths patients returned normal school employed illness , although 12 patients mild persistent weakness least foot
high frequency oscillation simulated altitude exposure ventilatory requirements using high frequency oscillation \( hfo \) simulated altitude exposure investigated control dogs animals oleic acid induced lung injury fio2 values 0 21 1 0 supplied bias flow normal injured dogs , respectively control period , animals exposed simulated altitude 8 , 000 ft \( pressure torr \) , followed second control period ground level experimental groups similar values paco2 ground level exposure reduced pressure tidal volume necessary maintain higher oleic acid injured animals compared control group cardiac output functional residual capacity lower alveolar arterial oxygen difference substantially larger oleic acid group adequate gas exchange maintained hfo exposure altitude provided ventilation inspired po2 reduced normobaric levels
mortality pulmonary embolism united states 1962 1984 examine effect advances prevention therapy pe , reviewed mortality pe united states 1962 1984 age adjusted pe mortality increased 67 100 percent 1962 1974 white non white men women 1975 1984 , rates declined 20 28 percent non white pe mortality greater white pe mortality men greater risk pe death women age specific patterns \( 40 years age \) pe mortality followed age adjusted death rates , increases noted groups 1962 1974 declines 1975 1984 period patterns might reflect improved ascertainment cases better prevention disease magnitude rates suggests list indications prophylactic anticoagulation examined possible expansion
bronchial cartilage alterations lung transplantation changes hyaline cartilage proximal bronchial tree investigated group combined heart lung double lung recipients without ob ossification , calcification ingrowth normally avascular hyaline bronchial cartilage observed almost patients independent small large airway inflammation alterations integrity hyaline cartilage produced others animals ligation blood supply finding similar changes airway cartilage transplanted lungs relatively poor perfusion proximal air conducting passage mechanism may contribute development ob , bronchiectasis predilection infections following pulmonary transplantation
bronchoalveolar lavage liquid paraffin pneumonitis evaluated cells lipids recovered bronchoalveolar lavage fluid seven patients liquid paraffin pneumonitis patient , balf oil droplets surface alveolar macrophages contained numerous , large vacuoles react may giemsa , papanicolaou , periodic acid stained black b , orange iii red oil red liquid paraffin identified thin layer chromatography balf extracted lipids hydrophobic compound migrating solvent front control liquid paraffin abnormal spot definitely identified liquid paraffin infrared spectroscopy gas liquid chromatography first patient number percentage ams largely decreased balf patient , whereas number neutrophils , eosinophils lymphocytes increased findings suggest cell mediated inflammatory response plays role development interstitial fibrosis late stages liquid paraffin pneumonitis
real pseudo late asthmatic reactions submaximal exercise challenge patients bronchial asthma new definition late asthmatic responses exercise challenge late asthmatic reaction exercise challenge remains controversial issue study , 21 patients recorded peak expiratory flow rate \( pefr \) two control days without performing exercise difference control days pefr 1 h compared baseline pefr pefr 4 13 hours compared baseline pefr analyzing variation coefficients baseline pefr control day exercise day , pefr allowed differ 15 3 percent patient comparing exercise day control day late fall pefr study 17 81 patients , late asthmatic reaction exercise challenge present pefr fall greater equal 20 percent compared baseline pefr value eight 17 patients , real late asthmatic reaction exercise challenge present pefr fall greater equal 20 percent least three successive time points pefr fall greater equal 20 percent compared corresponding control day late asthmatic reaction exercise challenge characterized nonspecific , fall pefr greater equal 20 percent compared baseline pefr value corresponding control day least three successive time points airway responses following exercises may facilitate detection late asthmatic response
permeability pulmonary edema following lung resection etiology edema associated pulmonary resection investigated five patients immediate postoperative period three patients received pneumonectomy two patients one lobe resected patients suffered severe respiratory distress x ray evidence diffuse interstitial pulmonary edema within 12 hours surgery hemodynamic data obtained radial pulmonary artery catheters edema fluid obtained along blood samples simultaneous determination protein albumin content patients studied normal high cardiac output , normal cardiac filling pressures , edema fluid protein serum protein ratio 0 6 greater suggestive permeability changes contributing edema fluid accumulation calculated shunt fraction exceeded 25 percent patients pulmonary edema noted patients following pulmonary resection early postoperative period patients reviewed , two factors appeared significant first increase pulmonary capillary pressure associated passage normal high cardiac output reduced volume pulmonary vascular bed second factor , demonstrated protein content edema fluid , injury alveolar capillary membrane
hydraulic conductivity canine parietal pleura vivo hydraulic conductivity \( lp \) parietal pleura measured vivo spontaneously breathing anesthetized dogs either supine \( n 8 \) prone \( n 7 \) position excised portion chest wall pleura adjacent tissue intact \( n 3 \) capsule exposed parietal pleura intercostal muscles removed capsule filled either autologous plasma isotonic saline fluid flow \( v \) measured several hydrostatic pressures \( delta p \) rate meniscus movement within graduated connected capsule delta p defined measured difference capsule pleural liquid pressures lp parietal pleura calculated slope line relating v delta p use linear regression analysis lp vivo averaged 1 36 x 10 \( 3 \) 0 45 x 10 \( 3 \) \( sd \) ml h 1 cmh2o 1 cm 2 , regardless whether capsule filled plasma saline irrespective body position value significantly different measured excised chest wall preparation \( 1 43 x 10 \( 3 \) 1 1 x 10 \( 3 \) ml h 1 cmh2o 1 cm 2 \) parietal pleura offers little resistance protein movement , observed difference plasma saline conclude lp intact parietal pleura extrapleural interstitium approximately 100 times smaller previously measured isolated pleural preparations , removal parietal pleural results damaged preparation
lung increases pulmonary microvascular protein permeability young lambs study effects inflation pressure tidal volume \( vt \) protein permeability neonatal pulmonary microcirculation , measured lung vascular pressures , blood flow , lymph flow \( ql \) , concentrations protein lymph \( l \) plasma \( p \) 22 chronically catheterized lambs received mechanical ventilation various peak inflation pressures \( pip \) vt nine lambs ventilated initially pip 19 1 cmh2o vt 10 1 ml kg 2 4 h \( base line \) , lungs pip 58 3 cmh2o vt 48 4 ml kg 4 8 h ql increased 2 1 0 4 13 9 5 0 ml h l p change , ratio albumin globulin lymph relative ratio plasma decreased , indicating altered protein sieving pulmonary microcirculation seven lambs mechanically ventilated 2 4 h pip 34 1 cmh2o vt 23 2 ml kg \( base line \) , chest abdomen bound pip increased 54 1 cmh2o 4 6 h without change vt ql decreased average 2 8 0 6 1 9 0 3 ml h \( p 0 08 \) , l p unchanged
placebo controlled trial immunotherapy two extracts allergic rhinitis , comparing clinical outcome changes antigen specific ige , igg , igg subclasses double blind , placebo controlled trial immunotherapy conducted patients rhinitis thirty patients received extract high content der p \( \) , 20 received conventional mite extract \( \) , 30 patients received histamine chloride \( placebo \) specific igg subclasses measured 3 12 months treatment ria elisa , specific ige rast clinical outcome assessed skin prick tests , nasal challenge , visual analogue , diary symptom drug scores findings , clinical index derived igg response occurred treated group igg igg1 increased 3 months \( p less 0 05 \) 12 months \( p less 0 05 \) igg4 levels increased throughout treatment \( p less 0 05 p less 0 01 \) , igg ige ratio subclass switch igg1 igg4 occurred ige rose 3 months \( p less 0 05 \) clinical improvement occurred 3 12 months treated group pretreatment levels ige , igg1 , igg4 predict clinical outcome findings compatible hypothesis igg subclasses may modulate antigen ige interactions , although antibody response potent extract need causally related improvement
neuropeptides nasal secretion recent research disclosed neurotransmitters neuropeptides released within autonomic nervous system exert control nasal secretion although cholinergic adrenergic influences long thought predominant mechanisms , , responses may suitable , longer lasting effects peptides sensory nerves , calcitonin gene related peptide , substance p , , may participate response mediated vasodilation plasma extravasation substance p gastrin releasing peptide may induce glandular secretion responses local mucosal injury may amplified response , vascular glandular reactions cholinergic effects primarily responsible mediating parasympathetic reflexes , vasoactive intestinal peptide may regulate acetylcholine release , augment glandular secretory responses , vasodilatory effect sympathetic nervous system , neuropeptide probably functions long acting vasoconstrictor integration sympathetic parasympathetic influence may regulate normal nasal cycle , sensory parasympathetic reflexes may respond epithelial mast cell stimulation possible , , pathophysiology vasomotor rhinitis involves neural influences
platelet activating factor leukotriene b4 induced release blood neutrophils atopic nonatopic individuals found increased accumulation neutrophils components , \( lf \) elastase , well platelet activating factor \( paf \) leukotriene b4 \( ltb4 \) sites ongoing human allergic reactions determine whether paf ltb4 , could stimulus vivo lf release , blood neutrophils 17 subjects incubated paf , ltb4 , phorbol ester , phorbol myristate acetate \( pma \) , released lf \( elisa assay \) compared spontaneous release significantly increased lf release induced paf , 10 \( 5 \) 10 \( 8 \) mol l \( p less 0 002 \) ltb4 , 10 \( 7 \) 10 \( 8 \) mol l \( p less 0 004 \) pma \( 0 05 micrograms ml \) dose dependent reaction cytochalasin required lf secretion enhance responses paf induced lf secretion inhibited specific paf antagonist , bn lf released neutrophils atopic nonatopic subjects response paf , 10 \( 6 \) mol l \( 4 2 micrograms ml 0 2 versus 2 6 micrograms ml 0 2 p less 0 001 \) ltb4 , pma , buffer \( p , significant \) conclude \( 1 \) paf ltb4 released vivo could stimulate local neutrophils release lf possible pathogenic effects \( 2 \) neutrophils atopic subjects responsive paf neutrophils nonatopic subjects regard
measurement histamine nasal lavage fluid comparison glass fiber based method two radioimmunoassays determination histamine nasal secretions nasal lavage fluid may importance monitor activation histamine containing cells nasal cavity however , studies controversy , specifically findings changes histamine levels relation allergenic stimulation controversy may due specificity accuracy various methods used determine histamine nasal fluid therefore applied compared three new methods determine histamine nasal lavage fluids obtained allergen challenge normal subjects patients allergic rhinitis used glass fiber based histamine method \( \) two , ii \( detection limit , 7 0 nmol \) ria ii \( detection limit , 0 2 nmol \) specific histamine , whereas ria \( detection limit , 18 0 nmol \) measures mainly cross reacts extent histamine histamine levels nasal lavage fluids nasal challenges demonstrated histamine values 100 2000 nmol l histamine significantly higher levels challenges allergic subjects compared normal control subjects correlated well ria ria ii methods correlation coefficients 0 77 0 88 \( p less 0 001 \) , respectively however , ria \( antibody \) always demonstrated absolute histamine values 5 20 values measured ria ii \( level cross reactivity histamine \)
developmental expression plasminogen activator inhibitor type 1 human alveolar macrophages possible role lung injury urokinase activity regulated specific endogenous plasminogen activator inhibitors type 1 \( pai 1 \) type 2 \( pai 2 \) one inhibitors , pai 1 , directly implicated connective tissue metabolism virtue ability bind extracellular matrix proteins normal lung relatively rich urokinase abnormalities urokinase activity associated fibrotic lung diseases , explored possibility local production pai 1 pai 2 human lung reverse transcription subsequent amplification polymerase chain reaction total lung rna revealed pai 1 mrna three normal samples two specimens patients adult respiratory distress syndrome \( ards \) situ hybridizations lung biopsy specimens patient ards probes pai 1 pai 2 indicated alveolar macrophages express pai 1 mrna acute injury phase subsequent reverse transcription pcr amplification normal human monocyte alveolar macrophage mrna revealed neither cell type expressed mrna urokinase inhibitors however , 24 h stimulation endotoxin vitro , monocytes strongly positive pai 2 negative pai 1 mrna whereas , conditions , alveolar macrophages exhibited mrna pai 1 pai 2 metabolic labeling endotoxin stimulated alveolar macrophages 35s methionine followed immunoprecipitation pai 1 pai 2 antibodies revealed macrophages synthesized pai 1 pai 2 judged immunoprecipitation functional studies , pai 2 found major intracellular pa inhibitor whereas pai 1 found predominate outside cell thus , mononuclear phagocytes exhibit developmental potential pai 1 expression release pai 1 stimulated macrophages , observed setting ards , may one mechanism cells promote connective tissue accumulation
randomized controlled trial glucocorticoid prophylaxis experimental infection effects combined intranasal systemic glucocorticoid steroids local inflammatory response , symptoms due experimental infection studied 45 adults randomized prophylaxis either placebo steroids intranasal beclomethasone \( 168 micrograms twice day \) begun 4 days viral challenge continued 5 days challenge oral prednisone \( 30 mg twice daily \) given 3 days beginning 1 day challenge first 48 h viral inoculation , nasal obstruction , nasal mucus weights , concentrations nasal lower steroid recipients , subsequent increases variables steroid group resulted significant cumulative differences treatment groups data suggest steroid prophylaxis may suppress nasal inflammation cold symptoms first 2 days experimental
effect fasting lung glutathione redox cycle air oxygen exposed mice beneficial effects sugar fasting increases susceptibility lung damage mice , least part , decreasing lung glutathione level determine whether fasting alters components glutathione redox cycle , whether diet sugar alone reverses fasting 's effects , normally fed , sugar fed , fasted mice exposed room air 100 oxygen 4 days air exposed mice , fasting decreased glutathione peroxidase \( gp \) glutathione reductase \( \) activities 15 20 days 3 4 \( p less 0 01 \) glutathione level 25 30 days 2 4 \( p less 0 05 \) corrected protein concentration , gp values similar fed mice , glutathione levels remained lower days 2 3 \( p less 0 05 \) oxidized glutathione \( gssg \) unchanged , ratio gssg total glutathione \( reduced glutathione plus gssg \) increased day 2 \( p less 0 05 \) oxygen exposed fed mice , gp increased 62 increased 39 day 4 \( p less 0 05 \) , time lung injury severe glutathione increased 30 days 3 4 \( p less 0 05 \) gssg increased threefold eightfold days 3 4 \( p less 0 01 \) oxygen exposed fasted mice dead day 3 \( versus deaths fed mice \) , failed increase total glutathione response oxidant stress , increased gp gssg day 3 extent fed mice day 4
treatment small cell lung cancer alternating chemotherapy regimen given weekly intervals southwest oncology group pilot study designed intensive , weekly treatment regimen patients small cell lung cancer \( sclc \) using six active chemotherapeutic agents disease \( doxorubicin , cyclophosphamide , vincristine vcr , etoposide vp 16 , cisplatin cddp , methotrexate mtx \) goal program gain rapid , repetitive exposure multiple , active drugs treatment administered weekly total 16 weeks seventy six sclc patients \( limited disease , 34 extensive disease , 42 \) treated overall complete plus partial response rate 82 complete response rates 47 38 observed patients limited \( ld \) extensive disease \( ed \) , respectively median survivals patients ld ed 16 6 11 4 months , respectively toxicities tolerable primarily hematologic twenty six patients one transient life threatening toxicities , one patient developed fatal toxicity eighty four percent patients received 80 greater intended protocol dosages entire 16 week treatment period conclude intensive , short duration treatment regimen least good standard regimens , encouraged aged complete response rate median survival patients ed sclc
relative value conventional staging procedures developing prognostic models extensive stage small cell lung cancer published prognostic models small cell lung cancer \( sclc \) either combined limited extensive stage patients included standard anatomic staging information assess relative value knowledge specific sites number sites metastases predicting survival extensive stage disease studied 136 extensive stage patients traditional staging procedures performed previously demonstrated significant pretreatment variables determined using cox proportional hazards model , data included , three variables significant performance status \( ps \) \( p 0001 \) , number sites metastases \( p \) , age \( p \) prognostic algorithm developed using variables , divided patients three distinct groups anatomic staging data omitted , serum albumin \( p \) variable addition ps \( p 0001 \) age \( p \) significant alternative algorithm using three variables nearly predictive original therefore , extensive stage patients , reasonable pretreatment prognostic information obtained without using number specific sites metastases variables presence distant metastases demonstrated
prediction postoperative clinical course autologous tumor killing activity lung cancer patients fifty patients primary localized lung cancer tested time surgery ability lymphocytes kill autologous , freshly isolated tumor cells , assay evaluated prognostic significance peripheral blood lymphocytes 27 patients \( 54 \) demonstrated significant autologous tumor killing activity 6 hour 51cr release assays twenty three 27 patients autologous tumor killing activity remained tumor free survived 5 years curative surgery , 23 negative autologous tumor killing activity relapsed 18 months surgery died within 42 months surgery differences survival curves two groups highly significant \( p less \) autologous tumor killing activity correlated natural killer \( nk \) cell activity k562 human myeloid leukemia cells proliferation lymphocytes stimulated autologous , freshly isolated tumor cells mixed culture differences total survival patients positive results negative results tests nk cell activity autologous mixed lymphocyte tumor culture reaction results indicate autologous tumor killing activity meaningful prognostic indicator provide evidence immunological control tumor growth metastasis according preliminary data , unlikely lung cancer patients remain tumor free 60 months follow develop recurrence die disease conducting study determine whether induction autologous tumor killing activity surgery , treatment biological response modifiers , improve clinical outcome patients naturally potential
serologic evidence subclinical pertussis immunized children incidental vaccine study involving immunized children conducted two study sites , inner city children significantly higher geometric mean pertussis agglutinin titers compared children fourth dose diphtheria tetanus whole cell pertussis vaccine \( 47 vs 25 p less 0 001 \) higher titers inner city correlated residence census tracts cases pertussis reported three hundred thirty two children placebo arm study clinically observed paired serum samples taken 2 4 month period analyzed evidence natural bordetella infection twelve \( 11 \) inner city children three \( 1 3 \) children spontaneous 4 fold greater rises least two different pertussis antibodies measured \( agglutinin , antitoxin enzyme linked immunosorbent assay igg pertussis toxin , igg iga filamentous \) eighty percent children iga filamentous nine 12 inner city children serologic evidence pertussis lived within 6 blocks case pertussis reported within 1 month observed antibody rise study subjects none household member pertussis none symptomatic disease
current epidemiology pertussis japan since introduction whole cell pertussis vaccine general use part routine immunization preventive immunization law , steady decrease reported cases pertussis noted 1974 time number reported cases reached time low deaths caused pertussis reported vaccine \( diphtheria tetanus whole cell pertussis vaccine \) given infants 12 weeks old older 0 5 ml dose deep subcutaneous injection three doses given intervals 3 8 weeks fourth dose \( booster \) given 12 18 months third dose immunization completed four doses whole cell vaccine appeared associated severe neurologic illnesses , suspended 1975 vaccine resumed soon thereafter age administration raised 24 48 months circumstances acceptance rates pertussis occurred , reaching peak 1979 although whole cell vaccine used even temporary suspension , considered unacceptable public result pertussis vaccine developed totally replaced whole cell vaccine since 1981 steady decrease reported cases pertussis well number deaths noted since 1979 accordance increase vaccine acceptance rates national surveillance system begun 1981 demonstrated also steady decrease incidence pertussis past 9 years
predicting risk bronchopulmonary dysplasia selection criteria clinical trials early identification neonates bronchopulmonary dysplasia likely develop permits appropriate enrollment clinical trials testing early intervention therapies prevention treatment bronchopulmonary dysplasia analysis 160 neonatal intensive care unit survivors 28 days revealed supplemental oxygen requirement 28 days could predicted logistic regression including \( 1 \) birth weight , gestational age , 5 minute apgar score , peak inspiratory pressure 12 hours 12 hour old neonates \( 2 \) birth weight , gestational age , peak inspiratory pressure 12 hours , mean airway pressure 10 days 10 day old neonates two regression analyses applied prospectively three new data sets 238 neonates test predictive ability neonates classified low , moderate , high risk groups basis predicted probability requiring oxygen supplementation 28 days low probability less 25 , moderate probability 25 75 , high probability greater 75 although populations distinct original group , regression analyses performed well regression analysis 12 hours age classified 125 neonates low risk 9 required supplemental oxygen 28 days , regression analysis 10 days classified 141 neonates low risk 7 required supplemental oxygen 12 hour regression analysis classified 80 neonates moderate risk 33 required supplemental oxygen 28 days 10 day regression analysis classified 49 neonates moderate risk 24 required supplemental oxygen
dyspnea multidimensional model dyspnea includes sensation , perception , distress , response , reporting components presented assessment tools currently available evaluated recent research findings pharmacologic , oxygen , physical , psychologic treatments article concludes suggesting role nurse dyspnea amelioration
viral pneumonias diagnostic therapeutic challenge viral pneumonias diagnostic therapeutic challenge primary care physicians illness suspected upper respiratory tract infection include dyspnea rapid diagnostic tests available detect viruses cause pneumonias fortunately , viral pneumonias usually resolve without specific antiviral therapy however , indicated respiratory syncytial virus pneumonia children ganciclovir sodium \( \) cytomegalovirus pneumonia immunocompromised patients acyclovir \( \) indicated pneumonias due herpes simplex virus varicella zoster virus infections high index suspicion bacterial essential reduce risk death complication
breathing exercises medical patient art science art breathing exercises traced late past 10 years , increased demand treatment respiratory muscle failure dysfunction resulted numerous studies evaluating methods treatment training article provides overview research practice , focused treating medical patient experiencing dyspnea loss respiratory muscle strength endurance
chronic obstructive pulmonary disease chronic obstructive pulmonary disease indeed illness obstructive picture result multiple pathologic processes common cause cigarette smoking key decreasing incidence disease education prevent people starting smoke educate smoke stop therapeutic management involves numerous medications , oxygen , physiotherapy unfortunately , pharmacologic management remains largely empiric sympathomimetics , , , corticosteroids agents , especially corticosteroids , without considerable toxicity therefore , pharmacologic plan requires weighing risk benefit ratio carefully comprehensive plan assess subjectively objectively efficacy toxicity chosen therapy
pathogenetic aspects cytomegalovirus infection cytomegalovirus \( cmv \) ubiquitous agent rarely causes disease immunocompetent humans important cause morbidity mortality immunocompromised number host viral factors associated pathology following cmv infection cmv found many sites body causes disease certain patient populations situations mechanism underlying disease direct viral replication , others , particularly cmv pneumonitis allogeneic transplant recipients , immunopathologic basis strongly implicated important factor pathogenesis infection expression symptomatic disease source cmv infection whether arises exogenous source due reactivation latent endogenous virus exogenous infection occur previously seronegative individuals prior exposure virus renal transplant recipients types exogenous infection associated disease another factor affects interaction cmv host modulating effect virus host immune response , mechanism remains unknown
cytomegalovirus infections allogeneic bone marrow transplantation cytomegalovirus \( cmv \) infection occurs approximately 50 recipients allogeneic bone marrow transplants seen frequently cmv seropositive patients cmv seronegative patients sources infection include reactivation latent endogenous virus , blood products cmv seropositive blood donors , use marrow cmv seropositive donor cmv seronegative recipient common severe clinical syndrome associated cmv infection allogeneic transplant recipients interstitial pneumonia , occurs approximately 15 patients risk factors cmv pneumonia include old age , conditioning total body irradiation , severe graft vs host disease rapid diagnosis cmv pneumonia facilitated immunochemical staining bronchoalveolar lavage fluid centrifugation cell cultures cmv monoclonal antibodies treatment cmv pneumonia remains problematic , therapy combination intravenous immune globulin \( ivig \) plus ganciclovir resulted survival rates substantially better achieved previous trials antiviral therapy cmv seronegative patients , cmv infection pneumonia prevented modified use cmv seronegative blood products ivig ivig may also additional benefits preventing infectious complications graft vs host disease patients receiving cmv seronegative blood products cmv seropositive patients , effective prophylaxis cmv reactivation pneumonia yet established , clinical trial prophylactic ganciclovir way
contributions b murphy thoracic surgery b murphy prominent surgeon lived chicago death career , associated medical schools responsible use artificial pneumothorax effective adjunct treatment pulmonary tuberculosis modality , however , original concept addition fields general surgery , murphy undertook management empyema lesions chest wall also performed procedures although done several thoracotomy procedures laboratory , rarely undertook operation clinical setting drop ether anesthesia used surgical procedures murphy use closed water seal drainage chest thoracic surgery , given annual meeting , , excellent subject undoubtedly contributed increased interest progress field surgery murphy surgeon , able high regard held best expressed mayo , surgical generation
ultrastructural localization proteinase 3 , target antigen anti cytoplasmic antibodies circulating wegener 's granulomatosis investigate distribution proteinase 3 , target antigen anti cytoplasmic antibodies \( acpa c anca \) , within organelles resting normal human polymorphonuclear leukocytes monocytes , authors used immunocytochemical techniques thin frozen sections obtain valuable tools , two murine monoclonal antibodies \( mabs \) directed acpa antigen produced neutrophils , authors observed immunogold label acpa antigen , predominantly myeloperoxidase positive granules , smaller amounts plasma membrane monocytes , acpa antigen could detected small granules , occasionally also contained myeloperoxidase , rare labeling found monocyte membrane finding acpa antigen expressed plasma membrane neutrophils monocytes , thereby becoming accessible circulating autoantibodies , supports acpa markers disease activity , also involved pathogenesis wegener 's granulomatosis
treatment atelectasis upper lung lobes selective bronchial suctioning j shaped catheter tip guide mark developed technique blind bronchial suction using curved tip catheter guide mark , treatment atelectasis lower middle lobes lung suction upper lobe bronchi could performed combination peculiar anatomy upper lobe bronchi catheter design treated successfully two cases atelectasis right upper lobes using catheter guide mark readily available therefore devised j shape tipped catheter guide mark successfully treated 13 episodes atelectasis right upper lobe 10 patients one episode left upper lobe one patient new catheter
effects famotidine cimetidine plasma levels epidurally administered lignocaine effects two h2 receptor antagonists , famotidine cimetidine , plasma levels epidurally administered lignocaine studied group \( n 20 \) received famotidine 20 mg orally night surgery 20 mg intramuscularly 60 minutes induction anaesthesia group b \( n 15 \) received cimetidine 200 mg orally night surgery 400 mg orally 60 minutes anaesthetic induction group c \( n 20 \) received neither famotidine cimetidine served controls twelve 2 0 lignocaine adrenaline 1 200 , 000 injected epidural space patients , establishment general anaesthesia nitrous oxide , oxygen , enflurane \( 0 3 0 5 \) patients received cimetidine showed significantly higher plasma concentrations lignocaine compared either group group c investigation times \( p less 0 01 \) mean peak plasma concentrations 2 4 \( sem 0 1 \) , 3 2 \( sem 0 2 \) 2 3 \( sem 0 1 \) micrograms ml group , b , c , respectively study suggests famotidine preferable cimetidine control gastric acidity use lignocaine epidural anaesthetic
local global function right ventricle canine model pulmonary oleic acid edema influence ventilation peep right ventricular \( rv \) dysfunction may occur due increased rv afterload , hence , might also contribute decrease cardiac output following institution peep patients adult respiratory distress syndrome \( ards \) test hypothesis , authors examined influence peep local global rv function 12 anesthetized dogs experimental ards \( \) induced pulmonary glass beads oleic acid local rv function analyzed rv inflow tract \( rvit \) rv outflow tract \( rvot \) assessing diastolic segment length , systolic segment shortening , segment work \( \) global rv contractility quantified measuring maximum rate pressure rise \( \) maximum velocity contractile element shortening \( vmax \) , despite fivefold increase pulmonary vascular resistance , change cardiac index \( ci \) , global rv contractility , rvit rvot work , rvit shortening , whereas rvot shortening decreased 12 4 7 4 \( p less 0 01 \) diastolic segment length increased rvit \( p less 0 05 \) rvot peep 10 cmh2o alter global rv contractility , rvit rvot shortening , rvit work reduced rvot work \( 35 p less 0 01 \) ci \( 11 p less 0 001 \) cardiac index decreased peep 20 cmh2o \( 38 p less 0 001 \) , global rv contractility remained intact despite decreased rvit rvot shortening \( 32 69 p less 0 05 \) work \( 26 59 p less 0 01 \) presence reduced fiber preload regions findings , concluded 1 \) decreased ci mechanical ventilation peep constant right ventricular end diastolic pressure \( \) caused depressed global rv contractility dogs normal myocardium prior insult decreased diastolic segment length segment shortening peep suggest 2 \) peep reduces stroke volume mechanism rather ischemia rv free wall finally , changes fiber preload indicate 3 \) local differences rv wall compliance likely occur subsequent peep
atypical presentation pulmonary embolism today discussed interesting patient atypical presentation pulmonary embolism outlined suggested algorithm aid diagnosis management disease references 8 24 reference section suggested readings offer insight diagnosis management entity
family study variability pulmonary function alpha 1 antitrypsin deficiency quantitative phenotypes group 52 alpha 1 antitrypsin deficient individuals phenotype pi z 117 relatives underwent protocol including pulmonary function testing , completion questionnaire , blood donation population permitted minimum frequency estimate \( 7 x 10 \( 4 \) \) pi null alleles five quantitative phenotypes measured , including fev1 , 75 , total serum alpha 1at , oxidized serum alpha 1at , total serum ige found \( 1 \) total alpha 1at levels higher pi z subjects lung function impairment \( fev1 less equal 65 predicted \) pi z subjects impaired \( 2 \) pi z subjects lung function impairment elevated serum levels oxidized alpha 1at \( 3 \) ige levels relatively elevated first degree pi relatives impaired pi z subjects moreover , fev1 tended relatively reduced heterozygous parents impaired pi z subjects , suggesting subset pi individuals risk development lung disease familial factors results represent initial step toward development intermediate phenotypes predictive severe course alpha 1at deficiency suggest , addition cigarette smoking , atopic predisposition undetermined familial factors may important lung disease progression
pulmonary denervation humans effects dyspnea ventilatory pattern exercise role pulmonary autonomic nerves respiratory sensation unclear pulmonary neurogenic mechanisms may contribute dyspnea either directly indirectly via influence pattern ventilation using human heart lung transplantation model pulmonary denervation , studied ventilatory response , respiratory drive \( p0 1 \) , sensation breathlessness \( modified scale \) maximal incremental bicycle exercise subjects four female heart lung transplant recipients 3 9 months post transplant 10 age matched control subjects ventilatory response increasing co2 output \( \) higher \( p less 0 001 \) transplant recipients control subjects , ventilation peak exercise similar two groups despite lower peak transplant recipients ratio tidal volume inspiratory capacity increased increasing ventilation similar fashion groups although respiratory rate increased quickly transplant recipients , similar peak ventilation two groups ventilatory timing duty cycle half peak peak ventilation similar transplant recipients control subjects dyspnea ratings different two groups similar levels ventilation dyspnea function p0 1 also similar transplant control groups results indicate pulmonary neurogenic mechanisms play role determining level , pattern , ventilation exercise furthermore , pathways appear contribute significantly perception breathlessness normal humans
determination serum concentrations type iii procollagen peptide mechanically ventilated patients pronounced augmented concentrations adult respiratory distress syndrome type iii procollagen peptide \( pcp \) type iii collagen synthesis potential marker collagen secretion chronic diffuse interstitial lung diseases , elevated pcp concentrations found serum well bronchoalveolar lavage fluid proposed pcp marker early , active stages fibrosis severe fibrosis frequent complication adult respiratory distress syndrome \( ards \) , investigated pcp patients ards compared results patients requiring mechanical ventilation heart failure neurosurgical surgical interventions , spontaneously breathing patients , including healthy volunteers patients pneumonia , liver cirrhosis , renal failure pcp concentrations patients ards extremely elevated compared control subjects \( p less 0 001 \) correlated positively fio2 \( r 0 71 , p less 0 01 \) results support pathophysiologic concept early fibrogenesis ards preventing pulmonary fibrosis ards essential improving survival rate , believe pcp valuable diagnostic tool ards
penetration aminoglycosides alveolar lining fluid rats effect airway inflammation concentration time profile gentamicin tobramycin alveolar lining fluid \( alf \) rats determined intravenous bolus injection using bronchoalveolar lavage \( bal \) bal used evaluating penetration aminoglycosides alf highly sensitive detection methods used , endogenous marker \( urea \) applied avoid unpredictable effect lavage procedure concentration gentamicin tobramycin alf reached peak 5 10 min , respectively , remained high plasma concentrations declining , suggesting accumulation reservoir lung ratio auc concentration time profile alf plasma 0 67 0 45 gentamicin tobramycin , respectively penetration aminoglycosides alf significantly higher induction airway inflammation inhalation endotoxin ratio auc alf plasma endotoxin exposed animals 0 76 0 55 gentamicin tobramycin , respectively ratio auc concentration time profile gentamicin alf tobramycin 1 27 without inflammation 1 44 endotoxin exposure thus , without inflammation , gentamicin better alf tobramycin
bronchodilator response ipratropium bromide infants bronchopulmonary dysplasia although muscarinic antagonist ipratropium bromide used clinically bronchodilator infants ventilated bronchopulmonary dysplasia \( bpd \) , studies compared response efficacy different dosages effectiveness combination beta adrenergic agonists measured response respiratory system mechanics 10 ventilated infants \( 25 2 days age \) 75 , 125 , 175 micrograms ipratropium bromide \( ib \) , 125 micrograms ib plus 0 04 mg salbutamol \( \) , 175 micrograms ib plus 0 04 mg , saline vehicle , delivered via ventilator circuit respiratory system resistance \( rrs \) compliance \( crs \) measured passive flow volume technique rrs crs measured 1 2 h 4 h delivery five drug dosages saline six studies completed within 72 h period saline significant effect mechanics significant responses ipratropium alone seen 175 micrograms rrs decreased 20 3 \( sem \) \( p less 0 05 \) 1 2 h 16 5 \( p less 0 05 \) 4 h 125 micrograms ib 175 micrograms ib , rrs significantly decreased 1 2 h 4 h , crs significantly increased 20 6 20 4 , respectively , 1 2 h greatest decrease rrs \( 26 6 \) seen 1 2 h 175 micrograms ib salbutamol
respiratory health effects indoor environment population dutch children effect indoor exposure nitrogen dioxide respiratory health studied period 2 yr population nonsmoking dutch children 6 12 yr age lung function measured schools , information respiratory symptoms collected self administered questionnaire completed parents children nitrogen dioxide measured homes children diffusion tubes addition , information smoking dampness home collected questionnaire relationship exposure nitrogen dioxide home respiratory symptoms respiratory symptoms found associated exposure tobacco smoke home dampness weak , negative association maximal flow \( \) exposure nitrogen dioxide fev1 , peak expiratory flow , negatively associated exposure tobacco smoke home dampness associated pulmonary function lung function growth , measured period 2 yr , consistently associated indoor exposure variables development respiratory symptoms time associated indoor exposure nitrogen dioxide significant association exposure environmental tobacco smoke home development also significant association home dampness development cough
rise tuberculosis america mortality , articles , , records specific references consumption , , terms tuberculosis reviewed determine occurrence importance tuberculosis american colonies review sources indicates marked increase proportional mortality tuberculosis united states century consumption may leading cause death adult american
six month isoniazid rifampin treatment pulmonary tuberculosis children one hundred seventeen children pulmonary tuberculosis underwent treatment 6 month daily regimen rifampin \( 15 mg kg day \) isoniazid \( 10 mg kg day \) criteria diagnosis pulmonary tuberculosis \( 1 \) clinical symptoms signs 93 children \( 79 \) , \( 2 \) history direct contact adult tuberculosis 106 children \( 91 \) , \( 3 \) tuberculin reaction 5 mm , without previous bacillus calmette guerin \( bcg \) , 45 children \( 38 \) , \( 4 \) suggestive radiologic alterations patients , \( 5 \) positive histology four patients \( 3 \) treatment completed 97 children \( 83 \) mean weight gain therapy 2 , 145 g excellent response treatment , improvement chest roentgenograms observed patients end therapy relapses occurred among patients followed average 21 4 months study indicates treatment primary pulmonary tuberculosis children combination rifampin isoniazid daily 6 months efficacious result relapse
systems architecture quantification dynamic kinematic activity human vocal tract paper describes systems architecture useful scientific investigations require acquisition analysis multiple , time synchronous signals large volume architecture recently developed group enhance capability research quantify central nervous system function production normal pathologic speech architecture utilizes modern advances designed vocal motor control laboratories \( similar settings \) modest funding fully participate comprehensive investigations speech production research experiments organized architecture may involve many subjects measures previously possible without significant increases time personnel resources paper demonstrate technique architecture used successfully guide research map central nervous system regions involvement two speech disorders architecture broad usefulness many areas otolaryngology health science
tracheal reconstruction polytetrafluoroethylene graft dogs use prosthetic materials long segment tracheal reconstruction limited owing infection , graft migration , ingrowth fibrous tissue , stenosis polytetrafluoroethylene \( ptfe \) flexible porous , may resist infection previously used materials evaluated ptfe use long segment tracheal reconstruction 5 cm segment trachea resected 9 dogs replaced 20 mm reinforced ptfe graft using 4 0 sutures 2 control dogs , one tracheal arch resected primary anastomosis performed animals followed weekly bronchoscopy endoscopic photography performed 16 weeks signs respiratory distress developed examination , anastomoses examined grossly light scanning electron microscopy 9 dogs underwent tracheal replacement ptfe , granulation tissue developed anastomoses resulting airway obstruction 3 8 weeks epithelial growth occurred graft anastomoses control animals well conclude granulation tissue formation anastomosis lack respiratory epithelial ingrowth across graft makes ptfe unsuitable long segment tracheal reconstruction
morbidity internal thoracic artery versus saphenous vein graft although use internal thoracic artery \( ita \) coronary artery bypass grafting results superior graft patency improved patient survival , initial clinical observations suggested increased incidence morbidity use one hundred consecutive patients left ita grafts studied prospectively compared consecutive retrospective group 100 patients undergoing coronary artery bypass grafting saphenous vein grafts preoperative , postoperative day \( pod \) 2 , pod 6 , postoperative week 8 chest roentgenograms analyzed atelectasis effusion postoperative left lower lobe atelectasis common groups pod 2 \( saphenous vein , 43 , versus ita , 53 significant \) pod 6 \( saphenous vein , 40 , versus ita , 41 significant \) significantly higher incidence pleural effusion pod 6 ita group \( 84 versus 47 p less 0 05 \) small chest tube drainage \( 1 , 413 versus 1 , 028 ml p less 0 01 \) greater need secondary thoracostomy \( 4 versus 0 \) ita group left pleural space opened 67 100 ita patients appear influence postoperative morbidity conclude use internal thoracic artery coronary artery bypass grafting results small significant increase morbidity
glucocorticoids inhibit neurogenic plasma extravasation prevent virus potentiated extravasation rat trachea capsaicin increases permeability blood vessels rat tracheal mucosa mechanism involving release sensory nerves capsaicin induced increase vascular permeability potentiated viral infections respiratory tract present study done determine whether neurogenic plasma extravasation inhibited glucocorticoids , learn time course inhibition , determine whether glucocorticoids prevent potentiating effect viral respiratory infections neurogenic plasma extravasation groups pathogen free rats treated dexamethasone 2 8 h \( 4 mg kg p \) 48 120 h \( 0 5 4 mg kg per p \) another group rats treated dexamethasone 120 h following intranasal inoculation virus magnitude plasma extravasation produced capsaicin substance p assessed treatment using blue pigment evans blue dye intravascular tracers found dexamethasone reduced , dose dependent fashion , magnitude plasma extravasation produced rat trachea capsaicin substance p significant inhibition produced dose dexamethasone small 0 5 mg kg p effect dexamethasone latency several hours reached maximum 2 treatment furthermore , dexamethasone prevented potentiation neurogenic plasma extravasation usually present 5 virus respiratory infection
avoiding wrapped endotracheal tube laser laryngeal surgery experiences apneic anesthesia metal laser endotracheal tubes ninety one laser laryngeal procedures using apneic technique anesthesia performed 28 patients 2 months 64 years age seventy two procedures \( 79 \) performed children 19 adults complications eight laser performed using new metal laser endotracheal tube obstruction endotracheal tube mucous plug occurred one case apneic technique described paper provides laser operative field free endotracheal tube , virtually eliminating danger laser fire relatively safe effective means performing laser laryngeal surgery addition , laser endotracheal tube appears acceptable alternative metallic wrapped endotracheal tube
trends lung cancer incidence mortality united states , 1980 1987 published erratum appears rep 1990 dec 14 39 \( 49 \) lung cancer common fatal malignant neoplasm united states based current smoking patterns , substantial public health burden smoking related lung cancer continue next several decades report describes trends lung cancer incidence 1980 1986 lung cancer mortality 1980 1987
surgical treatment secondary retracted nose surgical technique presented correct nasal tip retraction , frequently associated surgical sequelae corrected simultaneously based use shield , anchor , half anchor , one two posterior supports sutured together forming small l fixed bed project nasal tip , necessary , correct unilateral bilateral alar collapse
search protocols radiographic consultation six radiologists , acting radiograph reviewers , used two different consultation protocols differentiate among 292 ambiguous chest radiographic findings 120 simulated nodules 172 normal findings \( previous false positive reports nodules \) protocol identified finding \( film location \) , reviewers rated likelihood finding 's pulmonary nodule search protocol asked reviewers report rate locations regarded possible nodules radiograph assigned negative rating finding \( nodule normal structure \) receiver operating characteristic analyses demonstrated significantly higher accuracy 's search protocol nodules ambiguous normal findings superiority search result suggests second opinions suspected lesions might accurate follow search protocol , independently reviewing radiographs without prior knowledge specific findings concerned primary radiograph readers
potential usefulness artificial neural network differential diagnosis interstitial lung diseases pilot study artificial neural network approach applied differential diagnosis interstitial lung diseases neural network designed distinguish nine types interstitial lung diseases basis 20 items clinical radiographic information data base training testing neural network created 10 hypothetical cases nine diseases performance neural network evaluated means receiver operating characteristic analysis decision performance neural network high comparable chest radiologists superior senior radiology residents preliminary results strongly suggest neural network approach potential utility computer aided differential diagnosis interstitial lung diseases
pulmonary masses contrast enhancement radiographic studies discriminate benign malignant pulmonary masses previously focused morphologic , recently , computed tomographic \( ct \) attenuation characteristics lung mass experience use intravenously administered iodinated contrast medium examining enhancement properties lung masses reviewed distinctive differences vascularity , pathophysiologic features , pharmacodynamics malignant versus benign pulmonary masses identified forty five patients peripheral pulmonary masses examined enhancement evaluated means optical density values measured tomograms lung masses bolus injection contrast medium results suggest contrast enhancement pulmonary masses measured sectional images may become feasible diagnostic method detection lung cancer ct offers simplified technique explored authors
amiodarone postmarketing evaluation monitoring drug induced toxicity amiodarone , antiarrhythmic drug predominantly class iii effects , demonstrated serious adverse drug reactions interactions departments cardiology retrospectively evaluated monitoring parameters institution criteria based current literature developed twenty six patients administered amiodarone , qualifying entry audit patients , seven excluded medical records incomplete 19 eligible patients hospitalized initiation therapy followed outpatient cardiology clinic collected data extracted medical charts compared following elements criteria selected baseline evaluation prior start therapy monitoring signs pulmonary , hepatic , thyroid , cardiac , ophthalmologic , neurologic , toxicity evaluation potential drug interactions digoxin warfarin type anticoagulants percentage criteria elements appropriately monitored patient ranged 82 100 percent , average 91 percent frequently overlooked parameters warning patient possible photosensitivity reaction , decreasing digoxin dose patient concurrently taking amiodarone , performing slit lamp examination every six months frequent examination patient 's total organ system laboratory tests , addition patient education , essential safe monitoring amiodarone therapy
midfacial hypoplasia associated long term intubation bronchopulmonary dysplasia six preterm infants bronchopulmonary dysplasia intubated 68 243 days gestational age birth ranged 24 35 weeks endotracheal tube size changed account growth varied 2 5 4 0 mm infants developed features midfacial hypoplasia , namely , depressed nasal bridge , small tipped nose , long , areas , mouth features associated long term intubation premature infants suggest features prolonged intubation , direct compression tube method tube fixation , decreased air flow developing nares sinuses reduced activity , resulting observed midfacial hypoplasia degree growth corrects deformations unknown
respiratory response pharmacokinetics intravenous salbutamol infants bronchopulmonary dysplasia effects iv salbutamol respiratory mechanics studied six infants bronchopulmonary dysplasia salbutamol infused dose 30 micrograms kg 30 min five infants sixth infant received 66 7 micrograms kg 4 min salbutamol caused improvement total respiratory system compliance airflow resistance correlation salbutamol serum concentration pulmonary function elimination half time appears infants distribution volume \( vd \) clearance \( cl \) area concentration time curve salbutamol correlated inversely change heart rate \( hr \) significant positive correlation vd percent hr change data provide evidence preterm infants measurable activity bronchiolar beta 2 receptor responsive salbutamol
pentoxifylline attenuates edema formation proteolytic enzyme induced lung injury ex vivo canine lung lobes exposed pancreatic proteolytic enzyme \( chymotrypsin \) alone chymotrypsin pretreatment continuous infusion pentoxifylline lobes exposed chymotrypsin gained 133 g , pentoxifylline treated lobes gained 65 g \( p less 05 \) 3 h experimental period results suggest pentoxifylline significantly attenuates lung weight gain associated chymotrypsin
prototype volume controlled neonates infants twenty five infants receiving assisted ventilation icu ventilated 5 min periods using either new prototype volume controlled \( vcr \) standard self \( sir \) variables monitored 5 min periods included heart rate , respiratory rate , mean arterial pressure , mean airway pressure \( paw \) , end tidal co2 \( \) , pulse oximetry oxygen saturation , pao2 , paco2 significant differences posttrial values following variables \) \( 31 2 9 1 vs 25 6 8 2 torr , p less 001 \) b \) paco2 \( 38 0 4 9 vs 33 2 6 7 torr , p less 01 \) c \) ph \( 7 4 0 6 vs 7 5 0 1 , p less 04 \) comparable paw \( 9 5 7 6 vs 8 0 6 0 , ns \) eighty four percent \( 21 25 \) infants vcr group normal paco2 values \( 35 45 torr \) 44 \( 11 25 \) sir group achieved \( p less 001 \) measurements highest \( \) lowest \( \) inspiratory pressure \( cm h2o \) 15 patients demonstrated marked variation sir differences \( sir minus vcr \) significant \( 10 8 3 7 , p less 02 \) \( 0 5 3 5 , ns \) study demonstrates ventilation vcr resulted less hyperventilation minimal pressure variability compared sir studies neonate warranted
utility fiberoptic bronchoscopy pneumonia although fiberoptic bronchoscopy \( fob \) traditionally used evaluate pneumonia , efficacy unknown , therefore , reviewed fob 35 consecutive patients \( 1 \) roentgenographic infiltrate , \( 2 \) cough , \( 3 \) either temperature greater 38 1 degrees c , leukocytosis , sputum production , \( 4 \) symptoms present least ten days , antibiotic therapy least one week known lung cancer aids excluded fiberoptic bronchoscopy diagnostic 86 percent \( 12 14 \) specific cause found patient endobronchial cancer two patients nondiagnostic fob persistent systemic symptoms open lung biopsy specimens showing wegener 's granulomatosis bronchiolitis pneumonia \( \) twenty one patients nondiagnostic fob final diagnoses community acquired pneumonia conclude fob extremely useful finding specific diagnosis pneumonia specific diagnosis made fiberoptic bronchoscopy likely yield specific diagnosis nonsmoking patients infiltrates long duration could avoided older , smoking , otherwise compromised patients lobar segmental infiltrates decrease diagnostic yield series
selection evaluation recipients heart lung lung transplantation heart lung lung transplantation successfully performed increasing frequency patients end stage cardiopulmonary pulmonary disease transplantation must considered therapeutic option selected patients , physicians required understand principles involved determining suitable candidates operative procedures choice indications , contraindications , choice operation respect underlying disease discussed herein , methods evaluation appropriate timing transplantation special considerations regarding specific patient populations also addressed properly selected patients , heart lung lung transplantation provide viable therapeutic option end stage disease unresponsive conventional management
pleural effusion following liver biopsy pleural effusions patients chronic liver disease common usually little consequence pleural effusion occur following percutaneous biopsy cholangiography procedures pleura traversed report emphasizes role biliary tract obstruction development effusion importance biliary tract decompression treatment discuss laboratory evidence supporting diagnosis effusion review reported experience complication
altered function pulmonary surfactant fatty acid lung injury determine whether acute fatty acid lung injury impairs pulmonary surfactant function , studied anesthetized ventilated rabbits given oleic acid \( 55 mg kg iv , n 11 \) equivalent volume saline \( n 8 \) measurements pulmonary mechanics indicated decrease dynamic compliance within 5 min injury decrease lung volume disproportionately large low pressures , consistent diminished surfactant activity vivo bronchoalveolar lavage fluid obtained 1 h injury significantly increased erythrocytes total leukocytes , largely polymorphonuclear cells phospholipid content composition cell free fraction minor changes controls , protein content increased 35 fold measurements lavage surface activity vitro showed increase average minimum surface tension 1 3 0 4 \( se \) cm controls 20 2 3 9 cm injured animals alterations static pressure volume curves decrease lavage surface activity suggest severe alteration surfactant function form lung injury occurs despite presence normal amounts surfactant phospholipids
pulmonary blood volume edema lung growth rats pneumonectomy young animals , contralateral lung undergoes compensatory growth generally weight air space volume lungs age matched controls study , determined contribution lung edema increased blood volume weight gain rats three weeks pneumonectomy \( n 18 \) sham pneumonectomy \( n 17 \) , pulmonary blood volume extravascular water albumin evaluated use 51cr labeled erythrocytes 125i labeled albumin air space volume , blood free lung weights , dna protein content also compared data show total pulmonary blood volumes blood volume per gram blood free dry lung similar age matched sham controls total extravascular albumin extravascular albumin per gram blood free dry lung also similar well extravascular lung water , wet dry weight ratios , dna protein content , air space volumes data indicate increased weight lung due cellular stromal proliferation blood volume interstitial fluid increased proportion increase lung parenchyma neither vascular congestion increased extravascular protein water contributed observed weight gain
effects prostaglandin e1 platelet attenuation oxidant induced edema isolated rabbit lungs numerous studies suggest platelets may contribute preservation normal endothelial cell permeability models lung injury previously shown washed human platelets prevent xanthine oxidase induced edema isolated perfused lung protective mechanisms depend platelet glutathione redox cycle uncertain , however , whether platelets preserve endothelial function reducing toxic oxygen metabolites releasing endothelial cell supportive factors activity may require glutathione redox cycle study , present data demonstrating platelet prevention oxidant lung injury occurs independent platelet aggregation release isolated rabbit lungs perfused cell free medium instilled \( 2 mmol l \) xanthine oxidase \( 0 003 u ml \) generate oxidant lung edema infusion washed human platelets \( 1 x 10 \( 10 \) cells \) prevented lung edema formation measured lung weight gain , wet dry lung weight ratios , lung histology incubation platelets prostaglandin e1 \( pge1 \) , potent inhibitor platelet aggregation release , inhibit platelet attenuation lung edema additionally , instillation pge1 perfusate inhibit platelet aggregation , prevention lung protection pge1 treated platelets seen results compared studies lungs infused xanthine oxidase pge1 aggregometry studies documented inhibitory effect pge1 platelet aggregation persisted 60 minutes , duration isolated lung protocol conclude platelet aggregation release platelet factors required platelet attenuation oxidant lung edema
effect electron microscopic study twenty five cases suffering divided two groups first group consisted 15 patients treated systemically group consisted 10 patients treated locally form ointment electron microscopic study pathological changes lesions showed highly effective systemically locally treatment
inhibition exercise induced bronchoconstriction mk 571 , potent leukotriene receptor antagonist background exercise common stimulus bronchoconstriction subjects asthma , also bronchoconstriction leukotriene \( ltd4 \) purpose study investigate importance ltd4 mediator exercise induced bronchoconstriction methods double blind , randomized , crossover study , 12 subjects stable asthma treated intravenously mk 571 \( 160 mg \) , selective potent ltd4 receptor antagonist , placebo , 20 minutes two challenges involving exercise level previously demonstrated cause fall least 20 percent forced expiratory volume one second \( fev1 \) two exercise challenges separated one week results challenges expressed maximal fall fev1 exercise time recovery bronchoconstriction results treatment mk 571 attenuated exercise induced bronchoconstriction subjects mean \( sem \) maximal percent decrease fev1 exercise 25 2 3 5 percent subjects taking placebo 9 2 2 5 percent subjects taking mk 571 \( p less 0 001 \) mean percent inhibition entire group 69 5 percent mean time recovery exercise 33 4 4 0 minutes placebo group 8 4 2 5 minutes mk 571 group \( p less 0 001 \) conclusions study demonstrates pretreatment potent selective ltd4 antagonist markedly attenuates exercise induced bronchoconstriction , suggests ltd4 major mediator type bronchoconstriction
late pulmonary sequelae bronchopulmonary dysplasia background bronchopulmonary dysplasia chronic lung disease often develops mechanical ventilation prematurely born infants respiratory failure become common form chronic lung disease infants united states long term outcome infants bronchopulmonary dysplasia determined methods studied pulmonary function 26 adolescents young adults , born 1964 1973 , bronchopulmonary dysplasia infancy compared results two control groups 26 age matched adolescents young adults similar birth weight gestational age undergone mechanical ventilation , 53 age matched normal subjects results sixty eight percent subjects bronchopulmonary dysplasia infancy \( 17 25 tested \) airway obstruction , including decreases forced expiratory volume one second , forced expiratory flow 25 75 percent vital capacity , maximal expiratory flow velocity 50 percent vital capacity , compared control groups \( p less 0 0001 comparisons \) twenty four percent subjects bronchopulmonary dysplasia infancy fixed airway obstruction , 52 percent reactive airway disease , indicated responses administration methacholine bronchodilator \( increased ratio residual volume total lung capacity \) frequent subjects history bronchopulmonary dysplasia either matched cohort \( p less 0 0006 \) normal controls \( p less 0 0004 \) six subjects bronchopulmonary dysplasia infancy severe pulmonary dysfunction current symptoms respiratory difficulty conclusions adolescents young adults bronchopulmonary dysplasia infancy degree pulmonary dysfunction , consisting airway obstruction , airway hyperreactivity , clinical consequences dysfunction known
intraluminal irradiation palliation lung cancer high dose rate micro fifty patients inoperable , symptomatic endobronchial carcinoma treated single exposure intraluminal radiotherapy high dose rate system \( micro \) used radiation exposure staff relieved 24 28 patients , breathlessness 21 33 patients , cough nine 18 patients radiological collapse resolved 11 24 patients treatment given outpatient basis well tolerated intraluminal radiotherapy appears offer effective alternative conventional fractionated external beam radiotherapy
corticosteroids primary tuberculosis bronchial obstruction usefulness prednisolone combination modern potent drugs studied 29 children primary lung tuberculosis adenopathy causing bronchial obstruction children divided random two groups 15 14 patients groups treated similarly except one group received prednisolone groups similar onset treatment variables tuberculous infection healed groups group steroids improved earlier significantly fewer complications , radiography bronchoscopy two patients steroids still progressive lesions young baby probably developed two severe viral infections consecutively , another infant 7 months whose treatment unreliable , parents compliant patients initially treated prednisolone improved given prednisolone treatment recommended reliability treatment cannot , hazard harm would exceed expected benefit
ventilator dependency united kingdom 24 children currently long term ventilator dependent uk nine cared entirely home additional 11 children long term ventilator dependent since march 1983 prevalence children appears increasing financial resources needed children whether home hospital considerable reasons apparent increase prevalence continue
effect oral omeprazole intragastric ph volume women undergoing elective caesarean section studied obstetric patients efficacy omeprazole increasing intragastric ph 2 5 reducing volume less 25 ml omeprazole 40 mg given orally night morning surgery 30 asian women scheduled undergo elective caesarean section induction anaesthesia , gastric tube inserted intragastric contents aspirated volume ph recorded measurements repeated completion surgery median \( range \) volume 2 \( 1 13 \) ml surgery 4 \( 0 14 \) ml end surgery insufficient volume measure ph patients median \( range \) ph 6 7 \( 4 6 7 4 \) surgery 20 patients 6 6 \( 4 6 7 8 \) end surgery 28 patients adverse drug reactions noted mothers neonates omeprazole 40 mg orally twice elective caesarean section appeared effective reducing intragastric volume acidity acceptable values
causes cryptogenic fibrosing alveolitis \? case control study environmental exposure dust objective investigate role occupational domestic exposure dust aetiology cryptogenic fibrosing alveolitis design matched case control study subjects 40 patients cryptogenic fibrosing alveolitis 106 community controls matched age sex responded questionnaire main outcome measure responses self administered questionnaire asking lifetime exposure dust , animals , smoke home work results patients cryptogenic fibrosing alveolitis likely report occupational exposure metal dust \( matched odds ratio 10 97 \( 95 confidence interval 2 30 52 4 \) , p less 0 001 \) dust \( 2 94 \( 0 87 9 90 \) , p 0 08 \) , worked \( 10 89 \( 1 24 96 0 \) , p 0 01 \) , lived house fire \( 12 55 \( 1 04 114 \) , p 0 009 \) history smoking social class based occupation significantly related disease state conclusion environmental exposure dust may important factor aetiology cryptogenic fibrosing alveolitis
rising mortality cryptogenic fibrosing alveolitis objective determine pattern mortality ascribed cryptogenic fibrosing alveolitis identify factors might important aetiology disease assess validity death certification disease design retrospective examination mortality ascribed cryptogenic fibrosing alveolitis england wales 1979 1988 analysis , multiple logistic regression , independent effects age , sex , region residence , social class indicated occupation data 1979 87 also retrospective review hospital records patients certified died cryptogenic fibrosing alveolitis certified cause death patients known disease main outcome measures time trends mortality nationally effects mortality age , sex , region residence validity death certification results annual number deaths ascribed cryptogenic fibrosing alveolitis doubled 336 1979 1988 , increase occurring mainly ages 65 mortality standardised age sexes likewise increased steadily period deaths due cryptogenic fibrosing alveolitis men \( odds ratio 2 24 , 95 confidence interval 2 11 2 33 \) increased substantially age , 7 84 \( 7 24 8 49 \) times higher subjects aged much greater 75 aged 45 64 odds ratios death due cryptogenic fibrosing alveolitis adjusted age sex increased traditionally central areas england wales \( p less 0 02 , maximum odds ratio regions 1 25 \) , significant increase odds death found manual occupations 23 people whose deaths registered due cryptogenic fibrosing alveolitis , 19 ascertained clinical records disease 17 45 patients known cryptogenic fibrosing alveolitis life recorded died disease conclusions diagnostic accuracy death certification cryptogenic fibrosing alveolitis high , number deaths recorded due disease may underestimate number patients dying disease half mortality due disease increasing , male predominance regional differences mortality suggest environmental factors important aetiology
adult respiratory distress syndrome adult respiratory distress syndrome remains disorder high mortality rate , although sometimes managed effectively recognizing conditions associated first step preventing occurrence decreasing risk factors developing ards remains fundamental goal initial management syndrome developed particular patient , clinician 's goals management patient , avoid insults , maximize support therapies available , avoid potential adverse effects supportive therapies
hospitalization decision patients community acquired pneumonia prospective cohort study purpose identify low risk subset patients community acquired pneumonia could safely treated ambulatory setting assess clinicians make hospitalization decision patients methods performed prospective , observational study 280 ambulatory hospitalized adults clinical radiographic evidence pneumonia patients followed assess potential morbid complications 6 week mortality physicians responsible managing patients surveyed assess reasons treating hospital ambulatory setting therapies hospitalization results sixty one percent \( 170 280 \) patients indication admission presentation using modified appropriateness evaluation protocol criteria \( severe vital sign abnormality , alteration mental status , complication , arterial hypoxemia , severe laboratory abnormality , acute coexistent medical problem requiring admission independent pneumonia \) among 170 patients , 38 complicated course defined death within 6 weeks , development new medical complication due pneumonia , intensive care unit admission , persistent fever use intravenous fluids oxygen beyond 3 days , hospitalization lasting 3 days , subsequent hospitalization patients initially treated ambulatory setting five predisposing factors complicated course identified logistic regression models odds ratio age 65 years 2 7 comorbid illness , 3 2 temperature 38 3 degrees c \( 101 degrees f \) , 4 1 immunosuppression , 12 0 high risk etiology , 23 3 risk complicated course increased linearly number risk factors , 12 none 100 four factors \( p less 0 001 \) physicians often relied general clinical appearance patient making triage decision , commonly cited intravenous antibiotics chest physical therapy treatments requiring hospitalization conclusions validated , findings could improve physicians' assessment prognosis , may identify low risk subset patients community acquired pneumonia could safely managed ambulatory setting
intact epithelial barrier function critical resolution alveolar edema humans within 15 min endotracheal intubation , resolution pulmonary edema studied next 12 h 34 mechanically ventilated patients \( 1 \) serial measurements alveolar arterial oxygen difference , \( 2 \) extent edema initial follow chest radiograph , \( 3 \) initial final measurement total protein albumin concentration sequential samples pulmonary edema fluid based oxygenation chest radiographic data , 24 patients clinically improved 10 patients improve 10 patients clinically improve \( 3 , hydrostatic edema 7 , permeability edema \) , change final edema fluid protein concentration \( 4 1 1 1 g 100 ml \) compared initial edema fluid protein concentration \( 4 2 1 0 g 100 ml \) \( p ns \) however , 24 patients clinically improved \( 15 , hydrostatic edema 9 , permeability edema \) , increase every patient 's final edema protein concentration \( 5 6 2 3 g 100 ml \) compared initial edema protein concentration \( 3 8 1 2 g 100 ml \) \( p less 0 01 \) 13 24 patients , final edema fluid concentration \( 7 3 1 6 g 100 ml \) exceeded final plasma protein concentration \( 5 6 0 8 g 100 ml \) mean value 1 7 g 100 ml protein data provide first evidence humans support hypothesis active ion transport across alveolar epithelial barrier primary mechanism clearance edema fluid air spaces lung
surfactant replacement improves lung recoil rabbit lungs acid aspiration tested hypothesis surfactant replacement would beneficial acid aspiration model acute lung injury hcl \( 0 1 n , 2 ml kg \) injected trachea excised rabbit lungs \( n 8 \) control lungs \( n 4 \) intervention perfused 's solution mixed 1 1 autologous whole blood 40 ml min kg 30 min , modified natural surfactant \( survanta , laboratories \) injected trachea four lungs injured hcl \( 100 mg kg 25 mg ml \) two static pressure volume curves determined mean alveolar pressures 50 , 60 , 70 , 80 , 90 tlc greater hcl group control group \( p less 0 05 \) however , difference observed control lungs received hcl survanta 13 anesthetized , paralyzed , ventilated rabbits , deflation pressure volume curves determined tlc frc \( measured dilution \) , 0 1 n hcl \( 3 ml kg \) injected trachea , seven , survanta instilled 5 min later mean alveolar pressures 60 , 70 , 80 , 90 tlc higher 15 60 min hcl group compared pre hcl time point \( p less 0 05 \) hcl survanta group , differences seen 15 min , slight increased seen 60 min effect surfactant replacement arterial blood gases observed hcl aspiration increased recoil excised vivo lungs , surfactant replacement survanta returned recoil normal
inspiratory flow dynamics mechanical ventilation patients respiratory failure studied effect inspiratory flow rate respiratory resistance mechanical ventilation 15 patients acute respiratory failure \( arf \) resistance measured constant flow inflation occlusion methods inspiratory flow rates increased 0 66 2 0 l endotracheal tube resistance total resistance obtain respiratory resistance contrast flow dependent increase endotracheal tube resistance , respiratory resistance decreased continuously flow rate airway pressure increased , except four six patients asthma respiratory resistance increased flow increased mechanical airway dilatation , tissue resistance , stress relaxation , time constant may contribute decrease respiratory resistance status , however , effects , noncompliant airways , reflex bronchoconstriction may sufficient cause flow dependent increase resistance
methacholine responsiveness among working populations relationship smoking airway caliber suggested development bronchial hyperresponsiveness \( bhr \) smokers may intermediate event progression chronic obstructive pulmonary disease group true , prevalence data bhr general population show independent association bhr smoking status test , analyzed bhr inhaled methacholine white men without known asthma , relation smoking , skin test reactivity , type work \( office versus industrial \) , indicators baseline airway caliber \( fev1 predicted fev1 fvc \) bhr measured traditional way \( pc20 \) slope fev1 versus methacholine concentration \( linear scale \) pc20 less 16 mg ml considered responsive analyses outcome found although positive skin test , smoking , industrial worker appeared significant predictors increased bhr \( p less 0 05 \) , fev1 \( predicted \) fev1 fvc taken account , none variables alone remained significantly associated bhr strongest predictors bhr prechallenge fev1 fev1 fvc \( p less 0 01 \) combination smoking , atopy , work groups , identified small subgroup atopic smokers office workers , also remained significantly associated increased bhr also used regression model allowed comparison predictors bhr responsive subset population \( n 84 \) remainder study population
cigarette smoke causes physiologic morphologic changes emphysema guinea pig investigate long term effect cigarette smoke pulmonary structure function , exposed groups guinea pigs smoke 10 cigarettes day , 5 days per week , 1 , 3 , 6 , 12 months found guinea pigs developed progressive lung destruction \( emphysema \) alterations pulmonary function tests similar seen humans cigarette smoke induced chronic obstructive lung disease method smoke induced lung destruction provide good model study early changes emphysema
bombesin stimulation mitogenesis specific receptors , signal transduction , early events quiescent cultures 3t3 cells stimulated dna synthesis polypeptide growth factors , neuropeptides , various pharmacologic agents act via multiple signal transduction pathways neuropeptides bombesin family provide potent mitogens elucidate pathways peptides bind specific receptors characterized radioligand binding sensitivity antagonists identified glycoproteins mr 75 , 000 85 , 000 chemical cross linking binding , bombesin elicits cascade early molecular events including stimulation phosphorylation acidic mr 80 , 000 cellular protein , major substrate protein kinase c ca2 mobilization mediated ins \( 1 , 4 , 5 \) p3 , na k , egf receptor , enhancement camp accumulation , expression proto oncogenes c fos c myc studies using membrane preparations permeabilized 3t3 cells indicate g proteins play role transduction mitogenic signal triggered binding bombesin receptor pertussis toxin insensitive g protein couples bombesin receptor generation signal activates protein kinase c , whereas pertussis toxin sensitive g protein mediates cross transmembrane signaling pathways bombesin mediated mitogenesis blocked different antagonists signal transduction process various levels thus , prolonged treatment vasopressin causes heterologous desensitization mitogenic action bombesin mitogenic block mediated uncoupling receptor signaling system loss responsiveness bombesin stimulated dna synthesis also induced regulation protein kinase c
recessive oncogenes lung cancer observation carcinogen exposure strongly associated probability developing pulmonary neoplasms suggested many years acquired somatic mutations play key role genesis induced cancers advent new techniques cytogenetics molecular analysis dna extracted lung tumors , become possible test hypothesis search candidate genes may targeted chronic exposure environmental insults early work field , studying lung tumors different histologic types , appears implicate several distinct chromosomal loci \( chromosomes , , , others \) , suggesting sequential genetic events occur initiation progression pathways pulmonary tumorigenesis identifying candidate gene products understanding mutational events loci essential goal understanding cellular basis lung tumors developing strategies next generation diagnostic therapeutic studies
adherent subline unique small cell lung cancer cell line antigens neural cell adhesion molecule small cell lung cancer \( sclc \) lines distinguished non small cell lung cancer \( nsclc \) lines growth floating aggregates , contrast adherent monolayers formed nsclc cells culture 50 well characterized sclc lines recently described national cancer institute \( nci \) navy medical oncology branch , four variant cell lines \( sclc v \) grew adherent monolayers one line , nci , unique growing long term coexisting floating surface adherent subpopulations physically segregated two populations many passages vitro relatively pure cultures floating adherent cells differences c myc expression , keratin pattern , cytogenetic appearance found adherent floating however , expression neuroendocrine marker neuron specific enolase floating cells three times found adherent cells floating subline also much greater surface expression neuroendocrine tumor antigens detected monoclonal antibodies 1 , recently shown detect neural cell adhesion molecule \( \) sclc cells two adherent sclc v lines also found 1 , association expression growth sclc cultures floating aggregates conclusion , interesting model study expression related adhesive properties sclc cells
endoscopic findings patients otitis media effusion using fine , rigid endoscope \( , \) , examined middle ear , including tympanic orifice eustachian tube , children otitis media effusion \( \) active stage \( 26 ears \) , stage \( 13 ears \) , treatment ventilation tubes 10 days 6 months \( five ears \) patients general anesthesia several color photographs representative ears shown active stage , edema \( 73 1 \) hyperemia \( 23 1 \) characteristic features middle ear mucosa , normal mucosa seen one ear \( 3 1 \) tympanic orifice eustachian tube , could examined 12 ears , stenosed edema four ears \( 33 3 \) effusion three ears \( 25 0 \) group stage , dilated vessels often seen \( 69 2 \) , rest patients normal mucosa \( 30 8 \) middle ear , none edema hyperemia tympanic orifice eustachian tube , could examined five ears , clearly patent patients group one ear treated ventilation tube 1 month showed dilated vessels less severe inflammation ears active stage , three ears treated 3 months showed almost normal middle ear mucosa
aqueous beclomethasone nasal spray regular versus required use treatment seasonal allergic rhinitis objective determine effect alternative regimens nasal steroid administration symptoms quality life design randomized , double blind , parallel group comparison subjects sixty ragweed sensitive adults recruited participants previous studies media interventions 200 micrograms aqueous beclomethasone nasal spray , twice daily , 1 week 1 week ragweed pollen season \( regular \) 100 micrograms spray , taken required , 400 micrograms daily troublesome nasal symptoms treated , groups , increasing daily dose 800 micrograms symptoms controlled treatment insufficient , 120 mg , daily , added results one subject required treated group withdrew uncontrolled nasal symptoms remaining subjects , , nose , rhinorrhea , measured daily diary , significantly better controlled regular treated group \( p less 0 025 \) impairment quality life , including sleep disturbance , fever symptoms , practical problems , greater required treated group \( p less 0 001 \) subjects regular treated group required less additional \( 0 27 tablets per subject versus 1 40 p 0 022 \) eye symptoms eye drop use similar two treated groups conclusion patients seasonal allergic rhinitis , regular use inhaled steroids results fewer symptoms better quality life spray taken required
comparison propofol thiopental halothane short duration ent surgical procedures children experiences propofol pediatric anesthesia limited undertook study evaluate quality induction recovery anesthesia propofol compared thiopental halothane twenty children received 3 mg kg 1 min 1 propofol loading dose followed maintenance dose 0 1 mg kg 1 min 1 \( 10 \) twenty children received 5 7 mg kg thiopental , maintenance provided halothane \( 0 5 1 5 \) interval end administration propofol thiopental halothane , well discharge ward , significantly shorter propofol \( 4 4 versus 13 5 min 7 22 versus 30 4 min , respectively \) spontaneous movements pain injection seen significantly frequently propofol , whereas observed thiopental first 6 h surgical procedure , analgesics needed significantly often thiopental group nausea vomiting also observed frequently thiopental group conclusion , propofol used single anesthetic satisfactory technique ent surgery short duration children
controlled , double blind study effect quazolast nasal challenge ragweed antigen quazolast potent mediator release inhibitor determined vitro vivo testing placebo controlled , double blind , two way crossover study compared safety efficacy quazolast , 400 mg orally , placebo 23 subjects ragweed \( \) allergy , season subjects assigned two 7 day treatments random sequence 8 day washout subjects challenged days 1 7 trial serial dilutions \( 10 , 100 , 1000 , , 0 135 ml \) , using metered pump spray bottles , \( two delivered 0 135 ml \) , preceded saline control efficacy evaluation consisted nasal flow rates measured , counts , nasal scores , weight nasal secretions challenges quazolast treatment , subjects significantly lower \( p less 05 \) mean percent decreases nasal flow rate nasal scores significantly lower \( p less 05 \) quazolast treatment placebo 1000 , , although counts lower treatment quazolast placebo , results reach statistical significance significant improvement seen weight nasal secretions adverse experiences , clinical laboratory results , physical examinations unremarkable , posttreatment quazolast superior placebo protecting nasal congestion nasal ragweed nasal challenge
effect vitamin c histamine bronchial responsiveness patients allergic rhinitis effect acute oral administration 2 g vitamin c bronchial responsiveness inhaled histamine 16 patients allergic rhinitis compared placebo two consecutive days double blind , crossover design significantly increased one hour treatment vitamin c placebo
vestibular recruitment meniere 's disease aim study search vestibular recruitment sample patients meniere 's disease recruitment defined abnormal growth response increasing stimulus intensity twenty nine patients tested sinusoidal rotation three different four different frequencies also auditory recruitment patient via tests auditory brain stem responses , acoustic reflexes , balance discomfort level analysis vestibular responses indicated , average , linear relationship stimulus magnitude response magnitude , ie , doubling stimulus magnitude resulted twice response magnitude meniere 's patients yield results significantly different \( although variable \) normal subjects vestibular responses patients auditory recruitment differ systematically patients without auditory recruitment conclude vestibular recruitment , exists patients meniere 's disease , demonstrated sinusoidal rotational testing
identification characterization middle ear vascular leakage sites experimental otitis media site leakage middle ear vessels determined characterized experimental otitis media rats middle ear effusion induced intravenous administration local application tympanic substance p \( sp \) , acetylcholine , histamine another experiment , 14 degrees c blown external auditory canal carbon used trace leakage sites light electron microscopic levels mediators tested 14 degrees c resulted increased number leaking vessels pars middle ear mucosa leakage sites restricted capillaries postcapillary venules increased numbers pars mast cells observed sp gaps formed leakage vessels administration mediators stimulation external auditory canal 14 degrees c also , cytoplasmic vesicle like structures within endothelial cells increased number following sp histamine treatment , suggesting increased permeability experimental otitis media occur exclusively gaps
informed consent head neck surgery informed consent growing problem medical negligence debate highlighted recently united kingdom case informed consent comprises advice would give patient , consequences taking advice , specific risks surgery treatment mind , risks surgery general attempt identify present practice otolaryngology , postal survey carried members scottish north england societies
hearing aids high frequency hearing loss cross study compares relative benefits standard nhs contracted hearing aid high frequency emphasis commercial aid subjects high frequency hearing loss disability questionnaires free field speech noise \( ii \) tests used assess subjects 6 weeks wearing aid total ii test scores showed significant difference either aid , analysis frequency specific demonstrated less use low frequency information using high frequency emphasis aid overall questionnaire responses relating showed benefit high frequency emphasis aid subjects generally preferred aid , possibly due less low tone gain standard nhs aid
analgesia removal nasal packing present prospective controlled trial , comparing methods analgesia relief discomfort removing nasal packing , including general discussion considerations , methods , nasal tamponade basis nasal packing likely continue used frequently , nitrous oxide \( \) advocated safe relatively means pain relief statistically significant advantage
sensorineural hearing loss bullous prospective study eighteen patients eighteen patients seen period 3 years twenty ears diagnosed bullous pure tone reflexes performed within 48 h referral six ears demonstrated sensorineural hearing loss , 7 ears mixed loss 4 conductive loss recovery sensorineural hearing loss complete 8 13 ears reflexes elicited 5 patients showed recruitment findings study confirms fact sensorineural hearing loss common bullous previously thought temporary many cases reflex results suggest site lesion
test useful indicator peripheral vestibular dysfunction \? deviation gait test proposed useful indicator peripheral labyrinthine dysfunction prospective study 26 patients suspected peripheral labyrinthine dysfunction 49 normal patients normal labyrinthine dysfunction showed significant difference performance test patients significant canal paresis normal vestibular function
system local anaesthesia syringe local anaesthetic injection grip handle system designed anaesthetic per instrument used provide local anaesthesia 22 procedures adults performance syringe compared conventional dental syringe terms patient acceptability user convenience
comparison electro chemical cautery treatment anterior epistaxis ent department royal hospital , , impression \( supported \) electro cautery superior chemical cautery treatment simple anterior epistaxis since evaluation relative merits electro chemical cautery reported , prospective randomized study conducted assess effectiveness electro cautery cautery silver nitrate results study showed statistically significant difference two methods either controlling epistaxis incidence complications concluded since cautery silver nitrate tipped applicator simpler , equal effectiveness , would appear treatment choice simple anterior epistaxis
adenoid cystic carcinoma comparison ct , mr gd mr imaging techniques nasopharyngeal carcinoma continues difficult diagnostic problem many patients well known amongst many varied manifestations disease , unilateral middle ear effusion adult regarded suspicion case 42 year old patient presented case benefit gadolinium enhanced magnetic resonance imaging computerized tomography demonstrated
otitis media effusion association \? association non otitis media \( \) symptoms observed previously quantified children \( , 1980 , 1983 , 1984 \) study compared incidence balance related problems 154 children surgically proven glue ear 51 children normal ear function symptoms ranging true vertigo mild ataxia discovered 22 per cent children none within control group \( p less 0 001 \) periods associated episodes 64 per cent children increased unilateral compared bilateral effusions complete resolution symptoms occurred 85 per cent children following insertion history balance disturbance actively sought children otitis media effusion , present , provides strong indication early operative intervention
mucosal thickening sinus x rays significance mucosal thickening commonly seen x rays paranasal sinuses taken ent department sometimes leads sinus washout , clear , even though x rays strongly suggestive disease paper examines prevalence sinus x ray anomalies general population , facial x rays conditions possible sinus disease study suggests 50 per cent called normal population may sinus x ray appearances consistent sinus disease , may partly explain clear returns sinus washout
vocal cord paralysis children bilateral vocal cord paralysis common cause infants children significant differences entity children adults regard etiology , diagnosis , management , outcome review 10 years' experience children 's hospital philadelphia identified 51 children seen diagnosis vocal cord paralysis cases evaluated respect etiology paralysis , whether unilateral bilateral , delay diagnosis , need tracheotomy , abnormality voice , surgical treatment , outcome guidelines management child vocal cord paralysis presented emphasis flexible endoscopic evaluation conservative management
myogenic influences electrical auditory brainstem response \( \) humans two cases demonstrating effects myogenic artifact electrical auditory brainstem response \( \) using stimulation site presented intensity response functions obtained condition , repeated infusion neuromuscular agent cases , myogenic response observed lower stimulus intensities components intensity increased , myogenic responses grew extremely rapid rates made subsequent identification auditory responses virtually impossible alleviate adverse influence myogenic components , general anesthesia agent must incorporated test protocol acquiring using site stimulation
evaluation neonatal subglottic stenosis 3 year prospective study subglottic stenosis common cause chronic airway obstruction results prolonged tracheal cannulation infants children following widespread adoption past 20 years prolonged intubation respiratory support neonates , incidence acquired subglottic stenosis increased dramatically january 1 , 1987 , began 3 year prospective study delineate potential etiologic factors involved development subglottic stenosis neonates present study analyzes data 289 infants relationships birth weight , gestational age , endotracheal tube size , duration intubation ventilation , number difficulty , subsequent need medical surgical therapy discussed whole organ autopsy specimens provide histological correlation
artificial restoration voice experiments control canine larynx coordinated electronic pacing implanted nerve pedicles paralyzed laryngeal muscles allowed selective dynamic control abduction , adduction , elongation vocal cords modifications original circuit cervical muscle model added fine basic none pacing rehabilitation illustrated nature voice need restoration fine five mongrel dogs received nerve muscle pedicles , , posterior denervation one following appropriate reinnervation time , pedicles intact recurrent laryngeal nerves injected currents variable amplitudes pulse achieve graded vocal fold control air blown towards glottic spectral analyses indicated artificial could restored frequencies measured normal state experiments suggested rehabilitation impaired voice might eventually feasible
lasers otosclerosis one laboratory stapedotomy stapedectomy performed human temporal bones wave energy measured energy absorption stapes analysis data shows visible lasers \( argon \) possess ideal optical properties precision otosclerosis surgery conversely less ideal tissue characteristics co2 laser possesses ideal tissue characteristics recent advances optical engineering pulsing energy increased precision laser provide accuracy required two clinical studies analyze long term hearing results complications patients undergone co2 laser stapedectomy revision \( 59 patients \) co2 laser stapedotomy \( 153 patients \) advantages laser techniques provide conventional surgery methods discussed
head stability gaze vertical whole body oscillations understand head eye upright locomotion , investigated head eye movements vertical whole body oscillations various amplitudes \( 1 10 cm \) frequencies \( 1 3 hz \) normal subjects \( n 10 \) patients bilateral labyrinthine loss \( n 5 \) vertical oscillations produced motions head , amplitude markedly altered change oscillation frequency displacement vertical eye movements , correlated head movements , modified gaze 2 3 hz acquired bilateral lesions presented deteriorated head stability physically induced eye movements stronger however , significant increase head movement upon suppression motion upon running , characteristically found bilateral lesions , reproduced passive oscillations thus , features active locomotion may result imbalance produced alternate motions adaptation minimize , respectively
flap single stage procedure flap useful reconstructive technique repair defects nose improved technique used 32 patients presented , allows use procedure single stage rather commonly seen two stage procedure alterations include following \( 1 \) excision 's triangle superior edge defect toward inner \( 2 \) use periosteal suspension suture minimize across concave junction nose cheek \( 3 \) wide skin surrounding defect create stabilizing scar \( 4 \) significant thinning donor flap \( 5 \) adjust size flap original skin tension flap suturing none 32 patients presented required second stage procedure correct defects natural folds
epstein barr virus related antibody changes titers therapy nasopharyngeal carcinoma using long term follow data prospective , collaborative study 182 north american patients , evaluated significance various serologic tests antibody epstein barr virus predicting outcome treatment patients nasopharyngeal carcinoma restudied patients examining repeated measurements titer various times diagnosis treatment looked associations trends titers , measured slope log \( titer \) time , titer level , measured mean log \( titer \) , outcome alive evidence disease alive recurrence dead nasopharyngeal carcinoma found posttreatment sequential measurements predict outcome
distortion product normal impaired adult ears distortion product \( \) recorded group normally hearing subjects \( 29 ears \) group subjects whose conditions diagnosed sensorineural hearing loss \( 23 ears \) study correlation might exist characteristics hearing impairment different three different used investigate influence different test parameters data normal hearing impaired ears normally hearing ears demonstrated detectable , provided primary tone level certain value hearing impaired ears produced substantially reduced compared normally hearing subjects primary frequencies f1 f2 corresponded region hearing loss data also suggested , general , one f2 f1 ratio needed examine particular frequency region provide frequency specific information cochlear function , development , may form basis noninvasive , objective method evaluating cochlear function
small stapedotomy using fiberoptic hand held argon laser obliterative otosclerosis obliterative otosclerosis challenge since advent stapes surgery procedures generally poorer prognosis conventional stapes surgery excessive bleeding , acoustic trauma , oval window otosclerosis report , describe early experience using hand held fiberoptic argon laser small stapedotomy 10 cases obliterative otosclerosis closure air bone gap within 10 db seen 100 patients significant sensorineural hearing loss , vertigo , facial weakness argon laser stapedotomy using hand held fiberoptic system safe effective alternative stapedotomy cases obliterative otosclerosis
potential perichondrium cause hearing loss following stapedectomy perichondrium widely used tissue seal oval window following stapes surgery autogenous easily accessible , suitable substance cover total stapedectomy , seal around prosthesis small stapedotomy incidence complications use perichondrium manner exceedingly low report case perichondrium oval window resulted proliferation cartilage cartilage displaced stapes prosthesis , resulting conductive loss although potential perichondrium known , aware reports implicating cause failure stapes surgery pertinent clinical experimental literature regarding reviewed information suggests formation cartilage perichondrium oval window might influenced mechanical trauma tissue orientation
selective management early glottic cancer seventy patients stage ii glottic cancer treated university utah school medicine hospitals 1980 1987 forty four patients stage cancer 26 patients stage ii overall survival stage group 82 primary site control 93 three deaths due laryngeal cancer local control rates 93 co2 laser excision , 80 co2 laser irradiation , 67 radiation alone stage ii glottic patients overall survival 61 5 local control rate 76 twenty one 24 patients treated full course irradiation eight patients recurred primary site , irradiation failures initial bulky disease impaired vocal cord mobility selective co2 laser excision highly effective , whereas radiation therapy results somewhat disappointing open partial laryngectomy considered bulky stage ii disease patients
asymptomatic congenital cytomegalovirus infection audiologic , neuroradiologic , neurodevelopmental abnormalities first year twenty eight infants asymptomatic congenital cytomegalovirus infection 13 control infants followed prospectively congenital sensorineural hearing loss documented auditory brain stem responses four infected infants \( two mild bilateral loss , one mild unilateral loss , one extreme unilateral loss \) controls four infected infants diffuse periventricular radiolucencies computed tomographic scan none calcifications differences groups noted neurologic examination results bayley mental developmental index however , one infected infant severely delayed bayley psychomotor developmental index score addition , mean mental developmental index score four infected infants diffuse periventricular radiolucencies significantly remaining infected infants \( 93 8 vs 109 13 \) data suggest asymptomatic congenital cytomegalovirus infection may associated broad range audiologic , subtle neuroradiologic , neurodevelopmental differences early infancy
bilateral canal aplasia near normal cochlear development two case reports congenital malformations vestibular \( pars superior \) rare present two patients computed tomographic findings bilateral canal aplasia normal near normal initial bone conduction thresholds within normal limits , although patients significant conductive hearing losses due congenital middle ear malformations caloric responses absent knowledge first reports vestibular aplasia concomitant normal near normal cochlear development findings conflict conventional hypotheses state inner ear malformations result arrested development normal stages inner ear
effects cyclophosphamide pathogenesis cytomegalovirus induced cyclophosphamide used study define contribution inflammatory response relative direct cytopathic effects guinea pig cytomegalovirus \( gpcmv \) inducing sensorineural hearing loss guinea pig eighth nerve compound action potential \( cap \) threshold day 7 inoculation gpcmv average 35 db greater control animals immunosuppressed daily intraperitoneal injections cyclophosphamide \( 20 mg kg body weight \) amount gpcmv antigen , detected immunohistochemically correlate cap threshold however , greater inflammatory response gpcmv , higher cap threshold thus greater hearing loss study demonstrates inflammatory response gpcmv may important direct cytopathic effects virus producing sensorineural hearing loss gpcmv induced
efficacy oral steroids treatment persistent otitis media effusion one hundred thirty six children otitis media effusion least 2 months' duration investigated strict , double blind , randomized prospective study evaluate efficacy oral steroids treatment disease results study showed significant complete partial recovery otitis media effusion group treated combination antibiotics \( amoxicillin \) oral steroids \( prednisone \) , compared amoxicillin treated group placebo treated group believe treatment mostly benefits children aged 4 10 years without findings study imply combined course antibiotics oral steroids deserves place routine conservative trial surgery
localized antigen challenge nasal mucosa describe localized nasal antigen challenge measurement mediators found site eight ragweed allergic subjects challenged 2 days , 1 week apart challenges consisted six sequential , beginning two control challenges \( antigen phenol buffered saline \) followed four increasing antigen doses \( 0 6 , 6 , 60 , 160 protein nitrogen units \) \( antigen day \) additional four control challenges \( control day \) number symptom scores increased significantly increasing antigen doses levels histamine n alpha l arginine methyl ester esterase activity increased eluted secretions antigen day , control day amount secretions collected also increased per unit time antigen day found significant increase concentration level either histamine n alpha l arginine methyl ester esterase nasal secretions either day conclude total amount histamine n alpha l arginine methyl ester esterase activity increased per unit time concentration
excitation thresholds nerves paralyzed canine larynx electrical stimulation paralyzed laryngeal muscles implanted nerve muscle pedicles \( \) resulted documented return motion study , however , yet determined excitability correlates normal muscle nerve six anesthetized dogs , one denervated paralyzed , , posterior muscles via originating nerve 4 6 5 7 months , electric stimulator delivering biphasic pulses variable amplitude used test thresholds contraction nine , six intact recurrent laryngeal nerves \( \) , five normal cervical muscles one exception \( 2 1 \) , varied 0 0002 0 04 \( mean 0 sd 0 012 , n 6 \) two belonging animals stimulated several hours higher values \( 0 1 \) varied 0 01 0 09 control \( mean 0 sd 0 025 \) , 0 05 0 35 muscles \( mean 0 144 sd 0 109 \) histologic correspondence reinnervation established implanted muscles type atpase stains data suggest 1 \) nerve pedicles may offer promise eventual construction implantable low energy consuming laryngeal devices , 2 \) appropriate charge injected time remains determined
excitatory amino acids developing brain ontogeny , plasticity , besides role neurotransmitters , excitatory amino acids \( \) developing brain involved plasticity modified distinct ontogeny along incomplete , presynaptic markers eaa system immature developing brain however , postsynaptic eaa system activities , particularly n methyl aspartate receptors , transiently enhanced early life transient enhancement presumably beneficial immature brain physiologic activation eaa system plays critical role plasticity early learning time , transient hypersensitivity renders immature brain vulnerable pathologic excitation eaa system \( \) observed neonatal hypoxia ischemia
clinical determination brain death neuropathologic studies twelve infants serially examined determine would meet clinical criteria whole brain death within 7 day period protocol 1 infants \( 6 \) received intensive care including intubation birth protocol 2 infants \( 6 \) received intensive care period death brain death determined absence brainstem function , including loss cranial nerve responses sustained apnea \( pco2 greater 60 torr \) 48 hours confirmation findings outside child neurologist initial examinations 12 infants revealed spontaneous movements myoclonus \( 12 \) , , root , gag responses \( 7 \) , increased tone \( 8 \) , deep tendon reflexes \( 9 \) , absent pupillary responses \( 9 \) , absent corneal responses \( 6 \) , absent auditory responses \( 7 \) , optic nerve \( 8 \) mild depression neurologic function occurred first several days life subsequently , responses easier elicit sustained 2 infants met clinical criteria brain death neuropathologic findings indicated observed complex motor responses based upon cortical activity infant normally formed brainstem neuronal activity may accounted motor responses patients even level neurons absent findings suggest , although rare , clinical brain death determined infants ophthalmologic developmental abnormalities may examination cranial nerve function absence cortical neurons supports widely held opinion infants experience sensation
acth therapy infantile spasms relationship dose acth initial effect long term prognosis relationship dose acth initial effect investigated 41 children infantile spasms 0 015 mg \( 0 6 iu \) kg day acth needed good initial response seizures electroencephalographic abnormalities relationship dose acth long term prognosis investigated 29 patients relationship daily total acth dosage , provided dose greater 0 015 mg \( 0 6 iu \) kg day , outcome seizures electroencephalographic abnormalities however , acth 0 04 0 06 mg \( 1 6 2 4 iu \) kg day total acth dose 1 1 1 5 mg \( 44 60 iu \) kg resulted better mental development smaller doses acth side effects acth increased dosage small large dose acth lead better mental development proper dose acth used careful attention potential side effects
gross motor patterns children cerebral palsy spastic , sitting , patterns analyzed 72 children cerebral palsy spastic relation patterns severity disability studied , trunk rotation elbow support difficult severely children sitting , patients heel sitting pattern thighs knees , reciprocal thigh movements insufficient accompanied lateral bending trunk many patients impaired patients , thighs supported weight flexion move without reciprocal leg movements demonstrated severely affected children 2 years age
ethyl chloride venepuncture pain comparison intradermal lidocaine one hundred twenty patients undergoing surgery randomly allocated one three equal treatment groups assess effectiveness ethyl chloride producing instant skin anaesthesia prevent pain venepuncture 20 g cannula received either anaesthetic , 0 2 ml one per cent lidocaine plain ten second spray ethyl chloride cannulation site ethyl chloride produced skin anaesthesia significantly reduced pain venepuncture however , effective intradermal lidocaine effect vein ease cannulation ethyl chloride recommended method producing instant skin anaesthesia
brain protection physiological pharmacological considerations part physiology brain injury ischaemia , whether focal global nature , produces sequence intracellular events leading increased cell permeability water ions including ca loss cellular integrity function , increased production prostaglandins , free radicals , acidosis lactate accumulation events may exacerbated glucose administration pharmacological agents aimed alleviating ischaemic injury could directed decreasing cerebral metabolic requirements oxygen , improving flow ischaemic areas , preventing ca \( \) induced injury , inhibition free radical formation , lactate removal , inhibition prostaglandin synthesis , prevention complement mediated leukocyte aggregation part paper describes pathophysiological events leading ischaemic brain injury part 2 paper consider current agents available brain protection
myasthenia gravis myasthenia gravis disorder neuromuscular function resulting immunologically based premature destruction acetylcholine receptors disease characterized clinically variable weakness accentuated repetitive muscular activity usually responding administration acetylcholinesterase inhibitors myasthenia gravis complex disease requires understanding many facets natural history immunological basis ensure optimal individual patient management long term goal control immunological imbalance treatment regimens include thymectomy , corticosteroids , azathioprine , plasmapheresis common use acetylcholinesterase inhibitors provides symptomatic relief variable daily muscular activity disability due myasthenia gravis large extent reversible death preventable early recognition myasthenia gravis appropriate treatment often remission may permanent
dementia , depression , \? differential diagnosis depression , , dementia conditions frequently encountered among community living elderly review offers primary care perspective distinguishing features discusses special issues managing elderly major depression elderly usually responds antidepressant medication , whether depression occurs alone \( endogenous \) response another condition \( reactive \)
semantic deterioration alzheimer 's patterns expect differentiating language changes normal aged early stages dementia never simple differences expect aid making diagnosis
increased noradrenergic activity hepatic encephalopathy rats induced acute liver failure functional changes various neurotransmitter systems implicated pathogenesis hepatic encephalopathy study role brain neurotransmitter systems hepatic encephalopathy investigated rats induced acute liver failure concentrations serotonin , dopamine , noradrenaline metabolites 5 acid , dihydroxyphenylalanine \( following inhibition dihydroxyphenylalanine decarboxylase \) , acid , homovanillic acid 3 methoxy 4 glycol , measured cerebral cortex , striatum hippocampus high performance liquid chromatography detection hepatic encephalopathy concentrations 5 acid increased three brain areas \( 196 , 204 264 saline treated controls , p less 0 01 \) , concentrations serotonin increased frontal cortex \( 121 , p less 0 01 \) frontal cortex hippocampus rats dopamine levels increased \( 157 289 , p less 0 05 \) , levels noradrenaline \( 53 46 , p less 0 05 \) decreased associated increased 3 methoxy 4 levels \( 173 206 , p less 0 05 \) extent changes correlated stage hepatic encephalopathy hepatic encephalopathy dihydroxyphenylalanine accumulation increased hippocampus unchanged cerebral cortex dopamine , noradrenaline , acid homovanillic acid concentrations unchanged striatum results study indicate hepatic encephalopathy induced acute liver failure rats associated neurochemical changes , suggesting increased activity noradrenergic neurotransmitter systems
prevalence characteristics multiple analgesic drug use elderly study group exceptions , use multiple analgesic drugs achieves increases analgesia placing increased risk many potential adverse effects analgesic drugs potential duplication analgesic therapy among elderly great due prevalent painful chronic conditions variety prescription analgesic available prevalence multiple analgesic product use patterns concurrent use different analgesic categories investigated geographically defined population persons 65 years age older demographic characteristics users multiple analgesic drug products examined , smoking status , alcohol use , lifetime history rates major illnesses , physical functioning , pain experiences , memory performance , depressive symptoms substantial proportion analgesic users reported taking multiple products preceding 2 weeks \( 14 4 female 10 5 male analgesic users \) men reported pain preceding year likely use multiple analgesic products women experienced pain limited physical functioning , higher depressive symptom scores life time history ulcers likely use multiple analgesic products thus , although users multiple analgesic products reported significant pain , several factors shown related phenomenon multiple use
dementia dementia syndrome acquired intellectual deterioration interferes personal social functioning diagnosis requires historical information family mental status evaluation orientation , recent memory , comprehension , calculation , create permanent , even progressive cognitive deterioration , yet presentations remission exists common reversible conditions include depression , drug toxicity , normal pressure hydrocephalus , hypothyroidism , hematoma , neoplasm screening laboratory studies consist urinalysis , chemistry profile , blood count , thyroid survey , vitamin b12 folate measurements , serology , chest roentgenogram , computerized tomographic scan head , , electrocardiogram treatment focuses potential reversibility , psychosocial issues , restoring deficits , specific symptoms
acute long term changes serum lipids acute stroke studied serum lipid profiles 171 patients less equal 48 hours onset acute stroke 3 months later 83 patients suffering cerebral infarction significantly higher serum concentrations total cholesterol , low density lipoprotein cholesterol , apolipoprotein b significantly lower serum concentrations triglycerides lipoprotein \( \) less equal 48 hours ictus 3 months later lipid profiles 53 patients suffering lacunar infarction similar occasions , significant differences higher total cholesterol low density lipoprotein cholesterol concentrations less equal 48 hours ictus significant changes observed among 35 patients suffering cerebral hemorrhage apart significantly higher concentration high density cholesterol less equal 48 hours ictus study , many patients classified according stroke subtype , gives results different previous studies much fewer patients conclude studies serum lipid lipoprotein concentrations risk factors cerebral infarction , comparing values obtained less equal 48 hours admission control values may incorrectly identify certain lipid fractions risk factors
beneficial effect 1 , 3 butanediol cerebral energy metabolism edema following brain embolization rats assessed effect 1 , 3 butanediol cerebral energy metabolism edema inducing multifocal brain infarcts 108 rats intracarotid injection 50 microns microspheres ethanol dimer induces systemic , 25 mmol kg p butanediol injected every 3 hours produce sustained increase plasma level beta hydroxybutyrate treatment significantly attenuated ischemia induced metabolic changes increasing concentrations phosphocreatine , adenosine triphosphate , glycogen reducing concentrations pyruvate lactate lactate concentration 2 , 6 , 12 hours embolization decreased 13 , 44 , 46 , respectively brain water content increased 78 63 six rats 80 93 12 saline treated 79 57 seven butanediol treated rats 12 hours embolization \( p less 0 05 \) decrease water content associated significant decreases concentrations sodium chloride effect butanediol could explained osmotic mechanism since equimolar doses urea ethanol ineffective results support hypothesis beneficial effect butanediol mediated cerebral utilization ketone bodies arising butanediol metabolism , reducing rate deleterious accumulation lactic acid ischemia
etiologic importance intimal flap external carotid artery development endarterectomy stroke technically unsatisfactory end point \( transition removed diseased plaque normal distal intima \) leading intimal flap external carotid artery identified source perioperative stroke mechanism involves thrombus formation retrograde propagation thrombus subsequent embolization internal carotid artery report describes three cases illustrating mechanism methods identification correction mechanism postoperative stroke adds justification routine use intraoperative surveillance studies document technical result endarterectomy involving internal external carotid arteries unsatisfactory end point identified external carotid artery , corrected sense concern similar finding internal carotid artery
frequency three hex mutant alleles among jewish non jewish carriers identified tay sachs screening program mutations hex gene , encoding alpha subunit beta hexosaminidase \( hex \) , cause tay sachs disease well juvenile , chronic , adult examined distribution three mutations 4 nucleotide insertion exon 11 , g c transversion 5' splice site intron 12 , ser amino acid substitution exon 7 among individuals enzymatically diagnosed carriers hex deficiency mutation analysis included polymerase chain reaction \( pcr \) amplification relevant regions genomic dna , followed allele specific oligonucleotide hybridization another test heterozygosity exon 11 insertion based formation pcr fragments low electrophoretic mobility percentage distribution exon 11 , intron 12 , exon 7 , unidentified mutant alleles 73 15 4 8 among 156 jewish carriers hex deficiency 16 0 3 81 among 51 non jewish carriers regardless mutation , origin jewish carriers primarily eastern \( somewhat less often \) central europe , whereas non jewish carriers western europe jewish carriers four non jewish carriers hex deficiency mutant alleles three common ones tested , enzyme based tests cannot replaced dna based tests present time however , dna based tests two carrier couples could identify risk chronic adult rather infantile tay sachs disease
one mutant allele causes infantile tay sachs disease french two tay sachs disease \( tsd \) patients french canadian origin shown homozygous 7 6 kb deletion mutation 5' end hexosaminidase alpha subunit gene order determine whether french canadian tsd patients homozygotes deletion allele assess geographic origins tsd population , ascertained 12 tsd families french canadian origin screened occurrence mutations associated infantile tsd dna samples obtained 12 french canadian tsd families samples analyzed using polymerase chain reaction \( pcr \) amplification followed hybridization allele specific oligonucleotides \( \) restriction analysis pcr products cases southern analysis genomic dna performed eighteen 22 independently mutant chromosomes sample carried 7 6 kb deletion mutation 5' end gene one chromosome carried 4 nucleotide insertion exon 11 \( jewish mutation \) population individuals detected substitution splice junction exon 12 previously identified ashkenazi jews one chromosome carried undescribed b1 mutation allele came parent non french canadian origin patients three families carried tsd alleles different mutations 5' deletion mutation clusters persons originating southeastern quebec \( \) adjacent counties northern new
auditory hallucinations smaller superior temporal volume schizophrenia recent neuropathologic investigations schizophrenia report smaller volume medial temporal lobe structures findings confirmed preliminary magnetic resonance imaging \( mri \) studies direct stimulation lateral temporal lobe structures region superior temporal gyrus hallucinations authors' mri study young schizophrenic patients demonstrates smaller volume superior temporal gyrus \( auditory association area \) left amygdala smaller size left superior temporal gyrus left amygdala accounted smaller size overall brain temporal lobe shrinkage left superior temporal gyrus strongly selectively correlated severity auditory hallucinations
discriminant validity study negative symptoms special focus depression antipsychotic medication construct validity negative symptom syndrome established , conceptual overlap negative symptoms syndromes depression effects medication must explained author assessed 26 patients schizophrenia 21 patients without schizophrenia , depression , end average 2 week drug washout period approximately 2 months psychotropic medication administration negative symptoms remarkably consistent patients schizophrenia despite pharmacological intervention contrast , patients without schizophrenia manifested significant decreases negative symptoms
depression dementia alzheimer type multi infarct dementia authors used hamilton rating scale depression rating depressed mood investigate prevalence depression 55 patients alzheimer 's disease , 37 patients multi infarct dementia , 30 comparison subjects prevalence depressed mood depended severity dementia measured mini mental state examination significantly lower among patients severe stages alzheimer 's disease among patients severe multi infarct dementia
resistance lower motor neuron injury related increased acetylcholine receptors neuromuscular junction hypothesis lower motor neuron injury , associated proliferation acetylcholine receptors \( achr \) , induces resistance neuromuscular effects \( dtc \) tested rat left gastrocnemius denervated 75 80 lesion sciatic nerve effective dose 95 twitch depression \( \) studied denervated gastrocnemius compared contralateral sham injured \( control \) gastrocnemius muscles approximately 2 weeks injury achr number quantitated specific ligand 125i alpha \( 125i alpha \) plasma dtc concentrations , measured high performance liquid chromatography \( hplc \) , correlated twitch tension spontaneous recovery neuromuscular blockade denervated animal \( mean se \) dtc denervated leg significantly \( p less 0 05 \) higher \( 0 26 0 06 mg kg 1 \) contralateral \( 0 16 0 03 \) sham operated left \( 0 13 0 03 \) legs twitch tension recovered 50 control twitch height significantly \( p less 0 05 \) higher plasma dtc concentrations denervated \( 0 78 micrograms ml 1 \) compared contralateral \( 0 24 micrograms ml 1 \) limb achr number significantly increased denervated limb \( 96 fmol mg protein 1 \) compared contralateral right \( 109 4 \) control left limb \( 113 11 \) significant \( p less 0 05 \) positive correlation \( r2 0 73 \) achr number , 73 variability could explained changes achr study , therefore , confirms hypothesis proliferation achr nerve denervation results resistance neuromuscular effects dtc
prospective , double blind study metoclopramide hydrochloride control migraine emergency department study objective determine effectiveness iv metoclopramide sole therapy relieving pain acute migraine emergency department design prospective study fifty patients divided randomly subjects placebo controls treating physician patient participants patients presenting ed migraine requiring parenteral treatment interventions subjects received 10 mg iv metoclopramide controls received iv normal saline patient assessment relief followed means numerical scale measurements main results sixty seven percent subjects compared 19 controls effective pain relief within one hour \( p less 001 \) subjects achieved mean relief scores 2 46 compared 1 69 controls \( p less 02 \) significant side effects observed conclusion iv metoclopramide single agent effective safe therapy migraine ed
spectral toxicity three patients toxicity , \( \) red light found average normal range significant increase amplitude appeared cessation therapy two cases deterioration amplitude stimulus conditions \( white , blue , red lights \) occurred dose medication increased third patient
auditory brain stem implant effect tumor size preoperative hearing level function auditory brain stem implant investigational device designed provide hearing sensations patients without functioning auditory nerves analyzed results 17 implants 15 patients determine tumor size preoperative hearing level might related proper device function found significant correlation preoperative hearing level tumor size device function also found significant correlation preoperative hearing level tumor size 15 patients
cholinergic deficiency frontal dysfunction parkinson 's disease investigate influence central cholinergic deficit cognitive function parkinson 's disease \( pd \) , compared neuropsychological performance group 20 patients treated anticholinergic drugs \( mean daily dose , 10 2 mg \) group 20 patients received two groups matched variables parkinsonism levodopa therapy dose used , significant difference two groups patients intellectual , , instrumental , memory function contrast , group received severe impairment observed tests believed assess frontal lobe function results suggest lesion ascending cholinergic neurons , demonstrated post pd , may play role behavioral impairment disease
immunoreactivity plaques creutzfeldt jakob disease cerebellar plaques 2 cases creutzfeldt jakob disease studied immunohistochemically similar cerebellar senile plaques alzheimer 's disease , many plaques contained positive , tau negative small granular elements , presumably representing dystrophic results suggest similar mechanisms involved changes cerebellar plaques creutzfeldt jakob alzheimer 's diseases despite differences amyloid proteins plaques
vasoactive peptide release circulation humans migraine headache innervation cranial vessels trigeminal nerve , system , recently subject study view possible role aspects migraine since stimulation trigeminal ganglion humans leads facial pain flushing associated release powerful neuropeptide vasodilator substances , local release circulation humans determined patients either common classic migraine venous blood sampled external jugular fossa ipsilateral side headache plasma levels neuropeptide , vasoactive intestinal polypeptide , substance p , calcitonin gene related peptide determined using sensitive radioimmunoassays peptide , values fossa external jugular control population compared substantial elevation calcitonin gene related peptide level external jugular fossa blood seen classic common migraine increase seen classic migraine greater seen common migraine peptides measured unaltered finding may importance pathophysiology migraine
slow release carbamazepine treatment poorly controlled seizures thirty three children poorly controlled epilepsy , six new patients , treated slow release carbamazepine twelve former reduction number seizures half , 10 fewer side effects three new patients stopped seizures variations plasma concentrations doses significantly less patients took slow release preparation \( 22 \) compared standard preparation \( 41 \) slow release carbamazepine may improve conditions children whose seizures poorly controlled
routine evaluation syncope adults reviewed reports obtained \( \) veterans administration hospital september 1987 august 1989 seventy three patients referred evaluation syncope near syncope 73 patients , 10 \( 13 7 \) abnormal findings twenty six patients referred complaints similar syncope \( ie , , loss consciousness , falling , passing , \) 26 patients , five \( 19 2 \) abnormal findings reviewed medical records patients abnormal findings found final diagnosis treatment syncope affected one patient findings suggest routine significant value evaluation syncope adults
rehabilitation chronic stroke patients changes functional performance forty stroke patients least one year post onset completed one month intensive rehabilitation program month program served control period program , patients received individual sessions occupational physical therapy four days week , participated group activities fifth day therapy emphasized instruction motor planning , balance weight shift , use adaptive equipment motor abilities within real life situations patients demonstrated significant improvement outcome measures weight shift , balance , adl scores one month rehabilitation program \( weight shift f 16 1 , p 0001 balance f 6 26 , p adl f 13 8 , p 0001 \) retained new skills three month follow period
childhood stroke minor neck trauma case report cerebral infarction minor trauma neck rarely reported case presented child trauma vertebrobasilar artery resulting stroke computerized tomography scan angiography results presented despite two subsequent , separate transient episodes vertigo , child good functional recovery complete restoration language cognitive function 28 months , residual impairments identified mild right sided ataxia hemiparesis
apneic oxygenation apnea tests brain death controlled trial performed prospective controlled study apneic oxygenation 15 patients undergoing apnea tests brain death patients 100 oxygen existing settings 10 minute apnea tests , nine patients given continuous apneic oxygenation tracheal cannula six patients tracheal tubes open room air patients given apneic oxygenation little hypoxia end test patients given room air test became hypoxic many neurologists perform apnea tests oxygenation alone first prospective controlled study \( knowledge \) apneic oxygenation shows alone prevent hypoxia apnea tests brain death recommend apnea tests performed apneic oxygenation
geographic patterns parkinsonism dementia complex 1956 1985 average annual age adjusted incidence rates parkinsonism dementia complex obtained 19 districts 1956 1985 highest rates found southern central districts , lowest rates found northern western districts geographic temporal patterns incidence associated socioeconomic status factors risk parkinsonism dementia complex susceptible much higher general population even districts highest incidence rates , especially districts lowest incidence rates evidence tends support hypothesis multiple factors linked use play important role cause hypotheses related metal exposure simple genetic factors unsatisfactory explanations epidemiologic patterns observed
racial differences anterior circulation cerebrovascular disease much explained risk factors \? entry characteristics patients enrolled extracranial intracranial bypass study examined determine site differences intracranial extracranial arterial lesions among racial groups could explained differences risk factors blacks often hypertensive , diabetic , cigarette smokers , whites higher systolic blood pressure hemoglobin values lowest prevalence vascular risk factors despite differences risk factors , multivariate analysis showed race independent strong predictor location cerebrovascular lesions knowledge , study unique documenting risk factors prospectively systematically three racial groups simultaneously although limited possible related patient selection , results previous conclusions role race determining location cerebrovascular disease
large infarct clinical pathophysiological entity examined 29 patients strictly subcortical large infarctions eight aphasia neglect patients underwent transcranial doppler ultrasonography selective carotid angiography , magnetic resonance imaging , single photon emission tomography assessment cerebral blood flow , blood volume , cerebral perfusion reserve signs compatible cortical infarctions rather magnetic resonance imaging computed tomographic scans , lesions corresponded territories medial lateral group arteries , 's artery , anterior choroidal artery infarctions either due cerebral embolization m1 segment middle cerebral artery due stenosis site , ie , lesions acutely simultaneously occluded orifices arteries persistent occlusion middle cerebral arteries decrease cortical regional cerebral blood flow found patients aphasia neglect patients without aphasia neglect showed rapid recanalization middle cerebral artery occlusion stenosis m1 segment cortical regional cerebral blood flow decrease large infarctions occur due occlusive disease middle cerebral artery \( large vessel disease \) due disseminated situ occlusion long penetrating arteries \( small vessel disease \) , neuropsychological deficits explained decreased cortical blood flow due persistent occlusive lesion middle cerebral artery
brain imaging abnormalities mental disorders late life psychiatric inpatients dementia \( n 61 \) depression \( n 67 \) late life 2 6 times likely manifest magnetic resonance imaging abnormalities brain elderly controls \( n 44 \) controlling effects age gender , demented patients distinguishable controls increased prevalence cortical atrophy infarction , depressed patients exhibited increased prevalence cortical infarctions patients dementia distinguishable major depression increased prevalence cortical atrophy results indicate major depression late life , like dementia , associated remarkable increase overt pathologic changes brain
adjuvant chemotherapy primary lymphoma central nervous system ten immunocompetent patients primary non hodgkin 's lymphoma central nervous system treated neuro oncology service university california san francisco \( \) undergoing surgery biopsy removal tumors , patients \( group 1 \) received irradiation hydroxyurea followed adjuvant chemotherapy combination procarbazine , \( ccnu \) , vincristine outcome treatment group compared three groups patients primary cns lymphoma patients treated cancer research institute underwent surgery radiation therapy \( rt \) \( group 2 \) patients described literature surgery rt \( group 3 \) patients described literature surgery , rt , chemotherapy \( group 4 \) median quartile survival times greater patients received adjuvant chemotherapy \( group 1 , 30 50 months group 4 , 20 25 months \) patients receive chemotherapy rt \( group 2 , 13 20 months group 3 , 15 24 months \) results suggest adjuvant chemotherapy useful treatment primary cns lymphoma
epidural hematoma unusual presentation authors present patient traumatic epidural hematoma complained headache presented emergency department 48 hours fall mental status neurological examination normal delayed presentation commonly seen hematoma present may result epidural bleeding delayed formation traumatic epidural hematoma may occur following present elevated intracranial pressure , hypovolemic shock , concomitant mass lesion , coagulopathy , bleeding dural veins , dural sinus laceration , traumatic , arteriovenous fistula although criteria computed tomography patients head injuries remain variable literature , delayed presentation epidural bleeding must considered differential diagnosis posttraumatic headache time interval neurological presentation
effect flumazenil midazolam induced amnesia studied effect v flumazenil 0 01 mg kg 1 amnesia sedation caused midazolam 2 mg 5 mg v volunteers order determine relationship actions antagonist two effects midazolam caused dose dependent central neural depression assessed critical fusion frequency , dose dependent amnesia cards subjects given flumazenil 5 min administration midazolam , fusion frequency readings memory restored levels comparable midazolam administration two effects flumazenil similar time course extent , suggesting share mechanism action flumazenil given alone effect memory study demonstrated anterograde amnesia following benzodiazepine administration antagonism flumazenil neither retrograde amnesia retrograde antagonism amnesia
double blind comparison topical lignocaine prilocaine cream \( emla \) lignocaine infiltration arterial cannulation adults double blind , double study , efficacy topical 5 emla cream compared lignocaine infiltration alleviating pain arterial cannulation forty adults allocated randomly four groups receive emla cream alone , emla 0 9 saline infiltration , emla 1 lignocaine infiltration placebo cream 1 lignocaine infiltration following arterial cannulation , pain assessed patient using visual analogue score independent observer using four category verbal rating score significantly lower pain scores observed patients receiving emla compared receiving placebo cream lignocaine infiltration patient \( p less 0 01 \) observer \( p less 0 001 \) assessments significant differences three emla groups
cerebral effects sevoflurane dog comparison isoflurane enflurane cerebral effects sevoflurane compared dogs enflurane isoflurane initially , minimum alveolar concentrations \( mac \) sevoflurane enflurane determined electroencephalographic \( eeg \) responses increasing doses sevoflurane \( 1 5 , 2 0 2 5 mac \) enflurane \( 1 5 2 0 mac \) animals examined administration sevoflurane associated seizure activity concentration either \( paco2 5 3 kpa \) \( paco2 2 7 kpa \) , even presence intense auditory stimuli dogs enflurane demonstrated sustained eeg motor evidence seizure activity induced auditory stimuli concentrations enflurane greater 1 mac , particularly separate group dogs , effects increasing concentrations sevoflurane isoflurane \( 0 5 , 1 5 2 15 mac \) compared directly arterial pressure , cardiac output heart rate , cerebral blood flow cerebral metabolic rate oxygen \( \) using venous outflow technique sevoflurane , common isoflurane , minimal effects cerebral blood flow concentrations studied , significantly reduced end tidal concentrations sufficient produce burst suppression pattern eeg \( approximately 2 15 mac \) sevoflurane isoflurane significantly decreased arterial pressure dose dependent manner , neither drug significantly altered cardiac output
primary fibromyalgia exist \? twenty one 25 consecutive primary fibromyalgia patients , identified 5 year period tertiary care day ward pain syndromes , examined fifteen fulfilled criteria fibromyalgia unexpectedly , cases either psychiatric disturbance thyroid dysfunction four patients seen follow , two developed neurological diseases , another rheumatoid arthritis one hypothyroidism thus , 5 years patient fulfilled criteria primary fibromyalgia women occupied manual workers represented patients reported beneficial effects physiotherapy none patients able return full time work
randomized comparison manipulation fractured nose local general anaesthesia reduction simple nasal fractures may performed local general anaesthesia latter far popular method , though hard define attempted compare 2 approaches means randomized , prospective trial fifty consecutive , adult patients radiologically proved fractures nasal bones randomized local general anaesthesia group underwent manipulation 's 's forceps 7 15 days post injury analysis results 4 h 8 weeks post operatively showed significant benefit conferred fracture reduction general anaesthesia opposed local anaesthesia respect post operative airway patency cosmesis suggested significant benefits obtained terms patient convenience cost effectiveness nasal fractures reduced local anaesthesia outpatient procedure
patellar resurfacing total knee arthroplasty technical errors patellar resurfacing time total knee arthroplasty \( tka \) responsible many complications affect patellofemoral joint instability , patellar fracture , wear metal patellar implants significantly affected errors patellar resurfacing review 50 using condylar prosthesis standardized technique patellar resurfacing performed evaluate accuracy technique patients evaluated mean 2 5 years \( range , two five years \) surgery hospital special surgery knee score improved preoperative mean 56 92 last evaluation hospital special surgery knee scores excellent 92 good 8 knee society knee score improved preoperative mean 28 pain 49 function last evaluation mean 96 pain 85 function none patients symptoms patellofemoral joint patellar fractures , dislocations , instances implant loosening patella roentgenograms revealed nine five patellar patellar thickness maintained preoperative level 21 mm joint line height elevated 1 mm patellar height decreased 2 mm preoperative height using standard technique , satisfactory clinical results achieved , minor errors resurfacing alignment still occur
total knee arthroplasty fixation comparison early results paired cemented versus uncemented porous coated anatomic knee prostheses results 18 matched pairs porous coated anatomic knee prostheses studied compare early clinical functional performance cemented versus uncemented fixation average five year follow period knee score improved preoperative average 35 points postoperative average 90 points cemented group , 38 points 93 points uncemented group particular , individual pain scores range motion values well matched three , six , 12 month follow visits showed steady improvement subjectively , patients results surgery one third preferred cemented side , one third preferred uncemented side , one third found difference performance either knee clinical functional performance knee prostheses patients one cemented knee one uncemented knee comparable possibly unrelated type fixation method
cemented ingrowth fixation miller prosthesis clinical roentgenographic comparison three six year follow studies one hundred thirty nine cemented 132 cementless miller total knee prostheses followed three six years \( average , 43 44 months \) fixation technique based patient age , bone quality , ability delay full weight bearing clinical follow studies possible 116 cemented knees fifteen knees lost death three year follow study , eight knees required component removal one hundred twenty three cementless knees available clinical follow studies three deaths , six failures required component removal cemented failure due fixation , three cementless failures due lack tibial ingrowth two pain undetermined etiology one preoperative knee scores slightly significant cemented knees averaging 48 points cementless knees averaging 52 points similar significant difference maintained final follow study significant differences noted pain , , support scores average range motion similar two groups radiolucent lines femoral component rare cementless tibial radiolucencies partial 20 examined zones , complete tibial radiolucency seen three patients correlation radiolucency knee scores seen
anatomical , physiological , theoretical basis antiepileptic effect vagus nerve stimulation vagus mixed nerve carrying somatic visceral afferents majority vagal nerve fibers visceral afferents wide distribution throughout central nervous system \( cns \) either via nucleus solitary tract besides activation well defined reflexes , vagal stimulation produces evoked potentials recorded cerebral cortex , hippocampus , thalamus , cerebellum activation vagal afferents reflexes , decrease activity neurons , increase pain threshold depending stimulation parameters , vagal afferent stimulation experimental animals produce electroencephalographic \( eeg \) shown affect sleep states eeg appears depend activation afferent fibers conduction velocities less equal 15 vagal afferent stimulation also influence activity interictal cortical spikes produced topical strychnine application , either attenuate stop seizures produced , 3 acid , maximal , topical gel mechanisms antiepileptic effects vagal stimulation fully understood probably relate effects reticular activating system vagus provides easily accessible , peripheral route modulate cns function
feasibility safety vagal stimulation monkey model feasibility , safety , preliminary effects chronic vagal stimulation studied monkey model pilot studies perfect equipment , determine stimulation thresholds , comfort safety animals preceded study four monkeys equipped indwelling , 2 electrode cuff \( titanium bands spaced 7 mm apart silicone 1 5 cm total length \) contact around right vagus nerve avoidance cardiac branch confirmed electrocardiograms recovery , intact awake animals received constant current stimulation \( 5 83 hz , 143 hz , 50 250 hz randomly 0 5 ms pulse width \) onset every spontaneous seizure duration seizure every 3 h 40 stimulation occurred preceding hour stimulation periods 2 6 weeks , differing levels stimulation , preceded followed least 2 week baseline period stimulation stimulation periods , seizure rate decreased zero two monkeys intervals became remaining two monkeys effects carried baseline periods vagal stimulation consistent effects seizure severity eeg interictal spikes histological studies six vagus nerves unable separate electrode cuff damage direct effects stimulation may nerves although appears chronic vagal stimulation feasible epileptogenic processes influenced , safety efficacy procedure still question
implantable neurocybernetic prosthesis system neurocybernetic prosthesis \( , inc \) implantable , pulse generator constant current electrical signals vagus nerve purpose reducing frequency severity epileptic seizures device implanted subcutaneous chest pocket clavicle , similar cardiac pacemaker placement stimulation signal transmitted prosthesis vagus nerve stimulation lead prosthesis programmed using compatible personal computer programming programming electrodes used first group patients found break unacceptable rate design modifications appear resolved problem
surgical technique implantation neurocybernetic prosthesis surgical technique implantation neurocybernetic prosthesis described detail procedure straightforward easily carried surgeons familiar carotid surgery
efficacy safety vagus nerve stimulation patients complex partial seizures clinical trial chronic intermittent vagal stimulation five patients suggests procedure may safe effective adjunctive treatment medically intractable seizures partial onset patients tolerated well implantation neurocybernetic prosthesis vagal stimulation without serious physiological lifestyle changes stimulation vagus nerve either reduced seizure frequency decreased duration intensity seizures adverse side effects limited sensation stimulation major complication mechanical interruption wire electrode , consequent cessation stimulation small number patients relatively short follow period make pilot study , results promising
vagus nerve stimulation humans neurophysiological studies electrophysiological monitoring evidence studies experimental animals indicates electrical stimulation vagus nerve alters behavioral seizure activity report effects electrical stimulation vagus nerve five patients medically intractable seizures part clinical trial chronic vagal stimulation control epilepsy mechanism action vagal antiepileptic effect unknown , analysis electrophysiological effects vagal nerve stimulation help elucidate brain areas affected stimulation left vagus nerve neck accomplished implanted stimulator effects stimulus amplitude , duration , rate studied reference recording vagus nerve evoked potential showed unusual properties scalp negative component occurred latency 12 ms , high amplitude \( 60 microv \) , widespread scalp distribution field distribution studies indicate potential generated neck , region stimulating electrodes muscle paralysis confirms observation stimulation various frequencies noticeable effect electroencephalographic \( eeg \) activity regardless whether patient general anesthesia , awake ,
effects vagal stimulation experimentally induced seizures rats repetitive stimulation vagus nerve inhibits chemically induced seizures dogs report results conclusions studies designed answer immediate questions raised finding \( 1 \) maximal stimulation vagal c fibers frequencies greater 4 hz prevents reduces chemically electrically induced seizures young male rats \( 2 \) antiepileptic potency directly related fraction vagal c fibers stimulated \( 3 \) vagal stimulation chemical seizure begun \( 4 \) rats , optimal stimulus frequency approximately 10 20 hz duration stimulus , 0 5 1 ms stimulus strength , 0 2 0 5 mm2 nerve cross section results , taken together similar results obtained dogs , monkeys , humans , strongly suggest periodic stimulation vagus nerve using appropriate stimulation parameters powerful method preventing seizures data literature suggest antiepileptic actions vagal stimulation largely mediated widespread release gaba glycine brainstem cerebral cortex probable pathway via projections nucleus solitary tract reticular formation diffuse projections cortex areas intermittent vagal stimulation reducing number intensity seizures patients intractable epilepsy results indicate feasibility studies humans continued expanded
clinical implications international classification earliest days neurology , classification epileptic seizures generalized beginning definable localization cortex onset added knowledge function nervous system elaboration classification seizures localized six whose elaboration involves regions brain involved consciousness memory provided basic focus subspecialty epilepsy surgery increasingly apparent etiology seizure disorder least equal greater significance nature seizures product localization nervous system also causative factors implications reaching areas genetics , higher cortical function , intelligence prognosis concerning outcome epilepsy consideration based facets pathophysiological , seizure presenting symptom , constitutes epilepsy epileptic syndrome formulation rational treatment plan based
transient hyperprolactinemia associated luteinizing hormone surge study demonstrates lh surge cycles ivf patients associated significantly higher serum prl concentrations cycles spontaneous lh surge occur findings support hypothesis concomitant lh prl release time gonadotropin surge , well estrogen sensitization pituitary , suggest possible mechanism transient hyperprolactinemia
local anesthesia neonatal family practice residents likely use \? dorsal penile nerve block lidocaine \( dpnb \) local anesthetic technique neonatal circumcision effective consistent ethical concerns infant , included training programs prepare residents care newborns assess current level dpnb use residents family practice training program identify attitudes factors relate use , survey sent 127 residents department family practice community health , university minnesota 101 respondents , 55 used dpnb , 17 could characterized high users , employing technique one half performed residents comprehensive understanding newborn 's capacity feel pain likely using dpnb less well informed counterparts four factors identified predicting use cooperation staff procedure , instruction technique , belief effective reducing infant pain , likelihood parents giving consent results suggest strategies may implemented family practice promote principles techniques dpnb
serious migraine study epidemiological aspects data scant concerning epidemiological aspects severe headaches cause serious personal economic morbidity purpose study incidence epidemiological features patients suffering severe migraine exacerbations , unselected population 64 patients suffered severe migraine represented 10 5 new walk neurological consultations area covered study 70 patients 10 39 years old although females clearly predominated ages fifteen , age slight male predominance calculated incidence serious migraine exacerbations 90 per 100 , 000 people per year , corrected incidence females 143 100 , 000 males 37 100 , 000 highest incidence females 15 19 year \( 100 , 000 \) males 10 14 year \( 166 100 , 000 \) data seem confirm periodic nature condition since 80 patients migraine \( ie groups attacks \) lasted two nine months also support reported existence genetic hormonal factors susceptibility migraine exacerbations results may help planning public health aspect migraine add light natural history common condition
platelet monoamine oxidase activity female migraine patients platelet monoamine oxidase activity \( mao \) group \( n 17 \) white , female migraineurs acute migraine attack similar values obtained group patients two three weeks headache episode \( pain free period \) results obtained group \( n 18 \) sex race matched , age comparable , drug free healthy volunteers \( blind study substrate p , 38 7 5 7 , 41 9 8 8 43 0 3 4 p , 178 9 11 3 , 177 2 6 9 181 0 9 7 hr 10 \( 9 \) platelets sd respectively \) patient serving control , mao activity migraine episode pain free failed show significant trend neither number medical conditions use several medications appeared significantly influence results present work , dealing small well defined patient population , possible usefulness platelet mao activity biological marker migraine headaches
protocol , aspirin caffeine \( bac \) detoxification headache patients abuse combination drug containing 50 mg , aspirin 325 mg caffeine 40 mg \( bac \) , commonly recognized headache specialists causing headaches despite widespread problem , published treatment regimen bac detoxification patients describe protocol used four times three patients patients fulfilled diagnostic criteria ihs headache classification headaches induced chronic substance abuse \( 8 2 \) analgesics abuse headache \( 8 2 2 \) patients took 150 420 bac month 2 15 years two patients previously undergone inpatient detoxification one patient unsuccessfully tried detoxification twice outpatient patients required psychological support prior hospitalization protocol bac discontinued challenge test corroborated dosage patients given phenobarbital caffeine tapered several days dihydroergotamine \( \) metoclopramide used \( \) propranolol 60 mg started narcotics permitted hospital discharge , patients allowed continue subcutaneous , needed one patient bac use 8 months without two patients still bac free 18 14 months detoxification
dissociation pain autonomic disturbances cluster headache relationship pain autonomic disturbances cluster headache studied 54 patients whose attack always recurred side , 7 others whose attack affected either side different occasions one seven patients , facial flushing ocular sympathetic deficit observed original side headaches patients , orbital region painful side three cases region attacks common severe attacks , temperature difference increased increasing severity pain findings support view certain autonomic disturbances cluster headache provoked pain residual autonomic dysfunction could influence autonomic activity cluster headache , residual dysfunction pain free side could explain dissociation autonomic disturbances pain observed cases
study seasonal variation migraine available evidence supports migraine involves disturbance serotonin function several parameters serotonin function humans found vary may underlie seasonal fluctuations observed many clinical neuropsychiatric phenomena thought involve serotonin dysfunction therefore postulated migraine headaches might also vary examined admissions hospital 20 year period primary diagnosis migraine peak admissions found occur frequently spring females comparison males \( p less equal 0 04 , chi square \) implications findings discussed
clinical characteristics migraine episodic tension type headache relation old new diagnostic criteria eighty one patients diagnosed migraine , tension headache according previously used criteria performed standardized interview determine frequency severity headache characteristics used new diagnostic criteria international headache society \( ihs \) every patient original diagnosis fulfilled also ihs criteria , 9 patients criteria fulfilled half less attacks , applying ihs criteria also achieved additional diagnosis one patient attacks fulfill pain criteria 8 \( 4 migraine , 4 tension headache \) fulfill criteria accompanying symptoms overall ihs criteria sensitive specific , may possibly improved regard accompanying symptoms present study suggests recording frequency graded severity characteristics using headache diary may improve distinction different types headache
timing upper airway chest wall inspiratory muscle activity obstructive sleep apnea imbalance amplitude electrical activity upper airway chest wall inspiratory muscles associated collapse upper airway obstructive sleep apnea \( \) purpose study examine whether timing phasic activity inspiratory muscles also associated changes upper airway caliber hypothesized activation upper airway muscle phasic electrical activity activation chest wall pump muscles would help preserve upper airway patency contrast , anticipated reversal pattern delayed activation upper airway inspiratory muscles would associated upper airway narrowing collapse therefore timing amplitude midline margin moving time average \( \) electromyogram \( emg \) signals analyzed 58 apnea cycles stage 2 sleep six patients 86 breaths analyzed upper airway peak activity preceded chest wall peak activity 86 obstructed respiratory efforts upper airway peak activity followed chest wall peak activity onset phasic electrical activity followed pattern inspiratory efforts phasic inspiratory emg amplitude change apnea , timing changes noted occurred even within breaths relative timing upper airway chest wall electrical activities closely associated changes pressure flow relationship conclude relative timing inspiratory activity upper airway chest wall inspiratory muscles sleep
rat soleus muscle ultrastructure hindlimb suspension aim present investigation determine , quantitative electron microscopy , effects 5 wk tail suspension period rat soleus muscle ultrastructure marked decline \( 60 \) muscle mass occurred mean fiber cross sectional area decreased greater extent \( 75 \) capillary fiber ratio \( 37 \) , leading higher capillary density \( 148 \) hypokinesia total mitochondrial volume density remained unchanged , whereas volume density slightly significantly reduced \( 6 \) shift mitochondria occurred mitochondrial volume density highest near fiber border decreased toward fiber center increase volume density cells suggested muscle regenerative events soleus atrophy tail suspension greatly decreases muscular volume ultrastructural composition muscle fibers relatively unaffected
cognitive function testing comprehensive geriatric assessment comparison cognitive test performance residential clinic settings tests cognitive function frequently used geriatric assessment , effect test setting rarely explored determine effect testing site performance elderly patients undergoing comprehensive geriatric assessment , administered mini mental state exam 116 geriatric patients clinic residence cognitive abilities varied normal severely impaired patients' scores 1 5 3 6 \( mean sd \) higher residence clinical importance difference score 1 5 clear reason second analysis performed difference scores five points greater settings considered clinically meaningful twenty five percent \( 29 116 \) differed five points 29 patients , 22 \( 76 \) tested better residential setting differences statistically significant \( p 001 \) conclude testing site may affect test performance home assessment may reveal optimal cognitive function geriatric patients
foci increased t2 signal intensity mr images healthy elderly subjects follow study 18 month follow study conducted 26 healthy elderly subjects without foci increased t2 signal intensity mr imaging subjects differ respect health status cognitive performance measured cognitive subscale mental disorders elderly examination mini mental state examination follow significant decline performance digit substitution test subjects evidence t2 foci compared performance subjects without t2 foci may indicate presence t2 foci correlated subtle difficulties learning memory
decline prevalence childhood deafness jewish population ethnic genetic aspects longitudinal study performed 147 jewish children bilaterally sensorineural hearing loss moderately severe profound degree , born eighteen years 1968 85 prevalence rate children declined years 1977 85 , time rate parents decreased decline evident genetic group among children non ashkenazi ethnic origin decline found among ashkenazi children among parents children recorded study supports assumption restriction consanguineous may affect prevalence genetic deafness children well defined population tried remain certain shortcomings present study
compliance , reliability , validity self monitoring physical disturbances parkinson 's disease parkinson 's symptom diary previous clinical research parkinson 's disease recognized value self monitoring procedures patients observe record frequency severity symptoms occur within patient 's social work environment discuss issues methodology report study compliance , test retest reliability , validity new self monitoring instrument , parkinson 's symptom diary two recordings frequency \( loss balance , \) two ratings severity \( tremor , difficulty walking \) made four times daily one week patients \( n 73 \) without apparent loss cognitive memory functions total 91 received \( 97 requested \) met strict compliance criteria independent sampling days could assumed test retest stability one month demonstrated score \( greater 85 \) representative subsample 28 patients criterion validity demonstrated score expected pattern correlations independently obtained observer ratings related indices disease , comparison disability stages simplicity , self assessment device invaluable complement traditional methods clinical laboratory assessment care evaluation parkinson patients
genetics tourette syndrome review current status genetics tourette syndrome presented course 104 years since gilles de la tourette described syndrome bears name , body carefully collected , described , analyzed data produced model genetics implicates single dominant gene variably males females moreover , locus action gene likely dopaminergic system midbrain systematic search gene using recombinant dna techniques way
fatal severely disabling cerebral infarction hospitalization stroke transient ischemic attack six \( 1 \) patients admitted cerebral infarction transient ischemic attack \( \) suffered fatal severely disabling hospital cerebral infarction following period stabilization improvement lasting 1 day infarctions characterized sudden onset coma subsequent development herniation due carotid middle cerebral artery territory infarction , widespread brain stem infarction due basilar occlusion one patient survived four patients large vessel disease documented doppler , angiography , autopsy six infarcts occurred morning hours , 4 9 days initial event , 3 8 days initiation intravenous heparin , within 4 8 h intravenous heparin discontinued coagulation abnormalities documented believe cases indicate among patients admitted cerebral infarction , fatal severely disabling hospital cerebral infarction period stabilization improvement may occur patients initially mild moderate clinical deficit , suffering large artery disease may greater risk , may relationship heparin withdrawal cerebral infarction patients
unusual blink reflex four components patient periodic ataxia characteristic findings blink reflex reported 55 year old female periodic ataxia blink reflexes side ipsilateral stimulation consisted four components latencies 11 , 21 , 35 47 ms , instead usual two components seen normal subjects contralateral side , last three components also present second component different normal r2 response latency shorter normal stimulation rate 10 hz addition , affected diazepam third fourth components considered r2 may consisted three components shorter latency second component could explained facilitation
characterization periventricular edema normal pressure hydrocephalus measurement water proton relaxation times magnetic resonance longitudinal relaxation time \( t1 \) transverse relaxation time \( t2 \) water proton periventricular white cortical gray matter measured 17 control patients 21 patients suspected normal pressure hydrocephalus \( nph \) latter group , 14 showed good response shunting \( true nph group \) seven showed response \( false nph group \) true nph group , t1 t2 periventricular white matter significantly prolonged compared control values , slowly shortened cerebrospinal fluid \( csf \) shunting true nph group showed significantly longer t1 t2 white matter false nph group t1 t2 white matter longer gray matter group , reverse relationship observed control patients white matter false nph group , significant prolongation t1 difference seen t2 compared control values change either t1 t2 region csf shunting false nph group showed significant difference either t1 t2 white gray matter difference either t1 t2 gray matter false nph control groups measurements patient group suggested distinction true false nph , cannot made radiographic appearance alone , may possible measurement relaxation times mechanism varied relaxation behavior two entities may explained difference properties biological water environment
systems analysis cerebrovascular pressure transmission observational study head injured patients observational study head injured patients , cerebrovascular pressure transmission investigated using systems analysis approach whereby blood pressure \( bp \) waveform used measure input stimulus cerebrovascular bed \( \) intracranial pressure \( icp \) waveform response stimulus transfer function measure much pressure transmitted given frequency calculated using fourier analysis pressure waveforms transfer function allows quantification pressure transmission performance , thus providing basis comparison normal abnormal function fifteen hundred samples icp bp waveforms collected 30 head injured patients via microcomputer line spectral analysis waveform database revealed four main classes transfer function overall flat transfer function \( curve type 1 \) elevated low frequency response \( curve type 2 \) elevated high frequency response \( curve type 3 \) exhibiting elevated low high frequency response \( curve type 4 \) curve types 2 4 often associated raised icp \( greater 20 mm hg \) , whereas curve types 1 3 often affiliated icp less 15 mm hg studies type may provide insight pathophysiology ultimately aid prediction treatment raised icp
massive increases extracellular potassium release glutamate following brain injury increase extracellular k concentration \( k c \) rat hippocampus following fluid brain injury demonstrated microdialysis role neuronal discharge examined situ administration 0 1 mm tetrodotoxin , potent depressant neuronal discharges , 0 5 20 mm cobalt , blocker ca channels small short lasting k c increase \( 1 40 2 15 fold \) observed mild insult , pronounced longer lasting increase \( 4 28 5 90 fold \) induced without overt morphological damage severity injury rose certain threshold \( 200 250 seconds \) small short lasting increase reduced prior administration tetrodotoxin cobalt , indicating neuronal discharges source increase contrast , larger longer lasting increase resistant tetrodotoxin partially dependent ca , suggesting neurotransmitter release involved order test hypothesis release excitatory amino acid neurotransmitter glutamate mediates increase k c , extracellular concentration glutamate \( glu c \) measured along k c results indicate relatively specific increase glu c \( compared amino acids \) induced concomitantly increase k c furthermore , situ administration 1 25 mm acid , excitatory amino acid antagonist , effectively attenuated increase k c dose response curve suggested maximum effect acid obtained concentration substantially blocks receptor subtypes excitatory amino acids data suggest brain injury causes massive k flux likely related release excitatory amino acids occurring immediately brain injury
cerebrovascular metabolic effects rat brain focal nd yag laser irradiation investigate effects focal yttrium aluminum \( nd yag \) laser irradiation \( lambda nm \) regional cerebral blood flow , cerebral protein synthesis , blood brain barrier permeability , parietal brain surface 44 rats irradiated focused laser beam constant output energy 30 j survival times ranged 5 minutes 48 hours laser irradiation immediately caused well defined cortical coagulation necrosis within 5 minutes unilateral irradiation , 14c demonstrated severely reduced blood flow irradiation site perilesional neocortex , distinct reactive hyperemia areas forebrain apart persistent ischemic focus vicinity cortical coagulation necrosis , blood flow alterations remote areas brain within 3 hours irradiation autoradiographic assessment 3h tyrosine incorporation brain proteins revealed rapid onset prolonged duration protein synthesis inhibition morphologically intact cortical subcortical structures impairment amino acid incorporation proved completely reversible within 48 hours visualization plasma proteins using 3h labeled rabbit anti rat immunoglobulins showed , 1 hour irradiation , immunoreactive proteins confined neocortex irradiation site 4 hours , edema present vicinity irradiation site subcortical white matter , , later stages \( 16 36 hours \) , also extended contralateral hemisphere although followed gradual decrease labeling intensity , resolution edema still complete 48 hours analysis sequential functional changes conjunction morphological alterations indicates evolution morphological damage laser irradiation correlate time course spatial distribution protein synthesis inhibition edema although central coagulation necrosis represents direct effect radiation , final size laser induced lesion determined delayed necrosis due persistent ischemia extent severity ischemia zone initial preservation cells explained optical properties nd yag laser extensive scattering light within brain parenchyma associated high blood brain absorption ratio selectively affects blood vessels outside irradiation focus
long term evaluation monkeys adrenal cavitation alone autografts adrenal medulla implanted preformed cavities caudate nuclei four rhesus monkeys induced 1 methyl 4 1 , 2 , 3 , 6 \( \) five monkeys underwent caudate cavitation , received tissue implant animals marked bradykinesia affected arm stable induced cavitation implantation moderate behavioral recovery seen five monkeys cavitation two three monkey long term adrenal autografts \( fourth adrenal recipient sacrificed 10 days grafting \) improvement occurred months procedure early complete seen fetal dopaminergic grafts surviving adrenal tissue found animal showed behavioral recovery two adrenal autograft recipients \( surviving adrenal medulla \) animals cavitation ingrowth dopaminergic fibers area nucleus caudate , oriented toward cavity findings show mechanism improvement adrenal medullary implants parkinsonism dopamine secretion chromaffin cells , may related host fibers results also indicate limited recovery adrenal implants parkinsonian patients may result cavitation , necessarily result tissue implantation
facial bone fracture associated carotid cavernous sinus fistula cases facial bone fracture , ten patients carotid cavernous sinus fistulas \( 1 01 \) ages ranged 25 48 years seven male three female two ten patients lower third , three patients middle third , three patients upper third , two patients combined middle lower third facial bone fractures signs symptoms fistula appeared first postinjury day 50 days injury \( mean , 21 days \) four patients symptoms operation facial bone fracture fistulae identified arteriography treatment followup ranged 1 year , 8 months , 5 years , 9 months \( mean , 2 years , 9 months \) one patient nine patients complete resolution bruits complications included unilateral complete visual loss \( two \) , csf rhinorrhea \( two \) , stroke one two csf rhinorrhea patients one patient expired due severe head injury , one death unrelated cause
parathyroid hormone related peptide lactation umbilical cord blood parathyroid hormone related peptide \( pthrp \) expressed rat mammary glands , result increases prolactin rather per se addition , pthrp produced fetal parathyroid glands placenta may responsible stimulation placental calcium transport current study , used radioimmunoassay human pthrp measure levels peptide \( 1 \) human breast milk , cow 's milk , two infant formulas \( 2 \) sequential plasma samples postpartum women \( 3 \) women pathologic hyperprolactinemia \( 4 \) human umbilical cord blood normal subjects , plasma pthrp levels ranged less 2 5 pmol liter contrast , human breast milk contained substantially increased levels immunoreactive pthrp similar elevations found cow 's milk one infant formula column chromatography breast milk demonstrated pthrp immunoreactivity included region adenylate cyclase stimulating activity , consistent presence biologically active pthrp plasma pthrp values differ corresponding postpartum values women women hyperprolactinemia mean plasma pthrp value high normal range umbilical cord blood considerably suppressed parathyroid hormone values pthrp levels indistinguishable normal human plasma thus , pthrp present high concentrations breast milk apparently gain access maternal circulation significant amounts addition , women pathologic hyperprolactinemia seem increased levels circulating pthrp
auditory evoked responses benign intracranial hypertension syndrome study , auditory brainstem evoked responses conducted 28 patients symptoms \( pulsatile , hearing loss , \) secondary benign intracranial hypertension syndrome abnormalities consisting mainly prolonged interpeak latencies detected one third patients speculated pathophysiologic mechanisms responsible auditory brainstem evoked abnormalities stretching compression cochlear nerve brainstem caused intracranial hypertension primary edema structures due benign intracranial hypertension syndrome normalization improvement noticed majority patients management since number patients study small , felt diagnostic prognostic value test needs evaluation
efficacy brainstem auditory evoked potentials acoustic tumor surgery identification patients small acoustic salvageable hearing increases , intraoperative auditory nerve monitoring used increasingly attempt improve hearing preservation rate far field recordings obtained brainstem auditory evoked potentials \( baep \) , times enhanced , become standard method intraoperative auditory nerve assessment evaluate usefulness monitoring technique , hearing preservation results series acoustic tumor compared series patients monitored via standard brainstem auditory evoked potentials comparable average tumor sizes , 4 7 patients hearing preserved preoperative levels compared 4 9 monitored patients neither preoperative baep assessments absolute tumor size predictive hearing preservation report brings question effectiveness far field intraoperative baep monitoring acoustic tumor resection suggests direct auditory nerve monitoring may appropriate
circulatory thermal adjustments prolonged exercise paraplegic women circulatory thermal responses 90 min ergometer exercise examined five dependent \( wd \) women low level spinal dysfunction five able \( ab \) women served comparison group metabolic rate exercise 221 w wd 255 w ab \( p greater 0 05 \) oral temperature \( tor \) , mean skin temperature \( tsk \) , oxygen uptake \( vo2 \) , heart rate \( hr \) , cardiac output \( \) assessed periodically throughout exercise period ambient conditions 24 25 degrees c 38 52 relative significant group x time interaction found tor \( p less 0 001 \) tsk \( p less 0 001 \) tor wd group steadily increased exercise , whereas ab group showed stable tor tsk wd increased rapidly first 5 10 min exercise continued rise slower rate throughout exercise contrast , tsk ab rose peak first 10 min showed decreasing trend vo2 hr remained stable groups throughout exercise period following initial increase minute 10 minute 20 groups , values wd decreased 80 min 14 lower 10 min findings suggest wd women greater strain ab women indicated higher tor tsk inability maintain due paralysis lower limbs perhaps increase cutaneous blood volume
responses intercostal muscle biopsies normal subjects patients myasthenia gravis order evaluate mechanisms weakness muscles patients myasthenia gravis \( mg \) , intercostal muscle biopsies obtained 9 normal subjects 6 mg patients , compound muscle action potential \( ap \) tension responses nerve muscle stimulation , contracture responses exposure caffeine , monitored vitro normal muscle , stimulation nerve muscle 30 100 hz , ap responses showed decrement amplitude , one third attributable failure neuromuscular transmission two thirds failure muscle membrane excitation stimulation 1 5 hz , ap responses showed little decrement , contractile responses showed significant tension , due failure e c coupling contractility muscle patients generalized mg , stimulation nerve frequencies \( 1 100 hz \) caused much greater decrement tension responses normal muscle , due mainly failure neuromuscular transmission however , 100 hz , 40 decrement due failure muscle membrane excitation , 1 5 hz , 40 tension due failure e c coupling contractility , normal muscle direct stimulation contraction half relaxation times slower tetanic tension smaller normal muscle , especially mg patient caffeine induced contractures smaller mg muscle normal muscle results indicate weakness mg muscle due mainly failure neuromuscular transmission , also partly due reduced e c coupling contractility
sensitivity detecting fibrillation potentials comparison concentric needle electrodes sensitivity concentric electrodes detecting fibrillation potentials \( fp \) never formally compared studied 35 muscles fp , sampling 20 sites concentric needles concentric needle identified 0 88 3 44 \( mean standard deviation \) sites spontaneous activity although statistically significant \( wilcoxon signed rank test p less 03 \) , difference sensitivity appreciably affect diagnostic interpretation subjects described concentric needles painful needle insertions 25 muscles demonstrated needle movement generated majority fp suggest increased tissue injury caused concentric needles may account increased sensitivity discomfort
review techniques employed estimate number motor units muscle smallest functional units neural control , motor units play integral role muscle physiology however , present time , exist widely accepted technique quantifying estimating number motor units muscle specifically , existing techniques increment counting technique , technique based spike triggered averaging , macro emg based technique vary invasiveness noninvasive highly invasive , respectively discuss techniques , along associated shortcomings , detail
spatial dispersion magnetic stimulation peripheral nerves assess longitudinal dispersion stimulus induced magnetic coil , collision experiments performed seven normal ulnar nerves electrical stimulus s1 delivered wrist , followed stimulus s2 upper arm , either electrical \( electrical collision studies \) , magnetic \( magnetic collision studies \) interval varied 0 2 msec increments time complete s2 evoked motor response , include entire span recovery compound motor action potential collision curves obtained magnetic electrical stimuli amplitude motor response elicited s2 function interval seven normal ulnar nerves , comparison collision curves showed s2 evoked motor response restored significantly slowly magnetic stimulation used finding best explained longitudinal dispersion stimulus induced magnetic coil relative conventional electrical stimulation , large fibers stimulated away coil small ones interpretation confirmed findings obtained method two cases ulnar neuropathy , comparison different intensities magnetic stimulation
35 clinical experience transcranial magnetic stimulation elicited motor evoked potentials \( \) using magnetic stimulation 150 control subjects aged 14 85 years 275 patients variety diseases significant side effects cortex target muscle latencies measured 20 2 1 6 ms \( \) , 14 2 1 7 ms \( extensor digitorum \) , 9 4 1 7 ms \( biceps \) , 27 2 2 9 ms \( anterior \) central motor delay cortex c 7 l 5 measured 6 7 1 2 ms 13 1 3 8 ms , respectively mean spinal cord motor conduction velocity measured 65 4 mep amplitude expressed percentage maximum wave never less 20 wave value less 10 considered abnormal mep latency increases linearly age central motor delay longer older subjects compound muscle action potentials absolute mep amplitudes decreased linearly age multiple sclerosis \( ms \) , mep latency central delay often prolonged mep sensitive sep ms amyotrophic lateral sclerosis , mep latencies modestly prolonged characteristic abnormality reduced amplitude features predominated often absent mep normal latency parkinson 's disease , age related amplitude often increased mep latency amplitude normal huntington 's disease abnormal persisted several months stroke despite good functional recovery mep could used advantage demonstrate proximal conduction slowing block demyelinating neuropathies , ability elicit mep several days onset paresis good evidence neuronal continuity motor fibers
fibrillation potential amplitude muscle atrophy following peripheral nerve injury maximum peak peak fibrillation potential amplitude measured 69 subjects 7 days 10 1 2 years post complete partial peripheral nerve injury mean amplitude first 2 months third fourth months , fifth sixth months 320 first year , population fibrillation potentials greater 100 recorded sciatic nerve sectioned 13 guinea pigs animals studied 17 weeks fibrillation potential amplitude gastrocnemius muscles declined humans end study , type fibers lost almost half initial diameter type ii fibers twice amount fibrillation potential amplitude may useful estimating time post nerve injury appears correlate surface area fiber diameter type muscle fiber
structure , expression function schwannoma derived growth factor development nervous system , cells require growth factors regulate division survival identify new growth factors , serum free growth conditioned media many clonal cell lines screened presence mitogens central nervous system glial cells cell line secreting potent glial mitogen established tumour \( \) derived sheath sciatic nerve cells tumour , named cells , adapted clonal culture identified schwann cells schwann cells secrete autocrine mitogen human schwannoma extracts mitogenic activity glial cells , neither mitogen purified report purification characterization mitogenic molecule , designated schwannoma derived growth factor \( \) , growth conditioned medium schwann cell line belongs epidermal growth factor family , autocrine growth factor well mitogen astrocytes , schwann cells fibroblasts
limited selective posterior rhizotomy treatment spasticity secondary infantile cerebral palsy preliminary report limited selective posterior rhizotomy performed 30 children suffering spasticity secondary infantile cerebral palsy opposed standard techniques stimulate divide dorsal l2 s1 , dissected l4 , l5 , s1 dorsal roots l5 s1 laminectomy eight 12 root electrically stimulated two unipolar electrodes \( pulse width , 50 10 50 v \) muscle responses observed visually registered electromyography associated abnormal motor response evidenced sustained muscular contraction prolonged electromyographic response divided spasticity scored 0 muscular groups assessed involved flexion shoulder , elbow wrist upper limbs , involved flexion adduction hip , flexion leg , flexion lower limbs patients assessed 1 week 6 months operation reduction spasticity observed muscular groups , patients presented functional improvement motor abilities preliminary results indicate limited procedure reduces extension laminectomy length operation could effective treating spasticity secondary infantile cerebral palsy
fractures classification clinical features fractures clival complex diagnosed series 17 patients admitted maryland institute emergency medical services system university maryland medical system 30 month period fractures divided pathologically three types based upon appearance computed tomography longitudinal , transverse , oblique mechanisms injury similar groups , glasgow coma scale scores admission comparable , regardless fracture type , survivors nonsurvivors longitudinal fractures associated severe injury central nervous system brain stem infarction , 4 6 \( 67 \) patients died transverse fractures clival complex found 6 patients , 3 \( 50 \) died patients fractures petrous ridge 2 3 survivors multiple cranial nerve deficits , one patient developed carotid cavernous fistula 5 patients oblique clival fractures , 2 survived \( 40 \) , multiple cranial nerve palsies addition , one patients developed carotid cavernous fistula using present generation computed tomographic , fractures clival complex reliably diagnosed probably common previously believed separated three groups based characteristics computed tomographic scans clinical findings
mechanism stroke patients taking aspirin 1 year period , prospectively studied mechanism severity stroke 47 patients sustaining cerebral infarction taking aspirin mechanism stroke undetermined 12 patients \( 26 \) remaining 35 patients , identified 39 potential mechanisms large artery atherosclerosis \( 19 patients , 40 \) , \( 15 patients , 32 \) , small vessel occlusive disease \( 5 patients , 11 \) 11 patients carotid atherosclerosis stroke , 9 \( 82 \) greater 90 carotid stenosis occlusion 12 patients stroke undetermined mechanism , 10 \( 83 \) previous stroke , 8 also undetermined mechanisms disability stroke moderate severe 27 patients \( 57 \) data suggest \( 1 \) stroke patients taking aspirin variety etiologies frequently causes moderate severe disability \( 2 \) patients carotid disease failing aspirin often high grade carotid stenosis occlusion \( 3 \) stroke undetermined mechanism may recur frequently stroke subtypes patients taking aspirin
case control study alzheimer 's disease australia conducted case control study clinically diagnosed alzheimer 's disease \( ad \) 170 cases aged 52 96 years , 170 controls matched age , sex , possible , general practice origin trained lay naive hypotheses clinical status elderly person carried risk factor interviews significant odds ratios found 4 variables history either dementia , probable ad , 's syndrome 1st degree relative , behavioral trait recent distant past previously reported suggested associations confirmed study include head injury , starvation , thyroid disease , analgesic abuse , antacid use \( aluminum exposure \) , alcohol abuse , smoking , left handed
opposite pupil herniation serially examined pupil opposite one already enlarged herniation 13 patients main abnormalities , patients , initially diminished light reaction 2 5 4 mm diameter pupil , followed slight reduction size , greater original size , preserved subsequent deterioration varied among patients , transitional oval shape infrequent oculomotor function preserved pupils enlarged fixed pupil side mass , herniation , subsequent deterioration appreciated changes reactivity size opposite pupil
contrast sensitivity differs normal aging parkinson 's disease measured contrast sensitivity static laterally vertical 12 young adults , 7 normal elderly adults , 8 patients parkinson 's disease \( pd \) compared static motion contrast sensitivity spatial frequencies 0 25 , 1 , 4 cycles per degree \( cpd \) , temporal frequencies 1 , 3 , 9 hz results show normal aging leads reduction motion sensitivity spatial frequency 0 25 cpd compared elderly controls , pd patients present specific abnormalities domain however , spatial frequencies 1 4 cpd temporal frequencies 1 3 hz , motion sensitivity worse static sensitivity pd patients elderly controls findings suggest specific deficit motion perception pd , possible dopaminergic involvement control behavior
anti gm1 igm antibodies motor neuron disease neuropathy found anti gm1 igm antibodies 23 56 patients motor neuron disease \( mnd \) , 19 69 patients neuropathy , 7 107 controls neurologic diseases patients anti gm1 igm antibody titers 1 80 less slightly higher antibody titers \( 1 640 \) found 3 patients , 1 mnd 2 neuropathy , high titers \( 1 20 , 480 \) patient mnd igm kappa protein reacted gm1 , , gm1 six patients anti gm1 igm also bound reactivity correlate anti gm1 titers present patients mnd neuropathy anti gm1 igm antibodies may normal constituent human antibody repertoire frequency , cases , levels higher patients mnd neuropathy origin pathogenetic role antibodies neural impairment remain established
signs distinguishing spasmus nutans \( without central nervous system lesions \) infantile nystagmus clinical findings well eye head movement recordings analyzed 23 patients spasmus nutans without central nervous system \( cns \) changes , 10 patients spasmus nutans like disease \( head , intermittent nystagmus associated intracranial anomalies visual pathway disorders \) , 25 patients infantile nystagmus ten diagnostic signs established differentiate patient groups although helpful separating patients infantile nystagmus spasmus nutans , difference found patients spasmus nutans without cns lesions study indicates eye head movement recordings allow differentiation benign spasmus nutans spasmus nutans like disease differentiation must made basis neuroimaging
late juvenile onset krabbe 's disease krabbe 's disease autosomal recessive leukodystrophy characterized lack beta activity contrast classic early infantile onset form krabbe 's disease , less recognized , late onset variants exist authors present case late juvenile onset krabbe 's disease , including associated magnetic resonance imaging \( mri \) findings patients late onset krabbe 's disease present visual loss due optic atrophy associated gait abnormalities parental increase clinician 's suspicion child may late onset krabbe 's disease prolonged survival late onset krabbe 's disease , recent development bone marrow transplantation patient makes diagnosis disorder particularly important
antinociception cardiovascular responses produced electrical stimulation nucleus , nucleus reticularis , caudal medulla experiment 1 , quantitative regional comparisons antinociceptive cardiovascular responses produced electrical stimulation caudal medulla , including regions nucleus \( nts \) , nucleus reticularis \( nrv \) , nucleus reticularis gigantocellularis \( \) , nucleus reticularis \( \) , nucleus \( \) , medial portions lateral reticular nucleus \( \) , made rat electrical stimulation regions resulted inhibition nociceptive tail flick reflex , although threshold intensity inhibition greater sites nts compared many sites ventral nts antinociception generally accompanied increase mean arterial blood pressure , exception sites , depressor responses evoked stimulation detailed comparisons nts nrv revealed greater intensities electrical stimulation required produce antinociception sites nts compared nrv significant differences threshold intensities antinociception function subdivisions nts , lateral subdivision nts significantly efficacious medial subdivision difference within nts primarily due stimulation medial sites producing overt movements animals , probably due stimulation adjacent midline nuclei pathways within nrv , thresholds inhibition tail flick reflex greater sites dorsal subdivision compared ventral subdivision , contains projections slopes lines recruitment inhibition tail flick reflex stimulation sites either nts nrv steep , similar forms antinociception experiment 2 , pulse duration electrical stimulation varied sites stimulation lateral nts nrv generate strength duration curves experiment confirmed stimulation sites lateral nts required greater current intensities inhibit tail flick reflex sites nrv however , derived strength duration functions nts nrv approximately 170 , indicating antinociceptive effects regions may exclusively due stimulation fibers passage results discussed terms role nts , nrv , caudal medulla modulation nociceptive responses cardiovascular function
pain children assessment management children 's pain topic received great deal attention since late 1970s nurse researchers played dominant role areas pediatric pain relief likely continue currently number pediatric pain assessment instruments developed used selected practice settings , use extended document existence pediatric pain relief pharmacologic interventions pediatric pain relief hampered incorrect beliefs analgesic risks , prescribing habits , information area analgesics although nurses traditionally used nonpharmacologic interventions pain relief , methods well continued research efforts important area result improved diagnosis management pediatric pain
confusion term confusion describes possible cognitive deficits behavioral manifestations subjective assessment confusion must followed objective systematic evaluation develop cognitive behavior profile age associated physiologic pathologic changes , elderly patients high risk developing acute confusion management confusion presents challenge nursing nursing play significant role prevention early detection acute confusion preventing identifying confusion early decrease physical psychological stress patient well decrease cost hospitalization shortening length stay additional research needed determine efficacy present nursing activities identify new approaches management
steroids induce acetylcholine receptors cultured human muscle implications myasthenia gravis antibodies acetylcholine receptor \( achr \) , diagnostic human autoimmune disease myasthenia gravis , block achr function increase rate achr degradation leading impaired neuromuscular transmission steroids frequently used alleviate symptoms muscle fatigue weakness patients myasthenia gravis well documented immunosuppressive effects show steroid dexamethasone significantly increases total surface cultured human muscle exposed myasthenia gravis sera results suggest clinical improvement observed myasthenic patients treated steroids due effect immune system also direct effect muscle propose identification development pharmacologic agents augment receptors proteins reduced human genetic autoimmune disease broad therapeutic applications
controlling stability complex movement system human movement systems frequently treated one dimensional , single axis , rigid bodies order gathering , analysis , interpretation data problem approach results assumptions often lead conclusions production control movement relate control demands placed central nervous system order truly understand central nervous system plans produces movements match environmental demands , must take account many variations available within body purpose article examine two movement systems potential act multiple spatial dimensions variable muscle action patterns performing stabilizing task methods analyzing systems differing task constraints results experiments presented hypothetical models proposed explain complex movement systems also discussed
correlation clinical computed tomographic findings stroke patients evaluated correlation clinical features computed tomographic findings prospective study 1 , 191 consecutive patients acute cerebrovascular disease seen 1 year patients symptoms signs initially suggested cerebrovascular disorder , computed tomography revealed relevant lesion 154 \( hemorrhagic 52 33 8 , ischemic 102 66 2 \) significant abnormality 14 \( 3 1 \) among remaining patients symptoms signs suggesting central nervous system disorder stroke , computed tomography revealed cerebrovascular lesion 38 \( 4 7 \) 35 lesions ischemic computed tomographic findings compatible final clinical diagnosis 192 \( 84 2 \) 228 patients lesions entire sample 1 , 191 patients , cerebrovascular disorder would missed 38 \( 3 2 \) without computed tomography hand , computed tomography failed visualize cerebrovascular lesion 40 patients lesion clinically obvious results emphasize careful neurologic assessment policy early computed tomography crucial importance diagnosis stroke therapeutic considerations
progressing cerebral infarction relation plasma glucose gerbils studied neurologic morbidity evolution hyperglycemia induced immediately permanent unilateral common carotid artery ligation gerbils total 60 animals divided five groups one experiencing severe hyperglycemia 1 hour onset ischemia \( brief hyperglycemia group , n 13 \) , normoglycemic control group brief hyperglycemia group \( n 12 \) , group severe hyperglycemia 4 hours onset ischemia \( prolonged hyperglycemia group , n 11 \) , normoglycemic control group prolonged hyperglycemia group \( n 13 \) , normoglycemic control group prolonged hyperglycemia group \( n 11 \) neurologic morbidity mortality higher two hyperglycemic groups three normoglycemic control groups neurologic deficit progressed according duration severe hyperglycemia three normoglycemic control groups neurologic status stabilized 120 minutes onset ischemia , brief hyperglycemia group stabilization occurred 210 minutes , prolonged hyperglycemia group neurologic deficit progressed approximately 360 minutes , death one , neurologic deficit remained stable death 23 hours ischemia suggest hyperglycemia another cause progressing cerebral infarction
embolic stroke smoking cocaine 39 year old woman embolic upper division middle cerebral artery branch occlusion 3 hours smoking free base cocaine \( \) radionuclide ventriculography demonstrated cardiomyopathy , echocardiography documented left atrial thrombus case demonstrates embolism one mechanism ischemic stroke cocaine use , cardiomyopathy , possibly cocaine induced , may source embolus cardiac source embolus sought patients cocaine associated cerebral infarction
growth factor expression stroke fibroblast growth factors polypeptides potent trophic effects central nervous system cells acidic basic forms fibroblast growth factor found mammalian brain examined expression factors focal brain injury stroke infarction lateral cerebral cortex mature rat brain , found twofold threefold increase first 3 weeks stroke levels fibroblast growth factors tissue surrounding infarcts increase persisted least 2 months appeared mainly due increased levels basic , acidic , fibroblast growth factor , angiogenic , properties , basic fibroblast growth factor may play important role cascade cellular reactions contributes wound healing functional recovery stroke
molecular biology atherothrombotic brain infarction reduced high density lipoproteins may contribute atherothrombotic brain infarction , performed molecular biologic metabolic studies characterize high density lipoprotein metabolism respect role reverse cholesterol transport , clone high density lipoprotein receptor , determine gene polymorphism apolipoprotein , major protein high density lipoprotein , altered structure may impair reverse cholesterol transport high density lipoprotein metabolism measurements , high density lipoprotein 3 isolated , purified , labeled iodine 125 radiolabeled high density lipoprotein 3 , daily blood samples taken 10 days synthesis rates fractional catabolic rates determined specific activities daily decrements preliminary data indicate stroke prone fractional catabolic rates high density lipoprotein 3 twice normal individuals also , conversion high density lipoprotein 3 high density lipoprotein 2 reduced individuals , suggesting high density lipoprotein may abnormally processed individuals prone brain infarctions surveyed 100 patients carotid stenosis using 2 2 kb probe apolipoprotein gene subset patients displays polymorphism restriction enzymes psti preliminary findings suggest gene polymorphism apolipoprotein may provide molecular brain infarction
pharmacology recovery stroke laboratory research past decade begun provide insights basis functional recovery brain injury clear drugs influencing specific neurotransmitters also influence recovery process drugs may beneficial , others may detrimental difficulties interpreting results behavioral studies reviewed , potential mechanisms drug effects discussed types studies leading increased awareness potentially harmful effects drugs often given stroke patients pharmacotherapy designed enhance functional recovery stroke may possible future
influence amphetamine treatment somatosensory function normal infarcted rat brain consequences acute amphetamine administration metabolic responsiveness cerebral cortex physiologic activation studied normal infarcted rats treated rats received 4 mg kg intravenous injection amphetamine 1 hour unilateral stimulation 2 deoxyglucose study normal rats , metabolic activation restricted major circuit amphetamine treated rats , stimulation induced increased glucose utilization widespread , including ipsilateral contralateral cortical regions outside field circuit example , 84 increase glucose utilization control seen cortical areas anterior field region increased glucose utilization induced stimulation severely depressed rats undergone infarction left cortical field 2 weeks previously stimulation failed increase glucose utilization significantly cortical areas remote infarct contrast , bilateral increases glucose utilization observed within cortical regions treated infarcted rats example , 50 increase glucose utilization detected cortical areas infarct thus , normal infarcted rat , amphetamine appears promote alternate circuit activation pharmacologic property may advantageous recovery injury
effects mk 801 recovery sensorimotor cortex lesions histologic evidence suggests drugs acting noncompetitive antagonists n methyl aspartate receptor beneficial pathologic effects central nervous system neurons present experiments examined effects mk 801 recovery behavioral function unilateral lesions rat somatic sensorimotor cortex first experiment , rats unilateral sensorimotor cortex lesions given either mk 801 \( 1 mg kg \) saline 12 16 hours surgery additional injections given postoperative days 2 , 4 , 6 behavioral tests measured somatosensory \( e , bilateral tactile stimulation tests \) forelimb placing creation sensorimotor cortex lesions , rats showed ipsilateral somatosensory bias impairment placing contralateral forelimb rats treated mk 801 recovered slightly faster saline treated animals measured bilateral tactile stimulation test \( p less 0 05 \) contrast , significant difference groups recovery forelimb placing second experiment , rats sensorimotor cortex lesions treated single injection mk 801 behavioral recovery twenty hours mk 801 injection , rats sensorimotor cortex lesions showed placing deficits impairment least 7 days injection behavioral data support idea mk 801 either beneficial detrimental effects administered brain damage
ionic channels , cholinergic mechanisms , recovery sensorimotor function infarcts rats unilateral infarcts produced hind limb sensorimotor neocortex 243 rats intravenous injection fluorescein derivative rose focal intact skull surface facial contact stimuli degree recovery rate contralateral tactile forelimb placing reactions contralateral forelimb placing recovered , whereas hind limb placing resistant recovery infarcted rats displayed marked recovery spontaneous limb usage \( beam \) however , deficits isolated tactile hind limb placing reactions posttreatment class iv calcium antagonist flunarizine infarction protected sensorimotor function dose dependent manner protective effect may due peculiar ionic channel blocking profile flunarizine contralateral placing errors infarcted rats dosage affect neurologically intact rats cognitive enhancer , novel derivative , dose dependently blocked anticholinergic induced deterioration sensorimotor deficit rats
magnetic resonance imaging demonstrates electric stimulation cerebellar fastigial nucleus reduces cerebral infarction rats sought determine whether high spatial resolution magnetic resonance imaging useful noninvasive quantitation ischemic infarct produced occlusion middle cerebral artery detection reduced infarct volume elicited electric stimulation cerebellar fastigial nucleus male rats spontaneously hypertensive strain anesthetized , middle cerebral artery occluded , fastigial nucleus stimulated 1 hour twenty four hours later , rats t1 t2 weighted images obtained rats killed volume distribution lesion established histopathology magnetic resonance imaging estimates lesion volume 271 41 0 mm3 \( middle cerebral artery , n 5 \) 148 8 4 mm3 \( middle cerebral artery fastigial nucleus stimulation , n 6 45 reduction , p less 0 05 \) histopathological analysis revealed lesion 229 8 15 4 mm3 involving somatosensory cortex , lateral caudate , lateral hippocampus fastigial nucleus stimulation resulted 36 reduction infarct volume 146 0 10 3 mm3 retrieved zone largely cortex dorsal ventral lesion mostly posterior lesion estimates lesion volume magnetic resonance imaging histopathology differ highly correlated \( r 0 90 p less 0 001 \) study confirms previous finding fastigial nucleus stimulation reduces volume focal ischemic infarct demonstrates magnetic resonance imaging accurately estimates volume lesion also detect changes small 50 100 mm3
symptomatic carotid endarterectomy trials possible benefit carotid endarterectomy stroke prevention evaluated three major clinical trials date , european carotid surgery trial randomized 2 , 200 patients , 30 carotid stenosis greater 70 appropriate symptoms north american symptomatic carotid endarterectomy trial randomized 1 , 000 patients , half severity appropriate stenosis quality control evaluation outcome events trial achieved three review , including review medical surgical blinded treatment arm patient baseline characteristics patients eligible randomized similar patients randomized two percent patients randomized surgical arm declined surgery crossed medical arm , 3 elected surgery randomization medical arm studies , well veterans administration trial , continuing patients
putative cerebral ischemia brain injury involvement mechanisms cerebral ischemia brain injury explored experimental models repetitive forebrain ischemia temporary occlusion carotid arteries gerbils injury cerebral cortex rats gerbils observations models revealed pattern injury involved anatomic structures outside areas direct ischemic traumatic insult foci injury revealed abnormal uptake associated slight moderate neuronal alteration , whereas severely injured areas showed uptake electron microscopic observations revealed characteristic presence calcium swollen , closely resembling obtained conditions epileptic seizures abnormal uptake associated apparent blood brain barrier changes characterized intracytoplasmic uptake albumin neurons protein synthesis assayed vivo 3h leucine incorporation reduced regions showing calcium accumulation observations suggest may play important role development secondary chronic changes ischemic traumatic brain insults
platelet activating factor putative mediator central nervous system injury \? platelet activating factor \( 1 2 acetyl sn 3 \) potent lipid produced many cell types platelet activating factor produced cerebellar granule cells culture extracted brain tissue multiple platelet activating factor receptors demonstrated brain tissue activation platelet activating factor receptors transformed neuronal cell lines involved increases intracellular calcium platelet activating factor potent actions cerebral vessels cerebral metabolism administered vivo , may direct effects brain excessive platelet activating factor production pathological states nervous system stroke shown models \( e g , spinal cord ischemia reperfusion focal brain injury \) multiple studies using highly specific potent platelet activating factor antagonists , reversal prevention key consequences brain injury hypoperfusion following ischemia , reperfusion edema , inflammatory cell accumulation , neurologic motor deficits , neuronal salvage demonstrated review provides analyzes evidence support role platelet activating factor might modulation brain function pathophysiological processes brain ischemia trauma
physical features prader willi syndrome neonates retrospective study 16 patients undertaken identify physical features may neonates prader willi syndrome several features known typical prader willi syndrome early infancy confirmed , including genital hypoplasia number features previously emphasized characterizing prader willi syndrome also identified , notably abnormal cry , males , signs genital hypoplasia apparently normal features included disproportionately large head circumference , disproportionately large anterior , mild , mild anomalies alveolar , changes appearance skin appreciation features may assist pediatrician recognizing child prader willi syndrome neonatal period , appearance better known findings later onset , obesity
replication patterns fragile x heterozygous carriers analysis brdurd antibody method replication status fragile x chromosomes studied short term cultures lymphocytes six female heterozygous carriers fragile x induced adding 0 1 microm last 24 h culturing replication status x chromosomes studied using bromodeoxyuridine \( brdurd \) antibody method brdurd added \( 1 \) final concentration 0 2 micrograms ml early phase chromosome replication \( 16 10 h harvest \) , \( 2 \) 0 2 microgram ml late phase \( last 6 h culturing \) , \( 3 \) 20 micrograms ml early phase , \( 4 \) 20 micrograms ml late phase brdurd incorporated replicating chromosomes detected using nuclease brdurd monoclonal antibody frequency fragile x reduced brdurd treatment degree reduction severe 20 micrograms ml 0 2 microgram ml series severe late early treatment early late replicating fragile x chromosomes , actively replicating brdurd treatment reduced others thus , average rate early late treatment 0 2 microgram brdurd ml assumed closest reflection situation vivo correlation average rate early replicating , active fragile x intelligence heterozygous carriers studied
case reassessment 1953 , two patients , , anaesthetist negligence developed painful spastic spinal anaesthesia found phenol , used outside local anaesthetic , glass , contaminating solution , anaesthetist could aware risk case important , despite fact judgement anaesthetist , generated incidence paralysis spinal anaesthesia theory subject much new information obtained , case examined objectively probable source contamination , led paralysis two patients , third received spinal anaesthesia day , identified similar explanation may lie behind number episodes paralysis associated spinal anaesthesia
loss consciousness emergence anaesthesia case suspected micturition syncope case micturition syncope respiratory arrest described syncope occurs , temporary myocardial ischaemia cerebral hypoperfusion may increase anaesthetic risk marginally compensated patient loss airway protection period also cause concern recommend use indwelling bladder catheter prolonged surgical procedure
relief injection pain adults emla cream 5 minutes venepuncture effectiveness skin anaesthesia 5 topical application lignocaine prilocaine cream evaluated one hundred twenty patients estimated pain venepuncture linear scale use cream either 5 60 minutes , placebo cream treatment reported pain significantly less 5 minutes lignocaine prilocaine cream \( p 0 002 \) cream used relieve pain routine injections
resistance atracurium induced neuromuscular blockade patients intractable seizure disorders treated anticonvulsants previous studies demonstrated , exception atracurium , resistance neuromuscular blocking effects various muscle relaxants develops patients receiving anticonvulsant therapy studied effects 0 5 mg kg iv atracurium 53 neurosurgical patients 21 nonepileptic patients receiving anticonvulsant therapy \( med 0 \) 14 epileptic patients treated carbamazepine years \( med 1 \) 18 epileptic patients treated carbamazepine plus either phenytoin acid years \( med 2 \) evoked compound electromyogram adductor pollicis recorded , results analyzed using analysis covariance , weight age onset time significantly different among three groups times recovery baseline train four responses stimuli significantly shorter med 1 med 2 groups control patients \( med 0 \) recovery index \( time 25 75 recovery baseline electromyogram values \) progressively shorter three groups \( med 0 8 02 min med 1 5 93 min med 2 1 96 min p less 0 001 \) study demonstrates atracurium , used epileptic patients requiring long term \( , years \) anticonvulsant therapy , shorter duration action used nonepileptic patients
differential effect oncotic pressure cerebral water content cardiopulmonary bypass rabbits study effect oncotic pressure brain water content cardiopulmonary bypass \( cpb \) , 14 anesthetized new zealand white rabbits underwent 60 min cpb animals grouped according composition circuit priming fluid group 1 animals \( n 7 \) received priming fluid \( 6 5 hydroxyethyl starch 0 72 n nacl 13 mosm kg mean sd \) maintained normal colloid oncotic pressure \( \) cpb \( 19 0 1 5 mmhg \) group 2 animals \( n 7 \) received priming fluid \( 0 9 n nacl 23 mosm kg \) led state \( 6 2 1 2 mmhg \) blood chemistries hemodynamics recorded every 15 min cpb animals given additional priming fluid sodium bicarbonate cpb maintain circuit flow 85 ml kg 1 min 1 arterial ph greater 7 35 significant differences groups 1 2 respect temperature , central venous pressure , mean arterial pressure , pao2 , paco2 , plasma sodium concentration , osmolality time cpb , although osmolality increased groups 60 min bypass , animals killed organ water contents determined wet dry weight ratios separate group nine similarly prepared anesthetized animals undergo cannulation cpb also underwent measurement plasma chemistries tissue water contents served controls \( group 3 \) brain kidney water contents unaffected oncotic pressure , whereas duodenum skeletal muscle significantly greater water content \( p 0 003 p 0 008 , respectively \) cpb
neurologic complications cocaine abuse neurologic complications cocaine toxicity responsible major portion morbidity mortality associated cocaine complications appear related state induced cocaine may treated symptomatically diazepam effective drug cocaine induced seizures
improving outcomes analgesic treatment education enough \? frequent analgesic responsive acute pain chronic cancer pain persists , despite intensive efforts provide clinicians information analgesics set background factors must addressed interventions improve pain treatment traditional patterns clinician patient interaction ward , quality assurance , drug regulatory practices support prompt recognition treatment pain possible interventions modify patterns daily practice include monitoring displaying patient pain ratings routinely , making available educational tools assist optimal drug , encouraging patients pain , reviewing quality assurance pain treatment regimens , increasing behavioral research analgesic prescribing , selectively modifying narcotics regulatory practices
confusion confusion assessment method new method detection delirium objective develop validate new standardized confusion assessment method \( cam \) enables nonpsychiatric clinicians detect delirium quickly high risk settings design prospective validation study setting conducted general medicine wards outpatient geriatric assessment center university \( site 1 \) general medicine wards university chicago \( site 2 \) patients study included 56 subjects , ranging age 65 98 years site 1 , 10 patients 20 without delirium participated site 2 , 16 patients 10 without delirium participated measurements main results expert panel developed cam consensus building process cam instrument , completed less 5 minutes , consists nine criteria diagnostic statistical manual mental disorders \( dsm iii r \) hypothesis established diagnostic value four criteria acute onset course , , , altered level consciousness cam algorithm diagnosis delirium required presence first second criteria either third fourth criterion sites , diagnoses made cam concurrently validated diagnoses made sites 1 2 values sensitivity 100 94 , respectively values specificity 95 90 values positive predictive accuracy 91 94 values negative predictive accuracy 100 90 cam algorithm highest predictive accuracy possible combinations nine features delirium cam shown agreement four mental status tests , including mini mental state examination interobserver reliability cam high \( kappa 0 81 1 0 \) conclusions cam sensitive , specific , reliable , easy use identification delirium
auras subclinical seizures characteristics prognostic significance characteristics prognostic significance subclinical seizures independent auras studied 40 patients partial epilepsy long term electroencephalographic \( eeg \) monitoring intracranial electrodes focal , restricted subclinical seizures noted 23 patients , 11 patients experienced auras accompanied ictal eeg discharges auras subclinical seizures usually identical eeg appearance , distributed differently among patients subclinical seizures auras usually origin complex partial seizures , always reliably indicate complex partial seizure origin subclinical seizures auras favorable prognostic significance patients undergoing temporal lobectomy majority \( greater 80 \) individuals subclinical seizures auras free complex partial seizures surgery , whereas minority \( 29 \) patients without subclinical seizures auras became free complex partial seizures
substantia nigra site action muscle relaxant drugs sites action centrally active muscle relaxant drugs well defined clinical experience drugs suggests spinal cord may one important regions pathologically increased muscle tone may relieved centers may also involved expression muscle relaxant action yet defined report therapeutically relevant muscle relaxants midbrain genetically spastic rats decrease muscle tone substantia nigra region midazolam , baclofen , \( drugs used clinically treatment spasticity \) , gamma gaba , \( \) 2 amino 7 , substance p \( experimental drugs active animal models spasticity \) , reduce muscle tone genetically spastic rats reflexes normal rats effects muscle relaxant drugs restricted substantia nigra pars reticulata receptor specific observations previously unknown function substantia nigra mediating muscle relaxation
igm deposits nodes patient amyotrophic lateral sclerosis , anti gm1 antibodies , multifocal motor conduction block studied patient amyotrophic lateral sclerosis , multifocal motor conduction block , igm anti gm1 antibodies sural nerve biopsy demonstrated deposits igm nodes direct immunofluorescence deposits granular located nodal gap adjacent myelin , instances , extended along surface myelin sheath injected rat sciatic nerve , serum igm bound nodes , binding activity removed preincubation gm1 observations suggest anti gm1 antibodies may caused motor dysfunction binding nodal regions peripheral nerve
skin conductance arousal newborn measured skin conductance continuously sole foot babies different conceptional ages , , 10 minutes carried routine blood sampling studied 82 healthy babies whose gestational postnatal ages ranged 25 42 weeks , 1 73 days median skin conductance level \( prick \) babies 40 43 weeks' conceptional age 0 6 micros \( \) differed significantly awake babies \( 1 2 micros \) \( 0 5 micros \) contrast babies less 40 weeks significantly lower median skin conductive level \( 0 3 micros \) identical awake babies response heel prick babies became skin conductance rose sharply immediately 21 22 \( 95 \) babies 40 43 weeks' conceptional age , seven 23 \( 30 \) babies 36 39 weeks median rise one minute babies 40 43 weeks significantly higher 36 39 weeks \( 2 7 micros compared 0 5 micros \) babies less 36 weeks change skin conductance heel prick results consistent notion function maturity develop 36 weeks' conceptional age
misdiagnosis patients amyotrophic lateral sclerosis confirm impression high percentage patients amyotrophic lateral sclerosis initially misdiagnosed , reviewed records 33 patients definitive diagnosis amyotrophic lateral sclerosis seen 10 years fourteen patients \( 43 \) initially misdiagnosed mean time correct diagnosis significantly greater misdiagnosed group \( 16 0 9 3 months \) rest patients \( 7 6 4 1 months \) two three patients initial symptom dyspnea misdiagnosed three patients underwent misdiagnosis age , stage disease , unusual presenting symptoms identified causes misdiagnosis likely causes physicians' failure consider diagnosis lack familiarity common clinical presentations amyotrophic lateral sclerosis earlier diagnosis amyotrophic lateral sclerosis may help prevent medical may benefit patients medically
syncope presyncope associated probable adverse drug reactions purpose study determine whether syncope presyncope associated drug therapy 70 patients referred tertiary care ambulatory clinic drug use information obtained , validated , classified potential cause syncope presyncope utilizing standardized adverse drug reaction algorithm , nine \( 13 \) 70 patients rated probable drug induced syncope presyncope events overall , 12 medications implicated patients probable adverse drug reactions older , taking medications , taking antihypertensive seven nine patients probable adverse drug reactions previously classified syncope unknown origin initial clinic evaluation syncope presyncope commonly associated adverse drug reactions , especially elderly taking multiple medications
gilles de la tourette syndrome linked d2 dopamine receptor gilles de la tourette syndrome important genetic component pathophysiology disorder may involve dopamine system tested d2 dopamine receptor \( locus , recognized probe \) genetic linkage gilles de la tourette syndrome using genetic linkage map region long arm chromosome 11 restriction fragment length polymorphism data total four markers \( , , , \) , able exclude linkage candidate gene gilles de la tourette syndrome two extended kindreds gilles de la tourette syndrome causation gilles de la tourette syndrome mutation kindreds studied genetic assumptions employed use map linkage analyses also allowed us exclude gilles de la tourette syndrome susceptibility locus larger genetic region
quantitative evaluation sway indicator functional balance post traumatic brain injury test sway , using different conditions stance measurements average radial deviation center pressure path length sway per unit time , shown useful clinical tool determining balance problems traumatic brain injury \( tbi \) patients normative values established determine individual patient 's sway values fell within normal range \( mean \) tests shown good test retest reliability tbi patients addition , shown sensitivity test sufficient identify changes patients' performances clinical conditions change demonstrated different stance conditions battery tests become progressively difficult perform \( comfortable stance , eyes open eyes closed , narrow stance , eyes open eyes closed , tandem stance right left foot forward , eyes open eyes closed \) using , easy distinguish performances able patients tbi patients mild balance problems validity measure documented correlating sway performance clinical functional performance tests test performance also correlates patient 's assessment gait difficulties limited data available suggest test sway relates difficulties static balance frequency falls finally , permit identification specific problems maintaining balance basis therapeutic intervention
screening early dementia using memory complaints patients relatives study examined whether subjective impression memory function might differentiate healthy elderly subjects patients memory complaints , whether memory complaints differed patients without dementing illness self assessment relatives' responses new memory questionnaire differentiated patient groups control subjects relatives' form measuring deterioration memory function time identified dementing individuals non dementing causes memory complaints factor analysis indicated patients' memory complaints correlated depression rather objective memory performance , relatives' ratings correlated objective memory scores , depression stepwise discriminant function analyses showed objective memory testing greatly improved specificity sensitivity subjective memory questionnaire alone
cerebrospinal fluid central cholinergic amino acid neurotransmitter activity cerebellar ataxia cerebrospinal fluid \( csf \) amino acid neurotransmitters , related compounds , precursors , choline levels , acetylcholinesterase activity measured csf patients cerebellar ataxia randomized , double blind , crossover , placebo controlled clinical trial physostigmine csf gamma aminobutyric acid , methionine , choline levels , adjusted age , significantly lower patients cerebellar ataxia compared controls physostigmine selectively reduced level csf elevated levels phosphoethanolamine change occurred csf acetylcholinesterase activity levels plasma amino compounds patients cerebellar ataxia compared controls median ataxia scores statistically differ placebo physostigmine functional improvement occur patients
temporoparietal cortex aphasia evidence positron emission tomography forty four patients examined \( \) fluorodeoxyglucose positron emission tomography resting state determine whether consistent glucose metabolic abnormalities present ninety seven percent subjects showed metabolic abnormalities angular gyrus , 89 gyrus , 87 lateral transverse superior temporal gyrus pearson product moment correlations calculated regional metabolic measures performance western aphasia battery significant correlations found western aphasia battery scores right hemisphere metabolic measures left hemisphere regions correlated one score western aphasia battery temporal frontal regions significant correlations comprehension score left temporoparietal region consistently affected subjects , suggesting common features caused left temporoparietal dysfunction , behavioral differences resulted \( 1 \) extent temporoparietal changes , \( 2 \) dysfunction elsewhere brain , particularly left frontal subcortical areas
neurodevelopmental outcome children evidence periventricular late mri fifteen children , 8 months age older , neonatal follow program underwent magnetic resonance imaging neurologic , cognitive , language evaluations magnetic resonance imaging findings children included increased white matter signal t2 weighted images ventricular enlargement adjacent regions abnormal white matter extent degree abnormal white matter signal degree prominence variable twelve children cerebral palsy 5 children , 4 cerebral palsy , manifested significant sensory impairments median score cognitive testing 89 2 children exhibited severe profound cognitive disability cognitive scores stable degree motor disability correlated extent white matter signal abnormality however , cognitive outcome related extent degree white matter signal abnormality degree prominence despite association major condition periventricular , cognitive language functioning may relatively spared
ultrasonography magnetic resonance imaging disease infant disease , younger sister similarly affected infant , examined onset disease ultrasonography revealed hyperechoic lesions caudate nucleus preclinical stage onset , changes extended cerebral cortex medulla lesions also detected t2 weighted magnetic resonance imaging \( mri \) areas increased signal intensity brother demonstrated ultrasonographic results cranial computed tomography disclosed low density areas basal ganglia detected hyperechoic lesions ultrasonography findings suggest ultrasonography useful detecting early intracranial lesions disease
rett syndrome findings suggesting mitochondrial abnormalities report histopathologic findings 3 sural nerve biopsies 1 muscle biopsy 3 patients rett syndrome 3 sural nerve biopsies demonstrated ultrastructural abnormalities , including presence many pi granules mitochondrial changes cytoplasm schwann cells , occasional bands bulb , mitochondrial alterations myelinated axons morphometric analysis disclosed reduction number large myelinated fibers normal densities comparison age matched normal control light microscopic examination biopsied muscle 6 year old patient rett syndrome revealed existence many small , dark , fibers tr staining ultrastructural investigation muscle confirmed presence shaped mitochondria peripheral nerve involvement possibility mitochondrial abnormalities rett syndrome suggested results
use obstetric analgesia sweden 1983 1986 use obstetric analgesia investigated swedish population based prospective study , 207 births , represents almost women vaginal deliveries sweden 1983 1986 lumbar epidural analgesia \( \) used 16 , block \( pcb \) 12 , morphine 49 block 62 four types analgesia much commonly used variables maternal age , smoking , , relationship infant 's father gestational age moderate influence rates different types analgesia pcb frequently used larger smaller hospitals daytime night differences found morphine , block , administered routinely
disease molecular lesion alpha n gene causes infantile dystrophy disease recently recognized infantile dystrophy resulting deficient activity lysosomal , alpha n \( alpha galnac \) recent isolation expression full length cdna encoding alpha galnac facilitated identification molecular lesions affected brothers family , first cases described autosomal recessive disease southern northern hybridization analyses dna rna affected homozygotes revealed grossly normal alpha galnac gene structure normal transcript sizes amounts therefore , alpha galnac transcript affected reverse transcribed , amplified polymerase chain reaction \( pcr \) , sequenced single g transition nucleotide detected multiple containing pcr products point mutation resulted glutamic acid lysine substitution residue 325 \( \) alpha galnac polypeptide base substitution confirmed dot blot hybridization analyses pcr amplified genomic dna family members allele specific oligonucleotides furthermore , transient expression alpha galnac construct containing mutation resulted expression immunoreactive polypeptide detectable alpha galnac activity
effect normal msafp screening maternal age genetic amniocentesis routine maternal serum alpha fetoprotein \( msafp \) screening neural tube defects considered many standard obstetrical care , recently many encouraged test screen trisomy 21 \( 's syndrome \) questioned whether , normal msafp screen , risk trisomy 21 decreases enough warrant modifying recommended age genetic amniocentesis 's syndrome logistic regression developed , using reported values sensitivity specificity msafp detection trisomy 21 assuming constant threshold risk amniocentesis , indicates genetic amniocentesis trisomy 21 may deferred women normal msafp screening sensitivity analysis varying thresholds normal msafp demonstrates 37 year old woman median msafp level risk trisomy 21 women 4 5 years younger abnormal msafp useful screening neural tube defects possibly trisomy 21 normal msafp may allow delaying potentially risky amniocentesis otherwise low risk pregnancies
early cerebral infarction gadopentetate dimeglumine enhancement gadopentetate dimeglumine administered prospectively 50 patients presented magnetic resonance \( mr \) imaging within 2 weeks cortical cerebral infarction twenty two patients \( 44 \) imaged within 3 days clinical ictus abnormalities detected gadopentetate dimeglumine enhancement observed 46 \( 92 \) 50 patients classic parenchymal enhancement late finding , observed patients \( 17 17 \) imaged 7 14 days infarction time , three additional phases contrast material related abnormalities observed enhancement vessels supplying infarct \( intravascular enhancement sign \) earliest finding , seen 17 \( 77 \) 22 infarcts aged 1 3 days day 2 day 6 , abnormal enhancement adjacent infarct frequently noted \( meningeal enhancement sign \) finally , transition phase combined intravascular meningeal enhancement early parenchymal enhancement seen day 3 day 6 gadopentetate dimeglumine enhanced mr imaging early stroke reveals evidence vascular flow , precede development classic parenchymal enhancement
neuromuscular diseases evaluation high frequency sonography forty four patients clinically suspected neuromuscular disease 12 healthy volunteers underwent high frequency ultrasound examination rectus femoris , vastus , vastus lateralis , biceps brachii muscles , number septa determined numbers muscle soft tissue ratios lower extremity compared findings correlated results muscle biopsy patients suspected disease using number septa lower extremity , authors found significant differences muscles healthy volunteers patients duchenne muscular dystrophies , muscular dystrophies , spinal muscular receiver operating characteristic curve showed average 12 septa within 1 cm muscle ideal cutoff value differentiate subjects without morphologic changes pathologic findings authors conclude measurement useful differentiation neuromuscular diseases may noninvasive , reproducible means evaluate disease progression
cerebral blood flow velocities anterior cerebral arteries basilar artery hydrocephalus treatment studied 's index \( pi \) , shows cerebral vascular resistance , anterior cerebral arteries basilar artery , pi ratio \( 's index anterior cerebral artery 's index basilar artery \) 11 measurements hydrocephalus mean values pi anterior cerebral artery , basilar artery , pi ratio treatment significantly higher treatment normal infants treatment , mean pi anterior cerebral arteries significantly higher mean pi basilar artery pi ratios increased 1 00 treatment normal infants , mean pi anterior cerebral arteries significantly lower mean pi basilar artery pi ratios decreased less 1 00 believe pi ratio useful evaluate need effect treatment hydrocephalus
cerebral hemodynamics patients normal pressure hydrocephalus correlation cerebral circulation time dementia regional cerebral blood flow regional cerebral circulation time measured 13 demented patients chronic hydrocephalus , mostly normal pressure hydrocephalus average hemispheric , frontal , temporal cerebral blood flows significantly reduced average regional cerebral circulation time values significantly prolonged frontal , temporal , thalamic regions , markedly frontal white matter , periventricular observed computed tomography clinical improvement obtained patients operation postoperative regional cerebral blood flow values change compared preoperative ones , postoperative regional cerebral circulation time values significantly reduced regions measured , markedly frontal white matter present results suggest microcirculation frontal lobe closely correlated dementia association pressure exerted nerve fibers frontal white matter patients normal pressure hydrocephalus
metoprolol aggressive behavior persons mental retardation persons mental retardation sometimes exhibit behaviors difficult control use neuroleptic medications may limited side effects beta blockers propranolol metoprolol shown decrease aggressive behaviors patients mental retardation
vu experience things past \? vu experience common phenomenon , occurring pathological well conditions defined subjectively inappropriate impression familiarity present experience undefined past authors discuss epidemiologic data , clinical features , etiology phenomenon vu also review different hypotheses vu experience introduce explanation based model
brainstem auditory evoked response subcortical abnormalities autism previous studies autism used brainstem auditory evoked response given contradictory results authors study considered two supplementary aspects added ipsilateral procedure , compared results every subject values \( corrected age sex \) large number normal children twenty autistic \( according dsm iii r criteria \) 13 mentally retarded \( iq less 75 \) subjects assessed eighty percent autistic subjects abnormal interpeak latencies , compared 15 mentally retarded subjects v iii v prolonged interpeak latency values seen autistic subjects ipsilateral procedure doubled rate detection higher brainstem abnormalities autistic children
university utah epidemiologic survey autism etiologic role rare diseases twelve rare diseases known cause cns pathology found 26 \( 11 \) 233 autistic probands identified recent epidemiologic survey utah 26 probands significantly lower mean remaining patients \( 43 versus 60 \) similar sex distribution prevalence abnormal eegs seizures rarity diversity 12 diseases make highly unlikely randomly occurred autism presence epidemiologic survey compelling evidence date support hypothesis different diseases producing different types cns pathology play etiologic role autism
pharmacologic treatment behavioral disturbances elderly demented patients fifty nine elderly residents long term care facilities dsm iii diagnoses dementia studied 8 week randomized , double blind comparison trial haloperidol , , test efficacy agents treatment clinically significant behavioral disturbances patients dementia three agents demonstrated modest significant efficacy measured clinician ratings behavior activities daily living absolute magnitude improvement greater haloperidol , differences among groups approach statistical significance frequencies acute adverse events trial similar across drug treatment groups although drugs may differ terms long term safety efficacy , appear equivalent short term management behavior severely demented patients
rapid eye movement sleep deprivation probe elderly subjects effects 2 night rapid eye movement \( rem \) sleep deprivation \( rsd \) procedure electroencephalographic sleep mood examined 15 healthy elderly control subjects , 14 elderly patients endogenous depression , 15 patients primary degenerative dementia compared control subjects , patient groups maintained higher amount rem sleep time rem activity rsd unexpectedly , depressed patients showed little rebound visually scored automated rem sleep measures following rsd , showed stability rem activity temporal distribution baseline recovery conditions contrasted rebound rem sleep activity seen control subjects , modest increase demented patients rsd fairly specific , impact delta sleep procedure recovery sleep mood ratings unaffected rsd findings demonstrated greater plasticity rem sleep regulation healthy elderly control subjects suggested higher rem pressure effect depressed patients patients dementia appeared impaired capacity respond challenge rsd
myelopathy associated human cell lymphotropic virus type \( htlv \) , south africa clinical investigative study 24 patients unexplained spastic myelopathy black \( \) patients , similar seen , previously described , south africa following reports linking human cell lymphotropic virus type \( htlv \) spastic myelopathy , undertook prospective retrospective search htlv antibodies 36 patients labelled unexplained myelopathy 24 \( 66 \) positive htlv isolated 4 6 patients whose peripheral blood lymphocytes cultured eighteen \( 75 \) gave short history \( less 6 months \) female preponderance \( 71 \) , dysfunction common \( 55 \) many half severely disabled \( 50 bound \) routine laboratory studies showed specific trends apart csf \( greater 5 cells microliter 66 patients \) total csf protein raised \( greater 0 4 g l \) 45 patients igg index greater 0 7 15 19 patients conventional myelography show specific abnormalities computer assisted myelography undertaken 22 patients 3 showed 2 spinal cord atrophy periventricular lucencies seen 1 10 patients computed tomography head nerve conduction studies demonstrated abnormalities 46 patients indicating subclinical peripheral nerve dysfunction common visual evoked responses abnormal 1 patient brainstem auditory evoked response studies showed abnormality 42 patients finding htlv antibodies significant number , isolation htlv blood 6 black patients myelopathy , represents substantial clinical advance future studies define clearly role virus disorder
cerebral blood flow progressive aphasia without dementia case report , using inhalation , technetium 99m oxime single photon emission computerized tomography report case progressive aphasia without clinical signs intellectual behavioral impairment , 's clinical criteria primary progressive aphasia , 4 yrs extensive psychometric testing radiological imaging , comprising ct mri , failed detect evidence relevant involvement outside left regions cranial ct normal mri showed multiple bilateral lesions deep white matter cerebral blood flow \( cbf \) studies single photon emission computerized tomography , however , showed initial focus hypoperfusion progressively extended include ipsilateral hemisphere contralateral frontal lobe suggests cbf imaging may yet sensitive technique revealing subclinical injury degenerative brain diseases focal onset
innervation territories touch pain afferents single fascicles human ulnar nerve mapping peripheral distribution fibre content individual ulnar nerve fascicles supplying skin muscles hand human volunteers indirectly mapped tracing fields projected sensation evoked electrical \( inms \) tracing receptive fields delineated recording afferent activity elicited natural stimulation end organs moderate intensity inms , delivered cutaneous fascicles , induced sensations areas skin , fascicular projected fields \( \) fascicular receptive fields \( \) mapped recording determining area skin , activated light tactile stimuli , elicited afferent neural discharges recorded found given electrode position skin nerve fascicle , moderate intensity inms induced sensations cutaneous field \( \) coincides , high intensity inms induced painful sensations within cutaneous field sensations pain induced inms muscle nerve fascicles projected muscles innervated fascicle , instances , areas beyond muscular receptive field study demonstrates individual ulnar nerve fascicles , wrist levels , well defined cutaneous territories hand , area skin covered sum ulnar fascicular receptive projected fields maximal possible cutaneous distribution ulnar nerve insights practical relevance regarding clinical expression fascicular nerve injuries also brought study
volume conduction parietal n20 potential frontal area somatosensory evoked potentials recorded frontal parietal areas patients various lesions central nervous system stimulation median nerve five representative cases showed selective loss positive potential frontal area reported case , parietal n20 potential relatively well preserved , frontal central areas \( fc area \) showed negative potential following peak negative potential synchronous parietal n20 potential fc area considered volume conducted potential parietal n20 frontal area anterior volume conduction parietal n20 would explained concept oriented generated posterior bank central sulcus instead , generator parietal n20 potential , radically oriented generated mainly parietal area postulated
selective spatial attention patients visual present study designed verify attentional performance patients parietal lesions experimental condition attention 3 spatial positions located left , right directly fixation stimulus \( experiment 1 \) 1 3 spatial positions time \( experiment 2 \) twelve patients \( 6 subjects right parietal lesions 6 subjects without neurological deficits \) participated experiment results experiment 1 showed patients right parietal lesions speed accuracy response aligned stimuli increased gradually right left , whereas control group showed effect due different retinal 3 stimuli , , responses central stimuli faster accurate responses left right stimuli results experiment 2 showed neurological control groups faster respond central left right stimuli , neurological group faster respond right left stimuli , whereas difference rts two visual fields obtained control group furthermore , patients respond 3 spatial locations aligned \( experiment 1 \) , speed accuracy response right stimulus focus attention \( experiment 2 \) results showed focus attention patients visual stimulus increased attention right accompanied decreased attention left
titanium implants total hip arthroplasty defined direct contact light microscopic level living bone tissue implant using titanium screw dental implants jaw , lasting interface loaded conditions extending 20 year follow period demonstrated demonstration brings question whether similar interface achieved total hip arthroplasty \( tha \) living bone titanium alloy implant necessitated conditions immediate loading two series cases reported first series used femoral , press fit , titanium alloy component second used press fit titanium acetabular component femoral , press fit , titanium alloy component demonstrated high percentage good excellent results roentgenograms showed changes femoral component gave early indications better fixation loading valgus , less , less evidence distal stress transfer two one half year postoperative anatomic specimen study confirmed press fit titanium alloy femoral component multiple areas contact bone metal without fibrous interposition seen examination electron microscopy supported light microscopic findings findings support use smooth , press fit titanium components thas without need porous coating , mesh , surface modifications
intraoperative dexamethasone irrigation lumbar 45 lumbar patients , control group 23 patients standard operative procedure remaining 22 patients treated intraoperative irrigation long acting dexamethasone incision closure age , weight , gender ratio , mean postoperative hospital stay , mean hospital narcotics usage , incidence perioperative complications among two groups compared age gender ratios comparable , although control group significantly heavier body weight steroid group steroid group significant reduction hospitalization marked reduction narcotics usage compared control group postoperative fever occurred one patient steroid group control group three postoperative complications preliminary observations suggest dexamethasone irrigation lumbar safe effective adjunct surgical management
continuous removal middle molecules hemofiltration patients acute liver failure patients acute liver failure hepatic coma , increase abnormal middle molecules seen sera suspected playing etiologic role coma pilot study continuous hemofiltration using high performance membrane conducted 16 patients attempt decrease serum levels middle molecules procedure used alternately plasma exchange high performance liquid chromatography showed notable removal substances sequential removal serum hemofiltration eight \( 50 \) 16 patients amelioration level consciousness successfully hemofiltration although three 16 patients survived acute illness , 13 others lived average 15 days five patients survived greater 3 wk continuous removal middle molecules serum may reverse liver failure , procedure used conjunction plasma exchange may provide means life support , e g , patients awaiting liver transplant
limited diagnostic investigation obstructive sleep apnea syndrome oximetry static charge sensitive bed simplified sleep apnea investigation consisting combined oximetry respiration movement monitoring compared conventional polysomnography two types recordings performed simultaneously one night 77 patients suspected obstructive sleep apnea syndrome \( osas \) static charge sensitive bed \( \) used simplified recording provides comfortable reliable means recording respiration movements periods obstructive apneas gave diamond shaped periodic respiration movement pattern , usually accompanied repetitive oxygen average number greater equal 4 percent per hour termed oxygen desaturation index \( \) compared apnea index \( ai \) whole population well correlated \( p less 0 0001 , r2 0 41 \) , individual cases considerable discrepancies patients periodic respiration movements less 18 percent total time less 2 never ai greater equal 5 , whereas patients periodic respiration greater 45 percent greater 6 always ai greater equal 5 fifty one 77 patients fulfilled criteria bradycardia response apneas absent 29 percent patients ai greater equal 5 combination respiration movement oximetry recording thus seems give sufficient information confirm diagnosis osas majority patients clinical symptoms borderline patients , investigations performed
maxillofacial surgery nasal cpap comparison treatment obstructive sleep apnea syndrome nasal continuous positive airway pressure \( cpap \) primary therapy obstructive sleep apnea syndrome \( osas \) recent reports indicated , however , small significant number failures related patient compliance primary surgical treatment , \( \) , declined poor results reviewed failures shown eliminated palatal obstruction , failed eliminate base tongue obstruction maxillofacial surgery reported treatment osas correcting base tongue obstruction thirty patients severe osas evaluated compare nasal cpap maxillofacial surgery goal determine surgical protocol effective nasal cpap patients initially underwent baseline diagnostic polysomnography document osas nasal cpap study performed determine appropriate positive end expiratory pressure patients study using nasal cpap , found unacceptable long term treatment elected surgery maxillofacial surgery consisted maxillary , mandibular , advancement polysomnography performed six months following surgery compared night 2 cpap results parameters included investigation respiratory disturbance index \( rdi \) , lowest sao2 , number sao2 falls 90 percent , total sleep time \( \) , rem sleep percent , stage 3 4 sleep percent , wake sleep onset mean rdi treatment 72 0 \( sd 25 7 \) completing therapy , rdi surgery cpap 8 8 \( sd 6 0 \) 8 6 \( sd 4 1 \) , respectively mean low sao2 prior treatment 61 0 \( sd 13 5 \) , cpap results results 86 2 \( sd 5 5 \) 86 1 \( sd 4 2 \) , respectively analysis variance used examine results , statistical difference nasal cpap surgery respiratory variables
lack change neurochemical markers phase tetanus toxin syndrome rats chronic epileptic syndrome induced injecting tetanus toxin rat hippocampus causes functional changes essentially permanent , period active seizures least 1 year long term changes characterized impaired performance range behavioral tasks , turn associated physiologic depression hippocampal evoked responses histopathology present study , examined rats phase tetanus toxin model observed significant changes concentration neurochemical markers six neurotransmitters therefore , long term reduction hippocampal excitability cannot attributed major loss afferents hippocampal neurons using aspartate , acetylcholine , gamma aminobutyric acid \( gaba \) , glutamate , norepinephrine \( ne \) , serotonin
endorphin derivatives hydrocortisone prevent eeg limbic seizures induced corticotropin releasing factor rabbits corticotropin releasing factor \( crf \) injected cerebral ventricles small mammals induces eeg limbic seizures , behavioral excitability , behavior , tardive enhancement hippocampal theta voltage frequency addressed phenomenon explained pathogenesis infantile spasms children , wished study interference exerted gamma endorphin fragments eeg epileptiform behavioral symptoms induced crf rabbit animals implanted intracerebroventricularly \( c v \) cortical hippocampal electrodes , together cannula left lateral ventricle gamma endorphin derivatives \( dt gamma e , de gamma e \) injected intravenously \( v \) 4 days \( hydrocortisone \) , prevented eeg ictal seizures induced hippocampus rabbits crf injected c v hydrocortisone de gamma e also prevented appearance scattered spiking partially prevented tardive enhancement theta voltage hippocampal eeg finally , de gamma e also prevented behavior excitability induced crf results confirm regulatory role exerted crf limbic structure excitability suggest peptides may involved regulatory feedback mechanism crf metabolism activity possibility peptides may also interesting properties considered
neonatal monosodium glutamate corticotropin releasing factor induced epileptogenic activity rats \( c v \) injection rat corticotropin releasing factor \( \) doses 5 20 micrograms rats induces epileptogenic activity characterized pacemaker like spikes localized hippocampal leads effect still present rats treated saline absent treated monosodium glutamate \( \) , treatment caused marked changes concentration several brain neurotransmitters neuropeptides hypothalamic nuclei crf highly concentrated believed induce behavioral effects present results suggest induced spiking activity mediated activation neuronal pathways sensitive neurotoxic effect
triiodothyronine brain excitability investigated mechanisms involved thyroid hormone action brain excitability effect acute exposure triiodothyronine \( t3 \) rat hippocampal slices vitro studied significant changes could detected , field excitatory postsynaptic potentials \( \) population spike amplitude , minor , nonsignificant trend toward shortening population spike latency time t3 effect penicillin induced epileptiform activity , however , active accumulation labeled t3 slices rat preparation used determine focal seizure thresholds visual cortex , acute \( 2 4 h \) effects demonstrated significant acute effects t3 brain excitability hippocampus visual cortex observed , despite active accumulation t3 thus , effect t3 brain excitability likely due delayed effects
confirmation focal positron emission tomographic abnormalities children intractable epilepsy relationship focal disturbances glucose utilization demonstrated positron emission tomography \( pet \) electrophysiologic abnormalities defined intraoperative \( \) studied eight children \( aged 13 months 12 years \) underwent cortical resection intractable seizures none children pure temporal lobe epilepsy computed tomography \( ct \) magnetic resonance imaging \( mri \) normal four eight children scalp \( eeg \) showed interictal epileptiform abnormalities eight ictal onset five eight seven children , interictal pet showed focal eighth child focal , ictal time surgery showed epileptiform spiking , slowing , suppression normal background activity every case corresponded focus pet scan findings support notion children epilepsy focal metabolic abnormalities pet correspond abnormal areas cortex , presumably also epileptogenic regions areas appear normal anatomic imaging studies \( ct mri \) ictal scalp eeg data ambiguous contradictory , pet provides less invasive means chronic grid depth electrode recording evaluating whether localized epileptogenic area exists
effects subclinical epileptiform eeg discharges performance children interaction subclinical epileptiform discharges cognitive tasks investigated 21 children \( 12 girls 9 boys , mean age 10 6 years \) seventeen diagnosis epilepsy \( partial secondarily generalized \) testing reading , arithmetic , intelligence continuous eeg video monitoring children left sided discharges significantly lower reading performance children right sided discharges reading , epileptiform discharges occurred relatively less frequently shorter total duration left hemisphere right supports view cognitive tasks suppress epileptiform discharges activate region brain within epileptogenic zone discharges epileptogenic zones directly activated tasks increased , however
glucocorticoid induced muscle atrophy prevention exercise fast twitch fibers exercise shown effective preventing glucocorticoid induced atrophy muscles containing high proportions type ii fast twitch fibers investigation undertaken evaluate response type iia iib fibers , determined histochemical staining alkaline acid preincubation steroid cortisol acetate \( ca \) , 100 mg kg body wt exercise \( running 90 min day , 29 min \) treatments initiated simultaneously 11 consecutive days female rats fiber distribution area measurements performed deep superficial region plantaris muscle exercise regimen spared approximately 40 ca induced plantaris muscle atrophy deep region , fiber population , contained approximately 13 type \( slow twitch \) , 24 type iia , 63 iib fibers , affected either treatment superficial section , consisted solely type ii fibers , proportion type iia fibers higher \( 27 vs 9 , p less 0 01 \) steroid vehicle treated groups within region , type iia fibers less susceptible atrophy type iib fibers , within fiber type , deep region less atrophy superficial region type fibers unchanged steroid treatment type iia fibers , exercise prevented 100 atrophy deep region 50 superficial region type iib fibers , activity spared 67 40 atrophy regions , respectively results show glucocorticoids capable changing myosin phenotype
disturbance daily sleep wake patterns patients cognitive impairment decreased daily activity sleep wake patterns 121 chronically ill , mentally physically handicapped patients visually monitored hourly 14 consecutive days four types sleep wake patterns found order investigate cognitive physical functions correlated sleep disorders , patients classified based scale mental function grading daily activity percent total sleep hours sleep rating , showing disturbances sleep wake pattern , evaluated found high degree sleep wake patterns sleep disturbance associated daily activity well cognitive impairment monitoring system provides medical personnel valuable information clinical management
practicing physicians north carolina rate challenging geriatric medicine concerns recently surveyed random sample 500 physicians family practice , general practice , internal medicine north carolina , discover challenging geriatric concerns using three stage survey technique , respondents asked answer two open ended questions challenging geriatric problems face specific geriatric content areas would participation educational program asked rank 34 topics would like information total 242 responses received 55 response rate \( 63 500 \) responses indicated physicians concerned management diagnosis revealed considerable evidence concern top three topics management dementia , multiple problems , depression approximately 25 physicians consider problems health care among challenging problems
delirium misdiagnosis elderly inpatients delirium organic mental disorder defined transient , global dysfunction cognition common elderly medical inpatients , yet varied presentation often missed misdiagnosed
multiple muscle enzyme release psychiatric illness associations \( p less 001 \) serum concentrations lactate dehydrogenase \( ldh \) glutamic transaminase \( sgot \) observed physically well patients mania \( n 100 , r 70 \) , depression \( n 138 , r 51 \) , chronic schizophrenia \( n 85 , r 68 \) , atypical psychosis \( n 39 , r 52 \) discharged 1978 1981 contrast , negligible association enzymes 90 nonpsychiatric inpatient control subjects patients mania \( 229 0 106 1 iu l \) showed significantly \( 3 16 , p less 002 , two tailed \) higher lactate dehydrogenase \( ldh \) levels control subjects \( 191 41 7 iu l \) 14 incidence abnormally high serum ldh levels vs 1 among control subjects results unchanged patients taking neuroleptics excluded results indicate psychiatric illness , especially mania , induces release ldh sgot , occasionally unusually high levels similar previous reports muscle creatine phosphokinase release psychiatric patients presumably , enzymes released skeletal muscle association agitation , muscle tension , blood stasis local tissue hypoxia consequent
infarction territory medial branch posterior inferior cerebellar artery report 10 cases cerebellar infarction territory medial branch posterior inferior cerebellar artery \( \) axial sections mri middle medulla cerebellum showed infarction area dorsal base ventral apex directed towards fourth ventricle infarct also involved lateral dorsal medulla supplied part regions three clinical patterns observed 1 \) signs without ataxia medulla spared marked axial present cases 2 \) complete incomplete 's syndrome , medulla involved 3 \) silent infarction syndromes precisely previously attributed occlusion without distinction branch involved alteration consciousness recorded spontaneous recovery rule cerebellar infarction distribution regarded benign condition good prognosis
motor unit discharge characteristics short term synchrony paraplegic humans frequency firing discharge human motor units , short term synchrony pairs motor units , assessed extensor digitorum \( \) anterior \( ta \) muscles control subjects clinically complete paraplegic subjects discharge pattern ta motor units paraplegia ranged extremely regular irregular different motor units whereas control population , groups , narrow , intermediate , range little difference incidence degree short term synchrony \( sts \) paraplegic normal subjects contrast , virtually sts motor units observed ta muscles paraplegic group whereas control subjects exhibited approximately amount sts ta muscles concluded extra burden placed arm muscles paraplegia change amount motor units furthermore , section spinal cord increase sts predicted lesions tract cats may reflect removal inputs synaptic inputs chronic paraplegia
involvement central nervous system chronic inflammatory demyelinating polyneuropathy clinical , electrophysiological magnetic resonance imaging study consecutive series 30 patients chronic inflammatory demyelinating polyneuropathy \( \) minor clinical evidence cns involvement found five cranial magnetic resonance imaging \( mri \) performed 28 revealed abnormalities consistent demyelination nine patients aged less 50 years abnormalities five aged 50 years measurements central motor conduction time \( \) obtained 18 showed unilateral bilateral abnormalities six concluded subclinical evidence central nervous system \( cns \) involvement common , least patients united kingdom , clinically evident signs cns disease infrequent association multiple sclerosis like syndrome rare
long term potentiation coupling mixed synapses long term potentiation chemical synapses closely related memory learning studies process concentrated chemically mediated excitatory synapses contrast , activity dependent modification gap junctions , also widely exist higher structures hippocampus neocortex , described report mixed synapses sensory afferents identified neuron , coupling potential potentiated , well chemically mediated excitatory postsynaptic potential , prolonged time period using stimulation paradigm like produces long term potentiation hippocampus effect coupling due increase gap junctional conductance data indicate potentiation synaptic components requires increase intracellular calcium , involves activation nmda \( n methyl aspartate \) receptors , specific pathway
indications thymectomy myasthenia gravis fifty six board certified neurologists interest expertise myasthenia completed survey indications thymectomy myasthenia gravis thymectomy advocated virtually patients , variable subset patients generalized myasthenia without , occasionally selected patients disabling ocular myasthenia
phenotypic heterogeneity spinal muscular atrophy mapping chromosome 2 13 3 \( sma 5q \) made phenotypic analysis 14 families spinal muscular atrophy \( sma \) linking chromosome 2 13 3 \( sma 5q \) , 2 may map locus , assess clinical symptoms among sma families known result mutation identical gene locus although current number families still small , correlation clinical phenotype molecular genotype supports 2 observations first , sma mutations 5q locus present broad continuum clinical abnormalities , 2nd , single clearly family presents unusual phenotype characterized relatively late onset early death thus , yet unambiguous cases typical sma families clearly locus 5q ie , clear cases heterogeneity analysis sma 5q families supports view , certain exceptions , little phenotypic variability families ranked severity disease strong correlation age onset onset within 1st months associated early death , cases rare exception , onset 1 year age associated less severe disease greater longevity
routine quantitative eeg analysis gilles de la tourette 's syndrome gilles de la tourette 's syndrome \( \) neurobehavioral disorder , high frequency eeg abnormalities performed eegs 48 consecutive patients , frequency analysis 26 patients \( 17 males \) , compared results age sex matched normal controls routine 18 channel eeg revealed minimal diffuse nonspecific slowing 3 48 patients \( 6 \) 2 26 controls \( 7 7 \) frequency analysis eeg 26 patients normal controls showed similar brain activity conclude significant differences exist eeg activity patients compared sex age matched controls routine well quantitative eeg
deteriorating ischemic stroke risk factors prognosis determine risk profile deterioration cerebral infarction less 8 duration , studied prospectively series clinical radiologic data 98 patients evaluated canadian neurological scale score barthel index follow period 3 months deterioration 1st 48 hours 40 8 patients high systolic blood pressure , elevated blood sugar concentration admission , carotid territory involvement independently related deterioration logistic regression analysis death occurred 35 patients deteriorating infarcts 8 6 stable infarcts end study , functional capacity lower deteriorating infarcts , 2 groups improved parallel 4th day
infantile cns degeneration 14 cases clinical update studied 14 arab infants infantile degeneration , 13 products consanguineous presented infancy , poor visual behavior blindness , axial spasticity brain ct mri showed diffuse symmetric , even neurologic symptoms relatively normal eegs visual evoked responses \( \) either absent delayed early course brainstem auditory evoked responses showed milder abnormalities , loss later components earlier ones deficient activity cultured fibroblasts brain biopsy confirmed diagnosis patients
dominantly inherited , central , parkinson 's syndrome clinical , biochemical , neuropathologic studies 2 new cases describe 2 new patients family 10 persons 3 successive generations dominant neuropsychiatric disorder characterized , central , parkinsonism , patients showed severe neuronal loss reactive gliosis substantia nigra neurochemical studies showed marked depletion dopamine substantia nigra , , caudate nucleus , well reduction serotonin content substantia nigra glutamate contents low frontal cortex thalamus , gamma aminobutyric acid \( gaba \) contents low thalamus substantia nigra patients addition , phosphoethanolamine contents reduced brain regions patients , especially substantia nigra one patient severe symptoms low levels homovanillic acid , 5 acid , gaba csf repeatedly 3 years death \( aged 58 \) , 2nd patient died \( aged 51 \) unrelated cause developing symptoms familial disorder brain deficiencies multiple neurotransmitters appear involved , disorder unlikely respond treatment however , neurochemical studies csf may make diagnosis feasible
study verbal description neuropathic pain aim paper study quality verbal description diagnostic value neuropathic pain verbal description pain assessed french list questionnaire \( \) compared group 100 patients neuropathic pain mixed group 97 chronic benign cancer non neuropathic pain patients seventeen descriptors 61 descriptors significant intergroup frequency difference principal component analysis rotation matrix descriptors neuropathic group 7 factors accounting 66 0 total variance derived six factors reflect purely sensory affective aspects pain experience seven descriptors discriminant analysis function correctly 77 neuropathic pain patients 81 non neuropathic pain patients second neuropathic pain group 32 patients , discriminant function coefficient permits correct diagnostic 66 cases implications clinical practice trials discussed
quantitative evaluation suggested hyperaesthesia analgesia painful laser stimulation ability reduce clinically experimentally induced pain suggestion analgesia well known however , nature analgesia still remains uncertain attempts demonstrate identify specific mechanisms , far , unsatisfactory methodological problems inducing pain monitoring physiological responses may reason lack success present study , attempted eliminate methodological problems sensory pain thresholds laser stimulation determined , laser evoked brain potentials measured 8 highly susceptible subjects 3 conditions \( 1 \) state , \( 2 \) suggestion hyperaesthesia , \( 3 \) suggestion analgesia thresholds reduced induced hyperaesthesia increased analgesia hyperaesthesia sensations could evoked laser intensities intensities could perceived awake state amplitude evoked brain potentials increased hyperaesthesia decreased analgesia latency potential remained constant perception pain change fast , indicating slow endogenous mechanisms may play minor role suggested hyperaesthesia analgesia
antinociceptive interaction opioids medetomidine systemic spinal synergy antinociceptive interaction tail flick \( tf \) hot plate \( hp \) tests opioid analgesics medetomidine intravenous \( iv \) intrathecal administration examined analysis male sprague dawley rats received fixed ratios medetomidine morphine , fentanyl , meperidine 1 10 1 30 , 10 1 , 1 3 , respectively , iv administration 10 1 , 3 1 10 1 , 1 3 intrathecal administration , respectively data expressed percentage maximal possible effect \( \) \( dose producing 50 \) drug drug combination determined dose response curve analysis revealed effect medetomidine combined fentanyl , morphine , meperidine additive iv administration intrathecal administration combinations medetomidine opioids produced synergistic antinociceptive effect tf hp test data confirmed interaction medetomidine opioids producing antinociception may additive synergistic , depending route administration , drug ratio administered , level processing nociceptive input \( e , spinal vs \) moreover , results consistent spinal role alpha 2 adrenoceptors mediating antinociception authors suggest interaction opioid alpha 2 adrenergic receptors occurs within spinal cord
survey adolescents severe intellectual handicap diagnostic survey undertaken children aged 11 19 years severe learning difficulties \( intelligence less equal 50 \) eighty two children identified medical records reviewed specific diagnosis retardation documented 25 \( 30 \) children , 18 's syndrome probable aetiology disorder unknown aetiology identified 21 \( 26 \) children confirm existing diagnosis , identify new diagnoses , offer genetic , parents 63 children offered detailed reassessment child fifty three children reviewed , specific disorder identified 25 31 previously undiagnosed children frequent diagnoses made fragile x syndrome rett 's syndrome completion survey , 61 82 children \( 74 \) specific diagnosis probable aetiology identified , 12 \( 15 \) associated disorders cerebral palsy , nine 82 children \( 11 \) clues cause retardation
quantitative assessment extradural bupivacaine analgesia bupivacaine \( 0 5 \) 20 ml administered six healthy volunteers found simultaneous application 10 needles skin could evoke pain analgesia obtained one needle stimulation addition , laser beam used quantitative technique activate simultaneously many cutaneous 7 h , thresholds \( sensory pain \) pain evoked brain potentials \( amplitude latency \) laser stimulation monitored used quantitative assessment onset , efficacy duration analgesia various dermatomes \( c7 , , , t12 , l1 , l3 , s1 \) onset time analgesia shortest conduction delay longest dermatome related site injection \( l3 \) full analgesia obtained l1 , l3 s1 , although peak efficacy s1 delayed 120 180 min injection minor effect found dermatome c7 approximately 60 min injection
onset phase spinal bupivacaine analgesia assessed quantitatively laser stimulation analgesia assessed quantitatively various dermatomes \( c7 , , , t12 , l1 , l3 , s1 \) first 30 min subarachnoid administration 0 5 bupivacaine 3 5 ml stimulation 10 needles laser stimulation could evoke pain dermatomes adequate analgesia single needle stimulation analgesia assessed thresholds \( sensory pain \) pain related brain potentials \( amplitude latency \) laser stimulation little analgesia found , increased gradually towards caudal segments dermatome related site injection \( l3 \) blocked greater extent surrounding dermatomes conduction time \( latency evoked brain potential \) increased relatively s1 dermatome compared l1
codeine increases pain thresholds copper vapor laser stimuli extensive poor metabolizers analgesic efficacy kinetics single oral dose 75 mg codeine investigated 12 extensive metabolizers 12 poor metabolizers double blind , placebo controlled crossover study codeine morphine oxidation polymorphism confirmed hence morphine could detected plasma poor metabolizers , whereas detectable morphine plasma levels found 10 12 extensive metabolizers pain thresholds laser stimuli determined drug intake 90 , 150 , 210 minutes drug intake codeine significantly increased pain thresholds extensive metabolizers \( p less 0 05 \) , whereas significant changes poor metabolizers change pain thresholds occurred placebo two phenotypes extensive metabolizers significant positive correlation increase pain threshold plasma concentration codeine study supports hypothesis morphine formation essential achievement analgesia codeine treatment
changes thermal mechanical pain thresholds hand clinical physiological long term follow previous study , cold stimuli found finger 24 patients amputations , control values obtained fingers intact contralateral hand treated regional intravenous block \( \) , patients short lasting relief symptoms , whereas others experienced long lasting beneficial effect present long term follow study patients examined 6 years treatment aim investigate whether earlier symptoms signs persisted , whether differences respects , patients long lasting \( group 1 \) short lasting relief symptoms \( group 2 \) 24 patients asked answer questionnaire concerning clinical symptoms addition , 14 visited laboratory determination thermal vibration induced pain thresholds comparisons made values obtained first examination treatment values 14 healthy subjects tested similar way 2 occasions interval 8 years twenty 23 patients reported cold exposure still evoked stump pain however , threshold measurements showed time patients become tolerant thermal stimuli injured also uninjured hand rise pain threshold also observed vibration induced pain tested injured hand significant difference groups 1 2 similar changes pain thresholds time observed group healthy control subjects
health locus control , gender differences adjustment persistent pain locus control \( \) beliefs , long thought important adjustment persistent pain , studied among 160 subjects \( 67 males 93 females \) referred comprehensive pain rehabilitation program subscale structure multidimensional health locus control \( \) sample three unique profile clusters identified males females among men , cluster assignment related age younger male patients reported stronger internal style older male patients relied heavily chance powerful factors among women , cluster assignment related use coping strategies example , patients high internal scores , reflecting strong internal orientation towards self management health care needs , likely utilize information seeking , self , threat coping strategies patients high scores internal powerful factors appears presence internal powerful health styles associated less frequent use cognitive self management techniques understanding scores important rely pattern analysis scores implications clinical treatment discussed
neonatal facial cry responses invasive non invasive procedures evaluation pain neonates difficult due limited means communication aim determine whether behavioural reactions cry facial activity provoked invasive procedure could discriminated responses non invasive tactile events thirty six healthy full term infants \( mean age 2 2 h \) received 3 procedures order intramuscular injection , application triple dye umbilical , thigh alcohol significant effects procedure found total face activity latency face movement cluster facial actions comprised bulging , eyes , open mouth associated frequently invasive procedure comparisons 2 non invasive procedures showed facial activity thigh least application triple dye umbilical cord acoustic analysis cry showed statistically significant differences across procedures latency cry cry duration group whole however , babies two procedures showed higher greater intensity injection significant differences , , methodological difficulties investigators area examined , including criteria selection analysis , logical statistical challenges contrasting induced different conditions babies always cry concluded facial expression , combination short latency onset cry long duration first cry cycle reaction acute invasive procedures
characterization descending inhibition facilitation nuclei reticularis gigantocellularis gigantocellularis pars alpha rat descending influences spinal nociceptive tail flick \( tf \) reflex produced focal electrical stimulation glutamate microinjection nuclei reticularis gigantocellularis \( ngc \) gigantocellularis pars alpha \( ngc alpha \) examined characterized rats anesthetized inhibition facilitation tf reflex produced electrical stimulation identical sites ngc ngc alpha glutamate microinjection inhibited tf reflex stimulation inhibition tf reflex 169 28 inhibition tf reflex stimulation produced throughout ngc ngc alpha intensities stimulation inhibition least ventral ngc ngc alpha threshold intensities stimulation , inhibition tf reflex period stimulation facilitation tf reflex produced many sites stimulation inhibited tf reflex , always lesser intensities stimulation \( mean , 10 vs 43 inhibition , n 25 \) stimulation ngc ngc alpha threshold intensities facilitation inhibition tf reflex significantly affect blood pressure strength duration characterization electrical stimulation microinjection glutamate identical sites ngc ngc alpha suggest descending inhibition tf reflex results activation cell bodies ngc ngc alpha
transcranial electrical stimulation high frequency intermittent current \( 's \) potentiates opiate induced analgesia blind studies transcutaneous cranial electrical stimulation \( tces \) high frequency \( 166 khz \) intermittent current \( 100 hz current \) used several years cardiac , thoracic , abdominal , urological micro surgery main benefits reduced requirement analgesic drugs , especially opiates , long lasting postoperative analgesia confirmed clinical observations rats using tail flick latency \( \) test measure pain threshold tces found modify pain threshold drug free rats , potentiated morphine induced analgesia \( systemic injection \) obtain maximal effect , stimulation must initiated 3 h drug injection maintained throughout duration pharmacological action tces found depend dose drug , intensity current electrodes findings confirmed blind tests efficiency tces several opiate analgesic drugs currently used human surgery \( morphine , fentanyl , alfentanil \) analgesic effect 4 opiates \( baseline without tces \) respectively 174 , 306 176 , 336 160 , 215 , 392 results obtained systemic opiate treatment , also injection morphine \( 10 micrograms analgesic effect 152 , 207 tces \) suggesting tces potentiation opiate induced analgesia centrally mediated
influence warning signal timing cognitive preparation electric shock many medical dental procedures finding optimal way warning patients concerning procedures could help better model effective use warning signal coping pain person needs enough time able react possess skills necessary utilize time effectively felt short warning period , e g , 5 sec , could long enough , 180 sec warning period would become reactions electric shock obtained 36 paid , volunteer subjects tested within subject , order 4 different warning periods 5 , 30 , 60 , 180 sec subjects divided 3 groups \( 1 \) experimental group provided self learn variety pain control techniques \( 2 \) placebo group provided self \( 3 \) control group 13 min significant results obtained different pain coping conditions significant differences , however , obtained various warning periods maximum skin resistance changes , higher ratings pain anxiety obtained 60 180 compared 5 30 sec warning periods maximum heart rate obtained 30 sec warning results discussed terms psychological meaning various measures well clinical implications
efficacy methylphenidate among mentally retarded children attention deficit hyperactivity disorder twelve children iq scores 50 74 \( mental retardation \) met rigorous diagnostic criteria attention deficit hyperactivity disorder participated double blind crossover study efficacy two doses methylphenidate compared placebo dependent measures included behavioral ratings , work output , laboratory measures attention learning , direct observations social behavior improvement medication hyperactivity index observed 75 subjects significant increases work output , task behavior , attentional skills associated methylphenidate however , gains measures attention associated improvement learning , measured paired associate learning task additionally , significant increases appropriate social interactions free play associated methylphenidate results suggest mentally retarded children attention deficit hyperactivity disorder respond methylphenidate similar rates similar domains population
quantifying language development birth 3 years using early language scale point scoring technique early language scale described normative data based original 1982 cross sectional sample validation data based separate longitudinal sample presented mean early language scale point scores , standard deviations , percentile equivalents raw point scores presented ages birth 36 months correlations point scores early language scale scores standardized developmental tests stanford intelligence scale , picture test , illinois test abilities presented clinical research advantages point scoring technique presented compared original pass fail scoring method
familial trigeminal neuralgia charcot tooth neuropathy report two families review typical trigeminal neuralgia occasionally occurred multiple members family several generations clinical features cases , including increased incidence females , absence apparent hereditary , neurologic , metabolic , structural abnormalities identical sporadic cases rarely , familial trigeminal neuralgia described setting hereditary peripheral neuropathy , especially charcot tooth disease describe patients two different families charcot tooth disease medically intractable trigeminal neuralgia patients successfully treated percutaneous glycerol occurrence cranial nerve symptoms patients demyelinating peripheral neuropathies discussed light current hypotheses regarding etiology trigeminal neuralgia
anteromedial tibial transfer without bone graft followed 30 patients 2 years anteromedial tibial transfer persistent patellofemoral pain associated patellar articular degeneration twelve patients followed 5 years report 93 good excellent results subjectively 89 good excellent results objectively quality improvement sustained 12 patients evaluated 5 years surgery examined separately , 75 patients advanced patellar achieved good result none patients achieved excellent result postoperative continuous passive motion markedly reduced incidence stiffness serious complications compartment syndrome , infection , skin avoided completely 51 consecutive cases patellofemoral contact pressure studies five cadaver knees shown anteromedial tibial transfer provide substantial reduction patellofemoral contact stress helping balance medial lateral facet pressures surgical procedure mechanically clinically successful alleviating intractable pain related patellar malalignment articular degeneration procedure enables majority appropriately selected patients malalignment patellar articular degeneration resume increased levels activity substantially diminished pain
community hospital carotid endarterectomy patients age 75 compared prevalence stroke death 133 patients aged 75 older 170 carotid endarterectomies performed 501 patients less age 75 640 carotid endarterectomies performed three strokes \( 2 \) patients aged 75 older nine strokes \( 1 \) younger patients \( p 0 7 \) 8 deaths \( 5 \) patients aged 75 older 14 deaths \( 2 \) younger patients \( p 0 1 \) controlling possible confounding effects diabetes , prior stroke , history angina , prior carotid artery disease , previous vascular surgery , history myocardial infarction , preoperative hypertension requiring medication , female gender , logistic regression model showed patients aged 75 older likely stroke death patients age 75 conclude age alone contraindication safe performance carotid endarterectomy community hospital
prilocaine intravenous regional anaesthesia suitability clinical use eighty patients undergoing day case hand surgery intravenous regional anaesthesia randomly allocated receive , double blind study , either 40 ml 0 75 prilocaine hydrochloride , 5 ml 8 4 sodium bicarbonate 5 ml 0 9 saline group significantly less pain injection \( p 0 \) , surgery \( p 0 \) 5 minutes tourniquet \( p 0 \) time elapsed insertion block surgery affected
ph adjustment discomfort caused intradermal injection lignocaine published erratum appears anaesthesia 1991 mar 46 \( 3 \) 242 one hundred adult day case patients required intravenous access inserted using local anaesthesia 1 lignocaine , 1 lignocaine adrenaline corresponding ph adjusted solutions local anaesthetic solutions modified addition 1 ml 8 4 sodium bicarbonate 10 ml lignocaine pain scores different stages cannulation noted showed significant reduction use ph adjusted solutions \( p less 0 02 plain lignocaine , less 0 001 lignocaine adrenaline \) modification ph lignocaine solutions addition sodium bicarbonate simple method significantly reduce discomfort caused infiltration local anaesthetic
synaptic transmission human neocortex removed treatment intractable epilepsy children synaptic transmission pyramidal cells studied slices neocortex resected infants children \( n 10 , age 8 months 13 years \) undergoing surgical treatment intractable epilepsy specimens least abnormal area resection stable intracellular recordings could obtained 8 hours recorded neurons electrophysiological characteristics similar regular firing pyramidal cells layers iii v , confirmed intracellular staining yellow local extracellular stimulation evoked sequence excitatory inhibitory postsynaptic potentials application gamma aminobutyric acid antagonist , \( 10 30 microm \) , extracellular stimulation induced large excitatory postsynaptic potentials epileptiform bursts spontaneous bursts occasionally occurred effect observed tissue samples , even infant patients \( n 4 , age 8 16 months \) acid depressed abolished spontaneous stimulation induced bursts competitive antagonist n methyl aspartate receptors , dl 2 amino 5 acid decreased duration induced bursts data provide evidence , similar rat cat neocortex , excitatory inhibitory amino acids important pyramidal cells immature human neocortex
nmda antagonists potentiate actions l dopa monoamine depleted rats systemically administered n methyl aspartate \( nmda \) antagonists , mk 801 \( \( \) 5 methyl 10 , 11 \( , \) 5 , 10 \) cpp \( 3 \( \) 2 4 1 \) , potentiate ability l dopa \( l 3 , 4 dihydroxyphenylalanine \) reverse alleviate muscular rigidity monoamine depleted rats basis findings , proposed nmda antagonists may beneficial adjunctive treatment therapy parkinson 's disease cpp locally injected nucleus , nucleus rat homologue internal segment substantia nigra pars reticulata monoamine depleted rats stimulates locomotor activity rigidity , whereas local microinjection cpp ineffective results make unlikely site action nmda antagonists monoamine depleted rats , whereas nucleus , internal segment , substantia nigra pars reticulata appear important effects nmda antagonists
failure nine month phenobarbital administration reverse amygdaloid kindled seizure susceptibility cats upon completion left amygdaloid kindling , 4 cats underwent long term phenobarbital administration subsequent 5 9 month rest period plasma phenobarbital levels maintained 15 20 micrograms ml following plasma phenobarbital washout three cats served controls 7 cats subjected repeated 6 hour sleep monitoring observation interictal discharges , observed often immediate period frequency decreased gradually throughout experiment medicated control animals , never completely disappeared except contralateral amygdala 1 medicated animal upon primary site , medicated animals responded generalized induced animals underwent secondary site amygdaloid kindling , 3 showed positive transfer effect findings suggest although phenobarbital potent anticonvulsant , little effect acquired seizure susceptibility previously amygdaloid kindled cats
fetal \( ventral mesencephalon adrenal tissue \) striatum parkinsonian subjects fetal ventral mesencephalon fetal adrenal tissue grafted caudate nucleus four three parkinsonian patients , respectively , shown alternative treatment amelioration signs disease ventral mesencephalon patients significant amelioration rigidity , bradykinesia , postural imbalance , gait disturbance , facial expression three four patients returned work fatal adrenal group showed amelioration rigidity bradykinesia though patients able perform basic daily living activities , one renewed household tasks , two yet able return work differences observed ventral mesencephalon fetal adrenal transplanted patients may related heterogeneity disease type graft implanted however encouraging results may , experimental procedure obviously requires studies , outside highly qualified clinical research centers
white matter dementia alzheimer 's type healthy subjects without cerebrovascular risk factors magnetic resonance imaging study t2 weighted \( 0 5 \) magnetic resonance images used study prevalence subcortical white matter \( wmhis \) 22 patients dementia alzheimer 's type \( dat \) , 20 age matched older healthy control subjects , 10 younger healthy control subjects criteria groups included cerebrovascular risk factors subjects ischemic index scores less 2 computed tomographic scans showing infarct wmhis classified periventricular wmhis deep wmhis graded 0 3 \( 0 indicated absent , 3 , severe \) group dat older control subjects , periventricular wmhis deep wmhis graded 2 3 fewer 17 27 subjects , respectively , whereas younger control subjects , ratings grade 1 less serum cholesterol systolic blood pressure values , although within normal range , elevated significantly older control subjects compared younger control subjects significant differences ratings , blood pressure , cholesterol , triglyceride levels found patients dat age matched control subjects systolic blood pressure levels correlated severity periventricular wmhis older control subjects age correlated periventricular wmhis deep wmhis within older control subjects patients dat significant correlation wmhis severity dementia group dat results suggest , subjects screened cerebrovascular risk factors , wmhis rare occur identical frequency patients dat age matched healthy control subjects
primary progressive aphasia longitudinal course , neuropsychological profile , language features four patients clinical syndrome primary progressive aphasia aphasia profile followed period 3 5 years extensive neuropsychological data three patients revealed progressive , quantitative decline language relative stability memory , skills , reasoning activities daily living preserved even speech although several aphasia types may associated primary progressive aphasia , aphasia profile errors useful differentiating much common clinical syndrome , probable alzheimer 's disease correlates probable alzheimer 's disease differ associated primary progressive aphasia therefore , clinical distinction two syndromes may important predicting underlying pathophysiologic changes life patient
plasticity aging brain reversibility anatomic , metabolic , cognitive deficits normal pressure hydrocephalus following shunt surgery course idiopathic normal pressure hydrocephalus studied 78 year old woman 4 year history progressive dementia underwent neuropsychologic testing , quantitative x ray computed tomography , magnetic resonance imaging , positron emission tomography f 18 measure rates regional cerebral glucose utilization cognitive testing demonstrated progressive deterioration 2 years , positron emission tomography showed significant reductions regional cerebral glucose utilization 34 49 compared age sex matched control subjects frontal , temporal , parietal , whole brain regions periodic testing , carried 2 year period shunt surgery , showed steady improvement clinical status parallel clinical changes , significant reversal neuropsychologic test scores increased brain volume increased regional cerebral glucose utilization several brain regions results documented considerable potential recovery compromised brain function older subjects even 4 years progressive brain disease
effects physostigmine spatial attention patients progressive supranuclear palsy tested patients progressive supranuclear palsy control subjects task attention targets preceded cues side termed validly cued opposite side , cued subjects , validly cued targets responded faster cued difference reaction times validly cued targets , hypothesized measure attentional movement , significantly increased patients performance controls certain neuropsychological tests correlated attentional ability correlations altered progressive supranuclear palsy physostigmine treatment patients induced responses cued targets function duration disease studies show defects cognition attention patients progressive supranuclear palsy demonstrate physostigmine reduces abnormal visual attentional performance
safety , stability , effectiveness immunoadsorption membrane plasmapheresis treatment myasthenia gravis nine patients \( five women four men , average age 50 4 years \) refractory myasthenia gravis \( mg \) underwent thymectomy treated immunoadsorption membrane \( iap \) thymic histology showed hyperplasia nine patients immunoadsorption column \( , med , co \) made 1 , 000 \( , med , co \) used machine plasma first filter \( , med , co \) , immunoadsorption columns used plasma perfusion iap treatment performed three times weekly total six times , iap done every 3 weeks removal rate anti ach r titer 54 12 igg , iga , igm levels improved nine nine patients iap treatment , improvement gait disturbances seen two two muscle strength improved nine patients , whereas speech disturbances improved two three eye ptosis improved nine nine patients subjective improvement reported nine nine patients , none severe side effects iap conclusion , iap safe , stable , effective , clinically useful treatment mg
aids visual impairment article provides type range aids available visually impaired person many aids leisure , learning , daily living illustrated equipment
disease delirium managing declining elderly patient many geriatric patients concurrent physical psychiatric illnesses , times may difficult determine primary delirium , transient syndrome presents psychiatric symptoms , usually manifestation organic disorder , undetected untreated , fatal clinicians , therefore , must learn recognize syndrome , search underlying etiology , treat accordingly
phenotypic functional characterization cells patients myasthenia gravis study cell surface phenotypes pbl myasthenia gravis \( mg \) patients showed cells significantly higher percentage cells \( helper inducer subset \) age sex matched controls pbl mg patients proliferated significantly higher normal subjects \( ns \) response purified alpha chain acetylcholine receptor \( achr \) anti achr antibody present sera 88 mg none ns pbl b cells mg , cultured autologous cells stimulated either pokeweed mitogen \( 69 \) , achr alpha chain \( 38 \) , secreted antibody achr alpha chain , whereas b cells alone secreted antibody cells pbl mg patients readily cloned cells ns , limiting dilution , presence recombinant il 2 absence achr alpha chain 50 cell clones mg patients , compared none ns , proliferated achr alpha chain response hla dr restricted mg cell clones display significant cytotoxic activity , compared control cell clones results indicate mg , regulatory cells play role pathogenesis mg , cytotoxicity , likely ability stimulate specific antibody production b cells
magnetic resonance imaging evaluation vitreoretinal disease eyes intraocular silicone oil media opacification eyes filled silicone oil makes evaluation recurrent retinal detachment difficult ultrasonography silicone oil subject significant imaging artifacts performed magnetic resonance imaging six patients unilateral silicone oil determine technique would detect detached retina subretinal oil patients undergone pars vitrectomy silicone oil injection proliferative vitreoretinopathy five patients solid silicone scleral five patients media clear , findings correlated magnetic resonance findings four patients recurrence inferior retinal detachment magnetic resonance imaging demonstrated subretinal oil three patients one patient concentric , shallow , anterior retinal detachment magnetic resonance scanning demonstrated globular suggestive subretinal oil sixth patient , cornea , magnetic resonance imaging suggested retina attached preoperatively confirmed subsequent surgery chemical shift artifact helpful defining contour retinal detachments presence subretinal oil silicone oil within eye
histopathologic study glaucoma implant three patients three eyes glaucoma implant \( one eye epithelial downgrowth , one eye endothelial syndrome , one eye glaucoma \) enucleated two six years implantation histopathologic examinations disclosed evidence erosion conjunctiva eye glaucoma implant device outer layers wall , mostly degenerated inflammatory cells present , represented minimal inflammatory reaction scanning electron microscopy tubes three patients showed tube intact , patent , without signs degradation tube entering anterior chamber caused appreciable inflammation maintained patency even downgrowth epithelial cells lined anterior chamber plate induced little inflammatory reaction therefore , glaucoma implant useful device patients high risk failure surgery glaucoma
vision screening primary care setting missed opportunity \? determine effectiveness vision screening primary care setting , administered questionnaire vision test patients general medical clinic subjects referred complete ophthalmologic evaluation failed vision test met high risk criteria based information contained questionnaire patient initiated requests eye examinations also total 169 patients scheduled eye examinations , 148 actually underwent ophthalmologic evaluation one hundred one examined referred basis study criteria serious eye disease \( cataract , glaucoma , diabetic retinopathy , age related macular degeneration \) diagnosed 96 \( 95 \) patients prompt surgical intervention recommended 27 \( 27 \) , medical treatment begun 21 \( 21 \) serious eye disease , 59 met criteria failing vision test , 69 met high risk criteria determined questionnaire 148 subjects received ophthalmologic evaluations , 47 requested serious eye disease diagnosed 23 \( 50 \) 47 patients none individuals required immediate surgery , medical treatment glaucoma begun eight \( 17 \) data suggest screening serious eye disease primary care setting efficient mechanism use identification patients undetected ocular disorders require follow treatment
multicenter trial cryotherapy retinopathy prematurity one year outcome structure function cryotherapy retinopathy prematurity cooperative group study safety efficacy cryotherapy treating severe retinopathy prematurity registered infants birth weights less g 23 study centers two hundred ninety one infants developed defined threshold retinopathy prematurity , cryotherapy performed approximately half eyes randomization protocol twelve months randomization , results masked grading fundus photographs posterior pole similar results obtained 3 months randomization , indicated unfavorable outcome 25 7 eyes received cryotherapy compared 47 4 control eyes \( p less 0001 \) first time , masked acuity assessment acuity performed study group indicated unfavorable functional outcome 35 0 treated eyes compared 56 3 control eyes \( p less 0001 \) results indicate cryotherapy reduces risk unfavorable retinal functional outcome threshold retinopathy prematurity
clinical morphometric results penetrating keratoplasty one piece anterior chamber suture fixated posterior chamber lenses absence lens capsule clinical records serial corneal endothelial images 25 , eyes style , one piece , anterior chamber intraocular lenses 24 , eyes suture fixated , posterior chamber intraocular lenses following penetrating keratoplasty reviewed determine clinical success endothelial survival 1 year twenty two \( 88 \) 25 grafts anterior chamber intraocular lens group 23 \( 96 \) 24 grafts sutured posterior chamber intraocular lens group clear 1 year best corrected visual acuity 20 40 better noted 25 eyes anterior chamber intraocular lens group 29 eyes sutured posterior chamber intraocular lens group mean intraocular pressure anterior chamber intraocular lens group significantly lower sutured posterior chamber intraocular lens group 3 months \( 17 4 vs 21 7 mm hg \) 6 months \( 17 3 vs 20 5 mm hg \) differ 1 year mean percent endothelial cell loss 1 year differ anterior chamber intraocular lens group \( 32 26 \) sutured posterior chamber intraocular lens group \( 27 26 \) clinical endothelial morphometric advantages noted 1 year suture fixated , posterior chamber intraocular lens style , one piece anterior chamber , intraocular lens following penetrating keratoplasty however , long term , prospective , randomized study two intraocular lens types recommended
survey initial referral children ophthalmology department report survey referral children making first visit ophthalmology department information gathered parents reviewing case notes parents relatives initiated referrals 223 cases \( 42 \) health visitors initiated 123 cases \( 23 \) general practitioners rarely first condition , though played major part subsequent referral process reasons referral important \( cases , 57 \) , followed poor vision \( 106 cases , 19 \) 44 confirmed cases amblyopia , 15 \( 34 \) detected child aged 5 years overall accuracy referral 66 \( reasons referral confirmed \) 109 cases \( 21 \) child found normal parents relatives first noticed 54 cases confirmed 15 cases poor vision health professionals , especially health visitors , great importance first detecting poor vision
aqueous serum zinc copper concentrations patients glaucoma cataract serum aqueous zinc copper concentrations 44 patients glaucoma cataract determined serum values found within normal ranges highest mean copper concentration seen glaucoma group addition significant negative correlation aqueous levels zinc copper patients glaucoma concluded increased copper value together low zinc value might importance patients glaucoma
topical timolol serum lipoproteins oral timolol taken treatment systemic hypertension shown affect adversely serum lipoprotein levels 15 week study 19 patients topical timolol therapy raised intraocular pressure found significant adverse effect serum lipoprotein levels view large number patients form long term therapy , selection type beta blocker use influenced lipid changes associated oral form drug
adenovirus keratitis technique corneal made severely affected eyes 12 patients presenting typical signs symptoms epidemic adenovirus isolated eyes histopathological study cytology diseased cells removed showed diffuse mild oedema epithelium , scattered moderately swollen deformed cells clinically observed lesions histologically consisted markedly swollen cells become oval fusion cells led small syncytial , development like processes occasionally observed loss cell contents resulted formation surface many cells two types inclusion bodies detected epithelial cells first type , intranuclear vacuolar inclusions , contained homogeneous material second type inclusions round , dense bodies , developed homogeneous material intranuclear vacuolar inclusions dense bodies contained replicating virus particles cell degeneration dense bodies become extracellular making corneal beneficial effect clinical course adenovirus keratitis
pupillary responses amblyopia relative afferent pupillary defects \( \) detected 32 3 patients amblyopia modification test consideration various clinical investigations significant factors identified patients showing , early age onset strabismus present , level visual acuity following treatment , longer period occlusion therapy points bear similarities results pattern \( \) , possibility causative defect ganglion cell level discussed effect occlusion treatment cannot predicted presence absence
multifocal posterior uveitis clinical pathological findings pathological study performed necropsy eyes 59 year old woman suffered nine years multifocal posterior uveitis disease controlled steroid therapy good preservation visual function extensive investigation reveal aetiology macroscopic examination numerous focal lesions various degrees pigmentation observed scattered across lesions studied light electron microscopy immunohistochemistry ongoing inflammation foci , producing destruction 's membrane , retinal pigment epithelium \( rpe \) , outer retina focal scars showed migration rpe glial cells capillary endothelial cells swollen inflammatory sites attempts establish cause condition unsuccessful
glaucoma screening little , late \? screening glaucoma , usually measuring intraocular pressure , popular , repeated analysis indicates poor sensitivity specificity extensive testing required testing focused high risk groups , including blacks elderly regular comprehensive eye examinations , schedule adjusted risk factors , probably cost efficient means identifying patients glaucoma primary care provider pivotal role encourage patients undergo examinations warranted encourage intraocular pressure lowering medications comply medication use
increase rim area surgical intraocular pressure reduction optic nerve head analyzer used measure optic disc structure 18 eyes \( 13 adult glaucoma patients \) surgical intraocular pressure reduction rim area markedly increased \( 0 15 mm2 0 45 mm2 \) eight eyes , changed either little \( less 0 1 mm2 \) remaining 10 eyes mean increase 0 75 0 26 mm2 0 92 0 36 mm2 increased rim area found time remained eyes reexamined 1 3 years surgery data support previous findings glaucomatous disc may reversed even adult eyes , perhaps result adequate pressure reduction
evaluation visual fields program introduction perimetry standardized measuring conditions much possible spite , possible influence results perimeter measurements introduction computer controlled perimetry , however , largely eliminated influence investigator perimetry results nevertheless , interpretation result clinical situation still extensively subjectively vary , depending doctor carrying program g1 introduced years ago used glaucoma program greatly simplified visual field assessment visual field indices indices make possible compare visual field results normal population present introduction program represents step forward program analyses measured visual fields aid standardized , statistical criteria based large , normal value study analysis thereby simplifies interpretation visual field results study compares outcome program visual field interpretations eye doctors
unusual retinal detachment 9 months scleral buckling surgery 49 year old man developed retinal detachment 9 months uncomplicated scleral buckling surgery left eye subretinal strictly localized along buckle showed remarkable response steroid cause would inflammation like posterior , triggered buckle associated factors important note subretinal long scleral buckling occur consequence steroid responsive inflammation well bacterial fungal infection described previously
glaucomatous optic nerve atrophy small discs low cup disc ratios glaucomatous optic nerve damage generally associated high cup disc ratios fifteen eyes nine patients increased intraocular pressure glaucomatous visual field loss low cup disc ratios reported optic disc area significantly \( p less 0 01 \) smaller 429 normal subjects glaucoma patients high cup disc ratios atrophy significantly larger retinal nerve fiber bundles significantly less visible normal group latter two parameters significantly different glaucoma groups low high cup disc ratios groups matched mean loss authors conclude eyes small optic discs , glaucomatous optic nerve damage may indicated changes cup disc ratios glaucomatous eyes small optic nerve low cup disc ratios
unilateral mydriasis caused transdermal contamination eye handling transdermal patch may cause accidental mydriasis simple office test discussed identify pharmacologic blockade thereby avoid extensive neurologic workup
assessing acquired ocular diseases assessing patient 's ocular complaint , one must carefully description symptoms decrease vision frequently symptom person seek attention pain around eye next frequent symptom complained discomfort often tolerated long periods professional attention obtained visual acuity must checked , vital sign exacerbation improvement many conditions measured take eyes suddenly cannot see , world takes completely different complexity , loss vision may mean loss independence
use cartilage graft simple stable technique repairing described incision lower border lower lid , eyelid divided orbicularis muscle external internal layers internal layer moved upward turn outward , sutures placed corrected state resultant defect lower end filled cartilage graft raw surface cartilage surrounding mucosa within 1 2 weeks without shrinkage technique stable technique performed
stromayr century stromayr , hernia surgeon , writing first german ophthalmic work known written , larger work hernia surgery , ophthalmic describe stromayr 's etiology treatment cataract stromayr , , also expresses eye surgeons day interesting historical article provides stromayr , description , translation two , cataract eye take beginning come recognize cataract , taken away
lateral wall advancement orbital decompression treatment enhanced modified craniofacial approach using lateral wall osteotomy , anterolateral advancement osteosynthesis conjunction medial inferior wall orbital decompression technique lateral wall advancement described , results discussed authors advocate orbital decompression optic neuropathy , advancement lateral orbital wall easily performed adjunct two three wall decompression procedure advancement appears increase overall effect providing potential space lateral expansion occur bony orbital volume also appears lessen lid retraction facilitates \( cases , \) need lid retraction surgery
assessment tear drainage obstruction using fluorescein dye disappearance assessment tear drainage impairment obstruction difficult authors used fluorescein dye disappearance evaluate tear drainage experimental obstruction upper , lower , neither , 20 subjects marked impairment noted subjects occluded \( p less 0 004 \) obstruction \( either upper lower \) generally resulted minimal impairment , though 10 subjects showed marked impairment fluorescein dye disappearance proved reliable , rapid method assessing tear drainage detecting lacrimal obstruction
epiphora treatment means balloon dilation drainage apparatus new interventional radiologic procedure developed treatment epiphora small bore , soft tipped guide wire introduced superior guided fluoroscopic control drainage system retrieval nasal aperture small bore angioplasty catheter introduced retrograde direction drainage apparatus dilated fluoroscopic control procedure attempted 18 eyes 17 patients moderate severe epiphora technically completed 16 13 cases demonstrated improvement , 11 patients showing complete resolution symptoms three patients whose epiphora improve , worsening symptoms occurred results preliminary follow ranged 7 weeks 6 months authors believe technique may hold promise treatment epiphora may obviate use invasive procedures
effect local anesthesia ocular central corneal curvature using standard , obtained central corneal curvature measurements 19 patients administration local anesthesia noted flattening mean average approached statistical significance , along increase overall astigmatism decreased intraocular pressure found factor
influence prior therapy success trabeculectomy role early surgery management primary open angle glaucoma debate determine whether previous medical therapy influences outcome subsequent trabeculectomy , retrospectively reviewed results surgery two groups patients first group underwent primary trabeculectomy , average 2 weeks preoperative medical therapy , group compared group patients received least 1 year topical glaucoma therapy undergoing trabeculectomy \( multiple treatment group \) two groups similar terms number variables , including race , age , sex , presenting intraocular pressures , presenting visual fields , differed known duration disease success rate trabeculectomy significantly higher primary trabeculectomy group compared multiple treatment group \( p less 001 \) discuss possible reasons difference implications future management primary open angle glaucoma
early intraocular pressure rise trabeculectomy intraocular pressure \( iop \) measured 4 6 hours surgery first postoperative day 35 eyes 35 consecutive patients undergoing initial trabeculectomy 27 eyes , anterior chamber formed completion surgery balanced salt solution , eight eyes sodium total six eyes \( 17 \) iop 40 mm hg greater 4 6 hours surgery patients received maintain depth anterior chamber significantly greater chance experiencing marked postoperative iop rise , 4 6 hours \( p 005 \) first postoperative day \( p \) correlation postoperative iop rise patient 's age , sex , glaucoma diagnosis , preoperative iop , use 5 fluorouracil , number sutures used close scleral flap may contribute early increase iop could result visual field loss eyes severe glaucomatous damage recommend early monitoring iop trabeculectomy avoiding routine use
serous retinal detachment following glaucoma filtering surgery report occurrence serous retinal detachment association choroidal effusion six eyes undergone glaucoma filtering surgery choroidal effusion documented five patients onset serous retinal detachment one patient underwent vitrectomy , treatment conservative patients serous retinal detachment choroidal effusions resolved spontaneously intraocular pressure normalized although one patient regained preoperative visual acuity , patients lost least one line acuity
surgical techniques rates retinal detachment due macular hole evaluated rates transvitreal transscleral techniques treating 250 eyes retinal detachment due macular hole initial success rate transvitreal approach 56 \( 53 94 \) difference results gas tamponade alone vitrectomy gas tamponade initial success rate transscleral approach 83 \( 130 156 \) macular diathermy macular buckling showed higher rate macular diathermy alone final success rates \( 95 \) , regardless approach selected initial technique patients whose initial transvitreal failed underwent additional transvitreal procedures \( including macular laser photocoagulation \) showed success rate 93 believe gas tamponade , possibility better visual prognosis , selected initial technique final success rate found regardless initial surgical techniques
graves' ophthalmopathy correlation saccadic eye movements age , presence optic neuropathy , muscle volume quantitative infrared used record saccadic eye movements 49 patients graves' ophthalmopathy peak saccadic velocities decreased patients developed presented optic neuropathy effect pronounced larger eye movements peak saccadic velocity also decreased total muscle volume limitation ocular motility increased given muscle volume , peak saccadic velocity 40 degrees slower patients 40 years older younger patients relationship velocity motility limitation pronounced intermediate muscle volumes \( 8 15 total orbital volume \) saccadic velocities patients optic nerve compression often improved following treatment study demonstrated eye movement recording useful adjunct evaluation patients graves' ophthalmopathy furthermore , age related lowering peak saccadic velocities implicated changes muscle structure factor development optic neuropathy
hydrogen peroxide localization experimental optic association reactive oxygen species altered permeability blood brain barrier acute experimental encephalomyelitis investigated ultrastructural cytochemical localization hydrogen peroxide \( h2o2 \) sites optic nerve previously identified extravasation intravascular peroxidase using modified method , found electron dense derived h2o2 reaction product localized perivascular space lamina , lamina , lamina optic nerve head , electron dense reaction product observed presence intravascular leukocytes , although adjacent perivascular interstitial inflammatory cells site scant myelinated optic nerve , derived h2o2 reaction product seen intravascular space blood vessels surrounding perivascular interstitial foci inflammatory cells reaction product also observed extracellular space adjacent axons glial cells optic nerve head nerve perivascular intravascular distribution derived reaction product suggests h2o2 may play role pathogenesis altered vascular permeability experimental optic supports previous observations suppression blood brain barrier permeability detoxification h2o2 exogenous administration antioxidant enzymes
whitnall 's sling poor function ptosis severe unilateral ptosis poor levator function previously treated maximal levator muscle resection bilateral unilateral suspension one us \( r l \) developed technique called whitnall 's sling , levator resected , preserving whitnall 's ligament attachments whitnall 's ligament underlying resected levator muscle sutured superior portion plate surgery levator muscle , 's muscle , whitnall 's ligament without altering structures produce three layer tear film 69 eyelids operated july 1976 july 1986 , minimum 1 year follow one use obtained , results satisfactory directly related levator function believe technique anatomically physiologically superior maximal levator resection similar long term results recent results shown addition 5 mm superior provides additional elevation 1 1 5 mm whitnall 's sling best suited cases opposite height 9 mm less levator function eyelid 3 5 mm
immunohistologic study epiretinal membranes proliferative vitreoretinopathy performed immunohistologic study 11 specimens epiretinal membranes surgically obtained patients rhegmatogenous retinal detachment proliferative vitreoretinopathy immunostaining procedures used identify immunoglobulin complement deposits , visualize class ii antigen expression proliferating cells , determine eventual infiltration cells immune system diffuse deposits igg , iga , ige , c1q , , c3d found epiretinal membranes , whereas numerous cells , including glial pigmented epithelial cells , expressed hla dr hla dq antigens macrophages b lymphocytes identified results suggest activation immune system course proliferative vitreoretinopathy class ii antigen expression could dependent upon growth promoting factors interferon gamma could play crucial role immune reaction , resulted immunoglobulin deposition activation complement however , eventual role immune phenomena extension proliferative processes remains determined
experimental biopsy performed transvitreal biopsy rabbit eyes develop reliable safe technique obtain retinal specimens attached retina pars vitrectomy without followed injection ringer 's solution subretinal space produce focal retinal detachment apex focal detachment excised intraocular removed eye expulsion fluid air exchange reattached retina biopsy sites evaluated clinically light electron microscopy regular intervals 20 weeks postoperatively initial five procedures performed without heparin infusion fluid , complicated severe fibrin reaction early retinal detachment remaining 17 eyes , 15 without intraoperative complication maintained attached biopsy site developed early ring along border , biopsy bed became increasingly cytoplasmic hyperplasia hypertrophy pigment epithelium epiretinal membranes subretinal neovascularization observed histologically retinal biopsy specimens reproducible suitable diagnostic studies
topical use cyclosporine treatment treated 11 patients four nine months topical cyclosporine 2 dilution oil significant side effects occurred , except mild transient upon administration within first 15 days , symptoms signs condition improved significantly , results maintained throughout entire treatment relapses disease occurred two four months end therapy double masked clinical trial nine patients \( 2 cyclosporine oil vs oil alone \) confirmed results treated eyes improved significantly signs symptoms compared control eyes topical cyclosporine may , therefore , considered effective substitute corticosteroids , excellent anti inflammatory activity patients corticosteroid dependent corticosteroid resistant
ocular movements essential blepharospasm essential blepharospasm histopathologic electrophysiologic evidence supports existence lesions proximity brainstem nuclei controlling ocular movements studied horizontal ocular movements eight patients treated previously surgery botulinum toxin injection control essential blepharospasm \( mean age , 58 years \) compared seven control subjects blepharospasm \( mean age , 68 years \) examined fixation stability , saccades , ocular reflex , visual enhancement suppression ocular reflex , nystagmus , using sampled , direct current electro patients blepharospasm exhibited ocular movement abnormalities since quantitative aspects ocular movements sensitive nonspecific brainstem lesions , absence abnormal ocular movements suggests lesion blepharospasm specifically limited neurons regulating facial muscles
use superior oblique sling third nerve palsy new single stage surgical technique management third cranial nerve palsy surgical usual technique correct alignment eyes first stage , followed ptosis correction sling operation second stage new single stage surgical technique involved superior oblique muscle bring eye midline position simultaneously used sling raise upper eyelid postoperatively fairly good cosmetic effect achieved , upper eyelid showed paradoxic aberrant elevation depression
contact transscleral laser glaucoma new way treat glaucoma laser coagulation ciliary body developed laser beam eye fiberoptic system tip fiberoptic probe placed direct contact surface eye treated technical equipment developed contact transscleral laser simple , practical , easy use method investigated experimentally \( animals human eyes enucleated \) tried clinical practice patients facing glaucoma surgery \( methods conservative therapy failed \) selected kind treatment immediate hypotensive effect approximately 13 mmhg first 24 hours gradual elevation tension , reducing initial effect average 30 method definite advantages surgical far safety simplicity concerned use contact fiberoptic systems may open new possibilities fields laser treatment glaucoma , including techniques channel laser beam structures anterior chamber angle
miniaturized vitrectomy system vitreous retinal biopsy author developed miniaturized vitrectomy system size 23 gauge needle hand piece inserted inside eye knife track instrument used removal vitreous biopsy specimens removal small pieces retina system also seems application vitreous surgery premature eyes
possible significance cilioretinal arteries low tension glaucoma cilioretinal arteries arise short posterior ciliary artery circulation directly choroidal circulation presence cilioretinal artery may compromised discs steal flow peripapillary circulation account worsening glaucoma damage reviewed records 33 patients unilateral cilioretinal arteries admitted investigation low tension glaucoma looked absolute difference affected unaffected eyes well percent difference relative mean value two eyes value unaffected eye following variables mean defect , corrected loss variance corrected pattern standard deviation , adjusted rim area statistically significant differences found mean disc area eyes cilioretinal arteries significantly larger previously reported normal eyes results suggest vascular steal exists presence artery , major clinical importance
recession superior oblique tendon pattern strabismus performed 9 12 mm recession superior oblique tendon pattern strabismus 10 patients average preoperative pattern measured 29 4 prism \( pd \) , average pattern correction 29 3 pd patients residual pattern 6 pd less \( average 2 3 pd \) patient experienced significant superior oblique , surgical complications , ptosis , brown 's syndrome , laceration vein superior rectus , occur procedure corrected 14 40 pd pattern amount pattern corrected correlated size preoperative pattern total amount recession done significant shift primary position noted patients underwent superior oblique recession procedure appears particular value patients moderate superior oblique advantages recession superior oblique tendon include potential reversibility reoperation , low risk induced superior oblique palsy , asymmetric surgery potential adjustable suture technique
glaucoma secondary epithelial downgrowth 5 fluorouracil since epithelial downgrowth involves actively proliferating intraocular tissue , possible 5 fluorouracil may inhibit report case secondary glaucoma caused epithelial downgrowth filtration surgery performed adjunctive use 5 fluorouracil cessation injections , membrane grew rapidly involve entire posterior cornea eye eventually became blind painful enucleated use 5 fluorouracil given usual manner appears failure
use ring treatment filtration leaking glaucoma filtration surgery report use ring treatment seven cases flat anterior chamber \( six cases total touch , one touch \) secondary leak cases , anterior chamber within 24 hours ring used advantages using ring \( \) permits testing visual acuity , , intraocular examination without removing \( b \) require suturing conjunctiva \( c \) corneal epithelium \( \) may available institutions lacking \( e \) cost effective
back recession description technique review literature describe modification back loop techniques call back recession , muscle reattached posterior original insertion single , absorbable suture recommend difficult strabismus cases , specifically 7 mm required
posterior horizontal vertical treat combined medial tendon laxity classical operations treat either medial tendon laxity occurring alone possess used treat conditions occur simultaneously simplified procedure described whereby tissue removed via posterior eyelid approach eyelid may vertically , thus lacrimal procedure quite easy perform done local anesthesia office
learning curve radial keratotomy prospectively evaluated learning curve radial keratotomy \( \) comparing results achieved two groups 20 consecutive eyes performed without previous experience procedure \( group 1 \) 20 eyes , matched age , sex , preoperative refractive error , performed performed procedure 250 times \( group 2 \) although nine group 1 none group 2 , postoperative uncorrected visual similar groups since adverse effect visual results , reasonable conclude , effect , learning curve involved experience
role communities decision making eye care programs concept primary health care involves people live lives ways beneficial health communities whole must participate decision making involved education , , preventive , curative , rehabilitative refer participation communication based two fundamental 1 \) community special knowledge contribute development health community 2 \) person superior another subsequent studies communities southern norwegian aid , norwegian association blind partially conducted village based concept
visual results complications sutured intraocular lenses penetrating keratoplasty retrospectively reviewed charts 56 consecutive patients undergone penetrating keratoplasty transscleral fixation posterior chamber intraocular lens follow ranged 3 28 months \( mean , 11 1 months \) postoperative visual acuity improved 46 patients \( 82 \) , remained eight \( 14 \) , worsened two \( 3 6 \) 32 patients least 10 months' follow , best corrected visual acuity measured hard contact lens 20 40 better 12 \( 38 \) , 20 50 20 10 10 \( 31 \) , 20 200 worse 10 \( 31 \) problems lens , tilt , scleral suture related infections minimal glaucoma common cause decreased vision patients 10 months' follow three patients \( 5 4 \) developed rhegmatogenous retinal detachments early postoperative course
new ophthalmic present new instrument designed facilitate tissues required various ophthalmic procedures 21 gauge steel tube , 0 81 mm diameter 16 mm long , cutting end plastic finger grip area facilitate micro rotation standard plastic allows used syringe , either standard type one spring assisted scar tissue , biopsy specimens , abnormal inflammatory fluids syringe subsequent pathologic examination
viscous fluid pump describe device useful injection material vitreous cavity internal tamponade instrument proven reliable user clinical setting
uremic platelets functional defect affecting interaction von willebrand factor glycoprotein iib iiia uremic patients impaired platelet function related membrane glycoprotein \( gp \) abnormalities using perfusion system , studied interaction normal uremic platelets vessel \( se \) flow conditions reconstituted blood containing washed platelets , purified von willebrand factor \( vwf \) \( 1 u ml \) , normal washed red blood cells exposed de rabbit segments 10 minutes two different shear rates \( 800 1 , 600 seconds 1 \) experiments monoclonal antibody gpiib iiia complex \( \) added perfusates normal platelets , percentage vessel covered platelets \( cs \) 23 1 3 7 800 seconds 1 30 4 3 1 , 600 seconds 1 platelets observed contact forming monolayers vessel se inhibited spreading normal platelets cs \( 11 1 3 3 \) statistically decreased \( p less 01 \) platelets observed contact vessel surface data indicate , flow conditions , interaction vwf gpiib iiia support spreading normal platelets absence exogenous fibrinogen experimental conditions , interaction uremic platelets se markedly impaired shear rates studied \( p less 01 v normal platelets \) presence modify interaction uremic platelets results confirm impairment platelet adhesion observed uremic patients furthermore , indicate presence functional defect interaction vwf gpiib iiia fact normal uremic platelets presence antibody gpiib iiia complex show differences gives indirect evidence functionally normal interaction vwf gpib uremic patients
myxoid malignant fibrous histiocytoma bladder although common soft tissue sarcoma adulthood , malignant fibrous histiocytoma \( \) extremely rare tumor urinary bladder three well documented cases reported world literature patient presented report represents first case myxoid variant develop urinary bladder whereas previous patients bladder intermittent hematuria , patient 's chief complaint bladder outlet obstruction due extension tumor prostate managed radical , postoperative radiation therapy tumor bed , adjuvant chemotherapy using doxorubicin patient tolerated therapy well disease free 3 year follow visit , clinical features , pathologic characteristics , treatment considerations rare bladder tumor discussed detail
evaluation new rapid office test microalbuminuria comparison fully quantitative radioimmunoassay novel enzyme linked immunosorbent assay \( elisa \) rapid office measurement microalbuminuria evaluated performance compared commercially available radioimmunoassay \( double antibody albumin \) urine samples containing 0 75 1800 micrograms ml albumin obtained 31 diabetic patients assayed methods comparison paired values obtained two methods gave correlation coefficient greater 0 99 assay , used detachable eight well strips \( 1 strip sample \) , 10 min incubation , water wash , 2 min color development step , read elisa hand held analytical device \( u \) designed specifically test findings study indicate assay , used conjunction u device , rapid , convenient , sensitive method quantitative determination broad range \( 0 3 micrograms ml \) urinary albumin levels office setting
comparison albumin excretion rate obtained different times collection study undertaken assess usefulness different techniques determination albumin excretion rate \( aer \) ninety patients type \( insulin dependent \) diabetes mellitus 45 type ii \( non insulin dependent \) diabetes mellitus , aer 24 h less 200 micrograms min , included patients free major systemic complications diabetes overt kidney disease \( mean serum creatinine 1 1 0 1 mg dl , range 0 4 1 2 mg dl \) compared timed day , night , 24 h specimens , well timed spot specimens water induced patients type \( 75 90 \) type ii \( 30 45 \) diabetes aer less 20 micrograms min showed significant differences aer dependent collection time differences diminished absent aer less 20 micrograms min sensitivity , specificity , prediction rates aer different specimens evaluated 24 h aer use albumin concentrations albumin creatinine ratios improve test performance comparison aer sampling time overall rate aer influenced measurement urinary albumin excretion day 24 h aer useful determine presence abnormal aer aer albumin concentration spot samples limited use initial screening frequently require day 24 h specimens aer confirmation day 24 h aer used long term follow diabetic patient
treatment idiopathic testicular failure high dose testosterone undecanoate double blind pilot study effect high dose \( 240 mg \) intake testosterone \( \) undecanoate studied sperm characteristics , function accessory sex glands , hormonal parameters men idiopathic , , using two phase protocol including 3 month double blind period followed 3 month open phase increased sperm viability semen content adenosine triphosphate either reproducible patients placebo switched undecanoate reach statistical significance , whereas changes detected sperm characteristics accessory sex glands intake undecanoate significantly increased concentration 5 alpha \( \) ratio peripheral blood , suppressed luteinizing hormone concentration , tended decrease serum follicle stimulating hormone concentration concluded high dose undecanoate effective treatment men infertility idiopathic testicular failure
portable digital data recorder long term monitoring scrotal temperatures application new , miniaturized portable digital data recorder \( institute reproductive medicine , , west \) continuous determination scrotal temperatures revealed great variations scrotal temperature 24 hours normal men maximum temperatures approached body core temperatures mean scrotal temperatures 10 normal men rose 32 72 0 23 degrees c 37 53 0 38 degrees c treadmill running , scrotal temperatures increased 2 5 degrees c minimal scrotal temperatures increased men varicocele compared normal fertile men indicating impaired cooling mechanisms continuous temperature measurements facilitate assessment temperature dynamics miniaturized design makes suitable routine use outpatients infertility clinics , occupational medicine evaluation heat hazards , investigations body temperatures various experimental conditions
analysis sperm function implications mechanism sperm zona interaction condition provided unique opportunity determine abnormal mitochondrial organization loss associated syndrome , influence sperm function despite abnormal architecture , movement characteristics spermatozoa , terms curvilinear , path , progressive velocities , amplitude head displacement , within normal range similarly , behavior spermatozoa gradients normal , although capacity isolated fractions generate reactive oxygen species negligible particular significance fact spermatozoa sperm oocyte fusion binding human zona , even intracellular calcium signal generated ionophore a23187 sudden induction sperm zona interaction could , however , achieved use ion promoter system induce limited result demonstrates enhancing effect peroxidation sperm zona adhesion involves direct action properties sperm plasma membrane , rather indirect consequence damage leakage findings emphasize value specific conditions , , dissecting mechanisms regulate human sperm function
development hypertension unilateral renal artery stenosis conscious dogs renal systemic changes stenosis left renal artery \( n 5 \) sham stenosis \( n 6 \) conscious dogs studied sequentially 25 days stenosis produced prompt rise arterial pressure , times due reduced peripheral vascular conductance , increase cardiac output despite initial evidence mild fluid retention decrease peripheral conductance attributable 1 \) stenotic kidney \( 25 total due mechanical effect stenosis \) , 2 \) nonstenotic kidney \( 15 total caused angiotensin ii \) , 3 \) vasculature \( 60 \) decrease conductance vasculature due partly angiotensin ii , also gradually developing non angiotensin ii component acute administration captopril caused significantly greater changes arterial pressure peripheral conductance throughout period stenosis stenosis \( greater sham stenosis dogs \) , indicating angiotensin ii peripheral vasculature even plasma renin levels longer elevated stenotic kidneys , captopril produced fall renal vascular resistance , renal blood flow rise approximately equal rise resistance stenosis evidence role autonomic nervous system hypertension , ganglion blockade \( \) similar hemodynamic effects stenosis thus , hypertension due times reduced peripheral conductance , two kidneys responsible 40 reduced conductance
experimental treatment benign prostatic hyperplasia transurethral balloon dilation prostate preliminary study 73 humans prospective study safety potential efficacy transurethral balloon catheter dilation prostate \( \) treatment benign prostatic hyperplasia \( \) performed 73 subjects moderate severe symptoms signs selected basis quantitative symptom score \( ss \) , measurements , residual urine volume seven patients urinary retention mean age 69 6 years \( range , 59 95 years \) successfully accomplished 70 patients \( 96 \) significant complications mean follow 16 2 months \( range , 6 36 months \) forty six patients \( 66 \) showed improved ss recent follow 24 patients \( 34 \) ss unimproved , necessitating prostatectomy 17 subjects \( 24 \) reduction mean residual urine volume statistically significant 38 patients median lobe enlargement showed improvement ss , compared 74 others authors conclude safe shows promising effectiveness ultimate demonstration effectiveness requires controlled clinical trial
nephrotoxicity associated concomitant ace inhibitor nsaid therapy angiotensin converting enzyme \( ace \) inhibitors nonsteroidal anti inflammatory drugs \( nsaids \) may synergistically compromise renal function computer assisted study done prevalence compromised renal function clinical importance drug interaction search records patients seen university medical center internal medicine clinic conducted identify cases involving renal insufficiency , therapy ace inhibitors , therapy nsaids records cases meeting criteria reviewed clinical correlation revealed patients treated nsaids , ace inhibitors , 162 nephrotoxicity found conjunction monotherapy , three cases reversible renal failure found conjunction combination therapy significant nephrotoxicity concomitant use ace inhibitors nsaids uncommon , attention drawn potentially important interaction
absence nephrotoxicity differential nephrotoxicity tobramycin gentamicin conducted prospective , double blind , randomized trial gentamicin tobramycin evaluate differences nephrotoxicity evaluated levels creatinine , creatinine clearance , beta 2 microglobulin , n acetyl beta \( nag \) indicators nephrotoxicity , attempted correlate forty patients met criteria evaluation 14 given tobramycin remaining 26 received gentamicin significant nephrotoxicity , defined increase creatinine 0 5 mg dl , occur either group increases beta 2 microglobulin values seen 67 patients tobramycin group , 52 gentamicin group elevations nag levels occurred 54 tobramycin group 52 gentamicin group elevation nag beta 2 microglobulin levels 40 cases conclude significant difference nephrotoxicity gentamicin tobramycin elevations nag beta 2 microglobulin occurred rates similar reported literature , correlate significant nephrotoxicity
natural history low stage prostatic cancer impact early detection expanding increasingly older population , rising incidence prostate cancer , regarding treatment effectiveness made disease target special concern natural history cancer must consequence host tumor interactions , little known subject growth rate tumor determined many factors , including genetic instability present , tumor grade , volume , ploidy useful techniques growth rate metastatic potential stage a1 tumors generally , whereas stage a2 tumors aggressive natural history stage b lesions well documented author two questions \( cure necessary may possible \? cure possible may necessary \? \) reviews problems inherent screening prostate cancer time
epidemiology prostate cancer available epidemiologic data allow targeting specific populations prostate cancer screening early detection programs although certain strong factors identified \( age , race , location \) , none sufficiently defines high risk groups recommendations differ age matched patients certainly , strong familial tendency identified , relative contribution genetic environmental factors patients remains unclear hypotheses pathogenesis prostate cancer possible based available data genetic factors appear permissive , hormonal influences , partially regulated genetics environmental factors appear promotional genetically susceptible men dietary fat may also important promotional factor genetically susceptible men dietary factors appear exert influence modulating sex hormone concentration several factors demand investigation understanding epidemiology prostate cancer relative frequency disease increasing death rate prostate cancer concern similarities incidence latent prostate cancer among various groups strong differences rate clinically apparent disease raise significant issues regarding potential lifestyle environmental promotional factors understanding pathogenesis prostate cancer may allow refinement definition programs prevention early detection disease
screening carcinoma prostate whether adopt system mass screening carcinoma prostate u well suited clinical decision analysis approach authors demonstrate using available data , suggest offering screening program men ages 50 70 would expensive method also permits calculation eventual morbidity screening costs analysis demonstrates importance attempting predict ultimate patient outcomes implementing health care strategy standard
digital rectal examination early detection prostate cancer screening using digital rectal examination improves clinical stage distribution prostate cancer prolongs survival unfortunately , digital rectal examination may sensitive enough detect small volume tumors amenable cure several studies , approximately 50 per cent cancers detected screening already spread beyond prostate regardless , key demonstrating overall benefit screening diminished disease specific mortality rate date , shown lower mortality rates prostate cancer demonstrated randomized study comparing screened populations study , recently approved national health , require 10 15 years complete time , value screening prostate cancer digital rectal examination method unknown beyond lack proved benefit , screening prostate cancer may harmful variable natural history disease morbidity mortality rates associated treatment exists large population patients pathologically detectable prostate cancer never clinical disease detection tumors may expose patients risks unnecessary treatment large scale prostate cancer screening studies may ultimately shown advantageous sooner occurs , earlier aggressive screening advocated , similar screening breast cancer however , screening programs without first demonstrating clear benefit
transrectal ultrasonography early detection staging prostate cancer relatively recent changes improvements equipment increased image resolution transrectal ultrasonography prostate expanded use transrectal ultrasonography greatly knowledge prostate zonal anatomy permitted clinical evaluation internal prostate architecture technique dependent , quality results related directly person 's knowledge experience significant majority prostate cancers originate peripheral zone palpable stage b nodules characteristically hypoechoic appearance disagreement tumor characteristics cause , large tumors may obscure normal prostate anatomy appear lack contrast surrounding prostate tissue transition zone prostate origin benign prostatic hyperplasia almost 20 per cent prostate cancers tumors probably correspond stage lesions transrectal ultrasonography less accurate identifying transition zone tumors mixed transition zone , interference prostatic calculi calcified , poorer image resolution area studies evaluating use transrectal ultrasonography early detection prostate cancer generally shown twofold increase detection rate compared digital rectal examination however , decreased morbidity expense transrectal prostate biopsy using automatic gun device increased frequency biopsy ultrasound examined patients compared historically evaluated digital rectal examination increased detection rate may part function increased use biopsies , independent factors transrectal ultrasonography rarely detects cancer patient normal digital rectal examination normal serum prostate specific antigen level transrectal ultrasonography may capable identifying early capsular penetration seminal vesicle invasion patients known prostate cancer however , superiority digital rectal examination purpose demonstrated unequivocally ultrasonography allow directed biopsies seminal vesicles suspect areas , may helpful staging disease use transrectal ultrasonography prostate cancer evolved rapidly , changes technology reports within years \( abstract truncated 400 words \)
laboratory studies detection carcinoma prostate acid phosphatase prostate specific antigen extremely useful markers management patients prostatic carcinoma prostatic acid phosphatase , relatively low sensitivity specificity , well instability diurnal variability , unsuitable prostate cancer screening improved performance characteristics , stability , lesser diurnal variation , association elevated prostate specific antigen prostatic intraepithelial neoplasia make prostate specific antigen possibly better candidate early detection common malignancy investigations area clearly indicated recommend screening prostate specific antigen
radiation therapy localized prostate cancer justification long term follow series presented , survival patterns 15 years radiotherapy patients clinical stage carcinoma prostate significantly age matched peer group patients clinical stage b disease \( nodular disease exceed involvement one lateral lobe \) , survival 5 less 15 years age matched group california men spite fact lymph node status true incidence capsular penetration unknown moreover , patients stratified histopathologic grade either acid phosphatase prostate specific antigen values one restrict patients intermediate low scores , normal acid phosphatase , low prostate specific antigen values , likely would difference survival prostatic cancer age matched peers one conservative selection criteria includes patients advanced stages , likelihood achieving 15 year survival radiation treatment , however , patients whose disease , clinical examination , extends beyond prostate seem advanced radical prostatectomy still may 20 per cent 30 per cent chance 15 year survival
patient selection , results , impact tumor resection potency sparing radical prostatectomy results show using nerve sparing radical prostatectomy , potency preserved majority appropriately selected patients without compromising adequacy tumor excision however , proper patient selection important patients focal , well differentiated tumors , especially young patients stage b1 tumors , ideal candidates patients extensive less well differentiated tumors , higher risk incomplete tumor excision although suspect adequacy tumor excision determined extent tumor technique radical prostatectomy used , believe nerve sparing surgery used great caution , , patients extensive high grade tumors patients , microscopic extracapsular tumor extension extremely common , impossible detect time operation , less likely adequately nerve sparing techniques hand , current data provide little evidence excision neurovascular bundles beneficial possible extensive resections alter incidence positive margins cure rates finally , might argued forms radical prostatectomy inappropriate patients poorly differentiated clinical stage b2 prostate cancer really effective treatment options continue recommend radical prostatectomy patients based finding patients clinical stage b2 disease organ confined tumors expected excellent long term disease free survival rates similar clinical stage b1 patients remaining patients clinically , prospects minimal microscopic tumor remaining controlled adjunctive radiation therapy may better controlling bulky primary tumor radiation therapy alone hypothesis need tested randomized clinical trial
case initial treatment localized prostate cancer contribution summarizes evidence natural history pathology disease , given high incidence latent cancer , policy radical treatment diagnosis represent treatment majority cases yet , neither radical prostatectomy radical radiotherapy shown effective managing poorly differentiated tumor patient localized disease patient well differentiated disease , little evidence early treatment mandatory , majority patients die prostatic cancer adoption policy diagnosis followed active surveillance would many patients hazard discomfort major operation course radiotherapy , would minimize expenditure , would ensure treatment given patients progression demonstrated approach almost certain effective treatment diagnosis confirmation view likely obtained existing studies immediate versus delayed orchiectomy lhrh therapy currently undertaken urological working party medical research council united kingdom urological group within europe
current options management clinical stage c prostatic carcinoma evaluation clinical stage c prostatic cancer enhanced advances staging modalities past 15 years better staging local lesion possible transrectal ultrasound guided multiple biopsies prostate vicinity biopsies suspect pelvic lymph nodes guided ct \( \) may obviate pelvic lymphadenectomy , particularly patients high grade stage c lesions advances understanding serum markers supplemented staging information single therapeutic modality appropriate cases clinical stage c cancer c1 lesions , radical prostatectomy adjunctive radiation hormonal therapy seems produce best 5 10 year survival rates external beam radiation alone , combination interstitial radiation , may equivalent success clinical stage c2 disease , external beam radiotherapy seems present best therapeutic modality interstitial radiation sole method management stage c disease carries high local recurrence rate significant risk metastatic progression transurethral prostatectomy hormonal treatment continue place management selected poor risk patients current results surgery radiation therapy alone less ideal recommended aggressive combination treatment compared monotherapy randomized clinical trials monitored jointly radiation oncologists
flow cytometry carcinoma prostate flow cytometry quantitative cytologic technique demonstrated utility assessment prostate cancer well tumors authors summarize current data use disease detection diagnosis , prognostic evaluation , monitoring response therapy also project future developments
treatment primary nocturnal enuresis oral androgen clinical cystometric study double blind clinical study 30 boys , six ten years age , primary nocturnal enuresis undertaken assess role androgens treating enuresis oral synthetic androgen selected minimal potential toxic effects twenty boys treated 10 received placebo fourteen boys \( 70 \) became dry treatment \( 20 mg daily 14 days \) , 5 \( 25 \) remained dry follow period four months increased cystometric bladder capacity disappearance detrusor contractions noticed significant number cases treatment side effects recorded probably modulated autonomic innervation vesical musculature correction defective neural mechanism believed implicated pathogenesis nocturnal enuresis
presenting intracytoplasmic inclusions monocytes small gray blue intracytoplasmic inclusions noted peripheral monocytes neutrophils patient renal failure ultrastructural analysis revealed within cytoplasm authors case report introduce previously undescribed morphologic feature leukocytes may mistaken light microscopic level bodies inclusions
geriatric pharmacokinetics kidney general population aging , result , drugs increasingly prescribed variety medical conditions group patients multiple physiologic pharmacokinetic abnormalities present report summarizes principles prescribing elderly , especially related decline renal function frequently occurs
nutritional causes renal impairment old age occurrence renal insufficiency tends increase late adulthood common complication old age associated increased physical dependency , morbidity , mortality , lowered quality life review , authors develop dietary practices early middle adulthood importantly influence risk renal insufficiency elderly
basic evaluation female urinary incontinence urinary incontinence common disorder frequently social implications although several types urinary incontinence recognized , generally classified failure bladder store failure urethral mechanism systematic approach evaluation incontinence includes history , physical examination , basic laboratory tests , often urodynamic evaluation , offers comprehensive assessment etiology incontinence
treatment renal calculi elderly management renal calculi geriatric patient population poses unique problems include anesthetic risks , underlying medical disease , general risk benefit concerns variety relatively noninvasive procedures available , including extracorporeal shock wave lithotripsy \( eswl \) percutaneous \( \) practical management plan presented based primarily stone size takes consideration problems unique elderly patient
hemodialysis elderly patient potential advantages quality life , urea generation , serum creatinine , less weight gain total 204 patients treated maintenance hemodialysis continuous ambulatory peritoneal dialysis \( capd \) studied ascertain advancing age influences adaptation uremia therapy difference karnofsky score noted among patients 70 years age two groups patients , 16 59 , 60 69 years age , respectively subset 33 hemodialysis patients studied , noted increasing age associated lower serum creatinine concentration , lower weight gain , lower urea generation rate three findings contribute relative ease treating older uremia patients hemodialysis capd , tend stable compliant relative younger patients
elderly dialysis considerations compliance compliance scheduled treatments , dietary fluid restrictions , multiple medications important component care well end stage renal disease \( esrd \) patients given complex demands dialysis , important examine issue compliance , focusing large ever increasing segment patient population , elderly esrd literature reflects efforts define measure levels compliance , identify factors influence predict compliance , develop intervention strategies improve adherence treatment regimens limited attention focused specifically elderly , studies suggesting age may factor associated improved adherence social support may significant compliance patient group effort examine current status needs dialysis elderly , research progress american kidney center , washington university , study 5 years ago eighty four patients age 60 , dialysis minimum 6 months , identified sociodemographic , treatment , compliance , functional capacity data collected additional mental psychological testing completed patients willing able participate preliminary data suggest current elderly population larger significantly older 5 years ago sociodemographic data indicate population increasingly female , black , regard compliance , vast majority elderly demonstrate good compliance measured serum potassium , fair good compliance phosphorus , fair poor compliance fluid restrictions
strategies enhancing compliance dialysis elderly noncompliance must viewed symptom another problem problems treatment plans developed based individualized assessment patient 's physiologic functioning psychosocial situation must determined whether patient staff must also aware impact compliance staff responsibility maximize individual 's efforts comply , must realized ultimate decision responsibility rests patient
ethical issues geriatric overview developments medical care past five six decades provided remarkable life sustaining technologies \( \) contributed prolongation life span patients , well general increase health well end stage renal disease \( esrd \) treatment prototype treatments issues surrounding provision chronic catastrophic care remarkable progress accompanied ethical dilemmas include allocation scarce resources , initiation termination care consideration ethical dilemmas especially elderly , raise hard choices easy answers ethical dilemmas
ethical legal issues geriatric ethical legal issues affecting geriatric conditioned status elderly , sick people distinctive characteristics kidney disease failure key ethical issues respect persons , particular recognizing competent autonomy medical choice due protection dependent vulnerable individuals , good , acting , treating like cases alike avoiding discrimination law ethical legal concepts informed consent duty maintain appropriate , special applications concerning medication management elderly additional legal issues concern advanced care directives terminal care decisions
health care end stage renal disease program potential impact health care end stage renal disease \( esrd \) program considered possible implications recommendations study conducted institute medicine national academy also mentioned particular emphasis given potential consequences health care elderly certain socioeconomic groups esrd
effects calcium antagonists renal hemodynamics recent attention focused effects calcium antagonists renal function administered vitro isolated perfused kidney , calcium antagonists exhibit consistent actions permitting characterization actions permitting characterization renal effects calcium antagonists affect isolated perfused kidney , markedly alter response kidney vasoconstrictor agents presence norepinephrine , calcium antagonists markedly augment glomerular filtration rate produce modest improvement renal perfusion studies using isolated perfused rat kidney model , permits direct visualization afferent efferent arterioles , demonstrated augmentation glomerular filtration rate attributable preferential vasodilation vessels although clinical implications observations fully delineated , preliminary studies experimental animal models indicate calcium antagonists might exert salutary effects renal function clinical settings characterized acute impairment renal hemodynamics apparent , however , renal hemodynamic effects calcium antagonists use management essential hypertension
pharmacokinetics enoxacin following intravenous administration patients different degrees renal impairment enoxacin quinolone potential clinical use treatment serious infections twenty three patients \( age , 19 87 years \) different degrees renal function , including group undergoing chronic hemodialysis , received enoxacin \( 400 mg \) intravenous infusion \( 1 h \) blood samples collected infusion end infusion 5 , 10 , 20 , 30 , 45 , 60 , 90 , 120 min 3 , 4 , 6 , 12 , 18 , 24 , 48 , 72 h infusion enoxacin concentrations measured high pressure liquid chromatography pharmacokinetic parameters \( mean standard deviation \) calculated using model according creatinine clearances \( per minute \) total clearance enoxacin decreased 4 95 1 16 ml min per kg group normal creatinine clearance 0 76 0 21 ml min per kg patients severe renal failure \( creatinine clearance , less 15 ml min \) , whereas elimination half life increased 4 5 1 0 20 5 h , respectively elimination \( main metabolite enoxacin \) urine markedly decreased creatinine clearance less 15 ml min hemodialysis removed insignificant amount enoxacin data indicate creatinine clearance falls 30 ml min , daily enoxacin dose reduced half prolonged administration enoxacin patients creatinine clearances less 30 ml min , accumulation might lead unexpected side effects
spontaneous resolution congenital nephrotic syndrome neonate infant congenital nephrotic syndrome recovered spontaneously completely age 11 days remained well age 1 year view reversible congenital nephrotic syndrome occur single disease universally prognosis
ionized calcium , parathormone , mortality critically ill surgical patients prospective study measured ionized calcium parathormone sequentially 48 72 hour intervals 25 surgical intensive care unit patients twelve patients \( 48 \) died mean day 40 median day 26 levels ionized calcium , parathormone , blood urea nitrogen , creatinine , albumin , magnesium , phosphate patients lived compared levels patients died incidence hypotension , renal failure \( creatinine greater equal 3 0 \) , bacteremia , well amount red cell , crystalloid , colloid administration two groups compared hypotension , bacteremia , red cells , crystalloid , colloid different days 1 2 ionized calcium levels significantly lower parathormone levels significantly higher nonsurviving patients difference persisted days 3 4 blood urea nitrogen creatinine levels increased early nonsurviving patients renal failure , occurred nine nonsurviving patients , develop mean day 14 , median day 18 phosphate level slightly higher still within normal range nonsurviving patients days 5 6 ionized calcium parathormone levels different nonsurviving patients , despite improvement renal function magnesium albumin levels different groups ionized calcium levels lower parathormone levels higher early nonsurviving patients difference readily explained associated clinical conditions , including renal dysfunction although etiology remains unclear , low ionized calcium elevated parathormone early predictors mortality critically ill surgical patients
safe , cost effective alternative general anaesthesia review cases technique developed provide safe satisfactory operating conditions wide range patients independent age overall level fitness \( although use children remains established \) suitable endoscopic open procedures , day cases patients used day case surgery significantly improves overall efficiency recognised day case surgery important cost effective element surgical care increasing restraints imposed upon hospital , patient beds staffing levels , strategies designed improve efficiency sphere surgical activity 93 patients prefer conventional general anaesthesia high degree acceptability technique , applications potential impact detailed
vitro evaluation pollen extract , 60 , regulation prostate cell growth nine human derived cancer non cancer continuous cell lines employed evaluate relative vitro activity pollen extract , 60 responses cell lines drug assessed measuring growth cell survival determined cell count results demonstrated 9 continuous cell lines tested , derived human prostate growth inhibited pollen extract , whereas non prostate derived cells exhibited variable degrees resistance 60 selectivity drug prostate cell lines even pronounced hormone independent models , suggesting might place pollen extract control abnormal growth hormone insensitive cells
treatment outflow tract obstruction due benign prostatic hyperplasia pollen extract , cernilton double blind , placebo controlled study whilst prostatectomy remains gold standard treatment outflow tract obstruction due benign prostatic hyperplasia , medical treatment symptomatic relief appears attractive alternative pharmacological agents use block hormonal sympathetic neurological pathways influence prostate growth function drugs known side effects sixty patients outflow obstruction due benign prostatic hyperplasia \( \) entered double blind , placebo controlled study evaluate effect 6 month course pollen extract , cernilton statistically significant subjective improvement cernilton \( 69 patients \) compared placebo \( 30 \) significant decrease residual urine patients treated cernilton posterior \( p \) diameter prostate ultrasound however , differences respect flow rate voided volume statistically significant concluded cernilton beneficial effect may place treatment patients mild moderate symptoms outflow obstruction
prostatic carcinoma histological factors affecting prognosis neuro endocrine paracrine cells human prostate urethra identified various methods , predominantly silver stains immunocytochemistry incidence neuro endocrine differentiation prostatic carcinoma varied considerably 10 100 , studied previously independent factor affecting prognosis nucleolar regions \( \) loops ribosomal rna occurring nucleoli cells ultimately process rna genes demonstrated silver \( ag \) staining techniques studied numerous malignant tumours pilot study laboratory shown distinct significant difference staining prostatic carcinoma benign prostatic epithelial hyperplasia retrospective study performed least 6 years' follow confirmed presence neuro endocrine cells half patients investigation significant correlation survival absence neuro endocrine cells demonstrated staining shown prognostic value
familial testicular cancer five members cancer prone kindred family 13 siblings , four brothers developed testicular neoplasms , one embryonal cell carcinoma three testicular first removed mother 's side family \( fourth degree relative \) developed embryonal carcinoma treatment alive well mother twin one ten siblings multiple cancers diagnosed among siblings offspring including breast carcinoma age 30 years twin associated abnormalities , concordance age , discordance pathology five males testicular cancer discussed identification reporting risk factor encouraged
comparison pathological lesions repeated renal biopsies 73 patients primary iga glomerulonephritis value quantitative scoring approach final prognosis order improve possibility establishing long term prognosis iga nephritis , 73 patients cohort 282 , followed mean period 12 years institution iga nephritis , prospective second renal biopsy 5 years later biopsies \( \) , developed quantitative scoring lesions glomerular , interstitial , tubular vascular index sum 4 indexes gave global optical score \( gos \) pathological improvement light microscopy \( delta gos less equal 2 \) noticed 3 patients \( 4 \) , stability \( 2 less delta gos less 2 \) 30 patients \( 41 \) , mild deterioration \( 2 less equal gos less 5 \) 23 patients \( 32 \) major progression \( delta gos greater equal 5 \) 17 patients \( 23 \) observed pathological remission , even 14 patients complete clinical remission pathological progression characterized increase lesions , mainly interstitial vascular ones immunofluorescence mesangial iga deposits remained stable disappearance however , number intensity vascular c3 deposits significantly greater chronic renal failure \( serum creatinine greater 1 5 mg dl \) correlated best major pathological progression mainly progression lesions iga nephritis slowly progressive disease pathological remission , evolution characterized progression lesions , mainly vascular , might play major role ultimate development chronic renal failure
treatment mesangial iga nephropathy cyclophosphamide , dipyridamole warfarin two year prospective trial 52 patients mesangial iga nephropathy , 25 allocated treatment cyclophosphamide \( 6 months \) , dipyridamole warfarin \( 2 years \) 27 treatment randomized prospective 2 year study entry , treated untreated groups patients differ mean serum , urinary protein excretions , quantitative urinary erythrocyte counts blood pressure readings end trial mean \( sem \) serum creatinine values 0 12 0 01 0 13 0 01 mmol l \( p less 0 05 \) untreated patients 0 10 0 01 0 12 0 01 mmol l \( p less 0 05 \) treated patients mean \( sem \) log values urinary erythrocyte \( rbc \) counts changed significantly 5 47 0 09 5 21 0 14 log rbc ml untreated patients , 5 45 0 11 5 49 0 19 log rbc ml treated patients however , treated patients , mean \( sem \) urinary protein excretions decreased 1 67 0 35 1 15 0 31 g 24 h \( p less 0 01 \) whereas untreated patients urinary protein unchanged initial values 1 76 0 34 follow 1 89 0 45 g 24 h significant changes blood pressure occurred either group study supports observation treatment iga nephropathy cyclophosphamide , dipyridamole warfarin associated reduction urinary protein excretion significant effect preservation renal function , least determined serum creatinine values , could confirmed two year study
preliminary binephrectomy necessary patients autosomal dominant polycystic kidney disease undergoing renal transplantation \? patients end stage chronic renal failure due autosomal dominant polycystic kidney disease underwent renal transplantation without preliminary binephrectomy retrospectively studied determine effect binephrectomy outcome nineteen patients identified thirteen patients surgery prior transplantation six underwent preliminary binephrectomy one patient died result nephrectomy twenty one renal allografts performed 18 patients seven died sepsis 10 functioning grafts one returned dialysis patients undergoing preliminary binephrectomy statistically significant \( p less 0 05 \) increase mortality morbidity due septic complications related polycystic kidney disease indications bilateral nephrectomy
hypophosphatemia infants continuous ambulatory peritoneal dialysis three infants irreversible renal failure treated continuous ambulatory peritoneal dialysis \( capd \) developed hypophosphatemia one lesions observed x ray bone biopsy showed different mechanisms may origin hypophosphatemia high doses phosphate binders , low phosphorus intake , phosphate loss dialysate possibly nutritional repletion dietary phosphorus restriction use phosphate binders applied caution serum phosphate monitored regularly infants treated capd
validity creatinine clearance estimates assessment renal function clinical practice , estimations renal function commonly used calculate appropriate dose drugs cleared continuous infusion inulin clearance \( clin \) , 4 hour creatinine clearance \( clcr , \) , 24 hour creatinine clearance \( clcr , \) measured 109 subjects \( 86 men 23 women \) varying degrees stable renal function \( clin , 6 209 ml min \) compared clcr values predicted five equations basis plasma creatinine concentrations , age , weight , height clcr , positively correlated clin \( r 0 92 p less 0 0001 \) exceeded clin 15 range 30 209 ml min \( clin \) similarly , clcr , correlated well clcr , \( r 0 84 p less 0 0005 \) clin \( r 0 84 p less 0 0001 \) relative role tubular secretion overall clearance creatinine increased declining clin exceeded 40 clin 30 ml min clcr estimated methods significantly differ either clcr , clcr , , whereas equations generally underestimated clcr among numerous mathematical equations , clcr estimated method proposed either best predictor clin \( clin 1 18 38 clin 1 20 60 , respectively r 0 81 p less 0 0001 \) present data support use equations proposed rapid estimation renal function clinical setting
interaction parameters male female fertility couples previously unexplained infertility prospective study undertaken relationship semen variables , serial endocrine follicular ultrasound measurements one complete menstrual cycle , treatment independent chance conception couples referred unexplained infertility 91 couples studied , mean length infertility 70 months 100 follow rate achieved stepwise analysis performed examining semen variables ultrasonographic endocrine variables , mean ratio salivary progesterone plasma estradiol days 1 3 , respect luteinizing hormone surge grade 2 motile sperm density , variables achieved 5 level significance highly significant relationship product two variables chance conception study clearly demonstrates interaction parameters male female fertility
psychological assessment follow vitro fertilization assessing impact failure present study conducted assess immediate psychological impact failed vitro fertilization \( ivf \) emotional status marital functioning also examined pre ivf , demographic information psychological test scores evaluated predictors reaction treatment failure failed first cycle , males females showed significant increases anxiety depressive symptoms although group means clinically elevated participants coping adequately , prevalence mild moderate depression increased substantially , particularly among women addition , women without children subgroup particularly vulnerable stress failure predisposition towards anxiety , pre ivf depressive symptoms , fertility history important predictors emotional response treatment implications findings discussed
reverse \( antibody capture \) enzyme linked immunosorbent assay detection antisperm antibodies sera genital tract secretions reverse \( antibody capture \) enzyme linked immunosorbent assay \( elisa \) detection antisperm antibodies developed assay enables detection immunoglobulin \( ig \) , igg , iga , igm , igg , iga antisperm antibodies serum , cervical mucus , seminal plasma samples reverse elisa specific sensitive conventional elisa detecting human antisperm antibodies different isotypes using assay , statistically significant differences levels antibodies infertile fertile individuals demonstrated sera genital tract secretions studies 143 infertile couples revealed presence antibodies sera necessarily reflected individual 's genital tract secretion vice versa data emphasize importance detecting antisperm antibodies sera well genital tract secretions correct evaluation sperm immunity
protein differences normal oligospermic human sperm demonstrated two dimensional gel electrophoresis protein expression sperm obtained men normal semen analysis men evaluated two dimensional gel electrophoresis proteins solubilized 9 5 urea 2 \( , , sweden \) lysis buffer underwent second dimension separation 10 16 polyacrylamide gradient gels set 36 proteins identified samples , whereas 8 10 evaluable oligospermic samples lacked 1 proteins proteins absent oligospermic samples may critical normal sperm function may serve markers infertility
pooled sequential ejaculates way increase total number motile sperm oligozoospermic men investigated yield total number motile spermatozoa oligozoospermic men pooling two closely spaced sequential ejaculates semen characteristics compared sequential ejaculates \( within period 1 4 hours \) 18 oligozoospermic males \( sperm concentration less 20 x 10 \( 6 \) ml total sperm count less 40 x 10 \( 6 \) ejaculate \) control group 16 men whereas median total number motile sperm males significantly decreased 70 x 10 \( 6 \) first ejaculate 23 x 10 \( 6 \) second sequential ejaculate , decrease detected oligozoospermic males , 3 6 x 10 \( 6 \) 3 1 x 10 \( 6 \) , respectively percent oligozoospermic men demonstrated decreased \( less 50 \) , comparable \( 50 150 \) , increased \( greater 150 \) total motile sperm count second ejaculate comparison first ejaculate 69 , 31 , 0 versus 39 , 28 , 33 , respectively consequently , pooling two sequential ejaculates significantly increased median total number motile sperm males 144 oligozoospermic males 329 , \( 10 2 x 10 \( 6 suggest pooling two sequential ejaculates oligozoospermic males simple cost effective method increase significantly total number motile sperm intrauterine insemination , vitro fertilization , gamete intrafallopian transfer , semen
studies requirements automated semen analysis \( resources , , new york , ny \) system computer assisted sperm analysis evaluated appropriate settings fifty eight human spermatozoa exhibiting complex modes chosen analysis room temperature accumulated measures curvilinear velocity , linearity , mean maximum amplitude lateral head displacement , beat cross frequency determined range 2 37 stable measures \( within 95 confidence interval 37 frames \) observed 4 frames curvilinear velocity 20 frames linearity corresponding figure mean amplitude lateral head displacement beat cross frequency 8 frames conclude frame requirements concerning measures curvilinear velocity linearity mean amplitude lateral head displacement beat cross frequency 20 8 , respectively thus , 20 consecutive frames analyze
intrarenal de novo production angiotensin subjects renal artery stenosis estimate renal extraction de novo production angiotensin assess contribution blood borne renin renal angiotensin production , aortic renal venous plasma levels renin intact 125i angiotensin endogenous angiotensin continuous systemic intravenous infusion 125i angiotensin measured subjects unilateral renal artery stenosis \( n 8 \) treated captopril \( 50 mg b \) results demonstrated 80 angiotensin delivered renal artery extracted affected unaffected kidney sides major part angiotensin renal vein derived intrarenal de novo production production plasma angiotensin excess extraction \( p less 0 01 \) affected side , whereas extraction excess production \( p less 0 01 \) contralateral side plasma level de novo produced angiotensin renal vein seven times higher affected side contralateral side difference far big explained difference transit time blood two kidneys , augmented production angiotensin circulating blood passing affected kidney due higher level venous plasma renin activity kidney , combination
anti 5 alpha reductase autoantibodies serum patients prostatic cancer human sera tested ability inhibit 5 alpha reductase binding potent inhibitor enzyme thirty one 227 serum samples patients diagnosed suspected prostatic cancer significant inhibitory activity , whereas 128 serum samples patients inactive majority inhibitory activity igg fraction purified chromatography protein sepharose affinity column anti human igg column igg fractions non inhibitory sera inactive inhibitory igg also inhibited enzymatic activity microsomal 5 alpha reductase liver , ventral prostate gland rat , liver , prostate , facial skin human inhibitory igg effect reductase 17 beta dehydrogenase results suggest 5 alpha reductase autoantibodies present blood prostatic cancer patients
treatment testicular cancer new improved model testicular cancer become model curable neoplasm prior advent cisplatin combination chemotherapy , standard chemotherapy consisted dactinomycin , alone combination methotrexate disseminated germ cell tumors older regimens , 50 objective response rate 10 20 complete remission rate however , cure rate 5 10 1974 , began initial cisplatin plus vinblastine plus bleomycin \( pvb \) chemotherapy thirty three 47 patients disseminated germ cell tumors treated 1974 1976 achieved complete remission \( cr \) , additional five \( 11 \) rendered disease free post pvb resection teratoma carcinoma twenty seven \( 57 \) patients continuously disease free minimal follow 13 years thus , cisplatin based chemotherapy produced one log increase cure rate compared dactinomycin subsequent phase iii study performed 1976 1978 demonstrated vinblastine dosage could reduced 25 0 4 mg kg 0 3 mg kg reduction toxicity without decrement therapeutic efficacy third generation pvb study 1978 1981 documented optimal cure rates achieved 12 weeks induction therapy pvb long term maintenance therapy vinblastine unnecessary 1978 , initiated salvage therapy cisplatin plus etoposide \( vp 16 \) patients cured pvb , 25 patients subsequently cured regimen represented first time adult solid tumor cured second line regimen 1983 , began studies third line therapy cisplatin plus ifosfamide combination chemotherapy , even refractory setting , approximately 20 patients curable 1981 1984 , compared cisplatin plus vp 16 plus bleomycin \( \) pvb first line chemotherapy significant reduction neuromuscular toxicity favoring vp 16 arm , furthermore , 78 patients continuously disease free compared 66 pvb approximately 75 patients disseminated germ cell tumors cured , additional 10 curable salvage chemotherapy represents highest cure rate adult malignancy
comparative study renal scintigraphy clearance technetium 99m mag3 iodine 123 patients renal disorders aim study compare kit prepared technetium 99m \( 99mtc mag3 \) routine radiopharmaceutical , iodine 123 routine radiopharmaceutical , iodine 123 \( 123i oih \) renal dynamic scintigraphy seventeen patients different disorders hypertension first studied oih mag3 2 8 days later renal mag3 gamma camera images almost identical oih except higher \( p less 0 01 \) liver background ratios 20 min postinjection , irrespective kidney function urinary visible longer clearly mag3 studies mag3 oih showed identical relative kidney uptake \( r 0 99 \) , elimination mag3 kidneys slower \( p less 0 01 \) plasma clearance mag3 lower oih , correlated \( r 0 92 \) significantly plasma distribution volume content blood cells lower \( p less 0 01 \) , binding mag3 plasma proteins higher , 90 , compared 74 oih , p less 0 01 urinary excretion expressed percent given dose 60 min injection two substances thus , significant differences renal handling , plasma distribution , cell penetration mag3 123i oih mag3 , however , seems particular radionuclide dynamic renal scintigraphy , especially patients require acute investigations low renal function
diagnostic use angiotensin converting enzyme \( ace \) inhibited renal scintigraphy identification selective renal artery stenosis presence multiple renal arteries case report patients renovascular hypertension , unknown whether angiotensin converting enzyme \( ace \) inhibited renal scan identify stenosis segmental branch single renal artery accessory artery multiple renal arteries present since multiple renal arteries may present approximately 25 individuals , important establish whether ace inhibited renal scan useful population report case stenosis involving renal artery patient multiple renal arteries , successfully identified ace inhibited renal scintigraphy
stress incontinence low urethral closure pressure correlation preoperative urethral hypermobility successful sling procedures forty eight women genuine stress incontinence low urethral closure pressure treated sling procedure using polytetrafluoroethylene patients underwent preoperative clinical evaluation urodynamic testing clinical examination included q tip test determine presence absence urethral hypermobility urethral hypermobility defined maximal angle change greater equal 30 degrees horizontal , measured straining coughing position thirty four patients underwent repeat urodynamic testing three months postoperatively determine objective surgical success ninety three percent patients \( 27 29 \) positive preoperative q tip test cured patients negative preoperative q tip test , 20 \( 1 5 \) cured preoperative urethral hypermobility good prognostic indicator operative success sling procedure used treat genuine stress incontinence low urethral closure pressure
patient acceptance satisfaction external negative pressure device impotence patient acceptance satisfaction external negative pressure device treatment impotence retrospectively analyzed among 100 men satisfaction rate 68 reasons discontinuing use device included premature loss penile rigidity , pain discomfort either application suction intercourse negative pressure therapy effective treatment impotence various etiologies among treatment options offered patient
's urethral new instrument posterior urethral valves difficult newborns , especially small gestation date premature newborns small caliber urethra difficulty prompted described outer diameter 3 mm easily introduced without stretching urethra instrument used successfully 8 patients date patient age ranged 3 days 3 1 2 years varying degrees hydronephrosis patients good urinary regression hydronephrosis
urethral plug new treatment modality genuine urinary stress incontinence women new modality , urethral plug , used treat 22 women genuine urinary stress incontinence plug made \( g \) , consists plate , soft 1 2 spheres along spheres located according result urethral pressure profile proximal sphere placed bladder neck distal sphere placed maximum urethral pressure point voiding plug removed afterwards new plug inserted plug 2 spheres tested week 1 \( period 1 \) plug distal sphere tested week 2 \( period 2 \) total 22 patients completed period 1 eight patients complete period 2 , mostly due either unchanged incontinence period 1 repeated loss plug 1 sphere periods 1 2 , 73 79 patients subjectively objectively continent improved total 14 patients completed periods eight patients preferred plug 2 spheres , 1 preferred plug 5 preference side effects preliminary study shows urethral plug seems promising alternative treatment female genuine urinary stress incontinence
long term urinary continence renal function neonates posterior urethral valves posterior urethral valves known associated considerable morbidity mortality especially neonate recently role bladder dysfunction pathophysiology renal function impairment urinary incontinence valve ablation questioned 1976 1986 treated 50 male newborns posterior urethral valves institution initial treatment cases consisted bladder drainage urethral catheter , correction existing fluid electrolyte abnormalities subsequent treatment degree upper tract abnormalities included valve ablation alone 24 patients , vesicostomy later valve ablation 8 , valve ablation later upper tract reconstruction 14 cutaneous 4 followup ranges 2 12 years \( mean 6 8 \) long term renal functional impairment related serum creatinine age 1 year serum creatinine 1 0 mg patients \( 31 \) normal values long term followup greater 1 0 mg \( 19 \) 7 patients normal values followup urinary continence assessed 42 patients normal 34 \( 81 \) etiology incontinence remaining 8 patients bladder dysfunction 6 sphincter incompetence 2 patients urinary incontinence also high incidence upper tract abnormalities \( 6 8 , 75 \) compared continent valve patients \( 10 34 , 29 \)
management posterior urethral valves initial vesicostomy delayed valve ablation managed 32 neonates infants temporary vesicostomy delayed valve ablation criterion successful management estimated creatinine clearance renal failure death occurred 30 patients 7 required transplantation apparent difference patients managed initially vesicostomy series managed initially valve ablation preventing complications posterior urethral valves
primary testicular neoplasm case report review literature report case presenting mass testis mimicking neoplasm diagnosis confirmed radical orchiectomy unusual presentation systemic disease discuss physical findings , ultrasonographic features pathological findings , well review literature previous similar cases
burkitt 's lymphoma testicle report 2 cases occurring elderly patients burkitt 's lymphoma rare patients older 50 years almost never presents testicular tumor report 2 cases primary burkitt 's lymphoma testicle men 68 79 years old 1 man tumor rapid lasting response combination chemotherapy cases interest unusual presentation disease possibility control burkitt 's lymphoma older patients without toxicity management testicular lymphoma requires radical orchiectomy prophylactic irradiation contralateral testis chemotherapy indicated advanced disease may prevent relapses patients early disease role central nervous system prophylaxis controversial
mechanical properties urethra healthy stress incontinent females dynamic measurements resting urethra relationship pressure cross sectional area resting urethra inflation deflation examined 30 healthy females 30 patients genuine stress incontinence \( gsi \) measurements performed bladder neck , high pressure zone distally urethra mechanical properties urethra found vary significantly function time induction cross sectional area \( stress episode \) groups women pattern response urethra showed significant differences normals gsi particularly dynamic conditions results indicate mechanical laxity urethra bladder neck especially dynamic events \( stress episodes \) pathophysiological importance gsi
determination norepinephrine levels adult human prostate tissue levels norepinephrine measured prostate tissue 24 men ranging age 41 83 years prostatic tissue obtained men subtle palpable prostate nodules undergoing needle biopsy none patients shown histologic evidence adenocarcinoma severity symptoms evaluated prospectively using standardized micturition symptom score questionnaire norepinephrine levels quantified using sensitive assay \( \) overall , contained relatively high levels norepinephrine \( 124 ng gm \) inverse correlations observed tissue norepinephrine levels severity symptoms \( r 0 58 p 0 003 \) age \( r 0 53 p 008 \) prostate size \( r 0 48 p 02 \) norepinephrine levels also measured tissue specimens obtained men undergoing enucleation prostatectomy transurethral resection prostate \( \) level norepinephrine prostatectomy specimens \( 115 ng gm \) 14 level prostate biopsy specimens relatively low level norepinephrine specimens obtained patients symptoms necessitating prostatectomy provides evidence norepinephrine levels inversely related degree symptomatic bladder outlet obstruction
time course alterations bladder function following acetone induced cystitis although chemical cystitis known clinically cause decreased bladder function , experimental studies progression , recovery chemical cystitis mature male rabbits underwent intravesical instillation 50 acetone solution urethral catheter micturition profiles showed marked decrease mean maximal micturition volume increase number early one day treatment micturition profile gradually normalized four eight weeks instillation vivo cystometry showed small bladder capacity low compliance first week following instillation , gradually recovered control levels four weeks functional studies using vitro whole bladder model showed significant decrease ability bladder generate pressure empty three days instillation parameters recovered partially two weeks , completely four weeks chemical cystitis induced intravesical acetone instillation resulted severe decrease bladder function , e contracted bladder low compliance poor ability generate pressure empty however , changes reversible within two month period study
effects intracavernosal trazodone hydrochloride animal human studies trazodone hydrochloride oral antidepressant agent associated improvement erections men development prolonged erections priapism potent men vivo study animal human subjects performed gain experience effect intracavernosal trazodone anesthetized new zealand white rabbit , intracavernosal trazodone major metabolite \( cpp \) produced full penile erection 76 84 animals studied respectively doses ranging one 15 mg hand , intracavernosal administration five mg papaverine resulted prolonged erection 90 animals studied 13 selected volunteer patients , intracavernosal trazodone caused full penile erection body pressures 28 2 5 8 mm hg intracavernosal papaverine papaverine phentolamine subjects resulted significantly higher body pressures 58 18 mm hg \( p less 05 \) intracavernosal administration alpha adrenoceptor agonists normal saline resulted complete trazodone cpp induced prolonged erection animal studies intracavernosal trazodone results erectile activity appears part based local alpha blocking activity like intracavernosal alpha blocking agents effective initiating penile erections intracavernosal agents directly induce smooth muscle relaxation
hyperfiltration induced renal injury normal man current knowledge fails support notion adaptive hyperfiltration remnant kidney donor nephrectomy deleterious rather , hyperfiltration appropriately loss functional renal mass accordingly , kidney donors expected maintain stable level renal function without proteinuria hypertension essential proper selection donors nephrectomy exclusion high risk potential donors , bearing mind fact apparently healthy , asymptomatic relatives end stage renal disease patients prone disease processes general population higher risk underlying renal disease
triamterene renewed attention warranted although triamterene known contribute urinary calculus formation , presumed rare phenomenon review stone analyses performed last decade single laboratory reveals increasing incidence triamterene stones awareness potential triamterene containing medications emphasized
prospective comparison plain abdominal radiography conventional digital renal tomography assessing renal extracorporeal shock wave lithotripsy patients effectiveness renal extracorporeal shock wave lithotripsy used plain abdominal radiography assess residual calculi treatment compared radiologist sensitivity specificity detection calculi plain abdominal radiographs versus conventional film screen digital renal tomograms extracorporeal shock wave lithotripsy patients patients 50 imaged within 24 hours lithotripsy six radiologists evaluated resultant 300 studies presence location calculi mean sensitivity digital tomograms 83 pre lithotripsy post lithotripsy studies , significantly higher plain abdominal radiography conventional tomography lithotripsy however , significantly false positive stone diagnoses associated digital interpretation signal detection analysis verified superiority digital tomography post extracorporeal shock wave lithotripsy imaging calculus detection conventional digital tomography superior detection plain abdominal radiography however , perform delayed imaging , possible impact digital tomography might management extracorporeal shock wave lithotripsy patients
extracorporeal shock wave lithotripsy patients bleeding five patients known bleeding treated extracorporeal shock wave lithotripsy specific therapy administered extracorporeal shock wave lithotripsy reverse bleeding disorder treatment patient monitored serial hemoglobin determinations renal ultrasonography course lithotripsy uneventful patients conclude extracorporeal shock wave lithotripsy viable option patients significant bleeding provided specific therapy reverse condition available used treatment
dose titration study evaluating terazosin , selective , day alpha 1 blocker treatment symptomatic benign prostatic hyperplasia efficacy safety terazosin , selective long acting alpha 1 adrenergic blocker , evaluated 45 normotensive patients symptomatic benign prostatic hyperplasia ranging 50 76 years old patients underwent complete urodynamic evaluation transrectal prostatic ultrasonography enrollment study dose terazosin titrated 5 mg per day 1 month interval , provided adverse drug reactions observed patients 39 \( 87 \) completed dose titration study parameters used assess effectiveness terazosin included peak mean urinary flow rates , micturition symptom scores global assessment patient symptomatic improvement , mean systolic diastolic blood pressures changed less 1 peak mean urinary flow rates increased 42 48 , respectively obstructive symptom scores improved 63 35 , respectively , 30 45 participants \( 67 \) indicated voiding symptoms markedly improved terazosin five patients complete dose titration study due development adverse drug reactions , including erectile dysfunction \( 7 \) , \( 7 \) , light \( 4 \) , palpitations \( 4 \) , nasal congestion \( 2 \) asymptomatic hypotension \( 2 \) 25 patients \( 55 \) followed terazosin 4 10 months \( mean 6 5 months \) improvements urinary flow rates symptom scores maintained interval although preliminary experience terazosin encouraging , ultimate role terazosin long term treatment benign prostatic hyperplasia needs evaluation
flutamide hormone resistant prostatic cancer flutamide \( 250 mg orally 3 times daily \) yielded subjective response 5 25 fully evaluable patients hormone resistant prostatic cancer four additional patients early progression 40 greater decrease pre treatment prostate specific antigen level observed 7 24 patients finding correlated improved survival toxicity mainly gastrointestinal resulted permanent discontinuation flutamide 5 patients flutamide similar antiandrogens may role management hormone resistant prostatic cancer relief subjective symptoms important treatment goal together improvement survival however , drug used routinely management hormone resistant prostatic cancer phase 3 studies must confirm effectiveness , especially comparison less expensive drugs
kinetics cellular proliferation rat urinary bladder treated n butyl n \( 4 \) cellular proliferation bladder epithelium determined sequentially rats treated n butyl n \( 4 \) \( \) incorporation bromodeoxyuridine \( brdurd \) dna synthesis phase determined vitro labeling technique percentage labeled cells expressed labeling index \( li \) average li values normal subjects cancer bearing subjects 5 1 \( \) 24 2 \( \) respectively transition bladder epithelium simple hyperplasia cancer , li values bladder epithelium increased cases papillary nodular \( pn \) hyperplasia divided two types according localization brdurd labeled cells li pn hyperplasia 12 4 \( \) difference cancer significant another experiment , effect partial cystectomy bladder tumors examined group partial cystectomy showed increases grade stage cancer , li cancer group without partial cystectomy results indicate partial cystectomy may play role bladder tumors current study may practical value conventional one investigating progression human bladder cancer
use prostaglandin f2 alpha prophylaxis cyclophosphamide induced cystitis rats well established cystitis significant cause morbidity cyclophosphamide administration clinical populations induced hemorrhagic cystitis rats using cyclophosphamide compared controls pretreated prostaglandin f2 alpha rats evaluated differences bladder weights , gross edema , gross bleeding , histologic changes weights bladders treated cyclophosphamide 94 greater controls weights bladders pretreated prostaglandin f2 alpha cyclophosphamide 19 greater controls significant differences found cyclophosphamide controls prostaglandin f2 alpha pretreated groups gross weight \( p less 0005 \) , gross edema \( p less 0005 \) , histology \( 0005 less p less 005 \) conclude prostaglandin f2 alpha may helpful preventing cyclophosphamide induced cystitis
cell injury associated calcium oxalate renal tubular cell damage , resulting , induced administration subcutaneous gentamicin male sprague dawley rats one group rats received gentamicin , second group given gentamicin plus ethylene glycol drinking water concentration increased urine oxalate alone cause calcium oxalate occurred early combined treatment groups persisted duration experiment present animals receiving gentamicin ethylene glycol results suggest cellular fragments serve heterogeneous foci nucleation calcium oxalate crystals
interpretation variation dialysate volume dwell time capd intraperitoneal fluid volume \( ipv \) changes versus time followed patients undergoing continuous ambulatory peritoneal dialysis \( capd \) using simple volume recovery method patient containing 1 36 3 86 percent glucose osmotic agent investigated patients' ipv versus time data fitted function determined four arbitrary coefficients , initial ultrafiltration \( uf \) rate immediately following intraperitoneal \( p \) fluid instillation final peritoneal blood fluid absorption rate could assessed peritoneal osmotic conductance glucose , , peritoneal ultrafiltration coefficient \( kf \) , times peritoneal osmotic reflection coefficient glucose \( sigma g \) , kf sigma g , determined using two related approaches kf sigma g major determinant volume exchange , calculated 3 54 0 85 \( se \) 3 81 0 52 microliters min mm hg , respectively , depending assumption employed kf sigma g analysed according three pore model membrane permeability determine possible range kf sigma g compatible peritoneal small solute sieving coefficient \( phi \) ranging 0 3 0 61 according calculations kf sigma g ranged 0 0 \( ml min mm hg , respectively \) maximal peritoneal lymph flow \( l \) realistic according analysis , compatible measured total peritoneal blood fluid absorption rate 1 25 0 14 ml min , 0 75 ml min , values , however , falling 0 3 0 5 ml min
peritoneal transport capd patients permanent loss ultrafiltration capacity 10 year period , 14 227 patients \( 6 2 \) undergoing continuous ambulatory peritoneal dialysis \( capd \) developed permanent loss ultrafiltration capacity \( ufc \) risk ufc loss increased 2 6 one year 30 9 six years treatment six hour , single dwell study glucose 3 86 dialysis fluid carried nine ufc loss patients 18 capd patients normal ufc intraperitoneal dialysate volumes calculated using 131i albumin \( \) volume marker correction applied elimination peritoneal cavity elimination coefficient \( \) , serve estimation upper limit lymphatic flow , also calculated diffusive mass transport coefficients \( \) investigated solutes \( glucose , creatinine , urea , potassium , total protein , albumin beta 2 microglobulin \) calculated period dialysate two patterns ufc loss observed \( \) seven patients high values small solutes resulting rapid uptake glucose , whereas values proteins normal \( b \) two patients normal values threefold increase fluid reabsorption rate conclude loss osmotic driving force \( due increased diffusive mass transport small solutes \) increased fluid reabsorption \( possibly due increased lymphatic reabsorption \) two major causes permanent loss ufc capd patients
angiotensin ii receptor regulation anti glomerular basement membrane nephritis expression glomerular receptor angiotensin ii \( ang ii r \) examined longitudinally following induction anti glomerular basement membrane \( gbm \) nephritis rat specific aim project determine whether immunologically induced glomerular injury led significant abnormalities relationship glomerular ang ii r circulating ligand , ang ii scatchard analysis used measure ang ii r purified glomeruli selected time intervals two months following single dose sheep anti rat gbm antibody corresponding values plasma ang ii determined receptor density fell approximately 50 16 hours following injection antibody \( control 96 4 9 3 x 10 \( 6 \) 52 6 5 6 x 10 \( 6 \) receptors glomerulus p less 0 001 \) corresponding threefold increase plasma ang ii \( control 21 0 2 5 66 6 20 6 pg ml p less 0 01 \) however , reduction receptor binding could explained rise plasma ang ii concentration , effective blockade ras enalapril alter receptor expression \( 56 1 4 6 x 10 \( 6 \) receptors glomerulus \) subsequently , rise receptor density corresponding fall plasma ang ii observed three days antibody administration , receptor concentration increased significantly control values \( 150 5 11 9 x 10 \( 6 plasma ang ii undetectable \( , less 5 pg ml \) ang ii r remained elevated next two weeks returned normal four eight weeks administration antibody
toxicity comparison neoadjuvant versus adjuvant methotrexate , vinblastine , doxorubicin , cisplatin \( vac \) radical cystectomy patients reduction toxicity vac chemotherapy postulated patients receive drugs prior radical cystectomy muscle invasive bladder carcinoma review toxicity patient dropout rates group 9 patients received neoadjuvant vac little different 9 patients treated vac radical cystectomy similarity suggests preoperative vac favored basis reduced patient morbidity
bidirectional populations drosophila cytoplasmic \( ci \) describes phenomenon whereby eggs sperm infected fail unidirectional ci populations well documented phenomenon bidirectional ci , however , described mosquito populations , recently closely related species parasitic , interest unusual form reproductive isolation potential means population suppression report first known example bidirectional ci populations drosophila , show defects early first cleavage division associated ci observation suggests cellular basis ci involves disruption processes formation ci arises defects structure function sperm fertilization
urinary incontinence symptoms urinary incontinence distressing life also indicative serious underlying disorders many methods symptom management available matching affected person effective appropriate treatment method significant challenge nursing need develop test conceptual model symptom management includes primary prevention
tissue , developmental , tumor specific expression divergent transcripts wilms tumor wilms tumor locus chromosome mapped region defined overlapping , tumor specific deletions complementary dna clones representing transcripts 2 5 \( wit 1 \) 3 5 kb \( wit 2 \) mapping region isolated kidney complementary dna library expression wit 1 wit 2 restricted kidney spleen protection revealed divergent transcription wit 1 wit 2 , originating dna region less 600 bp transcripts present high concentrations fetal kidney much reduced amounts 5 year old adult kidneys eleven 12 wilms tumors classified histopathologically heterogeneous exhibited absent reduced expression wit 2 , whereas 4 14 histopathologically homogeneous tumors showed reduced expression data demonstrate molecular basis pathogenetic heterogeneity wilms tumorigenesis
whole bladder photodynamic therapy critical review present day technology rationale development intravesical laser catheter monitoring system present day whole bladder photodynamic therapy \( \) time consuming ultrasonic manipulations necessary position light within bladder important , inherently often ineffective since neither uniform accurate light achieved techniques employed bladder wall intravesical laser catheter \( \) eliminates need cystoscopy ultrasonography passage treatment fiber catheter 's central lumen automatically positions light diffusing tip within center bladder use delivery system also accurate bladder wall since inflation catheter 's balloon asymmetric bladder sphere known diameter light sensor incorporated balloon wall provides method monitor light measure total light dose provided parameters bladder volume , laser energy output , desired light dose , computerized control system treatment time automatically period compensate variations laser light production , energy losses transmission , variations light intensity resulting sphere effect bladder wall delivery system also increases safety since monitor automatically treatment situation , respect light , develops
stress incontinence new endoscopic approach describe experience using new endoscopic technique bladder neck urethra 16 patients stress incontinence procedure started dissecting space , first sound foley catheter passing absorbable suture abdominal fascia bladder neck using needle introduced bladder neck urethra dissection space helped form postoperative fixed bladder neck urethra firmly technique simple , require vaginal surgery , incidence complications minimal
prognostic implications disappearance rate biologic markers following radical prostatectomy six patients localized prostatic carcinoma undergoing radical prostatectomy studied serial sample collection time surgical removal prostate one week postoperative period three markers studied \( pap , psa , \) , half life specific prostatic markers calculated half life pap found 7 25 hours se 0 7 hours psa half life could obtained 4 6 patients found 45 5 hours se 4 9 hours 2 patients psa fall regular fashion half life could obtained patients metastatic disease developed within six months surgery demonstrated progressive increase following surgery , likely due associated inflammatory reaction studies confirm previous observations psa sensitive marker pap , presence elevated psa radical prostatectomy presence residual disease
use distal proximal hypospadias repairs conjunction short island pedicle flap experience 8 boys proximal hypospadias severe dorsal presented use distal tube incorporated addition island pedicle flap achieve correct location one boy perineal hypospadias required proximal distal tube island flap interposition follow nine months 3 5 years demonstrated excellent cosmetic functional results recurrent urethral stenosis fistula noted developed proximal tube island flap anastomosis boy perineal hypospadias advantages aforementioned procedure include decreasing risk basis island pedicle flap , use vascularized flaps , completing procedure one stage satisfactory result
magnetic resonance imaging cystic , partially differentiated magnetic resonance imaging \( mri \) appearance cystic , partially differentiated described , together pathologic correlation difficulty reaching correct preoperative diagnosis even multimodal imaging techniques emphasized mri adjunct ultrasonography may superior computerized tomography \( ct \) scan evaluation child cystic renal mass
urodynamic tests female geriatric urinary incontinence urodynamic tests currently use evaluation female urinary incontinence applied community based sample determine specificity study random sample elderly , 258 self reported continent 198 self reported incontinent women sixty years older , participated household survey , underwent clinic evaluation \( history , physical examination , urinalysis \) 67 continent 100 incontinent female respondents underwent urodynamic testing , cystometry , supine static urethral pressure \( \) findings differ significantly continent incontinent subjects \( whether based self report clinician 's diagnosis urinary continence status \) standing static dynamic lateral showed significant differences self reported continent incontinent respondents provocative stress test significantly distinguishes continence incontinence , stress incontinence types sensitivity provocative stress test 39 5 percent , whereas specificity 98 5 percent urodynamic testing including study , static , lateral used screening test rather selectively confirmatory test , determine therapeutic approach , assess outcome therapy
influence high energy shock waves cisplatin antitumor effect murine bladder cancer potential application high energy shock waves \( hesw \) control experimental bladder cancer investigated subcutaneous 3 murine bladder cancer \( 2 \) c3h mice exposed hesw alone \( 250 1 , 500 shocks \) combination cisplatin \( 5 10 mg kg , p \) although hesw alone showed influence tumor growth , hesw cisplatin combination therapy suppressed tumor growth cisplatin alone subsequent studies revealed air fluid interface relative tumor location played pivotal role effect hesw hesw treatment able enhance cisplatin cytotoxicity tumors placed adjacent air fluid interface
treating impotence , sex therapy complementary mental health professionals neither principles sex therapy represent sensitive way approach patients almost clinical problem comfortable recommended tests treatments sex therapy may helpful adjunct treating organic well primarily emotional erectile dysfunction believe information help build bridge mental health professionals
applications prostate ultrasonography transrectal ultrasonography relatively new imaging modality may useful evaluation management patients prostate cancer although cancer may characteristic appearance , cannot always reliably differentiated benign conditions technique clinical applications staging , monitoring tumor response therapy , biopsy , unclear whether useful information obtained evaluation patients palpable disease role transrectal ultrasonography patients nonpalpable disease screening tool yet determined diagnostic tests conjunction ultrasound may future prove useful carefully performed prospective investigations state art equipment still needed define role diagnostic modality
extracorporeal removal anti hla antibodies transplant candidates report results clinical trial 14 transplant candidates treated extracorporeal immunoadsorption system using protein selectively removes immunoglobulin plasma also assessed dynamics anti hla antibody model igg removal , well clinical safety procedure end treatment course , plasma igg levels reduced 90 8 control values \( p less 0 01 \) contrast , albumin levels reduced 15 \( p less 0 05 \) specific cytotoxic anti hla antibody titers reduced approximately 18 fold panel reactivity measured proportion 40 member cell donor panel killed patients' serum presence complement nine 14 patients , significant reduction parameter \( range , 23 87 \) 4 week follow period , anti hla antibody titers returned baseline levels remarkable changes observed blood chemistries , adverse reactions seen patients treated conclude selective extracorporeal immunoadsorption safe effective way removing igg type antibodies , potential application reduction hla antibodies transplant candidates
adult minimal change glomerulopathy acute renal failure acute renal failure occurs adult patients minimal change glomerulopathy look clinical pathologic factors increase risk developing acute renal failure , 21 adults minimal change glomerulopathy serum creatinine greater 177 mumol l \( mean , 486 mumol l range , 194 1 , 344 mumol l \) \( greater 2 0 mg dl mean , 5 5 mg dl range , 2 2 15 2 mg dl \) compared 50 adults minimal change glomerulopathy serum creatinine less 133 mumol l \( mean , 88 mumol l range , 53 124 mumol l \) \( less 1 5 mg dl mean , 1 0 mg dl range , 0 6 1 4 mg dl \) minimal change glomerulopathy patients acute renal failure older \( 59 5 v 40 3 years , p less 0 001 \) , higher systolic blood pressure \( 158 v 138 mm hg , p 0 001 \) , proteinuria \( 13 5 v 7 9 g 24 h , p 0 01 \) , arteriosclerosis renal biopsy specimen \( 1 7 v 0 7 scale 0 4 , p 0 005 \) tubular epithelial identical observed ischemic acute renal failure \( acute tubular necrosis \) observed 71 patients serum creatinine greater 177 mumol l \( greater 2 0 mg dl \) 0 less 133 mumol l \( less 1 5 mg dl \) 18 patients renal failure follow data available recovery function \( mean creatinine , 539 301 mumol l 6 1 3 4 mg dl time biopsy 106 27 mumol l 1 2 0 3 mg dl last follow \) , sometimes weeks dialysis support
prolonged neuromuscular blockade vecuronium neonate renal failure 11 day old neonate renal failure caused dysplastic kidneys thiopentone , vecuronium , nitrous oxide oxygen , insertion long term peritoneal dialysis catheter complete neuromuscular block 210 duration ensued initial dose vecuronium \( 97 micrograms kg \) partial block persisted 30 minutes prolonged neuromuscular block case may proportionately greater dependence renal clearance vecuronium neonates
angiotensin thromboxane enhanced renal adrenergic nerve sensitivity acute renal failure roles intrarenal angiotensin \( \) thromboxane \( tx \) vascular hypersensitivity renal nerve stimulation \( rns \) paradoxical vasoconstriction renal perfusion pressure \( \) reduction autoregulatory range 1 wk norepinephrine \( ne \) induced acute renal failure \( arf \) rats investigated renal blood flow \( rbf \) responses determined intrarenal infusion aii txa2 antagonist alone partially corrected slopes rbf rns reduction ne arf rats \( p less 0 02 \) normalized rbf response rns combined eliminated vasoconstriction reduction , similar effect renal denervation , appropriate vasodilatation restored renal vein norepinephrine efflux rns disproportionately increased ne arf \( p less 0 001 \) suppressed infusion \( p less 0 005 \) concluded enhanced sensitivity rns paradoxical vasoconstriction reduction 1 wk ne arf kidneys result intrarenal tx aii acceleration neurotransmitter release adrenergic nerve activity
vivo human testicular function assessed p 31 mr spectroscopy clinical feasibility assessing testicular metabolic integrity phosphorus 31 magnetic resonance \( mr \) spectroscopy investigated six healthy volunteers 23 patients azoospermia mr spectroscopic findings compared sperm count motility patients findings testicular biopsy 23 patients significant differences \( p less 05 \) found p 31 spectra normal following peak area ratios phosphomonoester \( pm \) beta adenosine triphosphate , pm , inorganic phosphate pm patients azoospermia , significant differences peak area ratios patients primary testicular failure chronic tubular obstruction although differences two groups statistically significant , large overlap numbers , therefore study larger patient population required p 31 mr spectroscopy sensitive tool assessment testicular metabolic integrity differentiation normal markedly decreased spermatogenesis
intrauterine spermatic cord torsion newborn sonographic pathologic correlation five newborn patients spermatic cord torsion , sonography demonstrated enlarged globular testis , , skin thickening four patients testicular parenchyma heterogeneous peripheral hypoechoic areas seen two four patients two central hypoechoic region peripheral rim testis fifth patient diffusely hyperechoic duplex doppler sonography performed two patients failed demonstrate signal spermatic cord either abnormal contralateral scintigraphic findings positive testicular torsion two patients equivocal three patients surgery performed 2 12 days sonography established diagnosis spermatic cord torsion pathologic examination demonstrated hemorrhagic infarction entire testis well scattered calcifications authors conclude solid globular testicular mass seen neonatal period suggestive intrauterine spermatic cord torsion
sodium loading treatment amphotericin b induced nephrotoxicity increased frequency duration antifungal treatment amphotericin b immunocompromised patients stimulated great deal research mechanisms effects treatment modalities designed attenuate effects review amphotericin b induced nephrotoxicity , underlying pathophysiologic mechanisms , role salt loading means minimizing renal impairment described animal human studies regarding efficacy sodium loading presented well case report describing use salt supplementation prolonged course therapy
effect calcium entry blocker nitrendipine renal function renal vascular occlusion ability ca entry blocker nitrendipine improve postischemic renal function studied nine groups \( n 70 \) rats anesthesia , nitrendipine administered 15 min femoral vein dose administered depended group group 1 \( n 7 \) , control , received 0 9 nacl , group 2 \( n 12 \) 0 25 mg kg group 3 \( n 10 \) 0 50 mg kg group 4 \( n 8 \) 0 75 mg kg group 5 \( n 6 \) 1 00 mg kg group 6 \( n 7 \) 1 50 mg kg group 7 \( n 7 \) 2 00 mg kg group 8 \( n 6 \) 2 50 mg kg group 9 \( n 7 \) 3 00 mg kg administration nitrendipine , kidneys rendered ischemic one hour cross clamping renal vessels comparison 24 h creatinine clearances 72 h reversal ischemia demonstrated nitrendipine capable providing degree protection renal ischemia protective effect dose dependent \( p less 05 \)
placebo response couples attending tertiary referral centre objective study determine whether placebo response clinic attendance couples prolonged \( greater 4 years \) subfertility 4 18 years subfertility observed treatment independent cumulative conception rate 22 , independent length subfertility twenty seven women conceived 1 4 years' subfertility , 30 conceived greater 4 years' subfertility latter group significantly greater women 1 4 years' subfertility , similar normal subjects stopped contraception study demonstrates subgroup apparently normal women greater 4 years' subfertility responded positively clinic attendance independent investigation \( \) therapy
fertility prognosis infertile men results follow study semen analysis infertile men two different populations evaluated cox regression model using cox proportional hazard regression model one material \( group , 1950 1951 \) identified four variables semen analysis significant prognostic information fertility four variables combined model establishing probability individual male achieve pregnancy function time model tested first another material \( group ii , 1977 1985 \) fit test indicates excellent agreement expectations model observed number pregnancies group ii second , two groups pooled \( 1 , \) three variables give significant prognostic information time pregnancy \( 1 \) man 's age semen analysis \( years \) \( 2 \) percentage morphologically normal spermatozoa \( ln \) \( 3 \) degree motility \( good poor \) three important variables enter new better prognostic model
hyaluronic acid \( sperm select \) improves retention sperm motility velocity oligospermic specimens effects sperm select \( ab , , sweden \) , hyaluronic acid medium , motility membrane integrity properties sperm studied 15 specimens overnight incubation , motility parameters control versus sperm select group follows \( mean sem \) motility , 18 8 2 8 versus 27 4 2 9 velocity , 21 5 2 4 versus 27 2 2 2 microns linearity , 3 8 0 3 versus 4 4 0 2 lateral head displacement , 1 5 0 2 versus 1 9 0 1 microns tail beat cross frequency , 8 8 1 3 versus 10 8 1 4 hz density motile sperm 10 8 2 3 versus 18 5 2 5 x 10 \( 6 \) sperm ml finally , velocity coefficient , multiple sperm motility linear velocity , 4 6 1 1 versus 8 1 1 4 however , found sperm select related differences testing sperm membrane integrity swelling staining thus , sperm select improves retention sperm motility \( prominently velocity \) apparently due direct action hyaluronic acid sperm metabolism contractility rather preservation sperm membrane integrity 20 oligospermic specimens , sperm select caused similar improvements sperm motility , duration motility could predicted degree enhancement sperm velocity short term sperm select exposure modified sperm select protocol described increases motile sperm yield without centrifugation step
prevalence subfertility review current confusion report two new studies difficulties inherent measuring prevalence subfertility discussed four subtypes subfertility defined , enabling comparisons made widely different approaches previously reported detailed assessment made prevalence subfertility two different samples british women aged 25 44 years , using interviews , postal questionnaires , medical record data collected women general practice hospital patients combined data showed 24 women attempting conceive experience episode subfertility stage reproductive life thirteen percent experience attempting conceive first child , 17 attempting conceive subsequent child three percent women 6 parous women able many children would
urodynamic database three hundred sixty four patients urinary incontinence presenting complaint evaluated laboratory , department obstetrics gynecology , university rochester , rochester , new york , \( 62 \) found genuine stress urinary incontinence \( gsi \) subset incontinent patients characterized symptoms stress incontinence , incidence , occurrence incontinence intercourse influence weight bladder pressure using clusters symptoms accurately distinguish gsi types urinary incontinence four percent gsi patients nulliparous reasonable explanation incontinence anatomic relaxation twenty three percent 154 sexually active gsi patients incontinence intercourse none anatomic urodynamic parameters evaluated distinguished group gsi counterparts lose urine intercourse increasing weight , expressed body mass index , correlated increase vesical pressure supine standing positions
transrectal sonographic studies stress urinary incontinence transrectal ultrasonic sagittal transducer excellent modality image bladder urethra dynamic change female patients , found also helpful diagnosis urinary stress incontinence posterior \( \) angle measured transrectal strain non strain conditions compared results sonographic radiographic chain sonographic superior radiography former may estimate angle accurately differentiate patients without stress urinary incontinence furthermore , also use transrectal sagittal probe intraoperatively adjust suspension force well angle patients underwent vesical neck suspension stress urinary incontinence \( sui \)
continence level following radical prostatectomy relationship urethral anastomosis postoperative continence following radical prostatectomy uncertain objective study determine radiographically functional level continence following radical prostatectomy relative site intraoperative urethral anastomosis 8 patients radical prostatectomy , intraoperative placed site urethral anastomosis postoperative functional level continence determined using standing lateral functional level continence 9 mm \( sd 3 0 \) distal site urethral anastomosis level urethra continence occurs may function intrinsic continence parameters individual patient
overlooked , retained double j stent series 4 patients long overlooked , retained ureteral stents presented illustrate variable , unpredictable , times , hazardous course patients cases cited emphasize need careful documentation , observation , follow patients stents placed
x linked treatment , height gain , nephrocalcinosis clinical data 18 patients x linked analysed retrospectively height data expressed sd scores difference final height patients treated vitamin \( 1 , 25 dihydroxyvitamin \) phosphate least two years \( n 12 \) 16 family members never treated mean final sd score \( 2 07 \) treated patients , however , significantly higher value treatment \( 2 79 \) , indicated average absolute height gain 4 4 5 cm compared expected height values six treated patients developed detectable nephrocalcinosis normal renal function daily phosphate intake excretion patients nephrocalcinosis significantly higher patients normal renal morphology difference doses vitamin two groups average urinary calcium creatinine ratio two groups similar 0 6 mmol mmol limit group nephrocalcinosis , however , higher incidence episodes group without nephrocalcinosis \( 12 130 observations compared six observations , respectively \) benefits risks treatment patients x linked must evaluated high dose phosphate seems important factor development nephrocalcinosis group patients
5 alpha reductase deficiency without hypospadias boy aged 4 hypospadias brother aged 12 typical changes homozygous 5 alpha reductase deficiency three injections chorionic trivial rise plasma normal increase plasma testosterone urine steroid chromatography showed abnormally high 5 beta 5 alpha ratios 5 alpha reductase activity appreciably reduced genital skin fibroblasts results indicate 5 alpha reductase deficiency invariably associated genital
double blind , placebo controlled , cross study treatment idiopathic detrusor instability detrusor instability occurs approximately 10 adult population , producing troublesome symptoms pharmacotherapy currently available usually partially effective cannot adequately evaluated except blind conditions significant component attributable placebo effects results present study revealed advantage resulting treatment , assessed subjectively objectively suggest therapy appear beneficial medical management detrusor instability
serum levels sex hormone binding globulin oestradiol patients testicular cancer serum testosterone \( \) , oestradiol \( e 2 \) sex hormone binding globulin \( shbg \) measured 84 testicular cancer patients treatment 4 6 12 15 months therapy patients divided 3 groups according treatment group 1 cisplatin based chemotherapy \( 27 patients \) group 2 abdominal radiotherapy \( 32 patients \) group 3 antiproliferative treatment \( chemotherapy radiotherapy \) \( 25 patients \) 4 6 months antiproliferative treatment , particularly chemotherapy , reversible significant increase e 2 shbg observed patients without antiproliferative treatment showed significant changes comparable hormone levels 15 normal values associated elevated levels shbg e 2 although aetiology hormonal changes remains unknown , may related clinical symptoms displayed 10 30 patients undergoing treatment testicular cancer
treatment desmopressin severe nocturnal enuresis childhood series 22 patients severe nocturnal enuresis treated desmopressin randomised double blind cross study treatment 20 40 micrograms highly effective compared placebo difference dry nights found 2 dosages desmopressin proved safe effective treatment
effect post pubertal varicocele testicular volume paediatric varicocele well known entity effect adult infertility adequately clarified since measurement testicular volume currently best method estimating male reproductive potential , boys aged 13 18 years examined regard testicular volume incidence varicocele average volumes right left testes 15 0 237 14 0 ml respectively , incidence varicocele 16 7 incidence increased 14 5 21 7 ages increased 14 18 differences volume 2 testes boys varicocele statistically significant compared normal group , significance failed become pronounced slight varicocele group \( grade \) included normal group compared severe varicocele group \( grades ii iii \) may significant differences volumes 2 testes boys varicocele careful measurement strict statistical analyses applied however , boys varicocele group found testicular volumes confidence interval \( mean se \) 1 sd , 2 testicular volumes differed certain age groups group requires follow results study added contradictory findings issue paediatric varicocele terms testicular atrophy , estimation potential fertility indications immediate surgery need prospective controlled trials
role ifosfamide plus cisplatin based chemotherapy salvage therapy patients refractory germ cell tumors prospective study four cycles etoposide ifosfamide cisplatin \( vip \) chemotherapy conducted 42 germ cell tumor \( gct \) patients refractory cisplatin etoposide vinblastine based therapy forty patients evaluable response ten patients \( 25 \) complete response seven chemotherapy alone additional three patients surgical resection viable gct median follow 15 months , four complete responders relapsed , six patients \( 15 \) remain remission hematologic nephrotoxicity moderately severe durable complete responses vip second salvage achieved suggests ifosfamide adds efficacy standard first salvage therapy observed nephrotoxicity considerations design ifosfamide cisplatin based regimens hematopoietic growth factors may useful ameliorating early use ifosfamide based chemotherapy may reduce nephrotoxicity exacerbated prior cisplatin trial vip first salvage relapse complete response platinum based induction therapy warranted modest proportion patients achieve durable remission vip second salvage emphasizes need efficacious salvage therapy patients achieve durable complete response
cancer urinary bladder blacks whites case control study racial differences risk cancer urinary bladder associated cigarette smoking alcohol consumption examined study cases \( whites 129 blacks \) controls matched 3 1 sex , race , age cases significant increases cancer risk associated cigarette smoking observed whites blacks however , dose response patterns appeared differ race whites , statistically significant elevations threefold higher observed odds ratios smoking levels 20 pack years , whereas blacks , corresponding point estimates increase significantly greater 60 pack years smoking although risk patterns compatible higher incidence bladder cancer white men , sample blacks small , tests significance suggestive higher risks whites specific amounts smoking \( p less 0 15 \) effects alcohol consumption inconsistent , detectable synergism smoking drinking additional study race specific risk factors tobacco metabolism needed determine true nature apparent racial differences risk urinary bladder cancer associated cigarette smoking
shortening hemodialysis procedure mortality healthy dialysis patients influence shortening chronic hemodialysis mortality studied following cumulative survival ideal nondiabetic dialysis patients , diseases besides renal disease beginning dialysis thereby problems shortening dialysis could separated problems inherent patient otherwise healthy dialysis patients \( n \) divided age groups \( less 50 , 51 75 , greater 75 years \) studied four periods , 1966 75 , 1976 82 , 1983 85 , 1986 88 dialysis time shortened 17 2 7 hr per treatment time , kt v 1 3 maintained generally , first four year cumulative survival improved dialysis shortened , four year cumulative survival best age groups 1986 88 dialysis shortest time , four year cumulative survival different age matched total u population shortening dialysis time increasing efficiency keeping least 4 0 , stable , weekly kt v harmful healthy patients dialysis , led continued improvement cumulative survival
morbidity mortality hemodialysis patients increase mortality hemodialysis patients united states rising concern study , annual mortality rate 1981 1989 determined morbidity mortality 136 patients dialyzed 1988 analyzed patients followed urea kinetics \( uk \) patients divided according mapping bun protein catabolic rate \( pcr \) group 1 , inadequate protein intake \( n 28 \) group 2 , adequate dialysis \( n 51 \) group 3 , excessive dialysis \( n 28 \) group 4 , undefined domain \( n 13 \) group 5 , transitional domain \( n 16 \) uk parameters measured predialysis bun , pcr , kt v group 1 definition lowest pcr \( 0 7 g kg day vs greater 1 0 groups \) patients group 1 significantly lower bun , creatinine , hematocrit , serum albumin results laboratory tests significantly different numbers hospitalizations days hospital higher group 1 causes hospitalization similar groups mortality rate 8 group 1 vs 4 4 group 2 dialysis prescription using uk maintained annual mortality rate 14 past nine years
kt v hemodialysis morbidity revisited analysis national cooperative dialysis study \( \) showed dialysis morbidity related kt v recently , various shown accurate easier calculation kt v calculated kt v outpatient unit utilizing kt v \( r 0 03 uf w \) 51 patients kt v less 0 8 16 patients \( group \) , 0 8 1 0 20 \( group b \) , greater 1 0 15 \( group c \) difference hematocrit \( hct \) , bun , creatinine , serum phosphorus , albumin ratio men women 11 5 , 15 5 , 4 11 mean age 54 , 63 , 58 years mean body weight 177 , 144 , 122 lb groups , b , c , respectively dialysis related hospital admissions similar \( p greater 0 05 \) data suggest patients higher body weights , men , frequently kt v less 0 8 kt v influence biochemical parameters hospitalizations population indicates kt v may good predictor morbidity , heavier patients may fairly well even kt v less 0 8 search better index dialysis adequacy continued
income survival chronic dialysis patients relationship income survival rates chronic dialysis patients michigan examined evaluate relative risk \( rr \) dying , income , cox survival regression model used adjust age , race \( black versus white \) , gender , treatment modality , year first end stage renal disease \( esrd \) therapy , primary cause esrd average household income reported census data code residence patient analyzed socioeconomic indicator treatment modality day 120 esrd classified either center hemodialysis \( hd \) capd new patients , aged 20 59 registered michigan kidney registry 1 1 80 12 31 87 included study patients followed day 180 esrd death , transplant , 12 31 87 adjusted relative risk dying decreased black patients 3 3 per 1 , 000 increase income \( p less 0 01 \) , trend income white patients negligible \( p greater 0 10 \) difference trends two groups statistically significant \( p less 0 01 \) surprising result , since white patients higher death rates , overall , black patients , particularly among subgroups diabetes hypertension whose rr 1 77 1 82 , respectively poor socioeconomic status area residence strongly negative effect survival black patients , white patients reasons relationship death rates income , especially black patients , need examined greater detail
non heparin hemodialysis oral administration newly developed antiplatelet agent non heparin hemodialysis \( hd \) successfully done dogs oral administration newly developed antiplatelet agent , 4 5 , 5 bis \( 4 \) 4 acid , \( e5510 , pharmaceutical co , japan \) current study , antithrombotic effect e5510 hd investigated eleven mongrel dogs bilateral ureteral ligation given 0 1 mg kg e5510 orally 1 hr undergoing 4 hr hd using hollow fiber dialyzers , \( 5 , regenerated cellulose 6 \) without heparin general anesthesia blood samples taken administration e5510 1 , 2 , 3 , 4 hr starting hd blood counts , hematocrits , blood chemistries , plasma thromboxane levels \( txb2 \) examined platelet aggregation , activated clotting times \( act \) , activated partial thrombin times \( aptt \) also measured , sequential plasma e5510 concentrations determined 10 11 dogs , non heparin hd successfully done minimal clotting dialyzer chambers maximum aggregation rate depressed less 20 initial value throughout hd plasma txb2 concentration depressed , act aptt mildly , significantly prolonged neither hemorrhagic complications side effects e5510 observed
sterile versus non sterile dialysis fluid chronic hemodialysis treatment quality water dialysis fluid varies considerably , view fact endotoxin active derivatives cause acute side effects patients , dialysis fluid must sterile therefore , introduced ultrafiltration dialysis fluid entering dialyzer fifteen patients , \( ten women , five men \) treated 4 weeks , sterile dialysis fluid bacterial loading dialysis fluid hemodialysis 1 34 x 10 \( 5 \) ml , hemodialysis 2 9 x 10 \( 3 \) ml endotoxin concentration high varied less 1 ml greater 10 ml hemodialysis ultrafiltration dialysis fluid hollow fiber membrane , samples free bacteria concentration endotoxin lower detectable limit \( less 0 03 less 0 5 ml \) ultrafiltration dialysis fluid obtain sterile dialysate , endotoxin free interleukin 1 tumor necrosis factor patients ultrafiltration significantly lower without ultrafiltration
ionic strength affects diffusive permeability inorganic phosphate ion negatively charged dialysis membranes electrolytes undergo resistances reaching membrane surfaces passing membrane weakly charged dialysis membranes used hemodialysis treatments diffusive permeability electrolyte weakly charged dialysis membranes depends upon effective charge density membranes , varies ionic strength authors carried dialysis experiments temperature 310 k , 32p aqueous nacl bovine serum , obtain diffusive permeability inorganic phosphate ion regenerated cellulose , membranes various fixed charge densities varying ionic strengths ranging 1 66 100 mol m3 diffusive permeability inorganic phosphate ion increased ionic strength bovine serum , ionic strength approximately 150 mol m3 , gave higher diffusive permeability inorganic phosphate ion internal structure dialysis membranes , pore size , surface , tortuosity , also affects diffusive permeability electrolyte diffusion theory gives effective charge density 5 3 mol m3 membrane conclusion , ionic strength enhances diffusive permeability inorganic phosphate ion aqueous nacl bovine serum inorganic phosphate ion transport negatively charged dialysis membranes depends upon degree dissociation inorganic phosphate , molecular size inorganic phosphate ion , effective charge density internal structure membrane , ionic strength
rapid methods estimating kt v three formulas compared three rapid formulas kt v compared 1 \) kt v pru 0 04 pru 1 2 2 \) kt v 0 026 pru 0 46 3 \) ln \( r 0 03 uf w \) accuracy compared database 339 3 week modeling sessions 256 patients standard comparison kt v obtained 3 point variable volume single pool modeling , using k values estimated , qb , , uf rate accurate formula kt v ln , correlated kt v high degree \( 0 \) , error 2 2 1 7 \( sd \) correlation error modeled kt v least accurate formula kt v pru although correlation kt v pru modeled kt v high \( 0 \) , error 12 0 11 , error correlated significantly modeled kt v \( 0 68 \) kt v showed high correlation modeled kt v \( 0 \) , error 5 0 3 8 latter minimal correlation modeled kt v \( 0 168 \) relative three kt v ln vs kt v pru 5 98 , kt v ln vs kt v 2 45 results suggest kt v ln accurate estimate kt v formula based pru alone
various methods calculation kt v clinical comparison analysis national cooperative dialysis study \( \) showed dialysis morbidity mortality related kt v urea various formulas derived make calculation kt v simpler compared measured kt v \( \) estimated kt v derived approximate total body water \( 0 6 body weight \) uniform dialyzer clearance \( b \) , kt v 0 04 pru 1 2 pru reduction bun \( c \) kt v \( r 0 03 uf w \) r post pre bun , uf ultrafiltration l hd w weight \( \) 26 patients correlation coefficient \( r \) 0 14 \( p less 0 05 \) vs b 0 75 \( p less 0 01 \) vs c 0 77 \( p less 0 01 \) vs 0 97 c vs additional 51 patients , kt v calculated using formulas b , c , r 0 91 c vs , 0 70 b vs , 0 68 b vs c b , greater 30 patients could using criteria adequacy dialysis study suggests use formulas c , b , appropriate accurate kt v calculation formula c may simpler easier , uf w required serial kt v could easily accurately calculated using c quality assurance quantitation dialysis
evaluation plasma sodium concentration hemodialysis dialysate conductivity kinetics modeling based sodium mass balance changes conductivity dialysate outlet compared dialysate inlet , led predicting plasma water conductivity blood inlet conductivity transducers , temperature compensation , located dialysate inlet outlet ports dialyzer connected , interfaced portable computer data acquisition 38 dialysis sessions , close relationship found estimated plasma water conductivity \( \) measured plasma sodium concentration na bi , according formula 0 101 na bi 0 37 \( n 38 r 0 \) study shows plasma sodium concentration dialyzer inlet could evaluated , standard error 1 5 meq l , continuous measurement conductivity gradient dialysate inlet outlet
pressure effects roller pump blood flow hemodialysis accurate measurement blood flow hemodialysis essential avoid blood roller pumps high flow rates high performance dialyzers , flow may overestimated study examined effect inflow \( pa \) outflow \( pv \) pressures induced hemodialysis roller pumps flow vitro vivo blood flow measured , ultrasonic flow probe , whereas pa adjusted 50 400 torr pv 50 300 torr pa influenced flow 200 torr , true flow measured averaged 8 5 1 3 less blood pump per minute \( \) meter reading 400 torr , difference 33 0 1 9 visible indication flow reduced less pump meter readings pv , hematocrit , source pump tubing significant effect flow measured ultrasonic transit time probe routine hemodialysis 64 patients 9 0 2 7 less pump meter readings pa varied 180 220 torr blood pump meter readings greater 400 ml min usually inaccurate low pa monitoring arterial inflow pressure prevent hidden reductions blood flow decrease dialysis efficiency
modulation peritoneal macrophage antimicrobial activity peritoneal dialysis fluid , ca , 1 , 25 \( oh \) 2d3 capd patients previous vitro studies showed ca 1 , 25 \( oh \) 2d3 modulate peritoneal macrophage \( \) antimicrobial activity capd patients twenty four capd patients evaluated vivo \( 12 never peritonitis , 12 overall peritonitis incidence one episode per 8 patient months \) , effects different peritoneal dialysis fluids \( \) ca concentrations \( 1 25 , 1 75 , 2 25 mmol l \) cytoplasmic ca concentration superoxide generation leukotriene b4 \( ltb4 \) release bacterial killing staphylococcus epidermidis parameters also evaluated adding 1 , 25 \( oh \) 2d3 \( 0 25 microgram l \) results showed direct correlation ca concentration ca levels , superoxide ltb4 generation , bacterial killing , 2 25 mmol l ca , values significantly higher seen 1 75 mmol l addition 1 , 25 \( oh \) 2d3 potentiated ca \( \) induced effects hand , ca levels 1 , 25 mmol l , inhibition aforementioned parameters seen however , effect reversed addition 1 , 25 \( oh \) 2d3 vivo results confirm importance ca 1 , 25 \( oh \) 2d3 antibacterial function capd patients , may useful determining prophylaxis therapy peritonitis
long term experience swan neck missouri catheters swan neck missouri catheters designed reduce major complications including 1 \) exit tunnel infections , downward directed exit hole 2 \) leaks , placement deep cuff rectus muscle 3 \) catheter tip migration , caudal direction intraperitoneal segment 4 \) outer cuff extrusion , permanent bend 5 cm 3 cm spaced cuffs sn m2 sn m3 catheters , respectively april 1986 april 1990 , 103 swan neck catheters implanted comparison prospective data 103 swan neck catheters retrospective data 148 standard \( toronto western hospital \) catheters implanted january 1982 june 1985 showed reduced complication rates swan neck catheters overall survival 64 36 months swan neck catheters significantly better 29 standard catheters
phenotypic characterization monocytes macrophages capd patients purpose study phenotypically characterize compare peripheral blood monocytes capd patients peritoneal macrophages isolated peritoneal dialysis monocytes macrophages labeled fluorescent ligands monoclonal antibodies specific 1 \) receptors c5a , met leu phe \( fmlp \) fc region igg \( cr1 \) \( cr3 \) , 2 \) class ii histocompatibility antigens hla dr hla dq 3 \) monocyte macrophage surface antigen cd14 cells analyzed using flow cytometry results indicated differences monocytes peritoneal macrophages receptor expression fmlp , cr1 , cr3 however , paired testing indicated peritoneal macrophages significantly increased expression fc c5a receptors , well enhanced antigen expression hla dr , hla dq , cd14 results suggest peritoneal macrophages capd patients activated increased expression receptors antigens important host defense
influence phosphatidylcholine ultrafiltration solute transfer capd patients fifteen patients \( mean age 59 9 16 1 years \) treated capd mean 21 6 14 months , underwent peritoneal clearances 15 days intraperitoneal phosphatidylcholine \( pc \) treatment \( 50 mg l \) difference observed urea , creatinine , uric acid , reverse dextrose clearances statistically significant increase phosphate clearances \( 4 6 hr dwell times \) \( 1 36 \) reduction drainage volume \( 2 hr dwell time \) \( 1 36 \) observed treatment urine output percent dextrose reabsorption unchanged ultrafiltration \( uf \) showed tendency increase , lasted 15 days discontinuation treatment tendency allowed patients reduce , period , amount hypertonic solution \( 23 8 l vs 21 3 l \) required tendency increase uf time deserves study
chronic tidal peritoneal dialysis tidal peritoneal dialysis \( ntpd \) technique , initial fill peritoneal cavity , portion dialysate rapidly five , stable , pd patients entered 4 month study determine ntpd session length necessary clinically adequate dialysis creatinine clearance similar four daily 2 l capd ntpd performed using modified pac x 2 , drain phase regulated target volume one patient completed 3 5 months study , one 4 months , three 6 months , one patient continued ntpd 13 , 14 , 32 months mean ntpd session time 9 hr 24 min \( range 8 hr 35 min 9 hr 55 min \) end 4 months patients clinically adequate dialysis three patients preferred ntpd capd , particularly empty abdomen daytime one patient required increase ntpd time , addition one daytime exchange , low creatinine clearance conclusion , ntpd provides weekly creatinine clearances comparable capd , acceptable duration dialysis sessions patients new pd machine providing inexpensive dialysis solution large quantities , well safe false free dialysis sessions , needed practical ntpd implementation
biocompatibility dialysis membranes importance objective subjective symptoms hemodialysis clinical importance biocompatibility hemodialysis membranes matter controversy authors studied relationship biocompatibility acute symptoms hemodialysis \( hd \) twenty three patients underwent 12 different bicarbonate hd using , , membranes short \( 2 hr \) long \( 4 hr \) treatments , small large membrane areas subjective objective symptoms registered hd 12 36 hours thereafter type membrane , membrane area , kt v importance occurrence subjective objective symptoms patients registered fewer symptoms 2 hr hd high blood flow 4 hr hd slow blood flow \( p 0 04 \) headache particularly frequent 4 hr hd blood pressure , extent subjective symptoms , influenced ultrafiltration volume type membrane biocompatibility determinant acute side effects hemodialysis
clinical effects polyethylene glycol grafted cellulose membrane thrombogenicity biocompatibility hemodialysis biocompatibility thrombogenicity polyethylene glycol \( peg \) grafted cellulose hemodialysis \( hd \) membranes \( \) investigated cross hd five hd patients ordinary cellulose \( oc \) significantly suppressed transient leukocyte thrombocytopenia , release c3a , beta platelet factor 4 , corresponding quantity grafted peg hd resulted lower granulocyte elastase production , protein blood cells adsorption membrane surface oc minimum heparin hd three times lower oc , thrombin antithrombin iii complex elevation lower hd oc results indicate grafted peg effectively suppresses blood membrane interaction , thus improving biocompatibility reducing thrombogenicity clinical hd
difference beta 2 microglobulin removal synthetic polymer membrane dialyzers several kinds dialyzers , highly permeable membranes \( \) , designed specifically remove beta 2 microglobulin \( \) clarify solute transport characteristics , nine types dialyzers evaluated vivo vitro studies using human plasma aqueous solutions membrane adsorption seen membrane dialyzers vitro experiments using human plasma hand , synthetic polymer membrane dialyzers properties , dialyzer membrane , large amount removed adsorption alone dialyzers cellulose membranes showed higher values diffusive \( greater 20 ml min \) sieving coefficient \( greater 0 9 \) vitro experiments using aqueous solution containing several solutes relatively small middle molecular weights , dialyzers higher overall mass transfer coefficient conventional membrane dialyzer
one year rhuepo therapy prolongs rbc survival may rbc membranes despite natural progression chronic renal failure uremia need dialysis rhuepo administered eight patients chronic renal failure \( crf \) uremia \( u \) 1 year creatinine clearance \( gfr \) averaged 14 3 \( 9 25 \) ml min hct 28 \( 26 30 \) baseline rbc survival 51cr t1 2 highly correlated gfr \( r 0 66 \) , p less 0 05 \( 2 \) , average 21 6 days repeat 51cr t1 2 3 months gfr 10 ml min hct 38 prolonged 7 days 28 6 \( p less 0 005 \) , 1 year remained increased 28 days \( p less 0 001 \) hct 39 , despite decreased gfr less 4 ml min need dialysis reticulocytes varied 1 6 7 4 \( 3 6 weeks \) 3 1 \( 3 months \) 1 5 \( 1 year \) bone marrow cellularity increased 36 47 \( 3 months \) 44 \( 1 year \) e ratio decreased 3 9 1 1 7 1 \( 3 months \) 1 6 1 \( 1 year \) marrow iron decreased 4 1 6 2 4 6 \( 3 months \) 1 8 6 \( 1 year \) doses rhuepo reduced avoid polycythemia rhuepo stimulates erythropoiesis pts progressive crf u 1 year initial increase hematocrit due early peak reticulocytes 3 months , rhuepo maintains increased hematocrit three mechanisms 1 \) increased , 2 \) trend increased bone marrow erythroid cellularity , 3 \) lengthened rbc survival 1 year rhuepo therapy , trend increased marrow cellularity persists , however , maintenance target hematocrit via lengthened rbc survival despite progression crf u , rhuepo produced rbcs longer survival expected rbc membranes may stabilized rhuepo
suppression immunoglobulin interleukin 6 production peripheral blood mononuclear cells dialysis membranes influence dialysis membranes immunoglobulin interleukin 6 production estimated vitro peripheral blood mononuclear cells 11 patients undergoing hemodialysis incubated 7 days , , flat sheet membranes igg , iga , igm , il 6 assayed supernatants aid enzyme linked immunosorbent assay \( elisa \) techniques pokeweed mitogen stimulated igg production declined significantly 40 ng ml 162 26 ng ml 135 25 ng ml 109 20 ng ml similar pattern observed iga igm production il 6 production significantly reduced presence \( 151 45 pg ml \) , \( 167 6 pg ml \) , \( 108 33 pg ml \) compared \( 34 pg ml \) concluded long term exposure mononuclear cells artificial surfaces dialysis may contribute impaired humoral response observed dialysis patients effect may due decline b cell stimulation monocytes , possibility suggested reduction monocytic il 6 production
gastric mucosal pge2 levels gastric non ulcer ulcer patients chronic renal failure without renal diseases healthy subjects pge2 like immunoactivity mucosal specimens gastric corpus antrum measured individuals chronic uremia without renal diseases absence presence gastric ulcerations healthy subjects regardless group patients , compared normal mucosa , significant decrease pge2 like immunoactivity \( 50 70 \) found mucosa atrophic , superficial gastritis whenever patients control group patients renal diseases suffered ulcers , pge2 like immunoactivity , compared nonulcer subjects , revealed decrease 60 70 mucosa compared mucosa , tissue ulcer rim patients gastric ulcer showed relative increase pge2 like immunoactivity , eg , pge2 like immunoactivity twice high tissue ulcer rim output pge2 like immunoactivity gastric juice subjects without renal diseases comparable found patients chronic uremia basal pentagastrin stimulated conditions therefore conclude gastric mucosal formation probably influenced chronic uremia
minimizing urinary incontinence nursing home nursing home , urinary incontinence common problem often treated problem aging physicians , nurses , patients etiologies numerous , approaches treatment setting however , approach diagnosis care , primary care physician may able determine patients , forms urinary incontinence , benefit specific therapies
activity type 1 erythrocyte complement receptors uremia renal transplantation effect uremia activity erythrocyte complement receptors type 1 \( cr1 \) , changes occurring renal transplantation , studied complement receptor activity measured immune adherence utilizing technique patients terminal kidney failure hemodialysis program exhibited significantly lower values erythrocyte cr1 activity comparison healthy controls circulating immune complexes affect erythrocyte cr1 activity successful renal transplantation , irrespective immunosuppressive program used , significant increase erythrocyte cr1 activity appeared , similar control group values however , activity erythrocyte cr1 , graft recipients cyclosporin treatment , significantly higher patients receiving azathioprine prednisone therefore , possible cyclosporin , transported erythrocytes , complement receptor function
comparison two methods estimation urea kinetics introduction third simplified method claimed computed urea kinetic \( uk \) modelling patients , estimation protein intake , leads overestimation protein catabolic rate \( pcr \) present study , three different methods kinetic modelling determination pcr kt v compared 24 patients first method direct quantification method \( \) based collection urea eliminated body first computed method \( icmi \) urea kinetic modelling method described dialyzer clearances measured directly estimated theoretical extrapolation second computed method \( icmii \) based indirect calculation urea distribution volume \( vu \) , according , dialyzer clearances vu pre post dialysis urea concentrations three methods resulted pcr 's significantly different \( 1 03 0 19 icmi 1 04 0 22 icmii 1 08 0 25 mg kg bw 24 p greater 0 05 \) results correlated , following results obtained icmi vs icmii r 0 89 , p less 0 001 icmi vs r 0 68 , p less 0 01 vs icmii r 0 78 , p less 0 001 comparison kt v values resulted virtually identical results , especially comparing icmi icmii , regression line identity line conclusion , methods seem equally reliable determining mean pcr kt v data , obtained directly measured dialyzer urea clearances , confirm earlier held opinion computed modelling results overestimation pcr
palmar keratoses family members individuals bladder cancer total 270 bladder cancer cases , 178 first degree relatives 127 spouses bladder cancer cases 329 hospital controls studied evaluate association palmar keratoses , bladder cancer environmental genetic factors crude prevalences keratoses 4 groups 67 , 54 , 42 23 , respectively logistic regression models showed bladder cancer patients raised risk palmar keratoses relative hospital controls \( odds ratio 6 95 95 ci 4 77 10 12 \) whereas blood relatives spouses significantly increased odds ratios case family \( blood relative \) possessed keratoses among several environmental behaviour factors , cigarette smoking significantly associated increased risk \( odds ratio 2 32 95 ci 1 63 3 29 \) data suggest genetic component may influence occurrence palmar keratoses , unknown environmental agent appears causing association spouses
percutaneous operative gastrostomy gastric decompression major urological surgery postoperative gastric decompression necessary percutaneous gastrostomy tube alternative nasogastric intubation percutaneous insertion bladder catheter easy procedure without notable complications increases comfort patient immediate postoperative period advocate use major urological abdominal operations
screening prostatic carcinoma routine testing prostatic carcinoma digital rectal examination , transrectal ultrasonography prostate specific antigen determination proposed reduce deaths earlier diagnosis questionable reliability results , cost screening , inability establish balance benefits treatment adverse effects quality life men screened make screening experimental controlled studies prove value
enhancing effect partial cystectomy rat urinary bladder carcinogenesis effects 5 50 partial bladder tumorigenesis initiated n butyl n \( 4 \) \( \) investigated wistar rats examining histological findings cell proliferative activity incorporation bromodeoxyuridine \( brdurd \) dna synthesis phase determined vitro labeling technique eight weeks treatment drinking water containing 0 05 , 5 50 partial cystectomy performed end week 16 , resected bladder sutured silk difference incidence papillary nodular \( pn \) hyperplasia control partial cystectomy groups however , incidence cancer group given partial cystectomy much higher control cancers control group grade 1 superficial tumors , whereas grade 2 invasive tumor observed six 40 animals partial cystectomy group 31 0 labeling index cancer partial cystectomy group greater 24 1 control group also significant difference number brdurd labeled cells pn hyperplasia control partial cystectomy groups findings indicate partial cystectomy enhances initiated bladder carcinogenesis increase dna synthesis found pn hyperplasia cancer may associated induction bladder tumors
immunotherapy murine bladder cancer irradiated tumor vaccine investigation explored efficacy irradiated autologous mouse bladder tumor \( ir mbt2 \) active specific immunotherapeutic agent adjuvant therapy bacillus calmette guerin \( bcg \) subcutaneously transplanted murine bladder tumor tumor incidence significantly reduced groups receiving bcg \( 27 , p less 0 005 \) ir mbt2 bcg \( 53 , p less 0 025 \) , compared control \( 93 \) survival significantly improved groups treated bcg \( 100 , p less 0 005 \) , 10 \( 5 \) ir mbt2 bcg \( 53 , p less 0 01 \) , 10 \( 7 \) ir mbt2 bcg \( 47 , p less 0 025 \) compared control \( 13 \) surprisingly , ir mbt2 consistently reduced efficacy bcg alone ir mbt2 alone \( 10 \( 7 \) \) appeared enhance tumor growth autologous irradiated bladder tumor vaccine , alone combination bcg , displayed immunotherapeutic advantage use irradiated tumor cell vaccine bladder cancer therapy may reduce results bcg alone
effects basic fibroblast growth factor suramin cell motility growth rat prostate cancer cells suramin , new type cancer chemotherapeutic agent growth factor antagonist properties , reported affect growth prostate cancer metastatic lesions et al previously reported prostate cancer cell motility essential tumor cell metastasis studied effects suramin cell motility cell growth prostate cancer cell model demonstrated suramin differential effects rat prostate cancer cells vitro effects suramin cell growth biphasic low concentrations 0 01 mm 0 1 mm , suramin stimulated growth inhibitory higher concentration 1 0 mm , 10 mm suramin resulted cell death cell motility inhibited suramin concentration 0 1 mm inhibition cell motility suramin may blockage growth factor effects reducing serum growth factor concentration reduced cell motility motility restored addition basic fibroblast growth factor \( bfgf \) media motility restored bfgf could blocked presence suramin inhibition cell motility suramin reversible washout drug suramin inhibits cell motility human prostate cancer cells \( \) rat \( \)
experience calculi treatment algorithm may 1984 january 1988 , 18 patients \( 31 units \) documented symptomatic stones treated stone size ranged 5 56 mm largest diameter , average 21 mm units treated initially methods , including ureteroscopy 10 , percutaneous ultrasonic lithotripsy 9 , extracorporeal shock wave lithotripsy \( eswl \) 10 2 patients 10 required combination technologies 2 required open operation 31 units 23 free stones patient discharged hospital 8 patients retained stones 3 fragments greater 3 mm diameter based experience algorithm developed urological management stones ureteral calculi may removed techniques renal pelvis managed renal stones renal calculi less 1 5 cm may treated eswl monotherapy stones 1 5 3 cm may treated eswl dissolution , percutaneous ultrasonic lithotripsy plus dissolution calculi may treated percutaneous ultrasonic lithotripsy plus eswl dissolution retained fragments
intracavernous injection prostaglandin e1 combination papaverine enhanced effectiveness comparison papaverine plus phentolamine prostaglandin e1 alone compared erectile response intracavernous injection combination papaverine prostaglandin e1 combination papaverine phentolamine \( 49 patients \) , prostaglandin e1 alone \( 38 \) degree erection achieved significantly better papaverine plus prostaglandin e1 papaverine plus phentolamine duration erection less , although incidence prolonged erections \( greater 5 hours \) similar combinations papaverine prostaglandin e1 likewise resulted significantly better degree erection prostaglandin e1 alone \( prolonged erections occurred drug combination \) erections spontaneously none required medical intervention throughout study pain noted injection prostaglandin e1 incidence clearly lower \( 7 38 versus 13 38 \) injection 5 micrograms prostaglandin e1 combination papaverine \( although difference statistically significant \) subjectively , side effects caused drug combination described much less dramatic patients prostaglandin e1 alone combination papaverine prostaglandin e1 shows clearly synergistic effect might replace papaverine plus phentolamine prostaglandin e1 alone patients respond well suffer side effects high single doses
fate residual fragments extracorporeal shock wave lithotripsy monotherapy infection stones reviewed 53 patients infection stones treated extracorporeal shock wave lithotripsy \( eswl \) monotherapy determine long term rate free stones stone recurrence rate correlated pre treatment stone burden radiological presence fragments procedure long term followup \( mean 26 6 months \) available 33 patients representing 38 kidneys although 3 kidneys free stones immediately eswl , 20 without stones 3 months 18 \( 47 \) stone free followup 9 kidneys fragments 5 mm final treatment 7 \( 78 \) residual fragments 3 months experienced stone progression 9 kidneys remaining 6 \( 66 \) 3 kidneys appeared free stones eswl without stones followup 3 month plain film kidneys , ureters bladder reliable indicator eventual outcome 20 kidneys free stones 3 months 16 remained without stones 18 kidneys residual stone particles 3 months 14 showed disease progression , 2 stable disease 2 passed residual 1 17 patients free stones stable stone disease positive urine culture followup patients infection stone fragments 3 months eswl monotherapy high rate stone progression \( 78 \) undergo treatment eswl monotherapy infection stones requires close patient followup assure residual fragments passed urine remains sterile
pathophysiology prolonged penile erection associated trazodone use treatment antidepressant trazodone associated occurrence prolonged penile erection priapism evaluate effect trazodone erection monitored periodic physiological sleep related erections 6 healthy volunteers double blind crossover study comparing effect trazodone , \( tricyclic antidepressant \) placebo addition , determine effects trazodone neurovascular control penile smooth muscle performed vitro studies corpus tissue obtained patients undergoing penile prosthesis implantation trazodone significantly increased total interval nocturnal erectile activity , effect high dose treatment \( nights 4 5 \) average duration erectile activity per night placebo 158 41 minutes \( mean standard deviation \) night 4 177 21 minutes night 5 trazodone treatment erectile activity per night significantly prolonged 285 115 minutes night 4 232 86 night 5 \( p less 0 01 \) analysis erectile activity relation rapid eye movement sleep period erectile activity usually occurs revealed phase erection , sympathetic control , significantly prolonged average 2 4 times trazodone compared placebo \( p less 0 05 \) vitro , trazodone concentrations comparable reached plasma significantly impaired smooth muscle contractions elicited electrical stimulation adrenergic nerves antagonized contractions induced exogenous norepinephrine conclude trazodone enhance penile erection man propose mechanism related alpha adrenoceptor blocking properties trazodone interference sympathetic control penile
epidural analgesia herpes 23 yr old herpes spontaneously delivered normal healthy infant epidural analgesia received five injections bupivacaine 0 5 per cent ten hour period infection lumbar region , even though body covered vesicles bullae including face neck eight months delivery patient still vesicular eruption occurs mainly menses
treatment tubal pregnancy local injection methotrexate adrenaline injection report 25 patients twenty five patients tubal pregnancy treated injection methotrexate \( mtx \) tubal swelling vasoconstriction adrenaline twenty four 25 patients uneventful clinical course one case , tube ruptured despite falling serum human chorionic gonadotropin \( hcg \) concentrations 17 24 patients , dose 100 mg locally injected sufficient seven patients given additional systemic injections 3 4 patients high initial serum hcg levels \( greater 10 000 ml \) , clinical course uneventful side effects mtx adrenaline minimal whether way treatment better chances fertility future unknown therefore prospective , case controlled study comparing fertility rates different ways treatment needed
serum levels antibodies pathologically increased active immunization patients recurrent spontaneous abortion although pathophysiological mechanisms leading recurrent spontaneous abortion still fully understood , treatment schemes based immunological principles advocated recent years production called blocking factor specifically stimulated investigated , retrospectively , whether active immunization affect production immunoglobulin \( ig \) g igm antibodies group untreated recurrent spontaneous abortion patients \( n 9 \) , range variation antibodies , consecutive controls taken time interval immunization , statistically significant contrast , significant increases igg igm antibodies occurred active immunization paternal 10 15 , 6 15 cases , respectively mean basal posttransfusion levels 7 26 2 53 30 15 23 u ml igg 2 26 1 2 6 82 5 6 u ml igm , respectively conclude active immunization human lymphocytes leads production antibodies effect exerted igm igg antibodies
serial section study visually normal pelvic peritoneum patients endometriosis defined criteria used select small samples visually normal study peritoneum serial section light microscopy 45 patients biopsy proven endometriosis 10 patients without endometriosis glandular element compatible possible endometriosis found 1 patient visually normal peritoneum harbor high prevalence microscopic endometriosis
heterologous transplantation activated murine peritoneal macrophages inhibits gamete interaction vivo paradigm endometriosis associated subfertility macrophage postulated pathologic aberration patients suffering endometriosis associated subfertility report vivo model macrophage mediated infertility described populations macrophages obtained inbred strain mice \( balb c \) follows \( 1 \) vivo macrophages \( harvested donor mice treated intraperitoneal \) \( 2 \) macrophages ex vivo protein synthesis inhibitor \( 3 \) basal state \( \) macrophages obtained untreated mice recipient mice underwent ovarian pregnant serum gonadotropins 2 x 10 \( 6 \) macrophages transferred afternoon stimulation day 3 injection human chorionic gonadotropin \( hcg \) oocytes 4 cell embryos counted day hcg 2 reflection reproductive performance heterologous transfer vivo macrophages , basal state macrophages , significantly inhibited fertilization effect largely reversed pretreatment experiments confirm relevance macrophage mediated interference early reproductive performance provide model development alternative therapies \( e g , peritoneal fluid environment \) endometriosis associated subfertility
small cell neuroendocrine carcinoma 's gland small cell neuroendocrine carcinoma arose 's gland 30 year old woman reported tumor light , electron microscopic , immunohistochemical features typical pulmonary small cell carcinoma metastatic inguinal lymph nodes presentation first reported example tumor occurring 's gland
contraception ectopic pregnancy risk studies association ectopic pregnancy contraception generated conflicting array results methodologic differences studies estimated absolute incidence rates ectopic pregnancy various contraceptives pregnancy rate proportion pregnancies ectopic implantation method results indicated 500 fold difference ectopic pregnancy incidence , low 0 005 ectopic pregnancies per 1000 women years oral contraception high 2 6 per 1000 women years contraception estimated incidence rates useful clinicians patients seeking better understand risks benefits contraceptives
calcium supplementation pregnancy may reduce preterm delivery high risk populations results presented randomized , double blinded controlled clinical trial calcium supplementation \( 2 0 gm elemental calcium calcium carbonate \) placebo participants 17 years age less clinically healthy patients enrolled twenty third week gestation mean duration calcium supplementation placebo approximately 14 weeks treatment consisted 2 8 \( 1 5 \) tablets per day placebo group \( n 95 \) 3 0 \( 1 4 \) tablets per day calcium group \( n 94 \) dietary calcium intake similar groups 1200 mg day calcium group lower incidence preterm delivery \( less 37 weeks 7 4 vs 21 1 p 0 007 \) spontaneous labor preterm delivery \( 6 4 vs 17 9 p 0 01 \) low birth weight \( 9 6 vs 21 1 p 0 03 \) effect also present stratified analysis level treatment compliance , urinary tract infection , chlamydial infection life table analysis demonstrated overall shift higher gestational age calcium group compared placebo group \( log rank test , p 0 02 \) suggested previously , observed effect could mediated reduction uterine smooth muscle confirmed future research , results could represent important preventive intervention prematurity high risk populations
ovarian pregnancy report twenty cases one institution series 20 cases primary ovarian pregnancy diagnosed treated one institution reported prevalence rate 1 deliveries seems increasing past years comprises 3 3 extrauterine pregnancies clinical presentation , possible pathogenesis , diagnostic steps , preferred management , future fertility detailed inasmuch 18 fertile patients used intrauterine contraceptive device operation , special emphasis made controversial relationship use intrauterine contraceptive devices ovarian pregnancy
preoperative evaluation serum ca 125 , tag 72 , ca 15 3 patients endometrial carcinoma evaluated 109 women endometrial carcinoma determine accuracy preoperative tumor associated antigen levels \( ca 125 , ca 72 , ca 15 3 \) prediction extrauterine disease whether tag 72 , ca 15 3 , would improve predictive value ca 125 alone eleven \( 12 \) 80 patients disease confined uterus positive cytologic findings ca 125 values greater 35 u ml versus 12 \( 65 \) 20 patients extrauterine metastasis therefore ca 125 values sensitivity 65 specificity 88 tag 72 level elevated \( greater 6 u ml \) 4 patients localized disease 30 metastasis ca 15 3 elevated \( greater 30 u ml \) 17 65 categories , respectively tag 72 ca 15 3 levels improve combination sensitivity specificity ca 125 alone addition , one 10 patients microscopic metastasis \( three cases \) positive peritoneal cytology \( seven \) elevation tumor associated antigen levels failure detect occult metastasis high false positive rate limit role tumor associated antigen assays preoperative evaluation patients endometrial carcinoma
effects intravascular fetal blood transfusion fetal intracardiac doppler velocity waveforms 12 fetuses pregnancies red blood cell doppler velocity waveforms recorded level atrioventricular valves immediately 15 minute intervals 2 hours intravascular transfusion left right cardiac outputs , ratio peak velocities early passive ventricular filling active atrial filling level ventricles well heart rate calculated transfusion , left right cardiac outputs significantly higher reference ranges gestation constructed cross sectional study 187 normal pregnancies transfusion significant temporary fall right left outputs associated increased ratios peak velocities early passive ventricular filling active atrial filling within 2 hours transfusion parameters returned toward normal range addition , significant changes found fetal heart rate values transfusion fall cardiac output significantly related amount expansion placental volume
prenatal diagnosis congenital cytomegalovirus infection virus isolation amniotic fluid cytomegalovirus isolated amniotic fluid two pregnant women cases prenatal diagnosis fetal virus infection aided subsequent management mother newborn infant
progesterone induced blocking factor corrects high resorption rates mice treated earlier showed presence functional progesterone receptors , lymphocytes healthy pregnant women produced immunomodulatory protein presence progesterone , whereas nonpregnant persons progesterone treated murine pregnancy lymphocytes release similar factor present study reveals biologic significance finding treatment balb c mice 8 days pregnant progesterone receptor blocker \( 486 \) resulted 100 resorption fetuses simultaneous administration supernatant progesterone treated murine pregnancy spleen cells restored resorption rate original 6 observed untreated control animals data suggest functional lymphocytic progesterone binding sites needed maintenance normal pregnancy blockage progesterone receptors consequent inability lymphocytes produce progesterone induced blocking factor , abortion initiated immune factors fact administration preformed blocking factor effect treatment suggests progesterone mediated immunosuppression needed maintenance normal gestation
maternal genetic effects ethanol teratogenesis relative embryonic resistance malformations maternal genetic factors fetal genetic factors contribute variations response prenatal alcohol exposure assess contribution maternal genotype ethanol teratogenesis , reciprocal cross study conducted animal model using c57bl 6j \( b6 \) long sleep \( ls \) mice b6 mice susceptible ls mice prenatal ethanol induced malformations mouse susceptible fetal weight deficits following utero alcohol exposure b6 ls dams b6 ls males producing four embryonic genotype groups true genotypes , genetically similar genotypes \( f1 genotype \) dams intubated either 5 8 g kg ethanol \( e \) isocaloric amount sucrose \( \) day 9 pregnancy fetuses removed gestation day 18 , weighed , assessed soft tissue skeletal malformations results showed greater weight deficit increased total malformation rate ethanol exposed f1 carried b6 mothers compared ethanol exposed f1 carried ls mothers result would expected maternal genetic factors contribute significantly towards susceptibility ethanol teratogenesis influence ls mother decrease susceptibility ethanol teratogenesis compared b6 mother influence b6 mother increase susceptibility ethanol teratogenesis compared ls mother average malformation rate f1 significantly less predicted value shows f1 genotype exhibited towards resistance prenatal alcohol effects
effect maternal ethanol infusion placental blood flow fetal glucose metabolism sheep intravenous infusion 1 g ethanol min 1 hr seven pregnant decreased blood flow sides placenta reductions blood flow maintained least 2 hr infusion ethanol ceased although blood flow reduced , fetal blood gases unchanged plasma glucose concentrations unchanged ethanol , fetal glucose supply consumption decreased following maternal ethanol infusions maintained chronic alcohol consumption changes could contribute growth retardation seen fetal alcohol syndrome
ectopic pregnancy ten common pitfalls diagnosis ectopic pregnancy \( ep \) common , life threatening complication pregnancy modern technology \( ultrasonography improved pregnancy tests \) facilitate diagnosis ep however , retrospective review 65 cases confirmed ep managed 18 months urban teaching hospital , 37 65 patients \( 57 , 44 , 69 \) received prompt diagnosis treatment delays occurred 28 patients \( 43 \) 10 27 delayed cases , diagnosis ep even considered time first visit patients delayed diagnosis , morbidity \( transfusions , cardiovascular instability , progression illness \) occur diagnostic pitfalls resulted delayed care reviewed , delays commonly occurred patients benign examination atypical pain risk factors ep missed \( 7 patients , 25 \) , subtle clues blood loss often ignored \( 10 patients , 36 \) , passage tissue thought exclude ep \( 2 patients \) ultrasound helpful half diagnoses misinterpreted 27 dry serous occurred frequently five patients , falling low quantitative human chorionic gonadotropin level believed indicate completed abortion authors conclude almost half eps still missed first physician visit errors pitfalls diagnosis still common 1980s
failure prevent preterm labour delivery twin pregnancy using prophylactic oral salbutamol double blind , controlled study performed see whether use prophylactic oral salbutamol would reduce incidence preterm labour twin pregnancy 144 women studied , 74 took salbutamol 70 placebo difference found length gestation , birthweight fetal outcome , although fewer babies suffered respiratory distress syndrome salbutamol group women experience troublesome side effects salbutamol
relative risks caesarean section \( intrapartum elective \) vaginal delivery detailed analysis exclude effects medical disorders acute pre existing physiological disturbances objective compare maternal attributable vaginal delivery , elective caesarean section \( cs \) intrapartum cs design number deaths associated method delivery ascertained among unselected among low risk women detailed retrospective review case notes women died delivery frequency method delivery throughout study period ascertained computer database enhanced analysis case notes unselected groups women setting maternity services \( \) years 1975 1986 inclusive subjects total 108 maternal deaths arising 263 , 075 provided accurate information relative frequency vaginal abdominal delivery determined computer database ratio elective cs emergency cs intrapartum cs obtained review first 200 operations years 1975 , 1977 , 1979 , 1982 1984 main outcome measures \( \) mortality rates associated different methods delivery unselected women women healthy surgery \( ii \) mortality rates apparently attributable method delivery results overall relative risk mortality associated caesarean section compared vaginal delivery 7 decreasing 5 exclusion women medical life threatening antenatal complications \( eg , haemorrhage , hypertension \) relative risk associated intrapartum compared elective sections 2 3 decreasing 1 4 exclusion women medical disorders life threatening complications relative risk maternal mortality apparently attributable intrapartum compared elective sections 1 7 however , 95 confidence intervals values , even large data set , wide nevertheless , rates broad agreement derived british maternal deaths conclusion attributable relative caesarean section compared vaginal delivery intrapartum compared elective caesarean section lower overall relative modes delivery approximately 5 1 1 5 1 respectively data important decision recommend elective caesarean section compared trial labour
diagnosis ectopic pregnancy vaginal ultrasonography combination discriminatory serum hcg level 1000 iu l \( \) diagnostic value vaginal sonography combination discriminatory serum hcg level 1000 iu l \( international reference preparation \) tested prospectively 200 pregnant women suspected ectopic pregnancy ectopic pregnancy diagnosed 68 women \( 34 \) , miscarriage 56 \( 28 \) normal pregnancy 76 \( 38 \) admission , intrauterine sac seen 89 intrauterine pregnancies , none ectopic pregnancies detection adnexal mass separate ovaries diagnostic ectopic pregnancy sensitivity 93 , specificity 99 , positive predictive value 98 negative predictive value 96 19 patients \( 9 \) initial non diagnostic final diagnosis obtained repeated scan within 6 days five women ectopic pregnancy , 12 miscarriage two normal pregnancy admission hcg level exceeded 1000 iu l 77 patients 67 ectopic pregnancies patients initial level exceeding 100 iu l , intrauterine sac found intrauterine pregnancies none ectopic pregnancies use threshold combination sonographic detection adnexal mass diagnostic ectopic pregnancy sensitivity 97 , specificity 99 , positive predictive value 98 negative predictive value 98
alterations phospholipase a2 activity luteal regression pseudopregnant pregnant rats activity phospholipase a2 measured microsomes prepared ovaries pseudopregnant rats spontaneous prostaglandin f2 alpha induced regression regression pregnant rats samples incubated 40 c 90 min buffer \( ph 8 3 \) 1 0 mm added substrate , radiolabeled phosphatidylcholine , incorporated liposomes spontaneous regression , significant 2 4 fold increase phospholipase a2 activity , compared levels mid pseudopregnancy \( days 8 9 \) elevation correlated significant decrease plasma progesterone concentration day 6 7 pseudopregnancy , treatment rats doses prostaglandin f2 alpha also caused significant increase phospholipase a2 activity , remained elevated throughout 72 h sampling period pregnant rats small significant rise phospholipase a2 activity results indicate activity phospholipase a2 increases luteal regression pregnant pseudopregnant rats could involved mechanism causes loss progesterone secretion
current concepts beta endorphin physiology female reproductive dysfunction beta endorphin role regulation normal menstrual cycle possibly onset puberty reviewed evidence pointing alteration neuropeptide may contribute pathogenesis various reproductive dysfunctions elevated high levels beta endorphin associated exercise associated amenorrhea , stress associated amenorrhea , polycystic ovarian syndrome depressed low levels beta endorphin associated pms menopause alterations levels beta endorphin may change pulsatile release gnrh via noradrenergic dopaminergic pathways primarily focused beta endorphin representative endogenous opioid peptides , opioid peptides may also contribute pathogenesis various types reproductive dysfunction perhaps become possible characterize understanding function beta endorphin substances endogenous opioid peptides better understanding role physiological well pathophysiological processes may allow development rational approaches treatment specific disorders pertaining many questions remain unanswered among relevant precise mechanism action beta endorphin exerts influence pulsatile gnrh release \? functional relationship cns peripheral \( serum \) levels beta endorphin \? detected changes beta endorphin levels merely associated , cause particular disorder \? since took almost 40 years time prostaglandins first discovered eventual clinical application , may take time beta endorphin complete
observations doubling time human chorionic gonadotropin early asymptomatic pregnancies doubling time \( dt \) human chorionic gonadotropin \( hcg \) serum investigated retrospectively using serial serum hcg values obtained asymptomatic pregnant women prior history infertility dt hcg increase significantly pregnancy advanced period gestation serum hcg concentration less 10 , 000 ml \( international reference preparation \) serum hcg concentrations increased 2 60 women normal intrauterine pregnancies , 5 8 women asymptomatic ectopic pregnancies \( eps \) , 2 8 asymptomatic women subsequently aborted pregnancies neither sensitivity specificity serial hcg testing ep enhanced different test criteria different serum hcg concentrations
oocyte retention follicle indirect evidence supports existence luteinized unruptured follicle syndrome infertile women seek direct evidence oocyte retention , infertile normal women studied early phase visual documentation ovulation stigma , needle aspiration ovarian follicles , peritoneal fluid collection estradiol progesterone assay luteal phase confirmed endometrial biopsy \( day 2 8 \) normal control subjects \( n 16 \) , 25 test cycles stigma negative oocytes recovered infertile group \( n 23 \) , 43 test cycles stigma negative five oocytes recovered including one stigma bearing follicle peritoneal fluid steroid levels failed discriminate stigma positive stigma negative cycles either group oocyte retention occurs infertile women
endocervical chlamydial deoxyribonucleic acid infertile women presence chlamydial deoxyribonucleic acid \( dna \) evaluated dna hybridization endocervical cells infertile normal fertile women chlamydial dna detected 49 186 \( 26 3 \) infertile patients , significantly common fertile control individuals \( 12 5 , 8 64 individuals \) among infertile patients , 49 3 \( 33 67 \) tubal factors cause infertility 13 4 \( 16 119 \) factors found contain chlamydial dna endocervical cells results show chlamydial dna could found significantly frequently endocervical cells infertile patients tubal factor without tubal factors normal controls
insemination alleviation infertility methods developed facilitate use insemination achieve fertilization vitro clinical trial undertaken patients previously failed achieve fertilization vitro fertilization , presenting severe 85 patients , 585 oocytes obtained , 0 3 activated vivo , 369 \( 72 \) metaphase ii underwent insemination , 15 , 0 5 three thirty eight percent patients fertilization 36 replacement one replaced 19 patients , two 8 patients , three 4 patients twin two singleton pregnancies established
role tubal pathology parameters ectopic pregnancies occurring vitro fertilization embryo transfer contradictory findings reported concerning role tubal disease genesis ectopic pregnancy vitro fertilization embryo transfer \( ivf et \) report six occurred 141 ivf et pregnancies \( 4 3 \) six cases among 84 patients tubal disease , none occurred remaining 57 patients etiological factors correlation found parameters including ovulation induction , number embryos transferred , luteal support comparison six matched controls demonstrated similar estradiol levels , beta hcg levels day 15 17 et lower salpingectomy performed six cases , contralateral resection carried three comprehensive studies needed clarify whether tubal pathology really increases risk ectopic gestation ivf et
effect serum patients minimal mild endometriosis mouse embryo development vitro two cell mouse embryos cultured 37 degrees c 5 co2 , 95 air 7 5 serum supplement patients minimal mild endometriosis , \( group , n 31 \) , tubal factor \( group ii , n 33 \) , male factor \( group iii , n 17 \) , fetal cord samples \( group iv , n 37 \) , ham 's f 10 medium \( , grand island , ny \) without serum supplement \( group v , n 30 \) progression stage \( mean percent se \) 96 hours groups , ii , iii , iv , v 29 9 3 7 , 60 6 4 9 , 56 2 5 2 , 61 7 5 8 , 63 2 6 9 , respectively serum factors appear associated inhibition early , may explain decreased fertility rates observed patients minimal mild endometriosis
peritoneal fluid fractions patients endometriosis promote two cell mouse embryo growth peritoneal fluid \( pf \) 10 infertile patients endometriosis , obtained follicular phase cycle laparoscopy , promote two cell mouse embryo growth extent observed fluid obtained seven normal controls five molecular weight \( mw \) fractions obtained ultrafiltration , used media supplement assay compared pf fractions normal controls fractions pf patients endometriosis inhibited mouse embryo growth greater extent normal controls however , mw fractions greater 100 , 000 daltons showed greater inhibition embryo development fractions less 100 , 000 daltons study cell free pf suggests presence humoral factor greater 100 , 000 daltons inhibitory mouse embryo growth
tubal pregnancy treated outpatient laparoscopic knowledge , represents first case laparoscopically treated ep first time double ep tube treated conservatively \( preservation tube \) multiple eps may common currently thought , report offers alternative explanation least cases persistent ep conservative surgical therapy finally , given substantial cost savings reduced postoperative recovery time associated operative laparoscopy , patient stable surgeon experienced , laparoscopic approach tried , regardless number eps size
clinical review 15 management ovulatory disorders pulsatile gonadotropin releasing hormone pulsatile gnrh therapy yet achieve widespread acceptance alternative exogenous gonadotropin therapy women hypothalamic amenorrhea complete gnrh deficiency however , physiologically based replacement regimen pulsatile gnrh used , high rate ovulation conception anticipated patients complete gnrh deficiency hypothalamic amenorrhea women polycystic ovarian syndrome may also benefit pulsatile gnrh , although rates ovulation lower pretreatment gnrh agonist may improve rates considerably , experience limited whether iv sc route administration chosen , simplified clinical monitoring protocol created requires minimum patient monitoring maximum safety seventy five per kg appears reasonable initiating dose , subsequent increases respond frequency gnrh administration best based gnrh pulse frequency normal women however , information needed determine whether variable frequency clearly superior fixed frequency regimen used appropriately , pulsatile gnrh safe , effective , offers excellent alternative conventional gonadotropin therapy women disordered endogenous gnrh secretion importantly , opposed exogenous gonadotropin therapy , pulsatile gnrh administered physicians office setting without necessity line e2 monitoring feature enable patients receive treatment local physicians , whereas exogenous gonadotropin therapy administered appropriately equipped referral centers future , studies required determine categories patients might benefit pulsatile gnrh
serum hcg beta core fragment masked associated macromolecules determine beta core fragment present serum individuals pregnancy choriocarcinoma , samples analyzed gel filtration fractions assessed immunoassays \( mr 15 , 000 \) agreement published reports , minute amounts beta core fragment detected \( less 0 1 hcg level \) small amount beta core fragment activity identified near void volume column \( mr greater 60 , 000 \) high molecular weight material pooled dissociated 3m ammonium , gel filtration repeated much significant beta core fragment peak detected \( mr 15 , 000 \) dissociation , beta core fragment 18 \( mol mol \) hcg level early pregnancy serum , 91 mid pregnancy serum , 50 term pregnancy serum , 1 3 choriocarcinoma serum , pre therapy conclude major form beta core fragment found serum associated macromolecules , mask beta core fragment epitope existing hcg beta antibodies measurements made dissociated beta core fragment complex much keeping pregnancy levels found urine
comparative study changes insulin like growth factor , procollagen iii n terminal extension peptide , bone gla protein , bone mineral content children turner 's syndrome treated recombinant growth hormone six girls \( 7 13 yr old \) turner 's syndrome short stature treated 1 yr recombinant human gh \( 0 15 u kg day , sc \) sequential determinations serum insulin like growth factor \( igf \) , osteocalcin , procollagen iii bone mineral content density spine radius measured treatment 90 360 days two girls received small doses ethinyl estradiol \( 0 025 micrograms kg \) addition gh height velocity increased 144 3 months treatment igf normal \( 0 75 0 20 l \) treatment increased 90 day 1 290 day 360 procollagen iii low treatment peaked 53 0 14 7 micrograms l \( 260 baseline \) day 30 , decreased normal range serum osteocalcin increased slowly reach plateau day 90 23 7 1 2 micrograms l \( 46 baseline \) treatment , bone mineral content spine 25 lower children matched bone age bone mineral contents peripheral axial skeleton increased 10 17 , respectively , 1 yr treatment , increase bone age four patients receive estrogen day 90 , however , although radius mineral density already increased 3 , mineral density lumbar spine significantly decreased 4 conclude treatment gh increases igf , collagen turnover , osteoblastic function , height velocity turner 's syndrome however , bone mineral content 1 yr treatment , early effect gh decrease spine mineral density
adenomyosis women four year experience university medical centre , part quality assurance programme university medical centre , , , hysterectomy specimens reviewed january 1986 december 1989 adenomyosis found 237 \( 56 5 \) specimens studied 237 patients , 232 \( 97 9 \) parous 196 \( 82 8 \) fourth fifth decades life high prevalence parous women aged 40 59 years significant , , endometrial hyperplasia common associated diagnoses associations studied , endometrial hyperplasia significantly prevalent group adenomyosis adenomyosis stated indication surgery 69 patients confirmed histopathology 49 \( 71 \) preoperative suspicion adenomyosis present 49 \( 20 6 \) patients ultimately found disease high prevalence adenomyosis population studied , indicates condition may past , especially difficult diagnose without surgery hysterectomy currently treatment
sodium lauryl sulfate induced irritant contact dermatitis vulvar forearm skin premenopausal postmenopausal women reactivity skin forearm labia majora three concentrations \( 2 , 3 , 5 \) sodium lauryl sulfate studied 20 healthy women , 10 premenopausal 10 postmenopausal patches irritant applied day 0 24 hours skin changes monitored visual scoring measurement transepidermal water loss capacitance indicators stratum corneum hydration days 2 , 3 , 7 , 10 forearm skin , irritant dermatitis developed majority subjects indicated visual scoring increase transepidermal water loss changes significantly dependent concentration sodium lauryl sulfate labia majora skin , irritant dermatitis developed 50 women determined visual scoring however , pigmentation , visual scoring readings less reliable labia majora skin transepidermal water loss increase , significant immediate decrease capacitance noted labia majora skin forearm skin , postmenopausal women reacted less frequently slowly sodium lauryl sulfate premenopausal women whereas age related differences observed reaction vulvar skin concluded labia majora skin reactive sodium lauryl sulfate forearm skin capacitance sensitive transepidermal water loss monitoring vulvar irritant dermatitis age related differences irritant reaction apparent forearm ,
conversion disorder psychosocial factors long believed important pathogenesis emesis \( morning sickness \) \( hg \) although confirmed extensive studies last 30 years , hg never described conversion reaction describe two women presenting clearly fulfill diagnostic criteria conversion suggest strong expressed potentially dangerous symptom subset individuals dynamic interventions role treating certain patients hg
ectopic pregnancy adolescents clinical review pediatricians pediatricians caring sexually active female adolescents young adults need aware history , symptoms , signs ectopic pregnancy thorough history physical examination , including pelvic examination , well specific diagnostic tests repeated quantitative hcg measurements , ultrasonography indicated , crucial proper early diagnosis ectopic pregnancy laparoscopy key early diagnosis include ectopic pregnancy differential diagnosis sexually active female patient abnormal vaginal bleeding abdominal pain early diagnosis , close observation , appropriate management , outcome likely favorable , minimal morbidity risk death
effect interleukin 1 gamete interaction mouse embryo development early stages endometriosis shown associated infertility pathophysiology relationship unclear determine interleukin 1 \( il 1 \) , peritoneal macrophage product , effect gamete interaction early embryo development , human recombinant il 1 added gametes sperm penetration assay \( spa \) , human zona assay \( \) culture medium \( ham 's f 10 \) used processing semen samples layering method , analysis velocity motility 24 hours il 1 also added mouse embryos \( two cells \) cultured 72 hours results showed il 1 caused impairment spa compared control medium , without significant alterations sperm velocity motility also , il 1 demonstrated significant inhibition mouse embryo development results help explain subfertility associated early stages endometriosis
perinatal outcomes twin pregnancies term review two year experience community disclosed 57 twin pregnancies \( 118 207 \) deliver term little attention focused perinatal outcomes twin pregnancies remaining 36 completed weeks therefore , reviewed experience determine whether practice change maximize perinatal care nearly study pregnancies \( 115 117 , 97 5 \) delivered estimated date fetal , failure progress patient 's lack desire vaginal birth cesarean delivery common reasons high cesarean rate \( 62 117 , 52 \) neonatal outcomes favorable regardless route interval deliveries discordant fetal growth found eight cases \( 6 8 \) perinatal deaths occurred , five minute apgar scores less 7 \( 2 234 , 0 9 \) rates anomalies \( 5 234 , 2 1 \) different singleton pregnancies delivering period using principles obstetric practice used community , would expect perinatal outcomes term twin gestations favorable
tubal pregnancy markedly elevated maternal serum alpha fetoprotein case report elevated maternal serum alpha fetoprotein levels reported occur variety pathologic conditions , including early tubal pregnancy case , markedly elevated maternal serum alpha fetoprotein associated tubal pregnancy breakdown normal circulatory barrier , allowing exchange alpha fetoprotein , likely etiology elevation
recall alcohol consumption pregnancy test retest reliability study self reported alcohol use pregnancy , two groups women provided two reports first trimester drinking 3 month interval \( group 1 \) 5 month interval \( group 2 \) women group 1 \( n 91 \) first trimester alcohol consumption fourth month pregnancy seventh month , 3 month recall interval group 2 women \( n 88 \) provided first trimester drinking reports fourth month pregnancy delivery , 5 month recall interval test retest pearson correlation coefficient recall first trimester average daily volume \( \) 61 \( p 000 \) group 1 53 \( p 000 \) group 2 scores grouped five categories , 51 6 group 1 56 8 group 2 remained category test retest leads conclusion self reported alcohol consumption moderately reliable 3 month 5 month time period
hypersecretion hormone , infertility , miscarriage relation follicular phase serum hormone \( lh \) concentrations outcome pregnancy investigated prospectively 193 women regular spontaneous menstrual cycles group included 26 nulliparous 167 women various obstetric histories 147 women lh concentrations less 10 iu l \( normal lh group \) 130 \( 88 \) conceived , whereas 31 \( 67 \) 46 women lh values 10 iu l \( high lh group \) high lh group , 20 \( 65 \) pregnancies ended miscarriage , whereas 15 \( 12 \) pregnancies normal lh group adverse effect high lh concentration fertility outcome pregnancy seen , women previously successful pregnancies , women history recurrent miscarriage data indicate important role hypersecretion lh conception miscarriage finding offers possibility simple predictive test women pregnancy , could also used identify patients endocrine abnormality
frequency costs diagnostic imaging office practice comparison self referring radiologist referring physicians background assess possible differences physicians' practices respect diagnostic imaging , compared frequency costs imaging examinations performed primary physicians used imaging equipment \( self referring \) ordered physicians always referred patients radiologists \( radiologist referring \) methods using large , private insurance claims data base , analyzed 65 , episodes outpatient care physicians acute upper respiratory symptoms , pregnancy , low back pain , \( men \) difficulty respective imaging procedures studied chest radiography , obstetrical ultrasonography , radiography lumbar spine , excretory , , ultrasonography results four clinical presentations , self referring physicians obtained imaging examinations 4 0 4 5 times often radiologist referring physicians \( p less 0 0001 four \) chest radiography , obstetrical ultrasonography , lumbar spine radiography , self referring physicians charged significantly radiologists imaging examinations similar complexity \( p less 0 0001 three \) combination frequent imaging higher charges resulted mean imaging charges per episode care 4 4 7 5 times higher self referring physicians \( p less 0 0001 \) results confirmed separate analysis controlled specialty physician conclusions physicians refer patients radiologists medical imaging use imaging examinations frequently physicians refer patients radiologists , charges usually higher imaging done self referring physician results possible determine group physicians uses imaging appropriately
maternal mortality united states , 1979 1986 understand better epidemiology describe causes maternal death , reviewed identified maternal deaths united states puerto rico 1979 1986 overall maternal mortality ratio period 9 1 deaths per 100 , 000 live births ratios increased age higher among women black minority among white women age groups causes death varied different outcomes pregnancy pulmonary embolism leading cause death live birth unmarried women higher risk death married women risk death increased increasing live birth order , except order develop strategies reduce risk maternal death united states , future studies include expanded information death , allow better understanding factors associated maternal mortality
maternal hemodynamics normal pregnancies longitudinal study preeclampsia disease unique pregnancy contributes substantially maternal fetal morbidity mortality condition thought one hypoperfusion increased vascular resistance characterizes associated hypertension study designed test alternative hypothesis , preeclampsia characterized high cardiac output blinded longitudinal study uncomplicated pregnancies , cardiac output measured serially doppler technique cardiac output elevated throughout pregnancy patients became \( p 006 \) six weeks postpartum , hypertension subjects resolved cardiac output remained elevated \( p 001 \) peripheral resistance remained lower normotensive subjects \( p 001 \) study demonstrates preeclampsia disease systemic hypoperfusion challenges current models disease based assumption
pregnancy liver transplantation define risks outcomes associated pregnancy liver transplantation , reviewed experience managing eight pregnant women undergone orthotopic liver transplantation seven patients conceived transplantation interval transplantation conception ranged 3 weeks 24 months one patient received allograft 26 weeks' gestation hepatic failure secondary acute fulminant hepatitis b seven patients conceived transplantation , six live births one terminated pregnancy five patients developed worsening hypertension preeclampsia three patients developed severe preeclampsia required delivery one patient suffered acute allograft rejection pregnancy successfully treated corticosteroids two patients persistent elevation serum transaminases two severe anemia mean gestational age delivery 32 8 weeks six live births women conceived transplantation , five infants survived well one infant died congenital anomalies mothers alive time pregnancy recipients hepatic allografts associated good perinatal outcome , increased risk preeclampsia , worsening hypertension , preterm delivery pregnancy appear deleterious effect hepatic graft function survival joint management patients transplant specialist essential
objective identifies labor onset earlier subjective maternal perception ability women self detection uterine contractions identify abrupt rise uterine activity known precede onset labor evaluated study designed assess temporal relationship objective uterine activity monitoring , subjective maternal perception uterine activity commonly used threshold value \( four contractions per hour \) , progressive cervical change daily \( 7 9 \) recorded 79 women preterm premature rupture membranes admission onset spontaneous labor \( 5 3 6 3 days \) subjects bed rest , received therapy , signs labor uterine self palpation patients simultaneously provided subjective assessment uterine activity \( four contractions per hour \) majority uterine activity recordings \( 78 \) revealed fewer four contractions per hour , patients' subjective reports agreed almost instances \( 97 6 \) 91 days , four contractions per hour recorded objectively , patients' subjective reports agreed 25 instances \( 27 \) day labor onset , significantly women objective assessment \( 32 \) \( p less equal 01 \) patients subjectively identified labor onset 10 6 6 7 hours objective monitoring indicated increased uterine activity , subjectively identified , cervical dilatation \( 4 9 2 5 cm \) \( 85 30 \) significantly advanced \( p less equal 001 \) compared admission examination \( 1 1 1 2 cm 20 30 \)
effect angiotensin ii infusion normal pregnancy flow velocity waveforms uteroplacental umbilical circulations women develop preeclampsia show increased systemic pressor response infused angiotensin ii , angiotensin sensitivity test accepted appropriate means identifying women however , effect angiotensin ii infusion uteroplacental blood flow unknown may deleterious patients undergoing angiotensin sensitivity tests part protocol examining effect aspirin incidence preeclampsia studied doppler velocimetry performed angiotensin ii infusion fetal well documented profiles performed infusions neither systolic diastolic ratios uterine umbilical arteries profile scores altered significantly \( p 43 , p 23 , wilcoxon signed rank median test , p 35 , fisher exact test , respectively \) findings suggest angiotensin sensitivity test increase resistance flow uterine umbilical circulation , therefore may used safely screening preeclampsia
serum estradiol aid diagnosis ectopic pregnancy value serum beta hcg measurement diagnosis ectopic pregnancy well established , recent studies use serum progesterone levels however , unable find reports potential application serum estradiol \( e2 \) assays diagnosis ectopic pregnancy therefore concurrently measured serum e2 , progesterone , beta hcg 100 women ectopic pregnancies , well 69 controls normal intrauterine pregnancies 36 women threatened abortion mean \( standard deviation \) e2 levels ectopic pregnancy patients , normal controls , women threatened abortion 1 115 6 , 2 45 5 , 8 40 6 pg ml , respectively mean levels ectopic group significantly different \( p less 0001 \) two groups one ectopic pregnancies values pg ml e2 23 ng ml progesterone , one normal intrauterine pregnancies values levels data suggest addition estradiol assay , without progesterone , early evaluation patients suspected ectopic pregnancy may helpful diagnosis
menorrhagia excessive vaginal bleeding , menorrhagia , one common presenting symptoms gynecologic patients although disorder many possible etiologies , generally possible approach diagnosis management fashion evaluating patient , important work toward differential diagnosis includes pregnancy related causes , hormonal problems , iatrogenic etiologies , mechanical intrauterine disorders , infections lower genital tract , gynecologic cancers \( \) differential approach guide types historical data obtained patient , focus physical examination , alert practitioner appropriate laboratory radiologic evaluation therapy differ widely , depending cause bleeding types menorrhagia respond medical therapy oral contraceptives , oral synthetic estrogens , long acting intramuscular gnrh agonists surgical approaches , dilatation curettage hysterectomy , less less first line therapy innovative surgical techniques laparoscopic surgery becoming increasingly important rapid , goal directed diagnosis specific therapy , medical complications , anxiety , discomfort suffered woman menorrhagia quickly
abnormal bleeding years , encounter situation normal diminution reproductive capacity , resulting disruption normal menstrual hormonal pattern , coincides real risk pelvic pathology limitation ability diagnose treat patients conservatively past resulted high rate hysterectomy increased understanding normal physiology stage transition improved diagnostic tools , able come definitive diagnosis patients ability assure diagnosis made much easier counsel patient appropriate course action continue encounter problem hysterectomy bleeding histologic lesion found although may considered unnecessary side , improved practice resulted efforts gives strong support continued activities confidence treatment plan evolved logical manner offers patients high probability benefit risk
congenital perinatal cytomegalovirus infections cytomegalovirus common cause congenital perinatal viral infections throughout world congenital infection occurs 1 live births developed countries even higher percentage developing result transmission birth , breast milk , blood transfusion , perinatal infections much prevalent congenital infections vast majority infections chronic , subclinical forms , symptomatic infections sufficiently prevalent dangerous represent major public health problem throughout world review epidemiologic , clinical , immunologic , therapeutic facets infections pregnant women offspring discussed
human oocyte donation evolving method treatment infertility utilization oocyte donation treatment infertility recently expanded since 1983 , modifications retrieval donated female gametes enhanced safety efficacy procedure pregnancy rates women receiving donated remarkably high , success occurring 25 50 transfer cycles technology used donation continues evolve , current future role donation treatment infertility
effect physical activity pregnancy preterm delivery birth weight relationship physical activity pregnancy , preterm birth , gestational age adjusted birth weight investigated prospectively cohort women study one evaluate employment non employment related physical activity prolonged periods standing associated modestly increased risk preterm delivery \( adjusted odds ratio greater equal 8 hours day standing 1 31 \) heavy work exercise associated preterm delivery \( adjusted odds ratio greater equal 4 hours per day heavy work 1 04 \) proportion infants born preterm differ among women working predominantly standing , active , sedentary occupations physical activity associated gestational age adjusted birth weight controlling confounding variables data suggest socioeconomic differences among women reporting different levels activity may account previously described associations physical activity pregnancy outcome pregnant women report increased levels physical activity increased risk preterm delivery reduced intrauterine growth however , data address role activity restriction management selected women high risk adverse pregnancy outcome
continuous interrupted fascial closure prospective evaluation 1 suture gynecologic procedures 14 month period using long term absorbable suture \( 1 \) , patients entered prospective , randomized trial fascial closure patients randomized continuous closure \( 201 patients \) interrupted en bloc \( 201 patients \) technique patient subjected preoperative intraoperative protocol wound management acute wound failures wound infection rates risk hernia apparently affected closure technique
corpus luteum function early pregnancies primarily determined rate change human chorionic gonadotropin levels regulation human corpus luteum activity studied radioimmunoassays sera drawn serially women suspected ectopic pregnancies progesterone values exhibited considerable overlap pregnancies subsequently classified normal intrauterine \( n 21 \) , ectopic \( n 35 \) , spontaneous abortion \( n 14 \) rate change human chorionic gonadotropin concentration significantly correlated progesterone levels ectopic \( r 0 64 \) pregnancies \( r 0 70 \) correlation \( r 0 18 \) rate change human chorionic gonadotropin bioactivity produced per volume serum ectopic pregnancies normal intrauterine pregnancies differ ratio vivo bioactivity immunoactivity data conclude corpus luteum activity primarily regulated rate change human chorionic gonadotropin concentration , without involvement serum factors also conclude reduced corpus luteum function ectopic pregnancies result biochemical modification human chorionic gonadotropin molecule finally , use single progesterone values screening ectopic pregnancies considerable overlap progesterone values among normal intrauterine pregnancies
perinatal impact cocaine , amphetamine , opiate use detected universal intrapartum screening universal urine testing cocaine , , opiates performed women admitted obstetric service 1 year period 20 5 positive results patients positive toxicology results matched race discharge date patients negative toxicology drug history significant differences age , prior obstetric history , prenatal care , alcohol history , smoking noted groups significant decrease birth weight , head circumference , length , gestational age drug positive group , marked cocaine multiple drug users differences persisted controlled smoking , prenatal care , prior preterm births differences birth weight head circumference remained controlled gestational age rates congenital anomalies placental similar groups perinatal substance abuse independently associated growth retardation prematurity multiple risk factors frequently present , necessitating comprehensive approach prenatal care
reappraisal need autologous blood donation obstetric patient recent interest autologous blood donation obstetric patients , little attention paid whether programs needed whether patients require transfusion accurately predicted university california san medical center july 1 dec 31 , 1988 , deliveries 13 women \( 0 57 \) received blood transfusions traditionally accepted risk factors identified 251 patients , four \( 1 6 \) requiring transfusion among 150 patients delivered repeat cesarean section , one \( 0 7 \) required blood one 27 \( 3 7 \) multiple gestations , two eight \( 25 \) patients placenta , none 66 women transfusions data suggest autologous blood donation may beneficial cost effective low frequency blood transfusions high risk obstetric population difficulty accurately predicting likely require transfusions considered
direct ultrasonographic measurement fetal lung length normal pregnancies pregnancies complicated prolonged rupture membranes fetal lung length measured directly ultrasonography 20 patients prolonged rupture membranes , 25 weeks' gestation measurements made weekly compared data collected 310 normal pregnancies measurement fetal lung length ultrasonography good predictor pulmonary hypoplasia , predicting greater 90 cases good correlation lung size assessed last ultrasonographic examination lung weight postmortem \( r 0 , p less 0 05 \) lung length measurements superior fetal chest circumference measurements identification pulmonary hypoplasia significant negative association amount amniotic fluid pulmonary hypoplasia \( p less 0 05 \) fetuses pulmonary hypoplasia respiratory movements seen majority ultrasonographic examinations
screening trisomy 21 ultrasonographic determination biparietal diameter femur length ratio ultrasonographic determination biparietal diameter femur length ratios performed 16 17 weeks' gestation fetuses trisomy 21 statistically different 155 normal fetuses appears test could used screening trisomy 21
prior cesarean delivery women secondary tubal infertility history cesarean delivery evaluated population based case control study secondary infertility king county , washington sixty one married women diagnosed secondary infertility due tubal problems previous viable pregnancy compared 343 married women previous viable pregnancy live birth conceived time infertile women began conceive risk tubal infertility substantially elevated women previous cesarean delivery recent viable pregnancy compared women vaginal delivery \( odds ratio 1 2 95 confidence interval 0 4 , 3 7 \)
clinical evaluation clonidine added lidocaine solution epidural anesthesia effects clonidine added lidocaine solution used epidural anesthesia assessed 92 women scheduled surgery diazepam 10 mg po patients received 18 ml 2 lidocaine clonidine 5 micrograms ml 1 \( group c 5 , n 26 \) , clonidine 10 micrograms ml 1 \( group c 10 , n 20 \) , epinephrine 5 micrograms ml 1 \( group e , n 26 \) , plain \( group p , n 20 \) significant difference number segments analgesia found observation period among four groups patients decreases mean blood pressure \( bp \) observed 20 min epidural injection given clonidine \( 5 8 c 5 , 10 11 c 10 , mean sd \) similar given plain lidocaine \( 7 12 \) significantly less given epinephrine \( 18 12 , p less 0 01 vs c 5 p \) response bp given restoring bp anesthesia attenuated patients received epidural clonidine heart rate \( hr \) decreased significantly patients given clonidine 10 micrograms ml 1 \( 7 8 , p less 0 01 \) , given clonidine 5 micrograms ml 1 , whereas hr increased significantly given lidocaine plain epinephrine \( 10 8 28 14 , respectively , p less 0 01 \) incidence sinus bradycardia similar among four groups patients significant differences also observed sedation score clonidine groups groups p e sedation appeared approximately 10 20 min epidural injection clonidine groups
genetic familial predisposition eclampsia pre eclampsia defined population familial predisposition patterns genetic inheritance eclampsia pre eclampsia investigated three four generations 94 families island population families index women delivered years 47 either eclampsia \( n 38 \) severe pre eclampsia \( n 69 \) inheritance followed sons daughters prevalence pre eclampsia eclampsia daughters significantly higher \( 23 \) daughters law \( 10 \) difference noted prevalence diseases whether daughter born eclamptic pre eclamptic mother whether first later born daughter non significantly higher occurrence pre eclampsia among grand daughters grand daughters law difference seen whether grand daughters sons daughters increasing numbers affected daughters grand daughters probability rose finding affected women family hypotheses single recessive dominant gene inheritance compared maximum likelihood estimates gene frequency obtained single recessive gene model 0 31 reflecting population prevalence 9 6 , whereas dominant model incomplete penetrance gave 0 14 48 gene penetrance , corresponding population prevalence 0 9 homozygous expression severe disease 11 heterozygous expression milder disease either genetic model could fit data
experience steroid replacement regimen establishment receptive endometrium women premature ovarian failure eighteen women premature menopause underwent assessment serial serum oestradiol \( e2 \) progesterone levels endometrial histology function patients received continuous transdermal e2 , progesterone either orally vaginally 14 days physiological levels e2 attained significantly higher levels progesterone achieved vaginal progesterone \( p less 0 01 \) endometrial biopsies obtained e2 replacement demonstrated normal proliferative features expression oestrogen related antigen \( er ag \) localized cytoplasm epithelium 3 days progesterone replacement endometrium showed normal secretory features expression er ag stroma well glands 7 days progesterone supplementation , vaginal administration produced consistent physiological appearance oral administration thus transdermal e2 combined vaginal progesterone highly satisfactory combination establishing physiological endometrium women premature ovarian failure
rate rise releasing factor endogenous digoxin like immunoreactivity normal abnormal pregnancy maternal plasma concentrations releasing factor \( crf \) endogenous digoxin like immunoreactivity \( \) estimated 80 normal 88 abnormal pregnancies sampled sequentially 24 weeks gestation delivery slope fitted woman 's antenatal crf values , rose significantly gestation , mean slopes normal abnormal groups value compared evidence significant mean differences groups evidence significant mean difference crf \( p less 0 05 \) adjustment variables may affect pregnancy outcome , slopes crf found significantly related outcome
new method dressing free skin grafts using adhesive disposable suction drain , new method dressing free skin grafts devised graft compressed pressure equivalent negative pressure suction drain method apply uniform constant pressure graft moreover , graft observed existence hematomas detected easily
serum concentrations ca 125 propeptide type iii procollagen \( piiinp \) patients endometrial carcinoma serum ca 125 \( marker epithelial cells \) propeptide type iii procollagen \( piiinp indicator collagen metabolism \) concentrations measured 148 patients endometrial carcinoma initial serum concentration ca 125 pathologic 17 patients , frequency abnormal values higher \( p 0 0001 \) advanced \( 63 \) early disease \( 10 \) serum piiinp concentration increased 35 patients often \( p less 0 05 \) advanced \( 63 \) early disease \( 31 \) among patients , least one tumor markers increased 43 cases early disease 12 108 patients contracted recurrent cancer accuracy pathologic ca 125 \( 9 \) piiinp \( 18 \) concentrations prediction poor total material , pathologic ca 125 piiinp concentrations appeared simultaneously 11 patients , eight poor prognoses monitoring treatment response 24 patients , regression accompanied normal decreasing ca 125 piiinp values persistence pathologic ca 125 piiinp concentration predicted relapse malignancy progressive disease , ca 125 piiinp concentrations together separately remained pathologic level increased continuously clinically stable endometrial carcinoma , ca 125 gave false negative results 71 determinations piiinp 12 current results suggest use ca 125 piiinp , simultaneously , monitoring clinical course advanced endometrial carcinoma
comparison endometrial biopsy urinary pregnanediol glucuronide concentration diagnosis luteal phase defect determine pregnanediol glucuronide \( pg \) excretion useful luteal phase assessment , compared daily first morning urinary pg concentrations luteal phase nine normal nine deficient cycles total luteal pregnanediol excretion \( 44 1 11 3 versus 64 0 11 6 area units sem \) different however , significantly less pregnanediol excreted abnormal group 1st 5 days luteal phase \( 12 7 1 2 versus 18 0 1 7 area units sem , respectively \) thus , delayed pg excretion may characteristic luteal phase defect measurement urinary pg may useful daily samples early luteal phase obtained
evaluation stimulated menstrual cycle magnetic resonance imaging changes uterine zonal anatomy six women cycle treatment citrate studied magnetic resonance imaging rapid rate increase endometrial thickness period similar pattern seen prior study women normal \( \) cycles junctional zone thickness parallel endometrial pattern differed response seen cycles results large scale studies may help understand effects medications
basal body temperature endometriosis investigation examined association pelvic endometriosis altered basal body temperature \( \) study population consisted infertile women diagnosed endometriosis significant association found presence pelvic endometriosis \( without previous treatment \) appearance late decline early follicular phase menstrual cycle temperature greater 97 8 degrees f first 3 days menses associated pelvic endometriosis findings study support early clinical diagnosis endometriosis infertile women basal body temperature chart analysis may useful clinical adjunct endometriosis suspected
home monitoring gonadotropin ovulation induction using ovarian monitor safe use gonadotropins relies close hormonal ultrasound monitoring assess response treatment , requiring multiple hospital visits home monitoring ovarian monitor \( st research foundation , , , australia \) minimizes hospital visits many logistic difficulties associated gonadotropin use utilizes system enzyme immunoassay using lysozyme conjugates measure quantitatively either urinary estrone 3 pregnanediol 3 glucuronide results obtained 24 patients 57 cycles using ovarian monitor home correlate closely results obtained laboratory \( estrone 3 glucuronide r 0 pregnanediol 3 glucuronide r 0 \) cycle outcomes \( ovulation , 74 cycle clinical pregnancy , 30 cycle multiple pregnancy , 13 pregnancy , 11 cycle \) different achieved laboratory monitored patients home monitoring safe effective laboratory monitoring , offers significant social benefits , improves access form therapy
cryopreserved thawed semen vitro fertilization results fertile donors infertile patients evaluated vitro fertilization \( ivf \) outcome 54 cycles using cryopreserved thawed semen fertile donors controls ivf patients matched time frame , female age , stimulation protocol , number pre embryos transferred , absence male factor using freshly normal semen samples study group controls , respectively , post motility 83 1 89 5 fertilization rate oocytes \( 91 8 , 95 7 \) ongoing pregnancy rate \( pr \) per transfer \( 21 1 , 25 0 \) similar excellent fertilization rate frozen thawed semen achieved high concentration insemination \( 0 5 x 10 \( 6 \) motile sperm ml \) use frozen thawed samples infertile men \( normal samples \) , pr similar fertilization rate lower cryopreserved semen valuable option infertile couples ivf therapy
correlation quantitative antibody titers sperm antibodies pregnancy rates treatments immunological infertility women possessed sperm \( si \) antibodies made difficult conceive using usual treatments examined si antibodies quantitative sperm immobilization test found antibody titers \( 50 sperm immobilization unit si50 unit \) associated pregnancy rates patients high si50 titers \( greater 10 units \) conceive ordinary repeated artificial husband 's semen \( \) except treated vitro fertilization \( ivf \) embryo replacement patients relatively low si50 titers \( less 10 units \) could conceive either repeated ordinary , though success rates lower ivf embryo replacement important assess si50 titers quantitative method select treatments infertile women si antibodies follow studies patients conceived successfully , found si50 titers tended decline pregnancy
twin pregnancy diagnosis treatment ectopic implantation retrograde selective intraluminal methotrexate injection case report , patient right tubal pregnancy managed new procedure combining retrograde local mtx injection twin pregnancy occurred shortly treatment conclude retrograde tubal cannulation may provide alternative method diagnosis treatment selected eps
establishment pregnancies humans transcervical transfer gametes immediately oocyte retrieval study , like et al demonstrates feasibility direct intrauterine transfer gametes initiating pregnancy whether success procedure improved modification \( preincubation , vitro insemination \) remains subject continued investigation uncertainty , feel transcervical transfer gametes may alternative ivf patients ethical concerns regarding ivf
distal tubal obstruction prognostic factors impact surgical technique reviewed clinical records women underwent microsurgical terminal distal tubal obstruction january 1983 june 1988 identified 95 women whose preoperative evaluation revealed contributory factors infertility analyzed pregnancy outcome procedure pregnancy success inversely related extent tubal distortion \( dilation , integrity , status \) degree adnexal adhesions using classification system distal tubal obstruction , patients mild disease 80 pregnancy rate , whereas patients moderate severe disease 31 16 success rate , respectively found statistically significant difference pregnancy outcome compared series previous group , reported 1978 , contemporary microsurgical technique used although feel optimal surgical technique important maximize success , conclude important prognostic factor pregnancy outcome distal tubal disease anatomical functional integrity tube
repair uterine cavity hysteroscopic septal incision performed follow multiple biopsies different intervals surgery 19 women underwent hysteroscopic septal incision seven days operation sectioned areas evident \( 3 patients \) 14 days , incised zone depressed scattered epithelialization \( 5 subjects \) 1 month , sectioned surfaces still depressed uniformly covered thin endometrium \( 5 cases \) 2 months uterine cavity almost normal minimal tendency central adhesions \( 6 women \) thus , spontaneous healing processes hysteroscopic progressed regularly completely probably reason delay attempts pregnancy longer two cycles surgery
ultrasound guided transcervical new technique described septum divided 4 mm endoscopic introduced uterine cavity cervix whole procedure monitored real time ultrasound scanner twenty four patients operated technique complication encountered fifteen patients third trimester deliveries ongoing pregnancies among 12 patients suffered repetitive pregnancy losses , 11 desired pregnancy 10 successfully pregnant beyond second trimester \( 91 7 \) , 8 delivered , living birth rate 72 7 results equal obtained hysteroscopic procedure short , safe , requires special equipment , concomitant laparoscopy
c reactive protein assessing antimicrobial treatment acute pelvic inflammatory disease serial serum c reactive protein \( crp \) determinations used evaluation antimicrobial treatment acute pelvic inflammatory disease \( pid \) proven laparoscopy endometrial biopsy findings upper genital tract 36 women sixteen patients treated ciprofloxacin 20 doxycycline plus metronidazole mean crp levels differ significantly patients severe moderate salpingitis comparison mild salpingitis admission treatment , significant difference mean crp levels patients acute chlamydial gonococcal pid mean crp levels decreased third day treatment treatment groups , decrease sixth day treatment significant \( p less 05 \) , reflecting clinical response therapy faster serial esr determinations documentation acute pid , serial serum crp determinations useful predictor short term response antimicrobial therapy
initiating chorionic villus sampling program placental location primary determinant sampling route initiating chorionic villus sampling \( cvs \) protocol , relied upon placental locations determinant choice technique anterior location prompted \( ta \) cvs , transcervical \( tc \) approach reserved posterior placentas needle system used ta cvs \( 18 gauge , 15 cm guide needle 20 gauge , 20 cm sampling needle \) , tc cvs accomplished 5 8 french , 27 cm polyethylene catheter july 1988 february 1989 initial 118 procedures performed 115 consecutive pregnancies using protocol testing indications antenatal characteristics ta \( n 56 \) tc \( n 63 \) groups similar one procedure failure occurred tc group , single aspiration sufficient 59 cases \( ta , 30 55 tc , 39 63 \) tc procedures increased aggregate sample weight observed compared ta cases \( 25 8 g vs 16 9 g , respectively p less 001 \) difference attributable increased number placental tc cases one abnormal karyotype observed \( \) , four pregnancy losses occurred \( tc , 3 ta , 1 \) using placental location determine choice cvs technique appears feasible may associated lower failure rate facility 's initial experience \( compared reliance upon one technique alone \) trials comparing safety two methods consider placental location independent variable randomization
aggressive evaluation atypical squamous cells papanicolaou smears retrospective study done women atypical papanicolaou smears referred immediate colposcopy smears obtained january 1985 march 1989 edwards air force base , california excluded evaluation abnormal papanicolaou smears , atypia suggestive human papillomavirus \( hpv \) infection evaluation included colposcopy , directed biopsies , endocervical curettage repeat papanicolaou smears total 101 patients included study cervical intraepithelial neoplasia \( cin \) seen 29 7 \( 30 patients \) 12 9 \( 13 \) cin , 12 9 \( 13 \) cin ii 3 9 \( 4 \) cin iii carcinoma seen 3 9 \( 4 \) patients 2 9 \( 3 \) carcinoma situ , 0 99 \( 1 \) invasive squamous cell carcinoma , stage iib hpv dysplastic lesions seen together 19 8 \( 20 \) patients hpv seen alone 45 \( 46 \) twenty one patients \( 20 8 \) apparent lesions colposcopy , although one developed microinvasive squamous cell carcinoma within 36 months colposcopy many significant lesions go undetected extended periods time women atypical papanicolaou smears , resulting delayed management referral immediate colposcopy advocated strongly
intrapartum cocaine use case report use cocaine pregnancy appears reaching epidemic proportions first reported case intrapartum cocaine use , fetal heart rate abnormalities detected
measurement activity urea resistant neutrophil alkaline phosphatase antenatal screening test 's syndrome objective investigate value measuring maternal urea resistant neutrophil alkaline phosphatase activity antenatal screening test 's syndrome design case control study blood samples collected nine 27 weeks pregnancy setting antenatal clinics london oxford patients 72 women whose fetuses diagnosed amniocentesis chorionic villus sampling 's syndrome 156 women whose fetuses syndrome singleton pregnancies studied main outcome measure activity urea resistant neutrophil alkaline phosphatase measured results median enzyme activity index patients 1 65 times expected median controls duration pregnancy \( p less 0 0001 95 confidence interval 1 56 1 74 \) cut value identified 5 control patients highest activities yielded rate detection 's syndrome 79 \( 95 confidence interval 70 89 \) conclusion activity urea resistant neutrophil alkaline phosphatase effective maternal blood marker 's syndrome use antenatal screening could lead substantial improvement detection disorder introducing test routine medical practice automated used large scale less subjective
expression rat prolactin like protein b pseudopregnant rat early pregnancy rat prl like protein b \( rplp b \) complementary dna \( cdna \) , originally cloned late term placental library , transcripts tissue artificially produced pseudopregnant rats expression rplp b first observed 48 h \( pseudopregnancy day 7 \) stimulus increases maximum 96 120 h \( pseudopregnancy day 9 10 \) situ hybridization studies show rplp b specifically cells tissue day 9 pseudopregnant rats homologous cells embryo trophoblastic structure day 9 pregnancy temporal study expression rplp b pregnancy shows rplp b concomitantly expressed cells maternal origin fetal origin around day 13 pregnancy
preliminary characterization angiogenic activity media conditioned cells luteinized rat ovaries angiogenic activity detected media conditioned ovarian cells , pseudopregnant \( human treated \) immature rats media conditioned cells luteinized rat ovaries stimulated directed migration rabbit endothelial cells mouse balb cells , mitogenic either cell type activity associated steroid indicated finding chemoattractant activity detected fractions reversed phase chromatography , removes 95 steroids present media , chemoattractant activity precipitated ammonium sulfate ethanol full chemoattractant activity recovered \( 95 c 30 min \) , , dialysis , sephadex g 25 columns , ph changes 3 10 sephadex g 200 chromatography , chemoattractant activity emerged elution volumes corresponding 20 , 000 30 , 000 mol wt chemoattractant activity retained concanavalin sepharose gelatin sepharose , partially retained heparin chemoattractant activity also partially retained cation anion exchange columns collective findings indicate presence nonsteroidal , heat stable , sensitive factor , nominal mol wt 20 , 000 30 , 000 , media conditioned cells luteinized rat ovaries factor mitogenic endothelial cells ovarian derived chemoattractant activity appears distinct fibroblast growth factor lacked detectable mitogenic activity , fibroblast growth factor active cell migration bioassay stimulation endothelial cell migration key event angiogenesis , demonstration ovarian chemoattractant consistent hypothesis angiogenesis factors play role paracrine regulation ovarian function
transplantable rat choriocarcinoma cells express placental lactogen identification placental lactogen immunoreactive protein messenger ribonucleic acid purpose investigation evaluate abilities transplantable rat choriocarcinoma \( rcho \) produce placental rcho tumor analyzed biochemically histologically expression placental expression placental prl mrnas determined northern blot situ hybridization analyses expression placental prl proteins determined western blot immunocytochemical analyses histologically , rcho tumors characterized appearance giant cell surrounding hemorrhagic regions female rats bearing rcho tumor beneath kidney capsule showed extensive mammary gland development rcho tumors expressed placental lactogen \( pl \) mrna protein , evidence placental lactogen ii \( pl ii \) , prl like protein \( plp \) , prl like protein b \( plp b \) rcho pl mrna proteins migrated 1 kilobase species 36 40 kda species similar expressed normal rat trophoblast tissues cell type responsible rcho pl production giant cell , similar observed normal rat trophoblast tissues summary , demonstrated production pl transplantable rat choriocarcinoma \( rcho \) rcho tumor resembles rat trophoblast tissue early stages \( days 6 10 gestation \) may useful tool studying placental prl expression trophoblast differentiation
use rectus abdominis myocutaneous flaps following excision vulvar cancer rectus abdominis myocutaneous flaps used 16 women following radical excision extensive vulvar cancer two women procedure part primary surgery , 11 recurrence vulvar cancer three symptomatic palliation fifteen \( 94 \) grafts took primary healing thirteen 16 patients alive 6 60 months \( median 29 months \) surgery three died benefited symptomatic palliation simultaneous vulvar reconstruction allows good cosmetic rehabilitation important part armamentarium management patients advanced primary recurrent vulvar carcinoma technique offers excellent surgical clearance massive painful vulvar tumors
morphological immunological study human placental bed biopsies miscarriage placental bed biopsies examined three groups pregnant women maternal vascular response well presence cells associated local immunosuppression activity group women undergoing legal abortion , histological appearance trophoblastic invasion normal one , proportion cells also normal missed miscarriage group histological appearances abnormal except one patient women history recurrent miscarriage immunization , normal defective others cells appeared diminished number , although correlation cytotoxic status sera pregnancy outcome
ovarian response exogenous gonadotropins pregnancy multiple ovarian follicles successfully induced patient undergoing gamete intrafallopian transfer \( gift \) procedure despite presence undiagnosed ectopic pregnancy gonadotropin releasing hormone agonist \( gnrh \) treatment coupled mechanical contraception previous cycle patients patent tubes
establishment donation program using simple fixed dose estrogen progesterone replacement regimen donation \( od \) programs involve cycle recipient donor normally cycling recipients complex estrogen progesterone replacement regimen recipients ovarian failure 1987 , \( 1 \) suggested use fixed dose estrogen progesterone regimen recipients normally ovulatory ovarian failure following protocol , still , authors administered 6 mg estradiol valerate \( e2 \) daily orally starting day 2 6 induced withdrawal bleeding , augmented 100 mg progesterone ethyl oleate \( p \) intramuscularly daily , starting time 4 days prior day oocyte pickup recipients underwent embryo transfer 2 \( \) 10 cell stage group 21 patients underwent 26 treatment cycles , resulting 16 pregnancies twelve patients gave birth , one , two twins , nine four patients first trimester pregnancy
value elderly women prior vitro fertilization embryo transfer \( ivf et \) comparative study two hundred eighty four performed 312 \( 91 \) candidates vitro fertilization embryo transfer \( ivf et \) divided two groups group consisted elderly women 40 years , group ii women age although visualization revealed uterine abnormalities 29 9 patients , abnormal findings significantly increased former group comparison latter \( p less 0 001 \) difference attributed mainly uterine rather cervical pathology furthermore , elderly women age related uterine pathology , endometrial hyperplasia , polyps prominent , younger patients uterine lesions adhesions tubal occlusion common moreover , treatment prior ivf et resulted 7 clinical pregnancies \( 8 9 \) group 41 clinical pregnancies \( 19 9 \) group ii , failed one three cycles previously seems hysteroscopic evaluation may reduce ivf et failure rate due intrauterine abnormalities elderly well young patients , thus becomes absolute prerequisite patients scheduled ivf program
gamete intrafallopian transfer \( gift \) women uteri fourteen women uteri underwent total 30 gamete intrafallopian transfer procedures patients responded adequately ovarian stimulation eight women conceived , two twice five women delivered term three premature delivery one spontaneous abortion ectopic pregnancy neonatal deaths occurred series increase incidence spontaneous abortion noted appeared increase incidence premature labor findings suggest prospects conception infertile women uteri treated gamete intrafallopian transfer similar rest infertile population treated center
interobserver variation histopathological grading cervical dysplasia order assess variability among grading cervical dysplasia , four experienced examined set 106 biopsy specimens assigned one five diagnostic categories dysplasia , mild dysplasia , moderate dysplasia , severe dysplasia carcinoma situ discuss grading criteria considerable disagreement among pathologists group kappa 0 28 , weighted group kappa 0 56 appeared grades dysplasia equally difficult distinguish adjacent categories various explanations interobserver variation put forward
ultrasonic integrated backscatter two dimensional imaging evaluation mode guided acquisition immediate analysis 55 consecutive patients shown previously cardiac cycle dependent integrated backscatter characterizes physical state myocardium patients ischemic heart disease cardiomyopathy present study clinical applicability mode guided two dimensional integrated backscatter imaging defined evaluation 55 nonselected patients mean amplitude cyclic variation integrated backscatter normal segments \( long axis view \) follows basal septum , 4 2 1 3 db \( mean sd n 27 \) , mid septum , 4 5 1 0 db \( n 26 \) , basal posterior , 4 8 1 0 db \( n 30 \) , mid posterior , 4 8 1 2 \( n 27 \) respective mean delay values \( r wave nadir \) follows 0 89 0 09 , 0 84 0 09 , 0 86 0 09 , 0 85 0 12 least one cardiac cycle could analyzed fully 62 patients limitations included technically difficult two dimensional echocardiography , inadequate line orientation , technically remediable errors , poor quality integrated backscatter images abnormal segments \( n 13 \) cyclic variation reduced delay prolonged \( 1 2 1 1 db 1 21 1 1 , respectively \) intraobserver interobserver variability amplitude measurements modest , respective correlation coefficients r 0 93 r 0 72 findings demonstrate mode assisted integrated backscatter practical approach characterization regional myocardial properties promptly bedside large portion patients cardiac disease
left right ventricular flows doppler echocardiography serial measurements patients aortic regurgitation exercise , cold pressor stimulation , vasodilation test doppler echocardiography measure serial change , biventricular outputs measured 15 patients aortic regurgitation control periods interventions bicycle exercise , cold pressor stimulation , vasodilation biventricular stroke volumes measured 10 normal subjects validation methods differed 2 8 reading errors 3 7 signal quality improved first last observation \( p less 0 05 \) velocity signals corrected intercept angles , averaged 12 19 degrees right heart flows 31 32 degrees left side heart subjects negative correlations occurred intercept angles chronologic order patients studied left \( p 0 02 \) right \( p 0 05 \) flows mean flow areas varied 9 left ventricle 20 right ventricle total variability measuring flow determined control values 11 13 twice variability used detectable level change , exercise provoked real increases biventricular flows majority patients conclude serial measurements flow doppler echocardiographic methods exceed 20 25 achieve significant change measuring intercept angle , resolving flow area , learning variables need greater emphasis
flow patterns dilated cardiomyopathy pulsed wave color flow doppler study 48 patients dilated cardiomyopathy , pulsed wave color doppler examination performed addition , 14 normal patients served control subjects peak inflow velocity level mitral valve , middle left ventricle , apex outflow velocity level apex , middle left ventricle , subaortic area measured normal patients brisk propagation inflow velocity apex patients dilated cardiomyopathy demonstrated delayed propagation prolongation duration inflow compared control subjects \( p less 0 04 \) continuous apical flow visualized 25 dilated cardiomyopathies normal patients apical velocities significantly increased cardiomyopathies significant mitral regurgitation outflow velocities decreased dilated cardiomyopathy patients dilated cardiomyopathy apical , flow directed toward base measured middle left ventricle isovolumic relaxation secondary dyskinetic rebound patterns abnormal flow dilated cardiomyopathies readily apparent color mode two dimensional color doppler
prevalence aortic regurgitation color flow doppler relation aortic root size determine whether correlation aortic root size prevalence aortic regurgitation , performed color flow doppler echocardiographic studies consecutive patients 3 month period patients grouped according mode aortic root diameter measured left position measured groups ranged 2 0 4 5 cm , grouped 0 1 cm intervals aortic root size enlarged , prevalence aortic regurgitation increased linearly \( p less 0 001 correlation coefficient , r 0 75 \) aortic root size small normal range 2 0 2 4 cm , prevalence aortic regurgitation 0 15 intermediate top normal ranges 2 9 3 7 cm , prevalence aortic regurgitation increased linearly 15 47 aortic root dilation , prevalence aortic root regurgitation generally 50 severity aortic regurgitation aortic root size good indicator severity aortic regurgitation patients moderate severe aortic regurgitation variable aortic root sizes throughout range aortic root sizes , mild aortic regurgitation predominated conclude aortic regurgitation common finding patients aortic roots dilated top normal size range , prevalence aortic regurgitation increases linearly aortic root size , aortic root size correlate severity aortic regurgitation
two dimensional echocardiographic features double outlet left ventricle cyanotic newborn infant , diagnosis double outlet left ventricle made two dimensional echocardiographic examination diagnosis later confirmed cardiac catheterization surgery subcostal views especially useful identification origin great arteries morphologic left ventricle review medical literature since 1967 revealed 77 cases double outlet left ventricle , diagnosed surgery postmortem examination anatomic features demonstrated two dimensional echocardiography case representative findings cited often cases reported medical literature
evolution continuity equation doppler echocardiographic assessment severity valvular aortic stenosis use doppler techniques greatly enhanced noninvasive ultrasound technique evaluation valvular aortic stenosis mode two dimensional echocardiography could reliably distinguish patients severe aortic stenosis milder obstructions hemodynamic information offered doppler complemented echocardiographic imaging provided alternative modality evaluation patients aortic stenosis application modified equation , pressure gradient across stenotic aortic valve could estimated doppler echocardiography though helpful widely used , information provided pressure gradient across valve severity obstruction complete assessment valvular aortic stenosis therefore includes estimation valve area application continuity equation review examines maturation continuity equation doppler techniques discusses implications procedure
determination aortic valve area gorlin formula cardiac know application gorlin formula cardiac catheterization laboratory standard reference determination aortic valve area continuity equation enables cardiac determine aortic valve area noninvasively echocardiography laboratory comparison results obtained two methods cardiac basic understanding theory pitfalls gorlin formula conflicting results obtained , possible reasons clear
evaluation abdominal aorta cardiac thorough evaluation abdominal aorta readily achieved use standard views echocardiographic examination ultrasound evaluation abdominal aorta represents logical extension standard echocardiographic examination adult patient article provides information needed carry complete ultrasound examination abdominal aorta including anatomy , vascular disease , steps involved ultrasound examination abdominal aorta
multivariate analysis prediction death hospital acute myocardial infarction prognostic factors patients acute myocardial infarction based clinical investigative data admission evaluated prospectively 111 consecutive patients seventeen patients \( 15 3 \) died hospital stay age , previous infarct , high class , cardiomegaly , high serum concentrations cardiac enzymes , low ejection fraction , high wall motion score index correlated significantly hospital mortality whereas sex , risk factors , pericardial effusion multivariate analysis showed age wall motion score index best predictors death hospital wall motion detected cross sectional echocardiography may reflect extent myocardial involvement age wall motion score index predicted hospital mortality sensitivity 76 5 , specificity 91 5 , predictive accuracy 89 2 age wall motion score index determined admission useful identifying patients high risk cardiac death might benefit early intervention
ischaemic left ventricular failure evidence sustained benefit 18 months' treatment xamoterol long term effects treatment xamoterol 14 patients aged 44 73 mild moderate heart failure result ischaemic heart disease reported 18 months' treatment xamoterol , patients assessed randomised double blind crossover comparison xamoterol \( 200 mg twice day \) placebo , given one month compared placebo , xamoterol significantly increased exercise duration work done bicycle ergometer reduced maximum exercise heart rate assessment symptoms activities 12 months visual analogue scales showed trend towards relief symptoms breathlessness improvement activity improvement clinical signs heart failure haemodynamic deterioration 12 month period assessed ejection fraction improvement exercise tolerance , symptoms , activities sustained 18 months without side effects development tolerance
geographical clustering risk factors lifestyle coronary heart disease scottish heart health study large cross sectional study , scottish heart health study , 10 , 359 men women 22 districts scotland undertaken try explain geographical variation coronary heart disease mortality analysis district showed classic risk factors cigarette smoking strongly associated heart disease mortality among men women mean diastolic blood pressure weakly associated rates among men high density lipoprotein cholesterol showed strong negative association among women total cholesterol showed weak negative association heart disease mortality , , serum concentrations cholesterol uniformly high districts , strong association mortality would expected men women many dietary factors showed moderate strong associations mortality coronary heart disease district low consumption vitamin c notable factors associated heart disease included alcohol consumption serum triglycerides among men , obesity , physical activity , serum triglycerides among women many factors associated heart disease showed strong clustering risk factors \( including smoking , alcohol , diet among men , smoking , diet , obesity among women \) associated much regional variation heart disease mortality scotland
cardiac catheterisation 5 french catheters beginning november 1987 end january 1989 , coronary arteriograms left ventricular angiograms performed 5 french coronary catheters \( 85 \) patients diagnostic obtained three standard types 5 french catheters \( 4 \) , left coronary , right coronary , pigtail catheters 60 patients \( 11 4 \) various 5 french catheters required complete study nine patients \( 1 7 \) , 7 8 french catheter used major complications causing cardiac arrest requiring urgent operation developed five patients sixty two patients \( 11 77 \) minor complications required single bolus atropine , developed need intervention mild reaction contrast material complications moderate severity developed 17 patients \( 3 2 \) severe chest pain , arrhythmia requiring temporary pacemaker , contrast reaction associated hypotension , requiring blood transfusion , transient ischaemic episode deaths 5 french catheters used routine coronary angiography left ventriculography 98 3 patients major complications related femoral artery puncture routine use 5 french coronary catheters increase feasibility safe coronary angiography outpatients reduce cost investigation
discrepancies measurement isovolumic relaxation time study comparing mode doppler echocardiography mitral valve cusp separation mode , mitral valve opening artefact , onset forward transmitral flow recorded doppler echocardiography taken mark end isovolumic relaxation , onset taken either aortic closure sound \( a2 \) recorded aortic closure artefact determined doppler technique possible differences measurement isovolumic relaxation time studied used 44 healthy people , 14 patients mitral stenosis , 21 patients left ventricular hypertrophy , 24 patients dilated cardiomyopathy recording mode mitral valve , pulsed continuous wave doppler spectra transmitral flow , simultaneous electrocardiograms a2 effectively synchronous aortic artefact however , onset doppler flow regarded end isovolumic relaxation , interval significantly longer mitral cusp separation mode used 25 \( 10 \) ms healthy individuals , 25 \( 15 \) ms patients left ventricular hypertrophy , 50 \( 35 \) ms patients dilated cardiomyopathy patients mitral stenosis interval 5 \( 5 \) ms longer mitral valve opening artefact consistently followed onset flow corresponded much closely e point mode shows occurred rapid filling period well beyond isovolumic relaxation definition thus isovolumic relaxation time measured a2 onset transmitral flow mitral valve opening artefact differs derived a2 mitral valve cusp separation intervals cannot used measure isovolumic relaxation time
retrograde recanalization occluded posterior tibial artery using posterior tibial two case reports recanalization two occluded posterior tibial arteries successfully achieved utilizing retrograde approach via posterior tibial artery level ankle cases previously unsuccessfully attempted using antegrade approach thus , choice access vessel \( arterial entry site \) becomes crucial determinant angioplasty success
simplified method estimating true aortic valve mean gradient simultaneous left ventricular peripheral arterial pressure recordings estimation aortic valve gradient simultaneous recording left ventricular peripheral arterial pressures subject error due delay modulation arterial pressure contour ascending aorta error corrected averaging mean gradients derived unaltered temporally aligned simultaneous left ventricular peripheral arterial pressure tracings 26 patients aortic stenosis simultaneous recordings ascending aortic femoral arterial pressure compared method simplified approach peripheral arterial pressure partially aligned advancing left ventricular pressure 50 time delay simultaneously recorded gradients measured way predicted true aortic valve gradients \( left ventricular ascending aortic \) mean difference 1 1 mm hg \( range 10 5 mm hg \) recommend use simplified method correction predicts true aortic valve gradient equally well averaging technique \( r 0 vs 0 \) requires half time effort
experience use coronary autoperfusion catheter complicated angioplasty february july 1989 , 22 patients underwent use autoperfusion catheter following acute occlusion obstructive dissection coronary angioplasty 20 cases conventional balloon used attempt correct angiographic appearance followed use catheter results sub optimal 1 patient \( 4 5 \) required surgical revascularization although study prospective randomized , observations suggest significant impact decreasing need emergency surgical revascularization complicated coronary angioplasty use approach
use guiding catheter contralateral femoral artery angioplasty describe unique method employing sheath guiding catheter allows contralateral retrograde femoral artery access perform balloon angioplasty proximal superficial femoral artery lesions technique simplifies arterial access , provides support crossing lesions , allows angiographic visualization target lesions procedure
percutaneous valvuloplasty patient mitral stenosis following surgical annuloplasty case described patient carpentier edwards annuloplasty ring developed mitral stenosis treated percutaneous mitral valvuloplasty possible mechanisms development mitral stenosis briefly discussed
left main percutaneous transluminal coronary angioplasty autoperfusion catheter animal model left main coronary angioplasty associated high risk interruption blood flow much left ventricle balloon inflation autoperfusion balloon angioplasty catheter allows blood flow passively distal inflated balloon tested dogs compared inflations standard balloon catheters 3 min occlusions left main coronary artery autoperfusion catheter , regional myocardial blood flow preserved 0 60 0 14 ml min g , compared 0 07 0 03 ml min g inflation standard balloon catheters \( p less 0 01 \) similarly , end 3 min inflation , left ventricular systolic pressure dp dt maintained autoperfusion catheter inflation , severely depressed standard angioplasty balloon inflation seven dogs survived autoperfusion balloon inflation , whereas five seven developed sustained ventricular tachycardia ventricular fibrillation standard balloon inflation thus , distal blood flow , hemodynamics , survival preserved autoperfusion balloon inflation left main coronary artery
rapid , effective technique retrograde crossing valvular aortic stenosis using standard coronary catheters retrograde crossing valvular aortic stenosis challenging even experienced consecutive patients aortic stenosis catheterized past 3 years , technique using standard right coronary catheter straight tipped guide wire successful rapidly efficiently crossing pathologically distorted valves retrograde fashion valve crossed , coronary catheter replaced pigtail catheter pressure ventriculography majority valves required less 2 min cross using technique method valuable limiting time required catheterization , thus helping reduce procedure related morbidity critically ill patients
nitrous oxide exacerbate pulmonary hypertension ventricular dysfunction patients mitral valvular disease using rapid response pulmonary artery catheter transoesophageal echocardiography , study examined effects 100 per cent oxygen , 70 per cent nitrous oxide 30 per cent oxygen , 70 per cent nitrogen 30 per cent oxygen pulmonary circulation ventricular function ten patients pulmonary hypertension comparison baseline measurements , nitrous oxide administration resulted small statistically significant \( p less 0 05 \) changes mean arterial pressure \( 76 14 67 12 \) , mean pulmonary arterial pressure \( 37 14 33 13 mmhg \) , cardiac output \( 3 7 1 4 3 2 1 1 l min 1 \) seventy per cent nitrogen resulted significant changes baseline repeat 100 per cent oxygen measurements nearly identical nitrous oxide measurements concluded nitrous oxide exacerbate pulmonary hypertension ventricular dysfunction high dose fentanyl anaesthesia patients mitral valvular disease
regulation fibrillar collagen types iii basement membrane type iv collagen gene expression pressure overloaded rat myocardium left ventricular hypertrophy based cardiac myocyte growth hypertrophic process considered heterogeneous based whether also includes remodeling accumulation fibrillar types iii collagens responsible impaired myocardial stiffness heart , messenger rna \( mrna \) fibrillar collagen types iii detected cardiac fibroblasts , whereas mrna basement membrane collagen type iv present fibroblasts myocytes studied early long term expression collagenous proteins rat myocardium abdominal aortic banding renal ischemia complementary dna probes rat pro alpha 2 \( \) , mouse type iii mouse type iv collagens , chicken beta actin used northern dot blot analysis total rna extracted left ventricular tissue indicated sixfold increase steady state levels mrna collagen type day 3 abdominal aortic banding , declined control levels day 7 remained rather constant 4 8 weeks type iii collagen showed similar pattern gene expression banding mrna levels type iv collagen , hand , elevated day 1 banding , returning control day 7 remaining constant actin mrna levels also increased day 1 banding , followed rapid return control levels antibody types iii collagens immunofluorescent light microscopy frozen sections myocardium revealed 1 week banding , distribution density collagens similar control animals
hemodynamic metabolic effects dobutamine 18 patients open heart surgery low cardiac output syndrome frequently follows cardiopulmonary bypass \( cpb \) surgery present study , used dobutamine increase cardiac index \( ci \) oxygen delivery \( do2 \) 18 patients open heart surgery using increasing doses dobutamine 10 micrograms kg min 1 , observed statistically significant \( p less 01 \) increases mean ci \( 2 50 0 10 3 56 0 18 l min m2 \) mean heart rate \( hr \) \( 83 3 105 3 beat min \) mean systemic vascular resistance index decreased significantly \( p less 01 \) patients \( 101 83 dyne sec cm5 m2 \) pulmonary vascular resistance index change ten coronary artery bypass graft patients , decreased significantly \( p less 01 \) eight valve replacement patients \( 98 79 dyne sec cm5 m2 \) mean do2 increased patients , although concomitant increase oxygen consumption \( vo2 \) four patients observed significant \( p less 01 \) increase mean vo2 remaining 14 patients \( 110 6 148 12 ml min m2 \) , spite significant decreases pao2 increases right left intrapulmonary shunting although increases hr ventricular arrhythmias may limit use , dobutamine increases ci do2 patients cpb present study , dobutamine 's varying metabolic effect need close monitoring hemodynamic metabolic variables using vasoactive drugs postoperative period
plasma epinephrine levels resuscitation cardiopulmonary bypass since highest plasma epinephrine levels recorded resuscitation , evaluated isolated effect cardiac arrest upon secretion determined plasma epinephrine dogs resuscitated cardiopulmonary bypass \( cpb \) cardiac arrest periods 12 \( cpb 12 n 4 \) 16 min \( cpb 16 n 5 \) 2 h cpb following 6 h critical care , difference cpb 12 cpb 16 regarding cardiopulmonary functional variables plasma epinephrine markedly elevated immediately initiation cpb \( p less 01 1 min cpb vs basal \) returned rapidly basal concentrations comparison plasma epinephrine levels cpb standard cpr groups showed responses cardiac arrest similar \( p greater 05 1 min cpb vs 11 5 min cpr \) conclude cardiac arrest main sole determinant plasma epinephrine elevation resuscitation
effect hemodilution capillary arteriolovenous shunt flow organs cardiac arrest dogs purpose study observe changes capillary arteriolovenous shunting blood flow cardiac arrest subsequent resuscitation venous return occlusion produced inflation intra atrial balloon cross clamping ascending aorta , determine hemodilution might modify changes organ capillary blood flow fractional distribution cardiac output measured microsphere \( 9 microns diameter \) trapping method dogs simultaneously , arteriolovenous shunt rate measured continuous collection venous blood drained 4 8 ml min 1 2 min brain , kidney , liver , splanchnic organs , skeletal muscle pelvic limb , systemic circulatory organs capillary blood flow brain , thyroid gland , pancreas , stomach decreased circulatory arrest five dogs \( group c \) arteriolovenous shunt rate unchanged circulatory arrest group however , hemodilution , induced either \( pre group , n 5 \) \( post group , n 5 \) circulatory arrest , change occurred shunt rate organs , exception increase systemic arteriolovenous shunt rate pre group capillary blood flow maintained almost level circulatory arrest pre group , increased significantly several organs post group data indicated hemodilution might effective prevention organ ischemia cardiac arrest
noninvasive determination pulmonary artery wedge pressure comparative analysis pulsed doppler echocardiography right heart catheterization compare left ventricular filling variables derived transmitral pulsed doppler echocardiography \( \) hemodynamic variables assessed right heart catheterization \( \) , 104 icu patients \( 64 male , 40 female \) aged 26 73 yr \( mean 54 6 10 3 \) without valvular heart disease examined simultaneously , transmitral flow velocity profiles obtained , ratio velocity time late diastolic active \( wave \) early diastolic passive inflow left ventricle \( e wave \) calculated \( e ratio \) determined pulmonary capillary wedge pressure \( wp \) ranged 3 36 mm hg \( median 13 35 , 5 95 6 31 mm hg \) linear regression analysis showed highly significant correlation e ratio wp \( r 98 , p less 001 , standard error estimate see 0 10 \) e ratio also correlated hemodynamic variables cardiac output \( r 68 , p less 001 , see 0 33 \) , cardiac index \( r 74 , p less 001 , see 0 31 \) , stroke volume index \( r 68 , p less 001 , see 0 34 \) interobserver agreement \( derived correlation analysis two \) e ratio high \( r 95 , p less 001 , n 26 \) conclude wp accurately determined noninvasively assessment systolic ventricular function , limited diagnostic value
traumatic rupture aorta diagnosis doppler echocardiography traumatic rupture aorta serious complication accidents , mainly accidents , high mortality unless immediate diagnosis surgical correction made case traumatic rupture aorta shown acute phase doppler echocardiography reported technique great value study patients thoracic trauma show clear signs aortic rupture require urgent aortography
orthostatic hypotension following right ventricular myocardial infarction corrected mineralocorticoid therapy severe hypotension standing became problem patient discharge hospital following right ventricular myocardial infarction hemodynamic studies showed right ventricular systolic function maintain adequate left ventricular preload patient compensate cardiac dysfunction increasing blood volume volume expansion mineralocorticoid therapy corrected orthostatic hypotension symptoms hypotension eventually resolved therapy stopped four months myocardial infarction
florid pulmonary veno occlusive disease young woman presented rapidly progressive dyspnea clinical findings strongly suggestive primary pulmonary hypertension possible pulmonary embolism \( \) died acute right sided heart failure diagnosis pulmonary veno occlusive disease made autopsy approximately 100 cases disease reported previously literature describe patient particularly florid progression unusual disease death occurred within six weeks onset symptoms
ventilatory diffusion abnormalities potential heart transplant recipients data available concerning pulmonary function patients severe chronic congestive heart failure 315 patients evaluated potential cardiac transplantation , 132 underwent pulmonary function tests latter patients severe heart failure mean left ventricular ejection fraction 19 percent mean cardiac index 2 1 l min m2 diffusion impairment either alone combined restrictive obstructive ventilatory defects occurred 67 percent patients evaluated diffusion impairment occurred sole abnormality 31 percent patients combination restrictive ventilatory defect 21 percent reduction diffusing capacity previously described frequent finding patients chronic congestive heart failure contrast studies involving patients acute heart failure , obstructive ventilatory defects uncommon none lung function abnormalities associated smoking status , prior drug use , chest roentgenographic changes , hemodynamic findings , clinical features , including duration congestive heart failure mechanism diffusion impairment unclear could due chronic passive congestion pulmonary fibrosis recurrent pulmonary emboli recognition diffusion impairment common finding patients severe chronic congestive heart failure candidates heart transplantation important proper interpretation possible post transplant changes diffusing capacity due causes
severe aortic regurgitation late complication temporal arteritis two patients remote history pathologically documented giant cell arteritis developed severe regurgitation first patient developed severe aortic regurgitation five years pathologic documentation giant cell arteritis temporal arteries giant cell arteritis involvement aortic root confirmed second patient developed aortic regurgitation seven years pathologic documentation giant cell arteries temporal arteries although pathologic confirmation aortic root process obtained , case strengthens clinical association giant cell arteritis temporal arteries subsequent aortic root dilatation severe aortic regurgitation observation signs de novo severe aortic regurgitation indicated follow patients temporal arteritis
caliber persistent artery stomach \( 's vascular malformation \) caliber persistent artery stomach \( also known aneurysm , 's lesion , submucosal arterial malformation \) clinically manifested recurrent , massive , often fatal lesion often seen endoscopically left gastric angiography one patient showed ectatic artery gastric fundus , proved caliber persistent artery stomach pathological examination tortuosity abnormal vessel condition attributed contraction stomach following excision formalin fixation first reported case pathologically proven lesion clearly visualized angiography demonstrates submucosal vessel truly proposed angiographic demonstration , artery territory left gastric artery highly suggestive caliber persistent artery stomach
time course hemodynamic responses sodium elderly hypertensive patients thirty one patients essential hypertension \( 81 6 6 9 years old \) studied two different regimens sodium intake 120 meq day 8 weeks 344 meq day 2 weeks systemic hemodynamic data measured doppler echocardiography mitral flow velocity integral , cardiac index , total peripheral resistance calculated salt sensitive patients increase total peripheral resistance greater increase cardiac index salt loading termed sst salt sensitive patients termed ssc , increase cardiac index greater increase total peripheral resistance increased sodium intake sst patients day 7 high sodium diet remained sst group day 14 nine 13 patients ssc group day 7 remained ssc group day 14 , remaining four patients ssc group day 7 fell sst group day 14 four eight non salt sensitive \( \) patients day 7 high salt regimen remained group day 14 , whereas remaining four patients group day 7 fell ssc group day 14 data suggest changing pattern sodium loading initially high cardiac index followed persistently raised total peripheral resistance celiac , superior mesenteric , renal arteries sodium repletion sst ssc patients salt loading , terminal aortic vascular bed ssc patients sst patients
two way study alcohol salt restriction treated hypertensive men aim study determine whether moderate restriction dietary salt intake leads additional fall blood pressure treated hypertensive men asked simultaneously reduce usual alcohol intake sixty three subjects entered initial 2 week period continued usual alcohol intake low sodium diet \( less 60 mmol day \) supplemented 100 mmol sodium chloride per day enteric coated tablets subjects randomly assigned either drink low alcohol beer alone 4 week period \( reducing self reported alcohol consumption 57 ml week \) continue usual alcohol intake \( versus ml week \) within low normal alcohol intake groups , subjects assigned either low normal sodium intake low sodium groups continued sodium restricted diet switched placebo sodium chloride tablets 4 weeks resulted fall 24 hour urinary sodium excretion 144 69 mmol day normal sodium groups continued low sodium diet kept taking 100 mmol day sodium chloride tablets , urinary sodium excretion remained unchanged \( 125 versus 142 mmol day \) regular antihypertensive therapy continued throughout fifty nine subjects completed trial reduced alcohol intake fall systolic blood pressure \( 5 4 mm hg supine , p less 0 01 \) diastolic blood pressure \( 3 2 mm hg supine , p less 0 01 \)
diurnal cardiovascular patterns spontaneously hypertensive wistar kyoto rats study designed determine whether diurnal patterns blood pressure , heart rate , locomotor activity differed among two wistar kyoto rats , derived originally charles river taconic farms , spontaneously hypertensive rat cardiovascular parameters continuously monitored 24 hours resting systolic diastolic blood pressure values statistically different among three groups lights \( rest \) lights \( active \) phases cycle blood pressure spontaneously hypertensive rats greater wistar kyoto rats taconic farms , greater wistar kyoto rats charles river largest difference arterial pressure wistar kyoto taconic farms wistar kyoto charles river lights period heart rates rats decreased lights period wistar kyoto charles river largest decrease \( 70 5 beats min \) , wistar kyoto taconic farms least \( 17 2 beats min \) , spontaneously hypertensive rats decrease intermediate \( 29 3 beats min \) pronounced diurnal variation pressure heart rate exhibited wistar kyoto charles river present either wistar kyoto taconic farms spontaneously hypertensive rats blood pressure magnitude correlated locomotor activity periods , although groups showed minimal activity rest period observed differences wistar kyoto charles river wistar kyoto taconic farms due lack abnormality baroreceptor reflex function
kallikrein like enzyme blood vessels one kidney , one clip hypertensive rats active inactive kallikrein kallikrein like enzyme found aorta , vena cava , tail artery veins rat studied concentration vascular kininogenase rats one kidney , one clip renovascular hypertension normotensive rats six weeks surgery , active total vascular kininogenase activity \( active plus trypsin activated \) measured blood pressure 212 4 mm hg hypertensive rats \( n 33 \) 120 1 mm hg normotensive rats \( n 32 \) \( p less 0 001 \) active kininogenase lower hypertensive rats although difference significant thoracic aorta \( 56 8 versus 77 15 \) , highly significant abdominal aorta \( 63 13 versus 167 17 , p less 0 001 \) tail artery \( 48 8 versus 197 31 , p less 0 003 \) total vascular kininogenase activity \( active plus trypsin activated \) lower hypertensive rats arteries examined thoracic aorta \( 183 16 versus 380 38 , p less 0 003 \) , abdominal aorta \( 61 versus 1 , 74 , p less 0 001 \) , tail artery \( 112 versus 1 , 243 135 , p less 0 003 \) active kininogenase vena cava higher hypertensive rats \( 213 56 versus 131 31 \) however , difference statistically significant , whereas tail veins highly significant \( 1 , 221 versus 79 , p less 0 003 \)
interleukin 2 attenuate hypertension spontaneously hypertensive rats recently reported interleukin 2 , administered single bolus injection \( 5 , 000 units kg \) , could prevent development hypertension young spontaneously hypertensive rats lower blood pressure normotensive levels spontaneously hypertensive rats established hypertension consequently , efforts made duplicate finding male spontaneously hypertensive rats \( 35 days old \) injected subcutaneously 50 , 000 units kg \( 3 , 500 units rat \) recombinant interleukin 2 \( \) systolic blood pressure measured twice weekly tail cuff technique systolic blood pressure interleukin 2 treated group significantly different vehicle treated control group time point 32 days follow second injection recombinant interleukin 2 \( 5 , 000 units kg \) administered 32 days first injection , reduction blood pressure observed interleukin 2 treated group additional 38 days mean arterial pressure \( sem \) measured via intra arterial cannula conscious rats age 105 days \( 38 days second treatment \) 168 5 3 5 mm hg interleukin 2 treated spontaneously hypertensive rats 170 3 3 6 mm hg vehicle treated controls recombinant interleukin 2 preparations respective manufacturer 's indicated specific activity determined ability interleukin 2 induce proliferation interleukin 2 dependent cell line ht 2 thus , study demonstrated interleukin 2 ineffective preventing attenuating hypertension spontaneously hypertensive rats
effects differential touch nervous system arousal patients recovering cardiac disease previous research suggests neural properties certain types touch well perceived significance disease state may related heightened activation nervous system study effects different types touch nervous system arousal examined 59 adult patients receiving treatment coronary artery disease exposed standardized protocol systematically varied neural properties procedural nature touch received measures cardiovascular reactivity \( heart rate rhythm data well blood pressure measurements \) state anxiety used indexes arousal results indicated types touch evoked heart rate deceleration contrast baseline verbal conditions however , differential effects related either neural properties procedural nature touch diastolic blood pressure state anxiety also lower result touch changes observed systolic blood pressure heart rhythm general , findings suggested touch served reduce arousal rather produce negative consequences recovery
de pointes critical care nurse 's dilemma de pointes polymorphous ventricular tachycardia characterized gradual change direction qrs complex critical care nurses first recognize arrhythmias , require knowledge skill appropriately case report focuses identification characteristics , contributing factors , therapeutic modalities , relevant nursing diagnoses patient de pointes
role angiotensin converting enzyme inhibitors congestive heart failure conventional therapy congestive heart failure \( chf \) includes sodium restricted diet , diuretics , digitalis , vasodilators , short term intravenous administration beta adrenergic agonists episodes decompensation specific class vasodilators , angiotensin converting enzyme inhibitors , recently gained predominance treatment congestive heart failure primary mechanism action reduce production angiotensin ii competitive inhibition enzyme converts angiotensin angiotensin ii reduced levels angiotensin ii , turn , promote vasodilation lower aldosterone production benefits angiotensin converting enzyme inhibitor therapy chronic congestive heart failure demonstrated improvement left ventricular performance , exercise capacity , functional status \( using new york heart association classification \) , survival
current results elective aortic reconstruction aneurysmal occlusive disease decisions resect small aortic aneurysms employ non operative treatment aorto iliac occlusive disease must depend current rather historical surgical results assess current morbidity mortality , reviewed 200 consecutive aortic resections two groups patients treated 1981 1989 undergoing elective bypass occlusive disease \( afb , 100 \) resection infrarenal abdominal aortic aneurysms \( aaa , 100 \) indications afb included claudication \( 54 \) , rest pain \( 32 \) , \( 13 \) aaa size ranged 3 14 cm \( mean 6 5 2 4 cm \) 45 presented abdominal back pain patients undergoing afb younger \( afb 61 5 10 years vs aaa 68 7 8 9 years \) higher incidence atherosclerotic risk factors , diabetes mellitus 30 vs 10 , tobacco use 77 vs 49 , hyperlipidemia 21 vs 7 p less 0 001 \) coronary artery disease \( cad \) prevalent aaa patients \( 49 vs 34 p less 0 001 \) postoperative mortality different occlusive aneurysmal disease \( 3 afb vs 2 aaa \) , occurrence serious complications myocardial infarction \( 2 vs 1 \) pulmonary embolism \( 2 vs 3 \) improvements patient selection , perioperative care surgical technique lowered mortality elective aortic surgery given current standard care , aggressive approach aaa even high risk patients appropriate low morbidity afb occlusive disease critical appraisal less effective nonoperative therapies
synchronous reconstruction combined aortoiliac femoropopliteal occlusive lesions role proximal bypass january 1984 december 1986 , 31 patients underwent synchronous revascularization \( sr \) serious clinical condition lower limb presence visible lesions average follow 30 months operative mortality 10 two patient populations identified group \( n 13 \) patients underwent femoral aorto femoral proximal revascularization \( pr \) group ii \( n 18 \) patients femoral pr group patients younger group ii \( 64 yr versus 72 yr p less 0 01 \) association pre operative risk factors \( arterial hypertension coronary , renal respiratory insufficiency \) twice frequent group ii group \( p less 0 02 \) rate sr compared pr alone 15 however , statistically significant difference groups ii comparison actuarial survival curves patients patency rates sr groups ii failed reveal statistically significant differences femoral bypass used pr sr necessary high risk patients
primary repair complete atrioventricular canal recommendation early primary repair forty patients complete atrioventricular canal \( \) underwent primary repair children 's hospital , japan , august 1 , 1981 july 31 , 1989 age repair ranged 2 months 6 years \( mean 19 months \) weight ranged 2 3 22 kg surgical mortality 2 5 justification early primary repair examined eleven patients underwent repair 6 months age \( group 1 \) , 12 patients , 7 11 months age \( group 2 \) , 17 patients , 12 months age \( group 3 \) degenerative changes atrioventricular valve increased significantly age repair increased \( p less 0 05 group 1 versus group 3 \) incidence residual mitral regurgitation tended increase order group 1 , 2 3 , though degree ranged trivial mild study left atrium aorta ratio echocardiography revealed stable values around 1 1 groups 1 2 around 1 3 group 3 continued follow period 3 years assessment diameter repaired mitral valve mean interval 26 months groups 1 2 revealed normal growth mitral valve annulus angle repaired mitral valve ventricular septum , affected growth ventricular septum , normal range mean interval 26 months postoperative pulmonary vascular resistance groups 2 3 higher 4 4 2 3 6 3 2 2 , respectively , group 1 3 3 2 2 \( p less 0 01 versus group 3 \)
perioperative myocardial injury patients undergoing aortic valve replacement cases myocardial hypertrophy myocardial protection may insufficient order determine factors responsible myocardial injury assessed myocardial injury 54 patients undergoing isolated aortic valve replacement cases hypothermic cardioplegic arrest induced 13 different times measured serum level creatine kinase \( ck \) , myocardial bound creatine kinase \( \) , lactic dehydrogenase \( ldh \) , alpha hydroxybutyrate dehydrogenase \( alpha \) , glutamic transferase \( \) mean duration ischemia 52 6 16 2 minutes mean time extracorporeal circulation 85 85 20 25 minutes performance multiple regression analysis significant correlation ischemia ldh alpha found ck , , ldh alpha correlated duration extracorporeal circulation none patients low cardiac output syndrome observed results conclude study myocardial protection sufficient therefore detrimental effects extracorporeal circulation determining factors enzyme release
right coronary artery injury tricuspid valve annuloplasty unusual complication tricuspid valve annuloplasty described ring suture ligated right coronary artery precipitated myocardial infarct patient death need caution prevent complication surgery emphasized
multiple breakpoint method measuring effect antibiotics endocarditis strains streptococci activity penicillin alone combined endocarditis strains streptococci examined good assay reproducibility obtained use phase cultures standardised opacity , careful inoculation well plates , removal antibiotic membrane transfer incubating survival counts hydrogen plus carbon dioxide use 10 fold intervals penicillin concentration simplified assay design without loss efficiency
improved morphologic characterization atrial septal aneurysm transesophageal echocardiography relation cerebrovascular events transthoracic transesophageal echocardiography performed 23 consecutive adult patients atrial septal aneurysm three patients cerebrovascular event diagnosis established transesophageal approach interatrial shunting transthoracic imaging use echocardiographic contrast imaging doppler color mapping , , detected 7 \( 41 \) 17 patients performing contrast imaging combination color flow mapping transesophageal echocardiography , positive shunting demonstrated 15 \( 83 \) 18 patients echocardiographic identification multiple \( n 4 \) thrombus within aneurysm \( n 2 \) could achieved first time transesophageal ultrasound application cerebrovascular events occurred 12 \( 52 \) 23 patients regarded definitely thromboembolic 10 \( 43 \) 8 \( 67 \) 12 patients repeated cerebral events except mitral valve prolapse one patient , potential cardiac source embolism could identified despite use transesophageal echocardiography thickening aneurysmal membrane greater equal 5 mm found 9 \( 75 \) 12 patients versus 3 \( 27 \) 11 patients without cerebrovascular event \( p less 0 05 \) proved significant difference two patient groups mechanism embolization may primary thrombus formation within aneurysm paradoxic embolization interatrial communication demonstrated findings two patients concluded atrial septal aneurysm cardiac abnormality thromboembolic potential patients lesion history embolic event , long term anticoagulant therapy indicated
transesophageal doppler color flow mapping assessment atrial septal defect transesophageal doppler color flow imaging performed 19 adult patients \( mean age 35 years \) atrial septal defect demonstrated cardiac catheterization surgery , transesophageal study correctly identified classified 19 19 shunts contrast 16 18 shunts identified transthoracic approach area atrial septal defect calculated assuming circular taking maximal doppler color flow jet width defect site diameter pulsed doppler sample volume placed parallel shunt flow direction defect site obtain mean velocity flow duration values , shunt volume calculated product defect area , mean velocity , flow duration heart rate calculated shunt flow volume obtained transesophageal study showed good correlation shunt flow volume \( r 0 91 , p less 0 001 \) pulmonary systemic blood flow ratio \( r 0 84 , p less 0 001 \) obtained cardiac catheterization size defect transesophageal doppler color flow mapping correlated fairly well size estimated surgery \( r 0 73 , p 0 004 \) concluded transesophageal doppler color flow imaging useful detection classification atrial septal defects assessment shunt volumes
acute myocardial infarction elderly compared patients aged 65 75 years little known concerning late outcome prognostic factors acute myocardial infarction elderly \( greater 75 years age \) accordingly , study compared clinical course mortality rate 1 year large multicenter data base included patients greater 75 years age \( mean sd 81 4 years \) , less elderly subset 1 , patients 65 75 years age \( mean 70 3 years \) 1 year cardiac mortality rate 17 6 greater 75 years age compared 12 0 patients 65 75 years age \( p less 0 01 \) differences prevalence several factors , including female gender , history angina pectoris , history congestive heart failure , smoking habits incidence congestive heart failure hospitalization multivariate analyses predictors cardiac death hospital survivors selected different factors important two age subgroups age selected 65 75 year age group independent predictor elderly survival curves beginning day 10 patients 65 75 greater 75 years old similar 90 days later elderly , 63 late cardiac deaths sudden due new myocardial infarction , similar causes 67 deaths younger age group
changes left ventricular diastolic performance aortic balloon valvuloplasty acute late effects evaluate acute follow changes left ventricular diastolic performance , simultaneous digital left ventriculography performed 49 patients undergoing aortic balloon valvuloplasty patients improved symptomatically valvuloplasty , 26 returned 6 3 1 5 months later follow catheterization immediately valvuloplasty , aortic valve area increased \( 0 5 0 2 versus 0 8 0 2 cm2 , p less 0 01 \) , cardiac output \( 4 3 1 2 versus 4 4 1 3 liters min \) ejection fraction \( 51 18 versus 52 17 \) change diastolic indexes worsened , decrease peak filling rate \( 247 80 versus 78 ml , p less 0 01 \) increase time constant isovolumetric relaxation \( tau \) \( 78 29 versus 96 40 ms , p less 0 01 \) chamber stiffness \( 0 107 0 versus 0 141 0 , p less 0 01 \) follow catheterization , 16 patients continued symptomatic improvement \( group 1 \) 10 recurrence symptoms \( group 2 \) aortic valve area , cardiac output ejection fraction follow catheterization groups similar unchanged values valvuloplasty
coronary angioplasty patients severe left ventricular dysfunction applications coronary angioplasty greatly expanded procedure increasingly used complex potentially high risk conditions report describes short long term effects coronary angioplasty 61 patients severely depressed left ventricular function \( ejection fraction less equal 35 \) unstable refractory anginal symptoms , , revascularization necessary despite increased risk retrospective analysis 1 , 260 patients undergoing angioplasty january 1985 december 1987 , 61 ejection fraction less equal 35 common clinical presentation unstable angina \( 70 \) without recent myocardial infarction mean left ventricular ejection fraction 27 6 forty five patients \( 74 \) multivessel disease clinical success angioplasty achieved 55 patients \( 90 \) major complications \( death , infarction emergency bypass surgery \) occurred five patients \( 8 2 \) , death two \( 3 2 \) long term \( mean 21 11 months \) follow study 55 patients successful angioplasty , 13 \( 23 \) died , including 3 noncardiac causes , 11 \( 20 \) clinically symptomatic recurrence continued clinical success present 39 patients \( 71 \) , 28 \( 51 \) event free patients 11 \( 20 \) clinical recurrence successful second angioplasty procedure performed 9 restenosis thus , patients depressed left ventricular function , coronary angioplasty performed short term success rate comparable routine angioplasty surgical procedures however , acute complications frequent late mortality rate higher patients less depressed function
natural history hypertrophic cardiomyopathy elderly prognosis patients diagnosed hypertrophic cardiomyopathy advanced age well defined study details follow information obtained 95 patients initially diagnosed hypertrophic cardiomyopathy age greater equal 65 years seventy five percent patients symptomatic , defined presence chest pain , dyspnea syncope , mean ventricular septal thickness 20 mm median duration follow study 4 2 years survival rate 1 5 years 95 76 , respectively , significantly different age gender matched control group patients presenting new york heart association functional class ii dyspnea , 18 progressed class iii iv follow period however , patients presenting class iii dyspnea 1 year mortality rate 36 , significantly higher control subjects \( p less 0 003 \) echocardiographic variables , indexed left atrial size strongly associated reduced survival \( p less 0 008 \) results suggest prognosis elderly patients hypertrophic cardiomyopathy generally favorable certain clinical echocardiographic variables appear use identifying patients less favorable prognosis
prognostic importance serum magnesium concentration patients congestive heart failure magnesium abnormalities common patients congestive heart failure clinical prognostic significance abnormal serum magnesium concentration disorder investigated therefore , relation serum magnesium concentration clinical characteristics long term outcome 199 patients chronic heart failure evaluated serum magnesium concentration less 1 6 meq liter 38 patients \( 19 \) , within normal range 134 patients \( 67 \) greater 2 1 meq liter 27 patients \( 14 \) patients hypomagnesemia frequent ventricular premature complexes episodes ventricular tachycardia patients normal serum magnesium concentration \( p less 0 05 \) even though two groups similar respect severity heart failure neurohormonal variables , patients low serum magnesium concentration significantly worse prognosis long term follow \( 45 versus 71 1 year survival , p less 0 05 \) patients severe symptoms , greater neurohormonal activation worse renal function patients normal serum magnesium concentration tended fewer ventricular arrhythmias patients worse prognosis normal magnesium concentration \( 37 versus 71 1 year survival , p less 0 05 \) conclusion , measurement serum magnesium concentration provides important clinical prognostic information patients chronic heart failure
cardiac rhythm disturbances early orthotopic heart transplantation prevalence clinical importance observed abnormalities precisely define incidence , type consequences cardiac arrhythmias early heart transplantation , 25 cardiac transplant recipients monitored continuously days day surgery discharge death subset 15 patients sinus node function studies suppression performed weekly time endomyocardial biopsy results revealed sinus bradycardia 10 patients \( 40 \) junctional bradycardia 6 \( 24 \) supraventricular tachycardia form atrial tachycardia , atrial fibrillation atrial flutter occurred 11 patients \( 44 \) ventricular tachycardia occurred 15 patients \( 60 \) nonsustained cardiac pacing 1 , 403 h used nine patients pulse rate less 50 beats min seven recovered permanent pacing instituted two subgroup sinus node function studies , seven patients identified clinical bradyarrhythmia abnormal sinus node recovery time \( greater 1 , 400 ms \) abnormal corrected sinus node recovery time \( greater ms \) least one study seven patients also significantly prolonged ischemic time \( 236 26 versus 159 68 min , p less 0 01 \) conclusion , cardiac arrhythmias , particularly ventricular tachycardia bradyarrhythmia , occur commonly early orthotopic heart transplantation previously reported sinus node dysfunction due prolonged organ ischemic time , antiarrhythmic drug use surgical trauma , alone combination , may contribute arrhythmias
new single catheter technique simultaneous measurement action potential duration refractory period vivo vivo correlations action potential duration measured monophasic action potential catheter effective refractory period measured separate pacing catheter poor , probably known variability action potential duration effective refractory period different ventricular sites study , new contact electrode catheter designed simultaneous pacing monophasic action potential recording closely adjacent sites \( 2 mm separation recording electrodes pacing electrodes \) tested five closed chest dogs four patients dog studies pacing thresholds extremely low , ranging 0 02 0 25 \( mean sd 0 0 , n 36 \) stable time \( less 20 increase 1 h continuous pacing \) close proximity pacing recording electrodes , pacing artifact nearly coincided monophasic action potential low pacing threshold , however , pacing artifacts small \( 33 17 monophasic action potential amplitude twice diastolic threshold strength \) affect duration configuration simultaneously recorded monophasic action potential short stimulus response time monophasic action potential signal fidelity pacing allowed precise simultaneous measurements action potential duration effective refractory period endocardial site
pattern antianginal effect long term three times daily administered isosorbide dinitrate three times daily administration isosorbide dinitrate may avoid much tolerance seen frequent dosing determine pattern antianginal effect three times daily isosorbide dinitrate , eight men stable exertional angina positive exercise test studied subjects demonstrated increased exercise duration response oral isosorbide dinitrate therapy absence complete tolerance long term three times daily isosorbide dinitrate treadmill exercise onset angina performed 2 days 8 , 9 , 11 , 1 pm , 2 pm , 4 pm , 6 pm 7 pm one day patient received isosorbide dinitrate 8 , 1 pm 6 pm previously titrated dose \( mean 27 5 mg \) , taken three times daily least 2 weeks day hours patient received double blind placebo identical appearance isosorbide dinitrate one hour 8 dose isosorbide dinitrate , mean systolic blood pressure rest fallen 19 mm hg mean exercise time angina increased 200 however , 11 exercise time returned control level one hour 1 pm dose isosorbide dinitrate , exercise time increased mean 150 control level 2 h later
myocardial amiodarone desethylamiodarone concentrations patients undergoing cardiac transplantation myocardial amiodarone desethylamiodarone concentrations measured multiple sites explanted heart four patients underwent cardiac transplantation patients taking amiodarone , 200 400 mg day \( mean 300 115 \) , 88 days \( mean 229 148 \) mean cumulative dose 58 21 3 g plasma amiodarone concentration three subjects 204 , 312 ng ml desethylamiodarone concentration , ng ml , respectively significant interindividual variability myocardial concentrations amiodarone desethylamiodarone observed \( p less 0 05 \) mean myocardial amiodarone concentration ranged 4 1 0 29 17 2 micrograms g \( p less 0 05 \) mean desethylamiodarone concentration ranged 22 8 8 141 102 5 micrograms g \( p less 0 05 \) site , save fat , myocardial desethylamiodarone concentration higher amiodarone concentration greater variability observed myocardial desethylamiodarone compared amiodarone concentration particularly septal scar tissue \( p ns \) significant relation found myocardial concentration duration treatment patients significant ventricular disease , usefulness plasma amiodarone desethylamiodarone concentration estimate myocardial concentration limited intra interindividual variability
effects benazepril metoprolol oros alone combination myocardial ischemia patients chronic stable angina efficacy benazepril , metoprolol oros combination evaluated 29 patients \( 42 74 years age \) chronic stable angina documented coronary artery disease placebo controlled , double blind , crossover trial using serial quantitated exercise testing ambulatory electrocardiographic \( ecg \) monitoring mean \( sem \) exercise time 8 5 0 7 min placebo , 8 3 0 6 min \( 95 confidence interval ci 1 06 0 54 \) benazepril , 9 4 0 5 min \( 95 ci 0 32 2 14 \) metoprolol oros 9 6 0 5 min \( 95 ci 0 25 2 47 \) combination benazepril metoprolol oros mean exercise time development 1 mm st segment depression prolonged 6 0 0 6 min placebo 6 3 0 6 min \( 95 ci 0 93 1 45 \) benazepril , 7 9 0 5 min \( 95 ci 0 83 3 0 \) metoprolol oros 8 1 0 6 min \( 95 ci 0 88 3 29 \) combination benazepril metoprolol oros benazepril alter rest maximal heart rate , whereas metoprolol oros alone combination significantly lowered heart rate rest maximal exercise systolic blood pressure rest reduced , whereas diastolic blood pressure lowered significantly treatments comparison placebo maximal exercise , metoprolol oros , whether given alone combination benazepril , able blunt significantly systolic blood pressure rate pressure product
intracoronary infusion fluosol da 20 prevent left ventricular diastolic dysfunction coronary balloon angioplasty \? distal intracoronary infusion fluosol da 20 shown prevent systolic dysfunction coronary artery balloon occlusion coronary angioplasty assess effect global diastolic dysfunction , randomized , single blind , crossover protocol comparing intracoronary infusion fluosol infusion \( control \) performed 60 balloon inflations 10 patients \( mean age 67 years \) undergoing coronary angioplasty assessment global systolic diastolic function obtained high fidelity micromanometer measurements left ventricular pressure eighteen pairs balloon inflations \( fluosol versus control \) analyzed patients reported significantly less severe chest pain inflations accompanied fluosol compared control however , coronary balloon occlusion , significant differences changes baseline values observed fluosol control regard ventricular relaxation , including time constant early ventricular relaxation \( tau \) maximal rate fall left ventricular pressure \( maximal negative dp dt \) differences fluosol control observed terms increase end diastolic pressure minimal diastolic pressure balloon inflation mean systolic pressure decrease baseline values greater control fluosol inflations \( 9 0 3 3 mm hg , p 0 013 \) , significant difference observed change maximal rate rise left ventricular pressure \( maximal positive dp dt \) results suggest fluosol preserve global left ventricular diastolic function coronary balloon occlusion , possibly limited oxygen delivery capability relative arterial blood
early late effects captopril treatment large myocardial infarction rats early \( 21 days \) late \( 4 months \) effects continuous treatment captopril left ventricular performance , weight volumes studied rats myocardial infarction early effects examined rats subjected coronary ligation randomized either immediate treatment captopril \( 2 g liter drinking water \) starting 2 h surgery treatment 21 days , treated group showed reductions mean arterial , left ventricular systolic left ventricular end diastolic pressures compared untreated rats right left ventricular weight left ventricular volumes decreased ejection fraction index increased captopril treatment study late effects captopril , second group rats randomized immediate captopril treatment \( starting 2 h surgery \) , delayed captopril treatment \( starting 21 days surgery \) treatment studied 4 months treatment , rats started captopril treatment 2 h infarction showed differences compared rats started treatment 21 days infarction treatment captopril 4 months produced changes similar rats treated 21 days captopril treatment improved hemodynamic function myocardial infarction rats examined either 21 days 4 months treatment extent benefit similar two treatment periods initiation captopril therapy immediately infarction appear produce greater effect treatment started 21 days infarction rats studied drug administered 4 months
echocardiographic definition left ventricular centroid ii determination optimal centroid systole normal infarcted hearts although two dimensional echocardiography widely used clinical experimental evaluations regional cardiac wall motion , established clinical method quantitative analysis wall motion , even normal radial motion observed short axis images measurement radial wall motion requires determination centroid depending definition , centroid affected throughout systole cardiac translation , regional wall motion shift subject position transducer floating centroid defined relative ventricular walls frame frame , whereas fixed centroid never respect transducer evaluation best approach definition centroid previously presented \( part , issue \) next question use centroid study examines four centroid applications provides best reference quantifying regional wall motion systole method 1 floating centroid \( defined separately every image frame \) , method 2 uses end diastolic centroid fixed reference image frames , method 3 uses end systolic centroid fixed reference method 4 uses average fixed reference wall motion measured respect determining radial wall motion end diastole end systole correlating radial motion throughout cardiac cycle normal control hearts
dietary preference sweet foods patients dementia using telephone survey , patients probable alzheimer 's disease \( n 31 \) vascular dementia \( n 14 \) compared elderly normal controls \( n 43 \) preferences different foods patients alzheimer 's disease greater preference normal controls relatively high fat , sweet foods high sugar , low fat foods , significantly differ preference foods , including high complex carbohydrates protein vascular dementia patients showed similar pattern , significantly different alzheimer 's patients results consistently support hypothesis increased sweet preference nonspecific form behavior related declining mental status , hypothesis relating sweet preference serotonin activity within brain consistently supported results provide preliminary evidence craving sweet food may significant part clinical syndrome dementia , research needed delineate psychological biological mechanisms accounting
neuropsychological outcome survivors hospital cardiac arrest thirty patients resuscitated hospital cardiac arrest \( 15 15 without coma admission \) underwent clinical examination neuropsychological testing order assess quality life , compared two matched control groups 15 patients previous myocardial infarction 15 healthy subjects none survivors showed severe neurologic impairment , returned self sufficient physical activity however , behavior rating scale scores significantly worse patients coma processing ability linked memory significantly worse coma group mood disorders also observed group , pathological significance remarkably low incidence neurologic psychological sequelae resuscitated patients , particularly early clinical evidence severe cerebral damage , encouraging result supports therapeutic systems development efforts management hospital cardiac arrest
traumatic rupture thoracic aorta presenting transient paraplegia patient involved high speed motor vehicle accident presented paraplegic emergency department noted abnormal chest x ray , subsequently , underwent aortography revealed aortic transection patient 's paraplegia resolved spontaneously prior definitive aortic repair hours later aortic rupture presenting paraplegia rare association , one emergency physician , especially case blunt trauma
lower extremity venography iohexol results complications frequency side effects nonionic contrast agent \( iohexol \) studied consecutive patients underwent venography clinically suspected deep vein thrombosis \( dvt \) compared frequency adverse reactions another series patients received either contrast material high osmolar ionic compound minor side effects , including local pain discomfort , nausea vomiting , dizziness , skin reactions , superficial , edema , occurred 83 patients \( 17 9 95 confidence interval ci , 15 22 \) serious adverse reaction \( bronchospasm \) seen two patients \( 0 4 95 ci , 0 1 1 4 \) thrombosis confirmed means repeat venography occurred one 41 consecutive patients previous normal \( incidence , 2 95 ci , 0 13 \) frequency side effects appears significantly less conventional high osmolar contrast agents used use iohexol venography associated minor side effects approximately one fifth patients , serious adverse reactions necessitating therapy rare
mitral stenosis evaluation mr imaging percutaneous balloon valvuloplasty evaluate findings mitral valve stenosis changes percutaneous balloon valvuloplasty \( pbv \) , magnetic resonance \( mr \) imaging performed 23 patients patients imaged 2 0 system within 1 week 3 10 days pbv angle interatrial septum measured transverse image facilitate successful puncture mr images , mean transverse anteroposterior diameters left atrium level aortic root ventricular diastolic phase decreased significantly pbv areas flow related intraluminal signal intensity detected left atrial cavity 17 patients \( 74 \) procedure disappeared 15 patients procedure mr imaging findings pbv disappearance intraluminal signal intensity pulmonary artery , normal curvature interatrial interventricular septa , pericardial effusion complication mr imaging thought provide useful information pbv patients mitral stenosis
vena caval flow assessment cine mr velocity mapping authors used cine magnetic resonance \( mr \) velocity mapping study flow superior vena cava \( \) inferior vena cava \( ivc \) 13 healthy control subjects 13 patients right sided cardiac disease control subjects , peaks flow systole diastole observed , mean flow 35 cardiac output respiratory used six control subjects acquire images end inspiration end expiration , although systolic peak reduced end expiration , total flow unchanged reduced systolic peak retrograde flow ivc observed patients tricuspid regurgitation reduced diastolic peak seen patients pulmonary hypertension , pericardial constriction , right ventricular dysplasia , reflecting reduced diastolic compliance right ventricle patient obstruction , absence flow confirmed , retrograde flow seen azygos vein authors believe cine mr velocity mapping reliable method studying vena caval flow noninvasively important potential applications investigation disorders right side heart
evolution deep venous thrombosis prospective evaluation us forty six patients diagnosis acute deep venous thrombosis \( dvt \) established means duplex ultrasound \( us \) prospectively followed serial duplex us examinations 6 month period assess persistence venous abnormalities patients asymptomatic isolated popliteal dvt found likely normal duplex compression us thrombosis involving femoral popliteal systems \( p less 05 \) increased venous diameter sign acute clot \( p less 005 \) clot help enable distinction acute dvt chronic dvt compression us , 10 21 patients \( 48 \) initially occlusive thrombosis persistent abnormalities mimicked findings consistent acute dvt chronic venous changes persisted 6 months consisted either lumen recanalization \( resultant intimal thickening \) persistent venous occlusion conditions result incomplete compression , major us indication acute dvt appearance confused acute dvt follow examinations establish baseline appearance obtained early 6 months acute episode dvt
fate patients undergoing transluminal angioplasty lower limb ischemia prospective study 370 patients underwent 500 percutaneous transluminal \( \) lower limb ischemia 7 year period performed 97 follow rate achieved first pta successful 188 patients \( 51 \) failures , 31 failed attempts dilation 73 occurred within 1 month intervention patients failed pta , 39 underwent bypass surgery 24 underwent amputation 30 day mortality rate 3 , 1 deaths attributed pta survival rate 5 years successes double failures \( p less 0005 \) best results femoropopliteal stenoses two three patent calf vessels \( cumulative patency rate , 78 3 years \) worst femoropopliteal occlusions one patent calf vessels \( cumulative patency rate , 25 3 years \) log rank tests life table data used show factors favoring good outcome concluded pta treatment first choice suitable patients , although failure intervention critical ischemia significant risk , valuable addition therapeutic options patients little chance surgical treatment
percutaneous transluminal angioplasty crural arteries authors dilated 103 stenosed crural arteries 71 patients primary success defined reducing lesion residual stenosis less 30 achieved 96 cases complications included one vessel rupture one occluding intimal flap , treated vascular surgeon bypass venous patch , respectively one hematoma puncture site treated surgically size modern materials guide wires low profile balloon catheters , dilation crural arteries become safe , indications percutaneous transluminal angioplasty \( pta \) crural arteries limited stages iii iv disease authors believe indications pta stage iib disease justified , especially intervention improves outflow proximal procedure performed
angioplasty contralateral approach use guiding catheter angioplasty balloons 8 f guiding catheter developed use angioplasty balloon catheters angioplasty femoral artery contralateral approach antegrade puncture ipsilateral femoral artery possible catheter may used angioplasty femoral artery bifurcation superficial femoral artery arterial stenoses patients renal transplants
irrigation device procedures simple irrigation device use diagnostic interventional procedures described device used flush blood clots catheter authors also describe technique device used prevent filling catheter air guide wire removed
response spinal cord blood flow motor sensory evoked potentials aortic ligation produce spinal cord ischemia , ligation thoracic aorta performed 15 , 30 , 45 minutes three animals spinal cord blood flow motor sensory evoked potentials measured , , aortic ligation ischemia blood flow zero ligation encountered thoracic lumbar cords , followed hyperemia upon release ligature somatosensory motor evoked potentials aortic ligation gradually recovered following flow motor sensory evoked potentials similarly high aortic ligation
lower extremity percutaneous transluminal angioplasty multifactorial analysis morbidity mortality analyzed outcome 202 percutaneous transluminal angioplasty \( pta \) procedures performed 1983 1989 quantitate procedural risks define factors associated suboptimal results immediate clinical failure premorbid factors studied included age , sex , treatment single versus multiple lesions , stenoses versus occlusions , premorbid status limb \( claudication vs limb threat \) , distal level pta adverse outcomes included complications \( hematoma , acute occlusion , thrombosis pta site , distal embolization , failure cross , arterial dissection , rupture , significant systemic derangement \) , major amputations \( knee knee \) , deaths 66 complications \( 32 7 \) , 22 amputations \( 10 9 \) , 12 deaths \( 5 9 \) series logistic regression analysis revealed major predictive variable occurrence complication \( p 0 002 \) , predictive variable outcomes amputation death \( p 0 0001 p 0 , respectively \) , premorbid clinical status limb lower extremity pta benign procedure associated significant risk complication , amputation , procedure associated death adverse outcomes cluster patients limb threat therefore may reasonable restrict use pta patients claudication strictly selected cases limb threat
hemodynamics internal carotid artery occlusion examined positron emission tomography using positron emission tomography nine patients minor strokes , unilateral internal carotid artery occlusion , good collateral circulation anterior portion circle , analyzed regional cerebral blood flow , cerebral metabolic rate oxygen , oxygen extraction fraction , cerebral blood volume studies allowed quantification regional hemodynamic status , especially relation watershed areas compared eight normal controls , patients significantly \( p less 0 01 \) decreased regional cerebral blood flow middle cerebral artery territory surrounding watershed areas occluded hemisphere oxygen extraction fraction rose distance anterior portion circle , highest value superior parietal posterior occipital watershed area concomitant decrease cerebral blood flow cerebral blood volume ratio suggested reduction mean blood flow velocity , whereby elevated blood viscosity would reduce cerebral blood flow findings suggest hemodynamic vulnerability watershed areas internal carotid artery occlusion persons good collateral circulation anterior portion circle results also emphasize importance systemic hemodynamic factors blood pressure circulating blood volume genesis watershed infarction
pharmacologic irreversible narrowing chronic rabbits associated functional damage studied isolated basilar artery segments rabbit model chronic autologous blood placed around basilar artery rabbits killed 1 , 2 , 3 , 4 , 5 , 6 , 7 , 9 days later caused narrowing segments biphasic time course first \( immediate \) phase reversed intra arterial papaverine second phase exhibited increasing component narrowing papaverine insensitive based passive force length curves , basilar artery segments became increasingly stiff 9 days contrast , contractility decreased responses basilar artery segments greater first days , became less saline injected controls contractions response norepinephrine potassium reduced endothelium based acetylcholine induced vasodilation progressively diminished , response sympathetic nerve stimulation negative correlation artery wall stiffness contractility papaverine insensitive component angiographic narrowing correlated directly loss contractility artery wall stiffness results consistent conclusion increased artery wall stiffness primary determining factor arterial narrowing chronic
two cases spontaneous internal carotid artery occlusion due giant intracranial carotid artery aneurysm although spontaneous thrombosis giant intracranial aneurysm relatively common , occlusion parent artery rare describe two recent patients parent artery spontaneously occluded one patient severe stenosis left internal carotid artery , delayed appearance faint vascular widening near posterior process one month later , complete occlusion left internal carotid artery shown angiographically second patient dysarthria left hemiparesis , resulting diagnosis left internal carotid artery giant aneurysm suffered episode visual disturbance right eye 5 years angiography showed right cervical internal carotid artery occluded believe mechanism parent artery occlusion two patients due first stretching internal carotid artery enlarged aneurysm , followed compression internal carotid artery aneurysm next , anterior process optic nerve involved , , finally , thrombosis aneurysmal cavity extends internal carotid artery
prostaglandins , kidney , hypertension prostaglandins part family oxygenated metabolites arachidonic acid known collectively eicosanoids formed , act , inactivated locally rarely plasma , affect blood flow tissues might contribute control peripheral vascular resistance studies shown derangement total body prostaglandin synthesis metabolism hypertension , increased renal synthesis one , thromboxane a2 , noted spontaneously hypertensive rats hypertensive humans potent vasoconstrictor may account increased renal vascular resistance suppressed plasma renin activity seen many patients hypertension increased renal vascular resistance could increase blood pressure directly component total peripheral resistance indirectly increasing glomerular filtration fraction tubular sodium reabsorption specific thromboxane synthesis inhibitors decrease renal thromboxane production also increase renal vasodilator prostaglandin synthesis prostaglandin synthesis stimulated renal prostaglandin synthesis toward prostacyclin might benefit correcting fundamental renal defect patients hypertension
time delays diagnosis treatment acute myocardial infarction eight cities report pre hospital study group heart project establish magnitude prehospital hospital delays initiating thrombolytic therapy acute myocardial infarction , time telephone 911 emergency medical system \( ems \) activation treatment components analyzed eight separate ongoing trials included estimates ambulance response time , prehospital evaluation treatment time , time admission hospital initiation thrombolytic therapy average time ems activation patient arrival hospital prospectively determined 46 1 8 2 minutes patients eight centers time admission hospital initiation thrombolytic therapy retrospectively determined 83 8 55 0 minutes separate group 730 patients six centers prehospital hospital time delays much longer perceived paramedics emergency department directors shorter hospital time delays observed patients prehospital ecg obtained part protocol driven prehospital diagnostic strategy diagnosis acute infarction made arrival hospital \( 36 3 11 3 minutes 13 patients \) results show magnitude time required evaluate , transport , initiate thrombolytic therapy preclude initiation treatment patients within first hour symptoms implementation protocol driven prehospital diagnostic strategy may associated reduction time thrombolytic therapy
intracoronary adenosine administration reperfusion following 3 hours ischemia effects infarct size , ventricular function , regional myocardial blood flow previous studies demonstrated adenosine significantly enhances myocardial salvage 90 minutes regional ischemia determine effect prolonged ischemia , closed chest dogs underwent 3 hours left anterior descending artery occlusion followed 72 hours reperfusion intracoronary adenosine \( 3 75 mg min 1 5 ml min total volume 90 ml n 10 \) equivalent volume saline \( 1 5 ml min total volume 90 ml n 9 \) infused left main coronary artery first 60 minutes reperfusion regional myocardial blood flow assessed serially microspheres regional ventricular function assessed contrast ventriculography infarct size determined histologically light electron microscopy utilized assess neutrophil infiltration microvascular injury adenosine failed reduce infarct size expressed percentage area risk \( 38 0 4 9 versus 34 8 4 6 p ns \) improve regional ventricular function measured radial shortening method \( 3 2 1 8 versus 2 2 3 1 p ns \) 72 hours reperfusion vasodilatory effects observed regions ischemic zone adenosine administration associated similar extent capillary endothelial changes neutrophil infiltration adenosine treated saline control groups results suggest severe functional abnormalities present vasculature 3 hours ischemia adenosine therapy ineffective enhancing myocardial salvage
clinical significance plasminogen activator inhibitor activity patients exercise induced ischemia assess fibrinolytic system patients exercise induced ischemia relation ischemia severity coronary artery disease \( cad \) , 47 patients cad confirmed results coronary angiography underwent symptom limited multistage exercise thallium 201 emission computed tomography patients cad exercise induced ischemia assessed thallium 201 images pre peak exercise blood samples patient blood samples control subjects assayed several fibrinolytic components also assayed plasma adrenaline extent ischemia defined delta visual uptake score \( total visual uptake score delayed images minus total visual uptake score initial images \) severity cad number diseased vessels basal condition , plasminogen activator inhibitor \( pai \) activity significantly higher patients exercise induced ischemia compared control subjects \( p less 0 01 \) , although significant differences fibrinolytic variables two groups moreover , pai activity basal condition displayed significantly positive correlation extent ischemia \( r 0 47 , p less 0 01 \) patients exercise induced ischemia divided two groups \( 24 single vessel disease 23 multivessel disease \) significant differences coronary risk factors , hemodynamics , plasma adrenaline levels exercise single vessel multivessel disease except delta visual uptake score significantly higher multivessel disease \( p less 0 01 \)
comparison coronary angiography early oral dipyridamole thallium 201 scintigraphy patients receiving thrombolytic therapy acute myocardial infarction evaluated 50 consecutive patients received thrombolytic therapy acute myocardial infarction using thallium 201 single photon emission computed tomography combination oral dipyridamole \( 300 mg \) assess frequency residual myocardial ischemia thallium studies performed early myocardial infarction mean 4 6 days \( range 3 11 \) 50 patients time onset chest pain administration thrombolytic therapy 2 6 hours \( range 0 5 5 5 \) q wave myocardial infarction evident 46 patients four patients non q wave infarction \( anterior infarction 31 patients inferior infarction 19 patients \) serum mean peak creatinine kinase iu l \( range 127 \) coronary angiography performed patients mean 3 1 days \( range 2 10 \) revealed infarct related vessel patent 36 patients \( 72 \) ejection fraction 48 \( range 26 67 \) dipyridamole administration , 13 patients \( 26 \) developed angina easily reversed administration intravenous systolic blood pressure decreased 122 115 mm hg \( p less 0 05 \) heart rate increased 76 85 beats min \( p less 0 05 \) none patients significant hypotension , arrhythmias , evidence infarct extension perfusion abnormalities present initial thallium images 48 patients redistribution suggestive ischemia present 36 patients \( 72 \) ischemia confined vascular distribution infarct vessel evident 22 patients seven patients ischemia infarct zone well remote myocardial segment thus 29 patients \( 58 \) ischemia distribution infarct vessel ischemia infarct zone evident 19 36 patients \( 53 \) open infarct vessels 10 14 patients \( 71 \) occluded infarct vessels conclusion , thallium 201 single photon emission computed tomography using oral dipyridamole safely performed patients recent myocardial infarctions receive thrombolytic therapy
prolongation ventricular refractoriness class ia antiarrhythmic drugs prevention ventricular tachycardia induction effects class la antiarrhythmic drugs \( procainamide , quinidine \) right ventricular effective refractory period \( verp \) intraventricular conduction time assessed serial invasive electrophysiologic studies sustained monomorphic ventricular tachycardia \( vt \) 47 patients remote myocardial infarction , sustained vt inducible two extrastimuli basic drive one two basic cycle lengths right ventricular apex oral drug administration , sustained vt longer inducible \( group \) 27 patients remained inducible \( group ii \) 20 protocol class la drugs prolonged verp groups , greater lengthening drugs effective \( e g , 32 14 msec group vs 12 19 msec group ii p less 0 005 , basic cycle length 600 700 msec \) prolongation verp greater 30 msec 88 positive predictive value prevention sustained vt induction except one patient group , drugs prolonged verp coupling intervals resulted sustained vt induction control conditions longer contrast , conduction time ventricle \( surface qrs duration \) sinus rhythm right ventricular pacing prolonged similarly regardless efficacy \( e g , 33 21 msec vs 27 27 msec cycle length 400 msec \) presence similar plasma levels drug imply equivalent prolongation verp two groups results suggest greater prolongation verp oral procainamide quinidine correlates drug efficacy vt induction better predictor drug effect achievement therapeutic plasma level
left ventricular end systolic stress volume index ratio aortic mitral regurgitation normal ejection fraction evaluate left ventricular contractile state regurgitant valvular disease normal ejection fraction , analyzed end systolic stress volume index relationship \( \) means cineangiography 15 normal subjects , 11 patients aortic regurgitation \( ar \) , 10 patients mitral regurgitation \( mr \) whose ejection fraction \( ef \) 60 end systolic stress volume index ratio normal subjects 5 57 0 60 cm5 m2 \( mean standard deviation \) , defined range including 2 standard deviations ratio normal range six patients ar five patients mr placed inside normal range , termed ar mr , remaining five patients ar mr placed right normal range , termed ar mr ef differ patients ar ar \( 69 4 5 4 70 7 6 1 \) mr mr \( 71 6 3 6 versus 71 1 7 9 \) ef subdivided groups ar mr also differ normal subjects \( 70 7 7 3 \) finding showed left ventricular contractile state depressed patients ar mr despite normal ef ar mr end systolic stress end systolic volume index differ , end diastolic volume index larger \( ar 156 8 27 9 versus ar 110 8 24 1 ml m2 , mr 160 5 44 7 versus mr 101 0 16 6 ml m2 p less 0 05 \) , regurgitant fraction higher \( ar 52 6 13 6 versus ar 29 7 13 3 , mr 52 9 10 2 versus mr 30 2 11 4 p less 0 05 \) addition , linear inverse correlation end systolic stress volume index ratio end diastolic volume index subjects \( r 0 82 , n 36 \) normal subjects linear inverse correlation end systolic stress ef \( r 0 91 , n 15 \) , relationship failed separate patients results present study suggest patients ar mr whose ef normal depressed contractile state , patients large end diastolic volume index high regurgitant fraction \( abstract truncated 400 words \)
maximal oxygen uptake severe aortic regurgitation different view left ventricular function respiratory gas exchange used assess left ventricular \( lv \) function 22 patients severe aortic regurgitation \( 19 men three women , aged 18 70 years , mean 49 years \) anaerobic threshold symptom limited maximal oxygen consumption \( vo2 max \) measured treadmill exercise , results compared conventional echocardiographic radionuclide indices lv systolic function results considered respect patients' new york heart association functional class rest exercise lv ejection fractions variable , mean results similar classes echocardiographic indices lv cavity dimensions , fractional shortening , radius thickness ratio , systolic wall stress also showed wide range similar mean results class contrast , vo2 max anaerobic threshold showed relationship functional class vo2 max 32 4 3 4 ml kg min age matched control subjects patients 27 9 4 7 class , 24 7 5 7 class ii , 14 2 2 combined class iii iv results patients classes ii similar , groups significantly different control subjects \( p less 0 05 \) patients class iii iv \( p less 0 01 \) half patients moderate lv dysfunction \( judged reduced vo2 max \) asymptomatic , lv function impaired 4 10 patients class thus , unlike conventional indices lv function , vo2 max appeared capable distinguishing patients moderate severe lv dysfunction little lv dysfunction measurement respiratory gas exchange appears valid useful supplementary means assessing lv function severe aortic regurgitation long term evaluation required
contribution transesophageal echocardiography patient diagnosis treatment prospective analysis capability transesophageal \( tee \) versus transthoracic \( tte \) echocardiography diagnostic tool clinical practice prospectively examined 86 consecutive cases conclusive diagnosis possible 95 tee , whereas result achieved 48 tte specifically , tee provided conclusive diagnosis 14 16 cases infective endocarditis , tte gave result 4 16 cases \( p less 0 001 \) similarly , tee allowed conclusive diagnosis 11 11 instances aortic dissection , tte gave indication two cases \( p less 0 001 \) tee similarly effective eight eight cases atrial thrombi , whereas tte gave diagnosis three eight cases \( p less 0 01 \) five subjects intracardiac masses , tee gave conclusive diagnosis five , whereas tte able diagnose conclusively one subject \( p less 0 02 \) seven patients mitral regurgitation , tee gave conclusive diagnosis seven tte able provide information four \( p ns \) tee able provide conclusive diagnosis four patients aortic insufficiency , tte gave information two four \( p ns \) 14 patients prosthetic valve dysfunction , tee gave diagnosis 12 tte gave eight patients \( p ns \) methods gave conclusive diagnosis 13 13 cases mitral stenosis \( p ns \) also , tee provided conclusive diagnosis eight eight patients adult congenital heart disease tte gave information four \( p ns \)
left ventricular mass regression aortic valve replacement measured ultrafast computed tomography left ventricular mass function measured using ultrafast computed tomography , correlated clinical status 17 patients aortic stenosis insufficiency undergoing aortic valve replacement balloon valvuloplasty wall mass 159 38 gm m2 initially , decreased 25 116 29 gm m2 4 month \( p less 0 001 \) , decreased total 34 105 33 gm m2 8 months valve repair 8 months mean wall mass within normal range , three patients retained abnormal hypertrophy ejection fraction increased 8 \( p 0 06 \) clinical function improved patients , three patients remaining outside new york heart association functional class 1 8 months regression ventricular mass normal range correlated attainment class 1 functional status \( p less 0 02 \) , despite lack increase ejection fraction single patient followed 8 months valvuloplasty minor wall mass regression minor clinical improvement
hypertensive heart disease relationship silent ischemia coronary artery disease left ventricular hypertrophy ecg evidence silent ischemia occurs commonly patients systemic hypertension , relationship left ventricular hypertrophy \( lvh \) , large vessel coronary artery disease \( cad \) , factors remains unclear accordingly validated results echocardiographic method used measure left ventricular \( lv \) mass union comparison necropsy measurements 30 patients , examined relationships 46 men essential hypertension among st segment depression ambulatory monitoring , exercise stress transesophageal pacing \( n 38 \) , lv mass , catheterization evidence cad \( n 25 \) , factors \( plasma catecholamines platelet aggregability \) echocardiographic measurements lv mass methods closely correlated necropsy values \( r 0 78 90 , respectively p less 0 001 \) ambulatory monitoring 1 17 episodes greater equal 1 mm st depression occurred 26 46 \( 65 \) patients hypertension ischemia also provoked exercise pacing stress patients \( 65 80 , respectively \) neither st depression occurrence additional episodes symptomatic angina related presence coronary obstruction catheterization patients without st depression differ age , blood pressure , lv mass
parental history independent risk factor coronary artery disease framingham study family history cad , defined parental death cad , found significant independent predictor cad logistic regression model controlling standard risk factors length follow among participants framingham study persons positive parental history 29 increased risk cad , strength association parental history cad similar found standard risk factors systolic blood pressure , cholesterol level , cigarette smoking evidence found persons family history cad decreased capacity deleterious effects known risk factors , significant interaction found risk factors parental history cad among men low risk cad risk factor profile \( e , nonsmoking , thin , persons \) , two thirds experience cad positive parental history study suggests cad among persons predicted low risk standard risk factors may substantial genetic component risk associated parental history may reduced modification factors nevertheless , among persons positive family history , favorable risk profile substantially less risk cad unfavorable risk profile
effect verapamil mortality major events acute myocardial infarction \( danish verapamil infarction trial ii ii \) effect verapamil death major events \( e , death reinfarction \) acute myocardial infarction studied double blind , randomized , placebo controlled multicenter trial eight hundred seventy eight patients started treatment verapamil , 360 mg day , patients placebo treatment started second week admission continued 18 months \( mean 16 months \) ninety five deaths 146 major events occurred verapamil group 119 deaths 180 major events placebo group 18 month mortality rates 11 1 13 8 \( p 0 11 , hazard ratio , 0 80 95 confidence limits , 0 61 1 05 \) , major event rates 18 0 21 6 \( p 0 03 , hazard ratio , 0 80 95 confidence limits , 0 64 0 99 \) verapamil placebo groups , respectively patients without heart failure coronary care unit mortality rates 7 7 verapamil group 11 8 placebo group \( p 0 02 , hazard ratio , 0 64 95 confidence limits , 0 44 0 94 \) , major event rates 14 6 19 7 \( p 0 01 , hazard ratio 0 70 95 confidence limits \( 0 52 0 93 \) patients heart failure mortality rates 17 9 17 5 \( p 0 79 , hazard ratio , 1 05 95 confidence limits , 0 72 1 54 \) , major event rates 24 9 24 9 \( p 1 0 , hazard ratio 0 98 95 confidence limits 0 72 1 39 \) long term treatment verapamil acute myocardial infarction caused significant reduction major events , positive effect found patients without heart failure
impact field transmitted electrocardiography time hospital thrombolytic therapy acute myocardial infarction assess impact field transmitted electrocardiogram \( ecg \) patients possible acute myocardial infarction , randomized open trials performed portable electrocardiographic system coupled cellular programmed automatically transmit ecgs base hospital consecutive patients served 6 units salt city emergency rescue system studied 71 patients randomized field ecg \( n 34 \) versus ecg \( n 37 \) time scene 16 4 9 7 minutes ecg group versus 16 1 7 0 minutes non ecg group \( difference significant \) time transport averaged 18 2 9 9 17 6 13 1 minutes , respectively \( difference significant \) six 34 patients field ecg showed acute myocardial infarction , qualified received thrombolytic therapy 48 12 minutes hospital arrival \( range 30 60 \) compared 103 44 minutes \( p less 0 01 \) 51 historical control patients 68 29 minutes 6 concurrent control patients without field ecg thus , field ecg causes negligible delays paramedic time , leads significant decreases time hospital thrombolysis may make field therapy feasible field ecg may important addition reperfusion strategies
sensitivity set myocardial infarction screening criteria patients anatomically documented single multiple infarcts subset 3 screening criteria \( q wave greater equal 30 ms lead avf , q r wave less equal 10 ms less equal 0 1 mv lead v2 , r wave greater equal 40 ms v1 \) proposed identify single myocardial infarcts , 3 criteria achieved 95 specificity , 84 77 sensitivities inferior anterior myocardial infarcts , respectively , among patients identified coronary angiography left ventriculography study establishes true sensitivities set screening criteria 71 patients anatomically proven single myocardial infarcts 32 patients multiple myocardial infarcts single inferior infarct group , avf criterion 90 sensitive v2 criterion \( q r wave less equal 10 ms less equal 0 1 mv \) 67 sensitive single anterior infarct group single criterion proved sensitive identifying posterolateral infarct set screening criteria performed well multiple infarcts single infarcts , cumulative sensitivity 72 overall sensitivity screening set 103 patients groups 71
two year outcome angiographically documented myocardial reperfusion acute coronary occlusion thrombolysis angioplasty study group reperfusion therapy clearly shown decrease early mortality acute myocardial infarction , impact therapy long term survival less extensively evaluated study reports extended follow large cohort 810 patients treated intravenous thrombolytic therapy combined , considered necessary maintain augment infarct vessel patency , mechanical reperfusion therapies patient underwent coronary angiography within 2 hours initiation thrombolytic infusion coronary angioplasty performed 62 patients hospital discharge 21 underwent coronary artery bypass graft surgery follow obtained 96 mean 18 8 months \( range , 1 5 48 months \) cause mortality period 3 3 2 1 died cardiac causes nonfatal reinfarction occurred 5 1 although low event rate limits validity statistical comparisons , patients survived follow period tended younger \( 56 10 vs 65 7 years \) , better predischarge left ventricular function \( left ventricular ejection fraction , 52 11 vs 46 13 \) lower prevalence multivessel coronary artery disease \( 45 vs 67 \) excellent long term survival may , part , reflect exclusion high risk patients enrollment thrombolysis angioplasty myocardial infarction \( \) studies may also attributable , however , frequent use combined thrombolysis mechanical revascularization population
functional significance myocardial perfusion defects induced dipyridamole using thallium 201 single photon emission computed tomography two dimensional echocardiography mechanisms responsible myocardial blood flow oral administration large dose \( 300 mg \) dipyridamole assessed 27 patients serial thallium 201 single photon emission computed tomography \( spect \) simultaneous 2 dimensional echocardiograms myocardial tomographic images obtained 50 minutes 3 4 hours administration dipyridamole two dimensional echocardiograms recorded baseline every 15 minutes 60 minutes dipyridamole caused mild reduction blood pressure \( 129 18 126 16 mm hg \) mild increase heart rate \( 69 15 73 4 beats min \) sixteen patients perfusion defects dipyridamole spect , underwent partial total filling fourteen patients \( 87 5 \) either new abnormality deterioration preexisting wall motion abnormality 2 dimensional echocardiography , thus considered developed transient ischemia dipyridamole administration ten 11 patients \( 91 \) normal perfusion fixed defects spect deterioration wall motion oral dipyridamole , thus considered evidence myocardial ischemia conclusion , patients transient thallium 201 defects dipyridamole develop transient worsening resting wall motion 2 dimensional echocardiography , suggestive true myocardial ischemia myocardial oxygen demand , indicated heart rate blood pressure product , change significantly , mechanism myocardial ischemia patients likely diminished regional blood flow related subendocardial steal induced dipyridamole
left ventricular dilatation pulmonary thallium uptake single photon emission computer tomography using thallium 201 adenosine induced coronary hyperemia study examined implications left ventricular \( lv \) dilatation increased pulmonary thallium uptake adenosine induced coronary hyperemia lung heart thallium ratio initial images significantly higher patients coronary artery disease \( cad \) normal subjects 0 48 0 16 3 vessel disease \( n 16 \) , 0 43 0 10 2 vessel disease \( n 20 \) , 0 43 0 08 1 vessel disease \( n 16 \) 0 36 0 05 normal subjects \( n 7 \) \( p less 0 001 , 0 09 0 06 , respectively \) significant correlation severity extent perfusion abnormality \( determined polar maps \) lung heart thallium ratio \( r 0 51 0 52 , respectively , p less 0 0002 \) also significant correlation lung thallium washout lung heart thallium ratio \( r 0 42 , p 0 \) peak heart rate \( r 0 49 , p less 0 0001 \) lv dilatation mostly due increase cavity dimension \( 30 increase \) lesser extent \( 6 increase \) due increase lv size \( cavity dimensions measured short axis slices level initial delayed images \) dilation seen patients cad normal subjects changes correlated extent severity thallium perfusion abnormality thus , adenosine induced coronary hyperemia may cause lv dilation increased lung thallium uptake basis subendocardial ischemia
effects bepridil diltiazem ventricular repolarization angina pectoris examine time course potential predictors prolongation ventricular repolarization calcium antagonist bepridil , effects bepridil \( 300 500 mg day n 45 \) diltiazem \( 180 300 mg day n 42 \) qt qtc interval duration analyzed randomized double blind study patients angina pectoris electrocardiograms recorded 14 , 28 , 70 112 days treatment begun 14 days , bepridil prolonged qt interval 26 35 ms \( range , 60 120 ms \) qtc \( 's formula \) 17 33 ms \( range , 73 107 ms \) compared baseline \( p less 0 05 \) qt qtc significantly increase thereafter however , among 30 patients less 40 ms qtc prolongation day 14 compared baseline , 13 \( 43 \) exceeded limit least 1 following visits diltiazem significantly alter qt qtc intervals absolute change qtc interval baseline observed 14 days bepridil therapy inversely proportional baseline qtc interval \( r 0 68 n 42 p less 0 001 \) degree bepridil induced qtc prolongation day 14 correlated pretreatment rr interval \( r 0 36 n 42 p less 0 02 \) conclusion , chronic administration bepridil diltiazem prolongs ventricular repolarization patients angina pectoris overall effects bepridil therapy qt qtc intervals assessed electrocardiogram recorded 14 days treatment subsequent measurements may required individual patients short baseline qtc interval slow initial heart rate may potentially useful predictors greater qtc prolongation bepridil
effects intravenous verapamil left ventricular relaxation filling stable angina pectoris left ventricular \( lv \) diastolic function often impaired coronary artery disease \( cad \) assess whether verapamil could improve lv diastolic properties , 12 patients cad undergoing right left sided cardiac catheterization , well simultaneous radionuclide angiography , studied intravenous administration verapamil \( 0 1 mg kg bolus followed 0 007 mg kg min \) heart rate kept constant atrial pacing studies lv pressure volume relations obtained verapamil decreased lv systolic pressure \( 130 22 117 16 mm hg , p less 0 01 \) end systolic pressure volume ratio \( 2 4 1 3 1 6 0 5 mm hg ml , p less 0 05 \) , increased lv end diastolic \( 13 4 16 4 mm hg , p less 0 02 \) pulmonary capillary pressures \( 10 5 12 5 mm hg , p less 0 005 \) despite negative inotropic effects , cardiac index increased \( 3 4 0 7 3 9 0 6 liters min m2 , p less 0 02 \) time constant isovolumic relaxation shortened \( 63 14 47 9 ms , p less 0 02 \) peak filling rate increased \( 370 155 184 ml , p less 0 001 2 6 1 1 3 3 0 9 end diastolic counts , p less 0 02 4 1 1 6 5 5 1 5 stroke counts , p less 0 001 \)
long term follow patients incessant ventricular tachycardia seventeen patients coronary artery disease , idiopathic dilated cardiomyopathy organic heart disease presented incessant ventricular tachycardia \( vt \) studied followed mean period 51 35 months patients incessant vt included greater equal 3 episodes sustained vt rate greater equal 120 beats min frequent episodes nonsustained vt 24 hour period patient electrolyte disorder , prolonged qt interval , drug induced arrhythmia myocardial infarction less 2 weeks old six patients died within 27 months follow 4 sudden death 2 acute myocardial infarction three 11 surviving patients remission vt within 1 week diagnosis incessant vt 3 patients antiarrhythmic drugs discontinued follow adverse effects drugs medical reasons , 2 found remission remaining 5 alive patients , attempts made antiarrhythmic drugs 4 patients found remission drugs discontinued thus , 9 patients \( 53 \) incessant vt remission mean follow 55 34 months discontinuation antiarrhythmic drugs probability remission patients surviving incessant vt warrants trials discontinuation antiarrhythmic drugs patients
mechanisms heart failure role angiotensin converting enzyme inhibition four major diagnostic criteria syndrome congestive heart failure left ventricular dysfunction , exercise intolerance , pulmonary congestion edema ventricular arrhythmias activation norepinephrine , angiotensin ii , vasopressin atrial natriuretic peptide may key factor vasoconstriction increased impedance left ventricular ejection heart failure interventions interfere vasoconstrictor mechanisms salutary effect left ventricular performance treatment angiotensin converting enzyme \( ace \) inhibitors , alpha adrenoceptor blockers vasopressin antagonists resulted hemodynamic benefits , difficult demonstrate long term clinical effectiveness reductions mortality demonstrated patients heart failure treated vasodilators ace inhibitors improvement quality life prolongation life two appropriate goals management heart failure understanding role angiotensin ii interference ace inhibition tissue processes heart failure needed
potential role tissue renin angiotensin system pathophysiology congestive heart failure circulating renin angiotensin system \( ras \) plays important role maintenance cardiovascular homeostasis recently demonstrated endogenous ras exist target tissues important cardiovascular regulation article reviews multiple effects angiotensin ii target tissues , evidence presence functional tissue ras data suggest role tissue ras pathophysiology heart failure activation circulating predictive worsened survival heart failure however , cardiac renal tissue ras activities also increased compensated stage heart failure , plasma renin angiotensin activity normal hypothesized plasma ras maintains circulatory homeostasis acute cardiac decompensation , changes tissue ras contribute responses chronic sustained cardiac impairment concept different functions circulating tissue ras pathophysiology heart failure may important pharmacologic implications
neuroendocrine activity congestive heart failure increased neuroendocrine activity patients congestive heart failure appears generalized attempt maintain blood pressure expense reduced cardiac performance salt water retention likely baroreceptor dysfunction contributes increased sympathetic nervous system activity patients congestive heart failure usual tonic inhibitory great vessels heart fail adjust sympathetic traffic brain periphery , leading sympathetic tone arginine vasopressin plasma renin activity may increased secondarily however , plasma renin activity activation could also induced low salt diet diuretic use preliminary baseline data indicate patients left ventricular dysfunction \( ejection fraction less equal 35 \) mild symptoms heart failure increased plasma levels norepinephrine , atrial natriuretic factor arginine vasopressin , plasma renin activity normal , suggesting neuroendocrine activity contributes pathogenesis congestive heart failure angiotensin ii may alter gene expression , leading changes shape size cell remodeling heart blood vessels associated heart failure hypertension angiotensin converting enzyme inhibitors demonstrated reverse remodeling process certain experimental conditions studies currently way test possibility patients
effects enalapril neuroendocrine activation prognosis severe congestive heart failure \( follow consensus trial \) consensus trial study group study enrolled 253 patients severe heart failure \( new york heart association functional class iv \) 35 centers , randomly assigned treatment placebo enalapril , addition usual treatment heart failure initial titration period , daily doses enalapril ranged 2 5 40 mg end trial , 46 placebo treated patients 61 enalapril treated patients alive \( p 0 003 \) survival figures 8 months completion trial 32 48 , respectively \( p 0 001 \) 21 30 , respectively \( p 0 006 \) 2 year follow placebo group , significant positive association mortality baseline levels norepinephrine , epinephrine , angiotensin ii , aldosterone atrial natriuretic peptide association found enalapril treated patients results suggest effects enalapril mortality related neuroendocrine activation general renin angiotensin system particular
pharmacology angiotensin converting enzyme inhibitors guide use congestive heart failure pharmacokinetics angiotensin converting enzyme \( ace \) inhibitors difficult assess several reasons first , compounds exert influence inhibiting enzyme cascade enzymatic events , whose rate limiting enzyme \( renin \) directly affected ace inhibition second , renin angiotensin accumulate ace inhibition change dose ace inhibitor could produce sudden shifts angiotensin angiotensin ii third , components circulating renin system require interaction several organ systems effector sites fourth , kinetics ace inhibitors influenced organ systems responsible drug absorption , metabolism excretion , functional status systems affected heart failure process fifth , least portion cardiovascular effects ace inhibitors influenced contributions systems whose physiologic effects may importance patients congestive heart failure sixth , potential impact tissue bound ace yet fully understood finally , appropriate drug dosing , effects aging heart failure process , extent renin system activity , disposition ace inhibitors need considered complex pharmacokinetics , treatment ace inhibitors guided pharmacodynamic clinical characteristics
clinical hemodynamic assessment reflux reflux \( \) test studied assess ability clinically predict response cardiac catheterization determine significance patients without heart failure correlate baseline hemodynamic parameters sixty five patients considered free heart failure undergoing routine cardiac catheterization enrolled test , defined venous pressure response sustained abdominal compression , performed standardized manner bedside assessing change internal jugular venous pressure right sided cardiac catheterization measuring change right atrial pressure comparison sustained increase greater equal 1 cm considered positive 62 65 patients test stabilized 15 seconds results examination bedside agreed catheterization \( k 0 74 , p less 0 001 \) test result correlated best baseline mean right atrial pressure \( r 0 59 \) right ventricular end diastolic pressure \( r 0 51 \) , regression analysis predicted right atrial \( f \( 1 , 63 \) 32 8 , r2 0 34 , p less 0 0001 \) right ventricular end diastolic \( f \( 1 , 63 \) 22 , r2 0 26 , p less 0 0001 \) pressures positive test high sensitivity specificity predicting right atrial pressure greater 9 mm hg \( 1 0 , 0 85 \) right ventricular end diastolic pressure greater 12 mm hg \( 0 90 , 0 89 \) concluded 15 seconds adequate interpretation , bedside observation predicts response right sided cardiac catheterization
anatomic correlations long axis views biplane transesophageal echocardiography number views obtainable transesophageal echocardiography \( te \) limited fixed position transducer end probe confined standard te studies short axis tomography heart aorta recently , biplane te probe become available capable long short axis imaging study prospectively assessed application long axis plane biplane probe providing complementary long axis views ambulatory patients six standard long axis views could obtained compared corresponding anatomic sections illustrate anatomic relations facilitate structure identification long axis views provide better appreciation 3 dimensional nature cardiac anatomy function , especially demonstrating relation vertically aligned structures
transient left ventricular filling abnormalities \( diastolic \) acute myocardial infarction variety experimental studies suggest diastolic left ventricular \( lv \) function changes acute myocardial infarction \( ami \) , limited data exist changes humans assess diastolic filling ami , 60 patients underwent doppler echocardiographic examination within 24 hours ami 54 patients also underwent catheterization , 45 \( 83 \) successfully reperfused subgroup 17 patients underwent follow doppler examination 7 days infarction , whereas 15 patients stable exertional angina served control subjects significant difference age , gender , incidence systemic hypertension diabetes mellitus , heart rate , mean arterial pressure severity coronary artery disease infarct control groups infarct group lower velocity time integral total \( 9 9 0 4 cm vs 12 0 0 9 cm , p less 0 001 \) , lower velocity time integral e \( 5 8 0 3 cm vs 6 8 0 5 cm , p less 0 01 \) lower velocity time integral 0 333 \( 3 5 0 4 cm vs 6 1 0 5 cm , p less 0 01 \) control group addition , velocity time integral total significantly greater infarction group \( 0 44 0 03 vs 0 35 0 04 , p less 0 01 \) compared control group follow subgroup showed increase velocity time integral total \( p less 0 01 \) , velocity time integral e \( p less 0 05 \) velocity time integral 0 333 total \( p less 0 05 \) first 7 days infarction final recovery values 7 days significantly different coronary artery disease group
functional status coronary artery bypass grafting percutaneous transluminal coronary angioplasty two cohorts consecutive patients comparable age similar cardiac function underwent either coronary artery bypass grafting \( cabg n 106 \) percutaneous transluminal coronary angioplasty \( ptca n 64 \) entered prospective comparison study examining functional status return work first year recovery patients evaluated using standardized functional status instruments activities daily living , work performance , social activity , mental health quality social interaction 1 , 6 12 months procedure within cabg group , statistically significant improvements functional status every subscale noted 1 year follow patients undergoing ptca demonstrated significant improvement dimensions except quality interaction 1 year compared baseline 2 groups compared , ptca group demonstrated greater participation cabg group routine daily physical social activities 1 6 months , apparent advantage disappeared 1 year measures psychological functioning better cabg ptca reduction number employment occurred cabg ptca groups , independent physical functional status measures , improved groups procedures employment , cabg group reported greatest improvement work performance
early postoperative balloon coronary angioplasty failed coronary artery bypass grafting small number patients , coronary artery bypass grafting \( cabg \) fails relieve anginal symptoms usefulness coronary angioplasty treatment early \( less equal 90 days \) recurrent ischemia cabg examined forty five patients treated 2 90 days cabg , including 8 patients studied prolonged ischemic symptoms one , 2 3 vessel native disease found 4 , 10 31 patients , respectively time postoperative angiography , major anatomic mechanism recurrent ischemia complete vein graft occlusion 12 patients \( 27 \) , internal mammary artery occlusion 3 \( 7 \) , vein graft stenoses 13 \( 29 \) , internal mammary artery stenoses 10 \( 22 \) , disease 4 \( 8 \) disease distal graft insertion site 3 \( 7 \) angioplasty successful 91 98 sites \( 93 \) , including 95 41 lesions native arteries , 89 46 lesions vein grafts 100 11 internal mammary artery lesions attempted complete revascularization achieved 84 patients 2 hospital deaths 2 myocardial infarctions two additional patients underwent repeat cabg discharge uncomplicated unsuccessful angioplasty late follow 43 survivors \( mean 44 months \) , 4 deaths , 2 noncardiac repeat cabg required 3 patients repeat angioplasty performed 10 angina absent minimal 35 patients 17 patients employed full time thus , percutaneous transluminal coronary angioplasty relieve myocardial ischemia unsuccessful cabg majority patients
comparison antihypertensive efficiency nitrendipine , metoprolol , enalapril using ambulatory 24 hour blood pressure monitoring randomized 6 month study 201 patients , antihypertensive efficiency calcium antagonist nitrendipine , beta 1 selective blocker metoprolol , , beta blocker intrinsic activity angiotensin converting enzyme inhibitor enalapril compared monitored 24 hour ambulatory blood pressure \( bp \) measurements study designed comparable decrease casual bp values obtained 4 drugs normotension achieved monotherapy , diuretic also administered pretreatment casual bp mean 24 hour ambulatory bp values differ 4 groups normotension assessed casual bp measurements observed 4 groups 6 months therapy , significant differences groups however , significantly diuretics required \( n 14 \) enalapril \( n 20 \) groups compared nitrendipine \( n 5 \) metoprolol \( n 7 \) groups despite comparable casual bp control , 4 groups differed significantly mean 24 hour measurements greatest systolic diastolic bp decreases seen metoprolol group metoprolol also effective drug decreasing frequency systolic pressure peaks greater 180 mm hg beta blockers enalapril significantly decreased morning bp increase compared values treatment , nitrendipine data show casual bp measurement good predictor 24 hour bp patients taking hypertensive therapy despite equal degree office bp control , different antihypertensive regimens confer degree bp control
usefulness verapamil congestive heart failure associated abnormal left ventricular diastolic filling normal left ventricular systolic performance normal left ventricular systolic performance impaired left ventricular diastolic filling may present substantial number patients congestive heart failure \( chf \) evaluate effect oral verapamil subset , 20 men \( mean age 68 5 years \) chf , intact left ventricular function \( ejection fraction greater 45 \) abnormal diastolic filling \( peak filling rate less 2 5 end diastolic volumes per second edv \) studied placebo controlled , double blind 5 week crossover trial patients underwent echocardiography rule significant valvular disease , thallium 201 stress scintigraphy exclude major active ischemia compared baseline values , verapamil significantly improved exercise capacity 33 \( 13 9 4 3 vs 10 7 3 4 minutes baseline \) peak filling rate 30 \( 2 29 0 54 vs 1 85 0 45 edv baseline \) \( p less 0 05 \) placebo values 12 3 4 0 minutes 2 16 0 48 edv , respectively \( difference significant \) improvement baseline objective radiographic heart failure score \( scale 0 13 \) significantly greater verapamil compared placebo \( median improvement score 3 vs 1 , p less 0 01 \) mean ejection fraction systolic blood pressure unchanged baseline diastolic blood pressure heart rate decreased small degree verapamil may therapeutic efficacy patients chf , preserved systolic function impaired diastolic filling
detection location myocardial infarction using technetium 99m sestamibi imaging rest technetium 99m \( tc 99m \) sestamibi imaging rest used detect localize myocardial infarction largest study date cooperative study 146 patients 17 institutions 24 normal subjects 122 patients documented myocardial infarction based clinical , enzymatic electrocardiographic criteria presence segmental myocardial perfusion defects compared presence q wave electrocardiogram wall motion abnormality gated blood pool scans , performed within 48 hours tc 99m sestamibi study 122 infarct patients , 118 \( 97 \) showed perfusion abnormalities tc 99m sestamibi imaging perfusion defect found 110 \( 99 \) 111 patients q wave wall motion abnormality , 113 \( 99 \) 114 patients wall motion abnormality 113 \( 98 \) 115 patients q wave 24 normal subjects , 22 \( 92 \) normal tc 99m sestamibi images 75 1 , segments , tc 99m sestamibi defect regional wall motion abnormality gated blood scans present 11 segments , wall motion normal tc 99m sestamibi imaging abnormal 14 segments , wall motion abnormal tc 99m sestamibi images normal 24 control subjects , 99 segments normal thirty eight patients coronary angiography close relation existed coronary anatomy myocardial tc 99m sestamibi uptake 9 territories supplied occluded vessel poor collaterals grade 0 uptake \( scale 0 2 0 markedly reduced 2 normal \)
detection assessment unstable angina using myocardial perfusion imaging comparison technetium 99m sestamibi spect 12 lead electrocardiogram forty five studies using technetium 99m \( tc 99m \) sestamibi single photon emission computed tomography \( spect \) performed patients hospitalized spontaneous chest pain suggestive myocardial ischemia studies done injection episode chest pain repeated injection patients free pain patients hospitalized presumed diagnosis unstable angina , none evidence previous myocardial infarction presence perfusion defect observed tc 99m sestamibi injected chest pain 96 sensitivity 79 specificity detection significant coronary artery disease \( stenosis greater equal 50 \) subsequent angiography criterion larger perfusion defect pain compared absence pain used , sensitivity 81 specificity 84 contrast , transient electrocardiographic ischemic changes pain sensitivity 35 specificity 68 electrocardiographic changes outside episodes chest pain sensitivity 65 specificity 63 diagnosis tc 99m sestamibi spect represents reliable noninvasive diagnostic tool could aid diagnosis myocardial ischemia patients spontaneous chest pain provide additional information provided electrocardiogram
planar imaging techniques used technetium 99m sestamibi evaluate chronic myocardial ischemia results published studies comparing planar imaging performed 2 radionuclides , thallium 201 \( t1 201 \) technetium 99m \( tc 99m \) sestamibi , reviewed average sensitivity detection coronary artery disease \( cad \) studies involving patients 85 \( range 73 96 \) average sensitivity individual vessels 65 \( range 60 70 \) average segmental concordance t1 201 tc 99m sestamibi 89 end diastolic gated perfusion images improved concordance tc 99m sestamibi angiography 22 patients 83 4 87 semiquantitative analysis increased concordance t1 201 tc 99m sestamibi 89 91 ventricular function derived gated tc 99m sestamibi perfusion images showed significant correlation echocardiography \( n 62 , r 0 85 \) angiography \( n 70 , r 0 91 \) equilibrium radionuclide ventriculography \( n 18 , r 0 86 \) ratio lung left ventricle uptake ratio right ventricle left ventricle uptake assessed eight 52 patients abnormally elevated lung index \( greater 42 \) patients severe cad six 52 patients abnormally elevated right ventricular index \( greater 56 \) patients severe cad
experimental studies physiologic properties technetium 99m recently , efforts directed development technetium 99m \( tc 99m \) labeled isonitrile compounds assessment regional perfusion viability experimental myocardial infarction ischemia one promising agents , tc 99m sestamibi , undergone rather extensive laboratory investigation like thallium 201 \( tl 201 \) , uptake tc 99m sestamibi myocardial tissue proportional myocardial blood flow intravenous injection similar indicators , tc 99m sestamibi underestimates blood flow high flow rates low flow regions , myocardial uptake agent higher relative nonischemic uptake microsphere determined blood flow attributed increased extraction low flows first pass myocardial extraction fraction tc 99m sestamibi less tl 201 however , tc 99m sestamibi higher parenchymal cell permeability higher volume distribution 201 tc 99m sestamibi shows minimal delayed redistribution initial intravenous administration uptake tc 99m sestamibi altered myocardial ischemic dysfunction produced sustained low coronary flow uptake isonitrile still proportional blood flow situations intact animal models , myocardial uptake tc 99m sestamibi coronary occlusion vivo area risk tc 99m sestamibi administered reperfusion following variable periods preceding coronary occlusion , tc 99m sestamibi uptake area viable myocardium salvaged simply degree reflow suggests serial tc 99m sestamibi imaging might useful assessing efficacy coronary reperfusion thrombolytic therapy
myocardial perfusion imaging technetium 99m sestamibi spect evaluation coronary artery disease technetium 99m \( tc 99m \) sestamibi new myocardial perfusion imaging agent offers significant advantages thallium 201 \( tl 201 \) myocardial perfusion imaging results current clinical trials using acquisition processing parameters similar tl 201 separate \( 2 day \) injection protocol suggest tc 99m sestamibi tl 201 single photon emission computed tomography \( spect \) provide similar information respect detection myocardial perfusion defects , assessment pattern defect reversibility , overall detection coronary artery disease \( cad \) detection disease individual coronary arteries tc 99m sestamibi spect appears superior tc 99m sestamibi planar imaging former provides higher defect contrast accurate detection disease individual coronary arteries research currently way addressing optimization acquisition processing tc 99m sestamibi studies development quantitative algorithms detection localization cad transmural nontransmural myocardial perfusion defects expected implementation final results new developments , significant improvement image quality attained , turn increase confidence image interpretation development algorithms analysis end diastolic myocardial images may allow better evaluation small nontransmural myocardial defects furthermore , gated studies may provide valuable information respect regional myocardial wall motion wall thickening implementation algorithms attenuation scatter correction , overall specificity tc 99m sestamibi spect improve significantly substantial decrease occurrence attenuation related image artifacts
clinical experience technetium 99m teboroxime , neutral , lipophilic myocardial perfusion imaging agent technetium 99m \( tc 99m \) teboroxime new technetium based myocardial perfusion imaging agent \( investigational code , diagnostics \) member class neutral , lipophilic , technetium containing complexes known acid technetium \( \) complexes , agent chemically different cationic tracer thallium 201 \( tl 201 \) cationic technetium complex tc 99m sestamibi \( , du imaging agents \) tc 99m teboroxime high myocardial extraction , rapid blood clearance , little lung uptake rapid myocardial washout pattern myocardial washout demonstrated animals man effective half lives 2 washout components man 5 2 minutes 3 8 hours represent approximately 66 33 myocardial activity , respectively first half life myocardium approximately 11 minutes agent heart , hepatic uptake occurs , peaking 5 minutes injection liver major organ excretion receives , along large bowel , largest radiation dose rapid imaging protocols using standard achieved good myocardial counts 3 planar views acquired 4 5 minute period single photon emission computed tomography \( spect \) images acquired 10 minute period entire stress rest procedure completed 1 hour analysis data 155 patients 4 centers using planar spect imaging showed sensitivity specificity blinded readings 82 91 , respectively , compared overall clinical impression
simultaneous measurement myocardial perfusion ventricular function exercise single injection technetium 99m sestamibi coronary artery disease new permit simultaneous assessment myocardial perfusion left ventricular function using single tracer injection purpose study quantitate relation myocardial perfusion function rest exercise patients documented coronary artery disease \( cad \) rest first pass radionuclide \( rna \) recorded 51 patients cad injection 10 mci technetium 99m \( tc 99m \) sestamibi , tomographic perfusion images obtained 60 minutes later treadmill test performed , attainment exercise end point second first pass rna recorded 30 mci tc 99m sestamibi tomographic images reflecting myocardial perfusion exercise obtained 1 hour later tomographic perfusion defect size , quantified using modifications program , correlated directly end systolic volume inversely ejection fraction rest exercise however , perfusion defect size often varied widely patients similar left ventricular function independence measurements perfusion function suggests simultaneous assessment 2 physiologic variables could improve diagnostic prognostic information radionuclide tests
comparison spect using technetium 99m agents thallium 201 pet assessment myocardial perfusion viability report reviews applications tomographic imaging current new tracers assessing myocardial perfusion viability multiple studies thallium 201 \( ti 201 \) single photon emission computed tomography \( spect \) imaging detection coronary artery disease \( cad \) demonstrated high sensitivity , high rates high reproducibility assessing viability , fixed defects frequently detected viable zones 4 hour studies ti 201 imaging redistribution imaging performed 18 72 hours injection reinjection ti 201 4 hour redistribution imaging shown improve accuracy viability assessment ti 201 spect studies limited suboptimal physical properties ti 201 , result variable image quality 2 new technetium 99m \( tc 99m \) labeled myocardial perfusion tracers offer ability much higher amounts radioactivity , making possible assess ventricular function well myocardial perfusion injection tc 99m sestamibi slow myocardial clearance , allows prolonged imaging time results image quality superior obtained ti 201 tc 99m teboroxime combination minimal redistribution tc 99m sestamibi high count rates makes gated spect imaging feasible , also permits assessment patients acute ischemic syndromes uncoupling time injection time imaging combination high image quality first pass exercise capabilities may lead choice agent ti 201 assessment chronic cad
technetium 99m sestamibi myocardial imaging day rest stress studies dipyridamole unlike thallium 201 , technetium 99m \( tc 99m \) sestamibi myocardium injection thus , 2 separate injections , 1 rest stress \( dipyridamole \) , required differentiate ischemia scar physical , 24 hour interval 2 injections preferable detection coronary artery disease \( cad \) tc 99m sestamibi imaging however , day studies convenient clinical practice results studies using different tc 99m sestamibi injection protocols presented emphasis advantages rest stress injection sequence low dose rest \( 7 mci \) followed 2 hours later higher dose stress \( 25 mci \) prospective study conducted patient population proven cad using day studies compare rest stress \( 7 25 mci , respectively \) stress rest \( 7 25 mci \) tc 99m sestamibi injection sequence agreement 87 3 analyzed segments 2 protocols however , largest discordance type defect applied 7 4 segments judged ischemic rest stress protocol , called scars stress rest study showed rest stress sequence preferable using day protocol short time interval \( less 2 hours \) 2 tc 99m sestamibi injections rest image performed initially represents true rest study , necessarily case stress rest sequence preliminary studies performed evaluate dipyridamole tc 99m sestamibi imaging normal subjects patients cad studies showed treadmill dipyridamole tc 99m sestamibi imaging comparable results similar obtained thallium 201
use technetium 99m sestamibi determine size myocardial area perfused coronary artery value new radionuclide tracer , technetium 99m \( tc 99m \) sestamibi , demonstrate myocardial perfusion areas supplied specific coronary arteries evaluated patients injected agent cardiac catheterization tc 99m sestamibi differs thallium 201 physical characteristics \( photon energy 140 \) , half life \( 6 hours \) lack significant redistribution , allowing administration episode chest pain ischemia occurring outside nuclear medicine laboratory later imaging visualize distribution 13 patients tc 99m sestamibi administered intravenously balloon occlusion angioplasty 11 13 patients , defects single photon emission computed tomography images corresponded area made ischemic angioplasty remaining 2 patients , abundant collateral flow present defects seen second study , 15 patients tc 99m sestamibi selectively injected coronary artery angiography later imaging identified area supplied artery injected tc 99m sestamibi imaging detect perfusion defects associated short episodes ischemia , area supplied different coronary arteries
technetium 99m sestamibi chronic coronary artery disease european experience since introduction technetium 99m methoxy isobutyl isonitrile \( tc 99m sestamibi \) europe , growing interest use several european multicenter trials conducted evaluate new agent relation traditional perfusion marker thallium 201 , studies progress understand use perfusion marker diagnosis coronary disease , use conjunction pharmacologic vasodilation , use assessment ventricular function wall motion assessment interventions
percutaneous excimer laser coronary angioplasty determine efficacy percutaneous excimer laser coronary angioplasty adjunct alternative conventional balloon angioplasty , 55 patients studied multicenter trial patients underwent procedure using modification conventional balloon angioplasty technique first generation , 1 6 mm diameter catheter constructed 12 individual silica fibers arranged around guidewire lumen used catheter tip energy density varied 35 50 mm2 mean number pulses delivered 20 hz 1 , 272 1 , 345 acute success defined greater equal 20 increase stenotic diameter lumen greater equal 1 mm diameter laser treatment acute success achieved 46 55 \( 84 \) patients adjunctive balloon angioplasty performed 41 patients \( 75 \) percent diameter stenosis determined quantitative angiography decreased baseline 83 14 49 11 laser treatment 38 12 patients undergoing adjunctive balloon angioplasty mean minimal stenotic diameter increased baseline 0 5 0 4 1 6 0 5 mm laser treatment 2 1 0 5 mm balloon angioplasty deaths vascular perforations one patient \( 1 8 \) required emergency coronary bypass surgery data suggest excimer laser energy delivered percutaneously specially constructed catheters safely ablate atheroma reduce coronary stenoses
results percutaneous transluminal coronary angioplasty patients greater equal 65 years age \( 1985 1986 national heart , lung , blood institute 's coronary angioplasty registry \) 1985 1986 national heart , lung , blood institute percutaneous transluminal coronary angioplasty \( ptca \) registry series 1 , 801 initial procedures included 486 patients age greater equal 65 years \( elderly \) comparison younger patients , greater proportion elderly patients women unstable angina elderly patients history hypertension history congestive heart failure although elderly extensive vessel disease , numbers lesions vessels attempted ptca similar older younger cohorts angiographic success rates similar age groups although complication rates catheterization laboratory differ , patients greater equal 65 years much likely require emergency coronary artery bypass graft surgery \( cabg \) \( 5 4 vs 2 8 , p less 0 05 \) elective cabg \( 3 9 vs 1 6 , p less 0 01 \) hospital death rate considerably higher among elderly \( 3 1 vs 0 2 , p less 0 01 \) 2 year follow , symptomatic status cumulative rates myocardial infarction , cabg repeat ptca similar elderly younger patients death rate 2 years higher among elderly patients \( 8 8 patients greater equal 65 years vs 2 9 patients less 65 years , p less 0 01 \) relative risk death elderly adjusted factors prevalent among greater equal 65 years \( history congestive heart failure , multivessel disease , unstable angina , history hypertension female gender \) , relative risk remained significant substantially reduced \( 3 3 2 4 \)
timing mechanism hospital late death primary coronary angioplasty acute myocardial infarction effect early myocardial reperfusion patterns death acute myocardial infarction \( ami \) unknown thus , mechanism timing hospital late deaths among group patients treated coronary angioplasty without antecedent thrombolytic therapy ami determined death occurred 49 patients \( 8 \) hospital discharge four patients died catheterization laboratory death due cardiogenic shock 22 patients , acute vessel 5 patients , sudden 8 patients followed elective coronary artery bypass surgery 8 patients cardiac rupture observed 2 patients failed infarct angioplasty , occur among patients successful infarct reperfusion intracranial hemorrhage occur multivariate predictors hospital death included failed infarct angioplasty , cardiogenic shock , 3 vessel coronary artery disease age greater equal 70 years follow period 32 21 months \( range 1 87 \) , 55 patients died cause death cardiac 36 patients , including arrhythmic death 23 patients due circulatory failure 13 others one patient died reinfarction due late infarct artery actuarial survival curves demonstrated overall survival hospital discharge 95 87 1 4 years , respectively freedom cardiac death 1 4 years 96 92 multivariate predictors late death included 3 vessel disease , baseline ejection fraction less equal 40 , age greater 70 years female gender
circadian rhythm heart rate variability acute myocardial infarction influence prognostic value heart rate variability study examined heart rate \( hr \) variability patients surviving acute myocardial infarction \( ami \) find optimum time duration recording ambulatory electrocardiogram prediction risk sudden cardiac death , serious arrhythmic events , twenty patients \( group \) initially survived ami later experienced serious events \( death symptomatic sustained ventricular tachycardia \) 6 month follow compared 20 patients \( group ii \) remained free complications greater 6 months discharge groups ii matched regard age , gender , infarct site , ejection fraction , beta blocker treatment hr variability assessed 24 hour electrocardiograms recorded first 2 weeks ami various portions complete 24 hour recording , beginning length analyzed portion varied 20 minutes \( total 5 , 113 possibilities \) maximum reduction hr variability group patients systematically found assessing hr variability recordings starting approximately 6 lasting approximately 8 hours low risk patient , diurnal rhythm hr variability marked high risk patient long term components hr variability due diurnal variation must included measurement hr variability using long term predictor risk arrhythmic events ami
doppler assessment left ventricular filling pattern silent ischemia patients 's angina spontaneous angina ideal condition study left ventricular \( lv \) dysfunction induced acute myocardial ischemia 6 patients 's angina , lv diastolic function 16 episodes spontaneous angina studied simultaneous recordings electrocardiographic \( ecg \) , echocardiographic hemodynamic parameters particular , pulsed doppler echocardiography measured peak velocity early \( e \) late \( \) transmitral flow e ratio , indexes relative early versus late lv filling ischemic attacks , time sequence pulsed doppler echocardiographic ecg changes showed 3 distinct phases \( 1 \) phase transmitral flow changes minimal ecg modifications \( e 0 85 0 1 \) \( 2 \) steady phase maximal ecg changes \( e 0 9 0 1 \) \( 3 \) phase regression ecg changes \( e 1 26 0 15 \) phase , e ratio showed significant difference baseline value \( e 1 17 0 2 \) result changes e , suggesting myocardial ischemia affects mainly early phase diastole phase , lv diastolic dysfunction preceded systolic abnormalities , documented significant reduction e ratio absence alterations lv ejection fraction , well systemic arterial pulmonary wedge pressures finally , recorded parameters consistent lv contractile rebound occurring phase affecting diastole systole
comparison direct indirect measures systemic arterial pressure coronary artery disease based measurements exercise , circuit weight training cardiac patients reported provoke minimal increases systolic pressure direct \( brachial artery catheter \) indirect \( \) measures blood pressure compared rest , lifting legs \( approximately fourth , repetition \) 2 minutes recovery lifting arms legs subjects performed 15 single arm , single arm military press single double leg press exercises 40 60 maximum load could apparatus indirect measures systolic pressure rest 13 less recorded directly \( 130 7 vs 149 8 torr p less 0 01 \) diastolic pressures similar using either method pattern maintained lifting legs intensities , exercise legs arms mean systolic pressure recorded indirectly immediately exercise 63 torr \( 31 \) 76 torr \( 34 \) less average peak intraarterial value recorded leg arm exercises , respectively highest intraarterial pressures generated final set immediately last repetition , systolic diastolic pressures rapidly decreased concluded indirect estimates systolic pressure significantly less true arterial values rest , lifting moreover , indirect measurements lifting allow accurate conclusions drawn arterial pressures generated lifting rapid decrease pressure occurs exercise
response angiographically normal atherosclerotic left anterior descending coronary arteries acetylcholine acetylcholine induced constriction human coronary arteries vivo commonly attributed endothelial dysfunction examine effects 2 important determinants vascular responses namely , agonist concentration segment circulation study diameters proximal , middle distal segments left anterior descending artery \( lad \) coronary sinus oxygen saturation measured 10 patients angiographically normal coronary arteries \( group 1 \) 7 patients coronary atherosclerosis \( group 2 \) intracoronary acetylcholine infused concentrations 10 \( 7 \) 10 \( 4 \) 10 \( 2 \) group 1 , acetylcholine caused minor \( less equal 6 \) progressive dilatation lad 10 \( 4 \) , constriction , particularly distal segments tertiary branches , occurred higher concentrations concentration range , coronary sinus oxygen saturation rose progressively basal level 36 3 maximum 72 3 absence changes heart rate blood pressure , suggesting marked progressive dilatation resistance vessels concentrations greater equal 10 \( 3 \) caused intense constriction distal epicardial vessels , cases , anginal pain objective signs ischemia conversely , group 2 , acetylcholine \( infused 10 \( 4 \) ethical reasons \) failed cause significant changes lad diameter data suggest local acetylcholine concentration coronary vascular segment study may determine observed response least equivalent extent presence absence coronary atherosclerosis , raising question whether response intracoronary acetylcholine reliably indicates presence coronary atherosclerosis
clinical electrophysiologic characteristics patients antidromic movement tachycardia wolff parkinson white syndrome antidromic movement tachycardia documented 36 345 consecutive patients wolff parkinson white syndrome undergoing detailed electrophysiologic evaluation twenty six patients men 10 women \( mean age standard deviation 26 12 years range 12 45 \) multiple accessory pathways identified 12 36 patients \( 33 \) ten patients \( 67 \) clinically documented antidromic tachycardia multiple accessory pathways dizziness syncope occurred 61 50 patients antidromic movement tachycardia six patients clinical documentation atrial fibrillation , 4 patients \( 11 \) resuscitated ventricular fibrillation 36 patients , 56 distinct antidromic tachycardias recorded several different pathways observed tachycardia frequently associated arrhythmia \( 72 \) dual atrioventricular nodal pathways present 12 patients \( 33 \) however , atrioventricular nodal tachycardia could initiated 2 interruption accessory pathway successfully performed 20 patients undergoing surgery
electrocardiographic signal averaging atrial pacing effect cycle length terminal qrs patients without inducible ventricular tachycardia electrocardiographic signal averaging sinus rhythm \( 61 99 beats min \) atrial pacing \( 100 171 beats min \) performed determine effect heart rate late potentials 15 patients without \( group 1 \) 7 patients \( group 2 \) inducible sustained ventricular tachycardia \( vt \) sinus rhythm \( 79 12 vs 77 12 beats min , difference significant \) , duration low amplitude signal less 40 microv longer group 2 group 1 \( 43 21 vs 26 8 ms , p 0 034 \) patients late potentials \( 57 vs 7 , p 0 \) , qrs duration \( 121 32 vs 98 19 ms \) terminal voltage \( 33 33 vs 50 26 ms \) significantly different atrial pacing group 1 \( 128 16 beats min \) , 3 patients developed simultaneous decrease terminal voltage increase terminal qrs duration consistent late potential , mean total terminal durations unchanged terminal voltage increased \( 50 26 59 40 \) significantly atrial pacing group 2 \( 119 12 beats min \) patients either late potential developed simultaneous decrease terminal voltage increase terminal qrs duration \( p 0 001 vs group 1 \) root mean square \( p 0 001 vs group 1 \) root mean square voltage decreased \( 33 23 22 23 \) became significantly different group 1 \( p 0 017 \) mean qrs duration , root mean square terminal voltage low amplitude terminal qrs duration , however , unchanged
comparison intravenous amrinone dobutamine congestive heart failure due idiopathic dilated cardiomyopathy prospective randomized study performed 46 consecutive patients refractory congestive heart failure \( chf \) due idiopathic dilated cardiomyopathy compare hemodynamic responses 48 hour infusions amrinone dobutamine drugs substantially reduced pulmonary arterial wedge pressure , right atrial pressure systemic vascular resistance increased cardiac index amrinone caused greater decrease right atrial pressure dobutamine \( p less 0 02 \) positive chronotropic effect observed dobutamine \( p less 0 01 \) increase heart rate produced amrinone correlated inversely changes right atrial pulmonary arterial wedge pressures , suggesting baroreceptor response reduced preload dobutamine produced larger increase stroke volume index amrinone \( p less 0 01 \) ninety one percent patients receiving amrinone 65 receiving dobutamine reduction greater equal 30 pulmonary arterial wedge pressure \( p less 0 05 \) cardiac index increased greater equal 30 similar numbers patients given amrinone \( 74 \) dobutamine \( 65 \) negative fluid balance recorded patients receiving amrinone 78 patients receiving dobutamine \( p less 0 05 \) target hemodynamic criteria achieved 83 patients receiving 10 micrograms kg min amrinone effective maintenance dose dobutamine extremely variable clinically important adverse effects observed either drug regimen amrinone dobutamine effective safe agents short term parenteral therapy patients dilated cardiomyopathy severe chf unresponsive oral medication
value congestive heart failure secondary coronary artery disease despite considerable interest use beta blocking agents congestive heart failure \( chf \) , clinical application limited negative inotropic effects beta blockers vasodilating properties may advantage , however , beta blocking agent vasodilating properties , evaluated 17 patients chronic chf secondary ischemic heart disease resting left ventricular ejection fraction less equal 45 , maintained diuretics exercise testing , radionuclide ventriculography , right sided cardiac catheterization performed intraarterial blood pressure measured 8 weeks therapy dosage 12 5 50 0 mg twice day twelve patients completed study 5 withdrew symptomatic hemodynamic improvement demonstrated 11 12 patients heart rate intraarterial blood pressure reduced chronic therapy mean standard deviation exercise time improved 4 3 1 6 7 1 2 7 minutes \( p less 0 0001 \) , resting left ventricular ejection fraction , 27 9 31 11 \( p less 0 02 \) pulmonary arterial wedge pressure fell 19 7 mm hg 12 5 mm hg \( p less 0 001 \) total systemic vascular resistance 1 , 403 1 , 497 310 dynes cm 5 m2 \( p less 0 02 \) stroke volume index improved also , 31 6 ml 40 6 ml \( p less 0 0005 \) hemodynamic changes mediated partly vasodilation , diminished myocardial oxygen demand reduction sympathetic overactivity failing heart data suggest may beneficial effects patients chronic chf secondary coronary artery disease
improvement early diastolic filling dynamics aortic valve replacement use ultrafast computed tomography , 13 patients undergoing aortic valve replacement aortic stenosis prospectively followed evaluate relation left ventricular mass diastolic function studies done intervention , 4 8 months later mass decreased 161 11 g m2 \( standard error mean \) baseline 106 5 g m2 , 97 7 g m2 4 8 months , respectively , 12 patients demonstrated significant \( greater 20 \) mass regression operation one patient failed show significant changes mass diastolic function , defined peak filling rate early diastole , improved \( p less 0 02 \) group mass regression , 2 11 0 17 1 baseline 2 12 0 23 1 , 2 62 0 26 1 4 8 months , respectively improvement time peak filling rate also noted heart rates unchanged , whereas end diastolic volumes decreased ejection fractions increased slightly postoperative increase peak filling rate correlated regression ventricular mass within normal range \( 2 standard deviations \) attainment new york heart association class status 8 months \( p less 0 02 \) thus , improvement diastolic function seen aortic valve surgery associated improved functional class diastolic function improves later regression wall mass may imply delayed remodeling ventricle
relevance intrinsic sympathomimetic activity beta blockers intrinsic sympathomimetic activity \( isa \) characterizes group beta blockers able stimulate beta adrenergic receptors \( agonist effect \) stimulating effects catecholamines \( antagonist effect \) competitive way partial agonists ligands elicit submaximal response bound beta receptors maximal occupancy isolated rat atrium , acebutolol produces maximal stimulatory effect 17 8 maximal effect induced full beta agonist isoproterenol presence isa results less resting bradycardia less reduction cardiac output observed beta blockers without isa long term , partial beta agonists may produce arterial vasodilation increase arterial compliance , possibly leading additional beneficial effects treatment hypertension beta blockers isa adverse effects plasma lipoproteins long term treatment addition , presence isa could counteract regulation beta adrenoceptors often observed beta blockers without isa finally , presence isa conflicting issue use beta blockers secondary prevention myocardial infarction however , impressive results acebutolol prevention secondary infarction trial high risk patients myocardial infarction show acebutolol , beta blocker moderate partial agonist activity , effective decreasing postinfarction mortality rate exhibiting strikingly different hemodynamic profile beta blockers without isa , partial beta agonists form pharmacologic class drugs prospective clinical trials extensively pursued
efficacy acebutolol acute myocardial infarction \( trial \) investigators randomized , placebo controlled trial carried determine effectiveness acebutolol preventing late death high risk patients surviving acute myocardial infarction \( mi \) average 1 year mortality rate placebo groups 9 trials beta blockers post mi patients 7 2 compared 17 nonselected cohort patients survived least 7 days mi trial based fact high risk patients whose mortality rate exceeds 20 enrolled significant numbers previous trials remains proved whether beta blocking therapy patient population beneficial selection high risk patients inclusion trial based algorithm set de prevention de du registry time second interim analysis , mortality rate placebo group 12 , lower expected \( greater equal 20 \) trial stopped time , 309 patients allocated placebo 298 patients acebutolol therapy days , 17 deaths acebutolol treated group 34 placebo group , reduction total mortality 48 \( p 0 019 \) 30 vascular deaths placebo group 12 acebutolol group thus , cardiovascular mortality acebutolol reduced 58 \( p 0 006 \) incidence cardiovascular related deaths lower acebutolol treated group total reduction mortality appear correlated secondary risk factors
secondary prevention acute myocardial infarction beta blocking agents calcium antagonists discovery beta blockers possess clinically useful hypotensive , antianginal antiarrhythmic properties interest clinicians , researchers pharmaceutical community alike addition , minor differences variety ancillary properties led specific classes drugs might advantages classes enthusiasm reports first small trials , showed beta blockers reduced infarction mortality rate , commercial support necessary evaluate different beta blockers clinical setting beta blockers subsequently became available study led considerable improvement design implementation large clinical trials despite apparent discrepancies results various trials , meta analysis indicates , , beta blockers reduce postinfarction mortality however , meta analysis cannot recommend particular drug specific dose use individual patient , clinical practice must based results individual trials , conclusions meta analysis clinical utility beta blockers secondary prevention myocardial infarction , coupled experimental evidence calcium antagonists reduce infarct size , led series large studies designed establish whether calcium antagonists effect reducing mortality patients myocardial infarction learned beta blocker trials permitted rapid evaluation efficacy calcium antagonists setting clear , unlike beta blockers , calcium antagonists effective secondary prevention myocardial infarction
characteristics participants baseline treatment mild hypertension study \( \) treatment mild hypertension study \( \) randomized , double blind clinical trial currently conducted compare effects nonpharmacologic therapy alone 1 5 active drug regimens combined nonpharmacologic therapy , long term management patients mild hypertension six classes drugs studied \( 1 \) acebutolol \( beta blocker \) , \( 2 \) amlodipine \( calcium antagonist \) , \( 3 \) chlorthalidone \( diuretic \) , \( 4 \) doxazosin \( alpha 1 antagonist \) , \( 5 \) enalapril \( angiotensin converting enzyme inhibitor \) \( 6 \) placebo participants received nutritional advice reduce weight sodium alcohol intakes increase physical activity end points include blood pressure change , side effects quality life indices incidence electrocardiographic echocardiographic abnormalities incidence cardiovascular clinical events , including death , among participants receiving drugs first step treatment well nonpharmacologic treatment compared incidence among participants randomized nonpharmacologic treatment initial step
mechanical factors large artery disease antihypertensive drugs hypertension may induce early alterations large arteries 2 mechanical stresses one related intravascular pressure , blood flow dynamics pressure force acts circumferential direction , inducing decreased arterial distensibility arterial distensibility evaluated humans measurement arterial compliance pulse wave velocity well established chronic hypertension age elevated pressure act together increase arterial rigidity blood flow dynamics induce forces endothelial surfaces arteries forces , expressed shear stress , proportional viscosity blood velocity gradient arterial wall measurement blood viscosity evaluation velocity profile brachial arteries hypertensive subjects shown reduction wall shear rate stress despite elevation blood viscosity several studies shown drug therapy successfully reduces blood pressure necessarily improve arterial compliance contrast , data available effects antihypertensive medication arterial wall shear humans arterial compliance wall shear stress 2 main therapeutic targets potential importance approach effects hypertension atherogenesis
documentation effective length action antihypertensive treatment technique automated ambulatory blood pressure \( bp \) monitoring offers innovative means measuring bp throughout 24 hour period recently available monitoring instruments shown accurate provide reproducible measurements circadian bp pattern monitoring procedure advantageous minimizes avoids placebo effects therapeutic trials moreover , power makes possible statistically valid conclusions regarding efficacy fewer patients would required conventional methods used procedure also enhances diagnosis hypertension identifying patients office white coat hypertension , thereby facilitates assessment treatment effects patients truly hypertensive automated monitoring measures bp critical times day , including early morning hours , enables peak trough antihypertensive drug effects carefully quantified since patient compliance appears enhanced twice daily dosing , antihypertensive agents long durations action \( 24 hours \) considerable interest report reviews recent studies monitoring technique used measure efficacy duration action differing antihypertensive drugs
acebutolol effects lipid profile published erratum appears j cardiol 1990 dec 1 66 \( 19 \) relation lipid profile incidence coronary artery disease confirmed results epidemiologic intervention studies among antihypertensive agents , beta blockers , particularly without intrinsic sympathomimetic activity \( isa \) , generally reported negative effects lipids , may increase risk coronary artery disease ongoing treatment mild hypertension study , third year , evaluated patients date regard lipid profile additional end points measured multicenter , randomized , controlled , double blind study include blood pressure reduction target organ deterioration trial , patients received nutritional behavioral modify diet , exercise habits alcohol sodium consumption control hypertension nonpharmacologic means addition , patients randomized receive low doses 1 5 classes antihypertensive medication acebutolol , beta blocker isa \( n 124 \) amlodipine , calcium channel blocker \( n 122 \) chlorthalidone , diuretic \( n 125 \) doxazosin , alpha blocker \( n 128 \) enalapril , angiotensin converting enzyme inhibitor \( n 127 \) placebo \( n 221 \) 1 year , acebutolol showed statistically significant \( p less 0 001 \) decrease total cholesterol \( 12 7 mg dl \) compared placebo \( 5 2 mg dl \) chlorthalidone \( 1 0 mg dl \) significant \( p less 0 001 \) decrease low density lipoprotein cholesterol \( 6 0 mg dl \) compared placebo \( 0 7 mg dl \) chlorthalidone \( 8 0 mg dl \) change high density lipoprotein cholesterol \( 0 4 mg dl \)
overview renal physiology pathophysiology aging cross sectional studies humans suggested progressive decline renal function age 40 years decline various functions \( eg , tubular , concentrating abilities , acidification \) tend parallel decreases glomerular filtration rate \( gfr \) renal blood \( plasma \) flow \( \) recent observations baltimore longitudinal study aging suggest individuals follow pattern , , indeed , many show decline even increase renal function time whether observed decreases renal function aging results intervening pathologic processes , eg , immunologic , infectious , toxic injury ischemia , related hyperfiltration resultant glomerulosclerosis , process , remains unclear purpose report review descriptive studies documenting changes renal morphology physiology age discuss known mechanisms involved losses renal substance function
systolic hypertension elderly reasons treat isolated systolic hypertension elderly associated increased morbidity mortality accurate measurement blood pressure older patients difficult therapy associated various complications , special problems elderly , orthostatic hypotension hyperkalemia , carefully considered drugs used low doses changes dosage made infrequently patients monitored frequently untoward effects therapy benefits blood pressure reduction optimal degree blood pressure reduction remain unknown
cardiac contractility conduction comparison antihypertensives four classes first line antihypertensive agents recommended 1988 report joint national committee detection , evaluation , treatment high blood pressure reviewed particular consideration given effects agents heart rate , atrioventricular nodal conduction , myocardial contractility patients cardiovascular diseases diuretics angiotensin converting enzyme inhibitors significant direct effects cardiac function beta blockers inhibit catecholamine stimulation heart may particularly beneficial treating patients history myocardial infarction calcium channel blockers reduce blood pressure dilating arterial resistance vessels structurally heterogeneous highly selective sites action consequence , cardiac effects minimized selecting calcium channel blocker potent peripheral vasodilatory effects new calcium channel blocker , , currently undergoing clinical trials , highly selective arterial smooth muscle appears safe effective antihypertensive agent
hypertension racial differences racial differences prevalence , course , pathophysiologic characteristics hypertension black white populations reviewed accumulated epidemiologic data indicate prevalence hypertension among blacks greater among whites almost age sex matched groups hypertensive blacks higher incidence left ventricular dysfunction , stroke , renal damage , lower incidence ischemic heart disease , hypertensive whites significant pathophysiologic difference blacks whites salt sensitivity normotensive , well hypertensive , blacks tend salt sensitive blacks also tend lower renin levels whites , dopamine response salt load diminished among blacks compared whites differences others lead recommendation hypertension among blacks managed initially salt restriction dietary control insufficient , administration antihypertensive agent 24 hour efficacy , lowers vascular peripheral resistance , promotes sodium excretion , potentially improves renal hemodynamics , recommended calcium channel blocker may requirements
diet , smoking , alcohol influence coronary heart disease risk framingham study coronary heart disease \( chd \) shown life style , particularly diet , smoking , alcohol consumption , great impact incidence chd blood lipoproteins , rather total blood cholesterol , found accurate predictors chd risk blood triglyceride , previously considered little bearing chd risk , found negative impact many cases population subgroup high triglyceride greater equal 1 7 mmol l \( greater equal 150 mg dl \) , low high density lipoprotein less equal 1 04 mmol l \( less equal 40 mg dl \) , increased insulin resistance , higher incidence diabetes mellitus found increased risk chd diet intervention trials shown reduction total cholesterol saturated fat consumption produced reduction chd incidence fall cholesterol cigarette smoking increased chd risk moderately smoked one pack per day twice risk nonsmokers alcohol consumption actually lowered chd incidence framingham study however , alcohol consumption greater two per day , rise mortality cancer stroke observed
mapping ataxia telangiectasia locus chromosome region recently mapped gene ataxia telangiectasia group \( \) chromosome 23 linkage analysis , using genetic markers thy1 12 \( \) likely order cent thy1 present paper describes mapping locus means panel 10 markers span approximately 60 cm 23 region centered around thy1 location scores indicate three contiguous within thy1 segment , well three contiguous segments thy1 , unlikely contain locus , segment likely contain locus data , together recent refinements linkage physical maps 23 , place locus
digitalis like activity human plasma relation blood pressure sodium balance purpose assumption renal tubular cells important target cells natriuretic factor blood cells , used well characterized cultured renal tubular cell line , canine kidney \( \) , cells monitor circulating digitalis like factor human plasma examine role regulation blood pressure sodium balance subjects methods investigated effects plasma binding radioactive ouabain cells order determine level circulating digitalis like factor first , measured specific 3h ouabain binding cells presence plasma 71 outpatients \( 34 normotensive subjects 37 hypertensive patients \) incubation 4 hours second , measured specific 3h ouabain binding incubation cells plasma 16 hospitalized subjects \( eight normotensive subjects eight hypertensive patients \) receiving low high sodium diets results study 1 , ouabain binding lower 30 plasma hypertensive patients plasma normotensive subjects \( p less 0 01 \) significant negative correlation individual subject 's systolic mean blood pressure ouabain binding \( r 0 34 , p less 0 01 r 0 29 , p less 0 01 \) study 2 , ouabain binding also significantly reduced 25 presence plasma hypertensive subjects compared plasma normotensive subjects irrespective sodium intake \( p less 0 01 \) significant negative correlation also found subjects either systolic , diastolic , mean blood pressure ouabain binding \( r 0 58 , p less 0 01 , r 0 51 , p less 0 01 , r 0 55 , p less 0 01 , respectively \) changes low high sodium intake , corresponding decrease ouabain binding \( p less 0 01 \) increase sodium excretion \( p less 0 01 \) significant negative correlation observed two parameters \( r 0 47 , p less 0 05 \) conclusions findings suggest circulating digitalis like factor , may act renal tubular cells ouabain compound , increased patients essential hypertension also demonstrate plasma levels may influenced changes dietary sodium intake
oral contraceptives , lipoproteins , atherosclerosis nonhuman primate model developed study effects oral contraceptives lipoproteins atherosclerosis macaques selected susceptibility diet induced atherosclerosis reproductive physiology , menstrual cycle , circulating sex hormone patterns similar human females first study compared vaginal ring containing estradiol oral contraceptive containing ethinyl estradiol second study compared two oral combinations ethinyl estradiol ethinyl estradiol predicted , use contraceptives led lowering high density lipoprotein cholesterol levels however , contrary might expected , use ethinyl estradiol containing oral contraceptives lead increase prevalence extent atherosclerosis concluded ethinyl estradiol neutralized atherogenic influence progestin component oral contraceptives
immunohistochemical study fibronectin experimental myocardial infarction light microscopic immunohistochemical studies performed evaluate distribution fibronectin paraffin sections p formaldehyde fixed normal rat hearts hearts rats undergone ligation left coronary artery peroxidase labeled antibody technique used , together appropriate immunohistochemical control procedures , localization fibronectin normal hearts hearts sham operated animals fibronectin localized interstitial space myocytes , beneath arterial , venous , capillary endothelium 4 hours coronary ligation , fibronectin localized patchy fashion cytoplasm interstitial space myocytes area supplied ligated vessel 24 hours , intense , homogeneous staining necrotic myocytes infarcted area capillary endothelium border zone 48 hours , intensity staining fibronectin maximal necrotic myocytes center infarct proliferating migrating capillaries fibroblasts border zone similar patterns localization observed 3 7 days coronary ligation , progressive decreases intensity staining two sources fibronectin appeared contributed changes plasma fibronectin diffusing damaged blood vessels would account early staining observed necrotic myocytes center infarct , whereas de novo synthesis fibronectin connective tissue cells endothelial cells sprouting capillaries would responsible subsequent staining observed viable capillaries border zone infarct known properties fibronectin vitro , combined vivo observations , indicate fibronectin may influence thrombotic , inflammatory , angiogenic , fibrotic processes involved infarct healing
accelerated arteriosclerosis heart transplant recipients associated lymphocyte mediated accelerated arteriosclerosis emerged major life threatening complication long term survivors heart transplantation proposed accelerated arteriosclerosis immune mediated complication rejection observed striking coronary arteries two explanted hearts obtained patients severe transplant related accelerated arteriosclerosis finding prompted us review pathologic changes coronary arteries 23 patients received heart transplants infiltrate vessels characterized using immunohistochemical stains lymphocytes \( cd45 \) , macrophages \( mac 387 \) , lymphocytes \( \) , b lymphocytes \( l 26 \) , smooth muscle cells \( actin \) addition , full panel monoclonal antibodies used fresh frozen tissue available one two explanted hearts ten eleven recipients accelerated arteriosclerosis moderate marked lymphocytic compared 3 14 without transplant related arteriosclerosis \( p less 0 005 \) immunohistochemical staining paraffin embedded material demonstrated lymphocytes subendothelial space vessels lymphocytes infiltrate associated accumulation macrophages proliferation smooth muscle cells intima explanted heart fresh frozen tissue available detailed cell typing , cells marked predominantly cytotoxic lymphocytes \( cd8 , cd2 \) results suggest accelerated arteriosclerosis may mediated , part , cytotoxic lymphocyte directed
isoflurane lead higher incidence myocardial infarction perioperative death enflurane coronary artery surgery \? clinical study patients examine choice volatile agents influences cardiac outcome coronary artery surgery , patients undergoing elective coronary artery bypass grafting without additional operations received enflurane \( \) isoflurane \( \) primary anesthetics inspired concentration volatile agent \( administered 50 nitrous oxide \) adjusted depending level blood pressure addition volatile agent assigned , patient received small doses fentanyl induction sternotomy \( total 0 006 0 008 mg kg \) groups differ preoperative surgical characteristics except frequent history renal dysfunction patients given isoflurane rates postoperative myocardial infarction , administration positive inotropic agents time weaning cardiopulmonary bypass , hospital deaths enflurane isoflurane groups 1 8 4 0 \( p less 0 05 \) , 4 9 8 1 \( p less 0 05 \) , 0 3 2 1 \( p less 0 01 \) , respectively although mechanism adverse effects isoflurane could clarified study , results demonstrate use isoflurane could inappropriate patients undergoing coronary artery bypass grafting
hemodynamic effects diltiazem vasoconstrictor pulmonary hypertension sheep calcium channel blockers effective pulmonary vasodilators patients pulmonary hypertension current study therefore compared effects prostaglandin e1 , effective pulmonary vasodilator , effects water soluble calcium channel blocker diltiazem pulmonary hypertension sheep pulmonary hypertension produced continuous intravenous administration halothane anesthetized sheep prostaglandin e1 decreased pulmonary artery pressure 29 , decreased pulmonary vascular resistance \( rp \) 57 , affect ratio pulmonary systemic vascular resistance \( rp rs \) diltiazem decreased pulmonary artery pressure 15 , decreased rp 50 , affect rp rs 0 33 ml kg polyethylene glycol ethanol vehicle \( vehicle used nifedipine administration prior study \) administered diltiazem infusion , pulmonary artery pressure increased 19 , rp increased 72 , rp rs increased 29 results indicate diltiazem effective pulmonary vasodilator suggest previously reported unfavorable results nifedipine may due vehicle used nifedipine administration
changes cerebral blood flow velocity release intraoperative humans transcranial doppler study effect release intraoperative thigh velocity blood flow middle cerebral artery examined five patients given general anesthesia controlled ventilation lower extremity orthopedic procedures using transcranial doppler sonography middle cerebral artery blood flow velocity increased significantly 52 6 \( sem \) 82 24 cm \( increase 58 13 \) within 4 1 min tourniquet release remained significantly elevated 7 min positive linear correlation found middle cerebral artery blood flow velocity occasion \( 0 97 greater equal r greater equal 0 84 , 0 001 greater p greater 0 0001 \) tourniquet deflation assuming linear relationship flow velocity flow , findings suggest significant increase cerebral blood flow occur intraoperative tourniquet release increase appears mostly co2 dependent
cardioprotective effects carnitine extensive aortocoronary bypass grafting double blind , randomized , placebo controlled clinical trial cardioprotective effects carnitine tested patients undergoing multiple aortocoronary bypass grafting intermittent aortic cross clamping 28 degrees c used mean total cross clamping time 30 11 min patients randomized three groups control group receiving placebo \( group 1 \) , group pretreated 3 g carnitine intravenously cardiopulmonary bypass \( cpb \) \( group 2 \) , group pretreated 6 g carnitine intravenously \( group 3 \) markers myocardial ischemia included levels adenosine triphosphate , , creatine phosphate transmural left ventricular biopsy specimens taken beginning end cpb , well hemodynamic recovery weaning cpb next 24 h intravenous infusion carnitine \( 3 6 g \) hemodynamic effect end cpb myocardial tissue levels adenosine triphosphate creatine phosphate differ significantly among groups \( p greater 0 05 \) recovery cardiac function weaning cpb following 24 h similar three groups \( p greater 0 05 \) concluded pretreatment carnitine neither facilitates weaning cardiopulmonary bypass patients undergoing aortocoronary bypass surgery favorably affects hemodynamic function next 24 h
endogenous vasopressin supports blood pressure prevents severe hypotension epidural anesthesia conscious dogs evaluate whether , extent , release endogenous vasopressin supports blood pressure efferent sympathetic drive blocked epidural anesthesia , authors studied effects high epidural anesthesia alone vasopressin prevented acting vascular \( v1 \) receptor six awake , trained , dogs different days , dose 0 5 bupivacaine \( 8 13 ml \) injected epidurally randomized fashion either presence absence \( v1 \) vasopressin receptor blockade , effects evaluated cardiovascular \( arterial blood pressure , heart rate \) respiratory \( blood gases , oxygen consumption \) variables , plasma concentrations vasopressin renin results also contrasted obtained epidural injection saline alone \( placebo \) dogs endogenous vasopressin prevented acting intravenous pretreatment specific v1 receptor antagonist \( beta beta , beta methylene tyr arg vasopressin \) , epidural anesthesia resulted rapid sustained 35 decrease mean arterial blood pressure 92 mmhg 5 se 60 mmhg 4 contrast , 14 decrease mean blood pressure 92 mmhg 5 79 mm hg 6 noted epidural anesthesia alone difference groups statistically significant \( p 0 0001 \) v1 receptor blockade alone detectable effect vasopressin plasma concentrations significantly increased 3 4 0 3 pg ml 1 16 2 3 2 pg ml 1 epidural anesthesia change epidural saline
experimental clinical percutaneous angioscopy experience dynamic angioplasty authors used high optical resolution assess effects dynamic angioplasty vitro vivo experimentally , angioscopy used study effects 5f kensey catheter normal porcine coronary arteries \( \) postmortem human coronary arteries \( \) , catheter position intimal flaps \( \) seen 21 23 occurred cam rotation speeds usually single small \( less 25 lumen \) perforations patent arteries rare \( 1 23 \) however , catheter forced wall passing narrowing 5f diameter \( made band ligature \) , perforations common higher cam speeds epicardium remained intact two thirds perforations angioscopy visualized perforations 10 cases \( 1 10 \) , common sign large multiple intimal flaps , often obstructive \( 5 10 \) , angioscopy sensitive angiography detecting atheromatous lesions authors able give better assessment effect dynamic angioplasty treated lesions , including demonstration intimal flaps visible angiography vivo , performed percutaneous angioscopy dynamic angioplasty using 8 french kensey catheters angioscopy revealed features shown angiographically
optimizing heparin utilization angiographic flush solutions various concentrations heparin angiographic flush solutions employed angiography effort determine whether differences outcome seen either high low concentrations heparin angiographic flush solutions utilized , two groups patients evaluated difference outcome small systemic effect heparin seen groups use low concentration heparin suggested routine angiography
ischemia produced bilateral vertebral artery occlusion moderate hypotension spontaneously hypertensive rats ischemia induced bilateral vertebral artery occlusion moderate hypotension spontaneously hypertensive rats \( shrs \) mean arterial blood pressure lowered 80 mmhg shrs 50 mmhg wistar kyoto rats \( \) controlled hemorrhage , vertebral artery bilaterally occluded alar first cervical vertebra following vertebral occlusion , blood flow cerebellum significantly decreased 9 4 2 0 ml min \( sem \) flow remained 32 1 5 4 shrs contrast , cerebellar blood flow preserved 24 2 2 9 ml min brain lactate , pyruvate , adenosine triphosphate \( atp \) determined shrs sixty minutes hypotension without vertebral occlusion although infratentorial metabolites actually unaltered rats hypotension alone , infratentorial lactate lactate pyruvate ratio significantly increased 14 38 3 61 mmol kg 67 7 12 1 , respectively , concomitant decrease atp shrs hypotension vertebral occlusion bilateral vertebral artery occlusion , together moderate hypotension , shown produce marked reduction cerebellar blood flow induce ischemic metabolic changes infratentorial brain shrs
comparison standard one minute treadmill exercise test \( absolute walking distance \) relation site lesion , walking distance , diastolic blood flow velocity \( doppler curves \) 215 outpatients suffering occlusive arterial disease lower limbs authors compared decrease ratio ankle systolic pressure brachial systolic pressure according whether treadmill exercise limited one minute extended pain forced patient stop one minute walk pressure index always decreased significantly , especially walking restricted decrease pressure index generally greater exercise continued absolute walking distance , recovery time usually twice long fall pressure index significantly greater patients single multiple iliac stenoses stenoses lower levels patients diastolic blood flow velocity doppler curves rest , modified walking , maximum drop peripheral pressure recorded walking one minute instance intensification decrease peripheral pressure , unlike patients without diastolic blood flow velocity rest one minute test maximal hemodynamic response , sufficient appreciation ischemia exercise , according different parameters measured
coronary artery dissection case report coronary artery dissection , spontaneous catheter induced , associated significant morbidity mortality authors present case middle aged woman spontaneous right coronary artery dissection causing inferior wall myocardial infarction left coronary artery dissection time coronary arteriography suggested emergency aortocoronary bypass surgery performed preceded insertion intra aortic balloon acute evolving cases coronary anatomy favorable limit infarction loss life
treatment effect crossover trials crossover trials subject serves control study cardiovascular diseases hypertension angina , properly designed crossover studies preferred parallel studies considerable subject variability symptoms conditions bias due eliminated use crossover design however , problem called treatment period interaction present study analyzes potential influences outcome trial physical effect , defined physical effect first treatment period carrying second , tends minimize differences two consecutive treatment periods experience inactive agent first treatment period outside influences change may affect lengthy crossover trials similar way author concludes treatment effect crossover trial tends underestimated current concept reports clinical trials generally toward treatment effects seem apply crossover trials
hemodynamic effects rest exertion patients heart failure novel b 1 adrenoceptor blocking drug unusual hemodynamic profile unlike classical b blockers dogs healthy volunteers decreases blood pressure heart rate improves left ventricular function authors studied 10 male patients coronary artery disease heart failure \( ejection fraction mean 46 \) swan catheter placed pulmonary artery , mean blood pressure , heart rate , pulmonary artery pressure , pulmonary wedge pressure , right atrial pressure , cardiac output , stroke volume measured rest exertion seven treatment oral \( 5 mg day \) blood pressure heart rate decreased significantly , pulmonary artery wedge pressures , well right atrial pressure cardiac output , change treatment stroke volume increased significantly maintained cardiac output cannot explained changes preload afterload instead positive inotropic mechanism must assumed unlike b blockers seems possible treat patients heart failure without causing hemodynamic situation
effects diltiazem functional recovery myocardium organ cellular level prolonged hypothermic ischemic cardiac arrest effectiveness diltiazem functional recovery heart , calcium \( ca \) uptake binding , ca atpase cardiac sarcoplasmic reticulum \( sr \) , mb fraction creatine kinase \( \) coronary sinus blood investigated one half hours reperfusion following three hours ischemic cardiac arrest dogs divided three groups group , sham bypass group ii , cold crystalloid cardioplegia group iii , cold crystalloid cardioplegia diltiazem decrease aortic pressures left ventricular pressure development \( dp dt \) , left ventricular work index \( \) , total systemic vascular resistance \( \) , left ventricular systolic pressure \( \) sham bypass group decrease cardiac index \( ci \) , , mean right atrial pressure \( \) increase pulmonary vascular resistance \( pvr \) group ii compared group although tendency decrease indices myocardial contractility group ii , significantly different group indices myocardial contractility , ci , group iii slightly higher group ii , significantly different values calcium uptake sr groups ii iii similar significantly lower group calcium binding group iii significantly lower group calcium atpase sr three groups similar although increased groups , increases significantly different among three groups results study indicate cold crystalloid cardioplegia diltiazem better cold crystalloid alone preserving cardiac contractility cellular function prolonged ischemic cardiac arrest however , cardiac function terms cardiac index better preserved diltiazem
successful direct ptca lad first episode acute myocardial infarction improve cardiac function \? patients received direct percutaneous transluminal coronary angioplasty \( ptca \) acute infarction maintained potency unimproved cardiac function studied 15 patients , first episode acute myocardial infarction caused left anterior descending branch lesion 11 ejection fraction 50 left follow period \( improved group \) , 4 patients ejection fraction less 50 \( unimproved group \) significant difference groups mean time onset infarction revascularization \( improved group , 259 3 76 9 min unimproved group , 168 0 101 6 min \) sigma q sum q wave depth v2 , v3 , time admission \( improved group , 12 1 15 6 mm unimproved group 29 8 13 4 mm \) maximum creatine kinase concentration significantly higher unimproved group \( improved group iu l unimproved group , iu l , p less 0 05 \) , time taken onset reach peak significantly shorter unimproved group \( improved group , 13 0 5 1 hr unimproved group , 6 8 1 3 hr , p less 0 05 \) results suggest probability sudden deterioration myocardium , factors thromboembolism considered cause unimproved cardiac function successful direct ptca
intraoperative coronary excimer laser angioplasty preliminary clinical experience diffuse coronary artery atherosclerosis generally recognized successful revascularization cannot adequately treated mechanical endarterectomy useful , optimal solution owing associated higher incidences perioperative infarction mortality use laser energy endarterectomy tool appears promising investigate application excimer laser radiation intraoperative coronary artery endarterectomy , 15 stenotic lesions 13 patients treated excimer irradiation coronary artery bypass grafting eleven \( 73 \) lesions enlarged excimer probe \( 6 successes calcified lesions \) 4 arteries enlarged excimer laser demonstrated calcified lesions 3 perforations 2 dissections , 1 heavily calcified arteries results phase 1 safety efficacy study indicate excimer irradiation arteries , including total subtotal occlusions calcified lesions evaluation better delivery systems needed determine whether perforation rate reduced
intravascular ultrasound new potential modality angioplasty guidance current angioplasty devices limited significant rates arterial perforation dissection , due inadequate techniques guidance , restenosis , may partly attributed inadequate debulking lesions paper describes authors' initial experience vitro vivo intravascular ultrasound possible method enhancing three dimensional guidance devices atherosclerotic obstructions using vitro model correlated dimensions histologic morphology animal human arteries ultrasound images specimens additional vivo evaluations technology canine arteriosclerotic human atherosclerotic arteries support hypothesis intravascular ultrasound defines transmural arterial morphology may enhance accuracy angioplasty procedures simultaneous imaging angioscopy intravascular ultrasound demonstrated potential method accurately defining intraluminal transmural arterial wall characteristics
improved survival reduced myocardial necrosis cardiopulmonary bypass reperfusion canine model coronary occlusion cardiac arrest study question cardiopulmonary bypass \( cpb \) improve resuscitation rates limit infarct size cardiac arrest acute myocardial infarction \? design controlled randomized trial animals undergoing left anterior descending coronary artery occlusion subsequent ventricular fibrillation resuscitation animals supported four hours resuscitation intensive care setting intervention group 1 \( eight \) resuscitated standard external cpr advanced life support group 2 \( eight \) resuscitated cpb measurements main results group hemodynamic , resuscitation variables , number resuscitated , number four hour survivors compared ischemic necrotic myocardial weights determined histochemical staining techniques four hour survivors infarct size measured ratio necrotic weight ischemic weight significantly fewer dogs resuscitated group 1 \( four eight \) group 2 \( eight eight \) \( p less 05 \) group 2 survivors required significantly less epinephrine lidocaine group 1 survivors \( p less 05 \) higher aortic diastolic coronary perfusion pressures cpb \( p less 001 \) ratio myocardial necrotic weight ischemic weight four hours 0 82 0 25 group 1 0 22 0 25 group 2 \( p less 05 \) however , collateral blood flow measured study conclusion pilot study improvement resuscitation rates obtainable cpb cpb may also limit infarct size period requires study
exercise thallium 201 scintigraphy diagnosis prognosis coronary artery disease objective determine discriminant accuracy exercise thallium 201 myocardial perfusion scintigraphy diagnosis prognosis patients known suspected coronary artery disease data identification survey national library medicine medline database study selection key medical subject used coronary disease , myocardial infarction , radionuclide imaging , thallium total 122 retrieved studies considered relevant reviewed depth data extraction studies reporting sensitivity specificity thallium scintigraphy analyzed results discriminant accuracy diagnosis prognosis summarized terms pooled sensitivity specificity conclusions exercise thallium scintigraphy useful noninvasive diagnosis coronary artery disease , especially patients abnormal resting electrocardiograms , restricted exercise tolerance , intermediate probability disease time testing well defining prognosis patients known suspected coronary artery disease , especially previous myocardial infarction various shortcomings published record , however , marginal discriminant accuracy cost effectiveness thallium scintigraphy compared conventional clinical assessment exercise electrocardiography remain controversial
combined internal mammary artery graft coronary artery revascularization five patients multiple vessel coronary artery disease underwent isolated coronary artery bypass grafting technique involving internal mammary arteries small piece saphenous vein combined internal mammary artery grafts used sequential grafting total 20 anastomoses performed \( average number , 4 anastomoses per patient \) operative deaths postoperative complications included reoperation bleeding 1 patient diaphragmatic dysfunction another postoperative coronary angiography 2 days discharge \( mean time , 10 days postoperatively \) revealed sequential anastomoses combined ima graft patent exercise tolerance tests performed 3 11 months postoperatively indicated excellent results ischemia based experience , conclude method appears promising multivessel coronary artery bypass grafting
long term amiodarone administration protects global myocardial ischemia reports effects amiodarone cardiac function variable study addresses effect long term amiodarone administration recovery cardiac function period global ischemia normotensive spontaneously hypertensive rats used normotensive rats \( n 6 \) received 240 mg kg amiodarone 4 weeks , total 72 3 mg hypertensive rats \( n 6 \) received 500 mg kg amiodarone 4 weeks , total 116 5 mg final myocardial concentrations amiodarone desethylamiodarone 1 85 1 75 0 50 0 61 micrograms g wet weight normotensive rats 1 30 0 58 0 31 0 17 micrograms g hypertensive rats \( p nonsignificant \) equal numbers controls received sterile saline solution 4 weeks hearts excised perfused langendorff apparatus results indicate , 15 minutes normothermic ischemia , hearts treated relatively low dose amiodarone recovered greater percentage preischemic work \( 97 13 \) compared controls \( 76 17 \) \( p less 0 005 \)
subaortic obstruction intraoperative echocardiography adjunct operation fourteen patients undergoing operation subaortic obstruction \( membranous obstruction 11 patients , tunnel obstruction 2 patients , obstruction due mitral valve tissue 1 patient \) evaluated intraoperative epicardial echocardiography 9 patients discrete obstruction underwent epicardial echocardiography , septal lateral attachments lesion correctly demonstrated precise extent tunnel stenosis seen patients lateral attachment membrane 4 patients multiple another 2 identified epicardial study \( missed echocardiography \) discrete membrane enucleated 10 11 patients partially resected 1 one tunnel obstruction completely relieved partially relieved mitral valve tissue remaining patient completely resected epicardial imaging bypass showed remnants membrane 2 patients intraoperative doppler echocardiography color flow imaging confirmed absence clinically significant residual gradients \( less 20 mm hg \) 1 patient tunnel obstruction epicardial imaging provided excellent morphological information obstructive lesions left ventricular outflow tract enabled immediate assessment surgical repair
use variable length intraluminal graft august 1987 may 1988 treated 4 patients acute ascending aortic dissections variable length intraluminal aortic prosthesis operation uses profound hypothermic circulatory arrest represents refinement existing techniques mortality , morbidity minimal modifications technique used performing proximal aortic root reconstruction composite valved conduit use variable length intraluminal prosthesis hypothermic circulatory arrest illustrated safe useful technique select cases acute ascending aortic dissection
liver transplantation anastomosis chiari syndrome report case young woman chiari syndrome shunt first performed , followed liver resection 3 years later liver transplantation became necessary 5 years later liver function portal hypertension bleeding successful transplantation performed anastomosis help cardiopulmonary bypass , considerably technical procedure reducing dramatically blood loss
polytetrafluoroethylene graft spontaneous coronary dissection 7 year follow spontaneous coronary artery dissection remains exceedingly rare cause myocardial ischemia patients usually young female , dissection frequently fatal use polytetrafluoroethylene aortocoronary conduit generally followed early occlusion report case spontaneous right coronary dissection polytetrafluoroethylene graft placed observed remain patent angiography least 72 months operation
improved cannulation method extracorporeal membrane oxygenation extracorporeal membrane oxygenation shown useful patients reversible cardiogenic shock effective arterial cannulation techniques infants developed simple use require minimal subsequent vascular repair reconstruction removal groin cannulation adults frequently requires bidirectional arterial cannulation ensure adequate distal perfusion well frequent complex arterial repairs discontinuation describe simple arterial cannulation technique using single right angle , high flow arterial cannula technique adequate bidirectional arterial perfusion maintained single arterial cannula need vascular repairs reconstruction minimized
financial impact rapid ck mb specific immunoassay diagnosis myocardial infarction purpose study twofold first , evaluated financial impact rapid , monoclonal antibody based ck mb mass assay \( stratus , dade division , laboratories , , \) direct measurement ck mb serum samples 65 patients admitted coronary care unit possible diagnosis acute myocardial infarction second , evaluated retrospectively stratus assay activity assay \( electrophoresis \) ck mb following patient categories acute myocardial infarction treated without thrombolytic therapy , angina , congestive heart failure , skeletal muscle trauma , acutely ill without acute myocardial infarction advantageous features stratus mass assay follows first , laboratory able perform assay frequently short assay time per specimen \( less 10 minutes \) without additional personnel substantial impact clinician 's ability diagnose acute myocardial infarction move patients intensive care unit substantial financial savings patient , hospital , third party second , stratus assay able detect low levels ck mb \( 1 2 micrograms l \) presence low total creatine kinase activity \( less 100 u l \) third , stratus assay showed interference due high total creatine kinase activities \( greater 100 , 000 u l \) , ck bb , macro creatine kinase , mitochondrial creatine kinase
angioscopy intraoperative management experience angioscopy suggests direct visualization arterial lumen procedures would provide reliable method assessing luminal morphologic characteristics angiography alone 32 grafts \( seven aortobifemoral , 18 infrainguinal bypass , seven dialysis access fistula grafts \) 32 patients thirty one patients thrombotic events one patient acute embolus angioscopy following standard catheter thrombectomy revealed significant amounts retained thrombus information 18 patients infrainguinal bypass graft led graft revision six cases placement new graft 10 cases one graft limb replaced seven aortobifemoral grafts , multiple repeated employed extract debris remaining six cases repeated graft thrombectomy also beneficial dialysis access fistulas angioscopy allowed us completion angiogram led improved technical result conclude angioscopy useful procedures
critical care transportation medicine new concepts stabilization critically ill patient health care trauma become , concept critically ill medical surgical patients developing recent evidence suggests current stabilization measures used transport teams inadequate critically ill patient population trauma , speed considered necessity get patient facility cannot carried field , eg , operating room acute medical illnesses , critical care transport teams bring intensive care technology patient accumulating evidence supports speed transport important stabilization transport , knowledge hemodynamics transport , early use critical care monitoring systems reports identify need initial evaluation stabilization critically ill patients physicians critical care level expertise accordingly , critical care transportation teams evolved , creating new stabilization applicable previous transport systems
ventricular arrhythmias hypertensive left ventricular hypertrophy relationship coronary artery disease , left ventricular dysfunction , myocardial fibrosis ventricular arrhythmias occur increased frequency hypertensive patients left ventricular hypertrophy \( lvh \) relationships , however , ventricular arrhythmias coexistent coronary artery disease , left ventricular dysfunction left ventricular fibrosis examined hypertensive lvh carried coronary arteriography fifteen hypertensive patients lvh nonsustained ventricular tachycardia \( greater equal 3 consecutive ventricular complexes \) nine \( 60 \) free significant \( greater 50 stenosis \) coronary disease identify possible correlates left ventricular arrhythmias , 28 patients lvh , comprising 17 ventricular tachycardia 11 without ventricular arrhythmias , underwent quantitative assessment left ventricular function \( angiographic ejection fraction \) , left ventricular mass \( echocardiography \) , left ventricular fibrosis \( endomyocardial biopsy \) ejection fraction significantly different two groups \( 53 8 v 62 2 , p ns \) however , left ventricular mass significantly greater \( 28 g v 339 34 g , p less 05 \) percentage fibrosis significantly higher \( 19 4 v 3 1 , p less 001 \) patients ventricular tachycardia thus ventricular arrhythmias hypertensive patients lvh cannot entirely attributed coexistent coronary disease , left ventricular dysfunction , related degree cardiac hypertrophy subendocardial fibrosis
effects n 3 fatty acids essential hypertension examined effects blood pressure , plasma lipoproteins , platelet function marine oil supplements \( rich n 3 fatty acids \) vegetable oil supplements \( rich n 6 fatty acids \) added usual diets patients mild essential hypertension randomized , double blind , parallel group study , patients received 50 g either marine oil \( n 8 \) vegetable oil \( n 8 \) daily 6 weeks following baseline observation period diastolic blood pressure declined treatment fish oil \( mean sem , 96 2 v 89 2 mm hg , p 02 \) , change vegetable oil \( 92 1 v 94 1 mm hg \) systolic blood pressure change significantly either treatment serum triglycerides declined \( approximately 30 \) patients receiving marine oil , total cholesterol , ldl , hdl , hdl2 , hdl3 cholesterol subfractions apolipoproteins b unchanged treatment groups bleeding time increased 33 treatment marine oil change vegetable oil supplements marine oil alter vitro platelet aggregation thresholds lack significant correlation blood pressure changes platelet membrane fluidity , plasma renin activity , aldosterone , norepinephrine , epinephrine suggests variables mediate antihypertensive effect marine oil conclude large doses marine oil reduce diastolic blood pressure , lower triglycerides , increase bleeding time patients mild hypertension
effect captopril injection patients moderate severe hypertension effect intravenous captopril studied 24 white patients moderate severe hypertension patients received incremental doses 1 10 mg delivered 10 min intervals 50 80 min blood pressure \( bp \) lowered within 5 10 min initial dose administered continued decline , reaching maximum response 20 min \( 2 4 mg \) time group mean bp fell 175 3 111 1 166 3 97 2 mm hg \( p less 0 01 \) additional dose increments average cumulative dose 40 mg increase initial effect adverse side effects symptomatic hypotension occurred subject significant correlation diastolic bp decreases observed response intravenous captopril subsequent long term oral captopril therapy addition hydrochlorothiazide increased proportion patients reaching normotension conclude small intravenous bolus injections captopril appear effective rapidly well tolerated moderate severe essential hypertension short term intravenous administration seems predict response chronic oral captopril therapy
amiloride blocks onset acth induced hypertension sheep study investigated ability two diuretics , amiloride , prevent development acth induced hypertension conscious sheep infusion amiloride \( 20 mg day \) \( 50 mg day \) three days normotensive sheep significant effects blood pressure amiloride blocked acth induced hypertension sodium retention hypokalemia usually associated acth administration failed completely block hypertension potassium loss , however blocked transient initial urinary sodium retention associated acth induced hypertension failed completely block hypertension unlikely amiloride effect due primarily effects urinary na excretion possible amiloride antihypertensive effects blocking sodium channels
randomized trials study antihypertensive drugs heterogeneity response antihypertensive drugs addressed randomized trials individual subjects trial patient receives pairs treatment periods \( one period pair active drug , one matched placebo , random order \) patient clinician blinded allocation , treatment targets monitored trials optimize antihypertensive therapy clinical practice facilitate investigation new drugs study pathophysiology trials also potential helping whether common , nonspecific symptoms reported patients really drug related
parallel group design crossover design , group approach individual approach consequences heterogeneity response antihypertensive drugs clinical development programs new antihypertensive drugs care individual hypertensive patient previously sufficiently recognized play role inappropriate choice high daily doses antihypertensive drugs end extensive international development programs also implicated insufficient control blood pressure observed long term multicenter trials hypertension , patients treated several years drugs appropriate disease adequately control blood pressure addition parallel group studies , use double blind two period multiple period crossover designs provide valid data dose finding new antihypertensive drugs comparative evaluation end trial , designs also offer patient opportunity treated right dose drug appropriate disease
humoral factors determining blood pressure response converting enzyme inhibition calcium channel blockade renin catecholamine levels determined patients mild moderate hypertension treatment sustained release diltiazem captopril correlated blood pressure response antihypertensives eight weeks treatment either agent led equal decreases systolic diastolic blood pressure pretreatment plasma renin activity \( pra \) plasma norepinephrine predict blood pressure response either agent diltiazem significantly increased pra supine norepinephrine levels however , diltiazem treated patients , correlation change plasma norepinephrine change systolic diastolic blood pressure contrast , negative correlation \( p less 05 \) reactive rise pra decrease systolic blood pressure thus , antihypertensive response calcium channel blocker may determined , part , reactive response pressor systems
reaction serum k hypertensive patients effect serum k reaction induced participation experimental noninvasive study evaluated 35 subjects borderline hypertension 18 essential hypertensives group 44 inpatients undergoing routine blood sampling served control serum k , blood pressure heart rate measured \( casual \) \( baseline \) 20 min rest position baseline serum k values significantly higher casual values patients participating experimental protocol change observed inpatients undergoing routine blood sampling increase serum k induced relaxation significantly related heart rate decrease \( r 0 73 \) relaxation 75 patients increase serum k change greater 10 35 patients subgroup patients repeated test three times , reaction still evident reproducible within patient data suggest potassium levels measured outpatients undergoing diagnostic experimental procedures falsely reduced levels found large proportion subjects
studies salt intake hypertension epidemiology us \? suggested small changes population blood pressure major impact upon incidence cardiovascular disease caused blood pressure elevation early reports indicated close correlation differences salt intake blood pressure epidemiological associations translated population advice , certain conditions met association validated scientifically , evidence produced relationship causal reversible changes salt intake , risk benefit analysis indicate net harm unlikely finally demonstrated population measures advocated produce adequate change dietary salt intake small individual effects upon blood pressure examined , prevailing changes blood pressure cardiovascular mortality suggest data always fall short ideal therefore extrapolation always necessary nevertheless , review present evidence indicates available data basis population advice
calcium blood pressure epidemiologic perspective reviewed research literature epidemiologic relationship blood pressure levels calcium , emphasis dietary intake conceptual framework causal summarized designs results observational intervention studies presented 25 reports observational studies relating intake calcium calcium rich foods blood pressure , majority found evidence inverse association however , many analyses support relationship , two studies confirmed inverse association prospective design nineteen randomized controlled clinical trials calcium supplementation reported , excluding exclusively pregnant women eleven showed significant effects blood pressure two trials , systolic diastolic pressure significantly reduced remainder results equivocal pooled analyses yielded estimates small \( 1 8 mm hg \) , significant reduction systolic blood pressure , effect diastolic pressure epidemiologic relationships serum urinary calcium , possible mechanisms effects , also discussed conclude evidence studies humans suggestive , conclusive , regarding role calcium hypertension recommendations epidemiologic studies presented
blood pressure response dietary calcium intervention humans epidemiological experimental studies suggested dietary calcium deficiency may lead development hypertension article reviews findings human trials calcium intervention special reference responses blood pressure biochemical variables calcium supplementation consistently resulted decreased blood pressure subset hypertensive normotensive subjects , led increased blood pressure hypertensive patients variable blood pressure responses calcium supplementation could predicted basis routine biochemical parameters appeared due differences backgrounds subjects design size trials concluded studies required hypotensive effect calcium supplementation
sodium calcium interactions salt sensitive hypertension humans essential hypertension , salt induced increases blood pressure reported correlate directly salt induced increases intracellular free calcium \( ca2 \) circulating mononuclear cells findings consistent hypothesis salt induced increases ca2 mediate phenomenon salt sensitivity evidence suggests salt induced increases intracellular sodium plasma levels 1 , 25 dihydroxy vitamin might mediate salt induced increases ca2 blood pressure however , humans salt sensitive hypertension , remains determined \( 1 \) whether salt induced increases white blood cell ca2 reflect corresponding increases vascular smooth muscle ca2 \( 2 \) whether salt induced increases ca2 cause consequence salt induced increases blood pressure \( 3 \) whether salt induced increases 1 , 25 dihydroxy vitamin intracellular sodium precede salt induced increases ca2
putative mechanism blood pressure reduction induced increases dietary calcium intake increase dietary calcium intake lowers blood pressure spontaneously hypertensive rats patients arterial hypertension mechanisms decrease come clear membrane stabilizing effect increase extracellular calcium would appear unlikely , since increases extracellular calcium concentration increased dietary intake minimal calcium regulatory hormones may mediators , framework suggested striking defects reported calcium handling hormonal household spontaneously hypertensive rat however , clear cut relationship terms hormonal template yet identified prospective experiments data presented show increased calcium intake direct effect regulatory areas brain however , mechanisms response would mediated entirely unknown increased calcium intake may induce natriuresis suggested increased calcium intake helps salt sensitive however , prospective studies effect presented increased calcium intake may induce however , evidence blood pressure lowering effects mediated phosphate depletion evidence suggests increased calcium intake may influence local regulatory processes turn influences cell integrity growth point , hypothesis available however , clues various possibilities
calcium regulating hormones essential hypertension importance gender alterations calcium metabolism described human essential hypertension experimental hypertension investigated parathyroid hormone \( pth \) 1 , 25 \( oh \) 2 vitamin \( 1 , 25 \( oh \) 2d \) patients untreated essential hypertension compared normotensive controls hypertensive subjects \( n 75 43 men , 32 women \) mean blood pressure 138 8 95 5 mm hg compared 120 11 80 8 normotensive group \( n 40 22 men , 18 women \) serum pth measured intact molecule assay 1 , 25 \( oh \) 2d measured radioimmunoassay hplc separation hypertensive men pth levels 36 higher normotensive men \( 5 3 2 9 v 3 9 0 8 pmol l , p 005 \) blood pressure analyzed continuous variable , direct correlation serum pth men \( r 31 , p 004 \) women , contrast , difference serum pth hypertensive normotensive subjects relationship blood pressure serum pth concentration blood pressure inversely correlated serum phosphorus levels sexes \( r 0 20 , p 04 \) men , elevated serum pth levels depressed serum phosphorus levels would predicted serum 1 , 25 \( oh \) 2d would higher hypertensive subjects however , observed , serum 1 , 25 \( oh \) 2d slightly lower hypertensive \( 38 3 15 2 pg ml \) normotensive men \( 42 7 11 3 , p 21 \)
hormones human experimental hypertension although altered cellular calcium handling plays critical role pathophysiology hypertension , little attention focused impact calcium regulating hormones process recent research provides evidence parathyroid hormone , calcitonin , 1 , 25 dihydroxyvitamin , well newly described factors calcitonin gene related peptide \( cgrp \) , exert target organ specific actions cardiac peripheral vascular tissues , linked renin aldosterone system , thus control sodium metabolism , may directly participate hypertensive process , especially low renin salt sensitive forms hypertensive disease metabolic set point linked renin calcium hormone systems , serve environmental dietary mineral signals cellular level , determines blood pressure consequences sodium calcium loading restriction , helps explain heterogeneous seemingly inconsistent effects dietary maneuvers blood pressure measurement renin calcium factors hypertension thus provides physiological basis individualized therapeutic recommendations human hypertension
dietary ca2 prevents nacl sensitive hypertension spontaneously hypertensive rats mechanism current study tested hypothesis dietary ca2 supplementation reverses nacl sensitive component hypertension associated neurochemical abnormalities nacl sensitive spontaneously hypertensive rat \( shr \) male shr begun one four diets 8 weeks age control \( 0 75 nacl 0 68 ca2 \) high nacl \( 8 00 nacl 0 68 ca2 \) high ca2 \( 0 75 nacl 2 00 ca2 \) high nacl high ca2 \( 8 00 nacl 2 00 ca2 \) high nacl shr \( weeks \) higher mean arterial pressure \( map \) \( 161 4 mm hg \) controls \( 149 3 mm hg p less 05 \) supplementation ca2 prevented rise map high nacl rats , alter map controls 8 nacl diet elevated plasma norepinephrine reduced anterior hypothalamic \( aha \) norepinephrine stores turnover concomitant ca2 supplementation restored plasma norepinephrine aha norepinephrine turnover normal clonidine aha rats maintained four diets 2 weeks test hypothesis dietary ca2 supplementation prevents previously observed nacl induced alpha 2 adrenoceptors aha clonidine caused dose dependent decreases map greater high nacl rats controls ca2 supplementation prevented exaggerated depressor response clonidine high nacl group , controls ca2 supplementation effect pretreatment map map responses clonidine control nacl resistant shr \( shr r \) wistar kyoto \( wky \) rats thus , dietary ca2 supplementation prevents nacl induced exacerbation hypertension augmented depressor response clonidine shr increasing noradrenergic input aha , thereby preventing aha alpha 2 adrenoceptors
vascular effects plasma spontaneously hypertensive rats circulating substances increase intracellular calcium , circulating substances increase blood pressure , described hypertensive animals humans study , report existence factor plasma spontaneously hypertensive rats effects dose dependent , time course effects correlated time course potentiation pressor agents plasma addition , plasma spontaneously hypertensive rats found inhibit depressor effects parathyroid hormone results confirm presence circulating hypertensive factor plasma spontaneously hypertensive rats , may act increasing calcium uptake vascular smooth muscle findings may also help explain secondary increase parathyroid hormone noted forms human experimental hypertension
epithelial abnormalities intestine kidney spontaneously hypertensive rat variety perturbations calcium metabolism reported occur spontaneously hypertensive rat \( shr \) compared genetic control wistar kyoto rat \( wky \) , including significant dysfunction calcium handling proximal renal tubule shr , resulting impaired active calcium transport gut apparent renal calcium leak explored intestinal renal epithelia 12 14 week old shr wky using electron microscopy biochemical comparisons transport epithelia included measurements three vitamin dependent cellular proteins one structural protein alkaline phosphatase , intestinal , renal , expression electron microscopy demonstrated patchy loss microvilli shr , accounting approximately 10 15 total surface kidney , morphological abnormalities observed proximal renal tubule , patchy loss microvilli brush border membrane shr duodenal alkaline phosphatase activity significantly reduced compared wky \( 0 145 0 002 v 0 186 0 002 integrated min micron 3 x 10 \( 3 \) brush border \( p less 001 \) duodenal renal significantly reduced shr compared wky differences expression data consistent previously characterized disturbances active calcium transport intestine inappropriate renal calcium leak shr possible link disturbances hypertension remains determined , study provides supportive evidence primary disturbance cell calcium handling epithelia form genetic hypertension
possible mechanisms abnormal norepinephrine sensitivity reactivity resistance vessels development hypertension spontaneously hypertensive rats hypothesis study examined structural functional changes mesenteric resistance vessels early , developing , established stages hypertension development spontaneously hypertensive rats attempt identify possible mechanisms development maintenance hypertension results suggest development hypertension spontaneously hypertensive rats may caused genetic structural functional abnormalities resistance vessels abnormalities may caused hyperreactivity norepinephrine altered signal transduction process , including regulation protein kinase c smooth muscle cells resistance vessels spontaneously hypertensive rats
contribution calmodulin protein kinase c renin release spontaneously hypertensive rats study designed evaluate contribution calmodulin protein kinase c renin release isolated glomeruli spontaneously hypertensive rats \( shr , \) male 7 week old shr age matched control wistar kyoto rats \( wky \) used study isolated glomeruli sealed chamber perfused krebs ringer solution constant flow 0 3 ml min renin release increased calmodulin inhibitor , w 7 , protein kinase c inhibitor , h 7 , shr wky shr showed higher maximal levels renin release w 7 lower maximal levels h 7 compared wky results indicate calmodulin protein kinase c play inhibitory roles renin release cells calmodulin mediated suppression mechanism renin release appears augmented shr , whereas protein kinase c mediated system attenuated
increase calmodulin activator hypertension modulation dietary sodium calcium aim study investigate effects dietary calcium sodium blood pressure \( bp \) normotensive rats \( wistar , wky \) , spontaneously hypertensive rats \( shr \) dahl rats calmodulin \( cam \) activator , newly discovered hydrophobic compound increases cam activity shr spontaneously hypertensive mice \( \) tissues \( j clin invest 82 , 1988 \) cam activator assessed capacity stimulate cam dependent phosphodiesterase \( cam pde \) wistar rats , fed high sodium diet \( 3 5 \) , bp significantly increased \( p less 01 \) 106 4 128 8 mm hg parallel elevation cam activator 1 57 0 14 2 80 0 18 u wky , shr , dahl salt sensitive \( ds jr \) salt resistant \( dr jr \) rats given low \( 0 15 \) high \( 2 5 \) ca diets , 1 sodium rats receiving high dietary ca progression hypertension diminished bp lower shr \( 156 4 mm hg \) young ds jr rats \( 125 3 mm hg \) receiving low dietary ca \( 192 10 183 2 mm hg \) concomitant decrease cam activator animals levels indistinguishable wky dr jr rats activator also found heart , kidneys erythrocytes presence exogenously added cam , extracts heart showed augmented cam pde activity relative normotensive preparations difference eliminated trifluoperazine
responses cytosolic free calcium adp platelets spontaneously hypertensive rats abnormalities ca2 handling reported patients essential hypertension spontaneously hypertensive rats \( shr \) study , responses cytosolic ca2 adp platelets shr examined four seven week old male shr age sex matched wistar kyoto rats \( wky \) used basal levels intracellular ca2 concentration platelets responses adp estimated using fluorescent indicator fura 2 medium containing 1 mmol l ca2 \( \) free buffer 1 mmol l egta basal levels platelet cytosolic ca2 shr significantly higher wky 4 7 weeks age presence external ca2 however , significant difference observed basal levels platelet cytosolic ca2 ca2 \( \) free egta containing buffer shr wky peak cytosolic ca2 concentration evoked adp significantly diminished shr compared wky absence external ca2 , whereas responses platelet cytosolic ca2 adp similar shr wky presence external ca2 results suggest release intracellular ca2 store reduced shr regulation cytosolic ca2 shr dependent extracellular ca2 compared wky
calcium contractile responses phorbol esters calcium channel agonist , bay k 8644 , arteries hypertensive rats study examined calcium dependency contractions arteries rats made hypertensive aortic coarctation rats genetic hypertensive \( stroke prone spontaneously hypertensive rats \) mesenteric artery aortic strips suspended tissue isometric force recording contractions two drugs characterized 1 \) phorbol ester , tpa \( 12 13 acetate \) , 2 \) calcium channel agonist , bay k 8644 thoracic aortae mesenteric arteries hypertensive rats sensitive contractile properties protein kinase c activator tpa comparable arteries normotensive rats thoracic aortae rats , contractile activity bay k 8644 potentiated compared normotensive values presence 19 2 mmol l kcl , responses bay k 8644 thoracic aortae normotensive rats potentiated differ values contrast , contractions bay k 8644 tpa abdominal aortae obtained coarctation different normotensive values upon exposure 26 2 mmol l kcl , contractions bay k 8644 abdominal aortae potentiated aortae rats differ sham values contractile responses drugs blocked nifedipine verapamil responses attenuated calcium free solution conclude calcium channel function regulation protein kinase c contribute altered vascular reactivity hypertension , abnormalities pressure dependency , occur abdominal aortae rats
age related changes membrane fluidity erythrocytes essential hypertension present study , age calcium related changes membrane fluidity erythrocytes examined patients essential hypertension use electron spin resonance method \( esr \) erythrocytes obtained patients essential hypertension examined esr spectra fatty acid spin label agent \( 5 \) incorporated erythrocyte membranes values outer order parameter \( \) significantly higher subjects essential hypertension normotensive subjects finding indicates membrane fluidity erythrocytes lower essential hypertension calcium loading erythrocytes ca ionophore a23187 decreased membrane fluidity \( value increased \) strongly essential hypertension normotensive subjects furthermore , ca induced change membrane fluidity significantly correlated age essential hypertension results demonstrate membrane fluidity erythrocytes markedly decreased calcium , especially essential hypertension older patients suggests increased calcium sensitivity cell membranes aged hypertensive patient
post transplant hypertension post transplant hypertension remains important risk factor cardiovascular mortality graft function multiple mechanisms responsible post transplant hypertension details mechanisms poorly understood steroids , acute chronic rejection , recurrent renal disease , native kidney disease , renal artery stenosis implicated causing post transplant hypertension addition cyclosporine , known hypertensive agent , immunosuppressive armamentarium , evaluation post transplantation hypertension become difficult presently , medical therapy initially directed toward complications cyclosporine nephrotoxicity empirically , converting enzyme inhibitors added antihypertensive regimen management aimed identification specific causes post transplant hypertension unfortunately , multifactorial etiology post transplant hypertension lack detailed information mechanisms , medical surgical therapy often study needed clarify mechanisms involved post transplant hypertension , thus direct therapy
blood normal myocardial infarction \? myocardial infarction acute deterioration flow properties blood present study designed test whether abnormality persists blood plasma viscosity , red cell aggregation deformability , haematocrit , erythrocyte sedimentation rate , white cell count , cholesterol , triglycerides measured 51 patients myocardial infarction 5 4 \( mean \) years results patients controls compared matched pairs identical cardiovascular risk factors also selected blood viscosity red cell aggregation increased red cell deformability decreased 51 patients abnormalities independent interval since infarction persisted years abnormalities present myocardial infarction least partly independent acute event acute phase reactions contribute reduced perfusion microcirculation heart
prospective evaluation protocol induction sustained ventricular tachycardia patients referred tertiary centre eight stages stimulation protocol used one two extrastimuli right ventricular apex sinus rhythm three ventricular drive rates \( 100 , 120 , 140 beats min \) performed 24 patients recurrent spontaneous sustained ventricular tachycardia despite drug treatment twenty two patients sustained previous myocardial infarct 18 long term treatment amiodarone sustained \( greater 30 \) ventricular tachycardia induced patients two extrastimuli significantly likely induce sustained ventricular tachycardia one , overall individually three ventricular drive rates ventricular drive rate 140 beats min significantly likely induce ventricular tachycardia ventricular drive rates 100 120 beats min significantly effective sinus rhythm ventricular drive rate 140 beats min one two extrastimuli induced ventricular tachycardia 23 24 \( 95 \) patients study full eight stage protocol progressive separately extrastimuli ventricular drive rate last two stages \( ventricular drive rate 140 beats min one two extrastimuli \) effective entire protocol inducing ventricular tachycardia
use computed tomographic scanning aortography diagnosis acute dissection thoracic aorta introduction computed tomographic \( ct \) scanning , aortography investigation choice acute aortic dissection 1978 1982 , 24 patients referred hospital suspected acute thoracic aortic dissection aortography diagnosis confirmed surgery \( n 12 \) necropsy \( n 2 \) supported clinical outcome \( n 8 \) one patient aortography negative type b dissection necropsy another patient lost follow ct scanning became available unit 1983 1983 1987 used imaging investigation 32 patients suspected acute dissection thoracic aorta 22 patients aortography used alone results confirmed surgery \( n 18 \) , necropsy \( n 3 \) , supported clinical outcome \( n 31 \) two patients lost follow additional 16 patients aortography ct scanning performed concordant findings 10 six results discordant , aortography normal three subsequent ct scanning showed type b dissection ct scanning normal three patients aortography showed type dissection ct scanning aortography reliable techniques assessment suspected acute dissection thoracic aorta techniques occasionally frequency misdiagnosis performing investigations patients level clinical suspicion high initial investigation negative ct scanning tends type dissection view success surgery condition failing serious clinical consequences
transoesophageal echocardiography longitudinal axis correlation anatomy images clinical implications transoesophageal echocardiographic imaging longitudinal axis recent addition non invasive evaluation congenital acquired heart disease technique provides unique images intracardiac anatomy interpretation remains difficult heart specimen therefore cut according echocardiographic imaging planes elucidate morphological details results suggested longitudinal transoesophageal imaging complements transverse axis approach gave new imaging information right ventricular outflow tract pulmonary trunk , atrioventricular valves , interventricular septum , cardiac apex , thoracic aorta particular , showed entire length right ventricular outflow tract longitudinal imaging used combination transverse imaging almost thoracic aorta could examined imaging longitudinal axis may also allow better assessment mechanisms atrioventricular valve regurgitation
changes continuous oestradiol treatment postmenopausal women identify changes balance continuous oestradiol treatment , 60 postmenopausal women complaints , mean age 55 4 years \( range 44 68 \) randomly allocated receive one four hormone replacement regimens one year four formulations administered daily continuously , contained 2 mg 17 beta oestradiol combination either acetate , 1 mg \( group \) 0 5 mg \( group b \) megestrol acetate , 5 mg \( group c \) 2 5 mg \( group \) significant changes occurred treatment within groups platelet count , fibrinogen 2 antiplasmin activated partial thromboplastin time shortened \( p less 0 05 \) group decline factor vii activity antigen \( p less 0 001 \) atiii activity \( p less 0 05 \) noted group protein c tended decline treatment groups statistically significant changes noted groups c two women developed crural thrombosis observation period
changes patients retinal vein occlusion haemodilution 83 patients central retinal vein occlusion branch vein occlusion measured haematocrit \( hct \) , plasma viscosity \( pv \) , red cell aggregation \( rca \) , red cell filterability \( \) apparent whole blood viscosity \( \) control group \( n 41 \) matched sex , age , cardiovascular risk factors measurements performed treatment haemodilution \( ihd \) found significant differences patients retinal vein occlusion \( \) control subjects haematocrit , plasma viscosity , red cell aggregation , red cell filterability increased whole blood viscosity patient group patients ischaemic retinal vein occlusion non ischaemic retinal vein occlusion show different parameters either treatment haemodilution , haematocrit whole blood viscosity significantly decreased , changes plasma viscosity , red cell aggregation red cell filterability
pulse oximetry new non invasive assessment peripheral arterial occlusive disease peripheral skin perfusion reflects level vascularity viability limb may help planning site amputation bypass surgery patients vascular disease study used peripheral pulse oximetry 20 healthy volunteers 20 patients limb ischaemia pulse oximetry saturation levels \( psa , o2 \) compared ankle artery doppler pressures transcutaneous oxygen measurements \( , o2 \) recordings taken two standard sites distally finger forearm calculate index significant correlation found , o2 psa , o2 patients ischaemia \( r 0 68 , p less 0 01 \) group 12 patients acute limb ischaemia similarly assessed revascularization revascularization mean \( \) , o2 increased 38 \( 13 \) 44 \( 1 \) mmhg \( p greater 0 05 \) mean \( \) psa , o2 increased 86 \( 3 \) 90 \( 4 \) per cent \( p less 0 01 \) data suggest pulse oximetry sensitive index peripheral perfusion , o2 ankle artery doppler pressure , accuracy simplicity , merits use
recent changes treatment aortoiliac occlusive disease oxford regional vascular service four years 1 january 1985 31 december 1988 , 192 patients treated aortoiliac occlusive disease oxford regional vascular service number patients treated percutaneous transluminal angioplasty increased two first year study 34 third year study increase accompanied decrease proportion patients treated aortobifemoral bypass proportion patients treated extra anatomic bypass remained constant around 30 per cent twice many patients treated fourth year first year study number surgical operations increased despite many patients treated exclusively percutaneous transluminal angioplasty number patients requiring mandatory treatment limb salvage increased 109 per cent treatment intermittent claudication 85 per cent introduction percutaneous transluminal angioplasty oxford coincided increase number patients presenting symptomatic aortoiliac occlusive disease allowed twice many people treated number aortobifemoral bypass operations remained unchanged concluded introduction percutaneous transluminal angioplasty generated workload also led increased demand surgical reconstruction aortoiliac occlusive disease
conservative management asymptomatic popliteal aneurysm historical review shows treatment popliteal aneurysm developed trial error disagreement proper management patient 1981 policy conservative management asymptomatic popliteal aneurysm adopted unit since time also managed nine patients thrombosed popliteal aneurysms arteriography low dose intra arterial streptokinase six patients treated within 72 h occlusion achieved significant \( 70 100 per cent \) lysis , streptokinase ineffective treated 10 days thrombosis six patients significant lysis , three treated elective reconstruction two anticoagulation one patient significant lysis died vascular patency five successfully treated limbs maintained limb loss occurred presented late failed achieve significant lysis results reinforce view thrombolysis treatment choice thrombosed popliteal aneurysms low complication rate asymptomatic popliteal aneurysms advent safe , effective thrombolysis indicate operation popliteal aneurysm longer required
angioplasty occluded coronary arteries use thin shaft balloon wire system without pre dilatation retrospective review done 13 consecutive patients underwent ptca totally occluded coronary arteries using recently released thin shaft balloon wire angioplasty system balloon size determined closest fit arterial size used without techniques technique initially successful 12 patients 2 clinically insignificant episodes distal embolization one probable early using thin shaft angioplasty systems , balloon dilatation totally occluded coronary arteries done safely single balloon many cases resulting simplified procedures economic benefits
probe angioplasty total coronary occlusion using catheter technique coronary angioplasty \( ptca \) total coronary occlusion limited inability conventional dilating catheters cross lesions new technique therefore prospectively evaluated ptca lesions using ultra low profile probe balloon wire device intracoronary catheter used facilitate crossing stenosis guidewire deliver probe obstruction balloon dilatation technique utilized 64 consecutive patients absolute coronary occlusions demonstrating angiographically detectable antegrade coronary flow successful dilatation achieved 47 \( 73 \) among 33 occlusions less 3 mo duration 31 \( 94 \) successfully dilated whereas 16 31 chronic occlusions dilated \( p less 01 \) chronic occlusions tapered morphology located 1 cm branch point frequently serious complications including vessel perforations technique catheter technique offers safe effective method dilatation recent coronary occlusions using balloon wire technology
regression infundibular pulmonary stenosis successful balloon pulmonary valvuloplasty adults july 1985 march 1988 , 22 adult patients congenital pulmonary stenosis underwent balloon pulmonary valvuloplasty 10 males 12 females aged 16 45 \( average 25 9 9 \) years patients additional mild severe infundibular stenosis 16 restudied 6 36 \( mean 12 6 \) months later repeat catheterization student 's test used comparison data right ventricular \( rv \) systolic pressure dilatation 84 196 \( mean 129 32 3 \) mm hg , peak pulmonary gradient \( \) 60 176 \( mean 111 33 2 \) mm hg immediately dilatation rv systolic pressure dropped 32 140 \( mean 59 2 27 \) \( p less 0 001 \) dropped 10 113 \( mean 37 8 26 4 \) \( p less 0 001 \) , infundibular gradient ranged 8 113 \( mean 35 1 25 8 \) mm hg infundibular diameter , dilatation , ranged 2 15 \( mean 9 5 4 \) mm hg repeat catheterization , rv systolic pressure dropped 33 66 \( mean 42 8 9 7 \) mm hg reduced 0 48 \( mean 18 4 10 9 \) mm hg \( p less 0 001 \) infundibular gradient regressed 0 34 \( mean 15 8 8 \) mm hg \( p less 0 001 \) infundibular diameter increased 8 25 \( mean 15 8 5 4 \) \( p less 0 001 \) concluded moderate severe infundibular stenosis , adults , regress successful pulmonary valvuloplasty
diagnosis left atrial thrombi mitral valve disease coronary arteriography arteriographic findings fistula formation coronary arteries left atrium occasionally described association left atrial thrombosis patients mitral valve disease validity coronary arteriographic findings diagnosis atrial thrombi evaluated 112 patients mitral valve disease comparison made surgery study diagnostic values sensitivity 70 , specificity 85 , positive predictive value 72 even angiographic finding complementary diagnosis atrial thrombosis , identification coronary arteriography patients mitral valve disease useful detection could improve diagnostic prediction thrombosis , especially patients without previous embolic events echocardiography failed reveal thrombi
balloon rupture due lesion morphology coronary angioplasty report case coronary angioplasty left anterior descending artery lesion complicated rupture three successive balloon catheters rupture occurred jet contrast diagonal side branch , causing staining case demonstrates balloon rupture may result lesion morphology
severe mitral insufficiency post balloon valvuloplasty late changes found disrupted mitral valve case 45 yr old woman balloon valvuloplasty rheumatic mitral stenosis presented anterior mitral leaflet tear occurred complication procedure partial healing anterior mitral leaflet gradual dilatation left atrium occurred allowed damaged valve remain situ several months late changes occur complicated valvuloplasty illustrated , patient eventually required surgery valve excision definitive repair
inflation pressure requirements coronary angioplasty examine balloon inflation pressures required successful percutaneous transluminal coronary angioplasty \( ptca \) , maximal inflation pressure required coronary lesions 200 consecutive patients determined retrospectively graded balloon inflations sufficient achieve full expansion used , maximal inflation pressure used less equal 8 atm 412 stenoses \( 86 \) less equal 10 atm stenoses \( 97 \) successful ptca achieved 98 lesions 3 5 major procedural complication rate second group 100 patients studied prospectively , inflation pressure required achieve full balloon expansion less equal 8 atm 214 232 stenoses \( 92 \) less equal 10 atm 228 stenoses \( 98 \) thus , ptca coronary stenoses achieved high success rates low complication rates graded inflations pressures sufficient achieve full balloon expansion performed coronary stenoses respond pressures less equal 8 10 atm
percutaneous popliteal approach angioplasty superficial femoral artery occlusions angioplasty using percutaneous popliteal approach utilized 50 patients \( pts \) 59 occluded superficial femoral arteries unsuccessfully using antegrade approach either flush origin occlusion inability maintain guide wire true lumen pts claudication 8 rest pain 3 non healing ulcers laser probe used 17 cases 3 cases occlusion length varied 1 40 cm 7 lesions less 10 cm \( group 1 \) 9 10 20 cm \( group 2 \) 43 greater 20 cm \( group 3 \) angiographic success obtained 48 59 lesions \( 81 \) 14 16 \( 87 \) groups 1 2 34 43 \( 79 \) group 3 three pts needed complementary common femoral endarterectomy one required percutaneous aspiration complications included arterial perforation dissection \( without clinical sequelae \) 11 popliteal hematoma 1 pt one patient severely ischemic leg underwent successful emergency vascular surgery , another limb salvage patient required knee amputation worsening limb ischemia popliteal approach attempt discharge , 39 patients \( 78 \) whose outcome would unsuccessful traditional antegrade approach clinically improved utilizing popliteal approach achieve successful angioplasty procedure
usefulness digital angiography assessment left ventricular ejection fraction modern digital cardiac systems image data digitized line real time , allowing subsequent interpretation analysis directly cardiac catheterization procedure study evaluated advantages limitations manual tracing technique left ventricular digital angiograms system thirty three patients catheterized suspected coronary artery disease studied manual tracings performed senior experienced function found short long term intraobserver assessment global ejection fraction small short term mean difference standard deviation \( correlation coefficient \) 0 5 2 7 \( r 0 97 \) global ef units long term 0 7 2 7 \( r 0 96 \) ef units interobserver \( 5 1 4 8 \( r 0 93 \) ef units \) slightly higher intraobserver decrease 25 amount contrast medium administered significantly influence contour tracings , would suggest use smaller doses average , function required 6 11 min analysis time left ventricular study , respectively , emphasizing need developments towards automated contour detection finally , excellent correlation found standard line analysis procedure thus , may concluded quantitative digital left ventricular angiography based manual tracing outlines performed immediately following cardiac catheterization \( post processing \) feasible routine procedure assessment left ventricular function
regional deformation pericardium cardiac cycle dogs hypothesized local contact forces pericardium heart cause regional variation pericardial deformation cardiac cycle , reflecting volume changes underlying cardiac chambers test , measured regional pericardial area right atrium \( ra \) right ventricle \( rv \) orthogonal pairs six open chest dogs left ventricular end diastolic pressure 5 mm hg , rv pericardial area paralleled rv volume , , shrinkage ejection 10 8 expansion filling ra pericardial area related rv pericardial area , average expansion ventricular ejection 2 2 , thus ra volume rv ejection volume loading , rv pericardial shrinkage ejection increased 14 6 , ra pericardial area change longer reciprocal \( 0 3 change rv ejection \) elimination contact forces cardiac tamponade resulted marked attenuation rv pericardial area changes rv ra pericardial area pattern , rv ejection two additional dogs , measurement pericardial area left ventricle atrium showed similar results conclude dynamic pericardial contact forces cause regional variation pericardial deformation , reflects volume changes underlying chambers findings imply influence pericardium filling ejection may complex previously recognized , varying chamber course cardiac cycle
biphasic effects doxorubicin calcium release channel sarcoplasmic reticulum cardiac muscle define mechanism doxorubicin cardiotoxicity , effects doxorubicin caffeine examined calcium release channels cardiac sarcoplasmic reticulum found calcium release cardiac sarcoplasmic reticulum vesicles induced compounds sarcoplasmic reticulum vesicles incorporated planar lipid , calcium permeable channels observed addition caffeine \( 2 5 10 mm \) increased channel open probability less 0 1 40 , effect persisted mean 44 minutes contrast , doxorubicin \( 2 5 10 microm \) biphasic effect initially , doxorubicin activated channel , whereas mean 8 minutes , channel became irreversibly inhibited although degree channel activation doxorubicin concentration dependent , time needed channel concentration independent pretreatment \( 0 2 mm \) prevented doxorubicin induced channel inactivation , channel activity persisted average 58 minutes alone alter channel open probability results support hypotheses 1 \) integrity sulfhydryl groups important aspects calcium release channel function 2 \) activation inactivation channel processes biphasic effect doxorubicin channel function may also correspond clinically observed adverse effects doxorubicin , widely used chemotherapeutic agent , prolonged usage , causes dilated cardiomyopathy
enhanced alpha 1 adrenergic responsiveness cardiomyopathic hamster cardiac myocytes relation expression pertussis toxin sensitive g protein alpha 1 adrenergic receptors pathogenesis myopathy occurring heart cardiomyopathic strain syrian hamster well understood believed associated abnormal calcium handling myopathic cells purpose study determine whether cardiomyopathy occurring strain 14 6 animals associated enhanced alpha 1 adrenergic receptor mediated rise cytosolic calcium , whether pertussis toxin sensitive g protein involved coupling alpha 1 adrenergic receptor changes intracellular calcium whether enhanced alpha 1 responsiveness associated increase level expression alpha 1 adrenergic receptor pertussis toxin sensitive g protein proteins test hypothesis cardiomyopathic state associated greater alpha 1 receptor mediated rise cytosolic calcium , studied effect phenylephrine \( presence propranolol \) time averaged cytosolic calcium concentration \( ca2 \) isolated cardiac myocytes cardiomyopathic age matched control hamsters phenylephrine caused greater increase time averaged ca2 \( increase 48 8 versus 12 3 , p less 0 01 \) contractility \( 181 22 versus 35 9 , p less 0 01 \) cardiomyopathic normal cardiac myocytes exposure pertussis toxin \( 200 ng ml 3 hours \) attenuated alpha 1 adrenergic receptor mediated increase contractility time averaged ca2 cardiomyopathic normal cells level pertussis toxin sensitive g protein , determined pertussis toxin mediated 32p adp , 1 6 fold higher cardiomyopathic versus normal hamster hearts density alpha 1 adrenergic receptors , measured antagonist radioligand 3h prazosin affinity receptor agonist antagonist similar myopathic normal heart membranes thus , cardiac myocytes hamsters , alpha 1 adrenergic receptor mediated effects ca2 contractility appear mediated pertussis toxin sensitive g protein proteins myocytes cardiomyopathic hamsters , alpha 1 adrenergic effects increased magnitude , level pertussis toxin sensitive g protein , measurable alteration density ligand binding properties alpha 1 adrenergic receptors
evidence decreased coronary flow reserve viable postischemic myocardium try complexity heterogeneity reflow phenomenon underlying mechanisms , studied tissue perfusion reperfused heart muscle using tracer microspheres anesthetized dog model 90 minute coronary occlusion followed reperfusion 2 1 2 hours , 24 hours , 1 week regional myocardial blood flow determined basal flow conditions reactive hyperemia effect intracoronary adenosine administration examined , ultrastructure postischemic myocardium analyzed viable reperfused tissue \( delineated triphenyltetrazolium chloride staining \) , reflow basal conditions unimpaired coronary flow reserve \( peak reactive hyperemic flow \) intact start reperfusion , decreases half 2 1 2 hours , completely within 1 week impairment coronary reserve relieved intracoronary adenosine administration ultrastructural examination , capillaries patent hand , irreversibly damaged myocardium , basal reflow impairment decrease coronary flow reserve severe permanent coronary flow reserve already decreased start reperfusion , pharmacological intervention beneficial effect ultrastructurally , extracellular intracellular edema invariably present , whereas vascular endothelium damaged capillaries packed red blood cells conclude reflow phenomenon \( e , mechanical obstruction blood flow \) limited infarcted tissue viable myocardium , however , coronary flow reserve transiently diminished , probably washout subsequent insufficient availability chemical mediator adenosine breakdown slow recovery precursor atp pool
time course cellular enzyme release dog heart injury transport time enzyme heart plasma studied two experimental models first , enzyme alanine aminotransferase slowly infused left ventricular wall open chest dogs half life washout alanine aminotransferase activity plasma 20 4 minutes \( mean sem , n 8 \) different ischemic normally perfused tissue measurements arteriovenous differences alanine aminotransferase activity left ventricular blood flow , concluded 77 14 total enzyme washout ischemic tissue occurred direct entry corresponding value vascular permeability surface area product 264 55 ml kg 1 hr 1 second model , studied myocardial enzyme release plasma abrupt heart injury induced 10 minutes calcium free coronary perfusion followed calcium \( calcium paradox mechanism \) half life release plasma 1 9 0 2 hours \( mean sem , n 6 \) influenced sustained ischemia slower washout , observed second model , consistent increased interstitial protein space corresponds permeability surface area product 135 285 ml kg 1 hr 1 results used calculate time course cellular enzyme leakage rate enzyme release plasma various forms heart injury significant shifts time curves evolving cellular injury enzyme release plasma observed 2 hours ischemia followed coronary reperfusion , permanent ischemia
effects adenosine human coronary arterial circulation adenosine potent vasodilator used extensively study coronary circulation animals use humans , however , hampered lack knowledge effects human coronary circulation concern safety investigated humans effects adenosine , administered intracoronary bolus \( 2 16 micrograms \) , intracoronary infusion \( 10 240 micrograms min \) , intravenous infusion \( 35 140 micrograms kg min \) coronary systemic hemodynamics electrocardiogram coronary blood flow velocity \( cbfv \) measured coronary doppler catheter maximal cbfv determined intracoronary papaverine \( 4 5 0 2 resting cbfv \) normal left coronary arteries \( n 20 \) , 16 micrograms boluses adenosine caused coronary hyperemia similar caused papaverine \( 4 6 0 7 resting cbfv \) right coronary artery \( n 5 \) , 12 micrograms boluses caused maximal hyperemia \( 4 4 1 0 resting cbfv \) intracoronary boluses caused small , brief decrease arterial pressure \( similar caused papaverine \) changes heart rate electrocardiogram duration hyperemia much shorter adenosine papaverine administration intracoronary infusions 80 micrograms min left coronary artery \( n 6 \) also caused maximal hyperemia \( 4 4 0 1 resting cbfv \) , doses 240 micrograms min caused minimal decrease arterial pressure \( 6 2 mm hg \) significant change heart rate electrocardiographic variables intravenous infusions normal patients \( n 25 \) 140 micrograms kg min caused coronary vasodilation similar caused papaverine 84 patients \( 4 4 0 9 resting cbfv \) submaximal infusion rates , however , cbfv often widely 140 micrograms kg min infusion , arterial pressure decreased 6 7 mm hg , heart rate increased 24 14 beats min one patient developed 1 cycle 2 1 atrioventricular block , otherwise , electrocardiogram change eight patients microvascular vasodilator dysfunction \( delta cbfv , less 3 5 peak resting velocity maximally vasodilating dose intracoronary papaverine \) , dose response characteristics intracoronary boluses intravenous infusions adenosine similar found normal patients \( abstract truncated 400 words \)
sex differences control cutaneous blood flow women far likely men suffer raynaud 's disease purpose study determine whether gender differences local central control cutaneous blood flow could account increased incidence raynaud 's disease women assess cutaneous blood flow , hand blood flow \( hbf \) , finger blood flow \( \) , skin perfusion \( sp \) measured fluid plethysmography , mercury strain gauge plethysmography , laser doppler spectroscopy , respectively , 47 volunteers basal hbf men exceeded women \( 12 1 2 0 versus 6 2 1 5 ml 100 ml min \) likewise , men women \( 19 5 4 1 versus 7 7 1 8 ml 100 ml min \) similarly , sp men greater women \( 270 42 versus 81 16 perfusion units \) however , total body warming \( induce thermal \) , hbf women exceeded men , suggesting lower basal hbf women due increased sympathetic outflow extremities mental stress deep inspiration reduced hbf sp men paradoxically , maneuvers increased hbf sp women determine whether paradoxical responses women due women 's elevated basal sympathetic tone , experiments repeated total body cooling men increase sympathetic tone total body warming women reduce sympathetic tone total body cooling reduced hbf sp men conditions , mental stress deep inspiration induced vasodilation women , total body warming 10 minutes increased hbf
mortality 10 1 2 years hypertensive participants multiple risk factor intervention trial multiple risk factor intervention trial \( \) randomized primary prevention trial tested effect intervention program coronary heart disease \( chd \) mortality 12 , high risk men aged 35 57 years men randomly assigned either special intervention \( si \) program , consisted dietary advice lowering blood cholesterol levels , counseling aimed cessation cigarette smokers , stepped care treatment hypertension elevated blood pressure , usual sources health care within community \( uc \) among 12 , randomized men , 8 , 012 \( 62 \) hypertensive baseline subgroup , mortality rates 10 5 years follow lower si uc group 15 \( p 0 19 \) chd 11 \( p 0 13 \) causes results reflected favorable outcomes si compared uc hypertensive men 3 8 posttrial years \( march 1982 december 1985 \) preceding 6 8 years \( february 1982 \) posttrial years , death rates lower si uc men 26 \( p 0 09 \) chd 23 \( p 0 02 \) causes diastolic blood pressure equal 100 mm hg , posttrial trend continuation trend trial therefore , 10 5 years follow , death rates markedly lower si uc 36 \( p 0 07 \) chd 50 \( p 0 0001 \) causes similarly , without baseline resting electrocardiographic abnormalities , favorable posttrial outcome si group continuation trend trial contrast , baseline diastolic blood pressure 90 99 mm hg baseline resting electrocardiographic abnormalities , favorable posttrial mortality findings si group reversal unfavorable trends recorded trial two factors appear contributed favorable mortality trend si group 1 \) change diuretic treatment protocol si men 5 years randomization , involved replacement hydrochlorothiazide chlorthalidone daily maximum dose 50 mg 2 \) favorable effect intervention nonfatal cardiovascular events trial years addition , delay full impact beneficial effects mortality end points smoking cessation cholesterol lowering could contributed \( abstract truncated 400 words \)
ten year follow survival myocardial infarction randomized coronary artery surgery study coronary artery surgery study \( cass \) randomized patients initial strategy coronary surgery medical therapy medically randomized patients , 6 surgery within 6 months total 40 surgery 10 years 10 years , difference cumulative survival \( medical , 79 vs surgical , 82 ns \) difference percentage free death nonfatal myocardial infarction \( medical , 69 vs surgical , 66 ns \) patients ejection fraction less 0 50 exhibited better survival initial surgery treatment \( medical , 61 vs surgical , 79 p 0 01 \) conversely , patients ejection fraction greater equal 0 50 exhibited higher proportion free death myocardial infarction initial medical therapy \( medical , 75 vs surgical , 68 p 0 04 \) although long term survival remained unaffected \( medical , 84 vs surgical , 83 p 0 75 \) significant differences either survival freedom nonfatal myocardial infarction , whether stratified presence heart failure , age , hypertension , number vessels diseased thus , 10 year follow results confirm earlier reports cass patients left ventricular dysfunction exhibit long term benefit initial strategy surgical treatment patients mild stable angina normal left ventricular function randomized initial medical treatment \( option later surgery symptoms progress \) survival equivalent patients randomized initial surgery
ten year follow quality life patients randomized receive medical therapy coronary artery bypass graft surgery coronary artery surgery study \( cass \) quality life indexes assessed patients 10 years randomization medical therapy \( n 390 \) coronary artery bypass graft surgery \( n 390 \) coronary artery surgery study 10 years , mortality 21 8 medical group 19 2 surgical group \( p ns \) , 144 \( 37 \) medical group undergone surgery increasing chest pain study entry , 22 medical surgical patients angina free 1 5 years entry , frequency asymptomatic patients 66 63 surgical group 30 38 medical group however , 10 years entry , proportion patients free angina fallen 47 surgical group 42 medical group activity limitation use beta blockers long acting less surgical medical group 1 5 years entry little different medical group 10 years entry throughout follow , recreational status , employment status , frequency heart failure , use medications , hospitalization frequency similar two groups thus , indexes quality life angina relief , increased activity , reduction use antianginal medications initially appear superior patients stable manifestations ischemic heart disease assigned surgery , 10 years entry , advantages much less apparent although observed similarities medically surgically assigned groups 10 years reflect return symptoms surgical group extent , important explanation performance late surgery large proportion medically assigned patients , asymptomatic
blood pressure level , trend , variability children 8 year study single birth cohort birth cohort children multidisciplinary health development study new zealand , resting blood pressures recorded five times age 7 15 years using previously described methods , examined level , trend , variability blood pressures children least three readings level , trend , variability height , weight , body mass index compared among six separate groups children two groups categorized basis high systolic pressure levels , one low variability high variability , thought resemble adult labile hypertension two additional groups categorized basis increasing decreasing blood pressure trends fifth group consistently low blood pressures , sixth group consisted remaining children significant differences among groups level physical measurements trend body mass index significant differences found among groups gender socioeconomic status parental history high blood pressure , stroke , heart attack significantly common first two groups
prognostic value radionuclide angiography medically treated patients coronary artery disease comparison clinical catheterization variables evaluate usefulness multiple measures rest exercise radionuclide angiography \( rna \) predicting cardiovascular death cardiovascular events \( death nonfatal myocardial infarction \) assess prognostic usefulness rna relative clinical catheterization data , studied 571 stable patients symptomatic coronary artery disease upright rest exercise first pass rna within 3 months catheterization medically treated median follow 5 4 years , 90 patients died cardiovascular causes , 147 patients either died suffered nonfatal myocardial infarction using cox regression model group rna variables , important rna predictor mortality exercise ejection fraction \( chi 2 81 , p less 0 00001 \) neither rest ejection fraction change ejection fraction rest exercise contributed additional predictive information two rna study variables , change heart rate rest exercise rest end diastolic volume index , contribute additional prognostic information exercise ejection fraction \( chi 2 23 , p less 0 0001 \) compared noninvasive clinical data \( history , physical examination , electrocardiogram , chest radiograph \) , rna variables considerably predictive mortality \( chi 2 71 clinical variables versus chi 2 104 rna \) remarkably , strength relation rna variables mortality equivalent set catheterization variables previously demonstrated large angiographic population important \( chi 2 104 rna versus chi 2 102 catheterization variables \) rna contained 84 information provided clinical catheterization descriptors combined furthermore , rna contributed significant additional prognostic information clinical catheterization data \( chi 2 13 6 , p 0 \) cardiovascular events , relative prognostic usefulness rna similar , although relations outcome generally weaker descriptors rest exercise rna exhibit powerful relation long term outcomes useful defining risk , even clinical catheterization data available
prognostic value electrophysiology testing asymptomatic patients wolff parkinson white pattern published erratum appears circulation 1991 mar 83 \( 3 \) prognostic value electrophysiology testing studied 75 asymptomatic patients wolff parkinson white electrocardiographic pattern patients underwent electrophysiology testing entry study followed annually total patient years \( median , 4 3 years \) 44 male 31 female patients , age enrollment ranged 7 77 years \( mean , 34 14 years \) median effective refractory period accessory pathway 293 msec \( interquartile range , 280 310 msec \) , median shortest rr interval beats atrial fibrillation \( \) corrected msec \( 240 320 msec \) twenty three patients 250 msec less eight patients median shortest interval 200 msec less twelve patients inducible sustained reciprocating tachycardia , 10 patients inducible nonsustained reciprocating tachycardia , 23 patients inducible sustained atrial fibrillation twenty patients \( 27 \) lacked retrograde conduction accessory pathway patient died suddenly median follow 4 3 years six patients \( 8 \) became symptomatic documented supraventricular tachycardia , two underwent operative ablation accessory pathways patient absent retrograde accessory pathway conduction electrophysiology study became symptomatic inducible sustained nonsustained reciprocating tachycardia electrophysiology study predict development subsequent symptomatic supraventricular tachycardia nine patients lost preexcitation follow age enrollment \( relative risk decade , 1 4 95 confidence interval , 1 0 1 8 \) anterograde accessory pathway refractory period \( relative risk , 1 06 10 msec 95 confidence interval , 1 0 1 12 \) independent predictors loss preexcitation
hormones regulating cardiovascular function patients severe congestive heart failure relation mortality consensus trial study group varying hormonal activation heart failure able evaluate activation relate prognosis , took blood samples baseline 6 weeks 239 patients severe heart failure \( new york heart association class iv \) randomized additional treatment enalapril placebo study \( consensus \) , previously reported , significant reduction mortality among patients treated enalapril present data show placebo group significant positive relation mortality levels angiotensin ii \( p less 0 05 \) , aldosterone \( p 0 003 \) , noradrenaline \( p less 0 001 \) , adrenaline \( p 0 001 \) , atrial natriuretic factor \( p 0 003 \) similar relation observed among patients treated enalapril significant reductions mortality groups patients treated enalapril consistently found among patients baseline hormone levels median values significant reductions hormone levels baseline 6 weeks group patients treated enalapril hormones except adrenaline correlations changes hormone levels , pronounced variable neurohormonal activation heart failure even patients similar clinical findings activation reduced enalapril therapy results suggest effect enalapril mortality related hormonal activation general renin angiotensin system particular
excretion thromboxane a2 prostacyclin metabolites exercise testing patients without signs ischemic heart disease addressed hypothesis platelets activated association effort induced myocardial ischemia stable coronary disease seventy two patients undergoing diagnostic bicycle exercise test stratified according development chest pain \( yes , 33 39 \) exercise induced st segment depression least 200 microv electrocardiogram \( yes , 12 60 \) noninvasive indexes platelet activation platelet vessel wall interaction \( urinary excretion 2 , 3 dinor metabolites thromboxane a2 tx prostacyclin pgi , respectively \) analyzed samples collected basal state test basal tx pgi differ patients \( 236 35 131 22 pg mg creatinine , respectively \) without \( 185 16 101 13 pg mg creatinine , respectively \) chest pain , \( 178 45 162 41 pg mg , respectively \) without \( 216 22 104 11 pg mg , respectively \) st segment depression test patients without chest pain without st segment depression moderately increased \( p less 0 05 \) urinary tx \( 21 13 , respectively \) pgi \( 28 23 , respectively \) exercise significant increases observed developing chest pain st depression exercise data indicate effort induced myocardial ischemia associated increase platelet activation platelet vessel wall interaction patients stable coronary disease
effect long term exercise regional myocardial function coronary collateral development gradual coronary artery occlusion pigs effect myocardial ischemia , induced long term exercise , regional myocardial function coronary collateral development examined pigs gradual occlusion left circumflex coronary artery \( lcx \) occluder thirty days surgery , regional myocardial function blood flow assessed exercise 22 pigs separated exercise \( n 12 \) sedentary groups \( n 10 \) exercise group trained treadmill 25 1 days , 30 50 min day , heart rates 210 220 beats min 5 weeks , another exercise test performed exercise group , training , observed improvement systolic wall thickening , expressed percentage rest , collateral dependent lcx region 64 8 87 6 \( p less 0 01 \) moderate exercise levels \( 220 beats min \) 45 7 73 7 \( p less 0 01 \) severe exercise levels \( 265 beats min \) transmural myocardial blood flow lcx region expressed ratio flow region left ventricle also increased significantly \( p less 0 01 \) severe exercise 5 weeks sedentary group showed improvement systolic wall thickening lcx region moderate exercise compared initial exercise test \( p less 0 05 \) significant change systolic wall thickening myocardial blood flow ratios severe exercise 5 weeks conclude long term exercise gradual lcx coronary artery occlusion pigs improves myocardial function coronary collateral reserve collateral dependent myocardium exercise
effect tachycardia regional function transmural myocardial perfusion graded coronary pressure reduction conscious dogs purpose present study examine subendocardial flow function graded coronary pressure reduction determine effect tachycardia lower autoregulatory pressure limit \( critical coronary pressure \) dogs atrial pacing rate 200 beats min , subendocardial flow measured radioactive microspheres averaged 1 55 0 34 ml min g remained unchanged pressure reduced autoregulatory plateau 84 10 59 7 mm hg reductions coronary pressure critical coronary pressure approximately 60 mm hg associated concomitant reductions subendocardial flow endocardial epicardial flow ratio tachycardia although regional function remained constant autoregulatory plateau , rightward shift coronary pressure function relation ischemia response steady state increase rate 100 200 beats min reductions regional wall thickening began coronary pressures reached 38 7 mm hg heart rate 100 beats min 61 6 mm hg heart rate 200 beats min \( p less 0 005 \) similar critical coronary pressure values obtained subendocardial segment shortening relations subendocardial flow myocardial function measured transmural wall thickening subendocardial segment shortening linear pacing heart rate 200 beats min relative reductions wall thickening related reductions subendocardial flow nearly one one basis results study demonstrate shift lower limit subendocardial autoregulation tachycardia manifest onset subendocardial ischemia higher distal coronary artery pressure shift critical coronary pressure relates increase resting flow requirements due increased demand diminished subendocardial vasodilator reserve given coronary pressure secondary reduction time available diastolic subendocardial perfusion tachycardia
optimizing exercise test pharmacological investigations exercise trials cardiology often inconsistent approaches exercise testing inconsistencies include choice exercise protocol , exercise end points , points analysis , absence misuse gas exchange data gas exchange techniques greatly enhance accuracy cardiopulmonary function assessed exercise commonly used protocols always appropriate patients studies cardiovascular disease exercise protocol important impact relation changes work rate oxygen uptake protocols appear offer greatest promise assessing cardiopulmonary function analyzing hemodynamic gas exchange responses several points , addition peak exercise , add important information concerning efficacy drug great deal confusion continues application gas exchange anaerobic threshold , many commonly used testing end points reliable
clinical evaluation single versus multiple mammary artery bypass superior patency clinical advantages internal mammary artery \( ima \) grafting well established however , relative benefits routine multiple ima grafting remain uncertain determine whether routine multiple compared single ima utilization improved survival patients undergoing coronary bypass procedures , 1 , patients prospectively allocated , beginning 1984 , divergent management strategies single \( group 1 , n 420 \) versus multiple ima grafting \( group 2 , n \) subsequent analysis anatomical extent disease preoperative baseline risk factors showed differences \( p ns \) two groups variables reflecting operative technique similar \( p ns \) two groups , except 74 group 1 patients multivessel disease received single ima graft , whereas 71 group 2 patients multivessel disease received multiple \( p less 0 05 \) multivariate analysis , impairment left ventricular ejection fraction , acute evolving myocardial infarction , advanced age , unstable angina incremental risk factors mortality \( p less 0 03 \) , group assignment \( p 0 4 \) ultimate therapy \( p 0 6 \) survival probabilities \( expressed 30 day group 1 group 2 4 year group 1 group 2 \) overall \( 0 97 0 98 0 93 0 90 \) , elective \( 0 98 0 99 0 97 0 92 \) , acute \( 0 95 0 97 0 89 0 88 \) , age less 65 years \( 0 98 0 99 0 97 0 93 \) , age 65 years older \( 0 93 0 97 0 84 0 89 \) , ejection fraction 0 40 \( 0 97 0 99 0 95 0 94 \) , ejection fraction less 0 40 \( 0 95 0 96 0 87 0 82 \) , nondiabetic \( 0 98 0 98 0 94 0 91 \) , diabetic \( 0 92 0 97 0 88 0 87 \) differences survival significant \( p ns \)
early late results isolated coronary artery bypass surgery 159 patients aged 80 years older studied 159 patients 80 years age older isolated coronary artery bypass grafting \( cabg \) since 1977 eighty seven percent surgery since 1984 two thirds patients male , mean age 82 years patients \( 97 \) new york heart association \( nyha \) functional class iii iv , 89 unstable postinfarction angina pectoris , 67 rest pain almost half \( 47 \) required preoperative admission coronary care unit , 6 required preoperative use intra aortic balloon pump , 20 operated significant left main coronary artery disease \( greater equal 50 stenosis \) present 41 ten patients \( 6 3 \) died within 30 days surgery , seven patients dying hospital admission soon transfer another institution resulted overall hospital mortality 10 7 median hospital stay 10 days univariate analysis , significant predictors hospital mortality nyha iv , angina rest , preoperative admission coronary care unit , emergency operation , ejection fraction less 0 50 , presence mitral regurgitation multivariate analysis , ejection fraction less 0 50 significant risk factor \( p less 0 01 \) hospital survivors , 98 followed mean 29 months estimated 5 year survival \( sem \) patients 71 4 5 , hospital survivors , 80 4 5 important predictor adverse survival ejection fraction less 0 50 seventy nine percent angina free , 89 nyha classes ii majority patients felt improved surgery conclude cabg patients 80 years older , although associated increased operative risk , gives excellent relief symptoms good 5 year survival patients denied cabg age alone
surgical repair postinfarction ventricular septal defect thirty one patients underwent repair postinfarction ventricular septal defect \( vsd \) 1980 1989 patients new york heart association functional class iv , 15 cardiogenic shock operated coronary arteriography performed patients surgery nine one vessel , 11 two vessel , 11 three vessel disease vsd anterior 15 patients posterior 16 operative technique evolved years fairly extensive reconstruction septum right left ventricular walls double dacron patch , minimal closure vsd excluding infarcted muscle left ventricular cavity accomplished suturing single patch bovine pericardium healthy endocardium surrounding infarcted muscle right ventricle left intact overall mortality 10 , three operative deaths deaths occurred patients cardiogenic shock three vessel coronary artery disease thus , mortality patients shock 20 , mortality patients three vessel disease 27 operative mortality patients posterior vsd twice high patients anterior vsd however , univariate analysis various clinical , hemodynamic , operative variables indicated three vessel disease predictive operative mortality number patients small overall operative mortality relatively low , results analysis may valid
relative risks left ventricular patients akinetic scars versus true dyskinetic aneurysms 1971 1988 , 303 patients underwent left ventricular aneurysm resection analyzed preoperative procedure related variables ascertain risk factors surgery distinction made akinetic dyskinetic aneurysms assess potential relation postoperative outcome indications surgery arrhythmia 20 patients , congestive heart failure 81 , angina 133 , congestive heart failure angina 42 , combinations remaining 27 patients left ventricular aneurysm dyskinetic 180 patients akinetic 121 risk factors surgical procedures similar groups left ventricular ejection fraction less equal 30 98 patients coronary bypass grafting performed 269 patients , average 2 3 grafts per patient mitral valve replacement , common concomitant procedure , performed 16 patients intra aortic balloon assist required postoperatively 47 patients overall operative mortality 13 \( 38 patients \) due low cardiac output 23 patients arrhythmia 12 patients univariate multivariate analyses related early mortality new york heart association functional classification heart failure , predominant indications arrhythmia congestive heart failure , left ventricular ejection fraction less equal 30 , need intra aortic balloon support , excision akinetic \( 18 \) rather dyskinetic \( 8 \) left ventricular aneurysm follow period averaging nearly 5 years , actuarial survival 5 years 63 dyskinetic group 51 akinetic group
latissimus dorsi cardiomyoplasty treatment patients dilated cardiomyopathy stimulated skeletal muscle grafts proposed means reinforce ventricular wall treatment severe myocardial failure latissimus dorsi cardiomyoplasty performed 11 patients advanced heart failure due cardiomyopathy new york heart association \( nyha \) class iii iv despite maximal medical therapy operative deaths eight patients followed mean 10 8 months two patients remain muscle conditioning protocol one patient died latissimus dorsi ischemia congestive heart failure four eight patients long term follow nyha class , three class ii , one class iii 3 months follow , rest left ventricular ejection fraction increased 20 5 3 6 26 8 8 1 \( p less 0 01 \) doppler echocardiography demonstrated left ventricular segmental wall shortening improved 11 3 2 5 16 5 3 9 \( p less 0 01 \) left ventricular stroke volume 22 9 4 6 33 1 10 ml \( p less 0 01 \) cardiopulmonary exercise test showed maximal oxygen consumption treadmill test increased 14 8 3 7 18 2 3 3 ml kg min \( p less 0 05 \) 6 months follow , values remained essentially unchanged furthermore , nonsustained ventricular tachycardia abolished without specific medical therapy four patients thus , cardiomyoplasty improves left ventricular function , reverses congestive heart failure , may improve long term survival severe cardiomyopathies
five year experience triple drug immunosuppressive therapy cardiac transplantation although triple drug immunosuppression combination cyclosporine , prednisone , azathioprine shown improve short term survival cardiac transplantation , long term effects still unknown december 1983 december 1988 , patients \( n 139 \) underwent orthotopic cardiac transplant institution received triple drug therapy follow averaged 32 2 15 8 months twenty one patients died 134 survived 30 days actuarial survival 92 1 year , 85 3 years , 78 5 years twenty five episodes acute graft rejection diagnosed 21 139 recipients \( 0 18 episode per patient \) patients , incidence infection 0 82 episode 72 infections viral , 10 due cytomegalovirus incidence coronary artery disease 10 1 year , 25 3 years , 36 5 years coronary artery disease responsible 60 late deaths arterial hypertension developed 81 patients , despite relatively well maintained renal function \( serum creatinine , 1 7 0 3 mg dl \) skeletal complications occurred 15 8 lymphoma 1 4 recipients complete long term rehabilitation achieved two surviving patients data support short long term effectiveness triple drug therapy regimen reduces incidence rejection , infection , lymphoma , well degree renal failure however , incidence posttransplant coronary artery disease reduced , graft atherosclerosis represents major cause late graft failure death
changing clinical spectrum \( buerger 's disease \) 1970 1987 , 112 patients diagnosed \( \) age 42 11 years \( mean sd range , 20 75 years \) 23 women , 7 60 years old first diagnosed ischemic ulcerations present 85 \( 76 \) patients 24 \( 28 \) patients upper extremity , 39 \( 46 \) patients lower extremity , 22 \( 26 \) patients upper lower extremity lesions ninety one \( 81 \) patients rest pain , 49 \( 44 \) patients raynaud 's phenomenon , 43 \( 38 \) patients superficial able follow 89 112 \( 79 \) patients 1 460 months \( mean follow time , 91 6 84 months \) sixty five \( 73 \) patients amputations , 24 \( 27 \) one following amputations finger , six \( 15 \) patients toe , 13 \( 33 \) patients , four \( 10 \) patients knee , 14 \( 36 \) patients knee , two \( 5 \) patients forty three \( 48 \) patients stopped smoking mean 80 105 months \( median , 46 5 months range , 1 420 months \) , two \( 5 \) patients amputations stopped smoking , 22 \( 42 \) patients amputations continuing smoke \( p less 0 0001 \) spectrum patients changing male female ratio decreasing \( 3 1 \) , older patients diagnosed , upper extremity involvement commonly present 48 patients stopped smoking , amputations continued disease activity uncommon
high risk reparative surgery neglected alternative heart transplantation selection patients either high risk reparative operations heart transplantation become increasingly difficult result improved results modalities retrospective review done patients referred heart transplantation considered candidates conventional cardiac surgery , yet instead underwent reparative procedures rather transplantation 23 adult patients referred 7 year period , 18 coronary artery disease , five valvular heart disease new york heart association class iv symptoms preoperative left ventricular ejection fractions range 0 08 0 63 \( mean , 0 28 \) ten 18 patients coronary artery disease required insertion intra aortic balloon pump hemodynamic support perioperatively seven patients primary coronary artery bypass grafts , 10 reoperative coronary bypass procedures one patient left ventricular , one endocardial stripping addition myocardial revascularization procedures patients valvular disease , three aortic valve replacement , two reoperations , two others mitral valve replacements tricuspid mean follow 25 months , 1 , 3 , 12 , 24 month actuarial survival rates 91 , 87 , 82 , 76 , respectively one patient underwent aortic valve replacement study successfully received heart transplantation 19 months postoperatively results compare favorably current results patients undergoing first graft heart transplantation survivors new york heart association class ii functional capacity
bradyarrhythmia heart transplantation incidence , time course , outcome june 1980 april 1989 , 72 401 \( 18 \) adult recipients orthotopic heart transplantation developed prolonged \( greater 24 hours \) \( less 60 beats min \) within 5 days transplantation junctional bradycardia occurred 50 \( 69 \) recipients , sinus bradycardia 18 \( 25 \) , slow ventricular response atrial fibrillation four \( 6 \) fifty five 72 \( 76 \) patients less 20 duration \( less 7 days , 50 patients 7 20 days , five patients \) fifty patients returned sinus rhythm \( greater 60 beats min \) time discharge five patients expired within 20 days seventeen 72 \( 24 \) patients bradyarrhythmia 20 days , symptomatic 11 17 patients \( junctional bradycardia , 13 patients sinus bradycardia , four patients \) received permanent pacemaker within 40 days transplantation 1 12 months \( mean , 4 3 months \) pacemaker implantation , 12 patients recovered sinus rhythm \( greater 70 beats min \) five patients intrinsic rates 32 57 beats min \( mean , 48 10 beats min \) 1 9 months \( mean , 4 3 months \) follow donor ischemic time bradyarrhythmia patients 202 34 minutes , significantly longer \( p less 0 01 \) 173 43 minutes patients without bradyarrhythmia conclusively , incidence bradyarrhythmia relatively high usually temporary , however , even patients prolonged duration bradyarrhythmia relation appears exist donor ischemic time incidence bradyarrhythmia
factors affecting survival total artificial heart recipients transplantation identify factors affecting successful bridge transplantation , experience 32 recipients jarvik 7 artificial heart reviewed patients without successful bridge , significant differences preoperative function postoperative hemodynamics , significant differences body size recipients divided according body surface areas less greater 1 8 m2 , smaller patients frequently developed dependence \( 73 vs 18 , p less 0 01 \) , renal failure \( 53 vs 18 , p less 0 05 \) , hepatic failure sepsis , resulting less frequent transplantation \( 20 vs 65 , p less 0 05 \) successful bridge operations seven patients body surface areas less 1 7 m2 , one success nine patients less 170 cm height , despite use smaller stroke volume model smaller patients poorer ventricular filling , largely compensated drive controls set significantly longer diastole higher vacuum , resulting similar hemodynamics groups results suggest device fitting manifested body size important factor affecting major organ recovery subsequent transplantation recipients jarvik 7 artificial heart device may advisable patients body surface areas less 1 8 m2 less 175 cm height even smaller model better fit thorax becomes available
deferoxamine fails improve postischemic cardiac function hypertrophied hearts myocardial hypertrophy well recognized risk factor congenital cardiac surgery hypertrophied hearts demonstrated increased vulnerability ischemia reperfusion injury studied effects iron chelator hydroxyl radical scavenger deferoxamine given early reperfusion model isolated rabbit hearts made hypertrophic aortic banding early life \( 1 week age \) rabbits studied 6 8 weeks age , hearts subjected 30 minutes 37 degrees c ischemia followed 30 minutes reperfusion postischemic recovery isovolumic developed pressure measured using intracavitary balloon untreated \( n 6 \) deferoxamine treated \( n 6 \) groups compared normal age matched controls deferoxamine \( 50 mumol kg \) given one group hypertrophied hearts first 10 minutes reperfusion left ventricular weight body weight ratio hypertrophied hearts 2 9 0 4 x 10 \( 3 \) \( n 14 \) versus 2 0 0 1 x 10 \( 3 \) age matched controls \( p less 0 05 \) postischemic peak developed pressure recovered 102 6 preischemic value normal hearts 30 minutes reperfusion compared 75 5 untreated 71 4 deferoxamine treated hearts \( p less 0 05 vs control \) conclude chronic hypertrophy early life leads increased susceptibility ischemia iron chelator deferoxamine effective preventing injury reperfusion hypertrophied hearts
right ventricular function metabolism right ventricular protection may limited current methods cardioplegic delivery sensitive measurements right left ventricular function metabolism made 30 patients undergoing elective coronary artery bypass surgery cold cardioplegic arrest myocardial adenine nucleotide concentrations decreased cardioplegia reperfusion right left ventricles despite adequate levels precursors , suggesting perioperative mitochondrial dysfunction postoperatively , right left ventricular pressures measured micromanometer catheters volumes measured nuclear ventriculography right left ventricular systolic elastance calculated method end systolic method methods provided sensitive indexes end systolic elastance study demonstrated right ventricular function metabolism evaluated methods analogous methods used left ventricle results suggest right ventricular functional metabolic recovery delayed despite apparently adequate myocardial protection sensitive measurements may permit improved assessment alternative methods right ventricular protection
adenosine 5' triphosphate derangement free radical mediated injury major cause ventricular dysfunction reperfusion \? role adenine nucleoside transport myocardial reperfusion injury aim study determine dual role atp energy substrate major source oxygen derived free radical mediated reperfusion injury using adenine nucleoside blocker , p \( nbmpr \) , adenosine deaminase inhibitor , 9 \( 2 hydroxy 3 \) adenine \( ehna \) randomized study , 16 dogs instrumented minor axis piezoelectric crystals intraventricular pressure transducers monitor , bypass , left ventricular performance using sensitive load independent index contractility \( slope stroke work end diastolic length relation \) hearts subjected 60 minutes normothermic global ischemia 120 minutes reperfusion normal saline without \( group 1 , n 8 \) \( group 2 , n 8 \) nbmpr ehna infused three boluses cardiopulmonary bypass reservoir ischemia reperfusion transmural serial biopsies obtained ischemia reperfusion analyzed myocardial adenine nucleotide pool intermediates using high performance liquid chromatography control group , three hearts developed ischemic contracture another three hearts exhibited cardiogenic shock reperfusion ehna nbmpr treated group , left ventricular performance recovered within 30 minutes reperfusion \( p less 0 05 vs control \) myocardial atp depleted 20 normal groups end ischemia \( p less 0 05 \) adenosine ehna nbmpr treated group 12 fold greater \( 15 09 1 6 nmol mg protein \) control group end ischemic period \( p less 0 05 \) fourfold higher control group \( 19 07 1 50 nmol mg protein \) compared drug treated group \( p less 0 05 \) reperfusion , myocardial atp levels increased approximately 50 normal ehna nbmpr group remaining depressed \( 20 normal \) control group thus , despite dramatic loss myocardial atp ischemia , complete recovery ventricular performance significant repletion atp reperfusion observed adenosine transport modulated ischemia reperfusion results suggest 1 \) myocardium may atp needed basic cardiac functions 2 \) washout atp detrimental ventricular performance reperfusion specific blockade nucleoside transport resulted complete functional recovery despite low critical atp levels \( abstract truncated 400 words \)
prolonged cardiac preservation evaluation university wisconsin preservation solution comparison st thomas' hospital cardioplegic solutions rat university wisconsin solution differs types solutions used organ preservation contains high energy phosphate precursors \( adenosine phosphate \) , \( \) , oncotic agent \( \) , antioxidants \( allopurinol glutathione \) components potential enhance preservation atp , reduce intracellular extracellular edema , attenuate free radical mediated injury university wisconsin solution demonstrated enhance extend preservation liver , pancreas , kidney , potential role heart remains evaluated university wisconsin solution \( du \) comparing st thomas' hospital cardioplegic solutions 1 2 \( \) , used europe united states routine cardiac surgery transplantation solution , 10 isolated working rat hearts arrested 10 ml solution \( 4 degrees c \) maintained solution 4 hours 4 degrees c mean recovery functional indexes \( expressed percentage preischemic control values \) use university wisconsin solution follows peak aortic pressure , 90 6 1 0 dp dt , 71 5 5 5 aortic flow , 81 6 4 7 coronary flow , 87 5 3 5 cardiac output , 82 6 3 5 contrast , mean recoveries st thomas' hospital solution 1 follows peak aortic pressure , 82 8 1 3 dp dt , 49 7 3 0 aortic flow , 58 4 5 3 coronary flow , 79 6 5 9 cardiac output , 63 0 4 9 contrast still , mean recoveries st thomas' hospital solution 2 follows peak aortic pressure , 83 1 1 2 dp dt , 40 7 6 1 aortic flow , 37 0 5 1 coronary flow , 65 8 3 6 cardiac output , 43 1 5 6 recovery indexes significantly superior \( p less 0 005 \) preservation university wisconsin solution compared either st thomas' hospital solutions
efficacy recombinant derived human superoxide dismutase porcine left ventricular contractility normothermic global myocardial ischemia hypothermic cardioplegic arrest porcine model normothermic global ischemia \( 40 minutes \) followed systemic cooling 25 degrees c 4 degrees c crystalloid cardioplegic arrest \( 90 minutes \) used assess efficacy recombinant derived human superoxide dismutase \( r \) left ventricular function cardiopulmonary bypass isovolumic hemodynamic function monitored , adenine nucleotide pool measured myocardial biopsy specimens coronary sinus effluent treatment group pigs \( n 7 \) received 15 mg kg r immediately warm reperfusion , left ventricular peak systolic pressure developed pressure significantly better r group pigs \( p less 0 05 vs placebo \) improvement persisted 60 minutes reperfusion \( p less 0 05 vs placebo \) myocardial atp total adenine nucleotides differ , adenine nucleotide coronary sinus effluent differ treatment groups pigs exception nucleotide , significantly elevated coronary sinus effluent pigs treated r 30 minutes reperfusion \( p less 0 05 vs placebo \) model global ischemia reperfusion , recombinant derived human free radical scavenger provides significant protection systolic diastolic function values myocardial atp total adenine nucleotide content suggest improvement mechanical function reperfusion due enhanced preservation myocardial
effects low perfusate ca2 concentration newborn myocardial function ischemia greater dependence ca2 flux immaturity ca2 sequestration capacity may potentiate ca2 \( \) mediated reperfusion injury newborn myocardium effect serum ionized ca2 concentration left ventricular systolic diastolic function ischemia studied 5 7 day old piglets undergoing 90 minute period cold blood cardioplegic arrest control group , ca2 maintained 1 2 mm \( group n 6 \) cardioplegic solution bypass perfusate modified achieve low ca2 concentration , 0 25 mm , group b \( n 6 \) left ventricular pressure volume loops acquired using high fidelity pressure sensor tipped volume conductance catheters ventricular function assessed slope end systolic \( ees \) end diastolic \( k \) pressure volume relations transient caval occlusion groups showed significant reduction ees ischemia \( p less 0 05 \) intergroup comparison ees ischemia demonstrated better recovery systolic function low ca2 group , 64 7 versus 49 6 normal ca2 group \( p 0 05 \) significant increase chamber stiffness index group \( k , 0 48 0 06 0 65 0 05 ml 1 , p less 0 01 \) versus significant change group b study shows 1 \) feasibility acquiring continuous pressure volume data neonatal hearts using conductance catheter system , 2 \) better preservation systolic function diastolic compliance normal newborn myocardium low ca2 concentration peri ischemic period
comparison medical surgical therapy uncomplicated descending aortic dissection guide choice medical versus surgical therapy patients descending \( type b \) aortic dissection \( tear descending aorta without involvement ascending aorta \) , multivariate survival analysis applied 136 patients admitted two medical centers 1975 1988 acute \( n 89 \) chronic \( n 47 \) descending dissection group 1 , 136 patients group 2 , 106 patients without rupture , pulse loss , visceral organ compromise group 3 , 56 patients group 2 without major cardiac renal disease \( 23 surgical 33 medical \) group 3 medical surgical subgroups well matched baseline characteristics potential candidates either mode therapy cox model analysis , significant predictors mortality pleural rupture , dissection complications , increasing age , cardiac disease \( p less 0 01 \) surgical versus medical therapy independent determinant survival three groups acute chronic dissection survival probabilities group 3 patients 1 , 5 , 10 years 0 94 , 0 87 , 0 32 \( medical \) 0 90 , 0 80 , 0 50 \( surgical \) despite limitations retrospective study \( including possibility undefined treatment selection \) , data suggest medical early surgical therapy associated equivalent outcome selected patients uncomplicated acute chronic descending aortic dissection
antihypertensive efficacy hydrochlorothiazide prostacyclin dependent tested hypothesis vascular prostacyclin synthesis stimulated hydrochlorothiazide could account drug 's antihypertensive effect studied 13 patients mild essential hypertension randomized , double blind design assess effects indomethacin hydrochlorothiazide 's ability lower blood pressure , alter body weight , stimulate plasma renin activity , modulate vascular prostacyclin biosynthesis assessed urinary excretion major enzymatically produced metabolite prostacyclin , 2 , 3 dinor 6 keto prostaglandin f1 alpha \( pgf1 alpha \) , measured gc ms administration hydrochlorothiazide , 50 mg daily 2 weeks , associated significant decrease systolic diastolic blood pressure supine \( systolic , 148 3 136 3 mm hg diastolic , 97 2 94 3 mm hg \) upright \( systolic , 151 4 131 2 mm hg diastolic , 103 2 97 3 mm hg \) positions hydrochlorothiazide administration resulted 1 kg weight loss stimulation plasma renin activity 1 7 0 4 5 3 1 1 ng angiotensin ml hr however , urinary excretion 2 , 3 dinor 6 keto pgf1 alpha unchanged administration hydrochlorothiazide \( 86 13 ng gm creatinine placebo , 74 13 ng gm week 1 hydrochlorothiazide , 70 9 ng gm week 2 drug \) administration indomethacin , 50 mg twice day , resulted greater 60 inhibition 2 , 3 dinor 6 keto pgf1 alpha excretion affect antihypertensive response hydrochlorothiazide indomethacin diuretic effect hydrochlorothiazide assessed weight loss attenuate rise plasma renin activity data demonstrate blood pressure lowering effect thiazide diuretic require enhanced prostacyclin synthesis cyclooxygenase inhibitor indomethacin antihypertensive efficacy hydrochlorothiazide
quality life among hypertensive patients diuretic background taking atenolol enalapril cardioselective beta blocker atenolol angiotensin converting enzyme inhibitor enalapril compared efficacy , safety , quality life factors 30 patients hypertension whose hypertension controlled diuretic alone atenolol \( 50 100 mg day \) enalapril \( 2 5 40 mg day \) , combined hydrochlorothiazide \( 25 mg day \) , similar levels efficacy safety comprehensive battery psychologic assessments quality life administered , including measures anxiety , depression , psychiatric symptoms , memory , psychomotor function five based clusters first analyzed multivariate analysis variance procedures , followed univariate analyses individual variables domain general , neither atenolol enalapril associated major changes psychologic functioning data cluster statistically significant change memory function , primarily result lower scores digit span \( \) test , atenolol relative enalapril preliminary findings suggest atenolol enalapril comparable degrees efficacy safety , major quality life effects , hypertensive patients history taking diuretics quality life assessment performed trials antihypertensive drugs
increased erythrocyte sodium lithium countertransport activity essential hypertension due increased affinity extracellular sodium 1 sodium lithium countertransport activity standard assay , sodium affinity constant maximum velocity measured erythrocytes normal subjects essential hypertensive patients without family history hypertension 2 normal subjects sodium concentration used standard assay similar sodium affinity constant activity measured assay less maximum velocity 3 patients essential hypertension positive family history , 33 sodium lithium countertransport activity greater upper limit normal control range \( 0 4 mmol li h 1 l 1 cells \) 4 reason raised sodium lithium countertransport activity increased sodium affinity \( lower sodium affinity constant \) outside ion binding site 5 patients essential hypertension positive family history sodium lithium countertransport activity within normal range standard assay , 30 also low sodium affinity constant 6 low sodium affinity constant outside site sodium lithium may specific indicator group patients inherited hypertension standard sodium lithium countertransport activity assay
depression recovery right ventricular function cardiopulmonary bypass transient left ventricular dysfunction commonly described association cardiopulmonary bypass \( cpb \) evaluated changes right ventricular \( rv \) function elective cardiac surgery 24 patients normal preoperative cardiac function , irrespective distribution coronary artery disease use pharmacologic support , transient depression rv systolic function respect preinduction initial postoperative \( postop \) values occurred 262 116 min post cpb represented decrease rv stroke volume index \( 25 0 1 7 vs 33 4 1 9 ml m2 postop \) rv ejection fraction \( 31 0 2 2 vs 45 6 2 5 postop \) , increase rv end systolic end diastolic volume indices depression responded readily pharmacologic therapy within 2 h , resolved within 24 h , adverse consequences otherwise healthy patients studies needed identify cause phenomenon importance patients preexisting cardiac dysfunction
bronchial hyperreactivity patients mitral valve disease elicit mechanism bronchial hyperreactivity \( bhr \) chronic heart failure \( chf \) , methacholine inhalation test , pulmonary function test , cardiac catheterization performed 19 patients mitral valve disease \( mvd \) , change severity bhr mitral valve replacement \( mvr \) also examined seven 19 patients mvd sixteen 19 patients mvd showed significant increase respiratory resistance methacholine inhalation test , normal subjects maximal expiratory flow 25 percent vital capacity \( \) , parameter small airway disease , correlated significantly log cumulative dose producing 35 percent decrease respiratory conductance \( \) \( r 0 \) duration symptoms \( r 0 \) significant correlation log mean pulmonary artery wedge pressure \( r 0 \) mvr , log significantly improved seven operated patients , although six patients retained bhr conclude patients long term mvd marked bhr bhr long term mvd related peripheral airway narrowing organic remodeling , mvr procedure , addition pulmonary congestion
respiratory muscle strength congestive heart failure experimental animals , conditions drastically decrease cardiac output may reduce strength endurance respiratory muscles leading respiratory failure patients chronic chf reduced cardiac output vital capacity \( fvc \) , measured pimax pemax maximal handgrip force 16 patients chf 18 patients chf mean left ventricular ejection fraction 26 7 percent maximal respiratory pressures significantly reduced group mean values \( sd \) pimax frc 41 4 5 6 cm h2o \( chf \) 102 1 27 4 cm h2o \( amn \) \( p less 0 001 \) , pimax values five patients chf low 20 30 cm h2o patients , pemax reduced handgrip force less dramatically reduced , suggesting selective respiratory muscle weakness possible explanations include reduction respiratory muscle blood flow generalized muscular atrophy weakness related cardiac
effects phenylephrine right ventricular performance patients pulmonary hypertension pulmonary hypertension causes right ventricular ischemia failure result increased afterload combined reduced coronary blood flow increasing coronary driving pressure raising aortic pressure phenylephrine shown reverse right ventricular ischemia pulmonary hypertension animals since vasodilators often fail reduce afterload , tested whether raising coronary driving pressure would improve right ventricular function man ten patients pulmonary hypertension hemodynamics right ventricular coronary driving pressure measured 10 minutes steady state reached phenylephrine infusion titrated raise aortic pressure 25 percent phenylephrine caused significant \( p less 01 \) increase mean aortic pressure \( 84 108 mm hg \) right ventricular coronary driving pressure \( 46 69 mm hg \) response , significant \( p less 01 \) rise mean pulmonary artery pressure \( 58 67 mm hg \) , right ventricular end diastolic pressure \( 10 16 mm hg \) wedge pressure \( 5 9 mm hg \) , insignificant fall cardiac output \( 3 26 3 09 l min \) pulmonary artery o2 saturation \( 57 49 percent \) although phenylephrine increased right ventricular coronary driving pressure , worsened right ventricular function manifest rise end diastolic pressure fall cardiac output benefit raising right ventricular coronary driving pressure may offset alpha vasoconstriction right ventricular coronary blood flow pulmonary arterial vasoconstriction phenylephrine appear useful therapy right ventricular failure pulmonary hypertension patients fail vasodilators
single lung transplantation primary pulmonary hypertension single lung transplantation become therapeutic option end stage interstitial lung disease obstructive lung disease group recently extended treatment three patients primary pulmonary hypertension patients marked decreases pulmonary artery pressures pulmonary vascular resistance increases cardiac output following single lung transplantation spirometry , lung volumes , diffusion capacity different comparison preoperative studies quantitative ventilation perfusion scans revealed majority perfusion distributed transplanted lung , ventilation approximately equally divided native transplanted lung despite ventilation perfusion imbalance , resting hypoxemia arterial oxygen desaturation exercise one patient expired postoperative day due cytomegalovirus infection lungs remaining two patients , maximum exercise capacity following transplantation near normal one recipient reduced second recipient note , evidence ventilatory limitation impaired oxygenation exercise two recipients although exaggerated exercise ventilatory response present , limit exercise performance report supports use single lung transplantation treatment primary pulmonary hypertension
abnormal hemodynamic response valsalva maneuver patients atrial septal defect evaluated doppler echocardiography hemodynamic responses valsalva maneuver studied eight healthy subjects \( group 1 \) eight patients asd \( group 2 \) using doppler echocardiography acute changes aortic blood flow profiles valsalva maneuver investigated basis beat beat estimation active strain phase \( phase 2 \) , group 1 showed significant decrease systolic blood pressure , sv co reflex tachycardia group 2 , significant decrease sv co reflex tachycardia , systolic blood pressure percentage decreases sv co group 2 significantly less group 1 \( 23 16 percent vs 48 10 percent sv , p less 0 01 17 12 percent vs 40 13 percent co , p less 0 05 \) release strain phase \( phase 4 \) , group 1 showed significant reversed changes systolic blood pressure , sv heart rate , indicating overshoot effect , however , observed group 2 thus , patients asd presented abnormal valsalva response characterized absence phase 4 overshoot less marked phase 2 change findings suggest decremental effect impaired venous return stroke output active strain may attenuated increased pulmonary blood volume due left right shunt patients asd , lesser decrement co phase 2 may provoke sufficient sympathetic activity induce overshoot response phase 4
hemodynamic status critically ill patients without acute heart disease physicians reduce use pulmonary artery catheter however , guidelines help clinician make decision use invasive monitoring individual patient study designed examine accuracy physician estimates cardiac function spectrum patients hemodynamic instability determine whether differences accuracy among subgroups would suggest subgroups patients could managed without invasive measurements physician estimates cardiac index found sufficiently accurate patients without acute heart disease initial management without invasive monitoring may appropriate selected cases however , due general physician estimates , efforts improve accuracy clinical cardiac function hemodynamic status pursued patients without acute cardiac dysfunction
randomized trial comparing direct current therapy bipolar diathermy outpatient treatment third degree fifty patients third degree randomized receive outpatient treatment either bipolar diathermy direct current therapy direct current therapy used treat 26 patients bipolar diathermy used treat 24 patients twenty patients group successfully treated judged resolution symptoms shrinkage tissue treatments effective outpatient management large , bipolar diathermy less time consuming better tolerated
short term effect hepatic arterial versus portal venous reperfusion energy levels liver tissue hepatic artery portal vein blood vary flow , oxygenation , hormonal content uncertain blood supply greater effect process hepatocytes ischemic liver initial reperfusion ability liver cells restore energy phosphates related viability liver study designed determine differences high energy phosphate liver upon whether reflow first provided either hepatic artery portal vein followed subsequent reperfusion vessels recovery atp upon 10 min hepatic arterial reperfusion 15 min total ischemia much slower compared portal venous reperfusion may undesirable , therefore , liver hepatic arterial blood first immediately warm liver ischemia
arterial blood oxygen desaturation infants children upper gastrointestinal endoscopy arterial blood oxygen desaturation abnormal electrocardiographic changes reported adults undergoing upper gastrointestinal endoscopy studied 32 infants children less 12 years age using pulse oximetry continuous electrocardiography , , upper gastrointestinal endoscopy performed intravenous sedation sinus tachycardia common electrocardiographic change , clinically significant electrocardiographic abnormalities induced procedure desaturation less equal 90 found 37 5 patients commonly noted endoscopy procedure patients cardiopulmonary disease desaturation unpredictable correlation desaturation medication , tolerance procedure , weight , age child patients subjectively appeared tolerate procedure well significant desaturation use pulse oximetry considered children undergoing upper gastrointestinal endoscopy
characteristics biliary lipid metabolism liver transplantation biliary lipid metabolism studied 10 liver continuous drainage bile within 3 wk transplantation , new liver produced bile concentrations biliary lipids agreement reported tube bile subjects although changes biliary lipid composition occurred response various forms disturbed liver function , provide substantially information standard serum tests simple measurements bile flow patients secretion rates phospholipids cholesterol found completely bile acid dependent bile acids , 0 22 0 08 mumol phospholipids cholesterol secreted , respectively bile flow related bile acid output , linear relationship found \( r 0 89 \) , positive intercept indicating bile acid independent bile flow approximately 44 microliters min analysis individual bile acids showed almost exclusively primary bile acids relative proportion chenodeoxycholic acid prominent first days transplantation different explanations discussed
early 24 hour blood pressure elevation normotensive subjects parental hypertension subjects family history parental hypertension reported slightly higher office blood pressure stage whether reflects hyperreactivity blood pressure measurement permanent blood pressure elevation , however , known present study , blood pressure measured 15 normotensive subjects whose parents hypertensive \( fh \) , 15 normotensive subjects one hypertensive parent \( fh \( \) \) , 15 normotensive subjects whose parents hypertensive \( fh \) among three groups , subjects matched age , sex , body mass index measurements made office variety laboratory stressors prolonged resting period , 24 hour period \( ambulatory blood pressure monitoring \) office blood pressure higher fh group fh group \( p less 0 05 \) pressor responses laboratory stressors similar two groups , fh group higher prolonged resting 24 hour blood pressure fh group difference always significant \( p less 0 05 \) systolic blood pressure fh group also greater left ventricular mass index \( echocardiographic examination \) fh group \( p less 0 01 \) blood pressure values echocardiographic values fh \( \) group tended two groups thus , higher blood pressure shown individuals stage family history parental hypertension reflect hyperreactivity stress early permanent blood pressure elevation
hormones , platelet calcium , blood pressure essential hypertension plasma ionized calcium , platelet cytosolic calcium \( using fura 2 method gel filtered platelets \) , parathyroid hormone \( intact hormone portion \) , calcitriol , measured 19 untreated male patients essential hypertension 19 age matched normotensive male research subjects mean levels platelet cytosolic calcium , parathyroid hormone , calcitriol , significantly higher , whereas plasma ionized calcium significantly lower , hypertensive group compared normotensive group platelet cytosolic calcium intact parathyroid hormone positively correlated mean arterial pressure \( r 0 58 , p less 0 001 r 0 54 , p less 0 001 , respectively \) , whereas plasma ionized calcium inversely correlated mean arterial pressure \( r 0 60 , p less 0 001 \) combined group study subjects three correlations significant hypertensive group alone normotensive group alone analyzed plasma ionized calcium , body mass index , serum calcitriol , regression model , significance partial platelet cytosolic calcium parathyroid hormone mean arterial pressure persisted intact parathyroid hormone positively correlated platelet cytosolic calcium \( r 0 43 , p less 0 01 \) plasma ionized calcium inversely correlated platelet cytosolic calcium \( r 0 44 , p less 0 01 \) results confirm previous reports disturbances calcium metabolism essential hypertension suggest elevated platelet cytosolic calcium observed essential hypertension may linked one alterations calcium metabolism
effects angiotensin converting enzyme inhibitors hydralazine endothelial function hypertensive rats function endothelium impaired hypertension spontaneously hypertensive rats \( shr \) , acetylcholine induced relaxation decreased serotonin induced constriction increased goal study evaluate effect long term treatment cilazapril , new angiotensin converting enzyme inhibitor , hydralazine , vasodilator , endothelium dependent responses aorta shr wistar kyoto rats used normotensive reference isolated aortic rings without endothelium suspended organ chambers rings intact endothelium contracted norepinephrine acetylcholine induced relaxation markedly enhanced cilazapril treatment tension achieved maximal relaxation 8 4 norepinephrine contraction cilazapril treated shr versus 55 5 untreated shr \( p less 0 001 \) hydralazine significant effect effect serotonin also markedly modified cilazapril untreated shr , serotonin induced release vasoconstrictor substance endothelium assessed ratio maximal tension induced serotonin rings endothelium maximal tension rings without endothelium , greater 1 ratio reversed cilazapril treated shr hydralazine treated shr captopril effects similar cilazapril finally , evaluation carotid arteries showed cilazapril also prevented morphological changes intima shr \( e , infiltration mononuclear cells \) conclude angiotensin converting enzyme inhibitors prevent functional morphological alterations endothelium found hypertension speculate action might participate antihypertensive effect
pressor systems hypertension congestive heart failure role vasopressin clinical conference elevated peripheral vascular resistance , characterizes hypertension congestive heart failure \( latter regardless absolute blood pressure level \) maintained large extent combined effects three major neurohormonal pressor mechanisms renin angiotensin system , system , arginine vasopressin blockade one mechanisms may lead compensatory stimulation others , thus part hemodynamic benefits specific intervention combination therapy , designed attack three systems \( use angiotensin converting enzyme inhibitor , sympathetic blocker clonidine , antagonist action vasopressin \) , may help treatment cases illustrate strategy , two experimental studies , one case malignant hypertension , one case congestive heart failure presented
clinical controversies surrounding thrombolytic therapy acute myocardial infarction treatment acute myocardial infarction changed past decade thrombolytic therapy become treatment choice patient acute myocardial infarction although many issues resolved , several controversial issues remain unresolved article addresses thrombolytic agents terms superiority achieving infarct vessel patency mortality reduction well role thrombolysis patients present chest pain greater 6 duration , elderly , inferior infarction
effects heparin versus saline solution intermittent infusion device irrigation purpose study compare effectiveness 1 ml 0 9 sodium chloride 10 units heparin 1 ml sodium chloride solution , containing alcohol , maintaining patency reducing incidence patients intermittent infusion devices subjects \( n 32 \) randomly assigned double blind experimental design repeated measures analysis variance revealed significant difference groups patency variables results controlled study would suggest 0 9 sodium chloride effective 10 units heparin sodium chloride solution maintaining intermittent infusion device patency preventing
effects anxiety family members patients cardiac disease learning cardiopulmonary resuscitation effects anxiety learning cardiopulmonary resuscitation \( cpr \) family members patients cardiac disease examined family members hospitalized patients \( n 17 \) , family members patients \( n 12 \) , control group \( n 21 \) took one nine heart programs cpr performance evaluated subjects took state anxiety inventory three times immediately program , immediately performance test , 2 months completion program family members hospitalized patients significantly higher program anxiety scores groups difference present immediately program 2 months later family members hospitalized patients showed significant decline anxiety three testing times outcomes support benefit teaching cpr group
left ventricular asynchrony patients pulmonary hypertension left ventricular regional wall motion evaluated 11 patients pulmonary hypertension 18 control subjects 11 patients secondary pulmonary hypertension less 20 measured diameter stenosis vessel study utilizes video intensity based frame frame computerized technique pulmonary hypertensive patients showed early diastolic asynchrony anterior apical regions lasted 100 200 ms size abnormal area varied 2 20 ventricular four patients also showed systolic abnormalities abnormalities detected control group cause asynchrony detected pulmonary hypertension probably due interventricular interaction caused pressure gradients across septum
muscle oxidative capacity work performance training local leg ischemia healthy young men executed supine one cycle training four times per week 4 wk legs cycle ergometer inside pressure chamber , opening sealed rubber membrane level training session started training one leg ischemic conditions induced increased chamber pressure \( 50 mmhg \) highest intensity tolerable 45 min leg trained power profile normal atmospheric chamber pressure training period , legs executed one exercise tests normal increased chamber pressure muscle biopsies taken vastus lateralis ischemic training increased performance normal training , difference greater exercise executed ischemic conditions difference performance increase legs paralleled greater muscle citrate synthase activity normally trained leg
surgical treatment aneurysm dissection involving ascending aorta aortic arch , utilizing circulatory arrest retrograde cerebral perfusion recently replaced ascending aorta aortic arch 8 patients aneurysm dissection , using profound hypothermic circulatory arrest retrograde cerebral perfusion operative deaths open aortic anastomosis facilitated repair aortic arch without clamping arch , embolism due particulate debris clamping arch vessels eliminated retrograde cerebral perfusion profound hypothermic circulatory arrest simplified technique may protect brain method offers advantages previously described methods , particularly dissection arch clamping , protecting central nervous system
effect enoximone dobutamine hemodynamic performance open heart surgery clinical comparison prospective , randomized study phosphodiesterase inhibitor enoximone compared dobutamine open heart surgery either group 25 patients treated enoximone dobutamine , respectively , beginning immediately weaning cardiopulmonary bypass 4 hours postoperatively drug administered continuous infusion 5 micrograms min kg body weight enoximone significant increase cardiac output enoximone \( e \) 100 dobutamine \( \) 38 significant decrease pulmonary vascular resistance \( e 34 , 65 \) total systemic vascular resistance \( e 59 , 7 \) achieved systemic blood pressure heart rate different side effects observed enoximone proved safe superior dobutamine low cardiac output states open heart surgery
valvular coronary surgery renal transplant patients authors report aortic valvular replacement \( avr \) coronary artery bypass graft surgery \( cabg \) successfully performed two renal transplant patients postoperative blood urea creatinine levels comparable preoperative values first patient underwent isolated avr second patient initial avr combined cabg followed two years later avr prosthetic dysfunction many reasons , coronary artery \( cad \) valvular diseases uncommon renal transplant patients cardiac surgery feasible without impairment renal function provided precautions taken , ie good mean perfusion pressure cardiopulmonary bypass \( cpb \) , adequate volume replacement , selected use dopamine
successful surgical treatment subaortic stenosis caused accessory mitral valve 22 month old boy subaortic stenosis found relatively mature mitral valve tissue beneath aortic valve , associated hypertrophic prominent interventricular septum tissue caused obstruction left ventricular outflow tract resulted pressure gradient 70 mmhg aorta left ventricle surgical treatment successfully performed tissue part hypertrophic ventricular septum results microscopic examination resected specimen shown discussed
assessment major venous anomalies computerized tomography congenital anomalies major venous structures common identification relative position , particularly relation abdominal aortic aneurysm , significant value planning conducting aortic operations computed tomography \( ct \) become common method preoperative evaluation aortic disease reliability providing accurate information regarding aneurysmal size , configuration , extension , well presence intraluminal thrombus involvement renal iliac arteries , demonstrated simultaneous visualization major adjacent venous structures use contrast enhancement obtained , anatomic variants overlooked commonly subtle considered incidental preoperative diagnosis venous abnormalities significant vascular surgeon information accurately reliably acquired present ct techniques without need diagnostic studies
primary varicose veins topographic hemodynamic correlations study conducted correlate clinical presentations uncomplicated primary varicose veins topographic anatomic source reflux \( escape points \) one hundred sixty three patients primary varicose veins \( 144 females , 19 males 96 unilateral , 67 bilateral \) 230 involved limbs examined origin extent venous reflux traced doppler ultrasound three distinct groups recognized group typical saphenous varicosities junctional occurred 164 \( 71 3 \) femoral junction \( \) incompetence 147 , popliteal junction \( \) incompetence 17 limbs group ii atypical saphenous varicosities non junctional occurred 51 \( 22 17 \) limbs 5 limbs , escape detected twenty two limbs localized main mid thigh perforator 17 , upper calf 2 , distal ankle 3 twenty four limbs pelvic 17 , circumflex iliac external epigastric , 7 limbs group iii non saphenous \( lateral venous system \) varicosities occurred 15 \( 6 52 \) limbs based physical examination alone , 55 limbs would possibly undergone unnecessary ankle groin stripping 83 limbs unnecessary ligation doppler us essential diagnostic tool accurately map origin extent venous reflux obtained hemodynamic information permit selective , multimodal therapy avoid , often unnecessary stripping entire saphenous system cases primary varicose veins
alterations aldosterone secretion metabolism low renin hypertension low renin essential hypertensives \( lrh \) normal plasma aldosterone levels inappropriately high relation pra posture major determinant plasma aldosterone pra levels , known whether postural increments \( delta \) plasma aldosterone \( delta \) pra also abnormal lrh evaluate , lrh \( n 8 \) , normal renin hypertensives \( n 9 \) , normotensive controls \( n 18 \) , subjects idiopathic \( iha n 5 \) studied metabolic unit controlled diet 7 days overnight supine 4 h upright pra , plasma aldosterone , 24 h urinary \( tha \) aldosterone secretion rates \( \) measured delta plasma aldosterone 4 h upright posture different four groups ratio delta plasma aldosterone delta pra , however , elevated iha lrh compared normals tha excretion also elevated iha lrh , lrh normal resulted higher fractional tha excretion \( tha \) lrh compared three groups data support enhanced adrenal angiotensin ii sensitivity lrh aldosterone preferentially metabolized tha lrh since tha reduced biological activity , may compensatory mechanism reduce mineralocorticoid activity lrh
endothelin family human plasma cerebrospinal fluid clarify whether endothelin may present human cerebrospinal fluid \( csf \) , exists , compare molecular forms endothelin human plasma , analyzed pooled human csf plasma high performance liquid chromatography specific enzyme immunoassays endothelin peptide four human endothelin peptides hitherto identified , big endothelin 1 major molecular form endothelin present human csf addition , small significant amount endothelin 1 endothelin 3 csf , endothelin 2 detectable similarly , big endothelin 1 , endothelin 1 , endothelin 3 identified human plasma although big endothelin 1 abundant , substantial amount endothelin 1 endothelin 3 found plasma resultant lower molar ratio big endothelin 1 endothelin 1 csf csf samples 17 patients requiring diagnostic lumbar puncture lumbar anesthesia , endothelin detectable , preponderance big endothelin 1 relative endothelin 1 endothelin 3 mean concentrations endothelin 1 endothelin 3 simultaneously collected plasma significantly \( p less 0 01 \) higher csf , significant difference mean big endothelin 1 concentration plasma csf significant correlation among concentrations big endothelin 1 , endothelin 1 , endothelin 3 paired sample results indicate endothelin present human csf differently processed endothelin vascular endothelial cells suggest possible role endothelin neuronal functions
coronary artery surgery study \( cass \) 10 year survival randomized randomizable patients coronary artery surgery study \( cass \) includes patients mild moderate stable angina pectoris asymptomatic survivors myocardial infarction randomized either medical surgical therapy 1 , patients eligible randomization randomized \( randomizable patients \) substantial aggregate differences observed survival comparisons 10 years follow study randomized randomizable patients assigned medical \( 79 versus 80 \) surgical \( 82 versus 81 \) groups patient subgroups stratified according coronary artery disease extent left ventricular ejection fraction cox regression analyses done independent variables known predictors survival , including surgical versus medical therapy randomized versus randomizable group , test null hypothesis mortality difference medical versus surgical assignment according group assignment \( randomized versus randomizable \) case initial group category enter significant predictor survival results randomizable group reinforce randomized group respect medical versus surgical comparison two subgroups identified significant surgical advantage 1 \) patients proximal left anterior descending coronary artery stenosis greater equal 70 ejection fraction less 0 50 , 2 \) patients three vessel coronary artery disease ejection fraction less 0 50 groups , coronary bypass surgery statistically significant beneficial effect survival \( p less 0 05 \) decade follow , cass randomizable patients confirm conclusions reached basis cass randomized trial
coronary lesion morphology acute myocardial infarction demonstration early remodeling streptokinase treatment coronary lesion morphology analyzed 72 patients 1 8 days streptokinase treatment acute myocardial infarction compared lesion morphology control group 24 patients stable angina streptokinase group infarct related artery patent 55 patients \( 76 \) compared stenoses stable angina group , differences stenosis length , severity , calcification proportion located acute bend branch point however , lesions streptokinase group often irregular \( p less 0 005 \) \( p less 0 01 \) , shoulder \( p less 0 0001 \) , globular filling defects \( p less 0 01 \) , linear filling defects \( p less 0 \) contrast staining \( p less 0 05 \) plaque ulceration index higher streptokinase stable angina group \( 6 2 7 9 versus 3 5 3 4 , p less 0 001 \) 72 streptokinase treated patients , 35 maintained heparin infusion angioplasty 2 10 days later repeat angiography angioplasty , globular lesion filling defects seen eight patients disappeared , whereas linear filling defects persisted 7 14 cases fewer lesions irregular \( p less 0 0001 \) ulceration index decreased 7 4 10 4 3 0 1 6 \( p less 0 001 \) data show lesion infarct related artery streptokinase treatment irregular often associated filling defects , perhaps corresponding plaque fissuring intraluminal thrombosis
clinical hemodynamic correlates sympathetic nerve activity normal humans patients heart failure evidence direct recordings characterize neural excitatory state heart failure , simultaneous measurements efferent sympathetic nerve activity muscle \( \) rest hemodynamics obtained 10 normal subjects \( age 25 2 years , mean sem \) 29 patients heart failure \( age 49 2 years new york heart association functional class ii iv left ventricular ejection fraction 21 1 cardiac index 2 16 0 13 liters min per m2 pulmonary capillary wedge pressure 23 2 mm hg \) sympathetic nerve activity significantly higher patients heart failure \( 54 7 4 5 bursts min \) normal subjects \( 16 7 2 2 bursts min , p less 0 001 \) multiple linear regression analyses indicated sympathetic activity human subjects strongly inversely correlated left ventricular stroke work index \( r 0 86 , p less 0 0001 \) stroke volume index \( r 0 85 , p less 0 0001 \) strong positive correlation sympathetic nerve activity pulmonary artery diastolic \( r 0 82 , p less 0 0001 \) mean \( r 0 81 , p less 0 0001 \) pressures similar correlations seen patients heart failure analyzed separately significant correlation sympathetic nerve activity mean arterial pressure , left ventricular ejection fraction \( radionuclide ventriculography \) , cardiac chamber size \( echocardiography \) arterial oxygen tension patients heart failure direct measurements sympathetic nerve activity correlated closely plasma norepinephrine \( r 0 72 , p less 0 0001 \) patients heart failure thus , sympathetic nerve activity rest parallels impairment cardiac performance patients heart failure
simultaneous transesophageal atrial pacing transesophageal two dimensional echocardiography new method stress echocardiography diagnostic use exercise echocardiography widely reported however , transthoracic exercise echocardiography inadequate 20 patients poor image quality related exercise attempt overcome limitations , system developed transesophageal echocardiography combined simultaneous transesophageal atrial pacing means probe prospective study , transesophageal echocardiography performed , immediately maximal atrial pacing 50 patients suspected coronary artery disease results transesophageal stress echocardiography considered abnormal new pacing induced regional wall motion abnormalities observed correlative routine bicycle exercise testing carried 44 patients cardiac catheterization performed patients success rate obtaining high quality diagnostic images 100 transesophageal echocardiography nine patients without angiographic evidence coronary artery disease normal result transesophageal stress echocardiogram \( 100 specificity \) thirty eight 41 patients coronary artery disease \( defined greater equal 50 luminal diameter narrowing least one major vessel \) abnormal result transesophageal stress echocardiogram \( 93 sensitivity \) sensitivity technique one , two three vessel disease 85 , 100 100 , respectively , compared 44 , 50 83 , respectively , bicycle exercise testing 12 lead electrocardiogram \( ecg \) rapid atrial pacing showed sensitivity 25 , 64 86 , respectively thus , rapid atrial pacing combined simultaneous transesophageal echocardiography highly specific sensitive technique detection coronary artery disease ischemia induced wall motion abnormalities detected earlier observed ecg changes technique appears particularly suited patients unable perform active stress test poor quality transthoracic echocardiograms
dynamic positron tomographic imaging nitrogen 13 glutamate patients coronary artery disease comparison nitrogen 13 ammonia fluorine 18 fluorodeoxyglucose imaging study designed test usefulness nitrogen 13 \( n 13 \) glutamate imaging positron emission tomography defining myocardial ischemia humans seventeen patients undergone coronary arteriography studied n 13 glutamate peak supine exercise using bicycle ergometer , well flow tracer n 13 ammonia peak exercise second similar exercise test six patients also underwent imaging n 13 glutamate rest exercise testing remaining 11 patients imaging fluorine 18 \( f 18 \) fluorodeoxyglucose performed assess glucose metabolism second exercise test seven patients classic metabolism flow consistent ischemia \( , decreased n 13 ammonia uptake region relatively increased f 18 fluorodeoxyglucose uptake \) evidence increased n 13 glutamate uptake ischemic mismatched regions patients 17 patients , uptake n 13 glutamate exercise paralleled uptake n 13 ammonia exercise , suggesting n 13 glutamate flow tracer rather metabolic marker ischemia humans
effects nitroprusside transmitral flow velocity patterns extreme heart failure combined hemodynamic doppler echocardiographic study varying loading conditions explore mechanisms change left ventricular diastolic filling associated preload afterload reduction , influence nitroprusside transmitral flow velocity pattern , pulmonary capillary wedge pressure left ventricular pressure interaction studied 11 patients end stage heart failure pulsed doppler echocardiographic recordings mitral inflow obtained simultaneous high fidelity left ventricular phase corrected pulmonary capillary wedge pressure recordings levels nitroprusside infusion nitroprusside , left ventricular systolic end diastolic pressures decreased 14 41 \( p less 0 05 , p less 0 05 \) , respectively , cardiac output increased 67 \( p less 0 05 \) pulmonary capillary wedge left ventricular crossover pressure decreased 41 \( p less 0 05 \) , time constant isovolumetric left ventricular pressure decrease changed isovolumetric relaxation time acceleration deceleration times early diastolic filling wave significantly prolonged nitroprusside infusion \( p less 0 05 , p less 0 05 p less 0 05 , respectively \) peak early diastolic filling velocity maintained \( 65 11 62 13 cm , p ns \) spite decreased absolute crossover pressure changes peak early diastolic filling velocity correlated weakly changes crossover pressure \( r 0 48 , p less 0 05 \) correlated better crossover left ventricular minimal pressure difference \( r 0 78 , p less 0 05 \) peak early diastolic filling velocity appears affected early diastolic pulmonary capillary wedge left ventricular pressure difference rather absolute pulmonary capillary wedge pressure lack peak flow velocity change nitroprusside infusion could explained either associated decrease left ventricular minimal pressure downward shift left ventricular diastolic pressure amount decrease pulmonary capillary wedge pressure may reflect reduction external ventricular distensibility produced reduction filling volume patients markedly dilated ventricle thus , prolonged early diastolic filling period preserved peak early diastolic filling velocity spite decreased left ventricular filling pressure constant relaxation rate associated beneficial effects nitroprusside left ventricular function patients severe congestive heart failure
determinants ventricular rate atrial fibrillation determinants ventricular cycle length atrial fibrillation examined 52 patients thirty three patients structural heart disease none accessory atrioventricular \( av \) connection av node effective functional refractory periods , shortest atrial pacing cycle length associated 1 1 conduction , av node conduction time indexes conduction av node measured baseline state \( 36 patients \) modification sympathetic tone infusion isoproterenol propranolol \( 8 patients \) atrial fibrillation induced rapid atrial pacing , mean , shortest longest ventricular cycle lengths measured variables correlated strongly mean rr interval atrial fibrillation av node effective refractory period \( r 0 93 p less 0 001 \) , av node functional refractory period \( r 0 87 p less 0 001 \) shortest atrial pacing cycle length associated 1 1 conduction \( r 0 91 p less 0 001 \) ah interval sinus rhythm \( r 0 74 p less 0 001 \) atrial pacing shortest cycle length 1 1 conduction \( r 0 52 p less 0 001 \) weaker correlations measures conduction improve prediction mean longest ventricular cycle length atrial fibrillation conclusion , refractory periods conductivity av node best indicators potential node transmit atrial ventricles atrial fibrillation degree conduction av node less important determinant mean ventricular rate atrial fibrillation
efficacy propafenone preventing ventricular tachycardia inverse correlation rate related prolongation conduction time efficacy propafenone preventing induction ventricular tachycardia evaluated 25 consecutive patients \( mean age 62 8 years \) remote myocardial infarction underwent programmed electrical stimulation ventricular arrhythmia using three extra stimuli basic drive right ventricular apex nine patients \( group \) , propafenone prevented induction sustained ventricular tachycardia \( four , nonsustained less 30 five \) 16 patients \( group b \) , sustained ventricular tachycardia still inducible 11 16 , tachycardia configuration unchanged cycle length significantly longer \( 431 99 versus 284 44 ms , p less 0 001 \) propafenone significantly affect either sinus cycle length ah hv intervals however , prolonged qrs duration sinus rhythm equally groups patients ventricular pacing , propafenone also prolonged right ventricular effective functional refractory periods surface qrs duration greater lengthening paced surface qrs duration drug therapy ineffective \( example , 35 12 ms group versus 69 23 ms group b basic drive 400 ms , p less 0 01 \) drug induced prolongation paced qrs complex greater 40 ms 94 positive predictive value drug failure prevent induction ventricular tachycardia drug induced percent prolongation ventricular tachycardia cycle length group b correlate well percent qrs prolongation
magnitude time course beta adrenergic antagonism oral amiodarone therapy examine presence time course beta adrenergic antagonism produced amiodarone , heart rate , qt interval arrhythmia frequency response graded doses isoproterenol evaluated eight patients treated oral amiodarone sustained ventricular tachycardia measurements made every 2 days beginning oral amiodarone therapy \( 600 mg twice daily \) isoproterenol given doses 12 5 , 25 50 ng kg body weight per min mean heart rate rest decreased 73 1 17 8 beats min day 0 57 8 15 0 beats min 12 days amiodarone therapy significant linear decline heart rate rest observed day 6 \( p less 0 05 comparisons \) days isoproterenol produced progressive increase heart rate reached 115 5 20 2 beats min day 0 94 2 18 5 beats min day 12 amiodarone blunted heart rate increase produced isoproterenol days 2 12 \( p less 0 05 versus day 0 \) effect present day 2 change significantly thereafter mean corrected qt \( qtc \) interval increased 430 30 ms day 0 449 63 ms day 12 significant linear increase qtc interval observed day 6 \( p less 0 05 comparisons \) systematic effect isoproterenol qtc interval five eight patients significant number isoproterenol induced premature ventricular complexes ventricular ectopic activity response isoproterenol abolished 4 days amiodarone therapy
surgical treatment endomyocardial fibrosis new approach endomyocardial fibrosis treated surgically many years complete removal fibrosis ventricles classic technique , atrioventricular \( av \) valve removed replaced prosthesis relapse endomyocardial fibrosis observed surgical correction reoperations carried complications valve prostheses new surgical technique removal ventricular fibrous tissue preservation mitral tricuspid valves used nine consecutive patients endomyocardial fibrosis initial results show reduction pulmonary hypertension , mean right left atrial pressures end diastolic pressures ventricles tricuspid annuloplasty performed seven patients mitral annuloplasty five valve prosthesis used death new york heart association functional class improved class iii iv preoperative period class ii postoperative period data suggest resection endocardial fibrous tissue indicated early clinical course performed preservation av valves
effect intravenous streptokinase relation initial st predicted size final qrs estimated size acute myocardial infarcts thrombolytic therapy documented reduce acute myocardial infarct size previously established relation initial st segment elevation final electrocardiographic \( ecg \) myocardial infarct size patients without coronary reperfusion might therefore altered thrombolytic therapy effect intravenous streptokinase relation therefore studied 73 patients initial acute myocardial infarction participated second international study infarct survival \( 2 \) patients received streptokinase considered one group patients receive streptokinase control group final myocardial infarct size , estimated qrs score , predicted admission standard ecg previously developed formulas based st segment elevation 40 control patients change st predicted final qrs estimated infarct size \( median 17 7 versus 18 3 p ns \) 33 patients streptokinase group , highly significant decrease predicted final myocardial infarct size \( median 21 9 versus 16 2 p less 0 0002 \) decrease found anterior \( median 23 7 versus 19 5 p less 0 03 \) inferior \( median 21 9 versus 12 0 p 0 001 \) infarct locations multiple regression analysis adjusting differences predicted infarct size confirmed significance streptokinase difference infarct size \( p 0 006 \) based variability percent change predicted final infarct size control group , threshold decrease greater equal 20 required identification salvage
intraoperative assessment regional myocardial perfusion using quantitative myocardial contrast echocardiography experimental evaluation test hypothesis myocardial contrast echocardiography used quantitate regional myocardial flow arrested heart time delivery cardioplegic solution , data acquired 13 dogs cardiopulmonary bypass different degrees stenosis placed random order left anterior descending coronary artery stenosis , myocardial contrast echocardiography performed injecting albumin cross clamped aortic root time delivery cardioplegic solution resultant echocardiographic images analyzed line computer background time intensity generated , exponential function , f \( \) ce alpha de beta , applied plot variables reflected total number entering coronary artery bed , area curve peak height curve , correlated best radiolabeled microsphere measured myocardial flow \( r 0 92 r 0 91 , respectively \) variables reflected appearance contrast myocardium , initial slope slope 1 , also good correlation myocardial flow \( r 0 84 r 0 89 , respectively \) variables reflected washout contrast medium myocardium , slope descending portion curve , fair correlation myocardial flow \( r 0 65 \) six dogs , technique injecting contrast medium cross clamped aortic root also examined although continuous infusion contrast medium produced smaller perturbations mean aortic distal left anterior descending artery pressures compared bolus injection \( p less 0 01 \) , correlation variables time intensity curves flow equally close techniques concluded possible quantitate myocardial flow using myocardial contrast echocardiography time delivery cardioplegic solution dogs cardiopulmonary bypass implementation technique humans might useful guiding sequence graft placement thereby improving myocardial preservation coronary artery bypass operations
prostaglandin modulation early afterdepolarizations ventricular tachyarrhythmias induced chloride combined efferent cardiac sympathetic stimulation dogs prostaglandins inhibit efferent cardiac sympathetic nerve effects acting presynaptic sites may act suppress arrhythmias present study , effects intravenous administration prostacyclin \( pgi2 \) prostaglandin e2 \( pge2 \) early afterdepolarizations ventricular tachycardia induced chloride \( 0 5 mmol liter per kg body weight intravenously \) combined stimulation bilateral anesthetized dogs examined right atrium paced constant cycle length 600 ms left ventricular endocardial monophasic action potential catheter used detect early afterdepolarizations prostacyclin \( 0 2 microgram kg per min \) reduced amplitude early afterdepolarizations \( 39 2 8 4 monophasic action potential amplitude control study 28 7 5 5 , n 10 p less 0 001 \) well prevalence ventricular tachycardia \( 11 14 dogs control study 5 14 dogs p 0 031 \) prostaglandin e2 \( 0 2 0 6 microgram kg per min \) significantly reduce early amplitude \( 34 7 8 9 25 1 10 7 , n 8 p 0 \) prevalence ventricular tachycardia \( 8 10 versus 6 10 dogs p 0 50 \) alpha beta adrenoceptor blockade combined intravenous administration propranolol \( 0 5 mg kg \) phentolamine \( 0 3 mg kg \) decreased amplitude early afterdepolarizations induced chloride bilateral stimulation 38 6 11 2 18 8 3 3 \( n 6 p 0 005 \) additional administration pgi2 reduced early amplitude 18 8 3 3 9 8 4 8 \( n 6 p 0 001 \)
effects calcium channel blockers coronary vasoconstriction induced endothelin 1 closed chest pigs purpose study determine effects endothelin 1 coronary vascular bed closed chest pigs endothelin 1 \( 3 30 pmol kg body weight \) selectively administered left anterior descending coronary artery coronary blood flow epicardial vessel diameter measured quantitative arteriography arterial pressure increased 30 pmol kg dose heart rate changed coronary blood flow vessel diameter left anterior descending artery significantly decreased 74 32 , respectively \( p less 0 01 versus control \) 30 pmol kg dose , whereas variables modestly decreased left circumflex artery endothelin 1 doses 10 30 pmol kg produced electrocardiographic st segment elevation associated decreased oxygen saturation coronary sinus venous blood endothelin induced coronary vasoconstriction significantly inhibited treatment intravenous diltiazem \( 0 2 mg kg , n 6 \) nifedipine \( 0 1 mg kg , n 5 \) , vehicle administration \( n 4 \) study demonstrates intracoronary administration endothelin 1 causes significant myocardial ischemia coronary vasoconstriction , inhibited calcium channel blocker data suggest calcium influx smooth muscle cells appears involved least part mechanism endothelin induced coronary vasoconstriction vivo
transesophageal echocardiography detect atrial clots candidates percutaneous mitral balloon valvuloplasty left atrial thrombi common patients mitral stenosis percutaneous balloon mitral valvuloplasty performed patients , potential risk thrombus dislodgment embolization study conventional transthoracic echocardiography transesophageal echocardiography performed percutaneous balloon mitral valvuloplasty 19 consecutive candidates \( 6 men , 13 women , 23 81 years old \) five patients \( 26 \) , transesophageal echocardiography revealed left atrial thrombus one suspicion left atrial thrombus transthoracic echocardiography balloon mitral valvuloplasty four five patients three underwent mitral valve surgery confirmed echocardiographic findings transesophageal echocardiography better conventional transthoracic echocardiography detecting left atrial clots candidates balloon mitral valvuloplasty potential risk embolization , transesophageal echocardiography recommended candidates balloon mitral valvuloplasty
relation beta adrenergic blocker use , various correlates left ventricular function chance developing congestive heart failure multicenter diltiazem post infarction research group study examined relations among beta adrenergic blocker use , various correlates left ventricular function chance developing congestive heart failure patients myocardial infarction study performed placebo group multicenter diltiazem post infarction trial ejection fraction data available 1 , patients , receiving beta blocker addition ejection fraction , correlates left ventricular function included presence absence pulmonary rales , chest x ray film evidence pulmonary congestion presence s3 beta blocker use less frequent patients ejection fraction less 30 , rales , s3 pulmonary congestion chest x ray film twenty one percent patients ejection fraction less 30 , 42 patients rales , 28 patients s3 28 patients pulmonary congestion receiving beta blocker therapy every correlate left ventricular function , chance developing congestive heart failure greater patients diminished left ventricular function without level left ventricular function , chance developing congestive heart failure requiring treatment greater patients taking beta blocker
single photon emission computed tomography thallium 201 adenosine induced coronary hyperemia correlation coronary arteriography , exercise thallium imaging two dimensional echocardiography feasibility , safety diagnostic accuracy single photon emission computed tomography \( spect \) thallium 201 imaging adenosine induced coronary hyperemia evaluated 53 patients 7 without coronary artery disease proved coronary angiography adenosine infused intravenously dose 0 14 mg kg body weight per min 6 min thallium injected 3 min adenosine caused increase heart rate \( 68 12 baseline versus 87 18 beats min peak effect , p less 0 0001 \) change blood pressure sensitivity specificity 92 \( 95 confidence intervals 81 98 \) 100 \( 95 confidence intervals 59 100 \) , respectively 20 \( 61 \) 33 patients multivessel coronary artery disease also correctly identified 30 patients , predictive accuracy adenosine thallium imaging slightly higher exercise spect thallium imaging \( 90 versus 80 , p ns \) \( 95 confidence intervals 72 97 61 92 , respectively \) 25 patients , two dimensional echocardiography adenosine infusion disclosed new wall motion abnormality 2 \( 10 \) 20 patients coronary artery disease 80 patients reversible thallium defects \( p less 0 001 \) side effects mild transient used three patients thus , adenosine spect thallium imaging provides high degree accuracy diagnosis coronary artery disease results comparable exercise spect thallium imaging reversible defects adenosine study associated transient wall motion abnormality
termination acute atrial fibrillation wolff parkinson white syndrome procainamide propafenone importance atrial cycle length effects intravenous procainamide \( n 30 \) propafenone \( n 25 \) evaluated 55 patients acute atrial fibrillation wolff parkinson white syndrome patients received either procainamide \( 12 15 mg kg body weight \) propafenone \( 1 2 mg kg \) sustained \( greater 10 min \) atrial fibrillation termination nonsustained atrial fibrillation termination atrial fibrillation attributed drug occurred less equal 15 min infusion measurements included mean cycle length electrograms \( mean aa interval \) measured high right atrium shortest rr interval pre cycles atrial fibrillation atrial fibrillation terminated frequently procainamide administration \( 65 \) propafenone \( 46 \) , although difference significant procainamide prolonged shortest pre rr interval \( 228 41 339 23 ms , p 0 0001 \) propafenone \( 215 40 198 ms , p 0 0001 \) magnitude increase greater propafenone \( p 0 \) patients sustained atrial fibrillation shorter mean aa intervals counterparts nonsustained atrial fibrillation \( 123 25 versus 186 35 ms , p 0 0001 \) termination sustained atrial fibrillation either drug accompanied prolongation mean aa interval necessarily shortest pre rr interval termination atrial fibrillation 68 increase mean aa interval procainamide administration compared 30 increase arrhythmia persisted propafenone increases 90 68 , respectively
plaque morphology pathologic changes arteries patients dying coronary balloon angioplasty morphologic correlates pathologic success failure studied autopsy 28 patients 40 coronary arteries subjected balloon angioplasty presence following histologic features evaluated plaque eccentricity , calcification , fibrous plaque , medial disruption , luminal thrombus inflammation angioplasty considered successful \( residual cross sectional luminal area greater 25 \) pathologic examination 14 arteries unsuccessful 26 arteries plaques likely successfully dilated concentric lesions \( p less 0 05 \) six \( 50 \) 12 plaques successfully dilated compared 8 \( 29 \) 28 fibrous plaques moderate severe calcification preclude morphologic success medial stretching dissection , , often associated successful result thus , plaque morphology may important determinant pathologic outcome coronary angioplasty
dissociation changes cardiovascular mass performance angiotensin converting enzyme inhibitors wistar kyoto spontaneously hypertensive rats effects angiotensin converting enzyme inhibitors cardiovascular mass function measured three groups 22 week old male wistar kyoto normotensive spontaneously hypertensive rats treated cgs , cilazapril quinapril left ventricular performance assessed electromagnetic flow meter rapid whole blood infusion arterial pressure increased aortic snare aortic distensibility also assessed vitro systemic hemodynamic effects three agents similar , yet structural effects varied although left ventricular aortic masses diminished right ventricular mass remained unchanged \( three agents \) spontaneously hypertensive rats , cgs cilazapril also reduced left ventricular mass normotensive wistar kyoto rats without changing aortic mass three agents improved aortic distensibility whether mass decreased left ventricular structural changes associated variable changes pumping ability data show reduced mass associated angiotensin converting enzyme inhibitor treatment consistent ventricles aorta , dissociation exists structural functional changes reduction cardiac mass alone relate changes chamber mass function thus , biologic pharmacodynamic differences exist among angiotensin converting enzyme inhibitors well classes antihypertensive agents
circulating heart reactive antibodies patients myocarditis cardiomyopathy corrected original , article originally j cardiol 1990 16 \( 4 \) 46 heart reactive antibodies commonly observed patients myocarditis cardiomyopathy antibodies may important pathogenesis disorders , yet specific antigens recognized studied systematically report characterizes circulating heart autoantibodies patients myocarditis \( n 17 \) idiopathic cardiomyopathy \( n 71 \) healthy volunteers \( n 15 \) indirect immunofluorescence demonstrated high titer \( greater equal 1 20 \) immunoglobulin g \( igg \) antibody activity occurred 59 myocarditis samples , 20 cardiomyopathy samples none normal samples samples tested western immunoblotting igg activity normal human heart extract number antigens recognized sample enumerated molecular weight antigen estimated prevalence reactivity antigens selected molecular weight classes determined difference mean number heart antigens recognized serum group weight classes , prevalence either differ significantly among various groups subgroups greatest among samples healthy volunteers prevalence reactivity 190 199 kilodalton \( kd \) antigens greatest \( p less 0 05 \) among low titer serum samples patients myocarditis high titer cardiomyopathy serum differed normal serum increased \( p less 0 05 \) prevalence antibodies 40 49 100 109 kd antigens results suggest western immunostaining may ultimately contribute identifying patients myocarditis cardiomyopathy
diagnostic value new myocardial perfusion agent , teboroxime \( 30 , 217 \) , utilizing rapid planar imaging protocol preliminary results corrected original , article originally j cardiol 1990 16 \( 4 \) 855 61 technetium 99m labeled agents advantages thallium 201 terms photon statistics , cost clinical availability suggested alternative thallium myocardial perfusion imaging teboroxime new acid adduct technetium \( \) compound demonstrates favorable characteristics preliminary studies use novel \( seated \) patient positioning technique rapid dynamic acquisition protocol , 30 patients underwent planar imaging rest maximal treadmill exercise postexercise scans completed average time \( mean sd \) 4 4 1 6 min , 4 8 1 5 min views rest results compared coronary arteriography thallium scintigraphy treadmill exercise , diagnostic agreement \( abnormal versus normal \) present 28 30 patients \( p less 0 001 \) regarding physiologic assessment compared thallium scintigraphy , finding infarction ischemia concordant 89 86 patients , respectively report describes initial use teboroxime rapid dynamic planar imaging technique , resulting high correlation exercise thallium scintigraphy delayed postexercise images obtained 5 10 min exercise demonstrated rapid disappearance exercise induced defects noted initial \( 0 5 min \) postexercise views rapid differential washout teboroxime previously described possible clinical significance discussed
plasma dehydroepiandrosterone dehydroepiandrosterone sulfate patients undergoing diagnostic coronary angiography corrected original , article originally j cardiol 1990 16 \( 4 \) 70 serum levels dhea sulfate inversely associated cardiovascular death men , urinary dehydroepiandrosterone \( dhea \) levels inversely associated clinical manifestations coronary artery disease observations may related antiproliferative effects dhea , resulting inhibition atherosclerotic intimal hyperplasia examine relation steroids direct measure coronary atherosclerosis , plasma dhea dhea sulfate levels determined 206 middle aged patients \( 103 men , 103 women \) undergoing elective coronary angiography plasma dhea sulfate levels lower men least one stenosis greater equal 50 compared without stenosis greater equal 50 \( 4 9 2 7 versus 6 1 3 5 nmol ml , p 0 05 \) levels dhea sulfate also inversely related number diseased coronary vessels \( r 0 20 , p 0 05 \) continuous measure extent coronary atherosclerosis \( r 0 25 , p 0 01 \) men association dhea sulfate levels extent coronary artery disease independent age conventional risk factors coronary disease women , association plasma dhea dhea sulfate levels coronary disease data demonstrate consistent , independent , inverse , dose response relation plasma dhea sulfate levels angiographically defined coronary atherosclerosis men plasma dhea sulfate may another important potentially risk factor development progression coronary atherosclerosis
hypertension acculturation elderly mexican americans results 1982 84 hispanic purpose study describe relationship acculturation hypertension elderly mexican americans two age groups , 55 64 65 74 , examined data provided hispanic health nutrition examination survey \( hhanes \) prevalence hypertension among subgroups different acculturation ascertained based modified acculturation scale age group also stratified using hhanes poverty index , index compared stepwise logistic regression performed among variables poverty , gender , age , acculturation relation hypertension results indicate acculturation age stronger predictors hypertension poverty elderly mexican americans , acculturation stronger predictor among age 55 64 factors related acculturation may stronger influence prevalence hypertension older mexican americans differences related socioeconomic status
ultrasound doppler diagnosis chiari syndrome report case apparently idiopathic chiari syndrome , diagnosed ultrasound doppler sonography , patient latent myeloproliferative disease case doppler sonography shows hepatic veins flow pattern suggestive partial thrombotic obstruction moreover , suggest search latent myeloproliferative disorder , means spontaneous erythroid colonies formation culture bone marrow blood mononuclear cells , routinely included diagnostic evaluation case hepatic vein thrombosis without recognizable causes
substance p , acetylcholinesterase , beta endorphin levels plasma pericardial fluid patients without angina pectoris measured substance p like immunoreactivity \( spli \) , beta endorphin like immunoreactivity \( beli \) , acetylcholinesterase activity , total protein content pericardial fluid plasma patients angina pectoris patients angina pectoris spli beli levels , acetylcholinesterase activity , total protein content determined radioimmunoassay , method , method et al \( j 1951 193 265 75 \) , respectively pericardial fluid , patients angina spli , beli , acetylcholinesterase , total protein values 1 69 0 23 fmol mg protein , 0 16 0 13 fmol mg protein , 0 06 0 02 units , 25 7 3 2 mg ml , respectively patients angina spli , beli , acetylcholinesterase , total protein values 0 93 0 17 fmol mg protein , 0 19 0 10 fmol mg protein , 0 16 0 02 units , 44 6 5 3 mg ml , respectively spli levels significantly higher \( p less 0 03 \) , acetylcholinesterase \( less 0 002 \) total protein content \( less 0 004 \) significantly lower pericardial fluid patients angina compared patients angina beli levels significantly different two groups plasma , significant differences found spli , beli , acetylcholinesterase , total protein values two groups patients patients angina spli , beli , acetylcholinesterase , total protein values 0 47 0 26 fmol mg protein , 0 06 0 06 fmol mg protein , 0 29 0 15 units , 68 2 8 7 mg ml , respectively
cardiac transplantation female muscular dystrophy young woman muscular dystrophy contractures received heart transplant severe dilated cardiomyopathy cardiac histopathology consisted myocyte hypertrophy , interstitial fibrosis , nuclear without mitochondrial abnormalities myopathy heart disease clinically evident family , although three relatives unexplained shortened tendons without weakness tendon contractures may partial expression myopathic disorder , suggesting autosomal dominant inheritance variable penetrance muscular dystrophy clinically similar \( \) type thus occur women rather cardiac arrhythmias typical , dilated cardiomyopathy may occur present severe congestive heart failure first report cardiac transplantation case
quantification reversibility stress induced thallium 201 myocardial perfusion defects multicenter trial using 's eye polar maps standard normal limits multicenter trial performed 140 patients four centers determine accuracy quantitative analysis stress delayed thallium 201 myocardial tomograms using normal limits assess relative amount reversibility stress induced defects patients found 85 fixed 124 reversible defects , determined visual interpretation reversibility 's eye polar maps compared gender matched normal limits 36 normals regions identified reversible normalized difference stress 4 hr greater 1 5 mean normal limits overall agreement experts multicenter sites reversibility maps 73 reversible defects 80 fixed defects sensitivity detecting reversibility highest left circumflex \( 88 \) lowest right coronary \( 60 \) results indicate reversibility polar maps normal limits offer objective , accurate technique determining reversibility stress induced perfusion defects
management asymptomatic chronic aortic regurgitation left ventricular dysfunction decision analysis study objective determine optimal strategy timing aortic valve replacement patients chronic , severe aortic regurgitation left ventricular dysfunction design decision analysis comparing early surgery \( timed onset left ventricular dysfunction \) delayed surgery \( timed onset symptoms \) using data literature expert opinion variables representative case \( 40 year old man aortic valve disease \) setting tertiary care center valve replacement surgery measurements main results early surgery approach preferred based quality adjusted life years sensitivity analysis showed result affected following variables within derived ranges rate symptom development onset left ventricular dysfunction delayed surgery approach , perioperative mortality approaches , occurrence major nonfatal stroke congestive heart failure approaches although decision sensitive yearly postoperative mortality rates , delayed surgery operative mortality rate almost low early surgery rate change preference delayed surgery approach preference could also change survival much important patient first five years five years patient living anticoagulants enough value year anticoagulants 80 year anticoagulants conclusion decision analysis provides quantitative support impression patients similar case better surgery timed onset ventricular dysfunction surgery delayed symptoms develop thus supports practice following patients noninvasively order time surgery
costs prevention prevention program cost effective yields health benefits alternative uses health care resources prevention programs meet standard either actually save health care resources utilize , net costs per healthy year life gained lower alternatives curative palliative medicine prevention programs , however , less cost effective medical treatments disease one public policy cost effectiveness prevention another prevention programs subjected higher standard health programs expected save , expected yield improved health reasonable price
embolization giant renal arterial aneurysm 49 year old man presented right flank pain angiography revealed giant right renal arterial aneurysm giant renal arterial aneurysms typically treated nephrectomy patient aneurysm successfully multiple gianturco alcohol case indicates embolization may reasonable alternative nephrectomy
renal autotransplantation children successful treatment renovascular hypertension renovascular hypertension children common disease improved surgical technique incidence nephrectomy decreased renovascular reconstruction currently preferred method manage entity 1977 1988 , 21 patients renovascular hypertension treated hospital 7 patients 6 16 years old underwent renal autotransplantation children 4 unilateral 3 bilateral disease requiring bilateral autotransplantation autotransplantation performed anastomosis renal artery end side common iliac artery renal veins anastomosed end side common iliac veins ureters left intact 1 patient required bench operation 4 patients unilateral procedure 3 cured 1 improved normal blood pressure small dose antihypertensive medication 3 patients bilateral cured results , normalization blood pressure 86 patients improvement blood pressure 14 patency rate 87 , similar reported reconstructive modalities children
doppler color flow images stenosed arterial model interpretation flow patterns capability recently introduced doppler color flow mapping devices accurately detect flow patterns region arterial stenosis evaluated use vitro flow model pulsatile flow simulating low resistance vessel induced straight tube , alternatively contained stenoses 0 , 20 , 40 , 60 , 80 diameter reduction doppler color flow images taken along tube 0 8 diameters downstream stenosis comparison doppler color flow mapping results similarly recorded flow visualization \( hydrogen \) images showed close correspondence key features flow , including detection high velocity , jet near wall separated flow zones distinctive flow patterns exist stenotic case , considerable value diagnosing clinical disease conditions
everted cervical vein carotid patch angioplasty benefits autologous vein undertook investigation evaluate cervical veins \( facial , external jugular \) patch material carotid endarterectomy device stimulated circumferential fixation sutures radial tension exerted vivo patches constructed measure burst strength tissue mean bursting pressure groin saphenous vein \( n 10 \) 94 5 15 1 pounds per square \( \) , 75 5 8 9 ankle saphenous vein \( n 10 \) , 83 3 14 5 everted \( double layer \) cervical vein \( n 5 \) 10 3 3 single layer cervical vein \( n 5 \) significant differences saphenous vein level everted \( double layer \) cervical vein , significantly different single layer cervical vein \( p less 0 05 \) june 1987 november 1989 , 19 patients underwent 21 carotid endarterectomies complemented adjunctive everted cervical vein patch angioplasty indications surgery asymptomatic stenosis \( 53 \) , transient ischemic attack \( 29 \) , cerebrovascular accident recovery \( 18 \) patients studied surgery duplex scanning asymptomatic recurrent stenosis observed one patient transient nerve dysfunction occurred one patient one postoperative death occurred result massive aspiration results indicate everted cervical vein comparable saphenous vein resistance bursting yield similar results patch material carotid endarterectomy accordingly , saphenous vein spared lower extremity incisions avoided
intraoperative peripheral nd yag laser assisted thermal balloon angioplasty short term intermediate term follow laser assisted thermal balloon angioplasty performed 48 arteries \( iliac , superficial femoral , popliteal \) indications surgery limb salvage \( 25 \) , rest pain \( 38 \) , claudication \( 38 \) patients categorized three groups lesions less 5 cm , greater 5 10 cm , greater 10 cm length demographic characteristics , risk factors , outcome measures compared use fisher 's exact test student 's test time vascular patency failure compared use standard kaplan meier survival analysis three groups initial failure noted 14 lesions less 5 cm , 40 lesions greater 5 10 cm , 73 lesions greater 10 cm overall success rate 38 , mean follow 1 year less 5 cm lesion group significantly higher rate overall success \( 59 , p 0 005 \) two groups combined greater 10 cm lesion group significantly worse \( 9 \) two groups combined \( p 0 028 \) patients less 5 cm group significantly longer patency two groups \( p less 0 01 \) iliac lesions higher overall success rate \( 73 \) superficial femoral popliteal artery lesions \( 35 \) \( p 0 038 \) conclusion , widespread application laser assisted thermal balloon angioplasty cannot justified without long term clinical laboratory investigation conversely , potential technique hand proper patient selection , length nature lesion treated , appropriate forms , doses , method delivery laser energy , remain defined
adult open heart surgery new york state analysis risk factors hospital mortality rates study analyzes data new york state 's new cardiac surgery reporting system , contains information cardiac preoperative risk factors , postoperative complications , hospital discharge purposes study determine set significant clinical risk factors identify cardiac surgical centers likely serious quality care problems significant risk factors hospital death age , gender , ejection fraction , previous myocardial infarction , number open heart operations previous admissions , diabetes requiring medication , dialysis dependence , \( acute structural defect , renal failure , cardiogenic shock , gunshot \) , unstable angina , intractable congestive heart failure , left main trunk 90 , type operation performed four 28 hospitals significantly higher mortality rates expected , given risk factors patients subsequent site visits medical record reviews confirmed facilities high percentages quality care problems among cases resulting mortality
glomerular hyperfiltration indicates early target organ damage essential hypertension 111 patients essential hypertension \( world health organization stage ii \) , examined relationship renal hemodynamics left ventricular hypertrophy left ventricular structure determined two dimensional guided mode echocardiography , renal blood flow iodine 131 acid clearance , glomerular filtration rate creatinine clearance glomerular filtration rate correlated left ventricular mass \( r 52 \) left ventricular cross sectional area \( r 21 \) conversely , similar age , body mass index , body surface area , arterial pressure , hypertensive patients left ventricular hypertrophy disclosed higher glomerular filtration rate filtration fraction without left ventricular hypertrophy , whereas renal blood flow renal vascular resistance measurements significantly different thus , similar levels arterial pressure renal blood flow , glomerular hyperfiltration linked early cardiac structural changes essential hypertension conclude , hypertensive patient normal renal function , high glomerular filtration rate may indicator early target organ damage essential hypertension
repair transposition great arteries intact ventricular septum left ventricular outflow tract obstruction repair transposition great arteries patients intact ventricular septum fixed left ventricular outflow tract obstruction restricted atrial procedures , without attempts relieve bypass left ventricular outflow obstruction however , suboptimal results procedures , coupled excellent functional results arterial switch operation patients without obstruction , made anatomic correction goal repairing anomalies report technique anatomic correction transposition great arteries , intact ventricular septum , fixed left ventricular outflow tract obstruction consideration difficult cases advocated
effects dopamine myocardial functional recovery reversible ischemic injury dopamine frequently used improve cardiac performance acute myocardial ischemia inotropic agents , however , increase myocardial oxygen demand could potentially delay recovery ischemic injury evaluate problem , studied eight chronically instrumented dogs conscious state performed two 15 minute coronary occlusions 48 hours apart one occlusions , either dopamine \( 15 micrograms kg min \) saline placebo administered intravenously 1 0 1 5 hours reperfusion alternative infusion given second study preload work area , area beneath stroke work versus end diastolic length relationship , used assess intrinsic myocardial performance ischemia decreased preload work area 13 control occlusions reperfusion , 30 minute dopamine infusion acutely increased myocardial function nearly threefold compared placebo myocardial performance dopamine administration , however , significantly depressed compared placebo throughout remaining 24 hours reperfusion \( p less 0 01 \) data indicate dopamine may impair functional recovery ischemic myocardial injury suggest inotropic interventions used setting absolutely indicated
studies controlled reperfusion ischemia reperfusion conditions attenuation regional ischemic effect temporary total vented bypass controlled reperfusion study tests hypothesis total vented bypass attenuate regional ischemic effect defined time interval controlled blood cardioplegic reperfusion thirty three dogs underwent 2 4 hours occlusion left anterior descending coronary artery received regional blood cardioplegic reperfusate total vented bypass cardiopulmonary bypass reperfusion started 2 hours ischemia eight dogs , 4 hours ischemia 25 others among 25 dogs , seven total vented bypass started first 2 hours 4 hours regional ischemia segmental shortening \( ultrasonic crystals \) , tissue water content \( wet dry weight \) , histochemical damage \( triphenyltetrazolium chloride stain \) assessed 2 hours reperfusion dogs reperfused 2 hours ischemia recovered 73 8 control systolic shortening sustained 11 triphenyltetrazolium chloride dogs undergoing 4 hours regional ischemia , total vented bypass 2 hours reperfusion improved recovery systolic shortening \( 49 versus 31 , p less 0 05 \) , limited epicardial edema \( 79 6 versus 81 1 water content , p less 0 05 \) , reduced histochemical damage \( 24 versus 39 triphenyltetrazolium chloride , p less 0 05 \) findings imply institution total vented bypass ischemia attenuates infarct process , increases regional recovery contractility , limits edema histochemical damage , may useful adjunct myocardial salvage controlled reperfusion provided
simulated left ventricular aneurysm aneurysm repair swine patch reconstruction left ventricular aneurysm may superior linear closure , hypothesis tested experimentally accordingly , six anesthetized domestic pigs instrumented measure regional left ventricular wall thickening , stroke volume , systolic left ventricular pressure , myocardial oxygen consumption total bypass cardioplegia , 6 8 cm dacron patch inserted left ventricle follows left ventricular aneurysm , patch open patch reconstruction , 50 patch standard repair , edges global function , stroke work \( stroke volume x integral left ventricular pressure \) left ventricular end diastolic pressure curves , depressed three compared control tendency stroke work greater standard repair left ventricular aneurysm patch reconstruction higher statistically significant mechanical efficiency , stroke work myocardial oxygen consumption \( joules per milliliter oxygen per beat \) , 2 43 0 52 \( mean standard error mean \) \( control \) , 2 22 0 94 \( standard repair \) , 1 27 0 39 \( patch reconstruction \) , 1 09 0 37 \( left ventricular aneurysm \) \( significant differences \) regional work calculated regional left ventricular wall thickening x integral left ventricular pressure slope regional work end diastolic wall thickness relation decreased posterior wall 14 0 2 9 \( control \) versus 8 4 2 0 \( left ventricular aneurysm \) , 6 9 1 4 \( patch reconstruction \) , 7 4 1 4 \( standard repair \) \( p less 0 05 \) anterior wall , contractility change significantly \( 7 4 1 2 , control 7 8 2 7 , left ventricular aneurysm 5 0 0 4 , patch reconstruction 5 3 0 4 , standard repair \) decreased end diastolic wall thinning anteriorly suggested results normal left ventricle suggest patch greater benefit linear repair either repair may function adjacent myocardium restriction regional diastolic lengthening
intraoperative transesophageal color coded doppler echocardiography evaluation residual regurgitation mitral valve repair mitral valve competence mitral valve reconstruction assess procedure , evaluated respect transesophageal color coded doppler echocardiography 23 patients undergoing mitral valve reconstruction severe mitral regurgitation transesophageal echocardiographic examinations performed induction anesthesia sternotomy \( baseline \) , mitral valve repair , sternal closure , similar mean aortic pressure echocardiographic instrument settings degree mitral regurgitation transesophageal color doppler flow mapping visually quantified 5 point scale \( 0 4 \) , left atrial extent regurgitant jet compared degree mitral regurgitation left ventricular cineangiography performed within several weeks operation also visually quantified 5 point scale \( 0 4 \) , use right anterior oblique projection good correlation two methods \( r 0 83 p less 0 001 \) conclude residual mitral regurgitation , assessed transesophageal color flow mapping operating room , highly correlates ultimate mitral regurgitation cineangiography therefore transesophageal echocardiography helpful evaluation mitral valve competence mitral valve reconstruction , hence , case repair failure , allow valve replacement surgical session , thus avoiding reoperation
health belief model predicting compliance dropout cardiac rehabilitation investigated health belief model health locus control predictors group membership \( dropouts \) cardiac rehabilitation whether added predictive utility routinely assessed patient demographics health behaviors questionnaires completed entry study 120 patients coronary artery disease , end 6 month program 58 62 dropouts discriminant function analyses carried determine prediction group membership health belief model predicted group membership 64 6 time , explaining 5 2 variance demographics , health behaviors , health belief model factors accounted 21 1 variance total dropouts group membership correctly predicted 74 4 time avoidable dropout correctly predicted 84 2 time 56 9 variance explained health locus control distinguish dropouts addition health belief model provided additional information compliance cardiac rehabilitation beyond explained demographic health behavior variables alone , particularly predicting avoidable dropout
regional myocardial metabolism high energy phosphates isometric exercise patients coronary artery disease background maintenance cellular levels high energy phosphates required myocardial function preservation animals , severe myocardial ischemia characterized rapid loss phosphocreatine decrease ratio phosphocreatine atp methods determine whether ischemic metabolic changes detectable humans , recorded spatially localized phosphorus 31 nuclear magnetic resonance \( 31p nmr \) spectra anterior myocardium , , isometric hand grip exercise results mean \( sd \) ratio phosphocreatine atp left ventricular wall subjects rest 1 72 0 15 normal subjects \( n 11 \) 1 59 0 31 patients nonischemic heart disease \( n 9 \) , ratio change hand grip exercise either group however , patients coronary heart disease ischemia due severe stenosis \( greater equal 70 percent \) left anterior descending left main coronary arteries \( n 16 \) , ratio decreased 1 45 0 31 rest 0 91 0 24 exercise \( p less 0 001 \) recovered 1 27 0 38 two minutes exercise three patients coronary heart disease clinical symptoms ischemia exercise repeat exercise testing five patients revascularization yielded values 1 60 0 20 rest 1 62 0 18 exercise \( p significant \) , compared 1 51 0 19 rest 1 02 0 26 exercise revascularization \( p less 0 02 \) conclusions decrease ratio phosphocreatine atp hand grip exercise patients myocardial ischemia reflects transient imbalance oxygen supply demand myocardium compromised blood flow exercise testing 31p nmr useful method assessing effect ischemia myocardial metabolism high energy phosphates monitoring response treatment
long term outcome surgical repair isolated atrial septal defect follow 27 32 years background atrial septal defects surgically 30 years long term survival rates among patients treated early era cardiac surgery poorly documented , data critical importance future medical care , , patients methods determine natural history surgically corrected atrial septal defects , studied 123 patients underwent repair isolated defect \( ostium secundum sinus venosus \) mayo clinic 1956 1960 , 27 32 years procedure follow status patients determined written questionnaires telephone interviews hospital records death certificates obtained interim hospitalization death occurred results overall 30 year actuarial survival rate among survivors perioperative period 74 percent , compared 85 percent among controls matched age sex perioperative mortality 3 3 percent \( four deaths \) actuarial 27 year survival rates among patients younger two quartiles according age operation \( less equal 11 years 12 24 years \) different rates among controls 97 percent 93 percent , respectively two older quartiles \( 25 41 years greater 41 years \) , 27 year survival rates significantly less \( p less 0 001 \) 84 percent 40 percent , respectively controls \( 91 59 percent \) independent predictors long term survival according multivariate analysis age operation \( p less 0 0001 \) systolic pressure main pulmonary artery operation \( p less 0 \) repair performed older patients , late cardiac failure , stroke , atrial fibrillation significantly frequent conclusions among patients surgically repaired atrial septal defects , operated age 25 excellent prognosis , older patients require careful , regular supervision
frequency dependent behavior cerebral autoregulation cerebral autoregulation complex physiological process composed fast slow components may respond differently different rates patterns blood pressure variation assess temporal nature autoregulation , transcranial doppler velocity recordings middle cerebral artery obtained prolonged periods compared blood pressure recordings 5 patients without cerebral disease 13 patients intracranial pathological changes correlations velocity pressure wave forms various frequencies variation measured systems analysis techniques patients aneurysmal subarachnoid hemorrhage high correlations indicating pressure dependent flow impaired autoregulation patients without cerebral disease significantly lower correlations \( p less 0 01 \) , indicating intact autoregulation examples increasing correlations correlations new frequencies emerging clinical condition worsened given preliminary examples suggest application systems analysis techniques velocity pressure data allow measurement temporal nature cerebral autoregulation
acute changes dynamics cerebrospinal fluid system experimental subarachnoid hemorrhage early changes intracranial pressure \( icp \) , icp volume index , resistance absorption cerebrospinal fluid induced experimental subarachnoid hemorrhage studied cats sah , icp slightly elevated , decrease buffering capacity intracranial space sharp rise outflow resistance infusion blood constant infusion rate , extensive increase icp could demonstrated contrast infusion saline , caused slight elevation icp furthermore , blood infusion , icp level reach plateau phase pressure , demonstrated infusion saline suggested marked increase icp blood infusion subarachnoid space caused intracranial volume loading simultaneous increase cerebrospinal fluid outflow resistance concluded reported relationship increased cerebrospinal fluid outflow resistance increased icp supports hypothesis strong increase icp subarachnoid hemorrhage human subjects
distribution angiographic vasospasm subarachnoid hemorrhage implications diagnosis transcranial doppler ultrasonography study undertaken determine frequently angiographic vasospasm occurs outside normal access range transcranial doppler ultrasound patients suffered subarachnoid hemorrhage vasospasm located basal vessels readily identifiable using transcranial doppler ultrasound whereas spasm affecting distal , vertically oriented arteries outside standard detection range therefore speculated sensitivity technique would adversely affected high incidence distal vasospasm total 136 angiograms performed 68 patients subarachnoid hemorrhage anterior circulation aneurysms reviewed determine typical distribution vasospasm 40 cases showed greater equal 25 vessel narrowing , 50 0 spasm restricted basal vessels , 42 5 spasm involving basal distal segments , 7 5 spasm distal segments none patients distal vasospasm alone developed delayed ischemic deficits concluded patients anterior circulation aneurysms develop vasospasm involvement basal vessels , small number patients may develop vasospasm distal vessels
pharmacological reversibility experimental cerebral vasospasm using morphometric technique , pharmacological reversibility luminal narrowing experimental subarachnoid hemorrhage \( sah \) investigated vasodilation , cocktail consisting 10 \( 4 \) papaverine , 2 x 10 \( 4 \) sodium nitroprusside , 10 \( 5 \) adenosine administered intra forty two rabbits divided six groups control \( normal animals \) control plus cocktail \( normal animals perfused cocktail fixation \) sah \( animals sacrificed 48 hours subsequent injection 1 5 ml kg arterial blood \) sah plus cocktail \( sah plus perfusion cocktail \) bacl2 \( animals sacrificed 10 minutes injection 2 ml 3 x 10 \( 3 \) bacl2 \) bacl2 plus cocktail \( bacl2 animals perfused cocktail \) diameter basilar arteries control control plus cocktail groups significantly different bacl2 reduced diameter 44 sah reduced diameter 27 significant differences diameter bacl2 plus cocktail group sah plus cocktail group compared control control plus cocktail group morphological examination light transmission electron microscopy showed luminal narrowing elastic lamina degenerative proliferative changes vessel wall animals sah results suggest cerebral vasospasm caused initially smooth muscle contraction rather proliferative vasculopathy irreversible process
factors determining success energy requirements cardioversion atrial fibrillation factors thought affect success energy requirements cardioversion atrial fibrillation studied 80 \( 49 male , 31 female \) patients aged 21 88 \( mean 61 5 years \) transthoracic impedance measured advance using 30 khz low amplitude ac current passed self adhesive ecg defibrillator \( diameters 8 12 cm \) applied chest posterior \( ap \) position 57 patients \( aa \) position 23 patients mean transthoracic impedance patients 69 3 16 \( sd \) ohms \( range 39 131 ohms \) , transthoracic impedance significantly greater aa ap position \( 75 4 13 vs 66 7 16 ohms , p 0 02 \) initial energy 50 j \( delivered \) gradually increased maximum 360 j required cardioversion successful 73 80 \( 91 2 per cent \) , low energy shocks \( less equal 200 j \) successful 45 80 \( 56 2 per cent \) patients using single factor analysis , sex , left atrial enlargement , electrode positions , aetiology atrial fibrillation , presence left ventricular failure , prior treatment verapamil beta adrenergic blockers significant determinants cardioversion success success low energy shocks prior treatment digoxin , cardioversion success success low patients transthoracic impedance less equal 70 ohms , low energy shocks often successful \( 33 50 , 66 per cent \) patients transthoracic impedance greater 70 ohms \( 12 30 , 40 per cent \) , p 0 04 using univariate analysis , cardioversion success low energy shocks significantly associated prior treatment digoxin also duration atrial fibrillation \( 24 hours one month one month three years \) shocks less equal 100 j , prior treatment amiodarone multifactorial linear regression analysis selected , rank order , duration atrial fibrillation 24 hours less one month one month three years significant predictors cardioversion success irrespective shock strength , success low energy shocks
deleterious effects testicular venous occlusion young rats determine differences testicular arterial venous obstruction , spermatic artery vein , , occluded varying periods time young rats two months later , conclusion study , testes examined histologic degeneration vascular obstruction graded modified 's tubular biopsy score \( \) testicular concentrations enzymes \( lactic dehydrogenase sorbitol dehydrogenase \) , known decrease testicular injury , measured tubule diameter \( std \) found decrease significantly two hours vascular occlusion similar regardless whether obstruction produced occlusion arterial inflow venous drainage , testicular concentration enzymes decreased significantly permanent ligation spermatic artery vein , decreased minimally vascular obstruction lasted less 120 minutes testicular injury produced venous occlusion equally severe occurred rapidly injury produced arterial combined arteriovenous occlusion significant injury noted contralateral testes group
sequential gradient pneumatic compression enhances venous ulcer healing randomized trial treatment venous ulcers remained largely unchanged centuries application properly applied graduated compression , use graduated compression stockings , surgery shown achieve healing however , ulcers persist despite appropriate management randomized study undertaken compare two regimens treatment patients regimens included ulcer debridement , cleaning , nonadherent dressing , graduated compression stockings one regimen , sequential gradient intermittent pneumatic compression applied 4 hours day one 24 patients control group complete healing ulcers compared 10 21 patients healed intermittent pneumatic compression group median rate ulcer healing control group 2 1 area per week compared 19 8 area per week intermittent pneumatic compression group results indicate sequential gradient intermittent pneumatic compression beneficial treatment venous ulcers
regression intracardiac thrombus embolic stroke using two dimensional echocardiography , studied pathophysiology intracardiac thrombus regression accompanied anticoagulant therapy 82 consecutive patients acute cardiogenic cerebral embolism noted intracardiac thrombus 15 patients nine 15 started anticoagulant therapy warfarin potassium maintain prothrombin time 2 5 3 5 \( international normalized ratio \) serial two dimensional echocardiograms obtained nine patients anticoagulation , plasma levels fibrinopeptide , fibrinopeptide b beta 15 42 , dimer measured time eight nine patients intracardiac thrombi gradually decreased size plasma level fibrinopeptide fell within normal range plasma levels fibrinopeptide b beta 15 42 dimer remained normal ranges patient thrombus disappeared , embolization right arm immediately starting anticoagulant therapy mobile small thrombi regressed earlier large ones conclude regression intracardiac thrombi anticoagulation may based relative predominance plasma fibrinolytic activity anticoagulation inhibited thrombin activity
ultrasonic evaluation early carotid atherosclerosis investigated prevalence carotid atherosclerosis , including mild early lesions , association cervical bruits various risk factors \( age , male sex , hypertension , hyperlipidemia , diabetes mellitus , obesity , cigarette smoking \) 232 consecutive japanese patients high resolution real time b mode ultrasonography performed determine extent atherosclerosis , quantified using scoring system prevalence carotid atherosclerosis 49 , 59 , 41 232 patients , 100 symptomatic patients , 132 asymptomatic patients , respectively although carotid lesions detected frequently \( 87 \) 30 patients cervical bruits , bruits noted 30 88 examined patients carotid atherosclerosis independent risk factors carotid atherosclerosis patients found age , male sex , hyperlipidemia diabetes mellitus possible risk factor carotid atherosclerosis study show close association hypertension carotid atherosclerosis , might caused high prevalence hypertension patients findings suggest increasing prevalence carotid atherosclerosis japanese , though confirmed population based study study demonstrates clinical usefulness high resolution b mode ultrasonography evaluation early carotid atherosclerosis
effect ischemia induced middle cerebral artery occlusion superoxide dismutase activity rat brain acute cerebral ischemia increases generation free radicals , causing cell damage , theoretically may decrease activity enzyme superoxide dismutase investigate role superoxide dismutase cerebral ischemia , used model middle cerebral artery occlusion rats model infarct produced frontoparietal , extending lateral basal ganglia measured superoxide dismutase activity using xanthine oxidase cytochrome c reduction assay areas rat brains tissue samples analyzed 20 minutes , 2 , 6 , 24 hours , 7 days middle cerebral artery occlusion 2 24 hours 7 days sham operation \( n 8 10 time \) significant change superoxide dismutase activity relative control values brain area time 24 hours surgery however , 7 days middle cerebral artery occlusion significant decline superoxide dismutase activity , 55 68 \( p less 0 05 \) unoperated controls , observed brain areas results support important role changes activity endogenous superoxide dismutase acute phase cerebral ischemia however , decrease superoxide dismutase activity 7 days ischemia could indicate ongoing additional damage peri infarct tissue
protein phosphorylation ischemia many investigations shown calcium adenosine triphosphate crucial central nervous system functions probable alterations substances central nervous system ischemia involved processes cause irreversible neural damage calcium regulates several protein kinases responsible phosphorylation proteins vital many central nervous system functions using rabbit spinal cord ischemia model , found protein kinase c calcium calmodulin dependent kinase severely affected first hour ischemia protein kinase significantly affected time course lost protein kinase c enzyme activity closely corresponded irreversible loss neurologic function , evidence protein kinase c inhibitor activity generated also , drugs inhibit protein kinase c increased neurologic damage administered early phases ischemia results suggest protein phosphorylation , particularly protein kinase c , critical maintenance neurologic function
coarctation aorta coarctation aorta common cardiovascular disorder unknown etiology type , blood flows patent ductus distal aorta coarctation , blood flows lower extremities way subclavian arteries collaterals plain films may show reverse sign coarctation arteriography gold standard making diagnosis however , magnetic resonance imaging probably become increasingly important diagnostic tool treatment choice surgery , complete resection stenosed segment
venous ulcers pathophysiology medical therapy venous ulcers may occur result lower extremity calf pump failure , ensuing edema , trapping white blood cells deposition fibrin acute , smaller lesions easily treated adequate compression occlusive larger , chronic wounds often benefit form external compression occlusive local wound care effective used simultaneously compression sequential compression pumps merit study may prove therapeutic prophylactic value refractory cases , long term use compression devices may required prevent ulcer recurrence
silent myocardial ischemia dilemma \? developing optimal strategy evaluation management patients silent myocardial ischemia extremely difficult although otherwise healthy , asymptomatic individuals may risk dying suddenly exercise , neither exercise testing holter monitoring reliably identifies greatest risk patients underlying coronary artery disease , silent ischemia increases risk adverse outcome
persistent uptake indium 111 antimyosin monoclonal antibody patients myocardial infarction indium 111 \( 111in \) antimyosin scintigraphy investigated 27 patients myocardial infarction 111in antimyosin fab administered intravenously , planar single photon emission computed tomographic images obtained 48 hours later uptake 111in antimyosin present 9 10 patients \( 90 \) studied within 6 days infarction second week positive scans seen 16 16 patients \( 100 \) including 13 \( 81 \) normal creatine kinase levels mechanism persistent positive antimyosin images subacute stage myocardial infarction remains clarified 111in antimyosin scintigraphy may useful noninvasive method detection myocardial injury late early suspected acute myocardial infarction
coronary perfusion catheter effectiveness experimental model acute coronary occlusion effectiveness coronary perfusion catheter studied animal model acute coronary occlusion systemic hemodynamic variables , regional myocardial blood flow \( rmbf \) , regional systolic function \( systolic segmental shortening \) area perfused circumflex coronary artery \( cx \) measured eight anesthetized dogs baseline measurements , cx coronary artery occluded silk snare measurements repeated 5 minutes ischemia \( occlusion 1 \) snare released 1 hour later snare occlusion repeated placement perfusion catheter cx coronary artery 5 minutes , measurements repeated \( occlusion 2 \) determine long term effectiveness catheter , hemodynamic variables regional function measurements obtained every 15 minutes total 60 minutes occlusion 1 , rmbf decreased 1 30 0 20 0 41 0 13 ml min 1 gm 1 \( p less 0 01 \) , subendocardial rmbf decreased 1 44 24 0 34 0 15 ml min 1 gm 1 \( p less 0 01 \) insertion perfusion catheter \( occlusion 2 \) , rmbf maintained 0 97 0 16 subendocardial rmbf maintained 0 78 0 13 ml min 1 gm 1 occlusion 2 rmbf greater \( p less 0 05 \) occlusion 1 different baseline
dose dependent reduction myocardial infarct size fluosol da fluosol da shown reduce infarct size however , dose response relationship agent unknown \( pfc \) potentially system decrease carbon clearance well cause transient elevation liver enzymes , present study conducted determine lowest effective dose new zealand white rabbits \( n 73 \) randomly selected prior infarction receive 10 , 15 , 20 , 25 , 30 ml kg pfc equivalent volume 5 dextran \( control \) intravenously animals underwent 30 minutes coronary artery occlusion pfc dextran infused 30 minute period starting 20 minutes occlusion animals put death 24 hours infarct size determined histologically quantitated computerized neutrophil infiltration ischemic myocardium evaluated hemodynamic differences noted within groups infarct size similar controls animals treated 10 15 ml kg pfc significant infarct size reduction , however , noted animals treated 20 , 25 , 30 ml kg pfc versus controls \( p 0 05 , 0 04 , 0 02 , respectively \) maximal infarct size reduction seen 30 ml kg pfc \( 35 \) neutrophil infiltration significantly decreased groups treated pfc results show intravenous fluosol da significantly reduces infarct size minimal dose 20 ml kg
left ventricular asynchrony indicator regional myocardial dysfunction marked heterogeneity myocardial wall thickening within left ventricle among different individuals therefore difficult detect regional myocardial dysfunction absolute values systolic wall thickening tested whether extent left ventricular asynchrony ischemia reperfusion used quantify severity regional myocardial dysfunction nonischemic baseline function known six anesthetized , open chest dogs regional myocardial wall thickness measured means control conditions , three degrees ischemic dysfunction \( mild , moderate , severe \) , release 15 minute occlusion left circumflex coronary artery , degrees moderate mild reperfusion dysfunction similar preceding ischemic dysfunction present two indexes left ventricular asynchrony calculated \( 1 \) thickening \( pet \) \( 2 \) phase difference first fourier posterior versus anterior myocardial wall motion \( pd \) systolic myocardial wall thickening decreased 15 3 3 1 \( standard deviation \) \( control value \) 9 7 1 4 \( mild ischemia \) , 4 2 1 6 \( moderate ischemia \) , 3 7 3 1 \( severe ischemia \) conversely pet increased 0 02 0 04 mm \( control value \) 0 15 0 22 mm \( mild ischemia \) , 0 19 0 15 mm \( moderate ischemia \) , 0 50 0 26 mm \( severe ischemia \) pd increased 9 28 degrees \( control value \) 22 19 degrees \( mild ischemia \) , 54 18 degrees \( moderate ischemia \) , 107 21 degrees \( severe ischemia \) release 15 minute left circumflex coronary artery occlusion , pet pd recovered 0 34 0 19 mm 36 24 degrees \( moderate dysfunction \) 0 25 0 31 mm 29 8 degrees \( mild dysfunction \) , respectively inverse linear relationships systolic wall thickening pet \( r 0 86 , p less 0 001 \) systolic wall thickening pd \( r 0 87 , p less 0 001 \) inotropic stimulation potentiation increased regional systolic myocardial posterior anterior wall thickening alter extent left ventricular asynchrony thus , normal baseline function known , severity regional myocardial dysfunction given inotropic state determined analysis left ventricular asynchrony significant correlation extent pet pd ischemia early reperfusion recovery contractile function late reperfusion thus pet provide prospective marker functional outcome reperfusion
detection quantitation ischemic left ventricular dysfunction using new video intensity technique regional wall motion evaluation eighty patients ischemic heart disease 17 normal subjects evaluated left ventricular regional wall motion means new method wall motion analysis based video intensity technique uses temporally sliding analysis evaluate cardiac cycle 100 msec intervals presence coronary artery disease defined 50 measured diameter stenosis wall motion abnormalities regions perfused stenotic vessels common early diastole \( 76 \) sensitivity method rest patients coronary artery disease 79 7 \( p less 0 0001 \) overall accuracy 84 2 \( p less 0 0001 \) abnormalities systole diastole common regions perfused severe lesions \( greater 75 \) perfused moderately stenotic \( less 75 \) vessels \( p less 0 05 \) comparison new method phase amplitude analysis performed 15 patients two frame analysis 40 patients new method yielded higher sensitivity either two methods
angiography , angioscopy , ultrasound imaging percutaneous balloon angioplasty report two patients undergoing peripheral percutaneous transluminal angioplasty angiography , angioscopy , ultrasound imaging performed balloon angioplasty first case smooth atheroma diagnosed angiography found unrecognized partially occlusive thrombus angioscopy angioplasty , intimal tear identified angioscopy ultrasound seen angiography intravascular ultrasound image showed tear extend second case , apparently smooth intimal surface imaged angiography found angioscopy ultrasound extensive damage , including hemorrhage , intimal flaps , arterial dissection angioplasty site data suggest type information derived three imaging techniques quite different , may specific role intravascular diagnosis
clinical significance simple heart rate adjusted st segment depression supine leg exercise diagnosis coronary artery disease evaluate clinical significance simple heart rate adjusted st segment depression \( delta st delta hr \) diagnosis coronary artery disease , 42 patients stable exertional angina underwent supine leg exercise testing cardiac catheterization exercise , heart rate , electrocardiogram , pulmonary artery wedge pressure recorded sensitivity accuracy delta st delta hr criteria \( greater equal 3 0 microv beat min \) significantly greater conventional analysis st segment depression criteria \( greater equal 0 2 mv \) detecting three vessel coronary artery disease matched specificity 72 \( 100 versus 46 , 81 versus 64 , p less 0 01 \) significant linear correlation found maximum pulmonary artery wedge pressure increments exercise \( delta \) score delta st delta hr \( delta r 0 51 , p less 0 001 score r 0 47 , p less 0 001 \) statistically significant differences delta score patients three vessel disease delta st delta hr greater equal 3 0 microv beat min one two vessel disease delta st delta hr greater equal 3 0 microv beat min \( delta 18 1 2 0 versus 21 9 3 3 , p ns score 68 5 6 6 versus 66 3 11 3 , p ns \) findings demonstrate delta st delta hr useful conventional analysis st segment depression identifying anatomically severe coronary artery disease also functionally severe coronary artery disease
ace inhibition improves vagal reactivity patients heart failure autonomic control heart rate studied 34 patients heart failure \( new york heart association nyha functional class ii iii \) examining carotid sinus baroreflex carotid sinus stimulated graded suction slope regression line increases cycle length degree neck suction taken index baroreflex sensitivity reflex response mediated selective increase vagal efferent activity baroreflex sensitivity therefore represents measure vagal reactivity using multiple regression analysis , baroreflex sensitivity \( \) correlated positively stroke volume index \( \) inversely plasma renin activity \( pra \) age 0 47 0 38 pra 0 23 age constant \( r 0 74 p less 0 0005 \) addition digitalis diuretics , angiotensin converting enzyme \( ace \) inhibitors \( captopril enalapril \) given 16 patients mean 17 3 days patients hemodynamic improvement \( group \) exhibited improved baroreflex sensitivity \( 1 4 0 4 3 6 1 2 msec mm hg p less 0 01 \) baroreflex sensitivity remained unchanged \( 3 1 0 8 2 4 1 0 msec mm hg n \) patients without hemodynamic improvement \( group b \) increase reflex sensitivity correlate hemodynamic alterations baroreflex sensitivity ace inhibition \( \) related baseline baroreflex sensitivity \( \) 2 8 0 46 \( r 0 84 p less 0 005 \) patients heart failure , reflex bradycardia decreases age pra increases stroke volume chronic therapy ace inhibitors enhances vagal reactivity patients hemodynamic improvement
ioxaglate iopamidol equally safe well tolerated cardiac angiography \? randomized , double blind clinical study randomized , double blind , parallel group study performed 50 patients undergoing left ventriculography coronary arteriography evaluate ecg changes effects left ventricular function low osmolar ionic contrast agent , ioxaglate , compared low osmolar nonionic contrast medium , iopamidol twenty five patients received ioxaglate \( group 1 \) 25 patients received iopamidol \( group 2 \) patients underwent 48 hours continuous ecg recording beginning 24 hours cardiac catheterization left ventricular systolic end diastolic pressure , peak positive dp dt , dp dt p ratio measured immediately left ventriculography 3 minutes later left ventricular systolic pressure change injection either contrast medium left ventricular end diastolic pressure increased 30 group 1 \( p less 0 01 \) 22 group 2 \( p less 0 01 \) immediately left ventriculography increase 45 group 1 \( p less 0 01 \) 24 group 2 \( p less 0 01 \) observed 3 minutes later differences observed values obtained two groups peak positive dp dt change immediately injection either contrast medium decreased 5 \( significant \) group 1 7 \( p less 0 02 \) group 2 three minutes left ventriculography significant differences two groups analysis continuous 48 hour ecgs showed ioxaglate iopamidol induced slight increase \( 8 7 , respectively p less 0 05 \) heart rate injection early complete recovery
transesophageal echocardiography awake elderly patient role clinical decision making process assess impact management safety transesophageal echocardiography \( tee \) elderly population , results limitations technique retrospectively analyzed 88 patients tee indicated whenever transthoracic approach diagnostic inconsistent clinical setting frequent clinical indications investigate source emboli , assess valvular regurgitation , identify valvular 72 patients \( 82 \) tee significantly influenced management decisions selected patients tee avoided use invasive diagnostic procedures adverse effects included occasional premature atrial ventricular beats \( 11 patients \) , sinus bradycardia \( six patients \) , protracted nausea \( one patient \) conclude elderly patients cardiovascular diseases , tee plays significant role decision making process without adding significant risk
noninvasive assessment cardiac output children using impedance study evaluated effect intracardiac shunting accuracy thoracic derived cardiac output determinations twenty six patients , ranging age 3 months 17 years , underwent cardiac catheterization simultaneous fick impedance measurements cardiac output obtained subjects divided three groups 10 children intracardiac shunts , nine children predominant left right intracardiac shunts , seven children predominant right left intracardiac shunts positive correlations impedance fick derived cardiac output determinations obtained non shunt group \( r 0 84 \) , lower correlations left right shunt group \( r 0 70 \) right left shunt group , impedance derived cardiac output correlated fick pulmonary flow \( r 0 82 \) , variability unacceptably large although study needed , impedance appears validity methodology pediatric critical care cardiovascular health research
's view contrast media , clotting angiography thrombosis coronary angiography ionic contrast media \( cm \) stronger anticoagulants antiplatelet agents , nonionic ionic cm clotting , fibrinopeptide generation platelet aggregation \( least born aggregometry \) thus , nonionic cm cause clots thrombi rather , driving force clot thrombus formation , occurs , blood contact activation foreign surface syringe catheter marked enhancement clotting glass comparison plastic ones supports view blood syringe catheter , therefore , clot slowly presence nonionic ionic cm , inhibitory effects latter profound respect models thrombosis sites vascular injury stenosis , antithrombotic effects cm may either transient owing dynamic nature blood flow \( local endothelial cell denudation model \) , case ionic cm , actually enhance local platelet aggregation \( stenosis model \) situations , preservation antithrombotic functions endothelium nonionic cm may quite critical
clinical cardiovascular magnetic resonance imaging magnetic resonance imaging \( mri \) powerful tool providing high resolution images heart great vessels without use ionizing radiation contrast agents mri systems currently use many hospitals used effectively routine , clinical evaluation many forms cardiovascular disease , including great vessel disease , ischemic cardiac disease congenital cardiac disease moreover , quantitative cine mri techniques available , provide highly accurate measures chamber size , wall motion wall thickening recent developments areas myocardial , high speed imaging mr assessments flow perfusion suggest potential increasing role mri clinical evaluation cardiovascular system
clinical nuclear magnetic resonance spectroscopy insight metabolism nuclear magnetic resonance \( nmr \) spectroscopy evaluate changes metabolites different disease states , well therapeutic interventions animal studies provided basis understanding changes high energy phosphates myocardial ischemia studies graded ischemia due partial coronary stenosis shown sensitivity ratio inorganic phosphate small reductions myocardial blood flow relation myocardial function application nmr spectroscopy humans requires precise localization techniques avoid acquiring contaminating information structures around heart , chest wall diaphragm localization techniques , metabolic evidence ischemia demonstrated patients myocardial infarction patients known coronary disease , although sensitivity technique diagnosis inducible ischemia unknown rest , patients dilated hypertrophic cardiomyopathies often elevated resonance , possibly abnormal breakdown membrane phospholipids increasing oxygen demand patients usually alter high energy phosphates , suggesting oxidative energy metabolism preserved conditions nmr spectroscopy powerful tool increase understanding metabolic changes variety pathologic conditions
positron emission tomography interventional cardiology current noninvasive diagnostic techniques limited accuracy detection coronary artery disease \( cad \) symptomatic \( particularly \) asymptomatic patients silent disease furthermore , standard noninvasive method provides reliable diagnostic information location coronary arteries involved , severity stenosis , presence collaterals myocardial viability based greater 1 , 000 cardiac studies university texas , cardiac positron emission tomography \( pet \) either generator produced rubidium 82 , produced n 13 ammonia , f 18 deoxyglucose suitable 4 routine diagnostic purposes \( 1 \) noninvasive diagnosis cad either symptomatic asymptomatic subjects sensitivity 95 98 specificity 95 100 accuracy sufficient schedule diagnostic catheterization multivessel angioplasty surgical basis pet scan university texas carry pet asymptomatic symptomatic patients direct mild disease cholesterol lowering reversal therapy severe disease percutaneous transluminal coronary angioplasty \( ptca \) \( 2 \) assessment physiologic severity coronary artery stenosis compared automated quantitative coronary arteriographic analysis changes stenosis severity followed interventions including ptca , bypass surgery , vasodilator drugs cholesterol control regimens reversal coronary atherosclerosis \( 3 \) imaging myocardial infarction , ischemia , viability , zone risk pathophysiologic processes
role magnetic resonance contrast agents cardiac imaging improvements magnetic resonance imaging \( mri \) technology allow adequate spatial temporal resolution capture cardiac anatomy contractile function detail little risk however , tissue characterization pathophysiologic state myocardium may require special indicators mr contrast agents must tailored detection mri process , available agents effective low dose provide wide range indicator properties \( e g , myocardial extracellular space , blood pool , capillary permeability membrane transport \) agent dynamic washout time intensity curve may reflect myocardial perfusion consequences ischemia combined use mri mr contrast agents may provide single diagnostic examination fully quantitatively assesses indexes cardiac performance information would global regional , would well tolerated patients cost , value cost effectiveness studies remain
beta blockers primary prevention nonfatal myocardial infarction patients high blood pressure population based , case control study conducted determine whether beta blockers , used treatment high blood pressure , prevent first events coronary heart disease study subjects health maintenance organization enrollees pharmacologically treated hypertension patients presented 1982 1984 new coronary heart disease , control subjects probability sample eligible hypertensive enrollees free coronary heart disease investigators blind case control status , subjects' medical records reviewed coronary risk factors , health maintenance organization 's computerized database used ascertain use beta blockers larger proportion controls cases using beta blockers difference confined subgroup nonfatal myocardial infarctions current use , estimated relative risk nonfatal myocardial infarction 0 62 \( 95 confidence interval , 0 39 0 99 \) among current users beta blockers , higher doses conferred greater protection past use total lifetime intake beta blockers weakly associated case control status current use beta blockers may prevent first events nonfatal myocardial infarction patients high blood pressure
timing triggers transient myocardial ischemia use exercise tolerance testing new techniques ambulatory electrocardiographic monitoring objectively measure myocardial ischemia enabled clinicians better recognize magnitude , timing variable characteristics transient ischemic events commonly occurring events patients coronary artery disease diurnal pattern strikingly similar reported catastrophic cardiovascular events myocardial infarction , sudden cardiac death stroke whether factors contribute reversible ischemic events similar causing infarction sudden death resolved however , parallel increase morning activity related phenomena suggests better understanding triggers reversible myocardial ischemia may help improve understanding causes myocardial infarction sudden cardiac death
application time series analysis circadian rhythms effect beta adrenergic blockade upon heart rate transient myocardial ischemia circadian variations transient myocardial ischemia heart rate identified , rhythms response beta blockade fully characterized time series analysis , mathematical technique describe activity occurring within continuous data set used , address issues nine men coronary artery disease underwent 72 hours ambulatory electrocardiographic monitoring therapy placebo metoprolol administration placebo , ischemic time heart rate showed primary peak periodicity approximately 24 hours tight coupling 2 variables secondary peak periodicity 5 8 hours metoprolol therapy , heart rate ischemic variation reduced 24 hour periodicity heart rate remained 24 hour periodicity ischemia eliminated , data 5 8 hour periodicity became major component signal
transient myocardial ischemia relation determinants myocardial oxygen demand conflicting data clear need establish relative role increase myocardial oxygen demand versus reduction coronary blood flow causation transient ischemia , role heart rate blood pressure changes immediately preceding transient ischemic events observed daily life evaluated 25 patients coronary artery disease elevations heart rate onset ischemia observed 61 episodes similarly , 73 ischemic events preceded increase arterial pressure data provide evidence significant role increased myocardial oxygen demand genesis transient myocardial ischemia
mental stress acute trigger ischemic left ventricular dysfunction blood pressure elevation coronary artery disease acute mental stress may frequent trigger transient myocardial ischemia , myocardial infarction sudden cardiac death experimental setting , effect mental stress hemodynamics left ventricular wall motion abnormalities \( detected radionuclide ventriculography \) measured 29 patients exercise induced myocardial ischemia seventy five percent patients demonstrated mental stress induced wall motion abnormalities patients frequently exhibited greater increases peak systolic arterial pressure mental stress exercise relevant mental stress potent type mental stress , terms frequency magnitude ischemia mental stress induced ischemic episodes clinically electrocardiographically silent occur heart rates significantly lower seen exercise systolic diastolic blood pressure increased mental stress induced ischemia , suggesting increased myocardial oxygen demand plays role pathophysiology mental stress induced transient ischemia significant magnitude acute onset mental stress induced blood pressure elevation may manner contribute atherosclerotic plaque rupture findings may provide pathophysiologic link epidemiologic association mental stress acute ischemic coronary events new ambulatory radionuclide detector concurrently monitor left ventricular ejection fraction electrocardiographic st segment change may enhance detection evaluation transient myocardial ischemia ambulatory coronary patients
potential usefulness combined thromboxane a2 serotonin receptor blockade preventing conversion chronic acute coronary artery disease syndromes evidence suggests unstable angina , non q wave myocardial infarction q wave myocardial infarcts represent continuum , transient reduction coronary blood flow associated platelet aggregation dynamic vasoconstriction sites coronary artery stenosis endothelial injury lead abrupt development unstable angina factors potentially responsible conversion chronic acute coronary artery disease include endothelial injury sites stenosis endothelial injury may result plaque fissuring ulceration , hemodynamic factors \( including systemic arterial hypertension flow shear stress \) , infection , smoking , coronary arteriography balloon angioplasty clinical experimental animal studies suggest interference thromboxane serotonin contributions platelet aggregation dynamic coronary artery constriction may prevent chronic coronary artery disease syndromes converting acute disease protect process may require thromboxane serotonin receptor antagonists combination thromboxane synthesis inhibitor receptor antagonist serotonin receptor antagonist studies needed test hypothesis
beta blocker duration action implications therapy two studies conducted measure effect serum half life beta blocker related heart rate reduction throughout 24 hour period first study , nadolol , atenolol pindolol associated significant \( p less 0 01 \) heart rate reduction even 24 hours dose nadolol , plasma half life 15 5 hours , pronounced heart rate lowering effect 24 hours daily dose compared pindolol , half life 5 5 hours randomized , double blind , crossover study , nadolol atenolol similar effects 3 4 hours daily dose nadolol , however , produced greater suppression heart rate double product \( blood pressure x heart rate \) atenolol \( compared placebo \) 24 hours ingestion daily dose ambulatory electrocardiography 24 hours medication administration , 80 100 heart rate attenuating effect nadolol maintained versus 20 45 atenolol 's effect statistically significant \( p less 0 05 \) reductions heart rate produced nadolol , atenolol , 4 5 , 6 7 , 8 9 9 10 furthermore , nadolol remained 52 peak blood level 24 hours , whereas atenolol 20 data 2 studies indicate significant differences duration action exist beta blockers
effect beta adrenergic blocking agents circadian occurrence ischemic cardiovascular events clinical observations suggest beta adrenergic blocking agents modify circadian occurrence variety ischemic events morning awakening associated rapid increase blood pressure pulse , serum catecholamine content platelet activation , time decreased blood thrombolytic activity beta adrenergic blocking agents potential modify many events current data indicate agents modify blood pressure pulse , prevent early morning increase addition , beta adrenergic blocking agents decrease ventricular ectopy circadian variation recent studies humans indicate , however , metoprolol affect circadian increase platelet activity serum catecholamines specific mechanism beta blockers affect circadian occurrence ischemic events remains uncertain
reduction mortality , sudden death non fatal reinfarction beta adrenergic blockers survivors acute myocardial infarction new hypothesis regarding cardioprotective action beta adrenergic blockade beta adrenergic blockers shown definitely reduce incidence total mortality , cardiovascular mortality , sudden death nonfatal reinfarction survivors acute myocardial infarction mechanisms explain protective action beta blockers never elucidated conclusively , include antiarrhythmic myocardial oxygen demand reducing effects drugs antithrombotic mechanism also suggested however , beta blockers relatively weak antiplatelet activity , suggesting antithrombotic effects may related prevention coronary artery plaque rupture subsequent propagation occlusive arterial thrombus rather direct anticoagulant action therapeutic ability beta blockers attenuate hemodynamic consequences catecholamine , may protect vulnerable atherosclerotic plaque fracture , thereby reducing risk coronary thrombosis , myocardial infarction death
exercise test predictors ambulatory silent ischemia daily life stable angina pectoris predictive value several exercise test parameters identifying stable angina patients risk silent myocardial ischemia daily life examined total 97 patients coronary artery disease , stable angina ambulatory electrocardiographic data evaluated 86 patients positive exercise test , 39 \( group 1 \) greater equal 1 episodes st segment depression 47 \( group 2 \) develop st changes ambulatory electrocardiographic monitoring comparison exercise test parameters 2 groups revealed early onset ischemia exercise tests single significant \( p less 0 0005 \) predictor ambulatory silent ischemia exercise test parameters showing significant differences 2 groups peak exercise heart rate \( 117 23 vs 126 20 beats min , p less 0 05 \) peak systolic blood pressure \( 160 27 vs 176 27 mm hg , p less 0 01 \) , significantly lower group 1 patients data used derive simple mathematical formulas calculating risk ambulatory silent ischemia results demonstrate stable angina patients risk silent ischemia daily life accurately identified evaluation selected exercise test parameters
effects theophylline , atenolol combination myocardial ischemia stable angina pectoris effects theophylline \( 400 mg twice day \) , atenolol \( 50 mg twice day \) combination myocardial ischemia studied 9 patients stable angina pectoris randomized , single blind , triple crossover trial placebo administered patients run run periods treadmill exercise test 24 hour ambulatory electrocardiographic monitoring obtained end treatment period compared placebo , theophylline significantly improved time onset myocardial ischemia \( 1 mm st segment depression \) 7 8 3 7 9 5 3 7 minutes \( p less 0 03 \) exercise duration 9 3 4 10 1 3 5 minutes \( p less 0 04 \) atenolol combination treatment , time onset ischemia exercise duration similar \( 10 8 4 2 11 2 3 2 minutes , 11 2 3 6 11 5 3 2 minutes , respectively \) longer theophylline administration \( p less 0 05 \) ambulatory electrocardiographic monitoring showed , theophylline administration , heart rate higher placebo throughout 24 hours \( p less 0 05 \) atenolol combination treatment heart rate similar cases lower placebo \( p less 0 05 \) compared placebo , theophylline decreased total ischemic time 97 110 70 103 minutes \( p less 0 05 \)
effects two types fish oil supplements serum lipids plasma phospholipid fatty acids coronary artery disease fish oil consistently shown lower triglyceride levels , effects low density lipoprotein \( ldl \) cholesterol remain controversial current study compares long term effects 2 different fish oil preparations \( ethyl ester triglyceride \) versus olive oil patients coronary artery disease eighty nine subjects randomly assigned receive capsules containing 6 g day \( triglyceride group \) 7 g day \( ethyl ester group \) n 3 fatty acids , capsules containing 12 g day olive oil 6 months mean triglyceride levels decreased 28 ester 32 triglyceride fish oil groups \( p less 0 05 \) ldl cholesterol levels increased 3 \( difference significant \) ester 12 \( p less 0 05 \) triglyceride fish oil groups subjects increase 23 \( p less 0 01 \) 14 \( difference significant \) , respectively plasma phospholipid fatty acid analysis showed fivefold increase eicosapentaenoic acid levels fish oil groups \( p less 0 001 \) , long term decrease arachidonic acid levels \( p less 0 001 \) achieved eicosapentaenoic acid level correlated degree increase ldl cholesterol \( r 0 38 , p less 0 05 \) data suggest fish oil administration associated increase ldl cholesterol levels diverse group patients coronary artery disease change appears correlated n 3 fatty acid absorption impact increase ldl unknown , considered potentially adverse
predictive value lipoprotein \( \) serum lipoproteins angiographic diagnosis coronary artery disease determine relation among lipids predicting coronary artery disease \( cad \) , 213 patients undergoing diagnostic angiography suspected cad prospectively studied twenty one patients normal coronary arteries 192 cad 1 3 arteries arteriography measurements obtained digital lipoproteins measured lipoprotein \( \) lp \( \) also assayed subset 98 patients cad statistical analysis performed using multivariate techniques test association among age , gender , systemic hypertension , diabetes mellitus , cigarette smoking , family history , total cholesterol , triglycerides , high density lipoprotein \( hdl \) cholesterol , low density lipoprotein \( ldl \) cholesterol , low density lipoprotein cholesterol , apolipoproteins \( apo \) apo b , ratio apo apo b , ratio hdl cholesterol total cholesterol , lp \( \) cad factors except gender , systemic hypertension , diabetes mellitus cigarette smoking univariate predictors cad multivariate predictors , decreasing order significance , family history , age , hdl total cholesterol ratio apo b lp \( \) included , multivariate predictors age , family history , apo b lp \( \) , order lipid parameters alone showed hdl total cholesterol ratio lp \( \) provide best predictive tests detection cad referral population may ultimately become important screening tests cad
videodensitometry versus digital quantitative coronary angiography single plane left coronary angiograms 18 patients prospectively analyzed using videodensitometry \( 70 system \) digital compare arterial dimensions , stenosis dimensions , intraobserver variability interobserver variability methods total arterial segments measured , yielding highly significant correlation videodensitometry caliper determined cross sectional area \( r 0 96 , p 0 0001 \) similarly , highly significant linear relation observed videodensitometry caliper determined diameter \( r 0 95 , p 0 0001 \) data subsets small , medium large arterial segments examined , higher variability correlation videodensitometry caliper determined area observed large segments \( greater 10 mm2 \) addition , caliper estimated areas tended slightly smaller videodensitometry estimated areas segments diameter estimations , correlations caliper videodensitometry data similar entire range arterial segment sizes intra interobserver variability low caliper videodensitometry determination diameter area thus , wide range arterial dimensions , results obtained caliper estimates luminal area diameter comparable obtained videodensitometry using 70 system
frequency myocardial indium 111 antimyosin uptake uncomplicated coronary artery bypass grafting reported incidence myocardial damage coronary artery bypass grafting \( cabg \) highly related methods used since indium 111 monoclonal antimyosin antibody scintigraphy shown highly specific sensitive myocardial necrosis , even small lesions , uptake evaluated cabg 23 consecutive patients without previous myocardial infarction underwent cabg stable angina , 80 mbq indium 111 antimyosin injected third postoperative day planar images obtained 48 hours later analyzed myocardial uptake indium 111 antimyosin scintigraphic results related creatine kinase mb levels , duration aortic cross clamping cardiopulmonary bypass , electrocardiographic changes patients surgical procedure postoperative course uncomplicated indium 111 antimyosin uptake present 19 23 patients \( 82 \) 7 patients localized 12 pathologic q waves occurred postoperatively fourteen patients exhibited st segment changes good relation found among indium 111 antimyosin uptake creatine kinase mb levels , duration cross clamping bypass , st changes concluded degree myocardial damage , though silent , common cabg
prognostic value predischarge low level exercise thallium testing thrombolytic treatment acute myocardial infarction low level exercise thallium testing useful identifying high risk patient acute myocardial infarction \( ami \) determine whether use also patients thrombolytic treatment ami , 64 patients underwent early thrombolytic therapy ami 107 patients without acute intervention evaluated ability electrocardiogram thallium tests predict future events compared groups mean follow days , 25 32 cardiac events 2 groups , respectively , versus without acute intervention included death , another ami , coronary artery bypass grafting angioplasty 75 events occurring 3 months first infarction significant predictors outcome left ventricular cavity dilatation intervention group st segment depression increased lung uptake group sensitivity exercise thallium 55 intervention group 81 group \( p less 0 05 \) therefore , patients thrombolytic therapy ami , nearly half events discharge predicted predischarge low level exercise thallium testing relatively weak correlation outcome ischemia laboratory discharge may due unstable coronary lesion rapid progression disease test tests considered useful ami may necessarily similar value acute intervention , thrombolytic therapy
long term effect left ventricular function relation suppression ventricular arrhythmia effects oral left ventricular \( lv \) ejection fraction \( ef \) ventricular arrhythmias possible relation effects evaluated 3 months therapy 29 patients chronic ventricular premature complexes \( \) moderately reduced normal lvef 24 hour holter monitoring radionuclide ventriculography rest maximum tolerable exercise testing average titration period 13 days , mean daily dose mg maintained throughout treatment end titration 3 months treatment , patients baseline lvef less equal 40 \( group 2 \) responded median reduction hourly rate 90 81 , respectively , compared 79 72 baseline lvef greater 40 \( group 1 \) runs ventricular tachycardia almost completely suppressed nearly patients single patient increase treatment compared baseline , significant changes resting exercise lvef 1 3 months treatment either 2 groups patients correlation found treatment induced changes arrhythmia frequency resting ef symptoms congestive heart failure developed study confirms long term use efficacious relatively free cardiac depressant effects even patients diminished lv function
effectiveness daily calcium antagonist , , controlling 24 hour ambulatory blood pressure efficacy new daily dihydropyridine calcium antagonist , , reducing ambulatory intraarterial blood pressure \( bp \) examined 12 untreated hypertensive patients intraarterial recording 24 hours first 4 mg dose continued 24 hours thereafter dose titration chronic therapy , second 24 hour ambulatory bp recording made steady onset drug action , maximal 2 hours , reflex tachycardia first dose chronic administration reduced bp throughout 24 hour period , without tachycardia mean daytime reduction bp 20 mm hg systolic \( p less 0 005 \) 12 mm hg diastolic \( p less 0 02 \) mean nighttime reduction 8 mm hg systolic \( p less 0 05 \) 6 mm hg diastolic \( difference significant \) postural decrease bp 60 degrees head hypotensive action maintained isometric exercise \( reduction peak 32 18 mm hg , p less 0 05 \) throughout dynamic exercise \( reduction peak 23 14 mm hg , p less 0 05 \) effective daily antihypertensive agent , good control stress response
atenolol therapy exercise induced hypertension aortic coarctation repair successful repair coarctation aorta childhood , exercise induced upper body systolic hypertension well documented beta blockade shown reduce arm leg gradient untreated coarctation aorta treatment coarctation repair decreased paradoxical hypertension repair ten patients successful surgical repair coarctation , defined resting arm leg gradient less equal 18 mm hg , evaluated treadmill exercise beta blockade atenolol mean age 5 5 years repair 18 study baseline evaluation , systolic blood pressures termination exercise ranged 201 270 mm hg \( mean 229 mm hg \) arm leg gradients exercise termination ranged 30 143 mm hg \( mean 84 \) follow treadmill exercise studies performed beta blockade upper extremity systolic pressures exercise termination normalized 9 10 patients maximal systolic blood pressure recorded exercise termination ranged 163 223 mm hg \( mean 196 mm hg , p less equal 0 005 \) arm leg gradient termination exercise also decreased significantly mean 51 mm hg \( p less 0 05 \) patient symptoms atenolol exercise endurance times unchanged study results small series suggest cardioselective beta blockade used treat exercise induced upper body hypertension effectively surgical repair coarctation high incidence premature cardiovascular disease well documented satisfactory surgical repair , findings importance group postoperative patients
subnormal parasympathetic activity cardiac transplantation heart period variability \( standard deviation 120 consecutive rr pp intervals \) used assess baseline parasympathetic activity 18 patients congestive heart failure orthotopic cardiac transplantation , compared 16 age matched control subjects mean heart period variability \( standard error mean \) significantly greater \( p less 0 05 \) control subjects \( 58 5 ms \) patients time transplantation heart period variability innervated recipient atria change significantly early \( 1 4 weeks \) transplantation \( 16 2 24 5 ms p 0 11 \) , increased significantly weeks 15 37 transplantation \( 30 5 ms , p less 0 002 versus transplantation \) stepwise regression model \( r2 0 35 p 0 01 \) showed heart period variability directly related time transplantation inversely related systolic arterial pressure transplantation degree rejection heart period variability denervated donor atria change early late periods transplantation , suggesting vagal reinnervation donor heart occurred data indicate baseline parasympathetic activity increase significantly first month transplantation increases significantly months 3 6
erythrocyte fatty acids , plasma lipids , cardiovascular disease rural china cardiovascular disease \( cvd \) mortality \( coronary heart disease , hypertensive heart disease , stroke \) , plasma lipids , red blood cell fatty acid composition examined study 65 rural counties people 's republic china means plasma total cholesterol , triglyceride , low density lipoprotein \( ldl \) cholesterol , high density lipoprotein \( hdl \) cholesterol concentrations substantially lower ratio hdl cholesterol total cholesterol higher chinese population western populations mortality rates cvd china well western values within china neither plasma total cholesterol ldl cholesterol associated cvd strong inverse correlation red blood cell oleate concentrations cvd observed however , red blood cell oleate concentrations associated plasma cholesterol strongly negatively associated concentrations , suggesting potential diminution cvd oleate reduced platelet aggregability results indicate geographical differences cvd mortality within china caused primarily factors dietary plasma cholesterol
developing improved observational methods evaluating therapeutic effectiveness therapeutic efficacy often studied observational surveys patients whose treatments selected results surveys fear results occur absence experimental principles , particularly randomization purpose current study develop validate improved observational study designs incorporating many design principles patient assembly procedures randomized trial specific topic investigated prophylactic effectiveness beta blocker therapy acute myocardial infarction accomplish research objective , three sets data compared first , developed restricted cohort based eligibility criteria randomized clinical trial second , assembled expanded cohort using design principles except restricting patient eligibility third , used data beta blocker heart attack trial \( \) , whose results served gold standard comparison research , treatment difference death rates restricted cohort trial nearly identical contrast , expanded cohort larger treatment difference observed trial also noted important largely neglected role eligibility criteria may play ensuring validity treatment comparisons study outcomes new methodologic strategies developed may improve quality observational studies may useful assessing efficacy many medical surgical therapies cannot tested randomized clinical trials
effects calcium channel blockade calcium homeostasis mild moderate essential hypertension calcium channel blockers may alter parathyroid hormone secretion vitro , would alter calcium homeostasis determine chronic effect calcium channel blockade vivo , conducted randomized , double blind , 16 week study comparing effects two pharmacologic antihypertensive agents , calcium channel blocker diltiazem angiotensin converting enzyme inhibitor captopril parameters calcium homeostasis diltiazem captopril lowered blood pressure similar degree neither drug produced significant change blood levels total ionized calcium , magnesium , phosphorus , affect regulation parathyroid hormone vitamin addition , eight 16 weeks following initiation , neither drug altered serum levels parathyroid hormone \( pth \) 1 , 25 \( oh \) 2 vitamin d3 \( 1 , 25 \) chronic calcium channel blockade diltiazem alter serum parameters calcium homeostasis , thus , affect bone mineralization
molecular biology cardiology recent developments opportunities clinical applications molecular biology taken place last decade provided powerful research methods changing understanding cardiovascular physiology disease editorial commentary highlight several areas current research activity within broad expanding field molecular cardiology , special emphasis prospects clinical applications cardiovascular medicine
clustering atherogenic behaviors coffee drinkers studied clustering coffee consumption selected atherogenic behaviors older adults living southern california community men somewhat likely drink caffeinated coffee women likely drink coffee men , women , caffeinated coffee drinking decreased age coffee drinking increased caffeinated coffee drinkers drank alcohol , consumed dietary saturated fats cholesterol , likely current smokers less likely current non coffee drinkers smoking exercise also showed dose response relationship amount caffeinated coffee consumed risk factor levels among drinkers coffee like caffeinated coffee non drinkers data illustrate clustering atherogenic behaviors coffee drinking highlight potential importance interpreting growing body literature coffee health
association type behavior change coronary risk factors among young adults association type b behavior pattern changes blood pressure , total serum cholesterol , serum triglyceride , body mass , smoking estimated cohort young black white men women rural county central 1978 79 1985 88 type participants experienced significant increases systolic \( 2 90 1 29 mmhg \) diastolic \( 3 80 1 17 mmhg \) blood pressure cigarette smoking \( 3 26 0 89 cigarettes per day \) eight year follow period , type b participants experienced change type b individuals showed similar changes total serum cholesterol , serum triglyceride , body mass differences behavioral types blood pressure present women men , blacks whites findings suggest possible significance type pattern development cardiovascular risk young adults
framingham disability study relationship various coronary heart disease manifestations disability older persons living community relation coronary heart disease disability examined 2 , community women men ages 55 88 years framingham study participants originally recruited 51 examination cardiovascular disease twenty seven years later , remaining members cohort interviewed ascertain physical abilities , score disability scale assigned multivariate logistic analyses examined disability relation uncomplicated angina pectoris \( ap \) , complicated ap , coronary heart disease ap , controlling possible younger older women men , uncomplicated complicated ap associated disability coronary heart disease ap associated disability younger men congestive heart failure predicted disability women results suggest onset ap recognized critical point development disability ap better predictor disability myocardial infarction coronary insufficiency
hypertension prevalence status awareness , treatment , control hispanic health nutrition examination survey \( hhanes \) , 1982 84 prevalence rates hypertension among adult \( ages 18 74 \) mexican americans , cuban americans , puerto ricans estimated using data 1982 84 hispanic health nutrition examination survey \( hhanes \) hypertension defined diastolic greater equal 90 mm hg , systolic greater equal 140 mm hg , currently taking antihypertensive medication among mexican americans southwestern united states , 16 8 percent males 14 1 percent females found hypertensive among cuban americans dade county , florida 22 8 percent males 15 5 percent females hypertensive among puerto ricans new york city area 15 6 percent males 11 5 percent females hypertensive age adjusted rates significantly lower comparable rates whites blacks measured second national health nutrition examination survey \( nhanes ii \) , 1976 80 control hypertension hhanes populations fall short 1990 objectives established us public health service 60 percent \( 34 percent controlled mexican american hypertensives , 27 8 percent controlled cuban american hypertensives , 29 percent controlled puerto rican hypertensives
note measurement hypertension hhanes using data hhanes , found rates elevated blood pressure readings clinical examination extremely low sample mexican american puerto rican women prevalence rates one fourth one fifth rates found comparable sample white women findings discrepant little known hypertension prevalence among hispanics estimates hypertension prevalence mexican americans puerto ricans drawn hhanes samples women much lower rates clinical high blood pressure whites , reported hypertension histories excess whites rates medicine usage among hispanics large effective treatment explain disparity prevalence estimates increased , relative discrepancies remained altered sample clinical high blood pressure measure possible explanation discrepancies physicians performed majority blood pressure readings hhanes sample may statistically inefficient discrepancies noted suggest hhanes may reliable source information hypertension among hispanic women
long term impact smoking cessation incidence coronary heart disease using simulation model us male population , estimated long term impact future smoking cessation programs would distribution occurrence coronary heart disease males ages 35 84 interventions reduce number smokers 25 percent 1990 , number men free coronary heart disease projected increase 416 , \( 0 7 percent \) , age standardized absolute incidence decline 2 3 percent incidence rates absolute incidences projected fall men age 65 , absolute incidence would rise men age 65 , large part increased number men risk coronary heart disease reduction non coronary smoking related mortality trends marked greater smoking reductions generally unaffected variety analyses using alternative assumptions , considered smoking risk factor elderly , lag time benefits smoking cessation realized secular declines smoking prevalence subject assumptions model , conclude smoking reductions markedly reduce coronary heart disease , especially younger age groups , benefit slightly offset small increase absolute incidence elderly men
fish oil supplementation patients stable claudication increased blood viscosity occurs patients claudication increase viscosity , mainly due elevated fibrinogen levels decreased red cell deformability , adversely influences blood flow addition positive effect blood pressure , blood lipids , platelet responsiveness , fish oil may improve blood flow due favorable influence prospective , randomized , double blind study , evaluated effect six capsules fish oil \( 1 8 g eicosapentaenoic acid 1 2 g acid \) versus six capsules corn oil \( 3 g linoleic acid \) , administered 4 months , walking distances , pressure indices rest exercise , blood pressure , red cell deformability , fibrinogen , lipid levels 32 patients stable claudication significant changes walking distances pressure indices rest exercise occurred , despite significant increase red cell deformability fish oil group fibrinogen levels change either group fish oil group , favorable change blood lipids noted high density cholesterol increased triglycerides decreased mean arterial blood pressure declined similar extent groups thus , short term supplementation fish oil lead clinically significant improvement symptoms patients stable claudication suggests red cell deformability minor importance arterial blood flow legs patients
comparison blood flow assessment laser doppler velocimetry hydrogen gas clearance method ischemic intestine dogs blood flow colon ileum measured intestinal laser doppler velocimetry hydrogen gas clearance technique 10 dogs order evaluate clinical usefulness laser doppler velocimetry submucosal blood flow colon ileum measured hydrogen gas clearance method significantly decreased , blood flow sites measured laser doppler velocimetry linear relationship flow values using two methods colon \( r 0 , p less 0 001 \) ileum \( r 0 , p less 0 001 \) data suggested laser doppler velocimetry may useful method assess degree intestinal ischemia good correlation submucosal blood flow hydrogen gas clearance technique
finding increased myocardial ischemia carotid endarterectomy anesthesia nitrous oxide nitrous oxide \( n2o \) implicated cause myocardial ischemia investigated whether substitution n2o portion anesthesia supplied isoflurane increased myocardial ischemia patients risk ischemia seventy patients carotid endarterectomies \( 63 patients \) carotid surgery \( seven patients \) prospectively , randomly assigned anesthetic regimen included excluded n2o aspects anesthetic management similar , except greater concentrations oxygen isoflurane patients given n2o perioperative monitoring myocardial ischemia infarction included 12 5 lead electrocardiography , transesophageal echocardiography , creatine kinase isoenzyme levels transesophageal echocardiographic electrocardiographic criteria , 44 patients given oxygen 21 given n2o myocardial ischemia intraoperatively \( p 0 \) similarly , myocardial infarction , identified changes creatine kinase isoenzymes , occurred one patient given n2o three given oxygen \( significantly different \) thus found trend indicating greater incidence myocardial ischemia infarction associated use n2o
thoracic epidural anesthesia improves global regional left ventricular function stress induced myocardial ischemia patients coronary artery disease aim present investigation study effects high thoracic epidural anesthesia \( tea \) , including cardiac sympathetic segments , ischemic st segment changes left ventricular global regional wall motion abnormalities ten patients two three vessel coronary artery disease , treated beta adrenergic blocker metoprolol severe stable angina pectoris , performed two identical exercise stress tests , first without tea \( control exercise \) second tea \( tea exercise \) stress test , intravenous metoprolol given achieve maximal near maximal beta adrenoceptor blockade systolic diastolic arterial pressures \( radial artery cannula \) , heart rate , rate pressure product , well global regional ejection fractions , using equilibrium radionuclide angiography left anterior oblique projection , measured rest maximal exercise st segment analysis \( v3 \) performed , regional wall motion score calculated control exercise tea exercise intravenous metoprolol intravenous metoprolol plus tea rest cause significant changes variables tea exercise , systolic arterial pressure , diastolic arterial pressure , rate pressure product , heart rate , significantly lower compared control exercise global anterolateral ejection fractions significantly higher \( 52 8 versus 46 5 53 2 versus 46 0 , respectively , p less 0 05 \) , regional wall motion score significantly lower \( 8 8 versus 11 8 , p less 0 01 \) tea exercise control exercise st segment depression significantly lower tea exercise \( 1 03 versus 1 84 mv , p less 0 01 \)
pulmonary hypertension heparin protamine roles left sided infusion , histamine , platelet activating factor severe pulmonary hypertension protamine neutralization heparin infrequent life threatening event following cardiopulmonary bypass effect left ventricular infusion protamine pulmonary hypertension well possible role platelet activating factor \( paf \) histamine heparin protamine reaction investigated 30 pigs four different groups general anesthesia group 1 animals received 250 iu kg heparin , followed 100 mg protamine intravenously 15 min group 2 protamine infused left ventricle group 3 animals received histamine h1 h2 antagonists ranitidine 5 min protamine infusion group 4 paf receptor blocker web 2086 given 5 min protamine platelet activating factor measured bioassay serum samples group 1 group 4 animals four groups protamine caused severe pulmonary hypertension , thromboxane a2 release , transient decrease leukocyte counts paf release detected protamine infusion neither left ventricular infusion protamine histamine paf antagonists prevented attenuated reactions protamine infusion authors conclude left ventricular infusion protamine provides protection pulmonary hypertension , histamine paf involved acute pulmonary vasoconstriction protamine neutralization heparin
effects thoracic epidural anesthesia coronary arteries arterioles patients coronary artery disease effect cardiac sympathetic blockade high thoracic epidural anesthesia \( tea \) \( t1 , bupivacaine \) luminal diameter normal diseased portions epicardial coronary arteries determined quantitative coronary angiography patients \( n 27 \) severe coronary artery disease \( cad \) separate group patients \( n 9 \) severe cad , effects tea coronary arterioles \( resistance vessels \) studied , measuring total regional myocardial blood flow metabolism retrograde coronary sinus thermodilution technique stenotic segments , tea induced increase luminal diameter 1 34 0 11 1 56 0 13 mm \( p less 0 002 \) , change diameter nonstenotic segments \( 3 07 0 13 2 99 0 13 mm \) second group patients , tea induced changes coronary perfusion pressure , total regional myocardial blood flow , coronary venous oxygen content , coronary blood flow distribution , regional myocardial oxygen consumption , lactate extraction uptake two patients chest pain control situation regional myocardial lactate production attenuated tea conclude tea may increase diameter stenotic epicardial coronary artery segments patients cad without causing dilation coronary arterioles effects may beneficial high tea used treat severe ischemic chest pain patients rest
effects ketamine cardiac papillary muscle normal hamsters cardiomyopathy effect ketamine \( 10 \( 5 \) 10 \( 4 \) \) intrinsic contractility left ventricular papillary muscle normal hamsters cardiomyopathy \( 82 62 , 6 month old \) investigated concentrations , ketamine induced positive inotropic effect normal papillary muscle , shown increase maximum unloaded shortening velocity \( 19 4 34 5 , p less 0 05 \) , active isometric force \( 32 8 57 11 , p less 0 05 \) , peak power output \( 40 8 80 16 , p less 0 05 \) , induced slight decrease sarcoplasmic reticulum function ketamine effect curvature total force velocity curve , suggesting modify contractility papillary muscle hamsters cardiomyopathy less controls , shown decrease isometric active force \( 41 , p less 0 02 \) , peak power output \( 33 , p less 0 05 \) , sarcoplasmic reticulum function positive inotropic effect ketamine papillary muscle hamsters cardiomyopathy less marked controls almost suppressed cases maximum unloaded shortening velocity significantly increased 10 \( 5 \) ketamine \( 7 6 , p less 0 05 \) , whereas significant changes observed active isometric force \( 14 8 13 11 nonsignificant ns \) peak power output \( 9 5 13 8 ns \) ketamine \( 10 \( 5 \) 10 \( 4 \) , respectively \)
prehospital cardiac arrest impact witnessed collapse bystander cpr metropolitan ems system short response times objective numerous studies shown initiation bystander cpr significantly improve survival prehospital cardiac arrest however , emergency medical services \( ems \) systems short response times , bystander cpr shown impact outcome purpose study determine effect bystander cpr survival hospital cardiac arrest system design prehospital , hospital , death data medium sized metropolitan area retrospectively analyzed adult , nontraumatic cardiac arrest 16 month period results total 298 patients met study criteria one hundred ninety five arrests \( 65 4 \) witnessed , 103 \( 34 6 \) twenty five witnessed victims \( 12 8 \) discharged alive , whereas victims survived \( p less 001 \) patients suffering witnessed episode ventricular fibrillation tachycardia \( vf vt \) likely survive \( 21 9 \) patients \( 2 0 , p less 0001 \) among witnessed patients , initiation bystander cpr associated significant improvement survival \( 20 0 \) compared bystander cpr group \( 9 2 , p less 05 \) bystander cpr also associated improved outcome witnessed patients successful prehospital resuscitation evaluated group 18 bystander cpr , 13 \( 72 2 \) survived compared 12 38 patients bystander cpr \( 31 6 , p less 01 \) conclusion data revealed improved survival rates bystander cpr initiated victims witnessed cardiac arrest ems system short response times
defibrillation study objectives study undertaken assess safety reliability device defibrillation design system consists patient unit base station patient unit contains monitor defibrillator , electrode , , microprocessor , defibrillator base station comprises control panel , computer , ecg display setting fifteen patients treated emergency department cardiac arrest placed patient units activated base station remote location within ed type participants thirteen patients treated ventricular fibrillation , two patients treated ventricular tachycardia interventions thirty one shocks delivered measurements main results cases , voice ecg transmission established without difficulty conclusions conclude system represents safe reliable method treatment ventricular fibrillation , advocate additional use study prehospital applications defibrillation
dissecting aneurysm pulmonary artery pulmonary hypertension pulmonary artery dissection observed 64 yr old female patient severe pulmonary hypertension , probably primary \( pulmonary vascular resistance , cm 5 normal range less equal 200 cm 5 \) patient admitted hospital severe dyspnea exertion echocardiography demonstrated dissecting aneurysm pulmonary artery right heart catheterization revealed severe pulmonary hypertension \( mean pulmonary artery pressure , 64 mm hg normal range , 10 22 mm hg \) dissection pulmonary artery confirmed pulmonary arteriography one year follow uneventful literature , 28 patients dissecting aneurysm pulmonary artery reviewed dissection diagnosed life one patient \( echocardiography \)
normal angiograms carotid pathology nonstenotic atherosclerotic plaques carotid arteries may associated symptoms transient ischemic attacks , , stroke preoperative evaluation patients symptoms traditionally included ultrasound arch aortography angiograms area carotid bifurcation recent evidence shown ultrasound accurate detection morphologic delineation nonstenotic lesions analyzed hospital records 21 patients ultrasonographic evidence disease arteriograms negative patient group comprised 15 men six women , average 66 years patients symptoms hemispheric transient ischemic attacks evaluated b mode ultrasound arteriography ultrasound positive arteriogram negative patients \( e , described radiologist without hemodynamic significant disease ulceration , normal \) ultrasound diagnosis confirmed operation findings 20 50 per cent stenosis ulcerative plaques retrospective review arteriograms , three ulcerations found 21 patients conclude b mode ultrasound better defines nonstenotic ulcerative lesions decisions perform carotid endarterectomy may based either positive test ulcerative plaque b mode ultrasound appropriate symptoms , therefore , may require angiography operation
selection patients acute myocardial infarction thrombolytic therapy purpose critically review current recommendations regarding eligibility patients myocardial infarction thrombolytic therapy data identification relevant studies published january 1980 january 1990 identified computerized search english language literature using medline manual search bibliographies identified articles study selection randomized , controlled trials intravenous thrombolysis acute myocardial infarction unstable angina reviewed smaller , observational studies previous review articles included relevant discussion data extraction key data extracted article , including proportions patients eligible thrombolysis , reasons exclusion thrombolytic therapy , clinical outcomes patients treated excluded treatment validity certain exclusion criteria examined using subgroup analysis large , randomized mortality trials intravenous thrombolysis observations smaller , studies results data synthesis date , relatively patients myocardial infarction considered eligible fibrinolytic therapy group , early late mortality significantly reduced patients excluded thrombolysis , however , continue high early mortality data suggest potential benefits treatment might extended selected high risk subgroups particular , risk benefit ratio may favor inclusion otherwise healthy elderly patients certain patients presenting 6 hours onset symptoms patients history controlled systolic hypertension brief , nontraumatic cardiopulmonary resuscitation data support use fibrinolytic therapy primary treatment patients unstable angina suspected myocardial infarction absence confirmatory electrocardiographic changes conclusions full potential thrombolytic therapy alter natural history acute myocardial infarction realized continued evaluation selection criteria identification treatment greatest possible number eligible patients
effect intravenous streptokinase early mortality patients suspected acute myocardial infarction meta analysis anatomic location infarction published erratum appears ann med 1991 mar 15 114 \( 6 \) purpose determine effect intravenous streptokinase early mortality patients suspected acute anterior acute inferior myocardial infarctions data identification literature search english language studies use intravenous streptokinase treatment suspected acute myocardial infarction period 1966 1989 using ii bibliographies relevant articles number instances , additional details early mortality location myocardial infarction provided authors study selection 140 originally identified articles , 6 specifically met inclusion criteria selected randomized trials used intravenous streptokinase dose 1 5 million units , without additional agents , compared group differed absence streptokinase trials selected review methods section without regard results data extraction data extracted independently two observers using specific methodologic criteria infarct location early mortality conferred , observers agreed completely data results data synthesis among patients suspected acute anterior myocardial infarction , mortality rate control group 17 4 contrast , patients treated streptokinase 12 5 mortality mean risk difference 4 8 \( 95 ci , 7 5 2 1 \) summary risk ratio 0 72 \( ci , 0 65 0 79 \) total patients suspected inferior infarction mortality rate control group 7 6 corrected mortality streptokinase treated patients 6 6 mean risk difference 0 8 \( ci , 1 8 0 2 \) summary risk ratio 0 87 \( ci , 0 76 1 01 \) conclusions intravenous streptokinase clearly confers protective effect early mortality patients suspected acute anterior myocardial infarction magnitude effect order 5 absolute reduction risk death 21 35 days patients , 21 need treated save 1 additional life patients suspected acute inferior infarction , benefit treatment reducing early mortality smaller magnitude less certain patients estimated absolute reduction early mortality approximately 1 , would require treating 125 patients save 1 additional life
laboratory diagnosis prolonged qt interval patients prolongation qt interval risk significant neurological morbidity mortality secondary ventricular tachyarrhythmias patients frequently undergo electroencephalographic \( eeg \) examination evaluate episodes loss consciousness , may associated convulsions electrocardiogram recording part eeg simple common practice , analysis possible qt prolongation routinely performed , part , due fact calculation corrected qt interval straight forward , generally required nomogram presented simplifies determination corrected qt interval , facilitating diagnosis prolongation qt interval eeg laboratory
repair aortic stenosis cardiovascular morphometric hemodynamic results aortic stenosis associated normal systolic pressure aorta branches exception coronary arteries , hypertensive uncommon lesion treated patch several types examined hemodynamics 13 patients underwent operation aortic stenosis 1979 1988 ranged age 2 43 years \( mean age , 14 5 3 8 years standard error mean \) operative deaths preoperative postoperative \( 1 5 years \) catheterization echocardiography combination done 3 patients \( 1 died late suddenly without postmortem examination 1 lost follow 1 yet restudied \) pressure gradients across stenosis patients treated single sinus patch \( n 4 \) 65 18 mm hg preoperatively 5 3 mm hg postoperatively \( p less 0 05 \) patients patch \( n 6 \) , 83 15 mm hg preoperatively 6 2 mm hg postoperatively \( p less 0 05 \) two groups significantly different measurements diameters coronary arteries , aortic annulus , descending aorta made , calculation ratio coronary artery annulus diameters descending aortic diameters preoperatively postoperatively possible 5 patients left coronary artery larger normal operation preoperatively disproportionate increase left coronary artery annulus size systole left ventricular wall thickness decreased significantly postoperatively \( p less 0 05 \) repair aortic stenosis \( localized diffuse \) single sinus patch repair safe hemodynamic results good
clinical performance st jude medtronic hall prostheses randomized comparative study newer improved models mechanical prostheses regularly added armamentarium study designed compare clinical performance two used current models mechanical prostheses august 1983 july 1985 , 182 white patients prospectively randomized implantation st jude medical \( 95 patients \) medtronic hall \( 87 patients \) prostheses 84 mitral , 85 aortic , 13 double \( mitral aortic \) valve replacements differences two groups regard sex distribution , age , functional class , emergency operation , site implantation early mortality 3 2 patients st jude valve 5 7 medtronic hall \( p ns \) survivors followed 3 5 years \( mean , 4 2 0 6 years cumulative follow , 559 patient years \) late mortality 7 1 patient year st jude group 3 2 patient year medtronic hall group \( p less 0 05 \) however , valve related mortality equal \( 1 4 patient year \) groups noncardiac causes accounted difference st jude medtronic hall groups \( 2 5 patient year 0 4 patient year , respectively \) cases thrombotic obstruction , whereas serious systemic thromboembolism occurred rate 1 8 patient year \( 5 episodes \) st jude group 2 5 patient year \( 7 episodes \) medtronic hall group \( p significant \) another nine episodes systemic embolism left sequelae three patients \( st jude , 2 medtronic hall , 1 \) , aortic valve replacement , required reoperation \( 0 5 patient year \) prosthetic endocarditis , two deaths
prolonged extracorporeal life support pediatric adolescent cardiac transplant patients options mechanical support pediatric patients severe heart failure awaiting transplantation undergone transplantation limited report examines 3 patients placed extracorporeal life support \( ecls \) awaiting transplantation 3 patients underwent transplantation suffered subsequent heart failure due rejection postoperative myocardial dysfunction overall survival rate 2 6 2 surviving patients failing transplanted heart survivors among patients placed ecls bridge transplantation case contraindication transplantation developed donor heart could obtained mean time ecls support 147 5 hours \( range , 70 370 hours \) ecls circuit affect cyclosporin levels therapy extracorporeal life support used support pediatric cardiac transplant patients biventricular failure due acute rejection postoperative dysfunction although results , ecls may still role bridge transplantation however , complications develop ecls may preclude transplantation
tension complication single lung transplantation tension uncommon adult population present case tension complication lung transplantation 54 year old woman thromboembolic pulmonary hypertension underwent single lung transplantation
new technique arterial switch operation difficult situations technique described , modification operation , avoids coronary also eliminates need use artificial material transfer coronary circulation
postinfarction ventricular septal defect repair retrospective historical perspectives evolution surgical techniques repair postinfarction ventricular septal rupture initially involved differentiation lesions prior experience surgical approaches congenital ventricular septal defects , main applicable second , understanding differing anatomical locations postinfarction ventricular septal defects required terms location type repair necessary achieve successful result given patient gradual appreciation different clinical courses pursued patients postinfarction ventricular septal rupture terms location defect degree right ventricular functional impairment led increased urgency relative timing surgical repair incorporation specific anatomical concepts surgical repair better understanding time course physiological deterioration patients ultimately lead integrated approach aimed toward improved salvage patients suffering catastrophic complication acute myocardial infarction
repair anterior leaflets tricuspid mitral valves cusp remodeling present alternative approach extensive rupture chordae tendineae leading anterior leaflets resection affected cusp segment , suture cut edges , extensive segment annulus devoid leaflets abolished massive regurgitation maintaining adequate valve orifice
cardioplegia induced damage ischemic immature myocardium independent oxygen availability known benefits hypothermic pharmacological cardioplegia protecting ischemic adult heart may extend children protection ischemic immature rabbit heart hypothermic krebs bicarbonate buffer better hypothermic st thomas' ii cardioplegic solution investigated whether availability oxygen preischemic perfusate responsible increased tolerance ischemia immature \( 7 10 day old \) hearts perfused krebs buffer comparison st thomas' ii solution immediately ischemia obtaining preischemic control data working mode , perfused hearts \( n 8 per group \) 3 minutes hypothermic \( 14 degrees c \) krebs buffer hypothermic st thomas' ii solution saturated 0 , 25 , 95 oxygen followed 2 hours global ischemia 14 degrees c hearts reperfused 15 minutes langendorff mode 35 minutes working mode , recovery function measured preischemic oxygen concentrations 0 , 25 , 95 , recovery aortic flow hearts protected hypothermia alone ischemia 74 9 , 82 4 , 99 2 preischemic values , respectively hearts protected hypothermia plus cardioplegia , values 69 6 , 72 3 , 86 5 , respectively thus , equal oxygen concentrations , recovery postischemic function better hearts protected hypothermia alone compared hypothermia plus cardioplegia conclude factors oxygen availability responsible damaging effect st thomas' ii solution ischemic immature rabbit heart
relationship sex hormones high density lipoprotein cholesterol levels healthy adult men objective study clarify complex uncertain relationship endogenous sex hormones high density lipoprotein \( hdl \) cholesterol levels healthy men fifty five healthy adult men consecutively recruited ongoing cross sectional study cardiovascular disease risk factors lipid research clinic university washington , seattle subjects receiving medication excluded multiple linear regression analysis identified several factors correlated highly significantly hdl cholesterol levels , including alcohol intake frequency strenuous exercise age levels total cholesterol , low density lipoprotein cholesterol , triglyceride carbohydrate intake nearly 80 heterogeneity hdl cholesterol levels could accounted factors despite finding significant correlations factors known influence hdl cholesterol levels , correlation estradiol level , testosterone level , ratio estradiol testosterone levels apparent conclusion , endogenous sex hormones appear influence hdl cholesterol levels healthy adult men alternatively , large proportion heterogeneity hdl levels group men accounted environmental factors disparity conclusion others may partially due differences accounting confounding variables
evaluation methods detecting venous reflux perspectives venous insufficiency using limbs nonobstructive venous reflux , evaluated number techniques used assessment venous reflux venous doppler examination found reliable screening tool excellent sensitivity good specificity 97 sensitive patients ambulatory venous hypertension however , milder forms reflux , less sensitive major large number false positive results obtained ambulatory venous pressure measurement another pressure based technique , valsalva induced foot venous pressure measurement , defined overlapping different normal abnormal limbs descending venography , performed described et al , found reliable tool assess reflux 90 sensitivity horizontal technique performing descending venography nucleotide descending unacceptably low sensitivity abandoned features venous reflux outlined modern technical tools described
prevalence symptoms raynaud 's phenomenon general practice objective investigate prevalence raynaud 's phenomenon populations five general practices design two populations studied questionnaire given new patients attending five general practices four weeks , questionnaire sent post random sample adults two practices setting general practices inner london , , subjects patients completed questionnaires \( surgeries \( response rate unknown \) 413 respondents postal survey \( response rate 69 \) \) main outcome measures response questionnaire symptoms raynaud 's phenomenon patients regarded disease episodes fingers precipitated cold accompanied sensory symptoms \( needles numbness \) subsequent interview clinical appraisal patients disease according responses questionnaire results prevalence raynaud 's phenomenon 11 \( 26 231 \) 19 \( 34 182 \) respectively men women completed postal questionnaire 16 \( 56 \) 21 \( 157 \) respectively completed questionnaire attending general practice thus overall rates slightly higher women , effect age even adjustment rates practice method survey conclusion prevalence raynaud 's phenomenon high compared low number patients seek treatment disease
current status antitachycardia devices limitations currently available modalities treating clinically important tachycardias , role implanted antitachycardia devices continue expand challenge future involve continued advances socioeconomic impact efficacious expensive mode therapy era increasing financial restraints studies prove efficacy widespread use antitachycardia device therapy needed
analysis randomized trials evaluating effect cholesterol reduction total mortality coronary heart disease incidence primary aim study estimate relation cholesterol reduction total mortality coronary heart disease \( chd \) incidence secondarily , clinical issues whether efficacy cholesterol lowering dependent treatment modality , presence chd baseline , simultaneous introduction interventions explored randomized clinical intervention trials cholesterol reduction used overview analysis total mortality rate chd incidence analysis performed weighted linear regression trials include used primary secondary intervention , diet drugs , single design nineteen trials analyzed total mortality , 19 , 16 analyzed chd incidence rate net difference cholesterol change study groups used independent variable , three previously mentioned design characteristics used additional independent variables every 1 reduction cholesterol , estimated 2 5 reduction chd incidence indicated \( 95 cl 1 1 , 3 9 \) regard chd drug trials tended toward better efficiency cholesterol lowering dietary trials regard total mortality , efficiency higher secondary primary preventive trials efficiency also somewhat dependent baseline cholesterol level study shows cholesterol reduction effective lowering chd incidence , cholesterol reduction must least 8 9 effective lowering total mortality
intermittent claudication , heart disease risk factors , mortality study study , 18 , subjects aged 40 64 years completed questionnaire intermittent claudication subjects , 0 8 \( 147 \) 1 \( 175 \) deemed probable intermittent claudication possible intermittent claudication , respectively within 17 year follow period , 38 40 probable possible cases , respectively , died compared subjects without claudication , probable cases suffered increased mortality rates due coronary heart disease cerebrovascular disease , mortality rate due noncardiovascular causes increased possible cases demonstrated increased mortality rates due cardiovascular noncardiovascular causes difference mortality pattern may due chance possible probable cases still showed increased cardiovascular cause mortality rates adjusting coronary risk factors \( cardiac ischemia baseline , systolic blood pressure , plasma cholesterol concentration , smoking behavior , employment grade , degree glucose intolerance \) intermittent claudication independently related increased mortality rates rare condition , simple questionnaires exist detection latter incorporated cardiovascular risk assessment screening programs
inotropic effects angiotensin ii human cardiac muscle vitro direct effects angiotensin ii \( ang ii \) human cardiac muscle investigated using isolated trabecular muscles failing functionally normal hearts atrial ventricular trabeculae studied results demonstrated positive inotropic effect ang ii human cardiac muscle comparison effects ang ii among groups indicated responsiveness tended greater atrial normal muscle compared failing muscle results study also demonstrated heterogeneity responsiveness ang ii among human muscles , correlated patient age , sex , diagnosis , prior treatment angiotensin converting enzyme inhibitor , heart function significant correlation response ang ii response isoproterenol demonstrated failing ventricular trabeculae , may suggest defects beta adrenergic responsiveness failing human ventricle accompanied loss responsiveness ang ii studies extended syrian cardiomyopathic hamster control dose dependent inotropic response occurred normal hamster ventricular muscle significantly diminished cardiomyopathic muscle ang ii shorten timing contraction , pretreatment adrenergic blocking agents shift dose response curve , indicating response cyclic amp mediated study demonstrates first time ang ii exert inotropic effect directly human cardiac muscle confirms direct effect ang ii hamster cardiac muscle study suggests , however , inotropic response ang ii cardiac muscle heterogeneous may diminished heart failure
functional asymmetry descending thoracic aorta determine whether rotational blood flow asymmetry exists human descending thoracic aorta , established ability color doppler ultrasound detect rotational flow tube model descending fluid column model human aortic arch pulse , color doppler used demonstrate rotational flow occurs first transverse arch proximal descending thoracic aorta use color doppler esophageal echocardiography , 53 patients \( age range , 25 78 years mean age , 56 4 years \) prospectively examined rotational flow descending thoracic aorta 10 cm superior retro left ventricular position , 22 38 patients \( 58 \) revealed rotational flow obvious diastolic counterclockwise rotation less obvious systolic rotation 5 cm superior retro left ventricular position , 29 46 patients \( 63 \) revealed rotational flow tendency toward systolic diastolic counterclockwise rotation retro left ventricular position , 47 53 patients \( 89 \) revealed rotational flow , usually direction , occurring systole data suggest aortic flow purely pulsatile axial rotational component rotational flow begins aortic arch carried descending thoracic aorta , flow asymmetric systolic diastolic counterclockwise components data demonstrate aortic rotational flow component may physiological implications organ perfusion
abnormal blood pressure response exercise hypertrophic cardiomyopathy investigate incidence abnormal exercise blood pressure responses hypertrophic cardiomyopathy \( \) potential role hemodynamic instability mechanism sudden death , 129 consecutive patients underwent maximal symptom limited treadmill exercise testing blood pressure recording four patterns blood pressure response observed forty three patients significant exercise hypotension , either continuous fall systolic blood pressure \( n 5 \) start exercise sudden fall systolic blood pressure \( 20 100 mm hg mean , 40 mm hg \) peak value \( n 38 \) , 23 patients normal response exercise abnormal blood pressure response recovery period , remaining 62 patients demonstrated normal blood pressure response patients exercise hypotension younger \( 33 14 versus 46 14 years \) family history sudden death compared normal blood pressure response \( 15 43 versus 6 62 patients \) similarly , 23 patients abnormal recovery blood pressure responses younger \( 43 16 versus 46 14 years \) higher incidence family history sudden death \( 10 24 versus 6 62 patients \) left ventricular cavity dimensions smaller exercise hypotension , 11 clinical , echocardiographic , arrhythmic variables similar assess mechanism exercise hypotension , 14 patients demonstrated exercise hypotension 14 symptomatic patients normal exercise blood pressure response underwent invasive hemodynamic exercise testing
beta adrenergic receptors lymphocyte subsets exercise alterations normal individuals patients congestive heart failure dynamic exercise increases number beta adrenergic receptors mixed lymphocytes mechanism incompletely understood set vivo studies , investigated effects dynamic exercise subset distribution circulating lymphocytes number beta adrenergic receptors subsets two groups patients healthy subjects , exercise increased plasma norepinephrine epinephrine caused lymphocytosis whereas number cells increased modestly , number cytotoxic natural killer cells tripled number beta adrenergic receptors varied among subsets significantly altered dynamic exercise subset except natural killer cells \( 35 increase , p 0 \) group patients congestive heart failure , dynamic exercise increased plasma norepinephrine alter plasma epinephrine cause significant lymphocytosis detect significant alterations circulating leukocyte subsets beta adrenergic receptors subsets exercise combined analysis healthy patients heart failure patients revealed significant correlation increases plasma epinephrine increases circulating lymphocytes conclude exercise induced increase beta adrenergic receptors mixed lymphocytes predominantly caused redistribution circulating cell subsets differ beta adrenergic receptor number appears mediated epinephrine rather norepinephrine
prostacyclin acetylcholine screening agents acute pulmonary vasodilator responsiveness primary pulmonary hypertension sodium \( prostacyclin \) administered intravenously considered standard assessing ability pulmonary circulation present , sodium investigational drug limited availability contrast , acetylcholine , also pulmonary vasodilator , readily available therefore , assessed feasibility using acetylcholine alternative prostacyclin testing capacity pulmonary vasculature twenty three patients primary pulmonary hypertension \( mean pulmonary arterial pressure , 58 5 13 4 mm hg \) received incremental infusions prostacyclin acetylcholine predetermined maximal infusion rates part battery vasodilator agents administered according standard protocols \( mean , 5 4 1 2 agents patient range , 3 8 agents patient \) administration different agents timed avoid synergistic effects agents tested , prostacyclin acetylcholine consistently effective acute pulmonary vasodilation , seemed distinguish patients capable acute pulmonary vasodilation however , maximal doses set protocol , prostacyclin generally elicited greater vasodilator response acetylcholine difference magnitude response may due use prescribed dosages acetylcholine submaximal respects , two agents similar equally well tolerated , side effects mild resolved rapidly vasodilator infusions stopped conclude majority patients primary pulmonary hypertension , acetylcholine appears effective available substitute prostacyclin screening pulmonary vasodilator responsiveness
differentiation ventricular tachyarrhythmias implantable devices capable several modes therapy require differentiation various ventricular tachyarrhythmias three methods arrhythmia analysis , magnitude squared , ventricular rate , irregularity cycle length performed 45 episodes induced ventricular tachyarrhythmia 15 patients differentiation monomorphic ventricular tachycardia polymorphic ventricular tachycardia ventricular fibrillation possible mean magnitude squared , less possible rate , possible beat beat irregularity faster monomorphic ventricular tachycardia rates polymorphic ventricular tachycardia ventricular fibrillation differentiation polymorphic ventricular tachycardia ventricular fibrillation possible rate irregularity progressive decrease mean magnitude squared monomorphic ventricular tachycardia polymorphic ventricular tachycardia ventricular fibrillation strengthens previous observations measure rhythm organization
adaptation ischemia percutaneous transluminal coronary angioplasty clinical , hemodynamic , metabolic features clinical , electrocardiographic , coronary hemodynamic responses sequential 90 second occlusions left anterior descending coronary artery 12 patients undergoing elective percutaneous transluminal coronary angioplasty examined lactate metabolism examined additional group seven patients clinical hemodynamic features similar first group noted comparison initial balloon occlusion second occlusion characterized less subjective anginal discomfort , less st segment shift \( 0 44 0 13 versus 0 21 0 07 mv , p 0 01 \) , lower mean pulmonary artery pressure \( 25 1 0 versus 20 1 7 mm hg , p 0 005 \) addition , heart rate blood pressure product , cardiac vein flow second inflation significantly lower recorded first inflation \( 96 1 4 versus 83 2 4 ml min , p 0 005 \) finally , significantly less myocardial lactate production second inflation \( lactate extraction ratio first inflation , 0 11 0 03 second inflation , 0 03 0 02 p 0 04 \) conclude clinical , electrocardiographic , hemodynamic , metabolic evidence myocardial ischemia second two periods coronary artery occlusion percutaneous transluminal coronary angioplasty supports concept adaptation myocardial ischemia \( ischemic preconditioning \)
intracoronary urokinase intracoronary thrombus accumulation complicating percutaneous transluminal coronary angioplasty acute ischemic syndromes intracoronary urokinase used treat flow limiting intracoronary thrombus accumulation complicated successful percutaneous transluminal coronary angioplasty \( ptca \) acute ischemic syndromes 48 patients followed acute phase illness study group comprised 10 patients unstable angina pectoris , 18 patients evolving acute myocardial infarction , 20 patients postinfarction angina initial mean percent coronary diameter stenosis entire population 95 7 decreased initial ptca 41 20 \( p less 0 001 \) , improved corresponding coronary flow thrombolysis myocardial infarction trial \( \) grade however , thrombus accumulation resulted significant increase percent diameter stenosis 83 17 \( p less 0 001 \) corresponding significant reduction coronary flow also occurred grade administration intracoronary urokinase \( mean dose , 141 , 000 units range , 100 , 000 250 , 000 units average period 34 minutes \) , additional ptca , mean percent diameter stenosis significantly decreased 34 17 \( p less 0 001 \) correspondingly significant improvement mean coronary flow grade occurred 2 9 0 2 overall , angiographic success rate 90 ischemic events requiring repeat ptca procedure related myocardial infarctions deaths hospital discharge one patient referred urgent coronary artery bypass graft surgery successful ptca plasma fibrinogen levels obtained 15 patients , patient level normal laboratory
coronary atherosclerosis associated left ventricular dysfunction dilatation aortic stenosis patients aortic stenosis develop widely variable patterns left ventricular hypertrophy dysfunction postulated coronary atherosclerosis \( cad \) may associated impaired left ventricular function chamber dilatation patients aortic stenosis left ventricular mass volumes quantified two dimensional echocardiography correlated coronary angiography 78 patients severe aortic stenosis previous myocardial infarction regional wall motion abnormalities eighteen patients \( group 1 \) smooth coronary arteries , 25 patients irregular coronary arteries 50 less stenosis \( group 2 \) , 35 patients obstructive cad \( group 3 \) even though calculated valve area similar three study groups , group 1 patients higher values ejection fraction \( 65 9 , 51 17 , 48 13 p 0 0002 \) , systolic mass volume ratio \( 9 2 3 9 , 5 6 2 8 , 5 2 2 2 p 0 0001 \) , cardiac index \( 2 9 0 7 , 2 5 0 7 , 2 3 0 6 l min p 0 015 \) patients groups 2 3 , respectively \( mean sd \) mean circumferential wall stress inversely related severity cad multivariate analysis showed cad independent predictor ejection fraction mass volume ratio group patients thus , elderly population severe aortic stenosis , patients obstructive nonobstructive cad increased incidence left ventricular enlargement systolic dysfunction
left ventricular regional wall stress dilated cardiomyopathy left ventriculography simultaneous pressure performed 11 normal control subjects 17 patients dilated cardiomyopathy \( dcm \) left ventricular right anterior oblique projection divided eight areas , regional wall stress computed 's method area excluding two basal areas wall stress higher dcm patients control subjects \( p less 0 01 \) percent area changes end diastole end systole area lower dcm patients control subjects \( mean six areas , 22 14 versus 54 9 , respectively , p less 0 01 \) , coefficient variation percent area changes six areas left ventricle dcm patients greater control subjects \( 32 17 versus 15 4 , respectively , p less 0 01 \) , indicating regional differences significant negative correlation end systolic regional wall stress percent area change \( r 0 60 0 86 , p less 0 05 \) area thus , excessive regional afterload may play important role causing regional dcm
body surface mapping high frequency components terminal portion qrs complex prediction ventricular tachycardia patients previous myocardial infarction study clinical significance terminal qrs high frequency components prediction ventricular tachycardia , 87 lead body surface signal averaged mapping performed 21 healthy subjects \( control \) 41 patients previous myocardial infarction \( anterior , 20 inferior , 21 \) mapping data analyzed averaged \( 129 7 26 5 beats \) 160 seconds , signal averaged beat filtered bidirectional \( 80 250 hz \) digital filter j point determined 87 lead rms voltage qrs lead , calculated sum absolute value filtered qrs 20 msec j point j point \( 20 \) body surface distribution 20 expressed 20 map 20 maps mainly located upper sternal region healthy subjects , left anterior chest patients previous anterior myocardial infarction , central anterior chest patients previous inferior myocardial infarction patients group anterior myocardial infarction group inferior myocardial infarction , value maximum significantly greater subjects control group \( 0 181 0 0 138 0 , respectively , vs 0 075 0 031 mv msec p less 0 01 \) patients myocardial infarction \( n 41 \) , value maximum significantly greater ventricular tachycardia \( n 11 \) without ventricular tachycardia \( n 30 \) \( 0 240 0 vs 0 130 0 mv msec p less 0 01 \)
area risk determination technetium 99m hexakis 2 isonitrile experimental reperfused myocardial infarction canine model reperfused myocardial infarction , tested hypothesis reperfusion , technetium 99m hexakis 2 isonitrile \( tc mibi \) tomographic imaging still reflects occlusion blood flow tracer injected reperfusion nine anesthetized dogs underwent 2 hours coronary occlusion followed 3 hours reperfusion killed reference coronary blood flow determined radioactive microspheres injected occlusion reperfusion biopsies normal ischemic myocardium single photon emission computed tomography obtained occlusion reperfusion circumferential profiles applied axial slices divided 5 degree sectors sectors divided 3 groups selected occlusion acquisition \( normal , mildly reduced , severely reduced \) compared acquisition tc mibi kinetics assessed tc mibi time activity curves normal ischemic tissue obtained biopsy relative gradient normal , ischemic , necrotic postmortem tissue samples biopsy samples , tc mibi content remained unchanged occlusion reperfusion normal well ischemic tissue \( 4 , 662 2 , 237 counts min mg vs 4 , 1 , 577 counts min mg normal tissue , ns counts min mg vs 1 , counts min mg ischemic tissue , ns \) postmortem tissue samples , good correlation occlusion microsphere blood flow tc mibi activity \( r 0 91 \) necrotic samples , mean normalized tc mibi activity \( 10 17 \) slightly higher normalized microsphere blood flow \( 3 3 , p less 0 001 \) markedly lower normalized microsphere reperfusion blood flow \( 63 31 , p less 0 001 \) comparing single photon emission computed tomographic reperfusion , tc mibi activity remained unchanged normal well mildly reduced severely reduced segments thus , data consistent hypothesis tc mibi traces blood flow , significantly despite reperfusion , used imaging area risk
effects brief coronary occlusion reperfusion porcine coronary artery reactivity loss coronary vasodilator reserve ischemia reperfusion may due endothelial injury , vascular dysfunction may contribute functional alterations observed ischemia determine whether endothelial dysfunction occurs relatively brief periods moderate low flow ischemia vivo , open chest swine subjected 15 minutes critical , subtotal left anterior descending coronary artery occlusion \( 80 \) followed 60 minutes reperfusion serial measurements regional coronary flow made radiolabeled microsphere technique 60 minutes reperfusion , left anterior descending coronary artery excised together section normally perfused left circumflex coronary artery examine vitro relaxations endothelium dependent dilators adp bradykinin endothelial independent dilators sodium nitroprusside adenosine contractions serotonin quiescent rings also examined endocardial transmural blood flows recovered levels within 60 minutes reperfusion , epicardial endocardial ratio vascular responses isolated , reperfused left anterior descending coronary artery rings significantly different responses control left circumflex coronary artery rings endothelium dependent relaxations adenosine diphosphate bradykinin significantly depressed left anterior descending coronary artery rings compared left circumflex coronary artery rings \( p less 0 05 \) serotonin induced contractions significantly greater occluded reperfused left anterior descending left circumflex coronary arteries \( p less 0 05 \) relaxations adenosine sodium nitroprusside significantly different two groups
fibrinopeptide released coronary circulation coronary spasm examine whether acute myocardial ischemia activates coagulation system platelet activation coronary circulation , measured plasma levels fibrinopeptide beta coronary sinus aortic root simultaneously 15 patients coronary spastic angina left coronary spasm induced intracoronary injection acetylcholine 15 patients stable exertional angina acute myocardial ischemia induced rapid atrial pacing fifteen patients chest pain normal coronary arteries coronary spasm served controls coronary sinus arterial difference fibrinopeptide increased markedly \( p less 0 001 \) 0 1 0 2 4 3 0 7 ng ml anginal attacks coronary spastic angina group however , fibrinopeptide levels remained unchanged attacks stable exertional angina group intracoronary injection acetylcholine control group plasma beta levels remained unchanged attacks patient groups acetylcholine control group data indicate coronary spasm induces thrombin generation may lead thrombus formation coronary artery involved , pacing induced ischemia activate coagulation system
increased endothelin experimental heart failure recent studies demonstrate endothelin , potent endogenous vasoconstrictor peptide , plasma normal animals humans however , role peptide pathophysiological states remains unclear present study designed test hypothesis circulating endothelin concentrations increased experimental congestive heart failure \( chf \) , pathophysiological state characterized activation vasoconstrictor mechanisms anesthetized dogs chf produced 8 days rapid ventricular pacing \( n 28 \) , circulating plasma endothelin increased compared values normal controls \( n 28 20 4 1 4 versus 9 7 0 9 pg ml , respectively p less 0 0001 \) plasma endothelin level 14 0 sensitive specific indicator significant chf moreover , within group experimental chf , right atrial pressure pulmonary capillary wedge pressure correlated independently circulating endothelin levels based recent studies demonstrating physiological actions twofold increases circulating endothelin , observed present study , possible role endothelin pathophysiology chf advanced
regulation alpha 1 adrenoreceptor coupling alpha skeletal actin myocardial infarction induced left ventricular failure rats determine effects myocardial infarction induced left ventricular failure regulation surface alpha 1 adrenoreceptors signal transduction , large infarcts produced rats animals killed seven days later documentation impaired left ventricular pump performance , radioligand binding studies alpha 1 adrenoreceptor , norepinephrine stimulated turnover , adp 41 kd substrate pertussis toxin examined unaffected myocardium moreover , expression actin isoforms analyzed northern blots hybridization specific oligonucleotide probes alpha 1 adrenoreceptor density found altered membranes obtained spared left ventricular tissue , whereas turnover increased 3 1 fold viable myocytes infarcted hearts furthermore , pertussis toxin substrate augmented 2 5 fold membranes prepared surviving left ventricular myocardium finally , skeletal actin isoform detected tissue failing left ventricle conclusion , possibility raised presence severe myocardial dysfunction ongoing reactive hypertrophy , effector pathways linked alpha 1 adrenoreceptor may stimulate myocyte hypertrophic response would tend normalize cardiac hemodynamics alpha skeletal actin may molecular indicator overload myocardium
mutation gene type iii procollagen \( \) family aortic aneurysms experiments carried test hypothesis familial aortic aneurysms , either thoracic abdominal , caused mutations gene type iii procollagen \( \) similar mutations gene shown cause rupture aorta consequences rare genetic disorder known ehlers danlos syndrome type iv family identified 37 yr old female united states air force many direct blood relatives died ruptured aortic aneurysms woman heterozygous single base mutation converted codon glycine alpha 1 \( iii \) chain type iii procollagen codon arginine studies cultured skin fibroblasts demonstrated mutation caused synthesis type iii procollagen decreased temperature thermal protein mutation identified dna extracted pathologic specimens mother died age 34 maternal died age 55 aortic aneurysms examination dna samples saliva revealed woman 's daughter , , brother , also mutation results demonstrated mutations type iii procollagen gene cause familial aortic aneurysms dna tests mutations identify individuals risk aneurysms
pathogenesis orthostatic hypotension evidence disordered venous innervation exclusively lower limbs pathogenesis orthostatic hypotension studied eight patients correction abnormal orthostatic changes inflated pressure \( mast \) confirmed previous evidence excessive gravitational pooling blood leg veins intravenous l norepinephrine infusion raised diastolic blood pressure relationship infusion induced increments plasma norepinephrine concentrations normal subjects , indicating normal arteriolar responses contractile responses veins infused l norepinephrine measured linear variable differential \( \) venous responses hand veins patients fell within 95 confidence limits responses normal hand veins , responses foot veins seven normal subjects however , foot veins patients orthostatic hypotension , hand foot veins patients diffuse autonomic failure , norepinephrine , reflected steeper slope regression log \( norepinephrine infusion rate \) percentage reduction venous distensibility , significantly lower ed50 \( e , norepinephrine infusion rate induced 50 reduction venous distensibility \) findings suggest anatomical functional denervation lower limb veins causing excessive gravitational blood pooling consequent orthostatic hypotension patients
cis l cis diltiazem anti ischemic action isolated , perfused working rat heart effect diltiazem \( cis diltiazem \) ischemic myocardium compared l cis diltiazem , optical isomer less potent calcium channel blocking action , isolated , perfused working rat heart ischemia decreased mechanical function tissue levels atp creatine phosphate , increased tissue levels fatty acids \( nefa \) , amp lactate reperfusion restore mechanical function , restored incompletely levels metabolites \( except nefa \) altered ischemia ischemia induced changes nefa prevented cis diltiazem completely l cis diltiazem incompletely metabolic changes induced ischemia attenuated cis diltiazem l cis diltiazem heart pretreated cis l cis diltiazem , mechanical function levels metabolites recovered reperfusion , degree recovery drugs similar results indicate cis diltiazem also l cis diltiazem anti ischemic action probably due inhibition tissue nefa accumulation results also suggest mechanism protective effect cis diltiazem ischemic myocardium entirely due calcium channel blocking action treatment low ca2 \( 1 0 mm \) also attenuated ischemia induced changes interval reoxygenation start function reperfused heart treated low ca2 significantly longer cis l cis diltiazem effect isomers shorten interval may contribute common anti ischemic action
carotid endarterectomy ten year analysis outcome cost treatment 1978 1988 , 215 patients average age 67 years , underwent carotid endarterectomies two hundred ten \( 85 4 \) patients symptomatic , 36 \( 14 6 \) asymptomatic six patients \( 2 4 \) postoperative stroke , immediate reoperation one patients died \( 30 day mortality rate , 0 4 series \) , two \( 0 8 \) recovered completely , whereas three \( 1 2 \) mild permanent neurologic deficit two patients \( 0 8 \) nonfatal myocardial infarction mean follow 42 2 months \( range , 1 126 months \) achieved 5 8 years actuarial survival rates 82 66 stroke free survival rates 67 37 observed actuarial stroke free rates 90 5 8 years noted introducing observing guidelines required preoperative study clearly defined classes patients admission surgical treatment , average length stay carotid endarterectomy lowered 9 5 days first 5 years study 5 8 days second 5 years \( p 0 001 \) average hospital charges , expressed constant dollars , decreased first 5 years second 5 years \( p 0 02 \) despite 88 increase medical price index experience shows length hospitalization patients carotid endarterectomy reduced cost admission lowered without untoward effect perioperative morbidity mortality rates
value pulmonary artery central venous monitoring patients undergoing abdominal aortic reconstructive surgery comparative study two selected , randomized groups one hundred two patients undergoing abdominal aortic reconstructive surgery prospectively , randomly allocated two groups , one monitored central venous catheter pulmonary artery catheter patients cardiopulmonary renal disease excluded study general anesthesia administered surgical procedure , patients followed hospital discharge statistically significant differences occurred two groups regard morbidity \( perioperative cardiac , pulmonary renal sequelae \) , mortality rate , duration intensive care , postoperative hospital stay , cost hospitalization one statistically significant difference groups professional charged anesthetic care , higher patients pulmonary artery catheters central venous catheters conclusion , prospectively gathered data patients presented abdominal aortic reconstructive surgery data seem indicate choice central venous catheter pulmonary artery catheter monitoring makes little difference outcome abdominal aortic reconstructive surgery , many patients pulmonary artery catheters necessary give appropriate , adequate care size sample , however , epidemiologic significance would therefore large scale , multicenter studies addressing outcomes remain necessary
relationship atherosclerosis young men serum lipoprotein cholesterol concentrations smoking preliminary report determinants atherosclerosis \( \) research group investigators eight communities collected aortas , right coronary arteries , blood , associated information 390 males , 15 34 years age , died violent causes pathologists central laboratories graded arteries atherosclerotic lesions , serum lipoprotein cholesterol concentrations measured percentage intimal surface involved atherosclerotic lesions aorta right coronary artery positively associated serum low density lipoprotein low density lipoprotein cholesterol concentration negatively associated serum high density lipoprotein cholesterol concentration serum concentration , marker smoking , strongly associated prevalence raised lesions , particularly abdominal aorta effect smoking explained lipoprotein levels blacks extensive total surface involvement aorta adjustment lipoprotein cholesterol levels smoking associations indicate serum lipoprotein cholesterol concentrations smoking important determinants early stages atherosclerosis adolescents young adults
case childhood cholesterol screening authorities proposed blood cholesterol screening children prevent coronary heart disease , reviewed published studies estimate potential risks benefits screening childhood cholesterol levels poor predictor high cholesterol levels young adulthood even poorer predictor coronary heart disease later life evidence blood cholesterol levels lowered easily children adults , seems unlikely cholesterol reduction childhood much effective preventing coronary heart disease cholesterol reduction begun middle age screening interventions lower blood cholesterol levels children would expensive , could lead labeling family , may cause malnutrition increased noncardiovascular mortality benefits cholesterol screening unlikely exceed risks , conclude children screened high blood cholesterol levels
inferior vena caval filter thrombi evaluation intravascular us 20 mhz intravascular ultrasound \( us \) transducer inside percutaneously inserted catheter used evaluate inferior vena caval \( ivc \) filters thrombi vitro vivo six different ivc filters studied intravascular us saline filled model filter characteristic , recognizable us pattern experimental thrombi small 0 5 cm3 easily detected intravascular us used clinically 25 times evaluate ivc 23 patients 24 ivc filters positive contrast available comparison 25 cases 13 cases , thrombi identified filter ivc either intravascular us five 12 cases thrombi , intravascular us demonstrated thrombi equally well six cases , intravascular us superior detection delineation thrombus ivc filter intravascular us considered superior external duplex us evaluation caval thrombi 21 cases available comparison complications intravascular us noted
iliac artery stenosis occlusion preliminary results treatment gianturco expandable metallic stents ten patients atherosclerotic stenosis occlusion iliac artery treated gianturco expandable metallic stents five cases stenosis , balloon dilation performed prior placement stents five patients occluded arteries given intraarterial infusions urokinase balloon dilation stent placement clinical symptoms improved patients , technical failures complications occurred doppler ankle brachial index studies performed nine cases , nine cases indexes improved stent placement follow 2 18 months \( mean , 10 3 months \) , arteries remained patent follow angiograms showed slight intimal thickening restenosis long term follow clinical experience necessary evaluate efficacy stent however , preliminary results suggest gianturco expandable metallic stent value treatment arterial occlusive disease
role preoperative radionuclide ventriculography defining outcome revascularization extremity revascularization extremity performed upon 110 patients preoperative radionuclide ventriculography \( \) mean ejection fraction \( ef \) 50 13 per cent ventricular wall motion abnormalities present 46 per cent revascularization included inflow procedures , \( n 25 \) bypass \( , n 11 \) infrainguinal reconstruction , including femoropopliteal distal bypass \( n 43 \) , procedures improve perfusion limb correct complications previous vascular reconstruction upon extremity \( n 31 \) perioperative \( 30 days \) mortality rate 0 9 per cent 97 0 per cent patients discharged alive hospital myocardial infarction \( mi \) occurred 3 6 per cent , new ventricular arrhythmia 1 8 per cent congestive heart failure 6 4 per cent patients perioperative period follow study \( days \) , 7 3 per cent required major amputation , ipsilateral reconstruction , 5 5 per cent required surgical angiographic revision hemodynamic failure reconstruction prior thrombosis 12 7 per cent thrombosed part reconstruction revascularization failure appear related level cardiac function normal \( greater 50 per cent \) ef greater survival life table analysis ef less equal 50 per cent \( p 0 0006 , mantel cox test \) ventricular wall motion abnormalities associated reduced survival \( p 0 008 , mantel cox test \) presence angina previous mi , combination , adverse effect survival , whereas diabetes \( p 0 , mantel cox test \) cigarette smoking \( p 0 , test \) associated significantly diminished survival preoperative identify subgroups survival disadvantage revascularization extremity population presence angina previous mi predict survival
medical management congestive heart failure syndrome congestive heart failure result variety cardiac disorders left ventricular dysfunction common clinical presentation determined interaction cardiac dysfunction series compensatory mechanisms activated throughout body therapy disorder best approached understanding complex relationship appreciation influence preload , afterload , contractility cardiac performance recent important advances therapy include use combined diuretic therapy , better understanding value digitalis , evidence angiotensin converting enzyme \( ace \) inhibitors relieve symptoms prolong life intensive therapy earlier course congestive heart failure appears clinical benefit use ace inhibitors phase may delay progression underlying left ventricular dysfunction future therapy influenced results ongoing trials testing new agents expanded indications drugs currently available
long term prognosis myocardial ischemia detected holter monitoring peripheral vascular disease assess long term prognostic significance myocardial ischemia , measured ambulatory electrocardiographic monitoring , patients occlusive peripheral arterial disease , 176 eligible patients scheduled elective peripheral arterial surgery women 's hospital prospectively studied patients monitored preoperatively without alterations baseline medications prospective follow obtained routine medical care provided blinded , independent physicians subsequent telephone contact patients thirty two patients \( 18 \) total 75 episodes myocardial ischemia , 73 \( 97 \) asymptomatic mean follow period days , 9 cardiac deaths , 1 occurring hospital peripheral vascular surgery , 13 nonfatal myocardial infarctions , 4 occurring hospital peripheral vascular surgery cardiac events occurred 12 32 patients ischemia \( 38 \) , including 6 cardiac deaths , 10 144 patients without ischemia \( 7 \) , including 3 cardiac deaths \( risk ratio 5 4 , 95 confidence interval 2 6 11 4 \) sensitivity ischemia 55 , specificity 87 , positive predictive value 38 , negative predictive value 93 multivariate cox proportional hazards model controlling age , gender , coronary risk factors , history angina , myocardial infarction , coronary artery disease antianginal medications , presence ischemia independent predictor outcome patients peripheral arterial disease , often unable perform adequate exercise testing , ambulatory monitoring myocardial ischemia significant independent predictor 1 2 year prognosis
coronary artery disease angiographic spectrum suitability revascularization angiographic findings 84 consecutive presenting symptoms coronary artery disease \( cad \) examined determine extent cad well suitability coronary artery bypass grafting \( cabg \) percutaneous transluminal coronary angioplasty \( ptca \) frequency 0 , 1 , 2 , 3 vessel left main cad 7 , 14 , 21 , 57 13 , respectively based angiographic criteria , 69 78 patients \( 88 \) significant cad suitable coronary anatomy cabg 24 patients \( 31 \) coronary anatomy amenable ptca cabg performed 19 patients operative mortality 16 major complication rate 37 ptca performed 12 patients clinical success rate 83 , mortality 8 major complication rate 8 concluded cad , cardiac catheterization often reveal coronary anatomy suitable cabg less suitable ptca morbidity mortality associated interventions high
changes plasma free fatty acids prolonged exercise trained hypertensive persons taking propranolol pindolol extent lipolysis attenuated prolonged submaximal exercise beta blockade determined 12 normotensive endurance trained 12 hypertensive sedentary men using nonselective drugs without intrinsic sympathomimetic activity \( isa \) initially , subjects performed graded treadmill test determine maximal oxygen uptake \( vo2max \) followed 2 hour 25 45 subject 's vo2max 3 treatments pindolol \( isa \) , propranolol \( non isa \) placebo distribution medication randomized double blinded blood samples taken rest every 30 minutes 2 hour analyzed determine concentrations free fatty acids \( ffa \) glycerol basis respective changes ffa , respiratory exchange ratio , beta adrenergic blockade attenuate lipolysis untrained hypertensive subjects compared placebo administration however , beta blockade demonstrate tendency attenuate lipolysis trained , normotensive subjects compared results placebo administration particularly evident 30 minutes exercise , glycerol ffa concentrations increased resting values conditions beta blockade differences pindolol propranolol observed therefore , beta blocking agent isa properties appears clear benefit respect lipid metabolism low moderate intensity exercise furthermore , data demonstrate beta blockade inhibit exercise induced lipolysis low moderate intensities exercise believed , unlikely cause fatigue normally observed work patient populations taking beta blocking medication
effects renin inhibition systemic hypertension effect direct renin inhibitor enalkiren \( laboratories \) examined 8 healthy patients essential hypertension sodium diet , plasma renin concentration inhibited within 10 minutes intravenous enalkiren remained essentially undetectable greater equal 6 hours \( 11 9 4 1 0 0 6 ng angiotensin ml hour , p less 0 05 \) mean arterial blood pressure declined gradually \( 108 5 84 4 mm hg , p 0 02 \) , plasma aldosterone concentration \( 14 4 3 8 4 4 0 8 ng dl , p 0 03 \) , whereas plasma immunoreactive active renin concentration increased progressively \( 35 14 160 60 pg ml , p greater 0 05 \) urinary excretion stable metabolite prostacyclin \( 6 keto prostaglandin f1 alpha \) decreased slightly , significantly \( 42 10 33 11 ng g creatinine , p 0 13 \) addition diuretic decreased baseline blood pressure increased baseline plasma renin aldosterone values blood pressure responses enalkiren slightly \( though significantly \) greater observed diuretic administration conclude enalkiren effective decreasing blood pressure inhibiting renin system , without significantly altering urinary prostacyclin excretion , patients essential hypertension results suggest renin system contributes maintenance elevated blood pressure patients essential hypertension
circumferential quantitative analysis planar myocardial scintigraphy diagnosis coronary artery disease methodology computer analysis myocardial perfusion images developed several laboratories substantial evidence advantage approach visual inspection alone reported currently available computer analyses use different algorithms analyze kinetics myocardium authors evaluated compared two widely used programs , medical data system \( mds \) mean count profile , \( cs \) maximal count profile , planar scintigraphy ability detect coronary artery disease \( cad \)
b mode imaging histomorphometric evaluation carotid atherosclerosis quantitative qualitative evaluation atherosclerotic lesions ultrasonography presented several problems , , determination accuracy reproducibility methodology humans present study aims evaluated results b mode imaging extracranial carotid arteries patients selected surgery compared histologic results observations samples obtained endarterectomy shrinkage effects histologic samples taken consideration several images atherosclerotic lesions , obtained ultrasound different incident angles , used establish maximum thickness maximum degree vessel stenosis calculated ultrasound showed high correlation \( 0 42 4 , se 0 11 , r 0 5 , p less 0 001 \) compared one obtained histology imaging methodology provided however , mean overestimation stenosis 7 relationships among amount calcium \( p less 0 03 \) necrotic core p less 0 \) types , ie , soft , mixed , hard suggested statistical trend results suggested vascular lumen due advanced atherosclerotic lesions qualitative interpretation atherosclerosis b mode imaging , ie , morphologic characteristics , seem , present , value , investigations depth needed
doppler diagnostics , indications , control surgical treatment patients carotid pathology major stroke relatively common cause death disabling patients atherosclerosis large percentage cases caused stenotic thrombotic processes carotid arteries emphasizes importance problem early diagnosis treatment carotid pathology recently doppler sonography become leading non invasive method early screening stenotic processes carotid arteries aim present study ascertain diagnostic abilities doppler sonography screening carotid pathology , assessment extra cranial intracranial hemodynamics , defining indications , control vascular reconstructions
bronchiolar morphology systemic arterial interruption assess ischemic lesions factor obliterative bronchiolitis lung transplantation , authors left bronchial arteries 15 dogs , together left stem bronchus , latter immediately examined bronchioles weekly three half months week chosen dog anesthetized , totally heparinized , perfused saline heart arrest , thoracic aorta injected barium solution white medium appeared bronchial arteries heart lung excised en bloc , submitted soft tissue x ray , fixed , 1 cm corresponding right left 5 mm thick samples slices prepared contact followed histologic 5 20 micron thick , stained , correlated specimens two weeks left bronchial arteries remained empty , necrosis edema two four weeks barium solution appeared bronchial arteries , bronchiolar epithelium become later left became similar right , folds mucosa little submucosal fibrosis studies provide proof significant ischemic lesions occurred bronchiolar vascular bed ischemia , , significant factor obliterative bronchiolitis
estrogen replacement coronary artery disease effect survival postmenopausal women relationship among postmenopausal estrogen use , coronary stenosis , survival examined retrospectively women undergoing coronary angiography patients selected study age 55 years older time angiography previously undergone bilateral oophorectomy postmenopausal estrogen use patients coronary artery disease \( greater 70 stenosis \) patients mild moderate coronary artery disease \( 5 69 stenosis \) compared control subjects \( 0 stenosis \) using life table analysis 10 years follow , significant difference survival among patients initially free coronary lesions arteriography either never used \( \) ever used \( 69 \) estrogens among patients mild moderate coronary stenosis , 10 year survival never used estrogens 85 0 95 6 among 99 ever users survival 60 0 among 70 coronary stenosis never used estrogen 97 0 among 70 ever users never users group older \( 65 vs 59 years \) , lower proportion cigarette smokers \( 40 vs 57 1 \) , higher proportion subjects diabetes \( 21 7 vs 12 9 \) hyperlipidemia \( 58 vs 44 \) , approximately equal numbers hypertensives \( 56 0 vs 54 3 \) cox 's proportional hazards model used estimate survival function multiple estrogen use found significant , independent effect survival women conclude estrogen replacement menopause prolongs survival coronary artery disease present , less effect absence coronary artery disease
impact public cholesterol screening program national cholesterol education program \( \) physician case finding primary method detect individuals elevated cholesterol levels despite recommendation , promotional profit public screening programs surveyed participants based cholesterol screening program 1 year screening sixty four percent screened previously known cholesterol levels newly screened less likely benefit testing general public , since older \( mean age , 55 3 years \) , likely female \( 67 4 \) , nonsmokers \( 88 \) excellent recall cholesterol level \( mean absolute reporting error , 0 24 mmol l 9 mg dl \) good understanding cholesterol coronary heart disease risk elevated cholesterol levels reported high distress screening reduction overall psychosocial well actual decrease 53 7 advised seek follow elevated screening value done within year following screening program however , values greater 6 2 mmol l \( 240 mg dl \) , 68 sought follow many participate public screening programs previously tested , fall low benefit groups , fail comply recommended follow therefore conclude cholesterol screening programs type commonly offered unlikely contribute greatly national efforts reduce coronary heart disease
biplane transesophageal echocardiography technique , image orientation , preliminary experience 131 patients transesophageal echocardiography use phased array transducer transverse horizontal scanning plane become well established tool evaluating cardiovascular diseases recent introduction biplane probes enhanced diagnostic capability imaging technique article discusses technique biplane transesophageal echocardiographic examination image orientation diagnostic value advantages various biplane transesophageal images heart , aorta , aortic arch various esophageal positions described
transesophageal echocardiography diagnosis ostial left coronary artery stenosis diagnosis ostial stenosis left main coronary artery usually made use coronary angiography however , positioning catheter across obstruction may obscure diagnosis contrast injection although arterial pressure catheter left coronary artery may suggest ostial stenosis , may possible make diagnosis cardiac catheterization report series four patients left coronary ostium proximal left coronary arteries visualized means transesophageal echocardiography ostial narrowing plaque abnormally fast flow velocities seen case echocardiographic findings contributed subsequent management patients
transesophageal echocardiography percutaneous balloon mitral valvuloplasty ascertain value transesophageal echocardiography percutaneous balloon mitral valvuloplasty , present study undertaken 26 patients \( 21 women 5 men mean age , 47 years \) symptomatic rheumatic mitral valve stenosis one patient balloon dilation mitral valve successful doppler derived valve area increased \( 0 9 0 3 1 9 0 4 cm2 \) transesophageal echocardiography provides continuous monitoring , well guidance procedure crossing arterial septum , well delivery sheath mitral valve orifice correct positioning balloon , highly facilitated reduced x ray exposure time degree mitral regurgitation presence interatrial shunting end procedure could readily assessed , making cineangiography necessary complications procedure , pericardial effusion , could detected hemodynamic deterioration occurred \( one patient \) advantages transesophageal echocardiography routine monitoring percutaneous mitral valvuloplasty , however , weighted added risk expense support
transesophageal echocardiography diagnosis left atrial appendage aneurysm intrapericardial left atrial appendage aneurysm rare describe transthoracic transesophageal echocardiographic findings 42 year old man atrial arrhythmia abnormal left atrial appendage chest roentgenogram presence intrapericardial left atrial appendage aneurysm confirmed surgery
evidence myocardium new transesophageal echocardiographic technique reversal resting wall motion abnormalities successful coronary angioplasty documented patient use novel approach stress testing transesophageal stress echocardiography utilizes transesophageal atrial pacing provoke myocardial ischemia left ventricular contractility monitored means transesophageal echocardiography potential use technique illustrated report
prevalence coronary heart disease scotland scottish heart health study data 10 , 359 men women aged 40 59 years 22 districts scottish heart health study used describe prevalence rates coronary heart disease scotland 1984 1986 relation geographical variation mortality districts prevalence measured previous history , rose chest pain questionnaire , minnesota code 12 lead resting electrocardiogram prevalence coronary heart disease scotland high compared studies countries used standardised methods history angina common men \( 5 5 \) women \( 3 9 \) , though response rose questionnaire 8 5 women 6 3 men reported chest pain history myocardial infarction three times common men women , q qs pattern electrocardiogram significant correlations different measures coronary prevalence district measures angina correlated well mortality coronary heart disease , correlations tended stronger women men significant correlation mortality coronary heart disease measures myocardial infarction study provides data prevalence coronary heart disease men women valuable planning services
transient myocardial ischaemia acute myocardial infarction prevalence characteristics transient myocardial ischaemia studied 203 patients recent acute myocardial infarction early \( 6 4 days \) late \( 38 days \) ambulatory monitoring st segment transient st segment depression much late \( 32 patients \) early \( 14 \) monitoring transient ischaemia \( greater 85 episodes \) silent 80 patients silent episodes late monitoring painful st depression accompanied greater st depression tended occur higher heart rate late transient ischaemia showed diurnal distribution , occurred higher initial heart rate , often accompanied increase heart rate early ischaemia thus first 2 months myocardial infarction transient ischaemia became increasingly common closely associated increased myocardial oxygen demand transient ischaemic episodes early late ambulatory monitoring dissimilar characteristics may also different prognostic implications
relation intraventricular pressure volume diastole pressure volume curves 10 patients various types heart disease studied throughout mid late diastole pressure volume increasing results used test currently held theory form relation exponential found patients examined hypothesis valid
operative findings percutaneous pulmonary balloon dilatation right ventricular outflow tract tetralogy fallot since 1983 percutaneous balloon dilatation right ventricular outflow tract performed alternative surgical palliation selected cases tetralogy fallot royal children 's hospital 31 december 1984 31 december 1988 , 27 patients underwent subsequent surgical correction age operation ranged 7 58 months \( median 2 7 years \) mean interval balloon dilatation correction 15 6 months \( range 3 39 months \) two patients systemic pulmonary shunt operation performed dilatation five required one afterwards overall 20 \( 74 \) patients anatomical alteration result balloon dilatation , seven \( 26 \) change right ventricular outflow tract consistent relation ratio balloon size pulmonary annulus diameter morphological findings balloon dilatation may obviate need systemic pulmonary shunt expense structural damage , particularly posterior cusp present data suggest dilatation bring growth annulus extent patch longer needed intracardiac repair
diagnostic echocardiographic features sinus venosus defect establish diagnostic criteria sinus venosus atrial septal defect cross sectional echocardiograms , , surgical notes patients diagnosis seen children 's hospital pittsburgh 1986 1988 reviewed seven patients identified extent atrial septum nature junction superior vena cava atria evaluated echocardiographically subcostal position overriding superior vena cava abnormally connected right pulmonary veins six patients undergone cardiac catheterisation cineangiography five patients underwent surgical repair operative findings consistent expected morphology five , features additionally confirmed specimen therefore , basic anatomical feature superior sinus venosus interatrial communication connection superior vena cava , together anomalous drainage right sided pulmonary veins , results interatrial communication outside true atrial septum overriding superior vena cava across upper rim oval fossa suggested diagnostic feature clearly demonstrated echocardiographically subcostal position lesion interatrial communication rather atrial septal defect
coarctation aorta post stenotic aneurysm formation despite earlier angiography , post stenotic aneurysm aorta unexpected finding operation two patients coarctation one aneurysm found intercostal artery 19 year old man false aneurysm distal coarctation site 7 year old boy aneurysms fragile , apt rupture , difficult diagnose preoperatively though local factors jet bacterial endocarditis may influence formation must underlying generalised weakness arterial wall coarctation regarded isolated arterial abnormality may feature generalised disease risk rupture , may prevented antihypertensive treatment , operation delayed age group
balloon dilatation mitral valve single \( 2 x 19 mm \) \( 3 x 15 mm \) catheter efficacy balloon dilatation mitral valve \( 2 x 19 mm \) \( 3 x 15 mm \) catheter \( single catheter technique \) assessed 53 patients \( mean age 28 \) mitral stenosis , women procedure unsuccessful three patients balloon dilatation left atrial pressure decreased 22 mm hg 13 mm hg mitral valve gradient 12 mm hg 4 mm hg mitral valve area increased 0 7 cm2 2 1 cm2 exercise time standard bruce protocol increased 3 9 minutes 7 2 minutes 22 \( 44 \) patients mitral regurgitation developed grade regurgitation increased left right shunts pulmonary systemic flow ratios greater 1 5 detected four patients transient cerebrovascular episodes developed two patients one patient died emergency valve replacement severe mitral regurgitation balloon dilatation mitral valve single catheter technique catheters effective treatment patients mitral stenosis mild mitral regurgitation frequent complication procedure
interleukin 2 induced lung permeability mediated leukotriene b4 interleukin \( il \) 2 therapy leads respiratory dysfunction due increased vascular permeability study examines role chemoattractant , , permeability promoting agent leukotriene \( \) b4 setting sheep chronic lung lymph fistulae given il 2 , 10 \( 5 \) u kg iv bolus \( n 6 \) within 2 hours led significant increase ltb4 levels plasma lung lymph mean pulmonary artery pressure \( mpap \) rose pulmonary artery wedge pressure unchanged arterial oxygen tension \( pao2 \) fell lung lymph flow \( ql \) tripled \( p less 0 05 \) 3 hours , increase lymph plasma \( l p \) protein ratio \( p less 0 05 \) resulting increase lymph protein clearance \( p less 0 05 \) , data documenting increased microvascular permeability protein mild leukopenia thrombocytopenia \( p less 0 05 \) occurred body temperature rose common pretreatment lipoxygenase inhibitor diethylcarbamazine \( dec n 6 \) reduced baseline plasma ltb4 levels prevented il 2 induced increases ltb4 plasma lung lymph \( p less 0 05 \) contrast il 2 treatment alone , dec blunted increase mpap prevented rises ql \( p less 0 05 \) , l p protein ratio \( p less 0 05 \) , lymph protein clearance \( p less 0 05 \) dec also prevented il 2 induced leukopenia , fall platelet count , rise body temperature \( p less 0 05 , respectively \) infusion il 2 control \( n 5 \) affect plasma lymph ltb4 levels mild increases mpap \( p less 0 05 \) ql also rose occurred l p protein ratio fell \( p less 0 05 \) body temperature rose moderately pao2 , leukocyte , platelet counts unaffected data indicate il 2 administration leads pulmonary dysfunction manifest pulmonary hypertension increased vascular permeability , events associated ltb4 synthesis prevented dec leukotriene b4 appears therefore mediate il 2 induced lung injury
baroreflex control renal sympathetic nerve activity potentiated early phase two kidney , one clip hypertension conscious rabbits conscious normotensive two kidney , one clip hypertensive rabbits studied determine sensitivity arterial baroreflex control renal sympathetic nerve activity \( rsna \) heart rate relations mean arterial pressure rsna mean arterial pressure heart rate examined wide range blood pressures produced infusions phenylephrine nitroglycerin maximum slope obtained logistic function analysis considered represent baroreflex sensitivity early hypertensive group \( n 8 mean arterial pressure sem , 88 2 mm hg \) day 5 renal clip application , maximum slope mean arterial pressure rsna relation 11 3 1 2 , significantly greater sham normotensive group \( 6 9 0 3 , p less 0 05 \) maximum slope \( 4 3 0 2 \) mean arterial pressure rsna relation late hypertensive group \( n 8 mean arterial pressure , 96 3 mm hg \) day 21 renal clipping significantly smaller another sham group \( 7 2 0 2 , p less 0 05 \) contrast changes baroreflex control rsna , control heart rate attenuated according magnitude mean arterial pressure elucidate mechanisms underlying potentiated baroreflex , effects endogenous neuropeptides investigated first , plasma concentrations angiotensin ii arginine vasopressin known affect baroreflex determined plasma concentrations vasopressin \( 3 1 0 6 pg ml \) well angiotensin ii \( 34 7 pg ml \) increased early hypertensive group , plasma vasopressin returned similar level sham group late hypertensive group \( 1 3 0 4 pg ml \) second , study endogenous effects neuropeptides baroreflex , maximum slopes baroreflex curves infusions antagonists peptides determined early hypertensive group maximum slope mean arterial pressure rsna arterial , angiotensin ii \( 16 4 1 5 \) significantly greater \( p less 0 05 \) , whereas maximum slope arterial infusion \( \) \( \) arginine vasopressin \( 4 7 0 5 \) significantly smaller \( p less 0 05 \) vehicle infusion \( 11 3 1 2 \) \( abstract truncated 400 words \)
chronic calcium channel blockade prevents progression myocardial contractile electrical dysfunction cardiomyopathic syrian hamster programmed onset myocardial dysfunction progression congestive heart failure cardiomyopathic syrian hamster alterations calcium regulation determine whether calcium channel blockade effective progressive depression myocardial contractile performance animal model congestive heart failure , oral verapamil therapy instituted 50 days age , treatment continued various durations time study either 150 250 days age left ventricular papillary muscle isometric isotonic performance , well transmembrane electrical characteristics , depressed diseased hamsters 150 days age deteriorated 250 days age changes evidenced prolongation contraction duration , marked depression load velocity relation , significant prolongation repolarization phase transmembrane action potential myocardial functional electrical alterations associated progression life myopathic hamsters completely verapamil therapy continuous 50 days birth death diastolic arrest , 150 250 days age however , premature termination verapamil treatment death resulted progressive functional electrical alterations duration drug termination concluded pathological changes seen lifetime cardiomyopathic hamster prevented continuous calcium channel blockade intermediate prevention attained protracted verapamil therapy thus , chronic verapamil therapy may useful adjunct prevention human congestive heart failure similar etiology
enhanced chemiluminescence measure oxygen derived free radical generation ischemia reperfusion suggested oxygen derived free radicals may contribute myocardial injury associated ischemia reperfusion presence enhanced free radical generation prerequisite damage , several techniques used provide evidence increased oxygen free radical production reperfusion however , techniques substantial limitations study , used enhanced chemiluminescence evaluate oxygen free radical generation ischemia reperfusion isolated langendorff perfused rat heart technique , high sensitivity monitor radical generation continuously , avoids limitations earlier methods chemiluminescence \( expressed counts per second \) decreased 219 11 baseline 142 9 ischemia markedly increased peak 36 first 3 5 minutes reperfusion followed slow decline 11 16 minutes steady state level 253 14 \( sequential change chemiluminescence highly significant p less 0 001 \) superoxide dismutase \( 2 , 000 units min \) significantly decreased peak reperfusion chemiluminescence 17 \( p less 0 01 \) hearts subjected second period ischemia reperfusion higher peak chemiluminescence \( 62 \) , also significantly attenuated 1 , 000 units min superoxide dismutase \( 398 16 p less 0 01 \)
collagen phenotypes development regression myocardial hypertrophy spontaneously hypertensive rats myocardium contains collagen matrix major determinant architecture , structural integrity , mechanical properties fibrillar matrix consists primarily type type iii collagens , , components present study shows alteration collagen phenotypes evolution hypertensive hypertrophy therapy captopril , angiotensin converting enzyme inhibitor cardiac hypertrophy , reduces total amount collagen reverses altered distribution type type iii collagen normotensive rats , captopril significantly reduce collagen content alter ratio type type iii collagen
regeneration myocardial phosphocreatine pigs despite continued moderate ischemia effects 1 hour mild moderate reductions coronary blood flow myocardial high energy phosphate levels evaluated thirty anesthetized pigs instrumented left anterior descending arterial venous catheters , crystals wall thickness , fluid filled occluder measurement myocardial blood flow performed microspheres , series myocardial biopsies also performed 10 pigs , overall coronary blood flow lowered 22 , fall subendocardial flow ratio 1 11 0 54 wall thickening 33 15 subendocardial flow fell 48 coronary blood flow thickening constant 1 hour ischemia phosphocreatine \( mumol g wet wt \) subendocardial third ischemic zone fell 7 6 3 8 5 minutes ischemia \( p less 0 005 versus control \) returned normal \( 7 9 \) 60 minutes \( p ns \) , despite ongoing ischemia subendocardial atp \( mumol g wet wt \) fell slowly 4 3 2 1 60 minutes ischemia \( p less 0 001 versus control \) similar regeneration phosphocreatine found seven additional pigs , 43 transmural reduction coronary blood flow 66 reduction subendocardial flow significant changes atp phosphocreatine noted two different control groups \( n 13 pigs \) regeneration phosphocreatine despite ongoing ischemia low atp levels related changes myocardial oxygen demand consumption , regional function period ischemia may reflect 1 \) successful downregulation energy needs ischemic myocardium maintain cell viability , 2 \) metabolic abnormality ability cells produce atp primarily use phosphocreatine
use pulmonary artery catheters patients acute myocardial infarction analysis experience 5 , patients registry study group study analyzes use pac registry comprising 5 , hospitalized patients ami total 371 patients received pac hospital mortality higher patients chf received pac , difference patients cardiogenic shock persistent hypotension mortality patients receiving pac higher irrespective presence absence pump failure separate analysis discharge 364 patients chf showed pac used frequently patients severity chf assessed , difference mortality found patients mild moderate chf conclude higher hospital mortality found patients receiving pac , excess likely related difference severity chf , assessed every individual unlikely pac increases mortality
clinical hospital cardiopulmonary arrest outcome hospital cardiopulmonary arrest studied extensively , clinical arrest less well defined studied group consecutive general hospital ward patients developing cardiopulmonary arrest prospectively determined definitions underlying pathophysiology , severity underlying disease , patient complaints , clinical observations used determine common clinical features sixty four patients arrested 161 26 hours following hospital admission pathophysiologic alterations preceding arrest classified respiratory 24 patients \( 38 percent \) , metabolic 7 \( 11 percent \) , cardiac 6 \( 9 percent \) , neurologic 4 \( 6 percent \) , multiple 17 \( 27 percent \) , 6 \( 9 percent \) patients multiple disturbances mainly respiratory \( 39 percent \) metabolic \( 44 percent \) disorders fifty four patients \( 84 percent \) documented observations clinical deterioration new complaints within eight hours arrest seventy percent patients either deterioration respiratory mental function observed time routine laboratory tests obtained arrest showed consistent abnormalities , vital signs showed mean respiratory rate 29 1 breaths per minute prognoses patients' underlying diseases classified ultimately fatal 26 \( 41 percent \) , nonfatal 23 \( 36 percent \) , rapidly fatal 15 \( 23 percent \) five patients \( 8 percent \) survived hospital discharge patients developing arrest general hospital ward services predominantly respiratory metabolic derangements immediately preceding arrests underlying diseases generally rapidly fatal arrest frequently preceded clinical deterioration involving either respiratory mental function features high mortality associated arrest suggest efforts predict prevent arrest might prove beneficial
family doctors screen asymptomatic children high blood pressure \? whereas united states task forces blood pressure control children recommended annual blood pressure screening children , working party british hypertension society formed opposite opinion relevant literature reviewed , conclusion reached epidemiological ethical grounds , screening children hypertension cannot present justified
brief angiotensin converting enzyme inhibitor treatment young spontaneously hypertensive rats reduces blood pressure long term study examines long term cardiovascular effects brief period angiotensin converting enzyme \( ace \) inhibitor treatment young spontaneously hypertensive rats \( shr \) shr treated perindopril \( 3 mg kg day \) 2 6 , 6 10 , 2 10 weeks age systolic blood pressure measured tail weekly 25 weeks age corresponding control groups received water periods treatment group blood pressure reduced significantly treatment , rose treatment stopped , significantly control shr thereafter difference blood pressure 25 weeks age due reduced total peripheral resistance determined microsphere methods , plasma renin activity angiotensin ii concentrations different cardiac hypertrophy also reduced treated shr separate experiment , perindopril treatment 6 10 weeks age resulted significant reduction media lumen ratios mesenteric resistance vessels 32 weeks age concomitant administration angiotensin ii perindopril 6 10 weeks age prevented long term effects blood pressure seen perindopril treatment alone associated cardiovascular hypertrophy excess untreated control shr finally , perindopril given shorter period \( 6 7 weeks \) later life \( 20 24 weeks \) significant long term effects blood pressure results demonstrate 4 week period ace inhibitor treatment young shr sufficient prevent full expression genetic hypertension cardiovascular hypertrophy angiotensin ii might important development hypertension model , role later life less important
white coat versus sustained borderline hypertension tecumseh , michigan survey young subjects receiving treatment hypertension tecumseh , michigan , clinic self monitored blood pressures taken home \( 14 readings 7 days \) obtained subjects \( 387 men , 350 women , average age 31 5 years \) hypertension clinic diagnosed clinic blood pressure exceeded 140 mm hg systolic 90 mm hg diastolic absence firm criteria constitutes hypertension home , subjects whose average home blood pressure upper whole population considered hypertension home criteria , 7 1 whole population white coat hypertension \( e , high clinic elevated home readings \) prevalence sustained hypertension \( e , high readings clinic home \) 5 1 subjects white coat sustained borderline hypertension tecumseh similar groups showed , previous examinations \( ages 5 , 8 , 21 , 23 years \) , significantly higher blood pressure readings normotensive subjects young adults \( average age 33 3 years \) , parents hypertensive groups significantly higher blood pressure readings parents normotensive subjects hypertensive groups faster heart rates , higher systemic vascular resistance , higher minimal forearm vascular resistance hypertensive groups overweight , higher plasma triglycerides , insulin , insulin glucose ratios normotensive subjects white coat hypertensive group also lower values high density lipoprotein normotensive group white coat hypertension frequent condition
thromboxane a2 development genetic hypertension lyon rat strain determine whether increased renal biosynthesis thromboxane a2 observed young genetically hypertensive rats lyon strain could involved development hypertension , lyon hypertensive female rats received either thromboxane synthetase inhibitors \( oky 046 \) thromboxane a2 receptor antagonist \( ah \) stage treatment 5 9 weeks age failed reduce systolic blood pressure given 3 9 weeks age , oky 046 induced similar progressive specific reduction \( 60 \) urinary excretion thromboxane b2 associated transient decrease blood pressure level longer lasting blood pressure lowering effect oky 046 ah , given according schedule , normalized blood pressure level effect persisted 1 week cessation treatment interestingly , active doses thromboxane synthetase inhibitors thromboxane a2 receptor blocker required 3 week delay exhibit antihypertensive properties concluded 1 \) elevated production thromboxane a2 observed young lyon hypertensive rats likely participate actively blood pressure regulation 2 \) effect may independent direct vasoconstrictor properties
role endothelium response endothelin hypertension relation endothelin acetylcholine \( ach \) examined compared aortas wistar kyoto \( wky \) rats stroke prone spontaneously hypertensive rats \( shrsp \) relaxation produced ach endothelin induced contraction less aortas wky rats shrsp aortas wky rats shrsp , contraction produced endothelin augmented intact aortic rings treated methylene blue \( 10 \( 5 \) \) augmentation also found preparations wky rat aortic rings endothelium removed augmentation present shrsp aortic rings similarly treatment indomethacin \( 5 x 10 \( 6 \) \) effect endothelin induced contraction either wky rat shrsp aortic rings findings indicate endothelin ach common ability release endothelium derived relaxing factor \( edrf \) wky rat aortic rings reduced endothelium dependent relaxation response ach wky rat probably reflects fact endothelin already released edrf rings strain rats release edrf endothelin less shrsp wky rats failure endothelin release edrf shrsp , endothelin may contribute increase total peripheral resistance form hypertension
fish oil effect propranolol mild essential hypertension forty seven male patients mild essential hypertension randomly allocated three subgroups run period 4 weeks , first subgroup \( n 16 \) received propranolol \( 80 mg day \) 36 weeks followed placebo period 4 weeks second subgroup \( n 15 \) , run period 4 weeks , given supplement encapsulated fish oil \( 9 g day \) 36 weeks subsequent period 4 weeks fish oil placebo given third subgroup \( n 16 \) , run period 4 weeks , given propranolol \( 80 mg day \) 12 weeks , propranolol \( 80 mg day \) plus fish oil capsules \( 9 g day equivalent 1 8 g day eicosapentaenoic acid 1 1 g day acid \) 12 weeks , propranolol plus fish oil placebo \( doses 12 weeks \) subsequent period 4 weeks propranolol placebo administered results indicate blood pressure lowering effect fish oil , comparable propranolol simultaneous intake fish oil plus propranolol effective propranolol fish oil alone propranolol treatment resulted decrease plasma norepinephrine , plasma renin activity , thromboxane b2 formation fish oil supplementation , plasma norepinephrine thromboxane b2 formation likewise reduced , whereas plasma renin activity appeared increased decrease serum triglycerides , total low density lipoprotein cholesterol well rise high density lipoprotein cholesterol concomitant beneficial effects , justify consideration fish oil alone combination antihypertensive drugs treatment mild hypertension
insulin resistance blood pressure young black men insulin resistance , independent obesity non insulin dependent diabetes mellitus , demonstrated associated high blood pressure determine insulin resistance could antecedent hypertension high risk population , studied normotensive \( 112 12 70 10 mm hg \) borderline hypertensive \( 135 8 85 5 mm hg \) lean young black men \( 22 26 years old \) euglycemic hyperinsulinemic clamp technique subjects clinically normal oral glucose tolerance body mass index percent adipose mass groups fasting plasma insulin concentration significantly higher borderline hypertensive group \( p less 0 01 \) insulin directed exogenous glucose metabolism degree steady state hyperinsulinemia significantly lower borderline hypertensive group \( 5 98 2 22 versus 8 22 1 96 mg kg min p less 0 01 \) total population , significant inverse correlation existed glucose infusion rate systolic blood pressure \( p less 0 01 \) data indicate relation insulin mediated glucose uptake blood pressure furthermore , high risk population insulin resistance may precede onset established essential hypertension
similar frequencies renin gene restriction fragment length polymorphisms hypertensive normotensive subjects prospective study conducted compare frequency renin gene polymorphisms normotensive hypertensive subjects hypertensive \( n 102 , blood pressure 168 17 103 9 mm hg \) normotensive \( n 120 , blood pressure 122 10 75 9 mm hg \) subjects white , similar age sex distributions \( hypertensive group , 45 10 years old 52 female normotensive group , 44 9 years old 55 female \) similar body mass index \( hypertensive group , 23 2 2 6 normotensive group , 22 5 2 4 kg m2 , p 0 \) familial susceptibility hypertension defined least one parent one sibling hypertensive age 65 subjects normotensive group familial history hypertension renin gene polymorphisms located throughout renin gene identified using three restriction enzymes \( taq , , \) polymorphic restriction site , allele frequencies similar hypertensive normotensive groups absence parental genotypes , haplotype frequencies combining three restriction fragment length polymorphisms estimated using maximum likelihood techniques similar groups \( hypertensive group , 0 429 , 0 277 , 0 177 normotensive group , 0 , 0 245 , 0 195 three common haplotypes \) rare haplotype detected taq hind iii apparently frequent hypertensive normotensive group \( hypertensive group , th 0 , th 0 022 normotensive group , th 0 038 , th 0 \) , difference statistically significant conclusion , association renin gene polymorphisms essential hypertension demonstrated present study
surprising kidney fluid mechanism pressure control infinite gain short paper , tried explain felt first realized kidney fluid mechanism controlling arterial pressure infinite feedback gain property , pressure control mechanisms , none ever shown similar infinite gain property , must alter kidney fluid mechanism causing long term changes arterial pressure able principle despite many experiments last 2 decades reason , first understanding infinite gain property kidney fluid mechanism like light end tunnel hope explain seconds first recognized principle 1966
vascular flow capacity hindlimb skeletal muscles spontaneously hypertensive rats total regional skeletal muscle flows \( radiolabeled microspheres \) determined isolated maximally spontaneously hypertensive rats \( shr \) age matched \( 11 12 mo \) normotensive wistar kyoto rats \( wky \) assess vascular flow capacity skeletal muscle vascular beds vascular flow capacity estimated measuring total regional muscle blood flows \( conditions maximal vasodilation papaverine papaverine plus isoproterenol \) wide range perfusion pressures wky shr capillary exchange capacity estimated determining capillary filtration coefficient capillary pressures segmental vascular resistances determined flows capillary pressures different wky shr however , total vascular resistances significantly elevated shr , postcapillary resistances different compared wky maximal capillary filtration coefficient values shr group averaged 20 lower wky values , suggesting hypertension associated reduction microvascular surface area available fluid exchange , therefore , capillary exchange capacity perfusion pressures studied , total flows averaged 60 lower shr wky flows individual skeletal muscles averaged 76 lower shr wky regardless muscle fiber type thus , modifications exist hindlimb skeletal muscle vasculature shr reduces capillary exchange capacity limit capacity deliver flow given perfusion pressure gradient
production thrombi intact endothelium use agents vivo suggested antithrombin activity surface intact endothelial cells may play role inhibiting platelet adhesion thrombus formation antithrombin activity may due activation antithrombin iii glycosaminoglycans , possibly combination inhibitory activity shown affected agents protamine , bromide \( chemical co , , \) platelet factor 4 , well enzymes used hamster cheek pouch preparation observe thrombus formation vivo normal vascular flow , determine whether production thrombi thrombin enhanced agents intra arterial injection topical application protamine bromide , platelet adhesion thrombus formation intact arteriolar endothelium produced dose thrombin , injected alone effect thrombi found venules capillaries injection heparin agents necessitated larger dose enhance action thrombin electron microscopy thrombi found consist primarily platelets adherent intact endothelium possible clinical implications observations discussed
clues electrocardiographic diagnosis subtle wolff parkinson white syndrome children electrocardiographic diagnosis wolff parkinson white syndrome \( wpw \) may missed delta waves subtle children , examined 66 electrocardiograms patients proven wpw , 24 questionable wpw \( subtle wpw \) , 369 consecutive electrocardiograms control patients identify additional clues wpw might present three features notable wpw q wave left chest leads \( 88 \) , pr interval less 100 \( 80 \) , left axis deviation \( 33 \) subtle wpw findings similar 79 , 67 , 46 , respectively comparison , 5 control subjects q wave , 16 pr interval less 100 , 4 left axis deviation \( p less 0 001 \) coexistence two features common \( 74 \) wpw subtle wpw \( 63 \) rare \( 2 \) control subjects \( p less 0 001 \) pr interval less 100 less specific 1 year age , 89 patients wpw qrs duration greater 80 versus 2 control subjects \( p less 0 001 \) obvious wpw disappeared later 11 patients however , left axis deviation lack q wave persisted eight \( p less 0 01 \) conclude diagnosis wpw children , even subtle , suggested presence four changes preexcitation may persist patients overt delta waves longer present
comparison coarctation resection subclavian flap angioplasty using monitored reactive hyperemia reported relatively high incidence early restenosis coarctation repair site subclavian flap angioplasty , especially infants less 3 months age , prompted physiologically oriented analysis relief obstruction coarctation subclavian flap angioplasty versus resection end end anastomosis infancy twenty one patients undergone repair coarctation infancy either subclavian flap angioplasty \( nine patients \) \( median age 8 years \) resection end end anastomosis \( 12 patients \) \( median age 8 years \) evaluated doppler spectrum analysis blood flow velocities femoral artery rest reactive hyperemia median resting right upper lower limb systolic pressure difference \( interquartile range \) similar angioplasty , resection anastomosis , control groups 5 mm hg \( 18 mm hg \) , 0 mm hg \( 12 mm hg \) , 2 5 mm hg \( 10 mm hg \) , respectively also , similar resting values maximum frequency advancing curve pulsatility resistance indices measured three groups reactive hyperemia leg , however , significant hemodynamic obstruction across repair site became clinically manifest angioplasty group , documented lower pulsatility index comparison control group \( p 0 01 , u test \) comparison hemodynamic results angioplasty resection anastomosis groups subdivisions infants operated age less greater 3 months , rest reactive hyperemia , showed , already rest , significantly lower value pulsatility index former angioplasty subdivision \( p 0 05 , student 's test \) , indicating significant resistance coarctation repair site angioplasty patients operated third month life disadvantage angioplasty \( compared resection anastomosis \) noted angioplasty performed third month life , unequivocal lack advantage noted performed beyond period regarding relief obstruction coarctation addition , definite potential adverse long term effects hemodynamics left upper limb subclavian flap angioplasty infancy documented reasons prefer perform resection end end anastomosis repair coarctation infancy
studies myocardial protection immature heart ii evidence importance amino acid metabolism tolerance ischemia study tests importance amino acid determining tolerance immature hearts ischemic damage amino acid inhibited metabolically pretreatment aminooxyacetic acid aminooxyacetic acid dose duration determined incubating vitro tissue homogenate showing 8 mmol l dose 5 minutes blocked 90 alanine aminotransferase aspartate aminotransferase activity control studies nonischemic hearts showed coronary perfusion aminooxyacetic acid 5 minutes impair myocardial performance contrast , pretreatment immature puppies aminooxyacetic acid severely impaired recovery 45 minutes normothermic global ischemia \( 30 versus 85 recovery untreated hearts , p less 0 05 \) biochemical analyses hearts undergoing ischemia showed aminooxyacetic acid limit lactate production , impair glutamate utilization , prevent alanine production , limit succinate accumulation \( p less 0 05 \) data suggest amino acid important adaptive process immature heart improves resistance ischemic damage
warm induction blood cardioplegia infant technique avoid rapid cooling myocardial contracture use profound hypothermia total circulatory arrest repair heart defects neonates usually involves period systemic myocardial bypass cooling rapid cooling muscle \( skeletal , smooth , myocardial \) result contracture elevation cytosolic calcium levels increased myocardial tone caused cooling might render heart vulnerable subsequent period cardioplegic ischemic arrest infants may susceptible contracture small body mass allows rapid myocardial temperature change bypass cooling used influence avoiding rapid myocardial cooling induced cardioplegic arrest analyzed group infants weighing less 6 kg time open cardiac operation myocardial ischemic arrest warm \( 37 degrees c \) induction blood cardioplegia used 57 infants compared results infants treated standard blood cardioplegia multivariate logistic regression analysis revealed patient diagnosis , weight , age operation significant risk factors operative mortality use warm induction blood cardioplegia strongly positive independent effect survival \( p 0 0003 \) patient weight , age , diagnostic group recommend avoidance rapid myocardial cooling bypass patients induction cardioplegic ischemic arrest
efficacy safety low high dose sotalol versus propranolol prevention supraventricular tachyarrhythmias early coronary artery bypass operations supraventricular tachyarrhythmias reported 40 patients early coronary artery bypass graft operations randomized study , compared efficacy safety class iii antiarrhythmic beta blocking drug sotalol versus propranolol low high doses prevention supraventricular tachyarrhythmias 429 consecutive patients coronary artery bypass graft operations patients severely depressed left ventricular function contraindications beta blockers excluded fourth hour sixth day coronary artery bypass , 74 patients received low dose sotalol \( 40 mg every 8 hours \) , 66 patients low dose propranolol \( 10 mg every 6 hours \) , 133 patients high dose sotalol \( 80 mg every 8 hours \) , 156 patients high dose propranolol \( 20 mg every 6 hours \) baseline characteristics comparable groups supraventricular tachyarrhythmia observed 10 72 \( 13 9 \) received low dose sotalol , 12 64 \( 18 8 \) received low dose propranolol , 13 119 \( 10 9 \) received high dose sotalol , 19 139 \( 13 7 \) received high dose propranolol \( significant \) drug related adverse effects necessitating discontinuation drug occurred four receiving low doses \( 2 9 \) 31 receiving high doses \( 10 7 \) \( p less 0 02 \) conclusion , medication found superior , although supraventricular tachyarrhythmias tended less prevalent patients treated sotalol treated propranolol moreover , significantly fewer adverse effects noted low dose groups therefore , low dose beta blocking treatment , especially low dose sotalol , seems preferable
temporal arteritis report simultaneous occurrence biopsy proven temporal arteritis husband serologic viral studies negative , including viral culture 's temporal artery concurrent incidence giant cell arteritis married would suggest common exogenous exposure
development prospective application quantitative 2 day stress rest tc 99m methoxy isobutyl isonitrile spect diagnosis coronary artery disease clinical diagnostic accuracy 2 day stress rest quantitative technetium 99m \( tc 99m \) methoxy isobutyl isonitrile \( tc sestamibi \) single photon emission computerized tomography \( spect \) assessed validation population 61 patients two different sites using two different camera computer systems study population made 53 catheterized patients , 29 medical center \( csmc \) 24 university texas southwestern medical center \( utsmc \) , eight utsmc patients less 5 pre test likelihood coronary artery disease interpretation employed gender specific normal limits developed additional 15 men 8 women csmc less 5 likelihood significant coronary artery disease results csmc compared utsmc different overall sensitivity detection patients coronary artery disease \( greater equal 50 stenosis \) 94 \( csmc 92 , utsmc 95 \) overall specificity five patients normal coronary arteriograms 80 \( csmc 67 , utsmc 100 \) rate patients low likelihood coronary artery disease 88 vessel sensitivity 85 \( csmc 84 , utsmc 85 \) , vessel specificity 71 \( csmc 72 , utsmc 69 \) also significant difference sensitivities specificities male female populations addition , agreement coronary angiography assessment disease extent \( normal coronary arteriogram , single multivessel disease \) 75 \( kappa 0 6 0 1 \) study demonstrated tc sestamibi spect quantitative analysis accurate detection localization coronary artery disease furthermore , csmc quantitative method shown provide similar diagnostic accuracy applied data acquired different site using different camera computer system
estimation post test probability coronary disease following exercise testing using sequential application two methods recent studies revealed methods estimate post test probability following exercise testing differ sensitivity specificity across range post test probability take advantage relative strengths method , combined two methods single method \( dual \) compared two original methods 436 patients underwent stress testing followed within 2 months coronary arteriography patients post test probabilities determined using cadenza \( better sensitivity \) cadenza derived probabilities greater equal 50 substituted post test probabilities determined diamond 's original method \( better specificity \) mean post test probabilities follows 34 , cadenza 48 , dual 37 \( actual incidence 38 \) comparison sensitivity specificity every fifth percentile post test probability revealed sensitivity dual better equal cadenza thresholds less equal 10 specificity better cadenza equal thresholds greater equal 60 therefore using methods indicated better using either method alone
clinical electrophysiological characteristics ventricular tachycardia children normal hearts characteristics 18 patients clinical ventricular tachycardia \( vt \) normal hearts documented physical examination , echocardiography , analyzed 13 males 5 females , aged 1 16 years \( mean sd , 9 7 4 8 years \) six patients hemodynamic instability vt 12 patients hemodynamically stable two patients \( 11 \) presented sustained vt 16 \( 89 \) episodes nonsustained vt varying intervals \( 3 16 repetitive monomorphic vt \) among 14 patients exercise tests performed , seven exercise induced vt electrophysiologic studies , vt induced 16 18 \( 89 \) \( 13 patients morphology identical clinical vt \) vt induced programmed stimulation \( single , double , burst stimulation right atrium right ventricular apex sinus rhythm eight beats \) 5 18 \( 28 \) patients isoproterenol , vt spontaneously 6 15 \( 40 \) patients stimulation vt induced 8 15 \( 53 \) patients among patients whose vt induced programmed stimulation , vt induced addition isoproterenol 11 12 \( 92 \) 14 patients follow stable condition , seven patients medication seven without medication pediatric patients normal hearts clinically detected vt usually vt induced programmed stimulation , either without isoproterenol stimulation
role beta blockade therapy ventricular tachycardia induced isoproterenol prospective analysis isoproterenol sometimes required ventricular tachycardia \( vt \) induction however , role beta blockade treatment vt critically assessed use beta blockade evaluated prospectively 14 consecutive patients required isoproterenol 2 4 1 3 \( \) micrograms min induce sustained monomorphic vt \( greater 30 seconds , requiring termination due hemodynamic collapse \) negative baseline study vt mechanisms enhanced automaticity \( group , six patients \) , triggered automaticity \( group b , three patients \) , reentry \( group c , five patients \) groups b serial intravenous tests propranolol alone \( 0 2 mg kg \) , verapamil alone \( 0 15 mg kg \) , propranolol plus verapamil , group c serial tests propranolol alone , procainamide quinidine \( class ia drug \) alone , propranolol plus class ia drug vt could longer induced six patients group responded propranolol alone group b , one patient responded verapamil alone , two patients responded propranolol plus verapamil group c , three patients responded propranolol alone , one patient responded class ia drug alone , one patient responded propranolol plus class ia drug follow 7 37 \( 17 9 10 7 \) \( \) months , vt recurred patient three patients treated initially propranolol alone required substitution amiodarone due refractory congestive heart failure patients requiring isoproterenol vt induction , beta blockade alone appears effective preventing vt caused enhanced automaticity heterogeneous response occurs vt mechanisms triggered automaticity reentry
double peaking circadian variation occurrence sustained supraventricular tachyarrhythmias studied 251 patients less equal 65 years age admitted treatment symptomatic supraventricular tachyarrhythmia assess whether arrhythmias begin throughout day manifest circadian variation occurrence arrhythmias included 152 episodes atrial fibrillation , 50 episodes supraventricular reentry tachycardia , 30 episodes atrial flutter , 19 cases ectopic atrial tachycardia total 209 patients could exact time symptoms started 38 \( 18 \) , arrhythmia begun midnight 6 00 , 63 \( 30 \) 6 01 noon , 46 \( 22 \) noon 6 00 pm , 62 \( 30 \) 6 01 pm midnight distribution differed significantly uniform occurrence \( chi square 8 7 , p less 0 05 \) fifty patients using beta adrenoceptor blocking agents arrhythmia occurred compared 159 patients , morning surge arrhythmias \( 20 versus 33 3 episodes 6 01 noon \) , instead much higher incidence night \( 34 versus 13 2 episodes midnight 6 00 \) \( chi square 14 4 , p less 0 005 \) conclude frequency onset sustained supraventricular tachyarrhythmias varies time day , showing nearly equal peaks morning evening trough night modifying effect beta adrenoceptor blockage suggests many morning arrhythmias adrenergic origin , probably vagal arrhythmogenic mechanisms , night
effects xamoterol inotropic properties human myocardium adenylate cyclase activity purpose present study characterize effects xamoterol human myocardium presence forskolin milrinone , xamoterol increased isometric force contraction , contraction velocity , relaxation velocity isolated , electrically driven preparations human myocardium , effect alone difference effect xamoterol right atrial myocardium left ventricular myocardium \( nf \) , moderately failing \( nyha ii iii \) , severely failing \( nyha iv \) human hearts positive inotropic effects reduced depending severity heart failure left ventricular myocardium \( e , nf greater nyha ii iii greater nyha iv \) presence norepinephrine , xamoterol produced negative inotropic effects similar beta adrenoceptor antagonists pindolol propranolol xamoterol alone effects force contraction , whereas pindolol propranolol markedly reduced contractile force nyha class iv , stimulated adenylate cyclase twofold xamoterol , like pindolol propranolol , effect experiments beta 1 beta 2 selective antagonists cgp 207 ici 118 , respectively , showed positive inotropic effects xamoterol mediated beta 1 adrenoceptors consistently , xamoterol selectivity 13 8 beta 1 adrenoceptors measured radioligand binding experiments concluded xamoterol acts beta 1 adrenoceptor antagonist selectivity 13 8 human ventricular myocardium compound intrinsic sympathomimetic activity , produces beta 1 adrenoceptor mediated positive inotropic effects presence forskolin beneficial effects xamoterol patients heart failure could due prevention detrimental effects norepinephrine beta 1 adrenoceptor downregulation increase gi \( inhibitory guanine nucleotide binding protein \)
new calcium antagonists relevance calcium antagonists heterogeneous class drugs used treat number cardiovascular disorders new generation calcium antagonists development higher degree selectivity vascular smooth muscle coronary vasculature compared verapamil , nifedipine , diltiazem clinical relevance impact drug selection discussed newer calcium antagonists important alternatives older agents may associated improved tolerance reduced incidence adverse effects place therapy yet defined comparative studies efficacy safety
epidemiologic aspects heart failure prevalence heart failure london 0 4 , lower figure united states heart failure common reason \( 5 \) medical admission hospital london area problem heart failure predominantly persons 65 years coronary artery disease frequent cause , hypertension relatively uncommon patients admitted hospital , prognosis poor
heart failure prevented , delayed , reversed \? review clinical course chronic heart failure demonstrates current outcomes remain highly unsatisfactory mortality perhaps important morbidity satisfactory functional responses seen patients undergo cardiac transplantation clearly identify primary cause status heart , whatever pathophysiologic adjustments neuroendocrine system , interventions wide variety drugs since donor hearts unlikely available even younger clinical syndromes , prevention must hallmark protection viability myocytes , acute myocarditis acute infarction , essential myocardial collagen undergoes continual synthesis , production greatly stimulated presence hypertrophy caused increased wall stress possible excess collagen involved diastolic ventricular dysfunction , may reversible process collagen producing stimulus removed thus reduction wall stress reversibility ventricular hypertrophy appear promising directions however , limit catastrophic effects chronic heart failure , early recognition precursors syndromes , prevention progression , surgical intervention valvular heart disease optimal point time essential
regional blood flow supply demand heart failure heart failure results fall cardiac output also redistribution blood flow favoring regional beds \( brain heart \) expense others \( kidney working skeletal muscle \) chronic resting hypoperfusion muscle compromised exercise vasoconstrictor control mechanisms prevent blood flow nonworking muscle liver working muscle inappropriate preservation nonworking organ perfusion compromises functional capacity working muscle associated evidence metabolic reduced oxygen extraction impaired oxidative phosphorylation becoming increasingly clear clinical response inotropic vasodilator therapy used heart failure part dependent differing regional blood flow profiles various agents studied ability angiotensin converting enzyme inhibitors blood flow away nonworking regional beds exercising muscle , thereby appropriate physiologic response changing metabolic needs , may overriding reason long term efficacy certainly future comprehensive therapy heart failure take consideration central hemodynamic also regional blood flow supply demand issues
compensation congestive heart failure compensatory mechanisms develop response heart failure well defined review , argued compensatory mechanism leads way distinguish beneficial aspects former harmful effects latter therapeutic agents maintain rather decrease blood pressure might perhaps beneficial crucial role hypotension initiating compensation
medical management chronic heart failure inotropic , vasodilator , drugs \? basis pathophysiologic mechanisms , medical therapy today chronic heart failure reviewed advantages disadvantages vasodilator drugs inotropic drugs presented finally , therapeutic value drugs , combine central myocardial effects positive inotropic agents peripheral vasodilators , discussed particular , orally available dopaminergic agents , ibopamine , interact beta receptors heart \( mediating positive inotropic effect \) well dopaminergic receptors peripheral vessels \( mediating systemic vasodilator effect \) kidneys \( potentiating natriuretic effect \) , seem advancement modern medical therapy chronic heart failure data shown long term treatment ibopamine , sustained clinical benefit heart failure diminished , despite decrease adrenergic receptors blood cells dopamine plasma concentration permanently normalized long term treatment discrepancy clinical improvement measured adrenergic downregulation may due interference neurohormonal systems multiple sites probably independent receptor activation suggested biosynthesis noradrenaline improved increasing intracellular dopamine transport
physiology pharmacology cardiovascular catecholamine receptors implications treatment chronic heart failure sympathetic nervous system physiologic effects endogenous catecholamines noradrenaline \( na \) adrenaline \( \) mediated alpha beta adrenoreceptors \( ars \) ar types subdivided two major subtypes alpha ars alpha 1 \( predominant effect vasoconstriction \) alpha 2 \( presynaptic inhibition na release postsynaptic vasoconstriction \) , beta ars beta 1 \( cardiac effects , renal renin release , lipolysis \) beta 2 \( presynaptic facilitation na release postsynaptic vascular , bronchial , uterine smooth muscle relaxation , possibly part mediated cardiac effects \) last 30 years growing evidence accumulated dopamine \( da \) , third endogenous catecholamine immediate precursor na , may also cause peripheral effects stimulation specific da receptors , addition known action alpha beta ars well accepted least two different da receptors present many peripheral tissues \( \) , including cardiovascular autonomic nervous system seem involved dilation certain vascular beds , inhibition na release nerve stimulation , natriuresis , aldosterone release chronic heart failure cardiac beta ar function decreases \( presumably due endogenous regulation elevated catecholamines \) , decrease related severity heart failure \( judged clinically new york heart association functional class \) human heart contains functional beta 1 beta 2 ars cardiac beta 1 beta 2 ars seem differentially affected different kinds heart failure end stage dilated cardiomyopathy beta 1 ars selectively reduced , whereas beta 2 ars nearly normal
select drug long term treatment chronic heart failure first line drugs treatment chronic congestive heart failure produce immediate symptomatic benefit , improve exercise tolerance , thereby improve quality life preferentially active monotherapy least reduce need drugs must safe well tolerated patients change , end , natural history disease , sudden death prevented life expectancy improves none currently available drugs criteria diuretics , digitalis , converting enzyme inhibitors , ibopamine come close described ideal
placebo effect heart failure many patients enrolled controlled clinical trials new drugs treatment heart failure show favorable hemodynamic clinical responses placebo therapy placebo effect results creation supportive therapeutic environment spontaneous improvement commonly seen measurements symptoms cardiac function repeated frequently long intervals time three months treatment placebo produces reduction symptoms 25 35 patients , increase cardiac output decrease pulmonary wedge pressure , increase exercise tolerance 90 120 seconds physicians commonly seek maximize placebo effect , since goal treatment clinical setting improve quality patient 's life hand , clinical investigators seek minimize placebo effect , since goal research study test hypothesis new drug superior placebo
efficacy ibopamine treatment heart failure loss myocardial contractility , enhanced vasoconstriction , neuroendocrine excitation pathophysiologic low output heart failure drugs counter consequences afford considerable therapeutic potential perhaps even consequences syndrome ibopamine possesses potential unique ability stimulate dopaminergic beta adrenoreceptors heart circulatory system stimulation dopaminergic receptors beta 2 adrenoreceptors results vasodilatation regional vascular territories beta 2 adrenoreceptor agonist activity also mild positive inotropic activity heart , whereas stimulation presynaptic dopaminergic receptors \( \) attenuates increased sympathetic neural outflow drug also suppresses renin angiotensin aldosterone system addition direct natriuretic activity pharmacodynamic effects ibopamine , exerted metabolite , translated measurable therapeutic benefits patients chronic heart failure increase peripheral blood flow induced regional vascular territories , including kidneys , associated increased cardiac output stroke volume reduction left ventricular pressure work , wall stress , myocardial oxygen consumption plasma norepinephrine , angiotensin , aldosterone also reduced , renal sodium excretion enhanced hemodynamic neuroendocrine activities , subject tolerance sustained administration drug , accompanied clinically significant improvement symptoms , exercise tolerance , new york heart association classification disability important , effects observed sustained treatment , minimal side effects observed long term treatment enhance safety profile drug
cardioprotective effects amlodipine ischemia reperfusion two experimental models cardioprotective effect amlodipine , long acting dihydropyridine derivative , studied 2 experimental models ischemia reperfusion isolated blood perfused hearts made ischemic 60 minutes reperfused 60 minutes alterations left ventricular developed pressure compliance monitored amlodipine treated hearts saline treated control animals changes perfusion pressure indicated amlodipine significantly reduced myocardial oxygen consumption coronary vascular resistance furthermore , progressive increase resting left ventricular diastolic pressure indicated amlodipine , administered onset global ischemia , attenuated development ischemic contracture return contractile function 60 minutes reperfusion maintenance tissue concentrations electrolytes significantly better amlodipine treated group control animals intact canine hearts , regional myocardial ischemia induced 90 minutes , followed 6 hours reperfusion although hemodynamic variables size region risk differ significantly treated animals control animals , infarct size significantly smaller amlodipine treated group control animals , gradual reduction coronary blood flow observed control group prevented amlodipine group comparison findings observed oxygen radical scavengers also discussed detailed report studies published american journal cardiology \( 1989 64 \) review included maintain continuity convenience
role echocardiography acute myocardial infarction interventional therapies thrombolytic agents , angioplasty surgery emerged important options management patients myocardial infarction therapies aimed improving myocardial perfusion ultimate improvement restoration myocardial function two dimensional echocardiography digital storage display ideal technique temporally monitoring regional ventricular function effectiveness interventional therapy design , 2 dimensional echocardiography noninvasive performed bedside reasons , echocardiography principal imaging technique indiana university hospital patients acute myocardial infarction computer retrieval echocardiograms achieved 10 seconds station coronary care unit availability examination , physician better understanding site , size function infarct area state noninfarcted myocardium also assessed may critical patient 's prognosis digital recordings , serial studies displayed side side , making easier physician follow natural history effect therapy echocardiography also useful identifying many complications occur myocardial infarction reasons , echocardiography also show related cardiac problems , management acute myocardial infarction
progress role calcium antagonists calcium antagonists widely used treatment clinical hypertension angina pectoris efficacious treatment , fixed atherosclerotic mixed angina reduce incidence silent ischemia shown reduce infarct angina experimental data suggest may certain cardioprotective properties cases acute myocardial ischemia infarction , stunned myocardium , diastolic dysfunction , left ventricular hypertrophy atherosclerosis moreover , shown improve exercise performance , well diastolic abnormalities patients hypertrophic cardiomyopathy animals , may delay reduce extent myocardial necrosis coronary occlusion coronary occlusion followed reperfusion , low doses alter hemodynamic profile , shown enhance return ventricular function animals stunned myocardium however , early first generation calcium antagonists \( nifedipine , verapamil , diltiazem \) shown reduce myocardial infarct size enhance survival patients acute myocardial infarction clinical studies suggest , unlike beta blockers , nifedipine may slow development atherosclerotic progression humans 2 year period , seems likely 1990s expansion use calcium antagonists angina hypertension also aspects calcium antagonists may delay , prevent possibly regress atherosclerotic lesions possibility
bone mineral density spontaneous hypertension differential effects dietary calcium sodium dietary calcium sodium postulated modify bone mineral status blood pressure regulation humans animals spontaneously hypertensive rat \( shr \) several defects calcium metabolism may contribute hypertension blood pressure bone mineral status measured shr normotensive wistar kyoto rats \( wky \) marker whole animal calcium metabolism addition , effect alterations dietary calcium sodium bone status examined 6 weeks age , seven male shr seven male wky placed control diet age , 28 shr 28 wky randomized four diets containing either 2 0 0 1 calcium 1 0 0 25 sodium four markers bone mineral status analyzed bone density measured direct photon absorptiometry , total bone calcium , phosphorus , magnesium content measured absorption shr exhibited significantly lower levels \( p less 0 001 \) bone density bone magnesium content wky , whereas bone phosphorus calcium differ two strains 2 0 calcium diets resulted increased bone density bone calcium content , lower bone magnesium strains 1 0 sodium diets associated decreased bone density shr , wky findings identify another indicator disturbed calcium metabolism shr may related impaired renal calcium handling consistent previously reported reductions renal calcium reabsorption decreased intestinal calcium transport older shr
possible triggering paroxysmal atrial fibrillation normal hearts psychological stressors report two cases paroxysmal atrial fibrillation triggered psychological stress two patients , normal echocardiograms coronary angiography neither patient alcoholic ingested ethanol relation onset atrial fibrillation free metabolic derangements possible mechanisms involved triggering atrial fibrillation discussed
incidence perioperative myocardial ischemia detected different electrocardiographic systems determine extent different electrocardiographic systems account differences reported incidence perioperative myocardial ischemia , authors simultaneously recorded 109 patients undergoing coronary artery bypass grafting \( cabg \) modified cm5 lead five ecg systems means specially constructed common lead systems included alpha 14 model series ecg 0 05 125 hz 0 5 30 hz \( typical operating room monitor \) , mac ii ecg 0 05 40 hz 0 05 100 hz \( standard ecg \) , mar holter recorder 0 1 100 hz relative st segment position incidence new ischemia compared preoperative ecg determined 109 sets preinduction traces sets intraoperative traces st segment position three recording systems american heart association \( aha \) low frequency response recommendations \( 0 05 hz \) similar compared standard ecg , st segment position 0 5 30 hz consistently negative displacement holter consistently less negative less positive 0 1 mv displacement criterion diagnosis myocardial ischemia one ecg system , 16 5 patients arrival 32 1 patients intraoperatively suffered new myocardial ischemia based operating room monitor , arrival intraoperative ischemia present 15 6 27 5 patients , respectively ischemia periods less frequent standard ecg system \( 5 5 12 8 , respectively \) least frequent holter recorder \( 4 6 8 3 , respectively \)
effect halothane isoflurane postischemic stunned myocardium dog short periods coronary artery occlusion known produce prolonged periods ventricular dysfunction effects halothane isoflurane contractility metabolism postischemic stunned myocardium studied open chest canine model left anterior descending artery \( lad \) occluded 15 min reperfused regional function lad circumflex artery \( circ \) areas measured , metabolic data determined simultaneous arterial venous measurements oxygen lactate halothane isoflurane produced equivalent decreases systolic shortening normal \( circ \) stunned \( lad \) areas heart furthermore , amount depression similar either halothane isoflurane halothane 0 75 mac significantly decreased systolic shortening lad region \( 38 8 25 9 11 0 21 8 \) circ region \( 116 7 24 7 87 5 23 3 \) equivalent mac concentrations isoflurane , values 42 5 45 7 7 0 49 9 lad region 91 5 11 9 66 9 23 9 circ area 1 5 mac halothane , systolic shortening lad region decreased 47 9 47 2 0 6 20 3 circ area 114 6 16 8 76 0 18 7 isoflurane 1 5 mac produced significant decreases , 23 4 54 5 15 6 27 1 lad region 94 4 33 2 61 3 28 2 circ area
patient hypertension therapy although stepped care approach remains antihypertensive therapy , patient 's profile must also considered important issues include patient 's age , race activity level , potential hypertensive complications , presence diseases , cost medications probability adherence recommended drug regimen nonpharmacologic treatment based lifestyle changes useful adjunct drug therapy , sufficient control hypertension patients selection pharmacologic therapy must based knowledge drug 's mode action side effects , well characteristics special patient populations
medication clonidine purpose study evaluate oral clonidine dose 0 3 mg routine sixty nine normotensive female patients studied randomized double blind investigation clonidine compared inert treatment clonidine produced significant reduction anxiety \( p less 0 05 \) sedation reduction sleep dose methohexitone \( p less 0 05 \) tachycardia response intubation attenuated clonidine \( p less 0 05 \) however , magnitude increase arterial pressure intubation affected intraoperative postoperative hypotension common premedication clonidine 0 3 mg caution use
combined alpha beta blockade versus beta 1 selective blockade essential hypertension black white patients purpose multicenter investigation determine efficacy safety alpha beta blocker labetalol versus beta 1 selective beta blocker atenolol white black patients essential hypertension equal numbers black white patients form four treatment groups \( white patients taking either labetalol atenolol black patients taking either labetalol atenolol \) two hundred ninety two patients \( 152 white 140 black patients \) essential hypertension characterized standing diastolic blood pressure 105 119 mm hg \( inclusive \) recruited trial patients randomized either labetalol \( dosage titrated 200 1600 mg day \) atenolol \( dosage titrated 50 100 mg day \) therapeutic goal achievement standing diastolic blood pressure 90 mm hg less fall 15 mm hg diastolic pressure baseline value end placebo run period end study significant differences blood pressure heart rate changes supine position labetalol atenolol groups contrast , labetalol produced greater reduction standing systolic diastolic blood pressure \( 12 13 mm hg , respectively \) compared atenolol \( 7 9 mm hg p less 0 05 p less 0 005 , respectively \) greatest decrease blood pressure observed white patients receiving labetalol black patients decrease blood pressure greater treated labetalol compared atenolol , particularly respect systolic blood pressure conclude alpha 1 blocking property labetalol provides additional lowering blood pressure seen beta 1 blockade alone , especially standing position , enhanced efficacy confined one radical group
elevated plasma noradrenaline concentrations patients low output cardiac failure dependence increased noradrenaline secretion rates 1 plasma noradrenaline concentrations elevated patients congestive heart failure however , pathogenesis elevated noradrenaline levels controversial 2 possible mechanisms elevated noradrenaline concentrations patients congestive heart failure include increased noradrenaline secretion , decreased clearance noradrenaline , combination increased secretion decreased clearance 3 present study , plasma noradrenaline clearance apparent secretion rates determined using whole body steady state radionuclide tracer method six otherwise healthy patients moderate degrees low output cardiac failure six normal control subjects 4 venous plasma noradrenaline level elevated patients congestive heart failure compared control subjects \( 4 18 1 34 versus 1 54 0 16 nmol l , p less 0 05 \) stimulation adrenal medulla evident normal plasma adrenaline levels groups \( 0 19 0 04 versus 0 18 0 02 nmol l , significant \) apparent secretion rate noradrenaline elevated patients congestive heart failure \( 4 75 1 95 versus 1 78 0 18 nmol min 1 2 , p less 0 05 \) , whereas clearance rate noradrenaline similar two groups \( 1 26 0 27 versus 1 16 0 02 l min 1 2 , significant \) 5 conclude high peripheral venous plasma noradrenaline concentrations patients mildly low output cardiac failure initially due increased secretion , rather decreased metabolic clearance , perhaps response diminished effective arterial blood volume
pineal hyperactivity spontaneously hypertensive rats muscarinic regulation metabolism 1 choline acetyltransferase activity 3h binding sites detected pineal gland normotensive wistar kyoto rats spontaneously hypertensive rats 2 vitro , muscarinic activation increased pineal metabolic production derivatives 5 hydroxytryptamine produced less marked stimulation biosynthesis 3 electrical field stimulation pineal gland slices caused similar metabolic effects 4 muscarinic blockade atropine inhibited effects metabolism 5 3h binding sites , indicative muscarinic receptors , numerous , basal 5 hydroxytryptamine levels higher , pineal gland spontaneously hypertensive rats compared wistar kyoto rats 6 atropine sensitive metabolic effects electrical field stimulation pineal gland increased spontaneously hypertensive rats compared wistar kyoto rats
evidence abnormal na h antiport activity detected phosphorus nuclear magnetic resonance spectroscopy exercising skeletal muscle patients essential hypertension 1 exercise induced ph changes skeletal muscle studied group eight subjects essential hypertension using 31p n r spectroscopy 2 leucocyte na h antiport activity measured vitro subjects using ph sensitive fluorescent dye 3 resting skeletal muscle ph unstimulated leucocyte ph values similar control subjects , increased na h antiport activity demonstrated hypertensive subjects acid loading vitro decreased skeletal muscle acidification increased rate ph recovery also demonstrated vivo patients acid load induced isotonic exercise 4 findings suggest increased cellular na h antiport activity , demonstrated vitro essential hypertension , also affects biochemical response skeletal muscle physiological levels exercise strengthens argument increased na h antiport activity hypertension generalized physiologically relevant cellular abnormality
central retinal vein obstruction axial length axial lengths 24 consecutive adult eyes unilateral central retinal vein obstruction \( \) compared contralateral unaffected eyes control population lengths two eyes persons unilateral significantly different contrast , eyes persons averaged 0 67 mm \( approximately 2 diopters \) shorter control counterparts \( p 03 \) anatomic difference may factor development
delayed detection coarctation infancy implications timing newborn follow recent 5 year period , 74 patients younger 6 months age diagnosed coarctation aorta coarctation correctly diagnosed 22 patients prior referral despite readily apparent femoral pulse abnormalities 86 infants whose symptoms detected 5 14 days age significantly ill infants outside age range high mortality rate \( 25 \) number associated cardiac defects related severity clinical illness group , suggesting closure ductus arteriosus primary disease severity observations two patients suggested detectable pulse discrepancy occurs 3 5 days upper extremity hypertension found commonly infants 5 days age despite presence congestive heart failure earlier detection coarctation newborn requires cardiovascular peripheral pulse examination 3 7 days life , upper extremity lower extremity blood pressure measurement , high index suspicion
apical hypertrophic cardiomyopathy non man japanese investigators first described apical 2 9 patients diagnostic left ventricular catheterization suspected ischemic heart disease cardiomyopathy entity initially thought limited individuals asian origin uncommonly described patients western origin patients western origin differ several ways original description et al , share classic criterion hypertrophy left ventricular apex major differences probably relate anatomic variation distribution left ventricular hypertrophy described et al known whether racial , genetic , environmental factors account variation disease expression asian western patients case illustrates diagnosis considered patients chest pain \( anginal atypical \) markedly abnormal findings electrocardiograms absence hypertension significant coronary artery disease
multiple arterial , multiple aneurysms , arteriovenous malformation patient subarachnoid hemorrhage report case 49 year old , right handed man multiple vascular pathologies , including fenestrated anterior communicating artery middle cerebral artery , aneurysm anterior communicating artery , multiple aneurysms middle cerebral artery , arteriovenous malformation diagnoses made computed tomography , cerebral angiography , magnetic resonance imaging , intraoperative dissection lesions managed surgically stages satisfactory results congenital hemodynamic factors may combined manifest anomalies present unique case believe similar combination vascular pathology reported previously
changes myocardial ischemic threshold daily activities study assesses variations myocardial ischemic threshold \( heart rate onset ischemia \) daily activities patients ischemic episodes holter monitoring eighty patients known coronary artery disease , positive treadmill stress test results greater equal 2 ischemic episodes 24 hour period holter monitoring studied lowest highest ischemic thresholds determined patient mean lowest ischemic threshold 85 beats min , mean highest ischemic threshold 109 beats min highest ischemic threshold identical ischemic threshold values noted exercise ischemic episodes , \( 74 \) preceded moderate \( greater 10 \) increase heart rate variability ischemic threshold \( difference percentage highest lowest ischemic thresholds \) increased number ischemic episodes \( range 2 60 \) however , different patients similar number ischemic episodes , different variability observed differences ischemic thresholds probably indirect indicators vasomotor activity coronary arteries different patients
determinants significance diltiazem plasma concentrations acute myocardial infarction multicenter diltiazem postinfarction trial research group total 1 , plasma diltiazem concentrations obtained 1 , patients enrolled multicenter secondary intervention study diltiazem acute myocardial infarction evaluate determinants significance diltiazem concentrations patient population , related drug concentrations variety clinical variables recorded case history forms multiple linear regression analysis showed \( 1 \) time last drug dose , \( 2 \) drug dose taken , \( 3 \) patient height \( index lean body weight \) , \( 4 \) patient age important determinants plasma concentration equivalent dose , plasma diltiazem concentrations 75 year old patient double 25 year old patient total weight drug dose prescribed significantly affect plasma concentrations whereas drug concentrations higher \( p 0 01 \) among patients left sided heart failure , altered renal dysfunction , hepatic disease beta blockers diltiazem concentrations significant determinant diastolic arterial pressure \( p less 10 \( 9 \) , neither systolic pressure heart rate significantly related diltiazem concentration overall incidence adverse experiences related drug concentrations , occurrence second third degree atrioventricular block coronary care unit need temporary pacemaker substantially higher among patients drug concentration greater 150 ng ml \( 7 4 1 9 , respectively \) among patients lower concentrations \( 2 6 atrioventricular block , 0 3 pacemaker p 0 02 \) risk atrioventricular block particularly increased high diltiazem concentrations face acute inferior infarction results suggest diltiazem 's pharmacologic clinical effects large population concentration related , consideration patient size , age , left ventricular function selecting diltiazem dose may allow effective drug therapy reduced likelihood adverse effects
prehospital thrombolysis acute myocardial infarction benefit risk prehospital thrombolysis acute myocardial infarction \( ami \) evaluated double blind randomized trial patients presenting less 4 hours symptom onset received 2 million units urokinase intravenous bolus either \( group , n 40 \) \( group b , n 38 \) hospital admission mean time interval onset symptoms thrombolytic therapy 85 51 minutes group 137 50 minutes group b \( p less 0 0005 \) 91 patients , thrombolytic therapy administered less 3 hours symptom onset complication rates pre hospital period low differ groups three patients died \( 1 group , 2 group b \) reinfarction 7 14 days admission left sided cardiac catheterization discharge revealed patency rate infarct related artery 61 group 67 group b \( difference significant \) global left ventricular function regional wall motion infarct site differ significantly group b \( ejection fraction 51 10 , n 28 vs 53 14 , n 28 wall motion 2 3 1 3 vs 2 2 1 1 standard deviation , respectively \) also , peak creatine kinase differ significantly \( u liter group vs u liter group b \) prehospital thrombolysis using bolus injection urokinase low risk performed trained physician mobile care unit saving 45 minutes early stage acute infarction prehospital thrombolysis appear important salvage myocardial function
comparison thallium 201 technetium 99m hexakis 2 isonitrile single photon emission computed tomography estimating extent myocardial ischemia infarction coronary artery disease single photon emission computed tomography \( spect \) using thallium 201 \( tl 201 \) compared technetium 99m hexakis 2 isonitrile \( tc 99m mibi \) 24 patients coronary artery patients exercised work load isotope studied normal left ventricular mass determined automated method estimated total left ventricular mass similar stress redistribution tl 201 stress rest tc 99m mibi images mean estimated defect size redistribution tl 201 images 32 34 7 vs 33 38 4 g resting tc 99m mibi studies \( difference significant \) individual determinations defect mass highly correlated \( r 0 93 p less 0 0001 \) estimated defect size stress tl 201 images \( 52 46 2 g \) significantly larger exercise tc 99m mibi estimates defect mass \( 42 39 9 g p less 0 05 \) linear correlation existed stress thallium technetium estimates defect size \( r 0 85 \) 15 24 tc 99m mibi defects smaller tl 201 defects partial redistribution tc 99m mibi could explain discordance stress tc 99m mibi spect defect size determined visual interpretation use analysis may smaller seen stress tl 201 spect
temporal relation left ventricular dysfunction chest pain coronary artery disease activities daily living forty three ambulatory patients angina increasing frequency underwent continuous monitoring left ventricular \( lv \) function average 2 9 1 9 hours determine incidence temporal sequence lv dysfunction , st segment depression chest pain indicators ischemia decrease ejection fraction greater 5 lasting greater 1 minute horizontal st segment depression greater equal 1 mm onset patient 's typical chest pain complex , combination monitoring interval , subjects performed daily activities sitting , walking , climbing eating 11 patients , 22 episodes chest pain st segment depression , , observed eighteen episodes accompanied decrease ejection fraction \( 9 patients \) chest pain accompanied decrease ejection fraction 13 episodes , whereas st segment changes occurred 7 12 13 episodes decrease ejection fraction began earlier onset chest pain , whereas 1 patient ejection fraction decrease chest pain onset started time average interval decrease ejection fraction onset chest pain 56 41 seconds \( range 0 120 \) st changes occurred onset decrease ejection fraction 6 7 episodes average interval onset ejection fraction decrease onset st change 99 91 seconds data suggest lv dysfunction manifested decrease ejection fraction earlier indicator myocardial ischemia angina pectoris electrocardiographic evidence ischemia
recanalization chronic , totally occluded coronary arteries new angioplasty systems benefit safety new angioplasty equipment compared conventional guidewire approach evaluated 154 consecutive patients chronic , totally occluded coronary arteries protocol followed stepwise design first , conventional low profile balloons used , followed balloon wire systems \( probe , ace \) shaft , tip catheter \( \) 97 patients occlusions 2 12 weeks' duration , recanalization achieved 51 patients \( 53 \) conventional approach 29 patients new devices \( balloon wire n 5 , n 24 \) , thereby raising success rate 82 57 occlusions greater 12 weeks' duration , recanalization attempt successful 58 , mediated 16 patients \( 28 \) catheter 5 patients balloon wire systems life threatening complications 1 \( 0 6 \) emergency bypass operation necessary new angioplasty devices therefore considerable value attempt improve results coronary angioplasty chronic total occlusions
arterial vasodilator effects dihydropyridine calcium antagonist amlodipine alone combination verapamil systemic hypertension arterial vasodilator properties dihydropyridine calcium antagonist amlodipine compared effects vascular muscle cyclic guanosine monophosphate production sodium nitroprusside effects combined infusion amlodipine calcium antagonist verapamil 8 untreated patients primary hypertension arterial vasodilation assessed measurement changes forearm blood flow mercury silastic strain gauge plethysmography brachial artery drug infusions forearm blood flow increased amlodipine infusions \( 0 4 45 micrograms min 100 ml forearm tissue \) 2 9 1 7 maximum 23 6 7 6 ml min 100 ml \( \) , sodium nitroprusside caused increase 3 0 1 8 16 2 5 4 ml min 100 ml \( 449 \) , importance transmembrane calcium influx maintenance vascular tone addition verapamil 40 micrograms min 100 ml infusion amlodipine 44 5 micrograms min 100 ml resulted increase forearm blood flow , 23 6 7 6 34 4 9 8 ml min 100 ml \( p less 0 05 \) precise mechanisms finding yet elucidated may due interactions effects binding 2 chemically pharmacologically different calcium antagonists distinct binding sites calcium channels clinical relevance observation treatment coronary artery disease systemic hypertension needs study
left ventricular filling impairment asymptomatic chronic alcoholics systolic left ventricular dysfunction relatively common even asymptomatic alcoholics , whether diastolic function also altered much less well studied used mode doppler echocardiography study left ventricular size , mass , systolic function diastolic filling 32 alcoholics free clinically detectable heart disease 15 healthy control subjects left ventricular mass index posterior wall thickness higher alcoholics controls , statistically significant difference either end diastolic size systolic ventricular function abnormalities found doppler indexes diastolic function , however alcoholics prolonged relaxation time \( 200 6 vs 184 5 ms mean standard error , p less 0 05 \) , decreased peak early diastolic velocity \( 52 2 vs 60 3 cm , p less 0 05 \) , slower acceleration early flow \( 410 18 vs 43 cm s2 , p less 0 01 \) , higher atrial early peak velocity ratio \( 0 74 0 04 vs 0 60 0 05 , p less 0 05 \) pattern changes suggests primary abnormality relaxation left ventricle multivariate analyses , abnormalities doppler indexes independent duration alcoholism , quantity recent ethanol exposure increased mass left ventricle impaired early filling left ventricle due delayed relaxation common asymptomatic alcoholics may fact earliest functional sign preclinical alcoholic cardiomyopathy
physiologic peripheral stenosis infancy studied 14 premature infants clinical diagnosis peripheral stenosis \( pps \) 15 normal full term neonates echocardiographic doppler examinations pps group average main pulmonary artery \( pa \) diameter similar control group \( 0 91 vs 0 96 cm , difference significant \) , smaller branch pa diameters right pa 0 41 vs 0 50 cm , p less 0 001 , left pa 0 41 vs 0 49 cm , p less 0 001 pps group also greater peak velocities main pa \( 76 vs 63 cm , p less 0 05 \) , right pa \( 193 vs 118 cm , p less 0 001 \) left pa \( 187 vs 123 cm , p less 0 001 \) similarly , ratio peak velocity branch main pa greater pps group right main pa peak velocity 2 91 vs 1 92 , p less 0 01 , left main pa peak velocity 2 73 vs 1 99 , p less 0 05 calculated right ventricular output pps group control group vs 261 ml min kg , p less 0 001 hematocrits done control group , pps group average hematocrit low \( 34 \) concluded patients pps mild pa branches , consequent increased flow velocity turbulent flow turbulent flow may contributed increased cardiac output mild anemia
spectrum hemodynamic changes cardiac tamponade investigate pathophysiology cardiac tamponade , hemodynamics 77 consecutive patients greater 150 ml pericardial effusion studied patients classified 3 groups based intrapericardial right atrial pulmonary arterial wedge pressures \( mm hg \) group \( n 16 \) , intrapericardial pressure less right atrial pulmonary arterial wedge pressures group ii \( n 13 \) , intrapericardial pressure right atrial pulmonary arterial wedge pressures group iii \( n 48 \) , intrapericardial pressure right atrial pulmonary arterial wedge pressures pericardiocentesis produced following changes group significant \( p less 0 03 \) decreases intrapericardial pressure \( 7 2 mm hg \) , right atrial pressure \( 3 2 mm hg \) , pulmonary arterial wedge pressure \( 2 2 mm hg \) , inspiratory decrease arterial systolic pressure \( 3 4 mm hg \) significant change cardiac output group ii significant \( p less 0 02 \) decreases intrapericardial pressure \( 11 5 mm hg \) , right atrial pressure \( 6 4 mm hg \) , pulmonary arterial wedge pressure \( 4 5 mm hg \) , inspiratory decrease arterial systolic pressure \( 8 7 mm hg \) , increase cardiac output \( 1 1 1 2 liters min \) group iii significant \( p less 0 001 \) decreases intrapericardial pressure \( 16 7 mm hg \) , right atrial pressure \( 9 4 mm hg \) , pulmonary arterial wedge pressure \( 8 5 mm hg \) , inspiratory decrease arterial systolic pressure \( 17 11 mm hg \) , increase cardiac output \( 2 8 1 5 liters min \) changes pericardiocentesis parameters significantly \( p less 0 05 \) greater group iii groups ii except change right atrial pressure , significantly different groups ii versus iii changes pericardiocentesis indicate pericardial effusion caused greatest abnormalities group iii also caused significant abnormalities pressure flow group ii pressure alone group
transesophageal echocardiography critically ill patients feasibility , safety clinical impact transesophageal echocardiography evaluated 51 critically ill intensive care unit patients \( 28 men 23 women mean age 63 years \) transthoracic echocardiography inadequate time transesophageal echocardiography , 30 patients \( 59 \) mechanically ventilated transesophageal echocardiography performed without significant complications 49 patients \( 96 \) , 2 patients heart failure worsening hemodynamic respiratory difficulties insertion transesophageal probe frequent indication , 25 patients \( 49 \) , unexplained hemodynamic instability indications included evaluation mitral regurgitation severity , prosthetic valvular dysfunction , endocarditis , aortic dissection potential donor heart 30 patients \( 59 \) , transesophageal echocardiography identified cardiovascular problems could clearly diagnosed transthoracic echocardiography remaining patients , transesophageal echocardiography permitted exclusion suspected abnormalities superior imaging cardiac surgery prompted transesophageal echocardiographic findings 12 patients \( 24 \) findings confirmed operation therefore , transesophageal echocardiography safely performed definite role diagnosis expeditious management critically ill cardiovascular patients
aspirin primary prevention angina pectoris randomized trial united states physicians purpose objective study examine effect low dose aspirin \( 325 mg alternate days \) primary prevention angina pectoris united states physicians' health study despite postulated role platelets atherogenesis myocardial ischemia , effect chronic platelet inhibition development clinical angina pectoris unknown subjects methods physicians' health study randomized , double blind , placebo controlled trial among 22 , male physicians aged 40 84 years , free previous myocardial infarction , stroke , transient cerebral ischemia entry , followed average 60 2 months 21 , physicians also free angina pectoris baseline constituted study population present analyses results 106 , person years follow , patients confirmed angina pectoris diagnosed , 194 underwent coronary revascularization procedure \( coronary artery bypass graft surgery coronary angioplasty \) compared participants assigned placebo , relative risk confirmed angina pectoris aspirin group 1 10 \( 95 confidence interval ci , 0 88 1 38 \) coronary revascularization , relative risk 1 19 \( 95 ci , 0 88 1 59 \) simultaneous control coronary risk factors proportional hazards model , relative risks remained near unity 1 07 \( 95 ci , 0 84 1 36 \) 1 11 \( 95 ci , 0 81 1 52 \) , respectively risks angina pectoris examined according year randomization trial , pattern increasing benefit longer duration treatment conclusion randomized trial data indicate chronic platelet inhibition low dose aspirin average duration 60 2 months reduce incidence angina pectoris
vitro vivo evaluation intraluminal ultrasound normal atherosclerotic arteries study evaluated dimensional morphologic precision arterial images obtained using intraluminal rotating scan ultrasound catheters 5 \( 30 mhz \) 8 \( 20 mhz \) dimensions vitro ultrasound images human arteries \( eight normal nine arteriosclerotic \) compared histologic sections vessels addition , vivo ultrasound studies \( 23 normal 22 arteriosclerotic \) canine femoral arteries compared luminal dimensions obtained angiograms vessels correlation vitro ultrasound images luminal diameters \( n 22 , r 0 96 \) , diameters \( n 19 , r 0 83 \) , wall thickness \( n 19 , r 0 68 \) normal human vessels significant \( p less 0 05 \) vitro measurements images histologic specimens human atherosclerotic arteries also correlated significantly \( p less 0 05 \) luminal diameters \( n 27 , r 0 91 \) , diameters \( n 24 , r 0 60 \) , wall thickness \( n 24 , r 0 62 \) morphologically , vitro images wall normal human arteries concentric appearance atherosclerotic vessels patchy areas vivo studies showed significant correlation diameters normal \( n 16 , r 0 91 , p less 0 05 \) arteriosclerotic \( n 16 , r 0 57 , p less 0 05 \) canine arteries compared luminal dimensions measured angiograms conclude rotating scan intraluminal ultrasound accurately defines normal atherosclerotic arterial wall morphology dimensions technology may valuable intravascular guidance angioplasty devices identifying location consistency lesions
stunned myocardium extracorporeal membrane oxygenation stunned myocardium syndrome reversible myocardial dysfunction may mediated oxygen derived free radicals phenomenon seen neonates undergoing extracorporeal membrane oxygenation performed echocardiograms measured creatine phosphokinase isoenzymes lipid peroxide levels 16 neonates , , extracorporeal membrane oxygenation infants developed stunned echocardiography shortly initiation bypass exhibited concurrent elevations mb fraction creatine phosphokinase lipid peroxide levels simultaneously rise data suggest oxygen derived free radicals may cause stunned myocardium seen neonates undergoing extracorporeal membrane oxygenation
circulating plasma platelet activating factor persistent pulmonary hypertension newborn platelet activating factor \( paf \) endogenous phospholipid mediator causes pulmonary hypertension thrombocytopenia experimental animal models investigate circulating paf persistent pulmonary hypertension newborn \( pphn \) , studied paf enzyme , thirteen neonates pphn , diagnosed routine clinical methods including echocardiography , compared six age matched control patients respiratory distress overall , plasma paf levels elevated patients pphn compared control patients \( 20 1 3 9 versus 1 6 0 7 ng ml , p less 0 01 \) addition , plasma paf concentrations patients pphn correlated severity disease defined delta \( r 0 65 , p 0 015 \) three patients elevated paf levels , clinical status improved , plasma paf values decreased activity similar groups \( 3 96 0 90 versus 3 78 1 44 nmol ml min , p ns \) conclude paf production increased pphn abnormal production paf may associated pulmonary hypertension
analysis outcome following percutaneous transluminal coronary artery angioplasty autopsy series analyzed autopsy findings 26 patients died following percutaneous transluminal coronary angioplasty \( ptca \) twenty one patients died within 3 weeks undergoing ptca demonstrable cardiac complications found 19 patients platelet fibrin thrombi \( 10 patients 48 \) , coronary artery dissections \( 17 patients 81 \) , \( 13 patients 62 \) , \( seven patients 33 \) , myocardial infarcts \( 17 patients 81 \) increased incidence coronary platelet fibrin thrombi noted compared non ptca cardiac autopsy population \( five 53 patients \) apparently increased incidence coronary patients coronary platelet fibrin thrombi \( eight patients \) compared patients platelet fibrin thrombi \( five patients \) , although statistically significant evidence systemic state disseminated intravascular coagulation pathogenesis unclear however , vasospasm disruption endothelial surface induced ptca subsequent platelet activation possible causes although statistically significant , female subjects \( seven patients \) increased incidence diabetes mellitus \( six patients \) hypertension \( 13 patients \) compared control population patients undergoing ptca \( \) clinic foundation 1987 , suggesting diabetes mellitus , hypertension , female sex may clinical risk factors fatal complications following ptca
real impact mechanical bridge strategy patients severe acute infarction results obtained past 3 years patients referred acute myocardial infarction \( ami \) cardiogenic shock mechanical bridge urgent transplantation permit one assess real impact present strategy clinical practice ten patients \( mean age 49 \) admitted serious condition \( ci 1 8 0 2 l min m2 , 28 6 mmhg , systolic aortic pressure 88 20 mmhg , urine output 11 20 ml hr \) treated maximal sympathomimetic support v enoximone two implanted total artificial heart \( tah \) one left ventricular assist device \( lvad \) recurrent fibrillation despite hemodynamic improvement , within 8 hr two received transplants living well 20 months seven initially improved markedly listed urgent transplant candidates two successfully transplanted , three died suddenly 6 , 25 , 45 days , respectively one undergone successful coronary surgery one patient \( age 62 , diabetic \) secondarily rejected transplant died experience clearly shows despite initial hemodynamic improvement , due medical management , death rate transplant sudden ventricular fibrillation remains unacceptably high prompt early mechanical support , less invasive systems , patients ami
complement activation use cell cardiopulmonary bypass complement activation evaluated ten patients undergoing cardiopulmonary bypass \( cpb \) intraoperative blood salvage cell \( cs \) assess inflammatory response related cs washed red blood cell protamine injection plasma c3a measured radioimmunoassay preoperatively , 5 min cpb , 5 , 60 , 90 min cpb , 5 min protamine infusion , end surgery , 24 hr addition , clinical score based renal , pulmonary , neurologic , myocardial postoperative evolution given \( 0 8 \) every patient results compared c3a changes clinical scores obtained 26 routine \( cs \) cardiac surgical patients results showed maximal c3a generation protamine activation cases cs reinfusion , ranged 400 ml 2 , 000 ml difference clinical score observed cs \( 1 1 \) control \( 0 85 0 6 \) groups authors conclude cs enhance complement activation resulting extracorporeal circulation safely used blood saving strategy cardiac surgery
differential light scattering cuvettes measurement high shear blood flow systems newly developed optical scattering cuvettes constructed modification existing 1 0 mm 3 0 mm internal diameter \( id \) cuvettes facilitate measurement platelet microemboli ranging 20 microns 1 , 000 microns diameter whole blood 0 9 mm id flows ranging 250 4 , 000 ml min perturbation solution one speed transport equation used design cuvettes series tests performed cuvettes extracorporeal left ventricular assist device bovine model , closed loop flow system containing anticoagulated whole baboon blood , determine extent affect platelet erythrocyte function ex vivo vitro serial hemolysis tests , thromboxane radioimmunoassay measurements , platelet counts , activated partial thromboplastin times measured tests cuvettes extracorporeal vitro circuits statistically indistinguishable baseline measurements , suggesting usefulness system measurement microemboli blood contacting materials extracorporeal circuits cardiac assist devices
design mediated thrombus reduction utah 100 total artificial heart utah 100 total artificial heart initially designed tested 1983 general design goals , including improved fit human application , improved reliability , elimination thrombus formation , identified improvements clinically used jarvik 7 artificial heart , previously developed institute engineering , university utah specific design goals included 1 \) elimination valve associated thrombus formation 2 \) elimination gross mineralization , thrombus formation , blood pumping diaphragm device retrieval results 29 calves sheep implanted jarvik 7 artificial heart compared results 25 calves sheep implanted utah 100 artificial heart macroscopic thrombus formation found 44 jarvik 7 artificial hearts , compared 2 \( p less equal 0 01 \) animals utah 100 artificial heart subvalvular thrombi observed 33 valves jarvik 7 artificial heart 10 \( p less equal 0 01 \) valves utah 100 artificial heart mineralization pumping diaphragm observed 12 animals implanted jarvik 7 artificial heart 4 animals utah 100 thrombus formation diaphragm interface occurred 2 jarvik 7 ventricles 6 utah 100 ventricles identifiable diaphragm utah 100 , 10 incidence found jarvik 7 devices results validate substantial progress toward improved design methods utah 100 total artificial heart
vitro vivo testing new valved intravascular catheter design long term intravascular catheterization carries finite risk catheter occlusion catheter tip valve design presented \( , medical corporation , , \) features designed decrease risk thromboembolism reduce need maintenance procedures aspiration infusion controlled separate valves , making possible inlet outlet parameters outlet valve elastic sleeve expanded around outlet ports injection pressure inlet valve tubular elastic element compressed inlet port within lumen , opening aspiration pressure series valves outlet pressures ranging 2 100 h2o , inlet pressures ranging 40 70 h2o , 36 h2o greater 1 , 400 ml hr dog implants two outlet valve pressures 10 h2o , inlet pressures 40 h2o , demonstrated periods 7 5 weeks could achieved without detectable blood cell entry lumen significant hemolysis observed blood samples aspirated 6 cc syringe \( 8 scored slightly vs 44 controls \) indicating hemodialysis application likely
vitro vivo evaluation right ventricular assist device simple right ventricular assist device \( rvad \) developed device useful situations biventricular failure partially treated placement left ventricular assist device , right ventricular failure occurs isolation , r wave synchronized , sac type pump contains valves , connected graft pulmonary artery rvad tested circulation verify hemodynamic efficacy implanted six calves 2 4 weeks evaluate biocompatibility vitro testing rvad demonstrated restored normal hemodynamics presence severe simulated six animal , small amount thrombus found one pump anticoagulants employed thrombus present connecting graft three animals two clearly related technical implant errors evidence significant hemolysis found simple rvad found hemodynamically effective , simple use , well tolerated refinements graft pulmonary artery device necessary
pulmonary artery counterpulsation skeletal muscle power source evaluated feasibility using skeletal muscle \( sm \) provide pulmonary artery \( pa \) counterpulsation acute pulmonary hypertension \( pht \) model pa counterpulsation achieved six dogs dual pump powered latissimus dorsi muscle rate responsive stimulator used make muscle counterpulsation graded pht induced 150 microns glass beads pa , rv pa pressures monitored pa pressures ranging 19 10 115 62 mmhg , effective counterpulsation observed degree counterpulsation influenced extent pht induced , amount rv tension time index \( \) unloading correlated level pa systole \( r 0 92 \) therefore , results divided two groups \( group 1 pa systole less equal 40 mmhg , group 2 pa systole greater 40 mmhg \) group 1 , rv decreased 11 29 0 76 9 99 0 72 mmhg sec , pa diastole increased 20 2 3 31 3 0 mmhg , pa mean increased 24 2 2 2 9 2 2 mmhg \( p less 0 05 \) group 2 , rv decreased 15 12 1 83 10 99 0 90 mmhg sec , pa diastole increased 41 3 5 64 6 2 mmhg , pa mean increased 49 4 8 55 5 7 mmhg \( p less 0 05 \)
novacor left ventricular assist filling ejection presence device complications order better understand relationship among certain device related complications novacor left ventricular assist system \( lvas \) pumping parameters , mock circulatory loop utilized simulate following clinically realistic conditions 1 \) inflow valve regurgitation , 2 \) inflow cannula obstruction , 3 \) outflow valve regurgitation , 4 \) outflow cannula obstruction various pumping parameters \( e g , pump rate , stroke volume , pump output \) recorded baseline \( control \) simulation additionally , pump volumes continuously recorded differentiated calculation rates pump filling \( fr \) ejection \( er \) results indicate perfusion pressures rates filling ejection change significantly presence device complications implications findings , relates assessment pump operation lvas patients , discussed
novel mechanical cardiac assist device reversing left ventricular failure diastolic augmentation aortic pressure efficacious means improving coronary perfusion heart failure novel mechanical cardiac assist device \( mcad \) , advantages conventional intraaortic balloon pump left ventricular assist devices , developed consists high efficiency rotary , coupled pair plates clamp shunt aortic graft section , diastolic counterpulsation mode system evaluated six anesthetized , dogs myocardial ischemia mcad activated 30 40 min coronary artery occlusion synchronized r wave illustrated representative sample data obtained one several trials , preliminary experimental results demonstrated mcad worked effectively fulfill primary functions counterpulsation assist device , e , augmentation coronary perfusion reduction vascular impedance ventricular ejection
ecmo assisted angioplasty cardiomyopathy patients unstable angina patients otherwise unsuitable candidates coronary bypass surgery standard coronary angioplasty \( ptca \) may successfully treated ptca ecmo five patients \( 3 men , 2 women \) , mean age 57 years , reported considered good candidates standard therapy poor left ventricular function \( mean ef , 24 range , 16 28 \) patients supported percutaneous femoral bypass using machine , underwent successful ptca either two vessels \( three patients \) three vessels \( two patients \) addition , one patient dilatation stenotic aortic valve patients supported ecmo 26 140 \( mean 104 \) minutes , required transfusion 0 4 \( mean 2 \) units blood procedure complications included groin hematoma two patients discharged within 4 days procedure follow patients completed \( 4 7 mo \) hospitalizations unstable angina patients remain nyha class ii iii data suggest ecmo assisted angioplasty safe effective method palliation unstable angina associated cardiomyopathy
recovery processes injured myocardium employed transplanted nonworking myocardium simulate condition heart supported ventricular assist device , investigate recovery processes injured myocardium 31p nuclear magnetic resonance \( nmr \) techniques heterotopic graft placed cervical portion recipient rat one week later , control 31p nmr spectrum obtained graft day , aorta graft clamped 30 minutes room temperature procedure , 31p nmr measurements graft performed 1 week phosphocreatine \( pcr \) inorganic phosphate \( pi \) ratio , beta phosphate adenosine triphosphate \( beta atp \) pi ratio first second day injury significantly lower control \( p less 0 05 \) however , ratios recovered significant extent third fourth day results suggest 3 4 days required recovery reversibly injured myocardium , even nonworking conditions
additional salutary hemodynamic effects combined use paraaortic counterpulsation device intraaortic balloon pump versus paraaortic counterpulsation device alone hemodynamic effects combined use paraaortic counterpulsation device \( \) \( stroke volume 65 ml \) implanted ascending aorta , 20 ml intraaortic balloon pump \( \) placed descending aorta , compared working alone 12 dogs induction heart failure heart failure characterized left ventricular end diastolic pressure \( lvedp \) greater 18 mmhg systolic aortic pressure \( sap \) stage 116 mmhg greater equal sap greater 70 mmhg stage b 70 mmhg greater equal sap greater 30 mmhg stage c sap less equal 30 mmhg modalities mechanical assistance produced significant salutary hemodynamic effects stages b difference observed stage c conclusion , combined use effective use either devices alone modality mechanical assistance may easily applied patients cannot extracorporeal circulation , unsuccessfully applied
hemodynamic effects new right ventricular assist device right ventricular assist device \( vad \) based principle counterpulsation developed institution device , , 40 cc , sac type pump , single inlet outlet port right ventricular support , pump end side pulmonary artery previous experimental trials , device shown minimal trauma blood components study , biventricular failure induced eight calves normothermic ischemia cardiopulmonary bypass left vad \( lvad \) used left ventricular support following ischemic insult hemodynamic measurements obtained throughout study , animal served control significant increase post injury cardiac output \( 33 5 11 4 \) obtained use lvad , compared use lvad alone \( p less equal 0 005 \) hemodynamic parameters right heart failure , including right atrial pressure \( \) , pulmonary artery pressure \( pap \) , left atrial pressure \( lap \) significantly affected data suggest right ventricular assist device significantly improves cardiac output model moderate right ventricular failure additional studies required , however , optimize pump stroke volume , define performance envelope device
light scattering detection microemboli extracorporeal lvad bovine model studies performed two calves supported extracorporeal left ventricular assist devices \( lvad \) using light scattering \( ne laser \) microemboli detector \( lsmd \) lsmd system placed outflow cannula lvad extracorporeal loop animal measurements included size , number , rate production circulating microemboli range 20 microns less microemboli diameter less 1 , 000 microns data compared independently concurrently obtained measurements emboli shear rate \( \) , platelet count , red blood count \( rbc \) , leukocyte count \( wbc \) , plasma free hemoglobin , factors xiii , x , v , sorbitol dehydrogenase embolic number volume seen dynamic early phases acute \( 0 40 minutes \) peak embolic response within first 30 minutes dynamics reduced emboli volume , rather number , may implicated later stages thromboembolic ventricles lsmd results generally showed inverse correlation microemboli volume rate measurements ventricle lsmd , , leukocyte platelet counts , showed direct correlation reduced counts additional ventricle calves factor seen direct correlation time lsmd measurements ventricle parameters investigation study represents first time laser scattering filtration methods applied simultaneously hematologic assays order study dynamics device associated
comparison right ventricular biventricular circulatory support porcine model right heart failure effects right ventricular \( rvad \) biventricular assist devices \( bvad \) acute porcine model right heart ischemic failure produced occluding right coronary artery 2 min \( \) compared right left ventricular pressures measured transducers respective septal free wall dimensions \( , \) ultrasonic crystals alone resulted significant right heart failure , marked 36 5 reduction cardiac output \( pulmonary artery flow \) 54 16 reduction rv stroke work isolated rvad significantly improved hemodynamic conditions restoring pulmonary blood flow left heart filling control levels rvad also resulted reduced control levels increased via rightward septal shift due right heart unloading biventricular support resulted hemodynamic improvement , estimated lv peak systolic wall stress reduced 65 15 compared control , due concomitant lv unloading reductions therefore , either right biventricular devices effective treating rv failure advantage biventricular support left ventricle also unloaded , thus allowing improved circulatory support minimal lv wall stress
hemodynamic influence lvad right ventricular failure left ventricular assist device \( lvad \) pumping hemodynamic anatomic influences right ventricular performance total artificial heart \( tah \) model employed better understand hemodynamic influence lvad failing right ventricle biventricular failure simulated reducing ventricular drive pressures tah hemodynamic data , lvad pumping case right ventricular failure simulated increasing left ventricular drive pressure lvad simulating condition , cardiac output increased right atrial pressure decreased significantly \( p less 0 05 \) compared biventricular failure condition , whereas right ventricular function minute work two conditions even though changes accompanied adaptive increases pulmonary resistance , substantially lower pulmonary artery left atrial pressures resulted lvad simulating condition hemodynamic perspective , results indicate lvad increase right ventricular volume work decreasing right ventricular pressure work , whereas right ventricular net pressure volume work unchanged right ventricular failure worsened
left ventricular versus left atrial cannulation ventricular assist device retrospective study 28 patients \( 23 men , 5 women \) supported ventricular assist devices greater 3 days , effect lv cannulation versus la cannulation device performance compared patients ranged age 12 67 years \( mean 46 years \) supported 3 81 days \( mean 15 years \) fifteen patients supported left \( 6 lv 9 la \) , 13 patients supported \( 5 lv 8 la \) mode operation 91 time fill empty mode ten data points taken patient lv cannulation results higher vad flow index decreased preload , lower vad systolic vacuum pressures , shorter diastolic durations eleven 28 patients survived although survival greater patients lv cannulation , survival dependent upon reversibility myocardial damage , eligibility transplantation , development complications data indicate lv cannulation provides better vad performance la cannulation fill empty mode
early late tamponade novacor left ventricular assist system cardiac tamponade major complication implantation novacor left ventricular assist system \( lvas \) 1987 1989 , 14 patients received lvas bridge cardiac transplantation 3 developed early tamponade \( 33 12 hr postoperatively \) 5 diagnosed late tamponade \( 9 4 3 2 days postoperatively \) one patient early late tamponade early tamponade common increased perioperative blood loss \( 5 , 270 1 , ml vs 1 , 420 1 , 160 ml patients , p less 0 05 \) early tamponade suggested reduction mean arterial pressure \( 74 1 64 3 mmhg \) , lvas output \( 5 0 5 2 7 0 7 l min \) , lvas stroke volume \( 55 4 23 5 ml \) , increase central venous pressure \( 13 1 21 1 mmhg , p less 0 05 values \) late tamponade associated marked rise central venous pressure \( 14 1 22 2 mmhg , p less 0 05 \) , mild decrease lvas output \( 4 9 1 3 8 0 9 l min \) stroke volume \( 49 8 36 3 ml \) , without significant change mean arterial pressure two five late episodes occurred patients anticoagulated heparin \( 52 100 sec \) , one warfarin \( pt 27 sec , 55 sec \) two patients anticoagulants surgical drainage pericardial effusions , especially blood found frequently posterior left ventricle space created lvas left ventricle , resulted immediate return hemodynamic measurements normal early late tamponade
ventricular support patients undergoing high risk coronary angioplasty prophylactic implantation \( , , \) evaluated nine patients selected high risk coronary angioplasty unstable patients , refractory maximal pharmacology , indications revascularization , contraindications surgery low ejection fraction lack material bypass , target lesion located last patent vessel pump inserted local anesthesia , without graft specially designed occluder permitted avoidance retrograde bleeding implantation bypass flow ranged 2 5 3 2 l min , permitted rise cardiac index 2 05 2 55 l min m2 , drop capillary wedge pressure 13 \( 7 18 \) 10 \( 7 13 \) mmhg balloon inflation , electrocardiographic changes observed , minor ventricular arrhythmias occurred significant hemolysis seen \( plasma free hemoglobin less 10 mg dl \) 2 hr pumping limitation technique appears difficulty time implantation narrow , stenosed , tortuous arteries \( 3 patients \) experience strongly supports benefit temporary left ventricular support high risk situations clearly shows need smaller pump
blood liquid interface prolonged extracorporeal oxygenation excellent antithrombogenicity authors verified excellent antithrombogenicity blood liquid interface \( \) introduced oxygenator based principle gas exchange across direct newly developed oxygenator , three layers liquid , contacting one another o2 saturated silicone oil top , o2 saturated bottom , blood middle gas exchange carried across direct system provided excellent antithrombogenicity well good gas exchange results indicate method become promising modality prolonged extracorporeal oxygenation
increase free calcium ion extracorporeal circulation hollow fiber oxygenator arterial filter dynamics platelet thrombosis oxygenator filter pig model free calcium \( ipfc \) ions provide common pathway platelet activation leading thrombosis embolization ipfc levels determined extracorporeal circulation \( ecc \) systemic heparin eight pigs \( weighing 30 40 kg 3 control 5 ecc \) ratio slow phase calcium sequestration fast phase platelet membrane binding index free calcium 3 hr ecc hollow fiber oxygenator \( hfo \) \( cm 50 \) af \( \) , seven blood samples collected 5 min ecc platelet deposition \( microci \) hfo \( \) simultaneously measured 111 labeled autologous platelets \( 300 400 microci \) probe detector 5 , 0 , 5 , 30 , 45 , 60 , 120 , 180 min ecc , ipfc hfo thrombus increase significantly \( p less 0 05 \) 45 min respect control ipfc values 0 4 0 1 , suggesting direct participation calcium activated platelets thrombosis hfo decline ipfc due extrusion sequestration dense granules , decline hfo thrombus due embolization hand , embolus arterial filter trapped linear fashion , consistent increase time ecc
lvas pump performance following initiation left ventricular assistance prevention disturbed flow \( e g , flow stasis \) consequent thrombosis heart pumps based upon design characteristics determined laboratory bench tests tests employ optimal filling emptying characteristics , full fill complete empty mode novacor left ventricular assist system filling characteristics novacor lvas examined first 48 hours implantation 14 patients fill volume pump reduced pathologic states , cardiac tamponade , following initiation right ventricular mechanical circulatory support addition , multiple regression analysis revealed right ventricular function measured amount inotropic support required , right ventricular ejection fraction , total pulmonary resistance , significantly predicted left ventricular assist pump fill volume first 48 hours support flow visualization simulating clinical conditions incomplete filling suggest inadequate valve washing , particularly around inlet valve conduit , may predispose thrombus formation
clinical use biventricular assist device bridge transplantation artificial heart system biventricular assist device \( bvad \) used 38 patients 1 \) twenty eight patients awaiting cardiac transplantation \( tx \) \( age 23 56 yrs \) patients contraindications allowing immediate tx 2 \) five patients emergency cases tx list \( cardiac failure , acute myocarditis \) \( age 28 59 \) 3 \) five patients post tx patients graft failure \( age 22 52 \) circulation used implantation bvad group 1 , 21 28 patients \( pts \) recovered , subsequently transplanted 6 hours 39 days , organ function restored 7 pts , mechanical circulation terminated 1 40 days deterioration five transplanted pts died , 14 pts survived \( greater 30 days \) , 2 pts transplanted satisfactory postoperative courses group 2 3 pts , two successfully one patient allograft recovered 11 days support
dynamics platelet thrombus formation rate , thrombus retention time , rate embolization control heparin polyurethane catheter dynamics platelet deposition embolization control heparin polyurethane catheters \( hbpc \) evaluated 111 labeled autologous platelets \( \) computerized gamma camera \( \) ten non heparinized dogs \( 18 25 kg \) catheterized femoral arteries 10 cm hbpc \( 5 fr , \) 24 hr injection 300 420 microci , imaged 3 hr computerized gamma camera regional platelet deposition curves \( \) indicated multiple peaks curves analyzed early rate thrombus formation \( \) , thrombus retention time \( full width half peak \) , rate embolization \( \) catheters four parameters \( mean sd \) thrombosis catheters integral radioactivity time curve 3 hr duration imaging calculated normalized counts sec rate thrombus formation rate embolization higher control hbpc , suggesting heparin bonding decreases early rate thrombosis embolization thrombus retention time appear shorter control catheter , indicating control thrombogenic catheter forms multiple thrombi emboli hbpc integral appears larger control catheter hbpc vivo \( dynamic \) studies , vitro studies , critical analyses radioactivity time curve essential complete evaluation thrombogenicity catheters cardiovascular prostheses
socioeconomic conditions childhood ischaemic heart disease middle age objective examine association socioeconomic conditions childhood ischaemic heart disease middle aged men , including role physiological behavioural risk factors design prevalence study extensive examination testing recall childhood conditions setting population based study , finland subjects representative sample men aged 42 , 48 , 54 , 60 main outcome measures ischaemic findings progressive maximal exercise test results low socioeconomic style childhood associated significantly higher prevalence findings indicating compared highest tertile childhood socioeconomic conditions , age adjusted odds ratio subjects lowest tertile 1 44 middle tertile 1 35 adjustment years cigarette smoking times average number cigarettes smoked , ratio high density lipoprotein low density lipoprotein cholesterol , fibrinogen serum selenium concentrations , adult height appreciably association adjustment adult socioeconomic state resulted 16 decline association association reduced non significance adjustment measures prevalent cardiovascular illness conclusions socioeconomic state childhood significantly associated ischaemic heart disease middle aged men levels risk factors measured middle age account association , adult height childhood socioeconomic conditions precede development ischaemic heart disease substantial impact prevalent illness observed association suggests ischaemic heart disease develops earlier lower socioeconomic state childhood
buerger 's colour hands feet buerger 's disease known 's characteristic skin colour produced venous plexus reactions venous plexus patients buerger 's disease observed fractional blood volume tissue using visible light capillary morphology investigated using video microscopic system twenty seven subjects , comprising 13 normals 14 patients buerger 's disease , studied patients buerger 's disease , increase number loops , cyanotic colour change dilatation observed condition incompetence venular regurgitation venular valves buerger 's colour probably due excessive congestion venous blood venous plexus produced mechanisms
cardiovascular response continuous variable rate alfentanil infusion abdominal aortic surgery prospective study undertaken determine cardiovascular response continuous alfentanil infusion abdominal aortic surgery \( \) subject \( n 20 \) received beta blocking drug preoperatively , oral anaesthesia induced alfentanil 50 micrograms kg 1 thiopentone 3 mg kg 1 , maintained variable rate infusion alfentanil 66 per cent nitrous oxide oxygen infusion , boluses alfentanil , 7 5 micrograms kg 1 , administered maintain heart rate blood pressure within 20 per cent awake baseline values haemodynamic stability surgery achieved infusion rates varying 0 5 2 5 micrograms kg 1 , resulted mean alfentanil serum concentrations ranging 186 53 315 98 ng ml 1 mean cumulative alfentanil dose 15 4 6 2 mg patient 1 surgery lasted average 141 41 min throughout surgery , patient required anaesthetic agents vasoactive drugs fifteen 20 patients perioperative holter monitoring myocardial ischaemia detected intraoperative period however , 33 per cent incidence myocardial ischaemia first postoperative day myocardial infarcts deaths conclude beta blocked patients undergoing aortic reconstructive surgery , variable rate alfentanil infusion administered 66 per cent nitrous oxide provides anaesthesia characterized good haemodynamic control without need supplemental agents vasoactive drugs
increased rat cardiac angiotensin converting enzyme activity mrna expression pressure overload left ventricular hypertrophy effects coronary resistance , contractility , relaxation compared activity physiologic effects cardiac angiotensin converting enzyme \( ace \) using isovolumic hearts male wistar rats left ventricular hypertrophy due chronic experimental aortic stenosis control rats response infusion 3 5 x 10 \( 8 \) angiotensin isolated buffer perfused beating hearts , intracardiac fractional conversion angiotensin ii higher hypertrophied hearts compared controls \( 17 3 4 1 vs 6 8 1 3 , p less 0 01 \) ace activity also significantly increased free wall , septum , apex hypertrophied left ventricle , whereas ace activity right ventricle aortic stenosis rats different control rats northern blot analyses poly \( \) purified rna demonstrated expression ace mrna , increased fourfold left ventricular tissue obtained hearts left ventricular hypertrophy compared controls groups , intracardiac conversion angiotensin angiotensin ii caused comparable dose dependent increase coronary resistance control hearts , angiotensin ii activation significant effect systolic diastolic function however , associated dose dependent depression left ventricular diastolic relaxation hypertrophied hearts novel observations suggest cardiac ace induced hearts left ventricular hypertrophy , resultant intracardiac activation angiotensin ii may differential effects myocardial relaxation hypertrophied hearts relative controls
apical segmental dysfunction hypertrophic cardiomyopathy subgroup unique clinical features segmental wall motion abnormality unusual finding patients hypertrophic cardiomyopathy clarify clinical significance , 48 patients hypertrophic cardiomyopathy analyzed eight patients \( group \) apical segmental dysfunction 40 \( group b \) normal wall motion patient either group coronary artery stenosis selective coronary arteriography patients group , apical segmental dysfunction revealed left ventriculography however , could detected echocardiography two patients group left ventricular hypertrophy electrocardiogram \( ecg \) common group b \( p less 0 05 \) abnormal q waves frequently discovered group \( p less 0 005 \) recognized predominantly lateral leads serial ecgs , gradual development abnormal q waves noted six eight patients group malignant arrhythmias common group \( p less 0 001 \) two patients group , left ventricular dilation congestive heart failure developed follow period thus , presence q wave lateral leads ecg patients hypertrophic cardiomyopathy may indicate presence apical segmental dysfunction left ventriculography performed examine presence abnormality 24 h ambulatory ecg monitoring done detect malignant arrhythmias patients abnormal q waves lateral leads patients unique type hypertrophic cardiomyopathy need careful follow evaluation
contrast echocardiographic mapping myocardium humans coronary angioplasty conventional coronary arteriography able demonstrate presence coronary collateral vessels cannot delineate specific region myocardium supply blood test hypothesis contrast echocardiography specifically identify myocardium , contrast echocardiographic perfusion maps compared patients \( n 12 \) without \( n 12 \) angiographic evidence coronary collateral flow , coronary angioplasty contrast echocardiographic images mid left ventricle short axis view end diastole obtained separate injections contrast agent right left coronary arteries computer based system used determine individual areas myocardium perfused two coronary arteries images two perfusion beds resulting area overlapping perfusion represented myocardium receiving blood flow coronary systems defined myocardium normalize heart size , overlap area expressed percent total myocardial area , area endocardium epicardium short axis view adjust differences vascular distribution , overlap area expressed percent perfusion area recipient vessel patients angiographic collateral flow , recipient vessel vessel receiving collateral flow patients without angiographic collateral flow , right coronary artery considered recipient vessel overlap area 1 3 0 4 total myocardial area 6 6 1 7 recipient vessel area patients without angiographic evidence collateral flow compared 30 6 2 5 89 2 6 4 , respectively , patients angiographic collateral flow \( p less 0 001 \) four patients angiographic collateral flow abolished angioplasty , overlap area decreased 30 3 5 3 6 8 2 7 total myocardial area 100 18 5 5 4 recipient vessel area \( p less 0 05 \) thus , contrast echocardiography able map specific myocardial territory perfused coronary collateral flow document immediate reduction perfusion territory collateral flow abolished angioplasty
ventricular stroke work loss validation method quantifying severity aortic stenosis orifice formula aortic stenosis results loss left ventricular stroke work \( due resistance flow valve aorta \) , percentage stroke work lost may reflect severity stenosis index calculated pressure data alone relation percent stroke work loss anatomic aortic valve orifice area \( measured videotape \) investigated pulsatile flow model thirteen valves studied \( nine human aortic valves obtained necropsy four bioprosthetic valves \) stroke volumes 40 100 ml , giving 57 data points valve area ranged 0 3 2 8 cm2 mean systolic pressure gradient 3 84 mm hg percent stroke work loss , calculated mean systolic pressure gradient divided mean ventricular systolic pressure x 100 , ranged 7 68 closely related anatomic orifice area inverse exponential relation significantly related flow \( r 0 15 \) orifice formula derived predicted anatomic orifice area 95 confidence interval 0 5 cm2 \( orifice area cm2 4 82 2 39 x log percent stroke work loss , r 0 94 , see 0 \) results support clinical use percent stroke work loss easily obtained index severity aortic stenosis
origin significance diastolic doppler flow signals left ventricular outflow tract diastolic doppler flow signals \( greater equal 0 2 \) left ventricular outflow tract well characterized , origin significance remain controversial fifty nine patients \( 55 16 years age \) technically good doppler echocardiographic studies studied prospectively 14 normal subjects , 21 patients left ventricular hypertrophy , 10 dilated cardiomyopathy 14 cardiac disease rhythm sinus 55 atrial fibrillation 4 two distinct doppler flow signals detected left ventricular outflow tract diastole termed e' \( early \) a' \( active \) occurred 40 100 ms higher velocity mitral inflow e \( passive filling \) \( atrial contraction \) signals among 59 patients , e' signals present 48 \( 81 \) mean velocity 0 41 0 23 55 patients normal sinus rhythm , a' signals present 52 \( 95 \) mean velocity 0 52 0 24 a' signals present four patients atrial fibrillation e' a' velocities pulsed wave doppler ultrasound low left ventricular apex increased along basal septum left ventricular outflow tract prominent a' velocities \( greater equal 0 45 \) seen 62 patients left ventricular hypertrophy , 50 normal subjects 10 patients dilated cardiomyopathy a' velocity higher patients left ventricular hypertrophy \( 0 63 0 26 \) normal heart \( 0 45 0 16 p less 0 05 \) dilated cardiomyopathy \( 0 25 0 13 p less 0 01 \) major determinants diastolic outflow tract velocity mitral inflow e velocities left end diastolic dimension , particularly combined \( r 0 64 , p less 0 0001 e' r 0 72 , p less 0 0001 a' \) distinctive e' a' doppler outflow tract signals result mitral inflow may detected patients normal heart size e' a' velocities increase apex base prominent patients small , normally contracting heart left ventricular hypertrophy
reduction incidence inducible ventricular tachycardia myocardial infarction treatment streptokinase infarct evolution aim study determine whether intravenous streptokinase administered without oral aspirin patients evolving myocardial infarction reduces ventricular tachycardia electrophysiologic study thus risk sudden death infarct survivors 159 patients randomized hospital multicenter second international study infarct survival \( 2 \) streptokinase aspirin acute myocardial infarction , 87 underwent electrophysiologic testing 6 28 days infarction determine risk subsequent ventricular arrhythmias \( streptokinase 20 patients aspirin 25 patients streptokinase aspirin 21 patients 21 patients \) patients underwent electrophysiologic testing similar clinical characteristics patients stimulation protocol comprised including four extrastimuli applied right ventricular apex twice diastolic threshold abnormal result defined ventricular tachycardia cycle length greater equal 230 ms lasting greater equal 10 ventricular tachycardia inducible electrophysiologic study 8 patients received placebo streptokinase , patient received active streptokinase \( 8 46 versus 0 41 p 0 005 , fischer 's exact test \) ventricular tachycardia inducible 4 patients received aspirin therapy 4 \( 4 41 versus 4 46 p ns \) mean follow period 39 9 months , spontaneous episodes ventricular tachycardia , ventricular fibrillation witnessed sudden death streptokinase treated group compared three events placebo treated group \( p 0 13 \) compared placebo therapy , intravenous streptokinase substantially reduced incidence inducible ventricular tachycardia infarct survivors similar benefit attributable aspirin therapy
effects nicardipine , calcium antagonist , myocardial salvage high energy phosphate stores reperfused myocardial injury current study determined effectiveness nicardipine , 1 , 4 dihydropyridine calcium antagonist , preserving reperfused myocardium cat model temporary coronary occlusion ascertained myocardial phosphate stores reperfusion defined phosphorus 31 nuclear magnetic resonance \( nmr \) spectroscopy indicative salvage twenty open chest , anesthetized cats studied use snare ligature around proximal left anterior descending coronary artery , coil sutured epicardial surface overlying distribution artery peak areas phosphocreatine , inorganic phosphate adenosine triphosphate \( atp \) nmr signals measured 1 h occlusion followed 1 5 h reperfusion infarct size jeopardy area determined vitro simultaneous infusion blue dye triphenyltetrazolium chloride aorta left anterior descending coronary artery , respectively , 5 h myocardial reperfusion nicardipine treated control groups similar jeopardy area values \( 41 2 1 6 versus 47 4 3 1 left ventricle \) , infarct area significantly reduced nicardipine treated group \( 3 2 1 1 versus 24 9 7 5 jeopardy area , p less 0 01 \) high energy phosphate compounds remained markedly altered reperfusion groups significant improvement phosphocreatine inorganic phosphate recovery observed animals pretreated nicardipine despite 87 reduction infarct size myocardial atp greater reperfusion nicardipine treated compared control group \( average initial 90 min reperfusion 58 6 versus 46 3 baseline values , p less 0 05 \) , suggesting improved recovery atp however , measured levels high energy phosphate compounds reperfusion ratios correlate infarct size thus predictive myocardial salvage
hemodynamic efficacy rapid saline infusion dobutamine versus saline infusion alone model cardiac rupture despite recent reports describing survival cardiac rupture , effectiveness circulatory support awaiting definitive surgical treatment controversial assess efficacy volume expansion pharmacologic support cardiac tamponade due cardiac rupture , model hemorrhagic cardiac tamponade developed treatment rapid saline infusion dobutamine compared rapid saline infusion alone 15 closed chest dogs right ventricular wound reproducible size produced aortic valvuloplasty balloon previously passed way internal jugular vein pericardial space stab wound right ventricular free wall hemodynamic values compared baseline , tamponade rapid infusion \( 1 liter 100 ml min \) either saline solution alone saline solution plus dobutamine \( 20 micrograms kg per min \) atrial pericardial pressures increased significantly groups mean arterial pressure , cardiac output stroke volume increased combined saline dobutamine infusion values similar baseline \( 91 19 , 114 43 94 37 baseline , respectively \) contrast , saline infusion alone caused small increase cardiac output failed significantly increase mean arterial pressure stroke volume \( 76 8 14 2 , 55 18 51 17 baseline , respectively \) combined rapid infusion saline solution dobutamine infusion beneficial hemodynamic effect may effective rapid saline infusion alone patients hemorrhagic cardiac tamponade due cardiac rupture
alterations endocardial vascular resistance reperfusion low flow , high demand model ischemia effects dipyridamole web 2086 , platelet activating factor antagonist determine alterations regional coronary vascular resistance could occur type myocardial ischemia present severe angina pectoris , regional perfusion function studied 35 conscious sedated dogs stenosis producing severe hypokinesia perfused segment created 2 h left anterior descending coronary artery 10 episodes 1 min high demand ischemia \( atrial pacing rate sufficient induce dyskinesia segment \) superimposed reperfusion dogs randomized three treatment groups control \( n 13 \) , dipyridamole \( n 10 \) web 2086 \( n 12 \) , antagonist effects endogenous platelet activating factor stenosis , residual endocardial blood flow ischemic area averaged 0 72 0 14 , 0 38 0 13 0 68 0 17 ml min per g control , web 2086 dipyridamole groups , respectively twenty four hours reperfusion , endocardial blood flow ischemic area significantly lower control dogs \( 1 04 0 15 ml min per g \) dogs treated web 2086 \( 1 44 0 28 ml min per g p less 0 03 \) dipyridamole \( 3 00 0 83 ml min per g p less 0 01 \) accordingly , control dogs , endocardial coronary vascular resistance ischemic area increased reperfusion 85 11 124 27 mm hg \( ml min per g \) \( p less 0 05 \) 24 h contrast , coronary vascular resistance ischemic area remained unchanged dogs receiving web 2086 \( 77 8 79 9 mm hg \( ml min per g \) p ns \) decreased significantly dogs receiving dipyridamole \( 72 8 44 8 mm hg \( ml min per g \) p less 0 01 \) regional function 24 h remained depressed three groups data indicate low flow , high demand ischemia induces alterations subendocardial microvasculature alterations regional coronary vascular resistance might play role several forms ischemic heart disease severe angina , appear susceptible improvement therapeutic interventions influence granulocyte platelet activation
early readmission elderly patients congestive heart failure repetitive hospitalizations major health problem elderly patients chronic disease , accounting one fourth inpatient medicare expenditures congestive heart failure , one common indications hospitalization elderly , also associated high incidence early , variables identifying patients increased risk analysis potentially remediable factors contributing readmission previously reported prospectively evaluated 161 patients 70 years older hospitalized documented congestive heart failure hospital mortality 13 \( n 21 \) among patients discharged alive , 66 \( 47 \) within 90 days recurrent heart failure common cause readmission , occurring 38 patients \( 57 \) cardiac disorders accounted five \( 8 \) , noncardiac illness led readmission 21 cases \( 32 \) factors predictive increased probability readmission included prior history heart failure , four admissions within preceding 8 years , heart failure precipitated acute myocardial infarction uncontrolled hypertension \( p less 05 \) using subjective criteria , 25 first \( 38 \) judged possibly preventable , 10 \( 15 \) judged probably preventable factors contributing preventable included noncompliance medications \( 15 \) diet \( 18 \) , inadequate discharge planning \( 15 \) follow \( 20 \) , failed social support system \( 21 \) , failure seek medical attention promptly symptoms recurred \( 20 \) thus , early elderly patients congestive heart failure may preventable 50 cases , identification high risk patients possible shortly admission , study nonpharmacologic interventions designed reduce readmission frequency justified
blood pressure levels increasing denmark \? city heart study prospective cardiovascular population study designed evaluate incidence risk factors cardiovascular disease random population sample comprising approximately 20 , 000 individuals invited participate blood pressure measured , information regarding use antihypertensive medication collected initial survey period 1976 1978 \( attendance rate 74 \) second survey period 1981 1983 \( attendance rate 70 \) significant increase systolic diastolic blood pressure survey 1 survey 2 found among men women greater 40 years age using antihypertensive medication increase blood pressure follow survey could explained changes methods , changes prescription antihypertensive medication , selection bias factors associated changes systolic diastolic blood pressure examined multiple linear regression analysis increase body mass index increase alcohol consumption positively correlated changes systolic diastolic blood pressure , use antihypertensive medication , high value body mass index survey 1 high level education negatively correlated changes systolic diastolic blood pressure female sex advanced age also negatively correlated changes diastolic blood pressure consumption tobacco alcohol , income changes consumption tobacco significantly correlated changes systolic diastolic blood pressure
nisoldipine effects renin angiotensin aldosterone system catecholamines studies normotensive hypertensive subjects studied effects nisoldipine , new calcium channel antagonist , renin angiotensin aldosterone system plasma catecholamines 10 healthy volunteers 29 patients primary essential hypertension 29 patients , thirteen normal renin hypertension \( \) , sixteen low renin hypertension \( lrh \) eight healthy volunteers received placebo short term \( 24 h \) effects measured subjects long term \( 6 months \) effects 10 40 mg nisoldipine daily monitored 29 hypertensive patients plasma renin activity \( pra \) increased slightly , although rise statistically significant , 1 h first dose nisoldipine normotensive subjects hypertensive patients 2 h pra returned pre treatment level change pra observed administration placebo plasma angiotensin ii \( aii \) levels showed considerable variation nisoldipine administration plasma aldosterone levels decreased despite increase pra aii concentrations however , concomitant reduction urinary aldosterone excretion observed plasma noradrenaline levels increased slightly 2 4 h administration nisoldipine , decreased thereafter , changes plasma adrenaline levels seen nisoldipine long term effects renin angiotensin aldosterone system serum catecholamine levels
components delay time suspected acute myocardial infarction particular emphasis patient delay two hundred thirty four patients admitted coronary care unit \( \) interviewed days arrival hospital determine reasons patient delay various components total delay time onset symptoms arrival three major components delay , decision time \( time onset symptoms decision go hospital \) , hospital procedure time \( time arrival hospital arrival \) , magnitude , 1 h 15 min 1 h 30 min \( median \) , whereas median time preparation transportation hospital somewhat shorter , 45 min decision time appeared similar patients confirmed non confirmed acute myocardial infarction \( ami \) associated intensity pain infarct size half patients go hospital , resulted prolonged decision delay \( 3 h \) concluded patient seek medical help important reason delay hospital arrival patients suspected ami
prevalence raynaud phenomenon adult population south carolina prevalence estimate raynaud phenomenon among adult residents south carolina based data obtained respondents statewide health survey , followed face face interviews clinical screening raynaud phenomenon , using screening procedure developed authors survey obtained personal interviews probability sample 3000 households , survey subjects participated clinical screening prevalence estimates standard errors computed using survey case weights , design based estimation , logistic modelling techniques prevalence raynaud phenomenon among adult residents south carolina determined 3 5 , standard error 0 6 prevalence higher females \( 4 3 , se 0 7 \) males \( 2 7 , se 0 6 \) figures much lower estimates existing literature raynaud phenomenon
alcohol consumption blood pressure comparison native japanese american men compared cross sectional association alcohol consumption blood pressure 810 japanese men \( jm \) living white men \( wm \) living new york mean systolic \( jm wm , p less 0 001 \) diastolic blood pressure \( jm , p less 0 002 wm , p less 0 001 \) associated alcohol consumption groups compared abstainers , drinkers highest systolic \( jm , p 0 001 wm , p less 0 01 \) diastolic \( jm , p less 0 002 wm , p less 0 05 \) blood pressures relation blood pressure alcohol intake j shaped americans , linear japanese exploratory analyses revealed j shape may due reporting heavy alcohol ingestion american abstainers abstainers excluded , relationships similar american japanese positive association blood pressure alcohol consumption persisted adjustment age , cigarette smoking , use antihypertensive medications , body mass index , heart rate , abdominal thickness , hematocrit , fasting blood glucose , serum uric acid levels urinary sodium potassium ratio alcohol use also related prevalence hypertension findings confirm presence independent association alcohol intake blood pressure jm wm suggest , despite differences metabolism alcohol , relation alcohol consumption blood pressure similar
effects recombinant human interleukin 3 aplastic anemia phase ii study , nine patients aplastic anemia treated recombinant human interleukin 3 \( rhil 3 \) assess toxicity biologic effects hematopoietic growth factor doses ranging 250 micrograms m2 500 micrograms m2 administered subcutaneous bolus injections daily 15 days increase platelet counts 1 , 000 microl 31 , 000 microl induced rhil 3 one patient , increase reticulocyte counts 10 , 000 microl four patients blood leukocyte counts increased eight patients 1 5 3 3 fold \( median , 1 8 fold \) , mainly due increase number neutrophils , eosinophils , lymphocytes , monocytes two patients , bone marrow cellularity increased 7 33 10 80 , respectively , without resulting substantial improvement peripheral blood counts mild side effects \( headache flushing \) observed patients , low grade fever occurred patients transient thrombocytopenia necessitating discontinuation rhil 3 treatment occurred one patient conclusion , rhil 3 stimulate hematopoiesis patients aplastic anemia however , lasting effects obtained
impact marrow cytogenetics morphology vitro hematopoiesis syndromes comparison recombinant human granulocyte colony stimulating factor \( csf \) granulocyte monocyte csf marrow cells 36 patients syndromes \( mds \) \( 13 refractory anemia ra , 14 refractory anemia excess blasts raeb , 9 raeb transformation raeb \) evaluated vitro proliferative responsiveness recombinant human granulocyte colony stimulating factor \( g csf \) granulocyte monocyte csf \( gm csf \) gm csf exerted stronger proliferative stimulus g csf marrow myeloid clonal growth \( cfu gm \) patients \( 44 v 12 colonies per 10 \( 5 \) nonadherent bone marrow cells nab , respectively , p less 025 \) gm csf stimulated increased cfu gm growth 16 patients abnormal marrow cytogenetics comparison 20 patients normal cytogenetics \( 52 30 colonies per 10 \( 5 \) nab , respectively , p less 05 \) , whereas difference could demonstrated g csf \( 11 16 colonies per 10 \( 5 \) nab , respectively \) contrast , granulocytic differentiation marrow cells induced liquid culture g csf 15 32 \( 47 patients \) , gm csf 4 18 \( 22 \) patients \( p less 025 \) including , raeb raeb patients 9 18 versus 0 9 , respectively \( p less 025 \) mds patients normal cytogenetics , g csf gm csf induced marrow cell granulocytic differentiation 12 18 \( 67 \) versus 3 11 \( 27 \) , respectively \( p less 025 \) , contrasted granulocytic induction 3 14 \( 21 \) 1 7 \( 14 \) patients abnormal cytogenetics , respectively conclude g csf greater granulocytic less proliferative activity mds marrow cells gm csf vitro , particularly raeb raeb patients normal cytogenetics
specific vitro bioassay measuring erythropoietin levels human serum plasma accurate measurement biologically active erythropoietin \( ep \) human serum plasma using present vivo vitro difficult presence inhibitors non ep erythropoiesis developed simple procedure quantitatively ep serum plasma subsequent testing treated mouse spleen cell assay method involves absorption ep immobilized high affinity anti ep monoclonal antibody acid elution antibody bound material neutralization , eluted ep tested directly vitro bioassay without interference serum proteins using magnetic beads solid support antibody , washing elution steps performed rapidly efficiently recoveries ep procedure show little sample sample variation consistently 45 55 , close maximum binding expected anti ep antibody coupled 7 4 fold concentration procedure , overall increase sensitivity three fourfold , makes assay suitable accurately measuring ep levels patients average titers results magnetic bead assay indicate accurate reproducible estimates ep levels serum plasma healthy donors well patients hematologic disorders obtained titers biologically active ep sera group patients either leukemia lymphoma found elevated , values correlated well titers immunoreactive ep measured ep radioimmunoassay specificity high sensitivity , magnetic bead assay valuable alternative immunoassays measurement elevated , normal , even subnormal ep levels human serum plasma
transfusion alloimmunization sickle cell disease cooperative study sickle cell disease 1 , patients sickle cell disease transfused , overall rate alloimmunization erythrocyte antigens 18 6 rate alloimmunization group appears function number transfusions received increases exponentially increasing numbers transfusions alloimmunization usually occurred less 15 transfusions , although rate alloimmunization continued increase transfusions given rate alloimmunization less patients hemoglobin sc disease sickle beta thalassemia patients received fewer transfusions children less 10 years old slightly lower rate alloimmunization patients age groups even correction number transfusions given women frequently men largely due fact women received transfusions men , age group 16 20 years increase may due part alloimmunization owing pregnancy forty five percent made antibodies one specificity 17 made four antibodies reacting different antigens antibodies c e antigens rh group , antigen , lewis antigens commonly made findings may important rational transfusion policy sickle cell disease
syndrome case report paper presents report child syndrome clinical picture laboratory findings characteristic disease prevailing symptoms included recurrent respiratory tract infections , dermatitis type skin lesions , thrombocytopenia humoral cellular immunological disturbances noted , pedigree pattern characteristic
increased serum ige increased prevalence eosinophilia 9 year old children smoking parents studied relationship serum ige levels eosinophil counts passive smoking 9 year old , nonselected children three italian near male children smoking parents significantly higher total count percentage eosinophils \( p 0 008 \) higher ige levels \( p 0 01 \) male children nonsmoking parents prevalence eosinophilia \( defined greater equal 4 total white blood cell count \) significantly correlated number cigarettes smoked parents among boys \( p 0 003 \) among girls \( p 0 20 \) significant trend \( p 0 008 \) prevalence eosinophilia increase increasing levels serum ige given level serum ige , frequency eosinophilia higher among children smoking parents among children nonsmoking parents parental smoking studied analysis controlling variable , still significantly associated eosinophilia children smoking parents serum ige levels conclude parental smoking associated significant enhancement expression important markers allergic sensitization children smoking parents particularly evident boys may explain , least part , increased frequency respiratory symptoms children smoking parents
prenatal identification potential donors umbilical cord blood transplantation anemia reported studies anemia fetal cells led first use umbilical cord blood hematopoietic reconstitution clinical trial prenatal diagnosis hla typing performed fetuses risk anemia \( fa \) identify , prior birth , unaffected syndrome hla identical affected siblings umbilical cord blood harvested delivery infants assays progenitor cells indicated presence colony forming units granulocyte macrophage \( cfu gm \) numbers similar bone marrow cfu gm associated successful engraftment hla matched allogeneic bone marrow transplantation possibility umbilical cord blood single individual used alternative bone marrow hematopoietic reconstitution demonstrated successful engraftment two patients fa progenitor cell assays umbilical cord blood collected birth child affected fa , misdiagnosed basis chorionic villus sampling \( cvs \) studies , indicated profound deficiency colony formation , consistent previously reported abnormalities growth fa cells vitro results suggest hematopoietic disorder fa related underlying problem cell proliferation
detection drug dependent , platelet reactive antibodies antigen capture elisa flow cytometry effectiveness flow cytometry detection drug dependent , platelet reactive antibodies investigated studies seven sera known contain quinine quinidine dependent , platelet reactive antibodies , flow cytometry 5 10 times sensitive detecting drug dependent antibodies \( ddabs \) 51cr release assay , antigen capture enzyme linked immunosorbent assay \( elisa \) , indirect immunofluorescence microscopic assay flow cytometry , ddabs could detected drug concentrations low 0 1 microm , less one tenth level required methods antigen capture elisa sensitive flow cytometry detection , allow identification target molecules assay , five seven ddabs recognized glycoprotein ib ix \( gpib ix \) glycoprotein iib iiia \( gpiib iiia \) complexes , remaining two sera reacted gpib ix 44 consecutive patients developed thrombocytopenia taking quinidine , ddabs detected flow cytometry 11 \( 25 \) , twice number detected methods one patient developed thrombocytopenia taking trimethoprim sulfamethoxazole , ddabs could detected flow cytometry concluded flow cytometry highly sensitive detecting ddabs allows detection pharmacologic concentrations drug quinidine dependent antibodies recognize least two different glycoprotein complexes platelet membrane
incubation platelet transfusion improve posttransfusion recovery incubation stored platelet \( pcs \) 37 degrees c 1 hour reported result better morphology score improved platelet recovery study conducted adult patients leukemia determine whether incubation stored pcs results improved platelet recovery measured 10 minute posttransfusion corrected count increments \( \) eligible patients platelet counts less 30 , 000 per microl clinically stable patients transfused 6 10 units pc stored 3 days \( 15 studies \) 4 days \( 5 studies \) platelets pooled split two equal volumes patient received two sequential half transfusions , one incubated 37 degrees c 1 hour kept 22 degrees c 1 hour patients randomized half transfusion received first mean incubated half transfusions 13 6 x 10 \( 3 \) given first 14 5 x 10 \( 3 \) given second significantly different mean half transfusions 13 8 x 10 \( 3 \) given first 13 8 x 10 \( 3 \) given second contrast earlier reports , concluded incubation pooled pcs improve platelet recovery
autoimmune hemolytic anemia kawasaki disease case report 3 year old boy presented fever , , rash , lymphadenopathy diagnostic kawasaki disease treatment antibiotics , aspirin , intravenous immunoglobulin instituted hematocrit decreased 35 percent admission 11 percent hospital day 10 , white cell count increased 13 7 42 x 10 \( 3 \) per microl , patient blood smear direct antiglobulin test demonstrated igg complement red cell \( rbc \) surface acid eluate reacted \( titer 4 \) panel cells antiglobulin phase intravenous immunoglobulin lot used treatment contain antibody reacted patient 's group rbcs panel group rbcs , contain igg anti b \( titer 4 \) patient received transfusion given direct antiglobulin test acid eluate negative 4 days later patient uneventful recovery distinction antibody mediated hemolytic anemia autoimmune hemolytic anemia important treatment disease
primary splenic lymphocyte depletion hodgkin 's disease case lymphocyte depletion hodgkin 's disease described purpose reviewing criteria currently used distinguish disease pleomorphic large cell malignancies 76 year old man 3 month history daily underwent extensive evaluation exploratory laparotomy , revealed two large , separate splenic tumor nodules postoperatively , patient remained asymptomatic histologically , tumor composed giant cells , including typical reed forms mononuclear variants inflammatory stromal response along borders immunoperoxidase showed tumor cells strongly reactive leu m1 \( \) , h2 \( cd30 \) , leu 3 \( cd4 \) , \( cd2 \) weakly reactive leu 4 \( cd3 \) ema , lca , lysozyme , leu 9 , leu m3 , leu , immunoglobulin light chains southern blot analysis revealed isolated clonal band kappa light chain included discussion case primary splenic lymphocyte depletion hodgkin 's disease review clinical , histologic , immunohistochemical , gene rearrangement characteristics defined lymphocyte depletion hodgkin 's disease
prognosis chronic granulomatous disease records 28 patients chronic granulomatous disease born 32 year period reviewed characteristics group , frequency various clinical laboratory features recorded , assessed nine patients known died , cases progressive infection actuarial analysis showed 50 survival third decade life long term survival patients developing symptoms end first year life significantly better patients whose illness started infancy data confirm severity chronic granulomatous disease uniform , prognosis long term survival better suggested earlier reports early onset may poor prognostic sign invasive aspergillosis life threatening complication absence curative treatment , trials assess effectiveness interferon gamma necessary early antenatal diagnosis offered many affected families possible
social integration older patient social policy possible social integration chronically ill patients , evaluated facilities needed achieve patients beta thalassaemia major light therapeutic advances permit survive adulthood investigated social integration adolescent young adult patients , 171 112 italy patients areas show good level social integration self image , indicating may achieved providing psychosocial support part comprehensive approach treatment
hla b38 , dr4 , dqw3 clozapine induced agranulocytosis jewish patients schizophrenia agranulocytosis develops approximately 1 patients chronic schizophrenia treated atypical neuroleptic drug clozapine previous studies identified mechanism risk factors adverse reaction observed association jewish ethnic background development agranulocytosis patient sample treated clozapine refractory symptoms , hla typing performed 31 patients \( 19 4 developed agranulocytosis \) hla b38 phenotype found 83 patients developed agranulocytosis 20 clozapine treated patients develop agranulocytosis b38 part haplotype known occur frequently ashkenazi jewish population , frequencies combined alleles hla b38 , dr4 , dqw3 examined incidence hla b38 , dr4 , dqw3 significantly increased patients agranulocytosis \( five five patients \) compared control patients ashkenazi jewish \( two 17 patients \) findings indicate genetic factors marked major histocompatibility complex haplotypes may associated susceptibility jewish schizophrenic patients treated clozapine develop agranulocytosis postulate gene products contained haplotype may involved mediating drug toxicity
hematopoietic defect aplastic anemia assessed long term marrow culture thirty two patients aplastic anemia \( aa \) studied using long term bone marrow culture \( \) system patients , 26 treated immunosuppressive therapy including globulin \( \) without androgens high dose methyl prednisolone remaining six patients either required treatment studied therapy begun thirty one 32 patients \( 96 \) defective hematopoiesis little evidence generation primitive progenitor cells exception patient spontaneous recovery aplasia defect less marked crossover experiments performed 23 cases \( 1 \) patient marrow hematopoietic cells depleted adherent cells onto preformed , irradiated , normal assess proliferative capacity hematopoietic cells , \( 2 \) normal marrow hematopoietic cells depleted adherent cells onto preformed , irradiated patients aa assess stromal function results experiments demonstrated hematopoietic defect patients independent degree hematologic recovery therapy one patient probable stromal defect defect regenerative capacity hematopoietic cells conclude sensitive method detecting defining hematopoietic failure aa suggest defective hematopoiesis present patients studied may important pathogenesis clonal evolution aa
enhanced endogenous leukotriene biosynthesis patients treated granulocyte macrophage colony stimulating factor hematopoietic cytokine granulocyte macrophage colony stimulating factor \( gm csf \) used clinical trials potential treatment hematopoietic insufficiency due various causes involvement leukotrienes effects gm csf suggested analytical pharmacologic evidence obtained vitro however , data support role leukotrienes gm csf action vivo presented present investigation question approached measurement endogenous cysteinyl leukotriene formation patients treated cytokine induced cytostatic drugs refractory anemia excess blasts \( raeb \) endogenous cysteinyl leukotriene formation assessed determination urinary leukotriene metabolites using combined high performance liquid chromatography radioimmunoassay analysis gm csf administration distinct increase urinary cysteinyl leukotrienes found raeb patients ranged 2 3 57 fold 2 4 333 fold , respectively patients increase leukotriene production correlated expansion peripheral blood leukocytes raeb patients responded gm csf enhanced leukotriene biosynthesis even peripheral leukocytes decreased , possibly due abnormal number irritability leukotriene producing cells increase endogenous leukotriene production therapy gm csf may indicate leukotrienes play role gm csf action vivo
deficiency phosphatidylinositol linked membrane glycoproteins leukocytes paroxysmal nocturnal hemoglobinuria , description new diagnostic assay paroxysmal nocturnal hemoglobinuria \( pnh \) disease affects red cells , blood cells well common defect acquired deficiency phosphatidylinositol \( gpi \) anchored membrane proteins , may present already hematopoietic stem cell level recently , panel monoclonal antibodies \( moabs \) become available directed various gpi linked membrane proteins makes possible study various cell lineages deficiency proteins pnh detail using , could show granulocytes 20 different pnh patients gpi linked \( cd16 antigen \) , also three gpi linked proteins , ie , antigen , antigen granulocyte specific 50 80 kd antigen affected granulocytes neutrophils also eosinophils , found detailed analysis three patients moreover , 10 pnh patients tested , monocytes found deficient gpi linked cd14 antigen , found \( \) antibodies lymphocytes may involved well however , abnormal b lymphocytes detected subset patients \( 2 10 tested \) uniform deficiency gpi linked proteins granulocytes allows introduction new diagnostic assay pnh moabs gpi linked granulocytic antigens test positive pnh patients studied group 40 control patients 50 normal donors , exception three 16 aplastic anemia \( aa \) patients three aa patients , subpopulations \( 10 20 \) pnh granulocytes could detected , whereas patients negative serum \( ham \) test indicates new test sensitive ham test allows early diagnosis pnh aa advantage neutrophil assay , contrast ham test , influenced recent red cell transfusions moreover , possible quantify number affected cells single cell analysis
fluosol da 20 treatment severe anemia randomized , controlled study 46 patients evaluated safety efficacy fluosol da 20 \( fda \) blood substitute treatment severe anemia thirty six patients received either fda \( n 21 \) crystalloid hydroxyethyl starch \( chs \) \( n 15 \) part randomized , controlled trial ten patients received fda part protocol 's refused transfusion , bled recently , average levels 4 3 g dl pulmonary artery catheter insertion , patient infused chs attain pulmonary artery wedge pressure \( wp \) 10 18 mm hg fda given one time dose 30 ml kg data collected baseline , 12 , 24 , 48 h none patients negative reactions 0 5 ml test dose fda adverse reactions subsequent infusion plasma dissolved component oxygen content significantly higher fda group 12 h \( fda group 1 58 0 47 ml dl , control group 1 01 0 31 ml dl , p less 02 , test \) nineteen patients died 12 \( 37 5 \) fda , seven \( 46 6 \) control difference significant conclude following \) fda given safely severely anemic patients doses 30 ml kg b \) fda significantly increased dissolved component oxygen content 12 h effect persist c \) severely anemic patients survive without transfusion although mortality high study , inability fda sustain increased oxygen content due part rapid elimination fda also limited amount given
serum concentration soluble interleukin 2 receptor sensitive parameter disease activity sarcoidosis investigated clinical value measuring serum concentrations soluble il 2r monitoring sarcoidosis serum concentrations soluble il 2r measured 70 patients sarcoidosis mean value active untreated sarcoidosis 1 , 143 u ml , normal range 97 healthy control subjects 80 300 u ml mean value active untreated sarcoidosis significantly higher disease \( 183 u ml \) corticosteroid treated patients \( 380 151 u ml \) serial changes serum soluble il 2r level studied cases spontaneous remission corticosteroid treated patients good correlation noted changes serum level soluble il 2r clinical status positive correlation noted serum concentration soluble il 2r serum ace activity data confirmed measurement serum concentration soluble il 2r could used monitoring disease activity sarcoidosis
cardiac abnormalities children sickle cell anemia cardiac status 64 children \( ages 0 2 18 yr \) sickle cell anemia documented hemoglobin electrophoresis evaluated echocardiography left atrial , left ventricular aortic root dimensions significantly increased 60 percent children ages compared values 99 normal black \( non sca \) control subjects left ventricular wall thickness increased 20 percent older children sickle cell anemia estimated lv mass m2 left ventricular cardiac index increased compared control subjects \( p less 0 001 \) left heart abnormalities expressed single composite function , derived multivariate regression analysis , correlated well severity anemia expressed grams hemoglobin \( r 0 52 , p less 0 001 \) percentage hemoglobin \( r 0 51 , p less 0 001 \) , extent age echocardiographically assessed left ventricular function rest comparable control subjects data suggest major cardiac abnormalities children related volume overload effects chronic anemia , age group , evidence distinct sickle cell cardiomyopathy cardiac dysfunction
pulse oximetry uses pulse oximetry made significant contribution noninvasive monitoring wide variety clinical situations allows continuous reliable measurements oxygen saturation avoiding discomfort risks arterial puncture extent hypoxic episodes various procedures clinical settings better appreciated , role continuous noninvasive monitoring undoubtedly expand understanding principles technology pulse oximetry allow physicians obtain maximal clinical benefit use
purpura purpura characterized , recurring purpura , elevated erythrocyte sedimentation rate , presence rheumatoid factor indicative circulating immune complexes significant association autoimmune diseases , especially sjogren 's syndrome lupus erythematosus purpura considered primary associated disease secondary associated diseases , usually autoimmune immune derangements fundamental pathogenesis , although cause still unknown therapy probably unnecessary usually benign condition three cases presented representative patients purpura
improvement brain function hemodialysis patients treated erythropoietin evaluate effects recombinant human erythropoietin \( rhuepo \) brain function , 15 chronic hemodialysis patients studied event related p300 , stimulus related evoked potentials , \( hematocrit 22 7 \) rhuepo \( hematocrit 30 6 \) p300 peak latency elicited tone discrimination paradigm improved \( vs ms p less 0 01 \) confirming beneficial effects cerebral cognitive processing p300 amplitude \( 13 6 vs 15 8 microv p 0 06 \) tended improve \( 55 vs 43 \) p300 measures influenced low hemoglobin levels rhuepo \( p less 0 01 \) , suggesting severe anemia may contribute uremic brain dysfunction furthermore , decrease stimulus related auditory brainstem v interpeak latency \( 4 28 vs 4 17 ms p less 0 05 \) increase somatosensory n20 amplitude \( 4 8 vs 7 0 microv p less 0 05 \) improvement sensory pathways mechanisms unrelated cognition brain dysfunction chronic hemodialysis patients may , factors , part caused severe anemia improved rhuepo treatment
molecular defect band 3 protein southeast asian ovalocytosis background southeast asian ovalocytosis form hereditary red cells rigid resistant malaria invasion underlying molecular defect unknown methods results studied red cells 54 patients ovalocytosis 122 normal controls found contain structurally functionally abnormal band 3 protein , principal transmembrane protein red cells structural lesion band 3 revealed limited proteolytic cleavage protein , produced fragments abnormal size derived cytoplasmic domain protein structural lesion present subjects ovalocytosis none controls region band 3 serves principal binding site membrane skeleton , protein network composed ankyrin , spectrin , actin , protein 4 1 structural defect dominantly inherited , tightly linked inheritance ovalocytosis \( probability linkage excess 10 million 1 \) band 3 bound considerably tightly normal band 3 ankyrin , membrane skeleton band 3 protein tight binding band 3 underlying skeleton containing ankyrin directly confirmed intact cells finding band 3 markedly reduced lateral mobility membrane conclusions red cells southeast asian ovalocytosis carry structurally functionally abnormal band 3 protein molecular defect may underlie increased rigidity red cells resistance invasion malaria parasites
doppler umbilical artery studies twin twin transfusion syndrome eleven patients twin pregnancies identified twin twin transfusion syndrome basis like sex twins umbilical venous blood hemoglobin differences exceeding 50 g l delivery umbilical artery velocity time waveform studies performed pregnancies part large series twin pregnancies 11 cases , systolic diastolic \( \) ratio differences twins less 1 unit \( mean 0 4 0 2 \) , indicating twin twin transfusion , umbilical artery ratios concordant even presence fetal size
immunoglobulin g subclasses serum circulating immune complexes patients kawasaki syndrome igg subclass concentrations sera 17 patients kawasaki syndrome determined significantly increased igg1 \( p less 0 001 \) igg3 \( p less 0 001 \) found patients compared 22 age matched healthy children , whereas igg2 igg4 normal slightly decreased igg immune complexes measured protein enzyme linked immunosorbent assay \( elisa \) combined polyethylene glycol eight 17 patients \( 47 1 \) found circulating immune complexes \( cic \) values normal control range \( geometric mean 2 sd \) igg subclass composition cic analyzed subclasses cic predominantly igg1 igg3 antibody responses different antigens exhibit igg subclass restriction , would suggest change serum cic igg subclasses kawasaki syndrome may relevance pathogenesis disease
antigenic recognition intravenous gamma globulin selected bacteria isolated patients kawasaki syndrome kawasaki syndrome \( ks \) lymph node syndrome acute febrile illness unknown etiology therapy intravenous gamma globulin \( ivgg \) results rapid , disappearance signs symptoms inflammation prevention coronary artery aneurysms hypothesized ivgg might neutralize bacterial toxin produced staphylococcus streptococcus present nasopharynx speculated toxin might detectable serum urine patients goal work identify microbial antigens different materials taken patients clinical diagnosis ks tested 23 aerobic bacterial isolates cultures 15 patients ks , acute serum 121 patients 38 acute urine specimens patients ks patients ranged age 1 6 years specimens tested standard system reacted ivgg prepared 25 solution ten 23 aerobic bacteria \( 43 5 \) isolated cultures demonstrated precipitation reaction ivgg testing ivgg acute serum acute urine specimens uniformly negative ivgg contains precipitating antibody limited number aerobic organisms possible antigenic products one bacteria may involved pathogenesis ks
viral infections transfusion dependent patients beta thalassemia major predominant role cytomegalovirus 9 months , 38 transfusion dependent patients beta thalassemia , ranging age 3 4 19 1 years , observed serologic evidence viral infections , collection serial serum samples seventy six age matched healthy subjects , two patient , followed controls samples taken beginning , middle , end study tested 18 viral antigens complement fixation \( cf \) addition , tests antibodies hiv , epstein barr virus , hepatitis virus , markers hepatitis b virus performed changes antibody titer cf tests \( greater equal 2 fold increase decrease \) persistently high titers \( greater equal 64 \) revealed , specific enzyme immunoassays \( \) igm iga antibodies performed concomitant cf tests sera symptomatic infections occurred , viral cultures direct detection antigens carried immunofluorescence methods , eia , latex agglutination tests thalassemic patients controls similar \( p greater 0 05 \) overall rates serologically confirmed viral infections \( 53 versus 132 \) , former group higher \( p less 0 01 \) incidence cytomegalovirus \( cmv \) infections \( 9 versus 4 \) cmv infections associated thalassemic patients hepatitis \( 2 cases \) , lymphadenitis \( 2 cases \) , upper respiratory tract infection \( 1 case \) , remaining cases cmv subclinical course moreover , thalassemic patients lower \( p less 0 01 \) incidence symptomatic infections \( 27 versus 110 \) controls therefore , study showed symptomatic subclinical cmv infections may occur often thalassemic patients , otherwise subclinical viral infections overall rate similar healthy subjects
evaluation manual bromide \( \) technique investigation autoimmune hemolytic anemia use direct manual bromide \( \) test \( dpt \) investigation patients autoimmune hemolytic anemia \( \) evaluated seventy nine blood samples 68 patients tested direct antiglobulin test \( dat \) using reagents dpt performed , concentrated ether eluate tested dat positive 62 \( 78 \) 79 patients negative 17 \( 22 \) good correlation among dat , eluate , dpt demonstrating presence immunoglobulin red cell surface contrast , dpt detect c3d often negative cases c3d alone demonstrated dat dat negative cases , dpt results correlated reactive however , four cases steroid responsive , dat negative hemolytic anemia , dpt supported diagnosis eluate react dpt useful additional screening test investigation , recommended replacement either eluate testing dat
life threatening , antiglobulin test negative , acute autoimmune hemolytic anemia due non complement activating igg1 kappa cold antibody pra specificity 21 year old man fulminant cold autoantibody hemolytic anemia \( \) hospitalized , hemoglobinuria , hemoglobin concentration 3 3 gm per dl , negative direct antiglobulin test \( dat \) anti c3d reagents , negative test , cold agglutinin titer 80 failed respond corticosteroids , multiple plasma , cyclophosphamide required 54 transfusions 10 days maintain hemoglobin concentration 6 0 10 0 g per dl improved dramatically splenectomy performed wide thermal amplitude cold agglutinin proved igg1 kappa antibody pra specificity patient 's serum exhibited normal complement activation dat carried 0 4 degrees c , result strongly positive igg indirect antiglobulin test 0 4 degrees c positive patient 's serum diluted 1 640 within 6 months , complete remission receiving therapy compared eight patients exclusively igg mediated , patient remarkable requirement many transfusions consistently negative c3d
impaired thermoregulation thyroid function iron deficiency anemia ten women iron deficiency anemia , 8 depleted iron stores \( \) , 12 control women , similar body , exposed 28 degrees c water bath test hypothesis iron deficiency anemia impairs performance anemic women lower rectal temperatures control women \( 36 0 0 2 vs 36 2 0 1 degree c , respectively , p 0 001 \) lower rate oxygen consumption \( 5 28 0 26 vs 5 99 0 29 ml min 1 kg body wt 1 , respectively , p 0 04 \) 100 min cold exposure plasma thyroxine triiodothyronine concentrations significantly \( p less 0 002 \) lower anemic control women baseline cold exposure responses iron depleted subjects similar control subjects iron supplementation corrected anemia , significantly \( p 0 03 \) improved rectal temperature 100 min , partially normalized plasma thyroid hormone concentrations plasma catecholamines unaffected iron status experiment demonstrates functional consequence iron deficiency anemia balance heat production loss suggests thyroid hormone metabolism may responsible
histiocytosis x 100 protein , peanut agglutinin , transmission electron microscopy study twenty seven cases histiocytosis x \( \) paraffin blocks available studied use 100 protein immunohistochemistry , peanut agglutinin affinity histochemistry , transmission electron microscopy results show techniques enable identification type histiocytes 88 5 , 75 , 47 4 cases , respectively techniques proved diagnostic value , none able confirm diagnosis instances none could prognosis patients study shows besides cells , indeterminate cells skin dendritic reticulum cells lymph node may also involved process moreover , giant cells cells may derived related cells
total differential leukocyte counts clinically well children information \? determine whether total differential leukocyte count value case finding test , applied evaluation criteria developed us preventive services task force criteria comprise review current burden suffering disease prevented , attributes intervention used , quality evidence available literature search revealed evidence form data patients , chart review complete blood cell counts ordered 1 year period one group pediatricians undertaken least one value outside published normal ranges found 74 7 tests performed clinically well children unsuspected illness discovered result abnormal total differential leukocyte count
bioavailability iron hemodialysis patients treated erythropoietin evidence inhibitory role aluminum dose recombinant human erythropoietin \( r huepo \) required correct anemia end stage renal disease \( esrd \) varies among patients response r huepo impaired absolute relative iron deficiency exists aluminum may cause microcytic anemia patients esrd , mechanism remains incompletely defined twenty two patients canadian multicentre epo trial studied 6 months randomized double blind placebo controlled trial , free erythrocyte \( fep \) used indicator iron deficient deficient erythropoiesis relationship fep estimates iron availability \( serum iron , transferrin saturation , ferritin \) iron utilization \( corrected reticulocyte count , hemoglobin \) evaluated multiple linear regression analysis effect aluminum fep evaluated adjusting statistical model variable patients iron replete assessed serum ferritin fep related serum aluminum administration r huepo , significantly correlated aluminum treated group hemodialysis patients treated r huepo , proportion variability explained parameters iron utilization iron availability 0 27 effect aluminum increased 0 59 hemodialysis patients receiving r huepo , proportion variability fep explained model increased 0 16 0 28 adjusting aluminum data support hypothesis aluminum interferes bioavailability stored iron erythropoiesis thus may result microcytic anemia patients esrd may blunt response r huepo therapy
disseminated intravascular coagulation due intravenous administration hetastarch disseminated intravascular coagulation occurred patient intravenous administration hetastarch onset acute within 3 hours exposure agent course fulminating patient died 48 hours clinical , hematologic , pathologic features presented possible pathophysiologic mechanism discussed view experience documented effects hetastarch coagulation , use hetastarch avoided patient history coagulation disorder , patient receiving agent closely monitored appropriate coagulation tests
prenatal diagnosis laryngeal atresia patient preeclampsia developed 23 weeks' gestation , ultrasonographic examination fetus showed enlarged lungs , compressed fetal heart , severe ascites , fetal hydrops , placental edema autopsy infant showed laryngeal atresia ultrasonographic appearance rare malformation presented
cytokine production \( il 1 alpha , il 1 beta , tnf alpha \) endothelial cell activation \( elam 1 hla dr \) reactive lymphadenitis , hodgkin 's disease , non hodgkin 's lymphomas immunocytochemical study cryostat sections 58 lymph nodes polyclonal rabbit serum il 1 alpha , monoclonal antibodies directed il 1 alpha \( \) , il 1 beta \( \) , tumor necrosis factor alpha \( tnf alpha \) \( 7 \) furthermore presence cytokine containing cells correlated expression endothelial leukocyte adhesion molecule \( elam 1 \) human leukocyte antigen \( hla dr \) \( 1 \) endothelial cells cells containing il 1 tnf alpha detected mainly pathologic conditions characterized reactive neoplastic expansion lymph node cells positive il 1 detected 16 21 cases hodgkin 's disease , 4 4 cases nhl , 5 cases diffuse mixed lymphadenitis interleukin 1 alpha detected macrophages , reticulum cells \( \) , endothelial cells , neoplastic hodgkin 's reed \( h rs \) cells cells positive il 1 beta much fewer consisted mainly macrophages hodgkin 's reed cells negative il 1 beta even vitro stimulation bacterial endotoxin tumor necrosis factor alpha \( tnf alpha \) present macrophages h rs cells endothelial leukocyte adhesion molecule 1 expression endothelial venules detected 17 20 cases hodgkin 's disease , 2 4 cases nhl , 5 5 cases diffuse lymphadenitis pathologic conditions , hla dr antigens also expressed frequently endothelial cells cytokine containing cells elam 1 positive high endothelial venules \( \) extremely rare lymph nodes involved follicular lymphadenitis \( 12 cases \) b nhl \( 16 cases \) cases reactive neoplastic b cell , hla dr positive still present often results indicate il 1 tnf alpha production tissue level often associated elam 1 expression , less well correlated expression hla dr antigens endothelial cells
b19 induced perturbation human megakaryocytopoiesis vitro b19 infection leads transient aplastic individuals chronic hemolytic immunodeficiency states additional unexplained b19 infection thrombocytopenia b19 known remarkable tropism human erythropoietic elements , known replicate cells , etiology thrombocytopenia uncertain sought define b19 associated thrombocytopenia examining role b19 vitro megakaryocytopoiesis b19 infection normal human bone marrow cells significantly suppressed megakaryocyte \( mk \) colony formation compared mock infected cells inhibition observed human , associated virus 2 \( \) b19 mk cell interaction also studied molecular level whereas low density bone marrow cells containing erythroid precursor cells supported b19 dna replication , viral dna replication observed b19 infected mk enriched fractions determined presence viral dna replicative intermediates southern blots however , analysis total cytoplasmic rna isolated b19 infected mk fractions showed low level expression b19 genome detected quantitative rna dot blots well northern analysis furthermore , frame shift mutation recombinant b19 hybrid genome segment encodes viral \( \) protein significantly reduced observed inhibition mk colony formation studies indicate tissue tropism b19 beyond erythroid progenitor cell , support hypothesis b19 genome expression may toxic cell populations viral dna replication
analysis platelet aggregation disorders based flow cytometric analysis membrane glycoprotein iib iiia conformation specific monoclonal antibodies normal primary platelet aggregation requires agonist mediated activation membrane gpiib iiia , binding fibrinogen gpiib iiia , cellular events ligand binding monoclonal antibody distinguishes resting activated states gpiib iiia , antibodies preferentially recognize gpiib \( 1 \) iiia \( anti \) binding fibrinogen fibrinogen mimetic peptides , using antibodies platelet flow cytometry , studied two distinct persistent platelet aggregation abnormalities platelets variant , contained near normal amounts gpiib iiia , failed aggregate bind response agonists addition , , binds normal gpiib iiia without prior cell activation , failed increase binding 1 anti platelets , suggesting primary defect ligand binding chromatography detergent solubilized platelets affinity column confirmed patient 's gpiib iiia lacked fibrinogen binding site another patient defective aggregation , failed bind adenosine diphosphate stimulated platelets , bind protein kinase c directly activated phorbol myristate acetate furthermore , binding 1 anti increased response , confirming defect agonist mediated fibrinogen receptor activation rather fibrinogen binding events distal binding studies indicate immunochemical approach useful classification clinical abnormalities platelet aggregation defects either \( \) fibrinogen receptor activation , \( b \) fibrinogen binding , \( c \) events
sickle erythrocytes inhibit human endothelial cell dna synthesis patients sickle cell anemia experience severe vascular occlusive phenomena including acute pain crisis cerebral infarction obstruction occurs microvascular arterial level , clinical presentation vascular events heterogeneous , suggesting complex etiology interaction sickle erythrocytes endothelium may contribute vascular occlusion due alteration endothelial function investigate hypothesis , human vascular endothelial cells sickle normal erythrocytes stimulated synthesize dna erythrocytes onto replicate monolayers centrifugation 10 minutes 17 g contact endothelial cells incorporation 3h thymidine endothelial cell dna markedly inhibited contact sickle erythrocytes inhibitory effect enhanced twofold autologous sickle plasma present endothelial cell labeling normal erythrocytes , without autologous plasma , modest effect endothelial cell dna synthesis sickle erythrocytes autologous sickle plasma applied endothelial monolayers 1 minute , 10 minutes , 1 hour removed , subsequent dna synthesis endothelial cells inhibited 30 40 although adherence sickle erythrocytes endothelial monolayers observed experimental conditions , effect sickle erythrocytes endothelial dna synthesis occurred absence significant adherence hence , human endothelial cell dna synthesis partially inhibited contact sickle erythrocytes inhibitory effect sickle erythrocytes occurs brief \( 1 minute \) contact endothelial monolayers , persists least 6 hours 3h thymidine labeling results indicate interaction sickle erythrocytes endothelium may result altered endothelial function altered endothelial function may contribute development vascular occlusive phenomena patients sickle cell anemia
human neutrophil cytochrome b light chain \( phox \) gene structure , chromosomal location , mutations cytochrome negative autosomal recessive chronic granulomatous disease membrane bound cytochrome b , heterodimer formed 91 kd glycoprotein \( heavy chain \) 22 kd polypeptide \( light chain \) , essential component phagocyte nadph oxidase responsible superoxide generation cytochrome b absent two subgroups chronic granulomatous disease \( cgd \) , inherited disorder characterized lack oxidase activity mutations cytochrome heavy chain gene , encoded locus 1 , result x linked form cgd rare subgroup autosomal recessive cgd also lacks cytochrome b \( cgd \) , genetic defect previously identified order search possible mutations cytochrome light chain locus , , structure gene characterized locus localized , approximately 600 bp open reading frame determined encoded six exons span approximately 8 5 kb three unrelated patients cgd studied evidence mutations light chain gene one patient , whose parents first , homozygous large deletion removed extreme 5' coding sequence gene two patients grossly normal light chain transcript northern blot mononuclear cell rna light chain transcript amplified polymerase chain reaction sequenced one patient compound heterozygote two alleles containing point mutations open reading frame predict frame shift amino acid replacement , respectively second patient , whose parents second , homozygous different single base substitution resulting another amino acid change results indicate cgd results defects gene encoding 22 kd light chain phagocyte cytochrome b
iron nutrition monitoring nutrition status assessment majority united states characterized low mean corpuscular volume thus classified microcytic iron deficiency , chronic disease thalassemia traits three leading causes microcytic anemia true cause anemia must always sought prevalence estimates iron deficiency accurate appropriate treatment initiated anemic individual clinical setting surveys , frequent differential diagnosis microcytic anemia involve distinguishing iron deficiency chronic disease erythrocyte sedimentation rate \( esr \) , sedimentation rate \( \) , c reactive protein \( crp \) elevated variety diseases indicators may help differentiate anemia chronic disease iron deficiency , iron deficiency overestimated hospitalized aged populations red cell distribution width \( \) appears elevated greater extent iron deficiency chronic disease thalassemia traits crp two several indicators iron status third national health examination survey \( nhanes iii \)
newborn screening sickle cell disease infant follow \? success programs screen newborns sickle cell disease depends timely follow education regarding fever splenic palpation , initiation prophylactic penicillin therapy , reduce morbidity mortality occur prior 4 months age however , contacting parents permit implementation care may difficult , particularly large urban populations nine \( 36 \) 25 infants recently identified sickle cell disease arrived institution initial medical providers must aware medical legal related follow newborns sickle cell disease prevent untoward events missed cases
alterations pulmonary mechanics transfusion anemic preterm infants pulmonary mechanics studied ten anemic preterm infants using esophageal balloon mask , transfusion 10 ml kg packed rbc mean birth weight g gestational age 29 27 2 4 wk transfusions carried mean postnatal age 41 9 21 8 days mean hct increased 28 3 1 38 3 3 3 dynamic lung compliance decreased infants transfusion 33 8 increase resistance work breathing increased transfusion changes might due volume overload increased lung water content
elevated serum procollagen iii levels sarcoidosis procollagen iii \( p iii p \) , peptide released conversion type iii procollagen type iii collagen , considered potential marker fibroblast activity variety pulmonary diseases aim present article investigate levels p iii p serum samples \( sp iii p \) large number sarcoid patients , particular looking relationship markers disease activity presumed role marker pulmonary fibrosis sp iii p overall series 57 patients levels higher \( 19 18 9 17 ng ml \) 25 age sex matched controls \( 11 32 2 15 ng ml p less 0 001 \) elevation neither sex related related obvious liver sarcoid localization although sp iii p levels slightly higher patients stage ii , significant difference patients stage iii found positive relationship serum angiotensin converting enzyme \( ace \) levels \( p less 0 04 \) , markers disease activity \( 67ga uptake , bronchoalveolar lavage bal lymphocyte percent , vital capacity , lung diffusing capacity \) relationship ace confirmed longitudinal follow study , sp iii p strictly paralleled ace behavior finally , initial sp iii p levels predict cases either disease relapse resistance corticosteroid treatment conclude , study , sp iii p levels failed characterize sarcoid patients radiologic fibrotic pattern \( stage iii \) , , addition , unable predict patients would poor prognosis rather , reflect metabolic activity sarcoid granuloma cells thus , usefulness sp iii p treatment patients sarcoid may considered similar ace
constitutive antibody normal human serum directed rabbit bone marrow cells lack , neonates , hematologic disorders normal human serum effectively inhibits bioassay erythropoietin based dna synthesis rabbit erythroid precursors heat sensitive inhibitory activity readily lost dilution serum , revealing presence erythropoietin potentiating activity inhibitory activity caused rapid cytotoxic effect rabbit bone marrow cells mouse cells less sensitive cytotoxic activity removed serum adsorption protein , expressed 4 degrees c , neutralized anti complement antibody cytotoxicity inhibited egta effect egta reversed addition ca2 ions findings show cytotoxicity exerted antibody via classical pathway complement dependent cell lysis although serum healthy , adult human donors consistently contains cytotoxic activity , activity observed serum samples neonates , , patients severe anemia patients polycythemia chronic renal failure occasionally lack cytotoxic activity serum serum samples lacking cytotoxic activity found deficient antibody component 34 35 cases examined results show antibody directed rabbit cells constitutively present normal human serum absent number pathologic situations well absent neonates
increased incidence monoclonal undetermined significance blacks age related differences whites basis study men one woman hospital setting serum samples 398 individuals \( 270 whites 128 blacks \) exhibiting quantitatively normal amounts five typically seen fractions \( albumin , alpha 1 globulin , alpha 2 globulin , beta globulin , gamma globulin \) serum protein electrophoresis showing evidence multiple myeloma , diseases , diseases known produce monoclonal proteins tested monoclonal undetermined significance \( mgus \) electrophoresis individual study serum protein electrophoresis pattern suggestive monoclonal protein except one 37 year old woman , subjects men subjects divided seven age groups 20 29 years \( \) , 30 39 years \( ii \) , 40 49 years \( iii \) , 50 59 years \( iv \) , 60 69 years \( v \) , 70 79 years \( vi \) , 79 years \( vii \) age considering subjects given race , blacks two times \( 14 8 \) higher incidence mgus whites \( 7 8 \) difference statistically significant increased incidence mgus blacks compared whites age group , difference statistically significant age groups except group ii mgus found groups iii either race showed threefold increase incidence mgus group ii group vii routine laboratory test erythrocyte sedimentation rate subjects mgus significantly different age race matched individuals without mgus results show incidence mgus higher group \( blacks \) also known higher prevalence multiple myeloma
negative screening sickle cell diseases monoclonal immunoassay newborn blood eluted filter paper common method blood sample collection neonatal screening programs inherited diseases blood spots filter paper poorly suited screening sickle cell diseases conventional assays denaturing effects medium hemoglobins affect electrophoretic monoclonal antibody beta 6 1 specifically recognizes hemoglobin beta chain residue 6 \( glutamic acid \) , , normal counterpart hemoglobins c , recognition unaffected changes hemoglobins induced filter paper storage beta 6 1 immunoassay analysis 67 samples extracted filter paper permitted unambiguous group identification , virtue , pathologic sickle cell disease phenotypes ss \( sickle cell anemia \) sc \( sickle cell hemoglobin c disease \) , along homozygous hemoglobin c phenotype \( hemoglobin cc disease \) phenotypes identified beta 6 1 would include beta degrees thalassemia , c beta degrees thalassemia , beta degrees thalassemia \( 's anemia \) systems collecting newborn blood specimens filter paper laboratories already established many states , assay sickle cell hemoglobin c diseases could rapidly combined mass screening programs inborn errors metabolism
properties mixed hemoglobin gels obtain new information concerning behaviors , turn structures , gels formed mixtures hemoglobins , physical properties characterized stress relaxation rotational variables \( 1 \) initial total hemoglobin concentration , \( 2 \) mole fraction hemoglobin present mixture , \( 3 \) hemoglobin intact hybridized hemoglobin , \( 4 \) annealing time , \( 5 \) shear history , \( 6 \) temperature , \( 7 \) temperature time annealing characteristics monitored gain information effect variables gel properties \( 1 \) lag time , \( 2 \) polymer mass , \( 3 \) polymer fraction , \( 4 \) polymer composition , \( 5 \) equilibrium total hemoglobin activity , \( 6 \) total hemoglobin polymer mass \( total hemoglobin fraction \) expected , mixed hemoglobin sa gels less solid pure similar initial hemoglobin concentrations lower polymer mass , gel properties influenced shear history , annealing time , temperature , temperature time annealing however , compared basis similar quantities gel present , mixed hemoglobin sa gels found solid pure mole fraction hemoglobin decreased initial mixture explained predominant influence gel properties high hemoglobin activity incurred volume exclusion effect total hemoglobin concentration presence hemoglobin hemoglobin results polymers gels differ found pure hemoglobin pathophysiologic implications findings sickle cell disorders proposed
properties mixed hemoglobin gels f obtain new information concerning behaviors turn , structures gels formed mixtures f hemoglobins , properties characterized stress relaxation variables \( 1 \) initial total hemoglobin concentration \( 2 \) mole fraction hemoglobin present mixture \( 3 \) hemoglobin f intact hybridized hemoglobin \( 4 \) hemoglobin f predominantly g gamma , gamma , mixture gamma chain types \( 5 \) annealing time \( 6 \) shear history , \( 7 \) temperature \( 8 \) temperature time annealing characteristics monitored gain information effect variables gel properties \( 1 \) lag time , \( 2 \) polymer mass , \( 3 \) polymer fraction , \( 4 \) polymer composition , \( 5 \) equilibrium total hemoglobin activity , \( 6 \) total hemoglobin polymer mass \( total hemoglobin fraction \) expected , mixed hemoglobin f gels less solid pure hemoglobin gels similar initial total hemoglobin concentrations lower polymer mass , gel properties influenced annealing time , shear history , temperature , temperature time annealing however , compared basis similar quantities gel present , mixed hemoglobin f gels found solid pure mole fraction hemoglobin decreased initial mixture explained predominant influence gel properties high hemoglobin activity incurred volume exclusion effect total hemoglobin concentration pathophysiologic implications findings various sickle cell disorders proposed
intravenous immunoglobulin virus associated syndrome 1 year old boy virus associated syndrome caused cytomegalovirus infection described persistent severe thrombocytopenia responded repeated intravenous infusions immunoglobulin
treatment 13 cis retinoic acid transfusion dependent patients syndrome decreased toxicity addition alpha tocopherol purpose purpose study determine response tolerance long term treatment using 13 cis retinoic acid \( 13 cra \) transfusion dependent patients syndrome \( mds \) determine effects therapy natural history disease patients methods sixty six consecutive patients transfusion dependent mds seen medical school hospital outpatient clinic 1981 1988 studied first 21 patients treated 13 cra alone next 45 patients 13 cra plus alpha tocopherol \( \) compared responses toxicities therapy , rates transformation , survival onset therapy 20 evaluable patients treated 13 cra alone 43 patients treated 13 cra plus results four patients responded \( 20 \) 4 8 months 13 cra alone , response associated considerable toxicity resulted cessation therapy among responders , one continued therapy currently remission , whereas three discontinued therapy toxicity relapse died 13 cra plus group , observed one prolonged complete remission 10 partial remissions \( 26 \) , decrease skin constitutional toxicities addition , enabled continuation 13 cra although response rates similar groups , fewer patients \( 28 versus 60 \) experienced progression acute leukemia 13 cra plus group group receiving 13 cra alone , terminated treatment \( p 0 018 \) twofold increase median survival ra raeb patient groups observed 13 cra plus significant \( p greater 0 5 \) conclusion study shows 20 26 response rate 13 cra suggests 13 cra , given continuously , decreases rate progression transformation acute leukemia patients mds addition toxicity 13 cra allows long term treatment 13 cra since standard treatment mds currently unsatisfactory , findings indicate longer treatment non marrow suppressive agent 13 cra important , trials determine role 13 cra plus combination new recombinant growth factors therapy transfusion dependent mds offer new approach disease common elderly population
normal reticulin level iliac bone marrow level marrow reticulin may factor used presence hematologic disorder considered , knowledge study graded amount reticulin present normal iliac bone marrow grading reticulin stains bone biopsy specimens 100 normal patients documented normal amount reticulin marrow low twenty seven percent patients marrow reticulin grade 0 using scale , 42 grade n , 27 grade 1 , 4 grade 2 patient grade 3 4 reticulin level knowledge normal range reticulin essential reticulin level used factor evaluating possibility hematologic disorder
colony stimulating factors recombinant hematopoietic colony stimulating factors profound effects developing mature granulocytes , macrophages , lymphocytes use agents treatment disease may result variety adverse cutaneous reactions recent discovery colony stimulating factor production keratinocytes dermal cells suggests agents may also significant cutaneous homeostasis pathogenesis cutaneous diseases
characteristics cholinergic transmission ganglionic aganglionic colon hirschsprung 's disease differences release content acetylcholine alpha 2 adrenoceptor mediated interaction noradrenergic cholinergic neurons investigated neurochemical pharmacological methods aganglionic ganglionic segments isolated human colon taken children suffering hirschsprung 's disease rest transmural stimulation release acetylcholine significantly higher spastic \( aganglionic \) segment proximal dilated bowel significant differences found tissue concentration acetylcholine ganglionic aganglionic specimens pattern response transmural stimulation also different spastic dilated bowel transmural stimulation induced relaxation contraction ganglionic specimens contractions aganglionic specimens sensitivity smooth muscle aganglionic portion exogenous acetylcholine field stimulation found higher ganglionic portion noradrenaline added organ bath reduced stimulation evoked release acetylcholine spastic segments , via alpha 2 adrenoceptor mediated process , enhance release suggested hirschsprung 's disease increased acetylcholine release , enhanced sensitivity smooth muscle cells acetylcholine , lack alpha 2 adrenoceptor mediated noradrenergic modulation acetylcholine release cholinergic might responsible spasm aganglionic segments
intrauterine growth retardation diagnosis based multiple parameters prospective study scoring system previously developed diagnose intrauterine growth retardation \( iugr \) based three parameters estimated fetal weight , amniotic fluid volume , maternal blood pressure status test iugr score prospectively , authors computed score third trimester fetuses , 39 growth retarded normal , scanned within 2 weeks prior delivery iugr score identified three groups , distinct probability iugr score 50 virtually iugr \( 3 probability \) , score 60 allows diagnosis \( 74 probability \) , score 50 60 indeterminate \( 13 probability \) iugr score performed best patients accurate early ultrasound \( us \) , even among patients lacking accurate , performance iugr score superior previously reported single sonographic parameter iugr score used us facility diagnose exclude third trimester iugr
chromosomal region cystic fibrosis gene yeast artificial chromosomes model human genome mapping general strategy cloning mapping large regions human dna yeast artificial chromosomes \( yac 's \) described relies use polymerase chain reaction detect dna called sequence sites \( sts 's \) within yac clones method applied region human chromosome 7 containing cystic fibrosis \( cf \) gene thirty yac clones region analyzed , map 1 , 500 , 000 base pairs assembled individual yac 's large kilobase pairs containing entire cf gene constructed vivo meiotic recombination yeast pairs overlapping yac 's
association intrapartum asphyxia mature fetus newborn behavior matched cohort study mature newborns biochemically determined intrapartum fetal asphyxia mature newborns normal blood gas acid base assessments delivery studied demonstrate effect fetal asphyxia newborn behavior expressed newborn behavioral assessment scale newborn behavioral assessment scale administered 3 days delivery 2 weeks delivery newborn behavioral assessment scale summary scores group asphyxia order control group also true group newborns asphyxia severe metabolic acidosis low apgar scores findings support many newborns undergone intrapartum insult evidence central nervous system injury threshold central nervous system injury severe end spectrum asphyxia expressed metabolic acidosis
placental histology fetuses 18 23 weeks' gestation abnormal karyotype placentas abnormal fetuses \( 18 23 weeks' gestation \) analyzed prospectively light microscopic level group consisted 14 control placentas group ii consisted 14 placentas fetuses abnormal karyotype secondary tertiary stem villi counts , small muscular artery counts , total vessel counts determined per 100 x field differences secondary tertiary stem villi counts groups significant decrease small muscular artery counts \( p less 0 01 \) total vessel counts \( p less 0 01 \) noted group ii placental fetal weights comparable groups may represent placental immaturity result arrested delayed appears abnormality established third trimester may enhanced late vascular reported others data substantiate concept structure function placenta determined great degree fetal karyotype may help explain morbidity mortality seen fetuses
anterior pressure visual evoked potentials neonates infants undergoing profound hypothermic circulatory arrest determine effects cardiopulmonary bypass profound hypothermic circulatory arrest \( phca \) anterior pressure \( afp \) visual evoked potentials \( veps \) , 21 neonates infants undergoing cardiopulmonary bypass \( cpb \) phca surgical correction congenital heart defects studied mean \( sd \) minimum nasopharyngeal , esophageal , rectal temperatures 16 4 2 2 , 11 2 2 7 , 17 7 1 9 degrees c , respectively , achieved mean duration phca 51 6 18 7 min afp increased significantly pre cpb values first 21 7 8 1 min rewarming duration increase afp related directly product nasopharyngeal temperature \( \) end phca duration phca \( r2 0 82 , p less 0 0001 \) nineteen patients simultaneous monitoring veps latency components veps increased temperature decreased cerebral perfusion pressure linearly inversely related afp \( r2 0 72 , p less 0 01 \) veps disappeared nasopharyngeal temperature \( \) 18 9 2 8 degrees c 21 9 8 8 min post phca 32 8 1 4 degrees c significant difference duration increased afp \( 20 9 8 1 min \) duration absence veps post phca period duration increased afp correlated linearly directly duration absence veps \( r2 0 84 , p less 0 005 \) data demonstrate transient dysfunction occurs phca dysfunction related duration elevation afp cannot explained solely temperature effect
natural modified history complete atrioventricular septal defect 17 year study reviewed 103 cases isolated complete atrioventricular septal defect cases represented 4 4 cases congenital heart disease diagnosed hospital catheterisation angiography 1971 88 children \( n 76 \) 's syndrome banding pulmonary artery performed seven cases complete repair 67 cases period 1971 82 complete correction performed mean age 23 months surgical mortality 88 8 period 1983 8 mean age complete correction 13 months , mortality 43 2 , five year actuarial survival 46 8 22 patients survived complete correction functional classes ii new york heart association classification mean follow 10 years eight \( 36 \) 22 followed treated medically survived developed pulmonary vascular obstructive disease functional classes iii iv findings stress importance early complete surgical repair
value transesophageal echocardiography repair congenital heart defects two dimensional transesophageal color doppler echocardiography employed intraoperatively 30 children undergoing repair variety simple complex cardiac malformations 16 female 14 male patients , mean age 9 3 years \( range , 4 13 years \) mean weight 31 9 kg \( range , 16 50 kg \) , 16 children weighing less 30 kg standard , commercially available transesophageal echocardiography probe \( 5 mhz , 64 elements \) used patients without complications transesophageal echocardiography proved helpful selecting surgical approach , assessing adequacy surgical repair , detecting residual intracardiac shunts , allowing monitoring ventricular performance throughout procedure initial experience suggests transesophageal echocardiography valuable tool used children congenital cardiac malformations , particularly requiring complex intracardiac procedures amount information obtained surgeon favor routine use transesophageal echocardiography open heart procedures stimulate development probes safely used even infants newborns
glenn lecture cavopulmonary shunt evolution concept development , cavopulmonary anastomosis , appeared originate several centers almost simultaneously extensive research right heart bypass , glenn first north america perform successful experimental cavopulmonary shunt , became known name properly selected patients , palliation success excellent , mortality rates low 1988 , used cavopulmonary anastomosis palliation 139 infants children eight hospital deaths , occurred early series palliation generally lasted 6 8 years child blood supply contralateral lung palliation could restored increased flow lung another shunt six otherwise inoperable patients received benefit addition axillary arteriovenous fistula late pulmonary arteriovenous fistulas identified 11 patients angiography , sensitive testing , incidence rate may high 21 occurrence pulmonary arteriovenous fistulas caused general concern less frequent use shunt recent application end side anastomosis , creating bidirectional shunt , restored interest major cavopulmonary anastomosis demonstration feasibility partial right heart bypass , way fontan operation , frequently constructed part operation currently , glenn shunt often used temporary permanent alternative fontan repair appears significant risk risk factors usually encountered include small pulmonary arteries , young age , poor ventricular function , atrioventricular valve incompetence , myocardial hypertrophy sometimes alone often combination
longitudinal results first stage palliation hypoplastic left heart syndrome evaluate results palliative surgery hypoplastic left heart syndrome , reviewed records 57 infants underwent first stage reconstruction institution july 1983 april 1989 57 infants , 12 \( 21 \) long term survivors 45 \( 79 \) died thirty one infants died within first 30 days surgery twenty six 31 early deaths occurred within first 24 hours surgery causes early mortality low cardiac output \( 23 \) , sepsis \( two \) , sudden death \( two \) , pulmonary vein atresia \( three \) , cardiac transplant \( one \) late death occurred 14 infants due sepsis \( three \) , sudden death \( four \) , death reoperation \( seven three fontan procedure , three shunt replacement , one transplant \) 31 patients survived 24 hours , complications noted echocardiography confirmed catheterization reoperation indicated significant arch obstruction \( 13 \) , branch pulmonary artery stenosis \( 23 \) , small atrial septal defect \( 16 \) , inadequate shunt \( 26 \) , regurgitation \( 13 \) , tricuspid regurgitation \( 13 \) , ventricular dysfunction \( 29 \) , thrombus \( 6 \) , superior vena cava obstruction \( 3 \) 31 patients survived 24 hours , 16 additional palliative surgical procedures performed eight patients procedures included arch reconstruction \( four \) , additional shunt \( four \) , glenn shunt \( three \) , atrial \( two \) , coarctation balloon angioplasty \( two \) , pulmonary artery reconstruction \( one \) 12 long term survivors , four successful fontan procedure , one transplant , seven awaiting second stage procedure thus , 69 deaths occurred within first 30 days surgery , 58 deaths occurred within first 24 hours due cardiovascular collapse
right ventricular growth pulmonary valvotomy central aortopulmonary shunt pulmonary atresia intact ventricular septum performed pulmonary valvotomy initial surgery 22 consecutive patients pulmonary atresia intact ventricular septum patent infundibulum nineteen patients also placement central aortopulmonary shunt patients survived surgery , 16 patients preoperative later postoperative purpose study determine response right ventricle pulmonary valvotomy regard relief right ventricular hypertension growth entire right ventricle , including tricuspid valve , right ventricular volume , right ventricular outflow tract right ventricular systolic pressure decreased 111 3 31 7 mm hg initial surgery 65 6 26 2 mm hg right ventricular end diastolic volume increased 59 1 39 3 predicted normal initial surgery 114 6 63 2 late follow catheterization tricuspid valve anulus circumference also increased size 73 2 21 3 predicted normal initial surgery 90 4 22 8 late follow catheterization one patient \( 6 \) required right ventricular outflow tract patch time biventricular repair twenty 22 patients \( 91 \) either awaiting biventricular repair conclude pulmonary valvotomy central aortopulmonary shunt performed safely newborn infants pulmonary atresia intact ventricular septum patent infundibulum effective valvotomy right ventricular hypertension , allows excellent right ventricular tricuspid valve growth , potential biventricular repair
fontan operation 176 patients tricuspid atresia results proposed new index patient selection 1973 march 1989 , 176 patients tricuspid atresia fontan procedure performed mayo clinic age range time surgery 7 months 42 years , 43 patients \( 24 \) 16 years old older hospital mortality rates 17 \( nine 54 \) 1973 1980 8 \( 10 122 \) 1981 1989 10 late cardiovascular deaths postoperative follow 139 survivors \( range , 6 months 14 years mean , 5 5 years \) revealed 91 excellent good condition 9 fair poor condition patients fair poor condition poor fluid retention intermittent pleural effusion , ascites , two factors clearly influence operative late results preoperative pulmonary arteriolar resistance \( rpa \) left ventricular diastolic function preoperative catheterization index devised adding rpa left ventricular end diastolic pressure divided plus may helpful selecting candidates likely survive benefit fontan operation experience , index less 4 0 , postoperative right atrial mean pressure 20 mm hg less , associated 95 early 89 overall survival rates
atrial cardiomyoplasty fontan type procedures purpose right atrial cardiomyoplasty increase atrial pulmonary flow patients undergoing fontan type procedures developed two surgical techniques bypass right ventricle , followed right atrial cardiomyoplasty stimulated latissimus dorsi muscle flap \( \) 10 goats , left transferred chest removal second rib sternotomy , right atrial five goats \( group 1 \) connected distal main pulmonary artery polytetrafluoroethylene tubing proximal pulmonary trunks ligated five goats \( group 2 \) , cardiopulmonary bypass , bioprosthetic valves implanted inferior tricuspid orifice closed , connection performed left sutured right atrium stimulated using synchronous 30 hz bursts delivered medtronic hemodynamic studies performed acute phase right atrial , pulmonary arterial , aortic pressures assessed cardiac output measured using ultrasonic flow studies stimulation restored pulsatile pressure patterns pulmonary artery increased cardiac output observations evident model caval valvular implant functional right atrium could improve long term results fontan type procedures extend operative indications chronic experimental studies necessary evaluate diastolic systolic functions right ventricle
partial anomalous pulmonary venous return anomalous pulmonary venous return left lung extremely rare condition reported general case reports 1964 1988 , identified 13 patients condition , underwent surgical correction represents single largest reported institutional experience anomaly patients ranged age 15 months 40 years seven asymptomatic , six symptoms ranging recurrent pulmonary infection moderate congestive heart failure six anomalous venous return entire left lung , seven anomalous return upper lobe eight patients associated cardiovascular anomalies four patients underwent surgical correction via sternotomy approach cardiopulmonary bypass allow correction coexisting intracardiac anomalies remaining patients underwent surgical repair left thoracotomy technique included high ligation division persistent left superior vena cava anastomosis left atrium site partial excision atrial appendage deaths one complication series
hypoplastic left heart syndrome outcome initial reconstruction modified fontan procedure outcome clinical course modified fontan procedure reviewed 200 patients hypoplastic left heart syndrome underwent initial reconstructive surgery august 1985 march 1989 median age time initial reconstruction 6 days \( range , 1 day 7 2 months \) 28 patients , right modified shunt used 172 patients , central shunt placed additional procedures \( n 41 \) performed 38 patients \( median age , 5 months range , 6 days 17 5 months \) revision systemic pulmonary shunt \( n 15 \) , arch reconstruction \( n 8 \) , balloon angioplasty arch obstruction \( n 7 \) , atrial \( n 4 \) , pulmonary artery angioplasty \( n 2 \) , tricuspid valve annuloplasty replacement \( n 4 \) , modified glenn shunt \( n 1 \) significant difference frequency additional procedures performed 30 postoperative days survivors compared nonsurvivors actuarial survival rates 0 66 \( 1 month \) , 0 48 \( 12 months \) , 0 44 \( 18 months \) seventy percent deaths occurred initial admission , 32 resulting acute cardiovascular collapse first postoperative day statistical difference actuarial survival assessed type shunt used anatomical subtype influence additional interventions considered substantial improvement outcome may possible immediate perioperative mortality reduced speculate intermediate mortality \( 30 days 1 year \) may related effects chronic exposure right ventricle volume overload systemic pressure
clinical approach prenatal detection human structural defects tremendous advances prenatal diagnosis allowed clinicians recognize variety structural defects developing fetus guidelines fetal ultrasonography approach fetal evaluation outlined developmental morphologic approach emphasized way congenital anomalies whether detected prenatal postnatal life use approach diagnosing managing fetal malformation syndromes illustrated
induced fetal anomalies variety infectious physical agents , maternal diseases altered metabolic states , drugs chemicals shown cause postnatal structural functional disabilities embryonic fetal exposure occurs human pregnancy disabilities potentially preventable public education awareness health care providers must equipped collect relevant data regarding exposures concern pregnant patients , locate evaluate pertinent current information resources , counsel women regarding associated potential risks comprehensive care patient exposed human may also include discussion prenatal diagnostic procedures pregnancy management options
aberrant central nervous system overview congenital defects cns emphasized pathogenesis developmental pathways continue elucidated , approach remains extent hypothetical , however , understanding features helps indicate time onset elucidate causal factors , important steps toward prevention birth defects taken
use palatal stabilizing device prevention palatal premature infants prospective , randomized study using palatal stabilizing device \( \) conducted evaluate effectiveness device preventing disruptions palatal architecture total 26 premature infants birth weights 540 g , intubated orally period varying 7 109 days randomized control experimental groups neonates control group developed palatal ranging 2 5 mm depth , whereas experimental group \( \) showed evidence palatal conclude effective preventive device premature orally intubated infants
comparative value transthoracic transesophageal echocardiography assessment congenital abnormalities atrioventricular junction information obtained transthoracic transesophageal echocardiography \( two dimensional echocardiography spectral doppler color flow imaging \) compared 17 patients major congenital abnormalities atrioventricular \( av \) junction \( 10 discordant av connections , 1 cross connection , 5 absent right connections 1 absent left connection \) findings either technique correlated findings cardiac catheterization \( 12 patients \) surgery \( 5 patients \) two six patients absent av connection defined transthoracic echocardiography , transesophageal imaging demonstrated av valve 11 11 patients discordant cross connection , assessment av valve ventricular morphology \( defining attachments av valves \) possible transesophageal echocardiography \( 3 11 patients transthoracic echocardiography \) detected 1 patient excluded 3 others associated inlet ventricular septal defect anomalous pulmonary venous connection \( one patient \) , atrial septal defect \( three patients \) stenosis \( five patients \) better assessed transesophageal imaging , atrial appendage morphology could demonstrated transesophageal technique less useful demonstrating anterior subaortic infundibulum aortopulmonary shunt \( two patients \) although systemic ventricular function could assessed either method use short axis mode scans , transesophageal pulsed doppler av valve pulmonary venous flow patterns provided clues diastolic dysfunction systemic ventricle
cardiac teratogenesis trichloroethylene dichloroethylene mammalian model recent epidemiologic studies demonstrated greater expected number pediatric patients congenital heart disease areas drinking water contaminated trichloroethylene , principal contaminants previous study embryos demonstrated injected air eggs trichloroethylene produced three times number cardiac defects found control embryos mammalian study demonstrates similar effects trichloroethylene dichloroethylene applied provocative circumstances \( , solutions delivered catheter gravid uterus intraperitoneal osmotic pump \) developing rat fetus utero period organ differentiation development furthermore , effect dose dependent agents although small number congenital heart anomalies \( 3 \) found control group , 9 12 5 found lower dose trichloroethylene dichloroethylene groups 14 21 higher dose groups , respectively \( p less 0 05 \) variety cardiac defects found dichloroethylene appears least great cardiac trichloroethylene even though administered 10 fold lower concentration agents appear specific cardiac single noncardiac anomaly found study rat model demonstrates dose dependent relation fetal exposure trichloroethylene dichloroethylene utero period appearance variety congenital cardiac defects
prenatal screening \? report discusses role prenatal screening preventing congenital abnormalities , prevention possible , avoiding conception birth would untreatable abnormalities women found screening immune safely vaccinated prior pregnancy found risk children genetic disorders tay sachs disease thalassemia option avoiding conception affected offspring screening pregnancy permits primary prevention rh disease sequelae results prophylactic administration rh immune globulin rh negative women maternal serum alpha fetoprotein screening identifies pregnant women increased risk carrying fetuses neural tube defects 's syndrome , giving option avoiding birth affected fetuses abortion recombinant dna technology permit screening many genetic disorders disease related genes mutations identified many disorders , ability predict risk disease preventive therapeutic interventions many years lag phase , issues concerning validity tests , severity conditions screening offered , safety interventions , autonomy pregnant women deciding screened important
child abuse one pair twins japan nationwide survey japan child abuse neglect revealed 10 victims products multiple births none victims multiple birth siblings , cases twins abused findings indicated one rather pair twins likely abused japan abuse twins likely serious parental family problems , whereas abuse one twin associated child 's medical problems non home care instance abuse pair twins handicapped comparisons abused twin non abused co twin examination 's victim suggested difference twins development response parents increased stress child rearing encouraged , resulted abuse one twin comparison parents children siblings may common factor general child abuse natural parents
relation genotype phenotype cystic fibrosis analysis common mutation \( delta f508 \) background methods clinical manifestations cystic fibrosis genotypes patients heterogeneous , associations two known therefore studied blood samples 293 patients cystic fibrosis presence common disease causing mutation \( delta f508 \) chromosome 7 compared results clinical manifestations disease results prevalence delta f508 allele cohort 71 percent 52 percent patients homozygous mutation , 40 percent heterozygous , 8 percent , undefined mutations patients homozygous mutation received diagnosis cystic fibrosis earlier age greater frequency pancreatic insufficiency pancreatic insufficiency present 99 percent homozygous patients , 72 percent heterozygous patients 36 percent patients genotypes patients pancreatic insufficiency three genotype groups similar clinical characteristics , reflected early age diagnosis , similar sweat chloride values diagnosis , similar severity pulmonary disease , similar percentiles weight contrast , patients heterozygous genotype genotype groups pancreatic insufficiency older milder disease lower sweat chloride values diagnosis , normal nutritional status , better pulmonary function adjustment age conclusions variable clinical course patients cystic fibrosis attributed least part specific genotypes locus cystic fibrosis gene
analysis human dna excision repair gene involved group containing zinc finger domain \( xp \) autosomal recessive disease , characterized high incidence sunlight induced skin cancer cells people condition hypersensitive ultraviolet defect dna repair nine genetic groups xp , groups h variant cloned mouse dna repair gene complements defect group , xpac gene report molecular cloning human mouse xpac complementary dnas expression xpac cdna confers ultraviolet resistance several group cell lines , lines xp groups almost group lines tested showed abnormality absence xpac messenger rnas results indicate defective xpac gene causes group xp human mouse xpac genes located chromosome 1 chromosome , respectively human xpac cdna encodes protein 273 amino acids zinc finger motif
early amniocentesis report 407 cases neonatal follow amniocentesis performed prenatal diagnosis 407 pregnancies gestational ages 11 14 weeks safety accuracy procedure compared data obtained collaborative studies amniocentesis performed later second trimester differences observed respect accuracy , , maternal cell contamination related timing procedure fetal loss rate within 4 weeks procedure 2 3 fetal losses appeared related maternal complications bleeding leakage fluid occurred within day procedure major maternal complications noted information regarding neonatal outcome , including pulmonary complications congenital orthopedic postural deformities , found similar previous reports
elevated maternal serum alpha fetoprotein amniotic fluid alpha fetoprotein pregnancy reduction forty patients underwent fetal reduction approximately 12 weeks' gestation multiple pregnancy twenty two maternal serum alpha fetoprotein \( msafp \) determinations one elevated , mean value 9 41 median \( mom \) total 53 amniotic fluid specimens evaluated afp 25 elevated 2 0 mom one sample positive acetylcholinesterase none elevations associated neural tube defect , although two neural tube defects detected means routine msafp recommended patients pregnancy reduction
effect maternal smoking age congenital anomalies incidence congenital anomalies examined level maternal paternal smoking pregnancy 17 , 152 infants multiple regression analysis used control possible confounding effects maternal age , formal education , ethnic origin , , marital status , parity , social class , work outside home neither maternal paternal smoking habits significantly associated occurrence congenital malformations maternal age significantly \( p less 005 \) related incidence major anomalies mothers aged 35 years older smoked found significantly \( p less 002 \) higher risk minor malformations increased rate major malformations maternal cigarette smoking may important preventable risk factor congenital anomalies among mothers aged 35 years older
macular dystrophy cornea systemic disorder sulfate metabolism serum patients type 1 macular corneal dystrophy \( mcd \) , prevalent subtype , lacks detectable antigenic sulfate \( ks \) , postulated individuals may lack antigenic ks cartilage well test hypothesis , studied cornea , serum , nasal cartilage mcd patient using light electron microscopy , immunohistochemistry , quantitative enzyme linked immunosorbent assay \( elisa \) uses monoclonal antibody sulfated epitope ks chain measure ks content histologically , corneal deposits seen characteristic mcd abnormal deposits noted cartilage lack immunoreactivity corneal sections antibodies sulfated epitope ks absence epitope serum showed patient type 1 mcd cartilage specimen showed immunoreactivity chondrocytes extracellular matrix quantitative analysis elisa demonstrated antigenic ks content cornea cartilage least 800 times lower normal controls provided direct evidence abnormality sulfation type 1 mcd involves cornea cartilage
impact intrauterine growth retardation body proportionality fetal neonatal outcome previous prognostic studies infants intrauterine growth retardation \( iugr \) adequately considered heterogeneity iugr terms cause , severity , body proportionality prone misclassification iugr errors estimation gestational age based cohort infants early ultrasound validated gestational ages indexes body proportionality standardized birth weight , consequences severity cause specific iugr proportionality fetal neonatal morbidity mortality assessed progressive severity iugr , significant \( p less 001 \) linear trends increasing risks stillbirth , fetal distress \( abnormal electronic fetal heart tracings \) , neonatal hypoglycemia \( minimum plasma glucose less 40 mg dl \) , \( minimum ca less 7 mg dl \) , polycythemia \( maximum capillary hemoglobin greater equal 21 g dl \) , severe depression birth \( manual ventilation greater 3 minutes \) , 1 minute 5 minute apgar scores less equal 6 , 1 minute apgar score less equal 3 , hospital death trends persisted common outcomes even restriction term \( 37 42 weeks \) births convincing evidence outcome among infants given degree growth retardation varied function cause growth retardation among infants iugr , increased length weight significant crude associations hypoglycemia polycythemia , associations disappeared adjustment severity growth retardation gestational age
maternal serum alpha fetoprotein screening activities state health agencies survey maternal serum alpha fetoprotein \( msafp \) screening demonstrated cost effective population basis becoming standard practice american society human genetics twice published policy statements define essential elements quality screening program present study reviewed impact policy statements state public health agencies respect regulation provision msafp screening exceptions , states elected play major role provision regulation test need address issues funding , standards , data collection collaborative effort , policy statements genetic services translated effective state population screening
localization probe dxs426 xp linkage x linked retinitis pigmentosa marker dxs426 maps interval 1 21 , chromosomal region contains two loci x linked retinitis pigmentosa \( rp2 \) refined localization dxs426 physically , mapping deletion interval 3 23 , genetically , studying multiply informative indicate dxs426 lies \( e , 4 22 \) region contains rp2 gene , rp2 families could identified basis linkage dxs426 multiply informative two rp2 families indicate likely location rp2 gene dxs426 dxs426 therefore important highly informative marker purposes carrier detection early diagnosis rp2 localization disease gene
autosomal dominant retinitis pigmentosa absence rhodopsin proline histidine substitution \( codon 23 \) pedigrees europe exon 1 codon 23 rhodopsin gene , mutation resulting proline histidine substitution previously observed approximately 12 american autosomal dominant retinitis pigmentosa \( \) patients region around site mutation rhodopsin gene amplified analyzed affected individuals 91 european pedigrees codon 23 mutation found absent cases , including large pedigree disease gene previously shown closely linked rhodopsin locus indicates presence either allelic heterogeneity
functional residual capacity anesthetized children normal values values children cardiac anomalies assess increase functional residual capacity \( frc \) growth , frc measured induction anesthesia two groups children one group consisted 74 children , 0 1 11 2 yr age , without signs cardiorespiratory disease \( referred normal children \) , 21 children , 0 2 6 9 yr age , cardiac malformations anesthesia maintained halothane normal children fentanyl , droperidol , nitrous oxide children cardiac anomalies patients paralyzed , intubated , lungs mechanically ventilated frc measured automated tracer gas washout technique 70 patients measurements performed duplicate mean coefficient variation 2 0 frc correlated significantly height , weight , age groups multiple regression analysis groups considered together indicated significant improvement factors sex child presence cardiac anomalies incorporated model normal children simple linear nonlinear regression equations frc \( \) versus height \( centimeters \) frc 9 48 x height , r 0 96 frc 0 x 66 , r 0 97 , respectively corresponding equations frc \( \) versus weight \( \) frc 92 29 9 x weight , r 0 93 frc 9 51 x 31 , r 0 95
gut blood flow velocities newborn effects patent ductus arteriosus parenteral indomethacin effects gut blood flow velocities parenteral indomethacin \( 0 2 mg kg \) given either quickly bolus slowly infusion compared consecutive studies two groups infants symptomatic patent ductus arteriosus presence patent ductus arteriosus range velocities superior mesenteric artery indomethacin given pronounced abnormalities including absent cases even retrograde diastolic flow eight subjects first rapidly given bolus dose indomethacin \( duration 20 seconds less \) caused pronounced sustained fall velocity superior mesenteric artery blood flow \( mean peak systolic velocity \( cm second \) 74 38 median time maximum fall 7 4 minutes median time recovery 50 minutes \) 10 subjects received first dose indomethacin slow infusion \( duration 30 35 min \) percentage fall peak systolic velocity substantially less \( 22 compared 47 \) later \( median time maximum fall 37 3 minutes \) rapid infusion qualitatively similar smaller changes seen coeliac axis return antegrade end diastolic flow superior mesenteric artery within one hour first dose indomethacin good predictor subsequent closure ductus data suggest profound disturbance mid gut perfusion infants patent ductus , exacerbated indomethacin given rapidly intravenous bolus may also provide rational explanation well recognised association necrotising enterocolitis patent ductus arteriosus indomethacin administration
operation heart subaortic stenosis neonate setting single ventricle , subaortic stenosis may enhanced pulmonary artery banding may later fontan operation operation may prove preferable alternative infants procedure successfully used procedure initial operation newborn tricuspid atresia , transposition great arteries , coarctation , severe arch hypoplasia secondary restrictive foramen
cardiac transplantation hypoplastic left heart syndrome modified technique see modified technique infant orthotopic cardiac transplantation arch reconstruction using cannulation described , results 4 infants hypoplastic left heart syndrome presented technique minimizes donor myocardial ischemic time recipient circulatory arrest time
deposits syndrome young child syndrome presented well 8 years age lost interest activities school performance declined age 11 years , began episodes blepharospasm , accompanied bilateral ptosis occasional episodes crisis age 12 years , motor coordination declined began exhibit evidence dementia , dystonia , dysarthria , tremor motor incoordination , dystonia , tremor progressed patient chair bound multiple tests performed , including metabolic studies , magnetic resonance imaging , bone marrow biopsy , electron microscopy buffy coat bone marrow buffy coat revealed inclusions granular knowledge , third case report inclusion bodies found patients manifestations syndrome findings suggest obtaining buffy coat bone marrow biopsy may aid diagnosis syndrome ultimately provide information regarding etiology
persistent right umbilical vein ominous prenatal finding \? persistence right umbilical vein uncommon finding , cases reported since persistent right umbilical vein may replace normal left umbilical vein anomaly associated numerous occasionally lethal malformations series , three six fetuses \( another two literature \) associated anomalies others variety associated lesions ranging minor lethal appearance ultrasound easy recognize intrahepatic portion umbilical vein lateral gallbladder , portal vein curves toward stomach , instead parallel since recognition persistent right umbilical vein simple require additional scanning \( visible section used measure abdominal perimeter \) , author suggests using indicator depth scanning
parenchymal vascular magnetic resonance imaging brain extracorporeal membrane oxygenation three dimensional \( volume \) magnetic resonance angiography new noninvasive method imaging intracranial vasculature combination magnetic resonance angiography conventional magnetic resonance imaging used evaluate brain parenchyma vessels 30 survivors extracorporeal membrane oxygenation magnetic resonance imaging findings abnormal 33 patients , increased frequency right hemispheric lesions magnetic resonance angiography demonstrated good intracranial flow infants demonstrable right internal carotid arterial flow 35 patients permanent carotid ligation abnormal magnetic resonance imaging study found often infants abnormal predischarge neurologic examination results techniques several advantages neuroimaging modalities , including better definition deep structures , myelin formation , intracranial vasculature , absence bone artifact , elimination catheter contrast use
ultrasonic forms posterior frequent deformations globe encountered pediatric ophthalmology staphylomas paper reviewed 16 diagnosed staphylomas classified ultrasonographic patterns produced cases four types \( 1 \) staphylomas involving posterior pole optic nerve head , \( 2 \) staphylomas involving posterior pole optic nerve head , \( 3 \) peripapillary staphylomas , \( 4 \) giant peripapillary staphylomas morphologic ultrasonographic characteristics described
intraoperative transesophageal versus epicardial ultrasound surgery congenital heart disease twenty eight patients \( age range , 0 7 65 years median age , 6 1 years \) undergoing correction congenital heart disease entered prospective study intraoperative transesophageal epicardial ultrasound determine relative values techniques bypass surgery introduction transesophageal probe successful 26 patients \( 93 \) children studied use pediatric transducers epicardial studies performed 28 patients epicardial studies allowed higher resolution imaging complete assessment bypass surgery intracardiac morphological condition \( ventricular septum right ventricular outflow tract \) assessment obtained transesophageal approach period immediately bypass surgery , transesophageal technique allowed detailed insight atrioventricular valve function \( valvar regurgitation five patients ventricular inflow patterns \) continuous monitoring left ventricular function volume residual interventricular shunting \( three patients \) residual outflow tract obstruction \( four patients \) could reliably documented transesophageal studies concluded intraoperative transesophageal epicardial ultrasound surgery congenital heart disease complementary rather alternative techniques
aortic atresia survival adulthood without surgery aortic atresia rare congenital cardiac defect usually leads death neonatal period patient aortic atresia survived age 24 years without surgical procedure view uncertain results reconstructive surgery case may therapeutic implications
magnetic resonance imaging evaluation congenital dislocation hips magnetic resonance \( mr \) images obtained preoperatively postoperatively 12 pediatric patients congenital dislocation hip \( cdh \) images compared computed tomography scans mr images accurate defining soft tissue anatomy , hip position , obstructive factors mr imaging efficient diagnostic tool cdh
results 25 year screening programme neonatal hip instability 1962 1986 , 117 , 256 neonates screened congenital dislocation hip \( cdh \) primary physical examination performed paediatric staff persistent late diagnosis rate 0 5 per 1000 live births primary examination undertaken experienced orthopaedic personnel \( 1982 1984 \) late diagnosis rate fell fewer infants
respiratory muscle function cystic fibrosis maximal static expiratory inspiratory mouth pressures \( pemax pimax \) quadriceps femoris muscle strength measured 25 patients aged 16 28 years cystic fibrosis \( mean fev1 46 predicted \) mean \( sd \) pemax 64 \( 18 \) predicted \( 75 predicted 16 25 patients \) , pimax 64 \( 24 \) predicted \( 75 predicted 14 patients \) quadriceps muscle strength 68 \( 20 \) predicted \( 75 predicted 17 patients \) relatively small reduction respiratory muscle strength patients unlikely contributed appreciably respiratory problems
tolerance dependence neonates sedated fentanyl extracorporeal membrane oxygenation undertook retrospective chart review 37 neonates received fentanyl continuous infusion undergoing extracorporeal membrane oxygenation \( ecmo \) may 1986 october 1988 quantified doses utilized , determined incidence neonatal abstinence syndrome \( nas \) , identified risk factors associated nas determined peak fentanyl infusion rate , mean fentanyl infusion rate , total fentanyl dose , duration ecmo therapy nas observed 21 37 neonates \( 57 \) nas non nas neonates , mean infusion rate increased steadily ecmo therapy , mean 11 6 6 9 \( sd \) micrograms kg 1 h 1 day 1 mean 52 5 19 4 \( sd \) micrograms kg 1 h 1 day 8 total fentanyl dose duration ecmo significantly greater neonates nas found neonates total dose greater 1 6 mg kg ecmo duration greater 5 days significantly greater incidence nas \( chi squared test , p less 0 01 p less 0 005 odds ratios 7 0 13 9 , respectively \) multiple logistic regression , ecmo duration found powerful predictor occurrence nas also measured plasma fentanyl concentrations separate group 5 neonates receiving fentanyl continuous infusion sedation fentanyl concentrations increased steadily period infusion , suggesting development tolerance effects conclude continuous administration fentanyl sedation associated uniform development tolerance significant incidence dependence alternative approaches sedation investigated
effects newborn screening cystic fibrosis reported maternal behaviour screening cystic fibrosis highly controversial concerns expressed newborn screening may cause mothers , considered child healthy diagnosis , child screening also suggest period delay onset symptoms diagnosis may help mother adjust child 's lethal condition study compared strength child rearing attitudes 29 mothers whose children screened \( 13 symptomatic children 16 asymptomatic children \) attitudes 29 mothers whose children diagnosed onset symptoms results indicate newborn screening increased mother 's tendency child cystic fibrosis cases tendency decreased , delay diagnosis screening conducted usually caused mothers considerable personal distress
vasa aplasia cystic fibrosis bilateral vasa aplasia considered finding cystic fibrosis , patients rarely seen male infertility clinics improved survival beyond 20 years age likely change clinical study group male vasa absent 8 11 boys abnormalities palpable majority main cause infertility appears mechanical obstruction whether absence due primary failure duct development secondary luminal obstruction subsequent atrophy known
neonatal development group experience neonatal advisory group tertiary care setting reviewed identify aspects experience valuable development group consultations requested 31 patients seen august 1984 december 1988 review patients indicated 21 31 infants born full term gestations , 11 31 infants seen beyond neonatal period , type congenital anomaly principal diagnosis 64 7 patients reasons seeking consultation primarily involved decisions regarding withdrawal withholding treatment 22 31 patients , consensus group supported decision health care team remaining consultations , recommendation group information communication needed analysis neonatal advisory group 's experience consultations characteristics neonatal patients identified value discussing difficult ethical issues facing members health care team validated
recombinant human dnase reduces viscosity cystic fibrosis sputum respiratory distress progressive lung destruction cystic fibrosis attributed bacterial persistence accumulation viscous purulent secretions airways 30 yr ago suggested large amounts dna purulent secretions contribute viscosity bovine pancreatic dnase could reduce viscosity evaluate potential clinical utility recombinant human dnase \( \) treatment cystic fibrosis , cloned , sequenced , expressed catalytic amounts greatly reduce viscosity purulent cystic fibrosis sputum , transforming within minutes viscous gel liquid reduction viscosity associated decrease size dna sputum inhalation aerosol may simple direct approach help individuals cystic fibrosis patients pneumonia bronchitis clear airways purulent secretions
development new transvenous patent ductus arteriosus occlusion technique using shape memory polymer novel percutaneous patent ductus arteriosus \( pda \) occlusion technique , without potential problems associated conventional techniques , long development novel transvenous pda occlusion technique using temperature shape occluder device , vitro performance , demonstrated study principles technique 1 \) bar form device inserted pda guide wire catheter , 2 \) device hot water catheters , 3 \) device expanded hot water pda , pda occluded occluder device , made shape memory polymer \( \) , designed configuration thin disk hole guide wire center cone device hot press fully expanded within 10 sec upon immersion 45 degrees c water mock circulation test great arteries specially designed pda showed 1 \) introduction hot water \( 45 degrees c \) catheters caused expansion device stayed pda without support , 2 \) aortic pressure distal aortic flow increased rapidly , pulmonary flow reduced promptly resulted drastically reduced shunt ratio pda 68 30 thus , novel pda occlusion technique developed functioned well occlude pda great arteries model
total artificial heart neonates allowing bridging transplantation since early 1980s , rapid increase successful pediatric heart transplantation improved chance survival many children suffering otherwise fatal cardiomyopathies congenital cardiac defects last 5 years , heart transplantation neonates infants \( 0 28 days 1 12 months , respectively \) rapidly growing area within pediatric patient population adequate mechanical circulatory support system , designed used bridge transplantation , available many pediatric patients neonates smallest candidates potentially benefit heart transplantation , often acute need either heart transplantation temporary circulatory support indicates new development pediatric bridging device focus youngest group subsequently , device may modified weight age group innovative total artificial heart design developed attempt meet anatomic physiologic requirements neonates infants report discusses rapidly growing pediatric heart transplantation patient population , well innovative total artificial heart design
changes circulating following administration first trimester pregnancy occurrence haemorrhage investigated 30 women measuring maternal serum \( afp \) levels administration \( 486 \) termination first trimester pregnancy significant rise afp levels seen 21 women \( 70 \) , increase ranging 6 baseline levels apparent frequency haemorrhage similar reported previously surgical termination first trimester pregnancies
core polypeptide cystic fibrosis tracheal mucin contains tandem repeat structure evidence common mucin airway gastrointestinal tissue cystic fibrosis trachea cdna library constructed probed synthetic oligonucleotide containing consensus sequence recently identified human intestinal mucin one isolated clones , amn 22 , characterized extensively cdna sequence bp fragment determined , revealed tandem repeat structure rich threonine proline residues sequence amn 22 similar identical determined gut mucin examined northern analysis , mrna hybridizing amn 22 extremely cystic fibrosis \( cf \) trachea , apparent message length varying approximately 2 kb greater 10 kb similar pattern observed , less abundant message , cf lung parenchyma lung cdna hybridized similarly message ulcerative colitis colon rna , control rna u937 lymphoma cells stomach rna pedigree analysis restriction genomic dna revealed pattern indicating single polymorphic locus mucin gene expressed lung intestine southern analyses human mouse somatic cell hybrid cell lines allow chromosomal localization mucin gene human chromosome ii , within region taken together , data demonstrate polymorphic gene encodes mucin core polypeptide expressed lung intestine
prevalence additional cardiovascular anomalies patients referred transcatheter closure patent ductus arteriosus catheter closure patent ductus arteriosus purpose study establish prevalence associated cardiovascular defects accuracy echocardiography patients referred transvenous ductal closure study reviewed 146 patients seen 1981 1988 126 patent ductus arteriosus \( group \) 20 additional cardiovascular anomalies \( group ii \) groups ii differ significantly age , gender physical examination except presence continuous murmur \( group 100 versus group ii 80 , p less 0 001 \) left patent ductus arteriosus visualized two dimensional echocardiography 96 patients evident doppler study 100 patent ductus arteriosus seen six patients including patient found collateral network aorta main pulmonary artery 12 patients noncardiovascular abnormalities 's syndrome likely overall group additional cardiovascular anomalies \( 6 12 , p 0 001 \) cardiovascular anomalies encountered varied eight 20 patients anomalies restrictive ventricular septal defect addition patent ductus arteriosus significant anomalies found catheterization included two thoracic arteriovenous malformations isolated right carotid artery draining right pulmonary artery way right ductus arteriosus study indicates echocardiography effective diagnostic technique patient group thorough cardiac catheterization angiography performed implantation ductal device
intraoperative echocardiography infants children congenital cardiac shunt lesions transesophageal versus epicardial echocardiography determine utility limitations intraoperative transesophageal echocardiography infants children congenital intracardiac shunts , intraoperative transesophageal \( n 50 \) epicardial \( n 49 \) echocardiograms performed cardiopulmonary bypass children 4 days 16 years old 3 45 kg body weight miniaturized transesophageal probe \( 6 9 mm maximal diameter \) used 36 patients less equal 20 kg epicardial imaging performed 5 mhz probe intraoperative transesophageal echocardiographic findings cardiopulmonary bypass correct complete 94 patients transesophageal echocardiography correctly identified atrial septal defects , types ventricular septal defects , anomalous pulmonary veins , atrioventricular septal defects , tetralogy fallot , arteriosus double inlet ventricles failed provide correct diagnosis three patients , committed ventricular septal defects epicardial echocardiography identified cases committed ventricular septal defect correct complete intraoperative diagnosis obtained use epicardial imaging 92 cardiopulmonary bypass , technique required interruption surgery could completed three patients induced arrhythmias hypotension results demonstrated intraoperative transesophageal echocardiography consistently defined important morphologic , color pulsed doppler ultrasound features congenital shunt lesions lesions involved right ventricular outflow tract sometimes difficult image transesophageal echocardiography complications 50 subjects
increased birth prevalence cardiac defects yuma , arizona systematic study undertaken estimate birth prevalence congenital heart disease clinical impression disproportionate number cases occurred yuma , arizona control data obtained sierra vista , arizona , region similar demographic characteristics , baltimore washington infant study patients chromosomal associations excluded baltimore washington infant study echocardiographic documented cases included 1983 1988 birth prevalence significantly higher yuma \( 10 5 1 , 000 \) sierra vista \( 5 4 1 , 000 , p less 0 0001 \) assessed invasive echocardiographic diagnosis , higher birth prevalence congenital heart disease study population \( 6 7 1 , 000 \) compared baltimore washington infant study \( 3 7 1 , 000 , p 0 0008 \) sierra vista \( 4 6 1 , 000 , p 0 04 \) families interviewed exclude cases mother month conception first trimester yuma sierra vista birth prevalence yuma \( 6 0 1 , 000 \) remained significantly greater sierra vista \( 3 8 1 , 000 , p 0 03 \) exclusion cases mother resided elsewhere suggests , prove , environmental influence may played role increased birth prevalence congenital heart disease community
twins urological aspects separation 10 year followup twins occur 50 , 000 births 6 twins type twins pelvis fusion begins level common longitudinal axis extends straight line opposite directions genitourinary gastrointestinal tracts shared subtype 4 lower extremities present oriented right angles axis common trunk two sets female twins born 1977 successfully separated st children 's hospital following year describe genitourinary associated anomalies , surgical separation long term urological followup 2 sets twins
dna content 12 binding psoriatic lesion treatment vitamin d3 analogue betamethasone twenty patients psoriasis treated vitamin d3 analogue betamethasone ointment double blind trial left right comparison addition clinical severity scores , 12 binding detects keratin 16 expression dna synthesis quantified using flow cytometry markers decreased significantly treatment , remained normal range even total clearance lesions treatment regard 12 binding significantly better betamethasone
neutrophil zinc levels psoriasis dermatitis median zinc content neutrophils significantly reduced 16 patients psoriasis comparison normal controls six patients dermatitis \( p less 0 05 \) reduction unrelated extent skin involvement plasma erythrocyte zinc levels unchanged
autologous mixed lymphocyte reaction reduced patients psoriasis autologous mixed lymphocyte reaction \( auto \) studied test interactions immunocompetent cells patients psoriasis auto 20 patients psoriasis significantly lower 16 normal controls lower values found untreated psoriatic patients remission following treatment values latter group significantly lower controls six patients atopic dermatitis remission tendency increase auto decrease disease activity confirmed five patients studied treatment contrast , allogeneic lymphocyte reaction \( \) similar normal controls
pentoxifylline inhibits proliferation human fibroblasts derived , scleroderma skin production collagen , glycosaminoglycans fibronectin pentoxifylline , analogue , inhibits proliferation certain biosynthetic activities fibroblasts derived normal human skin fibroblasts skin patients , scleroderma cultured vitro presence absence pentoxifylline \( 100 1000 micrograms ml \) determine whether inhibits fibroblast proliferation production collagen , glycosaminoglycans \( gag \) , fibronectin collagenase activity exposure fibroblast cultures pentoxifylline resulted non lethal , dose dependent reductions serum driven fibroblast proliferation , 1000 micrograms ml pentoxifylline virtually proliferative effect serum cells fibroblasts assayed confluent cultures produced reduced amounts , 95 , collagen gag , dependent concentration pentoxifylline , presence absence serum pentoxifylline similarly inhibited fibronectin production scleroderma fibroblasts , effect collagenase activity
effects haem porphyria four patients porphyria \( vp \) treated repeated haem infusions daily 4 days weekly 4 weeks initial four daily doses haem \( haem 3 mg kg \) , excretion faecal \( mean nmol g dry wt \) fell almost normal level \( mean 123 nmol g dry wt \) , \( mean 162 nmol g dry wt \) normal level \( mean 21 nmol g dry wt \) patients however , period four weekly infusions haem excretion increased almost pretreatment level showed changes skin , improvement skin lesions seen treatment except one case side effects occurred child homozygous vp , four daily infusions haem \( 2 mg kg \) normalized faecal content , effect increased erythrocyte concentration
prevalence sources sensitization clinical study patients suspected cosmetic related contact dermatitis patch tested 6 agents , alcohol , , , , l 101 39 patients \( 5 3 \) gave 1 positive patch tests total 54 positive reactions found , 23 clinically relevant , frequent patients sensitivity generally give high prevalence positive patch tests common topical preparations , active topical detected source sensitization equal number patients patch tests patients' causative preparations frequently negative avoid sensitivity , advisable test compounds patients contact dermatitis possibly due topical preparations , regardless whether clinically relevant positive reactions whether patch tests products negative
olive oil cause contact allergy patients venous eczema , 1985 1989 , 13 cases contact allergy olive oil identified departments dermatology hospitals known components olive oil could proved cause allergy high number patients contact allergy olive oil possible explanations discussed
contact allergy due \( vi \) sensitizing capacity minor resin acids 7 commercial modified products 3 minor resin acids 7 commercial modified products different origins studied experimental sensitization means modified method 3 resin acids almost negative commercial products gave different results modified product greek origin showed strong sensitizing power , modified , phenol modified moderate remarkable difference obtained swedish finnish tall oil , , contrast previously studied french product , exhibited weak sensitizing capacity
contact dermatitis acrylate compounds embedding media electron microscopy report occupational contact dermatitis found 3 6 workers chemistry laboratory using embedding media , contain \( meth \) acrylate monomer mixtures known composition \( meth \) acrylates used refer acrylates \( meth \) acrylate absence oxygen induced metal ions , , heat ultraviolet light low viscosity remain liquid state temperatures far 0 degree c volatile compounds , exhibit , tendency tissue , property makes suitable , , embedding material , etc toxicity may represent danger health individuals need work , especially precautions taken show patch testing one patient reacted strongly compound 2 hydroxyethyl acrylate dilutions tested \( 0 5 1 v v \) , 10 \( meth \) acrylates test , 3 volunteer controls negative 2 hydroxyethyl acrylate demonstrate maximum working concentration , 2 hydroxyethyl acrylate latex gloves elicits irritant allergic reactions patient irritant reactions control finally , discuss necessary protective measures
aging skin recognizing managing common disorders changes structure function skin chronic solar radiation damage predispose skin elderly certain inflammatory infectious diseases context , diagnosis treatment senile pruritus discussed , common types , infections ,
activation pathways synovial lymphocytes expression function um4d4 antigen accumulating evidence implicates central role synovial cells pathogenesis rheumatoid arthritis , activation pathways drive proliferation effector function cells known recently generated novel monoclonal antibody rheumatoid synovial cell line recognizes antigen termed um4d4 \( \) antigen expressed minority peripheral blood cells , represents surface component distinct pathway human cell activation current studies performed examine expression function um4d4 cells obtained synovial fluid synovial membranes patients rheumatoid arthritis forms inflammatory joint disease um4d4 antigen expressed high surface density three synovial fluid cells small subset synovial fluid natural killer cells synovial tissue present 90 cells lymphoid aggregates , approximately 50 cells stromal infiltrates addition , um4d4 expressed synovial tissue previously undescribed population hla dr dp negative non cells dendritic morphology anti um4d4 co mitogenic ra non ra synovial fluid mononuclear cells , induced il 2 receptor expression um4d4 antigen may represent functional activation pathway synovial compartment cells , could play important role pathogenesis inflammatory arthritis
cultured epidermal autografts allografts study differentiation allograft survival cultured epidermal examined various times grafting skin ulcer beds grafting , sheet consisted four five layers keratinocytes incomplete differentiation ten days grafting , graft recipient sites showed , normal appearing epidermis , flat dermoepidermal junction 6 months , stratum corneum basket appearance dermoepidermal junction remained flat monoclonal antibodies keratins 14 10 showed normal basal suprabasal localization , respectively electron microscopy showed normal basement membrane anchoring fibrils 2 , monoclonal antibody binds type vii collagen molecule , stained dermoepidermal junction biopsy specimens ae 1 , antibody stains suprabasal cells skin , expressed 12 weeks healing \( 16 weeks grafting \) , expression confined basal layer 18 weeks healing \( 6 months grafting \) anti staining found deeper layers epidermis 12 weeks healing \( 16 weeks grafting \) normal distribution upper spinous granular layers 18 weeks \( 6 months grafting \) overall , histologic patterns observed recipient sites first 4 months grafting resembled observed 10 14 days newly healed epidermis states psoriasis four sex mismatched graft sites , specimens reacted biotinylated probe chromosome situ hybridization lack chromosome positive cells suggested host keratinocytes replaced allografts dna analysis one patient confirmed observation data suggest altered state epithelial maturation persists several months culture grafting , restoration normal pattern 6 months differences detected sites
condylomata children frequent association human papillomaviruses responsible cutaneous warts identify papillomavirus types associated condylomata children evaluate mode transmission , studied 32 children anogenital warts external condylomata found 12 mothers 10 fathers ten mothers , including two without external lesions , cervical condylomata blot hybridization studies disclosed genital human papillomavirus \( hpv \) 14 27 children \( hpv 6 12 hpv 11 two \) 8 14 patients \( hpv 6 \) hpv 6 found another child polymerase chain reaction technique infection occurred likely birth contact , sexual abuse could excluded one 11 year old girl cutaneous hpv 2 found seven children yet papillomaviruses found two children three mothers hpv 2 infected children common hand warts , two children warts study shows frequent transmission genital papillomaviruses children unexpectedly high association children 's condylomata papillomaviruses responsible skin warts , possibly transmitted
localized hyperhidrosis two cases spontaneous hyperhidrosis limited lesions studied quantitative measurements stimulated eccrine sweat made intradermal injection methacholine sweat rate two four times greater lesional skin perilesional skin eccrine secretory glands excisional biopsy specimens lesions significantly larger perilesional skin knowledge , hyperhidrosis localized areas reported
method determination uva protection normal skin although uvb portion electromagnetic spectrum \( 290 320 nm \) responsible harmful effects sunlight skin , wavelengths uva region also contribute simple rapid clinical test , sun protection factor determination , available assess protective effect sunscreen , primarily uvb effect however , practical test proposed measure sunscreen 's uva protection described method calculation uva protection normal subjects determination uva protection involves three steps \( 1 \) uv absorbance spectrum sunscreen skin determined \( 2 \) spectrum calculated solar spectrum commission de uv hazard spectrum \( 3 \) sunscreen transmission spectrum incorporated spectrum obtain uva effectiveness ratio , expressed uva protection percentage uva protection percentage value based normal risk standard sunlight , protection product easily measured procedure simple , values generated reproduced laboratories
treatment pure antiandrogen flutamide effectiveness antiandrogen flutamide combination oral contraceptive studied 20 patients moderate severe eight patients previous therapy , whereas 12 failed respond oral contraceptives , spironolactone , dexamethasone therapy treatment antiandrogen flutamide \( 250 mg twice daily \) oral contraceptive \( 1 35 \) resulted particularly rapid marked decrease total score , reached normal range 7 months , , hair loss score also rapidly corrected treatment associated decrease plasma luteinizing hormone , progesterone , estradiol levels plasma sex hormone binding globulin levels initially low 18 20 patients increased significantly therapy clinically significant side effects observed
transdermal treatment male pattern fifty seven men randomly assigned treatment alopecia , vehicle , placebo twice daily 24 weeks hair growth assessed subjectively patient investigator objectively hair counts target area target area hair counts declined three treatment groups end 6 month study effective hair growth promoter alopecia
piroxicam induced photosensitivity contact sensitivity thiosalicylic acid dermatitis developed three patients application gel containing 0 5 piroxicam patch tests positive thiosalicylic acid photopatch tests piroxicam several concentrations positive three patients negative 62 normal volunteer subjects patch tests performed 14 patients proved systemic photosensitivity piroxicam positive thiosalicylic acid nine 12 patients previously sensitized thiosalicylic acid history exposure piroxicam showed positive photopatch test reactions chemical results support relation piroxicam induced photosensitivity contact sensitivity thiosalicylic acid contact allergic sensitivity latter marker patients high risk developing photosensitivity reactions piroxicam reactions may due drug rather metabolites
itraconazole treatment tinea capitis fifty patients tinea capitis treated itraconazole , 25 100 mg day , 20 73 days six countries forty seven patients \( 94 \) responded clinically \( healed markedly improved \) therapy , 38 patients \( 76 \) completely healed 9 patients \( 18 \) markedly improved three patients \( 6 \) failed therapy forty two patients assessable mycologic examination 38 patients \( 93 \) converted mycologically negative 4 patients \( 7 \) remained positive organisms one group 20 patients treated 30 days , 6 patients clinically mycologically healed 2 week follow visit 9 additional patients healed , 4 weeks treatment 20 patients clinically mycologically healed primary organisms reported canis one patient reported possible side effect \( legs \) laboratory values within normal limits , except one patient transient slight increase serum transaminase level low dose itraconazole appears safe effective treatment tinea capitis
surgical management palmar hyperhidrosis hyperhidrosis idiopathic pathologic condition characterized excessive beyond required cool body disturbance central nervous system , endocrine system , obesity associated condition patients history several years occupational social embarrassment individuals japanese jews northern african , , descent predisposed condition nonoperative therapy merely unacceptable lack efficacy side effects surgical intervention provides effective permanent control key surgical correction appears division sympathetic chain 2 ganglion 3 ganglion involved side removal entire t2 3 segment corresponding spinal nerves paper presents experience dorsal thoracic approach interruption sympathetic innervation severe palmar hyperhidrosis also review surgical efficacy various approaches sympathetic chain , well possible side effects operative intervention
marfan syndrome china collective review cases among 98 families collective review patients marfan syndrome among 98 pedigrees reported 18 cities china 37 year period 1951 1987 positive family history marfan syndrome found 74 3 patients mode inheritance dominant 73 8 recessive 0 5 sporadic cases occurred 25 7 screening 29 , children found five children marfan syndrome , giving prevalence 17 2 per 100 , 000 population , gene frequency 8 61 per 100 , 000 genes , penetrance 71 69 clear cases 77 , 86 8 , dilated aortic root 80 1 chromosome examination showed regular aberrations except family five giant chromosome 14 found three members two unaffected relatives high prevalence aortic root dilation marfan syndrome makes echocardiography useful practical means diagnosis close follow regular echocardiographic evaluation indicated patients marfan syndrome also families , diagnostic therapeutic purposes
basophil histamine release airway response mite allergen atopic dermatitis twelve patients atopic dermatitis \( ad \) subjected vitro histamine release peripheral blood leukocytes \( basophils \) vivo bronchial inhalation challenge using house dust mite \( \) allergen seven patients asthmatic history also five patients without asthma responded vitro vivo challenges significant correlation observed \( mite concentration producing 30 release total cellular histamine \) pc20 allergen \( mite concentration producing 20 fall fev1 \) also significant correlation \( maximal histamine release \) maximal fall fev1 relationship held ad patients asthma without asthma results suggest histamine release induced house dust mite allergen good vitro test predicting bronchial response allergen also suggest tests disease specific , valuable evaluating degree atopic state subject
abnormal essential fatty acid metabolism 's disease fatty acid levels plasma erythrocyte cell membranes determined 13 danish patients 's disease 21 danish controls concentrations main dietary essential fatty acids , linoleic acid \( 18 6 \) alpha linolenic acid \( 18 3 \) , consistently modestly normal concentrations delta 6 metabolites linoleic alpha linolenic acids , however , consistently often significantly normal results suggest capacity enzyme delta 6 activity inadequate patients 's disease
ionizing radiation induced pemphigus case presentations literature review reports pemphigus following ionizing radiation exposure rare report two cases review literature regarding association characteristics common cases include persistent nonspecific eruption often interpreted radiation dermatitis , latency variable duration onset eruption begins portal irradiation direct immunofluorescence positive intercellular igg , indirect immunofluorescence commonly positive low titers hla correlations studied documentation clinical course laboratory confirmation diagnosis , including hematoxylin eosin , direct indirect immunofluorescence , hla determinations \( available \) , recorded enable clarification entity
severe phototoxic burn following ingestion 65 year old woman developed severe , generalized phototoxic reaction following visit history taking revealed consumed large quantity root \( \) 1 hour earlier use thin layer chromatography , \( 8 methoxypsoralen \) 5 methoxypsoralen identified extract similar root biologic activity extract , evaluated semiquantitative candida albicans inhibition technique , indicated total psoralen dose approximately 45 mg substantial amounts psoralen may absorbed vegetables , , unusual circumstances , may constitute health hazard
autoantibodies patients localized generalized bullous pemphigoid 230 kd keratinocyte antigen two patients demonstrating typical clinical , histologic , immunopathologic features localized bullous pemphigoid described patients possess circulating igg autoantibodies bind epidermal side 1 0 mol l sodium chloride split human skin indirect immunofluorescence microscopy studies demonstrate patients circulating autoantibodies 230 kd bullous pemphigoid antigen precipitated autoantibodies patients generalized bullous pemphigoid findings indicate localized bullous pemphigoid true clinical variant generalized pemphigoid rather separate entity
comparative efficacy toxicity second line drugs rheumatoid arthritis results two performed 2 placebo controlled comparative clinical trials examine relative efficacy toxicity methotrexate \( mtx \) , injectable gold , penicillamine \( dp \) , sulfasalazine \( \) , \( aur \) , antimalarial drugs , second line drugs commonly used treat rheumatoid arthritis \( ra \) efficacy study , applied set inclusion criteria focused trials provided information tender joint count , erythrocyte sedimentation rate , grip strength found 66 clinical trials contained 117 treatment groups interest , drug , combined treatment groups outcome , results showed aur tended weaker second line drugs results 3 outcome measures synthesized composite measure outcomes , aur significantly weaker mtx \( p 0 006 \) , injectable gold \( p less 0 0001 \) , dp \( p less 0 0001 \) , \( p 0 009 \) slightly , significantly , weaker antimalarial agents \( p 0 11 \) also found heterogeneity among antimalarial agents , patients treated chloroquine better treated hydroxychloroquine found little difference efficacy mtx , injectable gold , dp , power analysis showed trial contain least 170 patients per treatment group successfully differentiate effective less effective \( e g , aur \) second line drugs none reported comparative trials reviewed large toxicity study , inclusion criteria ra trials reported proportion patients discontinued therapy drug toxicity total proportion dropped found 71 clinical trials contained 129 treatment groups average proportion dropped average proportion dropped drug toxicity computed drug overall , 30 2 patients trials dropped 50 drug toxicity injectable gold higher toxicity rates \( p less 0 05 \) higher total dropout rates \( p less 0 01 \) drug 30 gold treated patients dropped side effects versus 15 trial patients antimalarial drugs aur relatively low rates toxicity rate mtx discrepancies trials thus , commonly used second line drugs , aur , injectable gold toxic agents introduced future compared drugs \( abstract truncated 400 words \)
diminished incidence severe rheumatoid arthritis associated oral contraceptive use suggested negative association rheumatoid arthritis \( ra \) oral contraceptive \( oc \) use might limited severe forms ra investigate , studied 121 consecutive female patients definite ra , 52 female patients probable ra , female controls patients ra symptoms recent onset mean followup period 6 years , patients definite ra classified either severe disease course \( n 76 \) mild disease course \( n 45 \) negative association oc use prior onset ra symptoms development ra limited patients definite ra severe disease course therefore conclude oc use prior onset ra symptoms associated reduction incidence severe ra may explain divergent results previous studies
use molecular cloning methods map distribution epitopes topoisomerase \( scl 70 \) recognized sera scleroderma patients report initial molecular characterization autoimmune response dna topoisomerase \( scl 70 \) sera 36 patients scleroderma 4 healthy control subjects studied using 6 portions twenty three sera recognized least 2 independent epitopes molecule therefore , anti , like non organ specific autoantibodies characterized date , polyclonal multifocal cloned protein prove suitable sensitive early detection anti clinical setting
alteration cellular fatty acid profile production eicosanoids human monocytes gamma linolenic acid administered seed oil \( 9 capsules day \) 12 weeks 7 normal controls 7 patients active rheumatoid arthritis therapy provided 1 1 gm day gamma linolenic acid \( gla \) gla administration resulted increased proportions first metabolite , gamma linolenic acid \( \) , circulating mononuclear cells ratios arachidonic acid acid increased significantly cells significant reductions prostaglandin e2 , leukotriene b4 , leukotriene c4 produced stimulated monocytes seen 12 weeks gla supplementation antiinflammatory effects gla administration observed animal models , apparent clinical improvement experienced 6 7 rheumatoid arthritis patients given seed oil open , uncontrolled study may due part reduced generation arachidonic acid oxygenation products
increased expression platelet derived growth factor type b receptors skin patients systemic sclerosis expression b type receptors platelet derived growth factor \( pdgf \) investigated skin biopsy samples patients systemic sclerosis \( ssc \) , immunohistochemical staining using monoclonal antibodies specific receptor whereas skin healthy individuals lacked expression pdgf b receptors , receptor expression seen skin lesions 13 14 patients increased receptor expression observed dermal vessels , well many stromal fibroblast like cells close vessels pdgf b receptor expression pronounced within around dermal vessels perivascular infiltrates leu 4 positive lymphocytes hla dr positive , positive activated macrophages present perivascular inflammatory cell infiltrates pdgf b receptor expression generally also seen macroscopically normal areas skin ssc patients , indicating observed phenotypic alterations may precede macroscopically observable features scleroderma skin observed induction pdgf b receptors , together indirect indications increased synthesis release pdgf , would compatible altered pdgf mediated control connective tissue cell growth part molecular basis development skin lesions ssc
anaesthetic management systemic mastocytosis systemic mastocytosis uncommon disorder mast cell proliferation connective tissues mast cell degranulation may occur exposure various stimuli drugs release histamine , heparin vasoactive substances prostaglandin d2 may cause severe hypotension manifestations anaesthetic management include perioperative stabilization mast cells avoidance use histamine releasing drugs intradermal skin testing useful predicting sensitivity drugs may used anaesthesia present patient systemic mastocytosis underwent uneventful cholecystectomy
inhibition nk cell function azathioprine treatment patients rheumatoid arthritis treatment azathioprine patients rheumatoid arthritis leads dramatic reduction 4 h nk cytotoxicity k562 cells 24 h cytotoxicity k562 u937 cells , however , remains intact generation cell free supernatant cytotoxic factor \( \) incubating non adherent mononuclear cells u937 cells 24 h similar azathioprine patients controls large part supernatant cytotoxicity due tumour necrosis factor alpha inhibited specific monoclonal antibody mechanism reduced 4 h nk cytotoxicity remains unknown probably related anti inflammatory properties azathioprine
median sternotomy vertical skin incision used routine approach sternotomy resulting scar often disappointing top visible , especially young women 35 women ranging 10 48 years \( mean 29 2 years \) , median sternotomy performed via skin incision cases open heart surgical procedure performed adequate exposure heart achieved every case technical problems related approach , hospital mortality major complications cosmetic result excellent approach certainly justified open heart surgery young women
treatment idiopathic liquid nitrogen light electron microscopic studies idiopathic common skin disorder unknown cause studies shown significantly fewer dopa positive melanocytes white idiopathic normal skin electron microscopy observed melanocytes lesional skin round less dendritic fewer normal pigment cells lesions frozen liquid nitrogen 6 8 weeks number dopa positive melanocytes significantly greater areas untreated lesions less normal skin
treatment using lidocaine prilocaine cream \( emla \) analgesia eighty three 4 12 year old children , scheduled curettage least five lesions , participated double blind study children randomly allocated receive lidocaine prilocaine \( emla \) cream \( n 58 \) placebo cream \( n 25 \) , applied 15 , 30 , 60 minutes treatment pain assessed children physician none , slight , moderate , severe addition , children rated pain visual analog scale emla cream effectively prevented pain three application times \( p less 0 01 \) significant difference pain observed among 15 , 30 , 60 minute emla treated groups , proportion children reporting pain verbal scale increased 36 15 minute group 61 60 minute group placebo group , one 24 children \( 4 \) reported pain transient local skin reaction noted conclusion , application time emla cream less 60 minutes satisfactory curettage children
comparative histopathologic study drug eruptions study compares histopathologic characteristics drug eruptions 13 patients types said , unknown proportion , different idiopathic involve deep well superficial plexus , contain eosinophils , scale found features often present drug eruptions seldom present eruptions thus biopsy specimen shows classic features used evidence drug eruption , especially lesions
prolonged remission cyclosporine therapy pemphigus vulgaris report two young siblings report clinical evolution two young siblings severe pemphigus vulgaris treated cyclosporine 30 12 months , respectively one resistant treatment high dose corticosteroids azathioprine good clinical response achieved cases major side effects observed patients remained disease free 20 months stopping cyclosporine therapy
treatment treatment frequently difficult unsatisfactory representative case presented chronic subcutaneous fungal infection , characterized , like lesions usually extremities treatment reviewed , attention itraconazole , new triazole compound , possible drug choice
contact dermatoses disposable glove use review contact dermatoses disposable gloves reported greater frequency variety eruptions occur become increasingly relevant , procedures use disposable gloves article represents review relevant issues use disposable gloves methods management prevention morbidity associated disposable glove use also discussed
prevention occupational contact dermatitis contact dermatitis frequent type occupational skin disease although prevention contact dermatitis workplace accomplished total elimination cutaneous exposure hazardous substances , often feasible therefore eight basic elements multidimensional approach prevention identified elements include recognition potential cutaneous irritants allergens , engineering controls chemical substitution prevent skin exposure , personal protection appropriate barrier , personal environmental , regulation potential allergens irritants within workplace , educational efforts promote awareness potential allergens irritants , motivational techniques promote safe work conditions practices , periodic health screening comprehensive prevention program based multidimensional approach requires cooperative efforts employees , , , , industrial , safety personnel , union representatives , agencies , occupational health practitioners
management oral terbinafine safety efficacy oral terbinafine treatment finger caused evaluated open study including 11 patients treatment consisted 125 mg terbinafine given twice daily 6 months infection cleared end treatment period , patients clinically mycologically normal , drug acting fungal barrier prevent distal fungal invasion mild gastric discomfort one patient side effect reported study laboratory abnormalities detected
subacute cutaneous lupus erythematosus lesions progressing women annular lesions subacute cutaneous lupus erythematosus slowly resolved replaced plaques immunologic implications unique transitional case subacute cutaneous lupus erythematosus discussed
persistent melanocytic lesions associated cosmetic bed use patient persistent melanocytic lesions bed use described review literature provides two additional examples similar clinical histologic presentations uva exposure without psoralen knowledge , first reported case united states
linear porokeratosis successful treatment diamond dermabrasion patient linear porokeratosis successfully treated diamond dermabrasion follow evaluation revealed excellent cosmetic result adequate , scarring , recurrence lesions long term follow necessary determine whether dermabrasion treatment linear porokeratosis provides adequate prophylaxis subsequent development malignancy
role antihistamines atopic dermatitis although several lines evidence support role histamine pathogenesis atopic dermatitis , antihistamines generally offered marginal therapeutic benefit efficacy classic antihistamines severely limited sedative effects , demonstrating need improved , agents antihistamines , third generation antiallergic drugs , appear offer variety advantages beyond ability inhibit histamine release , inhibition mediator release interference eosinophil migration double blind studies high dose regimens needed help clarify therapeutic efficacy antiallergic drugs
mechanisms involved allergic contact dermatitis allergic contact dermatitis common inflammatory skin disease caused agents plants , chemical compounds , topical medications histologic features typically include edema within epidermis dermis infiltrate admixture basophils langerhans cells keratinocytes play pivotal roles allergic contact dermatitis reactions langerhans cells synthesize express class ii molecules allow presentation exogenous antigens lymphocytes additionally , keratinocytes langerhans cells produce interleukin 1 , thought second signal activates cells mast cells basophils also may play proinflammatory role treatment primarily consists removal agent times , systemic corticosteroids may required , especially acute phase chronic cases , topical corticosteroids may beneficial antihistamines may useful effects , usefulness limited
arthritis mast cell activation significance mast cell pathogenesis rheumatic diseases continues receive attention increased numbers mast cells found synovial tissue fluid patients inflammatory , mast cells activated many substances found inflammatory synovial fluid activation results release mediators capable inflammatory process within joint space recent research shown mast cells also produce variety cytokines hematopoietic growth factors may paracrine autocrine functions important development inflammatory cell infiltrate increased numbers mast cells also found many fibrotic conditions , including scleroderma mast cells , directly mediator generation , affect function endothelial cells , fibroblasts , growth factors important proliferation function cells understanding mast cell involvement inflammatory fibrotic processes lead new therapeutic strategies
epidermal growth factor transforming growth factor alpha receptors psoriasis abnormal growth differentiation psoriasis reflected abnormal regulation epidermal growth factor transforming growth factor alpha \( egf tgf alpha \) receptor metabolism psoriasis skin conditions receptors persistently expressed throughout epidermis long growth stimulatory signal persists one first biochemical signs effective therapy psoriasis return egf tgf alpha receptor pattern toward primarily basilar distribution seen normal human adult skin whether abnormal expression tgf alpha involved skin induces persistent expression egf receptors known signal causes increased production tgf alpha studies determine factors regulate egf receptor expression tgf alpha induction may yield important new insights pathogenesis therapy psoriasis
immunologic mechanisms psoriasis demonstration activated lymphocytes , hla dr , , gamma ip 10 keratinocytes , increased levels lymphokines active plaques suggests immunologic mechanisms may play role pathogenesis psoriasis epidermal hyperplasia inflammation psoriasis may linked cytokines many produced keratinocytes leukocytes epidermal keratinocyte mitoses observed delayed type hypersensitivity reactions intradermal injection gamma interferon gamma interferon induced proteins demonstrated active psoriatic plaques increased levels keratinocyte autocrine cytokines , transforming growth factor \( tgf \) alpha interleukin \( il \) 6 , detected active plaques apparent overexpression il 6 hyperplastic psoriatic tissue may explain features psoriasis link keratinocyte proliferation immune activation tissue inflammation il 6 gamma interferon increased tgf alpha expression normal cultured keratinocytes cytokines produced immune activation inflammatory processes may lead epidermal hyperplasia
psoriasis vulgaris genetic approach evidence genetic contribution psoriasis comes direct examination large segment population isolated island environment , epidemiologic questionnaire studies presented psoriatic patients , twin studies collected literature twin registries , analysis concordance psoriasis monozygotic twins 65 72 , whereas psoriasis twins 15 30 determination concordance older twin pairs national twin registry denmark revealed nearly 90 100 order link psoriasis known markers within human genome , serologic studies carried variety blood group polymorphic protein antigens weak association lewis blood groups systems \( relative risk , 3 5 \) identified stronger associations class b locus class ii locus genes \( relative risk , 8 12 \) also determined studies human lymphocyte antigen system finally , strong association hla determined marker thought linkage disequilibrium b locus genes previously associated psoriasis relative risk developing psoriasis hla positive individuals 24 large kindred reported dermatology literature support hypothesis autosomal dominant inheritance penetrance approximately 60 cooperation national psoriasis foundation , identified 90 families psoriasis three generations begun process ascertainment , construction family , collection leukocyte dna linkage analysis established restriction fragment polymorphisms \( rflp \) initial assessment directed four rflp span approximately 30 short arm human chromosome 6 although uncommonly done patients psoriasis , seek evidence chromosome 6 association psoriasis
psoriasis cell keratinocyte sphere influence advanced differences antigen processing presentation described fresh cultured langerhans cells vitro reflect similar differences intraepidermal langerhans cells vivo functional properties langerhans cells dependent upon microenvironment reside thus , intraepidermal langerhans cells influence cytokines secreted keratinocytes , whereas langerhans cells come influence lymphokines lymphocytes speculated genetic lesion psoriasis keratinocytes capacity create appropriate epidermal microenvironment consequence , intraepidermal langerhans cells adopt functional program cells uninvolved psoriatic skin receives cutaneous challenge antigen , langerhans cells , activating naive cells situ , microenvironment appropriate lymph node skin becomes involved gradually features associated lymph nodes \( high endothelial venules \) derangement complicated abnormalities proliferation differentiation among keratinocytes dermal fibroblasts respond inappropriate cell derived lymphokines , giving rising typical , active psoriatic lesion
lymphocyte chemoattractants psoriasis normal skin local production lymphocyte may influence physiologic lymphocyte trafficking skin well infiltration cells pathologic states recent evidence production acidic lipid lymphocyte chemoattractants , particularly 12 r acid , psoriatic lesions reviewed water lymphocyte activity may also recovered normal skin samples psoriatic lesional stratum corneum , may important pathophysiology lymphocyte trafficking less 10 kd activity normal skin undergone detailed characterization led isolation novel , yet unidentified compound normal skin , termed plasma associated lymphocyte chemoattractant \( \)
interleukin 1 human skin dysregulation psoriasis cytokine dysregulation attractive concept explain many observed abnormalities psoriasis il 1 , particular , potentiate immune cellular activation , activate fibroblasts , increase endothelial cell leukocytes , review il 1 regulation normal psoriatic skin vivo relation normal skin cultured keratinocytes contrary expectations , il 1 functional activity psoriatic lesions reduced , increased , relative normal skin reduction attributable presence il 1 inhibitors , reduced il 1 alpha levels , il 1 beta lacked function cell assays il 1 beta protein actually significantly increased psoriatic lesions , mechanism non remains unclear unlike cultured keratinocytes , accumulate large , inactive il 1 beta precursors , normal psoriatic skin process il 1 beta mature form novel mechanisms post processing epidermis vivo may generate novel form il 1 beta unknown functions marked abnormalities il 1 regulation psoriatic skin suggest molecule may important normal skin homeostasis
role epidermal cytokines inflammatory skin diseases cytokines \( hormone like polypeptide mediators \) play major role inflammatory immunoregulatory responses skin , particularly keratinocytes skin , represent potent source many cytokines , including 1 , 6 , 8 , hemopoietic colony stimulating factors cytokines initiate biologic action interacting target cells bearing cytokine receptors initiating cascade cellular interactions certain inflammatory skin diseases associated overproduction cytokines , alteration cytokine receptors , dysregulation cytokines data still quite preliminary , likely cytokines contribute pathogenesis many inflammatory skin diseases
lymphocyte adhesion psoriatic dermal endothelium mechanism modulation psoriasis characterized hyperproliferation keratinocytes epidermis accumulation activated cd4 lymphocytes upper dermis recently tested hypothesis abnormal endothelial proliferation dermal papillae psoriatic lesions may linked expression endothelial ligands capable promoting lymphocytes binding extravasation results indicated specialized endothelial cells lining post capillary venules psoriatic lesions capable promoting selective adherence human cd4 cells memory subset contrast , b cells , cd8 cells , cd45ra cells deficient capacities bind adhesion process energy calcium dependent involves tissue specific lymphocyte receptors , lfa 1 molecules playing accessory role concluded transformation dermal endothelium lymphocyte receptive phenotype defined growth factors cytokines may represent positive feedback mechanism promoting lymphocyte migration diseased sites
role immune system pathogenesis psoriasis psoriatic involved skin contains increased number activated cells mechanism cells achieve maintain activated state unknown , antigen dependent independent mechanisms may contribute recently novel pathway antigen independent cell activation described pathway identified monoclonal antibody binds cell membrane surface molecule termed um4d4 molecule expressed minority \( 20 \) psoriatic peripheral blood cells majority \( 75 \) cells lesional skin thus , um4d4 could play role antigen independent cell activation psoriasis indeed monoclonal antibody anti um4d4 consistently induces proliferation psoriatic um4d4 cell clones activity antigen dependent pathways also enhanced psoriatic epidermis much involved skin relative uninvolved skin contains increased number function antigen presenting cells upon activation , lesional cells release lymphokines central immune hypothesis psoriasis cell lymphokines act keratinocytes induce changes characteristic psoriasis indeed lymphokines lesional psoriatic cell clones directly alter vitro keratinocyte phenotype induction intercellular adhesion molecule 1 \( icam 1 \) hla dr cell surface expression furthermore , lymphokines also enhance keratinocyte growth data suggest critical role immune system pathogenesis psoriasis
lymphocyte trafficking psoriasis new perspective emphasizing dermal active dermal recruitment mediated via endothelial cells followed intra epidermal cell activation prominent within inflammatory infiltrate psoriasis hla dr positive lymphocytes factor positive dermal dendrocytes many investigators studying psoriasis assumed hla dr positive cells activated , thereby capable producing lymphokines gamma interferon however , immunohistochemical analysis , greater 95 dermal cells psoriatic lesions ki 67 negative , suggests resting non cycling \( go \) state contrast dermal cell population , epidermal cell population contains greater population ki 67 positive lymphocytes entry cells epidermis , therefore , apparently associated important activation event , likelihood involves interaction keratinocyte presence activated intraepidermal cells ability detect gamma interferon mrna polymerase chain reaction epidermal psoriatic lesions pathophysiologic implication psoriasis involving dermal epidermal cells placed context cascade cellular trafficking events , dissected specific network molecular mediators inflammation report suggests attention placed microenvironment skin , specific emphasis mechanism cells accumulate dermis epidermis , elucidation selective inductive recruitment capabilities endothelial cells , perivascular dermal dendrocytes , keratinocytes
expression retrovirus like particles psoriasis retrovirus like particles isolated patients psoriasis antigens major internal protein , p27 , particles demonstrated wall dermal vessels cells psoriatic lesions antigen also observed blood lymphocytes psoriatic patients p27 antigen anti p27 antibodies present complement activating immune complexes psoriatic scale blood patients psoriasis psoriatic arthritis potential contribution circulating immune complexes inflammatory process psoriasis discussed
cytotoxic immunologic effects methotrexate psoriasis based recent experience cyclosporin , immunosuppressive drug , produces marked improvement psoriasis , possible immunomodulatory activities methotrexate \( mtx \) reviewed look alternate mechanisms mtx action psoriasis generally considered therapeutic results mtx psoriasis related direct effect epidermal cell hyperplasia inhibition dna synthesis several studies literature suggest possible effects mtx immune system well animal models may pathogenic similarities psoriasis receiving mtx , neutrophil chemotaxis suppressed , resulting possible alteration potential pathologic activity neutrophils commonly found lesional skin mtx improve psoriatic rheumatoid arthritis animal studies latter using adjuvant arthritis graft vs host disease \( gvhd \) indicated several possible mechanisms mtx affect processes gvhd , mtx selectively cycling cd8 cells , adjuvant arthritis activation macrophages prevented inhibition cell function mtx generally clinically utilized immunomodulatory drug immunologically related diseases , may , nonetheless , selective actions could specific diseases mtx cyclosporin could work similar ways different steps activation cells macrophages may major direct effect mtx epidermal cell proliferation complemented even mediated subtle immunoregulatory effects cells affected skin systemic immune response
psoriasis application genetic technology mapping recent progress molecular genetics led creation map human genome utilizing rflp given sufficient family structure , genetic diseases placed map genetic studies psoriasis help resolve problems disease heterogeneity , environmental effects disease expression , lack clear model inheritance
cyclosporine treatment psoriasis clinical perspective cyclosporine , unique immunomodulatory agent , used increasingly last 5 years management severe psoriasis remarkable efficacy drug coupled known immunosuppressive properties enabled appreciation role immune system induction maintenance psoriatic plaques although acting primarily lymphocytes , also evidence effect cyclosporine constitutive cell types within skin future use systemically administered cyclosporine treatment psoriasis cutaneous diseases dependent successful balance efficacy side effect profile namely , dose related problems hypertension nephrotoxicity result toxicity encountered systemically administered cyclosporine , attempts successful topical preparation use cutaneous disease made advent cyclosporine provides new therapeutic management psoriasis , although long term safety interventional therapy remains
sodium lauryl sulphate irritant patch testing dose response study using methods determination skin irritation dose response relationship patch testing sodium lauryl sulphate \( \) studied irritant skin response quantified visual scoring well following noninvasive methods measurement transepidermal water loss \( tewl \) , measurement skin color , measurement superficial blood flow laser doppler flowmetry , measurement edema skin ultrasound scan twelve volunteers patch tested 0 12 , 0 25 , 0 50 , 1 00 , skin response evaluated 24 48 h , respectively found statistically significant linear dose response relationship dose skin response evaluated measurement tewl , skin color , superficial blood flow , edema statistical evaluation regression analysis proved measurement tewl method best suited overall quantification relation patch testing , whereas found least sensitive applied methods ultrasound scan found promising method quantification inflammatory response , consistently sensitive measurement skin color
experimental models psoriasis evidence suggests inherent skin psoriatic subjects cells , architectural structures , mediators , , minimum , responsible epidermis objective laboratory establish vitro definition inherent aberration fibroblasts important epidermal proliferation differentiation , report fibroblasts psoriatic subjects might drive abnormal epidermal proliferation psoriasis , caused focus fibroblast data show fibroblasts patients psoriasis , involved uninvolved , presence human serum , either normal psoriatic , increased rate proliferation fibroblasts uninvolved psoriatic sites responsive determine fibroblasts could induce phenotype normal keratinocytes , interactive skin equivalent system developed system , fibroblasts uninvolved involved sites cause normal keratinocytes enhanced uninvolved fibroblasts cause greatest changes nature skin equivalent system calls occur via message distance conclude fibroblasts psoriatic subjects induce phenotype via soluble message
immunosuppressive effects clonidine induction contact sensitization balb c mouse clonidine transdermal therapeutic system \( clonidine \) associated significant incidence allergic contact sensitization incidence predicted skin sensitization testing animals humans one possible explanation lies recent findings guinea pigs clonidine exposure could inhibit elicitation skin reactions unrelated strong contact however , studies also showed clonidine pretreatment appear affect induction contact sensitization basis , sought specifically evaluate induction phase sensitization clonidine alternative means assessing sensitization properties method selected assay situ lymphocyte proliferation lymph nodes draining sites clonidine exposure , method recently promoted alternative means assess contact allergenic potential utilizing various induction application techniques regimens , consistently unable demonstrate clonidine 's allergenic potential assessment lymphocyte proliferation also unable demonstrate sensitization vivo ear swelling vitro lymphocyte assay techniques however , subsequent assessment effect clonidine exposure induction sensitization unrelated strong contact allergens demonstrated consistent 40 70 inhibition proliferative response contact allergens similar degree suppression produced corticosteroids hydrocortisone tested 80 10 times lower concentrations addition , observed comparable inhibition ear swelling response data extend knowledge immunomodulatory effects clonidine offer additional insights failure short term predictive patch test methods detect chemical 's potential induce allergic contact sensitization
growth factor proto oncogene expression psoriasis expression several proto oncogenes growth factors analyzed normal skin psoriatic lesions rna blot hybridization isolation intact rna frozen biopsy samples required immediate exposure tissue ii transcripts used internal controls transcripts abundant slightly significantly elevated psoriatic lesions results normalized according reference transcripts , increase expression c myc , c ha ras , c erbb \( egf receptor \) , c jun , transforming growth factor beta \( tgf beta \) transcripts psoriatic lesions , lesional c fos transcripts decreased relative normal skin contrast , expression tgf alpha mrna transcripts markedly increased psoriatic lesions even normalization placement normal psoriatic tissue organ culture 2 4 h resulted strong induction c fos , c jun , c myc transcripts , genes studied thus , overexpression proto oncogenes may characteristic epidermal response acute injury steady state hyperplasia characteristic psoriasis interferon gamma \( ifn gamma \) increased tgf alpha mrna levels cultured human kc long time intervals \( 24 48 h \) however , various cytokines tested , egf tgf alpha induced tgf alpha mrna short time intervals \( 2 4 h \) results well selective tgf alpha mrna psoriatic lesions among various cytokines tested suggest activation egf receptor tyrosine kinase tgf alpha important pathogenesis psoriatic epidermal hyperplasia
natural history 's disease natural history 's disease evaluated 97 men means questionnaire disease duration ranged 3 months 8 years questions addressed pain , bending , ability intercourse , effect disease , psychological effects , treatments received degree disease progression approximately 40 patients found pain , bending , ability intercourse effects unchanged course disease bending ability relations worsened 40 patients interval , 6 worsening pain patients 77 reported psychological effects due 's disease , improved 28 , change 36 worsened 36 , 13 patients believed disease one gradual resolution , 47 believed little change 40 believed disease pattern one gradual progression found statistically significant association disease duration spontaneous improvement penile bending similar lack statistical significance found improvement variety categories compared patients received therapy versus received variety conventional medical therapies
epidemiology natural history pressure ulcers elderly nursing home residents analyzed prospective data 19 , elderly residents 51 nursing homes 1984 1985 determine prevalence , incidence , natural history pressure ulcers among residents admitted nursing homes , 11 3 possessed stage ii stage iv pressure ulcer residents admitted nursing home without pressure ulcers study period , 1 year incidence 13 2 increased 21 6 2 years nursing home stay people already residing nursing home start study 1 year incidence 9 5 , increased 20 4 2 years pressure ulcers associated increased rate mortality , hospitalization longitudinal follow residents pressure ulcers demonstrated majority lesions healed 1 year improvement occurred early person 's nursing home stay although nursing home residents pressure ulcers higher mortality , good medical care pressure ulcers expected heal
cutaneous phototoxic patients receiving incidence cutaneous phototoxic reactions induced intravenous injection assessed series 180 patients \( 266 injections \) undergoing photodynamic therapy \( pdt \) park cancer institute period 1986 1989 addition usual verbal questions regarding phototoxic reactions follow , forty two patients group also responded written questionnaire designed answers specific questions doses ranged 0 5 2 0 mg kg overall , 20 40 patients reported type phototoxic response
pruritus pruritus common clinical disorder caused various inflammatory disorders , infections , , neoplasms laboratory evaluation , including bacterial fungal cultures , microscopic examination , skin biopsies , measurement blood glucose levels , useful establishing diagnosis management pruritus includes avoidance irritants , allergens , restrictive use topical systemic agents provide symptomatic relief specific treatment underlying cause
correcting deformity secondary lower abdominal scars use flap author describes flap used correction prevention retracted scars deformities common cesarean sections patients undergo followed retrieval excess skin surgical technique described author also analyzes advantages results occur without increase either time surgery complications
cicatricial pemphigoid identification two distinct sets epidermal antigens iga igg class circulating autoantibodies patient severe cicatricial pemphigoid demonstrated vivo bound circulating anti basement membrane zone antibodies iga igg classes complement component 3 \( c3 \) also deposited basement membrane zone lesional skin well normal appearing buccal mucosa patient however , c1q absent , granular deposits two factors alternative complement activating pathway , factor b , present basement membrane zone lesional skin , normal buccal mucosa deposition alternative complement pathway lesion suggests complement activation iga associated lesion development western blot analysis patient 's serum cultured keratinocyte antigens identified two distinct sets epidermal antigens igg bound antigens 230 , 205 , 140 , 90 kd , patient 's iga antibodies bound distinct set antigens , 180 130 kd potential pathogenic role iga cicatricial pemphigoid discussed
dermatitis herpetiformis bodies ultrastructural study skin patients using direct immunogold labeling skin samples three adult patients dermatitis herpetiformis \( dh \) granular iga deposits papillary tips studied using ultrastructural immunogold technique iga positive , called dh bodies identified amorphous probably aggregates scattered throughout upper papillary dermis dermatitis herpetiformis bodies seen basement membrane , sometimes along microfibrillar bundles , well adjacent papillary collagen fibers within surface \( microfibrillar \) region elastic tissue dh bodies , however , related fibrillar components collagen elastic fibers , microfibrillar bundles , anchoring fibrils , elastic dermatitis herpetiformis bodies found normal human skin results ultrastructural study indicate dh bodies either bound component dermal connective tissue represent deposits immune complexes trapped dh skin
familial occurrence bullous mastocytosis \( diffuse cutaneous mastocytosis \) studied four patients \( mother , two daughters , \) bullous mastocytosis , diffuse cutaneous mastocytosis , whose genetic inheritance suggested autosomal dominant pattern clinical characteristics included extensive bullae , numerous urticaria , pruritus , flushing , skin body surfaces without systemic organ involvement histopathologic findings disclosed pronounced accumulation mast cells dermis electron microscopic studies lesional skin obtained infancy showed round spindle shaped mast cells numerous villous cytoplasmic granules varied size shape , appearance degranulation markedly noted adult , mast cells markedly decreased numbers granules cytoplasmic villi cells displayed degenerative necrotic appearances findings correlated well clinical course cases , improved spontaneously time
aspirin , hydroxychloroquine , hepatic enzyme abnormalities methotrexate rheumatoid arthritis levels serum glutamic transaminase \( sgot \) serum glutamic transaminase \( \) patients rheumatoid arthritis 5 centers involved arthritis , , aging medical information system correlated use specific antirheumatic medications elevated levels sgot frequent patients taking methotrexate \( mtx \) least frequent patients taking hydroxychloroquine combination mtx greatly increased frequency abnormal liver enzyme values contrast , addition hydroxychloroquine regimen either mtx aspirin essentially eliminated sgot abnormalities results 5 centers consistent remained adjustment age , sex , disease duration knowledge important drug interactions may permit continuation mtx therapy patients drug might otherwise discontinued
functional studies soluble low affinity interleukin 2 receptors rheumatoid synovial fluid since abnormal regulation interleukin 2 \( il 2 \) demonstrated rheumatoid arthritis \( ra \) , functional role low affinity soluble il 2 receptors \( sil 2r \) purified ra synovial fluids \( sf \) studied levels sil 2r detected ra sf using enzyme linked immunosorbent assay levels higher serum sf ra patients controls \( p less 0 001 \) higher ra sf paired ra serum \( p less 0 01 \) soluble il 2r ra sf estimated molecular weights 40 50 kd 80 100 kd gel filtration analysis 80 100 kd peak likely dimer 40 50 kd peak , since single 45 kd peak found elution sodium dodecyl sulfate polyacrylamide gels since inhibitory activity lymphocyte proliferation found 80 100 kd range , sil 2r purified anti cd25 affinity column analyzed purified fractions interfere proliferation mitogen stimulated lymphocytes binding radiolabeled il 2 2 cells , although direct binding il 2 demonstrated affinity sil 2r ra sf binding il 2 range 25 nm , similar affinity sil 2r purified human cell clone , indicating sil 2r low affinity receptors il 2 conclude concentration binding affinity low affinity sil 2r purified ra sf render unable interfere il 2 related activities
dermal mast cell degranulation systemic sclerosis paired biopsy samples involved uninvolved skin obtained 19 patients generalized scleroderma \( 11 early , progressive disease 8 late , improving disease \) skin biopsy samples double stained mast cell granules mast cell membrane number mast cells increased patients systemic sclerosis \( ssc \) , involved uninvolved skin early late disease increase number mast cells involved skin patients early late disease yet involved skin patients early disease however , increase number mast cells areas previously involved normal skin patients late disease increases mast cell number degranulation precede clinically apparent dermal fibrosis ssc observations absence mast cell degranulation skin suggest role mast cell clinical progression skin changes ssc
spontaneous rheumatoid like arthritis line mice sensitive collagen induced arthritis twenty eight percent 13 month old male mice high antibody responder line 's selection \( hi \) spontaneously developed long lasting inflammatory arthritis disease clinically histologically similar human rheumatoid arthritis synovium joints tendons hypertrophied , thickening synovial cell layer infiltration polymorphonuclear mononuclear leukocytes cases , synovial formation led destructive damage articular cartilage bone rheumatoid factor antinuclear , anti dna , anti type ii collagen \( \) antibodies often found sera arthritic mice clinically normal littermates presence autoantibodies line mice suggests potentially harmful anti cell autoimmunity also develop spontaneously lead joint damage moreover , hi mice also susceptible collagen induced arthritis , closely related mouse line \( \) resistant diseases data support hypothesis collagen induced arthritis related spontaneous arthritis rheumatoid arthritis
decarboxylase splice site mutation causes deletion exon 6 multiple families porphyria cutanea tarda decarboxylase \( \) cytosolic biosynthetic enzyme converts defects decarboxylase locus cause human genetic disease familial porphyria cutanea tarda splice site mutation found pedigree familial porphyria cutanea tarda causes exon 6 deleted mrna intron exon junctions either side exon 6 fall codons , resulting protein shorter normal protein , missing amino acids coded exon 6 shortened protein lacks catalytic activity , rapidly degraded exposed human lymphocyte lysates , detectable western blot analysis lymphocyte lysates derived affected individuals mutation detected five 22 unrelated familial porphyria cutanea tarda pedigrees tested , appears common first splice site mutation found locus , first mutation causes familial porphyria cutanea tarda found one pedigree
substitution non glycine position triple helical domain pro alpha 2 \( \) collagen chains present individual variant marfan syndrome substitution highly conserved non glycine residue triple helical domain pro alpha 2 \( \) collagen molecule found individual variant marfan syndrome single base change resulted substitution glutamine position gly x repeat , responsible decreased migration sds polyacrylamide gels pro alpha 2 \( \) chains type collagen synthesized dermal fibroblasts individual family studies suggest substitution inherited individual 's father also produces abnormally migrating pro alpha 2 \( \) collagen chains shares abnormal skeletal features single base change new \( , ii \) restriction site detectable genomic dna southern blot analysis probed fragment analysis 52 control individuals \( 103 chromosomes \) negative new site , suggesting substitution common polymorphism
protective effect oral contraceptive pill rheumatoid arthritis overview analytic epidemiological studies using meta analysis oral contraceptive pill \( \) implicated protective effect development rheumatoid arthritis \( ra \) results 12 studies reported produced differing results conclusions discrepancy results importance issue undertook review studies performed meta analysis , 9 independent studies satisfied criteria selection , 6 case control design 3 longitudinal using standard meta analysis techniques , overall pooled odds ratio studies 0 68 crude results \( 95 ci 0 58 0 78 \) 0 73 adjusted results \( 95 ci 0 61 0 85 \) man method produced 94 interval 0 70 0 72 pooled odds ratio case control studies lower longitudinal studies however , studies type case source produced pooled odds ratio studies using hospital based cases 0 49 \( 95 ci 0 39 0 63 \) considerably less studies using population based cases 0 95 \( 0 78 1 16 \) difference unlikely explained bias due selection controls suggest use may protective effect development ra may prevent progression severe disease modifying disease process
health status reports care patients rheumatoid arthritis examined use formal health status reports every 3 months 1 year clinical care patients rheumatoid arthritis \( ra \) reports consisted single page , computer generated scores derived either aims \( arthritis impact measurement scales \) \( modified health assessment questionnaire \) health status questionnaires total subjects 27 community practice sites randomly assigned three study groups practice intervention , attention placebo control results showed 55 physicians found reports least moderately useful aid patient management , primarily improving doctor patient relationship however , detectable differences among three groups seen terms medication compliance , number physician visits , number referrals , frequency major medication changes , attitudes towards physician , patient satisfaction change health status 1 year failure demonstrate objective benefits health status reports study may due physician health status scores , failure link report office visit , relative stability clinical status subjects 1 year relatively short time frame study
spinal synovial cyst case report using magnetic resonance imaging case 65 year old woman developed spinal synovial cyst l4 5 disk space reported clinical signs symptoms presented comparison among preoperative , computed tomography scan , magnetic resonance imaging showed magnetic resonance imaging accurate intraoperative pathological findings
125i fibrin deposition occurs early late intervals ige dependent contact sensitivity reactions elicited mouse skin mast cell dependent augmentation fibrin deposition early intervals combined ige dependent contact sensitivity reactions elicited skin mice , either ige dependent immediate hypersensitivity reactions cell dependent contact sensitivity \( cs \) reactions result local extravasation 125i fibrinogen deposition 125i fibrin however , two types reaction differ kinetics requirement ige , mast cells , cells present study , investigated kinetics magnitude 125i fibrin deposition combined ige dependent cs reactions elicited simultaneously site compared results obtained two reactions elicited separate sites found 125i fibrin deposition pure ige dependent reactions greater 2 6 h challenge 24 h , significant fibrin deposition persisted sites 24 h challenge cs reactions , 125i fibrin deposition detected early 2 h challenge , indicating fibrin deposition early component cs detected van et al use measurements tissue swelling much 125i fibrin deposition present cs reactions 24 h 2 6 h ag challenge ige dependent cs reactions elicited site , 125i fibrin deposition early intervals \( 2 6 h \) challenge increased three 25 fold compared seen isolated cs reactions , 24 h results combined reactions virtually identical cs responses studies genetically mast cell deficient normal mice indicated mast cells required expression ige dependent augmentation 125i fibrin deposition observed early intervals combined ige dependent cs reactions , 125i fibrin deposition associated pure cs reactions findings indicate net effect ige dependent mast cell activation cs responses increase fibrin deposition associated responses , effect appreciated early intervals elicitation reaction
il 1 regulation stromelysin transcription rheumatoid synovial fibroblasts appears involve two transduction pathways , inhibitory , prostaglandin dependent pathway mediated camp , stimulatory , protein kinase c dependent pathway il 1 , like agents shown capacity induce protein kinase c , potent transcriptional activator metalloproteinase , stromelysin , synovial fibroblasts camp shown inhibit stromelysin transcription fibroblasts origin , regarded important second messenger il 1 addition stimulating metalloproteinase transcription , il 1 also induces pge2 production determined ril 1 alpha led time dependent accumulation intracellular camp serum rheumatoid synovial fibroblasts , effect blocked indomethacin camp agonists forskolin , 3 isobutyl 1 , pge2 suppressed il 1 induction stromelysin conversely , indomethacin il 1 elicited stromelysin mrna results transcriptional level cells transfected rat stromelysin promoter reporter \( cat \) construct 2' , 5' , inhibitor adenylate cyclase , also augmented il 1 induction mrna , h 8 , specific inhibitor camp dependent protein kinase staurosporine h 7 , inhibitors protein kinase c , blocked il 1 induction stromelysin mrna conclude il 1 appears stimulate least two transduction pathways synovial fibroblasts patients rheumatoid arthritis , effects regulation stromelysin transcription
identification isolation phospholipase a2 activating protein human rheumatoid arthritis synovial fluid induction eicosanoid synthesis inflammatory response joints injected vivo eicosanoids important mediators destructive arthropathy observed rheumatoid arthritis rate limiting step eicosanoid synthesis pathway availability free arachidonic acid phospholipase enzymes release arachidonic acid membrane phospholipids thus play important role regulation eicosanoid production previously demonstrated enhanced phospholipase a2 c enzyme activities cells patients rheumatoid arthritis also described phospholipase a2 activating protein \( plap \) mammalian cell lines attempt determine biochemical basis enhanced phospholipase a2 activity found patients inflammatory joint disease , examined synovial fluid patients rheumatoid arthritis plap determine whether plap specific rheumatoid disease , assayed specimens patients histologic examination rheumatoid joint tissue , use immunohistochemical techniques , demonstrated high concentration plap monocytes , macrophages , chondrocytes , vascular smooth muscle , endothelial cells human plap could biochemically isolated synovial fluid patients rheumatoid arthritis found similar plap previously isolated murine bovine sources determine whether plap could directly mediate aspect inflammatory disease , purified plap injected rabbit knee joints resulted acute inflammatory arthritis synovial cell proliferation synovial fluid leukocytosis purified plap also induced eicosanoid formation vivo vitro enzyme linked immunosorbent assays , found plap synovial fluid specimens patients rheumatoid arthritis compared samples patients inflammatory well osteoarthritis , noninflammatory arthropathy data suggest plap may responsible , least part , aspects destructive inflammatory arthropathy observed patients rheumatoid arthritis
induction ornithine decarboxylase following stripping normal psoriatic skin ornithine decarboxylase \( odc \) measured epidermis healthy volunteers uninvolved skin psoriatic patients various times stripping basal levels less 1 pmol min mg protein activity peaked maximum 86 pmol min mg protein 8 h followed abrupt decline lower level remained relatively constant least 36 h difference seen response controls psoriatic patients pretreatment topical corticosteroids reduced peak odc levels one half , oral indomethacin effect
effect long term puva treatment psoriasis collagen elastin gene expression growth skin fibroblasts vitro proliferation rate , collagen metabolism collagen elastin messenger rna levels studied fibroblasts derived patients received many courses either systemic 8 methoxypsoralen topical puva treatment proliferation rate fibroblasts measured incorporation 3h thymidine cellular division decreased obtained patients puva treatment compared controls collagen synthesis slightly increased cells puva treated patients , relative collagen synthesis ratio types iii collagen unchanged levels collagen elastin mrnas increased fibroblasts derived puva treated patients significant differences histology could found biopsies taken topical systemic puva treated patients
cyclosporin combination \( puva \) treatment psoriasis forty patients relapsing plaque psoriasis involving 20 body surface treated either cyclosporin \( cya \) plus puva retinoid etretinate plus puva \( \) initially received either cya \( 2 weeks \) etretinate \( 1 week \) alone puva given concomitantly complete remission patients monitored period 6 months relapse recorded combined treatment regimen , cya plus puva , patients cleared within comparable periods time \( mean treatment period 5 3 vs 4 7 weeks initiation therapy 3 3 vs 3 7 weeks initiation puva \) however , cumulative uva dose required clearance \( 110 9 j cm2 vs 62 1 j cm2 \( p less 0 05 \) \) incidence severe early relapses significantly higher cya cohort within 6 months severe relapses occurred 58 cya plus puva 15 treated patients \( p less 0 001 \) suggests cya plus puva regimen performed study less effective
quantitative estimation hair growth alopecia women effect quantitative growth hair 40 week period reported eight women alopecia using random , double blind protocol , women given either 2 solution placebo vehicle hair permanently marked site fronto parietal scalp pulled 1 cm square clear plastic template , outline template drawn scalp hair carefully hand clipped collected five eight week intervals \( one untreated four treated \) , using great care collect within marked area subsequent measurements included total weight hair grown marked area , total number , , randomized 50 hair subsample , weight , lengths , optical diameters calculated quantities included average weight per hair , average length , average optical width average total hair weight treated subjects increased 32 week test period 42 5 , compared 1 9 placebo treated subjects \( average p 0 018 \) changes average number count 29 9 2 6 , respectively \( average p 0 022 \) increases , observed using unusually small number subjects , clearly distinguished treated subjects untreated test period , averaged quantities weight , diameter , length 50 hair subsample showed insignificant change \( p usually greater 0 5 \) addition showing larger percentage increase total number , total weight easier obtain , less prone error sampling measurement therefore , recommend total weight defined area considered primary quantitative hair growth
extracellular collagenase , products activity , released organ culture intact dermal inflammatory lesions produced sulfur mustard peak \( 1 2 \) healing \( 3 , 6 , 10 \) inflammatory lesions produced rabbits topical application military , bis \( 2 \) , commonly called sulfur mustard \( sm \) sm produces acute sterile dermal inflammatory reaction little necrosis , except epidermis , first day animal killed , lesions excised intact , full thickness 1 0 cm2 explants organ cultured 3 order maintain viability local infiltrating cells extracellular fluid lesion culture fluid , collected daily analyzed collagenase activities metalloproteinase activities measured \) destroyed alpha inhibitors , ii \) destroyed tissue inhibitor \( \) reduction , iii \) activated latent proteinase activity acetate \( \) hydroxyproline containing peptides glycosaminoglycans \( gag \) released culture fluids also measured indicators local collagenase activity within inflammatory lesions general , levels products activity higher second third day culture fluids first day culture fluids , higher fluids sm lesions normal skin activated fibroblast apparently major cell type producing collagenase hydrolysis collagen ground substance occurs excess inhibitors exists outside region daily change culture fluids apparently decreased inhibitors , second third day culture could detect changes enzyme activity detectable first day culture inflammatory lesions healed , extracellular enzyme products \( hydroxyproline gag \) increased enzymes produced products healing , decrease occurs extravasation serum components , especially large ones alpha inhibitors propose healing , decrease inhibitors allows begin remodeling process , peak phase inflammation , inhibitors protect extracellular matrix hydrolysis
arthropathy syndrome juvenile rheumatoid arthritis like arthropathy previously documented 12 patients syndrome additional 9 patients described literature reviewed unknown whether patients juvenile rheumatoid arthritis unique arthropathy light genetic immunologic abnormalities associated syndrome patients progressive course polyarticular disease complicated long lag time diagnosis purpose reporting children increase awareness association facilitate appropriate timely diagnosis arthritis syndrome patients
anti \( u1 \) small nuclear rna antibodies anti small nuclear ribonucleoprotein sera patients connective tissue diseases small nuclear ribonucleoprotein \( snrnp \) particles class rna containing particles nucleus eukaryotic cells sera patients connective tissue diseases often contain antibodies proteins present antibodies rna components , u , thought rare tested 118 anti snrnp sera presence anti antibodies found 45 sera \( 38 \) sera antibodies \( igg f \( ab \) 2 fragments \) exclusively directed u1 anti \( u1 \) rna antibodies always accompanied anti \( u1 \) antibodies found sera contain antibodies sm serotype directed u snrnp particles like anti antibodies , anti u1 rna activity confined sera patients sle sle overlap syndromes rarely found patients connective tissue diseases analyzing binding u1 made vitro , demonstrated anti \( u1 \) rna antibodies recognize epitopes distributed throughout u1 rna molecule sera , however , either second fourth loop main target antibody possible mechanisms could lead production new type autoantibody discussed
multiple keratoacanthomas treated oral retinoids multiple rare disorder characterized numerous small , tumors larger , typical keratoacanthomas affected patients features type keratoacanthomas type two patients multiple keratoacanthomas treated oral retinoids patients follicular papules trunk extremities less common lesions included nodules central horn filled characteristic classic keratoacanthomas retinoid therapy resulted regression larger , typical keratoacanthomas patients small follicular keratoacanthomas remained unaffected thus oral retinoids partially beneficial treatment type type multiple keratoacanthomas
molecular identification major minor bullous pemphigoid antigens skin antigens defined basement membrane zone antibodies 38 patients bullous pemphigoid analyzed western immunoblot thirty four patients \( 89 \) antibodies major bullous pemphigoid antigen molecular weight approximately 230 kd twelve patients \( 32 \) antibodies minor bullous pemphigoid antigen molecular weight approximately 160 kd included four patients antibodies 230 kd antigen depending epidermal extract used , variable number patients \( 75 \) also antibodies minor bullous pemphigoid antigens molecular weights approximately 180 200 kd results study confirm bullous pemphigoid antigens heterogeneous molecular level approximately 10 patients antibodies directed solely minor bullous pemphigoid antigen
digital imaging techniques dermatology digital imaging technique infrequently used dermatology record visual images used technology 10 patients follow cutaneous lesions , including alopecia , psoriasis , dysplastic nevi included personal computer , digitizer board , monitor , video camera , lights introduction electronic \( digital \) imaging given many possible applications dermatology discussed
clinical , laboratory radiographic features early rheumatoid arthritis evaluated disease status relation age , sex disease duration using short term indices disease activity , laboratory tests , radiological features 315 patients rheumatoid arthritis duration varying 3 36 months \( mean 12 months \) differences observed among various age groups disease duration , female male ratio , incidence radiologic lesions indices disease process clinical markers disease process involvement flexor tendons hands ritchie 's index \( score greater 9 \) significantly frequent women \( p less 0 p less 0 04 , respectively \) patients disease recent onset women slightly numerous \( 56 \) men however , disease duration 36 months significantly women \( 72 \) \( p less 0 \) , suggesting greater tendency chronic disease sex radiological lesions small joints hands , feet , found 37 cases disease duration 4 months 91 36 months \( p less 0 0001 \) lesions associated significantly frequently ritchie index \( p less 0 02 \) laboratory indices inflammatory activity \( erythrocyte sedimentation rate greater equal 25 mm h \) \( p less 0 001 \) immune response \( latex test greater equal 80 \) \( p less 0 0001 \) logistic regression analysis showed duration illness important factor correlating radiologic lesions
clinical laboratory effects prolonged therapy sulfasalazine , gold penicillamine effects disease duration treatment response serial observations 5 years clinical score \( subjective global assessment \) , serum c reactive protein \( crp \) erythrocyte sedimentation rate \( esr \) analyzed 3 groups patients active rheumatoid arthritis \( ra \) requiring treatment second line drug groups comprised 315 patients \( 243 women , 72 men \) sulfasalazine \( \) 203 patients \( 141 women , 62 men \) sodium \( gold \) 163 patients \( 131 women , 32 men \) penicillamine groups matched respects gold group smaller proportion women , shorter median disease duration higher median crp remaining 2 groups penicillamine group contained higher proportion seropositive patients group significant improvements clinical score , crp esr time points 6 30 months improvements maintained longer \( 60 months \) gold groups differences drugs 30 months probably consequence falling number patients , differing drug mean esr crp levels fell 30 mm h 20 30 mg l , respectively response defined \( 1 \) treatment duration greater 6 months , \( 2 \) clinical score improvement greater 4 6 months , \( 3 \) esr fall less 30 mm h 6 months criteria 142 patients \( 20 9 \) responded response rates 20 3 , gold 24 1 , penicillamine 17 8
phenotypic characteristics dissociated mononuclear cells rheumatoid synovial membrane phenotypic characteristics enzymatically dissociated synovial membrane mononuclear cells 8 patients \( 14 samples \) rheumatoid arthritis \( ra \) assessed fluorescence activated flow cytometry compared peripheral blood \( pb \) mononuclear cells 18 patients ra 14 normal controls significant difference percentage cd4 cd8 lymphocytes synovial membrane compared ra normal pb double labelling experiments revealed similar percentages cd4 \( helper inducer \) cd4 \( suppressor inducer \) cells ra normal pb contrast , sm cd4 cells present significantly higher proportions ra normal pb \( p less 0 001 \) conversely , synovial membrane cd4 cells present significantly lower proportions ra normal pb \( p less 0 001 \) similar pattern antigen expression noted cd8 lymphocytes reflecting increased killer effector \( p less 0 001 \) decreased suppressor effector \( p less 0 001 \) cells , respectively experiments revealed significant increase percentage synovial membrane cd20 cells \( b lymphocytes \) hla dr cells compared ra pb \( p less 0 02 p less 0 001 \) normal pb \( p less 0 01 p less 0 005 \) , similar proportions cd14 cells \( monocytes macrophages \) results suggest ra synovial membrane contains populations b lymphocytes differ quantitatively qualitatively pb may account abnormalities intraarticular humoral cellular immune responses patients ra
temporomandibular joint rheumatoid arthritis correlations clinical computed tomography features clinical computed tomography \( ct \) examination temporomandibular joint \( tmj \) performed 26 patients rheumatoid arthritis \( ra \) 26 control subjects examination scored group ra 61 2 physical signs system compared 42 3 control group \( ns \) 88 4 group ra erosive cystic lesions tmj compared 57 6 control subjects \( p less 0 05 \) clinical dysfunction score correlate ct tmj score ra correlated number slow acting antirheumatic drugs used , rheumatoid factor titer radiographic scores hands cervical spine agreement others , believe specific ct lesions ra cysts mandibular condyle , correlation clinical ct findings tmj ra , intensity destructive lesions tmj ct ra well correlated severity disease
specificity anti scl 70 antibodies scleroderma increased sensitivity detection using purified dna topoisomerase calf thymus large scale purification dna topoisomerase calf thymus obtained using combinations 62 ammonium sulfate precipitation , 70 , chromatography silver staining preparation separated sodium dodecyl sulfate polyacrylamide gel electrophoresis revealed 2 bands apparent molecular weight 70 60 kda immunoblotting serum anti scl 70 specificity also recognized proteins anti scl 70 antibodies detected 24 32 \( 75 \) patients diffuse scleroderma elisa 28 32 \( 87 \) ability neutralize topoisomerase activity 14 sera antibodies react dna topoisomerase assays presence anti scl 70 antibodies remained disease specific despite increase sensitivity assays
nutritional assessment requirements nutrition plays important role health disease , prevention treatment increasing emphasis placed upon nutrition therapeutic tool decrease morbidity mortality associated obesity , hypertension , coronary artery disease , cancer adequate nutrition concern health care workers impact overall health patients health care professionals familiar nutritional assessment basic nutritional requirements able improve patients' care face nutritional deficiencies excesses
nature , , nutrition interdisciplinary programs address prevention malnutrition dehydration malnutrition dehydration common problems nursing home patients one explanation may large number patients requiring feeding assistance dysphagia team department veterans affairs medical center , florida served primary source expansion supportive environment assist prevention malnutrition dehydration patients feeding swallowing disorders silver , program volunteers provide supervised feeding , hour , time day provided hydration , second , provided patients require modification eating style , food , timing described analysis program 's outcomes show timely , patients , cost effective
hypokalemic ecg sequelae combined beta agonist diuretic therapy protection conventional doses spironolactone triamterene salbutamol \( albuterol \) diuretics commonly prescribed together patients airflow obstruction associated electrocardiographic effects investigated whether use potassium sparing drugs might prevent ecg sequelae combined therapy ten healthy subjects received seven days randomized treatments placebo , \( 5 mg \) , plus triamterene 50 mg \( conventional dose \) , triamterene 200 mg \( high dose \) , plus spironolactone \( 100 mg \) potassium ecg responses inhaled salbutamol , 2 mg , measured treatment period wave flattening response salbutamol \( 0 24 ci , 0 19 0 29 mv \) attenuated addition triamterene , 200 mg \( 0 33 ci , 0 28 0 37 mv p less 0 05 \) spironolactone 100 mg \( 0 42 ci , 0 37 0 47 mv p less 0 01 \) , triamterene 50 mg \( 0 25 ci , 0 20 0 30 mv \) spironolactone high dose triamterene also diminished frequency u waves st depression ecg effects hypokalemic responses also blunted high dose \( p less 0 01 \) low dose triamterene , well spironolactone \( p less 0 001 \) thus , use high dose triamterene spironolactone protected hypokalemic ecg sequelae combined beta agonist diuretic therapy , whereas conventional dose triamterene effect findings may important prevention potentially dangerous interaction susceptible patients taking combination drugs
menarche associated diabetic retinopathy \? goal study evaluate association status diabetic retinopathy diabetic retinopathy present 51 129 females 7 , 44 range severity retinopathy greater group multivariate analyses , duration diabetes , status , diastolic blood pressure associated prevalence diabetic retinopathy duration diabetes years years menarche , significant , number years diabetes menarche strongly associated 4 yr follow examination , females progression retinopathy \( p 0 06 \) data suggest stage sexual development , reflected status , associated presence possibly risk progression diabetic retinopathy
randomized crossover study effect resistance training glycemic control , muscular strength , cholesterol type diabetic men goal study evaluate program resistance weight training cardiovascular risk factors , blood glucose management , overall strength diabetic subjects randomized crossover design performed eight male type \( insulin dependent \) diabetic subjects \( mean sd age 31 3 5 yr , height 176 5 6 cm , body wt 80 15 kg , duration diabetes 12 3 9 8 yr , insulin dose 24 u nph day 21 u regular day \) program consisted heavy resistance weight training 3 days wk 10 wk , concentrating strengthening major muscle groups progressive resistance blood tests included total cholesterol , triglycerides , low density lipoprotein high density lipoprotein cholesterol , hba1c tests repeated three time points program field strength testing performed training improvement seen \( 93 6 increase , p less 0 0001 \) bench press \( 58 increase , p less 0 005 \) hba1c triglyceride levels showed change resting portion experiment showed significant change training program hba1c 6 9 1 4 vs 5 8 0 9 \( p 0 05 \) triglyceride 5 044 1 06 vs 4 0 88 mm \( p 0 01 \) self monitored glucose \( taken pre postexercise \) showed decrease 7 85 3 13 7 05 2 91 mm \( p 0 0001 \) low density lipoprotein cholesterol triglycerides change training analysis variance showed significant differences time three time points regard reductions cardiovascular risk factors hba1c
impact glucose self monitoring non insulin treated patients type ii diabetes mellitus randomized controlled trial comparing blood urine testing goal study compare relative efficacy cost self monitoring blood glucose \( smbg \) routine urine testing management patients type ii \( non insulin dependent \) diabetes mellitus treated insulin fifty four patients type ii diabetes mellitus , treated insulin , inadequate glucose control diet alone diet oral hypoglycemic agents studied patients performed smbg urine glucose testing part standardized treatment program also included diet exercise counseling 6 mo study , urine testing smbg groups showed similar improvement glycemic control within group , significant improvements fasting plasma glucose \( reduction 1 4 3 2 mm , p less 0 03 \) glycosylated hemoglobin \( reduction 2 0 3 4 , p less 0 01 \) levels seventeen \( 31 \) 54 patients actually normalized glycosylated hemoglobin values , 9 urine testing group 8 smbg group comparisons urine testing smbg groups showed significant differences mean fasting plasma glucose \( p greater 0 86 \) , glycosylated hemoglobin \( p greater 0 95 \) , weight \( p greater 0 19 \) patients type ii diabetes mellitus treated insulin , smbg effective , 8 12 times expensive , urine testing facilitating improved glycemic control results support widespread use smbg diabetic patients treated insulin
incidence iddm 1984 1986 population aged less 30 yr residents , italy goal study measure incidence insulin dependent diabetes mellitus \( iddm \) 1984 1986 residents , italy , aged less 30 yr primary data source list subjects diagnosed iddm diabetes clinics data sources general register death certificates , list hospital discharges , computerized data base insulin eighty incident cases iddm identified study 1 , 130 , 284 person yr less 30 yr age age adjusted \( world standard \) incidence rates 8 05 , 8 10 , 6 96 100 , 000 age groups 0 14 , 0 19 , 0 29 yr , respectively estimated completeness primary data source compared data sources 91 , whereas estimated completeness ascertainment registry 99 incidence rates iddm northern italy compare european countries low medium incidence population based register established province \( , aged 0 29 yr \) collection incident cases since 1984
project childhood diabetes diamond project group insulin dependent diabetes mellitus \( iddm \) one important chronic diseases children worldwide iddm leads 8 10 fold excess risk mortality developed countries , whereas developing countries , cases die within years 60 fold international gradient iddm incidence reported , epidemic periods identified new world health organization program , project childhood diabetes \( diabetes diamond \) , developed investigate characterize global incidence , mortality , health care 10 yr \( 1990 \) , study collect population based data concerning iddm greater 90 centers 50 countries worldwide goals diamond collect standard information incidence , risk factors , mortality associated iddm evaluate efficiency effectiveness health care diabetes establish national international training programs diabetes epidemiology diamond project instrumental prevention serious disease sequelae
controlled study diabetic children comparing insulin dosage adjustment manual computer algorithms controlled trial new microprocessor device insulin dosage adjustment undertaken two matched groups well controlled diabetic children prospective study design three equal 8 wk periods used first period , groups used manual methods insulin dosage adjustment manual criteria second period , one group children adjusted insulin dosage computer algorithms , whereas continued use manual methods third period , groups adjusted insulin traditional methods mean glycemia glycosylated hemoglobin levels change either group throughout study second period , episodes hypoglycemia frequent children without computer used device keeping latter outcome , group used microprocessor device given less insulin second period first \( 0 88 0 02 vs 0 94 0 02 u kg 1 day 1 , p less 0 0001 \) comparison control group patients concurrently given increased insulin dose second period compared first study showed insulin treatment specific computer mediated dosage adjusting algorithms safe minimized hypoglycemia effectively changing insulin requirements recommend device help diabetic children families care insulin dependent diabetes
complement fixing antibodies sympathetic parasympathetic tissues iddm autonomic brake index heart rate variation describe herein complement fixing anti adrenal medullary \( cf adm \) anti sympathetic ganglia \( cf sg \) antibodies insulin dependent diabetes mellitus \( iddm \) study describes complement fixing anti vagus \( cf v \) nerve antibodies relationship cardiovascular autonomic brake index \( measure transient decrease heart rate 1st min tilt \) , r r interval variation deep breathing cf v detectable 7 83 \( 8 4 \) subjects iddm aged 1 5 65 5 yr \( mean se 28 7 1 8 yr \) duration diabetes 0 47 yr \( 11 8 1 4 yr \) seventy six nondiabetic subjects \( aged 10 65 yr \) negative cf v scores cf v scores correlated cf adm \( 0 16 yr iddm , r 0 61 , p less 0 0001 \) cf sg \( r 0 39 , p less 0 05 \) seventy iddm subjects \( aged 28 5 yr , duration diabetes 17 3 yr \) without proteinuria proliferative retinopathy screened cf adm , cf sg , cf v antibodies five 70 \( 7 1 \) cf sg \( negative cf adm cf v \) brake indices ranged 14 7 51 3 \( 37 3 6 9 \) three 70 \( 4 2 \) cf adm , brake indices 26 9 45 1 \( 32 9 6 1 \) four 70 \( 5 7 \) cf v antibodies , brake indices 12 7 17 3 \( 15 1 1 1 \) subjects cf sg cf adm \( anti sympathetic \) higher brake indices subjects cf v \( anti parasympathetic \) antibodies \( p less 0 03 \)
impact intensive educational approach dietary change niddm aim study compare effects intensive educational approach incorporating longer time , greater simplicity , repetition , cognitive motivational techniques conventional one subjects established non insulin dependent diabetes mellitus \( niddm \) whose weight , glycemic control , diet optimal subjects randomly allocated intensive conventional education 350 subjects , 70 met study criteria , included established niddm \( greater equal 3 mo \) , suboptimal recent glycemic control , dietary fat intake greater equal 35 total energy intake , body mass index greater equal 25 kg m2 intensive approach associated significantly greater improvements dietary compliance , dietary intake \( complex carbohydrate , p 0 013 , p less 0 0001 , fiber p less 0 0001 , total fat p less 0 004 , saturated fat p less 0 004 \) , total cholesterol level \( p 0 007 \) transient improvement glycemic control similar groups intensive education program improve dietary compliance established niddm subjects conventional one recommended dietary improvements achieve better improvement total cholesterol necessarily improve glycemic control
effects childbearing glucose tolerance niddm prevalence published erratum appears diabetes care 1990 13 \( 11 \) goal study estimate effects childbearing subsequent glucose tolerance non insulin dependent diabetes mellitus \( niddm \) prevalence sample subjects 64 different locations united states recruited inclusion second national health nutrition examination survey complex survey design used select probability sample subjects location total women recruited , underwent clinical laboratory evaluation presence diabetes mellitus women classified glucose tolerance based results oral glucose tolerance test previous physician diagnosis diabetes mellitus combined current use hypoglycemic medication childbearing defined number live births experienced woman time interview fasting plasma glucose increased linearly increasing number live births \( coefficient 0 009 , 95 confidence interval ci 0 006 0 012 \) , 2 h value \( coefficient 0 015 , 95 ci 0 009 0 \) adjustment age , body mass index \( bmi \) , education , income substantially reduced magnitude association childbearing either plasma glucose measurement prevalence niddm relation childbearing examined logistic regression analysis , significant linear increase diabetes prevalence seen increasing number live births \( relative prevalence niddm , 1 birth vs 0 1 73 , 95 ci 1 39 2 15 \) , adjustment age , bmi , education , income greatly reduced magnitude association \( relative prevalence niddm , 1 birth vs 0 1 07 , 95 ci 0 98 1 17 \)
lowering plasma glucose concentrations bezafibrate patients moderately controlled niddm goal study investigate whether treatment bezafibrate improves glucose tolerance non insulin dependent diabetes mellitus \( niddm \) study included 37 niddm patients hba1 concentrations greater 8 5 normal kidney liver function treated diet alone diet together sulfonylurea drug one patient withdrew constipation randomization 3 mo treatment , patients given standard mixed test meal tolerance test \( mtt 500 cal \) overnight fast , plasma glucose , insulin , c peptide , metabolite , fatty acid \( nefa \) , triglyceride concentrations measured 15 30 min intervals serum lipid , hba1 , fructosamine concentrations measured monthly intervals glucose , nefa , triglyceride concentrations significantly lower throughout second mtt bezafibrate patients \( p less 0 01 0 001 \) placebo group fasting serum insulin c peptide levels , postprandial concentrations , reduced bezafibrate patients \( p less 0 05 \) 3 mo , mean fasting serum triglyceride concentrations fell 2 2 1 4 mm \( p less 0 001 \) , total serum cholesterol concentrations 6 3 5 5 mm \( p less 0 001 \) , low density lipoprotein cholesterol concentrations 4 2 3 5 mm \( p less 0 001 \) bezafibrate patients changes serum lipid concentrations placebo group treatment patients moderately controlled niddm bezafibrate improves glucose tolerance serum lipid profile bezafibrate treatment may useful adjunct hypoglycemic therapy patients niddm
development iddm kidney diabetic sibling goal study describe patient developed insulin dependent diabetes mellitus \( iddm \) kidney sibling suggest possible solution prevent occurrence 42 yr old man found islet cell autoantibodies \( icas \) part screening program first degree relatives iddm two years previously , donated kidney hla identical sibling long standing iddm oral intravenous glucose tolerance tests demonstrated gradual loss insulin secretion increasing glucose intolerance patient developed iddm 6 yr nephrectomy whether presence ica absolute contraindication kidney donor could nonetheless , ica used screening test identify individuals risk subsequent iddm found positive , counseling provided
effect isocaloric substitution cake type diabetic patients traditional dietary advice given people diabetes includes eliminating simple sugars \( primarily sucrose \) diet many people difficulty following recommendation patients type \( insulin dependent \) diabetes need overall calorie restriction , caloric reason restrict sucrose study , looked effect isocaloric substitution piece cake mixed meal determine whether would increase blood glucose patients type diabetes glucose response cake added meal significantly greater standard meal glucose response different cake substitution meal standard meal reproducibility studies showed difference repeated standard meals urinary glucose excretion significantly greater cake added meal different pairs significant differences counterregulatory hormone responses baseline paired studies conclusion , patients type diabetes may substitute sucrose containing another carbohydrate diet without compromising postprandial glucose response data suggest exchange may helpful harmful management diabetic patients inherent variability \( least 16 \) insulin requiring patient 's response meal , making self monitoring blood glucose adjustment insulin doses necessary achieve near euglycemia
sulfonylureas , , \? although controversies remain usefulness sulfonylureas , evidence favor use many patients non insulin dependent diabetes mellitus used properly , sulfonylureas improve insulin secretion action , effects may maintained years combined dietary regulation , rapid short acting sulfonylureas may help patients reach maintain euglycemia without chronic hyperinsulinemia weight increase evidence sulfonylurea treatment causes beta cell exhaustion instead , effect helps improve beta cell function sulfonylurea failures often dietary failures may due late introduction drugs , e , beta cell function already attenuated desensitization effect sulfonylureas may occur might avoided discontinuous \( less 24 h day \) sulfonylurea exposure , e , daily administration short acting sulfonylurea moderate dose important adverse effect sulfonylureas long lasting hypoglycemia , may lead permanent neurological damage even death mainly seen elderly subjects exposed intercurrent event , e g , acute energy deprivation drug interaction , e , aspirin long acting sulfonylureas may likely promote long lasting hypoglycemia dose response relationships sulfonylureas poorly investigated , sulfonylurea therapy always initiated maintained lowest possible dose
effect acarbose carbohydrate lipid metabolism niddm patients poorly controlled sulfonylureas ability acarbose lower plasma glucose concentration studied 12 patients non insulin dependent diabetes mellitus \( niddm \) poorly controlled diet plus sulfonylurea drugs patients studied 3 mo addition acarbose treatment program , significant improvement glycemic control noted although decrease fasting plasma glucose concentration modest \( 12 0 0 8 10 8 0 3 mm \) , average postprandial plasma glucose concentration decreased 3 4 mm acarbose therapy discontinued 5 patients , plasma glucose levels rapidly returned toward pretreatment levels addition improvement glycemia , acarbose treatment also led significant reduction hba1c \( 7 4 0 2 6 4 0 2 , p less 0 01 \) triglyceride \( 2 4 0 1 2 1 0 1 mm , p less 0 01 \) concentrations neither plasma insulin response meals insulin stimulated glucose uptake improved acarbose therapy , consistent view acarbose improves glycemic control delaying glucose absorption considerable individual variation noted response acarbose , results 4 patients dramatic , striking reductions fasting postprandial glucose concentrations addition acarbose patients niddm well controlled sulfonylureas appears significant clinical benefit
sulfonylureas combination therapy niddm oral combination therapy \( \) sulfonylureas discussed rationale use combination based different sites action two kinds drugs possibility obtaining additive potentiating effects reduced side effects clinical usefulness chlorpropamide combination demonstrated clinical trials combination may provide satisfactory glycemic control several years , possibly insulin therapy even avoided special safety problems encountered use combination attributed use sulfonylurea alone , e , lactic acidosis hypoglycemia , respectively lethality risks associated conditions comparable concluded data needed evaluate full clinical potential mechanism action oral combination therapy
metabolic effects combination glipizide human proinsulin treatment niddm effects 3 mo treatment combination glipizide human proinsulin studied small group closely monitored patients patients non insulin dependent diabetes mellitus \( niddm \) poor glucose regulation , despite maximal sulfonylurea therapy randomized double blind placebo controlled trial three treatment groups received either 20 mg glipizide given 30 min breakfast human proinsulin given subcutaneously bedtime \( n 5 \) , glipizide human proinsulin placebo \( n 5 \) , glipizide placebo human proinsulin \( n 5 \) glycemic regulation assessed measurements 24 h plasma glucose profiles glycosylated hemoglobin observations demonstrate combination glipizide plus human proinsulin effective either agent alone controlling overall glycemia patients niddm data support concept use agent day major effects another agent bedtime relatively
combined insulin sulfonylurea therapy treatment niddm past years , interest focused combination insulin sulfonylurea search effective treatments non insulin dependent diabetes mellitus \( niddm \) patients fail oral hypoglycemic agents although several studies demonstrated beneficial effects therapy niddm patients , average effect small observed half patients however , several problems previous studies , including small sample size , selection patients , simultaneous use several end points first , residual beta cell function considered prerequisite beneficial effect combination therapy therefore , studies failed demonstrate improved glycemic control adding sulfonylurea insulin therapy patients insulin dependent diabetes mellitus inclusion patients impaired beta cell function therefore attenuate effect combination therapy second , studies used glycemic control end point nevertheless , insulin dose reduced 20 30 avoid hypoglycemia adding sulfonylurea insulin thus , comparison made treatments smaller insulin dose sulfonylurea larger insulin dose without sulfonylurea patient likely benefit combination therapy slightly obese , niddm relatively short period , preserved beta cell function patient , combined insulin sulfonylurea therapy predominantly stimulates basal insulin secretion , resulting effective suppression hepatic glucose production lower fasting plasma glucose side effects , notably frequent mild hypoglycemic reactions
sulfonylurea treatment impaired glucose tolerance delay development complications niddm \? chronic hyperglycemia non insulin dependent diabetes mellitus \( niddm \) gradually usually preceded transient hyperglycemia , classified impaired glucose tolerance \( igt \) already phase , increased risk cardiovascular complications , many igt subjects , like niddm patients , often display several metabolic circulatory disturbances associated hyperglycemia , e g , insulin resistance , hyperinsulinemia , delayed insulin release , dyslipidemia , hypertension therefore , untreated hyperglycemia self condition , early detection early intervention may necessary prevent progression complications niddm turn would screening procedures , therapeutic goal include euglycemia normalization plasma insulin , plasma lipids , blood pressure study german republic indicated mortality screening detected niddm patients differ patients detected routine care swedish study screening detected niddm subjects , igt rather manifest niddm could maintain fasting blood glucose less equal 6 mm 5 yr dietary regulation alone screening detected niddm , delayed acute insulin release net postprandial hyperglycemia improved addition glipizide , managed attain maintain fasting blood glucose less equal 6 mm approximately 2 yr addition however , 4 yr , increase blood glucose , suggesting preventive intervention either may possible may start igt phase
insulin mimetic effects vanadate possible implications future treatment diabetes vanadate ions , low molecular weight phosphate analogues , mimic rapid actions insulin various cell types administered orally diabetic hyperglycemic rats , vanadate circulation , mimics insulin stimulation glucose uptake metabolism , leads normoglycemic partial anabolic states addition , vanadate restores tissue responsiveness insulin hepatic glycogen levels activates new synthesis key enzymes carbohydrate metabolism suggests correcting hyperglycemia sufficient correct typical metabolic alterations found streptozocin induced diabetic rats several weeks oral administration vanadate diabetic rats produced detectable liver kidney toxicity mechanism vanadate mimics actions insulin still obscure unlike insulin , vanadate seem stimulate endogenous tyrosine phosphorylation insulin receptor kinase intracellular proteins either directly virtue known inhibitory effect protein phosphotyrosine phosphatase results many studies support model vanadate activates glucose metabolism either utilizing alternative \( insulin independent \) cascade early events insulin dependent cascade either possibilities clinical importance , early insulin events may become defective , result severe hyperinsulinemia , may contribute insulin resistance alternative pathways vanadate may stimulate glucose metabolism , e g , increasing intracellular ca2 levels regulating intracellular ph , discussed clinical perspective , studies continued evaluating level vanadate toxicity prolonged treatment agents potentiate insulin mimetic actions vitro vivo
association elevated fasting c peptide level increased intra abdominal fat distribution development niddm japanese american men japanese american population king county , washington , known high prevalence non insulin dependent diabetes mellitus \( niddm \) part community based study , reexamined 146 second generation japanese american men initially classified nondiabetic mean follow period 30 mo , 15 men developed niddm , 131 remained nondiabetic variables measured initial visit distinguished 15 diabetic men 131 nondiabetic men older age , higher serum glucose level 2 h 75 g oral glucose , higher fasting plasma c peptide level , increased cross sectional intra abdominal fat area determined computed tomography older age higher 2 h glucose levels variables associated development niddm , association higher fasting c peptide level greater intra abdominal fat area subsequent development niddm new observations elevated fasting c peptide level persisted adjustment fasting serum glucose elevated c peptide level represents hypersecretion insulin interpreted reflect compensatory response underlying insulin resistant state development niddm fasting c peptide level correlated intra abdominal fat area , suggesting intra abdominal fat area may associated insulin resistance thus , individuals develop niddm , insulin resistance , increased insulin secretion , increased intra abdominal fat present diabetic glucose tolerance demonstrated
absence angiogenesis inhibitory activity aqueous humor diabetic rabbits studied inhibitory activity angiogenesis eye explore formation new blood vessels diabetic microvascular diseases examined effects extracts various ocular tissues nondiabetic rabbits proliferation bovine aortic endothelial cells , potent inhibitory activity found lens aqueous humor aqueous humor inhibited angiogenesis membrane vivo promotion endothelial cell growth vitro , induced retinal extracts however , diabetic rabbits , aqueous humor lost ability inhibit growth endothelial cells loss activity became evident 1 mo injection lasted animals hyperglycemic addition , diabetic aqueous humor failed suppress retinal extract induced angiogenesis promotion endothelial cell growth absence inhibitory activity angiogenesis diabetic aqueous humor might involved promotion neovascularization diabetic ocular disease
leucine metabolism iddm role insulin substrate availability effect insulin plasma amino acid concentrations leucine metabolism examined 18 healthy nondiabetic young volunteers 7 subjects insulin dependent diabetes mellitus \( iddm \) euglycemic insulin clamp technique \( 40 mu 2 min 1 \) combination 1 14c leucine diabetic subjects studied poor metabolic control \( fasting glucose 13 3 1 1 mm hba1c 10 8 0 2 \) 2 mo intensified insulin therapy \( fasting glucose 7 2 0 5 mm hba1c 8 0 0 2 \) insulin mediated total body glucose uptake poorly controlled diabetic subjects \( 3 6 0 5 mg kg 1 min 1 \) significantly reduced compared control subjects \( 7 5 0 2 mg kg 1 min 1 p less 001 \) improved slightly insulin therapy \( 4 8 0 3 mg kg 1 min 1 p less 05 \) , although still remained significantly lower control subjects \( p less 01 \) insulin clamp study performed subjects poorly controlled iddm , endogenous leucine flux \( \) , leucine oxidation \( lo \) , leucine disposal \( \) decreased \( 50 1 2 0 26 4 0 4 9 2 0 4 6 0 0 3 40 9 2 0 20 4 2 0 mumol 2 min 1 , respectively \) extent control subjects 2 mo intensified insulin therapy , effect acute hyperinsulinemia , lo , comparable control subjects , whereas insulin stimulated glucose metabolism still impaired examine effect substrate availability leucine turnover , well regulated iddm control subjects underwent repeat insulin clamp study combined balanced amino acid infusion designed increase circulating plasma amino acid levels approximately twofold conditions , equally enhanced baseline control iddm subjects \( p less 01 \) , whereas inhibited greater extent \( p less 01 \) insulin clamp performed without amino acid infusion \( control vs diabetic subjects , ns \) conclusion , insulin mediated glucose metabolism severely impaired subjects poorly controlled well controlled iddm , whereas effect acute insulin infusion leucine turnover normal , combined hyperinsulinemia stimulated similar extent iddm control subjects
polymorphisms hepg2 erythrocyte glucose transporter gene linkage relationships implications genetic analysis niddm assess contribution hepg2 erythrocyte glucose transporter \( hepg2 gt \) gene inherited susceptibility non insulin dependent diabetes mellitus \( niddm \) , cdna genomic probes used search restriction endonuclease polymorphisms locus analysis dna 16 unrelated black american individuals 19 enzymes many six different probes , defined four polymorphisms 45 kilobase region nucleotide diversity \( pi 0 006 \) low relative loci , average 1 base pairs different two chromosomes locus observed combined heterozygosity four sites 0 69 , indicates markers locus could useful linkage analysis families linkage disequilibrium values four polymorphisms evaluated pairwise analysis extended haplotypes calculating pairwise associations disequilibrium statistic delta another measure disequilibrium , \( maximum likelihood disequilibrium , less dependent frequency \) , significant linkage disequilibrium could demonstrated however , frequencies observed extended haplotypes shown differ \( chi 2 9 1 , df 2 , p less 0 025 \) predicted frequencies sites linkage equilibrium blacks frequencies four polymorphisms determined black nondiabetic \( n 44 \) niddm \( n 63 \) subjects neither allelic genotypic frequencies polymorphisms differed two groups
absence brown product ffi nondiabetic diabetic rat collagen accumulation brown products long lived proteins might important factor determining long term diabetic complications fluorescent 2 \( 2 \) 4 \( 5 \) \( 2 \) \( ffi \) , isolated brown products synthesized vitro , proposed specific brown product responsible functional structural changes long lived proteins study , attempt made demonstrate means collision spectroscopy presence ffi collagen samples taken diabetic rats diabetic rat collagen samples showed mean values absorbance per 4 hydroxy l proline significantly higher observed nondiabetic rats , suggesting higher ffi levels surprisingly , collagen samples diabetic nondiabetic rats gave collision spectra peak diagnostic ffi presence observed data suggest absorbance level observed diabetic rats due presence ffi structurally related compounds , investigated means mass spectrometry
family glucose transporter genes implications glucose homeostasis diabetes glucose transport facilitated diffusion mediated family tissue specific membrane glycoproteins least four members gene family identified cdna cloning hepg2 type transporter widely distributed proteins provides many cells basal glucose requirement atp production biosynthesis sugar containing macromolecules liver type transporter expressed tissues net release glucose occur beta cells pancreatic islets genetic defect resulting reduced activity transporter could lead two principal features non insulin dependent diabetes mellitus , insulin resistance relative hypoinsulinemia adipocyte muscle transporter expressed exclusively tissues insulin sensitive respect glucose uptake protein excellent candidate highly specific genetic defect predisposing insulin resistance
differences lipoprotein composition distribution type diabetic men control subjects subfractions low density low density lipoproteins examined 10 male type \( insulin dependent \) diabetic patients improvement metabolic control compared subfractions male control subjects matched diabetic patients entry age , body mass index , plasma cholesterol , plasma triglycerides two consistent differences composition noted diabetic patients entry control subjects first , subfractions diabetic patients tended cholesterol ester poor triglyceride rich particularly marked low density lipoprotein subfractions second , subfractions pretreatment diabetic patients contained higher proportions non apolipoprotein b apolipoproteins anomaly , lipid modifications , responded completely normalized improved glycemic control , also accompanied reductions plasma concentrations subfractions treatment modified distribution lipoprotein profile posttreatment diabetic patients closely resembled profile observed control subjects changes achieved without significant modification daily insulin dose context blood lipid risk factors , results argue need maintain optimal even apparently diabetic patients avoid modifications lipoprotein pattern toward potentially atherogenic profile
increased mrna pancreatic islets incubated islet cell stimulating antibodies type diabetic patients recently described autoantibodies stimulate release insulin pancreatic beta cells vitro vivo aim study establish whether islet cell stimulating antibodies \( \) also increase islet cell mrna content wistar rat islets , isolated collagenase digestion , exposed 2 7 11 1 mm glucose insulin release increased 10 fold response higher glucose concentration , dot blot analysis islet mrna rat cdna probe showed concomitant increase mrna levels globulin fractions four test , three patients type \( insulin dependent \) diabetes one patient insulin autoimmune syndrome , showed clear \( 5 8 fold \) stimulation insulin release fractions fractions three control failed stimulate secretion insulin insulin mrna content islets incubated globulin fractions greatly increased compared levels observed islets treated control serum globulin fractions conclude stimulate release insulin also increase mrna content islet cells
fasting postprandial concentrations somatostatin 28 somatostatin 14 type ii diabetes men recent evidence suggests somatostatin 28 \( srif 28 \) , cleaved cells upper intestine , acts nutrient stimulated inhibitor insulin secretion healthy men role srif 28 pathophysiology diabetes previously explored , although several groups measured circulating immunoreactivity \( \) diabetic subjects investigate possible abnormal insulin secretion diabetes srif 28 , plasma levels measured 10 non insulin dependent diabetic men 9 age weight matched control subjects concentrations srif 14 also obtained subjects admitted study overnight fast , blood collected 30 min intervals 4 h fat meal , plasma samples analyzed srif 28 srif 14 specific methods basal glucose levels diabetic men significantly higher control subjects \( 10 2 1 vs 5 8 0 2 mm \) , insulin levels similar \( 79 14 2 vs 93 3 14 2 pm \) diabetic men significantly lower basal srif 28 levels control subjects \( 11 4 0 6 vs 14 6 1 0 pm , p 0 017 \) fat intake , srif 28 levels throughout 4 h study indistinguishable two groups \( 270 vs 292 basal \) basal srif 14 levels significantly different two groups , srif 14 concentrations rose similarly meal correlations basal srif 28 glucose insulin levels
physiological pharmacological stimulation pancreatic islet hormone secretion type diabetic pancreas allograft recipients successful heterotopic denervated pancreas allograft transplantation \( pat \) often results normoglycemia peripheral hyperinsulinemia insulin dependent \( type \) diabetic recipients contribution altered hepatic insulin extraction \( \) resulting hyperinsulinemia patients remains uncertain furthermore , whether denervated pancreas allografts exhibit beta cell hyperresponsiveness physiological pharmacological stimulation controversial evaluated beta cell function successful whole cadaveric pat systemic venous drainage 13 type diabetic patients mixed meal intravenous glucose glucagon administration results compared 5 nondiabetic patients kidney transplantation , native innervated portal insulin delivery receiving equivalent triple immunosuppressive therapy \( cyclosporin , azathioprine , prednisone \) , 7 healthy control subjects family history diabetes pat , fasting serum glucose concentrations normalized pat associated marked basal hyperinsulinemia \( 3 8 fold \) assessed immunoreactive insulin \( \) levels type diabetic patients \( mean se 345 43 pm \) compared control subjects \( 43 14 pm \) nondiabetic kidney transplantation patients \( 129 38 pm \) mixed meal ingestion , mean incremental integrated insulin area similar pat patients \( 18 3 nm min \) compared kidney transplantation patients \( 20 4 nm min \) healthy control subjects \( 21 3 nm min \) basal serum c peptide levels significantly greater pat \( 1 72 0 13 nm \) kidney transplantation \( 2 15 0 33 nm \) patients healthy control subjects \( 0 50 0 10 nm p less 0 01 \)
properties trace elements characterization vivo mode action lithium vanadate actions vitro study , examined vivo effects lithium vanadate glucose metabolism diabetic \( 90 partial pancreatectomy \) rats four groups chronically catheterized rats studied control , diabetic , diabetic treated lithium \( plasma 1 0 0 1 meq l \) vanadate \( 0 05 mg ml drinking water \) , diabetic treated lithium , vanadate , zinc , magnesium plasma glucose increased diabetic versus control rats \( 18 7 vs 7 7 mm , p less 0 01 \) normalized addition lithium vanadate \( 8 mm \) lithium , vanadate , zinc , magnesium \( 7 4 mm \) euglycemic insulin clamp studies performed 2 wk posttreatment insulin mediated glucose uptake reduced diabetic compared control rats \( 142 4 vs 200 5 mumol kg 1 min 1 , p less 0 01 \) , returned normal lithium vanadate \( 206 6 mumol kg 1 min 1 \) , increased levels lithium , vanadate , zinc , magnesium \( 238 6 mumol kg 1 min 1 \) insulin clamp , muscle rate severely impaired diabetic versus control rats \( 18 vs 70 mumol kg 1 min 1 \) normalized lithium vanadate \( 91 mumol kg 1 min 1 \) lithium , vanadate , zinc , magnesium \( 93 mumol kg 1 min 1 \)
limited duration remission insulin dependency children recent overt type diabetes treated low dose cyclosporin preliminary data group indicated cyclosporin induced frequent remissions insulin dependency group 40 insulin dependent \( type \) diabetic children given onset clinical manifestations diabetes report 2 yr analysis response cyclosporin group 81 patients included initial study observed , remission could obtained patients \( 65 \) association shorter duration symptoms , less severe hyperglycemia , lower incidence ketoacidosis , higher plasma c peptide concentrations remissions ended follow period mean se duration 21 days \( range 31 days \) two parameters linked duration remissions mean circulating level cyclosporin first 3 mo duration unable relate end remission variations cyclosporin regimen , titer autoantibodies , progression beta cell failure euglycemic clamp technique revealed insulin sensitivity decreases time patients taking insulin 24 mo , patients remission insulin dependency better glycemic control , lower insulin dosages , c peptide levels two threefold higher patients four sixfold higher historical control subjects cyclosporin regimen well tolerated observed period specifically , serum creatinine remained unchanged , kidney biopsies performed 18 24 mo treatment within normal limits
biochemical studies rt6 alloantigens bb normal rats evidence intact structural gene diabetes prone bb rats lymphocytes bearing lymphocyte differentiation antigen rt6 play important immunoregulatory role development autoimmune diabetes bb rats immunofluorescence studies suggest diabetes prone \( dp \) diabetes resistant \( dr \) bb rat lymphocytes fail express rt6 antigen ontogeny two forms molecule exist , e , rt6 1 rt6 2 linked cell membranes phosphatidylinositol \( pi \) linkage studies , pi phospholipase c \( plc \) treatment lymphocytes bb normal rats followed sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis released proteins anti rt6 specific monoclonal antibodies performed rt6 1 several nondiabetic rat strains found consist family variably glycosylated molecules n resistant 24 , 000 26 , 000 mr peptide four n sensitive peptides 29 , 000 , 31 , 000 , 33 , 000 , 34 , 000 mr contrast , rt6 2 found 24 , 000 26 , 000 mr polypeptide electrophoretic pattern rt6 1 observed antigen extracted 25 \( cd4 \) versus 25 lymphocytes resting versus mitogen activated cells pattern bands characteristic rt6 1 antigen found normal rat strains detected plc treatment detergent lymphocytes obtained dr rats contrast , evidence either rt6 species found plc detergent treatment comparable numbers lymphocytes dp bb rats interestingly , lymphocytes wistar \( rt6 2 \) x dp \( rt6 \) f1 crosses observed rt6 2 rt6 1 molecules , electrophoretic pattern rt6 1 similar obtained dr rat strains study provides biochemical evidence dp rats may intact structural gene
diabetes myo inositol paradox test general applicability hypothesis diabetes mellitus causes increased pathway activity , decreased tissue free myo inositol , resultant pathological changes tissues susceptible diabetes , measured glucose , sorbitol , myo inositol quantitative histochemical techniques layers cornea , aortic , cardiac left ventricle atrioventricular node \( avn \) , retina kidney 19 days 2 mo \( mildly diabetic non insulin treated md severely diabetic insulin treated sd groups \) induced diabetes model aqueous humor , glucose rose linearly increased serum glucose , sorbitol markedly increased md sd groups , myo inositol change diabetic group change glucose sorbitol aortic group , decreased 19 day diabetic rabbits 26 , unchanged md rabbits paradoxically increased 60 sd rabbits glucose , sorbitol , myo inositol increased three corneal layers sd rabbits epithelium stroma 19 day md rabbits avn glucose sorbitol change 19 day diabetic , md , sd diabetic rabbits avn myo inositol three times higher ventricular myo inositol appear change sd rabbits retinal pigmented epithelium myo inositol decreased 30 sd rabbits glomerular myo inositol also decreased , significantly , sd rabbits conclude paradoxical increase corneal myo inositol raises fundamental questions general applicability myo inositol depletion hypothesis
uncoupling biliary lipid bile acid secretion organic anions rat number organic anions shown inhibit biliary phospholipid cholesterol secretion without affecting bile acid secretion however , mechanism uncoupling phenomenon still unclear study shows comparison effects ampicillin \( 18 mumol body wt \) , sulfated acid \( 0 2 1 0 mumol 100 g body wt \) , indocyanine green \( 0 6 mumol 100 g body wt \) control groningen yellow wistar rats chronic \( 8 days \) biliary drainage groningen yellow rats hereditary defect hepatobiliary transport various organic anions bile secretion , hepatic uptake , three organic anions strongly impaired groningen yellow rats compared controls ampicillin sulfated acid caused strong uncoupling control rats effect much smaller effect lipid secretion groningen yellow rats indocyanine green affect lipid secretion , either control groningen yellow rats gel filtration chromatography bile showed specific ampicillin sulfated acid bile acid fraction , whereas indocyanine green phospholipid cholesterol fraction study concludes uncoupling ampicillin sulfated acid occurs secretion bile caused interaction compounds bile acids hypothesized interaction inhibits capacity bile acids induce secretion phospholipids cholesterol bile
practical nutritional advice elderly , part evaluation , supplements , panel discussion time someone old age , know , need , know nutrition yet malnutrition many effects rising danger first two panel discussion , nutritional experts review practical concerns treating physician , including assessment , interpretation weight loss , use supplements , relevance elderly
hyponatremia rats induces downregulation vasopressin synthesis hyponatremia due inappropriate secretion vasopressin common disorder human pathophysiology , vasopressin synthesis investigated used new method quantitate synthesis vasopressin rats 3 , 7 , 14 hyponatremia induced administering ddavp \( vasopressin agonist \) liquid diet vasopressin synthesis completely turned 7 vasopressin mrna levels hypothalamus paralleled reduction synthesis reduced levels 10 15 content control rats hyponatremia corrected withdrawal ddavp , vasopressin mrna slowly returned normal 7 observation vasopressin synthesis completely turned leads several conclusions normal physiological conditions chronically upregulated must osmotic threshold initiation vasopressin synthesis \( release \) large store hormone posterior pituitary essential vasopressin available times decreased synthesis , finally , stimulus synthesis must present clinical disorders vasopressin secreted \( synthesized \) despite
relationship content lysyl oxidase dependent cross links skin collagen , nonenzymatic glycosylation , long term complications type diabetes mellitus many abnormalities collagen reported insulin dependent diabetes mellitus , attributed increased cross linking although recent work focused role glucose derived collagen cross links pathogenesis diabetic complications , relatively studies investigated role lysyl oxidase dependent \( lox \) cross links present study , lox cross links nonenzymatic glycosylation quantified skin collagen diabetic subjects increase cross link \( \) well one maturation products , lox normal nonenzymatic glycosylation increased diabetic skin collagen , increase correlated increases \( p less 0 001 \) biochemical results examined correlations clinical data subjects increases content associated duration diabetes \( p less 0 003 \) , levels \( p less 0 001 \) , hand contractures \( p less 0 05 \) , skin changes \( p less 0 005 \) , microalbuminuria \( p less 0 01 \) nondiabetic subjects age correlated collagen cross link content exception increased age \( r 0 79 , p less 0 02 \) diabetic subjects , pa levels decreased age \( r 0 51 , p less 0 02 \) increased duration diabetes , content increased \( r 0 55 , p less 0 003 \) increased \( r 0 59 , p less 0 01 \) , whereas pa levels decreased \( r 0 48 , p less 0 04 \) nonenzymatic glycosylation collagen also increased increased duration diabetes \( hex , r 0 47 , p less 0 02 hex , r 0 39 , p less 0 05 \) conclude \( \) lysyl oxidase dependent cross linking increased skin collagen diabetes \( b \) changes skin collagen correlated duration diabetes , glycemic control , long term complications
chylomicron remnant clearance plasma normal familial hypercholesterolemic homozygotes defined receptor defects palmitate fat tolerance test used measure chylomicron remnant clearance 10 normal subjects \( apolipoprotein e apo e isotypes 3 4 \) , 6 apo e2 2 homozygotes 5 familial hypercholesterolemic homozygotes skin fibroblasts fully upregulated ldl receptors latter subjects degraded rabbit 125i beta vldl vitro rates ranging less 10 48 normal experiments vivo revealed significant differences normal homozygous familial hypercholesterolemic \( \) subjects chylomicron remnant clearance assessed basis areas curves palmitate levels present post serum , chylomicron remnants \( sf less 1 , 000 \) , \( sf greater 1 , 000 \) remnant clearance greatly decreased times apo e2 2 homozygotes , indicative important degree flux control exerted receptor mediated step involving apo e ligand absence excess remnant accumulation subjects varying impairment ldl receptor mediated degradation apo e containing lipoproteins , permits conclusion chylomicron remnants initially cleared plasma apo e recognizing receptors genetically distinct ldl receptors
regulation parathyroid hormone gene expression , , vitamin rat vivo rat 1 , 25 \( oh \) 2d3 decreases low calcium increases pth mrna levels report effect 3 8 wk changes dietary vitamin calcium pth mrna levels pth mrna levels increased 3 wk calcium deficiency \( five times \) , vitamin deficient diet \( two times \) , combined deficiency \( 10 times \) , changed high calcium vitamin deficient diet pth mrna decrease single large dose 1 , 25 \( oh \) 2d3 , decrease partially repeated daily doses 1 , 25 \( oh \) 2d3 rats vitamin , calcium deficient \( ca \) diet respond changes serum calcium 1 h flow cytometry isolated cells parathyroid thyroid tissue separated smaller parathyroid larger thyroid cells allowed analysis parathyroid cell number normal vitamin normal calcium \( \) rats parathyroid cells 24 7 3 4 \( n 6 \) total cell number , whereas ca rats 41 8 6 6 \( n 6 \) \( p less 0 05 \) , ca rats 1 7 times number cells , whereas 10 times amount pth mrna , indicating major contribution \( 6 times \) increased pth gene expression per cell moreover , calcium deficient , vitamin deficient diet , expression pth gene , vitamin necessary intact response pth mrna 1 , 25 \( oh \) 2d3 calcium
promoting adherence low fat , low cholesterol diets review recommendations evidence lowering blood cholesterol levels reduces risk coronary heart disease prompted widespread recommendations hyperlipidemic individuals undergo dietary therapy however , extent people adopt maintain diets lower lipids unclear article , review currently known regarding adherence low fat diets present approach dietary counseling lowering cholesterol elements behavioral self management social learning theory discuss specific recommendations counseling hyperlipidemic patients based dietary alternatives study recommendations include providing patients adequate knowledge base make dietary changes , using goal setting self monitoring help patients initiate dietary changes , support patient 's family , enhancing self efficacy promote long term dietary maintenance
beneficial effects fetal liver tissue fetal pancreatic transplantation recently , composite grafts hepatocytes islets shown improve survival hepatocytes possibility reciprocal effect hepatocytes islet function investigated diabetic lewis rats \( 1 \) fetal pancreas fetal liver \( fp fl \) , \( 2 \) fetal pancreas alone \( fp \) , \( 3 \) fetal pancreas fetal spleen \( fp fs \) grafts transplanted small bowel \( 6 6 \) fp fl recipients cured \( glucose less 250 mg dl greater 30 days \) , whereas 72 \( 13 18 \) fp alone 60 \( 3 5 \) fp fs recipients cured amount time normoglycemia fp fs recipients less \( 26 15 days \) compared fp \( 50 29 days \) fp fs recipients \( 71 40 days \) mean glucose levels 6 weeks 166 78 mg dl , 237 97 mg dl , 355 81 mg dl cured fp fl , fp , fp fs recipients , respectively glucose tolerance test results significantly different nondiabetic control rats contrast fp alone , fp fl recipients well hyperplastic islets hepatocytes histologic examination new isograft recipients treated cyclosporine , fp recipients remained hyperglycemic however , 75 \( 6 8 \) fp fl recipients cured conclusion , fl composite graft fp resulted better engraftment , earlier isograft function , protection cyclosporine islet toxicity
assessment cardiac function patients morbidly obese cardiac function 30 patients morbidly obese studied surgery twelve patients studied 13 4 months surgery patients mean age 37 1 2 9 years body mass index 50 0 1 4 kg m2 cardiac function measured echocardiography , radionuclide angiography scanning , right heart catheterization determine degree cardiac dysfunction , patients studied exercise intravenous fluid challenges ultrasonography produced evidence myocardial thickening increased interventricular septum eight patients \( 32 \) increased left ventricular mass 17 patients \( 53 \) radionuclide scan suggested morbid obesity associated significantly \( p less 0 05 \) increased end diastolic volume decreased left ventricular ejection fraction compared patients normal weight exercise patient normal weight increase end diastolic volume , stroke volume , heart rate , patient morbidly obese increased heart rate produce necessary increase cardiac output right heart catheterization indicated relationship pulmonary wedge pressure left ventricular stroke work index abnormal 14 29 patients \( 48 3 \) depressed six 29 patients \( 20 7 \) exercise one liter fluid caused abnormal relationship pulmonary wedge pressure left ventricular stroke work index 12 30 patients \( 40 \) depressed response 10 30 patients \( 33 3 \) cardiac studies repeated 12 patients 54 8 1 9 kg weight loss echocardiography indicated decrease dilatation \( 27 3 9 1 \) significant \( p less 0 05 \) decrease hypertrophy \( 45 5 0 \) weight loss , radionuclide right heart catheterization studies indicated improved cardiac function reduced filling pressures increased left ventricular work fluid exercise challenges results support presence obesity related cardiomyopathy ventricular dysfunction , appears caused noncompliant ventricle significant weight loss achieved results increased ventricular compliance improved cardiac function
changing epidemiology diabetes mellitus among navajo indians although early descriptions diabetes mellitus among navajo indians characterized disease infrequent benign chemical abnormality , prevalence diabetes complications among appears increased substantially century reviewed recent indian health service inpatient ambulatory care data compared data previous reports estimated navajo population aged 45 years older , 4 , \( 16 9 \) ambulatory care visit diabetes october 1 , 1986 , september 30 , 1987 diabetes coded 1 , 041 \( 7 0 \) hospital admissions persons aged 20 older lower extremity amputations done 1978 1987 , diabetes involved 245 \( 66 \) 1986 age adjusted mortality rate diabetes 30 3 per 100 , 000 , approximately twice general us population explanation increased prevalence diabetes mellitus among probably relates increasing prevalence obesity
overview hemochromatosis hemochromatosis autosomal recessive genetic disorder occurs high prevalence populations european origin gene abnormal hemochromatosis found short arm chromosome 6 close proximity \( approximately 1 \) hla , product coded gene unknown pathogenetic mechanism hemochromatosis continued , excessive absorption dietary iron loss normal control mechanisms , leading gradual vast expansion storage iron ferritin especially mechanisms probably include peroxidation lipid membranes , excess iron hepatocytes , islet b cells , anterior pituitary , myocardium , synovial cells , chondrocytes , probably cells tissues well patients hemochromatosis remain undiagnosed throughout life removal excess iron phlebotomy prevent complications hemochromatosis begun early significantly improve survival virtually patients important , therefore , diagnosis hemochromatosis considered much frequently clinical medicine order effective therapy utilized
serial evaluation lipid profiles risk factors development hyperlipidemia cardiac transplantation determine prevalence , time course factors responsible hyperlipidemia heart transplantation , 83 consecutive 1 year survivors studied 1 year , 83 patients serum total cholesterol levels greater 5 2 mmol liter \( 200 mg dl \) 28 patients serum total cholesterol higher age sex matched ninety fifth percentile end 1 year follow , serum total cholesterol correlated recipient age \( p less 0 0001 \) , preoperative cholesterol level \( p less 0 001 \) , actual dose maintenance prednisone 1 year \( p less 0 02 \) cumulative 1 year steroid dose \( p less 0 03 \) similarly , serum triglyceride level 1 year correlated pretransplant level serum triglycerides \( p less 0 0001 \) , recipient age \( p less 0 03 \) cumulative 1 year steroid dose \( p less 0 03 \) patients pretransplant diagnosis coronary artery disease significantly higher level serum total cholesterol triglyceride levels 1 year \( p less 0 02 p less 0 03 , respectively \) heart transplant recipients body mass index greater equal 25 kg m2 also presented significantly elevated serum total cholesterol triglyceride levels 1 year compared nonobese patients \( p less 0 01 p less 0 002 , respectively \) hyperlipidemia occurs frequently detected within first month heart transplantation optimal management problem requires study
haplotype analysis human apolipoprotein b mutation associated familial defective apolipoprotein haplotype analysis conducted mutant allele 14 unrelated subjects heterozygous mutation codon amino acid human apolipoprotein mutation associated defective binding low density lipoprotein low density lipoprotein receptor moderate hypercholesterolemia ten markers used eight markers within structural gene two hypervariable loci flanking gene seven eight unequivocally deduced haplotypes identical , one revealed minor difference one hypervariable loci genotypes six affected subjects consistent assigned haplotype data consistent common chromosome provide evidence recurrent mutation potentially dinucleotide , despite fact mutation rare
definitive prenatal diagnosis type iii glycogen storage disease prenatal diagnosis type iii glycogen storage disease performed using \( 1 \) immunoblot analysis polyclonal antibody prepared purified porcine muscle enzyme \( 2 \) qualitative assay enzyme activity cultured amniotic fluid cells three pregnancies \( three families proband absence protein \) subjected immunoblot analysis two unaffected one affected fetus predicted addition , cultured amniotic fluid cells nine pregnancies \( eight families \) screened qualitative assay based persistence polysaccharide structure approaching limit cells exposed glucose free medium qualitative assay predicted six unaffected three affected fetuses predictions either method confirmed except one spontaneously aborted fetus data indicate definitive diagnosis type iii glycogen storage disease made prenatally methods
alkaline phosphatase \( tissue nonspecific isoenzyme \) phosphoethanolamine 5' phosphate normal fibroblast study clarify physiologic role , alkaline phosphatase \( alp \) examined normal skin fibroblasts shown tissue nonspecific \( \) isoenzyme type \( evidenced heat inhibition profiles \) active toward concentrations putative natural substrates phosphoethanolamine \( pea \) 5' phosphate \( plp \) fibroblast alp low affinity activity , alkaline ph optimum \( 9 3 \) , toward 4 phosphate \( 4 mup \) , pea , plp physiologic ph optimum \( 8 3 \) toward physiologic concentrations \( micromolar \) pea plp normal fibroblast alp linked outside plasma membrane , since intact cell monolayers \( 1 \) rates membrane impermeable substrates pea plp medium physiologic ph similar observed disrupted cell monolayers , \( 2 \) brief exposure acidic medium resulted greater 90 inactivation total alp activity , \( 3 \) digestion phosphatidylinositol specific phospholipase c \( pi plc \) released 80 alp activity fibroblasts markedly deficient \( 2 5 control values \) alkaline physiologic alp activity 4 mup , plp , pea used substrate majority detectable alp activity , however , appeared properly lipid anchored orientation thus , findings genetic deficiency pea plp phosphatase activity fibroblasts , well biochemical findings , indicate alp acts physiologically lipid anchored pea plp
aberrant localization substrate specificity alkaline phosphatase cultured skin fibroblasts explored biochemical basis disorder \( \) one patient examining substrate specificity localization alkaline phosphatase \( alp \) cultured dermal fibroblasts despite substantial alp activity , cell homogenates , toward artificial substrate 4 methyl phosphate \( 4 mup \) , marked deficiency alp activity toward natural substrates 5' phosphate \( plp \) phosphoethanolamine \( pea \) , indicating altered substrate specificity furthermore , although 4 mup phosphatase \( 4 mup p'tase \) activity predominantly localized enzyme , small amount plp phosphatase \( plp p'tase \) activity intracellular differential localization apparent intact cells , since \( 1 \) brief acidification medium 4 degrees c inactivated majority 4 mup p'tase activity 15 plp p'tase activity \( contrast greater 85 inactivation homogenates \) , \( 2 \) greater 70 4 mup p'tase activity 30 plp p'tase activity released phosphatidylinositol specific phospholipase c \( pi plc \) digestion , \( 3 \) degradation extracellular plp less 35 disrupted cells 4 mup plp p'tase activities predominantly lipid anchored form could converted soluble , lipid free form pi plc digestion findings suggest clinical biochemical presentation patient results production two aberrant alp species one form alp appropriate preferentially deficient activity toward natural substrates alp species appropriate substrate specificity substrates intracellular location
long term maternal fetal exposure high low insulin concentrations alter liver brain insulin receptors investigated effects long term \( 5 6 days \) vivo exposure hyperinsulinemia hypoinsulinemia maternal fetal rat \( 18 20 gestation term approximately 21 days \) brain liver insulin receptors studied vitro effects long term insulin exposure cultured rabbit neuronal cell insulin receptors long term glucose infusions maternal rats resulted maternal fetal hyperglycemia mild hyperinsulinemia , decreases liver insulin receptor abundance mother increased fetus streptozotocin induced maternal diabetes resulted maternal fetal hyperglycemia hypoinsulinemia \( near normal insulin levels \) increased maternal fetal liver insulin receptors maternal fetal brain insulin receptor abundance failed change high low insulin concentrations similarly long term insulin \( 5 micrograms ml \) exposure failed alter cultured neuronal cell insulin receptors well conclude perturbations maternal fetal circulating insulin concentrations fail affect brain insulin receptors protective phenomenon may critical maintaining normal neuronal energy balance functioning certain disease states diabetes mellitus
use doppler flow velocity waveform analysis detection initial diabetic microangiopathy doppler flow velocity waveform analysis \( \) , recorded pedis artery \( dpa \) radial artery \( ra \) , performed 36 women attempting detect initial diabetic microangiopathy \( dm \) study comprised two groups women affected non insulin dependent diabetes mellitus , 6 patients \( pts \) reproductive age \( 1 \) , 12 pts menopause \( ii \) , two groups age matched healthy controls \( c \) \( iii iv \) clinical signs initial dm present group examined pts nonsmokers normotensive without , signs diabetic , collagen vascular disease raynaud 's phenomenon , renal failure four waveform dimensions capable separating different degrees peripheral obstructive arteriolar disease determined velocity tracing results used single best discriminant equation resultant discriminant score \( ds \) , derived dpa , showed highly accurate rate separating young pts dm c pts menopause without dm furthermore , resultant ds statistically different groups ii , iii , iv conclusion , dpa , experience , proved accurate sensitive method detection initial dm
assessment vitamin status disk applicator conjunctival impression cytology conjunctival impression cytology performed 236 preschool children , half mild half age matched controls devised applicator paper disk fixed area conjunctiva even pressure disk applicator used collect impression cytology specimens temporal bulbar conjunctiva one eye original strip technique used eye mean \( sd \) serum retinol values children normal abnormal discs 22 0 8 6 micrograms dl 18 0 7 2 micrograms dl p less 0001 \) mean serum values normal abnormal strips 21 7 8 6 micrograms dl 19 0 7 7 micrograms dl \( p less 03 \) specimens obtained new disk applicator corresponded closely serum vitamin levels therefore vitamin status obtained traditional strip technique
antigen identification human cell lymphocyte proliferation sites immune responses normal retinal proteins , including antigen , demonstrated patients variety retinal disorders , well received laser photocoagulation cell lymphocytes \( cells \) implicated pathogenesis several ocular inflammatory diseases possible autoimmune etiology used synthetic peptides correspond amino acid sequence antigen lymphocyte proliferation assays identify specific sites molecule recognized human cells ten patients type ii diabetes studied initial laser photocoagulation proliferative diabetic retinopathy cell responses , expressed stimulation index , antigen peptides negative patients treatment three weeks laser photocoagulation , eight 10 assays positive \( stimulation index greater 2 p less 01 \) lymphocytes stimulated peptide bsa \( 273 292 \) six nine positive \( p less 01 \) peptide bsa \( 303 \) six six positive \( p less 001 \) peptide bsa \( 343 \) study identifies several specific sites antigen elicit human immune responses implications findings regard pathogenesis treatment autoimmune uveitis discussed
lens early onset diabetes non lenses studied means photography digital image analysis 153 patients early onset insulin dependent diabetes 153 non diabetic controls anteroposterior axial lens thickness , cortical thickness , nuclear thickness , anterior posterior , anterior chamber depth assessed highly significant differences lenses diabetic subjects non diabetic controls found effect age accounted within diabetic subgroup , diabetic duration found highly significant determinant lens dimensions , age related dimensional changes various parameters accelerated 52 121 onset diabetes diabetic duration early onset diabetic subjects studied work accurately known , report first precise assessment effect diabetic duration lens possible
minimal diabetic retinopathy pattern diffuse flash measured 20 normal subjects 40 diabetic patients either normal amplitudes pattern found similar normals diabetics case flash diabetic patients showed division two main groups one group dissimilar group normal subjects , second group showed amplitudes explanation could given , data collected , subdivision , though suggested might reflect degree metabolic disturbance
recent progress understanding apolipoprotein b past 5 years , investigators many different laboratories contributed greatly increased understanding two important lipid carrying proteins plasma apo b 100 apo b 48 apo b 100 , extremely large protein composed 4 , amino acids , synthesized liver crucial assembly triglyceride rich vldl particles apo b 100 virtually protein ldl , cholesteryl ester enriched class lipoproteins metabolic products vldl apo b 100 ldl serves ligand ldl receptor mediated uptake ldl particles liver extrahepatic tissues ldl receptor binding region apo b 100 located portion molecule , whereas lipid binding regions appear broadly dispersed throughout length apo b 48 contains amino terminal 2 , 152 amino acids apo b 100 produced intestine result single nucleotide apo b mrna , changes codon apo b 100 amino acid 2 , 153 premature stop codon apo b 48 obligatory structural role formation therefore , synthesis essential absorption dietary fats fat soluble vitamins apo b 48 apo b 100 encoded chromosome 2 single gene contains 29 exons 28 elevated level apo b 100 plasma potent risk factor developing premature atherosclerotic disease past 3 years , many different apo b gene mutations affect concentrations apo b cholesterol plasma characterized mutation codon apo b 100 amino aid 3 , 500 associated hypercholesterolemia mutation results poor binding apo b 100 ldl receptor , thereby causing cholesteryl ester enriched ldl particles accumulate plasma disorder called familial defective apo b 100 , probably cause premature atherosclerotic disease familial condition associated abnormally low levels apo b cholesterol affected individuals may actually reduced risk atherosclerotic disease \( abstract truncated 400 words \)
low dose lovastatin safely lowers cholesterol cardiac transplantation hypercholesterolemia occurs many cardiac transplant patients may graft coronary well contributing peripheral vascular disease lovastatin , inhibits 3 hydroxy 3 coenzyme reductase , doses 40 80 mg day effectively lowers cholesterol general cardiac population associated cardiac transplant recipients determine whether lower doses lovastatin would effective safe lowering cholesterol cardiac transplantation , 44 patients blood cholesterol greater 200 mg dl least 6 months cardiac transplantation received 10 20 mg lovastatin daily addition , lovastatin enzyme inhibitor level assayed six patients determine whether metabolism drug abnormal lovastatin decreased total cholesterol 28 282 54 208 62 mg dl \( p less 0 005 \) , primarily reduction low density lipoprotein fractions , well tolerated without symptoms abnormal creatine phosphokinase levels 43 44 patients one patient developed reversible renal failure lovastatin increased 40 mg daily enzyme inhibitor levels six transplant patients 4 2 7 8 times higher measured normal volunteers low dose lovastatin effectively lowers cholesterol patients transplantation , metabolism altered , perhaps cyclosporine monitoring enzyme inhibitor levels may required allow safe administration drug cardiac transplant recipients
diabetic patients abnormal cerebral autoregulation cardiopulmonary bypass tested hypothesis insulin dependent diabetic patients coronary artery bypass graft surgery experience altered coupling cerebral blood flow oxygen consumption study 23 patients \( 11 diabetics 12 age matched controls \) , cerebral blood flow measured using clearance , alpha blood gas managed cardiopulmonary bypass conditions hypothermia diabetic patients , cerebral blood flow 26 6 2 42 degrees c 25 3 14 34 ml 100 g min 36 9 0 58 degrees c 27 3 7 40 ml 100 g min \( p ns \) control patients increased cerebral blood flow 20 7 6 78 ml 100 g min 28 4 2 81 degrees c 37 6 8 81 ml 100 g min 36 5 0 45 degrees c \( p less equal 0 005 \) oxygen consumption calculated jugular bulb effluent increased hypothermic values 0 52 0 20 ml 100 g min diabetics 1 26 0 28 ml 100 g min \( p 0 001 \) rose 0 60 0 27 1 49 0 35 ml 100 g min \( p 0 0005 \) controls thus , despite temperature mediated changes oxygen consumption , diabetic patients increase cerebral blood flow metabolism increased arteriovenous oxygen saturation gradients oxygen extraction across brain calculated arterial jugular bulb blood samples increase arteriovenous oxygen difference temperature conditions diabetic patients controls significantly different \( p 0 01 \) data reveal diabetic patients lose cerebral autoregulation cardiopulmonary bypass compensate imbalance adequate oxygen delivery increasing oxygen extraction
effects lovastatin diabetic patients treated chlorpropamide patients non insulin dependent diabetes mellitus \( niddm \) higher risk atherosclerotic cardiovascular disease nondiabetic subjects seven patients hypercholesterolemia niddm controlled chlorpropamide , lovastatin \( 20 mg b 6 weeks \) lowered low density lipoprotein cholesterol 28 , total cholesterol 24 , apolipoprotein b 24 lovastatin levels 4 hour period \( measured 3 hydroxy 3 coenzyme reductase inhibitory activity \) similar measured previously nondiabetic patients lovastatin alter chlorpropamide kinetics glycemic profiles patient elevation serum transaminases creatinine phosphokinase , patient laboratory clinical drug related adverse experience study lovastatin effective reducing low density lipoprotein cholesterol patients niddm nondiabetic subjects diabetic control unaltered , evidence alteration lovastatin chlorpropamide blood levels noted
insulin use niddm rationale based pathophysiology disease basal hyperglycemia major feature non insulin dependent diabetes mellitus , diabetes control monitored fasting blood glucose concentration sequence therapies proposed major aim maintain near normal fasting blood glucose concentrations , expectation help prevent development long term complications diet therapy longer effective keeping fasting blood glucose level less 6 mm , basal insulin supplement long acting insulin added monitored fasting blood glucose concentration , little risk hypoglycemia , patient continue normal life style without restrictions concerning exercise size individual meals basal insulin supplement induce marked weight gain dose insulin required predicted level fasting blood glucose degree obesity , provides index accompanying insulin resistance based current evidence , insulin therapy equally appropriate patients insulin deficiency insulin resistance , benefit maintaining near normal glucose concentrations probably putative risk hyperinsulinemia severely affected patients , additional regular insulin cover meals needed lowering fasting blood glucose normal basal insulin supplement reduces endogenous insulin production , may advantageous accompanying production islet amyloid polypeptide islet amyloid formation also reduced
insulin administration via liposomes liposomes used insulin therapy means selectively target insulin liver , enhance oral absorption insulin , prolong insulin action liposomes effective means delivering insulin specifically hepatocytes usefulness targeted liposomes treatment diabetes restricted due requirement given intravenously , dilute concentration insulin present liposomal preparations , cost associated production insulin liposomes results enhanced oral absorption insulin high doses insulin required , coupled extreme variability glycemic response liposomes , limits value liposomal insulin viable diabetic therapy insulin action sustained via encapsulation insulin liposomes given subcutaneously insulin appears remain injection site , presence lipid matrix subcutaneous insulin delivery raises concerns enhanced antigenicity liposomal insulin given subcutaneously viewed light limitations outlined , contribution liposomal insulin understanding treatment diabetes mellitus probably via use targeted liposomes pharmacological probe role liver metabolic complications associated diabetes mellitus
monomeric insulins experimental clinical implications due inherent pharmacokinetic properties available insulins , normoglycemia rarely , ever , achieved insulin dependent diabetic patients without compromising quality life subcutaneous insulin absorption influenced many factors , among associated state insulin \( \) pharmaceutical formulation may importance review describes development series human insulin analogues reduced tendency self association , rapid absorption , better suited meal related therapy dna technology made possible prepare insulins remain dimeric even monomeric high concentration introducing one amino acid substitutions human insulin analogues characterized used mechanisms involved subcutaneous absorption investigated preliminary clinical studies relative receptor binding vitro potency \( free fat cell assay \) , ranging 0 05 600 relative human insulin , strongly correlated \( r 0 97 \) vivo , analogues exhibited approximately 100 activity , receptor mediated clearance confirmed clamp studies correlation receptor binding clearance observed thus , analogue reduced binding clearance gives higher circulating concentrations , reduced potency cellular level absorption studies pigs revealed strong inverse correlation \( r 0 96 \) rate subcutaneous absorption mean association state insulin analogues studies also demonstrated monomeric insulins absorbed three times faster human insulin healthy subjects , rates disappearance two three times faster dimeric monomeric analogues human insulin concomitantly , rapid rise plasma insulin concentration earlier hypoglycemic response analogues observed monomeric insulin lag phase followed course throughout absorption process contrast , two phases rate absorption identified dimer three normal human insulin initial lag phase subsequent accelerated absorption soluble insulin explained associated state native insulin pharmaceutical formulation progressive dissociation smaller units absorption process light results , effects insulin concentration , injected volume , temperature , absorption process also understood \( abstract truncated 400 words \)
devices insulin administration significant need revised , safe , effective insulin delivery methods subcutaneous injections treatment type \( insulin dependent \) type ii \( non insulin dependent \) diabetes aim review describe rationale methods better use injection infusion devices intensive insulin therapy describe results animal human research lead implantable artificial pancreas injection devices , e g , jet , insulin , access ports , cannot considered major breakthrough improved control , although may improve patient 's comfort external pumps benefits multiple injections conventional insulin therapy specific subgroups patients , e g , recurrent severe hypoglycemia , used experienced personnel external artificial pancreas \( \) also used experienced personnel limited clinical research applications , e g , surgery diabetic patient development implantable version artificial pancreas linked progress field reliable long duration glucose finally , implantable insulin pumps , used open loop delivery system , promising alternative intensive subcutaneous insulin strategies short term , although clear evidence improved safety efficacy remains documented
role insulin management surgical patients diabetes mellitus surgery likely event lifetime patients diabetes , health care team members need aware metabolic problems may occur perioperative period surgery , especially presence general anesthesia , produce response generally due elevation counterregulatory hormones , although endogenous insulin also suppressed excessive lipolysis occur surgery particularly deleterious effects patients diabetes thus , sufficient insulin must provided period suppress catabolic processes major controversy regarding surgery diabetes concerns route insulin administration article reviews various treatment options patients insulin dependent non insulin dependent diabetes mellitus , particular emphasis role insulin special situations , e g , outpatient surgery , coronary artery bypass , emergency surgery , also discussed
natural history beta cell dysfunction niddm non insulin dependent diabetes mellitus \( niddm \) characterized insulin resistance beta cell dysfunction review focuses beta cell , defects occur two major anatomic observations made niddm beta cell mass mildly reduced , especially obesity taken account also , amyloid deposits frequently observed islets unclear whether changes genetically mediated result secondary loss glucose homeostasis many studies looked aspect insulin secretion niddm , two types distinct abnormalities described early , marked disruption pulsatile insulin delivery , potentially important insulin resistance unclear whether loss pulsatile delivery acquired genetically induced later , glucose intolerance started , several secretory abnormalities develop coincident loss beta cell net result deterioration timing insulin delivery postprandial hyperglycemia second important consequence glucose blindness inherent compensatory beta cell mechanisms hyperglycemia propose loss glucose responsiveness direct result elevated glucose concentration \( called \) generated substantial data rat models support idea logical conclusion beta cell function niddm achieving best metabolic control possible
reduced effects peptide \( 7 36 \) gastric inhibitory polypeptide isolated perfused diabetic rat pancreas pathophysiological role diabetes mellitus established therefore examined effects peptide \( 7 36 \) \( truncated glp \) gastric inhibitory polypeptide \( gip \) insulin glucagon release isolated perfused diabetic rats \( 12 14 wk age , mean se fasting plasma glucose 8 9 0 6 mm , n 25 \) injection 90 mg kg streptozocin 2nd day birth compared results nondiabetic control rats diabetic rats , infusion 1 nm glp gip perfusates varying glucose concentrations \( 2 8 , 5 6 , 8 3 , 11 1 , 22 2 mm \) caused nearly equal degree insulin stimulation similar basal insulin level , basal glp gip stimulated insulin release increased correlation ambient glucose concentration nondiabetic rats degree stimulation insulin release glucose concentrations 5 6 mm diabetic rats approximately 33 nondiabetic rats stimulation potency glp gip insulin treatment diabetic rats \( 5 u kg nph insulin 6 days \) brought slight improvement glucose dependency glp stimulated insulin release effects glp gip glucagon release completely opposite glp suppressed release gip stimulated diabetic rats , degree suppression glp stimulation gip almost similar basal glucagon levels perfusate varying glucose concentrations
characteristics learning memory streptozocin induced diabetic mice demonstrated mice streptozocin induced diabetes mellitus normal acquisition relatively simple tasks show problems learning complex tasks box avoidance enhanced learning previously reported simple passive avoidance tasks appears due increased foot shock sensitivity diabetic mice show marked memory retention deficit learning active avoidance task retention deficit reversed single injection insulin , suggesting may related hyperglycemia per se diabetic mice shift left inverted u shaped dose response curve memory retention produced acetylcholine agonist based preliminary screening , responses several pharmacological memory probably altered diabetic mice studies suggest mouse model diabetes mellitus demonstrates deficit memory retention retrieval similar seen humans diabetes mellitus
insulinlike activity new agent cp 68722 3t3 l1 adipocytes examined vitro effects cp 68722 , novel agent , 3t3 l1 adipocytes cp 68722 stimulated 2 deoxyglucose uptake absence insulin least 30 min incubation required stimulation uptake effect increased 5 h sustained 72 h stimulation 2 deoxyglucose uptake cp 68722 could inhibited approximately 60 inhibition protein synthesis cycloheximide half maximal maximal responses cp 68722 72 h incubation observed 10 100 microm drug , respectively , threefold stimulation uptake 100 microm maximal response cells acute insulin stimulation cp 68722 able overcome insulin resistance induced dexamethasone 3t3 l1 cells effect drug , like insulin , primarily increase vmax 2 deoxyglucose uptake stimulation uptake cp 68722 insulin could prevented incubating cells 10 degrees c , temperature translocation glucose transporters plasma membrane therefore , appears cp 68722 , like insulin , stimulates glucose uptake mechanism involves translocation intracellular glucose transporters plasma membrane de novo protein synthesis compared effect cp 68722 sulfonylureas , primary drugs used treatment non insulin dependent diabetes mellitus \( niddm \) cp 68722 potent effective stimulator 2 deoxyglucose uptake 3t3 l1 cells either first second generation sulfonylureas
glycosylation possible involvement free radicals ldl modification glucose postulated etiology complications diabetes involves oxidative stress , perhaps result hyperglycemia consistent hypothesis , shown glucose , physiological conditions , produces possess reactivity similar hydroxyl free radical acid , fragment protein , induce peroxidation phosphatidylcholine liposomes low density lipoprotein \( ldl \) ldl incubated hyperglycemic levels glucose vitro reactions accelerated transition inhibited metal agent atherosclerotic potential ldl diabetes mellitus often discussed terms protein glycosylation , may affect cellular interactions studies demonstrate , however , reactions also accompany ldl glycosylation vitro modification ldl also implicated ldl studies indicate glycosylation peroxidation occur concomitantly ldl modified glucose vitro may contribute behavioral changes lipoprotein
defective free fatty acid oxidative glucose metabolism iddm hypoglycemia influence glycemic control examine impact diabetes treatment plasma free fatty acid \( ffa \) oxidative fuel metabolism hypoglycemia , combined indirect calorimetry 3 3h glucose 4 h low dose insulin infusion \( plasma insulin approximately 2 fold basal \) six poorly controlled nine well controlled insulin dependent diabetes mellitus \( iddm \) patients six healthy subjects diabetic subjects received insulin overnight maintain euglycemia study although free insulin levels counterregulatory hormone responses similar , plasma glucose fall pronounced well controlled diabetic subjects well controlled diabetic healthy subjects , small increment insulin rapidly suppressed plasma ffa fat oxidation approximately 50 stimulated carbohydrate oxidation approximately 80 contrast , plasma ffa levels fall poorly controlled diabetic subjects , glucose oxidation stimulated determine whether resistance effect insulin occurs absence hypoglycemic , used sequential low dose euglycemic insulin clamp \( 0 2 , 0 3 , 0 5 mu kg 1 min 1 \) healthy subjects , plasma ffa nearly maximally suppressed lowest insulin dose contrast , plasma ffa remained persistently elevated poorly controlled diabetic subjects insulin dose however , insulin dose response curve suppression plasma ffa near normal well controlled subjects conclude poorly controlled iddm diabetic patients resistant effects insulin show impaired stimulation glucose oxidation insulin induced hypoglycemia amelioration defects well controlled patients may another factor contributing higher risk hypoglycemia intensified insulin therapy
calcitonin gene related peptide induction hyperglycemia conscious rats vivo effect calcitonin gene related peptide \( cgrp \) glucose metabolism investigated conscious rats vivo intravenous injection rat cgrp \( 5 67 0 nmol kg \) caused significant , dose dependent increase plasma glucose concentration simultaneous dose dependent increase plasma insulin level contrast , plasma glucagon level changed hand , intravenous infusion cgrp \( 46 6 pmol kg 1 min 1 \) decreased tolerance intragastric administration glucose \( \) plasma insulin response , however , affected cgrp infusion moreover , although intravenous injection cgrp \( 5 67 nmol kg \) elicited significant increase plasma epinephrine norepinephrine concentrations , concomitant administration epinephrine norepinephrine , inducing prominent rise plasma catecholamines induced cgrp , affected neither plasma glucose insulin levels finally , plasma insulin levels obtained simulating cgrp induced changes plasma glucose glucose plus catecholamine levels infusion glucose glucose plus catecholamines different induced cgrp injection results suggest cgrp hyperglycemic action mediated sympathetic outflow conscious rats , inhibition insulin secretion , , play major role hyperglycemic action cgrp demonstrated specific cgrp receptors linked adenylate cyclase activation rat liver plasma membranes hyperglycemic effect cgrp vivo may partly due direct action liver
change hexose distribution volume fractional utilization 18f 2 deoxy 2 fluoro glucose brain acute hypoglycemia humans used positron emission tomography \( pet \) study effects mild hypoglycemia cerebral glucose uptake metabolism nine healthy men studied basal saline infusion conditions , euglycemic hypoglycemic clamp studies insulin infused rate \( 1 mu kg 1 min 1 \) clamp studies euglycemic clamp studies , glucose infused rate sufficient maintain basal plasma glucose concentration , whereas hypoglycemic clamp studies , glucose infusion rate reduced maintain plasma glucose 3 1 mm study lasted 3 h included 30 min baseline period subsequent 150 min period insulin glucose administered blood samples measurement insulin , glucose , cortisol , growth hormone , glucagon obtained 20 30 min intervals bolus injection 5 10 mci 18f 2 deoxy 2 fluoro glucose \( 2 \) administered 120 min initiation study , plasma radioactivity dynamic pet scans obtained frequent intervals remaining 40 60 min study cerebral regions interest defined , concentrations radioactivity calculated used three compartment model 2 distribution described glucose levels similar saline infusion \( 4 9 0 1 mm \) euglycemic clamp \( 4 8 0 1 mm \) studies , whereas desired degree mild hypoglycemia achieved hypoglycemic clamp study \( 3 1 0 1 mm , p less 0 05 \) insulin level saline infusion 41 7 pm
altered steady state mrna levels basement membrane proteins diabetic mouse kidneys thromboxane synthase inhibition examined steady state levels mrna encoding type iv collagen , b1 chain laminin , basement membrane heparan sulfate proteoglycan kidney cortex mouse model \( \) non insulin dependent diabetes mrnas encoding laminin b1 proteoglycan unchanged kidneys taken diabetic mice demonstrable basement membrane thickening mrna levels type iv collagen , contrast , significantly elevated \( 2 fold \) diabetic mice concurrent preceding morphologically thickened basement membranes negative correlation ratio proteoglycan type iv collagen levels diabetic mice correlation noted laminin also examined effects inhibiting synthesis thromboxane , potent vasoconstrictor , steady state levels type iv collagen diabetic mice inhibition thromboxane stopped progression prevented increase type iv collagen mrna levels conclude basement membrane thickening diabetes , hallmark diabetic nephropathy , partly consequence increase production type iv collagen relative decrease proteoglycan production may contribute chronic
lack predictive value islet cell antibodies , insulin antibodies , hla dr phenotype remission cyclosporin treated iddm patients canadian european randomized control trial group effect immunosuppression humoral immune response islet autoantigens exogenously administered insulin predictive value islet cell cytoplasmic antibodies \( icas \) , insulin antibodies \( \) , hla dr phenotype remission immunosuppression studied prospective randomized double blind trial cyclosporin administration 98 newly diagnosed insulin dependent diabetes mellitus \( iddm \) patients hla dr phenotype glycosylated hemoglobin determined study entry , insulin requirement , glucagon stimulated c peptide , icas , measured entry 1 , 3 , 6 , 9 , 12 mo follow cyclosporin therapy caused significant suppression prevalence serum concentrations icas cyclosporin treated iddm patients ica study entry higher levels stimulated c peptide 1 mo study , increased beta cell function associated higher frequency insulin free remission 1 mo ica ia status entry predict cyclosporin insulin free remission assessed prevalence insulin free remission beta cell function 3 12 mo study , significant decrements titers total disappearance icas associated increased prevalence duration non insulin requiring remission higher stimulated c peptide values correlation serum levels icas entry beta cell function 12 mo follow
contribution impaired muscle glucose clearance reduced postabsorptive systemic glucose clearance niddm reduced postabsorptive rates systemic glucose clearance non insulin dependent diabetes mellitus \( niddm \) thought consequence insulin resistance peripheral tissues although peripheral tissues involved identified , generally assumed primarily muscle , major site insulin mediated glucose disposal test hypothesis , measured postabsorptive systemic forearm glucose utilization clearance 15 volunteers niddm 15 age weight matched nondiabetic volunteers although systemic glucose utilization increased niddm subjects \( 14 5 0 5 vs 11 2 0 2 mumol kg 1 min 1 , p less 0 001 \) , systemic glucose clearance reduced 1 40 0 06 vs 2 13 0 05 ml kg 1 min 1 , p less 0 01 \) although forearm glucose utilization increased niddm subjects \( 0 0 vs 0 0 019 mumol dl 1 min 1 , p less 0 001 \) , forearm glucose dl 1 clearance reduced \( 0 0 044 vs 0 0 ml l 1 min 1 , p less 0 01 \) however , extrapolation forearm data total body muscle indicated impaired clearance reduced muscle glucose disposal 61 21 mumol min , whereas impaired systemic clearance reduced systemic glucose disposal 662 82 mumol min thus , impaired muscle glucose clearance accounted less 10 reduced systemic glucose clearance niddm subjects therefore , conclude muscle insulin resistance plays minor role reduced systemic glucose clearance found niddm postabsorptive state propose reduced brain glucose clearance largely responsible
hepatic extrahepatic responses insulin niddm nondiabetic humans assessment absence artifact introduced tritiated nonglucose contaminants well established patients non insulin dependent diabetes mellitus \( niddm \) resistant insulin however , contribution hepatic extrahepatic tissues insulin resistance remains controversial uncertainty may least part due errors introduced use previous studies isotopes measure glucose turnover determine hepatic extrahepatic responses insulin absence errors , steady state glucose turnover measured simultaneously 6 3h 6 14c glucose sequential 5 4 h infusions insulin rates 0 4 10 mu kg 1 min 1 diabetic nondiabetic subjects low insulin concentrations , 6 3h 6 14c glucose gave similar estimates glucose turnover hepatic glucose release equal zero nondiabetic subjects , persistent glucose release \( p less 0 001 \) decreased glucose uptake \( p less 0 001 \) observed diabetic patients high insulin concentrations , isotopes underestimated glucose turnover 1st h initiation high dose insulin infusion time \( p less 0 05 \) required steady state niddm nondiabetic subjects steady state , 6 3h 6 14c glucose systematically underestimated \( p less 0 05 \) glucose turnover groups due presence tritiated nonglucose percentage radioactivity plasma due tritiated contaminants linearly related turnover
reduced membrane fluidity platelets diabetic patients platelets diabetic patients hypersensitive agonists vitro membrane fluidity modulates cell function , reduced membrane fluidity cholesterol enriched platelets associated platelet hypersensitivity agonists , including thrombin decreased membrane fluidity platelets attributed increased cholesterol phospholipid molar ratio platelet membranes examined response platelets diabetic subjects thrombin , platelet membrane fluidity , platelet cholesterol phospholipid molar ratio twelve poorly controlled diabetic subjects compared 12 age sex matched control subjects response low concentration thrombin , mean values release 14c serotonin washed platelets significantly different diabetic control subjects , 8 12 diabetic subjects , release response greater paired control subjects mean steady state fluorescence values 1 , 6 1 , 3 , 5 labeled platelets prepared diabetic subjects significantly greater control subjects indicates decreased membrane fluidity platelets diabetic subjects total low density \( vldl \) , low density \( ldl \) , high density \( hdl2 , hdl3 \) lipoprotein cholesterol concentrations plasma significantly different groups however , ratio vldl ldl hdl2 hdl3 significantly greater diabetic control subjects difference total platelet cholesterol phospholipid molar ratio groups
induction insulin resistance vivo amylin calcitonin gene related peptide hyperinsulinemic glucose clamp studies , intravenous infusion calcitonin gene related peptide \( cgrp \) rats antagonized ability insulin stimulate peripheral glucose disposal 52 \( 196 7 2 vs 105 10 5 mumol kg 1 min 1 , p less 0 05 \) inhibit hepatic glucose output 54 \( p less 0 01 \) cgrp also inhibited vitro effects insulin stimulate hexose uptake cultured myocytes insulin concentrations studied amylin peptide isolated amyloid deposits pancreatic islets type ii \( non insulin dependent \) diabetic subjects , present normal beta cells , bears striking homology cgrp synthetic human amylin infused clamp studies , inhibited ability insulin stimulate glucose disposal 56 \( 96 9 9 4 vs 42 4 5 0 mumol kg 1 min 1 , p less 0 05 \) suppress hepatic glucose output 64 therefore , amylin cgrp cause insulin resistance vivo may implicated insulin resistant states type ii diabetes mellitus
high frequency aspartic acid position 57 hla dq beta chain japanese iddm patients nondiabetic subjects hla dq beta chain \( \) genes 72 japanese patients insulin dependent diabetes mellitus \( iddm \) 85 control subjects studied polymerase chain reaction \( pcr \) amplification allele specific oligonucleotide hybridization \( \) \( 3 \) increased iddm patients compared control subjects , 2 , 9 , \( 1 \) decreased thirty five \( 48 6 \) iddm patients alleles carrying aspartic acid position 57 dq beta chain \( asp 57 \) , 35 \( 48 6 \) asp 57 non asp 57 heterozygous , 2 \( 2 8 \) non asp 57 alleles 85 control subjects , respective values three genotypes 49 \( 57 6 \) , 29 \( 34 1 \) , 7 \( 8 2 \) , respectively high frequency asp 57 alleles iddm control subjects contrasts data whites therefore , asp 57 hypothesis presence aspartic acid position 57 dq beta chain provides protection developing iddm japanese iddm patients gene , particularly position 57 dr beta chain , may contribute iddm susceptibility japanese
effects exercise insulin induced hypoglycemia purpose study determine effect exercise rate onset hypoglycemia induced infusion excess insulin \( 0 8 mu min 1 100 g 1 \) rats either fasted overnight \( fs \) fed ad libitum \( fd \) fs rats killed 5 , 10 , 15 min infusion rest running treadmill 21 min 15 grade fd rats killed 10 , 20 , 40 min infusion rest exercise rats also killed 15 min postexercise fs 60 120 min postexercise fd continued insulin infusion progressive decline blood glucose altered exercise fs rats fd rats showed significant difference due exercise 40 min \( rest 4 2 0 3 mm , exercise 3 2 0 2 mm \) significant postexercise repletion glycogen observed red vastus soleus muscles fd rats despite decreasing blood glucose values data indicate exercise accelerates rate development hypoglycemia fd rats fs rats , rate decline blood glucose greater , exercise effect time course development hypoglycemia
glucose substrate exchange forearm skeletal muscle hyperglycemic insulin treated type ii diabetic patients determine contribution skeletal muscle fasting hyperglycemia noninsulin dependent type ii diabetes \( niddm \) , forearm balance glucose , lactate , alanine quantified 25 control subjects , 21 hyperglycemic \( blood glucose 11 6 mmol l \) , 19 insulin treated patients niddm \( blood glucose 5 8 mmol l \) forearm glucose uptake similar controls \( 4 6 0 6 mumol l 1 min 1 \) hyperglycemic diabetic patients \( 4 5 0 9 mumol l 1 min 1 \) spite , diabetic patients lactate \( 5 1 0 8 mumol l 1 min 1 \) alanine \( 2 6 0 4 \) release forearm 3 2 fold higher control group \( lactate 1 7 0 8 , p less 0 005 alanine 1 3 0 2 , p less 0 05 , respectively \) ratio lactate release glucose uptake 57 18 diabetic control subjects , respectively insulin administration affect either glucose uptake release substrates forearm concluded 1 \) fasting patients niddm , glucose taken skeletal muscle normal amounts preferentially used lactate formation suggests , although muscle contribute directly fasting hyperglycemia , may play indirect role increased delivery glucose precursors 2 \) insulin induced normoglycemia maintained mechanisms involve exchange glucose substrates skeletal muscle
effect central obesity regulation carbohydrate metabolism obese patients varying degrees glucose tolerance proposed central obesity , virtue enhanced activity abdominal adipose tissue , leads higher plasma ffa concentrations , , turn , decrease hepatic removal insulin insulin stimulated glucose uptake peripheral tissues short , predicted consequences abdominal obesity elevations circulating ffa insulin levels well insulin resistance goal study evaluate relationships predicted overall hypothesis study carried 31 obese females , defined normal glucose tolerance \( n 12 \) , impaired glucose tolerance \( n 8 \) , noninsulin dependent diabetes mellitus \( n 11 \) abdominal obesity estimated determining ratio waist hip , fasting postprandial plasma ffa insulin concentrations measured hourly intervals 1600 h , insulin stimulated glucose disposal quantified euglycemic hyperinsulinemic clamp technique first step postulated sequence events tested greater whr , higher total integrated plasma ffa response correlation coefficient two variables 0 29 , indicating results support prediction furthermore , could demonstrate relationship magnitude plasma ffa insulin responses \( r 0 20 p ns \) however , modest inverse relationship height circulating plasma insulin concentration decrease insulin stimulated glucose uptake \( r 0 43 p less 0 03 \) group whole hand , three groups analyzed individually , significant inverse relationship seen control group \( r 0 67 \) , direct relationship actually seen patients impaired glucose tolerance \( r 0 88 \) furthermore , mean responses variables three groups compared , apparent postulated relationships abdominal obesity , plasma ffa concentration , insulin secretion action present thus , data presented support hypothesis differences degree central obesity play important role regulation plasma concentrations either ffa insulin modulation insulin stimulated glucose uptake patients studied
beta cell lymphocytes subjects risk type 1 \( insulin dependent \) diabetes progression diabetes within 2 years increased binding vitro cd3 cd4 lymphocytes type 1 \( insulin dependent \) diabetic patients beta cell membrane antigens compared lymphocytes control subjects previously shown marker cell mediated immunity , called diabetic rosettes present study diabetic rosettes detected subjects risk type 1 diabetes \( first degree relatives type 1 diabetic patients nondiabetic subjects previous transient \) mean number lymphocytes adherent beta cells \( beta cl \) significantly higher subjects risk type 1 diabetes age sex matched control blood bank donors \( p less 10 \( 6 number beta cl higher type 1 diabetic patients subjects risk \( p less 10 \( 6 , one way analysis variance rank \( \) revealed three populations \( controls , diabetics , risk subjects \) different terms beta cl values \( p less 0 001 \) percentage subjects risk positive test \( defined beta cl value higher 95th percentile 228 controls \) 20 difference observed two subgroups subjects risk terms either mean sem beta cl percentages individuals positive test diabetic rosettes slightly associated acute insulin response iv glucose lower 5th percentile controls \( immunoreactive insulin 1 3 min , 250 pmol l chi 2 , p 0 04 \) hla dr 3 4 heterozygosity \( chi 2 , p 0 04 \) associated islet cell antibodies \( regardless threshold positivity , expressed juvenile diabetes foundation units \) , insulin autoantibodies , activated \( hla dr \) lymphocytes , sex statistical association detected hla dr 3 4 heterozygosity low acute insulin response iv glucose \( chi 2 , p less 0 003 \) preliminary \( 2 yr \) longitudinal follow revealed five islet cell antibody positive subjects progressed type 1 diabetes , three displayed beta cl values higher percentile controls diabetic rosettes could , thus , detected individuals risk type 1 diabetes marker cell mediated immunity
increased overnight growth hormone concentrations diabetic compared normal adolescents determine extent spontaneous plasma gh concentrations abnormal adolescents insulin dependent diabetes mellitus performed 12 h overnight plasma gh profiles 21 diabetic adolescents \( 11 males 10 females aged 9 8 16 5 yr median , 13 6 yr \) 34 healthy adolescent controls \( 17 males 17 females aged 9 1 20 9 yr median , 13 1 yr \) data analyzed using pulse detection program time series analysis , presented respect age puberty stage mean maximum gh concentrations , sum peak amplitudes , mean calculated baseline concentrations normal children higher puberty highest levels seen girls puberty stages 2 3 , boys stages 4 5 similar pattern observed diabetic adolescents , measures pulse height mean calculated baseline concentrations significantly greater normal subjects \( multivariate analysis , p less 0 001 \) pulse frequency change puberty normal diabetic subjects , dominant pulse periodicity groups 180 min conclude predominant change gh release puberty pulse amplitude , increased diabetes , whereas pulse frequency remains constant normal diabetic adolescents
association fasting glucose levels delayed secretion insulin oral glucose subjects glucose intolerance two hundred nineteen second generation japanese american men classified 75 g oral glucose tolerance test 77 normal glucose tolerance , 74 impaired glucose tolerance \( igt \) , 68 noninsulin dependent diabetes mellitus \( niddm \) peak insulin response oral glucose load progressively delayed 3 glucose tolerance categories similar finding observed peak c peptide response oral glucose , except absence distinction igt niddm variables measuring initial rate insulin c peptide secretion \( 0 30 min \) oral glucose also demonstrated progressive diminution increasing glucose intolerance relative incremental insulin response 30 min relative incremental c peptide response 30 min highly correlated fasting glucose levels \( r 0 61 r 0 62 p less 0 0001 , respectively \) variables measuring 0 30 min secretory response high variances , whereas variance fasting glucose low twelve men initially classified igt subsequently developed niddm 12 men significantly higher fasting glucose levels baseline remaining men develop diabetes , 30 min secretory parameters oral glucose , although lower subsequently developed diabetes , significantly different baseline however , fasting glucose used surrogate measure secretory response , 12 men appear impairment oral glucose stimulated insulin secretion development niddm inability secretory parameters detect abnormality may due type ii statistical error , may resolved larger sample size
impaired growth hormone \( gh \) response type 1 diabetic patients exaggerated gh releasing hormone stimulated gh secretion present study investigated effects acetylcholinesterase inhibitor \( pd \) , hypothesized decrease hypothalamic somatostatin tone , alone association gh releasing hormone \( ghrh \) gh secretion 18 type 1 diabetic patients 12 normal subjects using randomized double blind placebo controlled protocol subjects received either 120 mg oral pd placebo 60 min iv injection either human ghrh \( 1 29 \) nh2 \( 100 micrograms \) sterile water \( 2 ml \) normal subjects pd alone ghrh alone caused significant increase gh pd ghrh acted synergistic fashion combined diabetic patients gh response ghrh variable responses , ratio gh increase ghrh plus pd ghrh alone calculated subject 10 diabetic patients \( group \) ratio lower 2 sd \( p less 0 05 \) mean response normal subjects patients showed exaggerated gh increase ghrh lower gh increase pd respect normal subjects eight diabetic patients \( group b \) showed ratio similar normal subjects similar gh responses stimuli significant differences found groups b respect age , body mass index , blood glucose levels duration diabetes longer basal gh levels higher group hemoglobin a1c higher group , borderline statistical significance \( p 0 \) data demonstrate diabetic patients exaggerated gh responses ghrh increase cholinergic tone affect gh secretion data suggest type 1 diabetic patients altered control gh secretion may contribute abnormal gh response ghrh
changes basal stimulated growth hormone secretion aging rhesus monkey comparison chair restraint tether sampling studied basal serum gh gh responses iv clonidine insulin induced hypoglycemia group four young \( 5 7 yr old \) four older \( 10 14 yr old \) adult male rhesus monkeys two restraint conditions , chair adaptation tether system , determine changes gh secretion occur aging serum gh response iv administration gh releasing hormone \( ghrh \) also studied groups tether restraint serum samples collected every 15 min assayed gh using human gh ria cortisol using enzyme linked assay gh cortisol concentrations young older groups analyzed analysis variance \( anova \) studies older animals lower mean 6 h basal gh concentration younger animals \( 2 7 0 8 vs 3 5 0 5 micrograms l p 0 0002 \) gh lower clonidine insulin older group \( 1 1 0 5 2 3 0 6 micrograms l , respectively \) compared younger group \( 3 6 0 8 3 8 0 7 micrograms l , respectively p less 0 001 \) gh lower clonidine insulin older group \( 3 2 2 4 7 1 2 8 micrograms l , respectively \) compared younger group \( 6 3 2 2 10 3 3 0 micrograms l , respectively p less 0 05 \) , differences gh increments statistically significant tether studies older animals lower mean 6 h basal gh concentration younger animals \( 1 7 0 4 vs 3 5 1 2 micrograms l p less 0 0001 \) gh concentrations also lower older animals clonidine \( 2 1 0 3 micrograms l \) ghrh \( 1 4 0 2 micrograms l \) compared levels younger animals \( 3 1 0 9 3 2 0 7 micrograms l p 0 p 0 0001 , respectively \) younger animals greater responses clonidine \( 8 7 3 0 micrograms l \) , insulin \( 8 8 3 6 micrograms l \) , ghrh \( 6 0 2 4 micrograms l \) older animals \( 3 8 0 9 , 3 9 2 5 , 2 9 0 7 micrograms l p less 0 0001 , p 0 0025 , p less 0 03 , respectively \) \( abstract truncated 400 words \)
brain glucose metabolism noninsulin dependent diabetes mellitus study indians using positron emission tomography hyperinsulinemia euglycemic glucose clamp determine whether insulin noninsulin dependent diabetes mellitus affects brain glucose metabolism , brain glucose utilization studied basal state hyperinsulinemic euglycemic glucose clamps nondiabetic diabetic indians positron emission tomography 2 18f fluoro 2 deoxy glucose \( 18fdg \) glucose utilization 75 brain areas determined analysis single scans least estimation rate parameters fdg model data compared results normal caucasian volunteers effect ethnicity diabetic status brain glucose utilization observed hyperinsulinemic clamps \( mean insulin , 11 , 3 , 026 pmol l \) , clearance 18fdg blood accelerated , accumulation brain radioactivity reduced however , glucose utilization brain identical results sham glucose clamps \( mean insulin , 204 56 pmol l \) performed patients studies hyperinsulinemia , \( representing loss tissue radioactivity \) increased brain areas \( mean increase , 0 0 min 1 p less 0 02 \) possible mechanisms effect multiple , physiological significance , , unknown studies effects insulin brain glucose metabolism needed
folate status adolescents effects folic acid supplementation study designed determine folate status adolescent population demonstrate effect folic acid supplementation subjects low folate status phase one , folate status evaluated sample 164 adolescents 12 15 years old socioeconomic , demographic , anthropometric , 7 day food record data collected , serum erythrocyte folate levels determined thirty five adolescents considered low folate status 6 months earlier participated phase two , 2 month supplementation period reevaluation racial differences observed folate status , indicated amount folate blood diet boys significantly \( p less 05 \) higher folate levels serum erythrocytes girls thirteen percent boys 40 girls folate deficient judged amount erythrocyte folate less nmol l \( 140 ng ml \) folate deficient subjects significantly \( p less 05 \) lower values hemoglobin normal subjects seventeen percent boys 42 girls folate intakes recommended dietary folate supplementation 400 micrograms folic acid daily 2 months resulted significant \( p less 05 \) increases serum folate , erythrocyte folate , hemoglobin values decrease mean corpuscular volume evidence high prevalence low folate status , positive relationship erythrocyte folate hemoglobin , responses hemoglobin mean corpuscular volume supplement indicated folate consumption may optimal groups adolescents , especially girls
effects moderate exercise training nutrient intake mildly obese women relationship moderate exercise training \( five 45 minute sessions per week , brisk walking 62 2 vo2 max 15 weeks \) changes nutrient intake investigated group 36 sedentary , mildly obese women study conducted using 2 x 3 design \( two groups subjects exercise groups three periods baseline , 6 week , 15 week testing sessions \) data analyzed using repeated measures anova pattern change caloric intake time tended different groups \( f 2 , 68 2 50 , p \) exercise group experienced significant decrease caloric intake 15 weeks significant group x time interactions found intakes carbohydrate , dietary fiber , thiamin , niacin , vitamin b 6 , folate intake tended decrease exercise group increase group change intake nutrients significantly correlated change bread cereal consumption pattern change bread cereal intake time significantly different groups \( trace 0 266 , f 2 , 33 5 99 , p 006 \) exercise group significant decreases intake 6 15 weeks vs baseline values data suggest mildly obese women reduce energy intake subsequent initiating exercise program concomitantly decrease quality nutrient intake diets compared sedentary controls
conjugated catecholamines human plasma \? origins conjugated catecholamines remain poorly known aim present study see whether major contribution comes sympathetic nervous system assumed kind activity sympathetic nervous system , amount catecholamines released taken , amount conjugated catecholamines circulating plasma accordingly , increase sympathetic activity followed increase plasma level conjugated catecholamines plasma levels catecholamines measured 10 patients mental disease resistant drug treatment , therapy expected , blood pressure , norepinephrine concentration , epinephrine concentration plasma transiently increased neither catecholamines significantly changed conjugated catecholamines measured 10 volunteers nadir insulin induced hypoglycemia expected , plasma levels norepinephrine epinephrine drastically increased plasma levels decreased increased narrow statistically significant variations data reported present article support major role activity sympathetic system fixing level conjugated catecholamines human plasma negative , nonetheless important , observation human subjects , currently available information suggests important role intestinal wall renal function determining level circulating
ten year follow behavioral , family based treatment obese children using prospective , randomized , controlled design , examined effects behavioral family based treatment percent overweight growth 10 years obese 6 12 year old children obese children parents randomized three groups provided similar diet , exercise , behavior management training differed weight loss behavior change child parent group reinforced parent child behavior change weight loss , child group reinforced child behavior change weight loss , nonspecific control group reinforced families attendance children child parent group showed significantly greater decreases percent overweight 5 10 years \( 11 2 7 5 , respectively \) children nonspecific control group \( 7 9 14 3 , respectively \) children child group showed increases percent overweight 5 10 years \( 2 7 4 5 , respectively \) child parent nonspecific groups significantly different either 10 years , child height related strongly height parent sex \( r 78 children 1 8 cm parents , differences height groups
primary hypertriglyceridemia borderline high cholesterol elevated apolipoprotein b concentrations comparison gemfibrozil vs lovastatin therapy common pattern dyslipidemia elevated levels plasma triglyceride , borderline high total cholesterol , reduced high density lipoprotein , increased apolipoprotein b pattern dyslipidemia frequently associated premature coronary heart disease acid drug first choice pattern study , gemfibrozil lovastatin compared effects overall lipoprotein profile 13 men type dyslipidemia drugs significantly reduced low density lipoprotein intermediate density lipoprotein cholesterol levels , modestly raised high density lipoprotein cholesterol levels gemfibrozil therapy , however , failed reduce total cholesterol total apolipoprotein b levels , whereas lovastatin therapy lowered levels total cholesterol 28 , low density lipoprotein cholesterol 33 , total apolipoprotein b 32 moreover , lovastatin therapy caused greater declines lipoprotein cholesterol ratios gemfibrozil therapy lovastatin thus seems certain advantages gemfibrozil treatment elevated plasma triglyceride levels accompanied borderline high total cholesterol raised apolipoprotein b levels therefore , lovastatin therapy considered one approach management condition
exogenous fructose metabolism truly insulin independent \? although fructose widely regarded insulin independent fuel source , vivo conversion glucose represents theoretical limitation clinical usefulness diabetics , particularly given large doses determine whether small amounts fructose well utilized setting , administered low dose fructose infusion \( 4 2 g hr \) fasting type 1 diabetic patient receiving continuous subcutaneous insulin dose previously maintained stable euglycemia 72 hr \( plasma glucose 80 110 mg dl \) despite low infusion rate \( less 20 calorie requirement \) , fructose caused immediate marked rise plasma glucose \( 370 mg dl 27 hr \) glucose loss urine accumulation plasma could account fully half administered hexose load thus , utilization even small quantities exogenous fructose profoundly impaired conditions misleading regard fructose truly insulin independent fuel source
removal inorganic acid load subjects ketoacidosis chronic fasting large inorganic acid load ingested normals , proton load eliminated rate excretion ammonium rise 200 300 mmol day subjects ketoacidosis chronic fasting , large increase rate excretion ammonium might possible atp balance considerations proximal cells subjects ketoacidosis chronic fasting excreted less net acid defined conventional way consumed large inorganic acid load \( 136 6 vs 176 26 mmol day control fasted subjects \) nevertheless , vast majority inorganic acid load eliminated steady state slightly lower concentration bicarbonate \( 13 0 6 vs 15 0 5 mmol liter \) ketoacid anions \( 3 3 0 2 vs 5 5 0 2 mmol liter \) blood using definition net acid excretion component bicarbonate loss expanded include potential bicarbonate \( ketoacid anions \) urine , rate excretion net acid higher subjects ingested inorganic acid load , owing much lower rate excretion ketoacid anions \( 9 2 vs 120 7 mmol day \) lower rate excretion due lower filtered load , also higher fractional reabsorption ketoacid anions acidosis \( 97 0 1 vs 77 0 2 \) higher fractional reabsorption could explained lower filtered load ketoacid anions restricted intake sodium
daily pattern vo2max heart rates normal school children pattern usage vo2max , expressed vo2max ordinary school days , minute minute heart rate recording , studied 106 boys 83 girls , 6 16 yr age divided three age groups \( 6 8 , 10 12 , 14 16 yr \) , living deprived conditions classified normal marginally malnourished 12 h period , 12 groups children spent , average , 7 10 h less 30 vo2max , 1 5 4 h 30 50 vo2max , accumulated time 20 60 min 50 vo2max latter occurred short bursts rather sustained periods statistically significant small decrease \( approximately 3 \) average 12 h vo2max age effects sex nutritional status overall average 25 vo2max groups data may suggest existence regulation physical activity level easily long periods expressing data 30 min 5 h school 5 h free time activity allows possibility group differences shorter periods time may prove useful exercise training programs studies effort workplace
accuracy self reports physical activity investigation determined accuracy self reports physical activity compared observations obtained subjects 44 adults engaged 1 h preferred physical activity actual activity levels obtained compared immediate self reported estimates physical activity results indicated subjects moderately accurate physical activity levels \( r 0 62 \) underestimated sedentary activities overestimated aerobic activities 300 males overestimated activity relative females , obese subjects underestimated activity levels compared normal weight subjects finally , number two way interactions accuracy subjects high chronic levels physical activity observed
time course sprouting muscle reinnervation vitamin e deficient rats typical aspect plasticity sprouting occurs muscle reinnervation , resulting multiple innervation muscle cells order verify effect decreased protection free radical attack sprouting , multiple innervation extensor digitorum longus muscle , following sciatic nerve crush regeneration , studied vitamin e deficient rats thus , innervated end plates end plates multiple innervation studied histochemical electrophysiological techniques percentage innervated end plates similar groups 30 well 60 days nerve crush nevertheless , multiple innervation found larger part muscle lasted longer deficient rats finding discussed relation major hypotheses sprouting may relevant treatment lesions peripheral nerve
temporary amelioration hyperlipidemia low density lipoprotein receptor deficient rabbits transplanted genetically modified hepatocytes familial hypercholesterolemia inherited disease humans associated coronary artery disease caused deficiency receptor mediates internalization low density lipoprotein \( ldl \) used animal model familial hypercholesterolemia , hyperlipidemic \( whhl \) rabbit , design therapeutic approach disease , attempts correct hepatic defect ldl receptor expression hepatocytes harvested whhl rabbits , primary cultures , exposed recombinant retroviruses capable efficiently transferring functional human ldl receptor gene genetically modified cells harvested infused portal vein whhl recipients , analyzed metabolic consequences human ldl receptor expression animal exhibited statistically significant decrease total serum cholesterol 2 6 days transplantation , eventual return pretreatment levels proviral dna sequences virus directed transcripts detected liver tissue 24 hr transplantation situ hybridization demonstrated expression small population hepatocytes distributed sections liver study illustrates potential somatic gene therapy ameliorating hyperlipidemia associated familial hypercholesterolemia
molecular mapping mouse db mutation diabetes \( db \) autosomal recessive mutation located mouse chromosome 4 results profound obesity , increased metabolic efficiency , insulin resistance clone gene generate molecular map region around mutation , two genetic crosses established backcross c57bl 6j db db females c57bl 6j db db x dba f1 \( db f1 \) male mice interspecific db f1 males c57bl 6j db db x f1 \( db f1 \) females progeny crosses characterized genotype db locus map series restriction fragment length polymorphisms relative db locus measurements body weight , body length , plasma concentrations glucose insulin animals allowed assignment genotype \( db db vs db \) total 132 progeny cross 48 db db progeny interspecific cross typed individual restriction fragment length polymorphisms generate gene order centromere brown \( \) p lambda mm3 \( 2 \) \( \) db glut1 13 several genes linked db , glucose transporter \( glut1 \) map human chromosome , suggesting db may part group human distal portion mouse chromosome 4 addition , progeny crosses revealed wide range plasma concentrations glucose insulin among obese progeny , animals developing overt diabetes remaining euglycemic distributions age controlled plasma glucose insulin among cross obese progeny , suggesting role differences progenitor strains \( c57bl 6j dba \) development overt diabetes
therapy hypercholesterolemia patients , hypercholesterolemia effectively lowered drug therapy several issues considered first , drug therapy never considered without adequate dietary intervention dietary therapy may effective many patients mild moderate elevations cholesterol none drugs used treat lipid disorders benign agents still debate interpretations recent studies , ability studies whole population , cost effectiveness drug treatment within framework aha guidelines , individualized approach therapy prudent initiated maximal patient education drug therapy maintained long term life ldl hdl levels , age , sex , chd risk factors , cost treatment , patient awareness , motivation must assessed making treatment decisions drug therapy considered patients isolated hypercholesterolemia , bile acid drugs choice
asian osteomalacia determined dietary factors exposure ultraviolet radiation restricted risk factor model twenty seven previously 77 normal asian women participated seven day survey dietary intake outdoor exposure individual levels outdoor exposure discriminated poorly normal women presence osteomalacia strongly related varying degrees \( meat , fish egg consumption \) associated significantly greater risk \( meat fish consumption \) unlike asian rickets , high extraction wheat cereal significant risk factor osteomalacia asian women dietary fibre less important risk factor absent dietary meat , fish egg exposure ultraviolet radiation limited , asian osteomalacia \( asian rickets \) determined dietary factors
mild elevations liver enzyme values exclude hemochromatosis determine whether physicians academic medical center excluded hemochromatosis diagnosis population patients mildly elevated liver enzyme values , reviewed 100 charts patients aspartate aminotransferase alkaline phosphatase levels less twice upper limit normal analyzed chart determine hemochromatosis would excluded subsequent workup patients complete workup assigned one three categories \( 1 \) made abnormal liver enzyme values \( 2 \) liver enzyme values ascribed condition hemochromatosis definitive workup done \( 3 \) condition patient poor assessment seem indicated ninety 100 patients given workup exclude hemochromatosis physicians often mild elevations liver enzyme values
approaching protein sparing modified fast protein sparing modified fast safe effective method large amount weight relatively quickly diet used combination exercise program , behavior modification patient education caloric intake range 400 800 per day candidates diet generally healthy least 40 lb lose 120 percent ideal body weight
obesity iron status women relationship iron stores obesity women studied 20 obese 20 nonobese women matched age contraception although difference observed serum iron total iron binding capacity , obese group showed significantly higher hemoglobin \( 137 9 vs 10 g l , mean sd p less 0 01 \) , hematocrit \( 0 41 0 02 vs 0 39 0 03 , p less 0 05 \) , serum ferritin concentrations \( 48 0 44 3 vs 25 8 19 5 micrograms l , p less 0 05 \) difference obese nonobese women either menstrual cycle interval duration menstrual flow iron intake significantly higher obese group \( 15 9 2 9 vs 14 1 2 9 mg , p less 0 05 \) results suggest obese women low risk iron stores , possibly high iron intake iron programs might thus undesirable subjects
urinary organic acid excretion feeding medium chain long chain triglyceride diets patients non insulin dependent diabetes mellitus medium chain triglycerides \( \) absorbed metabolized differently long chain triglycerides \( \) recent data indicate may useful dietary substitute variety clinical disorders current studies undertaken characterize urinary organic acid excretion patients non insulin dependent diabetes mellitus 4 mct diet urinary excretion acids , , 3 \( omega 1 \) hydroxylation products 5 acid 7 acid , increased mct feeding compared feeding urinary 7 acid excretions increased 55 30 fold , respectively , mct substituted diet urinary organic acid profiles provide information fate lipids mct feeding may also useful assessing clinical trials employing mct substituted diets
cholesterol lowering effect skim milk immunized cows hypercholesterolemic patients effect skim milk cows immunized variety human intestinal bacteria serum cholesterol concentrations examined 11 patients primary hypercholesterolemia 24 wk , randomized , double blind , placebo controlled , crossover study 4 wk baseline period , patients treated 8 wk either skim milk immunized cows \( active \) control skim milk \( placebo \) followed 8 wk period treatment order reversed eight weeks active treatment skim milk immunized cows reduced serum total cholesterol concentrations 0 52 0 59 mmol l \( mean sd p less 0 025 \) , 8 , ldl cholesterol 0 16 0 59 mmol l \( ns \) , 4 , atherogenic index \( total cholesterol hdl cholesterol \) 0 42 1 85 \( p less 0 05 \) , 8 , compared placebo treatment reversal favorable development occurred upon cessation active treatment conclude daily supplementation normal diet skim milk immunized cows result significant reduction elevated blood cholesterol concentrations
cholesterol lowering effects soluble fiber cereals part prudent diet patients mild moderate hypercholesterolemia soluble fiber breakfast cereals examined cholesterol lowering ability 58 male patients mild moderate hypercholesterolemia randomized , double blind , placebo controlled study patients followed step 1 diet minimum 6 wk , randomly assigned groups incorporating either corn one two soluble fiber cereals \( enriched psyllium enriched \) diet additional 6 wk diet phase , total cholesterol dropped 3 8 cereal plus diet phase , total ldl cholesterol values enriched cereal group dropped additional 2 1 \( p 0 243 \) 3 9 \( p 0 16 \) , respectively , dropped 5 9 \( p 0 005 \) 5 7 \( p 0 034 \) , respectively , psyllium enriched cereal group cereal plus diet phase , significant effects hdl cholesterol , triglyceride , body weight found within cereal groups results support use soluble fiber cereals effective well tolerated part prudent diet treatment mild moderate hypercholesterolemia
continuous glucose treatment patients type 1 glycogen storage disease comparison effects dextrose biochemical variables responses \( ucs \) , dextrose \( dex \) , 3 1 mixture \( ucs dex \) determined seven children type 1 glycogen storage disease \( 1 \) ucs maintained blood glucose \( \) serum insulin concentrations 3 5 0 3 4 0 0 4 mmol l \( mean sem \) 50 7 79 22 pmol l , respectively , six seven patients 4 h four seven patients completed 4 h test ucs dex \( 2 9 0 3 mmol l \) dex , tests stopped patients 150 min initiation \( 2 7 0 4 mmol l \) two methods providing dietary glucose overnight , continuous intragastric glucose infusion \( cog \) intermittent ucs , compared monitoring metabolites hormones use ucs amounts equal calculated glucose production rate effective method providing continuous dietary source glucose overnight patients 1
physical growth development children type 1 glycogen storage disease comparison effects long term use dextrose thirteen patients type 1 glycogen storage disease \( 1 \) studied compare effects biochemical control growth 2 therapy intermittent feedings \( ucs \) fasting glucose production rate therapy continuous overnight glucose \( cog \) dextrose feedings day mean biochemical abnormalities groups minimized normalized either cog ucs growth progressed normally cog started 1 2 age normal growth rate maintained ucs weight increased 101 3 ideal body weight onset cog 127 5 cog first year ucs therapy increase second year growth failure occurred onset cog 3 7 sd score age \( \) , partial correction \( 1 9 \) genetic potential height occurred intermittent feeding ucs provides effective alternative cog treatment 1
vitamin status preschool age children assessed modified relative dose response assay modified relative dose response \( \) assay validated rats function vitamin status tested group american children study assay applied west children risk vitamin deficient 86 children enrolled , 75 tested time course study involving 22 children aged 3 7 5 3 , blood samples taken different times doses 0 35 mumol 3 , 4 acetate kg body wt generally , ratio retinol \( dr r ratio \) peaked 4 8 h thereafter , survey 53 children aged 0 6 4 8 , single blood samples drawn 5 h acetate dose dr r ratio ranged 0 0 169 dr r ratio 0 03 cutoff value , 62 children judged marginal vitamin status
self reported weight height error self reported weight height compared measured weight height evaluated nationally representative sample 11 , 284 adults aged 20 74 second national health nutrition examination survey 1976 1980 although weight height reported , average , small errors , self reported weight height unreliable important population subgroups errors self reporting weight directly related person 's overweight status bias self report increased directly magnitude overweight errors self reported weight greater overweight females overweight males race , age , end digit preference ancillary predictors reporting error weight errors self reporting height related person 's age bias self reporting increased directly age age 45 overweight status also predictor reporting error height
evidence secular change obesity , height , weight among navajo indian survey measuring heights weights 1969 residing navajo indian conducted 1989 findings compared national center health statistics \( \) reference data surveys navajo children 1955 , 1968 , 1981 approximately twice many children exceeded 95th percentile weight age \( 11 2 girls , 12 5 boys \) would expected reference population mean weight height z scores exceeded reference population ages sexes compared data 1955 , mean heights increased 6 1 among boys 4 4 among girls whereas mean weights increased 28 8 among boys 18 7 among girls across age groups data suggest secular change height , weight , obesity navajo indian children past 35
renal concentrating defect associated potassium depletion independent prostaglandin e2 prostaglandin e2 \( pge2 \) impairs effect vasopressin bladder mammalian kidney studies animals suggested potassium depletion enhances renal pge2 production , present study examined whether renal concentrating defect potassium depletion humans mediated pge2 five normal volunteers studied moderate potassium depletion achieved 10 days dietary potassium restriction administration potassium exchange resin \( \) maximal urinary osmolality \( \) decreased 1 , 094 58 \( mean sem \) 26 mmol kg \( mosm kg \) \( p less 0 01 \) following potassium depletion , urinary pge2 excretion change \( 145 186 ng , respectively \) indomethacin suppressed pge2 excretion significantly , failed increase either normal potassium depleted state \( 1 , 094 34 56 mmol kg , respectively \) concluded renal concentrating defect produced moderate potassium restriction humans mediated pge2
nt 1311 polymorphism g6pd g6pd mediterranean mutation may originated independently europe asia polymorphic site exists exon 11 g6pd wild type enzyme , nucleotide \( nt \) 1311 c , individuals diverse populations present instead nine 54 x chromosomes mixed origins , nine 41 x chromosomes ashkenazi jewish subjects , three 18 x chromosomes , five 20 african x chromosomes , nine 20 asian indian x chromosomes mutant genotype contrast , mutation found three 59 x chromosomes three 30 central south american x chromosomes mutation absent four samples dna twenty one 22 male subjects mediterranean countries g6pd mediterranean genotype investigated present study reported previously nt 1311 one normal c nt 1311 contrast , g6pd males indian normal c nt 1311 findings suggest mutation nucleotide 563 giving rise g6pd mediterranean may arisen independently europe asia
origin spread glucose 6 phosphate dehydrogenase variant \( g6pd mediterranean \) middle east common glucose 6 phosphate dehydrogenase \( g6pd \) variant characterized severe enzyme deficiency b like electrophoretic mobility called g6pd mediterranean found different populations around mediterranean sea sequence analysis italian subjects revealed molecular basis g6pd mediterranean single c transition nucleotide position 563 , causing serine phenylalanine replacement amino acid position 188 g6pd mediterranean subjects also silent c transition \( without amino acid replacement \) nucleotide position 1311 twenty one unrelated individuals saudi , , , , , israel severe g6pd deficiency b like electrophoretic mobility tested mutations using amplification followed digestion appropriate restriction enzymes one 563 mutation , , , one 1311 mutation another 24 unrelated middle eastern individuals normal g6pd activity known g6pd deficient similarly tested four silent mutation position 1311 absence deficiency mutation position 563 conclude \( 1 \) large majority middle eastern subjects g6pd mediterranean phenotype mutation found italy , \( 2 \) silent mutation independent polymorphism middle east , frequency 13 , \( 3 \) mutation leading g6pd mediterranean deficiency probably arisen chromosome already carried silent mutation
behavioral covariates waist hip ratio examined lifestyle dietary habits men women \( mean age 67 years \) completed interview , examination , food frequency questionnaire 1984 87 waist hip ratio increased age body mass index men women multiple regression , waist hip ratio independently associated smoking , alcohol consumption , exercise men , smoking alcohol consumption women data suggest waist hip ratio affected , least part , behavioral , potentially , factors
delta \( delta \) gap approach mixed acid base disorders anion gap \( ag \) helpful , yet , clinical tool presence high ag suggest certain differential , knowledge relationship rise ag \( delta ag \) fall bicarbonate \( delta hco3 \) important understanding mixed acid based disorders simple arithmetic converts relationship numerical value , delta gap \( delta gap \) delta gap delta ag delta hco3 delta gap significantly positive \( greater 6 \) , metabolic alkalosis usually present rise ag fall hco3 conversely , delta gap significantly negative \( less 6 \) , acidosis usually present rise ag less fall hco3 relationship changes ag hco3 useful occult metabolic disorders
slow glucose removal rate hyperinsulinemia precede development type ii diabetes offspring diabetic parents objective determine whether insulin resistance insulin deficiency primary pathogenesis type ii diabetes design cohort analytic study persons normal glucose tolerance high risk developing type ii diabetes \( average follow time , 13 years \) setting outpatients intravenous glucose tolerance test contacted periodically ascertain diagnoses diabetes participants one hundred fifty five normal offspring , ranging age 16 60 years , two parents type ii diabetes 186 normal control subjects age range family history diabetes measurements main results two phenotypic characteristics distinguished offspring diabetic parents control subjects slower glucose removal rates \( kg \) \( p less 0 01 \) higher insulin levels \( fasting second phase insulin response intravenous glucose p less 0 0001 \) control subjects , even adjustment differences obesity sixteen percent offspring developed type ii diabetes mean kg baseline 1 7 min among offspring subsequently developed diabetes , 2 2 min among offspring remained nondiabetic , 2 3 min among control subjects corresponding means first phase insulin , 354 , pm , respectively , whereas second phase insulin means 329 , 117 , 87 pm , respectively multivariate analysis , low kg high serum insulin levels independently increased risk developing diabetes among offspring diabetic parents conclusions one two decades type ii diabetes diagnosed , reduced glucose clearance already present reduced clearance accompanied compensatory hyperinsulinemia , hypoinsulinemia , suggesting primary defect peripheral tissue response insulin glucose , pancreatic beta cell
amniotic fluid insulin concentration predictor obesity longitudinal correlations obtained amniotic fluid insulin concentration 32 38 weeks' gestation anthropometric characteristics age 6 years 56 children diabetic mothers prospective studies indicated age 6 years , birth , greatest increase weight relation height \( relative obesity \) seen children experienced greatest exposures insulin uterus \( judged amniotic fluid insulin concentration \) significant correlations amniotic fluid insulin relative obesity age 6 years found adjustment maternal obesity birth highest amniotic fluid insulin values clustered subgroup 14 children obviously obese age 6 years findings consistent hypothesis association anthropometric development intrauterine metabolism , suggest premature excessive exposure insulin gestation may predispose obesity childhood amniotic fluid insulin concentration may predict
treatment severe reactive hypoglycemia somatostatin analogue \( sms 201 995 \) reactive \( postprandial \) hypoglycemia sometimes represent severe disorder refractory conventional therapeutic measures present first individual trial , knowledge , administration somatostatin analogue \( sms 201 995 \) may alleviate severity complaints appear effects somatostatin analogue documented 5 hour oral glucose tolerance test , glucose induced c peptide rise clearly attenuated , also blood glucose concentration fall low enough induce hypoglycemic symptoms
quantitative histologic study sural nerve syndrome sural nerve 31 year old man syndrome obtained autopsy studied histologically large , myelinated nerve fibers reduced number myelinated nerve fibers larger 5 microns seen diameter distribution myelinated nerve fibers demonstrate pattern density myelinated nerve fibers 5 , mm2 decreased compared controls electron microscopic examination , lipid like inclusions observed cytoplasm schwann cells role inclusions could elucidated , reduction larger myelinated nerve fibers suggests peripheral nervous disorder patients syndrome therefore , patients syndrome must disorders peripheral nervous system
reduced beta cell glucose transporter new onset diabetic bb rats previous studies laboratories suggested defect glucose transport islets isolated bb rats first day overt diabetes quantitate immunostaining glucose transporter beta cells \( glut 2 \) onset autoimmune diabetes employed antibody terminal first day overt diabetes , defined day daily blood glucose first reached 200 mg dl , volume density ratio glut 2 positive insulin positive beta cells 0 48 0 06 , compared 0 91 0 02 age matched nondiabetic diabetes resistant controls \( p less 0 001 \) age matched nondiabetic diabetes prone rats , would become diabetic , ratio 0 85 0 02 , also less controls \( p less 0 05 \) protein gold labeling glut 2 beta cells day 1 diabetic rats revealed 2 17 0 16 gold particles per length plasma membranes compared 3 91 0 14 controls \( p less 0 001 \) 2 87 0 24 nondiabetic diabetes prone rats \( p less 0 02 \) reduction glut 2 correlates temporally may contribute loss glucose stimulated insulin secretion precedes profound beta cell depletion autoimmune diabetes
need accurate nutrition survey methodology south carolina experience assessment two nutrition related risk factors , obesity fat intake , completed representative sample south carolina adults obesity estimates determined self reported heights weights less prevalences determined direct measurements \( white males 21 4 vs 28 2 white females 20 8 vs 24 5 black males 29 2 vs 30 1 black females 43 6 vs 50 6 total 24 9 vs 29 8 \) nine fat intake habits identified dietary involving consumption red meat , fat meat , fish chicken , , eggs , whole milk , , use solid fats vegetables mean number nine habits exhibited four total number habits correlate well serum cholesterol , 27 individuals none nine fat intake habits blood cholesterol values greater 6 2 mmol l \( 239 mg 100 ml \) , 17 individuals seven habits high level cholesterol nine habits explained less 10 variability serum cholesterol values
importance context choosing nutritional indicators nutritional indicators used screen , diagnose , evaluate interventions individuals also used populations ascertain place surveillance magnitude nutritional problems , location causes , evaluate impact programs policies nutritional indicators also used research make biological social mechanisms affecting affected nutrition activities include measurements nutritional indicators , choice indicators , measurements , analyses , need data different research , patient management , making public policy , planning evaluating programs best indicator , best measure indicator , best analysis indicator sense definition best depends ultimately appropriate decision must made paper gives examples
use cholesterol measurements childhood prediction adult hypercholesterolemia study article describes validity utility screening tests total cholesterol levels school age children predict , adults , cholesterol levels national cholesterol education program suggests need continuing surveillance intervention two thousand three hundred sixty seven children aged 8 18 years examined several occasions followed ages 20 30 years children cholesterol concentrations exceeding percentile two occasions , 75 girls 56 boys would qualify intervention adults national cholesterol education program criteria children cholesterol levels exceeding percentile two occasions , 57 girls 30 boys would qualify intervention adults efficacy , safety , acceptability , cost treatment high cholesterol concentrations childhood evolving , need universal screening childhood cholesterol levels must considered carefully view number children high levels cholesterol , adults , meet criteria intervention suggested national cholesterol education program
increased testosterone type diabetic subjects severe retinopathy diabetic retinopathy rarely occurs puberty , suggesting changes sex hormones may influence development condition authors measured serum testosterone , estradiol , dhea , sex hormone binding globulin levels 26 men 22 women type diabetes wisconsin epidemiologic study diabetic retinopathy \( \) , population based study diabetic complications mean age 23 years mean duration diabetes 14 years subjects proliferative retinopathy \( greater equal retinopathy level 51 80 \) matched duration diabetes \( 2 years \) sex subjects minimal retinopathy \( less equal retinopathy level 21 \) seven retinal photographs eye obtained photographs read university wisconsin reading center serum testosterone concentrations significantly higher male diabetic subjects proliferative retinopathy \( 36 ng dl \) male diabetic subjects minimal retinopathy \( 43 ng dl \) \( p 0 017 \) statistically significant differences sex hormones subjects without proliferative retinopathy observed although results regarded preliminary small number subjects , support hypothesis testosterone concentrations may associated development retinopathy type diabetic patients
diet induced hypercholesterolemia mice prevention overexpression ldl receptors current studies designed determine whether chronic overexpression low density lipoprotein \( ldl \) receptors liver would protect mice increase plasma ldl cholesterol induced high fat diets line transgenic mice studied express human ldl receptor gene liver control transferrin promoter fed diet containing cholesterol , saturated fat , bile acids 3 weeks , transgenic mice , contrast normal mice , develop detectable increase plasma ldl current data indicate overexpression ldl receptors protect diet induced hypercholesterolemia mice
growth obese children treated obesity study assesses growth patterns 5 year period children aged 6 12 years treated obesity using behavioral family based treatment procedures previous studies suggested decrease height velocity weight reduction , results consider either height parent greater height obese nonobese children results show entry , obese children nonobese peers \( percentile \) , even 5 years , remain \( percentile \) child weight level physical maturity accounted 54 variance predicting baseline height percentile entrance height parental height accounted 9 variance changes height percentile , adjusted parental height weight change correlate growth adjusted parental height results suggest negative effects height long term side effect child weight control
l arginine augments endothelium dependent vasodilation cholesterol fed rabbits evidence exists endothelium derived relaxing factor nitric oxide l arginine precursor synthesis nitric oxide vitro whether exogenous l arginine contributes modulation vascular smooth muscle tone vivo still controversial hypercholesterolemia , resistance vessels relax normally response pharmacological stimuli release endothelium derived relaxing factor bioassay experiments suggested impaired synthesis release endothelium derived relaxing factor accounts , part , blunted relaxation hypothesized hypercholesterolemia reduces arginine metabolism thereby impairs endothelium derived relaxing factor synthesis accordingly , designed study determine whether exogenous l arginine could augment endothelium dependent vasodilation hind limb resistance vessels anesthetized cholesterol fed rabbits femoral blood flow recorded electromagnetic flow probe 16 cholesterol fed 12 control rabbits hind limb vasodilator responses incremental intra arterial infusions acetylcholine \( 0 3 9 0 micrograms kg min \) nitroprusside \( 0 3 9 0 micrograms kg min \) studied intravenous administration l arginine \( 10 mg kg min \) , arginine \( 10 mg kg min \) , saline vasodilator response acetylcholine impaired cholesterol fed rabbits compared control rabbits l arginine augmented vasodilation acetylcholine cholesterol fed control rabbits l arginine alter effect nitroprusside either group neither saline arginine changed response either acetylcholine nitroprusside data demonstrate exogenous l arginine endothelium dependent vasodilation hind limb resistance vessels cholesterol fed rabbits
experimental diabetes increases insulinlike growth factor ii receptor concentration gene expression kidney insulinlike growth factor \( igf \) mitogenic hormone important regulatory roles growth development one target organs igf action kidney , abundant igf receptors igf study involvement igf igf receptor development nephropathy , one major complications diabetes mellitus , measured expression genes kidney tissues streptozocin induced diabetic rat binding 125i labeled igf crude membranes measured tissues observed 2 5 fold increase steady state level igf receptor mrna diabetic kidney , accompanied 2 3 fold increase igf binding addition increase igf binding igf receptor , also binding lower molecular weight material may represent igf binding protein change detected level igf peptide mrna similarly , igf ii receptor mrna levels igf ii binding significantly increased diabetic kidney igf igf ii receptor mrna levels igf igf ii binding returned control values insulin treatment igf receptor able mitogenic signals activation tyrosine kinase domain , hypothesize , among factors , high levels receptor diabetic kidney may also involved development diabetic nephropathy increased igf ii receptor expression diabetic kidney may important intracellular transport lysosomal enzymes , although role receptor signal transduction cannot excluded finally , possible role igf binding proteins requires study
basis type diabetes association hras1 polymorphism hla dr3 , dr4 , dqw8 analyzed extended haplotypes composed dna loci short arm chromosome 11 segregation insulin dependent \( type \) diabetes mellitus markers loci tyrosine hydroxylase , insulin , c ha ras 1 proto oncogene \( hras1 \) report , study 27 families , specific haplotype \( h \) , containing 3 kilobase \( kb \) hras1 taq dna polymorphism , segregated differentially diabetic nondiabetic siblings \( p 0 005 \) parallel population study showed 3 kb hras1 taq polymorphism increased frequency type patients two strong hla susceptibility haplotypes compared type patients healthy control blood donors \( p less 0 p less 0 025 , respectively \) polymorphic variable , enhancer , promoter regions flanking human insulin gene h haplotype associated type diabetes results indicate hras1 locus genes linkage disequilibrium locus involved pathogenesis hla dr3 4 type diabetes mellitus
role two types glucose transporters enlarged adipocytes aged obese rats mechanism insulin resistant glucose transport activity enlarged aged adipocytes examined glucose transport activity assessed measuring 3 transport concentration hepg2 erythrocyte glucose transporter \( glut1 \) , muscle adipose tissue transporter \( glut4 \) estimated immunoblotting basal glucose transport activity increased 6 3 fold cell remained constant per unit cellular surface area due cell enlargement maximal insulin stimulated transport activity remained constant per cell decreased per unit cellular surface area per protein basis , glut1 glut4 aged rats decreased approximately 60 10 young rats , respectively however , protein content fraction recoveries marker enzymes used estimating amount transporters intact adipocytes , amount glut1 per cell remained relatively constant , whereas glut4 decreased basal cells young rats , 31 total glut1 per cell located plasma membrane , whereas aged rats , 63 located plasma membrane thus , comparing basal adipocytes aged rats young rats , glut1 per cell plasma membrane increased 2 8 fold , increase less transport activity \( 6 3 fold \) basal cells young rats , 8 total glut4 located plasma membrane , 4 5 fold increase observed insulin treatment , amount glut4 fraction aged rats markedly decreased
mild hypoglycemia impairment brain stem cortical evoked potentials healthy subjects evaluate impact mild hypoglycemia cns function healthy adults , measured brain stem auditory evoked potentials p300 potentials \( elicited cognitive processing auditory stimuli \) hypoglycemic euglycemic insulin clamps \( 80 mu 2 min 1 \) hypoglycemic clamp study \( n 8 \) , plasma glucose allowed fall 4 6 3 mm hourly approximately 0 5 mm steps subsequently returned euglycemic baseline levels euglycemic clamp study \( n 8 \) , plasma glucose maintained baseline levels throughout neither brain stem p300 responses changed euglycemic control study symptoms counterregulatory hormones also unaffected hypoglycemia study , epinephrine growth hormone rose plasma glucose reached 3 4 0 1 mm brain stem p300 potentials remained unchanged 3 mm glucose step , neurophysiological changes suddenly developed conjunction reported symptoms glucose level , wave v component brain stem potential selectively altered 7 8 subjects furthermore , p300 latency significantly increased , amplitude diminished changes brain stem cortical \( p300 \) responses reversed euglycemia restored conclude modest reductions plasma glucose \( 3 mm \) produce marked alterations brain stem cortical responses auditory stimuli changes neural function appear time symptoms follow rather precede rise counterregulatory hormones hypoglycemia data suggest adverse effects mild hypoglycemia brain function limited higher centers also involve brain stem
changes phosphoinositide turnover , ca2 mobilization , protein phosphorylation platelets niddm patients enhanced platelet functions demonstrated patients non insulin dependent diabetes mellitus \( niddm \) study evaluated abnormalities platelet signal transduction diabetic patients , including turnover , mobilization intracellular ca2 , phosphorylation 20 , 000 47 , 000 mr proteins \( p47 \) washed platelets obtained 6 patients niddm whose platelet aggregation rates abnormally elevated \( dm group \) , 11 niddm patients normal platelet aggregation rates \( dm b group \) , 8 age matched healthy control subjects mass specific radioactivity phosphatidylinositol 4 , 5 \( pip2 \) , phosphatidylinositol 4 phosphate \( pip \) , phosphatidylinositol \( pi \) , acid \( pa \) 32p labeled platelets different among three groups hydrolysis pip2 , pip , pi accumulation pa phosphorylation platelets stimulated 0 05 u ml thrombin significantly increased dm group compared control dm b group difference p47 phosphorylation among three groups contrary , p47 phosphorylation induced 50 nm 12 tetradecanoylphorbol 13 acetate , activator protein kinase c , significantly decreased dm group additionally , intracellular free ca2 concentration \( ca2 \) measured fluorescent ca2 indicator fura 2 although basal ca2 value similar three groups , rise ca2 induced 0 05 u ml thrombin presence absence extracellular ca2 significantly higher dm group groups
tumor necrosis factor increased hepatic low density lipoprotein production increased serum triglyceride levels diabetic rats previous studies demonstrated administration tumor necrosis factor \( tnf \) diabetic rats rapidly increases serum triglyceride levels stimulates hepatic without affecting activity adipose tissue lipoprotein lipase serum insulin levels purpose study determine mechanism tnf increases serum triglyceride levels stimulates hepatic fatty acid synthesis diabetic animals maximal increase \( approximately 2 fold \) serum triglyceride levels diabetic rats seen dose 10 micrograms tnf 200 g body wt , half maximal effect observed 5 micrograms tnf 200 g body wt clearance labeled triglyceride rich lipoproteins circulation affected tnf administration \( triglyceride 1 2 diabetic vs tnf administered diabetic , 3 5 0 7 vs 4 0 0 6 min , respectively ns \) production triglyceride , measured technique , increased twofold diabetic animals tnf administration results indicate rapid increase serum triglyceride levels tnf treatment accounted increased hepatic lipoprotein secretion tnf administration alter either amount activation state hepatic acetyl coa , key regulatory enzyme fatty acid synthesis also change hepatic levels fatty acyl coa , inhibitor acetyl coa however , 71 increase hepatic citrate concentrations citrate activator acetyl coa , changes hepatic citrate concentrations shown mediate changes rates fatty acid synthesis
coupling beta cell desensitization hyperglycemia excessive stimulation circulating insulin glucose infused rats nondiabetic rats infused glucose 48 h maintain moderate marked hyperglycemia \( mean blood glucose 13 2 0 7 22 8 0 3 mm , respectively \) two levels hyperglycemia increased plasma insulin levels decreased insulin response 27 mm glucose 19 95 , respectively , versus saline infusion diazoxide \( 5 mg kg 1 h 1 \) , continuously infused hyperglycemia protocols , completely inhibited glucose induced rise plasma insulin levels diazoxide transformed beta cell insensitivity stimulation glucose induced insulin release thus increased moderate hyperglycemia marked hyperglycemia stimulatory effects diazoxide reversed exogenous insulin infusion \( 8 2 u 24 h \) dose dependent manner concluded excessive beta cell stimulation rather underlies hyperglycemia induced beta cell insensitivity effects hyperinsulinemia form part mechanisms whereby excessive stimulation affects beta cell secretion
induced localized exogenous treated dermabrasion co2 laser exogenous localized result repeated use containing , many available counter report case managed dermabrasion co2 laser incidence proposed etiologies induced exogenous reviewed
management hypercholesterolemia family practice setting study undertaken assess physician adherence patient compliance national cholesterol education program guidelines management newly detected hypercholesterolemia study site department family medicine , medical university south carolina , charleston , university based family medicine residency program serum cholesterol levels measured july 1 , 1988 , september 30 , 1988 , reviewed patients classified normal , borderline , hypercholesterolemic based serum cholesterol levels coronary heart disease risk factors patients previously recognized hypercholesterolemic excluded six months later , medical record reviews performed 192 hypercholesterolemic 107 borderline hypercholesterolemic patients 39 hypercholesterolemic patients \( 20 \) received appropriate dietary therapy follow patient compliance physician recommendations excellent minimal unnecessary testing treatment borderline hypercholesterolemia low rates appropriate management hypercholesterolemia may related inadequate physician knowledge , low physician perceived self efficacy regarding dietary counseling , time constraints
late onset ornithine transcarbamylase deficiency male patients published erratum appears j 1991 feb 118 \( 2 \) 326 report 21 male patients presented 28 days age ornithine transcarbamylase \( otc \) deficiency , define late onset otc deficiency patients appeared normal birth , irritability , vomiting , , often episodic , later developed age presentation ranged 2 months 44 years biochemical testing revealed , , , increased urinary excretion , decreased liver otc activity measured vitro , ranged 0 15 normal male patients older presentation somewhat different pattern presenting symptoms likely die data illustrate phenotypic variability otc deficiency unexplained episodes repetitive protracted vomiting association progressive alterations behavior neurologic findings suggest diagnosis urea cycle defect \( another symptomatic inborn error metabolism \) , regardless age medical history patient
stimulatory activity fibroblasts enhanced cholesterol esterification another serum basic protein , bp ii cultured fibroblasts patients familial \( hyperapob \) used determine defect lipid metabolism present three basic proteins \( bp , bp ii , bp iii \) isolated normal human serum isoelectric focusing , sds page , reversed phase hplc mr pi values proteins 14 , 000 9 10 bp , 27 , 500 8 48 bp ii , 55 , 000 8 73 bp iii proteins differed significantly content arginine , cysteine , proline , histidine , serine , methionine bp appears protein stimulating protein , bp ii bp iii appeared different stimulating protein lipid carrier proteins bp , bp ii , bp iii stimulated incorporation 14c oleate lipid esters normal fibroblasts , effect time concentration dependent hyperapob cells , bp ii markedly increased \( 9 fold \) incorporation 14c oleate cholesteryl ester compared normal cells addition , 50 decrease stimulation triglyceride cholesterol esterification bp difference normal hyperapob cells observed bp iii summary , identification another serum basic protein , bp ii , led elucidation another cellular defect hyperapob fibroblasts , enhanced cholesterol esterification , may related precocious atherosclerosis abnormal lipoprotein metabolism seen hyperapob
southern blood update selected aspects hemochromatosis genetic epidemiology studies indicated hereditary hemochromatosis \( hh \) occurs frequency 3 13 per thousand clinical recognition however occurs far less frequently disparity best resolved defining hh hla linked hemochromatosis allele , regardless total body iron burden variability clinical expression explained part physiologic iron loss women variability males may due environmental factors , gene gene interactions polymorphisms mutated hemochromatosis alleles although clinical variability great , laboratory phenotype hh fairly constant marked elevation transferrin saturation elevated transferrin saturation occurs early life , organ iron loading occurs used screening tool detect hh organ damage occurs cloning characterizing hh gene , located within 1 hla locus resolve issues concerning clinical variability
mechanisms impaired growth hormone secretion genetically obese zucker rats roles growth hormone releasing factor somatostatin gh secretion markedly blunted obesity however , mechanism \( \) mediating response remains elucidated present study examined involvement two hypothalamic gh regulatory hormones , gh releasing factor \( grf \) somatostatin \( srif \) , using genetically obese male zucker rat spontaneous gh , insulin , glucose secretory profiles obtained free moving , chronically cannulated rats revealed marked suppression amplitude duration gh pulses obese zucker rats compared lean littermates \( mean 6 h plasma gh level , 3 9 0 4 vs 21 5 3 8 ng ml p less 0 001 \) obese rats also exhibited significant hyperinsulinemia presence normoglycemia plasma gh response iv bolus 1 microgram rat grf \( 1 29 \) nh2 , administered peak trough periods gh rhythm , significantly attenuated obese rats peak \( 137 4 26 1 vs 266 9 40 7 ng ml p less 0 02 \) , although trough , times passive immunization obese rats specific antiserum srif failed restore amplitude gh pulses normal values mean 6 h plasma gh level obese rats given srif antiserum significantly different obese rats administered normal sheep serum pituitary wet weight pituitary gh content concentration reduced obese group measurement hypothalamic grf immunoreactivity revealed significant \( p less 0 05 \) reduction hypothalamic grf content obese rats \( 2 60 1 pg fragment \) compared lean controls \( 1 50 2 pg fragment \) , although significant difference observed hypothalamic srif concentration peripheral srif immunoreactive levels significantly \( p less 0 01 \) elevated pancreas stomach obese rats results demonstrate genetically obese zucker rat exhibits 1 \) marked impairment spontaneous grf induced gh release , cannot reversed srif , 2 \) significant reduction pituitary gh concentration , 3 \) depressed hypothalamic grf content , 4 \) elevated gastric pancreatic , hypothalamic , srif levels findings suggest defect pituitary gh secretion observed genetically obese zucker rat due , least partially , insufficient stimulation hypothalamic grf , srif play significant role
depletion alcohol \( \) dehydrogenase activity epidermis jejunal mucosa sjogren syndrome using histochemical technique , demonstrated consistent deficiency alcohol \( \) dehydrogenase activity within epidermis jejunal mucosa patients sjogren syndrome biochemical assay fatty alcohol nad activity cultured fibroblasts leukocytes patients showed deficient activities compared controls histochemical biochemical results complementary , simpler histochemical method used reliably initial screening patients diagnosis sjogren syndrome suspected
transfer diabetes mice prevented blockade adhesion promoting receptor macrophages insulin dependent diabetes mellitus \( iddm \) disease autoimmune aetiology non obese diabetic mouse good spontaneous animal model human disease , iddm developing 50 80 female mice age 6 months disease transferred splenic cells diabetic donors prevented cell depletion mechanism \( \) beta cell specifically destroyed known , cells macrophages implicated , based presence macrophages infiltrated islet ability chronic silica treatment prevent disease monoclonal antibody specific myelomonocytic adhesion promoting type 3 complement receptor \( cr3 \) bind cells show blockade macrophage cr3 vivo prevents intra islet infiltration macrophages cells inhibits development iddm conclude cells macrophages essential role onset iddm
health homeless children housed , poor children homeless children families increasing numbers across country noted frequent health problems health status homeless children assessed multiple dimensions parental report survey conducted 196 homeless families 10 shelters los angeles 194 housed poor families march 1987 january 1988 month survey , homeless housed poor children experienced high rates illness symptoms , disability , bed days homeless housed poor children frequently rated parents fair poor health \( 17 vs 13 , p 14 \) homeless children , however , reported behavior problems school failure 30 vs 18 , p 06 housed poor children homeless children also high rates health problems developmental delay \( 9 \) overweight \( 13 \) diets homeless children frequently imbalanced , dependent food fast food , characterized repeated periods deprivation family problems common among homeless families , especially among single parent homeless families compared single parent housed families \( abuse , 68 vs 41 , p less 01 parental drug alcohol abuse , 60 vs 39 , p less 01 \) concluded homeless children significant child behavior developmental problems disorders nutrition growth , associated multiple risk factors environment
immunological evidence accumulation lipoprotein \( \) atherosclerotic lesion guinea pig lipoprotein \( \) lp \( \) extremely atherogenic lipoprotein lp \( \) found plasma humans primates , species mechanism exerts still poorly understood observed lp \( \) found plasma several species unable synthesize ascorbate species detected \( \) plasma guinea pig induced atherosclerosis animal dietary ascorbate depletion , using sds page subsequent immunoblotting , identified lp \( \) accumulating atherosclerotic plaque importantly , adequate amounts ascorbate \( 40 mg per kg body weight per day \) prevent development atherosclerotic lesions animal model accumulation lp \( \) arterial wall suggest analogous mechanism humans similarity guinea pigs humans respect lack endogenous ascorbate production role lp \( \) human atherosclerosis
morbidly obese patients' perceptions social discrimination surgery obesity morbidly obese patients' perceptions obesity related discrimination assessed 14 months operation obesity preoperatively , 57 consecutive patients perceived overwhelming discrimination work , within family , public places weight loss 45 5 kg \( 100 lb \) , patients perceived little discrimination examine factors contributing change patients' perceptions upon patients' perceptions negative attitudes held health professionals toward obese patients
hypoglycemia alters striatal amino acid efflux perinatal rats vivo microdialysis study adult brain , insulin induced hypoglycemia , striatal extracellular fluid concentrations excitatory amino acids glutamate aspartate rise markedly \( fourfold \) study , used vivo microdialysis determine insulin induced hypoglycemia altered striatal amino acid efflux similar fashion immature brain microdialysis probes inserted right striatum rats postnatal day 7 2 hour recovery period , animal 30 minute baseline sample obtained insulin \( 0 6 mu kg , intraperitoneal injection \) administered \( n 6 \) dialysate sampling continued next 210 minutes \( terminal blood glucose level less 5 mg dl \) untreated control rats \( n 6 \) sampled time interval pre column , dialysate samples assayed high pressure liquid chromatography detection measure amino acid content eight amino acids \( glutamate , aspartate , taurine , glutamine , alanine , serine , glycine , asparagine \) consistently detected controls , amino acid efflux change 4 hours hypoglycemic animals , glutamate efflux increased \( peak 238 85 baseline , p 0 02 , repeated measures analysis variance anova \) , glutamine efflux declined \( 44 5 baseline , p 0 002 , anova \) , taurine efflux increased \( 310 120 baseline p less 0 06 , anova \) contrast 9 12 fold increases aspartate efflux reported adult striatum , aspartate efflux increased slightly \( 174 69 baseline significant \)
efficient method removing bilirubin bilirubin tightly bound albumin , making hemoperfusion ineffective treatment hyperbilirubinemia adding safe agent blood \( \) , , hemoperfusion become efficient practical made intravenous infusion 5 mg ml solution \( \) 1 hour peak concentrations 14 22 mg dl reached adult dogs \( 25 35 kg \) hemoperfusion initiated without \( control \) \( sodium benzoate \) bilirubin effect sodium benzoate rapid effective simultaneous adsorption sodium benzoate , small activated carbon section located proximal main hemoperfusion column , addition continuous infusion reach 20 mm blood comparison normalized bilirubin concentration benzoate augmented hemoperfusion average control dogs , shows benzoate results threefold decrease normalized bilirubin concentration 1 5 hr hemoperfusion sodium benzoate may also advantage protecting platelets hemoperfusion
effect beta cell distribution performance pancreas insulin response available prototype hollow fiber pancreas devices remains unacceptably slow although previous experimental theoretical investigations provide insight factors governing performance devices , currently results effects beta cell distribution insulin response authors developed detailed theoretical model insulin response hollow fiber pancreas model predictions shown good agreement literature data insulin release vitro hollow fiber device study , model used evaluate effects axial radial variations beta cell density insulin response device recirculation \( e , diffusion controlled device \) , radical distribution cells matrix plays critical role determining device response , insulin response essentially independent axial beta cell distribution contrast , device substantial recirculation , strong dependence axial beta cell distribution , weaker dependence upon radial distribution results clearly demonstrate potential importance beta cell distribution analysis vivo vitro experimental data , design effective clinical devices
implanted peritoneal oxygen calibrated situ oxygen tension peritoneum continuously measured silastic integral oxygen electrode inlet outlet tubes electrolyte solution remote kinetic system periodically performed implanted six rabbits peritoneal oxygen tension measured awake anesthetized rabbits various oxygen breathing conditions
southern 1985 6 population structure , nutritional state , incidence death among children objective assess effects mortality children design prospective epidemiological study forming part nutritional monitoring relief work setting 24 food distribution sites southern patients monthly average 14 , 173 5 , children 5 examined 1985 1986 , respectively altogether 148 , child months \( 105 , 1985 43 , 094 1986 \) available analysis intervention families children supplied food month basic medical care also provided main outcome measure mortality children 5 results 40 increase crude mortality observed among children living traditional stable societies severe consequences observed mainly among children living relief shelters , threefold fourfold increase crude mortality recorded among children increased childhood mortality also associated high prevalence malnutrition , living areas , dry season long period food aid needed nutritional state , especially children living relief shelters conclusions severe consequences widespread occurred southern 1985 6 seen among children living relief shelters early food intervention may decrease scale migration thus also reduce severe consequences
management brittle diabetes implanted insulin pump delivering intraperitoneal insulin objective control young woman brittle diabetes design use fully implanted pump \( \) deliver insulin intraperitoneally variable rates , giving total dose 60 units 24 h setting department teaching hospital patient thirty year old woman 15 years' history brittle diabetes main outcome measures haemoglobin concentration plasma glucose concentration results implantation pump immediate sustained improvement diabetic control patient 's haemoglobin concentration decreased 15 2 9 2 seven months daily glucose concentrations range 3 5 12 mmol l admitted hospital since implantation pump , eight months time writing conclusion implanted intraperitoneal insulin pump may value management patients brittle diabetes attempts control failed
developmental cytosolic phosphate content ph regulation sheep heart vivo study examines myocardial cytosolic phosphate content buffering capacity occur vivo function development phosphate metabolites monitored open chest sheep preparation using 31p magnetic resonance surface coil left ventricle newborn lambs \( aged 4 9 , n 5 \) underwent exchange transfusion adult blood reduce blood borne 2 , 3 contamination heart monophosphate phosphomonoester , thus allowing determination phosphate concentrations blood newborns mature controls \( aged 30 60 , n 5 \) infused 0 4 n acid decrease ph greater 7 35 less 7 00 simultaneously , intracellular extracellular ph determined chemical shifts respective phosphate peaks compared arterial blood ph findings follows \( \) contribution cardiac spectrum found negligible , \( b \) significant decreases cytosolic phosphate \( p less 0 03 \) phosphomonoester \( p less 0 01 \) content occurred maturation , \( c \) large decreases extracellular ph \( greater 0 5 u \) groups similarly associated small changes intracellular ph \( less 0 1 u \) change cytosolic phosphate content implies alterations occur phosphorylation potential resulting effects regulation myocardial respiration , cardiac
glucagon , catecholamine pancreatic polypeptide secretion type diabetic recipients pancreas allografts successful pancreas transplantation type diabetic patients restores normal fasting glucose levels biphasic insulin responses glucose however , virtually data pancreas recipients available relative islet hormonal responses hormonal hypoglycemia consequently , glucose , glucagon , catecholamine , pancreatic polypeptide responses insulin induced hypoglycemia stimulation arginine secretin examined 38 diabetic pancreas recipients , 54 type diabetic , 26 nondiabetic normal control subjects glucose recovery insulin induced hypoglycemia pancreas recipients significantly improved basal glucagon levels significantly higher recipients compared normal subjects glucagon responses insulin induced hypoglycemia significantly greater pancreas recipients compared similar observed control subjects glucagon responses intravenous arginine significantly greater pancreas recipients observed normal subjects differences observed epinephrine responses insulin induced hypoglycemia differences pancreatic polypeptide responses hypoglycemia observed comparing recipient groups , less observed control subjects data demonstrate significant improvement glucose recovery hypoglycemia associated improved glucagon secretion type diabetic recipients pancreas transplantation
lack 3 beta hydroxy delta 5 steroid dehydrogenase fibroblasts child urinary excretion 3 beta hydroxy delta 5 bile acids new inborn error metabolism cultured fibroblasts shown capable conversion 7 alpha hydroxy cholesterol 7 alpha hydroxy 4 3 one , important reaction bile acid synthesis apparent km approximately 7 mumol liter vmax varied 3 9 nmol mg protein per h assay conditions used assay used investigate fibroblasts patient presented familial giant cell hepatitis found 3 beta , 7 alpha dihydroxy 5 acid 3 beta , 7 alpha , 12 alpha 5 acid urine \( , p , j v , , k r , , b , j 1987 j clin invest 79 \) addition 7 alpha hydroxy cholesterol found accumulate circulation cultured fibroblasts boy completely devoid 3 beta hydroxy delta 5 steroid dehydrogenase activity fibroblasts parents reduced activity , compatible heterozygous genotype results provide strong evidence suggestion patient 's liver disease caused primary defect 3 beta hydroxy delta 5 steroid dehydrogenase involved bile acid biosynthesis
mechanism increased noninsulin dependent diabetes mellitus role alterations systemic , hepatic , muscle lactate alanine metabolism assess mechanisms responsible increased noninsulin dependent diabetes mellitus \( niddm \) , infused 3 14c lactate , 3 13c alanine , 6 3h glucose 10 postabsorptive niddm subjects 9 age weight matched nondiabetic volunteers measured systemic appearance alanine lactate , release forearm tissues , conversion plasma glucose \( corrected krebs cycle carbon exchange \) systemic appearance lactate alanine significantly greater diabetic subjects \( 18 2 0 9 5 8 0 4 mumol kg min , respectively \) nondiabetic volunteers \( 12 6 0 7 4 2 0 3 mumol kg min , respectively , p less 0 001 p less 0 01 \) lactate alanine glucose also significantly greater niddm subjects \( 8 6 0 5 2 4 0 1 kg min , respectively \) nondiabetic volunteers \( 4 2 0 4 1 8 0 1 mumol kg min , respectively , p less 0 001 p less 0 025 \) proportion systemic alanine appearance converted glucose increased niddm subjects \( 42 7 1 9 vs 44 2 2 9 nondiabetic volunteers \) , whereas proportion systemic lactate appearance converted glucose increased niddm subjects \( 48 3 3 8 vs 34 2 3 8 nondiabetic volunteers , p less 0 025 \) latter increased hepatic efficiency accounted approximately 40 increased lactate conversion glucose neither forearm total body muscle lactate alanine release significantly different niddm nondiabetic volunteers therefore , conclude increased substrate delivery liver increased efficiency intrahepatic substrate conversion glucose important factors increased niddm tissues muscle responsible increased delivery precursors liver
increased hepatic mitochondrial capacity rats hydroxy cobalamin c lactam induced methylmalonic aciduria treatment rats vitamin b12 analogue hydroxy cobalamin c lactam \( hccl \) impairs methylmalonyl coa mutase function leads methylmalonic aciduria due intracellular accumulation methylmalonyl coa since accumulation acyl normal cellular regulation , present investigation characterized metabolism hepatocytes liver mitochondria rats treated subcutaneously hccl saline \( control \) osmotic consistent decreased methylmalonyl coa mutase activity , 14co2 production 1 14c \( 1 mm \) decreased 76 82 2 3 wk 5 6 wk hccl treatment , respectively contrast , 5 6 wk hccl treatment , 14co2 production 1 14c pyruvate \( 10 mm \) 1 14c palmitate \( 0 8 mm \) increased 45 49 , respectively isolated liver mitochondria , state 3 oxidation rates unchanged decreased , activities mitochondrial enzymes , citrate synthetase , succinate dehydrogenase , carnitine , glutamate dehydrogenase \( expressed per mitochondrial protein \) unaffected hccl treatment contrast , activities enzymes significantly increased liver homogenate \( expressed per gram liver \) isolated hepatocytes \( expressed per 10 \( 6 \) cells \) hccl treated rats mitochondrial protein per gram liver , calculated basis recovery mitochondrial enzymes , increased 39 5 6 wk hccl treated rats activities lactate dehydrogenase , catalase , cyanide insensitive coa oxidation , arylsulfatase liver affected hccl treatment hepatic levels mitochondrial mrnas elevated 10 fold hccl treated animals assessed northern blot analysis thus , hccl treatment associated enhanced mitochondrial oxidative capacity increased mitochondrial protein content per gram liver increased mitochondrial oxidative capacity may compensatory mechanism response metabolic insult induced hccl administration
familial disorder endogenous catabolism albumin immunoglobulin metabolism albumin igg investigated two siblings , products first marriage , female aged 34 yr male aged 17 , marked reduction respective serum concentrations igg \( 1 3 3 1 mg ml \) albumin \( 19 21 mg ml \) metabolism igg albumin studied two patients total circulating body pools igg less 28 normal igg synthetic rates within normal range however , igg survival short , respective fractional catabolic rates increased fivefold 31 36 intravenous pool per day \( normal , 6 7 2 \) furthermore , patients reduced total body pools , normal synthetic rates , increased fractional catabolic rates albumin proteinuria abnormality renal liver function addition , patients circulating antibodies directed toward igg , iga , albumin furthermore , patients normal fecal 51cr labeled albumin tests , thus excluding excessive gastrointestinal protein loss propose siblings previously unrecognized familial disorder characterized reduced serum concentrations igg albumin caused defect endogenous catabolism , leading short survival proteins associated family chemical diabetes skeletal deformity
hyperglycemia induced b cell toxicity fate pancreatic islets transplanted diabetic mice dependent genetic background role pancreatic b cell dysfunction phase preceding clinical onset insulin dependent non insulin dependent diabetes mellitus much investigation , impact prolonged diabetic environment pancreatic islet b cells transplanted kidney capsule c57bl 6 \( b6 \) c57bl ks \( \) mice studied diabetic mice bearing subcapsular islet graft insufficient normalize blood glucose level rendered normoglycemic second islet graft various period hyperglycemia examine reversibility hyperglycemia induced b cell dysfunction using perfusion technique graft bearing , found strains mice exhibited diminished glucose induced insulin secretion 6 wk hyperglycemia , compared normoglycemic mice carrying islet grafts normoglycemia splenic graft 4 12 wk , normalization glucose stimulated insulin secretion renal islet grafts b6 mice , whereas insulin secretion grafted islets remained impaired morphometric measurements islet grafts demonstrated 50 reduction graft volume diabetic mice 12 wk , compared normoglycemic animals , whereas decrease observed b6 mice islet grafts removed hyperglycemic mice strains exhibited diminished insulin mrna contents , mice also reduced glucose oxidation rate islet grafts vitro metabolic dysfunction partly explained reduced graft size present findings emphasize genetic factor survival function period sustained stress limited b cell mass
serum lipoproteins , apolipoproteins low density lipoprotein subfractions 6 month treatment primary serum lipoproteins apolipoproteins studied 14 \( htg \) patients 24 week period treatment gemfibrozil , 6 week washout period marked decrease low density lipoprotein \( vldl \) cholesterol triglyceride observed increase high density lipoprotein \( hdl \) cholesterol , particularly hdl3 component slight increase low density lipoprotein \( ldl \) cholesterol observed 12 weeks , almost disappeared 24 weeks treatment resulted increase serum apolipoprotein ii levels reduction serum apo c iii apo e vldl density gradient centrifugation four subfractions decreasing size \( , b , c \) showed predominant reduction large subfractions , b c , decrease vldl less marked percentage changes baseline level vldl vldl cholesterol found inversely correlated percentage changes hdl ldl cholesterol , respectively might reflect transfer cholesterol vldl hdl , vldl ldl data suggest induced stimulation lipoprotein lipase , indicate enhanced transfer cholesterol vldl ldl , induced htg patients , less pronounced prolonged period treatment
continuous subcutaneous insulin infusion \( csii \) , multiple injections \( mi \) conventional insulin therapy \( ct \) self selecting insulin dependent diabetic patients comparison metabolic control , acute complications patient preferences continuous subcutaneous insulin infusion \( csii \) multiple injections \( mi \) shown metabolic advantages highly selected insulin dependent diabetics \( \) , comparative studies self selected mi , optimal insulin preparation overnight insulin delivery defined compared conventional 2 3 injection therapy \( ct \) , csii mi human isophane insulin \( mi human isophane \) human insulin \( mi human \) , respectively , bedtime self selected 275 invited participate , 52 individuals \( 18 9 \) entered study indices control showed better values csii also mi compared ct , differences small fasting blood glucose higher mi human mi human isophane one subcutaneous abscess one case ketoacidosis requiring hospitalization occurred csii serious hypoglycaemic episodes non significantly increased intensified therapy patients clearly preferred intensified insulin therapy approximately one half csii
metabolic control complications 3 years patients insulin dependent diabetes \( iddm \) diabetes intervention study \( \) planned 5 year study , 97 patients insulin dependent diabetes mellitus \( iddm \) , non proliferative retinopathy unsatisfactory blood glucose control monitored 3 years patients randomized intensified conventional treatment \( ict , n 44 \) regular treatment \( rt , n 53 \) group hba1c \( normal range 3 9 5 7 \) reduced 9 5 0 2 \( mean value sem \) 7 4 0 1 ict group \( p 0 0001 \) , 9 5 0 2 9 0 0 2 rt group \( p 0 004 \) nerve conduction velocities sural peroneal nerves \( p 0 01 0 0001 \) impaired rt group , ict group retinopathy increased groups condition 22 ict patients \( 50 , 95 confidence interval 34 66 \) 37 rt patients \( 73 , 61 84 \) deteriorated regard least one microvascular complication \( retinopathy , nephropathy , neuropathy \) \( p 0 024 \) lower hba1c levels study significantly reduced risk deterioration \( p 0 01 \) total , 57 ict patients least one episode serious hypoglycaemia , compared 23 rt group \( p 0 001 \) patients ict group also gained weight \( p 0 0001 \) improved blood glucose control slowed progression microangiopathy 3 year period patients non proliferative retinopathy , price increased frequency serious hypoglycaemic episodes , gain body weight
hla antigens capillary microscopy studies patients insulin dependent noninsulin dependent diabetes mellitus limited joint mobility investigated hla status patients diabetes associated limited joint mobility microvascular complications increased frequency hla , dr3 dr4 patients insulin dependent diabetes mellitus \( iddm \) compared controls patients noninsulin dependent diabetes mellitus \( niddm \) confirmed hla antigen detected less frequently patients iddm negatively associated limited joint mobility retinopathy limited joint mobility significantly correlated disease duration iddm , associated neuropathy iddm niddm retinopathy iddm correlation found dr3 , dr4 limited joint mobility diabetic complications also investigated usefulness capillary microscopy large group patients iddm niddm although capillary enlargement avascular areas noted patients , capillary microscopy felt useful tool evaluation diabetes
tests thyroid function update diagnosis management thyroid disease current thyroid function tests give clinician powerful tools accurate assessment thyroid status majority patients encountered , however , small number clinical situations appear inconsistencies thyroid function tests apparently inappropriate clinical status patient instances , rational explanation observed alterations application information allow clinicians diagnostic accuracy thereby enable proceed appropriate therapeutic management program
management primary hypothyroidism primary hypothyroidism common condition requiring treatment monitoring type amount thyroid hormone replacement , selection laboratory tests , timing office visits important optimizing patient well reducing costs medical care aim treatment bring patient euthyroid state currently defined normal serum concentration tsh recently developed sensitive specific assays , accomplished dose levothyroxine changing often 4 6 week intervals indicator , sensitive tsh assay advantages tests serum t4 , , t3 , , tsh ria independent changes result pregnancy , birth control pills , estrogen replacement , elevated levothyroxine treatment , test detects subclinical hypothyroidism subclinical hyperthyroidism additional serum tests usually necessary advantages special circumstances optimal replacement dose determined , monitoring done yearly even bi yearly , depending adequacy patient education patient compliance
total serum glycosylated proteins detection monitoring gestational diabetes goal study determine whether serum glycosylated protein levels \( e , fructosamine \) reliably screen gestational diabetes whether levels valid markers short term glycemic control third trimester pregnancy ninety seven pregnant women 26 28 wk gestation evaluated 9 mo hba1c serum glycosylated protein \( serum fructosamine \) determined baseline venipuncture 100 g oral glucose tolerance test performed detect gestational diabetes 97 women studied , 13 tested positive gestational diabetes \( national diabetes data group criteria \) significant differences fasting 1 , 2 , 3 h glucose values nondiabetic diabetic patients \( p less 0 005 time point \) difference noted baseline serum glycosylated protein level \( 2 02 0 08 vs 1 98 0 02 mm , ns \) hba1c level \( 4 42 0 2 vs 4 6 0 3 , ns \) gestational nondiabetic patients diabetic patients followed 2 wk intervals , serum glycosylated protein analysis , hba1c , fasting glucose , mean glucose determined outpatient monitoring serum glycosylated protein correlated significantly fasting blood glucose \( r 0 81 , p less 0 001 \) mean outpatient glucose \( r 0 62 , p less 0 001 \) 2 wk follow visits correlation found hba1c fasting blood glucose \( r 0 11 , ns \) mean outpatient glucose \( r 0 12 , ns \) follow period serum glycosylated protein level \( serum fructosamine \) useful screening test gestational diabetes however , assay shows potential objective marker short term control evaluating maternal glycemic state
comparison hba1 fructosamine diagnosis glucose tolerance abnormalities total glycosylated hemoglobin \( hba1 \) fructosamine evaluated screening tools detection glucose tolerance abnormalities 144 asymptomatic subjects undergoing 75 g oral glucose tolerance test subjects classified according world health organization criteria normal \( n 78 \) , impaired \( n 40 \) , diabetic \( n 26 \) glucose tolerance found good specificity hba1 fructosamine \( 100 97 , respectively \) low sensitivity \( 15 19 , respectively \) curves sensitivity specificity drawn various thresholds , sensitivity specificity 75 hba1 55 fructosamine thus , neither hba1 fructosamine seems suitable diagnosis mild abnormalities glucose tolerance
occurrence type vi collagen extracellular matrix renal glomeruli increase diabetes human bovine glomerular basement membrane \( gbm \) preparations , representing extracellular matrix renal filtration units , found contain type vi collagen protein solubilized guanidine guanidine characterized polyacrylamide gel electrophoretic resolution immunoblotting antiserum directed alpha 1 \( vi \) alpha 2 \( vi \) polypeptide chains insensitivity collagenase digestion state contrast gbm , product three distinct cells , type vi collagen could detected extracts calf lens capsule , epithelial cell derived basement membrane quantitation radioimmunoassay type vi collagen content gbm 17 diabetic 15 nondiabetic human subjects indicated 2 8 fold higher level \( p less 0 001 \) diabetic preparations glomerulus type vi collagen considered basis immunohistochemistry localized , believe measurement protein gbm preparations provide valuable index mesangial expansion diabetic
effects converting enzyme inhibition barrier function diabetic glomerulopathy differential solute clearances used examine effects 90 day course enalapril glomerular barrier function 16 proteinuric patients diabetic glomerulopathy day 90 , plasma renin became elevated , arterial pressure declined passage broad size distribution \( 28 60 \) lowered significantly subset 8 patients , withdrawal enalapril followed additional 30 days return renin levels arterial pressure pretreatment levels dextran sieving profile also returned baseline , becoming uniformly elevated treated day 90 levels theoretical analysis serial dextran sieving profiles indicated enalapril shifted glomerular pore size distribution smaller size changes barrier size selectivity associated reduction fractional albumin igg clearances enalapril therapy subsequent rise quantities withdrawal urinary protein excretion rate tended vary parallel conclude inhibition converting enzyme humans established diabetic glomerulopathy glomerular permeability proteins enhancing barrier size selectivity neither enalapril therapy withdrawal influenced glomerular filtration renal plasma flow rates significantly , propose primary action enalapril may modulate intrinsic membrane properties glomerular barrier
interaction insulin glucose delivery route regulation net hepatic glucose uptake conscious dogs presence fixed basal levels insulin , route intravenous glucose delivery \( vs peripheral \) determines whether net hepatic glucose uptake \( \) occurs aims determine route intravenous glucose delivery also plays role regulating presence hyperinsulinemia determine length fast \( 18 vs 36 h \) influences regulation five conscious dogs fasted 18 h given somatostatin replacement insulin \( 245 34 microu kg 1 min 1 \) glucagon \( 0 65 ng kg 1 min 1 \) infusions 40 min control period , insulin infusion rate increased fourfold , glucose infused 3 h glucose given either peripheral vein portal vein 90 min double glucose load reaching liver order infusions randomized measured arterial venous difference technique insulin glucagon levels 12 2 , 35 6 , 36 5 microu ml 55 12 , 61 13 , 59 7 pg ml control , peripheral , portal infusions , respectively glucose infusion rate , load glucose reaching liver , arterial portal plasma glucose gradient 0 , 9 58 2 28 , 10 44 2 94 mg kg 1 min 1 29 4 3 6 , 56 8 3 4 , 56 8 2 8 mg kg 1 min 1 2 1 , 5 1 , 51 15 mg dl periods
increased escape rate albumin nondiabetic men response hyperinsulinemia diabetic patients manifest increased vascular permeability determine whether insulin per se might increase vascular permeability , five nondiabetic men studied hyperinsulinemic euglycemic clamp technique subject received 0 72 nmol kg body wt v insulin bolus , followed 72 pmol kg 1 min 1 insulin infusion 4 h euglycemia maintained glucose 7 h study , 10 microci v 125i labeled albumin injected bolus dose frequent blood samples drawn next 70 min determination escape rate \( \) albumin subjects returned 1 2 wk later control study , 0 45 saline infused rate identical dextrose insulin infusion rates hyperinsulinemic clamp mean se serum insulin levels hyperinsulinemic clamp saline infusion 126 46 4 pm , respectively , whereas serum glucose two sessions similar \( 5 0 0 2 vs 4 8 0 1 mm , ns \) identical fluid volumes infused two sessions \( 197 ml 7 h \) , urine outputs differ significantly \( 309 vs ml 7 h \) albumin greater five men hyperinsulinemia saline infusion \( 18 3 2 7 vs 2 8 2 3 h , p 0 01 \)
mutation signal peptide encoding region hormone gene familial isolated hypoparathyroidism hormone \( \) gene mutation proposed cause familial isolated hypoparathyroidism \( \) cloned alleles patient autosomal dominant sequenced coding regions , 5' flanking regions , splice junctions abnormal \( based previous linkage studies \) allele differed allele 's normal sequence one nucleotide c point mutation changes codon position 18 31 amino acid sequence cysteine arginine , hydrophobic core signal sequence hydrophobic core required secreted proteins efficient translocation across endoplasmic reticulum , mutant protein likely processed indeed , vitro studies demonstrated dramatically impaired processing mutant summary , observed point mutation signal peptide encoding region gene one kindred demonstrated functional defect caused mutation mutation signal sequence constitutes novel pathophysiologic mechanism man , study may yield important insights form hormone deficiency role signal sequences human physiology
intraoperative parathormone level measurement management hyperparathyroidism investigate potential use intraoperative intact parathormone measurements predict curative parathyroidectomy , measured ionized calcium \( cai \) levels parathormone levels 33 patients hyperparathyroidism underwent exploratory bilateral neck surgery nineteen patients solitary adenoma , 13 patients hyperplasia , one patient four normal parathyroid glands results compared results 37 patients underwent either thyroid lobectomy \( tl \) \( n 10 \) near total thyroidectomy \( \) \( n 27 \) 14 control patients underwent operations parathormone decline curative parathyroidectomy 86 4 1 2 \( mean se \) , significantly greater decline 25 7 9 8 three patients persistent postoperative hyperparathyroidism \( p less 0 01 \) declines 38 5 8 7 tl \( p less 0 01 \) , 52 2 5 9 \( p less 0 01 \) , 8 3 4 3 \( p less 0 01 \) , control patients intraoperative cai decline 4 0 0 6 curative parathyroidectomy differ significantly results tl , , operations control patients patients persistent postoperative hyperparathyroidism greatest decline cai levels \( 7 1 2 3 p less 0 05 \) data conclude \( 1 \) decline parathormone level 70 20 minutes parathyroidectomy predictive cure , \( 2 \) thyroidectomy , even , produces significant decline parathormone level affects interpretation intraoperative parathormone level changes , \( 3 \) cai level slow decline useful predicting effective parathyroidectomy , \( 4 \) measurement intraoperative parathormone level changes used substitute exploratory bilateral neck surgery
circadian rhythmicity rate normalized qt interval hypothyroidism significance development class iii antiarrhythmic agents lengthening repolarization refractoriness occurs hypothyroidism associated reduced probability arrhythmias , occurring hyperthyroidism qt interval circadian rhythmicity relative heart rate poorly defined man , used new computer assisted technique measure qt interval analysis 24 hour holter \( 8 12 weeks \) thyroxine \( t4 \) replacement 10 patients hypothyroidism findings compared 6 normal control subjects qtc interval prolonged \( p less 0 02 \) heart rate decreased \( p less 0 005 \) hypothyroid state data analyzed circadian rhythmicity repeated measures analysis circadian variation qtc heart rate statistically significant hypothyroid euthyroid states \( p less 0 001 \) well control subjects , circadian rhythmicity qtc interval heart rate phase maximum prolongation qtc occurred midnight 6 , time heart lowest qtc interval remained significantly prolonged 8 12 weeks t4 replacement , biochemical indexes hypothyroidism returned normal values computer assisted qtc interval determination technique used , data circadian rhythmicity qtc heart rate , significant implications development new class iii antiarrhythmic agents
lipoprotein apolipoprotein levels subclinical hypothyroidism effect levothyroxine therapy assess whether subclinical hypothyroidism associated changes lipoprotein fractions , 13 patients maintained stable state subclinical hypothyroidism least 3 months studied prior 2 4 months following restoration euthyroid state incremental levothyroxine sodium therapy thyrotropin levels \( sem \) decreased 16 6 3 2 mu l 3 1 0 7 mu l 3 2 0 7 mu l 2 months 4 months 2 months , levothyroxine treatment led decrease levels total cholesterol 5 5 0 3 mmol l \( 213 12 mg dl \) 4 8 0 3 mmol l \( 186 12 mg dl \) , low density lipoprotein cholesterol \( ldl c \) 3 7 0 3 mmol l \( 143 12 mg dl \) 2 9 0 3 mmol l \( 112 12 mg dl \) , apolipoprotein b 91 8 mg dl 74 7 mg dl 4 months , levels ldl c apolipoprotein b remained significantly lower pretreatment values \( 2 9 0 2 mmol l 112 8 mg dl 75 6 mg dl , respectively \) high density lipoprotein cholesterol \( hdl c \) , hdl3 c , apolipoprotein significantly affected levothyroxine therapy , slight trend increase hdl2 c levothyroxine substitution also tendency decrease triglyceride levels 1 3 0 2 mmol l \( 115 18 mg dl \) 0 9 0 1 mmol l \( 80 9 mg dl \) 4 months levothyroxine therapy levels hdl c tended decrease 4 8 0 4 mmol l \( 186 15 mg dl \) 4 5 0 5 mmol l \( 174 19 mg dl \) 2 months 3 9 0 4 mmol l \( 151 15 mg dl \) 4 months ldl c hdl c ratio also decreased 3 3 0 3 mmol l \( 128 12 mg dl \) 2 9 0 5 mmol l \( 112 19 mg dl \) 2 5 0 3 mmol l \( 97 12 mg dl \) 2 months 4 months , respectively results suggest long term levothyroxine therapy patients subclinical hypothyroidism associated decrease ldl c apolipoprotein b levels reflected trend decreases cholesterol hdl c ldl c hdl c ratios known relationship coronary artery disease
intercellular propagation individually programmed growth bursts frtl 5 cells implications interpreting growth factor actions five methods commonly used quantify frtl 5 growth vitro impact growth inhibiting stimulating maneuvers total cell count , mitotic index , dna measurement , total 3h thymidine incorporation , fraction 3h thymidine labeled cells assess cell growth though cells homogeneous identical response growth factors demonstrate assumption valid rather , growth prone cells appear pass growth signal cells variably sized colonies synchronized cells within cluster growing cells formed true frtl 5 cells growing vitro monolayers three dimensional , collagen embedded spheroids pattern cell suspensions collagen embedded spheroids implanted onto nude mice patches alternating high low growth become particularly prominent large tumor like grown cells nude mice pattern much similar observations growing intact thyroids since significant correlation fraction 3h thymidine labeled cells size two three dimensional clusters experiment , growth signal spreading cells assumed occur growth velocity cell population depends mean interval bursts number cells synchronized cell cell diffusion growth signal one dividing cell thus , growth promoting growth inhibiting factors may act mean interval successive growth bursts , may also change cell cell spreading growth signals
structural abnormality ldl diabetic patients revealed resonance spectroscopy resonance spectra low density lipoprotein \( ldl \) isolated plasma diabetic patients \( age range 13 77 yr , mean age 37 yr \) age sex matched control subjects recorded 1000 1600 cm 1 region function temperature \( 0 50 degrees c \) nondiabetic diabetic ldl yield spectra characterized two major bands near cm 1 due carotenoid component lipoproteins relative intensity cm 1 bands , assigned c c c c , respectively , e , ratio , plotted temperature nondiabetic control subjects , showed temperature range 30 39 degrees c , corresponded thermal transition ldl transition abolished ldl diabetic patients \( p less 0 001 \) , suggesting altered lipid structure transition \( 30 39 degrees c \) also abolished vitro glycosylated nondiabetic ldl lipid analysis show appreciable change nondiabetic control subjects diabetic patients change thermal transition properties diabetic ldl attributed change ldl protein
metabolic effects 1200 kcal diet obese pregnant women gestational diabetes calorie restriction widely used primary therapy obese pregnant women gestational diabetes better understand metabolic consequences marked calorie restriction , performed randomized prospective trial metabolic ward conditions obese diabetic women randomized control \( n 5 \) calorie restricted \( n 7 \) groups patients consumed approximately kcal day diet 1st wk study , end 1st wk , metabolic features two groups statistically indistinguishable 2nd wk , control group continued consume approximately kcal day , whereas calorie restricted group consumed approximately 1200 kcal day twenty four hour mean glucose levels remained unchanged control group \( 6 7 0 8 mm wk 1 vs 6 8 0 8 mm wk 2 \) , although dropped dramatically calorie restricted group \( 6 7 1 0 mm wk 1 vs 5 4 0 5 mm wk 2 , p less 0 01 \) fasting plasma insulin also declined calorie restricted group \( 265 165 pm wk 1 vs 145 130 pm wk 2 \) , resulting significant change groups \( p less 0 02 \) surprisingly , fasting plasma glucose glucose tolerance measured 3 h oral glucose tolerance test change within groups fasting levels beta hydroxybutyrate rose calorie restricted group \( 290 240 microm wk 1 vs 30 microm wk 2 \) control group \( p less 0 01 \) finally , urine increased significantly \( p less 0 02 \) calorie restricted group , whereas remained absent control group
thyroid hormones influences sex steroid binding protein levels infancy study congenital hypothyroidism order test hypothesis role thyroid hormones circulating levels sex steroid binding protein \( shbg \) children , shbg levels determined 15 infants congenital hypothyroidism diagnosis first 18 months t4 therapy separate group 13 children congenital hypothyroidism \( 7 1 0 5 yr , mean sd \) , treated 1 month age , adequate l t4 therapy 4 weeks therapy shbg levels significantly lower hypothyroid infants controls \( 48 2 6 5 vs 77 8 7 9 nmol l p less 0 01 \) , significantly lower infants compared ectopic glands \( p less 0 05 \) patients low values diagnosis , shbg increased rapidly remained normal therapy 1 5 18 months treatment , positive correlation \( p less 0 01 \) found shbg , , levels older hypothyroid children , 4 weeks withdrawal therapy significant \( p less 0 05 \) decrease shbg concentrations observed analysis results well previous reports adults , indicates thyroid hormones influence shbg concentrations infants children study also indicates thyroid hormones may play role physiological postnatal increase shbg
defective zone function mechanism glucocorticoid remediable glucocorticoid remediable characterized unusual sensitivity aldosterone secretion acth glucocorticoid continued exogenous acth provided basis diagnosis treatment disorder qualitative biochemical abnormality consisting marked overproduction products cortisol c 18 oxidation pathway , 18 18 , examined 10 patients disorder compared normal c 18 oxidation products corticosterone , aldosterone , 18 technique , based stable isotope dilution mass , measured urinary metabolites aldosterone , 18 , 18 18 4 c 18 oxygenated corticosteroids markedly elevated untreated state showed rapid parallel suppression low doses glucocorticoid proportional changes c 18 oxygenated together aldosterone 18 suggested mechanism common catalytic site cytochrome methyl oxidase serving cortisol corticosterone substrates acth dependent secretion c 18 oxidation products corticosterone cortisol disorder attributed acquisition methyl oxidase activity zone , abundant pools precursors
short term treatment somatostatin analog octreotide first double blind randomized placebo controlled study effects several studies suggest somatostatin analog octreotide , sms 201 995 , may effectively reduce gh hypersecretion however , double blind , placebo controlled study findings present results randomized double blind 14 day clinical trial octreotide 20 patients drug given sc every 8 h initial dose \( 50 micrograms \) added another 50 micrograms every day 200 micrograms gh levels , calculated mean values 12 observations hourly intervals 1800 h , insulin like growth factor \( igf \) levels significantly reduced octreotide treatment responses varied reduction 97 basal mean gh level significant reduction 2 10 patients good correlation reduction gh igf levels main side effects gastrointestinal well tolerated found spontaneous variation daily mean gh igf levels \( h \) placebo group , ranging approximately 150 50 gh 120 80 igf levels noted day 0 patients treated octreotide , occurrence gh rises administration times suggests may desirable give octreotide every 6 h patients
cold follicles multinodular human goiter arise partly failing iodide pump partly deficient iodine investigate whether common cold follicles human multinodular goiters consequence functional defect apical membrane peroxidase , failure iodide transport system , deficiencies , studied iodide accumulation iodine 30 fragments large multinodular goiter transplanted nude mice labeled 125i transplants frozen 80 c immediately removal avoid diffusion inorganic iodide autoradiographic assessment 1000 \( exposed either 20 c washing unbound iodide \) showed two types cold follicles , namely failed accumulate iodide , therefore , iodine , readily accumulated iodide failed bind , suggesting failure apical membrane peroxidase two types different cold follicles apparently randomly fashion throughout whole goiter
minimal model analysis intravenous glucose tolerance test derived insulin sensitivity diabetic subjects although minimal model analysis frequently sampled iv glucose tolerance tests \( \) measure insulin sensitivity well recognized , application limited need endogenous insulin secretion present study determined whether use exogenous insulin could permit minimal model assessment insulin sensitivity \( si \) extended diabetic subjects normal volunteers separate assessments supplemented insulin accelerate glucose disappearance , diabetics supplemented insulin strong highly significant correlation two assessments normal subjects \( r 0 87 p less 0 001 \) , rank order si generally maintained two assessments 3 fold range si however , insulin determined si 16 lower \( 3 4 0 4 vs 4 1 0 4 x 10 \( 4 \) min microu microl p less 0 01 \) diabetic subjects markedly lower insulin sensitivity controls \( si 0 61 0 16 p less 0 0001 \) across subjects , level fasting serum glucose correlated inversely insulin sensitivity \( r 0 62 p less 0 05 \) acute insulin responses \( r 0 72 p less 0 02 \) however , insulin sensitivity diabetic subjects little insulin secretion \( 0 6 0 2 \) comparable insulin sensitivity diabetic subjects near normal responses \( 0 6 0 3 \) subjects fasting hyperglycemia , significant correlations insulin sensitivity body mass index , percent fat mass , waist hip ratio \( p less 0 03 \) among female subjects , also strong correlation insulin sensitivity upper body obesity , measured waist hip ratio \( r 0 68 p less 0 02 \) model parameters also permitted glucose uptake estimated diabetic vs normal subjects comparable hyperglycemia \( 11 1 mmol l \) total glucose uptake decreased diabetic subjects \( 5 2 0 8 vs 12 7 1 7 mg min kg normals p less 0 001 \) , insulin dependent glucose uptake diminished greater extent \( 1 3 0 4 vs 6 2 1 2 \) noninsulin independent glucose uptake \( 3 9 0 5 vs 6 4 0 9 p less 0 02 \) administration insulin permits minimal model analysis applied diabetic well normal subjects , yielding information insulin noninsulin mediated glucose uptake well insulin sensitivity insulin secretion
tumor necrosis factor putative mediator sick euthyroid syndrome man tumor necrosis factor alpha \( tnf \) believed important mediator many diseases associated sick euthyroid syndrome investigate effect tnf thyroid hormone metabolism , performed controlled study six healthy postabsorptive males , plasma thyroid hormones tsh sequentially measured iv bolus injections recombinant human tnf \( 50 micrograms m2 \) isotonic saline 10 5 h study tnf produced characteristic changes circulating thyroid hormones tsh observed sick euthyroid syndrome compared control experiment , tnf induced significant decreases t3 \( 36 2 saline , 20 3 p less 0 05 \) tsh levels \( 68 3 saline , 44 8 p less 0 05 \) significant increase values \( 48 11 saline , 12 7 p less 0 05 \) t4 free t4 index affected tnf free t4 showed mean transient increase 18 five subjects \( nonsignificant \) , occurred transient 3 5 fold rise circulating ffa levels results suggest tnf involved , either directly indirectly , pathogenesis sick euthyroid syndrome
effects repetitive administration corticotropin releasing hormone combined lysine vasopressin plasma cortisol levels secondary adrenocortical insufficiency examine functioning hypothalamo pituitary adrenocortical axis secondary adrenocortical insufficiency , administered 100 micrograms synthetic human crh , iv , plus 10 u lysine 8 vasopressin \( lvp \) , im , three times daily 3 consecutive days changes plasma acth cortisol levels administration response insulin tolerance test \( \) conducted administration determined three patients isolated acth deficiency , basal plasma acth cortisol levels low , response noted crh lvp administration throughout observation period four patients adrenocortical insufficiency undergone successful transsphenoidal cushing 's disease six patients undergone curative unilateral adrenalectomy cushing 's syndrome , basal plasma acth levels low , responded considerably stimulation tests along 3 days crh lvp stimulation , however , neither peak time integrated acth response significantly enhanced , variability responses among patients compared acth response last day crh lvp stimulation , subsequent tended induce lower acth response post cushing 's disease patients higher response post cushing 's syndrome patients regarding plasma cortisol levels , basal , peak , integrated responses tended increase daily crh lvp administration conversely , repetitive crh lvp administration induced higher cortisol response test crh lvp administration post cushing 's disease patients serious complications noted patients treatment present findings indicate 1 \) repetitive administration crh combination lvp safe valuable provocation test examine pituitary acth reserve integrity pituitary adrenocortical axis 2 \) isolated acth deficiency usually due defect pituitary level 3 \) respect adrenocortical responsiveness , post cushing 's disease patients show better accumulation provocative effect post cushing 's syndrome patients 4 \) hypothalamic pituitary dysfunction responsible adrenal patients , post cushing 's syndrome patients \( especially short period \) appeared less impairment hypothalamic acth releasing activity post cushing 's disease patients
review iodine toxicity reports article summarizes case reports , population studies , experimental studies literature concerning adverse effects exposure iodine mid 1988 exposure excessive iodine foods , dietary supplements , topical medications , iodinated contrast media resulted thyroiditis , goiter , hypothyroidism , hyperthyroidism , sensitivity reactions , acute responses individuals reports maternal iodine exposure pregnancy lactation affecting newborn nursing infants cited susceptibility excess iodine discussed well relationship dose response concluded individuals tolerate high levels iodine apparent side effects iodine intakes less equal 1 000 mg day probably safe majority population , may cause adverse effects individuals determination maximum tolerable levels iodine intake require human experimental studies levels 0 150 1 000 mg day normal subjects , subjects thyroid tissue , iodine sensitive subjects
training obstetrics gynecology residents manage breast disease incorporation breast care clinic american board obstetricians gynecologists recently issued directive education breast disease incorporated residency training programs university michigan medical center , comprehensive breast care center \( bcc \) provides vehicle education training residents area breast disease department obstetrics gynecology fully integrated actively care patients bcc
treating diabetes elderly special considerations \? management diabetes elderly patients generally follows lines younger patients , improvement blood glucose status diet , oral hypoglycemic , insulin therapy required older patients fragile , however , caution must used therapeutic interventions
aberrant splicing androgen receptor mrna results synthesis receptor protein patient androgen insensitivity androgen insensitivity disorder correct androgen response androgen target cell impaired clinical symptoms x chromosome linked syndrome presumed caused mutations androgen receptor gene report g mutation splice donor site intron 4 androgen receptor gene 46 , xy subject lacking detectable androgen binding receptor complete form androgen insensitivity point mutation completely normal rna splicing exon 4 intron 4 boundary results activation splice donor site exon 4 , leads deletion 123 nucleotides mrna translation mutant mrna results androgen receptor protein approximately 5 kda smaller wild type mutated androgen receptor protein unable bind androgens unable activate transcription androgen regulated reporter gene construct mutation human androgen receptor gene demonstrates importance intact steroid binding domain proper androgen receptor functioning vivo
agents although either insulin oral may used conjunction diet exercise management type ii diabetes , drug therapy type diabetes involves insulin c peptide levels tested assess whether patient remaining pancreatic endocrine function patients started insulin first time receive single injection intermediate acting insulin human origin dose approximately 0 5 u kg thereafter , fasting , mid morning , mid afternoon , bedtime , possibly early morning blood sugars examined periodically determine insulin dose needs increased , decreased , split , patient needs two insulin regimen intensive insulin therapy become control plasma glucose levels majority patients receiving insulin therapy proper patient education regarding insulin regimen , injection techniques , blood glucose monitoring , well diet , exercise , foot care essential patient 's diabetes controlled adequately guidelines adequate glycemic control outlined table 6 recent evidence suggests tight control plasma glucose levels may decrease complications diabetes although also evidence suggest onset microvascular complications might delayed strict glycemic control , data conflicting benefits strict control must weighted problems hypoglycemia experienced many patients attempt tight control blood glucose levels compounds available europe , sulfonylureas comprise class oral agents united states commercially available treatment type ii diabetes two generations drugs reflect potency possible side effect profiles first generation agents , chlorpropamide widely prescribed sulfonylureas , possibly making good drug initiating oral therapy elderly chlorpropamide becoming less popular agent long duration action increased incidence side effects second generation agents , offers better dosing schedule \( daily compared twice daily glipizide \) however , may produce greater incidence hypoglycemia , particularly elderly patients significant renal impairment good studies comparing two drugs one difficult drug interactions numerous first generation drugs , less newer second generation agents \( abstract truncated 400 words \)
prevalence previously undiagnosed hypothyroidism residents midwestern nursing home published erratum appears south med j 1991 jul 84 \( 7 \) hypothyroidism elderly may associated nonspecific symptoms determine prevalence undiagnosed hypothyroidism residents skilled nursing facility , screened male 137 female residents , aged 60 years older , thyroid dysfunction overt hypothyroidism found three men two women subclinical hypothyroidism diagnosed 42 men \( 9 7 \) 20 women \( 14 6 \) tests thyroid antibodies positive patients overt hypothyroidism 12 \( 34 \) 35 men 12 \( 67 \) 18 women subclinical hypothyroidism thyroid antibody testing residents newly diagnosed overt hypothyroidism 54 \( 87 \) 62 subclinical hypothyroidism medical observation 1 year longer institutionalized elderly screened hypothyroidism abnormality may otherwise remain undiagnosed detection subclinical hypothyroidism important , affected individuals risk decline thyroid function
iodine selenium deficiency associated cretinism northern zaire selenium status determined endemic goiter area control area zaire compared reference values deficient area , serum selenium subjects living core northern zaire endemic goiter belt \( villages \) seven times lower 52 school children similarly low 23 erythrocyte glutathione peroxidase \( rbc \) five times lower still two times lower \( p 0 004 \) less severely iodine deficient city \( \) , selenium status moderately altered rbc activity linearly associated serum selenium concentration value nmol l approximately 15 u g hb greater selenium concentration villages , selenium supplementation normalized serum selenium rbc combined iodine selenium deficiency could associated elevated frequency endemic cretinism central africa
interrelationships age , thyroid volume , thyroid , thyroid function patients sporadic nontoxic goiter purpose test hypothesis natural history sporadic nontoxic goiter \( \) , diffuse goiter precedes multinodular goiter gradual development thyroid function patients methods cross sectional survey 102 consecutive patients \( seven male , 95 female \) performed thyroid volume measured ultrasonography , plasma thyroid stimulating hormone \( tsh \) sensitive assay \( tsh immunoradiometric assay \) results patients multinodular goiter older larger thyroid volume patients diffuse goiter plasma free thyroxine \( t4 \) total triiodothyronine \( t3 \) higher plasma tsh lower patients normal subjects free t4 higher subgroup patients multinodular goiter decreased tsh response thyrotropin releasing hormone plasma tsh \( , mu l \) negatively related thyroid volume \( x , ml \) 8 0 \( r 0 , p less 0 001 \) thyroid volume \( , ml \) positively related age \( x , years \) 21 8 2 \( r 0 , p less 0 001 \) duration goiter \( x , years \) 40 6 2 \( r 0 , p less 0 001 \) annual increase thyroid volume calculated 4 5 conclusion data suggest continuous growth provide support concept increasing thyroid autonomy thyroid function related increasing thyroid volume natural history disorder
genetic evidence sry testis determining factor testis determining factor gene \( tdf \) lies chromosome responsible initiating male sex determination sry gene located sex determining region human mouse chromosomes many properties expected tdf sex reversal xy females results failure testis determination differentiation pathways xy females , gonadal dysgenesis , lost sex determining region chromosome terminal exchange sex chromosomes deletions sry tdf , would predicted sex reversed xy females , without chromosome deletions , suffered mutations sry tested human xy females normal xy males alterations sry using single strand conformation polymorphism assay subsequent dna sequencing de novo mutation found sry gene one xy female mutation present patient 's normal father brother second variant found sry gene another xy female , case normal father shared alteration variant second case may associated , predisposing towards sex reversal de novo mutation associated sex reversal provides compelling evidence sry required male sex determination
human xy female frame shift mutation candidate testis determining gene sry primary decision male female sexual development human embryo depends presence chromosome , specifically gene chromosome encoding testis determining factor , tdf human sex determining region 35 kilobase interval near boundary region candidate gene tdf , termed sry , conserved specific chromosome mammals tested corresponding gene mouse chromosome deleted line xy female mutant mice , expressed expected stage male gonadal development identified mutation sry one 12 sex xy females gonadal dysgenesis lack large segments short arm chromosome four nucleotide deletion occurs sequence sry encoding conserved dna binding motif results frame shift presumably leading non functional protein mutation occurred de novo , father sporadic xy female bears normal sequence corresponding position results provide strong evidence sry tdf
selective serotonin inhibitor paroxetine effective treatment diabetic neuropathy symptoms effect selective serotonin inhibitor paroxetine diabetic neuropathy symptoms examined comparison imipramine placebo randomised , double blind , cross study paroxetine given fixed dose 40 mg day , dose imipramine adjusted yield optimal plasma levels imipramine plus desipramine 400 600 nm paroxetine significantly reduced symptoms neuropathy measured observer self rating , somewhat less effective imipramine however , patients showing weaker response paroxetine imipramine lower plasma concentrations paroxetine patients similar response 2 drugs imipramine 5 patients dropped side effects 4 19 patients completing study reported withdrawal symptoms discontinuing imipramine paroxetine patients dropped due side effects withdrawal symptoms reported self rating showed depressive symptoms baseline , changes study neither paroxetine imipramine caused changes objective measures peripheral nerve function conclusion , 40 mg paroxetine day significantly reduced symptoms peripheral diabetic neuropathy , suggested dose adjustment basis drug level monitoring , paroxetine may become effective imipramine paroxetine devoid often autonomic side effects limiting use imipramine several patients
advanced protein glycosylation induces human monocyte chemotaxis secretion platelet derived growth factor role vascular disease diabetes aging diabetes aging commonly accompanied atherosclerosis infiltration arterial subendothelial intima macrophages monocytes important early event preceding development atheromatous lesions macrophages known produce mitogenic factors early atherosclerotic lesions previously shown , time , vascular matrix proteins modified advanced glycosylation end products \( ages \) view fact macrophages monocytes age specific receptors associated expression several growth factors , investigated possibility ages mediate initial monocyte vessel wall interactions occur overt formation vascular lesions study demonstrates \( \) vitro vivo formed ages chemotactic human blood monocytes , \( ii \) sub endothelial ages selectively induce monocyte migration across intact endothelial cell monolayer , \( iii \) subsequent monocyte interaction age containing matrix results expression platelet derived growth factor results support existing hypothesis vivo forming glucose derived protein act signals normal turnover tissue protein means age specific receptor system time dependent glucose induced deposition ages matrix proteins may promote monocyte infiltration subsequent age triggered macrophage activation consequent elaboration proliferative factors may normally remodeling may also lead diverse pathogenic changes typical atherosclerosis diabetic aging populations
oral calcium load test diagnostic physiologic implications hyperparathyroidism oral calcium load test \( clt \) \( 1 gm ca 50 kg \) administered 11 control subjects 35 patients overt hyperparathyroidism assess efficacy diagnosis hyperparathyroidism participants placed low calcium diet 3 days clt intact parathormone ionized calcium \( cai \) levels measured 0 , 1 , 2 , 3 hours clt initial cai parathormone \( mean se \) 1 22 0 01 mmol l 2 94 0 03 pmol l control group compared 1 43 0 02 mmol l 10 6 2 2 pmol l group hyperparathyroidism groups similar percent increase cai values \( control , 5 9 0 8 hyperparathyroidism , 6 3 0 6 \( p greater 0 1 \) decline parathormone levels 47 6 2 8 patients hyperparathyroidism significantly less 75 3 5 3 decline observed control subjects \( p less 0 025 \) three hours clt , parathormone suppressed control subjects , whereas rebound occurred patients hyperparathyroidism postoperative clt demonstrated higher mean percent cai increase percent parathormone decline \( cai , 8 9 1 1 parathormone , 67 9 1 8 \) compared preoperative values \( cai , 6 0 1 0 pth , 49 6 4 3 \) \( p less 0 025 \) , 3 hours calcium intake , parathormone remained suppressed , similar control subjects surgery , three patients elevated parathormone low normal cai levels parathormone response clt confirmed diagnosis secondary hyperparathyroidism conclusion , clt \( 1 \) confirm diagnosis hyperparathyroidism successful parathyroidectomy , \( 2 \) distinguished postoperative secondary persistent primary hyperparathyroidism , \( 3 \) demonstrated abnormal parathyroid glands parathormone response calcium load characterized earlier nadir , decreased , rapid recovery , \( 4 \) produced dynamic changes distinguish patients hyperparathyroidism control subjects hyperplasia adenoma
hyperparathyroidism cellular mechanisms gastric acid secretion patients hyperparathyroidism appear particular risk peptic ulcer disease test hypothesis parathyroid hormone plays role promoting ulcer disease , studied effect varying concentrations extracellular calcium acid secretion using vitro isolated rabbit gastric glands acid secretion assessed accumulation carbon 14 labeled \( 14c ap \) glands incubated varying calcium concentrations unstimulated state histamine carbachol \( 10 \( 7 \) 10 \( 4 \) mol l \) 1 2 mmol l calcium medium effect parathyroid hormone also examined identical conditions compared 1 mmol l standard calcium medium , unstimulated 14c ap accumulation significantly inhibited \( p less 0 05 \) lower \( 0 33 mmol l \) higher \( 2 2 5 mmol l \) calcium concentrations accumulation 14c ap response histamine stimulation unaffected alteration extracellular calcium \( p greater 0 2 \) carbachol stimulated 14c ap accumulation significantly augmented \( p less 0 01 \) increase calcium concentration 1 2 mmol l addition parathyroid hormone \( 10 \( 7 \) 10 \( 4 \) mmol l \) alone combination carbachol histamine \( 10 \( 6 \) mmol l \) incubation alter 14c ap accumulation data suggest elevations extracellular calcium play active role potentiation cholinergic mediated gastric gland acid secretion may thereby play role related ulcer disease
reappraisal thyroxine treatment primary hypothyroidism optimum daily dose thyroxine calculated 13 children aged 3 16 years primary hypothyroidism doses monthly intervals condition thyroid assessed sensitive assay thyroid stimulating hormone concentrations , well measurement total free thyroid hormone concentrations systolic time interval ratios serum thyroid stimulating hormone concentration found responsive small changes thyroxine calculated optimum daily replacement dose thyroxine \( 102 micrograms m2 3 5 micrograms kg \) lower previously recommended , closely related surface area \( coefficient variation 8 2 \) body weight \( coefficient variation 16 2 \) results suggest though monthly may optimal time interval increases dose thyroxine , reduction dose made gradually
hyperinsulinemia increases amount glut4 mrna white adipose tissue decreases muscles increased fat insulin resistance state hyperinsulinemia , normal rats infused insulin 4 days via , compared saline infused rats end experimental period , abundance mrna increased white adipose tissue \( \) decreased muscles rats compared controls findings accompanied , tissues considered , except diaphragm , parallel changes amount glucose transporter protein parallel changes vivo glucose utilization index hyperinsulinemia thus driving force stimulating adipose tissue metabolic activity , muscle insulin resistance
vitro vivo testing glucose sensor prerequisite development implantable artificial pancreas availability stable , long life glucose sensor platinum \( pt \) catalyzed electrodes demonstrated vitro show high sensitivity glucose long cycle life sensitive co compared enzymatic methods authors developed special data processing method \( compensated net charge ratio , \) measured electrode response sensitive glucose , completely insensitive urea , moderately sensitive amino acids endogenous exogenous co show minor method involves determination ratio net oxidation charge total charge one complete cycle cyclic prototype electrodes tested vitro plasma shown typical sensitivities greater 2 x 10 \( 4 \) units per 1 mg dl change glucose concentration , linear response 400 mg dl vivo testing , modified 5 f vascular catheter membrane covered surface mounted electrodes used vena cava site swine several sensor designs tested vivo , sensitivities 1 5 x 10 \( 4 \) units \( mg dl \)
rebound increase serum thyrotropin , anti antibodies thyroglobulin discontinuation l thyroxine assayed serum thyrotropin \( tsh \) , antibodies \( msa \) , antibodies thyroglobulin seven individuals subclinical autoimmune hypothyroidism two 6 month periods l thyroxine substitution placebo , respectively serum tsh decreased l thyroxine administration , rebound increase serum tsh 6 months duration placebo treatment , parallel increase serum thyroglobulin agreement previous observations groups , found decreased serum concentrations msa l thyroxine treatment three individuals addition , slow significant transient increase serum msa recorded placebo administration four individuals showed pronounced increase serum tsh \( greater 20 mu l 1 \) association serum levels msa tsh probably related antigen presentation surface conclude changes serum tsh concentration taken account interpretation msa patients thyroid disease , whether untreated treated l thyroxine
selective regulation activity different hematopoietic regulatory proteins transforming growth factor beta 1 normal leukemic myeloid cells viability normal bone marrow myeloid precursor cells induced interleukin 6 \( il 6 \) il 1 alpha ability il 6 il 1 alpha induce formation colonies granulocytes , macrophages , megakaryocytes densely seeded bone marrow cultures suppressed transforming growth factor beta 1 \( tgf beta 1 \) induction normal bone marrow colony formation il 3 much less sensitive tgf beta 1 , little effect tgf beta 1 colony formation induced macrophage colony stimulating factor \( csf \) granulocyte macrophage csf \( gm csf \) different clones myeloid leukemic cells , tgf beta 1 suppressed differentiation induced il 6 , il 1 alpha , lipopolysaccharide \( lps \) , suppress differentiation induced il 3 gm csf effect tgf beta 1 differentiation leukemic cells dissociated effect cell growth tgf beta 1 suppressed production il 6 normal bone marrow cells cultured il 1 alpha production il 6 gm csf leukemic cells cultured il 1 alpha lps suppression il 6 production explain suppression tgf beta 1 effects il 1 alpha lps mediated il 6 tgf beta 1 also suppressed differentiation clones myeloid leukemic cells induced differentiation factor leukemia inhibitory factor tumor necrosis factor different leukemic clones tgf beta 1 suppressed enhanced induction differentiation dexamethasone results show tgf beta 1 selectively control activity different molecular normal leukemic hematopoiesis
secretion interleukin 1 beta granulocyte macrophage colony stimulating factor blast cells acute leukemia role interleukin 1 endogenous inducer acute leukemia \( aml \) blasts shown produce variety cytokines culture interleukin 1 \( il 1 \) , il 6 , granulocyte , macrophage , granulocyte macrophage colony stimulating factor \( gm csf \) , tumor necrosis factor alpha \( tnf alpha \) using two sensitive specific enzyme linked immunosorbent assays il 1 beta gm csf , document present study production two cytokines aml blasts culture coordinated first , observe striking correlation levels gm csf il 1 beta released cells thus , high production il 1 beta always concordant high production gm csf , conversely , low production il 1 beta concordant low levels gm csf second , neutralization intrinsic il 1 using antibodies specific il 1 alpha 1 beta suppresses release gm csf cells third , neutralization endogenous source il 1 also results gm csf mrna fourth , production il 1 beta gm csf regulated exposing aml blasts exogenous source il 1 , suggesting positive regulation autocrine growth factor production taken together , results indicate gm csf production aml blasts mediated endogenously produced il 1 il 1 beta 1 alpha produced aml blasts , although il 1 beta appears abundant spontaneous colony formation aml blasts abrogated addition neutralizing antibodies il 1 beta gm csf , whereas antibody alone little effect blast proliferation taken together , results consistent view production il 1 beta aml blasts supports autocrine growth culture , induction cytokines stimulate blast proliferation
rearrangement immunoglobulin , cell receptor , bcl 2 genes malignant lymphomas pattern malignant lymphomas chinese population characterized low incidence hodgkin 's disease follicular lymphomas authors studied immunoglobulin \( ig \) , cell receptor \( tcr \) , bcl 2 gene rearrangement 62 cases malignant lymphoma population southern blot hybridization two cases hodgkin 's disease showed rearrangement ig tcr genes 42 cases b cell lymphoma ig heavy chain \( \) rearrangement without additional rearrangement light chains \( c kappa c lambda \) one case diffuse b cell lymphoma additional cell receptor beta chain \( c beta \) rearrangement sixteen 18 cases cell lymphoma c beta rearrangement , one case lymphoblastic lymphoma additional rearrangement two eight \( 25 \) cases follicular lymphoma one 34 \( 2 9 \) cases diffuse b cell lymphoma bcl 2 rearrangement detected 1 probe none 62 cases showed bcl 2 rearrangement using 2 probe conclusion , ig tcr gene rearrangement pattern lymphomas found correlates well cell b cell lineage , similar reports white population however , incidence bcl 2 gene rearrangement follicular b cell lymphoma lower reported us comparable japan
\( intravascular \) large cell lymphoma clinicopathologic study seven cases unique clinical presentations authors recently reported antigenic phenotypes three cases called malignant suggested large cell lymphoma \( alcl \) appropriate designation disease authors report additional seven cases alcl unique clinical presentations one patient presented prostate enlargement , second lytic bone lesions thickened nasal sinus mucosa , third diffuse , fourth dyspnea pulmonary infiltrates , fifth lower extremities , total body skin involvement , pancytopenia , sixth lesion mimicking squamous cell carcinoma , seventh mediastinal mass cases histologic features characteristic alcl , two cases , extravascular spread soft tissue immunohistologic studies showed b cell phenotype five cases cell phenotype one case two patients received combination chemotherapy using established treatment protocol large cell lymphoma , remain complete clinical remission two patients responding clinically combination chemotherapy two patients died shortly receiving combination chemotherapy one patient recently diagnosed alcl long term follow available data indicate , although alcl affects predominantly central nervous system skin , unusual clinical presentations may occur , patients alcl may respond combination chemotherapy large cell lymphoma
genetic aspects juvenile chronic arthritis studies past decade confirmed theory association one 's background manifestation several forms juvenile chronic arthritis \( jca \) , particular pauciarticular onset jca considerable work done serologic level demonstrate disease association major histocompatibility class ii antigens pauciarticular onset jca nature jca best illustrated findings particularly well defined clinical subgroup evidence emerging analysis dna sequence , derived protein sequence , structure class ii molecules yield significant insight genetic predisposition jca
soluble mediators articular cartilage degradation juvenile rheumatoid arthritis juvenile rheumatoid arthritis \( jra \) involves wide range joint tissues tissue changes include proliferation synovial cells , alterations synovial fluid , degradation articular cartilage synovial cell proliferation results increased numbers fibroblasts lymphocytes changes synovial fluid include increased content antibodies , altered complement ratios , increased levels factors stimulating cartilage mediated proteoglycan degradation , decreased levels insulinlike growth factor levels cytokine interleukin 1 interleukin 2 vary cell culture assay technique cartilage degradation apparent increased quantities proteoglycan glycosaminoglycan serum synovial fluid type ii collagen peptide antibodies also prevalent jra patients cartilage degradation appears linked factors jra synovial fluid conditioned medium peripheral blood mononuclear cells patients jra also stimulates increased release cartilage proteoglycan thus , outcome jra likely reflects activities interacting soluble factors directly influence cartilage homeostasis
medical treatment juvenile arthritis range medications available treat juvenile arthritis markedly expanded past 15 years multiple new nonsteroidal antiinflammatory drugs \( nsaids \) available united states , although approved use children , none proven significantly better aspirin suppressing inflammation average time significant improvement noticed 30 days 50 children respond nsaid within three months percentage responders progressively increases length therapy , treatment continued one reasonably certain improvement occur changing medication severely involved child , gold disease modifying medications used however , difficult prove value medications controlled studies high rate significant improvement control group treated nsaids preliminary studies , methotrexate appears significant benefit children failed treatments newer therapies , intravenous , used small number patients yet proven beneficial
surgery juvenile chronic arthritis overview surgery well established place management childhood arthritis however , satisfactory results achieved team medical experts composed pediatric , orthopedic surgeon , , , others knowledgeable particular problems juvenile chronic arthritis aggressive team approach offers best available help
total hip knee arthroplasty juvenile rheumatoid arthritis total hip knee arthroplasty indicated patients juvenile rheumatoid arthritis marked functional impairment severe disabling pain advanced structural hip knee joint involvement relief pain dramatic improvement function achieved patients hip knee involved , hip arthroplasty probably done first regional anesthesia preferable careful preoperative planning essential custom prostheses often required small bone size , osteoporosis , soft tissue contractures make surgery technically demanding skeletal immaturity absolute contraindication surgery component loosening frequent late complication hip arthroplasty less common condylar metal plastic knee arthroplasty patellar complications predominate cementless arthroplasty evolving role patient juvenile rheumatoid arthritis , date , often used hip knee
characteristics correlates asthma university clinic population contribute comprehensive information characteristics asthma , article analyzed patients served university alabama comprehensive asthma program physicians rated one fifth patients severe asthma remainder equally divided moderate mild one two first received diagnosis asthma ten years previously common hypertension , obesity , rhinitis , bronchitis , , arthritis one half visited emergency room hospitalized asthma past year inhaled continuous theophylline commonly prescribed medications side effects , especially tachycardia , common almost exclusively associated theophylline corticosteroid therapy spirometric assessment showed chronic airflow obstruction severe asthma prevalence respiratory symptoms , intensity medication regimen , incidence side effects , health care utilization increased asthma severity increased
formoterol treatment nocturnal asthma formoterol new beta 2 adrenergic agonist long lasting effect effect 12 micrograms formoterol compared 200 micrograms albuterol \( salbutamol \) single center , double blind , randomized within patient study drugs given aerosols 16 patients nocturnal asthma stable phase inhalations given 10 pm fev1 values parameter measured 1 , 2 , 6 , 8 , 10 , 12 hours afterwards fev1 6 hours administration formoterol significantly higher albuterol \( p 0 008 \) , still case 12 hours test dose 10 following morning \( p 0 009 \) 4 , fev1 fell basic starting value albuterol , whereas remained least 10 percent formoterol inhalation five patients required rescue therapy albuterol two formoterol conclude formoterol dose 12 micrograms via confers good protection nocturnal asthma insufficient patients severe asthma , studies higher dosages patients clearly indicated
reactive airway dysfunction syndrome three police following chemical reactive airway dysfunction syndrome \( \) recently described syndrome bronchial hyperreactivity asthmatic symptoms develop previously healthy individuals single large exposure gas , , vapor report cluster three philadelphia police developed common exposure toxic truck accident results initial pulmonary function testing normal three , methacholine challenge required diagnosis two three syndrome needs recognized physicians dealing environmental industrial medicine potential cause loss work inability perform job also , potential multiple individuals develop syndrome single incident
effect paf acether inhalation nonspecific bronchial reactivity adrenergic response normal asthmatic subjects bronchial hyperreactivity , although recognized hallmark asthma , totally understood mast cell derived mediators , including histamine , shown cause immediate bronchoconstriction , recently , single mediator shown induce prolonged changes airway reactivity recent reports indicate paf acether \( paf \) induce increased nonspecific bronchial reactivity normal subjects asthmatics sought elucidate role paf airway hyperreactivity comparing effect inhaled paf methacholine isoproterenol airway responsiveness six nonasthmatic six asthmatic subjects neither nonspecific airway reactivity isoproterenol responsiveness changed following paf inhalation nonasthmatic subjects six days following paf asthmatics increased airway responsiveness methacholine two hours post paf , persist responsiveness isoproterenol change asthmatic subjects additional evaluation role paf causing changes airway reactivity warranted
hepatocyte plasma membrane reactive sera patients autoimmune chronic active hepatitis identification sulfatide sera patients autoimmune chronic active hepatitis found contain igg class antibody acidic fraction rabbit hepatocyte plasma membrane solid phase enzyme linked immunosorbent assay using serum positive antibody probe , isolated target antigen column chromatography analysis thin layer chromatography negative ion fast mass spectrometry revealed antigen sulfatide presence antibody also confirmed immunoblotting reactivity serum sulfatide diminished preincubation serum 6 sulfate sulfatide , indicating antibody reacted sulfated regardless position sulfate residue antibody found 92 3 , 42 9 , 15 8 , 14 2 , 0 0 , respectively , patients autoimmune chronic active hepatitis , primary biliary cirrhosis , cirrhosis , systemic lupus erythematosus , chronic active hepatitis chronic persistent hepatitis thus antibody characteristic autoimmune type chronic liver diseases antibody absorbed rabbit hepatocyte plasma membrane preincubation sera sulfatide immobilized sepharose decreased reactivities sulfatide also rabbit plasma membrane rat hepatocytes therefore sulfatide may target antigen antibody hepatocyte surface membrane
amyloid deposition intrahepatic large bile ducts peribiliary glands systemic amyloidosis amyloid deposition hepatic parenchyma portal tracts liver well known systemic amyloidosis recently experienced autopsy case systemic amyloidosis presenting amyloid deposits intrahepatic biliary tree experience prompted us survey 19 autopsy cases systemic amyloidosis amyloid deposition found lining epithelium intrahepatic large bile duct 10 19 cases around peribiliary glandular 7 19 cases , respectively amyloid deposition intrahepatic large bile duct peribiliary glands positively correlated degree amyloid deposition liver type amyloid protein double staining amyloid vascular endothelium disclosed amyloid deposition closely related inner part peribiliary vascular plexus vascular plexus peribiliary glands lining biliary epithelium peribiliary glandular acinar cells exact pathogenesis amyloid deposition anatomical components , however , remains unclear although cases failed show overt clinical related amyloid deposition biliary components , seems massive amyloid deposition anatomical components could give rise clinical symptoms
amyloidosis saphenous vein aortocoronary bypass grafts patient idiopathic amyloidosis aortocoronary saphenous vein grafts found autopsy two years myocardial revascularization due coronary atherosclerosis reported idiopathic generalized derived amyloidosis extensively studied autopsy obviously present time surgery although remained macroscopically inserted graft appears simultaneously deposition also significant redistribution amyloid within walls vein grafts additionally took place insertion seems interesting spite amyloidosis grafts functioned well found patent two years surgery
modulation interleukin 1 beta rna monocytic cells infected human immunodeficiency virus 1 effect hiv 1 infection cytokine levels studied monocytic cells using northern blotting analysis \( 1 , u937 \) express il 1 beta rna even cells infected hiv 1 exposure lps \( 10 micrograms ml \) 12 tetradecanoylphorbol 13 acetate \( tpa , 100 nm \) 12 h , hiv 1 infected accumulated 8 15 fold greater levels il 1 beta rna compared hiv 1 uninfected counterparts similarly stimulated contrast , levels rnas coding monocyte colony stimulating factor \( csf \) tumor necrosis factor alpha \( tnf alpha \) elevated less twofold hiv 1 infected cells compared hiv 1 uninfected cells stimulation lps tpa inhibition new protein synthesis block marked accumulation il 1 beta rna produced exposure lps tpa hiv 1 infected cells time course experiments showed maximal levels il 1 beta rna occurred 12 24 h lps tpa stimulation hiv 1 infected uninfected u937 cells , respectively studies stability rna using actinomycin showed il 1 beta rna equally stable infected uninfected u937 cells stimulation tpa lps taken together , data show hiv 1 infection markedly augments il 1 beta rna accumulation stimulated monocytic cells , probably increasing rate transcription il 1 beta
polyclonal b cell activation lupus prone mice precedes predicts development autoimmune disease polyclonal b cell activation early feature autoimmune disease humans mice systemic lupus erythematosus contribution polyclonal activation progression autoimmunity unclear , however , since precedes development end organ damage months years examine issue , 109 autoimmune prone \( nzb x \) f1 x nzb backcross mice splenectomized 10 wk number antigenic specificity ig secreting b cells quantitated elisa spot assay 61 mice increased numbers ig secreting cells spleen , 31 died 6 mo contrast , 0 48 backcross mice normal numbers ig secreting b cells 10 wk died period \( p less 0 001 \) activated mice also developed proteinuria earlier frequently littermates normal numbers ig secreting cells \( p less 0 001 \) adults , backcross mice proteinuria expressed repertoires skewed towards production anti dna antibodies 10 wk mice expressed repertoires marked polyclonal activation rather preferential anti dna production findings indicate autoimmune disease sle accompanied autoantigen driven production autoantibodies preceded predicted polyclonal b cell activation
failure cell receptor anti cd3 monoclonal antibody interaction cells marrow recipients induce increases intracellular ionized calcium multiple immune defects cells recipients bone marrow transplantation \( bmt \) study examines recipient cells increases intracellular ionized calcium concentration \( ca2 \) binding cell receptor cd3 complex anti cd3 mab pbl 10 23 short term recipients \( less 1 yr bmt \) responded poorly \( less 35 control \) anti cd3 stimulation pbl 9 23 blunted calcium flux responses \( 35 70 control \) purified cd2 , cells seven additional short term recipients including three autologous marrow recipients closely examined , sizable proportion cd3 cells six seven recipients increase ca2 anti cd3 stimulation decreased magnitude responses due decreased numbers responding cells decrease mean cd3 fluorescent intensity calcium flux responses single cell basis five seven long term recipients \( greater 1 yr bmt \) pbl responded normally two seven pbl blunted calcium flux responses data show signal transduction response mediated cd3 antigen receptor measured calcium flux defective early allogeneic bmt
platelet activating factor induced clinical histopathologic responses atopic skin modification platelet activating factor antagonist clinical histopathologic responses intradermal platelet activating factor \( paf acether \) atopic subjects , without evidence atopic dermatitis documented immediate acute wheal flare reaction observed volunteers histopathologically , reaction characterized predominantly neutrophilic response , seen 30 minutes maximal 4 hours eosinophils observed infiltrate early 30 minutes injection , maximal 12 hours specific paf acether antagonist antagonized acute flare response intradermal paf acether little effect cellular recruitment site injection
anaphylaxis induction general anesthesia subsequent evaluation management twenty seven patients referred evaluation anaphylaxis induction general anesthesia \( ga \) , muscle relaxants , antibiotics administered intravenously skin testing prick methods performed dilutions muscle relaxants beta lactam reagents used patients also received drugs skin test reactivity noted 16 normal subjects skin tests positive 13 patients \( five , muscle relaxants six , antibiotics two patients \) two patients yielded indeterminate skin test results eleven 27 patients subsequently ga patients received premedication regimen prednisone three patients negative skin tests , one experienced arrhythmia , signs attributable anaphylaxis noted one patient ga without reaction positive skin tests implicated agent avoided seven patients one patients experienced delayed urticaria angioedema completion ga thus , patients developed anaphylaxis subsequent ga agents producing positive skin tests avoided , premedication regimen used
determinants vivo histamine release cutaneous allergic reactions humans determine host factors influencing magnitude mediator release ongoing cutaneous allergic reactions humans , compared , 22 subjects , first hour , second fifth hour , total \( 0 5 hours \) skin chamber histamine release \( 1 \) vitro reactivity sensitivity basophils antigen histamine release \( 2 \) skin test sensitivity reactivity antigen , histamine , codeine significant correlation first hour second fifth hour histamine release combination basophil , antigen , histamine , codeine skin sensitivity reactivity , 64 75 magnitude first hour , second fifth hour , total \( 0 5 hours \) skin chamber histamine release could accounted conclude antigen induced vivo allergic responses complex phenomenon dependent , part , antigen sensitivity , basophil mast cell reactivity , end organ responsiveness mediators
relationships among shrimp specific igg subclass antibodies immediate adverse reactions shrimp challenge high levels shrimp specific ige , association positive prick test , always predictive positive , immediate response double blind , placebo controlled , food challenge \( dbpcfc \) shrimp observation shrimp sensitive individuals general increased levels circulating shrimp specific igg interest antigen allergen specific igg subclasses associated adverse reactions foods therefore , current study measured shrimp specific igg subclass ige antibodies 31 individuals histories immediate , adverse reactions shrimp immediately dbpcfc 20 shrimp tolerant subjects individuals history shrimp sensitivity significantly raised shrimp specific igg2 igg4 compared shrimp tolerant individuals challenge positive subjects distinguished subjects negative equivocal responses increased igg2 \( p less equal 0 001 \) specific igg4 raised \( p less equal 0 \) studies indicate shrimp specific igg subclass levels increased shrimp sensitive subjects however , none subclass responses significantly predictive positive response dbpcfc therefore diagnostic shrimp intolerance
molecular targets aids therapy development antiretroviral therapy acquired immunodeficiency syndrome \( aids \) intense research effort since discovery causative agent , human immunodeficiency virus \( hiv \) large array drugs biologic substances inhibit hiv replication vitro nucleoside analogs particularly belonging family inhibit reverse transcriptase anabolic phosphorylation 3' 2' , 3' \( azt \) first drug tested individuals aids , considerable knowledge structure activity relations emerged class drugs however , virtually every step replication hiv could serve target new therapeutic intervention future , non nucleoside type drugs likely become important experimental therapy aids , antiretroviral therapy exert major effects morbidity mortality caused hiv
hiv disease review family physician part evaluation conventional therapy family physicians challenged caring increasing numbers patients infected human immunodeficiency virus confirming presence infection , physician must follow logical sequence evaluation , counseling treatment current centers disease control classification series evaluation treatment protocols form basis prescribing zidovudine delay involvement lymphocytes neuronal cells
isolation human immunodeficiency virus \( hiv \) autopsy one six days postmortem blood tissue studied potential infectivity autopsy ten patients human immunodeficiency virus \( hiv \) infection special attention paid possibility detecting hiv bone craniotomy postmortem intervals one six days specimens hiv isolation included skull bone , brain , blood , bone marrow , spleen , lymph node , cerebrospinal fluid one case hiv grew culture least one specimen eight autopsies , one performed six days postmortem hiv recovered blood five patients tissue five patients , including three negative blood cultures skull bone contained hiv two cases hiv also grew native spleen specimens stored 14 days postmortem 20 degrees c recommended precautions , including bone , indicated autopsy hiv infected patients even long postmortem intervals
small intestinal disease potentially preventable cancer third world purpose review recent progress understanding clinical laboratory characterization well management small intestinal disease \( \) data identification literature search conducted using index , medline \( 1962 1989 \) , bibliographies identified relevant articles study selection international comprehensive reviews , reported epidemiologic immunologic studies , prospective clinical trials published english selected results data synthesis high incidence lymphoma primarily gastro intestinal tract third world countries stimulated epidemiologic pathogenetic , distinctive biologic marker \( alpha heavy chain para protein \) , affects young population countries initially benign appearing antibiotic responsive lesions often evolve fatal high grade lymphomas roles environmental host factors evolutionary course emerging recently demonstrated malignant potentials form early onset pathogenesis given new dimension traditional management strategy conclusions epidemiologic , immunologic , pathogenetic data emerged last 25 year study improved understanding complexity infection immunity cancer interrelationships , comparable arisen study acquired immunodeficiency syndrome early detection institution antimicrobial based treatment regimens judicious consistent follow save lives many young patients whose needed third world countries
morphometric analysis follicular center cell lymphomas classification non hodgkin 's lymphomas follicular center cell \( fcc \) lymphomas four categories based nuclear size , shape , state transformation well recognized difficulty making subdivisions routine histologic sections , morphometric analysis typical small cleaved \( sc \) , large cleaved \( lc \) , small noncleaved \( \) , large noncleaved \( \) performed describe compare four categories using objective parameters following features , previously tested normal follicles , measured calculated nuclear area \( na \) , nuclear contour index \( \) , nuclear contour index nuclear irregularity \( \) , relative chromatin index \( \) presence nucleoli also recorded mean values na , , , significantly different among four fcc lymphoma subtypes , except , reflects transformation , similar sc lc cell groups comparison using proportion cells nucleoli case revealed significant differences groups lc group highest mean nuclear nuclear irregularity values mean nuclear area smallest sc group followed lc , , groups despite many differences , parameters showed broad spectrum values either mean values individual cases fcc subtype distribution curves cells within certain subtype compared morphometric data demonstrates four histologically recognized types fcc lymphomas distinctive using analytic technique study also provides insight differences among evidence nuclear transformation \( nuclear size , chromatin , frequent nucleoli \) important criterion nuclear contours distinguishing lc lymphomas although lc lymphomas features intermediate sc noncleaved fcc lymphomas , closely resemble sc lymphomas finally morphometric analyses provide objective morphologic foundation future prospective investigations transformation related phenomena studies may facilitate comparison morphologic data immunophenotype genotype non hodgkin 's lymphomas comparison various b cell neoplasms follicular center cell neoplasms
bacterial lipopolysaccharide mesangial proliferative lupus nephritis without interfering processing pathogenic immune complexes nzb w mice systemic lupus erythematosus multifactorial systemic disease genetic , immunologic , hormonal , environmental factors may contribute disease pathogenesis bacterial products \( eg , bacterial lipopolysaccharide lps \) induce disease normal mice trigger early accelerated form lupus nephritis nzb w mice investigate whether mechanism lps accelerates nephritis nzb w mice involves interference processing immune complexes \( ic \) , administered lps nzb w mice 5 weeks probed kinetics removal , liver uptake , organ localization dose radiolabeled ic \( 2 5 mg bovine serum albumin serum albumin \) control nzb w mice received vehicle \( saline \) alone nzb w exposed lps , features polyclonal b cell activation \( \) enhanced , anti dna antibodies raised , proliferative glomerulonephritis developed associated renal insufficiency substantial proteinuria lps accelerated nephritis could attributed altered complement concentration , altered blood cell carrier function , delayed removal pathogenic \( large sized \) ics circulation , impaired liver uptake ics , enhanced localization ics kidney findings indicate transformation nephritis probably result lps induced , defective processing pathogenic ic contributory factor nephritis , mechanisms passive renal localization circulating ics must operative
antidepressant pharmacotherapy depression associated multiple sclerosis double blind clinical trial involving 28 patients multiple sclerosis major depressive disorder , 14 patients randomly assigned 5 week trial desipramine individual psychotherapy 14 placebo plus psychotherapy clinical indicated patients treated desipramine improved significantly placebo group confirmed scores hamilton rating scale depression depression inventory scores side effects limited desipramine dosage half treated patients authors conclude desipramine modest beneficial effect serious depression associated multiple sclerosis side effects may limiting factor patients without medical neurologic disease
dust mite assays clinical allergy practice mite antigen exposures among skin test positive patients kansas attempted determine whether sensitive monoclonal antibody assays mite antigens der p der f carried private clinical allergy practice laboratory , ascertain incidence significant home mite exposure dust samples patient homes kansas , consider whether information patient management analyzed 152 dust samples 62 patient homes patients skin prick test positive one common mite species available skin testing , potentially relevant histories der p der f antigen levels added together , levels 2 micrograms g dust considered positive definition , elevated levels found least one sample 48 62 homes tested \( 77 \) however , 61 samples tested , 41 samples , 54 5 samples levels considered likely cause symptoms 13 152 samples yielded der p levels 2 micrograms g conclude monoclonal antibody assays der p der f antigens performed well equipped office laboratory trained medical , der f predominant mite species kansas , data derived mite assays may important treatment planning patients suspected mite related allergy symptoms
effect exercise complement activity complement measurements c1 , c1q , c2 , c3 , c4 , c5 , c3a , , c5a total hemolytic activity classical alternative pathways made 26 experienced adult runners aerobic exercise baseline results compared age matched controls subjects tested , running resulted increases c3a corresponding decreases hemolytic activity c4 \( \) baseline values c3 decreased significantly runners compared controls preliminary studies measuring effect exercise c3a levels also done three asthmatic runners mean resting postexercise levels , exercise induced increases c3a asthmatic subjects significantly higher nonasthmatic subjects findings indicate short term exercise results activation c3 c4 subsequent generation c3a , suggest activation classical pathway complement selective downregulation c3 production may occur persons regularly engaged aerobic exercise exaggerated generation c3a asthmatic subjects exercise raises possibility play etiologic role exercise induced asthma
bronchoconstriction induced spirometric maneuvers patients bronchial asthma analyzed forced expiration maneuver induced bronchoconstriction 14 asthmatic patients seven normal subjects forced expiration maneuver spirometry \( fvc maneuver \) two phases slow , deep inspiration total lung capacity \( tlc \) \( di maneuver \) forced expiration residual volume \( rv \) \( maneuver \) specific airway conductance \( sgaw \) measured functional residual capacity \( frc \) three maneuvers maneuvers caused greatest bronchoconstriction immediately completion maneuver mean decreases sgaw immediately fvc , di , maneuvers 45 0 6 6 \( sd \) \( p less 001 \) , 29 6 5 3 \( p less 001 \) , 16 7 5 3 \( p less 03 \) , respectively decrease sgaw fvc maneuver close combined sum di maneuver maneuver normal subjects show changes sgaw maneuvers inhalation albuterol almost abolished response bronchoconstriction three maneuvers , inhalation anticholinergic agent , ipratropium bromide , blunt response study suggests forced expiration maneuver induced bronchoconstriction asthmatics caused deep inspiration tlc also forced expiration rv , bronchoconstriction may brought mainly increase parasympathetic activity
effects deep inhalation early late asthmatic reactions allergen published erratum appears rev 1991 feb 143 \( 2 \) eighteen asthmatic patients biphasic asthmatic reaction house dust mite studied effect deep inhalation \( di \) quantitated comparing maximal expiratory flow 40 \( \) vital capacity partial \( p \) maximal \( \) flow volume curves , specific airway conductance \( sgaw \) di \( \) baseline , ratio p significantly larger unity \( 1 45 0 26 sd \) , whereas ratio sgaw significantly different unity \( 0 92 0 24 \) early phase reaction , p sgaw significantly increased 2 66 0 97 1 96 0 47 , respectively late phase reaction , fev1 values similar observed early phase reaction , p sgaw 1 86 0 46 1 43 0 29 , respectively , significantly higher values baseline significantly lower early phase reaction similar results obtained subgroup nine patients sgaw values late phase reaction similar early phase reaction conclude di different effect early late asthmatic reactions , suggesting different ratio airway parenchymal hysteresis may result increased parenchymal hysteresis \( peripherally located bronchial obstruction \) decreased airway hysteresis \( prominent airway inflammation \) late phase reaction
effect repetitive exercise airway temperatures determine relationship exists intra airway thermal events reduction pulmonary mechanics occur asthmatics perform repetitive exercise , recorded intrathoracic temperatures seven subjects two identical cycle performed 30 min apart data , global regional thermal energy calculated inspired air conditions , work loads , minute held constant trials pulmonary mechanics measured prior serially challenge expected , second provocation produced smaller response first association mechanical changes , second challenge also produced less airway cooling slower rewarming central airways hence , repetitive exercise trials performed short intervals attenuate essential thermal gradients necessary produce obstruction extent differences intra airway temperature reflect changes perfusion , data raise possibility bronchial microcirculation asthmatics may altered repetitive exercise
effect long term treatment inhaled corticosteroid \( budesonide \) airway hyperresponsiveness clinical asthma dependent asthmatics several short term studies shown inhaled steroids reduce airway responsiveness asthma evaluate whether prolonged treatment bring full recovery , double blind , randomized , controlled trial examined effect budesonide , 400 micrograms daily 1 yr , airway hyperresponsiveness time course characteristics improvements associated changes clinical asthma severity also evaluated thirty two stable adult asthmatics , requiring alone , selected monthly throughout study , airway responsiveness methacholine measured clinical asthma severity assessed questionnaire , daily bronchodilator use , number asthma exacerbations patients receiving budesonide showed fourfold mean improvement airway responsiveness compared receiving placebo \( p less 0 0005 \) , whose responsiveness remained stable fifteen 16 budesonide subjects improved 5 returned normal range largest improvements occurred first 3 months , , still progressing slowly 1 yr improvements responsiveness accompanied significant improvements asthma symptoms , bronchodilator use , number asthma exacerbations results show regular , prolonged use inhaled steroid produce marked improvements airway hyperresponsiveness , sometimes full resolution , improvements accompanied clinically significant improvements clinical asthma
quantitation mast cells eosinophils bronchial mucosa symptomatic atopic asthmatics healthy control subjects using immunohistochemistry used fiberoptic bronchoscopy obtain endobronchial biopsies mast cells eosinophils enumerated using monoclonal antibodies directed mast cell tryptase \( \) eosinophil cationic protein \( \) eleven symptomatic atopic asthmatics treated beta 2 agonists alone six normal subjects studied period 2 wk prior bronchoscopy , patients recorded asthma symptom scores , bronchodilator usage , twice daily peak expiratory flow five days bronchoscopy , methacholine responsiveness assessed two biopsies taken , one processed immunostaining biotin immunoperoxidase method resin electron microscopy number staining mast cells present bronchial mucosa significantly different epithelium submucosa asthmatic normal subjects however , biopsies asthmatics , significantly greater numbers staining eosinophils epithelium \( median , 1 2 mm versus zero p less 0 005 \) submucosa \( median , 50 mm2 versus 1 mm2 p less 0 001 \) electron microscopy showed morphologic features mast cell eosinophil degranulation asthmatics correlation could established mast cell eosinophil numbers indices disease activity pc20 methacholine , points complexity mechanisms responsible symptoms airway hyperresponsiveness asthma
multiple sclerosis prevalent \( \) india using 's classification , determined prevalence rate clinically definite multiple sclerosis \( ms \) distinct \( largely \) community adjacent cities \( , 18 55 degrees \) \( \) prevalence day , 16 clinically definite cases ms counted , 14 2 , total population 50 , 3 , , respectively crude prevalence ratio 26 per 100 , 000 58 per 100 , 000 age adjusted prevalence ratio 24 per 100 , 000 , 95 confidence limits 13 1 40 3 much higher low rates believed prevalent india , comparable found parts europe united states
functional assessment scales study persons multiple sclerosis purpose study investigate disability persons multiple sclerosis \( ms \) using combinations functional assessment scales subscales predict \( 1 \) burden care measured minutes assistance provided per day another person home , \( 2 \) subject 's level satisfaction life general functional independence measure \( \) , status scale , environmental status scale , barthel index high although predictive ms subject 's physical care needs , useful change total score one point equivalent average 3 38 minutes help another person per day brief symptom inventory environmental status scale , contributed predicting patient 's general satisfaction well propose burden care subjective satisfaction life standards functional assessment instruments compared reflect , terms , impact disability lives individuals human economic resources community
penicillamine induced lupus erythematosus describe patient presented , , rash , positive antinuclear antibody result 5 years penicillamine therapy penicillamine induced antinuclear antibodies mainly high titer igg directed \( h2b \) dna complex weak igm activity h1 h2b also observed withdrawal penicillamine therapy resulted improvement clinical symptoms gradual resolution serologic abnormalities
cytotoxic activity hiv infected monocytes recombinant interleukin 2 activated natural killer cells natural killer \( nk \) cells long known aid control viral infections killing virus infected cells , including infected human immunodeficiency virus \( hiv \) among possible nk susceptible target cells infected individual , monocyte macrophages special significance since may serve reservoir hiv aid dissemination virus throughout body new technique enrichment large numbers recombinant interleukin 2 \( ril 2 \) stimulated nk cells developed provides cells high cytotoxic activity il 2 activated nk cells , adherent lymphokine activated killer cells \( lak \) , kill monocytes infected hiv 24 h 7 days , optimal target sensitivity 3 7 days recognition killing infected monocytes appear restricted major histocompatibility complex \( mhc \) antigens could cold target inhibited tumor cell lines lak cells may useful newer therapeutic approaches treatment hiv infection
macrophage tropism hiv 1 vivo vitro studies clearly demonstrate cells mononuclear phagocyte lineage major hosts human immunodeficiency virus type 1 \( hiv 1 \) replication presumably cells play key role pathogenesis acquired immunodeficiency syndrome \( aids \) delineate interactions hiv 1 host cells , susceptibility normal human peripheral blood derived monocyte macrophages \( \) lymphocytes , neoplastic monocytoid lymphoid cell lines various hiv 1 isolates assessed results suggest \( 1 \) fresh isolates recovered patients normal host cells exhibit dual tropism cells , regardless tissue origin cell type isolated \( 2 \) repeated passage hiv 1 isolate normal generally result loss ability infect normal cells vice versa \( 3 \) majority fresh hiv 1 isolates infect neoplastic cells either origin , show preference monocytoid lymphoid targets , regardless cell origin
full length recombinant cd4 recombinant gp120 inhibit fusion hiv infected macrophages uninfected cd4 expressing lymphoblastoid cells human immunodeficiency virus \( hiv \) infected monocyte macrophages may contribute pathogenesis hiv associated immune deficiency dysfunction acting target potential reservoir virus vivo , functioning abnormally following infection shown hiv infected macrophages fuse uninfected cd4 expressing lymphoid cells vitro may provide additional mechanism cd4 lymphocyte depletion vivo report inhibition formation hiv infected macrophages uninfected cd4 expressing lymphoid cells monoclonal antibody s3 5 , directed epitope cd4 involved binding hiv gp120 , recombinant protein comprises full length extracellular domain cd4 molecule , recombinant full length hiv envelope glycoprotein , gp120 results indicate molecules \( gp120 cd4 \) critical fusion process , suggest gp120 expressed surface hiv infected monocyte macrophages
effects glq223 hiv replication human monocyte macrophages chronically infected vitro hiv glq223 formulated version , single chain protein shown earlier studies inhibit human immunodeficiency virus \( hiv \) replication lymphoblastoid cells decrease hiv p24 levels hiv infected monocyte derived macrophages measured flow cytometry current studies performed test selectivity observed inhibitory effects hiv replication chronically infected macrophages infected vitro peripheral blood derived monocyte macrophages infected vitro cultivated suspension least two weeks prior glq223 treatment anti hiv effects quantitated measurement cytoplasmic hiv p24 , enzyme linked immunosorbent assay \( elisa \) flow cytometry hiv rna levels measured slot blot analysis incorporation 3h leucine acid \( tca \) protein also evaluated index nonspecific inhibitory effects mediated compound infected uninfected cultures five days single 3 h treatment glq223 concentration dependent decrease measurable hiv parameters within infected cultures anti hiv effects persisted least 28 days without evidence increasing hiv expression glq223 treatment parallel uninfected macrophage cultures showed significant inhibition tritiated leucine uptake experiments demonstrate single pulsed exposure glq223 macrophages infected hiv vitro caused sustained , concentration dependent decrease hiv p24 antigen levels well hiv rna without causing measurable toxicity uninfected cultures
ability anti hiv agents inhibit hiv replication monocyte macrophages u937 monocytoid cells conditions enhancement gm csf anti hiv antibody monocyte macrophages \( \) important target cell human immunodeficiency virus \( hiv \) infection body study hiv infection cells , however , rather complicated represent variable population , hiv entry replication may markedly influenced number factors must considered therapeutic approaches hiv infection present set experiments , studied interaction certain agents increase infection monocyte macrophages \( \) hiv two groups anti hiv agents specific inhibitors gp120 cd4 binding found cytokine granulocyte macrophage colony stimulating factor \( gm csf \) , markedly enhances hiv replication , affect activity recombinant soluble cd4 \( \) , two agents block gp120 cd4 binding however , varying effects different gm csf increased net anti hiv activity 3' , 3' \( azt \) , time reduced activity 2' , 3' dideoxycytidine \( ddc \) 2' , 3' \( \) effects probably represent varying effects gm csf drug entry phosphorylation additional experiments , showed low concentrations anti hiv antibodies could enhance hiv infection u937 monocytoid cell line interestingly , effect hypothesized occur cd4 independent mechanism , found anti hiv activities unchanged conditions enhancement
effect interleukin 4 \( 1 \) infection peripheral blood monocyte derived macrophages hiv 1 effects various cytokines examined vitro model human immunodeficiency virus type 1 \( hiv 1 \) infection human peripheral blood monocyte derived macrophages \( \) monocytes obtained blood normal donors gradient centrifugation adherence cells allowed mature presence varying concentrations cytokines five days culture , cells harvested , counted , inoculated , htlv iiib cells presence concentrations cytokines culture supernatants sampled 28 days p24 antigen \( ag \) measured ag capture assay repeat experiments , following observations made 1 donors could infected presence tumor necrosis factor alpha \( tnf alpha \) , granulocyte macrophage colony stimulating factor \( gm csf \) interleukin 4 \( il 4 \) 2 effect gm csf variable tnf alpha also enhanced hiv replication controls 3 il 4 potent enhancer hiv 1 replication cytokines tested , inducing p24 ag levels 75 230 times seen control cultures run simultaneously effect dose dependent ag production observed day 14 experiments multinucleated giant cell formation observed presence il 4
fcr mediated enhancement hiv 1 infection antibody although cd4 major receptor human immunodeficiency virus \( hiv \) infection cells , studied others clearly show fc receptor \( fcr \) also plays role infection , perhaps conjunction surface receptors igg antibodies hiv 1 enhance infectivity cells \( monocyte macrophages \) surface fc receptors f \( ab' \) 2 fragments antibodies enhance , blocking fcr inhibited enhancement high affinity fcr igg \( fc gamma ri \) appeared functional sera hiv 1 infected patients neutralizing activity high concentrations , enhanced infection low concentrations \( e , high dilutions \) studies show cd4 receptor required antibody mediated enhancement infection , enhancement blocked recombinant soluble cd4 antibody although enhancement demonstrated vitro , vivo importance enhancing antibodies remains defined hiv 1 infection
allogeneic marrow transplantation patients acute myeloid leukemia first remission randomized trial two irradiation regimens randomized trial 12 0 gy versus 15 75 gy total body irradiation \( tbi \) performed patients acute myeloid leukemia undergoing allogeneic marrow transplantation first complete remission patients received 120 mg kg cyclophosphamide followed tbi marrow hla identical siblings cyclosporine methotrexate used prophylaxis acute graft versus host disease \( gvhd \) thirty four patients received 2 0 gy fractions irradiation daily 6 days 37 received 2 25 gy fractions daily 7 days 3 year actuarial probabilities relapse free survival 0 58 patients received 12 0 gy 0 59 received 15 75 gy 3 year probabilities relapse 0 35 12 0 gy group 0 12 15 75 gy group \( p 06 \) 3 year probabilities transplant related mortality 0 12 0 32 , respectively \( p 04 \) probability moderate severe acute gvhd 0 21 12 0 gy group 0 48 15 75 gy group \( p 02 \) patients exposed higher irradiation dose received less , higher incidence , acute gvhd increased dose tbi significantly reduced probability relapse improve survival increased mortality causes relapse
zidovudine \( \) update zidovudine \( azt \) first antiretroviral agent licensed treatment human immunodeficiency virus \( hiv \) infection since initial placebo controlled trial showing improved survival among patients acquired immunodeficiency syndrome \( aids \) symptomatic hiv infection \( aids related complex arc \) zidovudine evaluated stages hiv infection review offers physicians treat patients hiv infection comprehensive analysis current data clinical efficacy zidovudine various stages hiv infection zidovudine 's adverse effects search medline pertinent articles published since 1985 , controlled studies studies long term zidovudine therapy , zidovudine therapy hiv related conditions incidence management adverse reactions evaluated addition , abstracts international reviewed significant difference clinical outcome found high dose low dose zidovudine therapy , significantly fewer toxic effects low dose group two studies zidovudine found delay disease progression patients asymptomatic mildly symptomatic hiv infection absolute cd4 count less 0 5 x 10 \( 9 \) l low incidence adverse reactions may due either early stage infection low dose used demonstration zidovudine resistant isolates least 6 months therapy yet correlated clinical deterioration begin zidovudine therapy among asymptomatic patients cd4 count less 0 5 x 10 \( 9 \) l remains unclear zidovudine used safely delay progression aids arc certain patients asymptomatic mildly symptomatic hiv infection prolong survival severe infection studies necessary identify indicators could better define start treatment alleviate toxic effects combination therapy agents interferon alpha may become preferred choice therapy prevent toxic effects zidovudine resistance zidovudine prophylaxis used hiv exposure although studies animal models encouraging results infection occurred despite immediate prophylaxis thus investigation required
hiv infection among quebec women giving birth live infants first anonymous seroprevalence study canada use serum samples newborns determine seroprevalence rate human immunodeficiency virus \( hiv \) infection among childbearing women 68 , samples tested 42 confirmed positive , overall crude seroprevalence rate 6 1 per 10 , 000 live births \( 95 confidence interval ci 4 4 8 3 \) , 1 woman women lived montreal island overall rate 17 9 per 10 , 000 live births \( 95 ci 12 2 25 4 \) , 1 woman 559 observed significant association index seroprevalence rates high 46 4 per 10 , 000 live births \( 95 ci 18 7 95 3 \) , 1 woman 216 , montreal island postal code areas indexes 20 provincial median extrapolation data suggested 56 women hiv infection gave birth live infant 1989 quebec even though attempts data childbearing women women childbearing age inherent conservative bias , results study suggest women \( 95 ci \) aged 15 44 years quebec hiv infection 1989 actual number likely substantially higher need well designed , interventions prevent hiv transmission women evident planning provision medical psychosocial services sensitive specific needs women already infected start immediately
randomized comparison methotrexate dose addition bleomycin chop therapy diffuse large cell lymphoma non hodgkin 's lymphomas cancer leukemia group b study 1978 , cancer leukemia group b initiated randomized study determine usefulness addition bleomycin high dose methotrexate standard therapy treatment certain adult non hodgkin 's lymphomas 1978 1985 , 177 patients diffuse large cell lymphoma \( dlcl \) 97 patients intermediate grade non hodgkin 's lymphoma randomized receive therapy three courses cyclophosphamide , adriamycin , vincristine , prednisone \( chop \) every 3 weeks without low dose bleomycin continuous iv infusion responders three courses randomized 3 weeks therapy either high dose methotrexate \( 3 gm m2 week intravenously leucovorin rescue \) standard dose methotrexate \( 30 mg m2 week orally without rescue \) therapy concluded three additional courses chop neither addition low dose infusion bleomycin use high dose rather low dose methotrexate significant effects response patients dlcl complete response rates four treatment programs ranged 47 51 median failure free survival \( ffs \) entire group dlcl patients 12 months 5 year ffs 27 significant effect ffs addition either low dose bleomycin chop \( 5 year ffs chop , 28 chop b , 26 , p 0 81 \) , use different doses methotrexate \( 5 year ffs high dose , 34 standard dose , 33 , p 0 51 \) patients follicular large cell lymphoma , without diffuse areas , better ffs \( 5 year ffs , 47 \) patients dlcl \( 5 year ffs , 27 \) , patients histopathologic subtypes diffuse lymphomas poorest ffs \( 5 year ffs , 16 \)
immune deficiency family members patients hodgkin 's disease indirect data supporting preexisting immunologic impairment patients hodgkin 's disease \( hd \) presented recent years immunologic defects related genetic environmental factors study , 65 first degree relatives 12 spouses 21 consecutive patients hd studied immunologically furthermore , seven twin pairs one partner hd four additional healthy co twins also included study decreased lymphocyte dna synthesis induced concanavalin , high spontaneous dna synthesis , low cd4 8 ratio found 21 \( 32 \) consanguineous , two \( 17 \) relatives , five \( 50 \) healthy co twins corresponding figures untreated patients hd control series 14 21 \( 65 \) 21 127 \( 16 \) , respectively total lymphocyte counts lymphocyte subpopulations differ hd relatives controls increased frequency blood lymphocyte defects among consanguineous first degree relatives existence genetically determined immune deficiency least proportion apparently healthy relatives patients hd however , nongenetic factors age environment may add defect
non hodgkin 's lymphoma elderly pathologic features presentation pathologic findings 118 patients aged 70 years older non hodgkin 's lymphoma \( nhl \) reported patients formed 27 2 consecutive cases nhl seen single institution 5 year period thirty one nhl cases histologically classified , whereas remaining could classified according international working formulation \( \) nhl clinical usage immunophenotypic analyses carried 112 nhl cases group 28 nhl elderly patients 95 elderly nhl could classified histologic categories 28 cases low grade , 41 intermediate grade , 26 high grade categories eighty one cases diffuse histologic types 14 follicular nodular histologic types thirty five cases g \( diffuse large cell \) h \( large cell , immunoblastic \) categories significant differences prevalence different subtypes observed among patients younger older 70 years immunohistologically , nhl cases elderly expressed b cell phenotype sixty two nhl elderly extranodal presentation results study indicate elderly patients form relevant proportion patients developing nhl thereby present difficult management problem pathologic features nhl elderly differ significantly younger counterparts , although increase diffuse versus follicular histologic patterns , extranodal versus nodal disease observed advancing age
sle nephritis ultrastructural immunogold study evaluate relationship immune complexes basement membrane components type iv collagen , fibronectin heparan sulphate nature immune complexes relationship normal glomerular basement membrane \( gbm \) components type iv collagen , fibronectin , heparan sulphate \( hspg \) examined glomeruli 7 cases systemic lupus erythematosus \( sle \) glomerulonephritis using ultrastructural immunogold technique fixed , resin embedded tissue , electron dense deposits contained igg , igm , iga , c3 whether subepithelial , , subendothelial , mesangial particular relationship class immunoglobulin site immune complex localization within glomerulus normal gbm components type iv collagen , fibronectin , hspg found within glomeruli , distribution type iv collagen fibronectin found predominantly inner aspect gbm diffusely throughout central regions mesangial matrix contrast hspg seen mainly outer aspect gbm periphery mesangial matrix none cases gbm antigens localized within electron dense deposits , results suggest autoantibodies gbm components may play role development glomerulonephritis
anaphylactic shock associated skin test case report review literature allergic response therapy well documented serious reactions anaphylactic shock , may result death various screening methods , including skin tests , proposed identify susceptible patients anaphylactic shock occurred 40 year old woman application screening skin test appropriate therapeutic intervention readily accessible test performed
monitoring glucocorticoid therapy pharmacokinetic approach although glucocorticoid therapy essential treatment severe inflammatory disorders , systematic approach patient variables may affect availability steroid dose development data base pharmacokinetic parameters , examined glucocorticoid pharmacokinetics 54 patients 2 70 years age using 70 pharmacokinetic studies administration intravenous methylprednisolone \( n 25 \) , oral methylprednisolone \( n 15 \) , intravenous prednisolone \( n 18 \) , oral prednisone \( n 12 \) eleven patients unusually rapid methylprednisolone elimination \( clearance , ml min 1 73 m2 population mean , sd 380 100 ml min 1 73 m2 \) without identifiable cause incomplete absorption methylprednisolone prednisone observed three patients one patient , respectively evaluation glucocorticoid pharmacokinetics children aged 1 year 8 months 18 years demonstrated significant inverse correlation \( r 0 88 p less 0 001 \) prednisolone clearance age therefore important consider age interpretation pharmacokinetic data measurement prednisolone clearance , single dose single point method developed based highly significant relationship 6 hour postdose prednisolone concentration prednisolone clearance \( log prednisolone clearance 2 66 6 hour postdose concentration 0 r2 0 96 p less 0 0001 \) evaluation glucocorticoid pharmacokinetics clinical setting used identify abnormalities absorption , elimination , patient compliance technique used glucocorticoid dosing regimens
effect facial cooling mucosal blood flow mouth humans 1 determine effects facial cooling intraoral thermal events , placed thermal conductivity sensor buccal surface left cheek six normal six asthmatic subjects room temperature cold stimuli applied surface sides face mucosal surface temperature thermal conductivity , index blood flow , recorded 2 room temperature challenge effect application cold stimulus left cheek caused decrease temperature mouth subjects associated change thermal conductivity blood flow increased fell baseline despite continued drop temperature responses purely local cooling right side face change temperature blood flow left side differences noted asthmatic normal subjects 3 data indicate lowering temperature skin face produces significant alterations thermal environment within mouth facial cooling , buccal temperature falls mucosal blood supply transiently rises effect appears purely local mediated event facial pressure cutaneous reflexes play role changes may contribute conditioning inspired air oral breathing
comparison aerosolized glycopyrrolate metaproterenol acute asthma efficacy nebulized glycopyrrolate compared metaproterenol evaluated 46 patients acute asthma double blinded , randomized fashion , patients received , sole therapy , either 2 mg glycopyrrolate 15 mg metaproterenol every 2 h 6 h study period 35 patients completing study , analysis variance demonstrated difference percentage change fev1 glycopyrrolate metaproterenol two hours initial dose , 30 percent increase fev1 glycopyrrolate compared 25 percent increase metaproterenol \( p greater 0 05 , ns \) contrast comparable bronchodilator activity , side effects profile two agents markedly dissimilar subjective complaints tremor , palpitations , paresthesias increased metaproterenol , heart rate response significantly elevated \( p less 0 05 \) compared glycopyrrolate based data , administration aerosolized anticholinergic agent , glycopyrrolate , reasonable therapeutic alternative acute asthma
multiple alterations insulin responses glucose islets 48 h glucose infused nondiabetic rats examine biochemical mechanisms hyperglycemia produces insulin secretory abnormalities , studied isolated islets control rats rats infused 48 h 50 glucose solution preserve effects vivo hyperglycemia vitro handling islet isolation , standard isolation procedure utilized containing 16 8 mm glucose islets infused rats released similar amounts insulin low high glucose first incubations 37 degrees c \( 92 4 7 0 ng 10 islets 1 45 min 1 2 8 mm , 84 4 4 1 ng 10 islets 1 45 min 1 16 8 mm \) contrast control \( \) islets \( 18 6 2 8 ng 10 islets 1 45 min 1 2 8 mm 109 8 8 0 ng 10 islets 1 45 min 1 16 8 mm glucose \) \( p less 0 01 \) secretion islets glucose infused rats lower 60 min second incubations 28 mm glucose first incubations islets low glucose \( p less 0 01 \) phenomenon comparable paradoxical hypersecretion observed first 10 15 min exposure glucose infused pancreas low glucose paradoxical secretion low glucose rapidly , second incubations 37 degrees c , little immunoreactive insulin release occurred 2 8 mm glucose , despite persistence two additional lesions glucose insulin dose response curves second incubations showed leftward shift glucose infused islets , two threefold higher secretion 5 6 8 4 mm glucose control islets termed sensitization glucose
computer assisted selection assessment antibodies diagnosis lymphomas increasing numbers reagents problem selecting appropriate antibodies problems diagnosis lymphoma becoming complex one approach use computer program selection process program devised , incorporating data extensive literature search presented differential diagnosis appropriate antibody panel given results evaluates relative likelihood possible diagnosis retrospective study 81 tests used non discriminatory , using results remaining 19 tests , computer able select correct diagnosis high degree development use system illustrated several problems application computer assisted diagnostic techniques histopathology problems include incomplete data lack understanding process histopathological diagnosis
identification human immunodeficiency virus hybridizing sequences peripheral blood patient systemic lupus erythematosus systemic lupus erythematosus , disorder , considered prototype autoimmune diseases although cause remains unknown , viral etiology proposed report rapid sensitive messenger rna situ hybridization technique detected hybridizing sequences human immunodeficiency virus type peripheral blood cells woman systemic lupus erythematosus presence acquired deficiency syndrome reasonably excluded
characteristics patients food related complaints forty five patients classic food allergic symptoms subjective food related complaints traditionally associated food allergy underwent evaluation basis comprehensive clinical history , skin testing , placebo controlled , double blind food challenges , patients assigned one two groups patients reactions highly suggestive ige mediated food hypersensitivity \( group , n 22 \) patients atypical adverse food reactions could confirmed double blind food challenge \( group b , n 23 \) patients groups female , 77 3 91 3 patients group b , respectively group b , onset symptoms occurred older age group , 28 9 years 17 2 versus 17 1 12 1 \( p 0 \) , respectively , involved foods , 25 6 22 1 versus 5 2 5 5 \( p 0 0002 \) foods causing prominent symptoms among patients group included , tree , , fish group b , milk , white sugar , wheat , egg , smoked cured meat , yeast among troublesome foods one patient group gave positive skin test response food four patients group b positive response conclude subset patients food related complaints accurately predicted negative double blind challenge suspected foods basis information obtained history skin testing
immunoblot analysis sera patients allergic bronchopulmonary aspergillosis correlation disease activity immunoblot analysis used evaluate igg , ige , iga responses aspergillus fumigatus antigen sera five patients allergic bronchopulmonary aspergillosis \( abpa \) , , suspected exacerbation disease results revealed heterogenous antibody response , unique patient , specific aspergillus fumigatus antigens correlated molecular weights previously well characterized antigens importance abpa rating scale devised measuring band intensity allowed patient 's antibody responses reproducibly immunoblot analysis demonstrated qualitative semiquantitative information available vitro assays used study patients abpa , elisa initial results emphasize need additional evaluation technique assess potential clinical application disease
basophil histamine release platelet activating factor aspirin sensitive subjects asthma histamine release induced platelet activating factor \( paf \) leukocytes aspirin sensitive subjects asthma higher normal control subjects , despite similarity anti ige induced histamine release moreover , basophils aspirin sensitive subjects asthma released histamine paf stimulation absence cytochalasin b affects histamine release required paf induced histamine release leukocytes atopic subjects asthma normal control subjects addition temperature dependency inhibition acid reported previously , paf induced histamine release enhanced cytochalasin b indomethacin inhibited dexamethasone features common ige mediated histamine release suggest existence common pathway paf induced histamine release ige mediated histamine release results present study indicate pathophysiologic significance paf induced histamine release activation basophils paf may relevant pathogenesis aspirin sensitive subjects asthma
use antihistamines prevention treatment anaphylaxis reactions pathophysiologic effects histamine anaphylaxis shown mediated h1 h2 receptors , individually combination h1 receptors mediate coronary artery vasoconstriction , wheezing , cutaneous vascular permeability , possibly increase pulse rate h2 receptors stimulate ventricular atrial , arterial , coronary vasodilation , rises basophil cyclic adenosine 3' 5' monophosphate \( cyclic amp \) \( neither receptor mediates increases cyclic amp mast cells \) h1 h2 receptors combination seem potent mediating flush , headache , increases pulse pressure , decreases diastolic blood pressure clinical trials conducted determine efficacy h1 h2 antagonists preventing anaphylactic reactions plasma , anesthesia inducing agents , morphine , material concurrently , retrospective observations prevention anaphylactic reactions recorded despite conflicting inconclusive data , sum studies indicates pretreatment combination h1 h2 antagonists effective h1 antagonists alone preventing reactions agents results , added available knowledge physiology histamine release , support preferential use h1 h2 antagonist combinations prevention treatment anaphylaxis reactions
normal responsiveness superficial hand veins alpha beta adrenergic stimuli allergic asthma effects terbutaline prednisolone beta adrenergic responsiveness impaired function adrenergic receptor system postulated contribute pathogenesis bronchial asthma using dorsal hand vein compliance technique , compared changes diameter superficial hand veins response phenylephrine , alpha adrenoceptor agonist , isoproterenol , beta adrenoceptor agonist , 14 untreated patients allergic asthma 16 nonatopic control subjects significant differences median effective dose phenylephrine produced 50 maximal \( ed50 \) maximal response \( emax \) two groups bronchial hyperreactivity \( assessed methacholine challenge tests \) patients asthma ed50 emax isoproterenol results demonstrate evidence generalized change alpha beta adrenergic responsiveness smooth muscle cells asthma hand vein responsiveness isoproterenol unchanged treatment 7 days oral terbutaline \( 5 mg three times per day \) thus , unlike leukocytes , smooth muscle appears readily susceptible beta adrenoceptor desensitization vivo local infusions prednisolone dexamethasone 2 hours systemic administration dexamethasone \( 24 hours \) caused significant fall emax isoproterenol mechanism attenuation beta adrenoceptor responsiveness corticosteroids remains determined
allergens proteases aspergillus fumigatus proteinase directly induces human epithelial cell detachment allergic bronchopulmonary aspergillosis \( abpa \) characterized pulmonary systemic allergic inflammatory processes triggered fungal antigens airway damage feature disorder , although aspergillus derived described , capacity aspergillus , however , directly induce damage human epithelium previously studied therefore cultured aspergillus fumigatus two patients abpa , extracted products filtration , evaluated capacity induce epithelial cell \( ec \) basement membrane using vitro model uses intact human amniotic ec native basement membrane fumigatus extracts induced detachment ec dose dependent fashion , producing 34 6 detachment \( p less 0 05 compared medium alone \) enzyme analysis fumigatus extract using synthetic substrates revealed presence number different enzymes therefore , studies specific proteinase inhibitors undertaken identify proteinase \( \) responsible detachment fumigatus induced partially inhibited substantially inhibited glutathione n , alpha 1 antitrypsin , 1 , 10 , acid , aprotinin , trypsin inhibitor concentrations inhibit serine gel filtration extract sepharose column revealed major epithelium activity appeared 20 35 kd fraction comparison proteinase standards suggested role chymotrypsin like proteinase thus , fumigatus releases proteinase directly able induce ec detachment
salsalate cross sensitivity aspirin sensitive patients asthma ten aspirin \( asa \) sensitive patients asthma underwent double blind , placebo controlled oral challenges salsalate followed asa sensitive confirmatory challenges 10 patients sustained asthmatic reactions asa , two developed respiratory reactions 2 gm salsalate two patients , repeat confirmatory challenges 2 gm salsalate reproduced asthmatic reactions patients asa , cross desensitization 2 gm salsalate achieved conclude salsalate , weak inhibitor cyclooxygenase vitro , less likely asa induce asthma known asa sensitive patients asthma may occasionally cross react patients reactions mild easily treated beta 2 agonists
aberrant regulation il 1 expression macrophages young autoimmune prone mice il 1 , immunoregulatory polypeptide produced many cell types activated macrophages major source il 1 also implicated pathogenesis autoimmune disease , investigated regulation il 1 expression several autoimmune prone strains mice peritoneal macrophages derived autoimmune prone strains mrl lpr , mrl , nzb , nzb w f1 , well , displayed transient expression il 1 contrast stable expression characteristic control normal strains including thy , j , b10 , b10 , b10 d2 , c57bl 6 , balb c , c3h regulation il 1 macrophages autoimmune prone mice attributable inherently defective signal transduction macrophages normal autoimmune prone strains displayed substantial initial levels cell associated secreted il 1 however , first 2 3 days culture , macrophages autoimmune prone mice became progressively refractory induction maintenance il 1 , pattern correlated changes levels il 1 alpha beta mrna progressive reduction il 1 expression macrophages autoimmune prone strains due reduction general metabolism viability , expression cell surface antigens , including mhc class ii ag lfa 1 , comparable control macrophages il 1 plays critical role homeostasis variety cell lineages , defective expression , maintenance il 1 \( perhaps cytokines \) macrophages autoimmune prone strains may contribute immune dysregulation develops mice alternatively , cytokine dysregulation might contribute directly disease , rather reflect basic defect related specific signal gene regulatory pathways
small proportion cationic antibodies immune complexes sufficient mediate deposition glomeruli positively charged antibodies mediate enhanced deposition circulating immune complexes glomerular basement membrane presented experiments demonstrate soluble immune complexes prepared mixture antibodies containing 10 25 cationic antibodies , noncationic antibodies complexes deposited mouse glomeruli one two cationic antibodies immune complex deposition complexes proof obtained two kinds experiments first , injected immune complexes prepared ag excess mixtures radiolabeled noncationic rabbit antibodies human serum albumin \( hsa \) rabbit antibodies hsa , thus permitting specific quantitation deposition noncationic antibodies glomeruli presence antibodies within complexes control experiment , immune complexes prepared noncationic antibodies resulted little deposition kidneys time period second , detection localization noncationic antibody deposits glomeruli immunofluorescence microscopy accomplished using immune complexes prepared mixtures noncationic goat antibodies hsa rabbit antibodies hsa thus , synthesis small population cationic antibodies immune response may lead formation circulating immune complexes enhanced propensity deposition glomeruli patients sle immune complex diseases
ultraviolet cross linking helical oligonucleotides two monoclonal mrl 1pr 1pr anti dna autoantibodies variations h l chain binding dna experiments performed determine whether h l chains different anti native dna autoantibodies uniformly involved binding dna two purified monoclonal mouse \( mrl 1pr 1pr \) igg autoantibodies , h241 , tested bound synthetic helical oligonucleotides 10 20 base pairs gel electrophoresis retardation assay differed preferences given base sequences exposure antibody radiolabeled oligonucleotide mixtures uv light \( 254 nm \) 10 min led specific cross linking oligonucleotide h l chains h241 h chain single labeling events detected without higher aggregation oligonucleotides cross linked unrelated igg , even 2 h irradiation cross linked \( labeled \) h l chains h241 isolated denaturing electrophoresis gels lysyl staphylococcal protease h241 h chains yielded major labeled peptide fragment , peptides two antibodies different experiments measured antibody dna interactions , probably bases major groove dna indicated two mrl 1pr 1pr igg anti native dna antibodies differ h l chain contacts dna provide approach identifying affinity labeled binding sites antibodies
vivo immune selection murine leukemia virus induced tumor results loss viral tumor associated antigens protocol vivo immune selection used isolate variant murine leukemia virus \( mulv \) induced tumor 2 characterization tumor variant indicated selection resulted isolation cell producing infectious virus longer capable synthesizing viral proteins although failure express viral ag rendered variant tumor cells resistant lysis ctl specific mulv viral ag , variant tumor cells retained susceptibility lysis ctl appear directed mulv induced tumor associated ag data indicate expression tumor associated ag 2 dependent upon continued viral gene expression
activation complement system human immunodeficiency virus infection relevance classical pathway pathogenesis disease severity vitro studies implicate classical alternative complement pathway activation pathogenesis human immunodeficiency virus \( hiv \) infection ascertain importance vivo , activation fragments classical \( c4d \) , alternative \( \) , common \( c3d \) pathways measured fragment parent molecule ratios derived 74 hiv infected individuals related circulating immune complex \( cic \) levels , centers disease control \( cdc \) stage , beta 2 microglobulin , neopterin , cd4 positive \( cd4 \) lymphocyte levels fragments ratios significantly higher patients \( p less 01 \) controls c4 conversion indices \( c4d c4d c4 \) increased linearly increasing cdc stage \( p less 001 \) , cd4 lymphocytes decreased linearly \( p less 001 \) c4d , c3d , c4d c4 , c3d c3 correlated increasing cic beta 2 microglobulin , c4d c4d c4 correlated decreasing cd4 lymphocytes \( p less 05 \) relationship classical complement pathway activation disease progression cd4 lymphocytes suggests involvement pathogenesis hiv infection
azt demonstrates anti hiv 1 activity persistently infected cell lines implications combination chemotherapy immunotherapy sensitive quantitative focal immunoassay used measure effects three different therapeutic agents tissue culture cells infected human immunodeficiency virus \( hiv \) effects drugs studied acutely persistently infected cd4 cell lines three agents , azidothymidine \( azt \) , interferon alpha \( ifn alpha \) , anti hiv envelope antibody coupled chain , tested alone combination azt found greatest effect early stages infection , also action persistently infected cell lines effect azt persistently infected cells seen within 24 h , increased extended exposure drug , persisted removal ifn alpha variable effects acutely infected cells suppressed chronic infection combinations therapeutic agents studied using model allowed treatment acute persistent stages infection , effective combination suppressing hiv infection continual use azt ifn alpha highest tolerable doses knowledge efficacy azt persistently infected cells allow effective design clinical protocols
analysis lymphocytes , monocytes , neutrophils human immunodeficiency virus \( hiv \) infected persons hiv dna human immunodeficiency virus \( hiv \) alters function cells involved immune responsiveness helper lymphocytes monocyte macrophages infected via cell surface cd4 vitro , previous studies showed blood cells express hiv rna vivo study used dna amplification determine levels hiv dna purified lymphocytes , monocytes , neutrophils hiv infected asymptomatic individuals persons aids average numbers hiv dna copies lymphocytes aids patients asymptomatic individuals similar \( approximately 100 140 copies 150 , 000 cells \) however , expressed basis numbers cd4 cells , aids patients' cells contained approximately 2 5 times hiv dna hiv dna present lymphocytes 27 subjects , little hiv dna observed monocytes neutrophils 1 asymptomatic person contained levels hiv dna monocytes \( 125 proviral copies 150 , 000 cells \) comparable levels expressed lymphocytes \( 160 150 , 000 \) expression monocyte hiv dna person persistent least 8 months , observed neutrophils , suggesting monocyte hiv dna originate myeloid precursors study shows aids asymptomatic hiv infection , lymphocytes predominant infected cell found blood
frequency indeterminate western blot tests healthy adults low risk human immunodeficiency virus infection aids vaccine clinical network part phase 1 trial candidate aids vaccine , blood specimens collected 168 healthy adult volunteers minimal risk becoming infected human immunodeficiency virus type 1 \( hiv 1 \) specimens screened evidence hiv 1 infection enzyme immunoassay \( eia \) du western blot \( n 168 \) , culture \( n 122 \) , polymerase chain reaction assay \( n 20 \) none subjects positive test result assays , 32 indeterminate western blot tests , demonstrated single band low intensity common bands p24 \( 47 \) , p55 \( 34 \) , \( 36 \) envelope bands unusual \( gp41 , 2 gp120 , 2 \) serum specimen collected 2 11 months individuals indeterminate western blot results positive eia western blot 91 agreement test results first second serum samples lot western blot kit used 36 agreement different used du western blot kit thus frequently yields indeterminate test results absence hiv 1 infection , reproducibility subject lot lot variability
serial studies evoked potentials circulating lymphocyte subsets multiple sclerosis attempts monitor progress concurrent change evoked potential measurements quantitation circulating suppressor \( cd8 \) lymphocyte subpopulations might indicate increased subclinical disease activity eight untreated patients clinically definite multiple sclerosis monitored monthly changes numbers cells positive cd8 markers , hence ratio cd4 cd8 positive cells changes found associated changes evoked potentials clinical status
gallium 67 imaging predictor residual tumor viability clinical outcome patients diffuse large cell lymphoma durable complete remissions \( crs \) achieved patients diffuse large cell lymphoma \( dlcl \) multidrug chemotherapy length time reach cr may predictive treatment outcome however , defining cr chest radiograph computed tomography \( ct \) often difficult since residual abnormalities always indicate residual disease prospectively evaluated ability gallium 67 citrate \( ga 67 \) imaging define residual disease predict outcome 37 consecutive patients dlcl patients received 370 \( mbq \) ga 67 imaged prior , following cycles 4 6 , completion intensive chemotherapy ga 67 scan results correlated radiographic studies seventeen 37 patients \( 46 \) showed persistent , abnormal ga 67 uptake halfway chemotherapy , four cr , 11 partial remission \( pr \) , two showed change tumor size follow , 10 \( 59 \) died \( three scored cr seven pr halfway therapy \) , two alive active tumor , one relapsed following bone marrow transplant , four \( three pr one cr therapeutic halfway point \) without disease median 28 months presentation 20 patients ga 67 negative halfway therapy , 11 cr nine pr five 20 patients \( 25 \) died three , radiographic cr died 11 , 26 , 28 months , two radiographic pr died 15 17 months one patient alive active tumor , 14 patients \( 70 \) alive without disease median 34 months presentation ga 67 imaging proved excellent indicator residual viable tumor positive scan halfway therapy predicted poor outcome may well justify change treatment
dideoxycytidine alone alternating schedule zidovudine children symptomatic human immunodeficiency virus infection objective determine whether short course 2' , 3' dideoxycytidine \( ddc \) could provide safe antiretroviral activity children symptomatic human immunodeficiency virus infection whether could used azidothymidine \( azt , zidovudine \) goal maintain antiretroviral therapy sparing azt related myelosuppression ddc related neuropathy methods pilot study , evaluated four dosage levels ddc 0 015 , 0 02 , 0 03 , 0 04 mg kg , given orally every 6 hours 15 children 6 months 13 years age centers disease control p2 \( e , symptomatic \) human immunodeficiency virus infection thirteen patients prior antiretroviral therapy two patients received benefited azt , dose limiting neutropenia developed dosage level , ddc given 8 consecutive weeks stopped 30 day rest , schedule ddc 1 week followed 3 weeks azt therapy \( 180 mg m2 every 6 hours \) alternating schedule repeated long tolerated age appropriate psychometric testing performed start ddc therapy 8 weeks results 8 weeks therapy ddc alone , neutropenia anemia observed 6 9 patients decreases p24 antigen levels , 8 15 increased cd4 cell count 0 04 mg kg level , rash developed three patients mild mouth developed 9 15 patients alternating ddc azt schedule , neuropathy observed conclusions 2' , 3' dideoxycytidine antiretroviral activity children appears safe short intervals longer courses ddc lower dosage levels , schedules ddc combination regimens , deserve explored
evaluation aids dementia complex clinical trials aids dementia complex \( adc \) one common important causes morbidity associated infection human immunodeficiency virus type 1 \( hiv 1 \) evaluation adc clinical trials significant clinical impact syndrome , also value measuring cardinal features index drug efficacy emerging role major clinical end point objectives therapy include prevention adc patient alleviation established disease present , pathogenesis adc incompletely understood several critical aspects , particularly processes underlying clinical manifestations central nervous system \( cns \) hiv 1 infection , , processes related systemic disease consequently , yet clear extent , patients , necessary achieve therapeutic drug levels within cns nevertheless , assessment adc prevention treatment relies principally complementary approach neurological examination diagnosis neuropsychological testing quantitative serial measurement treatment effects additionally , surrogate markers cerebrospinal fluid \( csf \) may hold promise objective , rapid assessment treatment response dose adjustment measurements , including routine csf analysis , neuroimaging , neurophysiological assessments , used principally differential diagnosis rather monitoring adc status accumulating experience available antiviral agents suggests adc effectively prevented treated , least period time , assessment condition indeed valuable approach measuring antiviral therapy
evaluation active control trials aids settings effective standard treatment exists , active control trials provide approach evaluating experimental therapies allowing patients randomized either promising new regimen standard would routinely delivered clinical practice paper describes appropriate statistical approach analyzing clinical efficacy new treatments studies confidence intervals relative efficacy new treatment standard therapy used provide information required determine whether experimental treatment improved therapeutic index desirable properties approach include ability standard group sequential guidelines early trial termination , ability use valid hard clinical outcomes , availability straightforward formulas sample size calculations
anaphylaxis following ingestion psyllium containing cereal recently , psyllium hydrophilic , bulk forming , added breakfast cereals cholesterol lowering effects report case 60 year old woman prior history psyllium ingestion developed anaphylactic symptoms eating psyllium containing cereal previous exposure psyllium containing nurse immunoglobulin e mediated sensitization documented skin testing basophil histamine release literature reviewed regarding allergic reactions psyllium health care workers pharmaceutical workers handling psyllium may increased risk due sensitization inhalation physicians aware potential serious reactions eating psyllium containing cereals even without prior history ingestion psyllium
hiv testing policies us hospitals determine human immunodeficiency virus testing policies adopted us hospitals , surveyed stratified random sample general acute care hospitals , drawn american hospital association 's 1987 database interviews completed chief hospitals \( response rate , 78 4 \) two thirds hospitals admitted least one patient acquired immunodeficiency syndrome , 83 formal written policies human immunodeficiency virus testing contain protecting patients' eg , 78 require pretest informed consent , 66 require special human immunodeficiency virus testing consent form , 75 require patients test seropositive informed many policies also contain protect providers eg , 56 require test results appear patients' records , 38 require review treatment plans patient tests seropositive , 3 require transferring patients hospital characteristics strongly associated adoption testing policies
protection allergen induced asthma effects long acting beta 2 agonist early late phase airways events provoked inhaled allergen assessed group atopic asthmatic patients placebo controlled study , 50 micrograms inhaled allergen challenge ablated early late phase allergen induced bronchoconstriction 34 h time period also completely inhibited allergen induced rise non specific bronchial responsiveness time period effects shown unrelated prolonged functional antagonism data suggest novel actions topically active long acting beta 2 agonists asthma extend beyond protective action airways smooth muscle
hiv 1 tropism mononuclear phagocytes determined regions gp120 outside cd4 binding domain cells mononuclear phagocyte system predominant cell producing hiv 1 tissues including central nervous system \( cns \) , spinal cord , lung skin infection associated dementia , neuropathy , pneumonitis , dermatitis respectively different hiv 1 isolates vary markedly ability infect mononuclear phagocytes describe molecular clones cns derived isolate , hiv 1 \( jr fl \) , replicate efficiently mononuclear phagocytes analysis polymerase chain reaction early events infection indicates early phase viral replication reverse transcription determines tropism genetic mapping macrophage phenotype construction recombinant viruses indicates mononuclear phagocyte infectivity determined 157 amino acid region gp 120 glycoprotein hiv 1 \( jr fl \) significantly , region upstream previously defined cd4 binding domain propose least one determinant mononuclear phagocyte tropism involves target cell interactions regions gp120 distinct cd4 binding domain
proton magnetic resonance spectroscopy multiple sclerosis regional vivo proton magnetic resonance spectroscopy provides quantitative data selected chemical constituents brain imaged 16 volunteers clinically definite multiple sclerosis 1 5 magnetic resonance scanner define plaque containing volumes interest , obtained localized water suppressed proton spectra using stimulated echo sequence twenty five 40 plaque containing regions provided spectra adequate quality , 8 spectra 6 subjects consistent presence cholesterol fatty acids remainder similar obtained white matter normal volunteers early experience regional proton spectroscopy suggests individual plaques distinct differences likely reflect dynamic stages evolution process previously accessible vivo investigation
myelin basic protein specific lymphocyte lines ms patients healthy individuals derived total 146 lymphocyte lines specific human myelin basic protein \( mbp \) peripheral blood 20 ms patients control group 12 healthy donors , determined reactivities cell lines 3h thymidine incorporation exposure mbp mbp peptides 1 44 , 45 89 , 90 170 defined hla restriction lines using monoclonal antibodies monomorphic determinants human hla dr , hla dq , hla dp molecules mbp specific cell lines could isolated comparable efficiency ms patients healthy individuals groups , mbp specific lymphocytes recognized least 4 different epitopes mbp molecule , specificities showed comparable patterns different mbp peptides mbp specific cell lines derived ms patients controls restricted dr products human major histocompatibility class ii locus notable phenotypic differences cell lines existed 2 groups lines isolated ms patients expressed predominantly cd3 cd4 cd8 phenotype , control lines composed 87 cd3 cd4 cd8 lymphocytes findings illustrate presence mbp specific cells ms patients controls similarly sensitized mbp restricted hla dr products
pediatric acquired immunodeficiency syndrome unusually high incidence surveillance data incidence twins among reported cases pediatric aids new york city presented pairs concordant hiv infection three discordant pairs described elsewhere possible reasons association discussed , including likely explanation twins show symptoms early early years surveillance pediatric aids
cytomegalovirus update primary care physicians cytomegalovirus infection spread various ways mother fetus baby , small children day care centers parents , blood transfusions , sexual contact although illness usually , congenital infection severe consequences , including mental retardation hearing loss dr describes different aspects virus discusses promising vaccine may prevent congenital disease
myelin multiple sclerosis recognition myelin basic protein context hla dr2 products lymphocytes multiple sclerosis patients healthy donors panel 20 human myelin basic protein \( hmbp \) specific lymphocyte lines generated peripheral blood eight multiple sclerosis \( ms \) patients two healthy donors , expressing hla dr2 haplotype , associated increased susceptibility ms using hla dr gene transfected mouse l cell lines antigen presenting cells , established 20 hmbp specific lymphocyte lines , 7 restricted gene products haplotype four cell lines recognized hmbp context products haplotype restricted cell responses demonstrable cell lines derived ms patients hmbp epitopes presented heterodimer mapped peptides covering amino acid residues 1 44 , 76 91 , 131 145 , 139 153 region spanning thrombin cleaved bond restricted cell lines recognized epitopes within amino acids 80 99 148 162 peptide 139 153 also presented context hla dr1 molecules data show \( \) ms patients products haplotype function restriction elements myelin autoantigen hmbp , \( ii \) molecule presents least five different epitopes hmbp specific lymphocytes , \( iii \) anti hmbp cell lines derived individual donors differ antigen fine specificity well hla restriction
transforming growth factor beta mechanisms immunodeficiency human immunodeficiency virus infection study examines contribution transforming growth factor beta \( tgf beta \) , one potent endogenous immunosuppressive factors , development immunodeficiency human immunodeficiency virus \( hiv \) infection increased titers tgf beta found supernatants peripheral blood mononuclear cells \( pbmcs \) hiv infected donors compared uninfected controls \( p less 0 001 \) correlated closely defective responses cd4 lymphocytes recall antigens tuberculin purified protein derivative tetanus toxoid addition tgf beta neutralizing antibody pbmcs partially restored defective cell responses furthermore , purified tgf beta hiv pbmc culture supernatants preferentially inhibited proliferation cd4 lymphocytes compared cd8 cells increased expression tgf beta protein associated increased tgf beta mrna determined polymerase chain reaction assay increase tgf beta protein mrna due selective tgf beta 1 isoform results indicate overexpression tgf beta 1 occurs hiv infected individuals cytokine contribute impaired immune functions depletion cd4 lymphocytes
laboratory methods diagnosis prognostic staging infection human immunodeficiency virus type 1 laboratory evaluation infection human immunodeficiency virus type 1 \( hiv 1 \) may involve detection antibodies hiv 1 , direct detection hiv 1 , measurement individual 's immunologic status time presentation elisa currently preferred initial screening test , although variety rapid immunoassays also developed methods defining antigenic specificity antibody response , western blot , become standard confirmatory tests setting cd4 cell hiv 1 antigen capture assay useful predicting course hiv 1 infection monitoring antiretroviral therapies newer techniques hiv 1 co permit characterization viral isolates stratification patients facilitate monitoring effects antiretroviral agents polymerase chain reaction value identifying hiv 1 infection individuals inconclusive serologic results judicious use laboratory tests , including surrogate markers beta 2 microglobulin , also provides prognostic information potentially useful clinical management hiv 1 infected patients
therapeutic approaches neoplasms aids multifactorial etiology kaposi 's sarcoma \( ks \) , seen primarily men , includes genetic predisposition immunosuppression recently , ks seen association human immunodeficiency virus \( hiv \) infection shown mediated production certain growth factors hiv per se may also play etiologic role via tat gene therapeutic options include irradiation local cosmetic control , interferon alpha , combinations antiretroviral agents interferon alpha , chemotherapy use antineoplastic agents , either individually combination , cases advanced disease somewhat successful , resultant immunosuppression neutropenia may predispose patients infection , thereby adversely affecting survival aids related lymphoma , late manifestation hiv infection , often presents widespread extranodal disease median survival time series approximately 6 months two thirds patients may central nervous system involvement time course illness intensive chemotherapeutic regimens associated increased likelihood opportunistic infection prolong survival combinations antineoplastic agents given low doses short periods may associated long term remissions
new antiretroviral agents clinic since first controlled clinical trial zidovudine \( act \) terminated fall 1986 , much learned concerning use agent treatment human immunodeficiency virus \( hiv \) infection recent report hiv resistance associated long term azt therapy accelerated sense urgency development additional agents use either alone combination azt infection several new agents various stages preclinical clinical evaluation , dideoxycytidine , , , , , inhibit viral dna synthesis inhibition reverse transcriptase potentially useful agents presumably act different stages infection soluble cd4 , example , soluble form receptor hiv must bind infect cells , represents new class compounds block maturation process viral glycoprotein apparently potent less toxic analogue latter agent , n butyl , currently phase testing
cytomegalovirus going \? nearly 30 years elapsed since colleagues discovered human cytomegalovirus \( cmv \) complex structure , long replicative cycle , low yield vitro , highly species specific cell substrate requirement , cellular molecular biologic analyses human cmv slow , recombinant dna monoclonal antibody technologies rapid changes long period latency wide range disease presentations , epidemiologic medical insights also come slowly however , clinical events occur iatrogenic immunosuppression \( transplantation cancer therapy \) result due human immunodeficiency virus infection currently promoting understanding epidemiology cmv disease definition clinical spectrum rapid diagnostic methods , antiviral drugs , vaccines cmv becoming available may yet understand completely impact agent aspects pathogenesis e g , immune functions controlling possibility increased disease severity detectable immune defect availability new approaches , issues clarified , functions host virus involved mechanism persistence
epidemiology cytomegalovirus infections determinants cytomegalovirus \( cmv \) infection disease understood studies newborns , recipients organ bone marrow transplants , subjects infected human immunodeficiency virus , recipients blood transfusions cmv transmitted neonate , passage contaminated birth canal , ingestion infected breast milk adult heterosexual homosexual sex infected partner transplant recipient infected organs major problem study cmv nature viral latency knowledge regarding requirements activation latent infection molecular , cellular , host level incomplete viral host factors may contribute successful transmission cmv infected cells transplanted organs transfused blood
cytomegalovirus setting infection human immunodeficiency virus human cytomegalovirus \( cmv \) several possible roles pathogenesis aids cmv causes number clinical syndromes , including retinitis , pneumonitis , patients infected human immunodeficiency virus type 1 \( hiv 1 \) addition , cmv may potentiate cellular immunodeficiency observed patients hiv infection either directly enhancement hiv replication finally , cmv may predispose host bacterial fungal infection compromising integrity mucosal barriers infection therapy ganciclovir cmv infection may result decrease morbidity related virus , problems drug toxicity resistance agent development additional therapeutic approaches
cytomegalovirus infection children aids data 38 children exposed human immunodeficiency virus \( hiv \) evaluated determine impact cytomegalovirus \( cmv \) infection course acquired hiv infection thirteen children p0 \( indeterminate \) group , one p1 \( asymptomatic \) group , 24 p2 \( symptomatic \) group , per classification centers disease control 24 children p2 group , 10 died mean follow time 22 8 months 10 children died 16 3 months 13 children p0 group serial cultures urine performed 38 patients cmv isolated seven 10 children died four 14 children survived \( p less 05 \) one 13 p0 children culture positive cmv , compared 11 24 p2 children \( p less 05 \) cmv infected children continued demonstrate cmv serial cultures mean age time first culture positive cmv 13 months present 15 \( 65 \) 23 p2 children none p0 p1 children \( p less 05 \) eight 11 cmv infected children seven 12 children infected cmv \( p greater 05 \) data suggest prevalence active cmv infection significantly higher p2 children p0 p1 children addition , significant association cmv infection mortality among p2 children
prevalence antibody htlv ii united states plasma donors united states french antibody htlv ii detected 19 \( 0 3 \) plasma donors five regions united states \( us \) seroprevalence rate approximately 10 times whole blood donors regional distribution infection follows southwest , 0 68 percent southeast , 0 45 percent , 0 28 percent , 0 1 percent , 0 0 percent rates htlv ii infection blacks \( 0 74 \) hispanics \( 0 66 \) higher \( , p less 0 001 \) whites \( 0 08 \) 19 infected units donated subjects aged 30 older , even though 52 9 percent donations came persons less 30 years old equal rates htlv ii infection found men \( 0 31 \) women \( 0 29 \) htlv ii antibody detected 154 french 25 us transfused regularly plasma derivatives suggests transfusion htlv ii seropositive plasma products transmit viral infection
tartrazine sensitivity tartrazine \( fd c yellow 5 \) approved dye present many drugs food products 1970s , many cases tartrazine sensitivity reported led new regulations required package drugs food products tartrazine sensitivity frequently manifested urticaria asthma although implicated syndromes , tartrazine considered vasculitis , purpura contact dermatitis infrequently occur manifestations tartrazine sensitivity cross sensitivity aspirin sensitive nsaid sensitive patients may also occur mechanism sensitivity obscure called management consists mainly avoidance drugs food products contain tartrazine
racial , social , environmental risks childhood asthma unlike number childhood problems , clear racial socioeconomic prevalence childhood asthma analyzed data child health supplement 1981 national health interview survey , population based survey information concerning 15 , 416 children , address following questions racial socioeconomic differences rates childhood asthma yes , contribution social environmental characteristics observed differences \? sample , black children likely asthma white children \( 4 4 vs 2 5 \) racial prevalence emerged early childhood ages due higher black rates onset ages 1 3 years poverty status , maternal cigarette smoking , large family size , smaller size home , low birth weight , maternal age younger 20 years child 's birth associated increased rates childhood asthma available social environmental characteristics controlled using multivariate analyses , increased risk asthma among black poor children reduced statistical conclude black poor children united states higher rates asthma , social environmental factors exert substantial influences rates asthma , much racial economic disparity prevalence accounted variety social environmental characteristics
immune complexes pediatric human immunodeficiency virus infection circulating immune complexes \( cic \) analyzed cohort 30 children infected human immunodeficiency virus elevated cic detected c1q assay 70 \( 21 30 \) patients cell assay 93 \( 28 30 \) patients less one third patients elevated cic free serum antibodies epstein barr virus , 80 \( 16 20 \) detectable antibodies epstein barr virus associated cic enriched cic human immunodeficiency virus infected children contained low levels complement findings document , expression humoral immunodeficiency , cic human immunodeficiency virus infected children deficient complement thus underestimated complement precipitating methods used detection
hodgkin 's disease cd30 positive anaplastic large cell lymphomas continuous spectrum malignant disorders quantitative morphometric immunohistologic study authors examined cellular areas lymphoma tissue 28 cases hodgkin 's disease \( hd \) anaplastic large cell lymphoma \( alcl , 1 cell \) evaluate boundaries two entities methods applied included conventional histology test point analysis morphometry nuclear profile features reed atypical large cells \( \) immunohistochemistry elements paraffin sections , 15 cases , frozen sections mean nuclear profile per case varied independently immunophenotype histologic diagnosis conversely , immunohistochemistry demonstrated significant , although consistent , preferential cd30 elements hd , epithelial membrane antigen \( ema \) latter , also exhibited tendency cd45 positivity expression cell associated antigens however , considerable continuous spectrum nuclear profile , ranging hd questionable cases , intermediate hd alcl , , paralleled differences reactive component lymphomas lymphocytes granulocytes significantly deficient
volunteer commitment aids care volunteers provide crucial assistance people hiv related illnesses based self administered questionnaires , study describes nature work volunteers indicated satisfaction personal performance program administration several factors associated volunteer satisfaction report first attempt describe special relationship created response human immunodeficiency virus \( hiv \) epidemic
aids related experiences practices primary care physicians los angeles 1984 89 telephone interviews random samples los angeles primary care physicians 1984 , 1986 , 1989 obtained information aids related practice experiences , sexual history taking data mid 1989 reveal almost 74 percent worked least one patient aids hiv infection past six months 39 5 percent caring least one patient aids aids related complex self reported use appropriate sexual history questions improved substantially five year period
evaluation efficacy cost effectiveness health education methods increase medication adherence among adults asthma randomized 135 adult asthma patients control group , 132 patients experimental group received special health education intervention four adherence measures documented baseline 12 month follow correct inhaler use , inhaler adherence , medication adherence , total adherence rating costs routinely deliver intervention 32 03 patient experimental group patients exhibited significantly higher level improvement adherence \( 44 percent \) control group patients \( 2 percent \)
effect education use universal precautions university hospital emergency department study objectives determine educational program would improve knowledge practice universal precautions nursing personnel design participants given 14 question test observed , practice universal precautions routine iv catheter placement phlebotomy trauma care six months education service setting university hospital emergency department type participants nursing personnel interventions one hour lecture addressing occupational risk human immunodeficiency virus \( hiv \) infection recommended use universal precautions measurements main results mean overall correct response rates questionnaire service 70 73 , respectively \( p ns \) pattern incorrect responses suggested perceived risks hiv transmission underestimated , particularly among healthy appearing patients care critical trauma patients , significant increases frequency rates service glove protective use \( 66 7 vs 87 7 , p less 025 0 0 vs 17 3 , p less 05 , respectively \) frequency rates glove use iv placement phlebotomy patients use trauma patient care also increased \( 52 6 vs 65 2 25 vs 39 5 , respectively \) however , changes statistically significant conclusion intensive educational program associated modest increase compliance ed nursing personnel universal precautions long term effect general knowledge hiv risk practice universal precautions still far universal ed
asthmatic airways disproportionate hyperresponsiveness lte4 , compared normal airways , ltc4 , ltd4 , methacholine , histamine airways responsiveness leukotriene \( \) c4 , ltd4 , lte4 , histamine , methacholine studied eight asthmatic six normal subjects airways responsiveness bronchoconstrictor agonist assessed cumulative dose response curves , dose produced 35 decrease specific airways conductance \( pd35 \) obtained linear airways subjects asthma approximately 14 , 15 , 6 , 9 , 219 fold responsive histamine , methacholine , ltc4 , ltd4 , lte4 , respectively , normal subjects thus , substantially augmented level hyperresponsiveness lte4 bronchial asthma , observed bronchoconstrictor agents , compared normal subjects contrast ltc4 ltd4 , histamine methacholine responsiveness increase , dose ratio histamine lte4 \( pd35 histamine pd35 lte4 \) dose ratio methacholine lte4 also tended increase suggests nonspecific airways responsiveness increases , relative potency lte4 also increases , whereas potency ltc4 ltd4 decrease results suggest mechanism bronchoconstriction induced lte4 may distinct produced ltc4 ltd4 subjects asthma may reflect leukotriene subtype receptor heterogeneity asthmatic airways
bronchial responsiveness histamine infants older children normal infants shown respond relatively low concentration inhaled histamine however , studies used partial maximal expiratory flow volume \( pmefv \) curves assess lung function order directly compare responsiveness infants older children , compared bronchial responsiveness histamine group 45 normal infants , median age 4 wk \( range 2 6 wk \) group 30 nonasthmatic older children , median age 10 yr \( range 5 15 yr \) using pmefv curves groups assess lung function infant group , pmefv curves generated using forced expiratory flow volume technique older children , pmefv curves generated voluntary effort provocative concentration histamine produced 40 fall \( \) maximum flow functional residual capacity \( \) calculated pmefv curves geometric mean infants \( 1 02 g l \) lower geometric mean older children \( 3 4 g l \) \( p less 0 001 \) however , results corrected dilution aerosol due air \( ae \) corrected values significantly different infants older children results demonstrate importance accounting ae evaluation histamine responsiveness suggest bronchial responsiveness may similar normal infants older children
circadian basis late asthmatic response late asthmatic response \( lar \) allergen challenge marked impact lung function patient asthma virtually studies lar done daytime study evaluated lar function time day inhaled allergen challenge performed allergen challenge given morning produced lar 4 10 subjects , challenge evening caused lar 9 10 \( p less 0 05 \) time onset lar following morning evening challenges 9 4 2 0 h versus 3 1 0 3 h , respectively \( p less 0 05 \) maximal decrease fev1 lar 32 8 5 6 morning challenge versus 43 0 3 1 evening \( p less 0 05 \) additionally , bronchial responsiveness methacholine significantly greater 24 h following evening allergen challenge morning \( p less 0 05 \) challenge thus , important take account time day patient exposed allergen regard development lar
clearance 99mtc dtpa pigeon 's hypersensitivity pneumonitis rate clearance inhaled 99mtc dtpa measured 20 nonsmoking pigeon 7 control subjects degree avian contact pigeon related symptoms noted , humoral immune response form igg antibody pigeon gamma globulin quantified , diffusing capacity total lung capacity measured thirteen high level antibody increased rates clearance 99mtc dtpa \( mean half time clearance 16 8 sem 2 02 min p 0 001 \) even asymptomatic even diffusing capacity total lung capacity normal seven control subjects without exposure pigeon derived antigens normal clearance \( mean 72 6 5 98 min \) , seven antigen exposure without antibody response intermediate rates clearance \( mean 42 57 5 11 min \) clearance directly related indices intensity duration antigen exposure measurement rate clearance 99mtc dtpa pigeon identify alteration pulmonary integrity subtle found conventional pulmonary function tests may therefore useful test studying pulmonary response inhaled antigen detecting earliest stages evolution hypersensitivity pneumonitis
profile disease puerto rican patients new york city possible relationship alpha 1 antitrypsin variants high prevalence symptoms noted among patients puerto rican descent attending israel north central medical centers new york city , compared ethnic groups evaluation family medical histories , pulmonary function data , alpha 1 antitrypsin phenotypes undertaken puerto rican patients control subjects without asthma patients showed higher proportion ms mv phenotypes patients mm variant phenotype groups , exception four mm patients , features indicative asthma , labile airway obstruction , elevated serum immunoglobulin e eosinophil levels latter significantly higher patients variant phenotypes mm patients patients alpha 1 antitrypsin variants also much shorter smoking histories compared mm group , reported histories asthma first degree relatives , compared 66 among mm patients conclude increased incidence asthma among puerto ricans new york city , antitrypsin variant phenotypes \( specifically v \) play role incidence expression
rescue interleukin 1 activity leucovorin following inhibition methotrexate murine vitro system recently shown methotrexate \( mtx \) inhibits interleukin 1 \( il 1 \) activity vitro effect may play important role rapid antiinflammatory action mtx rheumatoid arthritis present study , showed inhibition il 1 activity vitro mtx dependent folate pathways since , addition leucovorin , inhibitory effect mtx abolished findings may shed light mechanism action mtx rheumatoid arthritis also point fact il 1 activities may dependent intracellular folate pathways
serum soluble interleukin 2 receptor associated clinical pathologic disease status hairy cell leukemia hairy cell leukemia chronic lymphoproliferative disorder b cell lineage , whose malignant cells express interleukin 2 \( il 2 \) receptor soluble form il 2 receptor released cells culture , sera patients hairy cell leukemia contain elevated levels soluble receptor four hundred twenty seven serum samples 101 patients analyzed soluble il 2 receptor \( sil 2r \) clinical status patients appeared associated serum level sil 2r hairy cell index \( measure tumor cell burden \) correlated square root serum sil 2r level \( r 77 \) improved clinical status associated decreasing serum sil 2r levels , whereas disease relapse associated increasing levels notably , every patient responded therapy decline serum sil 2r level , every patient disease progression increase serum sil 2r level phenomenon observed several different treatments , including standard dose interferon , low dose interferon , predictive reliability test currently prospectively evaluated
differentiating agents facilitate infection myeloid leukemia cell lines hiv 1 strains published erratum appears blood 1991 apr 1 77 \( 7 \) human immunodeficiency virus type 1 \( hiv 1 \) isolates patients acquired immunodeficiency syndrome \( aids \) infect mononuclear phagocytes well activated cells , usually infect immature human myeloid cell lines vitro hl 60 promyelocytic cell line line , u937 , susceptible infection hiv 1 isolates \( hiv fl htlv l \) treatment retinoic acid , dimethyl , camp , 1 , 25 dihydroxyvitamin d3 \( 1 , 25 \( oh \) 2d3 \) , 12 phorbol 13 acetate \( tpa \) virus production detected compounds added virus infection virus replication correlate cd4 receptor expression undifferentiated hl 60 cells express cd4 level cd4 expression increase differentiation presence retinoic acid , 1 , 25 \( oh \) 2d3 , tpa mature monocytic cell line \( 1 \) capable infection without pretreatment , treatment differentiating agents enhanced virus production chronically infected cell line \( j hl 60 \) isolated hiv fl infection hl 60 cells treated retinoic acid virus production cell line enhanced 10 fold differentiation presence 1 , 25 \( oh \) 2d3 tpa majority virus production 1 , 25 \( oh \) 2d3 treated j hl 60 cells associated mature , adherent population molecular analysis cloned line j hl 60 showed integration single dna results suggest cellular factors associated precursor cell differentiation along myelomonocytic pathway required optimal replication hiv 1 strains vitro
cell membrane expression functional role p75 subunit interleukin 2 receptor lymphoproliferative disease granular lymphocytes cell membrane expression functional role interleukin 2 receptor \( il 2r \) analyzed nine patients lymphoproliferative disease granular lymphocytes \( \) using monoclonal antibodies \( moabs \) specific p75 \( tu27 \) p55 \( anti tac \) subunits il 2r four patients characterized proliferation cd3 cd8 granular lymphocytes \( gl \) expressing alpha beta cell receptor \( alpha beta \) one case proliferation cd3 cd4 cd8 gl expressing gamma delta cell receptor \( gamma delta \) four additional cases proliferating cells cd3 negative gl consistent data observed normal gl , phenotypic analysis demonstrated patients' gl lack expression p55 il 2r , whereas p75 subunit expressed expanding gl cell \( either alpha beta gamma delta \) natural killer \( nk \) origin variable proportions \( 11 94 cells \) analysis cytotoxic proliferative activity demonstrated anti p55 moab failed inhibit il 2 mediated activation , whereas marked inhibition cytotoxicity proliferation obtained using anti p75 chain specific moab data indicate p75 chain il 2r responsible il 2 signal transduction cd3 cd3 patients' gl
response patterns hairy cell leukemia b cell mitogens growth factors effect mitogens recombinant b cell growth factors \( \) vitro growth hairy cells examined tumor cells isolated spleens four patients hairy cell leukemia \( hcl \) sedimentation e rosetting enrichment tumor cells confirmed intracytoplasmic immunoglobulin \( ig \) staining , resistant acid phosphatase \( trap \) staining , staining using monoclonal antibodies \( moabs \) directed b , , myeloid , monocytoid antigens \( ags \) indirect immunofluorescence assays tumor cells b1 \( cd20 \) b2 \( \) b4 \( \) il 2r \( cd25 \) pca 1 trap neither synthesized dna secreted ig response culture granulocyte macrophage colony stimulating factor \( gm csf \) , interleukin 1 alpha \( il 1 alpha \) , il 1 beta , il 2 , il 3 , il 4 , il 5 , il 6 however , proliferative response \( stimulation index greater equal 3 0 \) without ig secretion triggered mitogens combinations specifically , dna synthesis induced 3 days three four hcl samples cultured staphylococcus aureus cowan \( sac \) combination phorbol ester \( tpa \) calcium ionophore \( ca2 \) dna synthesis triggered later \( day 7 \) tumor necrosis factor \( tnf \) il 4 il 5 contrast , fourth patient , sac tpa ca2 , demonstrated increased dna synthesis day 3 il 4 il 5 autoradiography staining \( brdu \) moab conjugated fluorescein confirmed dna synthesis minority \( 5 23 \) tumor cells within patient dual staining confirmed responsive cells brdu trap dna synthesis induced tpa ca2 blocked specifically anti il 6 ab contrast , hcl proliferative response sac , tnf , il 4 il 5 inhibited anti il 6 ab alpha interferon inhibited response tpa ca2 , tnf , il 4 il 5 without effect response sac finally , peroxidase staining demonstrated induced tpa ca2 , sac , produce intracytoplasmic il 6 data demonstrate il 4 , il 5 , il 6 mediated dna synthesis vitro suggest possible vivo role growth factors pathophysiology hcl
novel x linked combined immunodeficiency disease novel x linked combined immunodeficiency disease found five living males extended family united states age affected males ranged 2 5 34 yr prominent clinical abnormalities paucity lymphoid tissue recurrent , otitis media , bronchitis , pneumonia severe varicella chronic papillomavirus infections principal immunologic features disorder normal concentrations serum immunoglobulins restricted formation igg antibodies normal numbers b cells nk cells decreased numbers cd4 cd8 lymphocytes , particularly cd45ra subpopulations diminished proliferative responses blood cells allogeneic cells , mitogens antigens decreased production il 2 mitogen stimulated blood lymphocytes thus , affected males family carry abnormal gene x chromosome results combined immunodeficiency distinct previously reported disorders
mathematical models hiv infection threshold conditions transmission host survival second series modeling human immunodeficiency virus \( hiv \) infections four levels transmission , interaction immune system , gene regulation , selection mutants previous paper \( 1 \) described presented theory hiv cytopathic effect based upon models \( review literature \) article give mathematical equations threshold conditions infectivity , length host survival , frequency acts transmission formula derived homogeneous populations also populations arbitrary number subgroups varying frequencies risk behavior , varying rates infection latency periods , varying frequencies interaction groups
tracking spread hiv infection epidemic among young adults united states results first four years screening among u military service period infection clinically apparent disease long , variable , changing new therapies developed applied , aids data inadequate tracking current values critical parameters hiv infection epidemics prevalence infection , rate acquisition new infections \( incidence rate \) , direction rate change infection incidence time \( acceleration \) vital signs infection epidemics using serial cross sectional seroprevalence data , however october 1985 september 1989 , 2 3 million u military service screened antibody hiv overall seroprevalence 1 31 per 1 , 000 \( 3 , 014 2 , 300 , \) highest near urban centers aids epidemic independently associated age , race ethnicity , gender based age seroprevalence trends , estimated least one 2 , 000 young men one 7 , 000 young women infected hiv annually u infection incidence rates , estimated age temporal trends , estimated highest among black males \( 1 40 1 , 000 year \) lowest among white females \( 0 03 1 , 000 year \) regression analysis seroprevalence trends suggested infection incidence rates accelerated among black females first 3 years screening since selection factors undoubtedly changed period , estimates based data probably underestimate actual values general population , particularly near urban aids nonetheless , even crude estimates critical values , particularly among adolescents young adults , useful guide policy development , resources , monitor program effects
relapse safer sex next challenge aids prevention efforts prevention reduce sexual transmission human immunodeficiency virus \( hiv \) typically emphasize initial adoption safer sex techniques present data 5 year prospective study show vast majority resident gay men san francisco made initial risk reductions rather , relapse safer sex techniques predominant predominant kind high risk sex , accounting approximately two thirds prevalent high risk sex 1988 wave data collection predictors relapse safer sex identified , discussed terms implications preventing relapse exclusive practice safe sex communities already manifested widespread behavioral risk reductions hiv infection highly prevalent , finding ways prevent relapse behavioral risk reductions next important challenge acquired immune deficiency syndrome
seroprevalence hiv 2 infection \( \) seroprevalence hiv 2 evaluated 20 , 407 consecutive normal blood donors , 100 , 7 , presenting hiv test using eia test sixty seven sera revealed repeatedly positive analysis western blot confirmed infection four cases , indeterminate \( antibodies gag encoded proteins \) pattern revealed 25 cases , whereas 38 sera negative three four hiv 2 positive sera also reacted two distinct , close , synthetic peptides homologous viral gp36 fourth serum , display antibodies gp36 western blot , react gp36 derived synthetic peptides none sera reacted native hiv 1 antigens synthetic peptides homologous gp41 sera indeterminate hiv 2 western blot react gp36 derived synthetic peptides although 10 also displayed indeterminate hiv 1 western blot , serum sample reacted two gp41 derived synthetic peptides proved positive tested p24 antigen one bisexual one heterosexual hiv 2 positive subject reported sexual contacts west , whereas two multiple sexual partners different countries
seroprevalence hiv infection general population , west africa survey determine prevalence human immunodeficiency virus \( hiv \) infection general population coast carried february 1989 sera collected subjects 15 65 years old urban areas \( including \) rural areas using cluster sample technique total 1 , 700 people tested urban areas , 125 \( 7 3 \) hiv positive rate varied significantly age sex maximum rate 16 3 observed among men 35 44 years old rural areas , total 3 , 199 people tested , 159 \( 4 9 \) positive hiv highest rate \( 10 7 \) noted men aged 25 34 years high seroprevalence recorded general population urban rural areas compatible incidences acquired immune deficiency syndrome \( aids \) cases reported hospitals country
suppressive effects morphine pellet implants vivo parameters immune function chronic morphine treatment elicits variety immunosuppressive effects mice work describing suppressive activity opioid based vitro assessments performance certain components immune system morphine treated animals relatively little done way tracking effects chronic morphine treatment immunologic parameters intact animal therefore , study used several classic vivo determinations immune function mice treated chronically morphine morphine pellet \( 75 mg \) implantation led significant inhibition \( 91 \) paw swelling chloride induced delayed type hypersensitivity response uptake vivo lymphocyte proliferation assay splenomegaly graft vs host reaction also significantly suppressed morphine pellet implantation \( 34 52 , respectively \) pellet \( 10 mg \) completely reversed suppressive responses morphine assay alone significant effect assays suppressive effects morphine less pronounced adrenalectomized mice graft vs host assay \( 51 vs 9 reduction morphine pelleted relative morphine pelleted adrenalectomized mice \) findings indicate pathophysiologic significance previously reported suppression vitro correlates immune function morphine pelleted mice results demonstrate immunosuppressive effects observed morphine pellet implantation reversible suggest activation adrenal one potential mechanism effect
immunologic aspects acquired immunodeficiency syndrome initial clinical descriptions acquired immunodeficiency syndrome \( aids \) 1981 present time , much discovered concerning epidemiologic factors , pathogenesis , treatment prevention disease recent advances epidemiology included better understanding occupational risk human immunodeficiency virus \( hiv \) infection percutaneous exposure \( responsible approximately 0 4 per cent instances \) , appreciation potential variability time interval infection seroconversion \( generally order three months occasionally longer \) establishment need contact transmit infection following discovery hiv 1 etiologic agent aids , many rapid advances possible including development screening tests , elucidation hiv 1 genome discovery cd4 lymphocyte predominant cell destroyed hiv 1 progressive destruction cd4 cells results progressive decline immunologic function may take variety clinical forms , ranging symptoms severe opportunistic infections delineation life cycle hiv 1 helped development antiretroviral therapies , including agents interfere reverse transcription \( nucleoside analogues , zidovudine , dideoxycytidine , \) agents interfere viral assembly \( protease inhibitors interferon alpha \) precise understanding nature immune response elicited hiv 1 infection resulted development several candidate hiv 1 vaccines , including recombinant vaccinia viruses expressing hiv 1 envelope recombinant envelope proteins
silk induced asthma children report 64 cases total 64 children less 15 years age asthma caused silk studied diagnosis based history wheezing , positive skin tests silk , positive conjunctival nasal provocation tests , serum ige sw \( silk \) average age onset 4 years 2 months sex ratio \( f \) 3 6 1 positive skin test essential diagnosis conjunctival provocation tests performed 80 cases reliability , safety , convenience first symptom appeared average 10 months initial exposure silk 61 patients , asthma accompanied allergic rhinitis 14 cases cases , asthma occurred , due seasonal use bed filled silk silk highly potent allergen average mean wheal diameter elicited silk prick testing larger two histamine equivalent prick tests cross reactivity exists among silk , , ,
low level atmospheric sulfur dioxide pollution childhood asthma analysis \( 1983 1987 \) childhood asthma 13 , hospitalization episodes relation levels \( , , , , tsp , \) revealed seasonal pattern attack rates correlates inversely exposure sulfur dioxide \( r 52 , p less 05 \) cannot found many factors may contribute seasonal variation asthma attacks speculate prolonged exposure \( terms months \) low level one factor might induce airway inflammation bronchial hyperreactivity predispose episodes asthma
random double blind trial combination nebulized atropine albuterol nocturnal asthma combination nebulized atropine \( amn \) beta agonist shown produce greater longer lasting either drug alone examined efficacy combination morning pefr eight hospitalized stable asthmatics patients received nebulized albuterol along either amn \( amn \) placebo \( \) random double blind cross fashion 10 pm four nights pefr fev1 recorded 6 pm , 10 pm , 6 administration statistically significant difference amn reducing morning patients
effect procaterol arterial blood gas asthmatic children determined changes arterial blood gas inhalation procaterol , highly beta 2 selective long acting adrenergic agonist , 11 asthmatic children seven patients , maximum fall 14 mmhg \( 63 6 \) , showed decrease pao2 \( mean sd 7 1 4 0 mmhg \) poorer pulmonary function lower initial pao2 four subjects increase pao2 inhalation statistically significant correlation values pao2 inhalation \( p less 05 \)
anaphylaxis grand keyhole limpet \( like \) report five patients developed moderate severe anaphylactic reactions induced ingestion grand keyhole limpet \( \) specific ige mediated hypersensitivity demonstrated history , prick skin test , rast rast inhibition technique revealed cross antigenicity , , keyhole limpet
diagnosis mold allergy rast skin prick testing sera 33 patients mold allergy proven bronchial provocation analyzed specific ige six mold species comparing improved rast four techniques new method sensitive gave significantly higher ige antibody concentrations tested except
breakdown blood brain barrier precedes symptoms mri signs new lesions multiple sclerosis pathogenetic clinical implications extensive serial magnetic resonance imaging \( mri \) study multiple sclerosis \( ms \) identified 4 cases disruption blood brain barrier , detected gadolinium dtpa enhancement , preceded mri abnormalities 1 case clinical evidence new lesion supports view defect blood brain barrier , therefore inflammation , early possibly crucial event pathogenesis new lesion ms cases showed marked discrepancy mri abnormality symptoms mechanisms contributing disparity discussed , concluded far surprising expected
transfusion induced graft versus host disease patients malignant lymphoma case report review literature case transfusion induced graft versus host disease \( gvhd \) occurring 31 year old female hodgkin 's disease complete remission reported clinical features similar 19 reported cases transfusion induced gvhd associated malignant lymphoma lack relationship underlying histology disease stage nearly uniformly fatal outcome importance prophylactic irradiation blood products given patients malignant lymphoma undergoing therapy
predicting need hospitalization children acute asthma attempt identify factors influence decision physicians admit patients acute asthma hospital , studied prospectively 200 children \( age 5 6 3 1 years , mean sd \) presenting emergency room acute asthma children assessed arrival , disposition emergency room one investigators obtaining historic data , clinical score assigned , oxygen saturation pulmonary function measured 134 \( 67 percent \) children discharged home emergency room , five returned within seven days one subsequently admitted clinical score disposition sole variable found best predict decision hospitalization \( sensitivity 73 percent , specificity 95 percent \) variables obtained presentation , resulting decision tree found clinical score predict decision hospitalization \( sensitivity 79 percent , specificity 75 percent \) individual components clinical score analyzed , degree dyspnea , assessed investigator , chosen rule predict hospitalization decision \( sensitivity 88 percent , specificity 71 percent \) conclude decision respect need hospitalization acute childhood asthma , practice based mainly careful clinical evaluation pulmonary function sao2 measurements , although helpful adjuncts assessment acute asthma , appear contribute identification patients need hospital admission
effect inhaled methacholine inspiratory flow one hundred consecutive outpatients symptoms suggestive asthma came pulmonary function laboratory methacholine challenge test studied addition forced expiratory maneuvers , forced inspiratory maneuvers performed maximal response methacholine 24 patients , methacholine challenge suggested asthma \( forced expiratory volume 1 fev1 decrease greater equal 20 percent \) six 24 patients also decrease maximal forced inspiratory flow \( \) greater equal 20 percent nine decrease forced inspiratory flow 50 percent vital capacity \( \) greater equal 20 percent , suggesting bronchoconstriction cause decreased inspiratory well expiratory flows 76 patients , methacholine challenges negative \( fev1 decrease less equal 20 percent \) , suggesting asthma nevertheless , 11 76 patients decrease greater equal 20 percent , 14 patients decrease greater equal 20 percent , suggesting intermittent central airway obstruction responsible patients' symptoms
rapid oral desensitization isoniazid rifampin 45 year old black woman , sputum positive acid fast , developed hypersensitivity isoniazid rifampin admitted hospital medications using modified penicillin protocols skin testing negative drugs desensitization isoniazid complicated drug fever controlled prednisone patient able maintain day dosing without incident even steroid taper knowledge , first reported case dual isoniazid rifampin hypersensitivity rapid oral desensitization
late pulmonary allergic responses actively passively ige sensitized rats previous studies suggested although rats passively sensitized monoclonal murine immunoglobulin e \( ige \) would respond pulmonary antigen challenge immediate increase resistance , exhibited late increases resistance , unlike late changes rats actively sensitized preferentially produce ige antibody hypothesized passively sensitized rats also would develop antigen induced pulmonary inflammation blinded protocol compared immediate responses pulmonary resistance inflammation 8 , 19 24 h challenge placebo antigen , bovine serum albumin \( bsa \) elicit passively sensitized response , \( oa \) elicit actively sensitized response despite similar immediate responses oa bsa , rats challenged oa marked inflammatory changes significant incidence late elevations resistance inflammation scores lung resistance significantly correlated oa group also observed anesthesia fentanyl droperidol significantly attenuated immediate late responses antigen challenge , compared rats anesthetized ketamine conclude ige mediated immediate responses pulmonary antigen challenge insufficient , may unnecessary , initiate antigen induced late inflammatory changes
tachyphylaxis inhaled methacholine normal asthmatic subjects methacholine inhalation tests measure airway responsiveness asthmatic normal subjects tachyphylaxis occurs repeated methacholine inhalations normal subjects purpose study examine time course mechanisms methacholine tachyphylaxis normal subjects determine whether occurs mildly asthmatic subjects fifteen normal nine asthmatic subjects studied 2 study days , least 48 h apart day , two inhalation tests carried one day , subjects performed two methacholine inhalation tests 3 h later methacholine test results expressed provocation concentration causing 20 fall forced expiratory volume 1 \( fev1 \) , \( pc20 \) normal subjects developed methacholine tachyphylaxis mean pc20 increased 47 3 mg ml \( se 1 34 \) 115 6 \( se 1 51 \) \( p less 0 0001 \) 3 h interval increase lasted greater equal 6 h \( p 0 012 \) asthmatic subjects develop methacholine tachyphylaxis mean methacholine 1 6 mg ml \( se 1 4 \) 1 5 \( se 1 4 \) \( p 0 75 \) 3 h later two series experiments , normal subjects pretreated cyclooxygenase inhibitors indomethacin \( 100 mg day \) flurbiprofen \( 150 mg day \) placebo 3 days two methacholine tests 3 h apart indomethacin flurbiprofen significantly inhibited development methacholine tachyphylaxis results confirm methacholine tachyphylaxis occurs normal subjects , greater equal 6 h , may occur release inhibitory prostaglandins contrast , methacholine tachyphylaxis occur asthmatic subjects
effect thromboxane antagonists ozone induced airway responses dogs airway hyperresponsiveness inhaled ozone dogs may occur result thromboxane release airway study , two thromboxane receptor antagonists , l , 240 l , , used doses inhibit response inhaled thromboxane mimetic , u 46619 , determine role thromboxane ozone induced airway hyperresponsiveness dogs studied 2 days separated 1 wk day , dogs inhaled ozone \( 3 ppm \) 30 min one randomly assigned day , 10 dogs received infusion l , 240 \( 5 mg kg 1 h 1 \) 5 dogs received infusion l , \( 1 mg kg 1 h 1 \) day dogs received control infusion airway responses doubling doses acetylcholine measured inhalation ozone expressed concentration acetylcholine giving rise resistance 5 cmh2o l 1 baseline \( acetylcholine provocation concentration \) development airway hyperresponsiveness ozone inhibited thromboxane antagonists mean log difference acetylcholine provocative concentration ozone l , 240 treatment day 0 62 0 12 \( se \) control day 0 71 0 12 \( p 0 48 \) l , treatment day mean log difference 0 68 0 15 \( se \) control day 0 75 0 19 \( p 0 45 \) results support important role thromboxane causing ozone induced airway hyperresponsiveness
serologic , biologic , western blot analysis suppressor factor specificity 4 hydroxy 3 acetyl derived serum free medium cell hybridoma producing suppressor factor \( tsf \) specificity converted long term growth serum free medium product tested serology , bioactivity , western blot analysis results indicated ag specific suppressive activity present serum free medium tsf could exhibit characteristics ascribed various groups could bind nominal ag specificity , bound anti tsf mab , could mediate ag specific suppression vivo vitro western blot sds page analysis purified tsf revealed 43 kda single chain protein
recognition b cell lymphoma anti idiotypic cells idiotypic igm derived b cell lymphoma act tumor associated ag , immunization purified protein generates anti idiotypic immune response specifically suppresses tumor development spleens immune mice contain cells response idiotypic igm however , idiotypic ag presented cells efficiently natural form surface lymphoma cells , soluble igm plus presenting cells variant tumors display either little idiotypic igm cell surface , otherwise indistinguishable parental tumor , induce weak response fail stimulate cells , respectively anti idiotypic lines clones derived splenic cells growth presence irradiated tumor cells phenotypic analysis revealed cells lines clones express cd3 cd4 ag , cd8 recognition tumor id , required added presenting cells , inhibited antibody mhc class ii ag , variably anti cd4 proliferative responses inhibited anti idiotypic antibodies , also antibodies constant region mu h chain , indicating perturbation surface igm availability idiotypic determinants cells
value radioallergosorbent test diagnosing atopic disease young children purpose study investigate value new radioallergosorbent test , paediatric , diagnosis atopy children less 7 years age diagnosis atopic disease established history , physical examination , total serum ige concentration , results prick skin tests radioallergosorbent tests , compared result paediatric test patient one hundred two patients \( 62 boys \) ages 4 months 7 3 years enrolled \( median age 3 2 years \) history physical examination , 42 patients believed atopic 32 nonatopic diagnosis uncertain 26 skin prick test reactions variety foods positive 41 63 children tested results radioallergosorbent tests positive 35 61 children overall , atopy diagnosed 53 children 49 found nonatopic clinical diagnosis used gold standard , test resulted correct diagnosis atopy 49 53 cases atopy 43 49 cases sensitivity 92 , specificity 88 , efficiency 90 although paediatric test indicate specific sensitivities , provides clinician useful screening test atopic disease children 7 years age less , means atopic populations
effect continuous infusion zidovudine therapy neuropsychologic functioning children symptomatic human immunodeficiency virus infection neuropsychologic function assessed 13 children symptomatic human immunodeficiency virus disease \( centers disease control class p2 \) , ranging age 14 months 12 years initiation treatment , eight patients classified encephalopathy psychologic tests administered 6 12 months continuous infusion azidothymidine \( azt zidovudine \) treatment 6 months treatment significant increase 15 5 \( 3 3 \) iq points demonstrated general cognitive functioning \( p less 0 001 \) follow 10 patients indicated 12 months azt therapy , maintained gains iq points improvements adaptive behavior 6 months therapy , assessed standardized interview , paralleled findings iq data significant differences amount change observed different subgroups magnitude improvements could explained practice effects , environmental changes , general improvement physical state conclude neuropsychologic function significantly improved continuous infusion azt treatment
regular inhaled beta agonist treatment bronchial asthma 89 subjects stable asthma took part double blind , placebo controlled , randomized , crossover study effects regular versus demand inhaled bronchodilator therapy subjects inhaled fenoterol placebo dry powder delivery system 24 weeks control asthma judged daily morning evening peak expiratory flow rates , symptom , use additional inhaled bronchodilator , requirement short courses prednisone 64 subjects completed trial , 57 showed clear difference degree control asthma fenoterol placebo periods 17 \( 30 95 confidence interval 18 4 43 4 \) asthma better controlled regular inhaled bronchodilator treatment , whereas 40 \( 70 56 6 81 6 \) control better placebo treatment bronchodilator symptom relief mean airway responsiveness methacholine increased slightly fenoterol period adverse effect regular bronchodilator inhalation occurred among subjects used bronchodilator sole treatment \( 2 better 10 worse regular bronchodilator treatment \) also among took inhaled corticosteroids \( 14 better 29 worse \) thus , regular inhalation beta sympathomimetic agent associated deterioration asthma control majority subjects trends use regular , higher doses longer acting inhaled beta sympathomimetic treatment may important causal factor worldwide increase morbidity asthma
bronchodilator , cardiovascular , effects fenoterol , salbutamol , terbutaline asthma airway response cardiovascular effects fenoterol , salbutamol , terbutaline given standard doses metered dose studied ten patients mild asthma double blind , crossover , placebo controlled study subjects received 2 , 6 , 18 drug intervals 90 min , forced expiratory volume 1 , heart rate , qtc interval , plasma potassium concentration , tremor , bronchial reactivity histamine measured three drugs produced similar however , rises heart rate , qtc interval , tremor fall plasma potassium greater fenoterol salbutamol terbutaline maximum mean \( sd \) increases heart rate fenoterol , salbutamol , terbutaline 29 \( 24 \) bpm , 8 \( 9 \) bpm , 8 \( 14 \) bpm , respectively falls plasma potassium 0 76 \( 0 62 \) mmol l , 0 46 \( 0 32 \) mmol l , 0 52 \( 0 39 \) mmol l , respectively fenoterol afforded additional protection histamine compared salbutamol findings suggest doses based used clinical practice fenoterol causes adverse effects salbutamol terbutaline likely explanation effects fenoterol marketed higher dose beta 2 agonists fenoterol may addition less selective beta 2 receptors
effects 5 lipoxygenase inhibitor asthma induced cold , dry air background enzyme 5 lipoxygenase metabolism arachidonic acid form products implicated airway obstruction asthma hypothesized products 5 lipoxygenase pathway important mediating obstruction , prevention formation decrease severity induced asthmatic response methods randomized , double blind , placebo controlled , crossover study , examined effect 64077 , 5 lipoxygenase inhibitor , bronchoconstriction induced hyperventilation cold , dry air 13 patients asthma completeness 5 lipoxygenase inhibition confirmed examining profile eicosanoids produced whole blood ex vivo activation calcium ionophore results 64077 decreased mean \( sem \) ionophore induced synthesis leukotriene b4 , 5 lipoxygenase product , 74 percent \( 265 3 30 3 69 5 21 5 ng per milliliter , p less 0 001 \) , affect ionophore induced synthesis thromboxane b2 , cyclooxygenase metabolite arachidonic acid \( 80 0 17 1 ng per milliliter 64077 vs 75 8 14 3 ng per milliliter 64077 \) concert selective inhibition 5 lipoxygenase 64077 , amount cold , dry air \( expressed respiratory heat exchange \) required reduce forced expiratory volume one second 10 percent increased 47 percent 64077 \( 3 0 per minute placebo vs 4 4 per minute 64077 , p less 0 002 \) similar results obtained minute ventilation used indicator outcome \( 27 5 liters per minute placebo vs 39 8 liters per minute 64077 , p less 0 005 \) conclusions selective inhibition 5 lipoxygenase 64077 associated significant amelioration asthmatic response cold , dry air , suggesting 5 lipoxygenase products involved response approach may useful treatment asthma
biology retroviruses detection , molecular biology , treatment retroviral infection although human trace roots early part century , within last decade field seen greatest advances , including description first human retroviruses , htlv , subsequent discovery htlv ii aids retroviruses , hiv 1 hiv 2 growth field undergone recent years would possible key advances fields cell biology , immunology , biochemistry , molecular biology evident description hiv etiologic agent aids relatively short time since disease initially described , agent responsible isolated , much complex biology defined , drug helps combat licensed use rapidity events largely remain many unanswered questions regarding hiv aids , still effective vaccine cure significant questions regarding immune response hiv hiv response immune chemotherapeutic challenge , establishment maintenance hiv latency , important mechanisms hiv remain unanswered clear hiv offers easy answers , significant work remains done death aids
influence human immunodeficiency virus infection reproductive decisions article discusses role practitioner pregnancy decision making process hiv infected woman literature women 's decisions reviewed , variables influence decisions discussed author concludes hiv infection significant impact pregnancy decisions cultural psychosocial variables may importance
care infant born exposed human immunodeficiency virus expanding epidemic hiv infection reproductive age women , availability antiretroviral therapy children , recommendations increased case identification activities time pediatricians going called care hiv exposed infants article outlines comprehensive medical framework care children labor delivery setting , outpatient clinic , emergency room includes issues infection control medical , developmental , psychosocial care laboratory evaluations finally , address need long term follow children born exposed hiv
selective induction toxicity human cells expressing human immunodeficiency virus type 1 tat cytotoxic adenovirus vector human immunodeficiency viruses \( \) primarily infect cd4 lymphocytes , leading eventually development systemic immune dysfunction termed acquired immunodeficiency syndrome \( aids \) attractive strategy combat hiv mediated pathogenesis would eliminate initial pool infected cells thus prevent disease progression replication defective , cytotoxic adenovirus vector , ad tk , whose action dependent targeted expression herpes simplex virus type 1 thymidine kinase gene \( tk \) , cloned downstream hiv 1 long terminal repeat , human cells expressing hiv 1 transcriptional activator tat infection tat expressing human hela cells ad tk resulted high level tk expression , deleterious viability cells however , presence nucleoside analog ganciclovir , ad tk infection resulted massive reduction viability tat expressing cell lines natural passengers human lymphoid system , results suggest adenovirus vector based strategies targeted expression , control cis responsive hiv regulatory elements , cytotoxic agents hiv infected cells therapy hiv mediated pathogenesis
putative tyrosine kinases expressed k 562 human leukemia cells tyrosine phosphorylation important transmission growth differentiation signals known tyrosine kinases include several growth factor receptors interestingly , differentiated cell types , erythrocytes platelets contain high amounts phosphotyrosine analyzed tyrosine kinases expressed k 562 chronic myelogenous leukemia cell line , erythroid differentiation capacity analysis 359 polymerase chain reaction amplified cdna clones led identification 14 different tyrosine kinase related sequences \( 14 \) two clones \( \) represent unusual members fibroblast growth factor receptor gene family , clones , , may also family receptor tyrosine kinases lack close relationship known tyrosine kinase different genes characteristic expression pattern k 562 cells several human tumor cell lines addition , mrnas induced differentiation k 562 cells tyrosine kinases may role differentiation physiology platelets
use inhaled corticosteroids patients mild asthma double blind , parallel group study carried investigate effect inhaled budesonide moderate \( 200 micrograms \) low \( 100 micrograms \) twice daily dosage compared effect placebo 103 adults mild symptomatic asthma subjects recorded peak expiratory flow \( \) , asthma symptoms , beta 2 agonist consumption home period seven weeks \( one week run six weeks' treatment \) morning baseline \( around 80 predicted normal \) increased non significantly 88 200 micrograms budesonide daily 90 \( p less 0 05 \) 400 micrograms , compared 81 placebo evening \( around 94 predicted normal \) change significantly active placebo treatment comparison placebo , significant decrease nocturnal asthma symptoms beta 2 agonist consumption changes day less pronounced significant 400 micrograms budesonide daily significant differences two active treatments detected concluded low doses inhaled budesonide effective patients mild symptomatic asthma , particularly night time symptoms early morning lung function early introduction inhaled corticosteroids patients mild asthma night time symptoms may improve quality life night early morning
large volume spacer devices reduce systemic effects high dose inhaled corticosteroids \? used high doses , inhaled corticosteroids may cause suppression hypothalamo pituitary adrenal axis influence mode drug inhalation degree suppression clear hypothalamo pituitary adrenal function assessed measurement h serum cortisol concentrations , short test , 24 hour urine free cortisol excretion 48 adults asthma taking 1500 2500 micrograms beclomethasone daily via metered dose aerosol twelve patients hypothalamo pituitary adrenal suppression , judged subnormal results least two three tests \( one patient \) abnormal insulin stress test response patients changed dose beclomethasone 750 ml spacer device \( \) endocrine tests repeated nine days eight weeks later 10 patients comparison initial values showed adding device caused increase median h cortisol concentration 126 nmol l 398 nmol l , post cortisol concentration nmol l nmol l 24 hour urine free cortisol excretion 54 nmol 84 nmol rise serum cortisol concentration response change evidence persisting hypothalamo pituitary adrenal axis suppression present four 10 patients pronounced improvements function tended occur never required long term oral corticosteroids results uncontrolled study suggest asthmatic patients taking high dose beclomethasone may adverse effects using large volume spacer device
enhanced percutaneous absorption novel topical cyclosporin formulation assessment immunosuppressive activity clinically successful topical cyclosporin \( cya \) formulation produced , mainly due apparent lack drug penetration study produced first vitro kinetic data cya penetration across human cadaver stratum corneum shown addition penetration \( pe \) propylene glycol cya vehicle significantly enhanced drug permeation across skin barrier using flow permeability cells 5 w v cya \( \) alone \( cya \) pe \( cya pe \) olive oil donor chamber , penetration rate \( mean sd microgram cm2 h \) receptor fluid 53 43 \( n 13 \) cya 175 \( n 7 \) cya pe vivo efficacy formulation assessed guinea pigs undergoing delayed type hypersensitivity \( dth \) reactions \( \) cya applied topically time challenge twice daily thereafter 24 h , skin reactions revealed compared appropriate drug , concentrations 0 25 , 0 5 5 cya pe significant inhibitory effect upon erythema response corresponded significant reductions cell infiltrates \( 0 5 5 cya \) statistically significant reductions erythema demonstrated 0 05 cya pe , reduction number infiltrating lymphocytes sites receiving 0 05 cya pe compared vehicle treated sites \( p less 0 01 \) suggests pe permitted penetration otherwise non immunosuppressive concentration cya skin
histopathologic , immunophenotypic , genotypic analysis ki 1 anaplastic large cell lymphomas express associated antigens cd30 ki 1 antigen expression 243 cases malignant lymphomas examined using h2 monoclonal antibody among 20 cases categorized ki 1 anaplastic large cell lymphoma two cases associated markers also expressed cases histopathologic extensive situ immunophenotypic analyses used genotypic studies determination cell lineage histologic pattern involvement partial lymph node infiltration pleomorphic neoplastic cells noticed nodes patients solid areas node replacement resembling metastatic carcinoma seen patient 1 immunohistologically , tumor cells cases positive cd30 , cd25 , , \( hla dr \) , ema , cd45 , , vimentin , alpha 1 , patient 1 also , , whereas patient 2 positive alpha 1 antitrypsin cd4 tumor cells genotypic studies revealed tcr beta tcr gamma chain genes rearranged patient 1 , whereas rearrangements detected patient 2 study supports view ki 1 anaplastic large cell lymphomas may express multiple associated antigens confirms group neoplasms immunophenotypic heterogeneity results genotypic analyses used immunophenotyping exclude tumor cells cases may true origin despite ki 1 positive phenotype
monoclonal antibodies immunogenic lymphoma cell variants displaying impaired neoplastic properties characterization applications immunogenic , cell variants derived highly tumorigenic mouse lymphoma cell line 49 used raise monoclonal antibodies \( mabs \) syngeneic balb c mice mabs following derived \( \) mabs preferentially immunogenic variants , \( b \) mabs immunogenic variants parental tumorigenic cells , \( c \) mab immunogenic tumorigenic 49 cells normal balb c splenocytes six mabs raised way found recognize least five different cell surface epitopes functional analysis different mabs suggested potential usefulness passive immunization parental tumorigenic cells well enrichment immunogenic cells mixed population containing preponderance tumorigenic cells
annual summary vital statistics 1989 us infant mortality continued decline slowly 1989 rate , 9 7 per 1000 live births , lowest ever recorded final 1988 data showed change cause death distribution wide discrepancy white black infant mortality state rates varied 6 8 12 6 georgia worldwide , us rate 10 0 21 countries , japan lowest 4 8 births increased number rate , higher fertility rate women childbearing years birth rate mothers 17 years age younger increased proportion women inadequate prenatal care essentially unchanged deaths , crude death rate , age adjusted death rate decreased excess births deaths added almost 1 9 million persons us population , highest rate natural increase since 1971 marriage rate essentially unchanged , whereas rate decreased slightly , lowest level since 1973 exception human immunodeficiency virus infection , homicide , pulmonary malignancies , rates causes death declined 1988 1989 comparison , declines substantial , led pneumonia , 80 , perinatal conditions , 75 large scale increases among major causes half century two diseases related cigarette smoking chronic obstructive pulmonary disease , eightfold , respiratory cancer , almost sixfold death rates cancers , group , decreased 20 cardiovascular diseases 60
aids , minority patients , doctors 's risk \? 's talking \? asked 39 physicians providing primary care mostly minority patient population respond questionnaire concerning attitudes behavior toward aids risk assessment preventive counseling indicate beliefs concerning patients' knowledge behavior 36 physicians responded \( 92 \) agreed physicians must educate patients aids also reported patients engage risk taking behavior may know much aids transmission prevention despite beliefs , doctors reported gave advice 11 male patients 14 female patients one third physicians reported feeling talking patients' sexual preferences practices identify patients risk help prevent aids , methods must found make physicians comfortable discussing sexual issues patients , especially minority patients
disease control priorities developing countries health policy responses epidemiological change health systems developing countries facing major challenges 1990s beyond growing epidemiological diversity consequence rapid economic development declining fertility infectious parasitic diseases childhood must remain priority time chronic diseases among adults emerging serious problem health must engage epidemiological economic analysis major disease problems , evaluating cost effectiveness alternative intervention strategies designing health care delivery systems , choosing , , regulation , provision services world bank studies two diseases developing countries confirmed priority child survival interventions revealed interventions many neglected emerging adult health problems comparable cost effectiveness developing countries lack information major diseases among adults , reflecting lack national capacities epidemiological economic analyses , health technology assessment , environmental monitoring control critical need national international capacity building essential national health research build base health policies
aids related knowledge , sexual behavior , condom use among men women , zaire study conducted 1988 among random sample 6 , 625 men women reproductive age 24 zones , capital city zaire , determine existing levels knowledge regarding aids \( acquired immunodeficiency syndrome \) , sexual behavior , knowledge use condoms marital relations perceived risk aids , attitudes toward testing human immunodeficiency virus \( hiv \) awareness aids almost universal , vast majority know four main modes transmission almost half believed transmission vaccine cure aids majority male respondents knew condoms , negative attitudes toward condom use widespread , respondents perceived play central role aids
impact hiv related illness employment used structured telephone interviews determine extent work loss following onset symptoms , interval onset symptoms cessation work , risk factors work loss among 193 persons symptoms human immunodeficiency virus \( hiv \) related illness attending aids clinic university california , san francisco , october 1 , 1988 , september 30 , 1989 estimates duration time onset hiv related symptoms work loss derive life table method kaplan meier cox proportional hazards model used estimate effect risk factors probability work time interval eighty six percent respondents worked prior onset first symptom hiv related illness 40 percent working time recent interview , mean days later total number hours worked declined 59 percent time kaplan meier analysis indicates 50 percent worked prior onset hiv related illness stopped working within two years stopped within 10 years onset first symptom
comparative airway response inhaled bradykinin , kallidin , des arg9 bradykinin normal asthmatic subjects bradykinin , kallidin \( bradykinin \) , des arg9 bradykinin may contribute mediators pathogenesis asthma interacting specific receptors designated b1 b2 study , investigated airway response inhaled bradykinin , kallidin , des arg9 bradykinin normal asthmatic subjects changes airway caliber followed maximum expiratory flow 30 vital capacity \( \) forced expiratory volume 1 \( fev1 \) one six normal subjects responded bradykinin maximum cumulative concentration \( 5 33 mg ml \) neither kallidin des arg9 bradykinin measurable bronchoconstrictor effect normal subjects whether airway caliber measured fev1 10 subjects asthma , bradykinin kallidin , des arg9 bradykinin , produced concentration related fall fev1 geometric mean provocation concentrations inhaled agonist reducing fev1 20 baseline 0 03 , 0 08 , 0 44 mg ml bradykinin , kallidin , histamine , respectively bronchoconstriction produced bradykinin kallidin maximal within 3 5 min recovery occurring 30 45 min bradykinin kallidin agonists b2 receptors des arg9 bradykinin agonist b1 receptors , vivo structure activity studies suggest asthmatic , normal , airways kinins compared histamine potent bronchoconstrictor action specific pharmacologic effect compatible stimulation b2 receptors variant
identification activated lymphocytes eosinophils bronchial biopsies stable atopic asthma used immunohistochemistry monoclonal antibodies analyze phenotypic composition activation status cellular infiltrate bronchial biopsies obtained fiber optic bronchoscopy 11 atopic asthmatic subjects \( fev1 predicted range 78 114 \) , 9 atopic nonasthmatic control subjects , 10 normal healthy subjects examination mucosal biopsies obtained central \( level \) \( level ii \) bronchi showed highest number cd45 , , , cd8 positive cells found group asthma significant increase number interleukin 2 receptor \( cd25 \) positive cells \( marker lymphocyte activation \) airway level asthmatic group compared nonasthmatic atopic \( p less 0 05 \) normal control subjects \( p less 0 01 \) eosinophil numbers significantly increased asthma airway levels airway level ii nonasthmatic atopic group compared normal healthy control subjects \( p less 0 05 \) positive cells \( index secretion eosinophil cationic protein following activation \) found airway levels asthmatic group level nonasthmatic atopic control group \( p less 0 05 \) asthmatic subjects compared normal healthy subjects , reduction number neutrophil elastase positive cells asthmatic subjects , percentage leukocytes , significant \( p 0 05 \)
htlv sequences detected peripheral blood genomic dna brain cdna multiple sclerosis patients human cell lymphotropic virus \( htlv \) recently reported associated multiple sclerosis \( ms \) genomic dna peripheral blood lymphocytes brain plaques patients ms analyzed presence sequences homologous htlv pol gene using polymerase chain reaction dot blot techniques comparison dna amplification patterns patients ms , control subjects autoimmune conditions , healthy control subjects htlv infected cell line indicates htlv pol sequence present peripheral blood patients ms , virus active ms brain plaques
effect digitalis clinical symptoms conduction variables patients multiple sclerosis digitalis shown reverse conduction block nerve fibers experimental animals search symptomatic treatment multiple sclerosis , digoxin \( 0 02 mg per kilogram body weight \) given intravenously 7 patients probable clinically definite multiple sclerosis patients temperature dependent symptoms 3 patients , improvement clinical deficits observed concurrent significant changes evoked potential findings digitalis derivatives may useful ameliorating symptoms selected patients multiple sclerosis
monocytoid b cell lymphoma patient human immunodeficiency virus infection demonstration human immunodeficiency virus sequences paraffin embedded lymph node sections polymerase chain reaction amplification significantly increased incidence malignant lymphoma patients acquired immunodeficiency syndrome \( aids \) lymphomas usually high grade b cell phenotype frequent presence reactive monocytoid b lymphocytes patients aids related lymphadenopathy recently documented several studies , knowledge , reported cases monocytoid b cell lymphoma , neoplastic counterpart monocytoid b lymphocytes , patients aids describe human immunodeficiency virus \( hiv \) positive patient hiv related lymphadenopathy monocytoid b cell lymphoma developed course disease morphologic immunologic features lymphoma characteristic monocytoid b cell lymphoma , involved lymph node exhibited reversed cd4 cd8 ratio moreover , using polymerase chain reaction , able demonstrate hiv genome dna extracted lymph node tissue knowledge , first report case monocytoid b cell lymphoma occurring hiv positive patient able , using sensitive molecular biologic technique , demonstrate hiv sequence paraffin embedded , fixed lymph node sections
stereotactic biopsy active multiple sclerosis lesion immunocytochemical analysis neuropathologic correlation magnetic resonance imaging stereotactic biopsy active multiple sclerosis lesion 23 year old patient unilateral symptoms isolated high signal intensity magnetic resonance abnormality yielded 10 serial tissue \( 1 0 x 0 5 cm \) spanning 40 mm within around lesion performed semiquantitative analysis lymphocyte phenotype , using antisera cd3 , cd4 , cd8 , molecules , 11 separate perivascular cuffs three tissue sections lesion edge total cells cuffs varied 10 100 ratios cd4 cd8 cells individual cuffs varied 1 3 4 7 although intense parenchymal infiltrates least cellular cuffs , parenchymal perivascular cell phenotypes indistinguishable , selective trafficking lymphocytes tissue individual cells displaying cd45ra , cd25 , antigens present remarkable phenotypic heterogeneity lymphocytes multiple sclerosis lesion border consistent exposure situ diversity differentiating stimuli histologic demyelination correlated closely signal intensity abnormality observed magnetic resonance imaging studies provide unusual insight histologic immunocytochemical morphologic appearance active multiple sclerosis plaque
reduced cerebral blood flow early stages human immunodeficiency virus infection order determine brain perfusion abnormalities , known patients syndrome dementia , occur early stages human immunodeficiency virus infection , technetium 99m oxime single photon emission computed tomography studies performed 20 patients infected human immunodeficiency virus reed stages iv none patients demonstrated signs dementia severe neurological dysfunction pathological patterns oxime uptake seen 14 patients , seven normal results neurological examination four patients signs cerebral atrophy cranial computed tomographic scan data suggest subtle changes cerebral perfusion seem arise early course human immunodeficiency virus infection may indicate human immunodeficiency virus encephalopathy neurological symptoms noticeable structural damage occurs
genomic hiv 2 german aids patient probably infected complete nucleotide sequence hiv 2 isolate derived german aids patient predominantly neurological symptoms reported hiv sequence highly divergent previously described hiv 2 strains evolutionary tree analysis eight hiv 2 sequences reveals existence three hiv 2 groups hiv belongs group two isolates based comparison hiv six hiv 2 isolates , , variability structural env gag proteins similar within hiv 2 mac hiv 1 groups contrast , regulatory hiv 1 proteins highly conserved hiv 2 strains multiple sequence reveal domains envelope regulatory proteins well conserved among hiv 1 , hiv 2 mac , sivagm identification conserved domains within external glycoprotein could help develop broadly active vaccines
rapid specific diagnosis hiv 1 hiv 2 infections evaluation testing strategies identify cost effective testing strategies hiv 1 hiv 2 infections , evaluated different combinations tests serum specimens consecutive patients attending tuberculosis treatment centers , virus specific whole virus enzyme linked immunosorbent assay \( \) , western blot \( wb \) synthetic peptide enzyme linked immunosorbent assay \( spe \) used sequential fashion determine true prevalence infection 27 reactive hiv 1 , 5 hiv 2 , 10 viruses 239 specimens positive wb hiv 1 hiv 2 , spe diagnosed 38 hiv 1 reactive 16 hiv 2 reactive , 46 remained reactive viruses using one two rapid \( 5 10 min \) mixed \( hiv 1 hiv 2 \) antigen tests \( \) screening test , followed spe supplemental test , gave results sensitivity 97 3 99 2 , specificity 99 5 99 7 , positive predictive value diagnosing hiv infection 99 4 99 6 , important savings time reagent costs spe allows specific distinction hiv 1 hiv 2 infections wb , could replace supplemental test many settings wb may required specimens reactive screening tests negative spe , sensitivity spe evaluated mixed antigen screening test followed spe seems efficient testing strategy diagnosing hiv 1 hiv 2 infections
differences knowledge risk factors aids hispanic non hispanic women attending urban family planning clinic risk factors aids , contraceptive use , seroprevalence hiv , level knowledge aids education session assessed 657 clients attending family planning clinic los angeles , usa history partner bisexual , intravenous drug user , blood transfusion recipient common risk factors reported fewer traditional risk factors english also less likely report history drug alcohol use sexually transmitted diseases , fewer sexual partners less one third women identified risk exposure using condoms none consecutive patients tested hiv antibodies positive english scored higher pre post tests knowledge aids cultural factors may lower personal risk hiv exposure women , lack knowledge aids partner behavior may increase risk
high hiv risk taking among young gay men previous research shown younger age correlated greater hiv sexual risk taking among gay men purpose study identify variables associated hiv risk taking among younger gay men ninety nine gay men aged 18 25 three medium sized west coast communities completed self report questionnaires regarding hiv related behaviors attitudes respondents , 43 reported engaged unprotected anal intercourse previous 6 months men engaged unprotected anal intercourse reported greater unprotected anal intercourse , perceived less risk unprotected anal intercourse , labeled risk aids , reported poorer communication skills sexual partners , likely men engaged high risk sex addition , respondents perceived likelihood acquiring hiv unprotected anal intercourse young gay men significantly lower older gay men findings highlight need hiv risk reduction interventions designed specifically young gay men identify critical areas targeted interventions
immunology hiv infection , biology interferons interferons \( ifn \) biologic response modifiers comprise family regulatory proteins glycoproteins affect variety cellular functions , including normal neoplastic cell growth , immune reactivity , host parasite interactions importance basic cell biology cellular immune defense , interactions human immunodeficiency viruses \( hiv \) molecular cellular levels , form basis review
naturally occurring hiv 1 isolates differences replicative capacity distinguished situ hybridization infected cells replication human immunodeficiency virus type 1 \( hiv 1 \) isolates peripheral blood mononuclear cells \( pbmc \) studied situ hybridization using htlv iiib two series isolates tested \( \) 20 isolates individuals varying severity hiv 1 infection \( b \) sequential isolates 5 subjects showing signs clinical progression 45 month observation period results show hiv 1 isolates distinct replicative capacity distinguished intensity radioactive labeling single infected cells situ hybridization sequential isolates patients clinically progressive hiv 1 infection show gradual increase replicative capacity time pbmc cultures infected sequential isolates , intensity radioactive label single infected cells increases strongest isolates obtained time low cd4 counts blood results suggest restriction virus replication early stages hiv 1 infection gradually lost progression disease
search epitope specific antibody responses human immunodeficiency virus \( hiv 1 \) envelope glycoproteins resistance disease development essential development strategies prevention therapy human immunodeficiency virus \( hiv 1 \) infections define host factors playing dominant role determining clinical outcome infection antibodies directed restricted regions hiv 1 glycoproteins gp120 gp41 likely represent important factors involved host defense hiv 1 definition qualitative quantitative differences spectrum anti gp120 anti gp41 antibodies two different groups hiv 1 infected individuals , long term asymptomatic carriers , individuals acquired immunodeficiency syndrome \( aids \) died , might reveal epitope specificity antibodies contributing prevention clinical disease accomplish goal , sera groups assayed antibodies recognizing synthetic peptides gp120 gp41 shown earlier experiments mimic epitopes two hiv 1 glycoproteins none sera recognized distinct 27 peptides gp120 gp41 spectrum antibodies distinct sera groups hiv 1 infected individuals nevertheless , antibody responses distinguishing two groups particular , possible predict unfavorable outcome disease comparative measurements levels antibodies peptide \( 303 338 \) , corresponding entire v3 hypervariable loop gp120 providing evidence declining levels antibodies course infection antibodies recognizing additional peptides \( 219 245 \) , \( 280 306 \) , \( 425 \) , \( \) , \( \) , \( \) , \( \) significantly less prevalent aids patients asymptomatic carriers appears possible maintenance high levels respective antibodies would contribute preventing aids hiv 1 infected individuals active immunization antigens containing epitopes defined respective peptides administration corresponding antibodies may considered modality therapy hiv 1 infections
method analysis uses computerized medicaid method data analysis utilizes computerized medicaid data presented cohort design medicaid enrollees receiving drugs normally used treat similar underlying conditions described period time medicaid service evident required individual eligible selection cohort selection study subjects descriptions cohorts based medicaid service histories occurring preliminary , prerequisite period time risk considered begin prescription study drug continues either , prescription alternative drug within therapeutic class , predetermined number days passed subjects followed forward time relevant health care suggestive suspected adverse drug reactions noted incidence densities associated sequentially ranked within sequential courses therapy compared methods increase accuracy case ascertainment briefly discussed separate validation studies may used evaluate validity computerized case ascertainment methods compensate misclassification outcome proposed method intended provide timely estimates risk selected outcomes outcomes cannot accurately ascertained computerized data , method may useful determining feasibility studies
incubation period aids lengthening \? data cohort study 1 , homosexual men los angeles used estimate distribution times hiv infection aids , detect changes distribution find weak , statistically significant , evidence incubation period lengthening incubation period distribution assumed changed , estimate proportion developing aids within 6 years hiv infection 27 , 95 confidence interval \( 23 , 31 \) however , assume incubation period distribution began change july 1987 , estimate individuals infected first half 1979 , 28 develop aids within 6 years , infected first half 1983 , 25 develop aids 6 years four different hypotheses suggested lengthening incubation period treatment hypothesis , cofactor hypothesis , better health care hypothesis , changing virus disease hypothesis statistical method used modeling joint distribution date infection incubation period participants study methods , although intensive , attractive way analyzing data prevalent cohort minimal parametric assumptions made
epidemiology acquired immune deficiency syndrome persons aged 50 years older acquired immune deficiency syndrome \( aids \) persons ages , yet recently attention devoted aids older persons examine epidemiology aids persons greater equal 50 years old united states , analyzed cases reported centers disease control number reported annually persons greater equal 50 years old increased 13 1981 3 , 562 1989 december 1989 , 11 , reported , representing 10 cases although male homosexual contact accounted cases persons aged 50 69 , blood transfusion became common means exposure increasing age , accounting 28 cases persons aged 60 69 64 cases individuals aged greater equal 70 proportion women increased 6 1 persons aids aged 50 59 28 7 aged greater equal 70 proportion aids diagnoses made month death increased 16 persons aged 50 59 37 aged greater equal 80 , suggesting either rapid progression disease increasing delay diagnosis incidence older persons continues increase , clinicians caring older patients must become familiar aids
defective expression p70 75 interleukin 2 receptor cells patients systemic lupus erythematosus possible defect process increased intracellular calcium leading p70 75 expression phytohemagglutinin \( pha \) stimulated cells patients systemic lupus erythematosus \( sle \) showed interleukin 2 \( il 2 \) expressed less p70 75 il 2r healthy controls \( im , calcium ionophore \) selectively upregulated p70 75 expression , induced less p70 75 patients sle healthy controls however , intracellular calcium levels cells patients sle increased much healthy controls , cells stimulated im pha results suggest impaired expression p70 75 il 2r cells patients sle due defective calcium influx events rise calcium levels
fractures retrospective analysis retrospective review 107 patients treated eight year period fractures , average follow period 25 5 months \( range , six 96 months \) comparisons fracture patterns , fixation devices , complications osteosynthesis made attempt identify fixation devices best suited treatment difficult orthopedic problem system classification used , fracture risk identified long spiral fractures associated fragments bone elderly patients occurred frequently , complications osteosynthesis inherent instability despite biomechanical advantages offered intramedullary systems , follow observations showed better results patients treatment devices
history anterior cruciate ligament historic review anterior cruciate ligament \( acl \) investigation reveals two important \( 1 \) concepts recently proposed first put forth much earlier \( 2 \) controversy regarding ligament continues despite increased amount information available much recent acl literature , although regarded newly discovered , roots far older , apparently overlooked , work examples include \( 1 \) acl best tested full extension \( 2 \) acl rupture closely associated \( 3 \) acl rupture sometimes minor injury additionally , early investigators achieved notable advances surgical techniques contributions disappeared literature two major reasons first , early investigators observed patients , typical practitioners rarely acl injuries , consequently , little data existed support observations second , observations could confirmed advent widespread , successful surgery undoubtedly , know much acl , yet many issues remain controversial acl perform vital function \? efficacy operative versus nonoperative treatment \? relative merits direct repair , intraarticular substitutes , procedures \? origins continued existence controversy stem several sources , including less rigorous study design natural history , long term follow studies , basic science studies perception acl simple structural unit also controversy
outcome nonoperatively treated complete tears anterior cruciate ligament active young adults results nonoperative treatment 72 patients complete anterior cruciate ligament \( acl \) tears , documented examination anesthesia arthroscopy , evaluated patients acute injury previously normal knee patients meniscal repair excluded collateral posterior cruciate ligament tears associated fractures treatment cases consisted standard protocol early rehabilitation bracing detailed rating symptoms function performed average 38 months postinjury \( range , eight 84 months \) overall results 11 excellent , 20 good , 15 fair , 54 poor thirty five percent acl reconstruction follow period results indicate young adults return requiring strenuous physical activity frequently expect unsatisfactory results nonoperative treatment acute complete tear acl
isolated avulsion biceps femoris insertion case report clinical , roentgenographic , operative findings isolated biceps femoris avulsion 21 year old man demonstrated significance static knee , , articular cartilage examination dynamic structures knee , however , may present diagnostic problem systematic examination musculature \( , quadriceps , patellofemoral mechanism \) included evaluation every acute knee injury special attention given surface anatomy well function knee
ten year review treatment delayed union nonunion implanted bone growth stimulator ten year clinical roentgenographic review conducted patients original multicenter trial evaluated use implantable bone growth stimulator delayed union nonunion original 81 patients , 38 patients located , seven patients died unrelated causes , 36 38 patients located , 37 patients \( representing 38 fractures \) participated detailed clinical review roentgenographic assessment fractures remained united , normal bone remodeling occurred adverse effects generator wire six patients initially reported failures healed surgical intervention thus , normal osteogenesis occurs association electrical stimulation using implantable bone growth stimulator ten year review supports long term safety effectiveness technique treating fractures
toxic psychosis due chloroquine uncommon children toxic psychosis due chloroquine relatively uncommon occurrence childhood entity must kept differential diagnosis case unexplained psychosis , array detailed investigations purpose pediatricians relatively uncommon entity authors encountered four cases psychosis wide variety symptomatology period past 18 months
critical care clonidine poisoning clonidine may source serious toxicity ingested describe 11 cases clonidine ingestion \( mean dose 0 15 mg kg range 0 01 0 57 \) source clonidine grand parent six 11 cases symptoms included altered level consciousness \( n 11 \) , \( n 5 \) , bradycardia \( n 8 \) , hypotension \( n 5 \) , apnea respiratory depression \( n 6 \) , hypothermia \( n 5 \) hypertension \( n 3 \) therapeutic interventions included naloxone \( n 8 \) atropine \( n 4 \) , dopamine \( n 1 \) , fluid resuscitation \( n 4 \) , endotracheal intubation \( n 1 \) deaths symptoms clonidine ingestion typically mild dose ingested less 0 01 mg kg , bradycardia hypotension occurred usually doses greater 0 01 mg kg apnea respiratory depression common dose exceeded 0 02 mg kg effective measures needed prevent potentially serious
bronchial blood flow reduction positive end expiratory pressure acute lung injury sheep smoke inhalation increases bronchial blood flow \( qbr \) produces edema airway system study whether increased qbr seen 24 h inhalation injury affected mechanical ventilation peep \( 5 , 10 , 15 cm h2o \) sheep \( n 8 \) previously prepared cardiopulmonary catheters ultrasonic transit time flow probes mounted around bronchial arteries insufflated four sets 12 breaths cotton smoke different levels peep added mechanical ventilation 24 h injury peep level applied 45 min significant increases qbr lung lymph flow \( ql \) associated marked decrease bronchial vascular resistance \( \) 24 h injury however , change observed mean arterial pressure \( map \) cardiac index \( ci \) substantial reduction pao2 fio2 \( p f \) , indicated deterioration arterial oxygenation application varying levels peep decreased qbr \( p less 05 \) increased \( p less 05 \) , ql p f ci map recorded removal peep , none cardiopulmonary variables significantly different control values findings suggest mechanical ventilation peep markedly decreases smoke induced hyperemia edema frequently seen inhalation injury without significant alterations map ci
pulmonary functional impairment associated pleural asbestos disease circumscribed diffuse thickening define pulmonary functional impairment associated pleural asbestos signs \( pas \) , compared men circumscribed \( plaques \) diffuse pleural thickening chest roentgenograms irregular opacities criteria \( 1980 \) age matched asbestos exposed men without roentgenographic signs 228 men asbestos men white spirometry total thoracic gas volumes \( \) measured expressed percentage predicted white michigan men modeled spirometric values thereby adjusting height , age , current ex smokers duration smoking asbestos exposed men never smoked reduced 85 \( p less 0 01 \) increased \( p less 0001 \) compared men 155 men pas never smoked reduced flows \( p less 0001 \) , fvc \( p less 0 \) , \( p less 0001 \) compared 155 age matched asbestos exposed men 325 asbestos exposed current smokers normal chest roentgenograms compared smokers reduced expiratory \( p less 0 0001 \) , reduced fev1 \( p less 0 004 \) , increased \( p less 0 0001 \) 325 current smokers pas additional air trapping reduced vital capacity thus , pas associated significant pulmonary dysfunction men never smoked , current ex smokers additional dysfunction even adjustment duration smoking
foreign body removal removal button cell small impacted terminal ileum right colon described technique used effectively three patients
secondary total hip replacement fractures femoral neck studied rate revision 84 consecutive total hip replacements performed failed osteosynthesis femoral neck fractures compared primary arthroplasty osteoarthritis age sex adjusted risk prosthetic failure 2 5 times higher failure fixation , excess risk patients 70 years age radiographic signs loosening femoral component five 12 years secondary arthroplasty six 33 survivors general , results secondary replacement worse obtained primary arthroplasty femoral neck fracture consider internal fixation primary procedure total hip replacement safe secondary procedure osteosynthesis fails
ao dynamic hip screw pugh sliding nail femoral head fixation compared , laboratory conditions , resistance cutting ao dynamic hip screw pugh sliding nail mean load cut , adjusted bone strength , 70 greater pugh sliding nail reasons difference discussed
femoral neck fracture fixation comparison sliding screw lag screws rigidity sliding compression screw three cannulated lag screws treatment fractures compared five pairs female cadaver femora significant differences compressive strength , bone density , cortical thickness index bones pair fracture standardised using perpendicular saw cut across femoral neck test force length measurement facilities used mimic applied vivo frequency 0 5 hz 0 3 times body weight significant difference fixation afforded sliding compression screw three lag screws bone quality single important factor stability bone implant unit
locked intramedullary nailing displaced tibial shaft fractures published erratum appears j bone joint br 1991 jan 73 \( 1 \) 181 analysed results 93 tibial shaft fractures treated locked nail twenty six fractures comminuted , 19 open grade ii , 54 located outside middle third tibia deep infection rate 3 2 two poor results use method recommended discussed
grafting ao lag screw nonunion scaphoid retrospective analysis report experience 42 patients , using bone grafts lag screw fixation united scaphoid fractures using grading system , analysed suitability method three types nonunion recommend operation treatment scaphoid nonunion , except avascular necrosis proximal pole
extensor transfer rupture extensor pollicis longus tendon reviewed 21 patients 22 extensor pollicis longus mean 5 3 years transfer extensor tendon , 19 21 transfers described result good , two fair mean deficit extension operated unoperated 1 4 cm , mean flexion deficit 0 6 cm pressure gauge measurements showed strength transfer 51 uninjured extensor two fair results extensor lag 1 5 cm independent extension index maintained patients , none lag , strength index extension reduced 49 normal finger evidence functional loss extensor transfer rupture extensor pollicis longus tendon simple reliable procedure complications gives satisfactory long term extension thumb
long term prognosis soft tissue injuries neck reviewed 43 patients sustained soft tissue injuries neck mean 10 8 years , 12 recovered completely residual symptoms 28 severe 12 pain neck lower back commonest complaint older patients worse prognosis two years , symptoms alter passage time
blunt traumatic pericardial rupture ten year experience 1979 1989 blunt traumatic pericardial rupture rarely diagnosed preoperatively associated high mortality ten year period 1979 1989 20 , 000 patients admitted major trauma center 22 found blunt traumatic pericardial rupture sixteen 22 \( 72 7 \) injured vehicle accidents , 3 \( 13 6 \) motorcycle crashes , 2 \( 9 1 \) falls 1 \( 4 5 \) eighteen \( 81 8 \) diagnosed intraoperatively resuscitation surgery associated injuries , four \( 18 1 \) diagnosed preoperatively pericardial window eighteen males four females median age 40 14 years \( range , 17 68 \) tears found following sites left \( 14 22 64 \) , diaphragmatic \( 4 22 18 \) , right \( 2 22 9 \) , superior mediastinal \( 2 22 9 \) associated cardiac injuries found 5 22 \( 22 7 \) patients died overall mortality rate 63 6 \( 14 22 \) high index suspicion alert trauma surgeon make diagnosis intraoperatively emergency surgical resuscitation hemodynamically unstable patient pericardial window stable patient
\( \) physicians \( \) gives rise unnecessary hospital admissions expensive laboratory radiologic evaluations , times , hazardous therapy seven cases seen san francisco november 1986 january 1987 patients presented , times painful , acral patches plaques fingers , , nose exposure cool cold , environment histologic examination two cases revealed perivascular lymphocytic infiltrate endothelial swelling subcutaneous fat upper lower dermal plexus
incidence lingual nerve trauma postinjection complications conventional mandibular block anesthesia trauma lingual nerve potential risk factor patients receiving mandibular block anesthesia paper describes results patient survey 9 , conventional mandibular blocks received 2 , 289 adults incidence lingual nerve trauma postinjection complications reported along associated analysis duration complications , procedures time incident , side occurrence \( right left \) , gender ratios addition , recommendations patient evaluation , treatment , follow care discussed
aid management pediatric trauma peripheral centers pediatric trauma board 1986 , , 000 children age 15 living accounted 17 australia 's pediatric population year 39 pediatric deaths resulting traffic incidents another 408 injured children admitted hospital less 20 children treated accident emergency \( e \) department qualified pediatrician 35 e departments qualified emergency physician pediatric trauma board proposed , lead improvement care injured critically ill pediatric patients board made pre marked includes normal pediatric values replacement fluid flow charts approximately three feet height six feet width board aimed primarily clinicians may may specifically trained emergency medicine provides quick , easy access normal values vital signs children different ages sizes enables accurate calculation fluid requirements resuscitation provides means following response therapy drug doses per weight provided copy board made size inclusion hospital chart part admission notes
abdominal injury skateboard injuries sustained skateboard vary minor fractures report describes unique injury sustained young skateboard metal rod literature review 1 , 254 skateboard injuries reveal instances penetrating abdominal trauma
pneumatic firearm injuries trivial trauma pitfalls \? report describes injury due pneumatic firearm though powder firearm injuries generally considered serious , pneumatic injuries often viewed minor insignificant trauma children adolescents primarily contributing aura however , dramatic increases impact velocities transformed newer generation pneumatic firearms consequently , literature replete increasing incidences serious injury due pneumatic
tricyclic antidepressant overdose conservative management community hospital cost saving implications reports late onset cardiovascular complications following tricyclic antidepressant \( tca \) overdose led conservative approach patients many patients hospitalized continuous cardiac monitoring , regardless clinical presentation management algorithms based clinical predictors outcome recently proposed used algorithm developed young retrospectively evaluate care 33 tca overdose patients admitted hospital 3 year period identified 11 patients could treated outpatient basis algorithm employed ten admitted monitored unit spent mean 31 6 15 64 hours unit none 11 patients developed complications hospital stay use algorithm would resulted estimated cost savings 13 hospital days 14 , 000
effects 4 , methanol ethylene glycol , healthy humans 4 \( 4 mp \) , inhibitor alcohol dehydrogenase , may useful treatment methanol ethylene glycol placebo controlled , double blind , multiple dose , sequential , ascending dose study performed determine tolerance 4 mp healthy volunteers oral loading doses 4 mp followed supplemental doses every 12 h 5 days , producing plasma levels therapeutic range slight , transient elevation one serum transaminase values observed 6 15 subjects treated 4 mp effect dose related apparently mediated hypersensitivity reaction serum triglyceride levels increased 30 4 mp treated subjects , also 25 placebo subjects 4 mp treatment produce significant changes objective clinical parameters subjective side effects results suggest mild , transient increase liver function tests might observed subjects treated multiple doses 4 mp nevertheless , slower elimination rate lesser degree toxicity 4 mp would make preferable ethanol therapy poisonings
stabilization thoracolumbar injuries biomechanical analysis orthosis spinal orthoses traditionally used management thoracolumbar injuries treated without surgical stabilization however , treatment modality management spinal fractures remains subjective since objective data available effectiveness orthoses stabilizing injured segments study used finite element model spine evaluate effectiveness orthosis controlling progression deformities injury site gravitational flexion loads two types injuries simulated single level injury t12 l1 two level injury t12 l1 segments injury increasing severity simulated progressively reducing bending stiffness affected segments relative normal values flexion extension mode interaction three point orthosis spine simulated using experimentally measured stiffness properties orthosis authors' results suggest single level injuries cause 50 loss segmental stiffness , orthosis restore normal resistance deformity injured segments , gravitational well large flexion loads loss stiffness 50 85 normal , severe two column disruptions , orthosis restore resistance deformity restricted patient activity level brace \( low flexion moment \) beyond 85 loss segmental stiffness , three column injuries , orthosis alone appears ineffective preventing progression deformity
evaluation surgical treatment burst fractures authors instituted prospective , randomized study patients presenting acute burst fractures thoracolumbar lumbar spine patients alternately treated posterior distraction using pedicle instrumentation \( ao \) anterior decompression instrumentation \( harrington device \) forty patients presented mean follow 20 months preoperatively , significant canal compromise 39 patients measured 44 5 patients undergoing posterior surgery 58 patients undergoing anterior surgery postoperatively , reduced 16 5 4 , respectively statistically significant difference two groups \( p less 0 0001 \) mean preoperative deformity 18 7 degrees patients treated anterior surgery 18 2 degrees group treated posterior surgery last follow , mean improvement deformity 9 3 degrees anterior group 11 3 degrees posterior group statistically significant difference two groups two implant failures anterior harrington construct two implant failures ao blood loss significantly higher patients undergoing anterior surgery , complications thoracotomy anterior decompression dural sac study supports hypothesis posterior distraction instrumentation effectively canal correct patients sustaining burst type injuries anterior surgery , however , results complete reliable decompression canal
inadequate granulopoiesis major torso trauma hematopoietic regulatory paradox late postinjury sepsis largely result defective host defense including failure maintain adequate number functioning phagocytic cells study used stem cell culture techniques measure colony stimulating activity quantitated number circulating myeloid stem cells see defects granulopoiesis occur major torso trauma forty two acutely injured patients \( 13 blunt 29 penetrating injuries mean age , 29 7 years \) undergoing laparotomy abdominal trauma index 15 40 studied prospectively blood samples obtained days 1 , 5 , 10 patients segregated injury severity abdominal trauma index less 25 \( n 25 \) versus abdominal trauma index greater equal 25 \( n 17 \) severely injured \( abdominal trauma index greater equal 25 \) patients fewer circulating granulocytes monocytes colony stimulating activity normal control levels patients decreased increased injury severity severely injured patients blunted bone marrow response \( significantly fewer circulating myeloid stem cells \) suffered major septic complications \( 24 vs 8 \) conclusion , major trauma torso causes paradoxic depression granulopoiesis increased injury severity may contribute late septic morbidity colony stimulating activity deficiency state similar seen major burns may amenable future modulation
subxiphoid versus echocardiography prospective evaluation diagnosis occult penetrating cardiac injury diagnostic subxiphoid \( sp \) presently advocated diagnosis occult cardiac injuries patients stable vital signs cardiac penetrating chest wounds approach , however , results reported 80 negative pericardial exploration rate investigate reliability bedside two dimension echocardiography \( 2 echo \) predicting cardiac injury compared sp , prospective study undertaken patients stable vital signs admitted penetrating chest wounds located within space , , subcostal line initial evaluation patients bedside 2 echo found 96 accuracy , 97 specificity , 90 sensitivity predicting cardiac injury false negative findings patient sp 18 hours bedside 2 echo performed reliability bedside 2 echo compared sp significantly different according kappa measure reliability data suggest bedside 2 echo expeditious reliable method diagnose occult cardiac injuries initial assessment patient stable vital signs penetrating chest trauma approach may allow selective use sp patients positive bedside 2 echo could eliminate unnecessary surgical procedures
effort rupture diaphragm effort rupture diaphragm rare accounts 1 diaphragmatic injuries 23 year old patient bilateral rupture followed sudden movement described
alcohol trauma endemic syndrome injuries problem , alcohol use appears important risk factor injury examined blood alcohol levels selected demographic epidemiologic variables recorded trauma patients 1 trauma center 28 month period total 2 , 262 trauma patients admitted trauma center period , 75 male 72 injured vehicle related incidents blood alcohol levels 2 , patients \( 93 \) measured , alcohol present blood 855 \( 41 \) patients blood alcohol level done , 32 level higher 100 mg per dl conclude level alcohol involvement trauma high involvement must addressed medical community health care system
fish poisoning regarded many , fish source lethal food poisoning humans syndrome caused tetrodotoxin , one potent known intoxication produces symptoms , paresthesias generalized muscle weakness common complaints treatment symptomatic often needs aggressive life support may required series , mortality rate approached 60 percent
wounding effects 47 rifle used , california , january 17 , 1989 limited disruption produced tissue rifle bullets used , california , entirely consistent autopsy reports five children died wounds also entirely consistent well documented studies previous tissue studies many laboratories inconsistent many exaggerated accounts assault rifle wounding effects described media incident information documented historical record however , critical reason correcting produced media reaction incident prevent inappropriate gunshot wound treatment
identification driver two motorcycle accidents inguinal contusion laceration indication driver motorcycle accidents involving two , medicolegal identification driver necessary one die particularly important latter case , survivor almost always driving one characteristic injury distinguishes driver passenger inguinal contusion laceration \( accompanied pelvic fracture \) injury , caused collision pelvis fuel tank , identifies driver
fatal big cat attacks two cases fatal attacks large cats presented first case , 30 year old female worker cage second case , 2 year old girl injured father 's pet pattern injuries cases nearly identical wild
carbon monoxide poisoning five years' experience defined population review presented cases east denmark 1982 1986 manner death fatal carbon monoxide \( co \) poisoning incidence far frequent single substance poisoning yet decreased years despite preventive measures number fatal co poisoning cases may diminish result natural gas project progress purpose survey , therefore , contribute evaluation actual causes fatal poisonings east denmark , discuss existing measures prevent gas poisonings , expectation decline gas suicides accidental gas poisonings within next years
path bullet injuries determined radiography radiography commonly used find bullet pathways forensic pathology case presented , man sustained multiple gunshot wounds one bullet could traced radiograph used find bullet showed interesting bullet pathway observing bullet pathway radiograph , sometimes victim 's body posture time incident
identification driver automobile collision report three occupant automobile collision one two survivors claimed deceased operated vehicle attempted identify driver left face neck deceased appeared vehicle 's survivors slightly injured right side japan , passenger side left , case , right side vehicle damaged comparing injuries deceased survivors relation vehicle damages , concluded deceased occupant probably passenger , driver
fatal high cervical spinal cord injury automobile accident complicating os report case spinal instability incomplete fusion c2 \( os \) allowed anterior displacement skull first cervical vertebra following right frontal impact automobile accident resultant laceration spinal cord occurred level c1 c2 without either radiographic investigation detailed examination spine , fatal injury might overlooked death attributed acute alcoholic poisoning blood alcohol level
natural history alcohol abuse implications definitions alcohol use disorders dsm iii r category alcohol abuse validly differentiated dsm iii r category alcohol dependence , abuse primarily mild , condition typically dependence \? 4 year longitudinal epidemiologic study male drinkers provided data answer question study used identical questions baseline follow follow , 70 subjects initially classified alcohol abusers still abusers classified contrasted significantly outcome subjects initially reported alcohol dependence although additional research needed , results indicate alcohol abuse often course distinct alcohol dependence
plasma noradrenaline , platelet alpha 2 adrenoceptors , functional scores ethanol withdrawal plasma noradrenaline platelet alpha 2 adrenoceptor density \( sites cell using 3h rauwolscine without phentolamine \) correlated withdrawal score 23 hospitalized patients undergoing ethanol withdrawal control groups plasma noradrenaline 25 patients admitted hospital elective 12 laboratory workers venipuncture controls platelet alpha 2 adrenoceptor measurements separate group 31 normal subjects mean age close patients' ethanol plasma noradrenaline significantly higher patients undergoing ethanol withdrawal patients admitted hospital elective endoscopy twelve laboratory controls plasma noradrenaline levels significantly lower either patient group significant though poor statistical correlation existed ethanol withdrawal score simultaneously determined plasma noradrenaline level platelet alpha 2 adrenoceptor sites cell reduced ethanol withdrawal compared normal controls platelet alpha 2 adrenoceptor sites cell increased first 24 hr ethanol withdrawal remained significantly lower control values change platelet adrenoceptors accompanied fall mean plasma noradrenaline thus , stress hospital admission associated increase plasma noradrenaline , ethanol withdrawal enhances increase , accompanied probably causes reduction platelet alpha 2 adrenoceptor numbers changes begin return towards normal within 24 hr withdrawal reaction
application personality questionnaire population alcoholics substance abusers assess construct validity application , cloninger 's personality questionnaire \( tpq \) administered inpatient substance abusers one hundred seventy two patients alcoholic , 47 abused , 48 abused drugs , primarily benzodiazepines , marijuana , abusers sample 33 8 female analyses conducted \( 1 \) determine whether tpq scores could used classify alcoholics either cloninger type type ii \( 2 \) examine tpq scales identify differences patterns due drug choice \( 3 \) replicate previously obtained gender differences tpq results indicate \( 1 \) tpq scores classify alcoholics expected frequencies type type ii \( 2 \) scales independent give rise differences among drug user groups , \( 3 \) confirm previously reported gender differences results indicate cloninger 's model tpq must subjected careful empirical study prior widespread acceptance
murine model ethanol induced immunosuppression alcohol abuse associated increased susceptibility infectious diseases certain tumors basis observations , effect ethanol immune system suggested used mouse model system male c57bl 6 mice fed either liquid diet containing ethanol sufficient supply 37 total calories isocaloric control diet pair feeding design examine effect ethanol immune system group consuming ethanol containing diet maintained relatively stable levels blood ethanol 8 days feeding consumption ethanol 8 days resulted profound loss thymus spleen cells , recovery thymus cellularity delayed relative recovery spleen cell numbers ethanol feeding discontinued proliferation spleen lymphocytes cell stimuli \( concanavalin alloantigens \) diminished however , b cell proliferation lipopolysaccharide relatively unchanged mice fed ethanol containing diet also ethanol fed mice significant decrease primary antibody response sheep red blood cells independent antigen occurred data establish murine model system means define effect ethanol immune system host defense mechanisms
vitamin metabolism normal bone mineral density finnish male alcoholics study effect prolonged ethanol consumption calcium metabolism prevalence osteoporosis examined 38 finnish male alcoholics \( 30 55 years age \) dietary interviews biochemical measurements measuring bone mineral content forearm using single photon absorptiometry \( spa \) bone mineral density spine , humerus proximal femur using computer tomography \( ct \) dual energy x ray absorptiometry \( \) comparison two groups healthy controls studied mean daily dietary intake calcium 1 3 g patients 1 2 g controls dietary intake vitamin equal study groups , serum levels calcium , phosphate parathyroid hormone show difference patients controls alcoholics urinary excretion calcium reduced 42 \( p less 0 0001 \) compared controls serum levels 25 hydroxyvitamin d3 , 1 , 25 dihydroxyvitamin d3 , 24 , 25 dihydroxyvitamin d3 reduced alcoholics 40 \( p less 0 0001 \) , 23 \( p less 0 01 \) , 48 \( p less 0 0001 \) , respectively , compared controls alcoholic men normal levels serum testosterone bone mineral content dominant forearm measured spa similar study groups bone mineral densities \( bmd \) lumbar humeral areas measured ct bmd lumbar , femoral neck , ward 's triangle trochanter sites measured differ , either
detection alcoholism hospitalized comparison mast mac michigan alcoholism screening test \( mast \) alcoholism scale \( mac \) administered forty one schizophrenic inpatients also meeting dsm iii criteria either alcohol abuse alcohol dependence 29 schizophrenic inpatients qualify additional substance abuse diagnosis marijuana abuse dependence mac failed differentiate alcoholic nonalcoholic groups groups scored recommended cutting score mast significantly differentiated alcoholic nonalcoholic schizophrenic patients sensitive history alcohol abuse alcohol dependence neither mast mac sensitive recent versus remote drinking overall accuracy mast found 80 mac 56 logistic regression analysis revealed use four mast items yield group rate 83 concluded mast exhibited sufficient sensitivity specificity used initial screening instrument alcoholism schizophrenic patients
alcohol protects diaphragm dietary restriction recently reported alcoholic rat diaphragm develops greater contractile force diaphragm pair fed control animals present experiment examines whether alcohol dietary restriction likely cause surprising finding conditioned 10 rats using liquid diet containing ethanol 36 calories ten pair fed control animals received equal amount isocaloric , ethanol free liquid diet ten ad libitum control animals access lab chow water rats killed 30 weeks left diaphragm strips studied vitro optimal length using direct stimulation voltage isometric force measured divided muscle cross section stress maximal tetanic stresses developed muscle pair fed controls systematically less alcoholic ad libitum control values \( p less 0 0001 \) depend temperature \( 25 degrees vs 37 degrees p greater 0 50 \) pair feeding increased twitch half relaxation times \( p less 0 03 \) shifted tetanic stress stimulation frequency relationship leftward 10 hz \( p less 0 01 \) diaphragm pair fed rats continued generate lower stresses fatigue caused repeated contractions \( p less 0 01 \) conclude dietary restriction associated pair feeding compromises diaphragm performance rats chronic alcohol consumption prevents reverses changes , since diaphragm function alcoholic ad libitum control animals different
late versus early onset problem drinking older men age onset problem drinking studied 132 older men \( age 60 years older \) admitted va geriatric alcoholism outpatient treatment program demographics , alcohol history , self reported psychological status , special treatment , treatment compliance variables tested association onset age late onset \( defined onset first alcohol problem age 60 \) uncommon , occurring 15 sample \( 29 patients age 65 older \) compared earlier onset cases , late onset alcohol problems milder circumscribed , associated less family alcoholism greater psychological stability late onset patients also compliant outpatient treatment requirements however , treatment program variables better predictors compliance onset age
inpatient treatment employed alcoholics randomized clinical trial hazelden type traditional treatment first randomized clinical trial hazelden type treatment showed aa oriented treatment alcoholism result significant improvement drinking behavior compared traditional form treatment one hundred forty one employed alcoholics randomized either hazelden type treatment \( n 74 \) traditional type treatment \( n 67 \) treatment groups highly comparable bimonthly follow lasted one year according questionnaire \( short form \) , treatment hazelden type institute significantly involving , supportive , encouraging oriented personal problems traditional type institute accordance treatment drop rate 7 9 hazelden type institute 25 9 traditional type institute \( p less 0 02 \) participation outpatient treatment significantly better hazelden type treatment proportion \( admitted ethanol consumption , 0 g day transferase , mean cell volume normal \) higher hazelden type institute last \( 8 12 months \) follow period \( 26 3 vs 9 8 , p 0 05 \) fourteen percent type institute patients 1 9 traditional type institute patients stayed whole 1 year follow period \( p less 0 05 \) differences corresponding rates controlled drinking \( admitted ethanol consumption less 40 g day , ggt , mcv normal \) direction reach statistical significance thus hazelden type treatment obtained better results 1 year abstinence rate traditional type treatment
ethanol inducible cytochrome p 450 assessment specific chemical probes rat liver microsomes capacity liver microsomes various substrates known specific alcohol inducible cytochrome p 450 studied rats treated different 3 , phenobarbital , acetone , ethanol analysis results showed significantly marked increase following ethanol acetone treatments p hydroxylation \( 283 19 304 21 \) , n \( \) \( 280 105 228 95 \) , hydroxylation \( 258 60 236 61 \) , butanol oxidation \( 173 34 154 32 \) , hydroxylation \( 147 22 95 8 \) , ether de \( 95 17 83 17 \) significant increase n \( \) de \( 34 11 9 8 \) rat microsomes , respectively , versus control animals \( mean sd , values expressed nmol min p 450 \) activities significantly decreased 3 mc treatment , except p hydroxylation pb treatment markedly enhanced de , p , \( 106 38 , 109 14 , 153 62 , respectively \) versus controls results suggest especially 1 butanol specific useful probes alcohol inducible cytochrome p 450 crude liver microsomes
effects alcohol import aldehyde dehydrogenase precursor rat liver mitochondria previously showed incubation rat liver mitochondria resulted inhibition import aldehyde dehydrogenase precursor ornithine transcarbamylase precursor \( , j , h arch 272 449 , 1989 \) time required inhibition import occur measured ethanol \( 200 mm \) butanol \( 100 mm \) 0 degree 30 degrees c required approximately 30 min achieve 50 inhibition butanol 50 min ethanol substantiate membrane effects , also examined effect oleic acid import found incubation mitochondria oleic acid \( 0 100 microm \) resulted inhibition aldehyde dehydrogenase precursor import dose response fashion addition vitro effects import , conducted preliminary study import protein liver mitochondria isolated rats fed ethanol found rate aldehyde dehydrogenase precursor import liver mitochondria isolated ethanol fed rats identical control results consistent finding activity amount aldehyde dehydrogenase mitochondria isolated alcohol fed control animals
alterations splanchnic blood flow following chronic ethanol exposure purpose experiments determine whether tolerance develops effect 3 0 g kg ethanol total regional splanchnic blood flow male wistar rats animals given liquid diet containing ethanol 10 days ethanol fed animals withdrawn 24 hr prior experiments regional blood flow cardiac output \( co \) measured reference microsphere technique intraperitoneal injection 3 0 g kg ethanol acute ethanol administration produced early nonsustained increases portal vein blood flow animals fed ethanol 10 days withdrawn 24 hr control animals however , chronic exposure ethanol , pattern increase blood flow response ethanol splanchnic organs different ethanol fed control groups increases portal vein flow control groups due concomitant increases small intestinal , colonic , cecal blood flow increase ethanol fed group due rise small intestinal stomach blood flow increase stomach blood flow occurred animals treated chronically ethanol may viewed conditioned response ethanol , since found control group results , demonstrate pattern increase blood flow splanchnic organs produced acute dose ethanol depends animal 's previous exposure ethanol
examination cloninger 's type type ii alcoholism sample men alcoholics treatment cloninger 's clinical method classifying alcoholics two groups \( types ii \) examined data obtained 360 va hospitalized male alcoholic patients criteria , cloninger clinical method alcoholics age onset problem drinking symptom clusters associated subtype marked overlap found symptom clusters used define two subtypes ninety one percent entire sample satisfied criteria symptom clusters dividing sample early onset \( type ii , less equal 25 years \) late onset \( type , greater 26 years \) alcoholism substantially reduce overlap symptom clusters e , 96 early onset 83 late onset subgroups positive symptom clusters 21 men \( 6 \) could classified age onset type appropriate symptom cluster used separate patients hospital settings , least , findings suggest two group clinical alcoholism proposed cloninger reflects age onset problem drinking
separation ruptured angioplasty balloon successful percutaneous retrieval case report case ruptured angioplasty balloon complete separation catheter presented successful percutaneous retrieval balloon endoscopic biopsy forceps performed
interaction whole bowel irrigation solution activated charcoal implications treatment toxic study objectives purpose study address issues safety efficacy combining whole bowel irrigation activated charcoal administration treatment toxic study design two vitro studies performed first , serial ratios polyethylene glycol \( peg \) activated charcoal \( ac \) added water solutions analyzed peg concentration osmolality second , serial ratios pharmaceutical bowel irrigation solution ac preparation combined constant amount acid solution , peg , acid concentrations quantified results adsorption peg powder ac demonstrated however , changes solution osmolality negligible thus , concurrent administration therapies appears safe however , combining bowel irrigation solution ac resulted decreased acid adsorption especially smaller amounts ac would smaller doses ac used multiple dose charcoal therapy conclusion vitro data applicable overdose patients , administration routine initial charcoal dose treated whole bowel irrigation would appropriate however , unlikely addition multiple dose charcoal therapy whole bowel irrigation would provide additional benefit patient
whole bowel irrigation treatment zinc sulfate overdose 16 year old boy ingested approximately 50 zinc sulfate tablets \( 500 mg tablets \) spontaneous emesis , induced emesis , lavage , abdominal radiograph performed four hours ingestion still demonstrated approximately 50 tablets within stomach three pills within colon whole bowel irrigation begun polyethylene glycol lavage solution \( peg \) administered nasogastric tube within one hour , patient began producing rectal effluent contained pills patient remained asymptomatic throughout whole bowel irrigation stool tests negative serum chloride , however , increased 105 127 meq l follow kidney , ureter , bladder studies demonstrated clearance zinc tablets gastrointestinal tract next 24 hours
asbestos content lung tissue , lymph nodes , pleural plaques former workers autopsy samples eight former workers collected lung parenchyma , tracheal lymph nodes , pleural plaques tissue respective area prepared modified digestion technique , residue collected 0 2 micron pore 0 22 micron mixed cellulose ester filter quantitation bodies fibers done light transmission electron microscopy , respectively differences asbestos burden noted site bodies observed parenchyma nodes plaques three subjects found bodies per gram dry weight lymph nodes lung parenchyma likewise , subjects found fibers per gram nodes parenchyma chrysotile fibers noted lung sites , chrysotile predominant plaques majority fibers nodes plaques less equal 5 microns length however , fibers dimensions hypothesis reached areas residual patterns likely reflect impact clearance lung burden opposed eventual accumulation stasis areas
penetrating injuries abdominal aorta charts 56 consecutive patients penetrating injuries abdominal aorta reviewed attempt identify prognostic factors mechanism injury gunshot wound \( \) , 82 per cent \( 22 cal 15 2 greater 38 cal 84 8 \) shotgun wound \( \) , 5 per cent stab wound \( sw \) , 13 per cent overall mortality 73 per cent , 78 per cent \( 22 cal 0 greater 38 cal 92 \) , 67 per cent , 43 per cent sw average initial systolic blood pressure \( \) 53 \( 0 130 \) 87 \( 0 120 \) survivors 40 \( 0 130 \) nonsurvivors \( ns \) eighteen patients \( 32 \) , one survivor thirty \( 54 \) patients less 70 , three survivors six emergency department \( ed \) performed , five patients surviving reach operating room \( \) , none surviving long term ten patients died ed , 18 surgical intervention , six within 24 hr , seven greater 24 hr postop average time injury 75 minutes , 122 minutes survivors , 53 minutes nonsurvivors \( p less 0 05 \) 49 minutes dying 58 minutes surviving dying postop \( ns \) surgery , six patients thoracotomy celiotomy control thoracic aorta , three surviving two surviving long term survivors 2 53 associated injuries nonsurvivors 2 89 \( ns \) significant difference noted number location associated injuries survivors nonsurvivors
selective monitoring patients suspected blunt cardiac injury blunt chest trauma result cardiac injury consequent , valve malfunction , frank rupture typically , patients blunt chest trauma suspected cardiac injury required cardiac monitoring 48 72 hours predicting patients blunt chest trauma risk cardiac complications would obviate many patient hours monitoring intensive care unit series examines sensitivity two dimensional surface echocardiography predicting cardiac complications 24 month period , 115 patients admitted blunt chest trauma prospectively evaluated cardiac injury admission electrocardiograms , serial creatine kinase isoenzyme studies , two dimensional echocardiography thirty one patients \( 27 \) abnormal two dimensional echocardiograms 8 \( 25 8 \) patients , cardiac complications requiring treatment developed eighty four patients \( 73 \) normal two dimensional echocardiograms , cardiac complication requiring treatment developed 1 \( 1 2 \) 9 patients required treatment cardiac complications , 3 normal admission electrocardiograms 1 elevated levels myocardial specific isoenzymes creatine kinase believe two dimensional echocardiography sensitive test evaluating cardiac injury resulting blunt chest trauma helpful selecting patients require monitoring intensive care unit
mortality following hip fracture implementation prospective payment system recent studies patients hip fractures two hospitals suggested marked reduction length stay occurred following implementation medicare prospective payment system \( pps \) resulted decreased quality care patients assess whether change influenced mortality , studied patients hip fractures aged 65 years older 20 sample michigan medicare enrollees patients 2 years preceding \( october 1981 september 1983 \) 2 years following \( october 1984 september 1986 \) implementation pps although demographic characteristics patients hip fractures change pps , mean length stay \( 95 confidence interval \) decreased 4 4 \( 4 1 4 7 \) days however , mortality year following fracture change 23 2 pps , 23 7 pps rate difference 0 5 \( 2 0 3 0 \) finding consistently present within subgroups defined patient demographic characteristics furthermore , analysis restricted patients treated hospitals greatest reduction average length stay following pps \( 7 5 days , 35 \) , significant change 1 year mortality patients enrolled medicaid nursing home time fracture , increase rate nursing home residence 1 year fracture thus , findings population based study suggest key outcomes mortality nursing home residence affected implementation pps
long term therapeutic use benzodiazepines effects abrupt discontinuation published erratum appears arch psychiatry 1991 jan 48 \( 1 \) 51 compared effect abrupt discontinuation therapeutic doses short half life long half life benzodiazepines 57 benzodiazepine dependent patients \( daily use , greater 1 year \) despite use mean daily dose 14 1 mg diazepam equivalents , notable residual symptoms anxiety depression present intake \( hamilton rating scale anxiety score , 17 0 hamilton rating scale depression score , 14 0 \) benzodiazepine intake stabilized 3 weeks double blind assignment placebo \( n 47 \) , continued benzodiazepine use \( n 10 \) clinical assessments performed daily , including benzodiazepine plasma levels depending outcome criteria used , 58 100 patients judged experienced withdrawal reaction , peak severity 2 days short half life 4 7 days long half life benzodiazepines relapse onto benzodiazepines occurred 27 patients receiving long half life benzodiazepines 57 patients receiving short half life benzodiazepines baseline predictors relapse diagnoses , higher benzodiazepine dose , higher score short half life higher daily doses associated greater withdrawal severity , personality traits , dependency , less education higher baseline levels depressive symptoms patients able remain free benzodiazepines least 5 weeks obtained lower levels anxiety benzodiazepine discontinuation results provide detailed picture symptoms , time course , multidimensional determinants benzodiazepine withdrawal syndrome
long term therapeutic use benzodiazepines ii effects gradual taper compared effect withdrawal severity acute outcome 25 per week taper short half life vs long half life benzodiazepines 63 benzodiazepine dependent patients patients unable tolerate taper permitted slow taper rate ninety percent patients experienced withdrawal reaction , rarely mild moderate nonetheless , 32 long half life 42 short half life benzodiazepine treated patients unable achieve drug free state difficulty experienced last half taper baseline personality , high , female sex , mild moderate alcohol use found significant predictors withdrawal severity daily benzodiazepine dose benzodiazepine half life findings suggest personality factors contribute significantly patient 's difficulties gradual benzodiazepine discontinuation therapeutic doses benzodiazepines
arterial proximity valid indication arteriography penetrating extremity trauma \? prospective analysis three hundred seventy three patients penetrating extremity injury studied assess yield arteriography patients underwent arteriography following present , history hemorrhage hypotension , fracture , hematoma , decreased capillary , major soft tissue injury , nerve pulse deficit absence findings , arteriography performed injury proximity major neurovascular bundle 216 patients , arteriography performed abnormal finding noted sixty five injuries identified , 19 requiring intervention proximity indication arteriography 157 patients seventeen injuries identified , one required repair penetrating extremity trauma , need arteriography based clinical findings use arteriography screen arterial injury proximity alone indication rarely identifies significant injury abandoned
analysis potential risks associated 7 5 sodium chloride resuscitation traumatic shock published erratum appears arch 1991 jan 126 \( 1 \) 43 evaluated potential side effects rapidly 250 ml either 7 5 sodium chloride 7 5 sodium chloride per 6 dextran 70 , using ringer 's control , 106 critically injured patients two prospective double blinded emergency department trials eight patients significant acidemia association infusion hypertonic solutions , eight infusion many factors could contributed acidemia blood chemistry changes might associated hypertonic solutions , hypernatremia , made insignificant factors , high blood alcohol levels concomitant administration sodium bicarbonate cases central pontine bleeding potentiated difficulty blood reactions occurred setting limited volume resuscitation , solutions likely favorable risk benefit ratio
laboratory tests follow treated alcoholics often testing repeated \? study group consisted 60 male 13 female alcohol dependent employed patients participated inpatient treatment alcoholism followed bimonthly eight months treatment period results ggt , , , mcv combination ggt mcv studied respect effect taking tests \( eight months \) , twice \( every four months \) four times \( bimonthly \) according definition , treatment outcome good laboratory test values within normal range whole follow period differences observed outcome \( eight months treatment \) small whether one took tests end follow period four \( e bimonthly \) times nevertheless , differences laboratory markers get accurate picture drinking follow period one repeat test bimonthly , every four months ggt \( combined ggt mcv \) , eight months mcv time course relapses important study frequent test taking also indicated
serum urinary beta hexosaminidase markers heavy drinking serum urinary beta hexosaminidase \( shex uhex \) determined 32 alcoholic men admitted inpatient detoxification treatment seven days , 27 admission shex increased 68 8 uhex 81 3 seven days abstinence corresponding percentages 37 5 \( shex \) 71 9 \( uhex \) treatment shex decreased significantly uhex admission treatment uhex correlated positively shex \( r 0 54 p less 0 01 \) results suggest uhex may sensitive marker heavy drinking shex furthermore uhex stays longer elevated shex
estimation amount alcohol ingested single blood alcohol concentration capillary blood alcohol concentrations \( bal \) measured 22 young adult male volunteers received three different treatments alcohol \( total n 66 \) related quantitatively dose alcohol ingested linear regression reasonably homogeneous variances found bal 2 , 2 5 3 hr divided person 's body weight plotted versus g kg \( w \) dose error analysis indicated least error predicted dose \( w \) obtained bal measured 2 hr post dosing latter case mean absolute error 6 23 , 59 errors within 5 88 errors within 10
ethanol inducible cytochrome p 450 activity increase acetaldehyde bound microsomes chronic administration acetaldehyde ethanol chronic ethanol consumption results acetaldehyde adduct formation proteins haemoglobin liver proteins vivo purpose study binding acetaldehyde liver microsomal proteins , site ethanol oxidation via cytochrome p 450 \( especially p 450 ii e1 \) , chronic administration ethanol acetaldehyde 21 days rats liver microsomal oxidation 1 butanol ethanol inducible p 450 also examined acetaldehyde bound liver microsomal proteins higher ethanol fed rats compared acetaldehyde treated rats \( 0 vs 0 413 nmol mg protein respectively \) n butanol liver microsomes increased \( 136 \) ethanol fed rats vs controls , whereas acetaldehyde treated rats increase much lower \( 27 \) however , last group , significant negative relationship quantity acetaldehyde bound microsomal proteins catalyzed transformation butanol liver microsomes demonstrated \( r 0 79 , p less 0 01 \) results suggest proteins liver microsomes target acetaldehyde binding ethanol oxidation adduct formation could impair oxidative properties alcohol inducible cytochrome p 450
alcohol use depressive symptoms among mexican americans non hispanic whites alcohol use associated depressive symptoms several studies using data community survey , study examined whether relationship \( \) accounted ethnic sociodemographic differences among persons engage various levels alcohol use \( b \) differs mexican americans \( n \) non hispanic whites \( n \) using large quantities alcohol , , among men , daily drinking , associated depressed mood associations similar mexican americans non hispanic whites , associations quantity frequency depression independent among women , cultural demographic characteristics high quantity drinkers abstainers \( tended mexican americans \) accounted association alcohol use depression among men , suggestion unmarried status mediated association alcohol quantity depression people drank greater quantities alcohol per occasion reported somatic depressive symptoms , frequent male drinkers reported types depressive symptoms
prospective evaluation gastric emptying self patient authors prospectively studied effect gastric emptying \( ge \) activated charcoal \( ac \) upon clinical outcome acutely self patients presumed overdose patients \( n \) treated using alternate day protocol based 10 question cognitive function examination presenting vital sign parameters asymptomatic patients \( n \) receive ge ac administered asymptomatic patients even days ge remaining symptomatic patients \( n \) performed even days emptying days , alert patients induced emesis patients received gastric lavage ac therapy followed gastric emptying days , symptomatic patients treated ac clinical deterioration occurred asymptomatic patients treated without ge ac use alter outcome measures asymptomatic patients ge procedures symptomatic patients significantly alter length stay emergency department , mean length time intubated , mean length stay intensive care unit gastric lavage associated higher prevalence medical intensive care unit admissions \( p 0001 \) aspiration pneumonia \( p 0001 \) data support management selected acute overdose patients without ge fail show benefit ac asymptomatic overdose patients
controlling severity injuries emergency medicine research injury severity score \( iss \) age used retrospectively control trauma severity control variables revised trauma score \( rts \) triss method \( estimates probability survival patient \) additionally require values blood pressure , glasgow coma scale , respiratory rate , recorded emergency department authors question rts , iss , iss age , probability survival calculated using triss method used control severity injuries trauma research relations predictor variables \( 1 \) survival hospital discharge , \( 2 \) hospital length stay survivors , \( 3 \) length icu stay compared cause injury penetrating , motor vehicle accident , low fall , blunt data collected 12 months 2 , consecutive adult patients died stayed five three trauma centers 48 hours survival , false negative rates probability survival calculated using triss method approximately half iss age variable adequately explained survival among low falls combinations iss , rts , age explained variation lengths hospital stay among survivors , iss explained variation lengths intensive care unit \( icu \) stay researchers consider iss rts age control severity lengths hospital icu stay studied triss method used studies survival cases , rts requires data collection emergency department must calculated
whole bowel irrigation cocaine body new approach common problem gastrointestinal drug common problem many major cities though majority cases never require medical attention , body frequently presents life threatening symptoms intoxication , including seizures cardiorespiratory collapse , well mechanical obstruction ingested drug risk asymptomatic may vary materials , remains unknown lack controlled studies , variations materials clinical outcomes prevented formulation consistent management strategy current recommendations asymptomatic body vary immediate surgical removal , use , observation authors present first reported case asymptomatic cocaine body treated whole bowel irrigation polyethylene glycol electrolyte lavage solution strategy safe , well tolerated , resulted rapid elimination drug gastrointestinal tract , facilitated assessment contrast radiography potential benefits limitations use whole bowel irrigation difficult problem discussed
spectrum emergency care trauma central wisconsin among dangerous occupations united states injuries occur , emergency department \( ed \) primary source care 2 year period , emergency medicine section clinic st 's hospital , cared victims trauma although 11 initially admitted 4 later treated , remainder received care solely ed unlike occupational injuries , people age may involved injuries 27 series less 18 years age 5 65 years older half injuries mechanical devices , including remainder animals , falls , exposure although several different types injuries occurred , common diagnoses soft tissue injuries fractures common procedure diagnostic radiography followed wound fracture care ed rural setting prepared deal trauma
methylene chloride report five exposures two deaths five patients presented emergency department \( ed \) following exposure space methylene chloride \( \) , used removing two workers three involved two complained dizziness mild nausea , subsequently discharged ed one asymptomatic worker 1 arrived cardiac arrest eventually died ed despite resuscitation efforts worker 2 also presented ed cardiac arrest , successfully resuscitated pulse blood pressure however , never regained consciousness spontaneous , died fourth day interest worker 2 's level increased 2 8 9 hours following admission , despite administration 40 50 oxygen endotracheal tube among conclusions drawn \( 1 \) cause death patients carbon monoxide poisoning , solvent induced \( 2 \) levels may continue rise following cessation exposure , despite administration high flow oxygen \( 3 \) easily become victims proper protective worn
influence prophylactic orthoses abdominal strength low back injury workplace study designed determine effect multimodal intervention prevention back injury , evaluate adverse side effects using lumbosacral workplace subjects 90 male workers randomly selected 800 employees distribution center subjects assigned three groups true controls , back school , brace orthoses back school back school plus wearing custom lumbosacral orthosis comparisons pre testing 6 month follow post testing abdominal strength , cognitive data , work injury incidence use health care services evaluated controls training group showed changes strength lost time orthoses training group showed changes strength accident rate however , showed substantially less lost time study supports concept using education prophylactic bracing prevent back injury reduce time loss appears use intermittent prophylactic bracing adverse affects abdominal muscle strength may contribute decreased lost time work injuries
ureteric substitution bladder flap 1986 1989 , 12 patients underwent ureteric substitution bladder flap institute indications ureteric injury following hysterectomy , difficult forceps delivery , difficult ureterolithotomy , ureteric strictures caused basket previous ureteric surgery , tuberculosis , retroperitoneal fibrosis post ureteric fistula 2 patients solitary kidney 2 acute renal failure double j stenting carried 11 patients stent removed 3 6 weeks post operatively good results , morbidity mortality , achieved 1 patient simple silastic stent migrated pelvis required open surgery remove attribute success tension free anastomosis , wide based posterior flap preservation vascular supply , use double j stent suture material
stress surgeons sample 1000 members association surgeons great postal questionnaire relating occupational stressors , type coronary prone behaviour mental health six hundred seventy two \( 67 per cent \) forms returned major individual stressors \( 1 \) interference job personal life , \( 2 \) general administration , \( 3 \) number patients clinics type behaviour similar professional groups surgeons showed mean scores significantly higher general population two subscales mental health index \( free floating anxiety anxiety \) findings female surgeons \( 2 per cent \) similar men exhibit raised free floating anxiety levels
physician 's role physicians play important role society 's response alcohol problems diagnosis , alcohol problems among patients frequently overlooked physicians routinely ask patients alcohol intake light evidence effectiveness brief interventions , especially heavy drinking patients , physicians' treatment efforts focused direction patients alcohol dependent might best treated research contributions physicians concentrated topics physician input needed longitudinal studies health consequences , factors contributing mortality health service costs , biochemical markers alcohol use basic pharmacology strong evidence links population alcohol consumption levels overall harm therefore , prevention efforts aimed population well people may risk physicians contribute efforts influencing public policy setting healthy examples alcohol use
role medical schools prevention alcohol related problems agreement physicians play major role prevention alcohol problems among patients medical schools prepare physicians role teaching three major subject areas knowledge , attitudes clinical skills despite agreement high prevalence alcohol problems clinical populations , medical school coverage problems proportional importance barriers adequate coverage alcohol problems traditional attitudes , confusion whether problems medical lack adequate faculty role models problems could training faculty members , establishment substance abuse centres university medical schools , integration alcohol related material relevant topics departments inclusion alcohol related questions medical qualifying
spectrum drinkers intervention opportunities adults north america either light drinkers abstainers , alcohol cause problems however , small often highly visible minority approximately 5 adult population show major symptoms alcohol dependence , sizable group 20 population , particularly young men , drinking risk levels encountered problems related alcohol use traditionally , physicians' efforts focused diagnosing treating patients substantial history alcohol dependence , relatively little attention given early intervention problem drinkers , identifying patients present primary care settings alcohol related morbidity accidental injury recent evidence indicates early intervention primary care physicians effective strategy reducing alcohol problems among patients
early identification alcohol problems high proportion patients seen clinical practice underlying alcohol problem often difficult detect , failure make diagnosis may result unnecessary investigations inappropriate treatment furthermore , good evidence effectiveness brief intervention problem drinking still early stage several questionnaires procedures based clinical examination findings laboratory tests available help early diagnosis incorporated standard medical assessment form basis screening programs health risk factors
brief intervention strategies harmful drinkers new directions medical education recent advances technology behavioural interventions harmful drinkers created new role clinical practice new challenges medical education several reports expert recommended new initiatives secondary prevention alcohol problems physician based interventions primary care level conceptual scientific bases recommendations discussed terms recent studies harmful hazardous drinkers behavioural principles thought account effectiveness brief interventions explained despite promising developments , difficulties inherent introduction new technologies , especially behavioural technologies , medical practice major challenge medical education development academic programs skills secondary prevention also deal physicians behavioural practitioners
preventing alcohol problems survey canadian medical schools preparation national conference medical education prevention alcohol problems , survey conference participants conducted participants undergraduate representatives canadian medical school representatives 11 provincial alcohol drug agencies agreement physicians medical schools important roles prevention treatment alcohol problems , traditional medical roles seen important current training variable seen inadequate , time devoted treatment prevention correct situation , renewed priorities faculty needed respondents felt uniform standards assessing undergraduate skills dealing alcohol problems provincial alcohol drug agencies medical education prevention treatment alcohol problems
development medical education alcohol drug related problems university toronto medical education alcohol drug related problems university toronto undergraduate , residency programs , result since university addiction research foundation ontario undergraduate core , developed early 1970s , offered year 2 supplemented , comprehensive clinics undergraduate program rated highly students since 1978 , completed core program residency training started 1974 available lasting 1 12 months internal medicine , psychiatry , family community medicine date , 370 residents completed one 129 completed programs concerned alcohol drug related topics , additional 13 research despite progress , still need improve expand undergraduate residency programs develop effective program continuing medical education goals ensure , far possible , medical graduates university toronto knowledge , attitudes , skills needed contribute effectively prevention treatment alcohol drug related problems chosen field practice avoid problems personal use alcohol drugs
medical education alcohol drug abuse united states initiatives individuals , private led improvements united states medical education dealing alcohol drug related problems progress made , particularly past 5 years , developing new medical school faculty development greater activity national professional organizations helped raise priority training alcohol drug related areas undergraduate medical education example , project \( alcohol drug education physician training primary care \) brown university , island , described importance positive motivated faculty role models skills training emphasized
continuous suprascapular nerve block analgesia scapular fracture fracture scapular uncommon painful case described comminuted scapular fracture treated continuous suprascapular nerve block patient supine epidural needle directed towards scapular notch via superior approach epidural catheter placed notch believed identified repeat injections 10 ml bupivacaine 0 25 per cent 1 200 , 000 epinephrine provided analgesia within minutes duration 8 10 hr injection 10 ml radio dye demonstrated catheter lateral scapular notch however , dye dispersed throughout fossa including scapular notch thus blocking suprascapular nerve case demonstrates continuous suprascapular nerve block performed five days location scapular notch less important previously thought
treatment nonunion fractures knee long stem total knee arthroplasty retrospective study ten patients nonunions knee treated long stem total knee arthroplasty performed average age patients 76 years old , average follow 36 months nonunions present average 36 months six patients series prior total knee arthroplasty clinical union achieved ten patients patients improved ambulatory status range motion improved average preoperative range 40 degrees average postoperative range 85 degrees complications occurred three ten patients , one postoperative infection surgical techniques described aid treatment difficult nonunion fragments
latissimus dorsi musculocutaneous flap extremity reconstruction orthopedic surgery latissimus dorsi transferred pedicle flap ten patients free vascular flap ten others extremity reconstruction group comprised ten patients transfer used solely cover skin soft tissue defect although partial necrosis transferred skin one patient , remaining nine patients obtained complete coverage without reconstructive surgery group ii comprised five patients transfer latissimus dorsi performed active flexion extension elbow abduction shoulder postoperatively , muscle strength obtained classified grades 0 5 according muscle testing method three patients obtained muscle strength grade 3 , two obtained grade 2 group iii comprised five patients brachial plexus palsy high dose irradiation coverage skin soft tissue performed brachial plexus palsy free tissue bed tissue postoperatively , sensory motor disturbances four five patients
hypophosphatemia incidence , etiology , prevention trauma patient hypophosphatemia associated number undesirable physiologic consequences reported occur frequently trauma patients studied patients immediate posttraumatic period document \) decrease serum p , b \) renal p excretion , c \) response prophylactic administration group 1 \( n 12 \) group 2 \( n 10 \) patients , measured serum p , creatinine , ionized ca , urinary p excretion , creatinine clearance daily first 3 4 days postinjury patients group 2 also received 0 5 mmol kg day first 48 h admission group 1 patients exhibited significant \( p less 05 \) decrease serum p first 24 h \( 1 00 0 30 0 75 0 23 mmol l \) contrast , group 2 patients demonstrate decrease serum p urinary p excretion group 1 accounts observed decrease serum p results study show immediate posttraumatic period associated decrease serum p massive urinary p excretion also showed prophylactic administration 0 5 mmol kg day prevents serum p decrease
acute intoxication acute alcohol intoxication commonly encountered clinical presentation emergency medicine role considered many emergency department presentations , specifically major minor trauma , gastrointestinal , metabolic , neurologic , psychiatric disorders differential diagnosis change mental status must considered intoxicated patients management intoxicated patients generally supportive although complications chronic alcoholism considered management consist correction complications resultant intoxication , well observation provision safe environment patient recovery phase acute intoxication
alcohol withdrawal syndromes current studies begun elucidate pathophysiology alcoholism withdrawal syndrome newer benzodiazepines , beta blockers , alpha agonists , calcium channel blocking agents , alone combination , studied recently alcohol withdrawal article discusses evaluation therapy delirium , major alcohol withdrawal , mild alcohol withdrawal , adjunct therapy , admission criteria
alcoholism society problems alcohol abuse society emergency department experience cost society measured social , medical , occupational , legal effects exceedingly high probably underestimated emergency physicians opportunity cycle must learn role process
methanol , ethylene glycol , alcoholic patient , attempt maintain altered mental status , may ethanol substitutes containing methanol , ethylene glycol , subsequent clinical presentation emergency department highly variable depends ethanol substitute ingested , time since ingestion , concomitant ethanol abuse article describes clinical features intoxication ethanol substitutes early diagnosis therapeutic intervention may prevent irreversible sequelae rationale treatment interventions discussed
alcohol trauma alcohol related trauma essential public perception low risk detection alcohol precipitated violence addressed current legislation aimed decreasing availability alcohol \( e g , adjusting legal drinking age , decreasing serum alcohol intoxication limit , restricting alcoholic beverages public events \) , increasing detection \( e g , greater driver surveillance , increased number personnel \) , strengthening legal alcohol related , rehabilitative therapy physicians alcohol trauma cycle unfortunately , notably poor detecting patient alcohol related injury moreover , physicians infrequently refer patients facilities personnel expert alcohol detoxification rehabilitation positively impacted physicians sensitive medical social patterns alcohol abuse
dealing geographic variations use hospitals experience medical assessment foundation orthopaedic study group physicians organized medical assessment foundation deal problem variations rates hospitalization orthopaedic conditions five musculoskeletal injuries five orthopaedic procedures selected study variation decision making least fractures ankle fractures hip greatest fractures forearm , derangement knee , lumbosacral rates area tended consistently high low treatments major reasons variations appeared related lack agreement optimum treatment feedback data physicians variations patterns practice reduced variations
unexpected geographic variation rates hospitalization patients fracture hip medicare enrollees united states use data hospitals year 1985 , calculated rates hospitalization fracture hip , state residence , enrollees medicare sixty five years old older adjusted age race rate fracture hip highest south lowest , especially women cause difference known
replantation distal part leg successfully five legs five patients followed patients two years \( average , six years three months \) although patients found impossible run joint contractures , muscle weakness , deformities foot , patients could perform activities without difficulty none important pain intolerance cold , satisfied results replantation
osteogenic response distant skeletal injury tested hypothesis one bone skeleton injured , others experience osteogenic response although similar related phenomena observed previously , purposes study determine response reproducible , characterize terms magnitude duration , show related type injury sustained obtain information , model used intramedullary nail implanted femur standard closed fracture subsequently produced osteogenic response measured eight four nine week old male sprague dawley rats divided seven groups twelve animals groups ii consisted control animals injury produced group iii rats , cortical intercondylar notch fossa right femur performed , without intramedullary nailing groups iv vii , half group received intramedullary nails , half intramedullary nailing done closed transverse diaphyseal fracture produced two different fluorochrome labels , rates mineral measured left right animals labeling periods differed group designed determine peak response occurred , long lasted , whether aging course experiment affected response
stimuli alter patients spinal cord injury studies two quadriplegic patients developed severe hyponatremia episodes acute respiratory distress performed determine whether differences vasopressin release could identified patients compared quadriplegic subjects previously studied similar manner patients clinically stable , signs symptoms respiratory distress , studies performed however , exhibited evidence hemodynamic instability sitting posture linear regression analysis plasma vasopressin plasma osmolality \( \) relationship infusions 0 85 sodium chloride showed significant differences either slope \( sensitivity \) intercept \( osmotic threshold \) relationship compared quadriplegic subjects patients supine contrast , patients studied sitting posture marked shift relationship indicative increased sensitivity reduced osmotic threshold vasopressin release slopes relationships 0 249 0 178 two patients , respectively , compared 0 0 03 \( sd \) previously studied quadriplegic subjects oral water loading studies performed one patient revealed marked impairment urine ability free water clearance sitting posture compared observations similar studies performed patient supine impairment renal water excretion could attributed effect vasopressin , reduced levels water loading studies shown hemodynamic stress related autonomic dysfunction quadriplegic patients may result marked alteration vasopressin release severely affected individuals altered , may also associated vasopressin independent impairment renal water excretion sitting posture , may predisposing factor development hyponatremia , especially presence potent stimuli
venom study iii safety venom immunotherapy one thousand four hundred ten \( 44 \) subjects venom study accepted venom immunotherapy \( \) time maintenance averaged 95 days , largest number achieved maintenance \( 147 subjects , 10 4 \) day 56 ninety two percent treated subjects achieved maintenance , 84 continued therapy , subjects \( 91 \) study terminated one hundred seventy one subjects \( 12 \) experienced treatment systemic reactions \( srs \) incidence pruritus angioedema urticaria similar mild , moderate , severe srs sr severity correlate severity recent entry venom study , severe historical sr , severe sr venom skin tests , total dose venom , degree skin test reactivity , lowest concentration yielding positive skin test srs occurred 1 50 micrograms maintenance likely produce sr study , largest kind use standardized extracts , demonstrates \( 1 \) good compliance , \( 2 \) various historical diagnostic criteria predict srs , \( 3 \) srs likely occur 1 50 micrograms maintenance , \( 4 \) likely produce sr , \( 5 \) relatively safe
unusual type foreign body maxillary sinus broken end presenting foreign body nasopharynx right maxillary sinus 19 year old papua new described types foreign bodies mechanisms introduction site summarized
field performance 5000 comparison blood breath alcohol results wisconsin drivers 5000 blood alcohol results drivers arrested operating motor vehicle intoxicated related compared two year period three hundred ninety five pairs results studied breath blood alcohol specimens study collected within 1 h mean blood alcohol concentration obtained 0 180 g dl , range zero 0 338 g dl comparison , mean 5000 result 0 16 g 210 l range zero 0 32 g 210 l compared blood alcohol result , 5000 results lower 0 01 g 210 l 67 time , within 0 01 g 210 l 31 time , higher 0 01 g 210 l 2 time
fatal ethanol intoxication household products intended ingestion fatal acute ethanol intoxication frequently encountered medicolegal practice although vast majority acute ethanol toxicity deaths follow ingestion conventional alcoholic beverages , ethanol obtained variety commercial products , often contain high levels ethyl alcohol designed consumption products may easily limitations restrict availability early morning hours several acute ethanol fatalities encountered new mexico directly related consumption non beverage ethanol containing products , occurring times alcoholic beverage restricted despite fact manufacturers include compounds products ingestion , policy apparently little individuals source ethanol conventional beverages available products consumed fatalities also contained compounds would toxic much greater concentrations , effects comparison direct toxic effect ethanol investigation scene awareness alcohol containing products abused essential detecting ethanol sources
tardive dyskinesia informed consent antipsychotic medication forensic psychiatric hospital paper addresses informed consent antipsychotic medication forensic psychiatric hospital ways unique setting forensic psychiatric hospital upon three components informed consent information , , competency explored special attention given risk benefit ratio receiving antipsychotic medication terms freedom movement , , effects tardive dyskinesia , freedom space , , release forensic psychiatric facility
incised wound breast misinterpreted bite injury bite injuries upon homicide victims often initially identified forensic pathologist course autopsy examination following recognition , injury photographs site referred forensic examination , characterization , subsequent comparison suspect 's dentition however , pathologist injury caused another mechanism human bite , potentially dental consultant , since relatively regularly examine traumatic injuries arising bites illustrate event , case presented involving incised wound breast , originally identified bite wound detailed examination two confirmed wound caused human teeth , , related bite injury specific individual bite injury interpretation represented scientific evidence implicating suspect subsequent trial capital later examination tissues photographs forensic pathologist another dental consultant revealed injury due human dentition , rather resulted sharp instrument conducted unique experiment injury prove causation information presented suspect 's trial resulted charges
screening psychiatric substance abuse disorders clinical practice psychiatric disorders , particularly depression alcohol abuse , represent large burden illness society many individuals disorders receive care health care providers mental health specialists evidence non psychiatric physicians frequently recognize disorders patients screening questionnaires introduced improve detection patients several studies found screening questionnaires increase detection rates , important impact patient outcomes demonstrated review article outlines several reasons difficult improvement patient outcomes inadequate study design , insufficient physician education , psychiatric medical conditions , treatment guidelines practical use current psychiatric screening questionnaires key areas investigation considered
physician 's role injury prevention beyond u preventive services task force report injuries prevention received little attention medical community , despite fact injuries leading cause premature death however , much done reduce number severity injuries , practicing physician important role play process report outlines u preventive services task force report recommendations prevention strategies reduce injuries define broader role physician prevention injuries extends beyond office based practice screening counseling proven effectiveness certain situations , interventions passive automatic action , air bags , proven effective long term solutions reduce number severity injuries author outlines provides examples seven areas physicians major impact either directly implementing effective injury control strategies treatment , education , screening , hazard identification , research , , policy making using approaches , physicians play truly effective role reducing burden injuries patients
nicotine dependence preventable risk factor diseases nicotine meets critical criteria addictive drug furthermore , evidence would widespread compulsive use tobacco without nicotine findings led consideration cigarette contaminated vehicle addictive drug \( nicotine \) nevertheless , nicotine may also used therapeutically reduce exposure carcinogens tobacco nicotine replacement useful adjunct treating tobacco dependence example , nicotine replacement form resin \( \) alleviate physically based signs symptoms tobacco abstinence fact form nicotine replacement attractive non users tobacco opened use nicotine therapeutic modality , permitting hope eliminating tobacco dependence
facial trauma women resulting violence men 2 1 2 year period , women facial injuries treated 8 2 , injury related form violence exerted man cases individual known , usually husband \( almost 67 \) assault consisted beating hands 70 cases fracture mandible common injury also 62 cases home accidents
conventional radiographic computed tomographic findings cases fracture mandibular condylar process total 40 patients 46 fractures mandibular condylar process examined average 47 months injury conventional radiologic examination consisted panoramic radiography lateral transcranial view fracture mouth open mouth closed positions sixteen patients 21 fractures condylar process examined additionally computed tomography \( ct \) temporomandibular joint problems sagittal coronal projection computed tomography revealed bony changes fractured mandibular condyle position mandibular fossa conventional radiographic examinations furthermore , results showed disturbances position function articular disc may common earlier anticipated , suggesting frequent use ct examinations evaluate temporomandibular joint changes condylar process fractures
poly \( l \) implants repair defects orbital floor animal study life long presence , orbital floor implants complications use mentioned literature , use material appears preferable repair orbital floor defects high molecular weight , polymerized poly \( l \) \( \) used repair orbital floor defects type goats artificial defect created bony floor reconstruction orbital floor carried using concave implant 0 4 mm thickness 3 , 6 , 12 , 19 , 26 , 52 , 78 weeks postoperatively , one goat killed microscopic examination showed full encapsulation implant connective tissue 3 weeks 6 weeks , resorption remodeling bone points support implant could detected differentiation sinus orbital sides connective tissue capsule observed orbital side showed significantly dense capsule antral side , loose appearance 19 weeks , bony plate progressively formed , 78 weeks , new bone fully covered plate antral orbital side inflammation rejection implant seen
diagnostic peritoneal lavage accuracy predicting necessary laparotomy following blunt penetrating trauma purpose study evaluate ability diagnostic peritoneal lavage \( dpl \) predict intra abdominal injuries required surgical repair , retrospectively reviewed patients blunt penetrating abdominal trauma underwent initial dpl patients sustaining blunt trauma sensitivity 87 , specificity 97 , accuracy 95 , positive predictive value \( \) 85 , negative predictive value \( \) 97 initial dpl 336 patients penetrating trauma sensitivity 87 , specificity 89 , accuracy 89 , 75 , 95 utilizing final lavage results patients , dpl sensitivity 91 , specificity 94 , accuracy 93 , 80 , 98 predicting intra abdominal injury requiring surgical repair
major trauma outcome study establishing national norms trauma care major trauma outcome study \( \) retrospective descriptive study injury severity outcome coordinated american college committee trauma 1982 1987 , 139 north american hospitals submitted demographic , etiologic , injury severity , outcome data 80 , trauma patients motor vehicle related injuries frequent \( 34 7 \) twenty one per cent patients penetrating injuries overall mortality rate 9 0 mortality rate direct admissions strongly related presence serious head injury , 5 0 40 0 , head injuries less equal ais \( injury scale \) 3 greater equal ais 4 , respectively survival probability norms use revised trauma score , injury severity score , patient age , injury mechanism patients unexpected outcomes identified statistical comparisons actual expected numbers survivors made institution results provide description injury outcome support evaluation quality assurance activities
basophil severely burned patients thermal injury known induce dysregulation immune system however , precise mechanisms clarified investigated histamine release basophil granulocytes severely burned patients \( n 12 \) stimulation anti ige ca ionophore , respectively anti ige induced basophil histamine release patients reduced comparison healthy donors beginning day one postburn \( p b \) \( 5 0 2 3 vs 30 5 3 4 \) , ca ionophore induced release decreased day two p b basophils patients finally injuries showed poor responsiveness \( zero levels \) total time contrast , basophil surviving patients returned nearly normal levels \( fifth seventh week p b \) already second week p b significant difference histamine release survivors nonsurvivors e g , days 6 9 p b 23 7 4 0 vs 6 9 2 7 \( p less 0 005 \) ca ionophore stimulation altered basophil histamine release neither due diminished dose delayed time response stimuli due differences basophil counts cellular histamine content data indicate decrease basophil , may secondary altered signal transduction pathways severely burned patients correlates clinical outcome
studies b lymphocyte dysfunctions severely burned patients studied vitro functional parameters peripheral blood b lymphocytes severely burned patients \( n 10 burn injuries ranging 25 72 tbsa \) number b cells remained unchanged , b cell proliferation induced staphylococcus aureus strain cowan \( sac \) normal even enhanced early late phases postburn , showed marked suppression second fourth week similar pattern observed pokeweed mitogen \( \) sac stimulated synthesis immunoglobulin \( igm \) , whereas igg production decreased whole postburn period monitored cytokine \( interleukin 4 \) induced b cell activation indicated expression cd23 surface antigen impaired throughout second fifth week parallel , release proteolytic cleavage product represents b cell growth differentiation factor reduced data provide evidence activation , proliferation , differentiation processes b lymphocytes impaired severely burned patients , may contribute enhanced susceptibility infection sepsis
subxiphoid pericardial helpful selected cases small group patients sustain multiple penetrating injuries present haemodynamic changes , making difficult clinically exclude prove presence penetrating cardiac injury select group patients found subxiphoid pericardial extremely useful prove existence cardiac injury thereby prevent delay diagnosing injuries
bilateral sacroiliac joint fracture dislocation case report bilateral sacroiliac joint fracture dislocation sacrum displacement rare injury found four injuries previously reported literature nonoperative management case led complete functional return acceptable alignment
bilateral simultaneous fractures femoral neck case report case bilateral fractures femoral neck resulting high voltage electric injury reported surgeons caring patients electrical injuries must aware possibility injury well skeletal injuries may result muscle contraction falls related electric shock without injuries , diagnosis may delayed
organ injury scaling , ii pancreas , duodenum , small bowel , colon , rectum organ injury scaling \( \) committee american association surgery trauma \( \) charged injury severity scores individual organs facilitate clinical research first report \( 1 \) addressed 's spleen , liver , kidney following proposed 's pancreas \( table \) , duodenum \( table ii \) , small bowel \( table iii \) , colon \( table iv \) , rectum \( table v \) grading scheme anatomic description , 1 5 , representing least severe injury emphasize 's represent initial classification system must undergo continued refinement clinical experience
health locus control beliefs alcohol related factors may influence treatment outcomes treatment programs based treatment approach alcoholics exert internal control situations events affect since chronic alcohol use affects health individual , 's multidimensional health locus control scale administered 47 alcoholics treatment program population reflected higher belief health status control control chance powerful others however , results indicated recovering alcoholics powerful health orientation tended maintain membership longer alcoholics anonymous , would seek help sooner , would begin heavy drinking later age , would attempt formal treatment often
cranial \( ces \) use detoxification opiate dependent patients paper reviews scientific literature cranial \( ces \) non chemical means alleviate opiate withdrawal symptoms ces involves applying small amounts electrical stimulation electrodes applied skin surface paper summarizes major theories \( , endorphin , chinese acupuncture \) attempt explain ces may help alleviate drug withdrawal craving two studies reviewed show ces patients experienced severe withdrawal early part treatment comparison groups methadone patients studies show ces patients better methadone patients findings studies reviewed , however , limited low participation rates , high dropout rates , difficulties subjects , absence standardized procedures equipment evidence reviewed suggests ces promising line inquiry continued efforts develop ways opiate dependent individuals improved research designs , larger sample sizes , integrity data collection , improved data analysis needed future
case management addictions treatment need case management addictions treatment systems recognized least 10 years attention paid developing treatment component data available concerning implementation case management addictions , becoming apparent lack consensus concerning provide case management defined paper reviews sources variability case management services identified mental health field discusses implications development case management addictions programs
role buspirone management alcohol withdrawal preliminary investigation one hundred eighteen patients , 77 men 23 women ranging age 18 70 years age , admitted inpatient facility central new york administered buspirone hcl treatment alcohol withdrawal syndrome although one patient seizure , none subjects required buspirone hcl symptoms dizziness , nausea , headache , , , typical side effects described manufacturer one individuals given buspirone hcl alcohol detoxification completed phase treatment within six days manner effectively controlled withdrawal symptoms findings suggestive important role buspirone hcl detoxification alcohol dependent patient using pharmacologic agent traditional medications benzodiazepines , phenobarbital , beta blockers , magnesium sulphate , clonidine
effects fluoxetine overdose patient fluoxetine \( \) new antidepressant , first marketed united states january 1988 limited toxicologic information fluoxetine overdose available goal prospective multi center study develop toxicity profile initial signs symptoms observed fluoxetine overdose standardized data collection form used patients ingesting fluoxetine reported four centers information obtained included age , dose , co ingested drugs , presenting symptoms , vital signs , abnormalities lab values 127 cases acute fluoxetine overdose collected , 106 cases met criteria study , 69 106 ingested drugs , including ethanol 37 106 ingested fluoxetine alone latter group , amounts ingested ranged 20 1500 mg observed 48 6 \( 18 37 \) remained asymptomatic , 16 2 \( 7 37 \) , 24 3 \( 9 37 \) sinus tachycardia \( 100 beats per minute greater \) , 8 1 \( 3 37 \) diastolic pressure 100 mm hg data collection ongoing based upon initial experience , fluoxetine overdose appears relatively benign
screening three year experience poisonings results screening body fluids \( urine , blood gastric lavage \) pediatric patients analyzed period january 1985 december 1988 119 cases , approximately one half positive least one foreign substance one fifth cases , multiple substances detected commonly implicated drugs acting central nervous system including , tricyclic antidepressants , , benzodiazepines carbamazepine
salvage posterior failed initial repair pelvic fracture membranous urethral defects experience 20 salvage patients pelvic fracture membranous urethral defects failed previous delayed presented total 15 patients successfully managed 1 stage procedures , 14 1 pedicled island skin substitution staged skin tube performed 5 patients anastomosis could achieved either due long urethral defect anterior urethra elongation anastomosis free tension successful result achieved 19 20 patients \( 95 \) rationale procedure selection discussed
comorbidity mental disorders alcohol drug abuse results epidemiologic area \( \) study prevalence comorbid alcohol , drug , mental disorders us total community institutional population determined 20 , persons interviewed national institute mental health epidemiologic area program estimated us population lifetime prevalence rates 22 5 non substance abuse mental disorder , 13 5 alcohol dependence abuse , 6 1 drug dependence abuse among mental disorder , odds ratio addictive disorder 2 7 , lifetime prevalence 29 \( including overlapping 22 alcohol 15 another drug disorder \) either alcohol drug disorder , odds addictive disorder seven times greater rest population among alcohol disorder , 37 comorbid mental disorder highest mental addictive disorder comorbidity rate found drug \( alcohol \) disorders , among half \( 53 \) found mental disorder odds ratio 4 5 individuals treated specialty mental health addictive disorder clinical settings significantly higher odds comorbid disorders among institutional settings , comorbidity addictive severe mental disorders highest population , notably antisocial personality , schizophrenia , bipolar disorders
alcohol consumption college current use 10 year trends carefully executed study high response rate , random sample 10 undergraduate student body rural new england university surveyed subjects' use alcohol 1987 87 surveyed students returned questionnaires results compared similar studies conducted campus 1977 1983 daily almost daily use alcohol registered 4 7 respondents , represents continuing decrease daily consumption earlier studies one fourth sample indicated drinking one drink fewer per week , contrary common perception campus nevertheless , 25 5 recorded , 7 5 recorded vomiting drinking much 4 4 recorded , last week compared u population , alcohol consumption appears distributed college sample , still , drinking done one fifth groups
alcohol consumption problem drinking vietnam era veterans nonveterans relationship vietnam era status 13 indicators alcohol consumption problem drinking examined using data 1977 , 1983 1985 national health interview surveys conducted national center health statistics compared group nonveterans frequency matched age , greater proportion vietnam era veterans currently heavy drinkers smaller proportion abstainers , simultaneous adjustment seven demographic factors \( age , region u , , ethnicity , marital status , education income \) , white veterans white nonveterans demonstrate effect increasing increasing age across 3 interview years race groups proportion lifetime abstainers ranked increasing order follows white veterans , white nonveterans , non white veterans non white nonveterans ranking reversed lifetime heavy drinking nearly half white veterans report drinking heavily point lives among whites non whites , significantly greater proportion veterans nonveterans report alcohol related motor vehicle crashes violations
agreement two dietary methods measurement alcohol consumption study compares estimates alcohol consumption two dietary methods self reported diet diary quantitative food frequency questionnaire 1984 85 university michigan food frequency study , 228 black white , male female respondents , ages 23 51 years , kept diet covering 16 days 1 year period end year , respondents completed dietary quantity frequency questionnaire included alcoholic beverages two methods showed excellent agreement estimated group mean ethanol consumption good agreement ranking individual respondents respondents described alcohol consumption abstract terms questionnaire way consistent consumption recorded diary however , two methods showed poor moderate agreement classifying individuals infrequent , moderate heavier drinkers , suggesting classifications used cautiously results suggest general population studies dietary quantity frequency questionnaire diet diary covering several weeks measure moderate levels alcohol consumption similarly degree consistency suggests , moderate levels intake , measures alcohol consumption derived two methods equally valid
anomie , alcohol abuse alcohol consumption prospective analysis cross sectional 36 month prospective analyses relationships among anomie alcohol abuse alcohol consumption patterns provided little support anomie directly associated ethanol ingestion patterns sample male air traffic lack association observed self reported alcohol consumption , interview established alcohol abuse biochemical markers alcohol intake addition , anomie predictive change alcohol use abuse 36 months , controlling baseline levels alcohol use abuse relevant demographic factors measurement anomie alcohol use abuse , relative importance anomie various socioeconomic groups issues related prospective research topic discussed
alcoholic beverages using face face interview data sample young adults , study perceived risk alcohol consumption drinking driving , interactions police probability intoxication results show beer perceived less risky two risk situations , men drinkers particular ranking beer lower risk beverage intoxication considered , drinkers rank preferred beverage less risky alternative finally , analysis relative beer comparison reveals beer perceived less risky consensus vary significantly sex characteristics
alcohol time television alcohol analyzed 3 week composite sample time television programs fall 1986 approximately 64 195 episodes contained one appearances alcohol alcohol ingested 50 programs overall , 8 1 alcohol drinking acts per hour made television highest rate drinking acts per hour \( 10 0 \) followed situation \( 9 2 \) \( 7 4 \) \( 7 4 \) within category , evening 13 3 acts per hour drinking characters compared number attributes relevant role modeling regularly appearing characters likely drink characters drinking characters also tended high status , largely white , upper class professionals time trend analysis showed regular increase alcohol television 1976 1984 , reaching 10 2 acts 1984 1984 trend appears reverse
public support policy initiatives regulating alcohol use minnesota multi community survey public support policies control alcohol consumption surveyed seven minnesota communities total 438 women 383 men asked indicate level support nine different designed regulate alcohol general support policies , strongly related characteristics respondents type policy proposed women significantly supportive items men marriage , older age low alcohol consumption also associated support education status generally policies activities serve primarily protect received strongest support restrictions limiting less popular least support expressed increases alcohol measures would eliminate existing practice wine convenience stores majority respondents also indicated felt individual , opposed manufacturer , responsible problems associated alcohol focus intervention strategies shifting focus individual environmental regulatory control discussed
comparison familial male alcoholic patients without coexisting psychiatric disorder family history alcoholism presence additional psychiatric disorder male alcoholic patients associated earlier onset problem drinking , greater alcoholism severity poorer clinical outcomes assess relative contribution family history alone , sample 212 male alcoholics positive psychiatric disorder selected divided family history alcoholism \( fh \) family history alcoholism \( fh \) among first degree relatives although fh alcoholics reported younger age onset problem drinking greater severity alcohol related sequelae , differences extensive pronounced found previous study sample heterogeneous patients \( et al , 1987 \) bi dimensional alcoholism incorporating additional psychiatric diagnoses positive family history alcoholism suggested
relationship ethanol intake dsm iii r alcohol dependence purpose investigation quantify relationship ethanol consumption dsm iii r alcohol dependence using mathematical modeling techniques allowed control confounding assessment interaction although sex , education , ethnicity marital status identified actual logistic regression model , ethanol intake dependence association stronger among younger opposed older respondents 20 year , average log odds dependence increased 62 additional ethanol consumed daily , corresponding increase risk among 60 year 26 implications results discussed terms age differences drinking patterns differential social control drinking behavior separate analyses aggregates alcohol dependence criteria served outcome measures helped qualify interpretation overall ethanol intake dependence relationship need examine components global classifications alcohol dependence using better highlighted
mac scale normal population meaning false positives mac scale successful identifying alcoholics , studies clinical populations , often considered test predisposition alcoholism , however , holds mac scale assesses general personality trait characterized , , seeking present study examines distribution mac scale scores normal population tests correlates high mac scores alcohol related problems \( e g , arrest history \) sample consisted 1 , 117 men , participants normative aging study \( mean age 61 6 \) expected , heavier drinkers problem drinkers reported significantly higher mac scale scores drinkers however , without drinking problems mac scale scores nearly identical problem drinkers without arrest histories \( 23 19 23 42 , respectively \) , 36 sample without problem drinking arrest histories mac scale scores 24 , clinical indicator alcoholism , 32 scores 27 entire sample , 152 men mac scores 27 , 71 problems , either arrest drinking results interpreted supporting 's interpretation meaning mac scale general personality measure rather specific alcoholism instrument
effect gender subtype platelet mao alcoholism decreased platelet mao activity identified male alcoholics suggestions primarily true type 2 alcoholics defined criteria adoption study little information available regarding platelet mao activity female alcoholics study evaluated group 71 alcoholics receiving inpatient treatment , including 16 female alcoholics , platelet mao activity compared controls female alcoholic 's platelet mao significantly lower controls different activity levels male alcoholics among male alcoholics , type 1 type 2 subgroups lower controls type 2 levels differ type 1 levels thus , unable replicate gender subgroup low platelet mao specificity among alcoholics , find significant differences alcoholics controls
acute effects alcohol blood pressure young , normotensive men alcohol 's acute effects arterial blood pressure \( bp \) examined separate effects alcohol bp fluid volume expectancy , normotensive men divided three groups alcohol group received 1 0 ml absolute alcohol kg body weight expectancy group expected alcohol received tonic control group expected received tonic age , significant changes systolic bp found alcohol group , indicating changes systolic bp attributable subject expectancy volume fluid consumed expectancy control groups differ significant trend found systolic bp alcohol group , suggesting alcohol may acute biphasic effect systolic bp , initial decrease alcohol ingested followed increase toward basal level significant effects found diastolic bp
pulsed carbon dioxide laser ablation burned skin vitro vivo analysis pulsed lasers produce efficient precise tissue ablation limited residual thermal damage study , efficiency pulsed co2 laser ablation burned normal swine skin studied vitro mass loss technique ablation normal burned skin 2 , 2 , 416 j cm3 tissue ablated , respectively mean threshold radiant exposures normal skin 2 6 j cm2 3 0 j cm2 , respectively radiant exposures greater 19 j cm2 produced plasma , decreased efficiency laser ablation thus radiant exposures efficient ablation range 4 19 j cm2 , within radiant exposure range 20 40 microns tissue ablated per pulse also examined , gross histopathologic basis , vivo burn excision pulsed co2 laser laser allowed full thickness burns male hairless rats zone thermal damage approximately 85 microns fascia pulsed co2 laser ablate burn efficiently , precisely , may prove valuable excision burned necrotic tissue
knee analysis system reproducibility database development relatively new computerized system multidimensional analysis knee laxity therefore , purposes present investigation twofold 1 \) estimate reproducibility testing system ability obtain similar test values test subject within back back two test protocol 2 \) develop database normal values standard values suspected ligament injury compared reliably determine whether , fact , ligament injury occurred reproducibility phase study , 20 subjects tested two trials eight tests , yielding 20 separate test values per trial , accounting angle flexion plane force tested legs tested , providing n 40 test retest correlations two trials dependent tests indicated provided generally stable reproducible results normal value database phase study , 218 different subjects given one trial eight tests testing legs provided n greater 400 means standard deviations calculated test
neuroleptic malignant syndrome unique association tricyclic antidepressant report case neuroleptic malignant syndrome occurring patient receiving desipramine , tricyclic antidepressant , exposure neuroleptics case suggests syndrome may caused central imbalance norepinephrine dopamine , dopamine depletion alone
leakage fluid administered epidurally rats subcutaneous tissue epidural catheters implanted rats halothane nitrous oxide anaesthesia contrast medium \( iopamidol \) injected via catheter fluoroscopic control 24 48 h implantation 15 20 rats contrast could seen leaking epidural space , usually 25 microliters administered leakage associated diminished antinociceptive response morphine administered via catheter leakage decreased response morphine could largely prevented applying drop glue site entry catheter epidural space time catheter implantation investigators using epidurally cannulated rats document leakage occur results rats showing evidence leakage
children riding back pickup trucks neglected safety issue motor vehicle related trauma leading cause death children united states states pediatric restraint requirements passenger help prevent deaths injuries states , however , possess safety restrictions passengers back pickup trucks retrospective review medical records 40 month period revealed 40 patients whose injuries direct result passenger area \( bed \) pickup truck injuries pertinent data discussed representatives safety commission state surveyed specific safety responses revealed states district columbia child restraint requirements passenger , 34 states adult restraint , 17 states type restriction passengers riding back pickup trucks seventy one percent states pickup truck regulations include preschool age child data national traffic safety administration concerning pickup trucks passenger fatality presented discussed
hair burns children three children burn injuries caused home hair dryers described one patient injury believed accidental , two cases injuries caused lack prior experience hair burns initially led suspicion causes characteristics case aided final determination accidental vs injury cases prompted testing home hair dryers determine heat output highest heat settings , dryers rapidly generated temperatures excess 110 degrees c dryers turned , protective maintained sufficient temperatures cause full thickness burns 2 minutes cases results testing demonstrate hair dryers must added list known causes accidental burns children
simultaneous reconstruction cervical soft tissue esophagus gastro omental free flap microvascular transfer gastric tube omentum used simultaneously reconstruct cervical soft tissue esophageal defects five patients patients previous high dose radiation multiple flap reconstructions largest esophageal soft tissue defects 10 cm 160 cm2 , respectively wounds healed primarily except one fistula one death intraoperative stroke gastro omental flap useful cases reconstructive surgeon esophageal soft tissue defects particularly heavily irradiated patients reconstructive options
radial forearm flap reconstruction upper extremity radial forearm flap , owing good caliber arteries long length equally well distributed venous system , proved reliable place recognition reconstructive hand surgery , also emerged microvascular surgeon used 14 radial forearm flaps upper extremity reconstruction , present herein experience technique extracorporeal tissue transfer , published elsewhere , used two patients detailed four representative patients presented
calcium carbonate gel therapy hydrofluoric acid burns hand hydrofluoric acid used extensively industrial cleaning agent glass many workers injured cutaneous contact acid exposed skin surfaces , particularly hands hydrofluoric acid burns characterized delayed onset symptomatology skin ulceration , severe pain may extended duration treatment hydrofluoric acid burns traditionally consisted local infiltration intraarterial injections calcium solutions injections painful frequently require new treatment utilizing topical gel calcium carbonate described nine patients treated hydrofluoric acid burns hand calcium carbonate gel applied topically covered occlusive glove gel calcium carbonate tablets k affected fingers removed burn obvious gel put surgeon 's glove placed burned hand patient glove every 4 hours 24 hours first day , glove discontinued unless painful symptoms full range motion encouraged interval calcium carbonate gel technique successfully utilized nine patients need injection therapy patients , pain relief obtained within 4 hours treatment , progression skin ulceration reconstructive procedures required patient , one patient return full duty work within 1 week long term sequelae burns treated topical therapy , except one patient , presenting 24 hours burn , developed digital tip neuroma excised
controlled tissue expansion groin flap upper extremity reconstruction large upper extremity defect 8 year old girl expanded groin flap tissue expansion allowed complete coverage defect minimizing donor deformity expansion pedicled flaps offers alternative free flap reconstruction complex upper extremity defects especially valuable pediatric patient , donor site morbidity significant
role spinal flexibility back pain complaints within industry prospective study commonly used clinical measurements spinal flexibility sagittal frontal planes examined predictors future back pain reports within industry study sample consisted 3 , manufacturing employees examined 4 years reports back pain modified , reach , lateral bending measurements significantly associated risk future back pain reporting , trends present statistically significant relationship decreased flexibility reports current previous back problems however , differences flexibility subjects without history back problems small practical significance
loads lumbar spine work assembly line risks fatigue injuries vertebral bodies study performed attempt determine total spinal compressive load assembly line work find possible association many complaints back pain flexion analyzer used register trunk movements , analysis postures weights done video recordings load spine l3 level calculated biomechanical model , meant analysis static , symmetric postures lifting tasks maximum tests performed full work day peak load l3 l4 level lifting corresponded average 22 load test mean load work cycle n concluded many complaints back pain could attributed high peak loads , , large load doses , stress , low job satisfaction likely factors greater importance
traumatic disruptions thoracic aorta treatment outcome 27 patients admitted level trauma center acute disruption thoracic aorta , two patients died aortic repair one patient massive leakage aneurysm aortography died surgery patients suffered multiple injuries eighty three percent patients major operations addition aortic repair clamp technique used 18 patients \( 75 \) , two multiple tears aortic arch heparin coated shunts used five patients \( 20 8 \) , cardiopulmonary bypass performed one patient multiple tears three postoperative deaths related , cardiogenic shock , sepsis paraplegia developed three patients , two multiple aortic lesions necessitating longer ischemia time repair one patient complete neurologic deficit 1 year follow series , neither surgical procedure proved superior conclude clamp technique repair disrupted thoracic aorta may allow favorable outcome
pediatrician 's knowledge practices regarding parental use alcohol problems alcohol common united states frequently ignored physicians , particularly working children explored knowledge practices regarding parental use alcohol compared attributes family practitioners child health care providers attending three continuing medical education courses general pediatrics surveyed using closed item questionnaire one hundred ninety \( 69 \) participants responded , including 90 pediatricians 39 family practitioners forty six percent responding pediatricians , compared 90 family practitioners , stated ask problems alcohol taking routine family history thirty eight percent pediatricians knew frequency alcoholism , compared 47 , indicated include taking routine family history forty six percent pediatricians experienced problem alcohol family , compared 20 pediatricians without personal experience , routinely address issue alcohol use parents children similar analyses among family practitioners revealed significant differences conclude fewer half pediatricians ask problems alcohol taking family history likelihood asking problems influenced health care provider 's knowledge alcoholism , influenced provider 's personal family history problems alcohol important morbidity associated alcohol use families , intervention improve functioning adaptation child , training continuing medical education courses address issue
effects individually smoking cessation male blue collar workers adverse demonstrable health effects linked individual 's smoking shown 2 , american workers cessation routine examinations detect asbestosis intervention evaluated six 25 months later mailed questionnaire telephone non responders results compared yearly quit rates 2 5 percent 5 percent workers ex smokers initial examination 504 men responded mail , 29 8 percent quit smoking , 35 9 percent cut mean 28 13 cigarettes per day , 34 3 percent smoking subsequent follow one year showed 25 6 percent remained quit , 23 percent cut quit , overall quit rate 34 percent 101 non responders contacted telephone , 17 percent quit 53 percent reduced smoking samples , quit likely lower alveolar carbon monoxide \( coa \) levels , older , asbestosis responders mail age non responders smoked longer , higher prevalences asbestosis , emphysema , chronic bronchitis higher coa demonstration adverse personal effects smoking appear contributed quit rates reduced smoking rates 65 percent responding workers
injury disability matched men 's women 's sports eight matched men 's women 's teams studied prospectively one academic year determine incidence athletic injury resulting disability sports men women participated comparable manner chosen , , , , , indoor track , outdoor track , men \( 232 \) women \( 150 \) injured comparable rates , 42 percent versus 39 percent adjusted exposure time , seven eight sports continued show similar injury rates women , however , experienced 82 injuries per 100 person hours exposure compared 21 injuries men \( p 0001 \) disability greater women , 7 44 days per 100 person hours versus 1 15 days men \( p 0004 \) percent season lost injury also greater women types sites injury similar men women , strains accounting half injuries found evidence gender differences matched sports except , technically diverse events may accounted differences observed
coding external causes injury \( e codes \) maryland hospital discharges 1979 88 statewide study explore population examined trends hospital discharge e coding maryland 10 year period overall proportion e coded discharges increased 40 percent 1979 55 percent 1988 e coding lower severely injured , elderly , patients long hospital stays findings demonstrate e code reporting varies limited number data fields available coding discharge diagnoses universal , systematic reporting e codes hospital discharge data essential data provide critically needed information nonfatal injuries hospital discharge data contain separate fields e codes use codes , believe ,
potential pitfalls use medicare data epidemiologic research used medicare data bases us census data address two questions critical use medicare files epidemiologic research first , examined degree population enrolled medicare program similar elderly resident population united states , estimated us census found small differences total population estimates substantial differences age race second , found among medicare enrollees , physician claims identify small proportion hip fracture cases documented hospital discharge files proportion varies age , region , state within united states calculation rates based medicare hospital discharge data , probably hospital discharge data sets well , must take limitations account use available medicare data files overcome limitations
relationship oxygen dose angiogenesis induction irradiated tissue study accomplished irradiated rabbit model assess angiogenic properties normobaric oxygen hyperbaric oxygen compared air breathing controls results indicated normobaric oxygen angiogenic properties normal revascularization irradiated tissue air breathing controls \( p 0 89 \) hyperbaric oxygen demonstrated eight increased vascular density normobaric oxygen air breathing controls \( p 0 001 \) irradiated tissue develops hypoxic tissue spontaneously results failed demonstrate angiogenic effect normobaric oxygen suggested oxygen sense drug requiring hyperbaric pressures generate therapeutic effects chronically irradiated tissue
rapid visual peritoneal lavage fluid study hypothesis visual used rapidly precisely estimate erythrocyte count 1 5 dilutions simulated peritoneal lavage fluid population fifty four normal adult human subjects methods automated chamber rbc count often used fluid obtained peritoneal lavage patients abdominal trauma help determine need surgery unfortunately , method sometimes results excessive delay designed simple facilitated rapid direct visual comparison unknown samples known color standards radiograph view box used light source standards prepared 16 mm glass tubes simulate peritoneal lavage fluid rbc counts ranging 0 140 , 000 10 , 000 cell microl increments 1 5 dilutions water used throughout reduce opacity added standards color samples kept 4 c use double blind vitro study , subject matched 20 randomly distributed ranging 12 , 000 131 , 000 erythrocytes microl standard results mean absolute error 1 , determinations 3 , 560 rbc microl \( 95 ci 4 , 290 4 , sd 4 , 560 39 6 df 1 , p less 001 \) method correctly predicted rbc count within 9 , 000 cells microl 95 time conclusion visual comparison 1 5 dilutions simulated peritoneal lavage fluid known color standards used rapidly precisely estimate erythrocyte count
scapular dislocation \( locked scapula \) report case 19 year old woman presented emergency department pain inability move right shoulder falling striking radiographs shoulder revealed scapula closed reduction ed successful rare case scapular dislocation serves emphasize heightened awareness injury necessary recognized treated appropriately treatment prognosis reviewed
submersion netherlands prognostic indicators results resuscitation study objectives analyze prognostic indicators outcome resuscitation submersion victims \( drowning near drowning \) design retrospective study setting intensive respiratory care unit january 1 , 1979 , december 31 , 1985 , 87 submersion victims admitted files 83 victims available statistical analysis 66 male victims 17 female victims average age 31 4 25 8 years ten salt water 73 fresh water measurements main results predictors better survival potentials young age , submersion less ten minutes , signs aspiration , central body temperature less 35 c admission detect factors accelerated decrease core body temperature admission assume lethal hypoxia preceded protective hypothermia submersion victims score predictive value time found indicators score neurologic outcome patients , treated according brain protection protocol , worse outcome published authors used protocol thirty three percent victims arrest \( 15 \) victims ventilatory arrest \( 11 \) survived resuscitation discharged five victims died due late complications conclusion study shows indicator rescue site hospital absolutely reliable respect death survival
geriatric injury analysis prehospital demographics , mechanisms , patterns study objective evaluate emergency medical services \( ems \) system use , injury mechanisms , prehospital assessments among elderly victims trauma design analyzed prehospital data injuries among patients 70 years old older 911 ems requested medium sized metropolitan area 12 month period results total 1 , 154 cases occurred \( women , 65 1 \) , represented 30 3 911 involving elderly patients injury mechanisms fall \( 60 7 \) , motor vehicle accident \( mva 21 5 \) , \( 2 4 \) , accidental poisoning \( 2 3 \) , \( 2 1 \) persons lower frequency \( 3 4 \) younger patients \( 23 0 \) \( p less 005 \) frequent injuries determined prehospital assessment head face \( 25 1 \) , upper extremity \( 17 2 \) , hip \( 14 5 \) , lower extremity \( 13 8 \) , back \( 9 8 \) , chest abdomen \( 5 0 \) frequency serious neurologic injuries less falls mechanisms \( p less 005 \) suspected hip \( p less 001 \) pelvic \( p less 005 \) injuries occurred frequently falls mechanisms injury , whereas back injuries occurred frequently \( p less 001 \) seventy one fall victims \( 10 1 \) suspected medical causes fall twelve patients \( 1 0 \) cardiac arrest conclusion report injury patterns mechanisms among elderly victims trauma presenting ems system knowledge patterns useful emergency physicians ems
porta disruption blunt trauma extrahepatic porta injuries blunt abdominal trauma exceedingly rare recently reported cases involve disruption common bile duct intrapancreatic portion herein report patient lacerations proper hepatic artery bile duct occurring deceleration torsion porta high speed collision
endoscopic extraction nasogastric tube entrapment nasogastric tube within stapled gastrointestinal anastomosis preventable infrequent surgical complication report experience complication describe successful endoscopic approach management
low bone density etiologic factor stress fractures athletes objective determine whether low bone density risk factors osteoporosis associated stress fractures athletes design case control study setting institutional sports injury clinic primary secondary care participants twenty five athletes \( nineteen women \) confirmed stress fractures matched sex , age , weight , height , exercise history 25 control athletes history bone injury measurements main results bone mineral density measured dual energy x ray absorptiometry significantly lower athletes fractures control athletes spine , bone mineral density 1 01 0 14 g cm2 athletes fractures 1 11 0 13 g cm2 control athletes \( p 0 02 \) femoral neck , 0 84 0 09 g cm2 athletes fractures 0 90 0 11 g cm2 control athletes \( p 0 005 \) also significantly lower ward triangle \( p 0 01 \) greater trochanter \( p 0 01 \) eight athletes fractures control athletes less 90 predicted age related spine density \( p 0 01 \) , three athletes fractures bone mineral densities 2 sds predicted level athletes fractures control athletes current menstrual irregularity \( amenorrhea \) \( p less 0 005 \) fewer athletes fractures using oral contraceptives \( p less 0 05 \) seven day diet records indicated similar energy nutrient intakes , except athletes fractures lower calcium intakes \( 242 mg compared 309 mg p 0 02 \) product intake lower athletes fractures since leaving high school \( p less 0 05 \) incidence family history osteoporosis similar groups conclusions athletes similar training habits , stress fractures likely lower bone density , lower dietary calcium intake , current menstrual irregularity , lower oral contraceptive use
management tracheobronchial foreign bodies children update tracheobronchial foreign bodies continue source morbidity mortality pediatric population technical advances anesthesia equipment made removal troublesome feasible must still exercised coordinated team effort must employed order achieve satisfactory safe outcome patient appropriate use diagnostic studies management techniques discussed
hippocampus schizophrenia , suicide , control brains published erratum appears arch psychiatry 1991 may 48 \( 5 \) recent postmortem studies schizophrenia shown abnormalities medial temporal lobe structures , including hippocampus tried replicate previous studies explore specificity finding schizophrenia anterior hippocampus parahippocampal cortex evaluated area shape postmortem tissue 12 schizophrenic , 17 suicide , 10 nonpsychiatric control brains significant differences found hippocampal area , parahippocampal cortex significantly smaller schizophrenic group control group right left sides analyzed separately , suicide schizophrenic groups smaller right side controls corrected suicide group exhibited greater parahippocampal areas left right tissue samples within group , difference exist schizophrenic control groups study demonstrated changes temporal lobe structures schizophrenic suicide groups
new orthosis central cord syndrome brachial plexus injuries proximal upper extremity weakness may develop secondary central cord syndrome due spinal cord injury brachial plexus injury functional deficits , pain , decreased upper extremity arm gait , shoulder subluxation common sequelae injuries report describes new design easily two four hours readily available materials compensate deficits orthosis allows early participation activities daily living patients greater proximal distal upper extremity weakness orthosis consists figure eight shoulder unilateral bilateral forearm cuffs connected flexible rubber tubing length tubing adjustable clamps connected forearm cuff allow variable arm positioning three patients , aged 14 , 64 , 68 , two central cord syndrome one injury upper portion brachial plexus \( erb palsy \) described shoulder girdle musculature less 2 , biceps less 2 , less 4 , hands less 5 patients benefits use orthosis may include improved arm balance ambulation , reduced shoulder pain subluxation , increased independence tasks carrying , lower extremity dressing , , light , leisure activities
age effect prognosis functional recovery acute , traumatic central cord syndrome purpose study determine age significant functional recovery acute , traumatic central cord syndrome \( \) recovery ambulation , adl status , bowel bladder function evaluated retrospective study tested hypothesis functional recovery 51 consecutive patients better younger patients older patients four patients , 50 years , died ability independently discharge compared 30 patients younger 50 years 21 patients 50 years older results showed 29 30 \( 97 \) younger patients ambulatory compared seven 17 \( 41 \) older patients \( p less 002 \) younger patients also able achieve independence self care bowel bladder function significantly greater proportion prognosis functional recovery acute traumatic consider patient 's age prognosis less older patients , considerably favorable younger patients previously reported
sensory nerve evoked responses spinal cord injury previous studies documented presence , positive waves , decreased motor evoked response amplitudes spinal cord injury \( sci \) subjects purpose study evaluate sensory nerve status population twenty eight subjects sci least five months evidence spasticity included sural sensory tibial motor evoked response amplitudes measured mean sural sensory amplitude 8 0 5 9 microv \( normal 15 0 5 3 microv \) mean tibial motor amplitude 5 1 4 3 mv \( normal 11 7 3 8 mv \) six subjects significantly reduced sural sensory amplitudes , extensive testing performed studies showed diffusely decreased lower extremity sensory motor evoked response amplitudes diffuse positive waves particular distribution thus , subjects sci may sensory well motor nerve abnormalities intact connection second order primary sensory neuron may necessary maintenance axonal integrity primary neuron
relative biological effectiveness fractionated doses fast neutrons \( 42 \) normal tissues pig ii late effects cutaneous subcutaneous tissues late effects irradiation single fractionated doses x rays \( 250 \) fast neutrons \( 42 bc \) , cutaneous subcutaneous tissues pig , evaluated measurements changes relative field length determined intervals 26 104 weeks irradiation fractionated irradiation x rays average fractions , n , obtained log log plot effect dose \( ed50 \) fraction number 0 41 independent period assessment , significant indication time factor however , n vary level effect range 0 33 0 51 greatest greater equal 10 reduction relative field length assuming validity linear model cell survival , alpha beta ratio 1 95 gy however , model fitted data less well least severe levels damage , alpha beta ratios significantly different zero irradiation fast neutrons showed small effect doses given greater equal 6 fractions compared single dose significant increase effect dose dose given 30 fractions compared 6 fractions relative biological effectiveness late cutaneous subcutaneous damage energy fast neutrons used vary period assessment , e 26 52 weeks compared 65 104 weeks , significantly different previously obtained ischaemic dermal necrosis , seen higher doses , 12 20 weeks irradiation
acute opioid physical dependence humans effect varying morphine naloxone interval ii previous studies demonstrated antagonist precipitated withdrawal 45 min 24 hr acute opioid administration human subjects purpose study examine longer intervals determine maximum interval agonist administration antagonist challenge precipitated withdrawal observed study 6 male volunteers reported using opiates average 4 times per week received naloxone challenges \( 10 mg 70 kg \) 6 , 12 , 24 , 36 , 48 , 60 , 72 hr single injections morphine \( 18 mg 70 kg 30 mg 70 kg \) interval tested independently random order naloxone reliably precipitated withdrawal signs symptoms 6 12 hr withdrawal symptoms greatly diminished intensity 24 hr elicited intervals longer 24 hr withdrawal precipitation persisted somewhat longer pupillary constriction pupils returned diameters 24 hr , generally , appeared correspondence offset agonist effects precipitated withdrawal study extends observations time course acute physical dependence effects begin within minutes acute morphine exposure , within 36 hr , associated onset offset agonist effects require chronic opioid administration
pediatric penetrating head neck trauma penetrating head neck trauma children causes uncommon potentially life threatening injuries reviewed charts 21 patients sustained penetrating injuries face upper neck seventeen males 4 females , aged 32 weeks' gestation 19 years \( mean 10 2 years \) comprised study population 15 gun shot wounds , 1 shotgun injury , 5 stab wounds significant problems included 7 vascular injuries , 6 central nervous system injuries , 5 ocular injuries , 3 airway compromises , 2 facial nerve injuries , 1 cervical esophageal penetration , 2 cases pneumothorax three deaths occurred , majority patients survived sustained minimal permanent disability included review unique case intrauterine gunshot wound face approximately 32 weeks' gestation treatment protocol , differences adult patients , management highlights reviewed
excess injury mortality among children united states comparison recent international statistics using data national center health statistics world health organization , child injury death rates us compared canada , england wales , france , netherlands , norway except 1981 canadian figure , overall us childhood injury mortality greater childhood injury mortality rates countries studied year 1980 1986 injury mortality steadily declined countries , whereas us rate appears increasing attention specific causes reveals much difference explained motor vehicle injuries homicide , every childhood age group us death rates due drowning , firearms , homicide , poisoning , fire among highest excess us injury mortality largely attributable deaths among children younger 5 older 14 years age , vulnerable groups countries especially high rates among us account little observed differences many injuries , mortality rate us several times reported comparison behavioral strategies inadequate deal excess death rates magnitude limiting exposure regulation , greater use public transportation , accessible day care among measures implemented
injuries children french situation french situation respect mortality unintentional injuries children far satisfactory international comparison made difficult statistical bias , although excess injury mortality decreasing france , rates higher advanced european countries many regulations past 30 years reduce economic social burden injuries , insufficient establish national program existing legislation inadequate evaluation preventive educational programs less optimal many attempts met basic methodologic requirements situation improving , partly growing social concern new regulations preparation , solution major public health problem also demands behavioral change , much difficult effect measures greater commitment research , proper evaluation sound programs , existing law would reduce excess morbidity mortality resulting injuries children
childhood injuries paper present leading causes fatal childhood injury united states examine three types explanations injury rates high united states compared could actually number european countries conclusions based learn look specific injury problems apply knowledge field childhood injury prevention whole decrease number fatal injuries children , 1 recognize injuries major public health problem injuries perceived problems accidents determined fate , , consequently preventable addition , injuries addressed multidisciplinary fashion successful public health approach problems 2 address intentional injury part problem intentional injury treated separate field entirely addressed scientifically public health problem one consequence injuries due firearms addressed frequently problem unintentional injury result , 93 firearm injuries , ie , intentional , studied addressed adequately situation like studying motor vehicle injuries excluding driving contributing factors , like studying acquired immunodeficiency syndrome anal intercourse intravenous drug use 3 develop support organizations plan effectively national approach injury control
injuries pain cross country growing rapidly popularity ever increasing number participants , physicians must prepared deal injuries specific sports important , physicians need use epidemiologic data patients methods minimize risk injury participate healthy vigorous sports
methods minimize tissue loss treated successfully , direct indirect effects injury must understood rapid rewarming helps preserve tissue limiting amount direct cellular injury selective management helps protect plexus , application vera cream \( eg , cream \) local effects thromboxane oral administration ibuprofen decreases systemic levels thromboxane
lateral arm fascial free flap anatomy use reconstruction free fascial transfer used reconstruction surfaces upper lower extremities thin , pliable coverage required \( hand , heel , nose , ear \) experience lateral arm flap , found fascia alone excellent source tissue free flap transfer thorough investigation microscopic , gross , radiographic anatomy lateral arm fascia undertaken study 25 fresh cadavers vascular pathways mapped , locations analyzed , correlated elevation , design , transfer flap lateral arm large fascial component located anterior posterior lateral septum , lies muscles perfused posterior radial collateral artery \( \) , one terminal branches brachii vessel \( \) provides least four fascial branches 1 15 cm proximal lateral , largest located average 9 7 cm superior lateral fascia 12 x 9 cm may used good axial perfusion histologic cross sections demonstrate complex anatomy fascia , well relation nutrient vessels applied lateral arm fascial flap five cases upper extremity reconstruction also found flap valuable preservation underlying anatomic detail total reconstruction ear nose local tissue conventional flaps available
profile alcohol prescription drug abuse high risk community based elderly population substance abuse among elderly relatively common often remains undetected ignored health social workers psychosocial health factors related aging process major alcoholism drug abuse estimated two ten percent individuals age 60 suffer alcoholism article profiles alcohol prescription drug abuse among geriatric elderly services \( ess \) , division \( washington \) community mental health center addition traditional channels , ess uses unique network identify high risk , community based elderly elderly persons referred regarded hidden elderly highest risk notably , 37 percent ess clients referred via mechanism case management records ess clients reviewed history alcoholism , total 161 persons \( 9 6 percent \) diagnosed either primary secondary alcohol abuse fifty subjects \( five percent average active ess \) referred prescription drug abuse prescription drug classes sedative , agents , analgesics diazepam , codeine , , top four agents , 92 percent subjects found duration prescription drug abuse excess five years 60 percent correlation prescription drug abuse previous active alcoholism found additional characteristics geriatric study population discussed detail , including specific psychosocial factors , source referral , age , gender , living situation , marital status , psychiatric history , presence
flumazenil benzodiazepine antagonist although benzodiazepines proven safe effective induction maintenance sedation , instances require reversal events prior natural process metabolism elimination flumazenil , 1 , 4 , antagonist reduce benzodiazepine effects dose dependent manner antagonist acts competitive inhibition benzodiazepines central nervous system receptor sites administered intravenously incremental doses , flumazenil allows optimal patient response individual basis despite short elimination half life , small doses flumazenil usually effective producing benzodiazepine reversal flumazenil 's short duration activity due rapid hepatic metabolism elimination intravenous antagonist doses 0 2 mg followed 0 1 mg min total dose 1 mg produced significant results reversing benzodiazepine sedation much 5 mg flumazenil necessary treating benzodiazepine mixed agent situations , response rarely exceeds duration one hour occurs , additional doses infusion antagonist may provide desired response flumazenil well tolerated locally well systemically nausea vomiting occurring anesthesia documented adverse effect placebo treatment populations however , significant difference occurrence vomiting placebo compared flumazenil treated subjects careful observation slow reversal central nervous system depression crucial avoidance benzodiazepine withdrawal patients dependent upon agents flumazenil appears provide mechanism safe effective reversal benzodiazepine induced sedation
treatment digitalis intoxication emphasis clinical use digoxin immune fab many studies cases digitalis intoxication reported since time 's first publication recognition management digitalis toxicity challenging digoxin immune fab commercially available , treatment consisted managing signs symptoms toxicity digitalis eliminated digoxin immune fab offers safe , effective , specific method quickly reversing digitalis toxicity factors must considered clinical use agent include dosage calculation , administration technique , postdose monitoring , pharmacokinetics , mechanism action , interference commercially available digoxin assays , partial neutralizing dosing , rebound free digoxin , indications use severe , life threatening toxicity , digoxin immune fab treatment choice
dyskinetic movements , cognitive impairment , negative symptoms elderly neuropsychiatric patients presence absence tardive dyskinesia , cognitive status , psychopathology assessed group elderly male psychiatric patients \( n 49 \) nursing home setting twenty five patients found tardive dyskinesia , associated greater degree cognitive impairment negative symptoms finding related obvious macroscopic organic pathologies , less prevalent dyskinetic patients fact , patients frontal lesions \( primarily \) significantly lower prevalence tardive dyskinesia
removal blunt foreign bodies esophagus historically , removal blunt foreign bodies esophagus general anesthesia considered relatively safe effective recent years , alternative techniques blind removal balloon catheters advocated paper reports performed 19 year period remove blunt esophageal foreign bodies eighty one percent foreign bodies 74 children 3 years age deaths , perforations , instances complications encountered due esophageal erosion respiratory problems secondary long standing foreign bodies author 's opinion , best method removal esophageal foreign bodies simply seem need alternative methods involving blind removal
reappraisal pancreatic duodenal injury management based injury severity evaluated effectiveness treatment protocols pancreatic duodenal injuries according severity injury 81 patients , 65 survived initial injury pancreatic injuries without ductal involvement occurred 21 patients treated drainage late deaths occurred pancreatic injuries ductal disruption occurred 18 patients treated pancreatic resection abscesses developed seven \( 39 \) patients , late deaths occurred nineteen patients duodenal injuries without pancreatic injury , duodenal complications occurred simple closure injuries affecting 40 duodenal circumference wounds affecting 40 duodenal circumference treated suture closure alone adjunctive duodenal tube decompression reserved wounds affecting greater 40 duodenal circumference , closure tension , associated injuries head pancreas pyloric exclusion rarely necessary patients
chronic alcohol ingestion increases aortic lipid levels rats evaluated effects alcohol ingestion aortic lipid concentrations 15 pair fed sprague dawley rats divided three groups five animals control rats fed liquid diet , 36 energy provided 28 days , remaining two groups rats fed equivalent proportion energy alcohol 28 days 18 months alcohol fed rats significantly greater quantities ethane controls 28 days 18 months serum cholesterol levels increased 40 triglyceride levels increased 80 , phospholipid levels remained unchanged alcohol fed rats compared controls aortic concentrations cholesterol phospholipids increased twofold threefold , respectively , alcohol fed rats , corresponding alteration cholesterol phospholipid ratio time intervals tissue triglyceride levels elevated 28 days , differences aortic lipid peroxide levels detected alcohol fed rats controls results study indicate alcohol ingestion increases aortic cholesterol , phospholipid , triglyceride levels 28 days cholesterol phospholipid triglyceride levels 18 months mechanisms underlying accumulation lipids aortic tissue need elucidation
knee function complex femoral fractures treated interlocking nails twenty three complex femoral fractures treated interlocking nails fracture healing , knee function analyzed , including alignment , quadriceps strength , thigh atrophy , range motion \( rom \) similar previous studies nail era , knee function impaired comparison contralateral limb seventy three percent patients decreased quadriceps strength , 60 decreased strength sixty five percent thigh atrophy rom alignment satisfactory despite advantages early rom femoral fractures treated interlocking nails , knee function often unsatisfactory fracture union occurred therefore , formal knee rehabilitation program recommended achieve optimal result
cartilage bone versus observations cellular events involved embryonic long bone formation , ectopic osteogenesis , fracture repair , analysis mesenchymal stem cell potential provide evidence direct relationship osteogenesis angiogenesis vasculature sequence cellular events cartilage replaced bone , rather , target mind , may necessary replace term bone formation
endotracheal tube cuff pressure assessment pitfalls finger estimation need objective measurement estimation endotracheal \( et \) cuff pressure finger palpation one methods currently used clinical setting compared accuracy method instrumental pressure measurement tracheal model tests 20 members icu team four different et tubes three different pressure levels examined accuracy estimated method finger palpation 69 high pressures , 58 normal pressures , 73 low pressures observed differences terms sensitivity , specificity , positive predictive power different tubes reflecting differences tube characteristics interobserver variability conclude precise pressure measurement mandatory prevent complications
biomechanical strength non vascularised vascularised diaphyseal bone transplants experimental study studied healing strength non vascularised \( 28 \) vascularised \( 28 \) sections tibial 56 cats types graft achieved fracture union period time , 12 16 weeks non vascularised grafts strong vascularised grafts
extending intramedullary rods congenital pseudarthrosis tibia five patients boyd type ii congenital pseudarthrosis tibia underwent excision pseudarthrosis double bone grafting stability maintained extending intramedullary rods clinical union achieved cases mean 8 6 months \( range six 11 \) rods extended 15 7 \( range 2 31 4 \) growth occurred one rod removed infection vascularised free fibular graft subsequently performed extending rods provided stability union occurred require revision legs grew rods removed easily surgical options
morphine pharmacokinetics anesthesia surgery patients burns plasma clearance , plasma half life , apparent volume distribution morphine anesthesia surgery determined seven patients burns compared seven age matched control subjects burn group significantly lower clearance , longer terminal half life , smaller volume distribution control group clearance 12 2 ml min kg , half life 123 24 minutes , volume distribution 2 2 0 4 l kg subjects burns compared 25 3 ml min kg , 89 18 minutes , 3 2 0 8 l kg control subjects \( p less 0 001 , less 0 02 , less 0 02 , respectively \) data contrast theory patients burns tolerance narcotics suggest need study pharmacologic effects burn injury surgery
comparison resting energy expenditures caloric intake children severe burns nutritional support provided children severe burn injuries amounts derived empirical formulas measurements resting energy expenditure methods , indirect calorimetry measurements performed 74 survivors burns \( greater equal 40 total body surface area \) compared actual caloric intake , percent weight change , optimal caloric requirements formulated equations parameters showed spite initial deficit actual caloric intake compared formulated goals , weight maintained , whereas resting energy expenditures ranged 30 40 actual caloric intake furthermore , subgroup patients \( n 42 \) met 20 formulated needs stratified extent burn illustrated significant weight gain severely burned children conclusion , nutritional formulas popular use overestimate caloric requirements severe burns , whereas resting energy expenditure measurements require additional factor 30 maintain body weight
cyclosporine allograft survival patients massive burns cyclosporine \( \) immunosuppression used three patients massive burns prolong skin allograft survival cyclosporine kinetic studies patients burns revealed markedly accelerated blood clearance high variability drug absorption compared studies renal transplantation patients doses required maintain therapeutic levels varied widely patients receiving adequate maintenance therapy immunosuppression allograft tightly adherent without gross microscopic rejection indistinguishable autograft ultimately , patients' wounds permanently covered sequential autografts limited donor sites unusual septic complications , although prophylaxis opportunistic infections used disadvantage allograft use early rejection obligatory replacement permanent coverage autograft accomplished cyclosporine prolong allograft survival allow autograft coverage limited donor sites sequential fashion may lead increased survival patients massive burns
survey wound monitoring topical antimicrobial therapy practices treatment burn injury survey done determine burn wound microbial monitoring performed topical antimicrobial agents employed survey sent 90 burn care facilities , comprised major burn centers united states survey contained questions concerning frequency techniques wound monitoring , personnel involved monitoring , well questions decisions made initiate topical antimicrobial therapy , agents selected , administered sixty 90 facilities \( 66 \) responded survey although areas agreement , several trends emerge facilities monitored burn wounds \( 92 \) wound monitoring typically done least twice weekly either surface quantitative biopsy nursing staff played significant role specimen collection 69 facilities solely responsible obtaining biopsy specimens 29 facilities used biopsies exclusively responding facilities used topical antimicrobial agents silver sulfadiazine popular \( 95 \) 33 facilities surveyed laboratory microbial monitoring rapid techniques early diagnosis wound sepsis used 20 units , topical antimicrobial testing used 17 facilities surveyed
use intestinal antibiotics delay prevent infections patients burns bacterial colonization infection wounds seriously burned patients often comes patient 's indigenous bowel flora prospective randomized clinical trial involved 30 patients 20 greater total body surface area burns undertaken evaluate use standard antibiotic bowel preparation delay prevention bacterial colonization burn wound sepsis certain enteric bacteria seen less frequently treated group \( enterobacter organisms \) , bacteria appeared often treated group \( organisms \) average time colonization burn wounds 6 1 days treated group 6 7 days control group blood cultures positive enteric organisms earlier treatment group appeared earlier wound blood cultures treated group control group effect antibiotic bowel suppression patients burns varied unpredictable bowel preparation may select certain organisms lead earlier colonization wounds overall outcome survival improved use antibiotic bowel preparation patients
gasoline burns preventable cause thermal injury gasoline related burns significant cause thermal injuries year united states retrospective review admissions regional burn center 1979 1988 , 270 \( 14 5 \) persons gasoline related injuries natural gas excluded victims male \( 228 270 \) mean age 27 years mean burn size 25 total body surface area skin grafts performed 172 patients , 16 deaths mean length stay decreased 38 17 days \( p less 0 001 \) first second 5 year time periods , even though significant change age mean burn size majority \( 59 \) gasoline related burns result inappropriate use gasoline general public largely unaware dangers gasoline , education area needed
burns preventable injuries associated high morbidity frequent litigation identified burns significant cause preventable morbidity , long term functional cosmetic epidemiology burns experience described patients male , mean age 35 years average burn size 11 3 anatomic distribution burns , often dominant hand face , contributes morbidity burns injury associated increasingly frequent litigation believe active education addition warning labels compartments would make impact decreasing incidence burns
discharge means occupational physical therapy regional burn centers commonly receive patients medical facilities geographically distant logistic problems may follow care burn center lead decrease function result contractures hypertrophic scar formation part therapists community facilities serves problem discharge , respect physical occupational therapy programs , means documenting range motion time discharge providing visual documentation therapy program followed outpatient basis video community hospital 's therapy department order accomplish goals
familial values factors influencing long term psychological adjustment children severe burn injury study earlier findings children survive severe burn injury make positive psychological adjustment family support family value autonomy predicted critical variables promotion psychological adjustment addition , study presents hypothesis length time burn injury level intelligence contributing factors psychological adjustment forty four adolescents mean 60 total body surface area \( tbsa \) full thickness burns studied half subjects scored within normal range measure psychological adjustment familial value patterns critical prediction psychological adjustment positive psychological adjustment predicted greater family , independence , open within family level intelligence contribute adjustment length time injury , important psychological healing , appears factor initial 2 years burn injury
corneoscleral limbus human corneal epithelial wound healing studied epithelialization ocular surface 17 human eyes \( 14 patients \) large corneal conjunctival focused healing limbal region epithelialization , cell movement found occur along corneoscleral limbus corneoscleral limbus patient central corneal defect close corneoscleral limbus first completely normal limbal healing observed occur migrating tongue shaped corneal limbal epithelium tongue shaped projections developed either side remaining intact epithelium advanced along corneoscleral limbus met movement cells corneoscleral limbus completed healing process three patients , however , advancing conjunctival epithelium extended across corneoscleral limbus tongue shaped projections corneal limbal epithelium met surface cornea covered conjunctival epithelium thin irregular , later showed peripheral scarring , , recurrent
fixation posterior chamber intraocular lenses cases posterior capsule rupture method fixation posterior chamber intraocular lenses posterior capsule rupture described five lenses fixated technique reviewed
foley catheter balloon puncture risk free fragment formation incidence free fragment formation following balloon puncture spontaneous bursting examined 294 foley catheters 48 h urine catheters divided 3 groups 100 inflated manufacturer 's recommended volume , 100 twice volume 94 3 times recommended volume catheter balloons needle overall incidence free fragment formation 27 3 types catheter examined , increasing balloon volume associated increased risk free fragment formation following puncture however , increasing volume associated increased free fragment formation balloon burst spontaneously view high risk free fragment formation , cystoscopy performed cases spontaneous catheter balloon rupture percutaneous balloon puncture
recovery morphine controlled release preparation source opioid abuse ms \( , norwalk , ct \) controlled release preparation morphine sulfate demonstrated efficacy management chronic cancer pain problems recently come attention authors ms represents potential source opioid abuse extraction intravenous injection morphine preparation authors describe simple aqueous extraction method used quantitatively determine extent morphine could obtained ms tablets
effects acute chronic ethanol administration withdrawal level binding somatostatin rat brain 1 acute ethanol administration resulted increase total number specific somatostatin receptors rat frontoparietal cortex hippocampus , decrease level somatostatin like immunoreactivity hippocampus frontoparietal cortex 2 chronic administration ethanol caused decrease number somatostatin receptors frontoparietal cortex hippocampus , although level somatostatin like immunoreactivity unchanged brain areas 3 week suppressing ethanol value specific binding tracer somatostatin receptors frontoparietal cortex significantly different control rats , although actual number receptors slightly lower 4 results suggest possible role somatostatin nervous system alcoholism post withdrawal reaction
effects lesions anterolateral columns self behavior rats possible role anterolateral columns \( \) \( dlf \) pain mechanisms examined effects lesions tracts \( alone combined \) tests chronic deafferentation pain \( autotomy \) rats spinal lesions alone \( e , without denervation \) either alc dlf combined dlf alc lead form self behavior cervical surgery , without spinal lesion , followed limb denervation \( sham \) resulted similar autotomy characteristics observed following limb denervation alone \( control \) results considered one set controls alc lesions simultaneous , 1 2 weeks prior limb denervation \( \) produced significant delay onset autotomy decrease percentage rats showing behavior dlf lesions followed limb denervation produced significant acceleration onset autotomy increase percentage rats showing behavior combined dlf alc lesions limb denervation produced intermediate effects observed following either alc dlf lesions alone results give support concept autotomy related rostral transmission nociceptive information spinal inhibitory loop involving dlf alc triggered chronic deafferentation pain
efficacy tetracaine adrenaline cocaine topical anesthetic without tetracaine facial laceration repair children published erratum appears pediatrics 1991 feb 87 \( 2 \) 185 determine whether tetracaine component traditionally used tetracaine adrenaline cocaine \( tac \) necessary obtain effective topical anesthesia , prospective study performed compare tac adrenaline cocaine preparations repair facial lacerations children physicians blind preparation used 55 patients studied , 24 received tac \( 103 sutures placed \) 31 received adrenaline cocaine \( 151 sutures placed \) anesthetic efficacy preparation approximately 95 adverse reactions related administration either medication complications wound healing noted either group tetracaine component tac obtaining topical anesthesia minor dermal lacerations face children tac formulation simplified tetracaine without compromising anesthetic efficacy
two cases fatal atlantoaxial distraction injury without fracture rotation atlantoaxial injuries , regardless mechanism , typically result bony injury present two unusual cases fatal traumatic c 1 c 2 distraction without associated fracture rotation ligamentous anatomy , common underlying structural medical , possible mechanism injury discussed
reporting occupational injury illness semiconductor manufacturing industry united states , occupational illness injury cases meeting specific reporting criteria recorded company occupational safety health administration \( \) 200 logs case description data submitted participating state agencies coding entry national supplementary data system \( sds \) evaluated completeness reporting \( percentage cases recorded company 200 log \) semiconductor manufacturing industry reviewing company health clinic records 1984 10 manufacturing sites member national semiconductor manufacturing industry trade association 416 randomly selected work related cases , 101 met reporting criteria reporting completeness 60 percent lowest occupational illnesses \( 44 percent \) case description data 150 reported cases submitted twice state coding personnel evaluate coding reliability reliability high \( kappa 0 82 0 93 \) nature , affected body part , source , type variables coding sds appears reliable reporting completeness may improved use stepwise approach company personnel responsible reporting decisions
pathologic synovial knee results conservative treatment observations 136 cases pathologic synovial knee analyzed regard etiology , symptoms , results conservative treatment results obtained conservative treatment good 40 cases , average 20 , poor 40 opinion , results justify treatment condition physical therapy proceeding surgical correction objective physical therapy decrease compressive forces anterior compartment knee increasing structural flexibility flexor extensor muscles increase flexibility obtained stretching exercises , gastrocnemius , quadriceps
anterior cruciate ligament injury evaluation intraarticular reconstruction acute tears without repair two seven year followup 155 athletes evaluate effectiveness treatment regimen , retrospectively studied surgically treated knees 155 athletes , aged 15 42 years , sustained acute acl tears treated ligament excision intraarticular bone patellar tendon bone reconstruction followed early motion emphasis full extension follow period ranged 2 7 years 155 patients , 140 available final followup minimum 2 years reconstruction patients evaluated objective measures \( kt 1000 , , test , range motion , postoperative competition level \) subjective assessment scores \( pain , swelling , stability , activity level , walking , stair climbing , running , , \) subjective scores tabulated stability level , total score , activity level patients achieved full range motion , kt 1000 measurements 20 force revealed average difference 1 3 mm injured knees 3 140 patients firm endpoint test , tests showed mean strength 98 mean quadriceps strength 90 sixty 69 athletes eligible play returned competition level following season one reconstruction failure eight continue competition academic reasons questionnaire score average 92 7 \( maximum , 100 points , normal athletic knee score 93 5 \) concluded surgical procedure , emphasis early full extension postoperatively , achieved excellent results provided stable knee
comparison support provided orthosis adhesive ankle , , exercise purpose study compare relative effectiveness athletic orthosis providing inversion range restriction , , 3 hour practice effect support method subjects' vertical ability also assessed fourteen treated methods support passive inversion range motion measured ankle stability test instrument five testing sessions 1 \) support , 2 \) exercise , 3 \) 20 minutes exercise , 4 \) 60 minutes exercise , 5 \) exercise two way analysis variance comparisons revealed maximal losses restriction inversion 20 minutes exercise orthosis demonstrated mechanical restrictive failure exercise comparisons made , range motion compromised neither support system affected subjects' vertical ability results suggest orthosis may effective providing initial ankle protection ligamentous
living artificial grass knowledge update part 2 epidemiology part 2 study evaluated effect artificial grass athletes play section reviewed epidemiological studies evaluated influence artificial grass frequency site injury american football players review concluded play practice artificial surface probably responsible increase relative risk injury lower extremity participants however , evident well controlled studies necessary completely clarify issue
arterial abnormalities shoulder athletes vascular lesions shoulder may misinterpreted one familiar shoulder abnormalities treating physician reporting 13 athletes found symptoms related compression subclavian axillary artery nine professional pitchers severe arm fatigue finger ischemia , secondary embolization , presenting symptoms arm fatigue noted pitchers complete history physical examination , including bruits functional positions , athletes evaluated noninvasive tests \( doppler duplex scanning \) arteriography performed testing , activity , complete radiographic visualization dye digital arteries two patients found subclavian artery aneurysm remaining athletes found compression subclavian artery beneath anterior muscle \( five patients \) , axillary artery beneath pectoralis minor \( two patients \) , arterial segments \( two patients \) , one found arterial compromise level humeral head branch artery compression also noted one occluded posterior circumflex humeral artery embolization digit two patients subclavian aneurysms underwent saphenous vein bypass cervical rib resection athletes except one underwent resection 2 3 cm segment anterior muscle pectoralis minor muscles returned previous level activity except one patient developed impingement type symptoms required currently undergoing rehabilitation proper recognition vascular compromise upper extremity athletes essential avoid complications arterial thrombosis
injury patterns scottish heavy interest participation scottish american increased throughout united states , aim study define injury patterns risk factors field events modern track field evolved part seven events heavy retrospective prospective study 170 athletes least 3 years experience carried 10 years injuries , 60 involved upper extremities back incidence injury 42 9 injury exposure rate 0 3 per 40 hours competition training appropriate instruction , consistent weight program , exercise , injuries serious
early detection myocardial contusion complications patients blunt trauma myocardial contusion remains clinical entity , disproportionate amount scarce expensive critical care resources purpose cardiac monitoring study attempts define group patients high risk identified available data present time admission patients admitted suspicion myocardial contusion 3 year period retrospectively studied records examined history , physical findings , electrocardiographic \( ecg \) results , creatine kinase levels , injury severity score \( iss \) , echocardiographic findings diagnosis myocardial contusion made patients ecg consistent acute injury , increased creatine kinase mb , abnormal echocardiogram consistent acute injury patients stratified two groups group 1 patients satisfied criteria myocardial contusion group 2 patients lacked sufficient evidence substantiate diagnosis records examined presence factors available emergency room might predictive myocardial contusion complications total 88 patients evaluated 27 found myocardial contusion \( group 1 \) 61 patients placed group 2 \( myocardial contusion \) group 1 patients abnormal admission ecg \( p less 0 05 \) , iss greater equal 10 \( p less 0 05 \) multivariate analysis identified two factors predictive myocardial contusion abnormal ecg iss greater 10 two predictors absent , probability myocardial contusion 1 predictors complication myocardial contusion identified data suggest combination easily obtained variables emergency department used select patient population high risk myocardial contusion prospective evaluation variables necessary
trend toward nonoperative management splenic injuries treatment splenic injuries evolved past decade reflect effort conserve function spleen records 169 patients admitted 6 year period identified documenting treatment splenic injuries collected data regarding patient age , gender , degree hemodynamic stability , number units blood required , severity splenic injury , injury severity score , results treatment 143 adults \( age greater 16 years \) 26 pediatric patients \( age less 17 years \) , mean age 2 groups 31 6 11 4 years , respectively males comprised 72 group , blunt injury occurred 154 169 patients adults , splenectomy , , laparotomy without operative treatment spleen , nonoperative management observed 48 , 30 , 14 , 8 time pediatric group 31 , 27 , 19 , 23 time , respectively using operative splenic repair techniques increased use nonoperative management , splenic salvage rate increased last 6 years 41 61 without increase morbidity mortality incidence spleen salvage correlated severity spleen overall injury cardiovascular stability
open versus closed diagnostic peritoneal lavage evaluation abdominal trauma two hundred forty two patients underwent diagnostic peritoneal lavage \( dpl \) 12 month period one hundred sixteen patients \( 48 \) randomized open lavage technique 126 \( 52 \) percutaneous \( closed \) guide wire procedure closed procedure required average 16 minutes complete one , whereas open method required two operators average time 26 minutes \( p less 0 001 \) technical complications occurred 31 patients undergoing closed lavage \( 25 \) 4 patients undergoing open lavage \( 3 \) \( p less 0 01 \) fifty eight percent closed lavage complications related fluid return 42 guide wire placement open lavage complications caused inadequate fluid return data support initial use percutaneous lavage open technique favored certainly used closed method fails direct visualization peritoneal cavity indicated physicians involved management abdominal trauma must familiar methods dpl
asymptomatic patient suspected myocardial contusion diagnostic criteria guidelines hospital admission suspected myocardial contusion \( \) remain unclear study defines examines clinical sequelae patients admitted suspicion criteria observation following isolated , minor blunt chest trauma suggested hospital trauma registry records patients admitted 33 month period suspected reviewed conventional evaluation criteria , cardiac related complications , associated injuries analyzed patients twenty eight cardiac related complications occurred 27 patients \( 5 \) complications included 23 , 3 infarctions , 2 pericardial effusions 23 patients abnormal admission electrocardiograms 4 normal ones latter , one patient developed 4 hours admission , three major multi system injuries requiring admission intensive care unit overall incidence cardiac related complications minimally injured patients 0 1 complications patients isolated chest wall , normal admission electrocardiogram , normal rhythm 4 hours significant association creatine phosphokinase isoenzymes echocardiogram cardiac related complications complete absence significant cardiac sequelae patients isolated chest wall contusion , normal admission 4 hour electrocardiograms , associated major injuries suggests patients need admitted
tertiary trauma care rural state trauma patients rural areas usually access regional trauma systems designated trauma centers efforts provide quality trauma care small hospitals may seriously local capabilities urban trauma center retains important role trauma care even initial care must provided local level twenty five trauma patients transferred university hospital 1985 1988 definitive care initiated community hospitals time period , total 147 trauma patients transferred trauma service information available total incidence trauma medical records reviewed determine reasons transfer major reasons included need complex surgery , better critical care support , inadequate blood banks trauma centers serving rural areas provide valuable resource well beyond initial 24 hours
improved trauma care rural hospital establishing level ii trauma center study motor vehicle accident deaths occurring county , california , 1979 1983 showed preventable death rate 42 deaths related central nervous system injuries developing level ii trauma center hospital , preventable death rate decreased 14 statistically significant \( total chi square , 0 01 less p less 0 025 \) significant increase average injury severity score \( 34 versus 45 , p less 0 005 \) well significant improvements surgeon 's response time \( 32 minutes versus 11 minutes , p less 0 005 \) time hospital arrival start surgery \( 3 6 hours versus 1 9 hours , 0 01 less p less 0 025 \) conclude changes indicative improved trauma care reflect favorably upon effectiveness rural trauma center meets level ii trauma center guidelines established american college surgeons committee trauma
use diazepam chloroquine poisoning 39 year old patient found taken 2 5 g chloroquine treatment consisted mainly gastric lavage diazepam experimental clinical evidence presented show diazepam varying doses significantly decreases mortality rate
parameters related amosite asbestos induced fibrosis humans previously shown lungs group chrysotile miners , grade interstitial fibrosis \( asbestosis \) directly proportional tremolite fiber chrysotile fiber concentration inversely proportional mean fiber length length related parameters compare effects commercial asbestos amosite parenchymal fibrosis , histologically graded fibrosis four different sites lungs 20 workers heavy amosite exposure measured analytic electron microscopy fiber concentration size corresponding portions lung tissue fibrosis grade found strongly positively correlated amosite concentration negatively correlated mean fiber size parameters , including fiber length , width , surface area , mass comparison present results data chrysotile miners showed regression lines fibrosis grade versus concentration amosite , chrysotile , tremolite statistically different findings indicate amosite concentration , like chrysotile tremolite concentration , closely directly related fibrosis local lung level furthermore , observations raise possibility short fibers may important commonly believed genesis fibrosis man last , concentration comparison data indicate , fiber fiber , amosite chrysotile tremolite , indirectly suggest tremolite chrysotile
inhalation injury tracheal epithelium ovine model cotton smoke exposure early phase \( 30 minutes \) purpose study evaluate lung cell injury acute phase smoke inhalation injury group 10 sheep anesthetized halothane pancuronium followed endotracheal intubation first experiment 5 sheep given air \( sham group \) 5 insufflated cooled cotton smoke modified smoker second part study \( experiment 2 \) animals insufflated following number smoke breaths 1 x 12 \( n 3 \) 2 x 12 \( n 4 \) 3 x 12 \( n 4 \) 4 x 12 \( n 4 \) sham control \( n 1 \) 30 min animals killed kcl trachea prepared scanning , transmission electron , light microscopy initial observation scanning electron microscopy revealed large amount mucus surface epithelia numerous cells epithelium observed surface remaining cells cells intact , remained apical cell surface light transmission electron microscopy revealed cells process mucus cytoplasm basal cells appeared normal cells slightly cytoplasm , many process epithelial surface cells attachment separated light microscope evaluation tracheal epithelium showed dose dependent effect four treatment groups
motor unit numbers contractile properties spinal cord injury number motor units muscle group estimated 11 patients cervical spinal cord injuries surface electromyogram twitch force , response maximal stimulation median nerve divided average surface electromyogram twitch single units average single unit size obtained intramuscular motor nerve branches graded whole nerve stimulation , provided three independent estimates , two based electromyogram one based force motor unit estimates patients covered wide range essentially normal motor units numbers contractile properties , others varying reductions numbers units patients showed large reduction motor unit numbers also greatly enlarged units , produced average sixfold normal force enlarged units produce maximal compound action potentials twitches sometimes indistinguishable normal magnetic resonance imaging scans cervical spine obtained patients provided independent evidence patients low motor unit counts sustained direct injury anterior aspect spinal cord relevant segmental levels patients showed normal number motor units long injury evidence degeneration could demonstrated group patients current techniques
relative biological effectiveness fractionated doses fast neutrons \( 42 \) normal tissues iii effects lung function effect single fractionated doses fast neutrons \( 42 \) early late radiation responses pig lung assessed measurement changes lung function using washout technique results obtained irradiation schedules fast neutrons compared photon irradiation statistically significant difference values relative biological effectiveness \( \) early late radiation response lung neutron beam increased decreasing size dose fraction upper limit value 4 39 0 94 small x ray doses per fraction
lead article reviews historical current uses lead sources absorbed lead , water , lead based , , bullet wounds means absorption , collection specimens , quantification methods , effects lead toxicity discussed
tardive dyskinesia managing common neuroleptic side effect neuroleptics useful medications treatment psychosis severe behavioral disturbances elderly unfortunately , older patients high risk developing deleterious side effects medications , especially persistent tardive dyskinesia \( \) diagnosis , risk factors , cause treatment discussed important careful assessment indications neuroleptic use , monitor closely development side effects , work closely patient family making decisions neuroleptic use
subtle injuries joint fifteen patients , subtle injury joint \( \) found lesion defined two five millimeters bases first second , seen anteroposterior radiographs often long delay injury diagnosis eight patients treated knee cast , three treatment cast arthrodesis , two initial treatment later arthrodesis , two open reduction internal fixation duration follow ranged two thirteen years diagnosis correlation severity patient 's functional result marked disability pain persisted seven patients , six flattening longitudinal arch maintenance longitudinal arch usually associated better functional outcome patient subtle injury joint , weight bearing lateral radiographs feet needed identify flattening longitudinal arch radiographs made routinely evaluation injuries foot may involve joint
shielding patient 's gonads intramedullary interlocking femoral nailing levels exposure radiation recorded sixty sites fifteen patients intramedullary interlocking femoral nailing radiation film placed four gonadal sites subject standard male cup pelvic 0 5 thick lead equivalent put place shield gonads second set four placed external shield approximate unprotected exposure total duration fluoroscopy averaged five minutes \( range , thirty seconds fourteen minutes \) total exposure radiation external shield 35 34 male gonadal sites 17 11 female gonadal sites use gonadal shield , exposure radiation measurable thirteen fifteen patients differences exposures sites radiation statistically significant \( p less 0 001 \) highest level gonadal exposure found treatment proximal femoral fractures use locked nails regardless conditions , types fractures locations , results demonstrated gonadal shielding justified
injuries elderly inner city population even though injuries leading cause morbidity mortality among elderly united states , comprehensive population based study nonfatal fatal injuries carried elderly minority inner city population study injuries population , developed active surveillance system part large injury prevention program poor urban black community report 577 cases nonfatal fatal injuries community 12 , 139 persons 65 years age older resulted emergency room treatment death march 1 , 1987 , february 29 , 1988 nearly 5 elderly population treated emergency room , died result , injury study period overall injury rate 48 injuries per 1 , 000 persons injury rates older women exceeded older men increased advancing age sexes fall injuries accounted 312 \( 54 \) injuries 75 hospitalizations injury motor vehicle incidents violence second third common injuries , accounting 13 7 injuries , respectively given predominance falls relative injuries , prevention falls receive major emphasis injury prevention efforts inner city minority populations
effects trauma center system emergency department utilization university illinois hospital \( \) serves inner city urban population one highest crime rate districts chicago may 20 , 1986 , city 's level trauma took effect university illinois hospital declining participate measure impact hospital , undertook retrospective analysis trauma patient utilization statistics consecutive monthly patient census data 71 months emphasis patient presenting complaints related subspecialty evaluation observed significant decreases patients presenting head injuries , fractures , animal bites well major trauma , minor trauma , general surgery hospital admission final disposition patients ambulance consistent observed decrease major traumatic conditions minor traumatic conditions however , mean number patient presentations per day \( ppd \) admitted regular medical surgical beds decreased 2 70 ppd 2 30 ppd mean number ppd sent home increased 2 64 ppd 3 49 ppd data suggest loss trauma center status designation profound effect utilization emergency departments participating trauma system appears associated significant decrease utilization rates major minor trauma patients significant increase number patients discharged arrived chicago fire department paramedic system \( \) effect emergency department extends utilization inpatient services
case report severe ethylene glycol intoxication normal gap thought case 23 year old male presenting altered , vomiting , right flank pain despite normal gap , found suffering ethylene glycol intoxication little described presentation result clinician failing consider ethylene glycol causative agent
blunt trauma heart pathophysiology injury blunt injuries heart common potentially lethal injuries often go undetected obvious problems treated cardiac injury suspected patient severe chest trauma spectrum cardiac trauma ranges injuries actual cellular damage \( myocardial \) cardiac chamber rupture pathophysiology , diagnosis , treatment injuries discussed
scapular manipulation technique reduction acute anterior shoulder dislocations anterior shoulder dislocations common occurrence emergency departments numerous techniques treating problem reported majority techniques use traction humerus , often requiring considerable force causing significant patient discomfort report simple , relatively , method shoulder reduction involving manipulation scapula well humerus technique used emergency department considerable success complications
assessing nutritional needs burned patient assessment nutritional needs following thermal injury remains important adjunct providing dietary therapy designed minimize detrimental effects subsequent catabolism anthropometric measurements , frequently utilized patients , relatively little usefulness assessing burned individuals energy expenditure adequately estimated patients direct calorimetry , indirect calorimetry , direct calorimetry expensive complicated method , use formula inexpensive least complicated yield good results clinical setting differences estimated energy expenditure multiple may statistically significant , rarely clinically significant therefore selection formula based simplicity estimations formula require intervals 1 2 weeks general , enteral feedings remain superior parenteral delivery nutrients finally , current animal research suggests significant differences metabolic immunologic effects diet depending qualitative make dietary fat sources
effect early feeding postburn hypermetabolic response rats effect early enteral feeding hypermetabolic response following burn injury rat burn model investigated rates heat production heat loss determined postburn day five treatment groups \) burn , fed rat chow ad libitum starting 2 hours postburn ii \) burn , fed gastrostomy beginning 2 hours postburn iii \) burn , fed gastrostomy , delayed 72 hours postburn iv \) controls , fed gastrostomy 2 hours post anesthesia v \) controls , fed rat chow ad libitum 2 hours post anesthesia gastrostomy feedings delivered 175 kcal kg day mean rates heat production heat loss three burn groups differ significantly whether rats fed chow ad libitum , gastrostomy early late contrary previous studies using guinea pig model , method timing feeding burned rat model significant effect postburn increment rate heat loss corresponding increment rate heat production
antibiotics postburn hypermetabolic response severe burn injury documented significantly increase resting metabolic energy expenditure increase metabolic rate appears possibly correlated degree burn wound colonization infection bacteria prevention colonization infection use topical antimicrobial agents appears decrease metabolic alterations resulting burn injury findings indicate appropriate use topical antibacterial agents may decrease metabolic demands seen burned patients burn induced translocation intestinal bacteria also hypothesized contribute postburn hypermetabolic response attempts preventing entity burned guinea pig model use selective decontamination digestive tract administration enteral antibiotics failed demonstrate measurable effect
pulmonary circulation burns trauma lung critical organ victims thermal injury multiple trauma since blood injured organs pulmonary circulation passing organ lung therefore receive first released postinjury addition target injury , lung may also contribute injury systemic organs injury may result reduced delivery oxygenated blood direct release systemic circulation injury lung may pulmonary microvasculature airway bronchial circulation responds injury marked elevation blood flow microvascular permeability latter effects may important mediating changes occur lung parenchyma
evaluation management patients inhalation injury inhalation injury , present approximately one third burned patients treated burn centers , increases mortality maximum 20 relation age extent burn development animal models inhalation injury made possible identification airway vascular responses evoked smoke inhalation inflammatory occlusion terminal bronchioles necrosis endobronchial mucosa render airway pulmonary parenchyma susceptible infection resulting pneumonitis increases mortality early diagnosis , best achieved endoscopic bronchoscopy ventilation perfusion scan , permits timely application high frequency ventilation appears reduce incidence pneumonia decrease mortality pharmacologic agents give promise ameliorating deleterious changes vasculature recent advances understanding inhalation injury identified research needed improve patient salvage
pathophysiologic events related thermal injury skin acute thermal injury skin equivalent second degree injury involving approximately 25 total body surface results series pathophysiologic events lead local distant tissue organ injury distant effects involve intravascular hemolysis acute lung injury , attributed complement activation intravascular stimulation neutrophils , resulting oxygen radical production , results injury red cells pulmonary vascular endothelial cells local site thermal injury , progressive increase vascular permeability linked complement activation histamine release , outcome interaction histamine xanthine oxidase , resulting enhanced catalytic activity enzyme toxic oxygen products xanthine oxidase , including h2o2 conversion product , hydroxyl radical , appear linked damage dermal vascular endothelial cells , resulting progressive vascular permeability increased vascular permeability greatly attenuated use inhibitors xanthine oxidase , inhibitor histamine release \( \) , catalase , iron chelator \( deferoxamine \) , scavengers hydroxyl radical interestingly , neutrophils appear play little role dermal vascular injury animal model thermal trauma studies suggest pathophysiologic events following local thermal trauma complex involve variety mediator pathways
synergism hepatic injuries reovirus mice enhanced hepatic infection death reovirus type 1 , intravenous inoculation adult mouse , secreted via bile intestine infectious form although reovirus type 1 rapidly removed systemic circulation liver lung , hepatocytes express reovirus antigen infection intestinal cells , reovirus selectively crypts site preference may due active cell proliferation crypts hypothesized state cell may affect virus replication tested hypothesis using chemical surgical means increase hepatic mitotic activity adult mice treated carbon surgical trauma , inoculated reovirus type 1 intravenously , subsequently killed virus antigen identified using highly specific immunohistochemical technique liver sections stained using immunoperoxidase specific rabbit antibody surgical trauma increase reovirus antigen detection kupffer cells hepatocytes sequential administration ccl4 virus caused mortality doses sublethal alone data demonstrate synergism hepatic injury reovirus results significant increase magnitude viral infection contributes mortality synergism may important idiopathic liver disease
isolation serogroup collected colorado two viruses isolated collected northern colorado electron microscopy indicated isolates like indirect fluorescent antibody serum dilution plaque reduction neutralization tests showed isolates members serogroup , closely related antigenically viruses distinguishable suggest name virus isolates antibody birds northern colorado indicates presence viruses northern colorado raises unanswered questions introduction establishment serogroup viruses
effects 2 15 micron laser human atherosclerotic xenografts vivo chromium yttrium aluminum \( yag \) laser tissue effect similar co2 laser , advantage flexible fibers authors used human rabbit xenograft model evaluate thrombotic healing responses atherosclerotic vessels subjected laser energy occluded atherosclerotic human coronary artery segments vitro use yag laser destruction plaque laser achieved minimal collateral thermal damage vascular segments transplanted rabbit abdominal aorta authors observed luminal surface vessels thrombogenic control vessels however , occlusion vessels occur repair laser treated tissue progressed mature , fibrin platelet aggregate adherent luminal wall overall , vessels fashion similar control vessels basis results , authors believe yag laser may use human angioplasty
systemic amiloride inhibits experimentally induced neovascularization amiloride inhibitor urokinase type plasminogen activator , might therefore inhibitory effect neovascularization neovascularization induced rabbit corneas via local implantation prostaglandin e1 prepared slow release polymer animals received daily intraperitoneal injections 30 mg amiloride , equivalent volume saline solution 5 days well tolerated without severe untoward effect neovascular response , documented corneal photographs , evaluated 5 days injections area induced corneal neovascularization decreased 55 animals receiving amiloride compared controls thus , amiloride similar compounds may prove useful study management neovascularization
rat femoral artery model vasospasm new animal model vasospasm using rat femoral artery developed whole blood , washed erythrocytes , leukocytes platelet rich plasma selectively applied surface femoral artery 7 days 15 rats , vessels perfusion fixed examined light transmission electron microscopy immunohistochemistry compared matched control arteries , prominent reduction luminal cross sectional area 7 days vessels exposed whole blood washed erythrocytes , exposed leukocytes platelet rich plasma arteries luminal narrowing , light transmission electron microscopy demonstrated marked morphological changes throughout vessel wall similar seen cerebral vasospasm subarachnoid hemorrhage immunohistochemistry disclosed prominent loss immunoreactive actin smooth muscle cells arteries exposed whole blood erythrocytes assess time course arterial narrowing model , whole blood selectively applied surface femoral arteries 23 rats periods 2 20 days compared control arteries , arterial narrowing variably present 2 days , progressively increased 5 days , maximal 7 10 days , returned near control levels 20 days presence severity ultrastructural changes vessel wall corresponded degree arterial narrowing time results suggest chronic narrowing rat femoral artery exposed blood analogous observed cerebral arterial vasospasm subarachnoid hemorrhage new model represents simple reliable means investigate pathogenic mechanisms potential therapies vasospasm
increased activity calcium leak channels myotubes duchenne human mdx mouse origin elevated free ca2 concentrations found adult dystrophic muscle fibers result enhanced protein degradation since difference concentrations may reflect differences entry , ca2 leak channels cultures normal duchenne human myotubes , normal mdx murine myotubes , identified characterized open probability leak channels markedly increased dystrophic myotubes channel properties , mean open times , single channel conductance , ion selectivity , behavior presence pharmacological agents , similar among types compared ca2 concentrations normal human normal mouse myotubes , intracellular resting free ca2 concentrations \( ca2 \) myotubes duchenne mdx origin significantly higher time dystrophin first expressed normal tissue taken together , findings suggest increased open probability ca2 leak channels contributes elevated free intracellular ca2 concentration duchenne human mdx mouse myotubes
comparison phenytoin noncompetitive n methyl aspartate antagonists model focal brain ischemia rat recent vitro vivo experiments suggested excitatory amino acid antagonists , particularly active n methyl aspartate receptor subtype , effective ameliorating ischemic injury due activity however , drugs also potent effective vivo anticonvulsants present experiments compared noncompetitive n methyl aspartate antagonists mk 801 anticonvulsant phenytoin model focal brain ischemia fisher f 344 rats subjected tandem occlusion middle cerebral ipsilateral common carotid arteries halothane anesthesia compounds administered intravenously 30 minutes 24 hours arterial occlusion infarct size assessed 48 hours occlusion effect infarct volume 1 mg kg , significantly reduced \( 36 \) infarct volume 3 mg kg , produced nonsignificant 26 decrease 10 mg kg potent selective noncompetitive antagonist mk 801 reduced \( 32 \) infarct volume significantly 0 1 mg kg , produced nonsignificant 23 decrease 0 3 mg kg , effect 0 5 mg kg phenytoin , glutamate antagonist , reduced infarct volume 45 28 mg kg single dose phenytoin \( 28 mg kg \) administered 30 minutes occlusion , delaying drug administration 2 hours ineffective data suggest blockade n methyl aspartate receptor effective reducing infarct size focal cerebral ischemia activity phenytoin suggests may related common anticonvulsant action
virus cdna encoding protein recognized antibodies humans behavioral diseases disease virus \( bdv \) causes rare neurological disease sheep virus classified neither infectious particle specific nucleic acid identified identify genome bdv , complementary dna expression library constructed selected rna bdv infected cell line clone \( \) isolated specifically hybridized rna isolated bdv infected brain tissue bdv infected cell lines clone hybridized four bdv specific positive strand rnas \( 10 5 , 3 6 , 2 1 , 0 85 kilobases \) one negative strand rna \( 10 5 kilobases \) bdv infected rat brain nucleotide sequence analysis clone suggested represented full length messenger rna contained several open reading frames vitro transcription translation clone resulted synthesis 14 24 kilodalton bdv specific proteins 24 kilodalton protein , translated vitro clone , recognized antibodies sera patients \( three seven \) behavioral disorders bdv specific clone provide means isolate bdv specific nucleic acids identify virus responsible disease addition , significance bdv bdv related virus human pathogen directly examined
evidence requisite role defective virus establishment persistent infections factors involved establishment persistent infection poorly understood recent findings demonstrate sequence genome hepatitis b virus \( hbv \) variable infected individuals , cases , virus mutants predominate objectives present study analyze variability hepatitis virus \( whv \) genomes infected animal determine whether sequence heterogeneity played critical role ability whv induce chronic infection cloned determined complete nucleotide sequence three genomes animal became infected inoculation standardized whv serum pool \( e , virus pool \) found four nucleotide substitutions among three genome sequences well 73 nucleotide deletion one recombinants dna transfection experiments revealed one three recombinants capable independent replication data suggest significant proportion replicative infected whv defective virus genomes next , compared outcome acute infection inoculation serum pool containing uniform population replication competent virus \( e , pool \) serum pool composed whv genomes variable sequence serum pool originated became chronic carrier vivo transfection liver infectious recombinant neonatal inoculated 5 x 10 \( 6 \) whv genome equivalents either pool pool animals study became acutely infected whv animals infected serum pool , 65 became chronic carriers , 80 animals infected serum pool developed chronic infection thus , infection serum pool containing defective virus resulted rate chronic whv infection similar , even lower , rate pool containing wild type virus suggests presence defective virus inoculum prerequisite establishment persistent infections
tissue expansion head neck indications , technique , complications tissue expansion indicated reconstruction various defects head neck instances inadequate adjacent tissue allow either primary closure defect repair local flap may also indicated instances repair defect alternative method local , regional , distant flap result unacceptable donor recipient site deformity although tissue expansion concept , require judgment preoperative planning ensure optimal results complication rate high tissue expansion head neck , particularly cheek neck area despite frequency complications , vast majority cases intended reconstruction successful
induction mixed erythroid megakaryocyte colonies blast cell colonies recombinant human erythropoietin serum free culture effects recombinant human erythropoietin \( rep \) murine hematopoietic progenitors studied using serum free culture high concentration rep stimulated formation mixed erythroid megakaryocyte colonies \( em colonies \) blast cell colonies , well erythroid colonies , erythroid bursts , megakaryocyte colonies normal mouse bone marrow cells direct effects rep em colony , megakaryocyte colony , erythroid burst formation confirmed depletion accessory cells cells , b cells , macrophages crude bone marrow cells , inhibition colonies addition rabbit anti rep antibody culture dose dependent fashion experiments performed confirm differentiating ability blast cell colonies grown presence rep blast cell colonies yielded secondary erythroid colonies also megakaryocyte colonies presence 2 iu ml rep blast cell colonies produced secondary em colonies presence 16 iu ml rep 2 iu ml rep plus interleukin 3 , although granulocyte macrophage colonies found secondary culture results suggest ep acts late acting factor specific erythroid progenitors , also em stimulating factor murine hematopoietic cells
effect food aversions chemotherapy effects consuming novel food \( \) versus familiar food \( \) gastrointestinal \( gi \) toxic chemotherapy patients' preference familiar foods consumed chemotherapy treatment compared development aversions novel familiar foods also assessed patients history posttreatment nausea consumed either novel familiar food chemotherapy asked keep food record next breakfast rate preference foods patients consumed treatment significantly likely increase ratings foods consumed chemotherapy patients consumed familiar aversions novel food significantly frequent aversions familiar food findings provide evidence novel familiar food consumed chemotherapy act prevent items regular diet consumed chemotherapy decreasing preference providing patients novel food chemotherapy useful clinical intervention reduce likelihood forming aversions familiar foods consumed chemotherapy
myocyte cell loss myocyte cellular hyperplasia hypertrophied aging rat heart determine effects age myocardium , functional structural characteristics heart studied rats 4 , 12 , 20 , 29 months age mean arterial pressure , left ventricular pressure first derivative \( dp dt \) , heart rate comparable rat groups 20 months interval 20 29 months , elevated left ventricular end diastolic pressure decreased dp dt indicated significant impairment ventricular function occurred senescence period 4 12 months , reduction nearly 19 total number myocytes measured ventricles subsequent ages , similar decreases myocyte cell number found left ventricle , whereas right ventricle , initial loss fully reversed 20 months moreover , 20 29 months , 59 increase aggregate number myocytes occurred right ventricular myocardium left ventricle , 3 increment also seen , small change statistically significant estimations myocyte cellular hyperplasia , however , complicated fact cell loss continued take place age volume fraction collagen tissue , fact , progressively increased 8 7 4 months 16 22 29 months left right ventricles , respectively conclusion , myocyte cellular hyperplasia tends ventricular mass lost age adult mammalian rat heart
fibrillation \? ventricular fibrillation examined determine whether instance surface ecgs dogs fibrillation used generate state space fibrillation analysis failed identify low dimensional could associated fibrillation results suggest fibrillation similar random signal note , however , random looking behavior also generated nonlinear system
effects screws sleeve initial fixation uncemented total knee tibial components aseptic loosening tibial components remains serious problem uncemented total knee arthroplasties achieving rigid initial fixation porous coated components one important factors promoting bone ingrowth results biomechanical study tibial component shear axial compressive loading presented forty anatomic specimen stress tested mechanical test machine evaluate effects screws sleeve initial fixation uncemented total knee tibial component twenty specimens used shear loading 20 anterolateral axial compressive loading four cancellous screws inserted tibial cortex proximal tibia sleeve applied central stem rigidity fixation significantly improved combination screws sleeve bone strength also important factor affecting quality fixation
effect screws initial fixation stability uncemented knee replacement two uncemented tibial components examined initial fixation stability conventional design employed single posteriorly peg compared new design held place cancellous bone screws components implanted medial condyles 12 preserved human , cyclic load first applied screwed implants failed significantly higher loads \( 8 121 6 n , mean standard error mean \) pegged implants \( 3 152 0 n \) application 19 6 n preload , screwed implants moved significantly less pegged implants although differences always significant , definite trends screwed implants much lower levels temporary permanent displacement compared pegged implants load levels initial load 245 2 n including failure load motion resulted moving load anterior position posterior position examined , screwed implant 's average total motion less 10 microns compared almost 135 microns pegged implant 245 2 n load cycle cycle failure , screwed implant 's average motion increased less 29 microns , whereas pegged implant 's average total motion almost 354 microns information appears clear screws provide better initial fixation stability uncemented tibial components
influence postmortem time temperature activity demineralized ethylene oxide syngeneic bone implant rat bone protein labile easily inactivated many extracorporeal factors crucial establish whether delay retrieval donor bone ambient holding temperature donor body influence bone left situ ten adult rats killed , five kept 4 degrees five room temperature harvested 24 , 36 , 48 , 72 , 168 hours processing , segments implanted 20 four week old syngeneic rats 14 days level evaluated histologically excellent 4 degrees group 24 , 36 , 48 hour specimens less advanced 72 hours bone taken room temperature group showed findings identical kept 4 degrees 36 hours , less advanced 48 hours absent 72 hours bone formed 168 hours either temperature group following observations made \( 1 \) demineralized bone left situ death unexpectedly stable \( 2 \) retrieval time extended donor cooling \( 3 \) demineralized bone actively induced new bone formation \( 4 \) ethylene oxide inhibit correctly applied confirmed humans , retrieval bone used could delayed hours , particularly donor immediately would increase effective number bone tissue donors utilize resource
underlying illness associated failure thrive infants four year period pediatric practice , 38 infants aged six months less identified failure thrive \( \) breast feeding seven cases \( 18 4 \) , associated organic illness diagnosed 2 28 breast fed neonates \( 8 \) found associated another illness , compared 5 10 older infants \( 50 \) breast fed infants , particularly presenting first month life , considered high risk disease clinical evaluation include appropriate search organic illnesses
gastrointestinal bleeding 15 month old male presentation munchausen 's syndrome proxy munchausen 's syndrome proxy well described entity may always immediately considered complicated case describe syndrome gastrointestinal bleeding 15 month old male discuss difficulty involved diagnosis also consequences may occur diagnosis failure diagnose munchausen 's syndrome proxy often results failure consider diagnosis cases frequently specific characteristics allow clinicians suspect diagnosis diagnosis considered , crucial take steps protect index patient also siblings infrequently also recipients life threatening form child abuse
inflammatory nodular reactions hepatitis b vaccination due sensitization 2 patients , nodules appeared hepatitis b found responsible side effect contact allergy present patients , whereas controls negative
rapid admixture blood warming technical advances technique rapid admixture blood warming cold erythrocyte units designed warm erythrocyte units rapidly \( less 30 sec \) simultaneously providing saline dilution however , questions raised recommended use standard 250 ml bolus 70 degrees c admixture saline , speed blood unit warming , difficulties inherent keeping saline bags 70 degrees c , safety methodology answer questions , series tests performed modifications technique introduced mean weight 1000 successive units erythrocytes adult infusion 305 g \( range 220 410 \) maximum temperature 44 degrees c , using internal temperature probe \( 1 cm temperature 2 sec recording intervals \) smallest unit admixed 250 ml 70 degrees c saline bolus largest unit minimum temperature 30 degrees c plasma , osmotic fragility , k minimum size erythrocyte unit showed significant deviation control photographs internal temperature recordings erythrocyte units demonstrated solely due fluid , uniform mixing occurs within approximately 30 sec beginning admixture process blood units caused thermal layering fluids unacceptable maximum blood temperature 50 degrees c difference mixing time efficacy presence standard large bore iv tubing additional line filters volumes 250 ml saline bags admixture decreased markedly deviations electrolyte composition greater 2 wk 70 degrees c
effect prolonged hypothermia cardiac function young patient accidental hypothermia 20 year old man accidental , prolonged , severe hypothermia serial radionuclide ventriculography disclosed reduced myocardial contractility hypothermia resolved warming effects hypothermia cardiac function discussed
lung sound survey report terms used 223 pulmonary physicians 54 physicians specialties describe eight recorded examples lung sounds participants lung sounds 1988 american college chest physicians annual free form answers pulmonary physicians used terms crackles rales equal frequency describe discontinuous lung sounds \( als \) describe continuous als physicians preferred term rales describing discontinuous als terms used describing continuous als however , term frequently used describe continuous discontinuous als majority participants recognized normal breath sounds pleural friction use qualifying describe als , little agreement among lung sound used physicians well standardized recommendations subcommittee widely accepted
laryngomalacia children two hundred three \( 68 percent \) children laryngomalacia associated respiratory disorders flexible fiberoptic bronchoscopy \( \) associated disorders included congenital respiratory anomalies , variety anatomic obstructions upper lower airways , aspiration disorders mean age isolated laryngomalacia \( type 1 \) 11 5 weeks \( range , 5 weeks 4 months \) children laryngomalacia associated respiratory disorders \( type 2 \) mean age 9 06 years \( range , 6 weeks 18 years \) conclude following \( 1 \) complete evaluation pediatric airways \( bronchoscopy \) recommended every symptomatic child diagnosis laryngomalacia confirmed laryngoscopy \( 2 \) type 1 laryngomalacia common early infancy type 2 laryngomalacia associated older age \( 3 \) although type 2 laryngomalacia common endoscopic diagnosis experience , majority cases associated lower airway dysfunction
effects methoxamine epinephrine survival regional distribution cardiac output dogs prolonged ventricular fibrillation study compares effects methoxamine , pure alpha 1 agonist , epinephrine cerebral myocardial blood flow , central hemodynamics , survival randomized placebo controlled fashion prolonged ventricular fibrillation \( vf \) canine model twenty four anesthetized ventilated adult mongrel dogs instrumented regional blood flow determinations using radio labeled microspheres dogs randomized receive either 20 mg methoxamine single intravenous bolus repeated boluses 0 02 mg kg epinephrine , 0 2 mg kg epinephrine , normal saline solution placebo beginning three minutes following induction vf initiation closed chest cardiac \( \) organ blood flow measurements determined normal sinus rhythm five 20 minutes vf six dogs receiving methoxamine successfully resuscitated contrast one epinephrine treated groups none dogs receiving placebo \( p less 01 \) although epinephrine associated significantly higher blood pressures placebo cardiopulmonary resuscitation \( cpr \) , blood pressures achieved methoxamine significantly higher observed three treatment groups \( p less 001 \) cerebral blood flow significantly higher methoxamine high dose epinephrine \( p less 05 \) mean left right ventricular myocardial flows highest methoxamine achieve statistical significance contrast , organ flows measured animals receiving lowest dose epinephrine significantly higher associated placebo cardiac output 20 minutes cpr significantly lower high dose epinephrine methoxamine placebo \( p less 05 \) results suggest methoxamine significantly improves regional cerebral blood flow survival cpr although high dose epinephrine associated comparable improvements regional cerebral blood flow , treatment associated deterioration central hemodynamics prolonged vf enhance survival
healing experimental intestinal anastomoses parameters repair anastomotic dehiscence remains major complication surgery large bowel , studies healing sequence experimental anastomoses necessary define underlying mechanisms find ways improve surgical outcome , particularly high risk situations quantitative description anastomotic repair , mechanical biochemical parameters employed , limitations mechanical parameters , either bursting pressure strength , reflect growing anastomotic strength long disruption occurs within anastomotic area , less one week surgery bursting pressure probably two weeks strength biochemical description anastomotic repair limited behavior collagen , represented rather unique constituent amino acid hydroxyproline conclusions based collagen concentrations per unit weight considered caution since may change consequence changes substances respect , collagen content , per unit length , probably better parameter describe anastomotic collagen levels investigations addressed quality collagen \( e g , crosslinking type \) since , time , distinct correlations demonstrated development mechanical strength occurrence leakage collagen levels healing anastomosis , attention restricted description quantity collagen present quality anastomotic collagen investigated , perhaps even
behavioral modification colonic function constipation learned \? challenged two hypotheses first , defecation suppressed extended time , second , , effect upper colonic motility thus studied 12 male volunteers conditions identical nutrition patterns physical activity two week period , one week normal defecation one week voluntary prolonged suppression defecation followed randomized order frequencies defecation , stool weights , total segmental colonic transit times \( using markers \) compared frequency stool weights lower suppressed defecation 8 9 0 66 vs 3 7 0 41 \( mean se \) bowel movements per week , p 0 003 , 1 30 0 09 vs 0 98 0 13 kg week , p 0 01 total transit times increased 28 8 4 4 53 1 4 3 hr , p 0 004 segmental transit times increased \( 8 83 3 6 32 1 5 6 hr , p 0 04 \) right \( 14 5 0 9 hr 19 7 1 5 hr , p 0 02 \) suppression defecation conclude defecation habits may induce changes colonic function seen constipation functional anorectal outlet obstruction may , probably reflex , affect right colon
high dietary fiber low saturated fat intake among oligomenorrheic numerous functional risk factors associated occurrence secondary amenorrhea young women less known regarding factors associated prevalent problem evaluated nutrient intake , body composition , perceived psychological stress , 24 hour urinary cortisol , urinary c peptide \( \) 35 eumenorrheic , 11 mildly oligomenorrheic , 10 oligomenorrheic undergraduate women nutrient intake evaluated validated food frequency questionnaire oligomenorrheic women found consume significantly dietary fiber , crude fiber , polyunsaturated fat , significantly less saturated fat eumenorrheic oligomenorrheic women significantly lower 24 hour excretion mildly oligomenorrheic women groups differ aspect body composition , body weight , age menarche , perceived psychological stress , urinary cortisol excretion data suggest higher intake fiber lower intake saturated fat may associated among otherwise healthy undergraduate women
acute increases gastroduodenal resistance flow liquid rat effect volume expansion extracellular fluid gastroduodenal resistance flow isotonic saline assessed three groups rats using intravenous infusions isotonic , isotonic , isotonic solutions gastroduodenal segment 29 male wistar rats perfused constant pressure gradient 4 cm h2o changes flow \( ml minute \) taken reflection changes gastroduodenal resistance isotonic expansion led 33 drop gastroduodenal flow compared period animals \( p less 0 01 \) extracellular fluid expansion isotonic isotonic solutions associated reductions gastroduodenal flow 29 \( p less 0 05 \) 31 \( p less 0 01 \) respectively increase gastroduodenal resistance due per se haemodilution , decreases plasma oncotic pressure , electrolyte imbalance effect gastroduodenal resistance , reversed small \( 0 5 1 0 ml per 100 g body weight \) , may due changes phasic motor activity , , may part processes help organism liquid volume excess
family recovery vascular surgery twenty one families observed 3 month study assess family coping major vascular surgery recovery analysis family measures data \( family apgar , family inventory resource management , family crisis oriented personal evaluation scales \) combined theory method assess family responses time recovery outcomes containment emerged major conceptual category theory containment constructed events behavioral responses used families regulate impact surgical crisis reduce family disruption contained coping pattern manifested behaviors narrow definitions problem , defined situation terms surgical repair cure rather palliative intervention chronic , progressive disease factors development illness primary focus care providers hospital surgical care \( allowing narrow definitions situation remain \) also contributed containment containment resulted poor risk factor management major recovery outcome isolation family conflict evident throughout recovery period concerns generated continued evidence morbidity recovery contributed developing awareness underlying disease , containment growing awareness shared within family significant findings family measures analysis compared theory qualitative data corroborated key dimensions
nurse monitored cardiac recovery description first 8 weeks health problems related patient management early recovery cardiac surgery well documented part larger study recovery cardiac surgery 75 patient care pairs received telephone calls nurses 1 , 2 , 3 , 4 , 6 , 8 weeks discharge purpose intervening facilitate early recovery home call , nurses recorded detailed notes patients' progress concerns content analysis detailed recordings revealed following predominant nursing actions assessment , provision support , predischarge teaching , referrals , teaching five nursing diagnoses occurred frequently across 8 week recovery period altered comfort pain ineffective coping , individual activity intolerance sleep pattern disturbance altered nutrition response problems , patients managed prevented health related problems engaged health promotional activities common problems recovery , patients care better prepared going home similarly nurses better prepared anticipate respond common recovery problems
effects endotracheal suctioning mixed venous oxygen saturation heart rate critically ill adults purpose study determine effects endotracheal suctioning mixed venous oxygen saturation \( svo2 \) heart rate 189 critically ill adults one pass , intermittent suction applied 10 fewer seconds , three three breaths 100 oxygen subjects three hospitals \( n 127 \) underwent suctioning using anesthesia bags traditional suction catheters \( open suction method \) subjects one hospital \( n 62 \) underwent suctioning ventilator line suction catheters \( closed suction method \) subjects hospital sites combined , svo2 decreased 67 64 \( p 0 001 \) , 4 change baseline , returned baseline within 2 minutes however , subjects receiving open method suction , svo2 dropped 66 62 immediately suctioning returned baseline within 4 minutes contrast , closed suction method used , svo2 rose 67 7 67 86 immediately suctioning , upward 71 next 2 minutes toward baseline 4 minutes mean heart rate increased baseline 99 beats min 104 beats min immediately suctioning \( p 0 001 \) , 5 change baseline , gradually returned baseline next 4 minutes significant differences seen heart rate subjects open versus closed suction method conclusion , closed suction method showed higher svo2 endotracheal suctioning compared open suction method \( p 0 0001 \) form endotracheal suctioning recommended
blood loss reduced hip arthroplasty lumbar plexus block measured blood loss hip replacement two groups women , consisting 10 patients one group lumbar plexus infiltrated bupivacaine , group plexus blocked significantly less blood loss
insertion deletion polymorphism angiotensin converting enzyme gene accounting half variance serum enzyme levels polymorphism consisting presence absence 250 bp dna fragment detected within angiotensin converting enzyme gene \( ace \) using endothelial ace cdna probe polymorphism used marker genotype study involving 80 healthy subjects , whose serum ace levels concomitantly measured allele frequencies 0 6 shorter allele 0 4 longer allele marked difference serum ace levels observed subjects three ace genotype classes serum immunoreactive ace concentrations , respectively , 3 49 , 392 6 66 8 , 1 88 3 micrograms liter , homozygotes longer allele \( n 14 \) , heterozygotes \( n 37 \) homozygotes \( n 29 \) shorter allele insertion deletion polymorphism accounted 47 total phenotypic variance serum ace , showing ace gene locus major locus determines serum ace concentration concomitant determination ace genotype improve discrimination normal abnormal serum ace values allowing comparison appropriate reference interval
problem implant dentistry dental implants become accepted form dental care , reported functional 5 year success rates 90 higher impressive statistics include , identify , problems may created clinical diagnostic preventive measures stage implant treatment avoid many problems also , appropriate measures timely recognition , rescue , repair often restore implants prosthetic full function
effective transvenous defibrillation system using coronary sinus humans use coronary sinus catheter electrode , right ventricular catheter electrode chest wall patch electrode system , defibrillation threshold voltage , current energy measured four distinct transvenous defibrillation techniques delivered random sequence 12 survivors cardiac arrest immediately implantation standard epicardial patch defibrillation system four transvenous defibrillation techniques 1 \) single pathway monophasic pulsing , 2 \) single pathway biphasic pulsing , 3 \) dual pathway sequential pulsing , 4 \) dual pathway simultaneous pulsing transvenous defibrillation method considered potentially useful defibrillation threshold less equal 500 v \( less equal 15 j delivered energy \) 500 v value would allow 2 1 defibrillation safety margin device maximal output 30 j single transvenous pulsing technique uniformly superior efficacy however , choosing best pulsing technique patient , possible obtain average defibrillation threshold 410 135 v leading edge voltage , 7 2 2 5 leading edge current 11 3 7 4 j delivered energy group 12 patients ability vary defibrillation technique , transvenous antiarrhythmic device implantation would possible 10 \( 83 \) 12 patients 15 j defibrillation threshold cutoff point contrast , one transvenous defibrillation method used , 5 8 12 patients would candidates transvenous defibrillation system given 15 j defibrillation threshold cutoff point insertion
effects stress gastric mucosal prostaglandin generation intact , adrenalectomized , sham operated rats study effects \( \) cold restraint stress \( b \) adrenalectomy association cold restraint stress gastric mucosal ulceration prostaglandin generation , performed two experiments first , 40 rats divided four groups 10 rats \( \) \( b \) stressed 0 5 h , \( c \) stressed 2 h , \( \) stressed 4 h second experiment , another 80 rats divided four groups 20 rats \( \) adrenalectomy plus cold restraint stress 2 h , \( b \) adrenalectomy plus stress , \( c \) sham operated plus 2 h stress , \( \) sham operated plus stress experiments recorded ulcer index measured mucosal generation prostaglandin e2 \( pge2 \) prostaglandin \( 6 keto \) conclusion \( \) cold restraint stress associated time dependent decrease gastric mucosal pge2 generation , change 6 keto generation , increase mucosal injury maximal 2 h \( b \) adrenalectomy augments effects stress mucosal injury effect prostaglandin generation thus , effect adrenalectomy appears independent effect prostaglandin generation
different tumor derived p53 mutants exhibit distinct biological activities wild type form , protein p53 interfere neoplastic processes tumor derived cells often express mutant p53 full length mutant forms p53 isolated far transformed mouse cells exhibit three common properties vitro loss transformation suppressing activity , gain pronounced transforming potential , ability bind heat shock protein tumor derived mouse p53 variant described , whose site mutation corresponds hot spot p53 human tumors absolutely , weakly transforming exhibits detectable binding data suggest ability p53 mutant bind endogenous p53 sole determinant oncogenic potential data also support existence gain function p53 mutants
rhodopsin mutants bind fail activate rhodopsin member family receptors contain seven transmembrane coupled g proteins nature interactions rhodopsin mutants g protein , transduction \( gt \) , investigated flash order monitor directly gt binding dissociation three mutant alterations cytoplasmic loops bound 11 cis retinal yield native rhodopsin absorption spectra , failed stimulate guanosine activity gt mutations included reversal charged pair conserved g protein coupled receptors cytoplasmic border third transmembrane helix \( mutant \) , replacement 13 amino acids second cytoplasmic loop \( mutant cd2 \) , deletion 13 amino acids third cytoplasmic loop \( mutant \) whereas mutant failed bind gt , mutants cd2 showed normal gt binding failed release gt presence guanosine triphosphate therefore , appears least second third cytoplasmic loops rhodopsin required activation bound gt
comparison hospital costs morbidity patients undergoing general surgical operations hospital costs clinical results 304 patients 80 years old underwent general surgical procedures evaluated mortality rate 14 per cent 19 9 per cent occurred patients admitted emergency conditions compared 8 9 per cent occurred patients undergoing elective procedures \( p less 0 001 \) seventy nine per cent patients discharged 7 per cent required care skilled nursing facility survival rates good better standard life table survival rates 80 year old patients costs higher admitted conditions died hospital deaths result complications primary disease rather associated disease groups neither costs length stay could accurately predict survival individual patients concluded health resources directed treating problems , cholelithiasis , hernia carcinoma , early complications develop
effects medical surgical treatment cerebral perfusion cognition patients chronic cerebral ischemia effects medical treatment without cerebral revascularization procedures cognition cerebral blood flow compared among 36 patients extracranial occlusive cerebrovascular disease cognitive impairments three comparable groups studied first group \( n 18 \) received medical treatment control risk factors stroke \( including hypertension , diabetes , hyperlipidemia \) antiplatelet medication second group \( n 10 \) medical treatment plus superficial temporal middle cerebral artery bypass , third group medical treatment plus carotid endarterectomy regional cerebral blood flow cognition monitored three treatment groups 3 year interval groups showed stabilization without expected rates decline cerebral blood flow cognition , statistically significant differences emerged among treatment groups
safe drainage procedure purpose study evaluate role alternative method restoring continuity pancreaticoduodenectomy since 1975 , 45 patients undergone pancreaticoduodenectomy institution pancreaticoduodenectomy performed pancreatic carcinoma \( 24 patients \) , ampullary carcinoma \( 8 patients \) , duodenal carcinoma \( 4 patients \) , common bile duct carcinoma \( 4 patients \) , pancreatic islet cell carcinoma \( 1 patient \) , trauma \( 1 patient \) , extensive colon carcinoma \( 1 patient \) , chronic pancreatitis \( 1 patient \) , gastroduodenal artery aneurysm \( 1 patient \) one operative death , overall operative mortality rate 2 , seven patients major postoperative complications , overall morbidity rate 15 pancreatic anastomotic leaks complications related occurred twenty four patients died recurrent carcinoma , mean survival 25 months \( range , 5 66 months \) , 20 patients alive well , mean follow 27 months \( range , 2 106 months \) eight patients alive 2 years operation four exocrine pancreatic insufficiency experience confirms safe method pancreatic drainage pancreaticoduodenectomy suggests may technical advantages therefore merits widespread application
use jarvik 7 total artificial heart ventricular assist device bridge transplantation proliferation transplantation programs paralleled similar increase availability organ donors 1984 1987 , 104 orthotopic heart performed university medical center period , 25 patients died awaiting donor organ reduce mortality , began using total artificial heart \( tah \) ventricular assist device \( vad \) bridge transplantation 1988 29 patients underwent transplantation , 15 patients required tah three patients required vad bridge underlying heart conditions ischemic cardiomyopathy \( 11 patients \) , dilated cardiomyopathy \( 5 patients \) , giant cell myocarditis \( 1 patient \) , allograft failure \( 1 patient \) average duration mechanical support 10 days \( range , 1 35 days \) 17 patients successfully underwent transplantation , 1 patient died 17 days acute rejection transplanted heart , another patient died 14 days cerebral vascular event fifteen patients \( 83 \) long term survivors nine patients required reoperation bleeding mechanical device place , activated clotting time maintained 170 200 seconds heparin dipyridamole given conclude tah vad excellent mechanical transplantation
kidney transplantation patients aged sixty years older outcomes renal transplantation reviewed 26 transplants performed 25 patients 60 years age older 1985 1989 three grafts family donors 23 cadaver donors twenty one first transplants five cyclosporine used primary immunosuppression azathioprine prednisone administered patients overall patient graft actuarial survival rates 79 71 , respectively , 1 3 years patients \( n 14 \) free diabetes cardiac disease \( low risk \) 1 3 year patient graft survival rates 91 84 , respectively conversely , high risk patients \( n 12 \) patient graft survival rates 1 3 years 67 58 , respectively early deaths \( less equal 6 months \) caused sepsis \( two patients \) cardiac events \( three patients \) , four five high risk patients irreversible serious infectious complications common steroid induced diabetes , occurred five patients experience suggests kidney transplantation done safely successfully patients older 60 years age treatment choice low risk patients category
differentiation delayed serologic delayed hemolytic transfusion reactions incidence , long term serologic findings , clinical significance delayed serologic transfusion reactions \( \) delayed hemolytic transfusion reactions \( \) studied large tertiary care hospital dstr defined posttransfusion finding positive direct antiglobulin test \( dat \) newly developed specificity dhtr defined dstr case showed clinical laboratory evidence hemolysis thirty four cases dstr , 70 percent due anti e , documented prospectively 20 month period retrospective review medical records found clinical evidence hemolysis 6 \( 18 \) 34 thus , incidence dstr 1 \( 0 66 \) 151 recipients posttransfusion samples available testing , whereas incidence dhtr 1 \( 0 12 \) patients tested fifteen 34 patients followed 174 days reaction twelve 15 still demonstrated positive dat anti igg eluate studies indicated persistence positive dat dstr dhtr may involve several immunologic mechanisms , including development posttransfusion autoantibodies study indicates 1 \) frequent finding multiply transfused patients , although cases benign fail meet rigid criteria dhtr , 2 \) persistence positive dat dstr dhtr common
red cell autoantibodies , multiple immunoglobulin classes , autoimmune hemolysis effects interrelationships multiple immunoglobulin coating \( e , increased red cell rbc bound igm iga addition igg \) investigated 404 patients warm reactive rbc autoantibodies occasions multiple immunoglobulins detected enzyme linked direct antiglobulin tests 218 samples \( 37 \) , 87 \( 15 \) agglutination methods differences populations examined chi square , p less 0 005 required significance multiple tests compared igg coating alone , multiple immunoglobulins significantly associated larger quantities \( greater 800 molecules rbc \) igg , multiple igg subclasses , igg3 c3d bound cells , serum levels less 0 1 g per l latter association still significant higher levels rbc bound igg subclass pattern taken account samples multiple immunoglobulin coating , significant relationship \( p greater 0 05 \) less 0 1 g per l either c3d multiple igg subclasses concluded multiple immunoglobulin coating , even undetected agglutination methods , major cause hemolysis part generalized autoimmune response acts factors quantity bound igg , igg subclass pattern , complement also important hemolytic effect right
clinical significance white cell antibodies febrile transfusion reactions febrile transfusion reactions \( fnhtrs \) associated white cell \( wbc \) antibodies purposes study determine frequency wbc antibodies , associate severity reactions antibody specificity , distinguish fnhtrs infection postoperative fever using granulocyte indirect immunofluorescence test conjunction testing , found 70 percent fnhtrs 24 patients involved wbc antibodies remaining 30 percent apparent fnhtrs associated infections postoperative fever granulocyte specific antibodies prevalent hla antibodies associated reactions fnhtrs occur granulocyte specific antibodies , hla antibodies , possible monocyte specific antibodies \( studies \) , reactions could grouped together wbc associated reactions
use somatostatin complications occurring liver transplantation somatostatin helpful liver transplantation well defined indications uncontrolled digestive haemorrhage , short course somatostatin therapy great help controlling acute bleeding avoid emergency laparotomy somatostatin could also helpful intestinal fistula , case advantage elective surgical treatment remains confirmed
urothelial grafts mice mouse bladder epithelium successfully transplanted bladders syngeneic mice survived least twenty weeks fate transplanted tissue followed using fluorescein label recipient bladders prepared stripping either surgical chemical method possibility comparable technique treatment early bladder cancer man discussed
lesions side branches arteries undergone percutaneous transluminal coronary angioplasty histopathologic study percutaneous transluminal coronary angioplasty \( ptca \) may cause occlusion side branches histologic studies , however , made side branches arteries ptca performed histologic study therefore made explain effect ptca side branches histologic specimens prepared serial step sectioning 15 side branches 10 cases undergone ptca results examination light microscope follows \( 1 \) stenoses due ptca seen seven branches \( 46 7 \) \( 2 \) stenoses classified three types \( \) stenosis due blocking orifice side branch disrupted portion intima main artery \( one branch \) \( b \) stenosis due medial dissection main artery dissection occurring even side branches \( three branches \) \( c \) stenosis due fragmentation internal elastic lamina main artery accompanied proliferation smooth muscle cells even side branch \( three branches \) clear stenosis caused side branches long ptca extra care required major side branches exist portion procedure performed
nuclear pacemaker renewed interest warranted \? 1973 1987 , 155 powered nuclear pacemakers implanted 132 patients israel medical center longevity first 15 devices , fixed rate \( \) pacemakers , significantly better 15 lithium chemistry demand \( vvi \) pacemakers used control devices \( p 0 0002 \) entire cohort 155 nuclear pacemakers , 136 vvi devices 19 units patients pacemakers needed reoperations often vvi pacemakers , mode change \( p less 0 001 \) power source failure observed 1 case , 47 nuclear pacemakers removed reasons , including component malfunction \( 15 units \) , mode change \( 12 units \) , high pacing thresholds \( 8 units \) lead problems \( 5 units \) actuarial survival 15 years 99 power sources 82 entire pacing systems \( pulse generators plus leads \) frequency malignancy similar population large primary tumor sites randomly distributed deaths commonly due cardiac causes \( 68 \) thus , nuclear pacemakers safe reliable greater initial cost appears offset longevity resulting decrease frequency reoperations reasonable suggest use made long lasting nuclear power sources modern pacemakers implantable rhythm management devices
persistence arrhythmia exercise response healthy young men study assesses persistence arrhythmia rest exercise tests , , mean follow period 6 7 years 76 young men \( mean age 21 5 years \) without evidence organic heart disease exercise test performed using near maximal protocol based progressively increasing intermittent work loads , 5 duration initial work load 50 w electrocardiogram continuously registered throughout stages examination arrhythmia defined occurrence greater equal 1 supraventricular 1 ventricular premature beat stage examination follow examination , rate persistence arrhythmia differ significantly among subgroups , irrespective follow interval , type arrhythmia , arrhythmia patterns response exercise two dimensional echocardiography show structural abnormalities doppler examination demonstrate significant abnormal flow patterns data show almost patients continued present arrhythmia follow period , without evidence development organic heart disease moreover , arrhythmia pattern response exercise remained constant throughout years time , arrhythmia without underlying heart disease seems benign natural course young men
sudden unexpected nocturnal death syndrome sudden unexpected nocturnal death syndrome \( \) distinct clinical entity previously healthy , young , southeast asian males well known philippines recently recognized u nonspecific autopsy findings , evidence underlying disease absence toxic drug alcohol levels 1973 89 , 14 cases apparent came 's autopsy northern \( \) 14 cases , exception one , previously healthy , male , aged 23 55 , either found dead bed , described colleagues nocturnal seizure activity consisting , , tongue immediately prior death autopsy findings showed anatomic findings account death comprehensive serum urine drug analyses negative showed absence significant atherosclerosis grossly detectable structural cardiac anomaly , four showed cardiomegaly southeast asia carry pre disposition syndrome , appears decline longer residence new country mechanism death believed ventricular fibrillation , possibly precipitated sudden sympathetic discharge studies suggest least deaths may associated abnormal cardiac conduction system acute pancreatitis finding series , cases condition virtually limited males seemingly sleep triggered , adequately explained stress depression believed predisposing factors
ethical principles geriatric seven principles suggested resolve ethical issues raised medical developments affecting aging society first , must clear identification goals medical treatment second , treatments must consider whole person third , physiological concerns important age fourth , patient 's choice must choice result informed decision making process fifth , access sixth principle requires allocation resources finally , society must clearly identify appropriate principles guide care dying person
cytogenetic analysis 750 spontaneous abortions direct preparation method chorionic villi implications studying genetic causes pregnancy wastage altogether , 750 cases spontaneous abortion fifth week gestation analyzed direct preparation method using chorionic villi majority cases \( 68 \) derived early abortions week gestation frequency abnormal 50 1 trisomy predominant \( 62 1 \) , followed \( 12 4 \) , x \( 10 5 \) , \( 9 2 \) , structural chromosome anomalies \( 4 7 \) among trisomies , chromosomes 16 \( 21 8 \) , 22 \( 17 9 \) , 21 \( 10 0 \) prevalent frequency abnormal abortions increased maternal age increase trisomy polyploidy x , however , decreased mean maternal age significantly increased trisomies 16 , 21 , 22 highest trisomies 18 20 results obtained within range variability reported earlier tissue culture type studies consistent feature study excess females normal abortions \( male female sex ratio 0 71 \) according methodology applied , maternal cell contamination undetected 46 , molar samples cannot influenced sex ratio however , bias introduced social status maternal age cannot excluded rapid convenient direct preparation chorionic villi , reliable cytogenetic data causes spontaneous abortions obtained
thyroid antibodies risk factor syndrome trisomies test whether presence thyroid antibodies parent risk factor meiotic , measured levels thyroid antibodies serum samples drawn early pregnancy 101 gravidas delivered child trisomy , 11 gravidas child previous pregnancy , 44 case mother , three controls randomly selected population matched age , race , sex child , hospital birth cases controls came two longitudinal populations , child health development studies \( \) national collaborative perinatal project \( cpp \) , together comprising 70 , 000 live births cases definite diagnosis trisomy syndrome \( ds \) available serum included overall , association presence thyroid antibodies mother trisomy offspring \( odds ratio 98 , confidence interval ci 54 1 85 \) lack association seen three subgroups \( ds , trisomies , ds previous pregnancy \) , ethnic groups , age groups white mothers either less 30 years age \( 80 , ci 40 1 6 \) greater equal 30 years age \( 1 26 , ci 82 1 9 \) population , case fathers , compared control fathers , higher prevalence thyroid antibodies
effect race relationship fetal death altered fetal growth population study examines racial differences relationship birth weight fetal death earlier report showed birth weight results fourfold increased risk stillbirth constant birth weight percentile \( 2nd percentile 25 weeks , percentile 42 weeks \) analysis applied , 430 white black births illinois 1980 1984 mean 10th percentile growth white black infants identical 34 weeks' gestation growth 250 gm term , white infants larger race specific birth weights resulting stillbirth rate determined exponential regression analysis relationship birth weight fetal death rate gestational age data indicate \( 1 \) birth weights resulting stillbirth rate substantially denver 10th percentile previously race specific illinois 10th percentiles \( 2 \) term white infants demonstrate constant risk percentile , whereas black infants exhibit risk percentile data conclude black fetuses sensitive white fetuses factors adversely affect growth continued use race neutral data clinical management heterogenous populations accurately predict risk stillbirth
response bitot 's spots preschool children vitamin treatment double masked , placebo controlled , clinical trial , 88 preschool children ages 36 72 months bitot 's spots randomly assigned 200 , 000 iu oral vitamin placebo followed five weeks baseline follow serum vitamin levels obtained 45 children receiving vitamin , 33 \( 73 3 \) showed complete cure disappearance bitot 's spots , six \( 13 3 \) disappearance bitot 's spots , six \( 13 3 \) unresponsive treatment children older , male , higher initial mean serum vitamin levels , 23 0 micrograms dl , compared 15 9 micrograms dl cured group \( p 017 \) data suggest normal vitamin status may found approximately 13 children bitot 's spots vitamin intervention one fourth bitot 's spots originally cured bitot 's spots intervention important factors consider using bitot 's spots prevalence surveys clinical sign vitamin deficiency
facial nerve injury hemifacial spasm studied evidence facial nerve damage patients hemifacial spasm three types evidence nerve damage analyzed objectively measured weakness eyelid strength , clinically evident weakness muscles innervated seventh nerve , clinically evident aberrant seventh nerve regeneration 60 patients study , 54 \( 90 \) least one features seventh nerve damage objectively measured eyelid weakness noted 27 58 patients \( 47 \) tested clinically apparent weakness least one four facial muscle groups noted 42 60 patients \( 70 \) aberrant seventh nerve regeneration documented 25 60 patients \( 42 \) findings indicate facial nerve damage common patients hemifacial spasm
reversal colchicine induced mitotic arrest chinese hamster cells colchicine specific monoclonal antibody ability high affinity colchicine binding monoclonal antibody reverse effects colchicine chinese hamster ovary cells investigated using flow cytometry , complete mitotic blockade demonstrated 16 hours 2 5 x 10 \( 7 \) mol l \( molar \) colchicine colchicine induced changes reversible equimolar antibody added simultaneously 6 hours colchicine delay addition antibody , progressive irreversible increase mitotic blockade increase mean cell size observed prolonged colchicine exposure , without antibody reversal , led polyploidy structural chromosome early antibody reversal restored cells diploid state , whereas delayed reversal resulted time dependent increase polyploidy colchicine induced polyploidy chromosomal aberrations may basis colchicine toxicity time dependent increase colchicine effects
plasma norepinephrine chronic schizophrenia several lines evidence indicate altered noradrenergic function schizophrenia authors examined resting , standing , change \( standing minus resting \) plasma norepinephrine levels 14 drug free patients chronic schizophrenia disorder 33 age sex matched healthy volunteers schizophrenic patients significantly higher resting standing plasma norepinephrine levels significantly greater change resting standing levels significantly related positive negative symptoms significant positive correlation resting plasma csf norepinephrine levels significant negative correlation csf homovanillic acid resting , standing , change plasma norepinephrine levels
isoenzymes aldehyde dehydrogenase human lymphocytes types aldehyde dehydrogenase \( \) present human lymphocytes investigated using isoelectric focusing polyacrylamide gels followed substrate specific staining lymphocytes obtained individuals found contain types ii group individuals reported develop marked facial flushing rapid heart rate drinking alcohol develop erythema applied ethanol lymphocytes obtained individuals suffer alcohol induced flushing rapid heart rate developed erythema cutaneous ethanol displayed type ii , type , lymphocytes thus appear easily accessible suitable tissue determining type phenotype
low dose almitrine enhances hypoxic pulmonary vasoconstriction closed chest dogs effect almitrine hypoxic pulmonary vasoconstrictor response studied six closed chest dogs anesthetized paralyzed pancuronium right lung ventilated continuously 100 o2 left lung ventilated either 100 o2 \( hyperoxia \) hypoxic gas mixture \( hypoxia end tidal oxygen tension 60 3 0 6 mm hg \) two consecutive days , dog received either almitrine \( , lab \) malic acid consecutive almitrine doses 0 003 , 0 03 , 0 3 , 3 0 micrograms kg 1 min 1 , equivalent volumes malic acid without almitrine , administered intravenously constant peripheral infusion 15 min percent blood flow lung calculated based variation traditional shunt equation change percent left lung blood flow \( delta ql va \) increased significantly hypoxia drug hypoxia almitrine \( 3 0 micrograms kg 1 min 1 \) phase significant changes occurred almitrine doses respective malic acid control phases change arterial oxygen tension \( delta pao2 \) also increased significantly hypoxia drug hypoxia almitrine \( 3 0 micrograms kg 1 min 1 \) phase significant changes occurred almitrine doses respective malic acid control phases concluded dogs low dose almitrine enhances hypoxic pulmonary vasoconstriction enhancement dose related
electrocardiographic abnormalities cerebrovascular accidents electrocardiographic abnormalities found 100 patients acute cerebrovascular disease previously normal hearts described abnormalities often seen patients intracerebral subarachnoid common changes q tc prolongation st segment wave abnormalities mechanisms electrocardiographic abnormalities appear multiple
effect recombinant hirudin , specific inhibitor thrombin , endotoxin induced intravascular coagulation acute lung injury pigs hypothesized thrombin activation may play prominent role endotoxin induced secondary organ failure , acute lung injury test hypothesis , administered thrombin specific inhibitor , recombinant hirudin , pigs pigs anesthetized , mechanically ventilated , prepared swan extravascular lung water \( \) catheters total 18 randomly selected animals received pretreatment 1 , 000 u kg hirudin , followed continuous infusion 6 h 500 u kg h given simultaneously infusion 10 micrograms kg h salmonella endotoxin another 18 animals received continuous infusion 6 h endotoxin receive hirudin animals fluid resuscitated 17 ml kg h saline duration experiment data expressed mean \( 95 confidence interval \) hirudin reduced endotoxin induced consumption plasma fibrinogen 110 \( 138 82 \) mg 100 ml 39 \( 67 12 \) mg 100 ml \( p 0 0001 \) endotoxin induced increases soluble fibrin plasma \( 369 \) ng ml 236 \( 171 300 \) ng ml \( p 0 0002 \) data suggest effective inhibition endotoxin generated thrombin hirudin furthermore , hirudin significantly reduced endotoxin induced increases pulmonary vascular resistance 32 \( 27 37 \) x x cm 5 x kg 20 \( 15 25 \) x x cm 5 x kg \( p 0 \) increases 15 4 \( 13 2 17 6 \) ml kg 12 2 \( 10 0 14 4 \) ml kg \( p 0 \)
comparison parallel versus perpendicular placement retention sutures abdominal wound closure new technique placement retention sutures described twenty five rats underwent midline laparotomy incision control group closed traditional placement retention sutures placed perpendicular direction wound experimental group closed retention sutures placed parallel direction wound described wound bursting strength significantly \( p less 0 001 \) greater one five days experimental group compared control animals addition , inflammatory reaction pressure necrosis greater control group appears parallel placement sutures less tendency cut tissue subjected forces midline wound
laryngeal framework reconstruction miniplates defects laryngeal framework trauma , cancer , reconstructed mini reconstruction plates six patients miniplates used repair thyroid cartilage defect type prevent silastic implant three patients miniplates used bridge thyroid cartilage remnants , resulting better three patients miniplates used repair laryngeal fractures plates tolerated well patients major complications rigid fixation using miniplates laryngeal reconstruction unique advantages use wires offers advantages rigid immediate stabilization ability bridge large defects alternative existing techniques laryngeal reconstruction
cochlear implant flap complications series 52 patients received cochlear implants , 4 patients suffered flap complications \( 7 7 \) problems encountered involved flap usually minor nature none required direct result complications flap ischemia patient 's syndrome vasculitis , two cases suture extrusion one exposure implant , case receiver unit extrusion repaired vascularized flap based upon temporalis muscle presented flap design patients incisions demands special consideration principles useful avoiding complications well management discussed
percutaneous pedestal cochlear implantation direct electrical connection external sound processing device electrodes accomplished via percutaneous pedestal patient pedestal complaints experience recorded pedestal problems classified six classes , class 0 indicating problems severity problem increasing classes 1 4 class 5 indicates pedestal trauma class 5 problems encountered 48 months experience , 53 patients class 0 26 class 1 pedestal experience detailed paper percutaneous pedestal found well tolerated , efficient system information transfer cochlear implant patients
pharmacokinetics penetration inflammatory exudate pharmacokinetics penetration induced inflammatory exudate studied six volunteers following single 1 g intravenous dose concentrations plasma , urine , inflammatory exudate determined assay mean elimination half life plasma 1 1 h , concentration plasma declining mean 23 6 micrograms ml 1 h 0 7 micrograms ml 6 h inflammatory fluid penetration rapid \( time maximum concentration drug serum , 0 75 h \) , penetration 111 recovery urine 24 h 65 4 administered dose
recurrent cyanotic episodes severe arterial hypoxaemia intrapulmonary shunting mechanism sudden death pathophysiology recurrent cyanotic episodes investigated 51 infants children episodes began median age 7 weeks \( range 1 day 22 months , 39 less 4 months \) rapidity onset progression severe hypoxaemia early loss consciousness cerebral hypoxia common precipitating factor sudden naturally occurring stimulus pain , fear , uncontrolled trials , cyanotic episodes reduced frequency severity \( n 15 \) additional inspired oxygen \( n 10 \) eight patients died suddenly unexpectedly \( four cyanotic episodes \) twenty eight patients underwent physiological studies cyanotic episodes evidence seizure activity onset although prolonged absence inspiratory effort continued expiratory efforts common , breathing sometimes continued episodes caused upper airway obstruction sometimes occurred positive airway pressure ventilation rapidity fall arterial oxygen pressure continued breathing suggested right left shunt sudden onset results contrast echocardiography lung imaging studies confirmed occurring within lungs cyanotic episodes included intrapulmonary shunting prolonged expiratory best explained interactions central sympathetic activity , brainstem control respiration vasomotor activity , reflexes arising around within respiratory tract , matching ventilation perfusion lungs cause sudden unexpected death infancy early childhood
pharmacokinetics paracetamol cardiac surgery plasma concentration measured rectal nasogastric administration paracetamol 15 mg kg 28 febrile children aged 9 days 7 years undergone cardiac surgery equivalent doses , rectal administration neonates children first postoperative day found produce plasma concentrations therapeutic range higher concentrations nasogastric paracetamol second postoperative day less variance plasma paracetamol concentrations neonates plasma elimination half life area plasma concentration time curve significantly increased neonates dosing compared older children difference effect two routes administration , much lower previously reported febrile children
urinary tract long term diversion 20 year experience 177 patients 1969 1990 , previously diverted urinary tracts 177 patients whose ages ranged 1 31 years fifty six patients \( 32 \) diverted 10 years longer 67 female 110 male patients forty four patients one kidney two patients previous renal transplant one patient time reconstruction , two unsuccessful transplants diversions considered permanent types diversions reversed include ileal loop , colon conduit , loop , end , vesicostomy , long term nephrostomy ,
upper gi bleeding urban hospital etiology , recurrence , prognosis acute upper gastrointestinal bleeding \( \) continues common cause hospital admission morbidity mortality study reviews 469 patients admitted surgical service urban hospital 562 total admissions 53 patients 93 times \( recurrence rate , 20 \) common causes bleeding , endoscopically diagnosed , included acute gastric mucosal lesion \( \) \( 135 patients , 24 \) , esophageal varices \( ev \) \( 121 patients , 22 \) , gastric ulcer \( 108 patients , 19 \) , duodenal ulcer \( 78 patients , 14 \) , mallory tear \( 61 patients , 11 \) , esophagitis \( 15 patients , 3 \) nonoperative therapy sufficient 504 cases \( 89 5 \) endoscopic treatment used 144 cases operations performed 58 cases \( 10 5 \) , including 29 ulcers emergency operations control hemorrhage required 2 5 cases rate major surgical complications 11 mortality rate 5 2 58 deaths \( 12 6 \) , 36 deaths directly attributable factors correlating death include shock admission \( systolic blood pressure less 80 \) , transfusion requirement five units , presence ev \( p less 0 001 \) cases treated without operation , including endoscopic treatment , diagnostic endoscopy establishes source subsequent operation selected patients done low morbidity mortality rates
reoperations heart valve prostheses analysis operative risks late results evaluate risks complications reoperations heart valve prostheses , reviewed data 183 patients underwent reoperation prosthetic valve malfunction incremental effect procedure hospital mortality morbidity studied comparing primary reoperative procedures analyzing series possible predisposing factors late survival first second reoperations computed , possible determinants late mortality examined overall operative mortality 8 7 emergency operation \( p 0 0001 \) , previous thromboembolism \( p 0 05 \) , advanced new york heart association functional class \( p 0 031 \) independent determinants series 1 , 355 patients primary secondary isolated valve replacement , procedure significant risk factor univariate analysis \( p 0 025 \) multivariate analysis except subset patients mitral valve replacement \( p 0 \) postoperative course quite complicated , evidenced long mean stay intensive care unit \( mean stay , 3 8 days longer 2 days 26 survivors \) nevertheless , postoperative complications significantly greater procedure primary operation actuarial survival 7 years 57 3 8 comparison series institution demonstrate significant differences subset 16 patients second reoperation , late survival 37 8 16 2 years advanced new york heart association class \( p 0 0001 \) , double prosthetic valve dysfunction \( p 0 003 \) , indication primary tissue failure \( p 0 06 \) determinants late mortality
guidelines transfusion support patients undergoing coronary artery bypass grafting transfusion practices committee american association blood banks reviewed impact evolving issues coronary artery bypass grafting \( cabg \) transfusion support patients issues include increased awareness transfusion risks , reappraisal traditional indicators triggering transfusion , evolving alternatives homologous blood transfusion autologous blood pharmacologic therapy issues prompted programs , national health consensus , provide physicians guidelines appropriate use blood components however , evidence suggests transfusion practice coronary artery bypass grafting procedures remains variable take account results recently published clinical studies therefore developed guidelines recommendations transfusion support patients undergoing coronary artery bypass grafting summary , following 1 institutions coronary artery bypass grafting programs establish multidisciplinary approach use combination interventions designed minimize homologous blood exposure 2 prophylactic transfusion plasma platelets benefit therefore carry unnecessary risk patient 3 special request products designated blood donation first degree relatives used risk transfusion associated graft versus host disease 4 support intravascular volume , used potential transmit infection
efficacy central venous pulmonary artery catheters therapy based upon reducing mortality morbidity purpose study \( 1 \) evaluate relative cost effectiveness central venous pressure flow directed pulmonary artery catheters used maintain normal hemodynamic values therapeutic goals control groups vs values empirically observed critically ill postoperative survivors protocol groups , \( 2 \) evaluate tissue perfusion oxygenation relationship organ failure mortality two prospective clinical trials significant differences outcome central venous pressure pulmonary artery control groups used normal values therapeutic goals however , marked significant reductions morbidity mortality protocol groups using cardiac index , oxygen delivery , oxygen consumption values goals cumulative oxygen debt less organ failures fewer less severe protocol groups control groups
massive splenomegaly superior results combined endovascular operative approach splenectomy massive splenomegaly \( drained splenic weight , greater 1000 g \) uncommonly high morbidity mortality technical challenges problems hemostasis group 10 patients massive splenomegaly due myeloproliferative disorders \( average splenic weight , g \) , developed management algorithm based preoperative angiographic embolization splenic artery average operating time 1 7 hours \( range , 1 2 5 hours \) average blood loss ml six 10 patients blood loss less 250 ml four minor complications one major complication \( gastric ulcer requiring reoperation \) deaths perioperative period , patients required reoperation hemorrhage
urgent care center pediatric telephone advice pediatric telephone advice sought frequently members community study undertaken evaluate quality accuracy pediatric telephone advice given free standing urgent care centers one hundred facilities advice requested research case presented could represented pediatric medical emergency overall 17 centers gave adequate advice data suggest circumstances free standing urgent care center pediatric telephone advice may inaccurate inappropriate policies protocols pediatric telephone advice instituted facilities
alien hand sign localization , recovery alien hand sign first described feeling patient one hands affected hand frequently shows reflex reaction well elements brown referred magnetic associated frontal lobe damage notably , however , affected hand observed perform apparently behaviors perceived outside control patient patients interpret behavior affected limb controlled external agent feel initiating controlling behavior hand often express hand 's activity patients attempt control behavior alien hand unimpaired hand affected limb , act may termed self restriction paper , report additional four cases alien hand sign right handed subjects two involving right hand two involving left hand case , clinical findings associated extensive unilateral damage medial frontal cortex hemisphere contralateral affected hand furthermore , alien movement gradually course 6 12 months stroke clinical case studies presented discussed context dual systems hypothesis , model proposes action organized two separate interactive brain systems corresponding defined medial lateral cortical moieties hypothesized alien mode behavior results activity lateral system damaged hemisphere residual control limb occurs activity intact medial system ipsilateral hemisphere recovery may occur extension ipsilateral control mechanisms compensatory changes subcortical systems controlling hemispheric activation associated adaptive behavior observation may important understanding mechanisms involved motor recovery stroke
systemic pattern free radical generation coronary bypass surgery diffuse impairment ventricular function cardiac surgery may related generation reperfusion myocardium free radicals derived oxygen fifteen patients undergoing elective coronary bypass surgery studied previously described assays lipids lipids used indices free radical activity serial blood samples obtained systemic arterial , mixed venous , coronary sinus catheters , , ischaemic period patients underwent coronary artery surgery cardiopulmonary bypass membrane oxygenator , relative hypothermia 30 34 degrees c , intermittent cross clamping aorta ischaemic periods significant changes indices free radical activity reperfusion phase significant increase free radical indices arterial mixed venous blood small rise free radical indices coronary venous blood statistically significant data indicate free radical activity increased patients shortly cessation cardiopulmonary bypass pattern distribution different sampling sites suggests much observed increase lipids tissues myocardium
plasma concentrations methadone postoperative patient controlled extradural analgesia plasma concentrations methadone measured gas chromatography 16 patients receiving extradural methadone continuous infusion relief postoperative pain venous blood samples taken loading dose extradural methadone 2 mg infusion 0 46 mg h 1 plus patient controlled increments 0 2 1 mg mean \( sd \) plasma concentration methadone 9 8 \( 2 1 \) ng ml 1 15 min change significantly first 2 h , increased gradually 32 2 \( 4 6 \) ng ml 1 \( p less 0 001 \) end 24 h mean quantity extradural methadone required produce effective analgesia 10 3 \( 1 8 \) mg first 12 h operation 6 \( 1 0 \) mg subsequent 12 h mean amount methadone effective analgesia second day 7 6 \( 1 1 \) mg adverse effects detected 2 3 days methadone therapy plasma concentration methadone increased significantly patient controlled infusion extradural methadone first 24 h operation , suggesting rapid vascular uptake systemic activity drug contributes analgesic effect extradural methadone
comparison four pulse oximeters effects venous occlusion cold induced peripheral vasoconstriction ability four pulse oximeters \( 3700 , \) detect hypoxaemia determined presence venous obstruction cold induced peripheral vasoconstriction significant increases detection time hypoxaemia found cases significant differences detection time instruments , although 3700 displayed smaller values sao2 certain conditions peripheral vasoconstriction induced using three differing methods gave differing results , thus emphasizing importance methodology assessments pulse oximetry
serum acute phase proteins orthotopic liver transplantation acute phase proteins measured six patients liver transplantation 72 h orthotopic liver transplantation ability donor liver acute phase response demonstrated , although response less seen groups patients studied reduced response stress , value measurements indicators liver function group patients limited
muscle relaxation rates individuals susceptible malignant hyperthermia muscle relaxation rate following tetanic stimulus adductor pollicis muscle measured prospectively 26 patients potentially susceptible malignant hyperthermia \( mh \) day muscle biopsy obtained mh vitro screening eleven subjects found mh susceptible \( mhs \) 15 subjects mh negative \( \) patients , relaxation rate recorded three different temperatures skin overlying adductor pollicis \( 30 , 34 38 degrees c \) achieved small surface heating unit placed eminence mhs group exhibited slightly higher relaxation rate 34 38 degrees c compared group difference accentuated increasing temperature , statistically different results present study suggest relaxation rates normal mhs individuals physiological conditions cannot used mh screening
prolonged paralysis following suxamethonium use neostigmine case prolonged neuromuscular block following administration suxamethonium reported three hours administration suxamethonium , well defined , recovering phase ii block demonstrated t4 t1 ratio 0 25 , neostigmine administered although t4 t1 ratio improved 0 9 , t1 remained 25 control , significant paralysis persisted responded administration cholinesterase concluded neuromuscular monitoring cannot reliably predict reversibility cases , even 3 h , antagonism prolonged suxamethonium block cholinesterase , followed neostigmine necessary
hormone implants tachyphylaxis serum oestradiol levels women treated hormone implants menopause clinic reviewed 1988 thirty eight \( 3 \) found pmol l 38 women oestradiol levels 23 started therapy menopausal symptoms 15 premenstrual syndrome \( pms \) 23 women treated menopausal symptoms 11 history psychiatric referral depression nine undergone surgical menopause nine 15 women pms history psychiatric referral depressive symptoms conclude women attain levels oestradiol implant therapy high frequency psychopathology surgical menopause may require higher oestradiol levels adequate control symptoms
bleeding complications associated cardiopulmonary bypass bleeding cpb difficult characterize treatment equally difficult complexity problem related hemostatic process , technical variations operative procedures , many uncontrolled variables associated cpb , including effects anesthetic pharmacologic agents , nature priming solution , hemodilution , hypothermia , type oxygenator , use transfused blood products although multiple generally predictable complex changes hemostatic mechanism cpb , temporary loss platelet function common clinically relevant transient platelet dysfunction occurs patients undergoing cpb however , causes excessive bleeding small percentage patients unfortunately , yet possible predict patients develop hemorrhagic complications , although prolonged pump times contributing risk factor past decade extensive investigation management bleeding associated cpb , provoked primarily increased awareness transfusion transmitted viral diseases inappropriately excessive use homologous blood products several approaches autotransfusion shed blood blood donation developed minimize perioperative homologous blood transfusion pharmacologic agents desmopressin , aprotinin , topical fibrin also introduced improve hemostasis cpb protease inhibitor aprotinin particularly promising reduction bleeding associated cpb given prophylactically aprotinin may provide new insights mechanism cpb induced platelet dysfunction desmopressin indicated treatment bleeding cpb management bleeding associated cpb undoubtedly
intraoperative air testing colorectal anastomoses prospective , randomized trial total 145 consecutive patients receiving colorectal anastomosis randomized 'test' anastomosis completed anastomotic testing performed pelvis filled saline rectum distended insufflation air leaks demonstrated water soluble contrast enema performed tenth postoperative day seventy four patients randomized 'test' 71 one patient withdrawn group leaving total 143 analysis two groups well matched age , sex , diagnosis operative details eighteen \( 25 per cent \) air leaks detected repaired 'test' group operation three \( 4 per cent \) clinical leaks 'test' group ten \( 14 per cent \) group \( fisher 's exact test , p 0 \) eight \( 11 per cent \) radiological leaks 'test' group 20 \( 29 per cent \) group \( p 0 006 \) intraoperative air testing repair colorectal anastomoses significantly reduces risk postoperative clinical radiological leaks
graft stenosis justification 1 year surveillance , 412 grafts \( femoropopliteal \) , performed 1984 1988 , prospectively studied 6 weeks 3 , 6 , 9 12 months operation intervals 6 months thereafter duplex scanning intravenous digital subtraction angiography overall incidence stenoses 16 per cent \( 20 per cent , femoropopliteal 15 per cent \) stenoses detected first year operation none occurred twenty four non significant stenoses treated followed intervals 3 months forty two significant stenoses detected secondary procedures performed 30 grafts mean 8 months surgery thirteen percutaneous balloon dilatation six \( 46 per cent \) remain patent mean follow 22 months two grafts occluded within 30 days three mean 8 months tertiary procedures seventeen grafts surgically revised , nine patch grafts eight bypass grafts eleven remain patent mean follow 30 months one occluded immediately three occluded late two grafts mean 19 months successful tertiary procedures total , seven grafts tertiary procedures \( two balloon dilatation five surgery \) six remain patent mean follow 13 5 months conclusion , 37 procedures performed 30 grafts , 23 \( 77 per cent \) remain patent mean follow 12 months approximately one quarter grafts develop graft related stenoses graft surveillance worthwhile , first year operation
percutaneous puncture coronary artery angioplasty balloon report case balloon catheter became permanently inflated coronary artery saphenous vein bypass graft still inflated , balloon withdrawn graft external iliac artery successfully via percutaneous puncture using needle
percutaneous transluminal coronary angioplasty gastroepiploic artery graft right gastroepiploic artery used third arterial conduit coronary artery bypass surgery presented case demonstrating successful percutaneous transluminal coronary angioplasty gastroepiploic artery graft successful may avoid repeat surgical revascularization case failure gastroepiploic artery graft , hence may encourage people use often
temporary cardiac pacing using new , , balloon tipped pacing catheter new balloon tipped , flow directed , pacing catheter unipolar temporary ventricular pacing presented successfully tested 25 patients acute myocardial infarction coronary care unit main advantage new catheter ease stable contact may achieved pacing electrode endocardium
reduction postoperative morbidity following patient controlled morphine present study examined impact two methods pain management recovery 38 women undergoing hysterectomy one group received iv morphine recovery room im morphine ward prn basis \( prn group \) group , loading dose morphine 8 mg iv given patient first complained pain patient controlled iv morphine \( pca \) initiated continued 48 h \( pca group \) groups received similar amounts morphine overall , differently distributed time pca patients received 8 mg h 1 recovery room \( approximately 2 5 \) less thereafter prn patients received approximately 2 mg h 1 entire 48 hr period pain control better throughout less variable across time pca management minute ventilation also recovered faster day four 25 per cent preoperative baseline pca group addition , oral temperature became normal one day earlier , ambulation recovered rapidly patients discharged hospital earlier data suggest early treatment relatively high , self titrated morphine doses may alter course metabolic response surgery
brachial plexus block new local anaesthetic 0 5 per cent ropivacaine new local anaesthetic , ropivacaine hydrochloride , used concentration 0 5 per cent 32 patients receiving subclavian perivascular block upper extremity surgery one group \( n 15 \) received 0 5 per cent ropivacaine without epinephrine second group \( n 17 \) received 0 5 per cent ropivacaine epinephrine concentration 1 200 , 000 anaesthesia achieved 87 per cent patients groups c5 t1 brachial plexus dermatomes motor block profound 100 per cent patients groups developing paresis shoulder hand 100 per cent developing paralysis shoulder rapid initial onset sensory block \( mean less four minutes analgesia \) prolonged duration \( mean greater 13 hr analgesia \) addition epinephrine significantly affect quality onset sensory motor block duration sensory block reduced epinephrine t1 analgesia c7 , , t1 anaesthesia duration sensory block remaining brachial plexus dermatomes well duration motor block epinephrine evidence cardiovascular central nervous system toxicity either group mean dose 2 5 2 6 mg kg 1 ropivacaine
neurological phenomena emergence enflurane isoflurane anaesthesia emergence anaesthesia , transient neurological signs would usually considered pathological may appear objective randomized , patient \( n 30 \) observer blinded study compare prospectively incidence duration post anaesthetic neurological abnormalities healthy patients undergoing minor elective procedures following thiopentone succinylcholine induction , enflurane n2o isoflurane n2o anaesthesia patients studied 60 min anaesthesia arousal state , muscle tone , deep tendon reflexes , reflex , sustained , , intense muscular spasticity temperature assessed results neurological examination correlated patient 's state arousal transient neurological abnormalities occurred frequently following enflurane n2o anaesthesia isoflurane n2o anaesthesia statistically significant \( p less 0 05 \) quadriceps , \( positive reflex \) intense muscular spasticity neurological abnormalities occurred commonly 5 20 min anaesthesia abnormalities resolved within 60 min following enflurane anaesthesia , patients became alert incidence abnormalities declined , arousal state affect incidence abnormalities isoflurane significant difference axillary temperatures patients conclusion , temporary neurological abnormalities occurred often following enflurane n2o isoflurane n2o anaesthesia
vertigo epidural morphine severe complications use epidural morphine analgesia caesarean section rare case reported extreme vertigo several hours epidural morphine injection , time onset symptom coincided expected time arrival morphine within intra cerebral spinal fluid
influences action potentials isolated ventricular cells work combines theoretical study electrical interactions two heart cells , using variable coupling resistance , experimental studies isolated rabbit ventricular cells coupled variable coupling resistance passive resistance capacitance circuit theoretical results show response isolated cell increased frequency stimulation strongly altered presence coupling resistance another cell coupling resistance gradually decreased , stimulated cell becomes able respond successfully rapid stimulation , , levels coupling resistance allow conduction two cells , coupled pair cells exhibits arrhythmic interactions predicted intrinsic properties either cell experimental results show isolated rabbit ventricular cell extremely sensitive even small electrical load , shortening action potential 50 electrical coupling model cell \( similar input resistance capacitance ventricular cell \) high 1 , 000 omega , even though action potential amplitude current threshold insensitive electrical load
role calcium calcium channel initiation maintenance ventricular fibrillation cellular events initiation maintenance ventricular fibrillation \( vf \) poorly understood developed nonischemic , isolated , perfused rabbit langendorff preparation sustained vf could induced alternating current \( ac \) allowed changes perfusate composition also used na \( \) k pump inhibition \( 10 microm ouabain k \( \) free perfusate \) induce vf ac stimulation na \( \) k pump inhibition always initiated vf calcium channel blockade verapamil nitrendipine uniformly inhibited initiation vf models na \( \) k pump inhibition , 1 \) vf prevented calcium channel blockade , despite evidence ca2 overload , 2 \) abolition spontaneous sarcoplasmic reticulum generated cytosolic ca2 oscillations na channel blockade tetrodotoxin prevent vf initiation lowering extracellular ca2 80 microm uniformly prevented initiation vf due na \( \) k pump inhibition due ac stimulation vf maintenance also studied using 1 \) reduction perfusate ca2 , 2 \) blockade ca2 channels , 3 \) electrical defibrillation decreasing perfusate ca2 80 microm resulted defibrillation vf whether induced ac na \( \) k pump inhibition verapamil nitrendipine also resulted defibrillation regardless initiation method electrical defibrillation successful ac induced vf results demonstrate vf initiated maintained nonischemic rabbit langendorff preparation data suggest increases slow channel ca2 flux , opposed increases cytosolic ca2 per se , necessary initiation maintenance vf data , however , exclude important role cytosolic ca2 modulation vf
vagal modulation rate dependent properties atrioventricular node vagal effects atrioventricular \( av \) nodal conduction accentuated increases heart rate establish mechanism rate dependent negative actions , studied properties governing av nodal adaptation changes heart rate anesthetized dogs absence presence bilateral cervical vagal nerve stimulation \( 20 hz , 0 2 msec \) stimulation protocols applied evaluate contributions changes av nodal recovery , facilitation , fatigue independently vagal stimulation slowed av nodal recovery voltage dependent way , increasing time constant recovery \( tau r \) 80 7 194 16 msec \( mean sem , p less 0 01 \) highest voltage studied facilitating effect premature \( a2 \) beat manifested leftward shift recovery curve \( versus \) subsequent beat magnitude shift depended coupling interval reduced vagal stimulation intervals \( maximum shift control , 63 12 msec vagus , 24 11 msec p less 0 01 \) recovery facilitation kept constant , abrupt increases av nodal activation rate caused slow \( tau 75 beats \) increase ah interval \( fatigue \) vagal stimulation increased magnitude process \( maximum control , 11 2 msec vagus , 27 3 msec p less 0 001 \) , without altering time course activation rates comparable sinus rhythm humans , vagal stimulation intermediate voltage increased ah interval 25 msec heart rate increased , induced changes dynamic processes amplified ah prolongation fivefold maximum rate role vagal changes individual functional properties depended heart rate , slowing recovery single important factor , 50 overall vagal action rapid rates conclude vagal stimulation alters ways av node responds changes activation rate rapid rates negative action vagus due changes av nodal response tachycardia alterations rate dependent av nodal properties novel potentially important mechanism interventions may affect av nodal conduction
clinical doppler echocardiographic evaluation bioprosthetic valve failure 10 years four hundred thirteen consecutive patients underwent valve replacement bioprosthesis 1976 1982 aortic valve replacement performed 240 patients , mitral valve replacement 132 patients , multiple valve replacement 41 carpentier edwards porcine \( n 336 \) , shiley porcine \( n 23 \) , porcine \( n 11 \) , ionescu shiley pericardial valves \( n 43 \) inserted follow 5 12 years postoperatively 98 complete freedom structural valve deterioration 72 7 , 59 9 , 59 9 , respectively , aortic , mitral , double valve replacement risk structural valve deterioration reoperation valve related complications significantly increased ionescu shiley pericardial prosthesis risk reoperation inversely related patient age postoperative doppler echocardiographic studies 87 available patients revealed subgroup asymptomatic patients evidence structural valve deterioration patients \( n 61 \) significantly reduced prosthetic valve areas \( aortic less 1 cm2 , mitral less 1 7 cm2 \) , elevated resting gradients \( aortic greater 40 mm hg \) , moderate severe regurgitation summary , postoperative doppler echocardiographic examination identified asymptomatic patients structural valve dysfunction patients must followed carefully determine optimal timing reoperation
internal mammary artery saphenous vein graft patency effects aspirin part two department veterans affairs cooperative trials , obtained angiographic patency data internal mammary artery \( ima \) saphenous vein grafts left anterior descending \( lad \) coronary artery 1 year coronary artery bypass surgery patients received either aspirin 325 mg q , aspirin 325 mg , aspirin 325 mg dipyridamole 75 mg , placebo aspirin initiated either 12 hours 6 hours operation patients stratified preoperatively extent disease randomized therapies outlined randomization ima versus saphenous vein grafts lad patients taking placebo compared taking aspirin , differences ima \( 100 0 versus 92 1 , p 0 \) vein graft \( 88 8 versus 90 4 , p 0 \) patency rates patency rate , irrespective treatment , ima grafts 92 8 \( 220 237 \) versus 90 1 \( 345 383 \) vein grafts lad \( p 0 309 \) thus , ima vein grafts excellent patency rates 1 year aspirin alter 1 year , differences ima vein graft patency lad
mechanical myocardial actuation ventricular fibrillation improves tolerance ischemia compared cardiopulmonary bypass direct mechanical ventricular actuation \( \) unique non blood contacting biventricular assist device provides circulatory support ventricular fibrillation without demonstrating adverse effects myocardium purpose study assess preservation myocardial energy stores myocardial responses ischemia circulatory support ventricular fibrillation direct mechanical ventricular actuation versus cardiopulmonary bypass twenty adult mongrel dogs randomized receive circulatory support either cardiopulmonary bypass direct mechanical ventricular actuation 4 hours ventricular fibrillation , hearts left ventricular transmural biopsies obtained hearts excised subjected 90 minutes normothermic total ischemia serial biopsies obtained 15 minute intervals determine regional depletion high energy phosphates time peak ischemic contracture recorded using needle tipped catheters placed left ventricular endocardium , epicardium , septum , right ventricle time peak ischemic contracture endocardium \( 62 6 1 4 vs 58 8 1 0 minutes , p less 0 05 \) septum \( 61 1 6 9 vs 46 9 6 2 minutes , p less 0 004 \) significantly prolonged direct mechanical ventricular actuation versus cardiopulmonary bypass , respectively similar trends noted epicardium right ventricular regions however , differences statistically significant left ventricular adenosine triphosphate \( atp \) levels better preserved direct mechanical ventricular actuation \( 22 1 5 mumols g dry wt \) compared cardiopulmonary bypass \( 17 1 9 mumols g dry wt \) depletion left ventricular endocardium atp normothermic ischemia significantly delayed direct mechanical ventricular actuation compared cardiopulmonary bypass
identification patients greatest risk developing major complications cardiac surgery published erratum appears circulation 1991 jul 84 \( 1 \) part prospective program use risk adjusted outcome \( operative mortality morbidity \) measure quality care , analyzed perioperative complication data 10 , patients representing 73 patients undergoing cardiac surgery requiring cardiopulmonary bypass veterans administration medical centers april 1 , 1987 , march 31 , 1989 one complications occurred 15 patients undergoing coronary artery bypass grafting , 24 patients undergoing valve cardiac surgery patients experiencing one complications eightfold 10 fold increase operative mortality compared patients perioperative complications frequent complication requirement mechanical ventilation least 48 hours occurring 8 patients undergoing coronary artery bypass 15 patients undergoing valve cardiac surgery 24 25 patients died within 30 days surgery direct result surgical complication previous heart surgery strong predictor development one complications groups patients , associated adjusted relative risk 1 6 2 0 important predictors surgical groups surgical priority , older age , peripheral vascular disease , higher serum creatinine although number preoperative risk factors could identified development renal failure , low cardiac output , requirement prolonged mechanical support , risk factors could identified development reoperation bleeding observation suggests reoperation bleeding likely result technical factors rather patient related risk factors
iron deferoxamine inhibits lipid peroxidation cardiopulmonary bypass humans iron involved oxygen derived free radical generation subsequent lipid peroxidation , reported occur cardiopulmonary bypass humans assessed effects iron chelator deferoxamine susceptibility circulating low density lipoproteins \( \) induced peroxidation 20 adult patients \( 10 controls 10 treated \) undergoing cardiopulmonary bypass coronary valve procedures deferoxamine given intravenously \( 30 mg kg body wt , starting 30 minutes bypass extending next 4 hours \) additive cardioplegic solution \( 250 mg l \) blood samples taken atria immediately end cardiopulmonary bypass plasma lipid peroxidation assessed measuring thiobarbituric acid reactive substances \( \) content selectively isolated exposure agent cardiopulmonary bypass , right left atrial blood values ldl significantly different two groups cardiopulmonary bypass resulted lipid peroxidation significantly greater magnitude control treated patients right atrial values ldl \( expressed mumol mmol ldl phospholipids \) 45 7 17 2 \( mean sem \) control patients 6 9 2 9 treated patients \( p less 0 02 \) , whereas left atrial blood , ldl yielded values 62 7 20 5 10 3 3 9 , respectively \( p less 0 01 \)
treatment desmopressin acetate routine coronary artery bypass surgery improve postoperative hemostasis desmopressin acetate \( ddavp \) shown decrease blood loss transfusions complex cardiac operations long extracorporeal times use routine cardiac valve operations shown beneficial , role routine coronary artery bypass grafting operations defined examined effect ddavp prospective study 60 patients undergoing uncomplicated primary coronary artery bypass grafting operations thirty consecutive patients received ddavp \( 0 3 micrograms kg \) cardiopulmonary bypass compared 30 consecutive patients receive ddavp significant differences seen 12 hour mediastinal blood loss \( 207 ml ddavp versus 221 ml without ddavp \) 12 24 hour mediastinal blood loss \( 236 127 ml ddavp versus 260 112 ml without ddavp \) transfusion blood products similar groups platelet aggregometry intraoperative postoperative time points using adp , collagen , ristocetin significantly different baseline values either group subgroup patients poor initial ristocetin induced platelet aggregometry , significant increase \( p less 0 05 \) ristocetin induced platelet aggregometry seen postoperatively patients received ddavp decrease blood loss transfusions , however , demonstrable patients aspirin nonsteroidal anti inflammatory drugs preoperatively , ddavp improve mediastinal blood loss transfusion needs
late results carpentier edwards porcine bioprosthesis 1977 1984 , 429 patients underwent aortic valve replacement \( avr \) , 339 underwent mitral valve replacement \( mvr \) carpentier edwards bioprosthesis early mortality avr 4 6 \( isolated avr , 1 9 \) mvr 5 3 \( isolated mvr , 4 1 \) follow 99 3 complete mean 5 9 years actuarial event free rates 10 years avr mvr , respectively , 1 \) structural valve deterioration , 91 4 3 2 versus 75 1 4 0 \( p less 0 01 \) 2 \) dysfunction , 100 versus 97 8 1 6 \( p ns \) 3 \) thromboembolism , 90 6 2 3 versus 87 3 2 6 \( p ns \) 4 \) anticoagulant related bleeding , 95 3 1 1 versus 88 6 2 4 \( p 0 05 \) 5 \) endocarditis , 87 8 5 7 versus 90 6 2 4 \( p ns \) 6 \) reoperation , 91 0 2 5 versus 74 4 3 7 \( p less 0 01 \) 7 \) valve related mortality , 76 1 6 9 versus 71 4 5 2 \( p 0 01 \) 8 \) permanent physical impairment , 85 0 3 0 versus 71 5 3 6 \( p less 0 01 \) 9 \) combined operative mortality , valve related mortality , reoperation , 68 7 6 4 versus 51 5 4 9 \( p 0 01 \) structural valve dysfunction observed avr patient whose valve inserted age 70 age operation factor predicted structural valve deterioration \( p less 0 01 \)
reversibility canine vein graft assessed reversibility functional morphological changes vein segments returning venous circulation thirteen dogs underwent right carotid femoral veno arterial grafting 12 weeks , veno arterial grafts removed contractility \( norepinephrine ne 5 hydroxytryptamine 5 ht \) , luminal prostacyclin \( pgi2 \) , morphometric analyses remaining segments used left jugular femoral veno venous grafts another 12 weeks , veno venous grafts harvested ne , veno arterial grafts \( ed50 , 5 4 0 1 log \) less sensitive control veins \( ed50 , 6 0 0 2 \) veno venous grafts \( ed50 , 6 4 0 2 \) sensitive control arteries \( ed50 , 4 0 0 1 \) maximum tension veno arterial grafts \( 6 2 0 6 g \) greater veins , less arteries \( 9 8 1 0 g \) , comparable veno venous grafts \( 5 1 1 1 g \) 5 ht , veno arterial \( ed50 , 7 5 0 1 \) veno venous \( ed50 , 7 3 0 2 \) grafts sensitive arteries \( ed50 , 6 0 0 3 \) , vein unresponsive maximum tension veno arterial grafts \( 5 0 0 7 g \) less arteries \( 6 9 0 9 g \) greater veno venous grafts \( 1 4 0 3 g \) pgi2 production veins \( 3 6 0 8 ng ml \) , veno arterial grafts \( 3 9 0 8 ng ml \) , veno venous grafts \( 3 3 0 9 ng ml \) comparable less arteries \( 6 4 0 9 ng ml \) veno arterial graft intimal thickness \( 127 8 microns \) intimal area \( 15 6 1 8 x 10 \( 3 \) microns 2 \) tended greater veno venous graft \( 113 9 microns 12 4 1 8 x 10 \( 3 \) microns 2 \) also , veno arterial graft medial area \( 103 0 7 3 x 10 \( 3 \) microns 2 \) greater veno venous graft \( 80 3 6 9 x 10 \( 3 \) microns 2 \) , thereby resulting similar relative intimal area \( 13 1 \) therefore , changes associated , example , adrenergic sensitivity , maximum tension 5 ht , medial thickening , perhaps intimal hyperplasia , toward venous values replaced venous environment , possibly due variations pressure , flow , shear stress , graft preparation techniques luminal pgi2 unchanged grafts , implying graft contractility modulated luminal pgi2
influence calcium alginate swabs upon operative blood loss although regarded minor procedure , shown 18 patients may experience operative blood loss 10 20 total blood volume aim study determine whether calcium alginate swabs reduce operative blood loss seventy two patients \( ages 2 12 years \) entered prospective trial operation performed either normal swabs calcium alginate swabs thirty six children randomized group mean blood loss found 34 9 ml \( 2 07 total blood volume \) 47 8 ml \( 2 97 total blood volume \) respectively although significant reduction operative blood loss using calcium alginate , groups blood loss much smaller stated majority previous workers
radionuclide imaging asymptomatic versus symptomatic total knee arthroplasties ninety eight total knee prostheses evaluated roentgenograms bone scans fifty three asymptomatic , 45 symptomatic thirteen prostheses required revision surgery mean 54 months , asymptomatic knee replacements generally showed mild uptake one zones one knee uptake equal surrounding bone however , symptomatic knee replacements showed significantly greater uptake patella , femur , medial lateral tibial plateau regions \( two sample rank test \) bone scans symptomatic group obtained mean 44 months excluding patients revision surgery , differences remained significant furthermore , symptomatic knee replacements normal roentgenograms also significantly greater uptake radiolucent lines noted 30 asymptomatic patients , whereas 29 symptomatic knees radiolucencies radiolucencies generally associated significantly greater uptake lateral release effect patellar score
massive allografts salvage failed total knee arthroplasties ten patients failed total knee arthroplasties severe bone loss treated massive whole distal femur proximal tibial allografts combination prosthetic implants fourteen allografts inserted either segmental grafts fixed host bone clinically roentgenographically , 12 14 grafts \( 86 \) seemed united host bone average range motion 92 degrees five patients developed complications two involved allograft \( nonunion fracture \) two caused inadequate healing ligament allograft junction one patient late infection careful planning improved surgical techniques , complications avoided massive allograft prosthesis composite techniques viable reconstructive alternative clinical trials
reconstruction patellar tendon rupture total knee arthroplasty extensor mechanism allograft although patellar tendon rupture total knee arthroplasty \( tka \) rare complication , consistently poor outcome conventional tendon repair reconstruction favor prospective protocol using allograft distal extensor mechanism graft consists quadriceps tendon , patella cemented prosthesis , patellar tendon , tibial since december 1985 , 13 knees 12 patients reconstructed using method ten knees followed six 51 months five knees followed 24 months knee extension power improved function ultimately attained cases , although minimal extensor present three cases preoperative motion returned one knee healing allograft host tissue attained primarily tibial junctions two graft complications occurred , first three months surgery one quadriceps junction treated failed one month mark , graft revised extensor weakness rupture graft patella patellar tendon junction , attributed surgical damage tendon completion healing host rehabilitation knee joint , grafts series failed course normal daily activities one patient fractured allograft patella severe fall long term construct needs studied
immune responses allogeneic implants collagen collagen derivatives whereas collagen provided safe effective numerous medical applications , instances data permit correlation immunologic profile well defined devices clinical sequelae major exception use injectable bovine dermal collagen soft tissue contour correction low incidence hypersensitivity studied context clinical efficacy safety several devices findings indicate immunity usually results manifestation local symptoms dermal inflammation sites treatment resolve implant resorbed host contrast , immunogenic hemostatic agents may elicit frequent vigorous immune response clinically visible relevant application recent experiences collagen based devices repair regeneration bone also demonstrated presence immunity collagenous non collagenous components necessarily predict adverse clinical sequelae indeed , numerous specific data indicate immunity exist effect osteogenesis get true composite picture biocompatibility , significant steps must taken characterize properly ensure immunologic , clinical , histologic , pertinent laboratory data viewed relation one another isolation
effect continuous epidural analgesia postoperative pain , rehabilitation , duration hospitalization total knee arthroplasty efficacies three alternate methods postoperative analgesia studied 156 patients total knee arthroplasty \( tka \) forty two patients received parenteral meperidine hydrochloride morphine \( group 1 \) , 58 patients received periodic epidural injections morphine \( group 2 \) , 56 patients received continuous epidural infusions bupivacaine hydrochloride \( group 3 \) postoperative course patients documented terms incidence severity pain , range joint motion , duration hospitalization , occurrence complications although epidural analgesia increased cost duration operation , good excellent pain relief attained 86 \( group 2 \) 88 \( group 3 \) cases epidural analgesia compared 61 patients \( group 1 \) receiving conventional analgesia moreover , 67 patients group 1 experienced frequent episodes moderate severe postoperative pain contrast 40 patients group 2 10 patients group 3 result diminished pain , greater joint motion obtained within first 72 hours groups 2 3 also shorter hospitalization \( 9 6 days versus 11 2 days group 1 10 8 days group 2 \) however , use epidural analgesia reduce incidence complications , including nausea continuous infusion epidural bupivacaine provided good excellent control postoperative pain tka however , better analgesics needed reduce high incidence side effects associated various treatment methods
review polyethylene tibial component total knee arthroplasty minimum seven year follow period retrospective analysis 144 total knee arthroplasties performed 1975 1981 minimum follow period seven years posterior cruciate condylar prosthesis used procedure patients followed clinically roentgenographically , set statistical variables established based elevation joint line , tibial component angular alignment , overall limb alignment , position tibial component anteroposterior lateral roentgenograms review study group found hospital special surgery knee scores improved preoperative score 55 postoperative score 88 , 94 5 good excellent results mean postoperative range motion 106 degrees mean extension 0 3 degrees radiolucencies developed 41 knees 5 knees progressive radiolucencies eight knees considered failures based clinical roentgenographic evaluations factors found significantly affect formation radiolucent lines included shift tibial component greater 4 mm , varus tilt tibial component greater 2 degrees , diagnosis rheumatoid arthritis variable associated aseptic loosening elevation joint line greater 8 mm
polyethylene cementless tibial component five nine year follow study polyethylene cementless tibial component used 221 total knee arthroplasties one exception , failures occur three years failure characterized medial tibial component abrasion polyethylene components failed survivorship seven nine years \( 87 1 \) study demonstrated flexible cementless component function well used type bone however , abrasion polyethylene occurs shearing forces concern polyethylene components need adequate prevent shearing need surface treatment prevent abrasion
protocol investigation pregnancy loss protocol evaluation pregnancy loss include maternal history , examination fetus , photographs , autopsy , chromosome studies \( cases \) , radiographic studies selected cases suspected ascending infection may require investigation increasing specialized laboratory techniques may help diagnosis inborn errors metabolism storage disorders coordination studies requires interaction ob , pathology , genetics , cytogenetics , nursing order assure delivery clinical service knowledge causes pregnancy loss typical time mode presentation facilitate focused evaluation , high chance achieving accurate diagnosis goal investigations provide families recurrence risk data base future childbearing decisions , well information potential prenatal monitoring
effect amiodarone erythrocyte shape membrane properties 1 amiodarone potent anti arrhythmic drug lipophilic properties drug membrane erythrocytes may alter shape impact flow properties blood therefore studied influence amiodarone erythrocyte shape deformability vitro vivo 2 incubation vitro increasing amiodarone concentrations led progressive shape transformation decreased deformability erythrocytes 3 amiodarone treatment eight patients affect erythrocyte morphology deformability however , increase membrane cholesterol phospholipid ratio found 4 shape transformation erythrocytes vitro indicates amiodarone inner lipid leading membrane internalization results shed light interaction amiodarone
effects intravenous immunoglobulin hemorrhage induced alterations plasma cell repertoires hemorrhage produces decreases serum immunoglobulin \( ig \) levels alterations number frequency b cells producing antibodies bacterial antigens abnormalities immune response may contribute increased susceptibility infection injury hemorrhage examine relationship serum ig levels bacterial antigen specific plasma cell numbers frequencies blood loss , treated mice intravenous ig \( ivig \) mice given ivig increased total numbers splenic plasma cells compared normal , untreated mice immunization bacterial polysaccharide antigen immediately hemorrhage resulted approximately 60 fewer specific splenic plasma cells seen normal mice treatment mice ivig correct decrease specific plasma cells results demonstrate hemorrhage induced alterations numbers frequencies bacterial antigen specific b cells related changes serum ig levels cannot corrected administration ivig
myocardial revascularization third time clinical characteristics follow twenty five patients presenting third revascularization procedure retrospectively reviewed university medical center , , il represents 0 5 percent total revascularization cases five year period extending 1985 1989 perioperative mortality none , seven complications occurred six patients internal mammary arteries used revascularization 60 percent group follow reveals one patient died secondary arrhythmia patients except one symptomatically improved , 18 patients remain angina free mean follow 22 3 months therefore concluded patients clinically improved third revascularization , procedure offered effective means treatment
progressive functional deterioration assessed doppler ultrasonography doppler echocardiography used study function bioprosthetic heart valves noninvasive means 32 patients aged 29 72 years various postoperative intervals 24 ionescu shiley , four , four carpentier edwards prostheses , 19 aortic 13 mitral position initial studies performed mean 2 3 years implantation repeated one , two , three years thereafter flow velocities mitral orifice , left ventricular outflow tract , ascending aorta , well mitral pressure half time , measured pulsed wave continuous wave doppler recordings mitral aortic valve areas aortic pressure gradients calculated aortic prostheses valve area decreased pressure gradient increased progressively relation time implantation mean value \( sd \) aortic valve area 67 17 percent manufacturer 's nominal value first examination 57 20 percent one year later , 51 14 percent two years later , 46 11 percent three years later \( overall differences , p less 0 01 \) mitral prostheses , reduction valve area related time implantation mean mitral valve area 45 12 percent nominal value rest increased 68 18 percent exercise mean 45 months implantation change values one year repeat study concluded population predominantly pericardial , \( 1 \) aortic tissue prostheses showed progressive functional deterioration demonstrable doppler echocardiography , probably due degenerative changes \( 2 \) mitral tissue prostheses , significant reduction orifice area relation time implantation reduction mitral valve areas may , extent , reflect less full opening rest
measuring crackles crackles represented time amplitude plot associated waveform assess relative merits several measures might considered machine implementation diagnostic instruments , compared reproducibility based initial voltage deflection begins based largest deflection latter group showed less interobserver less intraobserver variability crackles measured twice two observers crackles teaching , categorized fine , used study ability various measures tested distinguish fine crackles individual basis assessed found favor measures based largest deflection showed average 9 96 percent incorrectly classified crackles , opposed 19 53 percent two measures based initial deflection
rapid percutaneous tracheostomy describe new method performing percutaneous tracheostomy rapidly safely using specialized instrument kit technique permits safe insertion full sized 7 0 \( id \) 7 5 mm \( id \) cannula trachea within 1 2 min , membranous second space animal studies demonstrated superior healing process compared seen conventional tracheostomy techniques
association anterior ectopic partial absence levator musculature woman impaired defecation report case 25 year old nulliparous woman adult onset constipation slight anterior displacement underwent pelvic magnetic resonance imaging diagnosed congenital levator ani sling impaired defecation confirmed anorectal function studies demonstrated anterior , perineal descent upper limit normal , partial obstruction defecation , appeared related levator sling abnormality knowledge , combination findings previously described cause adult onset constipation
evaluation antral mast cells nonulcer dyspepsia two hundred twenty five patients symptoms nonulcer dyspepsia underwent clinical endoscopic evaluation including histologic assessment endoscopic biopsies mast cells counted special staining low ph blue 225 patients , 31 \( 13 \) found 11 greater mast cells per high power field endoscopic routine histologic findings similar subset 31 patients 11 mast cells entire group 225 31 patients increased antral mast cells failed treatment standard drug used peptic ulcer disease h1 antagonists improved symptoms majority patients \( 79 \) adequate follow patients increased mast cells antral biopsy appear subset patients nonulcer dyspepsia amenable specific treatment h1 antagonists
morphological biochemical changes gastric mucosa aging rats although previous data laboratory indicated aging associated increased gastric mucosal proliferative activity , direct assessment proliferative potential tissue made aging order assess , determine whether changes mucosal proliferative potential would reflected growth tissue , examined labeling index \( li \) , height morphology gastric mucosa young \( 4 month old \) aged \( 24 month old \) fischer 344 rats addition , tyrosine kinase \( tyr k \) activity levels phosphotyrosine proteins determined evaluate relationship mucosal proliferative activity histologic evaluation revealed marked atrophy mucosal glandular component 32 reduction height aged rats compared young animals aged rats , also decrease gland density , resulting reduction number epithelial cells types evidence decreased secretory activity despite occurrence mucosal atrophy aged rats , li animals significantly increased 28 associated parallel rise mucosal tyr k activity , two threefold increase relative concentrations seven phosphotyrosine membrane proteins mr 120 , 105 , 90 , 60 , 55 , 48 32 kda conclude \( 1 \) although aging associated increased gastric mucosal proliferative activity , result mucosal growth \( 2 \) tyr k tyrosine phosphorylation certain proteins play role regulation gastric mucosal cell proliferation aging
late onset adrenal hyperplasia mutation codon 282 functional 21 hydroxylase gene ubiquitous ten patients affected 21 hydroxylase \( 21 oh \) deficient late onset adrenal hyperplasia studied determine prevalence mutation codon functional 21 oh gene \( \) results valine leucine amino acid shift mutation reported eight unrelated late onset adrenal hyperplasia patients ashkenazi jewish descent possessing human leukocyte antigen , dr1 haplotype normally , two 21 oh genes \( \) functional gene \( \) aberrant codon sequence normally present late onset adrenal hyperplasia patients , hybridization oligonucleotide probe specific mutation demonstrated mutation codon appear ubiquitous genetic marker 21 oh deficient late onset adrenal hyperplasia , suggesting disorder may demonstrate molecular heterogeneity congenital adrenal hyperplasia
retroperitoneal mobilization vas deferens complex anatomic distances along retroperitoneal , inguinal , infrainguinal segments vas deferens measured 14 formalin fixed cadavers 15 recently postmortem males significant differences segment lengths two groups right left vasa data recent postmortem group reveals mean length 5 83 65 cm gained retroperitoneal mobilization vas deferens information important surgical decisions cases microsurgical repair obstructive azoospermia resulting damage inguinal segment vas deferens data segment lengths beneficial planning repair complex cases obstructive azoospermia well
intravenous epidermal growth factor maintains proliferation rat colorectum role epidermal growth factor proliferation normal premalignant colonocytes vivo fully understood particular , relative importance possible systemic intraluminal routes action fully clarified rats surgically distal used , mini osmotic pumps implanted study effects intraluminal iv administration epidermal growth factor proliferation within 2 weeks bypass , proliferation colorectum decreased one third rate normal colorectum colorectum proximal colostomy intraluminal epidermal growth factor , infused time operation reverse hypoplasia , whereas iv epidermal growth factor maintained proliferation approximately normal rate colorectum model suitable testing putative colonic mitogens possible intraluminal systemic effects
aided ultrasonography common bile duct predictor biliary obstruction determined ercp biliary manometry observed changes common bile duct caliber following intravenous injection correlated distal common duct pathology defined endoscopic retrograde biliary manometry thirty two patients , 17 prior cholecystectomies , studied post cholecystectomy patients , 1 mm greater diminution duct caliber within 5 min represented normal response gallbladder contraction occurred normal patients intact gallbladder , change diminution duct caliber observed gallbladder contraction observed , normal response considered post cholecystectomy patients diminution duct caliber occurring using criteria two false negatives , hypertensive sphincters responded normally injection , encountered technique valuable defining non obstructed post cholecystectomy dilated bile ducts demonstrated prompt diminution caliber following injection
antibodies nuclear c chronic hepatitis delta virus infection sera patients chronic hepatitis delta virus infection stained nuclear periphery indirect immunofluorescence using proteins isolated nuclei , isolated nuclear , nuclear pore complex lamina fraction purified c antigen source immunoblotting experiments , nuclear c identified reactive antigen sera tested \( 8 10 \) recognized nuclear c exclusively , nuclear b antibodies reacting nuclear c , share extensive sequence , reported occur autoimmune hepatitis primary biliary cirrhosis present findings suggest novel autoantibody associated chronic hepatitis delta virus infection recognizes epitope localized short region nuclear c
hepatic injury induced bile salts correlation biochemical morphological events continuous intravenous infusion rate 0 4 mumol min 1 100 gm 1 30 min rats caused threefold greater release proteins \( alkaline phosphatase , lactate dehydrogenase albumin \) bile comparison animals infused tauroursodeoxycholate much higher rates \( 1 8 mumol min 1 100 gm 1 \) 2 hr simultaneous infusion tauroursodeoxycholate \( 0 6 0 4 mumol min 1 100 gm 1 , respectively \) 2 hr prevented marked biochemical changes bile induced 15 60 min exhibited significantly necrotic hepatocytes , especially zone 1 , comparison animals infused tauroursodeoxycholate combination tauroursodeoxycholate good correlation observed biochemical morphological indices bile acid induced hepatocyte injury data suggest \( \) primary events induced acute infusion toxic bile salts responsible cholestasis include zone 1 hepatocellular necrosis \( b \) prevented simultaneous infusion tauroursodeoxycholate
desmopressin desmopressin appears safe effective hemostatic agent use surgery patients mild moderate hemophilia von willebrand disease uremic patients also benefit substitution desmopressin control bleeding highly variable response desmopressin individual patients hemophilia von willebrand disease patient receive trial administration prior surgery surgery proceed following therapeutically effective increase factor viii vwf desmopressin use desmopressin patients normal baseline hemostatic function clearly advantageous , although certain patient subgroups might benefit , prospective studies documented drug 's safety cases data lacking clarify role desmopressin surgery patients taking aspirin therapy appears decrease bleeding without increased risk cardiac surgery addition , specific use urological surgery may beneficial absence upper urinary tract bleeding last ten years , applications therapy found surgical \( intracranial aneurysms , oral lacrimal surgery \) nonsurgical \( cancer patients gastrointestinal bleeding \) although anecdotal reports increased thrombosis , controlled studies indicate increased risk
hemodialysis associated febrile episodes surveillance major alteration water treatment system surveillance bacteremic episodes associated hemodialysis undertaken reconstruction water treatment system university medical center new water system included holding tank treatment water delivered individual dialysis occasional positive bacterial cultures \( 3 21 samples completion construction , 2 16 samples afterwards \) intermittent detection endotoxin \( 6 21 samples completion construction , 9 16 samples afterwards \) monthly sampling among 51 individual dialysis treatments \( 25 patients \) reconstruction 56 treatments \( 29 patients \) , , 2 3 febrile events identified , respectively associated underlying infectious illness hemodialysis procedure overall , conclude episodes associated directly hemodialysis treatment infrequent , addition water storage tank treatment appear increase risk bacteremia episodes
effects tracheal irritation hypercapnia tracheal smooth muscle humans hypercapnia tracheal irritation known airways animals see whether similar responses occur humans , investigated tracheal smooth muscle \( tsm \) responses hypercapnia tracheal irritation water 14 paralyzed anesthetized humans tsm tone monitored measuring pressure saline filled cuff endotracheal tube although , tracheal irritation caused tsm constriction 10 14 patients , 4 patients showed tsm response administration intravenous atropine attenuated tsm constriction response hypercapnia cause change tsm tone 14 patients results indicate paralyzed anesthetized humans , exist interindividual differences tsm responses tracheal irritation hypercapnia cannot effective stimulus tsm constriction
cerebral blood flow acute sickness changes cerebral blood flow \( cbf \) measured using radioactive technique related development acute sickness \( ams \) 12 subjects , ascending 150 3 , , cbf 24 increased 24 h 45 1 55 9 initial slope index \( \) units 4 increased 6 days \( 47 1 units \) four subjects similar increases cbf ascending 3 , 200 3 mo later , indicating reproducibility measurements nine subjects , ascending 3 , 200 4 , 5 , 430 , cbf increased 76 4 units , 53 estimated sea level values cbf increases cbf similar subjects without ams six subjects , cbf measured therapeutic intervention 2 h cbf increased 22 \( 71 3 87 3 units \) pretreatment values three subjects given 1 5 g acetazolamide , three subjects given placebo showed change symptoms remained unaltered subjects 2 h study overall , results indicated increases cbf similar subjects without ams acetazolamide provoked increases cbf ams subjects caused acute change symptoms alterations cbf cannot directly implicated pathogenesis ams
distribution pulmonary capillary transit times recruited networks pulmonary blood flow elevated , hypoxemia occur moving erythrocytes transit times capillaries fall minimum time complete oxygenation desaturation likely occur distribution capillary transit times mean large increasing cardiac output known decrease mean pulmonary capillary transit time , effect distribution transit times reported measured mean variance transit times single pulmonary capillary networks dependent lung anesthetized dogs vivo microscopy fluorescein dye bolus passing cardiac output increased 2 9 9 9 l min , mean capillary transit time decreased 2 0 0 8 transit time variance decreased proportionately \( relative dispersion remained constant \) , increasing cardiac output alter heterogeneity local capillary transit times lower lung capillary bed nearly fully recruited
maximal o2 uptake situ dog muscle acute hypoxemia constant perfusion investigated relationships among maximal o2 uptake \( vo2max \) , effluent venous po2 \( \) , calculated mean capillary po2 \( pco2 \) isolated dog gastrocnemius situ arterial po2 \( pao2 \) progressively reduced muscle blood flow held constant hypothesis vo2max determined part peripheral tissue o2 diffusion predicts proportional declines vo2max pco2 diffusing capacity muscle remains constant inspired o2 fraction altered six dogs produce four different levels pao2 22 2 , 29 1 , 38 1 , 79 4 \( se \) torr muscle blood flow , circulation isolated , held constant 122 15 ml 100 g 1 min 1 muscle worked maximally \( isometric twitches 5 7 hz \) four different values pao2 arterial venous samples taken measure lactate , ph , po2 , pco2 , muscle vo2 pco2 calculated using fick 's law diffusion integration procedure vo2max fell progressively \( p less 0 01 \) decreasing pao2 decline vo2max proportional \( r 0 99 \) fall muscle calculated pco2 calculated muscle diffusing capacity different among four conditions fatigue developed rapidly lower pao2 , although lactate output muscle different among conditions results consistent hypothesis resistance o2 diffusion peripheral tissue may principal determinant vo2max
two discharge patterns carotid body chemoreceptors goat twenty nine single carotid body chemoreceptor units recorded 20 anesthetized goats classified two groups discharge pattern thirteen fibers , interval distributions prominent peak 24 0 9 8 \( sd \) 0 20 ms , termed bursting fibers \( bf \) 16 remaining fibers termed fibers \( \) notable peak interval distributions hypoxia hypercapnia , chemoreceptor fibers continued discharge established patterns interval distribution spike could described process , none bf could however , except intervals range 0 20 ms , interval distribution bf could described exponential study suggests 1 \) two distinct populations goat chemoreceptor fiber , inherent discharge pattern 2 \) chemoreceptor code information arterial po2 pco2 different patterns 3 \) basic mechanism likely bf , difference discharge pattern likely reflect processes downstream transducer
increased fatigue isovelocity vs isometric contractions canine diaphragm comparison fatigue loss force repeated contractions time performed canine respiratory muscle isometric \( \) isovelocity \( shortening \) contractions situ diaphragm muscle strips attached linear ergometer electrically stimulated \( 30 40 hz \) via left phrenic nerve produce either isometric \( n 12 \) isovelocity \( n 12 \) contractions \( 1 5 \) optimal muscle length \( lo 8 8 cm \) similar velocities shortening isovelocity experiments 0 19 0 02 \( sd \) lo produced mean power output \( 210 27 mw cm2 \) could developed 1 5 displacement approximately 0 30 lo initial peak isometric tension 1 98 kg cm2 , whereas initial peak isovelocity tension 1 84 kg \( p less 0 01 \) 93 initial isometric tension fatigue trials 5 min conducted muscles contracting constant duty cycle \( 0 43 \) end trials , peak isovelocity tension fallen 50 initial isometric tension \( p less 0 01 \) , whereas peak isometric tension fallen 27 results indicate muscle shortening force production significant influence diaphragm muscle fatigue conclude effects shortening fatigue must considered models respiratory muscle function , muscles typically shorten breathing
measurement resistance versus flow assessing efficiency aortocoronary bypass grafts measurement flow saphenous bypass grafts electromagnetic complicated poorly reproducible since coronary flow largely dependent variable factors stable value resistance seems appropriate comparison simple method developed intraoperative measurement resistance respective coronary bed pressure recorded saphenous graft continuous flushing known amounts blood , resistance calculated procedure simple takes less one minute quality saphenous vein assessed simultaneously method resistances measured coronary surgery 500 saphenous grafts results highly reproducible comparable excellent flows expected resistance 200 peripheral resistance units \( pru \) 800 pru flow poor
traction injury internal mammary artery report case review literature internal mammary artery \( ima \) used routinely along saphenous vein myocardial revascularization procedures documented particular form non injury may reduce blood flow operation may lead early closure ima bypass graft traction injury intima well documented previously reported ima present potentially example traction injury ima
effect adjunctive arteriovenous fistula prosthetic graft patency controlled study canine model bilateral 6 mm ptfe grafts placed external iliac artery femoral artery ligation intervening segment artery 14 dogs arteriovenous fistula constructed distal anastomosis one randomly selected side animal contralateral graft served control graft follow ranged 8 12 months animals serial arteriography performed confirm graft fistula patency demonstrated persistence antegrade flow arterial tree distal patent bypasses femoral intraarterial pressures distal patent grafts identical sides animal throughout study cumulative life table patency rates showed higher patency arteriovenous fistula bypasses control grafts time intervals 71 vs 57 3 months , 48 vs 25 6 months , 40 vs 22 12 months , respectively first controlled study provides experimental evidence suggesting bypasses may produce increased patency prosthetic arterial grafts lends support use clinical , prospective , randomized study
effect antiplatelet anticoagulant therapy patency bypass grafts retrospective study , 210 autogenous saphenous vein grafts inserted 15 years 1967 1982 followed mean period 62 3 5 7 months seven patients , eight grafts died hospital remaining 202 grafts fell three groups \( 1 \) sixty grafts patients received 325 mg dipyridamole 1 0 g acid daily , starting second postoperative day continuing six months \( 2 \) one hundred two grafts patients antithrombotic therapy \( 3 \) forty grafts patients warfarin therapy maintain prothrombin time \( prothrombin method \) within therapeutic range \( 0 10 0 20 \) medication continued six months group included high risk patients two groups mean ages incidence risk factors vary significantly groups patency rates three groups five years 62 5 , 44 0 26 0 ten years 48 5 , 25 0 21 5 dipyridamole acid , therapy warfarin groups , respectively limb salvage rates 100 , 96 85 dipyridamole acid , therapy warfarin groups respectively thus , best results seen aspirin dipyridamole group
balloon dilatation versus surgical revision inguinal autogenous vein graft stenoses long term follow although inguinal autogenous vein graft stenoses may treated balloon dilatation \( pta \) surgical revision , optimal approach undefined last 7 years 24 pta procedures performed 37 vein graft stenoses 19 grafts graft stenoses diagnosed 2 72 \( mean 17 3 \) months implantation pta successfully completed 23 \( 96 \) 24 procedures including 18 \( 95 \) primary , 5 \( 100 \) secondary procedures recurrent vein graft stenosis graft thrombosis developed 12 \( 67 \) grafts 3 47 \( mean 12 5 \) months primary pta long term patency primary pta 69 6 , 29 12 , 22 36 months secondary patency 81 6 , 45 12 , 27 36 months period vein graft stenosis 7 fem 2 fem grafts surgically revised initial success rate 100 , 2 \( 22 \) complications four \( 44 \) grafts occluded 1 17 \( mean 6 2 \) months repair , yielding primary 5 year patency 62 although vein graft stenosis may safely , effectively , repeatedly treated pta , long term appears superior surgical revision
surveillance situ infrainguinal bypass grafts conventional vs color flow duplex ultrasonography surveillance situ saphenous vein bypass grafts duplex scanning detects graft abnormalities may lead graft thrombosis correction defects , grafts still patent , potentially improves overall graft patency study compared color flow conventional duplex determine whether color flow provided additional information obtainable conventional duplex examination primary patency rate \( patency maintained without intervention \) 51 cases 76 \( 39 51 \) secondary patency rate \( patency maintained identification correction graft defects failure \) 88 \( 45 51 \) duplex scanning reduced graft failure rate 50 color flow conventional duplex examination provided information regarding graft failure 20 patients monitored techniques , number proximal \( 100 \) distal \( 90 \) anastomoses imaged number graft defects \( three vein graft stenoses , one proximal femoral artery stenosis \) identified velocity data obtained using two techniques \( peak systolic velocity area stenosis duplex velocity ratio \) always , making calculation percent stenosis data inaccurate color flow duplex useful monitoring graft patency , provides additional information provided conventional scanning
reproducibility growth hormone testing procedures comparison 24 hour integrated concentration pharmacological stimulation purpose study compare reproducibility two approaches evaluation gh secretion integrated concentration gh \( ic gh \) , physiological test gh secretion , pharmacological stimulation tests ic gh determined 40 poorly growing children twice within 4 weeks first second ic gh highly correlated r 0 , p less 0 001 one hundred thirteen poorly growing children underwent pharmacological gh stimulation tests twice within 6 weeks moderate correlation found first second pharmacological test r 0 , p less 0 01 among three pharmacological stimuli studied , clonidine \( n 81 \) highest reproducibility followed arginine \( n 20 \) , insulin \( n 12 \) conclude ic gh consistently reproducible gh response repeated pharmacological stimulation
hypothalamic pituitary adrenal function patients premenstrual syndrome patients primary affective disorders , depression anorexia nervosa , frequently hyperactive hypothalamic pituitary adrenal \( hpa \) axis , characterized hypersecretion crh blunted acth response exogenous crh premenstrual syndrome \( pms \) luteal phase dysphoric disorder characterized primarily affective behavioral disturbances hpa axis function compared pms patients control women , respectively , diagnosed r criteria found current psychiatric disorders , determined schedule affective disorders schizophrenia lifetime interview urinary free cortisol excretion pms normal women , differences urinary free cortisol excretion follicular luteal phases occurred either group two hpa axis abnormalities , however , noted pms patients compared normal women first , basal evening cortisol concentrations plasma significantly decreased , time integrated response plasma cortisol ovine \( \) crh significantly increased second , negative correlation time integrated plasma acth cortisol responses basal luteal progesterone concentrations present normal control women seen pms patients changes basal stimulated plasma cortisol levels association normal urinary free cortisol excretion suggest women pms might transient episodic disturbances hpa axis , appear adequately corrected system 's probably explains maintenance regular menstrual cycles pms patients , contrasts irregular menses observed patients depression , anorexia nervosa , women participate chronic strenuous exercise
observations haemopoietic response critical illness peripheral blood common patients receiving intensive care , particularly multiple organ failure assess contribution bone marrow hypoplasia patients 44 bone marrow samples 24 patients intensive care studied standard morphological techniques granulocyte macrophage colony forming cell \( gm cfc \) assay frequently observed morphological abnormalities bone marrow included following \( \) reduction overall cellularity seven patients , progressive decrease patients studied sequentially \( ii \) increase number actively phagocytic macrophages \( iii \) disruption normal bone marrow architecture accumulation intercellular hyaluronic acid glycosaminoglycan mean gm cfc growth significantly reduced compared group normal controls four five patients studied sequentially gm cfc growth became subnormal association reduction bone marrow cellularity inhibitory serum factors identified morphological abnormalities similar changes observed degeneration bone marrow situations disruption haemopoietic microenvironment , accumulation hyaluronic acid proteoglycan , may important factor inhibition haemopoietic progenitor cell growth proliferation macrophages , release variety cytokines reactive oxygen intermediates , may also implicated impaired development disordered erythropoiesis
resin veneers clinically evaluated 2 year results clinical comparison two different types dental veneers heat pressure processed resin made 2 years although appearance gingival response equal systems , resin veneers greater tendency fracture end 2 years , 20 resin veneers failed , whereas veneers remained
comparison ventricular arrhythmia induction use indwelling electrode catheter newly inserted catheter two methods serial electrophysiologic testing widespread use commonly , electrode catheter removed study new catheter femoral vein every subsequent test alternative method electrode catheter remains place several days serial testing little known differences two methods respect likelihood induction arrhythmia frequency complications determine whether sustained arrhythmia altered frequency complications unacceptably high use indwelling catheter , prospective randomized study conducted 78 patients patient underwent baseline testing , several days testing indwelling catheter , 24 h drug elimination period placement new electrode catheter ventricular stimulation studies performed patient indwelling new electrode catheters differences found indwelling new catheter tests respect induction arrhythmia , number extrastimuli required induce arrhythmia , rate arrhythmia requirement cardioversion ventricular pacing thresholds higher effective refractory periods slightly longer measured indwelling catheter complications related 156 catheter insertions included two may related indwelling catheter \( one episode staphylococcal sepsis one presumed pulmonary embolism \) four related invasive procedures \( pneumothorax \) long term adverse sequelae complications
balloon expandable stent implantation stenotic right heart valved conduits although valved conduits used successfully severe forms right ventricular pulmonary artery , progressive valved conduit stenosis important clinical problem determine feasibility reducing right heart valved conduit stenosis balloon expandable stent , baboon model used , pulmonary artery ligated right ventricular pulmonary artery 14 mm bioprosthetic dacron valved conduit implanted five baboons , average 40 months valved conduit implantation , stenosis valve site resulted narrowing mean pressure gradient 49 mm hg \( range 33 65 \) tubular steel stent \( 1 2 cm long \) within valved conduit inflation 8 15 mm diameter balloon catheter introduced femoral vein stent delivered valved conduits however , two baboons , balloon resulted stent dislodgment remaining three baboons , gradient reduced 59 \( 49 20 mm hg \) right ventricular systolic pressure decreased acutely 35 \( 77 50 mm hg \) concluded stent feasible right ventricular pulmonary artery stenotic valved conduits may result significant hemodynamic improvement however , successful stent delivery critically dependent proper selection stent length balloon diameter
feasibility cost savings outpatient electrophysiologic testing feasibility outpatient electrophysiologic testing examined reviewing 100 consecutive outpatient tests performed 95 patients seventy one patients \( 75 \) underlying heart disease electrophysiologic tests performed evaluate supraventricular tachycardias \( n 47 \) , nonsustained ventricular tachycardia \( n 20 \) , unexplained syncope \( n 21 \) , \( n 9 \) intermittent heart block \( n 2 \) mean 2 8 0 5 electrode catheters inserted femoral vein electrode catheter inserted subclavian internal jugular vein 28 tests 5f cannula inserted femoral artery monitor blood pressure 20 tests results 61 tests \( 61 \) abnormal patients monitored mean 3 8 1 2 h procedure discharged complications occurred cost analysis subgroup 60 patients matched age , gender , heart disease indication electrophysiologic testing group 60 patients underwent electrophysiologic testing inpatients physicians' two groups similar however , mean hospital charge 5 , 3 , inpatient group compared 2 , 120 1 , 244 outpatient group \( p less 0 001 \) thus , outpatient electrophysiologic testing feasible safe results substantial cost savings patients without life threatening arrhythmias
interdisciplinary nutrition assessment intervention protocol children disabilities multifactorial nature nutrition problems associated developmental disabilities , well organized , interdisciplinary effort necessary deal problems team composed professional support staff , , family needs involved integrated approach service team members share knowledge expertise developing individual program plan meet identified needs article describes development implementation prototype interdisciplinary nutritional evaluation intervention outpatient setting 1987 , regional nutrition feeding diagnosis evaluation clinic established agreement university georgia university affiliated program st 's hospital , ga purposes clinic twofold offer direct services disabled infants children require outpatient services provide unique community based interdisciplinary training experience students nutrition health interdisciplinary treatment protocol based current knowledge treatment developmental disabilities
senior care study optimal use medications acutely ill older patients geriatric assessment units improved pharmacotherapy patients decreasing number medications prescribed senior care study , randomized controlled trial , compared multidisciplinary team approach patient care standard medical practice institution part trial , effectiveness interdisciplinary team intervention improving use medications studied study goals decrease medications used , decrease unnecessary medications , improve medication choices acutely ill inpatient population interviewed experimental patients patient records , presented medication concerns recommendations team conference medications counted admission third day , sixth week , third month randomization medications paired patient problems medication problem pairs judged inappropriate choices potential side effects would affect patient function , better alternatives available 215 control 221 experimental patients study similar age , sex , place origin , number medications admission experimental patients took fewer medications controls third day \( 5 3 versus 5 9 , p less 05 \) experimental patients received fewer multiple medications \( 11 versus 19 , p less 025 \) fewer inappropriate medication choices \( 20 versus 37 , p less 005 \) results suggest team intervention effective improving pharmacotherapy acute care setting
isolation novel tumor protein induces resistance natural killer cell lysis human metastatic tumor cell line cap 2 , produces soluble factor induces resistance nk lysis k 562 susceptible leukemia cell line , inhibit cytotoxic capacity effector cells use sequential hplc , hydrophobic interaction chromatography , reverse phase chromatography , coupled cytotoxic assays , resulted isolation separation homogeneity novel protein responsible biologic activity size estimation studies based tsk hplc columns showed protein mass 8 12 kda amino acid composition analysis cap 2 protein calculated hplc shows protein contains around 108 amino acids subsequent gas phase sequence analysis , however , hampered n terminus protein blocked therefore unsuitable sequencing degradation functional studies showed nk lysis resistance activity cap 2 protein mediated interaction nonspecific binding nk target cells lymphokine activated killer macrophage mediated cytotoxicity mitogen induced proliferation affected unexpectedly , cap 2 protein appears mitogenic cell line thus , induction nk lysis resistance mitogenic activity showed cap 2 protein could contribute tumor growth metastatic establishment
delayed facial palsy following uncomplicated stapedectomy report six cases partial lower motor facial palsy occurring four ten days uncomplicated stapedectomy aetiology unclear recovery rapid complete patients
middle ear late results surgical treatment late results one stage operation middle ear 73 patients period january 1965 december 1980 presented mean observation time 11 2 years \( range 3 20 2 years \) , follow rate 86 per cent among 64 patients stapes fixation , 59 removal masses stapes mobilization , five cases underwent stapedectomy series divided six groups results analyzed best stable results occurred group stapes mobilization intact chain followed group stapes mobilization type ii interposition poorest late results obtained ears lacking stapes stapes mobilization , ears subjected stapedectomy case post operative sensorineural hearing loss occurred recommend care taken preserve intact chain stapes mobilization performed stage also ears defective chain intact stapes fixation recommend stapes mobilization one stage ears fixation stapes defective , recommend stapedectomy stapedotomy two stages
electroencephalographic activity related palatal myoclonus rem sleep polysomnography , including , electromyography electro performed three patients palatal myoclonus \( pm \) amplitude myoclonus decreased sleep frequency change non rem sleep , increased rem sleep two patients ocular myoclonus synchronized pm disappeared deep sleep stages two patients rem sleep one patient , ocular myoclonus noted rem sleep , absent even patient awake patients showed episodic eeg activities synchronous rem sleep episodes noted 5 15 times throughout night , episode lasting 1 7 negative positive waves saw tooth appearance distributed predominantly central region episodes , frequency increased two patients although known rem sleep influences pm ocular myoclonus , first report demonstrating electroencephalographic activity associated pm
placement esophageal stethoscope acoustic criteria consistently yield optimal location monitoring core temperature esophageal stethoscope evolved device acoustic core temperature monitoring test whether routine placement according acoustic criteria results placement core temperature sensor region esophagus heart , determined depth placement electrocardiographically patients undergoing elective operations requiring general anesthesia tracheal intubation first , established different observers selected esophageal depth within 1 cm electrocardiographically , using criterion symmetric biphasic p wave maximal amplitude \( 7 patients \) , 30 patients , compared routine acoustic depths maximal amplitude biphasic p wave placed according acoustic criteria within 3 cm p wave depths 15 30 patients remaining patients , measured discrepancies ranged 13 5 cm conclude prevailing stethoscope design , tip , acoustic window , ensure placement within optimal region monitoring core temperature modification design would take advantage reliability electrocardiographic positioning suggested
observer reliability detecting random occlusions esophageal stethoscope esophageal stethoscope used often anesthesia monitor ventilation cardiac function deficiencies observer may limit effectiveness monitoring instrument aim study determine long took observer detect occluded esophageal stethoscope setting clinical anesthesia routine anesthesia , esophageal stethoscope use , computer guided device would artificially , , random time intervals , occlude stethoscope tubing personnel using stethoscope noted perceived absence stethoscope sounds studied 320 stethoscope occlusions 32 patients time stethoscope occlusion detection 34 59 seconds \( mean sd \) eighty seven percent made less 60 seconds however , 13 delayed 60 seconds , 2 3 240 seconds anesthesia personnel using esophageal stethoscope could detect stethoscope occlusions , failure episodes occurred small significant number cases suggests esophageal stethoscope definite limitations continuous monitor monitoring techniques , oximetry , , ventilator , well visual tactile inspection patient , used well
unruptured intracranial aneurysms arteriovenous malformations frequency intracranial hemorrhage relationship lesions among 91 patients unruptured intracranial arteriovenous malformations \( avm 's \) , 16 patients 26 unruptured intracranial aneurysms actuarial analysis showed risk intracranial hemorrhage among patients coexisting aneurysm avm 7 per year 5 years following diagnosis compared 1 7 patients avm alone difference length survival free hemorrhage significant \( log rank , p less 0 \) several angiographic clinical parameters investigated better understand relationship lesions aneurysms occurred similar percentages patients small , medium , large avm 's twenty five aneurysms arteries feeding malformation system , almost equally distributed proximally distally eleven aneurysms atypical location , arose primary secondary branch malformation 24 enlarged feeding arteries eleven \( 16 \) 67 patients high flow avm 's associated aneurysms , compared five \( 21 \) 24 patients low flow avm 's four \( 16 \) 25 low shunt malformations 12 \( 18 \) 65 high shunt malformations associated aneurysms five aneurysms associated low shunt malformations direct arterial malformation data suggest intracranial avm 's predispose aneurysm formation within avm feeding systems mechanism simply based upon high blood flow high arteriovenous shunt systems
biologically inert synthetic dural substitutes appraisal medical grade polyurethane polysiloxane carbonate block two types artificial membranes , medical grade polyurethane polysiloxane carbonate block , tested substitutes dura 24 12 rabbits , respectively films placed either epidurally , , dural grafts equal subgroups animals postoperative course uneventful manifestations disorder cerebrospinal fluid leak animals sacrificed 3 , 6 , 9 months implantation artificial membranes types artificial membranes easily removed underlying nervous surrounding tissues histological examination failed reveal adhesions , , type foreign body reactions polyurethane film implantation polysiloxane carbonate film caused reaction applied epidurally dural graft , polysiloxane carbonate induced formation thin one two layers fibroblasts formed seal dural defect similar thin found artificial membrane group animals implanted foreign body reaction polysiloxane carbonate film authors conclude materials hold promise dural substitutes prevention spinal dural scarring , evaluated clinically
spontaneous regression giant arteriovenous fistulae perinatal period case report unique case spontaneous regression giant arteriovenous fistulae infancy described report female infant , product normal labor delivery , demonstrated severe intracranial hemorrhage birth cerebral angiography 5 days age revealed several large fistulae fed anterior middle cerebral arteries draining deep venous system dilated internal cerebral vein ectatic vein two days following angiogram , second intracranial hemorrhage occurred active hydrocephalus developed next 6 months treated shunting child 8 months age , angiography failed demonstrate fistulae postulated pressure effects intracranial hematoma long standing intracranial hypertension well stenosis anomalous venous outflow resulted vascular stasis , venous thrombosis , selective arterial occlusion hydrocephalus result compression intraventricular dilated embryonic vessels anomaly , predominantly involving anterior circulation , may homologous vein aneurysm posterior circulation
facial muscle reanimation using trigeminal motor nerve experimental study rabbit surgical repair facial nerve deficits may lack muscle control donor region paresis using new zealand white rabbits , study undertaken evaluate facial muscle reanimation donor source previously used motor division trigeminal nerve results compared facial nerve facial atrophy scale calibrated facial muscles rabbit clinical , electromyographic , histomorphometric findings confirmed trigeminal nerve suitable donor source produced exponential rate repair
disability bicycle related injuries children bicycle crashes major cause injuries childhood goal study determine long term disabilities caused bicycle related injuries , clarify long term treatment priorities injured children hospital records children \( ages 2 15 yr , median 9 yr 232 boys 140 girls \) admitted bicycle related injuries 1979 1986 provided clinical information , social service visits , hospital outpatient rehabilitative interventions , physical status discharge complete evaluations made contacting parents telephone \( 82 children \) , personal interview physical examinations \( 27 \) head injuries predominated \( 69 1 \) twelve \( 3 2 \) died , major head injuries four suffered permanent severe impairment cervical spinal injuries head injuries remain institutionalized \( 1 4 \) one third persistent disability noted time discharge medical record \( 33 6 \) , reported telephone interview \( 31 7 \) , confirmed physical examination \( 37 0 \) still , 11 0 received physical therapy consultations hospitalization , 22 8 received social service assistance 39 0 seen surgeon pediatrician discharge , \( 7 3 \) received outpatient physical therapy cognitive behavior changes noted 31 7 , many changes school performance \( worse 20 7 \) , behavior \( 13 4 \) , sleep , particularly \( 34 1 \) recurrent injuries occurred 52 children \( 14 4 \) , ten \( 2 8 \) required hospital admission bicycle related injuries cause significant short long term disabilities among children
anatomical relationship renal venous arrangement kidney collecting system anatomical relationships renal venous arrangement system studied 52 , 3 dimensional resin 53 8 cases , 3 large venous trunks 28 8 2 venous trunks joining form main renal vein intrarenal veins demonstrated free anastomoses 3 systems longitudinal \( stellate , arcuate veins \) large venous around also horizontal crossing link anterior posterior veins 84 6 cases upper group anteriorly posteriorly venous plexuses , parallel infundibulum 50 0 cases lower group also enriched 2 venous plexuses close relationship existed large inferior renal vein anterior aspect ureteropelvic junction 40 4 cases 69 2 cases posterior \( \) vein 48 1 vein close relationship junction pelvis upper 21 1 crossed middle posterior surface renal pelvis
outcome renal transplantation urinary diversion retrospective , controlled study total 17 patients intestinal urinary diversion underwent renal transplantation 1970 1988 patient age ranged 4 35 years \( mean age 20 years \) patients divided 2 groups group 1 \( 10 patients , 2 required \) ureter transplanted kidney implanted ileal \( 7 \) colonic \( 1 \) conduit \( 2 \) group 2 \( 7 patients , 1 required second transplant \) diversion taken transplanted ureter implanted bladder 14 living related 6 cadaveric kidneys transplanted graft survival rates 58 87 groups 1 2 , respectively , rate 70 \( 14 20 kidneys \) statistical difference graft survival rate 2 groups complications group 1 included anastomotic leak \( 3 patients \) , stenosis \( 1 \) , calculus formation \( 1 \) , \( 1 \) , metabolic acidosis \( 1 \) , wound infection dehiscence \( 1 \) complications group 2 renal transplantation pre existing urinary intestinal conduit augmented bladder statistically adversely affect patient graft survival however , complication rate much higher ureter implanted intestinal segment therefore , preferable whenever possible implant ureter native bladder
right colonic segment urinary reservoir evolution technique continent diversion continent diversion urine via cecal right colonic reservoir performed university hospital since 1977 several modifications surgical technique devised prevent problems urinary leakage difficulties catheterization current technique , used last 3 years 14 patients , involves use right colonic segment reservoir , ileal mesenteric exclusion , ileal nipple valve staples anchoring fascia strip sling around nipple base anterior rectus sheath complication reservoir outlet occurred 1 patient
effects iron chelator cellular injury induced vascular stasis caused hypothermia rewarming cooled rabbit leg associated generation oxygen derived free radicals , shown instrumental tissue injury occurring rewarming present study used compound , ability bind free iron , remove hydroxyl radical \( oh \) tissue deferoxamine reduced tissue injury cooling rewarming , evidenced ability decrease tissue release lactic acid dehydrogenase creatine kinase deferoxamine also reduced formation oh lipid peroxidation rewarming phase compound effect arterial blood flow pattern , uniformly decreased cooling restored rewarming results study indicate efficacy deferoxamine reducing cellular injury associated cold rewarming suggest role oxygen derived free radicals pathophysiology cold rewarming injury
excess deaths nine chronic diseases united states , 1986 assess excess mortality chronic disease united states , state age adjusted combined mortality rates nine chronic diseases 1986 compared three minimum rates two calculated rates actually achieved states third estimated mortality remaining elimination one risk factor disease lowest mortality rate combined diseases \( 305 100 , 000 \) state excesses ranged 0 37 sum lowest disease specific rates state 284 per 100 , 000 , indicating excesses 7 41 minimum mortality rate 224 per 100 , 000 estimated result elimination one risk factor nine diseases , indicating state excesses 26 54 , , 000 us deaths reduction us mortality nine diseases risk factor eliminated rate estimated associated increased life expectancy birth 4 years
sick means concepts health , disease death man since beginning time evolving societies models proposed etiology disease view disease causation derived either natural forces western societies concepts well defined numerous advances fields genetics molecular biology added new dimension understanding various factors involved pathogenesis disease processes advances allowed greater understanding numerous disease processes including inborn errors metabolism , endocrine disorders human neoplasia several recent advances areas molecular biology physiology allowing increased understanding human disease presented
mitral valve replacement first year life 1973 1987 25 patients underwent mitral valve replacement first year life mitral stenosis mitral regurgitation patients mitral stenosis included two mitral , two mitral stenosis hypoplastic mitral valve , one mitral valve included group patients mitral regurgitation 12 atrioventricular canal defect , six leaflet defects , one marfan 's syndrome , one bacterial endocarditis prostheses included 12 shiley \( 17 mm \) , seven st jude medical \( 19 mm four , 21 mm three \) , five stent mounted dura valves \( 12 mm 16 mm \) , one porcine xenograft \( 19 mm \) four patients valves placed left atrium supraannular location nine operative \( atrioventricular canal defect seven , mitral regurgitation two \) five late \( atrioventricular canal defect four , mitral stenosis one \) deaths , giving actuarial 1 5 year survival rates 52 43 , respectively 6 patients tissue valves died four supraannular mitral valve replacement survived since 1983 operative mortality reduced 0 \( 70 confidence limits 0 24 \) nine patients required second mitral valve replacement prosthetic stenosis 5 69 \( mean 30 \) months original mitral valve replacement \( one operative death \) improvements repair atrioventricular canal defect infancy , need mitral valve replacement atrioventricular canal defect repair decreased although valvuloplasty advocated repair congenital mitral valve disease applicable infants mitral regurgitation , mitral valve replacement frequently congenital mitral disease accomplished low operative risk , even prosthesis positioned
features near death experience relation whether patients near death medical records 58 patients , believed near death illness injury later unusual experiences occurring time , examined 28 patients judged close death would died without medical intervention 30 patients danger dying although thought patients groups reported closely similar experiences patients really close death likely report enhanced perception light enhanced cognitive enhancement cognitive functions despite likelihood brain function probably become disturbed possibly diminished , deserves investigation
acute haemodilution avoid blood transfusion major surgery 16 patients underwent acute haemodilution dextran 40 lactate , see whether procedure could avoid preoperative blood transfusion packed cell volume \( \) oxygen extraction decreased , cardiac index pulmonary wedge pressure increased , although end systolic area unchanged significantly different patients lost less greater 20 initial blood volume preoperative , reduces loss red blood cells , allowed major surgery completed safely without blood transfusion
indications carbon dioxide laser tracheobronchial pathology infant young child 14 cases fourteen children aged 6 months 7 years \( mean age 3 5 years \) treated co2 ent department hospital three groups diagnostic indication identified 1 granulomas treated mucosal trauma \( tracheotomy , foreign body \) 2 granulomas due pulmonary lymph node tuberculosis 3 adhesions stenosis secondary neonatal ventilation operative anesthetic technique described detail , together possible adverse events co2 appears technique choice age group , airways makes endoscopic procedure difficult allows early treatment obstructive tracheobronchial pathology risks severe ventilatory sequelae
effects menstrual phase amenorrhea exercise performance runners well controlled studies terms subject selection , menstrual classification , exercise protocol examined maximal submaximal exercise responses different phases menstrual cycle eumenorrheic runners compared runners amenorrheic runners thus , purpose study measure selected physiological metabolic responses maximal submaximal exercise two phases menstrual cycle eumenorrheic runners amenorrheic runners eight eumenorrheic runners \( 29 0 4 2 yr \) eight amenorrheic runners \( 24 5 5 7 yr \) matched physical , , training characteristics studied eumenorrheic runners performed one maximal one submaximal \( 40 min 80 vo2max \) treadmill run early follicular \( days 2 4 \) \( 6 8 lh surge \) phases amenorrheic runners performed one maximal one submaximal \( 40 min 80 vo2max \) treadmill run cycle phases documented urinary luteinizing hormone progesterone assays plasma estradiol progesterone assays differences observed oxygen uptake , minute ventilation , heart rate , respiratory exchange ratio , rating perceived exertion , time fatigue \( maximal \) , plasma lactate \( following maximal submaximal exercise tests \) follicular luteal phases eumenorrheic runners amenorrheic runners conclude neither menstrual phase \( follicular vs luteal \) menstrual status \( eumenorrheic vs amenorrheic \) alters limits exercise performance female athletes
multiple pulse stimulation dantrolene malignant hyperthermia potentially fatal condition , yet preventable , malignant hyperthermia \( mh \) lacks satisfactory noninvasive diagnostic test studying effects intravenous dantrolene \( 3 mg kg \) electrically stimulated skeletal muscle , found approach conclusively distinguish normal humans susceptible malignant hyperthermia nonetheless yielded important information action dantrolene man mh single multiple pulse stimulation common peroneal nerve produced stable torque responses muscles \( monitored vivo \) , dantrolene suppressed multiple pulse stimulation \( 5 6 pulses \) torque suppression significantly less mh susceptible subjects control subjects distinction , also observed mh swine , confirms animal good model human mh dantrolene 's effect mh completely reversed high frequency stimulation presumably , excitation contraction coupling differs mh normal muscle
isometric features orthostatic tremor electromyographic analysis patient described orthostatic tremor electromyography revealed tremor bursts 15 hz lower extremities standing isometric activation muscles , bursts disappeared isotonic activation muscles similar tremor recorded arms isometric , isotonic activation review previously reported cases confirms findings clinical electrophysiologic features tremor distinguish recognized forms tremor
anatomy physiology nerve injury nerves structure considerable complexity features special relevance nerve injury nerve regeneration include variations cross sectional areas devoted fascicular tissue , fascicular redistribution mixing different branch fibers brought fascicular plexuses , numbers nerve fibers representing individual branches tensile strength nerve trunks capacity resist traction deformation reside fascicular tissue , provides protective compression nerve trunks provides basis classification nerve injuries five degrees severity partial mixed types clearly defined pathology distinguishing clinical features following transection injury , changes occur axons , tubes , , nerve trunk type injury nature changes determine outcome regeneration
operative complication patient true posterior communicating artery aneurysm case report review literature intraoperative oculomotor nerve injury patient true posterior communicating artery aneurysm reported detail comparison internal carotid artery aneurysms posterior communicating artery junction true posterior communicating artery aneurysms deserves special attention , vascular relationships aneurysm complex clip along internal carotid artery occlude blood flow aneurysm , aneurysmal neck distal posterior communicating artery oculomotor nerve reported case true posterior communicating artery aneurysm incidence true posterior communicating artery aneurysms ranges 0 1 2 8 aneurysm patients aneurysms constitute 4 6 11 called posterior communicating aneurysms two series difficulty associated preoperative diagnosis documented least 4 cases awareness rare aneurysm stressed order avoid operative complications
hemiatrophy syndrome clinical neuroradiologic features evaluated 11 patients hemiatrophy syndrome , 6 body contralateral cerebral hemispheric hemiatrophy , 4 body hemiatrophy , 1 brain hemiatrophy mean age symptom onset 38 1 years \( range , 18 54 \) 5 2 3 1 \( mean sd \) years illness last follow visit presenting symptom unilateral tremor 6 patients , hand dystonia 2 , bradykinesia 2 , abnormal gait 1 patient three patients good response levodopa , 4 moderate response , 2 patients poor response mean follow period 1 7 years \( range , 4 months 5 years \) , score changed 3 patients 2 gained 1 5 points 1 gained 3 points 2 5 years discuss association body hemiatrophy contralateral hemispheric hemiatrophy , raise possibility early childhood brain insult delayed onset parkinsonism
observer variability scoring colposcopy accepted tools assessing cervix atypical transformation zone studied validity measurement tool determining agreement experienced using 50 women interobserver agreement generally fair good \( kappa greater equal 0 40 \) presence junction area poor \( kappa less 0 40 \) area , border , color characteristics atypical transformation zone intra observer agreement fair good color characteristics atypical transformation zone , poor area border characteristics conclude observer agreement studies play role validation methods used visual diagnosis cervical intraepithelial neoplasia considerable lack agreement reporting cytologic findings well known problem , lack agreement might even problem reporting findings
maternal serum screening aneuploid pregnancy alpha fetoprotein , hcg , unconjugated number serum screening protocols either currently use proposed identify pregnant women 35 years age increased risk syndrome fetus suggested screening methods applied gravidas 35 years age identify women offered amniocentesis evaluate efficacy screening detection aneuploid pregnancy age group , serum samples 34 women underwent amniocentesis confirmed fetal aneuploidy assayed alpha fetoprotein \( afp \) , hcg , unconjugated \( e3 \) concentrations compared 85 women known euploid pregnancy underwent amniocentesis advanced maternal age mean multiple median \( mom \) three markers significantly different control values cases trisomy 21 \( afp median mom 0 82 unconjugated e3 median mom 0 77 hcg median mom 1 89 \) differences found considered likelihood ratios calculated cases controls examined ability predict need amniocentesis , based currently recommended risk levels significant difference mean likelihood ratio cases trisomy 21 compared controls \( mean likelihood ratio 13 48 \) significant difference \( mean likelihood ratio 1 08 \) 16 cases trisomy 21 analyzed , four would diagnosed recommendation amniocentesis made based woman 's individual age specific risk modified likelihood ratio
indomethacin alter hemodynamic response magnesium sulfate infusion hemorrhage gravid \? purpose study determine whether indomethacin alters maternal fetal hemodynamic response magnesium sulfate \( mgso4 \) infusion hemorrhage gravid studied seven chronically instrumented animals 0 8 0 9 timed gestation experimental sequence included 1 \) time 0 , indomethacin , 2 mg kg , vehicle intravenously \( iv \) 5 minutes 2 \) 60 minutes , mgso4 4 g iv 5 minutes 3 \) 65 minutes , mgso4 infusion 4 g hour 4 \) 150 minutes , maternal hemorrhage , 20 ml kg , 60 minutes 5 \) 215 minutes , reinfusion maternal blood 60 minutes animal studied without indomethacin indomethacin , vehicle , transiently increased maternal fetal mean arterial pressure \( map \) , decreased maternal fetal heart rate , decreased maternal cardiac output magnesium sulfate significantly decreased uterine vascular resistance increased uterine blood flow without indomethacin hemorrhage significantly decreased maternal map , heart rate , cardiac output , uterine blood flow groups magnitude change similar groups example , end hemorrhage , maternal map 36 7 baseline \( p 0001 \) indomethacin 41 2 baseline \( p 0001 \) vehicle group \( p significant groups \) hemorrhage significantly decreased fetal heart rate , ph , po2 , increased fetal map pco2 groups conclude indomethacin alter maternal fetal hemodynamic response mgso4 infusion hemorrhage gravid
influence menstrual cycle systemic diseases physiological changes associated menstrual cycle influence clinical course diseases bronchial asthma , , anaphylaxis , epilepsy , migraine , dermatoses , porphyria hormonal manipulation beneficial patients
amenorrhea amenorrhea , lack menstruation , gynecologic disorder may arise variety causes logical followed , correct diagnosis appropriate management plan formulated
premenstrual syndrome update clinician premenstrual syndrome complex disorder variety symptoms occur luteal phase menstrual cycle symptoms occur cycle time near ovulation soon onset menses least 1 week follicular phase symptom free symptoms severe enough significantly interfere ability patient function within normal lifestyle diagnosis based clinical information prospective symptoms 50 per cent patients think pms really suffer another type mental illness , usually depressive disorder laboratory tests generally helpful diagnosis treatment based type \( \) symptom \( \) available treatments reviewed documentation results double blind placebo controlled experimental designs etiology pms known however , good empiric therapies available help pms patients
management postoperative inflammation dexamethasone versus flurbiprofen , quantitative study using new flare cell meter consecutive , random , prospective study conducted compare effect topical dexamethasone flurbiprofen drops postoperative inflammation patients undergoing extracapsular cataract extraction lens implantation objective , quantitative measurements made postoperatively , using fc 1000 flare cell meter two treatments equally effective
early magnetic resonance imaging acute traumatic adduction deficiency following acute head trauma may result orbital damage also , instances weeks months date , noninvasive imaging studies acute phase following injury definitive pathology three cases adduction deficiency following head trauma caused reported lesion brain stem found three cases magnetic resonance imaging subacute post traumatic period lesions visible routine x ray computed tomography obtained time injury
histologic evaluation width soft tissue necrosis adjacent carbon dioxide laser incisions study evaluated width tissue necrosis lateral carbon dioxide laser incisions human intraoral excisional biopsy specimens measurements made specimens including epithelium , muscle , dense loose connective tissue , salivary gland results showed mean width tissue necrosis 86 microns epithelium , 85 microns muscle , 51 microns loose connective tissue , 96 microns dense connective tissue , 41 microns salivary gland range thermal necrosis different tissue types probably based water content within type cellular partially zone reversible thermal damage 500 microns width visible adjacent zone thermal necrosis relatively narrow width tissue necrosis technique may account claimed superior properties laser induced wounds compared created
low dose amitriptyline chronic pain gain modest double blind placebo controlled study presented , effects investigated low dose amitriptyline \( 75 mg \) patients chronic pain various origins active drug superior placebo reducing pain intensity reduction small second treatment week , amitriptyline treated patients longer differences active drug placebo found respect daily activities use analgesics based data studies , concluded amitriptyline \( antidepressants \) low doses positive effect intensity aspects chronic pain , effect modest must kept mind chronic pain treatment resistant condition therefore , even modest positive effects may worthwhile
pre discharge immunization among hospitalized children identifying opportunities eligible children one way boost rates immunization especially countries low immunization coverage infectious illness contraindication vaccination determine safety immunogenicity diphtheria tetanus toxoid pertussis oral polio immunization , 210 infants children community controls , comparable image nutritional status , studied using pertussis agglutination poliovirus neutralization tests , quantitative serologic responses compared two study groups significant differences incidence rates febrile reactions \( 23 controls 28 \) local reactions \( 92 controls 87 \) seroconversion \( p greater 0 05 \) noted two groups investigation suggests infants children infectious illnesses safely effectively vaccinated study suggests hospitalization provides opportunity children
assessment patient laboratory data acutely ill laboratory test results valuable source information nurses need assess laboratory test results part physical assessment patients comparison laboratory test results changes abnormal physical findings provides basis changes nursing care plan progressive monitoring laboratory results prompt interventions might lessen seriousness health problem acute care units , initial group laboratory tests serves baseline assessing additional test results several reference values , particularly electrolytes \( potassium , sodium , calcium \) , glucose , bun , creatinine , albumin specific group profiles assist identifying monitoring patient 's health status incorporating laboratory test results plan evaluation care result safer effective patient care referring laboratory test findings comparing physical assessment findings required delivery professional nursing care
neurologic assessment neurologic nursing assessment requires knowledge anatomic physiologic principles well complex assessment skills nurse often first consistent health team member interacting clients may provide key early recognition , prevention , treatment neurologic problems nurse , dynamic member health team , may first line defense initiating cost effective perhaps life saving measures neurologically impaired clients
fatigue fatigue , protective phenomenon affecting individual assessment management involve wide range activities address total human 's physical , psychological , cognitive , dimensions elimination neutralization effect antecedent condition option , one 's life style may primary fatigue management protective mechanism , fatigue , may fact return quality purpose one 's life
postinduction beta interferon gene mediated two positive regulatory domains virus induction human beta interferon \( beta ifn \) gene results increase rate beta ifn mrna synthesis , followed rapid postinduction decrease paper , show two beta ifn promoter elements , positive regulatory domains ii \( \) , required virus induction beta ifn gene also required postinduction although protein synthesis necessary activation , necessary promoter elements examination nuclear extracts cells infected virus reveals presence virus inducible , cycloheximide sensitive , dna binding activities interact specifically propose postinduction beta ifn gene transcription involves virus inducible either bind directly positive regulatory elements beta ifn promoter positive regulatory factors bound
estrogen receptor level determines sex specific vitro transcription xenopus promoter female specific expression xenopus gene reconstituted vitro addition recombinant vaccinia virus produced estrogen receptor nuclear extracts male livers , gene silent transcription enhancement least 30 times selectively restricted containing estrogen responsive unit thus , male hepatocytes , estrogen receptor limiting regulatory factor female liver controls efficient accurate sex specific expression gene furthermore , xenopus liver factor b , essential addition estrogen receptor activation gene , successfully replaced xenopus extract purified human nuclear factor , identifying factor b xenopus functional well characterized human transcription factor
accumulation gtp response stimulation epidermal growth factor oncogene products tyrosine kinase activity ras gene product \( p21 \) gtp binding protein thought signals regulating proliferation differentiation cells like gtp binding proteins , p21 gtp active conformation , signals downstream , whereas p21 inactive one recently , shown p21 gtp levels increased cells treated fetal bovine serum platelet derived growth factor initiate dna synthesis paper , report epidermal growth factor also increase amounts p21 gtp cells effects epidermal growth factor platelet derived growth factor additive contrast , mutant p21 , transforming activity , responded neither platelet derived growth factor epidermal growth factor also found ratio p21 gtp p21 increased 3 4 fold carrying activated erbb 2 neu v src oncogenes results strongly suggest important role p21 transduction signals normal proliferation malignant transformation growth factor receptors tyrosine kinase activity related oncogene products
myod induces growth arrest independent differentiation normal transformed cells myod gene involved control muscle differentiation show myod causes growth arrest expressed cell lines derived tumors transformed different oncogenes myod induced growth inhibition demonstrated reduction efficiency colony formation single cell level show myod growth inhibition occur cells induced activate muscle differentiation markers inhibitory activity myod mapped 68 amino acid segment necessary sufficient induction muscle differentiation , basic helix loop helix motif mutants alterations basic region myod fail bind activate muscle specific enhancer inhibited growth mutants deletions helix loop helix region failed inhibit growth thus , inhibition cell growth myod seems occur means parallel pathway one leads conclude myod gene capable functionally activating intracellular growth inhibitory pathways
role repeats flanking amino acids myb dna interactions c myb protooncogene codes sequence specific dna binding protein appears act transcriptional regulator highly conserved evolution dna binding domain myb shown contain three conserved repeats 52 amino acids constitute amino terminal end within repeat , three tryptophans separated 18 19 amino acids flanked basic amino acids determine role tryptophans flanking basic amino acids dna binding activity myb proteins , selectively individual tryptophans well amino acid residues flank tryptophans replacement tryptophans glycine , proline , arginine abolished dna binding activity whereas replacement amino acids leucine alanine appreciably affect activity hand replacement two amino acids , asparagine lysine , flank last acidic amino acids completely abolished dna binding activity results consistent model present tryptophans form hydrophobic plays crucial role maintaining helix turn helix structure dna binding domain basic polar amino acids adjacent tryptophans seem participate directly dna binding
mutations src homology regions 2 3 activated chicken c src result preferential transformation mouse chicken cells src homology regions 2 3 \( sh2 \) proteins encoded src closely related genes conserved domains believed modulate protein tyrosine kinase activity class proteins , perhaps interactions proteins explore possibility using src mutants probes interactions , compared mouse nih 3t3 cells chicken embryo fibroblasts host cells 24 previously described substitution deletion mutants lesions sh2 encoding regions transformation competent allele chicken c src although several mutants equally competent equally defective transformation two cell types , four mutants \( three map within \) preferentially transform nih 3t3 cells , seven mutants \( map within sh2 \) preferentially transform chicken cells sh2 mutants least able transform mouse cells exhibit augmented transforming activity chicken cells general , vitro protein tyrosine kinase activities mutants correlated transforming activities thus , many cases , catalytic activity mutant protein depended upon host cell protein made host dependent mutants may especially useful reagents biochemical genetic studies src gene family
percutaneous balloon dilatation benign biliary strictures percutaneous biliary dilatation effective alternative surgical management benign biliary strictures low morbidity reported mortality reported success rates procedure range 40 90 depending size series , type patient treated , length follow period procedure done fluoroscopy angioplasty balloon catheter transhepatic access common , procedure may done via existing tube tracts specially created jejunal loops frequency radical liver surgery liver transplant radical rises , , rate biliary stricture likely rise , making percutaneous balloon dilatation increasingly important tool interventional radiologist 's armamentarium
interventional radiology biliary tract metallic stents biliary metallic stents placed 18 patients bile duct obstruction six patients received gianturco stents 14 wall stents results tests discussed
biliary endoprostheses plastic versus metal stents plastic biliary endoprostheses relieved malignant obstructive jaundice 80 90 patients comfort completely indwelling endoprosthesis offered treated tumor patients , external internal catheters reserved minority patients return endoprostheses patients bacterial flora rapidly endoprosthesis causes thus , second endoprosthesis also would quickly mechanism plastic metal endoprostheses completely different plastic endoprostheses , bacterial contamination causes bile subsequent encrustation metal endoprostheses tumor stent cause tumor observed 6 5 metal prostheses narrow woven mesh \( \) , whereas prostheses large distances \( gianturco stent \) ingrowth rates 19 50 fact shows tumor reduced narrowing spaces metallic network , , therefore , improvements design metal stents reduce occlusion rate plastic endoprostheses , currently lower encrustation rate major advantages expandable metal prostheses relative ease minimal trauma implantation procedure endoprosthesis , particular , inserted 7 f sheath offers chance single step placement 30 day mortality rate , therefore , 5 significantly lower 30 day mortality rate insertion plastic prostheses \( 15 24 \) even simple external catheter drainage procedures higher reported 30 day mortality rate \( 27 \) expandable metal endoprostheses would useful device occlusion rate could kept 10 large series increasing length endoprostheses 10 cm expanded state could also improve long term patency rates
percutaneous biliary drainage high obstruction preferred route palliative drainage patients high biliary obstruction frequency obstruction setting requires familiarity right left transhepatic approach preferred right transhepatic approach guided left , ultrasonography guidance choice large caliber drainage catheters required , dilatation necessary transhepatic tracts extremely painful unless adequate inhalation anesthesia , preferably , epidural anesthesia , provided long term biliary drainage requires choice internal external external drainage catheters endoprostheses made considering patient 's life expectancy adjustment stent extending outside feasibility corrective procedures internal external drainage catheter endoprosthesis becomes blocked needs considered definitive placement interventional radiologist becomes involved follow care patients frequently direct appropriate patient evaluation familiarity antibiotic regimens important
regulation lfa 1 adhesion receptors c myc oncogene human b lymphoblastoid cells function c myc gene role tumorigenesis poorly understood order elucidate role c myc oncogene activation b cell malignancy , phenotypic changes caused expression c myc oncogenes human b lymphoblastoid cells immortalized epstein barr virus analyzed c myc oncogenes caused regulation lymphocyte function associated antigen 1 \( lfa 1 \) adhesion molecules \( alpha l beta 2 integrin \) loss b cell adhesion vitro regulation lfa 1 occurred \( \) modulation lfa 1 alpha l chain rna soon acute c myc induction , \( ii \) transcriptional modulation cells chronically express c myc oncogenes analogous reductions lfa 1 expression detectable burkitt lymphoma cells carrying activated c myc oncogenes since lfa 1 involved b cell adhesion cytotoxic cells , natural killer cells , vascular endothelium , results imply functions c myc normal b cell development
cytomegalovirus second trimester fetus persistent viral inclusions light electron microscopy fetus represents least one third perinatal deaths microscopic examination specimens often reported clinically unsuspected cytomegalovirus infection second trimester fetus cells suggestive cmv inclusions identified light microscopy , electron microscopy confirmed presence viral infection proved valuable making diagnosis even though necrosis severe
comparison structure , mechanical properties , functions lumbar spinal ligaments organization collagen , , longitudinal ligaments , well , lumbar human cadavers investigated light microscopy , scanning electron microscopy , x ray experiments performed ligaments situ , bony attachments , excised ligaments range applied strains results related composition \( investigated standard histologic techniques \) gross structures \( investigated light microscopy \) ligaments importantly , results related mechanical properties ligaments , include stiffness , failure conditions , stress relaxation , hysteresis necessary , results supplemented compared obtained pig ligaments mechanical properties related postural changes ligament strains induced cadaveric specimens , using results literature thus , ligament structures could related physiologic functions
stapling suturing anastomoses left side large intestine two hundred fifty patients undergoing elective surgical treatment involving anastomoses left side colon colon rectum studied randomized trial \( u surgical corp \) circular compared single layer sutured anastomoses patients either technique feasible included analysis operative techniques largely standardized patients studied means limited barium enema tenth postoperative day data analyzed leakage rate \( clinical \) , complications degree experience surgeon eleven patients excluded analysis selected technique could carried , eight stapled group possible perform sutured anastomosis instances possible possible suture remaining three patients either anastomosis procedure performed difference leakage rate , clinical total two groups however , analyzed surgeon , clinical leakage rate surgeons training greater sutured anastomoses stapled anastomoses \( p 0 \) thus , appears benefits experience pronounced sutured anastomoses , experienced hands , neither technique superior
rejection multivisceral allografts rats sequential analysis comparison isolated orthotopic small bowel liver grafts multivisceral isografts allografts transplanted lewis rats , histopathologic changes studied liver , intestine , constituent organs rats receiving isografts survival maintenance weight multivisceral allografts \( brown norway donors \) , intestinal component rejected severely liver severity intestinal transplantation performed alone intestinal rejection either lethal event , causing death 10 12 days earliest \( day 4 \) intense cellular rejection 's patches mesenteric lymph nodes associated followed , epithelial cell necrosis , focal abscess formation , mural necrosis , eventual perforation liver allografts transplanted alone part multivisceral grafts also histopathologic evidence rejection , self limiting spontaneously reversible liver transplanted alone thus 's heel multivisceral grafts intestinal component protected presence liver organ complex better immunosuppression permit successful experimental clinical transplantation grafts
molecular biology circulatory shock part iii human hepatoblastoma \( hepg2 \) cells demonstrate two patterns shock induced gene expression independent , exclusive , shock resuscitation , parenchymal cells solid organs exposed rapidly changing microenvironment , may include reduced oxygen tension increased concentration certain cytokines including tumor necrosis factor alpha interleukin 1 vivo experiments biopsied pigs undergoing cardiogenic shock resuscitation demonstrated several patterns gene expression study independent additive influences hypoxia cytokines vitro , human hepatoblastoma \( hepg2 \) cells hypoxia reoxygenation \( h r \) , heat shock , cytokines interleukin 1 tumor necrosis factor alpha alone combination h r induces new patterns protein synthesis secretion indistinguishable induced heat shock independent acute phase response mediated cytokines h r \( heat shock \) response priority gene expression supported cytokines previously unrecognized hierarchy stress gene expression could well form molecular basis shock related cell organ failure
spreading depression like depolarization selective vulnerability neurons brief review oxygen withdrawn rat hippocampal slices , spreading depression like response occurs earlier larger amplitude ca1 area dentate gyrus reoxygenation , recovery synaptic transmission correlates inversely time spent spreading depression recovery occurs frequently dentate gyrus ca1 chlorpromazine gm1 promote recovery hypoxic depression synaptic transmission ca1 prevention irreversible loss function correlates closely shortening time spent spreading depression ca2 withdrawn hypoxia , synaptic function upon restoration oxygen ca2 , despite prolonged spreading depression spreading depression lasting 6 9 minutes induced fully oxygenated slices high k solution , transient recovery followed long lasting loss synaptic function intact brain anesthetized rats , synaptic transmission ca1 spreading depression like depolarization lasting 30 minutes , lost irreversibly 60 minutes conclude entry ca2 neurons caused spreading depression like depolarization important selective vulnerability neurons duration depolarization critical cell survival presence normal blood supply , neurons resist protracted spreading depression like depolarization
possible mechanisms limiting n methyl aspartate receptor therapeutic efficacy n methyl aspartate antagonists cytotoxic neuronal n methyl aspartate receptors postulated contribute pathogenesis neuronal loss hypoxia ischemia however , several events associated hypoxia ischemia may limit n methyl aspartate receptor mediated injury perhaps important events development extracellular acidosis limiting events may help explain n methyl aspartate receptors contribute injury focal ischemia hypoxia vitro global ischemia
constipation pathophysiology treatment although many physicians consider constipation trivial problem , one frequent chronic digestive disorders united states , affecting 4 53 million people causing considerable morbidity 200 million spent counter dollars spent prescription drugs medical services manage disorder successful management requires appreciation magnitude problem , understanding colorectal function clear assessment causes careful examination patient 's anorectal anatomy improvement patient 's dietary habits first steps management therapeutic options include behavioral modification strategies , diet lifestyle changes , pharmacologic therapy , rarely , surgical intervention
electrophysiologic effects exogenous phosphocreatine cardiac tissue potential antiarrhythmic actions cellular electrophysiologic effects exogenous phosphocreatine \( pcr \) analyzed ascertain antiarrhythmic properties myocardial ischemia reperfusion transmembrane potentials recorded isolated guinea pig papillary muscles purkinje fibers studied vitro control , normoxic conditions , 10 mmol l pcr significantly increased action potential duration \( measured 90 repolarization \) ventricular muscle 14 6 3 3 msec effective refractory period 11 5 3 8 msec \( p less 0 01 \) ischemic like conditions \( hypoxia , lactic acidosis , elevated k , zero substrate \) pcr effect , related compound direct substrate creatine kinase reaction , acted similarly pcr suggesting alterations induced pcr involve change energy state cells however , pcr reduced free ca2 nearly 20 , electrical effects normoxic conditions could largely reversed concomitant 20 increase ca2 purkinje fibers low k 's solution elicit conditions ca2 overload , delayed afterdepolarizations triggered responses reversibly inhibited pcr data suggest antiarrhythmic effects pcr situ may involve prolongation effective refractory period nonischemic tissue attenuation membrane changes elicited ca2 overload ischemic cells mechanism pcr produces effects may related part changes extracellular ca2 composition
color doppler diagnosis mechanical prosthetic mitral regurgitation usefulness flow convergence region proximal regurgitant orifice prosthetic prosthetic mitral regurgitation , transthoracic color doppler flow mapping sometimes fail detect regurgitant jet within left atrium prosthetic valve overcome limitation , assessed utility color doppler visualization flow convergence region \( fcr \) proximal regurgitant orifice 20 consecutive patients mechanical prosthetic mitral regurgitation documented surgery cardiac catheterization \( 13 20 patients \) addition , studied 33 patients normally functioning mitral prostheses doppler studies performed apical , subcostal , long axis views fcr detected 95 \( 19 20 \) patients prosthetic mitral regurgitation jet area left atrium detected 60 \( 12 20 \) patients 18 19 patients doppler detected fcr , site leak correctly identified observing location fcr trivial jet area detected eight patients normally functioning mitral prosthesis none fcr identified thus color doppler visualization fcr proximal regurgitant orifice superior jet area diagnosis mechanical prosthetic mitral regurgitation moreover , fcr permits localization site leak good accuracy
patients risk cardiac death late aortic valve replacement total 100 patients aged 24 78 years screened prospectively mean 71 months aortic valve replacement presence left ventricular hypertrophy \( lvh \) ecg \( scores greater equal 5 0 \) repetitive ventricular premature beats vpbs greater equal 2 24 hr \) 24 hour holter monitoring subsequent 41 month follow \( range 10 50 months \) , yearly cardiac mortality rate 1 3 patients lvh , 2 9 patients vpbs , 8 0 patients lvh plus vpbs 0 6 none factors present \( p less 0 05 chi 2 test \) patient groups differ regard age , time elapsed since operation , underlying valve lesion , coronary artery disease lvh vpbs occurred frequently patients left ventricular dysfunction conclude aortic valve replacement cardiac mortality markedly increased patients lvh repetitive vpbs , since noninvasive markers left ventricular dysfunction
usefulness combined propranolol verapamil evaluation surgical ablation accessory atrioventricular connections patients without structural heart disease successful surgical ablation atrioventricular \( av \) accessory connections may confirmed postoperative electrophysiologic testing absence accessory connection conduction anterograde retrograde directions whereas former may readily apparent examination surface electrocardiogram sinus rhythm atrial pacing , assessment latter may complicated frequent presence enhanced retrograde av nodal conduction postoperative period consequently , availability interventions selectively affect av nodal conduction refractoriness without concomitant effects accessory connections may helpful assessing success surgical procedure study effects combined propranolol verapamil administration electrophysiologic properties av node accessory av connection assessed pre postoperatively 17 patients \( 12 men 5 women , mean age 33 years \) undergoing surgical ablation accessory connections preoperatively , electrophysiologic characteristics 1 accessory av connections unaffected propranolol verapamil administration postoperatively , hand , propranolol verapamil significantly prolonged retrograde av node effective refractory period \( baseline 272 34 ms vs drugs 70 ms p less 0 0001 \) shortest cycle length maintaining 1 1 ventriculoatrial conduction \( baseline 99 ms vs drugs 64 ms p less 0 0001 \) late postoperative electrophysiologic evaluation \( 7 3 weeks \) revealed evidence residual accessory av connection conduction , patients remain asymptomatic 21 10 months follow
growth , , resting metabolic rate demonstrated function fat free mass growth variable related food energy input imbalance rate use obligatory energy expenditure terms , two reservoir energy model applied shows growth fat free mass rapid whereas fat store slow growth excess energy onset initially fat store , decreases time greater fraction diverted fat free mass two reservoir model predicts weight gain per unit excess energy constant decreases ultimately reaching value theory experiment long term suggests considerations become increasingly important
neurodevelopmental performance low birth weight infants mild periventricular , intraventricular hemorrhage outcome 5 6 years age neurodevelopmental outcome 38 low birth weight neonates \( birth weight , less g \) followed prospectively birth 5 6 years age assess neurodevelopmental sequelae mild periventricular , intraventricular hemorrhage \( grades ii \) neonates screened periventricular , intraventricular hemorrhage 5 10 days age eleven incurred mild periventricular , intraventricular hemorrhage \( group 1 \) 27 periventricular , intraventricular hemorrhage \( group 2 \) infants normal 1 2 years age 38 children matched race , age , sex , socioeconomic status control children \( group 3 \) born term outcome measurements 5 6 years age , groups 1 2 scored significantly lower group 3 combined test measurements three four individual measurements group 1 scored significantly lower group 2 combined test measurements data indicate low birth weight infants risk learning problems although children mild periventricular , intraventricular hemorrhage demonstrate significant deficit individual test scores , significant difference combined battery suggests mild periventricular , intraventricular hemorrhage adverse effect global performance
primary abscess omentum 65 yr old man presented upper abdominal pain fever due primary abscess omentum finding microscopic size foreign particles within abscess raised possibility antecedent clinically silent perforation bowel surgical resection antibiotic therapy curative
revisited endoscopic surgical decompression malignant biliary obstruction study , 50 consecutive patients age 60 obstructive jaundice secondary malignant stricture distal common bile duct identified endoscopic cholangiography patients randomized palliative therapy either endoscopic endoprosthesis bypass surgery prospective indices survival time , complication rates , hospitalization requirements , quality life followed 25 patients randomized endoprosthesis treated procedure , whereas 19 25 patients randomized bypass surgery underwent operative biliary digestive anastomosis difference indices found two groups authors concluded palliation obstructive jaundice due malignant bile duct stricture endoscopically placed biliary stent effective operative bypass
brachial jugular polytetrafluoroethylene fistulas hemodialysis retrospective analysis made 16 patients received brachial jugular polytetrafluoroethylene \( ptfe \) graft hemodialysis four patients , procedure used treat axillary fistulas due long venous stenosis axillary vein 12 patients , operation chosen cases exhaustion veins upper extremity previous multiple failed fistulas two patients died functioning fistula 7 10 months placement graft causes unrelated vascular access 14 patients retained functioning fistulas 8 26 months construction shunt three patients needed graft thrombectomy treat occlusive episodes venous stenosis found postoperative fistulography made patients one patient needed substitution graft segment due stenosis prosthesis crossing clavicle believe brachial jugular graft procedure considered vascular access hemodialysis cases use veins upper extremity axilla possible
recombination two 14 bp homologous sequences mechanism gene deletion factor ix seattle 1 factor 1 10 kb deletion identified family hemophilia b sequencing across site deletion , discovered deletion junction 13 bp sequence \( 5' 3' \) homologous two 14 bp sequences 10 kb apart f normal factor ix gene presence homologous sequences two different regions normal gene allows us propose genetic recombination occurred sequences , resulting gene deletion precise recombination site able localized one 5 bp \( 5' 3' \) middle homologous sequences exact length deletion 10 , 000 bp
analysis dna polymorphisms suggests de novo dup \( 21q \) chromosomes patients syndrome syndrome rarely due de novo duplication chromosome 21 dup \( 21q \) investigate origin dup \( 21q \) nature chromosome , used dna polymorphisms 10 families syndrome due de novo dup \( 21q \) origin extra chromosome 21q maternal six cases paternal four cases furthermore , majority \( eight 10 \) dup \( 21q \) chromosomes \( 21q \) \( four paternal origin , four maternal origin \) however , two 10 families dup \( 21q \) chromosome appeared result translocation \( 21q 21q \) \( maternal origin cases \)
localization human gene chromosome band , proximal cell receptor alpha delta locus gene encoding , potent inducer blood vessel formation , localized within human genome present single copy per genome located chromosome 14 , basis analysis human rodent hybrid cell lines localization refined situ hybridization probe metaphase chromosomes prepared normal human lymphocytes cells results cells also establish gene resides proximal translocation breakpoint within cell receptor alpha delta locus therefore upstream locus rflp , present frequency 29 unselected collection human placental dnas , identified coding region gene results single silent transversion
bleeding risk index estimating probability major bleeding hospitalized patients starting anticoagulant therapy purpose construct test prospectively bleeding risk index estimating probability major bleeding hospitalized patients starting long term anticoagulant therapy patients methods cohort patients starting long term anticoagulant therapy one hospital , data gathered retrospectively bleeding classified using reliable criteria constructed bleeding risk index identifying independent predictors major bleeding using multivariate proportional hazards model bleeding risk index tested patients prospectively identified second hospital index compared physicians' predictions results major bleeding developed discharge 61 1 , 011 patients \( 6 \) bleeding risk index included four independent risk factors major hospital bleeding number specific comorbid conditions heparin use patients aged 60 years older maximal prothrombin partial thromboplastin time 2 0 times control liver dysfunction worsening therapy testing group , index predicted major bleeding , occurred 3 235 low risk patients , 16 96 middle risk patients , 19 63 high risk patients \( p less 0 001 \) bleeding risk index performed well physicians' predictions , integration bleeding risk index physicians' predictions led classification system sensitive \( p 0 03 \) physicians' predictions alone 86 patients high risk major bleeding , identified specific ways improving therapy , e g , avoiding nonsteroidal anti inflammatory agents conclusion bleeding risk index provides valid estimates probability major bleeding hospitalized patients starting long term anticoagulant therapy complements physicians' predictions possibility bleeding prevented high risk patients warrants prospective evaluation
postmortem chorionic villus sampling better method cytogenetic evaluation early fetal loss culture material utero chorionic villus sampling time diagnosis intrauterine fetal death compared traditional use cultured fetal skin , products conception , amniocentesis total 102 specimens early fetal losses evaluated success chromosomal results found postmortem chorionic villus sampling technically possible , offers highest likelihood cytogenetic result , rapid , reliable , safe technique component intrauterine fetal deaths appears remain viable continues grow long embryo died samples obtained time diagnosis fetal death offer greatest changes successfully obtaining karyotype incidence chromosome abnormalities associated fetal loss , particularly trisomies , higher previous data suggested
surgical staples cesarean section randomized controlled trial randomized controlled trial compares use auto suture poly cs 57 disposable surgical \( n 98 \) standard hysterectomy \( n 102 \) low transverse cesarean sections subjective assessment blood loss surgeon resulted lower mean \( sem \) total blood loss estimates stapled group \( 492 24 ml \) group \( 38 ml \) \( p 0 05 \) however , surgeon 's estimation blood loss result blood loss estimated hemoglobin deficit measured second postoperative day significantly differ two groups use stapling device tended total operating time , averaged 42 5 minutes group staples 39 2 minutes group standard \( p 0 05 \) risk febrile morbidity , frequency , length hospitalization similar two groups results support routine use auto suture poly cs 57 disposable surgical low transverse cesarean sections
neuroendocrine features reactive bile ductules cholestatic liver disease various cholestatic liver diseases accompanied striking increase number bile ductules called ductular reaction thought arise ductular metaplasia hepatocytes proliferation pre existing bile ductules previous studies shown reactive bile ductules differ normal counterpart enzyme immunohistochemical make using monoclonal antibodies directed neuroendocrine markers immunohistochemistry , found reactive bile ductules cholestatic liver disease display neuroendocrine features cases primary biliary cirrhosis \( pbc \) , primary sclerosing cholangitis \( psc \) , extrahepatic obstruction , acute hepatitis , reactive bile ductules expressed neural cell adhesion molecule \( n cam \) reacted monoclonal antibody n cam , recognized , restricted neuroendocrine cells tissues four cases , bile ductules expressed chromogranin , present matrix neuroendocrine granules furthermore , three cases cholestasis , scattered hepatocytes expressed chromogranin n cam neuroendocrine markers neuron specific enolase , synaptophysin , myelin associated glycoprotein lacking bile ductules hepatocytes neuroendocrine phenotype bile ductules hepatocytes confirmed , demonstrating various numbers dense , neuroendocrine granules near peripheral cell membrane bile ductules well cells intermediate hepatocytes bile ductular cells 10 cases normal liver tissue without ductular reaction , bile ductules lacked neuroendocrine markers except two cases weak reactivity chromogranin observed findings illustrate presence new , neuroendocrine cell type liver cholestasis elucidation significance neuroendocrine substance \( \) produced dense granules reactive bile ductules awaits isolation characterization speculate molecule plays autocrine paracrine regulatory role process ductular metaplasia hepatocytes growth bile ductules
mechanisms edema formation experimental autoimmune encephalomyelitis contribution inflammatory cells central nervous system \( cns \) endothelium regulates passage solutes functions blood brain barrier \( bbb \) experimental autoimmune encephalomyelitis \( eae \) , inflammatory demyelinating disease cns , loss bbb function occurs authors previously shown increase endothelial activity associated decreased mitochondrial content evidence bbb dysfunction eae changes occurred capillary bed correlated cns edema clinical signs present report , fixation procedure infusion intravascular tracer peroxidase \( \) rats height clinical eae used animals , tracer leakage noted inflamed venules diameters 12 19 mu authors detected several mechanisms passive leakage 1 \) increased junctional permeability 2 \) increased space 3 \) leakage migrating inflammatory cells small capillaries showed necrotic changes minimal tracer leakage report demonstrates bbb disruption also occurs via mechanisms may induced inflammatory cells
change mesenchymal stem cells induced activated ras oncogene 3t3 murine mesenchymal stem cells potential differentiate variety different cell types even though show predilection undergo adipocyte differentiation vitro possibility activated c ha ras \( ejras \) oncogene might influence pathway differentiation stem cells investigated current study activated ras oncogene transfected stably expressed 3t3 cells assays performed determine effect differentiation results show ejras transfected cell lines lose ability differentiate adipocytes instead differentiate cells express many characteristics macrophages cells contain numerous cytoplasmic granules , extensive nonspecific esterase activity , independent growth modulation differentiation pathway adipocyte lineage cell lineage result transforming effect ejras , nontransformed cell clone expresses protein also exhibits modified differentiation pathway data suggest ejras oncogene specifically modulates differentiation pathway 3t3 mesenchymal stem cells experimental system therefore provide excellent model evaluate role ejras process metaplasia
effects spermatic vascular division correction high testis testicular function division spermatic artery veins commonly used technique correcting high testis , although results clearly defined left spermatic artery veins 22 adult wistar rats divided preserving vessels associated vas muscle \( dt \) sham operation performed left testicle six additional rats \( st \) 3 weeks postoperatively , testes rats removed testes viable bled incised , although bleeding considerably reduced testes dt mean testicular weights dt 1 , mg compared 1 , 125 mg st rats \( p less 0 02 \) 1 , 119 mg contralateral testes mean tubular diameter dt 220 37 mu compared 303 1 10 7 mu st testes \( p less 0 02 \) testicular biopsy score based upon morphology spermatic tubules 4 46 3 32 dt testes 8 65 0 23 st testes \( p less 0 02 \) compared 8 38 0 18 contralateral testes absolute normal value 10 morphologic abnormalities observed contralateral unoperated testes rats contralateral testes 12 additional rats removed dt mean testosterone values rats one testicle 1 43 0 75 ng ml three weeks dt , testosterone values 0 19 0 31 ng ml \( p less 0 01 \) concluded division main spermatic artery vein rats produces testicular atrophy arrest interstitial cell dysfunction although collateral blood flow testis may demonstrated , tissue perfusion inadequate normal spermatogenesis endocrine function
intravenous fluid load recovery double blind comparison patients day case laparoscopy effect intra operative fluid dextrose administration upon recovery tested randomised , double blind trial three groups 25 patients , undergoing laparoscopic examination day cases , studied two groups received fluid \( 20 ml kg compound sodium lactate solution \) showed significant improvement \( p less 0 05 \) variables reflected hydration fluid group also received dextrose \( 1 g kg \) exhibited significant improvement intra operative fluid dextrose administration appears confer benefit upon recovery patients minor surgery
minitracheotomy complications follow fibreoptic complications changes tracheal mucosa minitracheotomy evaluated 28 patients tracheal mucosa insertion minitracheotomy cannula , 3 day intervals cannula removed thereafter , assessments made every third day mucosa considered normal three significant complications occurred mediastinal puncture , entrance cannula subcutaneous emphysema difficulties insertion minitracheotomy cannula encountered 15 28 patients \( 54 \) air flow detected cannula one patient , lack air flow another patient , misleading signs position cannula passing suction catheter three patients normal end tidal carbon dioxide tracing one patient , also found misleading correct position possible complications could verified fibreoptic changes tracheal mucosa independent duration minitracheotomy therapy
intravenous diclofenac sodium administration operation suppress postoperative pain \? intravenous diclofenac sodium evaluated double blind randomised trial relative intramuscular diclofenac , intravenous fentanyl , intramuscular placebo 160 patients undergoing extraction impacted lower third molar teeth test drug administered operation attempt alleviate postoperative pain 10 cm visual analogue scale used assess pain 30 minutes one day surgery , patients stayed overnight patients received intravenous diclofenac significantly less pain groups 30 minutes operation also significantly less pain one day surgery placebo opioid groups , less intramuscular diclofenac group capillary bleeding time , comparison placebo , significantly prolonged use intramuscular diclofenac , similar nonsignificant trend observed intravenous diclofenac group problems encountered excessive bleeding group
effect outcome prolonged exposure patients nitrous oxide prolonged \( several days repeated \) exposure nitrous oxide \( n2o \) cause injury death assess whether relatively prolonged anesthesia n2o normal patients might similarly cause untoward effects , investigated whether addition n2o isoflurane anesthesia caused injury patients surgical resection acoustic neuroma lasting approximately 10 h twenty six patients undergoing surgical resection acoustic neuroma randomly assigned regimen included excluded n2o \( 50 60 \) isoflurane anesthesia plus intravenous average , slightly less isoflurane \( 0 24 \) used anesthesia n2o measured standard clinical variables \( blood pressure , heart rate \) , oxygen saturation , neurologic status , pain , incidence type morbid outcomes exposure n2o increase incidence morbid outcomes \( including hepatic injury , infection , hypoxemia \) , prolong hospitalization , increase common postoperative complaints nausea , vomiting , coughing , headache patients anesthetized either regimen equally satisfied anesthetic
postoperative hypoxemia surgery frequent event caused nitrous oxide tested whether anesthesia includes nitrous oxide \( n2o \) results development intraoperative postoperative pulmonary complications , including hypoxemia also tested whether aging contributes development complications , particularly anesthesia includes n2o randomly allocated patients total hip replacements , carotid endarterectomies , transsphenoidal \( total n 270 \) anesthetic regimen without n2o \( stratified within surgical group \) heat included anesthetic circuit patients patients monitored perioperatively 1 wk surgery using intermittent continuous pulse oximetry determine saturation intraoperatively , mean oxygen \( o2 \) lower patients given n2o , particularly older patients hypoxemia \( o2 saturation less 86 \) developed five patients receiving n2o one receiving o2 difference significant administration n2o decrease postoperative o2 saturation , alter incidence postoperative hypoxemia , cough , sputum production
nitrous oxide epinephrine induced arrhythmias asked whether sympathomimetic effect nitrous oxide \( n2o \) predisposed patients receiving n2o arrhythmias response epinephrine administration also asked whether aging contributed development arrhythmias , without n2o one hundred patients transsphenoidal randomly assigned receive anesthesia including \( n 49 \) excluding \( n 51 \) n2o patients given injection epinephrine 1 200 , 000 , 0 5 lidocaine produce hemostasis using intermittent 12 lead continuous lead ii electrocardiography , determined incidence premature ventricular contraction , atrioventricular \( av \) dissociation , changes wave morphology patients given n2o significantly higher incidence av dissociation \( 61 2 vs 41 2 \) trend toward higher incidence multiple premature ventricular contractions \( 16 3 vs 7 8 \) statistically significant anesthetic groups high incidence postoperative changes wave morphology \( 46 9 n2o group vs 50 9 group given n2o \) aging alone affect incidence ventricular ectopic beats , av dissociation , changes electrocardiographic morphology , correlated development ventricular ectopy n2o anesthesia conclude use n2o correlated higher incidence av dissociation response injection epinephrine lidocaine
lidocaine local anesthesia arthroscopic knee surgery forty five patients evaluated knee arthroscopy performed using local anesthesia produced lidocaine epinephrine determine dose response relationship operative analgesia serum lidocaine concentrations also measured patients randomized prospectively receive 20 ml 0 5 , 1 0 , 1 5 lidocaine epinephrine intraoperative discomfort measured verbal response 11 point linear pain scale pain scores significantly higher patients receiving 0 5 lidocaine first 45 min surgery \( p 0 03 \) 45 min , pain scores continued higher 0 5 lidocaine group 1 0 1 5 groups , differences statistically significant ninety four percent patients 1 5 lidocaine group willing repeat anesthetic technique surgery compared 83 1 0 lidocaine group 75 0 5 lidocaine group \( p greater 0 05 \) duration postoperative analgesia similar groups serum lidocaine concentrations 15 , 30 , 60 , 120 min instillation lidocaine highest 1 5 lidocaine group peak concentration 278 ng ml patient symptoms lidocaine toxicity recommend lidocaine concentrations 1 0 1 5 used 20 ml instilled knee arthroscopy based patient comfort absence lidocaine toxicity
chloroprocaine antagonism epidural opioid analgesia receptor specific phenomenon \? sixty healthy patients scheduled elective cesarean delivery epidural anesthesia randomized receive either lidocaine 2 chloroprocaine primary local anesthetic agent patients first complained postoperative pain recovery room , given either fentanyl 50 micrograms butorphanol 2 mg , epidurally , randomized , blinded fashion postoperative analgesia , quantitated visual analogue scale , well time elapsed first request supplemental opioid , differ patients receiving butorphanol either 2 chloroprocaine lidocaine anesthesia contrast , epidural fentanyl produced shorter lesser degree sensory analgesia 2 chloroprocaine use , whereas epidural fentanyl lidocaine anesthesia provided pain relief similar seen butorphanol groups side effects limited somnolence butorphanol pruritus fentanyl evidence respiratory depression seen patient conclude 2 mg butorphanol epidurally provides approximately 2 3 h effective analgesia cesarean delivery either lidocaine 2 chloroprocaine anesthesia epidural fentanyl seems antagonized 2 chloroprocaine , lidocaine , used primary local anesthetic agent suggest possible mu receptor specific etiology effect
exogenous opioids human breast milk acute neonatal preliminary study opioid analgesia requirements , distribution breast milk , influence neonatal evaluated ten neonate pairs nursing elective cesarean section epidural anesthesia five patients received first loading dose intravenous meperidine umbilical cord clamping , patient controlled analgesia \( pca \) intravenous meperidine , finally meperidine tablets needed five patients received morphine manner treatment groups showed differences respect neonatal apgar scores visual analog scale \( vas \) pain satisfaction scores 24 48 h postpartum breast milk specimens , obtained 12 , 24 , 36 , 48 , 72 , 96 h postpartum analyzed opioids metabolites , showed persistently elevated concentrations meperidine group blinded evaluated infant 3rd day life neonatal behavioral assessment scale \( \) , three human orientation outcomes chosen analysis best measures opioid induced effects four outcomes , neonates morphine group scored significantly higher \( p less 0 05 \) neonates meperidine group conclude post cesarean delivery pca morphine provides equivalent maternal analgesia overall satisfaction provided pca meperidine , significantly less neurobehavioral depression among breast fed neonates 3rd day life
hypoxemia care unit observer study determine incidence duration hypoxemia care unit \( pacu \) , 200 patients investigated single blind observer study number unrecognized hypoxemic episodes , well risk factors possible association hypoxemia postoperative morbidity , studied oxygenation monitored continuously pulse oximeter one hypoxemic episodes \( spo2 less equal 90 \) noted 55 patients spo2 values less equal 80 noted 13 patients supplementary oxygen given 55 hypoxemic episodes registered hypoxemic episodes unrecognized staff 95 cases stepwise multiple logistic regression analyses , risk factors associated higher incidence hypoxemia duration anesthesia \( p less 0 0001 \) , age \( p less 0 002 \) history smoking \( p less 0 01 \) patients undergone regional anesthesia lower risk hypoxemia \( p less 0 0002 \) occurrence hypoxemia pacu could correlated postoperative morbidity conclude hypoxemic episodes pacu common routine use supplemental oxygen combined normal clinical surveillance prevent hypoxemic episodes
prehospital prophylactic lidocaine favorably affect outcome patients chest pain study objectives purpose study determine morbidity mortality initially stable patients presenting paramedics chest pain examine possible beneficial effects use , including reduction sudden death syndrome prehospital emergency department setting determine prophylactic lidocaine associated adverse effects patient population design setting randomized , prospective study using prophylactic lidocaine patients complaining chest pain presented paramedic system january 1984 january 1988 type participants patients aged 18 years older chest pain suspected cardiac origin presented paramedics study period included excluded patients presenting warning arrhythmias , second third degree heart block , less 50 , hypotension less 90 mm hg systolic , known allergy lidocaine interventions patients randomized two groups , lidocaine treated group control group initial bolus 1 mg kg iv lidocaine administered lidocaine treated group simultaneous 2 mg min iv established ten minutes first dose lidocaine , second bolus 0 5 mg kg administered measurements main results study period , 1 , patients entered received lidocaine , discharge diagnoses included acute myocardial infarction \( 31 \) , unstable angina \( 33 \) , cardiac problems \( 7 \) , noncardiac problems \( 29 \) overall mortality rate 7 4 equal distribution deaths lidocaine treated group \( 57 \) control group \( 48 \) six patients cardiac arrest prehospital setting , 15 cardiac arrest ed malignant ventricular arrhythmias precipitating arrest rhythm patients acute myocardial infarctions similar lidocaine treated control groups incidence adverse effects , including hypotension , , second third degree heart blocks , , altered mental status , similar groups conclusion benefits administration prehospital prophylactic lidocaine stable patients chest pain therefore , routine use setting appears
diagnostic impact prehospital 12 lead electrocardiography study hypothesis feasible apply prehospital 12 lead electrocardiography stable prehospital chest pain patients prehospital diagnostic accuracy improved compared single lead population one hundred sixty six stable adult patients sought paramedic evaluation chief complaint nontraumatic chest pain methods one hundred fifty one prehospital 12 lead ecgs diagnostic quality obtained paramedics 166 adult patients presenting nontraumatic chest pain paramedics base station physicians blinded information acquired prehospital 12 lead ecgs treated patients according current standard care clinical diagnosis single lead final hospital diagnoses classified three groups acute myocardial infarction \( 24 \) suspected angina ischemia \( 61 \) nonischemic chest pain \( 66 \) paramedics base station physicians' clinical diagnoses prehospital emergency department ecgs similarly classified compared prehospital ed 12 lead ecgs read retrospectively two results paramedics achieved high success rate \( 98 7 \) obtaining diagnostic quality prehospital 12 lead ecgs 94 6 eligible prehospital patients patients acute myocardial infarction , prehospital ecg alone significantly higher specificity paramedic clinical diagnosis \( 99 2 vs 70 9 p less 001 \) , significantly higher positive predictive value \( 92 9 vs 32 7 p less 001 \) patients angina , combining paramedic clinical diagnosis prehospital ecg significantly improved sensitivity \( 90 2 vs 62 3 p less 001 \) increased negative predictive value \( 88 9 vs 71 3 p less 02 \) compared paramedic clinical diagnosis alone high concordance prehospital ed ecg diagnosis \( 99 3 acute myocardial infarction 92 8 angina \) furthermore , ten patients whose prehospital ecgs demonstrated ischemia final hospital diagnoses angina acute myocardial infarction paramedics received base station physician directed therapy conclusion feasible apply prehospital 12 lead electrocardiography stable prehospital chest pain patients prehospital 12 lead ecgs potential significantly increase diagnostic accuracy chest pain patients , approach ed 12 lead ecg diagnoses , may allow consideration altering improving prehospital hospital based management patient population
effects inflammatory mediators responsiveness isolated human airways methacholine several studies suggested asthmatics quantities inflammatory mediators histamine , thromboxane a2 \( txa2 \) , prostaglandin d2 \( \) , prostaglandin f2 alpha \( pgf2 alpha \) , leukotriene c4 \( ltc4 \) present airway lumen related degree bronchial responsiveness inhaled methacholine \( mch \) therefore , studied effect mediators cholinergic responsiveness isolated human airway segments lung tissue collected thoracotomy 30 patients studied dose response curves mch obtained bronchial segments , , incubation either threshold concentration histamine \( 10 \( 10 \) 10 \( 8 \) \) , stable txa2 analogue \( 10 \( 11 \) 10 \( 9 \) \) , \( 5 x 10 \( 9 \) 5 x 10 \( 7 \) \) , pgf2 alpha \( 10 \( 9 \) 10 \( 7 \) \) , ltc4 \( 10 \( 11 \) 10 \( 9 \) \) exception ltc4 , presence mediators either concentration increased sensitivity mch factor 1 1 2 \( p less 0 05 , anova \) increase depend dose mediator \( p greater 0 05 , anova \) data indicate mediator induced muscle hypersensitivity explain small part leftward shift dose response curve inhaled mch observed asthma
objective appraisal role computed tomographic \( ct \) guided drainage intra abdominal abscesses computed tomographic \( ct \) guided drainage important tool treatment intra abdominal abscess important role treatment small , , well placed abscesses success rates experience diminish considerably abscesses involving necrotic tumors infected yeast frequently characteristic new procedures , initial evaluation success rate procedure procedure carries considerable complication rate \( 13 \) mortality rate \( 15 \) importantly , success usually evident early within first 24 48 hours length time , careful evaluation consider treatment
femoral arteriovenous fistula complication percutaneous transluminal coronary angioplasty report five cases arteriovenous fistula \( avf \) associated invasive diagnostic angiographic procedures rare incidence increased procedures percutaneous transluminal coronary angioplasty \( ptca \) still quite low report five cases avf within 17 month period , representing 0 15 per cent cardiac 0 87 per cent five patients presented groin bruits two associated one patient deep vein thrombosis patients underwent uneventful division fistula thorough understanding anatomy femoral triangle necessary order avoid complication fistulas superficial femoris arteries emphasizes importance avoiding low groin puncture early angiography surgical intervention recommended optimal results
management premature removal percutaneous gastrostomy percutaneous endoscopic gastrostomy \( peg \) become preferred method enteral access nutritional support increased use modality , complications encountered frequently premature withdrawal , removal gastrostomy tube within first seven days insertion , adherence gastric serosa parietal peritoneum , indication laparotomy report describes treatment premature withdrawal immediate endoscopic replacement 18 month period , 271 patients underwent insertion peg five patients \( 1 8 \) removed gastrostomy tube within seven days insertion treated immediate replacement using retrograde technique , avoiding laparotomy five successfully replaced gastrostomy site despite presence , patient developed peritonitis septic complications premature gastrostomy tube withdrawal safely managed endoscopic replacement observation laparotomy unnecessary potentially
tracheotomy first year life much written concerning complications pediatric , studies reviewed complication rates performed first 12 months life reviewed records 60 patients underwent tracheotomy first year life 1976 1988 study includes 30 full term infants 30 premature infants , 16 low birth weight preterm infants \( less equal 32 weeks' gestation less 1 , 500 g birth weight \) overall complication rates 3 intraoperative , 13 early postoperative , 38 late postoperative early postoperative complication rate preterm infants nearly double full term infants late postoperative complication rate patients undergoing tracheotomy airway obstruction double patients requiring tracheotomy pulmonary indications duration tracheotomy , however , felt important factor development late postoperative complication
breathing human fetuses serial recording 45 low risk fetuses throughout second third showed predominant diaphragmatic movement 26 weeks' gestational age significant negative correlation gestational age pronounced reduction 24 26 weeks , result decrease number episodes rather change duration episodes contrast , fetal breathing positively correlated gestational age , greatest increase breathing occurring 26 32 weeks' gestation result increase number duration episodes time rest activity cycles behaviour could determined recordings , breathing dependent behavioural state cycle , occurring predominantly active episodes association active behaviour breathing alter increasing gestational age , variables fetal behavioural state became increasingly closely linked importance prolonged repeated recording , also need take account variables fetal behaviour , conclusions drawn absence fetal breathing
blood conservation cardiac surgery reviewed current blood conservation techniques use cardiac surgery avoidance aspirin preoperatively important blood conservation measure patients scheduled elective operation participate autologous programs careful monitoring , patients major coronary artery disease safely blood preoperatively intraoperative processing blood withdrawn cardiopulmonary bypass provides autologous platelet rich plasma infusion reversal heparin sodium blood collected field operation blood remaining oxygenator bypass also processed yield washed concentrated red blood cells reinfusion randomized , prospective studies document postoperative autotransfusion safe effective reducing homologous blood use aprotinin reduces plasma protein activation platelet damage bypass integration available blood conservation techniques comprehensive program combined careful consideration indications transfusion may allow patients avoid transfusion entirely
continuous epidural postthoracotomy pain relief forty four patients treated continuous infusion lumbar epidural \( 0 05 \) thoracic operations postoperatively , visual analog pain scores obtained postoperative day 1 2 , 90 patients experienced either pain \( visual analog pain scale 0 \) mild pain \( visual analog pain score 1 3 \) rest incidence side effects \( , , nausea \) less reported epidurally administered opioids continuous infusion lumbar epidural produced safe , predictable analgesia thoracotomy
neuropsychological assessment monozygotic twins discordant schizophrenia comparison monozygotic twins discordant schizophrenia controls genetic variance reduces variance due environmental circumstances , thus serving highlight differences due phenotypic related variables study , assessed 16 twin pairs wide range neuropsychological tests affected twins tended perform worse unaffected counterparts tests deficits especially severe tests , memory , concept formation , suggesting dysfunction greatest cortex manifest symptoms highly associated neuropsychological scores , global level functioning address issue genetic , also compared sample discordant unaffected twins sample seven pairs normal monozygotic twins significant differences groups found neuropsychological test fact , results suggest neuropsychological dysfunction consistent feature schizophrenia related primarily clinical disease process genetic nonspecific environmental factors
bilateral phrenic nerve palsy associated open heart surgery incidence phrenic nerve palsy open heart surgery estimated 10 , usually unilateral cause symptoms bilateral phrenic nerve injury coronary artery bypass surgery rare complication case report describes patient developed bilateral phrenic nerve palsies required prolonged ventilatory support denervation documented needle electromyography four weeks bypass surgery patient required total ventilatory support three months partial ventilatory support additional three months case demonstrates usefulness electromyographic screening documentation phrenic nerve injury cause lesion unclear , hypothermia stretch leading hypotheses patient developed phrenic nerve palsies despite using cardiac
dystrophy quantification muscle weakness myotonia effect amitriptyline exercise purpose study quantify degree muscle weakness myotonia 12 patients dystrophy \( md \) , quantitatively determine effects four six month therapeutic trial amitriptyline patients exercised weights one years shown initial improvement muscle strength , reached plateau others improved study began muscle weakness quantified comparing five second maximum voluntary contraction \( mvc \) \( n \) per kg \( body weight \) 12 patients 20 healthy subjects knee extensor , elbow flexor , first dorsal \( fdi \) muscles compared myotonia quantified measuring relaxation times \( rts \) end five second mvc produced fdi , time taken mvc decrease 50 75 \( referred 1 2 3 \) results follows \( 1 \) mean muscle strength three muscles patients significantly \( p less 001 \) reduced compared healthy subjects \( 2 \) 1 2 3 means patients \( vs healthy subjects \) significantly prolonged \( p less 01 \) eight patients participated therapeutic trial amitriptyline therapeutic effects quantified measuring muscle strength , 1 2 3 , percent change evoked muscle action potential \( map \) fdi muscle ten second mvc , determine change excitability mean muscle strength fdi improved 27 kg , \( p less 05 \)
aortic occlusion vascular isolation allowing avascular hepatic resection occlusion abdominal aorta hepatic vascular isolation employed series 15 patients definitive method allow avascular hepatic resection series compared earlier group patients treated conventionally avascular hepatic resection group mortality hypotension occur time hepatic vascular isolation rapid , accurate excision hepatic lesions could achieved field resection midline lesions involving great veins possible , resections crossing segmental boundaries , could performed previously formal hepatic required concomitantly , greatest amount uninvolved hepatic parenchyma remained situ increased ease operative management , reduced blood loss , reduced operating time \( mean , 2 8 hours \)
circadian variation onset acute ischemic stroke circadian pattern onset myocardial cerebral infarction identified evaluate phenomenon , analyzed prospectively collected data 151 patients acute ischemic stroke number strokes per 6 hour period following midnight 6 , 20 \( 13 \) 6 noon , 86 \( 57 \) noon 6 pm , 21 \( 14 \) 6 pm midnight , 24 \( 16 \) pattern affected previous use aspirin frequent time onset 6 noon subgroups ischemic stroke small artery , 71 , 62 large artery atherothrombotic , 57 large artery , 46 unknown cause , 40 also investigated time awakening stroke onset 145 patients found 24 ischemic strokes occurred within first hour awakening data demonstrate early morning peak exists subtypes stroke data also suggest critical period first hour awakening
nontraumatic coma glasgow coma score coma etiology predictors 2 week outcome 1987 1988 , carried prospective study patients older 10 years nontraumatic coma intensive care units columbia medical center , new york , ny 188 patients glasgow coma scale \( gcs \) determinations within 72 hours , 61 dead persistent coma 2 weeks onset age , sex , ethnicity influence outcome 2 week outcome patients initial gcs 3 5 14 8 awake 85 2 dead persistent coma gcs 6 8 group , 53 1 awake 46 9 dead persistent coma hypoxic ischemic coma worst 2 week outcome \( 79 dead comatose \) coma caused metabolic disease sepsis \( 68 \) , focal cerebral lesions \( 66 \) , general cerebral diseases \( 55 \) intermediate , drug induced coma favorable outcome \( 27 dead comatose \) independent predictors 2 week outcome first gcs drug induced coma predicted probability 2 weeks eight times better drug induced coma causes gcs held constant patients initial gcs score 6 8 seven times likely score 3 5 motor alone significant independent predictor 2 week outcome modification coma score include etiology may give accurate predictions 2 week outcome nontraumatic coma
long term effect dopaminergic drugs legs 2 year follow thirty patients legs syndrome , initially responded well treatment levodopa , studied long term effect drugs \( least 2 years \) 2 year period , two patients switched levodopa two patients longer needed levodopa one developed paraplegia symptoms legs syndrome disappeared completely remaining 26 patients continued use levodopa eight patients maintained original dose , nine use increased dose , nine found decreased dose sufficient side effect transient nausea reported two 30 patients study showed relief symptoms legs syndrome dopaminergic drugs wear passage time , side effects minimal even long term use , dose needed obtain relief may increase well decrease
hemifacial spasm rochester county , minnesota , 1960 1984 incidence hemifacial spasm residents county , minnesota , studied reviewing medical records patients residing community 1960 1984 average annual incidence rate 0 74 per 100 , 000 men 0 81 per 100 , 000 women , age adjusted 1970 us white population average prevalence rate 7 4 per 100 , 000 population men 14 5 per 100 , 000 women incidence prevalence rates highest 40 79 years age
sjogren syndrome examined computed tomography , magnetic resonance , 18f 2 fluoro 2 deoxy glucose positron emission tomography sjogren syndrome autosomal recessive degenerative disorder characterized congenital cataracts , cerebellar ataxia , spasticity , mental deficiency , skeletal abnormalities studied two adult siblings sjogren syndrome using anatomic metabolic brain imaging techniques characterize pattern nature abnormalities brain computed tomographic magnetic resonance imaging showed diffuse brain atrophy mild moderate degree , involving primarily white matter , cerebellum , brain stem , cervical spinal cord pattern atrophy resembled seen diffuse measurements local cerebral glucose metabolic rates positron emission tomography revealed statistically significant differences normal control subjects regions , metabolic rate decreased thalamus one patient findings support diffuse white matter disorder sjogren syndrome
background review current concepts reperfusion injury define concept reperfusion injury , present background experimental work supporting concept identify several new influences , current clinical interest thrombolytic therapy acute ischemia heart brain growing recognition endothelium regulator homeostasis propose influences encourage reperfusion injury factor ultimate outcome tissue exposed reversible ischemia briefly discuss major mechanisms presently implicated reperfusion injury loss calcium homeostasis , free radical generation , leukocyte mediated injury , acute hypercholesterolemia
aplasia cutis congenita arteriovenous fistula case report review describe child congenital aplasia cutis congenita scalp occult giant posterior fossa arteriovenous fistula previous case reports central nervous system malformations associated aplasia cutis congenita reviewed exact incidence malformations unknown patients aplasia cutis congenita undergo neurologic evaluation , families examined similar lesions early central nervous system imaging workup may required , especially plastic surgery head region planned
subjective assessment hearing handicap study compares self perceived assessment hearing handicap derived measures hearing handicap sample elderly persons subjects evaluated traditional tests , speech perception noise test , hearing handicap inventory elderly , self assessment questionnaire hearing handicap also calculated derived american academy otolaryngology \( 1979 \) method results consistent studies indicate low correspondence measures hearing handicap self assessment hearing handicap furthermore , hearing handicap inventory elderly considered true measure hearing handicap , data indicate american academy otolaryngology method tends overestimate handicap among persons self perceived hearing handicap underestimates handicap among persons significant self perceived hearing handicap
vitamin b6 treatment premenstrual syndrome review published erratum appears br j 1991 mar 98 \( 3 \) 329 30 search literature yielded 12 controlled trials vitamin b6 treatment premenstrual syndrome discussed emphasis methodological aspects major trials limited number patients included existing evidence positive effects vitamin b6 weak , well designed trials positive results would needed change view
effect nontransmural necrosis epicardial potential fields correlation fiber direction effect nontransmural necrosis epicardial potential distributions studied 13 dogs previous studies , left ventricular epicardial pacing generated epicardial potential maps qrs onset negative central area two positive areas portions wavefront along fibers subsequently , positive areas expanded counterclockwise direction 90 degrees 120 degrees studies , expansion positive areas attributed spread excitation deep myocardial layers , fiber direction counterclockwise epicardium endocardium test hypothesis , tried counterclockwise expansion positive area creating localized , nontransmural necrosis various depths left ventricular wall injection formalin application laser energy epicardial potential maps obtained grid 12 x 15 electrodes 44 x 56 mm area epicardial pacing selected sites generated epicardial maps positive areas missing compared controls direction straight line joining pacing site site missing positivity correlated well average fiber direction necrotic mass \( r 0 82 , p less 0 01 \) angle epicardial fiber direction straight line described correlated well average depth necrosis , expressed percent wall thickness \( r 0 95 , p less 0 01 \) data support hypothesis counterclockwise expansion epicardial positivity occurring epicardial pacing results excitation spreading along deep fibers
bleeding time prolongation streptokinase reduction 1 8 arginine vasopressin mechanism treatment thrombolytic agents causes bleeding known recently , frequency bleeding events shown correlate bleeding time , particularly individuals treated aspirin examined effects streptokinase \( 20 , 000 60 , 000 iu kg \) bleeding time 40 rabbits pretreated aspirin , model fibrinolytic therapy tested effects 1 8 arginine vasopressin \( ddavp \) \( 0 3 microgram kg \) , agent known reduce bleeding time variety bleeding disorders , 20 rabbits compared results control group rabbits receiving normal saline placebo aspirin increased bleeding time baseline mean sem value 119 15 191 34 seconds control group 114 6 188 18 seconds experimental group addition streptokinase increased bleeding time 119 seconds control group 810 114 seconds experimental group \( p ns \) subsequent infusion ddavp decreased bleeding time experimental group 29 seconds \( p less 0 01 versus streptokinase \) compared 79 seconds \( p ns versus streptokinase \) control animals given saline placebo subset rabbits receiving aspirin streptokinase \( 40 , 000 60 , 000 iu kg \) , samples obtained platelet aggregation \( n 16 \) , von willebrand factor antigen concentration \( n 17 \) , von willebrand factor distribution \( n 14 \) maximal rates adp induced platelet aggregation affected ddavp infusion , plasma concentration von willebrand factor antigen , quantified immunoradiometric assay , significantly affected ddavp infusion furthermore , von willebrand factor ratio decreased ddavp administration findings indicate aspirin streptokinase combined result marked increase bleeding time reduced ddavp effect ddavp accompanied increase platelet aggregation response , plasma von willebrand factor antigen concentration , von willebrand factor ratio
channel specificity antiarrhythmic drug action mechanism potassium channel block role suppressing cardiac arrhythmias although work class iii remains early stage , agents still appear possess greater efficacy less conventional class agents experimental arrhythmia models considered representative clinical situation although prolongation repolarization carries tendency dependent \( e , de pointes \) , available data suggest may function potassium channel block rather general characteristic class iii activity availability new selective blockers specific cardiac potassium channels development class iii agents already helped clarify basic questions ionic mechanism repolarization heart , one growing clinical data base eventually determine relative safety efficacy agents preventing symptomatic life threatening arrhythmias
chronic illness depressive symptoms elderly population based study cross sectional study distribution depressive symptoms association depressed mood chronic illness conducted geographically defined population southern california men women aged 65 years older prevalence depressed mood total population 5 2 women exhibited significantly higher mean depressive symptom score prevalence rate almost twice men depressive symptoms associated several risk factors sexes , including age , self perception current health status , number reported chronic diseases medications amount exercise however , relationship physical illness depressive symptoms appeared differ sex respect nature disease disability type medication currently used findings indicate risk depression diminish age among elderly studies suggested
l tyrosine potentiates anorexia induced mixed acting sympathomimetic drugs rats effects l tyrosine \( l tyr \) anorectic activity several mixed acting sympathomimetics determined dark cycle rats made food deprivation l tyr \( 200 mg kg \) significantly potentiated anorectic activity , \( \) \( \) amphetamine 48 , 50 37 , respectively dose l tyr varied \( 25 400 mg kg \) , significant dose dependent relationship noted observed potentiation positively correlated increases brain tyr concentrations blockade l tyr uptake brain coadministration l valine prevented potentiation various l amino acids , well tyr , failed mimic potentiating action l tyr determined alpha methyl p tyr pretreatment , l tyr induced potentiation dependent upon increased catecholamine synthesis although various mixed acting sympathomimetic similarly potentiated l tyr , direct acting beta 2 adrenoceptor , salbutamol , results indicate l tyr specifically potentiates anorectic activity studied mixed acting sympathomimetics consistent requirement central conversion l tyr catecholamines via tyr hydroxylase response possibility effect mixed acting sympathomimetics normally limited availability l tyr suggested
peripheral opioid receptors mediating antinociception inflammation evidence activation like opioid peptides cold water stress study utilized inhibitors enzymatic degradation investigate possibility class opioid peptides contributes stress induced antinociception seen inflamed peripheral tissues rats 's complete adjuvant initiated unilateral hind paw inflammation following 1 min cold water stress , rats previously injected hind vehicle showed transient elevation paw pressure threshold , much greater inflamed returned control levels within 15 min preferential antinociception significantly pronounced prolonged rats previously injected bilaterally cocktail inhibitors \( 0 2 mg \) \( 0 2 mg \) enhancement stress induced antinociception dose dependently antagonized tertiary naloxone \( 0 125 2 mg kg 1 c \) evidence peripheral site action like peptides model provided antagonism actions \( 10 20 mg kg 1 c \) systemic administration orally active inhibitor \( 5 40 mg kg 1 p \) also able dose dependently potentiate preferential stress induced antinociception naloxone \( 1 mg kg 1 c \) reversible manner
gadolinium enhanced magnetic resonance imaging bell 's palsy inflammation facial nerve bell 's palsy demonstrated gadolinium enhanced magnetic resonance imaging studied series 17 bell 's palsy patients gadolinium enhanced magnetic resonance imaging , purpose paper report findings discuss significance acute bell 's palsy cases demonstrate facial nerve enhancement , usually distal internal auditory canal labyrinthine segments segments demonstrate enhancement less often gadolinium enhancement occurs regardless severity paralysis persist clinical improvement paralysis findings study evidence segments facial nerve often involved bell 's palsy segments often enhanced gadolinium enhanced magnetic resonance imaging role gadolinium enhanced magnetic resonance imaging management bell 's palsy patients discussed
use gadolinium enhanced magnetic resonance imaging determine lesion site traumatic facial paralysis gadolinium enhanced magnetic resonance imaging used evaluate 20 patients surgically confirmed facial nerve lesions nerve could seen , gadolinium enhanced magnetic resonance imaging accurately revealed lesion site well known extent , cases predicted testing technique appears provide accurate lesion site testing may importance surgical planning currently used tests facial nerve function frequently inaccurate determine proximal lesion site multiple extensive lesions focal nerve enhancement seen nerve injury , increased signal intensity within temporal bone trauma , increased signal intensity within dura surgery occasionally mask nerve lesions may confused tumors
computerized laboratory system computerized laboratory system \( \) developed part ongoing effort improve quality care hospital system identifies potentially life threatening conditions basis laboratory findings generates appropriate clinicians use system led significant increase proportion patients life threatening situations received appropriate care \( 50 8 implementation vs 62 5 afterward , p less 0 05 \) among patients hypokalemia , falling potassium levels , hyperkalemia , hypokalemia treatment digoxin , hyponatremia , falling sodium levels , hypernatremia , hypoglycemia , hyperglycemia , average length time spent life threatening situation decreased 30 4 15 7 hours \( p less 0 05 \) average length stay decreased 14 6 8 8 days \( p less 0 05 \) little change proportion patients findings indicating metabolic acidosis received appropriate care \( 32 3 vs 34 6 \) conclude important role patient care hospital
evaluating hematuria children start proceed bleeding along urinary tract unusual children many causes , systemic infection trauma among common history taking physical examination careful complete , results obtained help direct laboratory evaluation diagnostic testing always begins urinalysis may progress intravenous , voiding , endoscopic procedures upper lower urinary tract , sonography , arteriography , renal biopsy cases remain unexplained require follow assess renal function
hypothermia safe efficient methods rewarming patient hypothermia , relatively common problem months , cause significant morbidity presents variety situations affects wide age range diagnosis requires high index suspicion , symptoms , primarily related central nervous system , distinctive appropriate management requires accurate measurement core body temperature treatment centered rewarming patient safely efficiently providing supportive measures care taken avoid arrhythmias simple precautions greatly reduce risk hypothermia
efficacy methylprednisolone reducing flap edema suggested systemic steroids reduce postoperative flap edema poorly documented several reports based subjective clinical observations effort provide quantitative data methylprednisolone edema , flap edema model rat developed based inferior epigastric vessels significant edema developed 48 hours differing intraoperative doses methylprednisolone studied , producing dose response curve single low dose intraoperative steroid effective reducing flap edema previously recommended doses probably excessive
treatment chronic facial palsy transplantation free rectus abdominis muscle performed free rectus abdominis muscle two patients chronic facial palsy one patient , postoperative course uneventful , patient died rupture esophageal varices patient , morphologic functional results satisfactory therefore , rectus abdominis muscle considered suitable donor muscle transplantation treatment chronic facial palsy rectus abdominis muscle advantageous \( 1 \) simultaneous operations two teams possible patient supine position , \( 2 \) supplied long nerves long large vessels , \( 3 \) flat consists segments appropriate lengths , \( 4 \) force distance contraction appropriate , \( 5 \) suitable anchoring sutures
simplified technique vascularized rib periosteal grafts modified technique obtaining vascularized rib periosteal segment utilizing posterolateral approach presented technique avoids inclusion large muscle cuff pleura around isolated rib segment therefore minimizes donor site morbidity chest complications previously associated approach
obstructive jaundice use expandable metal endoprosthesis biliary drainage work progress expandable metal endoprostheses implanted 61 patients obstructive jaundice fifty three patients malignant eight benign obstructions small diameter compressed stent \( 7 f \) , primary implantation stent without previous catheter drainage preferred complications occurred three patients \( 5 \) \( biliary , peritonitis , hepatic artery aneurysm \) 30 day mortality rate 8 2 observed six patients malignant obstructions \( 11 \) \( observation period , 1 10 months mean , 4 5 months \) two patients benign stenoses \( 25 \) \( observation period , 3 21 months mean , 9 months \) higher rate benign obstructions must interpreted care small number patients preliminary experience , authors conclude expandable metal endoprostheses offer patency rates equal plastic stents implantation trauma reduced due small 7 f introducing catheter system
simplified technique control femoral arterial bleeding coronary angioplasty method achieving arterial control inserting embolectomy catheter femoral sheath patient femoral arterial bleeding ptca described herein approach allows quick control less dissection negligible blood loss
effects 1 32 micron nd yag laser brain thermal histological experimental data considering 1 32 microns nd yag laser properties close co2 laser , series experiments conducted rat cortex \( n 51 \) three laser wavelengths compared co2 laser \( 10 6 microns \) , 1 06 microns nd yag , 1 32 microns nd yag lasers shot , temperature measurements recorded infrared digitized signals thermal profiles temperature developments ninety five correctly studied analyzed co2 , n 29 1 06 microns nd yag , n 20 1 32 microns nd yag , n 46 histological lesions produced three lasers compared animals killed 24 hours \( n 20 \) , 8 days \( n 20 \) , 30 days \( n 5 \) laser equivalent densities energy , depth cortical necrosis comparable co2 laser \( 200 250 microns \) 1 32 microns nd yag laser \( 210 260 microns \) whatever date death 1 06 microns nd yag laser responsible much important damage \( 400 550 microns \) important absorption water nervous tissue , authors consider 1 32 microns nd yag laser suitable , particularly conducted optic fibers , therefore easy handle neurosurgical procedures
cytomegalovirus infections pediatric liver transplantation 1986 1989 , 26 consecutive pediatric liver transplant recipients followed hospital sick children , toronto , canada patients reviewed assess incidence infection cytomegalovirus , severity disease , relationship recipient donor cytomegalovirus disease overall , incidence infection 54 \( 14 26 \) 90 patients seropositive whose donors seropositive developed evidence cytomegalovirus infection transplantation forty three percent \( 6 14 \) cytomegalovirus infections developed severe , fatal cytomegalovirus disease , despite treatment immunoglobulins ganciclovir \( laboratories inc , , calif \) sodium \( , pharmaceutical products inc , , mass \) posttransplant deaths , two thirds associated severe cytomegalovirus infection cytomegalovirus related deaths occurred three four seronegative patients seropositive donors three six seropositive patients seropositive donors therefore , seropositive donor appeared major risk factor severe cytomegalovirus disease
effects pill giving maintenance placebo response patients chronic mild depression fifty outpatients mild , chronic , mood reactive depression whose mood improved markedly 10 day single blind placebo trial randomly assigned double blind design either placebo medication discontinued maintained additional 6 weeks half patients condition relapsed within 6 weeks , indicating pill taking influence maintenance placebo response placebo response likely maintained patients currently married end 3 months , overall relapse rate 58 authors raise questions utility initial 10 day placebo washout antidepressant clinical trials , discuss limits findings
outcome patients chronic affective disorder five year follow patients major depression , mania , affective disorder present without remission 2 years intake \( n 129 \) followed prospectively 5 years , patients ill shorter periods intake despite substantial durations episode , three chronic patients recovered , although recovery occurred much later follow period among patients factors associated recovery less severe illness intake , lack psychotic features , good patterns adolescence , , important , relatively high maximum level functioning 5 years preceding intake
late luteal phase dysphoric disorder young women authors determined prevalence late luteal phase dysphoric disorder 217 university women aged 17 29 years unaware focus premenstrual syndrome \( pms \) , participants rated dsm iii r symptoms late luteal phase dysphoric disorder 90 days using 30 greater premenstrual change index luteal variation , authors found 10 women \( 4 6 \) met symptom criteria two menstrual cycles compared 25 young women seeking treatment pms met diagnostic criteria , 10 women university sample reported significantly less fatigue impaired concentration somewhat less severe depression overall symptoms
conduction system injury aortic valve dilation dog single versus double balloon catheters range morbidity induced valvuloplasty fully known , transient conduction disturbances common authors performed aortic valve balloon dilatation 10 closed chest dogs normal aortic valves , using femoral approach fluoroscopic guidance four done single 15 mm balloon catheter , 6 two 12 mm balloon catheters used balloons inflated 5 12 pressure contrast solution several inflations dogs sacrificed , hearts removed examined gross examinations revealed subendocardial hemorrhage outflow tract 5 6 double balloons used microscopically , aortic valve areas showed hemorrhage , mostly loose connective tissues valve leaflets severity injury appeared greater two balloons used histologic examination showed definite injury myocytes left bundle branch 6 double dogs , none subjected single balloon procedure aortic valve dilation manifestation conduction system injury prolongation qrs complex 3 6 dogs double balloon catheter used results suggest electrocardiographic conduction disturbances observed patients undergoing aortic valvuloplasty may result direct injury conduction tissue may likely occur larger balloons used
three year outcomes maintenance therapies recurrent depression conducted randomized 3 year maintenance trial 128 patients recurrent depression responded combined short term continuation treatment imipramine hydrochloride interpersonal psychotherapy five cell design used determine whether maintenance form interpersonal psychotherapy alone combination medication could play significant role prevention recurrence second question whether maintaining antidepressant medication dosage used treat acute episode rather decreasing maintenance dosage would provide prophylaxis superior observed earlier trials maintenance dosage strategy employed survival analysis demonstrated highly significant prophylactic effect active imipramine hydrochloride maintained average dose 200 mg modest prophylactic effect monthly interpersonal psychotherapy conclude active imipramine hydrochloride maintained average dose 200 mg effective means preventing recurrence monthly interpersonal psychotherapy serves time episodes patients receiving active medication
delta sleep ratio biological correlate early recurrence unipolar affective disorder slow wave sleep abnormalities long described depression considered nonspecific indicators psychopathology computerized techniques , including amplitude frequency measures spectral analyses , permitting new approaches examination delta sleep early studies suggested many depressed patients demonstrate lower delta wave intensity first non rapid eye movement period second one finding , prominent middle aged depressed patients , led examination ratio first second non rapid eye movement periods delta sleep measure seems predictor recurrence rapid eye movement latency analysis data 74 patients long term maintenance treatment study minimum 24 months demonstrates delta sleep ratio predict survival time following discontinuation drug treatment individuals high delta sleep ratio remain clinically five times longer low delta sleep ratio
longitudinal study diagnoses children women unipolar bipolar affective disorder school age children unipolar depressed , bipolar , chronically medically ill , normal women diagnosed every 6 months 3 years offspring unipolar women highest rates disorder evaluations , children bipolar medically ill mothers also experienced significant rates disorder observing diagnoses past lifetime prospective follow assessments , appeared children diagnoses continued chronic intermittent course disorder thus , risk offspring ill mothers indicates course commonly includes effective disorders alone combination behavior anxiety disorders
effect chemodenervation cerebral vascular microvascular response hypoxia study evaluated effect bilateral carotid chemodenervation cerebrovascular response hypoxia conscious rats cerebral blood flow measured using 4 n methyl 14c , total perfused microvasculature studied injection fluorescein dextran alkaline phosphatase staining maintain constant pco2 , hypoxia achieved chemoreceptor intact rats use 4 co2 8 o2 88 n2 rats administration 8 o2 92 n2 blood gas hemodynamic parameters similar two groups rats chemodenervation significant effect either resting blood flow perfused microvasculature significant increase cerebral blood flow \( 71 3 138 9 ml min 100 g control 91 5 127 7 ml min 100 g rats \) percent cerebral arterioles capillaries perfused occurred hypoxic control rats chemoreceptor intact rats , greatest increase blood flow perfused microvasculature occurred caudal structures \( medulla pons \) comparison rostral structures \( cortex , thalamus , hypothalamus \) rats , similar increase blood flow perfused microvasculature occurred brain regions , regional differences thus , chemodenervation affect overall cerebral blood flow microvascular response hypoxia however , rostral caudal regional differences hypoxic response lost chemodenervation
intrathoracic current flow transthoracic defibrillation dogs transcardiac current fraction achieve transcardiac threshold current transthoracic defibrillation , considerably larger current must delivered thorax compensate shunting effect lungs , thoracic cage , elements torso shunting effect thus important determinant transthoracic defibrillation threshold quantified transcardiac current fraction \( fc , ratio transcardiac transthoracic threshold currents \) previous estimates fc ranged low 3 high 45 purpose study quantify fc major intrathoracic current pathways transthoracic intrathoracic currents simultaneously measured high voltage transthoracic shocks 20 dogs correction factors determined another set 12 dogs , raw data corrected compensate field distortion caused presence intrathoracic electrodes , adjusted data fit resistive network model results showed 82 transthoracic current thoracic cage , 14 lungs remaining 4 \( fc \) portion passed heart good agreement two independent methods used calculate fc analysis based model indicated fc 3 7 , whereas fc determined direct measurement calibrated electrodes 4 2 therefore , results study , contrast earlier estimates fc , show defibrillation dogs achieved 4 total transthoracic current
relation transcardiac transthoracic current defibrillation humans , transthoracic defibrillation threshold current considered function least two quantities directly proportional transcardiac threshold current inversely proportional transcardiac current fraction \( fc \) ratio transcardiac transthoracic current although experimental theoretical estimates fc high 45 , previous measurements humans made study designed quantify fc humans intraoperative testing automatic implantable cardioverter defibrillator , transthoracic rescue shocks 200 400 j delivered device failed simultaneous transthoracic voltage \( vt \) transcardiac voltage \( vc \) two implanted epicardial patch electrodes measured ratio , vc vt , 0 04 0 03 \( mean sd \) 10 patients 16 dogs , comparison made direct measurement fc vc vt fc determined specially designed electrode system , calibrated account field distortion introduced electrodes significant difference fc vc vt , approximately 0 05 , suggesting vc vt statistically equivalent fc results study , therefore , indicate transthoracic defibrillation humans , approximately 4 transthoracic current heart relatively small percentage current results existence parallel pathways , thoracic cage lungs , shunt current around heart
case porous coated hip implants femoral side series total hip arthroplasties \( thas \) using porous coated femoral components roentgenographically assessed implant fixation primary thas followed two 12 years , femoral revision rate 1 ten year survivorship rate 96 4 150 young patients fixation failure incidence 1 3 mean follow period 6 4 years 204 revision thas , femoral revision rate 4 mean follow period 53 4 months failures largely related inadequate femoral canal filling refinements implant design surgical techniques , press fit implant currently achieved 94 cases compared 36 first five years porous coated femoral components yielded results equivalent cement primary thas excellent results observed relatively young patients patients
cardiac arrhythmias critically ill patients epidemiologic study general prevalence cardiac arrhythmias 2 , consecutive patients 78 , ranging 44 multiple trauma patients 90 primary cardiovascular patients patients without recorded arrhythmias \( 22 , n \) used control subjects clinical group free cardiac arrhythmias atrial tachyarrhythmias highest prevalence population whole \( 28 \) clinical groups except multiple trauma atrial fibrillation common atrial arrhythmia \( 52 \) ventricular arrhythmias followed patients atrial tachyarrhythmias , nodal rhythm ventricular , ventricular rapid rhythms significantly \( p less 01 \) increased mortality rates \( 40 , 44 , 77 , 51 , respectively \) compared patients without arrhythmias \( 35 \) relative risk dying \( \) clinical groups increased 1 16 , 1 27 , 2 20 , 1 47 , respectively patients cardiorespiratory precipitating disease arrhythmia except atrial bradyarrhythmia mortality rate 32 74 , significantly \( p less 05 \) different patients within clinical groups without arrhythmias increased 1 67 3 40 septic patients atrial tachyarrhythmia nodal rhythm neurologic patients nodal ventricular arrhythmias also significantly \( p less 01 05 , respectively \) increased mortality higher \( 1 53 2 81 \) data suggest severe illness may present clinical groups critically ill patients cardiac arrhythmias
reduction bleeding heart lung transplantation importance posterior mediastinal hemostasis reduce perioperative hemorrhage following heart lung transplantation , several technical modifications introduced june 1988 secure better posterior mediastinal hemostasis intraoperative postoperative use blood blood products , well chest tube drainage first 24 hours postoperatively , compared seven patients operated since june 1988 nine patients operated date significant \( p less 0 05 \) reductions demonstrated intraoperative postoperative transfusion packed cells , postoperative administration fresh frozen plasma , chest tube drainage within first 24 hours postoperatively one month total hospital mortality rates 6 percent 12 5 percent , respectively concluded newer techniques obtain optimal posterior mediastinal hemostasis significantly reduced blood loss following heart lung transplantation experience contributed excellent early postoperative results
measurements right ventricular volumes fluid challenge effects fluid loading rv function studied 41 acutely ill patients monitored modified pulmonary artery catheter equipped measuring hemodynamic evaluation performed infusion 300 ml 4 5 percent albumin solution 30 min changes si correlate pra ppao rvedvi entire group , unchanged \( 27 9 vs 27 9 percent \) eight patients initial rvedvi greater 140 ml m2 , fluid challenge increased pra ppao reduced without significant effect significant correlation rvedvi pra weak correlation however , highly linear correlation rvedvi changes rvedvi , suggesting absence severe pulmonary hypertension rv output primarily dependent rv preload
premenstrual syndromes defined symptom sets analysis made pattern presenting premenstrual symptoms randomly selected general practice patients region , new zealand participants , healthy women 16 54 years old whose characteristics reasonably representative adult female population , asked general , obstetrical health women within last month , detailed questions asked last menstrual cycle woman assigned one seven premenstrual symptom sets three groups symptoms , ie predominant single symptom \( breast tenderness , bloating irritability \) three groups symptom sets largest groups formed women reported breast tenderness , bloating irritability together tension depression women group likely rate symptomatology severe last group contains large number women symptoms characteristics groups outlined study highlights importance distinguishing among premenstrual syndromes effective clinical management
liver transplantation side relatively large number patients liver disease , liver transplant always provide successful solution modern technology mean involved \? interviewed 30 relatives patients died turned transplant , shortly liver transplant operation performed groningen liver transplant programme quantitative data obtained means questionnaire one third respondents opinion patient would better entered programme half found loss difficult accept patient involved programme nevertheless , many feeling satisfaction possible done however transplantation technology may specific group patients , also involves undesirable side effects included careful judgement technology
muscle blood flow muscle metabolism exercise heat stress effect heat stress blood flow metabolism exercising leg studied seven subjects walking \( 12 17 \) 5 km h treadmill 90 min exhaustion first 30 min exercise performed cool environment \( 18 21 degrees c \) subjects moved adjacent room 40 degrees c continued exercise speed 60 min exhaustion , occurred first rate o2 consumption , 2 6 l min \( 1 8 3 3 \) \( average cool hot conditions \) , corresponded 55 77 individual cool environment steady state reached 30 min subjects shifted hot room , core temperature heart rate started rise reached values greater 39 degrees c near maximal values , respectively , termination exercise leg blood flow \( thermodilution method \) , femoral arteriovenous o2 difference , consequently leg o2 consumption unchanged hot compared cool condition increase release lactate reduction glucose free net fatty acid uptake exercising leg heat furthermore , rate glycogen utilization gastrocnemius muscle elevated hot environment tendency cardiac output increase heat \( mean 15 2 18 4 l min \) , may contributed increase skin circulation , together possible reduction flow vascular beds , muscle blood flow reduced
stress adaptation low frequency impedance rat lungs pressures \( ptp \) 7 12 cmh2o , pressure volume hysteresis isolated cat lungs found 20 50 larger predicted amount stress adaptation \( j , j 28 , 1970 \) behavior inconsistent linear interpreted terms phenomenon isolated lungs 12 wistar rats measuring 1 \) changes ptp 0 5 ml step volume changes \( initial ptp 5 cmh2o \) 2 \) response sinusoidal pressure 0 01 0 67 hz \( 2 cmh2o peak peak , mean ptp 6 cmh2o \) stress adaptation curves found fit approximately 's model delta ptp delta v b log \( \) 0 2 100 , delta v step volume change , b coefficients , time b averaged 1 06 0 11 0 173 0 019 cmh2o ml , respectively , minor differences stress relaxation stress recovery curves response sinusoidal characterized effective resistance \( \) elastance \( el \) decreased 2 48 0 41 cmh2o ml 1 0 01 hz 0 18 0 03 cmh2o ml 1 0 5 hz , el increased 0 99 0 10 1 26 0 20 cmh2o ml frequency range data analyzed frequency domain version model , complemented resistance \( r \) account airway resistance r b \( 9 \) el 0 b log 2 pi f , f frequency
control total peripheral resistance hyperthermia rats elucidate effect blood volume circulatory adjustment heat stress , studied alpha anesthetized rats three levels blood volume \( nbv \) , \( hbv 32 plasma volume isotonic albumin solution infusion \) , \( lbv 16 plasma volume furosemide administration \) body surface heating performed infrared lamp raise arterial blood temperature \( tb \) rate approximately 0 1 degree c min heating , central venous pressure \( cvp \) significantly higher hbv \( 0 41 0 25 mmhg \) lower lbv \( 1 44 0 22 mmhg \) nbv \( 0 41 0 10 mmhg \) tb cvp started decrease approximately 40 degrees c hbv , approximately 41 degrees c nbv , approximately 42 degrees c lbv , decreased 1 53 0 14 , 1 92 0 24 , 0 62 0 14 mmhg 37 43 degrees c tb hbv , nbv , lbv , respectively stroke volume closely correlated cvp , relationship affected tb heart rate responses raised tb similar among three groups mean arterial pressure \( map \) affected blood volume modification cvp maintained \( tb 37 degrees c \) level tb rose 40 degrees c tb , map increased tb reached 43 degrees c \( 30 40 mmhg \) three groups total peripheral resistance \( tpr \) inversely correlated cvp , slope linear relationship tpr cvp lbv three fourfold steeper nbv hbv
modeling human performance running paper focuses characteristics model interpreting effect training athletic performance model theory presented mathematically model , systematically quantified training produces dual responses fitness fatigue absence training , decay exponentially time repetitive training , responses individual recurrence equations fitness fatigue combined simple linear difference equation predict performance levels appropriate intensity training undertaken significant observed correlation model predicted performance measure actual performance training provides validation model athletes alike enables specific model parameters estimated used optimize future training regimens individual
muscle maximal o2 uptake constant o2 delivery without co blood present study investigated effects \( hbco \) muscle maximal o2 uptake \( vo2max \) hypoxia o2 uptake \( vo2 \) measured isolated situ canine gastrocnemius \( n 12 \) working maximally \( isometric twitch contractions 5 hz 3 min \) muscles pump perfused identical blood flow , arterial po2 \( pao2 \) total hemoglobin concentration \( hb \) blood containing either 1 \( control \) 30 hbco conditions pao2 set 30 torr , produced arterial o2 contents , muscle blood flow set 120 ml 100 g 1 min 1 , o2 delivery conditions minimize co diffusion tissues , perfusion hbco containing blood limited time contraction period vo2max 8 8 0 6 \( se \) ml min 1 100 g 1 \( n 12 \) hypoxemia alone reduced 26 6 5 0 4 ml min 1 100 g 1 hbco present \( n 12 p less 0 01 \) cases , mean muscle effluent venous po2 \( \) \( 16 1 torr \) pao2 conditions , mean capillary po2 \( estimate mean o2 driving pressure \) probably much different two conditions , even though o2 dissociation curve shifted left hbco consequently blood mitochondria o2 diffusive conductance likely reduced hbco
mechanical deficit persists long term muscle hypertrophy hypotheses tested deficit maximum isometric force normalized muscle cross sectional area \( e , specific po , n cm2 \) hypertrophied muscle would return control value time rate magnitude adaptation specific force would differ soleus plantaris muscles ablation operations gastrocnemius plantaris muscles gastrocnemius soleus muscles done induce hypertrophy synergistic muscle left intact female wistar rats \( n 47 \) 5 wk age hypertrophied soleus plantaris muscles control muscles age matched rats \( n 22 \) studied days 30 240 thereafter po measured vitro 25 degrees c oxygenated krebs ringer bicarbonate compared control values , soleus muscle cross sectional area increased 41 15 days 30 240 ablation , whereas po increased 11 15 days 60 90 compared control values , plantaris muscle cross sectional area increased 52 day 30 , 40 days 60 120 , 15 day 240 plantaris muscle po increased 25 days 30 120 day 240 different control value changes muscle architecture negligible ablation muscles specific po depressed 11 28 muscles times time ablation synergistic muscle increased muscle cross sectional area contribute fully isometric force production
aggressive granulomatous lesions cementless total hip arthroplasty describe six patients aggressive granulomatous lesions around cementless total hip prostheses two patients previously cemented prosthesis hip prosthesis used five patients , pca one prostheses made cobalt alloy pain weight bearing occurred average 3 2 years cementless arthroplasty , time radiography revealed aggressive granulomatosis around proximal femoral stem acetabular component five patients one large solitary granuloma proximal femur revision performed average 4 8 years cementless arthroplasty time granulomas grown large size waiting revision operation , two femoral stem components fractured granulomas showed uniform histopathology , included histiocytosis cause lesions thought plastic debris acetabular socket
cup containment orientation cemented total hip arthroplasties reviewed radiographs \( \) cemented total hip arthroplasties mean follow seven years \( maximum 16 years \) survivorship analysis used assess correlation radiographic performance bony containment coronal orientation acetabular cup cup orientation containment interrelated vertically oriented cups completely contained , whereas 25 horizontal cups partially contained completely contained cups significantly lower incidences complete cement bone radiolucency \( p 0 02 \) wear \( p 0 09 \) vertically oriented cups lower incidence continuous radiolucency oriented cups , statistically significant \( p 0 25 \) results confirm importance complete bony containment , also indicate better accept vertical orientation obtain full bony coverage horizontal orientation partial containment
endoscopic control upper gastrointestinal bleeding estimated gastrointestinal \( gi \) bleeding occurs 100 , 000 patients peptic ulcer disease year 75 80 cases , bleeding self limited major predictor persistent recurrent bleeding magnitude blood loss initial evaluation endoscopy important role evaluation patient suspected presumed upper gi bleeding active bleeding time endoscopy correlates likely probability persistent bleeding , carries higher morbidity mortality addition , continued interest finding visible vessel although controversy visible vessel actually closely observations agree recognition , general agreement important endoscopic finding carries high likelihood addition finding visible vessel , many feel ulcers found posterior inferior wall duodenal bulb high lesser curve stomach considered separate category owing proximity large vessels , feel endoscopic management carries greater risk possibility inducing bleeding wide variety endoscopic approaches available therapy upper gi bleeding convenient divide therapies four categories \( \) topical , \( b \) injection , \( c \) mechanical , \( \) thermal endoscopic therapy bleeding ulcers generally performed high degree safety
hemorrhage mice produces alterations pulmonary b cell repertoires nosocomial pneumonia occurs frequently hemorrhage trauma contributes increased incidence morbidity mortality severe injury production secretory antibodies associated b cells important component pulmonary host defense mechanisms determine effects hemorrhage pulmonary b cell function , examined hemorrhage induced alterations pulmonary b cell repertoires changes relative distribution b cells among pulmonary lymphocytes blood loss hemorrhage induced decreases 5 10 fold frequencies numbers pulmonary b cell clonal precursors specific bacterial ag pseudomonas aeruginosa polysaccharide decreases numbers frequencies bacterial ag specific pulmonary b cell clonal precursors present 3 10 days blood loss similar decreases numbers frequencies found among pulmonary clonal precursors specific autoantigen mouse transferrin , autoantigen dsdna external antigens ova keyhole limpet results demonstrate hemorrhage produces marked alterations pulmonary b cell repertoires , may contribute postinjury abnormalities host
adult height boys girls untreated short stature constitutional delay growth puberty accuracy five different methods height prediction determine accurately several methods height prediction estimate adult height , compared height predictions calculated bayley , \( \) , target height , mark \( tw mi \) , mark ii \( tw \) methods final adult height 37 boys 32 girls short stature constitutional delay growth puberty first seen chronologic age \( mean sd \) 14 80 1 70 years \( boys \) 12 87 2 56 years \( girls \) adult height 23 14 1 95 years 21 05 2 02 years 170 4 5 4 cm \( boys \) 157 8 4 2 cm \( girls \) , respectively , thus within lower range normal height predictions calculated total group patients parents normal \( group 1 \) well short stature \( group 2 \) boys , method gave accurate results , adult height 0 6 cm total group prediction errors methods 7 3 cm \( tw mi \) , 4 2 cm \( tw \) , 3 1 cm \( bayley method \) 1 7 cm \( target height \) girls , method superior estimating adult height mean prediction error 0 8 cm , 2 1 cm , 1 8 cm bayley , tw mi , tw methods , respectively contrast , adult height 2 3 cm 1 2 cm target height methods conclude patients short stature constitutional delay growth puberty reach adult height lower range normal height prediction methods differ respect accuracy tendency overestimate underestimate adult height
defective dystrophin duchenne becker dystrophy myotubes cell culture examined normal dystrophic human myotubes cell culture expression dystrophin , protein product duchenne muscular dystrophy locus dystrophin levels developing myotubes detected western blotting increased 24 hours reached maximum levels 10 days fusion medium detect dystrophin myotubes cultured duchenne myoblasts \( 7 cases \) myotubes becker muscular dystrophy patient 's biopsy produced lower molecular weight \( approximately 408 kd \) dystrophin , size whole muscle preparation biopsy 408 kd dystrophin expected size becker patient whose dna deleted exons 45 48 duchenne gene cell culture system allow detailed analysis effects potential pharmacologic agents steady state dystrophin levels
psychosocial correlates temporomandibular joint pain dysfunction study examines psychological differences temporomandibular joint pain dysfunction \( tmjpd \) patients , pain controls , healthy controls two hundred two patients classified , according diagnostic criteria , either myogenic facial pain \( n 42 \) , internal derangement type \( n 69 \) , internal derangement type ii \( n 85 \) , internal derangement type iii \( n 6 \) patients completed basic personality inventory , illness behavior questionnaire , multidimensional health locus control , perceived stress scale , ways coping checklist subjects also answered question pertaining tmjpd symptomatology , including chronicity severity conservative treatment simple jaw exercise ultrasound , patients contacted 5 months complete follow questionnaires similar previously completed comparison groups comprised 79 patients attending outpatient physiotherapy clinics pain related injuries involving temporomandibular joint 71 pain free , healthy students data analyzed using multivariate statistics results indicate significant relationship pain intensity \( extent chronicity \) diverse measures personality among pain controls among tmjpd patients calls question validity assuming individual pain disorders subsets larger , pain disorder population tmjpd patients pain controls score higher anxiety pain free controls elevations clinically significant elevations decrease normal levels response positive treatment outcome differences tmjpd patients pain controls measures results suggests tmjpd patients appear significantly different pain patients healthy controls personality type , response illness , attitudes towards health care , ways coping stress
degeneration superficial dorsal horn sciatic nerve injury effects chronic constriction injury , transection , strychnine lumbar cervical spinal dorsal horns adult rats chronic \( 8 days \) constriction injury sciatic nerve one side \( sham operation \) examined signs degeneration incidence neurons signs degeneration \( \) significantly increased lumbar dorsal horn sides ipsilateral lumbar increase significantly greater contralateral increase increase incidence dark neurons cervical dorsal horns rats distribution lumbar dark neurons similar bilaterally majority dark neurons found sciatic nerve 's territory ii second group rats received surgery addition received series 7 daily doses strychnine dark neurons found bilaterally \( ipsilateral predominance \) sciatic nerve 's territory lumbar ii , incidence significantly greater found group receive strychnine result obtained third group strychnine treated rats sham operation omitted thus appearance contralateral dark neurons dependent unintentional nerve damage created sham procedure additional group rats sacrificed 8 days receiving unilateral sciatic nerve transection , contralateral sham operation , 7 daily strychnine injections increase incidence dark neurons rats
filler dna associated spontaneous deletions determined structure five spontaneous deletions within \( wx \) gene , four found spontaneous wx mutants \( wx b , wx b1 , wx b6 , wx c4 \) include exon sequences fifth restricted intron represents restriction fragment length polymorphism allele \( wx \) deletions , range size 60 base pairs \( bp \) , cluster g c rich region approximately 1000 bp capable forming stable secondary structures striking finding alleles dna insertions \( filler dna \) 1 131 bp deletion endpoints three five deletions , filler dna sequences deletion appear derived sequences near one deletion endpoint previously reported spontaneous deletion gene \( r \) also contains filler dna association filler dna deletion endpoints contrasts dramatically rarity similar events animal germ line bacterial mutations
site strand specificity uvb mutagenesis gene yeast published erratum appears proc natl acad sci u 1991 mar 1 88 \( 5 \) dna sequencing used characterize 208 mutations induced trna gene yeast saccharomyces cerevisiae uvb \( 285 320 nm \) radiation results compared analysis 211 mutations induced 254 nm uvc light case , greater 90 mutations single base pair changes g c transitions predominated accounted mutations induced uvb uvc double substitutions , single base pair deletions , complex events also recovered however , uvb induced 3 fold tandem substitutions uvc double events detected irradiation uvc virtually induced substitutions occurred sites pyrimidine base pair part sequence although site specificities consistent roles dimers pyrimidine \( 6 4 \) lesions mutation induction , preliminary data implicated dimers major form dna damage agents , preference uvb uvc induced mutations occur sites transcribed strand
postoperative bile duct strictures bile duct strictures uncommon serious complication primary operations gallbladder biliary tree strictures occur result injury bile duct cholecystectomy addition , strictures occur site previous biliary anastomoses reconstruction biliary tree patients benign bile duct strictures present soon initial operation however , cases , presentation delayed years cholangiography essential defining anatomy biliary tree prior management many cases , nonoperative biliary drainage useful treat sepsis biliary fistulas number alternatives exist elective repair bile duct strictures experience would suggest , however , performed roux en limb jejunum preferable management cases postoperative biliary stenting may valuable optimizing results nonoperative management percutaneous transhepatic endoscopic balloon dilatation reported successful number small series long term results limited , however comparative data suggest surgical repair benign postoperative strictures associated fewer long term problems similar overall morbidity costs
rhythm primer theory application cardiology nonlinear dynamics new way looking past ignored explained away attempted give general introduction , applications cardiology , brief review new tools needed use concepts nonlinear careful mathematical approach problems cardiac electrical dynamics blood flow opening window behaviors mechanisms previously
addition clonidine enhances postoperative analgesia epidural morphine double blind study study undertaken evaluate analgesic effect combination epidural morphine clonidine versus epidural morphine alone patients postoperative pain randomized double blind design used , 91 patients scheduled post operative pain relief epidural morphine studied patients received either continuous epidural infusion morphine clonidine \( group 1 n 45 \) morphine alone \( group 2 n 46 \) 72 h major abdominal surgery first 24 h , dose morphine 6 mg per 24 h second 24 h , decreased 4 mg per 24 h final 24 h , decreased 2 mg per 24 h groups group 1 patients received clonidine \( 450 micrograms \) 24 h period additional epidural bolus injections 2 mg morphine intravenous meperidine given demand pain score , blood pressure , heart rate , respiratory rate , relative forced vital capacity measured fixed times first 72 h operation total consumption analgesics side effects recorded although total consumption analgesics significantly higher group 2 \( p less 0 05 \) , pain scores lower group 1 group 2 entire observation period \( p less 0 05 \) epidural clonidine produced significant decrease \( p less 0 05 \) heart rate blood pressure , whereas respiratory rate affected due better pain relief group 1 , forced vital capacity increased \( p less 0 05 \)
influence high dose aprotinin treatment blood loss coagulation patterns patients undergoing myocardial revascularization intraoperative administration proteinase inhibitor aprotinin causes reduction blood loss homologous blood requirement patients undergoing cardiac surgery ascertain blood saving effect aprotinin obtain information mode action , 40 patients undergoing primary myocardial revascularization randomly assigned receive either aprotinin placebo treatment aprotinin given bolus 2 x 10 \( 6 \) kallikrein units \( \) surgery followed continuous infusion 5 x 10 \( 5 \) h surgery additionally , 2 x 10 \( 6 \) added pump strict criteria used obtain homogeneous patient selection total blood loss reduced 1 , 431 760 ml control group ml aprotinin group \( p less 0 05 \) homologous blood requirement ml 163 308 ml \( p less 0 05 \) control group , 2 3 2 2 u homologous blood blood products given , aprotinin group , 0 63 0 96 u given \( p less 0 05 \) twenty five percent patients control group 63 aprotinin group receive blood homologous blood products activated clotting time indicator inhibition contact phase coagulation significantly increased aprotinin group \( 141 13 vs 122 25 \) remained significantly increased heparin neutralized cardiopulmonary bypass \( cpb \)
alterations brain electrical activity may indicate onset malignant hyperthermia swine time course changes brain electrical activity halothane anesthesia examined 12 malignant hyperthermia susceptible \( mhs \) 14 normal \( \) swine power densities selected frequency bands calculated \( eeg \) eeg systemic variables determined period 60 min starting halothane \( 1 inspired \) malignant hyperthermia \( mh \) triggered susceptible pigs initial changes eeg development mh consisted decrease total power shift lower frequencies \( delta theta activity \) animals eeg alterations noted increase heart rate , systemic variables still normal eeg changes mhs animals started arterial oxygen tension \( pao2 \) greater 90 mmhg arterial carbon dioxide tension \( paco2 \) less 50 mmhg 5 mhs animals eeg became isoelectric pao2 61 82 mmhg paco2 53 68 mmhg mean arterial blood pressure time 54 66 mmhg determine effects hypoxia eeg 7 animals , oxygen decreased period 45 60 min 7 inspired 7 animals , produced admixture carbon dioxide fresh gas supply achieve incremental increases paco2 110 120 mmhg significant eeg changes hypoxia comparable seen onset mh noted pao2 40 mmhg paco2 greater 68 mmhg
pilot study nicardipine acute ischemic stroke author performed pilot study nicardipine \( nc \) , ca \( \) channel blocker , study dosing , toxicity , possible efficacy hemispheric cerebral infarction within 12 hours \( mean 6 9 hr \) onset determine proceeding multi centered controlled trial nc administered iv \( 3 7 mg hr \) x 72 hours dose mean arterial blood pressure \( mabp less 10 baseline \) , orally x 30 days forty three patients entered mean age 63 \( range 34 89 \) , 25 male 18 female 3 ct evidence infarct entry results shown improvement 100 point \( pt \) graded exam \( 40 pts entry , 68 pts 3 months \) 20 patients completing 3 months' evaluation , 17 improved none worsened sixteen 20 home 8 minimal impairment mean barthel 's index 72 mean maximal serum nc level 75 ng ml mabp decreased 103 \( entry \) 83 \( 72 hours \) larger controlled study warranted determine efficacy nc acute cerebral infarct
failure thrive early childhood maximum weight centile achieved child 4 8 weeks age found better predictor centile 12 months birth weight centile children whose weight two major maximum weight centile month showed significant anthropometric differences second year life showed deviation suggested leads logical practical definition failure thrive
simultaneous rehabilitation treatment facial paralysis simultaneous dual system rehabilitation facial paralysis involves using two independent reanimation techniques optimize facial movement quantitative qualitative manner techniques involve use nerve grafting crossover procedures combined dynamic muscle transfer group 37 patients underwent five different combinations reanimation analyzed techniques evaluated using standard rating scheme success reanimation procedures combination masseter muscle transfer lower region face graft upper facial nerve division appeared offer excellent results terms independent motion upper lower regions face good eye closure , allowing spontaneous mimetic function 50 cases advantages disadvantages techniques described clinical situations techniques advantage single reanimation techniques outlined
comparison ketorolac morphine sulphate pain relief cholecystectomy ketorolac 30 mg compared morphine sulphate 10 mg cholecystectomy double blind , multiple dose , randomized study 100 patients assessments pain made immediately operation \( day 1 \) , next morning \( day 2 \) pain intensity \( verbal response score visual analogue scale \) recorded injection 6 h period pain relief assessed also effect ketorolac operative blood loss platelet function examined time oral intake duration administration v fluids recorded adverse events noted ketorolac produced significantly less analgesia morphine day 1 , day 2 two drugs produced similar effect blood loss increased ketorolac , although platelet function impaired repeated administration ketorolac produce serious adverse effects
preoperative piroxicam postoperative analgesia dental surgery fifty patients allocated randomly receive placebo piroxicam 40 mg , 2 5 h surgical removal lower third molars general anaesthesia significantly greater number patients piroxicam group require opioid analgesia operation \( p less 0 05 \) piroxicam group also required fewer doses paracetamol first 24 h recovery anaesthesia \( p less 0 05 \) , time recovery first postoperative analgesia longer patients received piroxicam \( p less 0 05 \) piroxicam significantly prolong duration recovery anaesthesia
effects nimodipine cerebral blood flow neuropsychological outcome cardiac surgery thirty five patients undergoing cardiac surgery requiring cardiopulmonary bypass \( cpb \) allocated randomly prospective double blind study receive either nimodipine 0 5 micrograms kg 1 min 1 placebo cerebral blood flow \( cbf \) measured immediately cpb neuropsychological tests performed 6 months surgery determine relationship ischaemic damage cbf administration nimodipine differences cbf nimodipine \( n 18 \) placebo groups \( n 17 \) significant changes neuropsychological tests found six patients tested 6 months surgery conclusive signs ischaemic damage nimodipine treated group performed better tests verbal visual retention , suggesting memory functions preserved better group
functional metabolic effects bupivacaine lignocaine rat heart lung preparation examined effects bupivacaine lignocaine myocardial metabolism rat isolated heart lung preparation bupivacaine 1 , 5 25 micrograms ml 1 lignocaine 4 , 20 100 micrograms ml 1 administered 5 min start perfusion bupivacaine 25 micrograms ml 1 lignocaine 100 micrograms ml 1 reduced heart rate significantly bupivacaine 25 micrograms ml 1 associated higher incidence arrhythmias groups three hearts bupivacaine 25 micrograms ml 1 group \( n 8 \) two hearts lignocaine 100 micrograms ml 1 group \( n 8 \) failed \( zero cardiac output \) end experiment although significant differences myocardial lactate glycogen concentrations groups , atp content bupivacaine 25 micrograms ml 1 lignocaine 100 micrograms ml 1 groups significantly less control group results suggest myocardial depression subsequent metabolic deterioration occurred high doses local findings account apparent increased cardiotoxicity bupivacaine
effect motion artefact pulse oximeters evaluation four instruments finger probes ability 3700 , , plus pulse oximeters detect induced hypoxaemia presence motion artefact assessed , conditions controlled vibration using industrial vibration facility vibration 4 hz 8 hz induced increases detection time hypoxaemia spurious decreases displayed sao2 oximeters tested finger dependent differences oximeter performance pulse rate registration noted especially oximeters without ecg linkage \( 3700 \) subsequently , eight different pulse oximeter finger probes assessed characteristics may predispose motion artefact marked differences mass probes , forces exerted test finger force required probes subject 's finger differences microprocessor physical characteristics finger probes may explain observed differences function similar studies form part standard evaluation new pulse oximeters
diclofenac day care arthroscopy surgery comparison standard opioid therapy sixty patients presenting day care arthroscopy surgery allocated randomly receive diclofenac 1 mg kg 1 , fentanyl 1 microgram kg 1 v analgesic course anaesthesia patients receiving fentanyl slightly , although significantly prolonged recovery times patients receiving diclofenac significantly improved postoperative visual analogue pain scores compared patients receiving placebo medication \( p less 0 05 \) fentanyl , pain scores reduced also , effect statistically significant fentanyl diclofenac produced significant reduction postoperative analgesic requirements \( p less 0 05 \) conclude diclofenac 1 mg kg 1 effective analgesic arthroscopic procedures knee useful alternative opioids day care patients
effect indomethacin pain relief thoracotomy effect indomethacin postoperative pain studied 60 adult patients undergoing thoracotomy prospective , randomized , double blind manner patients receiving indomethacin required significantly less opioid operation significantly lower pain scores compared control group pain movement coughing reduced also major adverse effects encountered
late postoperative episodic constant hypoxaemia associated ecg abnormalities twenty two patients without cardiopulmonary disease undergoing elective major abdominal surgery monitored continuously holter recorder pulse oximeter one night operation first two nights operation \( 23 00 07 00 \) , without oxygen therapy mean heart rate increased 16 beat min 1 \( p less 0 001 \) mean oxygen saturation \( sao2 \) decreased 2 6 \( p less 0 001 \) operation episodic oxygen desaturation less 80 occurred four patients operation , 13 patients operation \( p less 0 05 \) ecg abnormalities observed 10 patients operation 16 patients operation \( ns \) individual maximum st depression pronounced operation \( p less 0 05 \) episodic desaturation related closely tachycardia six patients operation one patient operation operation atrioventricular block one patient , operation st depression two patients mean sao2 second night operation correlated total dose opioid pain relief \( rs 0 48 p less 0 05 \) , postoperative decrease sao2 correlated postoperative increase heart rate \( rs 0 43 p less 0 05 \) patient postoperative cardiac complications indicating treatment
nitrous oxide cns stimulation laudanosine mice investigated whether nitrous oxide augments cns action laudanosine mice comparing mean doses \( \( se control group following pretreatment 65 nitrous oxide oxygen 20 180 min nitrous oxide significantly increased 46 8 \( 1 4 \) mg kg 1 control 57 3 \( 1 3 \) mg kg 1 20 min 53 5 \( 1 7 \) mg kg 1 180 min attenuation effect nitrous oxide 180 min , suggestive possible partial drug tolerance , statistically significant findings indicate nitrous oxide cns stimulating action laudanosine
profound digital collagen atrophy new cutaneous presentation adrenal dependent cushing 's syndrome 59 year old caucasian presented 2 year history marked loss tissue substance finger toe heel clinical evidence history urticaria inflammatory change investigations demonstrated raised plasma cortisol secondary left adrenal adenoma skin biopsies showed abnormalities dermal collagen , evidence elastin destruction case presents unusual variant cutaneous atrophy associated cushing 's syndrome
home treatment acute psychiatric illness objective determine factors influencing successful outcome community treatment severe acute psychiatric illnesses traditionally treated hospital design patients single ward either admitted hospital treated home two year period \( 1 october 1987 30 september 1989 \) included study case notes second year study reported setting ward , subjects 99 patients aged 16 65 severe acute psychiatric illness results 65 patients managed home treatment alone 34 required admission hospital location treatment significantly \( p less 0 05 \) influenced social characteristics patients \( marital state , age \( men \) , ethnicity , living alone \) characteristics referral \( occurring hours assessment taking place hospital police station \) dsm iii r diagnosis weakly associated outcome violence episode significantly related admission , although self harm conclusions home treatment feasible patients acute psychiatric illness 24 hour call assessment service increases likelihood success admission determined strongly social characteristics patient referral illness factors admission still required patients locally based mental health resource centre , 24 hour call service , open referral system , active follow policy increase effectiveness home treatment service
importance congenital hypertrophy retinal pigment epithelium familial adenomatous polyposis describe family familial adenomatous polyposis \( fap \) congenital hypertrophy retinal pigment epithelium \( rpe \) three five members fap showed flat , well , round oval pigmented patches congenital hypertrophy rpe stress importance congenital hypertrophy rpe clinical marker identifying patients fap since risk cancer
systolic wall stress ventricular arrhythmia role acute change blood pressure isolated working rat heart 1 effect sudden acute change blood pressure upon arrhythmia provocation studied isolated working heart model wistar kyoto strain rat twenty four hearts studied 2 perfused two different , modified , krebs solutions fixed left atrial pressure 3 acute changes pressure , increases decreases , arrhythmogenic whilst ectopic activity produced pressure reductions , consisted simple ventricular pressure increases , contrast , capable complex sustained arrhythmias 4 effect pressure changes highly dependent upon electrolyte concentrations perfusate low potassium magnesium concentrations increased amount arrhythmia provoked pressure increases tended reduce provoked pressure reductions 5 conclude direct effect acute change pressure upon myocardium arrhythmogenic however , myocardial response pressure change upon prevailing electrolyte concentrations
hypothalamic glucocorticoid implants prevent fetal ovine secretion response stress evaluated role hypothalamic nucleus \( pvn \) control acth secretion fetal sheep dexamethasone \( dex , 700 micrograms \) \( n 6 \) cholesterol \( chol , 700 micrograms \) \( n 5 \) implants placed bilaterally 2 mm lateral pvn fetal sheep 108 111 days gestation \( dga \) 5 days recovery , fetuses challenged 1 \) hypotension \( 50 drop blood pressure \) , 2 \) hypoxemia \( fall greater 5 mm hg fetal pao2 \) , 3 \) corticotropin releasing hormone \( crh \) \( 10 micrograms iv , single injection fetus \) hypotension hypoxemia repeated 125 dga compared chol , dex fetuses lower average concentrations acth plasma hypotension 23 0 5 vs 149 83 8 31 13 1 vs 101 31 3 pg ml 1 less 125 125 dga , respectively \( mean sem , p less 0 05 \) hypoxemia 11 1 6 vs 292 152 8 33 9 4 vs 304 91 3 pg ml 1 less 125 125 dga , respectively \( p less 0 05 \) dex chol responses crh 122 127 dga \( 10 micrograms iv \) different \( 38 23 9 vs 92 26 7 pg ml 1 , respectively \) immunocytochemistry demonstrated crh decreased pvn eliminated median eminence dex , chol fetuses arginine vasopressin \( avp \) immunostaining pvn dex chol fetuses similar however , unlike chol , dex fetuses showed avp immunostaining external zone median eminence results show , fetal sheep , high concentrations glucocorticoid near fetal pvn prevent increases plasma acth secretion seen controls response hypotension hypoxemia , exert least part effect level crh avp producing neurons located pvn
loss photosynthetic genes plastid genome parasitic plant hallmark plant life plastid metabolic process known controlled plastid genes complete loss photosynthetic ability , however , occurred several independent occasions parasitic plants plants known lack certain photosynthetic enzymes , known extent changes occurred genes encoding photosynthetic apparatus whether plants even maintain plastid genome report root parasite plastid chromosome 71 kilobases size , far smaller previously characterized plant plastid genome plastid genome lost , , 30 genes large family plastid genes , genes , whose products may involved plastid respiratory chain extensive changes plastid gene content must occurred relatively short time \( 5 50 x 10 \( 6 \) yr \) , , related photosynthetic parasite , typical complement genes plastid genome retained transcribed ribosomal rna ribosomal protein genes , suggesting expresses one gene products plastid functions related
induction rna stabilized dna transcription immunoglobulin switch region deletion dna rearrangement associated immunoglobulin class switching igm igg , iga ige recombination occurs immunoglobulin switch regions , complex , highly repetitive regions dna switch regions become active switch recombination , analysis behaviour sequences transcription could elucidate mechanism switch recombination , report transcription plasmid containing murine iga switch region \( alpha \) leads loss resulting series less stabilized rna dna formed rna transcripts , remain base paired dna
point mutation domain erythropoietin receptor resulting hormone independent activation tumorigenicity receptors erythropoietin cytokines constitute new tyrosine kinase enzyme motif signal mechanism unclear describe two classes activating mutations erythropoietin receptor \( epor \) single point mutation domain enables induce hormone independent cell growth tumorigenesis expression , interleukin 3 dependent cells c terminal truncation cytoplasmic domain epor renders receptor erythropoietin , insufficient induce hormone independent growth tumorigenicity activating point mutation intracellular transport turnover receptor alterations metabolism tumorigenicity caused epor activating point mutations similar observed erythropoietin independent activation wild type epor association gp55 , friend spleen focus forming virus glycoprotein
current trends suture fixation posterior chamber intraocular lenses corneal surgeons surveyed regard technique suture fixation posterior chamber intraocular lenses absence posterior capsular support fifty nine percent 260 respondents stated perform procedure almost exclusively penetrating keratoplasty scleral fixation marginally favored fixation surgeons intraoperative problems reported related relative technical difficulty procedure , although transient hemorrhage ciliary body also mentioned postoperative complications cited included mechanical problems involving lens , macular edema , glaucoma ,
differential regulation human immunodeficiency viruses \( \) specific regulatory element hiv 2 responds stimulation cell antigen receptor human immunodeficiency viruses \( \) types 1 2 similar genetic organization differ significantly nucleic acid sequence although infection either agent leads symptoms immunodeficiency , recent studies suggest potential differences time course severity diseases report , transcriptional regulation induction retroviruses analyzed report regulation hiv 2 differs hiv 1 distinct cell activation pathway , triggering cd3 component cell receptor complex , stimulates hiv 2 hiv 1 gene expression response cell receptor stimulation hiv 2 mediated partly upstream regulatory element , termed , recognized sequence specific dna binding protein , nf leukemia cell lines containing hiv 2 also showed increased viral replication stimulation cell receptor complex , contrast hiv 1 findings suggest transcriptional regulation induction hiv 2 differ hiv 1 raise possibility different contribute activation hiv 1 hiv 2 associated aids
retroviral promoter sufficient convert proto src transforming gene distinct src gene sarcoma virus src genes four natural isolates avian sarcoma viruses differ cellular proto src two genetic substitutions promoter cellular gene replaced retroviral counterpart , least six codons 3' terminus replaced retroviral heterologous cell derived elements since virus complete proto src coding region failed transform avian cells acquired transforming function point mutations various codons , proposed point mutation sufficient convert proto src transforming gene however , promoter substitution sufficient convert two proto genes , proto ras proto myc , retroviral transforming genes view , reexamined whether promoter substitution , point mutation , necessary convert proto src retroviral transforming gene found recombinant virus \( \) , src gene sarcoma virus \( rsv \) replaced complete coding region proto src , transformed chicken embryo cells oncogene differs src gene rsv three genetic properties \( \) weaker e g , transformed cells \( ii \) slower e g , focus formation takes 9 12 days compared 4 days rsv \( iii \) host range rsv e g , subsets heterogeneous embryo cells transformed even weeks months replacement proto src 3' terminus src rsv generates recombinant virus \( \) rsv transforming function concluded retroviral promoter , naturally substituted via recombination retroviruses , sufficient convert least three proto genes , src , myc , ras , retroviral transforming genes
molecular characterization inherited medium chain acyl coa dehydrogenase deficiency deficiency medium chain acyl coa dehydrogenase \( mcad \) common inherited defect energy metabolism characterization mrna encoding mcad dutch mcad deficient patient revealed g change nucleotide position mcad mrna coding region point mutation results substitution glutamic acid lysine amino acid position 304 mature protein single base change found wild type mcad mrnas mutant allele specific oligonucleotide probe used hybridization analysis amplified genomic dna mcad deficient family members , carrier , normal individuals hybridization analysis specifically identified individuals heterozygotes homozygotes addition point mutation , significant proportion index patient 's mcad mrna contained variety deletions insertions result exon skipping intron retention occurred multiple regions throughout mcad mrna analysis patient 's mcad gene regions occurred frequently reveal mutation splicing donor sites therefore , molecular characterization family revealed crucial point mutation mcad gene unusual abnormality mcad pre mrna splicing
transformed nontransformed cells differ stability cell cycle regulation binding activity murine thymidine kinase promoter dna binding activity upstream region murine thymidine kinase gene regulated differently transformed nontransformed cell line pair differences regulation observed \( \) serum levels reduced , \( ii \) serum levels returned initial high levels , \( iii \) protein synthesis inhibited reduction serum levels , binding activity unstable nontransformed balb c 3t3 clone cells significantly stable transformed balb c 3t3 cells serum concentration returned high levels , kinetic pattern binding activity differed nontransformed transformed cells protein synthesis inhibited , binding activity unstable nontransformed cells stable transformed cells partial inhibition protein synthesis stringent condition test instability prevented induction binding activity nontransformed cells previously , labile protein hypothesis set forth criterion protein regulating onset dna synthesis unstable nontransformed cells stable transformed cells dna binding activity described criterion
inactivation human alpha globin gene expression de novo deletion located upstream alpha globin gene cluster synthesis normal human hemoglobin , alpha 2 beta 2 , based upon balanced expression genes alpha globin gene cluster chromosome 16 beta globin gene cluster chromosome 11 full levels erythroid specific activation beta globin cluster depend sequences located considerable distance 5' beta globin gene , referred locus activating dominant control region existence analogous element \( \) upstream alpha globin cluster suggested observations naturally occurring deletions experimental studies identified individual alpha thalassemia structurally normal alpha globin genes inactivated cis discrete de novo 35 kilobase deletion located approximately 30 kilobases 5' alpha globin gene cluster conclude deletion expression alpha globin genes removing one previously identified upstream regulatory sequences critical expression alpha globin genes
prevalence prognostic significance exercise induced ventricular arrhythmias coronary artery bypass grafting exercise induced ventricular arrhythmias occur often coronary artery bypass grafting \( cabg \) , prognostic significance unknown two hundred patients examined exercise electrocardiography cardiac catheterization \( including left ventriculography , bypass graft native coronary artery angiography \) 3 months cabg prospectively followed exercise induced ventricular arrhythmias occurred often \( 49 200 patients , 24 5 \) \( 32 200 patients , 16 0 \) cabg \( p less 0 05 \) differences patients without ventricular arrhythmias prevalence graft patency \( 79 vs 80 \) postoperative ejection fraction \( 57 9 vs 57 12 \) ten cardiac deaths occurred mean follow time 61 19 months , 8 witnessed sudden cardiac deaths cardiac deaths occurred patients exercise induced ventricular arrhythmias cabg postoperative ejection fraction lower cardiac death patients \( 42 16 \) survivors \( 58 10 \) \( p less 0 01 \) clinical angiographic variable predicted occurrence cardiac death thus , prevalence exercise induced ventricular arrhythmias increases cabg , occurrence ventricular arrhythmias indicate increased risk cardiac death
low dose aspirin versus anticoagulants prevention coronary graft occlusion prevention graft occlusion aspirin \( 100 mg day \) heparin followed investigated randomized trial 235 patients aortocoronary bypass operation aspirin treatment started 24 hours , heparin 6 hours 2 days surgery results vein graft angiography clinical outcome 3 months postoperatively differ 22 218 vein graft distal anastomoses aspirin group 20 272 anticoagulant group occluded least 1 occluded distal anastomosis present 38 74 patients aspirin treated group 39 86 anticoagulant group worst case analysis randomized patients showed graft occlusions , cardiovascular complications lost follow 42 122 aspirin treated patients compared 41 113 patients treated anticoagulants grafts endarterectomy occlusion rate lower aspirin \( 12 49 \) anticoagulant \( 22 41 \) group \( p less equal 0 05 \) increased perioperative blood loss aspirin group \( 1 , 211 ml first 48 hours vs ml anticoagulant group p less equal 0 001 \) without higher reoperation rate indicates effective platelet inhibition low dose aspirin occlusion rates equal high patients advanced stage coronary artery disease , combination low dose aspirin anticoagulation investigated reduce graft occlusion rates
effect electrocautery wound healing midline laparotomy incisions effect electrocautery midline fascial wound healing studied 108 sprague dawley rats midline wound tensile strength significantly reduced fascia incised coagulation current compared cutting current addition , tissue necrosis inflammation well adhesion formation incision abdominal extensive animals incisions made using coagulation current results study indicate use electrocautery coagulation current associated increased tissue damage significant reduction tensile strength healing wounds contribution electrocautery wound complications patients needs evaluation
hypoxic events surgical intensive care unit oxygen monitoring protocol established surgical intensive care unit \( \) denver general hospital july 1988 3 month surveillance audit march 1989 prospectively documented 100 consecutive hypoxic events 51 241 \( 21 \) patients episodes occurred mechanical ventilation 46 patients , spontaneous ventilation 15 patients artificial airways , remaining 39 occurred patients hypoxemia recognized pulse oximetry 59 , arterial blood gas analysis 24 , mixed venous oximetry 15 , transcutaneous oxygen monitoring 2 events due problems ventilator airway 42 , recent interventions 21 , new pulmonary process 19 , progression underlying disease 11 , unknown causes 7 two thirds resulted mechanical problems amenable simple intervention two adverse outcomes conclusion , acute hypoxia frequent potentially morbid event advances continuous oxygen monitoring permit early identification thereby may limit adverse outcomes , prompt expensive diagnostic work
flumazenil ketamine midazolam anaesthesia double blind , parallel group study using flumazenil placebo carried determine whether patients received flumazenil would awake quickly whether drug would reverse protection conferred midazolam sequelae ketamine fifty female patients studied results showed significant reduction awakening time \( p 0 02 \) significant increase \( p 0 001 \) incidence dreams flumazenil group
evaluation level 1 blood series level 1 blood series comprises three infusion sets two blood different power outputs systems found extremely efficient , larger 500 series capable warming equivalent 80 units blood hour almost body temperature
right \? retrospective study found long term \( greater 6 months \) postoperative survival asa patients 41 21 respectively , 1986 supports peri operative recommendation life saving surgery patients present serious condition unlikely survive surgery
distribution human carotid bodies showing cellular proliferation chronic human carotid bodies obtained necropsy showed prominence either sustentacular cell dark variant chief cell chronic carotid studied immunogold labeling technique peptides methionine leucine similar distribution found normal human carotid body localized prominently predominantly dark progenitor variants chief \( type \) cells sustentacular \( type ii \) cells showed immunoreactivity cell counts chief cells cases sustentacular cell hyperplasia chronic carotid found lower end normal range , whereas dark cell prominence occurred upper limit
vivo heparin immobilized polymer surfaces authors developed two different methods heparin polymer surfaces one method involves situ heparin immobilization segmented polyurethane urea \( biomer \) surface via hydrophilic poly \( ethylene oxide \) \( peo , mn 4 , 000 \) method uses peo poly \( \) \( \) block co polymer heparin covalently linked block co polymer system \( peo hep \) surfaces demonstrated high heparin bioactivity vitro excellent blood vitro ex vivo experiments report evaluates long term vivo blood heparin immobilized surfaces vascular grafts \( 6 mm id , 7 cm length \) biomer , heparin immobilized situ peo \( b \) coated luminal surfaces peo hep biomer peo \( mn 4 , 000 \) grafted biomer \( b \) used controls grafts implanted abdominal aorta dogs retrieved 3 months graft occlusion suspected retrieved grafts evaluated scanning electron microscopy \( sem \) transmission electron microscopy \( \) measured thickness protein layer surface protein distribution \( albumin , fibrinogen , igg \) visualized immunogold method heparin immobilized grafts patent 3 months , whereas biomer b grafts occluded within 1 month sem heparin immobilized surfaces 3 months demonstrated minimal platelet adhesion activation without detectable fibrin formation heparin immobilized surfaces showed thin protein layer \( 300 600 \) even 3 months , high concentrations albumin igg less fibrinogen
monitoring platelet interactions prosthetic graft implants canine model study shows prosthetic arterial grafts stimulate platelets long 1 year implantation canine model carotid distal aorta dacron \( , , de \) grafts \( 0 8 x 50 0 cm \) subcutaneously right dorsal side , allowing percutaneous arterial sampling thromboxane b2 \( txb2 \) levels evaluated proximal anastomosis \( w \) , 5 0 \( x \) , 25 0 \( \) , 50 0 \( z \) cm distal w , platelet counts mean platelet volumes monitored sites w z txb2 levels increased blood entered graft progressively increased blood distal anastomosis platelet counts significantly change across graft time , systemic platelet counts decreased approximately 50 dog 's baseline levels remained depressed 1 year period mean platelet volumes peaked 1 3 weeks implant remained greater levels examination graft luminal surface showed developed characteristically similar develops mature human vascular grafts results suggest healed vascular grafts continue stimulate platelet release txb2 , reduce systemic platelet counts , increase mean platelet volumes 1 year data suggest platelets stimulated graft consumed
another way pumping blood rotary pump artificial heart article describes alternative mode pumping blood inside body device non centrifugal , , low speed rotary pump , electrically powered , based principle authors developed implantable electrical resulting , sealed motor pump unit electrical magnetic components fluids results flow curve pumping action show common points also basic differences compared classical pulsatile pumps centrifugal pumps blood atrium follows continuous movement without stop flow variations creating pulsatility ejection filling pump simultaneous always active filling hydraulic efficiency depends clearance pumping chamber outlet port pressure 60 cc device allows flows 8 9 liters implantable motor shape , moderate weight \( grams \) presents good efficiency \( 32 rotary speed 90 mean aortic pressure 150 mm hg \) authors conclude device could proposed experimental studies , lvad assistance good promise permanent application
improved biocompatibility treatment aldehyde fixed bovine pericardium long standing release locally cytotoxic aldehyde concentrations responsible lack spontaneous endothelialization increased calcification glutaraldehyde fixed bovine pericardium treatment amino acids made vitro endothelialization bioprosthetic heart valves possible treated pericardium calcified significantly less \( 13 4 micrograms mg dry weight \) conventionally processed pericardium \( 114 25 micrograms mg \) 63 days subcutaneous implantation rats test ability spontaneous vivo endothelialization , 5 sheep 6 mm grafts made treated pericardium \( ptp \) implanted carotid artery , compared ptfe grafts contralateral side , spontaneously animal models pregnant animal , grafts occluded remaining pericardial grafts remained patent , one additional ptfe graft occluded another one stenosed area covered red thrombus significantly smaller ptp grafts \( 3 05 3 9 \) ptfe grafts 42 14 \( p 0 \) sem showed endothelial cells growing directly ptp , myofibroblasts ptfe grafts treatment glutaraldehyde fixed pericardium aids spontaneous endothelialization decreases tissue calcification
matrix allograft small caliber vascular prostheses developed matrix vascular prosthesis \( amvp \) made detergent enzymatic extraction natural arteries , yielding tissue framework collagen elastin original vessel , preservation natural basement membrane blood flow surface excellent handling characteristics , well low whole vessel static testing circumferential compliance \( 8 9 1 sem x 10 \( 2 \) mmhg 100 mmhg \) revealed behavior virtually identical paired natural vessel amvp derived nine canine carotid arteries implanted 16 canine origin nine dogs \( 12 femoral three carotid arteries , one infrarenal aorta \) antithrombotic drugs angiographic patency maintained 15 16 \( one occlusion within 3 days \) follow 3 days 6 years , aneurysm formation three amvp 4 1 2 years analysis revealed preservation amvp collagen inflammation calcification amvp , almost total thrombus free flow surfaces results suggest allograft could achieve long term patency equivalent saphenous veins
development soft , pliable , slow heparin release venous graft prevent collapse , certain amount stiffness generally required prosthetic venous grafts , grafts used however , native vein pliable without stiffness developed soft pliable graft maintain patency lumen compliance fresh porcine ureter incubated solution remove cell components proteins one percent protamine sulfate solution injected ureter lumen inner surface ureter 1 glutaraldehyde solution , 1 heparin solution 5 hours , water procedure made ureter soft pliable , also conferred antithrombogenicity graft grafts implanted posterior vena 20 dogs removed 1 days implantation eighteen grafts patent , two grafts occluded anastomotic site 218 107 days , respectively control experiment , grafts implanted 15 dogs occluded fresh thrombi patent grafts kept original , allowed , similar appearance native vena cava effective preventing thrombus formation results indicate type graft ideal prosthesis venous graft , physiologic properties compliance antithrombogenicity
endothelialization vascular prostheses transplantation venous tissue fragments method accelerate endothelialization vascular prostheses seeding venous tissue fragments developed piece peripheral vein obtained , small fragments , 20 ml saline , making tissue suspension suspension wall highly porous vascular prosthesis \( water 3 , 600 4 , 000 \) prostheses , \( 7 mm id 5 7 cm length \) seeded tissue fragments , implanted thoracic descending aortae 20 dogs , removed 1 371 days implantation ten prostheses , fresh blood , used controls seeded grafts , infinite number endothelial cells migrated proliferated fragments produced numerous capillaries 5 days implantation reached opened onto luminal surface prosthesis , numerous endothelial cells spread formed colonies increase size colonies , inner surface completely within 5 weeks quick neointimal formation seeding venous tissue fragments might applicable several artificial organs
functional heart replacement spindle pump first results spindle pump blood pump double function , e , simultaneously first experiences type pump used biventricular assist device four short term animal experiments \( 13 hours \) described demonstrated cases normally beating heart , bvad ventricles 60 70 , aortic pressure slightly increased hand , case ventricular fibrillation , bvad two spindle pumps maintained entire circulation , arterial pressure 80 90 mmhg flow volume 3 5 4 l min
maintenance circulation ventricular fibrillation simultaneous use two counterpulsation devices two , single orifice counterpulsation devices , pumping stroke volumes 65 ml , implanted ascending aorta pulmonary artery seven open chest anesthetized dogs completion preparation , ventricular fibrillation induced devices synchronized pump simultaneously rate 85 100 bpm combined use counterpulsation devices provided maximal aortic pressure 111 4 25 1 mmhg ventricular fibrillation period 15 60 min mean left ventricular pressure 17 7 4 4 mmhg , cardiac index 64 5 23 6 ml kg min cardioversion ventricular fibrillation sinus rhythm restored normal hemodynamics counterpulsation device implanted ascending aorta able maintain circulation 5 min induction ventricular fibrillation , used alone conclusion , use two counterpulsation devices implanted ascending aorta pulmonary artery able maintain circulation experimental animals ventricular fibrillation
long term echocardiographic follow patients tricuspid bioprosthesis clarify long term results bioprosthetic valve function tricuspid position , 29 consecutive patients underwent tricuspid valve replacement \( \) evaluated 20 girls women 9 boys men , ages ranging 6 61 years \( mean 41 4 years \) bioprosthetic valves included 2 , carpentier edwards 27 follow period ranged 32 145 months \( mean 89 months \) regurgitant flow tricuspid bioprosthesis studied color doppler echocardiography peak velocity \( vp \) pressure half time \( pht \) measured continuous wave doppler echocardiography operative mortality 13 7 \( 4 29 \) , actuarial survival rate , including operative deaths , 75 10 years valve thrombosis developed one patient 4 years color doppler showed regurgitation 7 20 patients completely followed , asymptomatic required special intervention cusp tear calcification requiring reoperation observed study , including 8 patients younger 35 years age vp significantly slower , pht significantly prolonged , tricuspid rather mitral position data demonstrate bioprosthetic valves tricuspid position used safely doppler examination performed taking different flow dynamics account
effects prostaglandin , superoxide dismutase , catalase ischemia reperfusion injury liver transplantation study evaluated effects prostaglandin analogue \( \) , superoxide dismutase \( sod \) , catalase \( cat \) hepatic injury warm ischemia reperfusion terms survival , mitochondrial function , serum enzymes , histology hepatic ischemia created rats clamping ligament 90 min bypass reperfusion induced vessels bypass \( 350 ng kg min \) infused 60 min hepatic ischemia , sod cat \( 5 , 000 units kg \) administered immediately start reperfusion serum enzyme mitochondrial function assessments livers made ischemia , 2 hr reperfusion survival rate also assessed separate group rats liver enzymes sgot , , ldh showed correlation liver viability administration alone showed effect injured mitochondria however , free radical scavengers \( sod , cat \) , combination , showed significant improvement mitochondrial function together extension survival ultrastructure hepatocytes better preserved treated groups agents improved viability ischemic reperfused injured livers
comparison pumps increasing use centrifugal pump systems cardiopulmonary bypass \( cpb \) circulatory assistance centrifugal pump systems tested two side side , identical vitro flow loops blood trauma flow probe accuracy blood parameters tested hemoglobin , hematocrit , lactate dehydrogenase , free plasma hemoglobin , platelet counts pump demonstrated significant increases plasma hemoglobin levels three flow rates tested 2 l min \( p less 0 05 \) , 4 l min \( p less 0 005 \) , 6 l min \( p less 0 05 \) 4 hr pumping , drop platelet counts significantly greater loop compared loop \( p less 0 05 \) 2 l min 4 l min flow rates however , platelet levels remained within normal ranges systems 6 l min , statistical difference platelet counts noted flow probe readings found much 58 timed flow rate comparisons low flow rates , improved within 10 better 6 l min
development small caliber biologic vascular graft evaluation antithrombogenicity early healing process authors previously showed small caliber xenograft using crosslinking technique applicable aortocoronary bypass grafting study graft , antithrombogenicity healing process evaluated early stage implantation fresh sheep carotid artery \( id \) obtained cross linked compounds , used small caliber vascular graft graft white soft six cm segments graft implanted carotid arteries bilaterally nine dogs sodium heparin given surgery , anticoagulant used postoperatively fifteen grafts eight dogs removed 1 hr 30 days implantation , 13 15 grafts found patent two grafts , one 3 days , 14 days , occluded anastomotic area occluded grafts felt hard outside one dog , grafts shown angiographically patent 14 days implantation , dog kept long term observation macroscopically , thrombus observed patent grafts microscopically , inner surface near anastomotic lines covered endothelial cells , infiltration fibroblasts observed outside 7 days implantation foreign body reactions seen around graft 30 days implantation , thin layer plasma protein middle graft observed scanning electron microscopy \( sem \) observations , concluded grafts exhibited satisfactory early antithrombogenicity healing implantation
proliferation substrate effects endothelial cell thrombogenicity effects cellular differentiation status adhesive substrate endothelial cell function cell culture measured enzyme based assay surface thrombogenicity solid plastic , microporous polymeric , fibronectin \( fn \) treated microporous polymeric used substrates growth endothelial cells microporous fn treated synthetic substrates shown aid induction cellular differentiation mechanisms cells studied proliferative growth conditions thrombogenicity surface created endothelial cell monolayers various experimental conditions determined using enzyme based assay fibrin deposition actively proliferating cells solid plastic substrate produced thrombogenic surface , confluent endothelial cell monolayers grown fn treated microporous substrate least thrombogenic surfaces data suggest endothelial cell surface thrombogenicity substrate control , also related cellular differentiation status findings used design novel approach small diameter synthetic vascular graft problem
effect complement arachidonic acid pathway inhibition white blood cell count deposition vascular grafts determine role complement arachidonic acid metabolites decrease peripheral white blood cell count \( pwbc \) observed graft implantation , dacron aortic grafts implanted control rabbits \( group , n 13 \) , rabbits pretreated venom factor \( 80 u kg \) complement \( group ii , n 13 \) , indomethacin \( 2 5 mg kg \) inhibit cyclooxygenase \( group iii , n 7 \) , diethylcarbamazine \( dec , 90 mg kg \) inhibit leukotriene synthesis \( group iv , n 7 \) pwbc measured 15 min 1 hr graft implantation graft removal , wbc count grafts \( gwbc \) determined light microscopy \( \) scanning electron microscopy \( sem \) one hr graft implantation , pwbc decreased significantly groups iv 46 , 52 , 40 , 45 preoperative pwbc , respectively significant difference among groups revealed gwbc per field 8 0 , 12 3 , 5 8 , 6 8 groups iv , respectively similarly , sem showed gwbc per field 2 5 , 5 6 , 0 7 , 1 5 groups iv , respectively sem gwbc significantly greater group ii \( p less 0 01 \) , significantly less group iii \( p less 0 05 \) results suggested complement arachidonic acid pathways alone affect fall pwbc , may influence gwbc
total perinatal wastage clarification priorities pregnancy outcome 16 , women carrying 17 , living fetuses 16 weeks gestation studied well recording perinatal deaths , losses 28 weeks one year delivery recorded give total perinatal wastage rate 21 6 per 1000 fetuses alive 16 weeks compared perinatal mortality rate \( plus early neonatal deaths \) 7 8 per 1000 births deaths classified according pathological sub groups concept perinatal care using perinatal mortality compared using total perinatal wastage
magnetic resonance imaging idiopathic retroperitoneal fibrosis measurement t1 relaxation time magnetic resonance imaging 0 08 performed nine patients proven idiopathic retroperitoneal fibrosis total 11 scans performed three patients scanned diagnosis one also two follow scans six patients scanned variable time diagnosis treatment scan , soft tissue mass readily identified , distribution corresponding seen computed tomography difference mean t1 relaxation time mass patients scanned diagnosis scanned treatment however , patient followed serial scans showed progressive reduction t1 value mass time comparison results obtained patients lymphoma suggests t1 values retroperitoneal fibrosis lower lymphoma , particularly non hodgkin 's lymphoma
development reversibility lymphocyte dysfunction experimental obstructive jaundice study evaluates effect experimental biliary obstruction bile duct ligation \( \) biliary drainage cell mediated immunity wistar rats immune status assessed mitogen stimulation test lymphocytes animals followed 35 days regression analysis showed significant negative correlation lymphocyte function period jaundice \( correlation coefficient 0 57 , p less 0 001 \) following 21 days , groups animals internal biliary drainage 7 , 14 28 days , external drainage 14 days compared obstructed animals , 14 days internal drainage required improve lymphocyte function \( p less 0 05 \) animals 14 days external drainage significantly lower lymphocyte stimulation internal drainage animals \( p less 0 05 \) results demonstrate obstructive jaundice produces progressive reduction lymphocyte function reversed biliary drainage , internal drainage effective external drainage
assessment biliary tract liver transplantation tube cholangiography iodida scanning biliary tract obstruction anastomotic leakage common problems following liver transplantation sequential study , 31 patients liver transplant investigated 99mtc iodida \( iodida \) scanning tube cholangiography \( ttc \) results compared clinical outcome seven patients extrahepatic biliary obstruction one patient biliary leak detection biliary complications ttc iodida scanning similar terms sensitivity \( 63 per cent \) ttc better specificity \( 79 per cent versus 60 per cent \) accuracy \( 74 per cent versus 60 per cent \) iodida scanning liver function taken account , diagnostic efficacy tests patients bilirubin levels less 200 mumol l similar levels greater 200 mumol l greater number false positive results iodida scanning \( 12 per cent versus 54 per cent \) significant biliary leak clearly detected ttc iodida scanning ttc remains effective way evaluating biliary tract transplantation iodida scanning limited value bilirubin levels elevated , may provide additional information blood supply , hepatocyte function intrahepatic cholestasis
patterns dyspepsia patients clinical evidence organic diseases studied 2000 dyspeptic patients obvious signs organic disease first examination , order \( 1 \) verify many diagnoses idiopathic dyspepsia really made diagnostic procedures \( 2 \) evaluate diagnostic power symptoms distinguishing organic idiopathic dyspepsia latter considered structural abnormalities found cases , distinction made related associated organic dyspepsia according whether certain relationship abnormalities dyspeptic symptoms patients referred us follows \( 1 \) spontaneously , \( 2 \) sent physicians us , \( 3 \) referred open access endoscopic service results show frequency idiopathic dyspepsia 26 , whereas associated structural abnormalities present 45 4 obvious organic causes dyspepsia seen 28 6 \( 24 benign 4 6 malignant diseases \) considered separately , symptom alone allows correct diagnosis simultaneous evaluation symptoms linear discriminant analysis distinguishes idiopathic organic dyspeptic patients 70 cases higher discrimination percentage 70 cases higher discrimination percentage could probably obtained using wider range clinical parameters complex statistical analysis interrelationships exist clinical symptoms final diagnosis
evaluation 13c urea breath test detection helicobacter pylori monitoring effect non ulcer dyspepsia sixty nine patients non ulcer dyspepsia studied endoscopy , biopsy , quick urease \( \) test , helicobacter pylori culture , 13c urea breath test treatment \( \) two tablets twice daily four weeks symptoms non ulcer dyspepsia recorded using standard questionnaire using h pylori culture gold standard , sensitivity 13c urea breath test 90 , specificity 98 6 , accuracy 94 8 positive predictive value 98 2 negative predictive value 92 5 conversion rate h pylori positive negative status treatment 17 9 symptoms non ulcer dyspepsia improved appreciably treatment irrespective h pylori status 13c urea breath test accurate research tool suitable serial testing population surveys
demonstration area slow conduction human atrial flutter ten patients chronic atrial flutter studied prospectively using electrophysiologic mapping pacing techniques assess mechanism atrial flutter presence area slow conduction atria electrograms recorded greater equal 30 right atrial sites patient atrial flutter demonstrated right atrial free wall activation interatrial septum activation , consistent reentrant circuit involving right atrium six patients , slow conduction occurred atrial flutter inferior right atrium spatially associated fractionated recordings four patients , missing interval electrical activity occurred inferior right atrium average 40 atrial flutter cycle transient criteria demonstrated patient rapid high right atrial pacing mean activation time high right atrial pacing site coronary sinus \( inferior left atrial \) recording site long \( 228 ms \) consistent activation area slow conduction rapid pacing atrial flutter coronary sinus site , transient criteria could demonstrated mean activation time coronary sinus pacing site high right atrial recording site relatively short \( 134 ms \) consistent activation high right atrium area slow conduction high right atrial pacing sinus rhythm rates similar atrial flutter demonstrated short activation time coronary sinus low right atrial sites \( mean 169 88 ms , respectively \) , indicating activation area slow conduction coronary sinus pacing sinus rhythm demonstrated phenomena low right atrial electrograms recorded sinus rhythm rapid pacing sinus rhythm fractionated , although atrial flutter thus , atrial mapping pacing data complementary , indicating human atrial flutter patients studied generated reentrant circuit right atrium , area slow conduction low right atrium present atrial flutter
analysis base station morphine orders assessment physician consistency paramedic contact base station consistent recommendations reflecting consensus base station physician care urban ems system , paramedics must contact single base station provide morphine sulfate \( ms \) patient chest pain performed retrospective cohort analysis prehospital ms requests chest pain determine consistency circumstances paramedic team refused ms ms requests represented 123 1 , \( 7 \) line physician consultations 6 month study 15 123 \( 12 \) ms requests refused neither mean patient age , sex distribution , presenting vital signs correlated ms refusal maximum estimate transport time hospital less equal 5 minutes noted 7 15 \( 47 \) medication compared 11 96 \( 11 \) documented estimated transport times \( p less equal 0 005 \) simultaneous request nitroglycerin \( \) noted 6 15 \( 40 \) medication 15 108 \( 14 \) \( p less 0 05 \) found refusal ms administration uncommon physicians tended ms transport time short requested concomitant administration also noted physician inconsistencies refusal findings guide physician consensus development avoid mixed paramedics
predictors smoking nhanes followup experience published prospective studies predictors spontaneously cigarette smoking nationally representative u population paper describes study , using cohort taken first national health nutrition examination survey \( nhanes , 1971 1975 \) traced nhanes epidemiologic followup survey \( 1982 1984 \) successful \( least 1 year time followup \) ascertained among adults \( age 25 74 years \) smokers time nhanes disabled followup independent predictors \( proportional hazards multiple regression \) \( 1 \) older age \( 2 \) white race \( 3 \) fewer cigarettes smoked day \( 4 \) higher household income \( 5 \) hospitalization followup period predictors relapse \( ex smokers nhanes smoking time followup \) \( 1 \) younger age \( 2 \) urban residence \( 3 \) female gender findings implications intervention strategies , public health projections research
role membrane proteins monosodium urate crystal membrane interactions ii effect erythrocyte membranes membrane permeable impermeable protein crosslinking agents intact , human erythrocytes pretreated membrane permeable , dimethyl \( \) dimethyl \( \) membrane impermeable 3 , 3' \( \) \( \) protein crosslinking agents incubated monosodium urate monohydrate \( \) crystals percent inhibition lysis values pretreated cells relative untreated cells determined 3 agents caused concentration dependent inhibition induced hemolysis due decrease binding pretreated membranes proposed inhibition lysis due crosslinking integral cytoskeletal membrane proteins , resulting reduced mobility proteins , inhibition integral proteins aggregates decreased pore formation membrane
biliary gut function following shock aim study characterize alterations gallbladder intestinal function hemorrhagic shock blood reperfusion animals subjected shock 30 mm hg arterial blood pressure 60 minutes resuscitated blood reinfusion gallbladder epithelial ion transport , gallbladder motility vitro vivo , gastrointestinal motility , flora stomach small bowel studied 2 24 hours shock changes 2 hours included decreased gallbladder contractility vitro decreased emptying vivo , loss coordination intestinal motor activity , decrease frequency intestinal electrical slow waves , reduced duration intestinal migrating motor complex cycle 24 hours , gallbladder epithelial permeability increased vitro contractility remained reduced vivo functions showed partial recovery gastrointestinal flora affected changes data demonstrate hemorrhagic shock reperfusion affect digestive motility early timing alterations observed partial recovery 24 hours post shock suggest ischemia hypoxia mechanism injury
short term long term changes renal function donor nephrectomy retrospectively examined effect nephrectomy renal function 55 living related donors renal function measured scans patients studied preoperatively , 1 week 1 year postoperatively 20 patients 10 year followup available compensatory hypertrophy complete 1 week postoperatively effective renal plasma flow remaining kidney 32 5 higher preoperatively increase remained stable least year degree compensatory hypertrophy significantly greater male patients \( 46 9 1 week \) female patients \( 26 7 \) compensatory hypertrophy occurred age groups studied pronounced patients less 30 years old patients followed 10 years effective renal plasma flow decreased 387 7 ml per minute 1 week nephrectomy 4 ml per minute 10 years result similar decrease seen normal population according results , renal donation living related persons lead long term decrease renal function
treatment idiopathic retroperitoneal fibrosis immunosuppression idiopathic retroperitoneal fibrosis exceedingly uncommon childhood etiology uncertain support immunological basis disease given report 14 year old girl severe retroperitoneal fibrosis causing progressive azathioprine prednisolone used successfully case supports efficacy immunotherapy treatment idiopathic retroperitoneal fibrosis
en bloc transplantation kidneys donors weighing less 15 kg adult recipients en bloc transplantation kidneys donors weighed less 15 kg 20 adult patients described medial kidney allowed adequate renal positioning growth graft venous thrombosis occurred 1 patient irreversible graft rejection occurred 4 patients graft survival 65 excellent function mean followup 8 8 months en bloc transplantation pediatric cadaver kidney grafts adults acceptable procedure
afferent nipple valve malfunction caused anchoring collar unexpected late complication kock continent ileal reservoir construction kock continent ileal reservoir urinary diversion , significantly high rates late postoperative complications regarding nipple valves , efferent limb particular , reported reports afferent nipple valve malfunction total 42 patients underwent kock pouch operation observed 12 months \( mean 38 months \) evaluated terms afferent nipple valve malfunction late afferent nipple valve complications observed 10 42 patients \( 24 \) complications included erosion fiber fabric used collar \( 5 patients \) , stenosis afferent limb \( 2 \) obstruction afferent nipple mucous plug fungus ball \( 3 \) latter 2 complications due mechanical dynamic obstruction urine flow caused nonabsorbable collar none 10 patients problems efferent nipple valve function results suggest peristaltic direction intestine use nonabsorbable material collar primarily responsible late afferent nipple valve complications modifications needed produce stable nipple valve otherwise , simpler reliable alternative techniques anastomosis considered